Robert Lorway

• University of Manitoba

Community-based organizations (CBOs) are critical in providing trusted and tailored HIV/STI services to gay, bisexual, and other men who have sex with men (GBMSM). Despite significant strides in CBO involvement in HIV/STI research in Kenya, there remain gaps in meaningful engagement and capacity-building, especially quantitative research. We share...

Decolonizing global health research involves rethinking power structures and research collaboration to prioritize the voices and experiences of communities that have been historically marginalized. Cross-sectoral and cross-regional partnerships based on reciprocity, trust, and transparency can be facilitated by decolonized research frameworks. To a...

Background: Community-based organizations (CBOs) are critical in providing trusted and targeted HIV/STI services to gay, bisexual, and other men who have sex with men (GBMSM). Despite significant strides in CBOs’ involvement in HIV/STI research, there remain gaps in meaningful engagement, especially in quantitative research. This paper explores the...

Background The HIV epidemic in Kenya remains a significant public health concern, particularly among gay, bisexual, and other men who have sex with men (GBMSM), who continue to bear a disproportionate burden of the epidemic. This study’s objective is to describe HIV phylogenetic clusters among different subgroups of Kenyan GBMSM, including those wh...

This commentary explores the vulnerabilities faced by temporary foreign workers (TFWs) in Manitoba, Canada within the context of the COVID-19 pandemic. TFWs often endure substandard working conditions and lack access to essential healthcare services due to their status as non-citizens. The COVID-19 pandemic has further exacerbated their precarious...

We aimed to illuminate the challenges of treating anal diseases among gay, bisexual and other men who have sex with men (GBMSM) in a homophobic climate amid resource constraints. Building on a long-term Kenyan-Canadian collaboration, an anal healthcare intervention study, known as the WEMAH Project, was initiated in January 2022. The initial collab...

The Ubuntu-Pamoja study was conducted to understand the experiences and perspectives of African, Caribbean, and Black (ACB) communities in Manitoba regarding HIV and STBBI testing. This collaborative project involved the Community Guiding Circle (CGC), a group of 13 ACB community members, to guide the research process. Recruitment targeted ACB indi...

Introduction Since the onset of the Russian invasion on 24 February 2022, the health system in Ukraine has been placed under tremendous pressure, with damage to critical infrastructure, large losses of human resources, restricted mobility and significant supply chain interruptions. Based on a longstanding partnership between the Ukrainian Institute...

Background The HIV epidemic in Kenya remains a significant public health concern, particularly among gay, bisexual, and other men who have sex with men (GBMSM), who continue to bear a disproportionate burden of the epidemic. This study’s objective is to describe HIV phylogenetic clusters among different subgroups of Kenyan GBMSM, including those wh...

Background While the COVID-19 pandemic disrupted HIV preventative services in sub-Saharan Africa, little is known about the specific impacts the pandemic has had on men who have sex with men (MSM) in Kenya. Methods Data were from an HIV self-testing intervention implemented in Kisumu, Mombasa and Kiambu counties in Kenya. Baseline data collection...

Sexually diverse Muslim men (SDMM) are seen to present later and with more advanced symptoms of HIV and other sexually transmitted infections (STIs). The limited access to sexual healthcare services is attributed to the stigma associated with their multiple intersecting identities. We conducted a scoping review to synthesise research on barriers im...

This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each villag...

Background Men who have sex with men (MSM) in Kenya continue to face barriers to HIV testing, which leads to delays in HIV prevention and care. An HIV self-testing (HIVST) intervention was implemented in three Kenyan counties to increase coverage and frequency of HIV testing among MSM communities with high HIV prevalence. The evaluation study exami...

Introduction Sexually diverse Muslim men are seen to be at a higher risk for HIV and other sexually transmitted infections due to their limited access to sexual healthcare services. We outline a protocol to conduct a scoping review of research on the barriers that may impede these men’s access to sexual healthcare. Methods and analysis To conduct...

Introduction Kenya reported its first COVID-19 case on 13 March 2020. Pandemic-driven health system changes followed and unforeseen societal, economic and health effects reported. This protocol aims to describe the methods used to identify the gender equality and health equity gaps and possible disproportional health and socioeconomic impacts exper...

Background To develop effective public health policies, programs, and services tailored to the unique sexual health needs of migrant populations, it is essential to understand the myriad socio-ecological factors that influence their sexual health. This qualitative community-based participatory study aimed to explore factors influencing migrants’ se...

Background HIV programming in Ukraine largely targets “key population” groups. Men who purchase sex are not directly reached. The aim of our study was to explore the prevalence of sexually transmitted and blood-borne infections (STBBIs) among men who purchase sex from female sex workers. Methods Following geographic mapping and population size est...

Financial technology tools have been utilised to create readily available mobile loan platforms for urban-based, daily-wage earners in Kenya. From a financial lending perspective, this development signals greater inclusion and equality in formal bank financing systems. In this paper, however, we examine mobile loans and their repayment from the per...

Inferring HIV transmission networks from HIV sequences is gaining popularity in the field of HIV molecular epidemiology. However, HIV sequences are often analyzed at distance from those affected by HIV epidemics, namely without the involvement of communities most affected by HIV. These remote analyses often mean that knowledge is generated in absen...

A recent Supreme Court ruling that permitted LGBTQ + rights organisations to officially register as non-governmental organisations has led to rises in political homophobia in Kenya. Community leaders initiated and led a rapid agency assessment to examine the effects of this rising political homophobia on sexual health services access for gay, bisex...

Based on a diary writing exercise, this paper illuminates the complex ways in which sex workers in Ukraine actively work through and manage stigma in their daily lives. Pushing beyond the notion of stigma as a static and fixed psychosocial designation that can be readily measured, we argue that stigma is actively confronted by sex workers through v...

Communities that claim “2SLGBTQ+” (Two Spirit, Lesbian, Gay, Bisexual, Trans, and Queer plus) identities experience profound inequities within healthcare settings. In response, scholars and advocates have engaged in conversations about creating “safe space,” for them. These “safe spaces” are said to be produced through the display of objects such a...

Little is known about the impact of military conflict on sex work from the perspective of sex workers. We attempt to explore the meaning of conflict on sex work by asking women about the changes that they have experienced in their lives and work since the beginning of the 2014 military conflict in eastern Ukraine. The findings in this article are b...

Introduction: Approximately 240,000 people live with HIV in Ukraine, concentrated among key populations, including sex workers. Non-governmental organizations (NGOs) play an important role in the funding and delivery of HIV testing and prevention services in Ukraine. These services are set within the context of national healthcare reforms as well...

Background We evaluated the validity and reliability of the Neilands sexual stigma scale administered to 871 gay, bisexual, and other men who have sex with men (GBMSM) at two research locations in Kenya. Methods Using cross-validation, exploratory factor analysis (EFA) was performed on a randomly selected subset of participants and validated using...

The authors describe the plight of sex workers, a particularly disadvantaged community that is highly marginalized and vulnerable. Sex workers were hard hit by the pandemic. The authors examine the impact of COVID-19 on sex workers’ lives and livelihoods, their response to the crisis, and the strategies that they employed to battle the pandemic. Du...

Background HIV self-testing (HIVST) has emerged as a way of reaching individuals who may be less likely to access testing, including men who have sex with men (MSM). Understanding the social networks of MSM is key to tailoring interventions, such as HIVST, for particular locations. Methods We undertook a socio-sexual network study to characterize...

The Kenyan government offers free HIV self-testing kits to men who have sex with men. The value of self-testing is based on the imaginary of an autonomous technosubject empowered to independently control testing services, thereby "freed," through technology, from the social conditions that might inhibit health services utilization. Following a comm...

Objective: Little is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba. Design: Data were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men. Setting: Community-based cross-sectional study in Manitoba, Canada. Participants...

Purpose of Review To review the impact of the COVID-19 pandemic and its public health response on key populations at risk of HIV infection, with a focus on sex workers. Recent Findings Since last year several groups have documented how the COVID-19 pandemic has impacted the livelihoods and health of sex workers. We focus on case studies from Kenya...

Background: Understanding the basic principles for achieving research outcomes that are relevant to local communities is invaluable. The process allows for building of collaborative spaces and redistribution of power in knowledge production practices. This is because members of marginalized and vulnerable communities have long been critical of a re...

Background: Understanding the basic principles for achieving research outcomes that are relevant to local communities is invaluable. The process allows for building of collaborative spaces and redistribution of power in knowledge production practices. This is because members of marginalized and vulnerable communities have long been critical of a re...

We examine the typologies of workplaces for sex workers in Dnipro, Ukraine as part of the larger Dynamics Study, which explores the influence of conflict on sex work. We conducted a cross-sectional survey with 560 women from September 2017 to October 2018. The results of our study demonstrate a diverse sex work environment with heterogeneity across...

Following high levels of efficacy in PrEP clinical trials, demonstration projects were launched to assess its real-world effectiveness when rolled out as part of programmes. Based on an ethnographic study of a PrEP demonstration project in South India among female sex workers, we analyse a curious set of narratives in which participants claim PrEP...

The Manitoba Two-Spirit, Gay, Bisexual, and Queer (2SGBQ+) Men’s Health Study is a first-of-its-kind community-based, participatory research project that sought to address clear gaps in the literature pertaining to the health of 2SGBQ+ men in Manitoba. Drawing on the expertise of community members, local community-based organizations, and academi...

With growing attention to the vulnerability of men who have sex with men in African contexts to HIV, public health scientists and others have begun to draw connections between alcohol use in this population and the transmission of HIV and other sexually transmitted infections. In this chapter, we consider the role of the global health discourse in...

Decline in new HIV infections in the Asia–Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementa...

Objective: Both HIV infection and identifying as MSM have been linked to altered rectal microbiota composition, but few studies have studied sexual behavioural associations with rectal microbiota within MSM. In addition, most rectal microbiota studies in MSM have been limited geographically to Europe and North America, and replication of findings...

Abstract Background It is argued that Indian gender minorities displayed differential mental health problems and suicide attempts. Hence, the study was intended to understand the prevalence of anxiety, depression and suicidality among this group, specifically those living in a metropolitan city in South India. Methods The data was generated from a...

We illustrate the lively existence of the notion of success in the unfolding of a PrEP project led by a sex worker organization in India. In what we call the “search for success,” particular attention is placed on the role that care plays among sex workers guiding the project. Drawing on our ethnographic work, we highlight how the search for succes...

In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pandemic in terms of reported cases and mortalities. However, everyday life has been dramatically affected by highly restrictive government-imposed measures such as stay-at-home curfews, prohibitions on mobility across national and county boundaries, and...

Sex workers have been one of the marginalized groups that have been particularly affected by India's stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic. The sudden loss of livelihood and lack of access to health care and social protection intensified the vulnerabilities of sex workers, especially those living with HI...

Objective This report identifies the profound effects that the COVID-19 pandemic and the resultant government lockdown have had on sexual health services delivery to a community of marginalised male sex workers in Nairobi, Kenya. Methods Based on the experiences shared during ongoing virtual conversations with peer health workers, a case study was...

In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pandemic in terms of reported cases and mortalities. However, everyday life has been dramatically affected by highly restrictive government-imposed measures such as stay-at-home curfews, prohibitions on mobility across national and county boundaries, and...

Global health policy-makers have called for demonstration projects to better understand pre-exposure prophylaxis’ (PrEP) effectiveness across geographies and populations. Ashodaya, a sex worker collective, initiated a PrEP project in Mysore, India. We conducted a project ethnography to explore the role that community participation played within the...

Introduction In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web‐based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV‐positive status and linkage to antiretroviral therapy (ART), for HIV‐positive MSM who solely met partners via physical sites (PMSM), compared with thos...

In Kenya, globally circulating HIV surveillance techniques are implicated in an emergent experimental terrain that merges scientific interest with health administration agendas. Sex worker activists reroute and repurpose this technocratic knowledge to more precisely pinpoint and defy the undemocratic imperatives of an encroaching experimental order...

The COVID-19 pandemic, and its attendant responses, has led to massive health, social, and economic challenges on a global scale. While, so far, having a relatively low burden of COVID-19 infection, it is the response in lower- and middle- income countries that has had particularly dire consequences for impoverished populations such as sex workers,...

We explored general health and psychosocial characteristics among male sex workers and other men who have sex with men in Nairobi, Kenya. A total of 595 MSM/MSW were recruited into the study. We assessed group differences among those who self-reported HIV positive (SR-HIVP) and those who self-reported HIV negative (SR-HIVN) and by affinity group me...

To inform PrEP roll out, Ashodaya Samithi, a sex workers’ collective, conducted a community-led prospective demonstration project among female sex workers in Mysore and Mandya, India. Following a community preparedness phase and pre-screening, participants were recruited for clinical screening and enrolment, provided PrEP as part of combination HIV...

Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects worked to better engage communities an...

Drawing upon long-term ethnographic research in Namibia, I examine the label ‘MSM’ through a materialist interpretation of affect, viewing ‘MSM’ as a ‘doing thing’ that unsettles the boundaries between subjects and objects. From this analytic perspective, I reconsider the ‘MSM’ label as an inadequate signifier that overlooks, conceals, or erases so...

Targeted preventive interventions generally reach women after they self-identify as sex workers. In high risk settings, women tend to engage in risk behaviors before transitioning to Female Sex Workers (FSWs) with high risk behaviors. Studies hardly explored transitions of women from lower to higher risk behaviors (casual-transactional-commercial s...

Background: An ethnography study was conducted to explore and describe the environmental context of sex work, particularly the organization of the sex trade industry in Abuja and the social dynamics and power relationships that play out at various hotspots where sex workers congregate to meet clients and have sex. Methods: Participant observation...

In Northern Karnataka, South India, boys' behaviours and attitudes towards girls are regarded as one of the many important proximate structural barriers impeding girls' access to education and academic performance in rural communities. In response to these barriers, public health practitioners developed an intervention, known as the Parivartan prog...

Purpose: Gender-diverse individuals in India face considerable discrimination, stigma, and violence. There is a dearth of published literature describing experiences of violence among this population and potential links to mental health. Methods: A questionnaire was administered to 282 study participants, 18 years of age and older, who self-identif...

In the last couple of decades, there has been a significant turn toward critical and “culture-centered” approaches to health communication. Through the lens of critical ethnography, this paper aims to unsettle dominant Eurocentric and exclusionary notions of citizenship tied to a legislative and juridical framework of rights—as entitlements and obl...

This qualitative study highlights the complex interplay between the social and structural conditions in Chengdu, China that shape the possibilities and vulnerabilities of money boys’ sexual health. Within the context of China’s liberalised market economy, we explore (1) how money boys’ enter the sex trade market and navigate their sexual networks;...

Persisting inequities in maternal health pose a particular burden for marginalised populations such as sex workers. However, current literature on pregnancy and sex work is limited to mostly quantitative studies focusing on contraception use, unplanned and/or undesired pregnancies and unsafe abortions. Additionally, emphasis has been placed on the...

Public health and media discourses on men and HIV prevention in India have largely focused on changing knowledge, attitudes and risk behaviour pertaining to condom use and safe sex. Little attempt has been made towards intervening in areas such as masculinity, dominant gender norms and intimate partner violence (IPV) that have been shown to have a...

Ashodaya Samithi, an organization run by and for female, male, and transgender sex workers in Mysore, India, has worked since 2004 to prevent sexually transmitted infection (STI)/human immunodeficiency virus (HIV) transmission and improve HIV cascade outcomes. We reviewed published and programmatic data, including measures of coverage, uptake, util...

Background: HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-up of HIV testing services, many MSM remain unaware of their HIV status and thus do not benefit from accessing HIV treatment or prevention services. HIV self-testing (HIVST) may help address this gap. However, evidence is limited on how, when, and in wh...

Pre-exposure prophylaxis (PrEP) has emerged as a new HIV prevention strategy. A series of demonstration projects were conducted to explore the use of PrEP outside of clinical trial settings. Learning from the failures in community consultation and involvement in early oral tenofovir trials, these PrEP projects attempted to better engage communities...

Background HIV prevalence is influenced by biological, behavioural and structural factors. We sought to understand HIV prevalence among at-risk adolescent girls and young women (AGYW) in Kenya and the relative importance of location and subgroup. Methods We conducted a cross-sectional survey among AGYW aged 14–24 years in Mombasa, Kenya in 2015/16...

Background Ukraine has the highest HIV and HCV rates in Europe. Initially driven by unsafe injection use, more recent studies have documented the ongoing transmission of HIV via unprotected sex work. This paper describes the profile of clients of female sex workers (FSWs) in eastern Ukraine and their HIV and HCV prevalence and risk factors. Method...

Background Armed conflict erupted in eastern Ukraine in 2014. Ukraine has the highest HIV rates in Europe, there is concern that the epidemic can worsen in the current climate. Past research on HIV prevalence in conflict zones has been limited and the few studies that exist yield contradictory results. In this paper we describe the historical event...

Background Evidence suggests a range of HIV-associated vulnerabilities associated with the exchange of sex for money or other material goods, but most research and programs in Ukraine focus on formal sex work. We sought to describe the prevalence of HIV and HIV-associated vulnerabilities among adolescent girls and young women engaged in transaction...

Background Female Sex Workers (FSW) and their clients account for half of HIV infections among key populations (KP) in Nigeria. The aim of this study was to better understand sexual behavior patterns and influences related to HIV vulnerability among men and women in venues that facilitates sexual networks in Nigeria as it relates to sex work. Meth...

Background Venues where people meet sexual partners are understood to be important locations where HIV transmission risk plays out and represent potential intervention points. Women involved in sex work and those seeking casual partners spend time in the same venues, forming sexual partnerships with some of the same people and experiencing the same...

Background The environmental contexts and interactions between people within that environment impact a female sex worker’s (FSW) individual behaviour and likelihood of HIV acquisition. Understanding how the environment shapes HIV risk can provide important information for HIV prevention programs that go beyond behaviour-based interventions and addr...

Introduction Women in developing countries continue to face barriers to accessing sexual and reproductive health (SRH) services, with marginalized women facing increased challenges to accessing care. The Diagonal Interventions to Fast-Forward Enhanced Reproductive Health (DIFFER) project implemented a package of interventions for female sex workers...

Background: Armed conflict erupted in eastern Ukraine in 2014 and still continues. This conflict has resulted in an intensification of poverty, displacement and migration, and has weakened the local health system. Ukraine has some of the highest rates of HIV and Hepatitis C (HCV) in Europe. Whether and how the current conflict, and its consequences...

Newly proposed legislation that aims to protect the well-being of transgender people in India offers hope of greater recognition of human rights and improved access to entitlements for these marginalised groups. However, social welfare and health institutions have a long way to go in translating proposed legislation into policies that can concretel...

Drawing upon ethnographic research in Winnipeg, Manitoba, we complicate simplistic epidemiological and sexual health discourses that position African newcomer teen girls and young women as “at-risk” for HIV/AIDS and other consequences of being sexually active. By tracing the trajectories of sexual health messages and utilizing the concept of assemb...

Evidence suggests a range of HIV-associated vulnerabilities associated with the exchange of sex for money or other material goods, but most research and programs in Ukraine focus on formal sex work. We sought to describe the prevalence of HIV and HIV-associated vulnerabilities among adolescent girls and young women engaged in transactional sex outs...

Objective: The overall objective of this study is to compare the migration and mobility patterns of urban and rural female sex workers (FSWs) and understanding individual, structural, societal and contextual factors that contributes to their risk and vulnerability to HIV/AIDS. Material and methods: A cross sectional face to face interview of 1,567...

BACKGROUND Standard programmatic mapping involves identifying locations where key populations meet, profiling of these locations (hotspots), and estimating the key population size. Information gained from this method has been used for HIV programming—resource allocation, program planning, service delivery, and monitoring and evaluation—for people w...

Background Program Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health. Discussion To achieve this, Program Science involves the systematic application of theoretical and empirical knowledge...

Objective: Information on mental health and substance use challenges among gay, bisexual, and other men who have sex with men (GBMSM) is needed to focus resources on these issues and optimize services for HIV prevention and care. We determined factors associated with depressive symptoms and problematic alcohol and other substance use among GBMSM i...

Although health researchers have begun to examine the forms of violence and power dynamics that play out in the intimate relationships of female sex workers (FSWs) in India, this knowledge has tended to focus on the perspectives of women, leaving men’s motivations and attitudes relatively unexamined. This paper examines the contours of masculinity...

This paper highlights important environmental dimensions of HIV vulnerability by describing how the sex trade operates in Nairobi, Kenya. Although sex workers there encounter various forms of violence and harassment, as do sex workers globally, we highlight how they do not merely fall victim to a set of environmental risks but also act upon their s...

Despite decreased rates of HIV infection in Winnipeg, syphilis incidence continues to rise. Communities of men who have sex with men shoulder much of this burden of illness. This qualitative study aimed to better understand the co-evolution of HIV and syphilis in Winnipeg through a series of interviews with gay men. Eighteen individuals were recrui...

Background The HIV epidemic among men who have sex with men (MSM) continues to expand globally. The addition of an efficacious, prophylactic vaccine to combination prevention offers immense hope, particularly in low- and middle- income countries which bear the greatest global impact. However, in these settings, there is a paucity of vaccine prepare...

Decades of research have documented how sex workers worldwide, particularly female sex workers (FSWs), shoulder a disproportionate burden of the HIV epidemic. In India, although a substantial progress has been made in controlling the epidemic, its prevalence among FSWs and the Devadasis (also called traditional sex workers) in northern Karnataka is...

This chapter recounts the details of a participatory research project that took place in Mysore, southern Karnataka. Compellingly, a vital form of collective action grew that exceeded the initial project’s goal of generating knowledge around the effects stigma on health services access. The sparking of a social justice collective occurred because t...

This chapter portrays some of the less publically visible forms of activism waged in relation to the use of bio-experimental technologies to deliver routine health services to sex worker communities in Nairobi, Kenya. What becomes clear is how HIV surveillance techniques in Nairobi have begun to transform the very ground on which local sex workers...

As Avahan began to transition to the public system in 2010, the Gates Foundation began a concerted effort to “transfer the lessons learned” from HIV interventions in India to Kenya, through what was referred to as a “South-to-South collaboration.” This project translated into the bi-directional travel, between Bangalore and Nairobi, of Indian, Keny...

This chapter specifically portrays how a grassroots response to the HIV epidemic began to transform as Health Canada welcomed “the HIV movement” in Nova Scotia into the fold of legitimacy with operational funding, ushered in by the community health promotion discourses that were powerfully re-articulated in 1986. Vivid protests staged by activists...

Based on ethnographic research conducted between 2006 and 2010, this chapter presents a view from within a large-scale program that sought to manage local HIV responses and govern the participation of communities most highly affected by the HIV epidemic. Various business science logics and techniques—emanating from the large-scale, multi-state HIV...

Transformations in HIV activism in Nova Scotia transpired around the release of a new class of anti-retroviral therapies in late 1995. Decreases in mortality and the extension of life did not spell the death of social dissent, but transformed it into bodily rebellions as members of the local HIV movement confronted onerous treatment regimens, with...