By Dr. Kawango Agot, Director, Impact Research and Development Organization, and Principal Investigator of the Bondo, Kenya, site of the FEM-PrEP trial
It is so important to convey research results clearly and simply. Concepts like partial efficacy can be particularly confusing. This is something I have witnessed many times. People are very creative in the way they apply math! For example, if a given treatment is found to be 50 percent effective, some people might interpret this to mean that all they need to do is take double the recommended dose and they would be fully protected.
In 2007, I was part of a research team that published a scientific paper showing that medically performed male circumcision is safe and can reduce men’s risk of HIV infection during vaginal sex by about 60 percent (Bailey and others 2007). Our study was one of three that found similar results. The findings were exciting, but explaining them has been a challenge. Everyone talks about male circumcision providing 60 percent protection, but not everyone understands what it means. Our attempts at explaining this statistic have revealed gross misunderstandings. One interpretation we often hear is that if you have unprotected sex with an infected partner ten times, six of these times you will not get HIV. Another interpretation is that once a man is circumcised, it is okay to have sex with infected women as long as he stops or uses a condom after the sixth one.
After we announced the study results, our research team held numerous dissemination meetings with the media. We found in one media training workshop that the slides we were using were difficult for journalists to understand. One journalist dismissed the results as invalid because the percentage of protection was not exactly the same in all of the studies—reducing the risk by 51 percent in one, 59 percent in the second, and 60 percent in the third. To correct this misunderstanding, we took great care to emphasize that even though the results appeared slightly different in each of the three countries where the research was conducted, the difference was negligible and could be explained by differences in populations targeted by the studies, not differences in the effect of circumcision on HIV infection.
How we train our community educators to explain partial protection can also be useful when explaining it to journalists: Everyone who engages in unprotected sex has a chance of getting HIV whether they are circumcised or not, but men who are circumcised have a lower chance of getting HIV than do men who are not circumcised. We explain that in the research studies, circumcision prevented 60 percent of the infections that would have occurred if the men remained uncircumcised. In other words, 60 percent of all the infections that occur in men who are not circumcised would be prevented if those men were circumcised. For me, this experience with drastically inaccurate interpretations of scientific research has emphasized how important it is for researchers to take the time to make sure they are communicating their results simply and clearly.