Research Question
Several social researchers have shown that when men are more engaged with health issues, their own health improves as does that of women. Yet, men’s health uptake and engagement continues to be lower than women’s. In HIV prevention research in South Africa it has been shown that great involvement by men is linked to women’s adherence in bio-medical trials, and reduction of partner violence. To date much of the focus of Africa Centre research has been on women, and there is little understanding of the relatively low uptake rates among local Zulu men. We need to develop our knowledge of effective engagement, recruitment and retention techniques that specifically focus on men’s participation to improve the equity and diversity of our research activities. The main research question addressed in this exploratory work is: What are the key health issues for rural Zulu men and what strategies for engaging, recruiting and retaining young men in community-based biomedical and behavioural HIV prevention research are most likely to be effective?   

Data Sources
The aim of Impilo Yamadoda is to complete an exploratory research programme investigating key health issues for rural Zulu men and strategies for engaging, recruiting and retaining young men in community-based biomedical HIV prevention research. We will make our findings available to our AfrEVacc Network Partners to help define generalisable strategies for increasing men’s involvement in biomedical and behavioural HIV prevention research in southern African settings. Impilo Yamadoda’s study objectives relate to different research phases and the main research outcomes: 1) Explore and map the main general health and HIV concerns of rural Zulu men with specific attention to issues of understanding of the role and relevance of research and particularly, HIV prevention research; 2) Describe, define and test different community engagement strategies to establish a cohort of young Zulu men from the local area surrounding of the Africa Centre (i.e. Hlabisa Health Sub-district) and test mechanisms to increase participants ongoing engagement with the Africa Centre and its programme of behavioural and biomedical HIV prevention research; 3) Test the feasibility and efficacy of different follow-up/retention strategies, including monetary and non-monetary incentive packages for use with men recruited to an individually randomised study involving multiple observations and collection of bio-specimens. The study’ pragmatic approach involving ethnographic, qualitative, quantitative and experimental methods. The research activities are: 1) community familiarization, identification and engagement with men’s community groups; 2) community intercept survey; 3) qualitative exploration of young men’s perceptions of HIV prevention, health research and facilitators/barriers to recruitment and participation in biomedical HIV prevention research, and 4) an experimental evaluation and field test of different recruitment strategies, modalities of bio-specimen collection, follow-up questionnaire administration and participant reimbursement/participation incentives. 

Findings
We have nearly completed the first two phases of the study. The qualitative study is ongoing and we hope to begin the experimental phase in May 2010. Entry into the community was relatively easy and our initial engagement discovered a high degree of interest in the research, in collaborating with the Africa Centre and in improving HIV prevention work among local men, Different community groups, employer and trade union organizations, and social/development groups expressed interest in becoming research partners in Impilo Yamadoda. However, relatively few had sufficient organizational capacity to engage without additional support. Others, primarily employer, trade union and local business associations, despite their interest in the project were unable to use their organizational capacity to support the work. This has not proved an impediment to the research however. Several smaller organizations and a small number of enthusiastic local men have made substantial commitments and ensured that there is a genuine sense of ‘ownership’ of the project in the community. These processes of community entry have been carefully document and monitored and are currently being reviewed and analysed and will be prepared for publication later this year.

Implications
With a few exceptions, for example trials of male circumcision, biomedical and behavioural HIV prevention research in sub-Saharan Africa has focused less on men. Because of men’s generally poorer involvement and less frequent use of health care services, increasing their involvement requires engaging them in their communities. Our findings to date suggest that in doing this social networks and smaller community organizations, for example, football teams or individual small businesses are more effective engagement points, but require additional work and resources, than attempting to work through large organizations like trade unions or major employers. Within our local context this has implications for the design or future HIV prevention trials. Beyond our local context it may have important implications for the development of HIV prevention programme initiatives.