Engaging Men in HIV Clinical Trials: What Are the Challenges?

Should the focus shift to how best to reach men in trials?

BOSTON — Men may be at risk for being left behind in the search for HIV interventions, according to speakers at CROI 2016.

Helen Ayles, MSc, PhD, with the clinical research unit at the London School of Hygiene and Tropical Medicine and  Darrell P. Wheeler, PHD, MPH, Dean of the School of Social Welfare at the  University at Albany – SUNY both addressed the issue of engaging more men in clinical trials at the meeting. 

“Men have been portrayed quite negatively in discourse around HIV as perpetrators of gender-based violence, predators of young women,’ sugardaddies’, all of these slightly pejorative terms,” said Dr Ayles. “When we look at the cascade of care, we see that men are doing worse than women at virtually all stages, so we need to think innovatively about how we can change that and maybe give a little bit of focus to what men want and what men need.”

Dr. Ayles noted that large population-based, universal testing and treatment studies would provide researchers with opportunities to figure out the best ways to reach men and understand the barriers to reaching them.

“What’s very clear is that if we stay in our clinics, we’re never going to reach men. Clinics are very female places. They’re set up predominately for maternal and child health,” she said. “Men don’t feel happy at the clinics so we’ve got to go out of the clinic.”

Interventions in the home and in the community have shown some success in studies. Dr. Ayles added that men often say that they want interventions that encompanses a wider variety of health issues, and want specific areas for men where they can talk about male issues and male sexuality.

“We also need to look at where men are. There are great examples of going to workplaces, going to bars and also looking at male-only clinic,” she said. “There are some great examples of that in South Africa which have been set up near bus and taxi stations and gyms, places where men congregate.

Dr Wheeler echoed Dr. Ayles comments, in an interview with HIV Advisor Channel Site Editor Michael Tapper, MD. He discussed the study he presented during CROI 2016 about pre-exposure prophylaxis interventions for African American men.

“Unless we reach everybody, we’re never going to end this epidemic,” Dr Ayles concluded. 


1. Ayles H. 120. Missing But in Action: Where Are the Men? Presented at: CROI 2016. Feb. 22-25, 2016. Boston.

2. Wheeler D, Fields S, Nelson LE, et al. 883LB. HPTN073: PrEP Uptake and Use by Black Men Who Have Sex With Men in 3 Cities.