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Despite calls for an evidence-based focus on outcomes as a way to enhance accountability for public performance, findings from a prior study suggest that the public may be more impressed by high frequency (low cost) but ambiguous outputs (such as people served) rather than more meaningful but costly outcomes (causal effects). We attempt to replicate and extend the investigation of this output bias through a pair of survey experiments involving judgments about two evidence-based, highly effective social programs: one, an HIV/AIDS prevention program (adapted from the prior study), the other, a program for special needs high school students (Check and Connect). Our findings confirm that respondents viewed both programs more favorably when given information about mere outputs (people served) in comparison with more rigorous outcomes (causal effects). We then tested an extension of the Check and Connect experiment in which we modified the framing of cost and performance information in ways that reduced the tendency toward an output bias. We speculate on the possible mechanism that may lead to an output bias, and we discuss the implications of our findings for evidence-based public policy and management. [ABSTRACT FROM AUTHOR]

Despite the Internet's global importance as a sex-seeking venue for men who have sex with men (MSM) and other sexual and gender minorities, little is known about this topic in sub-Saharan Africa. Furthermore, existing public health research offers limited insight into the sociocultural aspects of sexuality and how they articulate with patterns in online sex-seeking behavior. In 2015, we conducted survey and ethnographic research with 105 sexual and gender minorities in Abidjan, Côte d'Ivoire. Nearly half of survey respondents reported finding partners primarily online. Three quarters reported having found at least one partner online. Interviews with 24 of the survey participants revealed that a primary motivation for using online venues was that they allowed for the preservation and management of discretion and anonymity, permitting users to avoid discrimination and violence. While secondary to their strategies for managing such social risk, participants also reported using the profile features of online venues to filter out partners they perceived as presenting a risk to their sexual health. Though interview participants perceived online venues as providing a degree of protection against potential stigma and violence in offline contexts, survey data showed that over one quarter of participants had experienced extortion and/or blackmail by sexual partners they met online. By taking into account the sociocultural context of sexuality and sexual activity in Abidjan, these findings highlight the disjuncture between essentialist notions of MSM who use the Internet to find sex partners as a universal, at-risk group, and the complexity of sexual and gender minorities' experiences. [ABSTRACT FROM AUTHOR]

Migration in West Africa is common and complicates the sustained delivery of comprehensive HIV care programmes for those with specific vulnerabilities to HIV, including female sex workers (FSW). This study evaluated whether migration potentiates the burden of stigma affecting FSW in Lomé, Togo. Respondent driven sampling identified 354 FSW who completed HIV testing and a questionnaire. Multivariable logistic regression was used to identify factors associated with stigma among FSW. Among study participants, 76.3% (270/354) were migrants, with 30.2% (107/354) reporting stigma. Migrant FSW were less likely to report stigma (aOR 0.40; 95% CI:0.22–0.73). FSW who had an abortion (aOR 3.40; 95% CI:1.79–6.30) and were tested for a sexually transmitted infection (STI) or HIV (aOR 2.03; 95% CI:1.16–3.55) were more likely to report stigma. Among FSW, 59.8% (211/353) disclosed selling sex to a health worker. Disclosure was more common among FSW who had been tested for an STI or HIV (36.7%; 77/210), or both (55.7%; 117/210), and resulted in an attenuated but significant association between STI or HIV testing and stigma, indicating that disclosure partially mediated the relationship. These results highlight the need to mitigate healthcare-related stigma affecting FSW, while also considering decentralised HIV testing approaches, including HIV self-testing. [ABSTRACT FROM AUTHOR]

In the USA, gay and other men who have sex with men and transgender women are disproportionately affected by HIV. Uptake of pre-exposure prophylaxis (PrEP), anti-retroviral therapy to prevent HIV-negative individuals from seroconverting if exposed to HIV, by members of this population remains low, particularly among African-Americans. We conducted two focus groups to assess responses to an online social media campaign focusing on PrEP use in New York City. We designed, produced and disseminated the campaign to address knowledge of PrEP; its physical and psychological side effects; and psychosocial barriers related to PrEP adherence and sex shaming. Focus group participants demonstrated a relatively high knowledge of PrEP, although considerable concern remained about side effects, particularly among Black participants. Participants suggested that stigma against PrEP users was declining as PrEP use became more common, but stigma remained, particularly for those not using condoms. Many focus group participants reported distrust of medical providers and were critical of the commodification of HIV prevention by the pharmaceutical industry. Participants reported that those in romantic relationships confronted unique issues regarding PrEP, namely suspicions of infidelity. Finally, Black participants spoke of the need for more tailored and sensitive representations of Black gay men in future programmes and interventions. [ABSTRACT FROM AUTHOR]

In the mixed and concentrated HIV epidemics of West Africa, the relative disproportionate burden of HIV among men who have sex with men (MSM) compared to other reproductive-age men is higher than that observed in Southern and Eastern Africa. Our aim is to describe the correlates of HIV infection among MSM living in Lomé, Togo, using the Modified Social Ecological Model (MSEM). A total of 354 MSM ≥18 years of age were recruited using respondent driven sampling (RDS) for a cross-sectional survey in Lomé, Togo. Participants completed a structured questionnaire and were tested for HIV and syphilis. Statistical analyses included RDS-weighted proportions, bootstrapped confidence intervals (CI), and logistic regression models. Mean age of participants was 22 years; 71.5% were between 18 and 24 years. RDS-weighted HIV prevalence was 9.2% (95% CI=5.4–13.2). In RDS-adjusted (RDSa) bivariate analysis, HIV infection was associated with disclosure of sexual orientation to a family member, discriminatory remarks made by family members, forced sex, ever being blackmailed because of being MSM, community and social stigma and discrimination, and health service stigma and discrimination. In the multivariable model, HIV infection was associated with being 25 years or older (RDSa adjusted OR (aOR)=4.3, 95% CI=1.5–12.2), and having sex with a man before age 18 (RDSa aOR=0.3, 95% CI=0.1–0.9). HIV prevalence was more than seven times higher than that estimated among adults aged 15–49 living in Togo. Using the MSEM, network, community, and policy-level factors were associated with HIV infection among MSM in Lomé, Togo. Through the use of this flexible risk framework, a structured assessment of the multiple levels of HIV risk was characterized, highlighting the need for evidence-based and human-rights affirming combination HIV prevention and treatment programs that address these various risk levels for MSM in Lomé. [ABSTRACT FROM AUTHOR]

Government performance measurement is often faulted for focusing on outputs, while citizens are said to demand more information on outcomes to hold government accountable. To compare the influence of these measures, we randomized 774 participants to receive outcome or output information about a real HIV prevention program, with or without cost information, in a survey experiment. Citizens expressed less support for spending on the program when shown outcomes (infections prevented), rather than outputs (people served). Showing participants the high cost of treating HIV/AIDS boosted support for program spending, but did not make outcome information more persuasive. We interpret these results as partly a reaction to the high per-unit cost of an outcome in an HIV prevention program. But it may reflect a tendency of citizens simply to misinterpret less costly outputs, including serving more people, as if these were outcomes. This bias has implications for performance reporting and accountability. [ABSTRACT FROM PUBLISHER]

Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using “high,” “medium” and “low” levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1–1.7,p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1–3.3,p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing. [ABSTRACT FROM PUBLISHER]

Despite reductions in the number of new HIV infections globally, the HIV epidemic among men who have sex with men (MSM) is expanding. This study characterises financing of HIV programmes for MSM and the impact of criminalisation on levels of funding, using data from five countries that criminalise same-sex sexual practices (Ethiopia, Mozambique, Guyana, India and Nigeria) and three that do not (China, Ukraine and Vietnam). For each country, all publicly available documents from the Global Fund to Fight AIDS, Tuberculosis and Malaria for approved HIV/AIDS grants in Rounds 5–9 and Country Operational Plans detailing investments made through the President's Emergency Plan for AIDS Relief (PEPFAR) from US fiscal year (FY) 2007–2009 were examined. Eleven of 20 HIV proposals to the Global Fund contained programmes for MSM totalling approximately $40 million or 6% of proposed budgets. In six countries providing activity-level data on MSM programming, PEPFAR funding that served this population and others ranged from $23.3 million in FY2007 to $35.4 million in FY2009, representing 0.5–25.9% of overall, non-treatment funding over this period. Countries that criminalise same-sex sexual practices spend fewer resources on HIV programmes serving MSM. However, they also show consistent underfunding of programmes serving MSM regardless of context or geography. [ABSTRACT FROM PUBLISHER]

Performance reporting to citizens is an important way to keep government accountable and transparent. This study uses data from a national online survey to examine the sources through which citizens obtain performance information about local government, how much they trust these sources, and their assessments of local government efforts at performance reporting. Results suggest that by far the most common source of information about local government performance is the local news, followed by the informal channel of friends or neighbors. The most trusted sources are nonprofit or civic associations, followed by colleges or universities. Levels of trust of government agencies and officials as sources of performance information were much lower. Ratings of local government efforts at performance reporting were positively associated with the presence of Web-based performance information, releasing an annual report, holding public meetings, and sending households a local government "report card." There was a strong positive association between government efforts at performance reporting and trust of government as a performance information source. [ABSTRACT FROM AUTHOR]