BackBolyai János Research Scholarship
According to the available epidemiological data, members of the MSM population belong to those being the most vulnerable to HIV infection in most parts of Europe, including Hungary: the most widespread mode of transmission of HIV being sex between men (ECDC 2016, OEK 2015). Even though the spread of HIV infection is preventable through effective public health measures, significant HIV transmission continues in Europe; thus it is crucial to have a better understanding of the main determinants of risky (sexual) behavioural patterns among the MSM population in East-Central Europe and in Hungary. Transmission modes of HIV in Europe include sex between men (42%), heterosexual (32%), and injecting drug use (4%) (ECDC 2016).
In the present study we want to reach those segments of the MSM population which are possibly out of the scope provided by the traditional sampling methods. This can be explained by the fact that MSM category membership is not officially registered and is indeed a personal characteristic that cannot be registered, so its ratio in the population is immeasurable. Thus, the creation of the sample that statistically represents MSM sex worker individuals and clients appropriately is a highly problematic, if not impossible task.
The main goal of this research project is to examine the perceptions and interpretations related to risky forms of sexual behaviour, safe(r) sex and behavioural patterns of MSM (men having sex with men) sex workers and their clients through the combination of qualitative and quantitative research methods: Interviewing MSM sex-workers (N=50): conducting life history interviews (n=20) and structured interviews (n=30); Online questionnaire (with community sampling) for clients of MSM sex-workers (N=100); Expert interviews with 10 experts (including epidemiologists, legal experts, human rights activists, members of advocacy organisations and NGOs working on MSM and/or sex-work related issues).
MSM sex workers and their clients rank among the hard-to-reach and under-researched population segments in Hungary. We will begin recruiting MSM sex workers for interviewing with the help of (LGBTQ) NGOs and by accessing the available same-sex oriented dating sites. Then we will try to reach out for additional research participants by using the snowball technique (Goodman, 1961), where possible. Regarding the clients of the MSM sex-workers, we will try to reach them via online survey data collection since it is unlikely that many of them would be willing to participate in face-to-face interviews. The invitation to participate in our research project will be advertised through mailing lists of specialised NGOs, dating sites and relevant social media groups.
Epidemiological HIV/AIDS prevention research often uses samples based on the MSM membership category instead of focusing on gay or bisexual men, because in this context the participants’ sexual orientation related identities are much less important determining factors than real life sexual experiences. On the basis of our previous national and international research findings we have already pointed out in our published studies (P.Tóth 2011, 2012, 2015, 2016; P.Tóth et al. 2017; Takács et al. 2013) that MSM sexual practices could be performed by any men, including those having bisexual or even heterosexual identities.
To conduct the structured interviews, we will use a questionnaire consisting not only of closed-ended questions, encouraging short answers, but also including open-ended questions focussing on the following main topics: social network and relationship characteristics, HIV and other STDs (sexually transmitted diseases) infection perceptions, sexual practices, risky sexual behaviour, as well as stigmatization and discrimination experiences. These topics will also be included in the online survey questionnaire, with the exception of discrimination experiences.
Applying the method of structural coding the verbatim transcripts will be transferred to a codebook designed for the purpose of the research, and the main topics identified during interviews: the relevant data will be arranged under the appropriate codes according to major topics and subtopics. Each code will help us to determine which are the joint text units to grasp concepts that are expressed by the participants the same way, and which ones are considered to be unique, based on rare occurrence. The qualitative analysis will be based on the content of this codebook, utilising the possibilities of qualitative methods with an interactionist focus.
Our goal is to present the patterns found in the interview material in a way that will help us understand the respondents' motivations, and how they perceive the surrounding society; inter alia in order to be able to develop (more) effective HIV-prevention methods in the future. The interviews with experts will contribute to positioning MSM sex work in a broader social context, and also to provide information on the experiences and attitudes of experts dealing with these issues.
It is important to note that during the proposed research, community-based sampling is planned that will not allow our findings to be generalised, not even to the MSM sex worker population living in Hungary. This limitation is a characteristic of qualitative research, but we believe that "deep drilling" can allow us to show such results that would otherwise remain hidden from non-qualitative analysis. These results, combined with epidemiological statistics may provide a good starting point to a variety of public health policy-making.
Probably, a significant majority of volunteer respondents will be constituted by those characterised by higher levels of awareness in the MSM population, thus the actors who are more hiding and more difficult to reach will appear in the sample at a lower rate. Furthermore, during the interviews, several sensitive issues are thematised; these, having possible verbal limitations in narratedness may prevent interviewees sharing their experiences with us. Also the fact cannot be ignored that the respondents' self-reflection capabilities and the embeddedness in their micro-community may vary, thus different interpretive frameworks will be applied, presumably when naming their behavioural motivations. According to the regularities of qualitative interview analysis methods and empirical studies based on community-based sampling processes, our study cannot be regarded as a general status report, but rather – on the basis of previous international and national research experiences – an attempt to reconstruct cases, attitudes and behavioural patterns that can be considered as "typical".
Considering these, we are convinced that the proposed research can contribute to a better understanding of the perceptions and practices of MSM sex workers and their clients regarding risky sexual behaviours and safe(er) sex interpretations; thus the expected results of the research can be used in the development of (more) effective HIV / AIDS prevention strategies in the future.
The length of the whole research project is three years. The first year will be devoted mainly to recruiting the research participants. During the first year of the research project there will be an interview schedule and the survey data-collection. The main themes of the interviews and the survey questionnaires will include social network and relationship characteristics, HIV and other STD (sexually transmitted diseases) infection perceptions, sexual practices, risky sexual behaviour, as well as stigmatization and discrimination experiences over and above basic demographic information.
In order to have a sufficient number of interviews, LGBT NGOs and internet portals will be approached for assistance in finding potential interviewees. Then a snowball sampling method will be applied to recruit further potential interviewees from among the acquaintances of the already contacted and/or interviewed people.
The text of the interviews will be transcribed verbatim. After checking the interview texts, transcripts will be transformed into a code book, and the content of the code book will be analysed.
The third year of the research will be devoted to summarising and analysing the research findings of the research.
Our research can contribute to a better understanding of the perceptions and practices of MSM sex workers and their clients regarding risky sexual behaviours and safe(r) sex interpretations; thus the expected results of the research can be used in the development of (more) effective HIV / AIDS prevention strategies in the future.