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Conducting a bio-behavioural survey among men who have sex with men in Tehran using respondent driven sampling: lessons learned

A. Feizzadeh1, M.-M. Gouya2, H. Setayesh1, A. Vassigh3, K. Azadmanesh4, N. Moshtagh5, M. Eftekhar6

1UNAIDS, Tehran, Iran, Islamic Republic of, 2Ministry of Health and Medical Education, Centre for Disease Control and Management, Tehran, Iran, Islamic Republic of, 3UNFPA, Tehran, Iran, Islamic Republic of, 4Pasteur Institute, Tehran, Iran, Islamic Republic of, 5University of Welfare and Rehabilitation Sciences, Psychology, Tehran, Iran, Islamic Republic of, 6Iran University of Medical Sciences, Psychiatry, Tehran, Iran, Islamic Republic of

Issues: Men who have Sex with Men (MSM) are one of the groups most affected by HIV epidemic and a major epidemic driver, especially in concentrated epidemics. Facing criminal charges and high stigma, they are one of the most hidden groups among the key populations-at-higher risk. During recent years, Respondent Driven Sampling (RDS) is introduced for reaching a probability sample of hidden populations, including MSM.
Description: This study was the first bio-behavioural survey among MSM in Iran. At first it was intended to address more affluent, western type, "gay" people in addition to less advantaged, slum dweller people who do not identify themselves as "gay" or "homosexual". However eventually, the study was only conducted among the latter, facing some trust challenges from the former group. Study started with three seeds, all drug users as well, and went to the sixth round in some branches. As the study ended reaching the New Year Holidays in Tehran, there was a considerable number of non-drug using MSM as well.
Lessons learned: Working with MSM in Iran is possible having political support of the high-level health authorities. While considered the best available solution for reaching probability samples of hidden populations, RDS is still very hard to conduct among too stigmatised, unsecured groups like gay people in Iran. Being dependent on dual incentives is a potential challenge, especially working with less advantaged groups and on issues where enrolment criteria are very hard to verify, like having sex with men. Audio-Computer-Assisted Self-Interviewing (A-CASI) software is easy to use, even working with illiterate or less-literate participants. Bio-sampling using Dried Blood Spot is manageable and provides enough blood for conducting ELISA, Western Blot, anti-HCV antibody, phylogenetic analysis.
Next steps: Exploring the possibilities of having an online RDS will be a promising way for reaching too-hard-to-reach populations, at least for behavioural data.

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