Taking culture seriously in biomedical HIV prevention trials: a meta-synthesis of qualitative studies

ABSTRACT

A substantial gap exists between widespread acknowledgement of the importance of incorporating cultural sensitivity in biomedical HIV prevention trials and empirical evidence to guide the operationalization of cultural sensitivity in these trials. We conducted a systematic literature search and qualitative meta-synthesis to explore how culture is conceptualized and operationalized in global biomedical HIV prevention trials. Across 29 studies, the majority (n = 17) were conducted in resource-limited settings. We identified four overarching themes: (1) semantic cultural sensitivity – challenges in communicating scientific terminology into local vernaculars; (2) instrumental cultural sensitivity – understanding historical experiences to guide tailoring of trial activities; (3) budgetary, logistical, and personnel implications of operationalizing cultural sensitivity; and (4) culture as an asset. Future investigations should address how sociocultural considerations are operationalized across the spectrum of trial preparedness, implementation, and dissemination in particular sociocultural contexts, including intervention studies and evaluations of the effectiveness of methods used to operationalize culturally sensitive practices.

KEYWORDS:

• HIV vaccines
• microbicides
• clinical trials
• HIV prevention trials
• cultural sensitivity
• cultural competency
• resource-limited settings
• qualitative meta-synthesis
• systematic review

Financial & competing interests disclosure

PA Newman is principal investigator on studies funded by the Canadian Institutes of Health Research (THA-118570), and receives funding from the Canada Research Chairs Program. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Approaches to conceptualizing and operationalizing cultural sensitivity in biomedical HIV prevention trials range from superficial consideration (e.g. language as culture) to in-depth implementation activities and nuanced analyses (e.g. incorporating historical and colonial contexts, and perspectives from participants’ firsthand experiences of the trial).

• Semantic challenges arise in communicating biomedical concepts to audiences with different understandings and vocabularies.

• Trialists’ understanding of how historical experiences of trial communities may be manifest in participants’ responses to and interpretations of trial activities is important to enable meaningful tailoring of activities and content across the spectrum of trial preparedness, implementation, and dissemination.

• Logistical, budgetary, and personnel implications of undertaking activities to meaningfully operationalize cultural sensitivity throughout the lifecycle of a trial must be considered, and such activities appropriately resourced.

• Researchers should highlight and approach sociocultural specificities as assets as well as challenges in preparedness and implementation of successful biomedical HIV prevention trials.

• Preparedness studies and biomedical prevention trials in the next five years should aspire to the standards set, and methods described, in the few investigations highlighted that demonstrate a high value placed on in-depth, comprehensive operationalization and analyses of cultural sensitivity.