“Why are you asking us about this? So you can fantasise?” asked one of the interviewees.
I began patiently explaining, for the third time, the purpose of my study.
“Yeah but can I suck you off afterwards?”
This exchange took place when, a few years ago, I conducted the first piece of research on sex between men in a tiny, very poor country. The national AIDS programme – with encouragement from the UN – wanted to gather information that would help get a better understanding of whether certain groups were more at risk for HIV and other sexually transmitted infections. They wanted me – in the space of a few days – to provide them with an understanding of the extent of sex between men, and whether there might be higher risk of HIV and other STIs in this group.
In the country I was visiting there was little or no knowledge of diverse sexual orientations or identities, and no real “gay” culture. The only piece of research information we could get our hands on before the study was that 1% of men seeking STI treatment had admitted having sex with another man. The position of officials was that sex between men was both rare and totally contrary to social and cultural norms. It was also illegal, though I was told by a senior prosecuting judge that no case had been brought to court for homosexuality in recent memory. Nonetheless, all of this meant it was extremely important to be careful about how any research results would be used or interpreted.
When absolutely nothing is known about a situation, it’s difficult to design a study. I developed a basic questionnaire and focus group discussion guide, but I had no idea if I would be able to meet anyone who would talk to me. It was going to be all about improvisation – basically, talk to anyone who is willing, be very flexible about the script, and end up, maybe, with a few case studies.
In the end a couple of healthcare professionals put me in touch with people who trusted them. Three men agreed to do individual interviews with me, and a group of 2 and one of 3 said they preferred a “group discussion”. All of them were carefully briefed by the intermediaries, and then by me, about the aims of the study, confidentiality procedures, and their rights to withdraw at any point.
Once the interview started, one of the three individuals changed his mind and told me he had never had sex with another man – instead, he told me all about his sex life with women. The other two individuals were incredibly open and frank about their sexual relationships both with men and women. One told me he was unfaithful both to his wife and to his male lover, also having sex with other men and women. But, he said, if he lived in a rich country, he would almost certainly call himself “gay”. Of the two groups, the group of three men also did not admit to ever having had sex with other men, but did tell me – in very informed detail – about male friends of theirs who did have sex with men. The group of two were very open about their sexual relationships with men and, as the transcript excerpt above shows, were intent on trying to wind up their interviewer. I also managed to find out a bit about the “community” of men who have sex with men, how much respondents knew about HIV and sexual health, and the levels of stigma and discrimination they faced if people knew or suspected they had sex with other men.
In the end then, I spoke to 8 people, 4 of whom could be, strictly speaking, considered to be men who have sex with men – hardly much to go on. Clearly I didn’t come close to being able to tell my clients about the extent of sex between men and risk behaviours for HIV. But it gave decision makers something – something very tiny – to go on, by showing that sex between men existed, and that they probably do face specific risks related to HIV and sexual health. It also potentially got respondents interested in getting involved in HIV and sexual health programmes. And it provided information that could be used to set up a more representative piece of research.
It’s pretty rare to find a country where absolutely no research or investigation has been done on topics I often work on such as sex between men and sex work, and where there are very few easy entry points for research. So, although I was disappointed with what I managed to do, given the time and resources I had it probably couldn’t have been much better. My bigger frustration is that from what I can tell there’s been no follow up – either with the respondents interviewed or with the design and implementation of new research or targeted programmes. Everything has to start somewhere but when you are dealing with highly stigmatised groups and major issues like HIV, it’s important to do more than just start. It raises important ethical issues since in explaining the study to participants I talked about how I expected local partners to follow up on the results.
Researchers – particularly independent ones – often don’t have a lot of control over how ideas for studies are developed, how results are interpreted and how and whether follow-up takes place. But in situations like this it’s worth trying to find out what the longer term plan is, what resources are available for follow up, and to try to get clients to be clear about how they will use the study. It’s particularly important in poor countries where so few resources are available, to make sure they are used wisely. And it’s even more important when working with people who are stigmatised and on issues where there’s a chance the research might be counter-productive – for instance where there is a chance of a negative backlash from the press or authorities.
It’s also important to practice your poker face so that you can deal with the odd questions that might come up from participants who are still trying to figure out exactly where you’re coming from.