- Study 1 : Understanding access to HIV-related and gender-affirming healthcare for trans women with HIV in Canada - a mixed methods study
- Study 2: Towards an understanding of structural drivers of HIV/STIs and protective factors among sexual and gender minority youth in Kingston, Jamaica
- Study 3: Using performance ethnography as an innovative approach to challenge stigma and promote empowerment among sexual and gender minorities in Swaziland and Lesotho
In order to do this, we draw on reflections from three multi-method research studies with LGBTQ populations in four settings.
Study 1 : Understanding access to HIV-related and gender-affirming healthcare for trans women with HIV in Canada - a mixed methods study
The first study - doctoral research conducted in 2016 by the first author with mentoring support from the second author - focused on understanding barriers and facilitators to accessing medical care for trans women living with HIV, and was designed in partnership with a recognised leader in the trans commit' nity. It used baseline survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), in which women living with HIV were included from study inception, from shaping the study, to develop' ing the survey, recruiting participants, collecting data and disseminating findings (Loutfy et al. 2016).
CHIWOS baseline data were collected between 2013 and 2015 in Ontario, British Columbia and Quebec, Canada. The full sample included 1,422 women living with HIV (including 54 trans women) aged 16 or older who were recruited by community researchers, who in this case were women living with HIV who were hired and trained to conduct research (Loutfy et al. 2016). A subset of trans women living with HIV (n = 11) who completed the baseline CHIWOS survey also participated in individual interviews. For this qualitative arm of the mixed methods study, community researchers were involved in participant recruitment and qualitative data collection. Community researchers also participated in study oversight, through participation in the CHIWOS Trans Community Advisory Board and in conference presentations and publications.
Support for CHIWOS community researchers included in-person training over the course of several days (Loutfy et al. 2016). During this training, researchers discussed the project, provided practical training around recruitment, informed consent and administering the online survey, and reviewed self-care support. An online version of the training was also created for refreshers or newly hired community researchers. Follow-up training was held at waves two and three of longitudinal data collection. Monthly teleconferences or in-person meetings were held to provide ongoing updates and support. Training on qualitative data collection (interviewing) was also provided and recordings of community researchers’ first interviews were reviewed to provide tailored feedback as data was collected.
Study 2: Towards an understanding of structural drivers of HIV/STIs and protective factors among sexual and gender minority youth in Kingston, Jamaica
The second study comes from a multi-method community-based research project that examined the HIV prevention needs of LGBTQ youth in Jamaica, with a focus on stigma. The study was led by the second author and was designed and conducted in partnership with ‘Jamaica AIDS Support for Life’, a communitybased organisation focused on HIV prevention and LGBTQ health in Kingston, Montego Bay and Ocho Rios, Jamaica. The first author became involved in the project during phase two as a doctoral student and research assistant. Six further organisations focused on LGBTQ issues were involved in participant recruitment and key informant interviews as part of the qualitative phase of work.
The first phase of data collection involved 63 individual interviews with young LGBTQ people and key informants from LGBTQ organisations, HIV clinicians and outreach workers in Kingston. Three focus groups also took place. For
Ethical dilemmas in peer research 179 this phase, the team hired and trained three community researchers aged 18-29 who self-identified as LGBTQ to conduct outreach and interviews with participants. Community researchers were identified by Jamaica AIDS Support for Life due to their perceived leadership in LGBTQ communities, intimate knowledge and connections to the LGBTQ community, and training and/or comfort level discussing HIV issues. Community researchers also pilot tested the qualitative interview guide questions.
In a second phase of work, seven community researchers (two continuing from the first phase, with another five rotating in and out through phase two) were recruited and trained. These community researchers self-identified as LGBTQ or as other sexual and/or gender minorities and were from Kingston, Ocho Rios or Montego Bay and surrounding areas. Drawing on the expertise of these seven community researchers as well as our community partners, we developed and implemented a survey with young LGBTQ people (n = 911).
Community researchers recruited participants from their social networks, and those who worked as HIV outreach workers also shared study information with potential participants during outreach shifts. Community researchers obtained informed consent from all participants and collected survey data and played an active role in data interpretation and reviewing manuscripts for publication. Training was delivered over the course of four days, covering conducting in-depth interviews (16 hours) and implementing computerised (tablet-based) data collection methods (16 hours). Weekly supervision was provided by research coordinators in Kingston and Ocho Rios. Community researchers received further in-person training in booster sessions as well as weekly supervision to discuss data quality issues and data collection procedures.
Study 3: Using performance ethnography as an innovative approach to challenge stigma and promote empowerment among sexual and gender minorities in Swaziland and Lesotho
The third study involved qualitative data collection followed by development and pilot testing of a participatory theatre intervention to reduce the general public’s stigma toward LGBTQ people in Swaziland and Lesotho (Logie et al. 2018, 2019). The study was built on pre-existing partnerships between academic researchers (including the second author as principle investigator) and community-based LGBTQ organisations in Swaziland (The Rock of Hope) and Lesotho (Matrix Support Group). The Rock of Hope and Matrix Support Group participated in all phases of study planning and implementation, including developing a series of participatory theatre vignettes, conducting data collection and assisting with data interpretation.
Six community researchers were hired across the two partner organisations. These community researchers identified as LGBTQ and were identified by partner organisations based on their involvement with the LGBTQ community and interest in learning research methods (Logie et al. 2018). Community researchers identified LGBTQ individuals willing to participate in the research, assisting inthe development and refinement of the qualitative interview guide for appropri-ateness to Swaziland and Lesotho contexts, conducting qualitative interviews, analysing qualitative data, and then working with local theatre groups, the academic research team and partner organisations to create three short skits tailored to local contexts (Logie et al. 2019).
Finally, community researchers participated in developing solutions to anti-LGBTQ stigma to be presented during the participatory theatre intervention performances and facilitating post-intervention focus groups. Training was provided in research methods and ethics (two six-hour sessions), and following the qualitative data collection, a two-day workshop took place with a local theatre group. Following skit development, there was further training about participatory theatre planning as well as focus group training (two six-hour sessions). Each participatory theatre event was followed by debriefing with community researchers.