Mobilising men who have sex with men for HIV counselling and testing

HIV Australia | Vol. 12 No. 2 | July 2014

By Matthew Vaughan

Matthew Vaughan looks at an innovative pilot project that aims to increase demand for HIV counselling and testing among regional networks of men who have sex with men.

HIV testing is a critical component of any successful response to the HIV epidemic. Throughout Asia and the Pacific, evidence shows that many people do not undergo HIV testing for fear of stigma and discrimination.¹

Disclosure of a person’s HIV status can negatively impact many areas of a person’s life, such as family relationships, status in the community and livelihood. In some settings in the region, testing is only available through government services such as public hospitals or public sanitation clinics.

This can be problematic for men who have sex with men (MSM) and transgender women who fear disclosure of their identity, or have concerns about discrimination.

Community-based testing and counselling programs clearly demonstrate that community-based approaches help reduce stigma and discrimination, encourage greater up-take of services, and ensure greater protection of human rights.²

At the Melbourne International AIDS Conference, Asia Pacific Coalition on Male Sexual Health (APCOM) will launch a regional report, MSM and HIV Counselling and Testing (HCT) in Asia and the Pacific. The report details HCT activities in the region that target men who have sex with men.

The report is based on inputs from key informants in Australia, Bangladesh, Cambodia, China, Hong Kong, India, Indonesia, Lao PDR, Malaysia, Mongolia, New Zealand, Pakistan, the Philippines, Singapore, Thailand, Tonga and Vietnam, and puts forward the following key findings:

Although current approaches such as direct and indirect models of outreach, HCT service provision, client retention, support networks and strategic partnerships have been very successful, scale-up of services is urgently needed to achieve comprehensive service provision in the region.

The success of HCT and comprehensive service provision is dependent on the visibility, availability, accessibility, confidentiality and affordability of services. Dependable partnerships and collaborations with public and private organisations that effectively offer effective treatment, care and adherence to antiretroviral therapy (ART) support also add to the success of HCT services.

Creative and innovative outreach messages are required to attract MSM to HCT services. These targeted messages need to be supported by the continuous upgrading of skills among non-government and community-based staff/volunteers in areas including professionalism and empathy, as well as technical skills.

For comprehensive service provision to be offered, the availability of funding from local governments and international organisations must be made a priority.

The report findings were fed into the development of the WHO Consolidated Key Population Guidelines, ensuring that the voices and experiences from grassroots organisations are present in this key global document.

Generating demand for testing

Mobilising the MSM community and generating demand for HIV testing, as well as increasing existing testing rates has been a great challenge for the region, and APCOM is looking at an innovative ways to increase testing rates through targeted messaging using platforms that are currently underutilised.

Building on from the 2010 Multicity MSM and Transgender (TG) Initiative, which had identified the need for city-based responses and increased data on younger MSM at much higher risk to HIV but less likely to access services, an innovative campaign was developed which could be replicated and adapted to other cities in the region – including the cities from the Initiative: Bangkok, Chengdu, Ho Chi Minh City, Jakarta, Manila and Yangon.

TestXXX

The TestXXX campaign is a regional campaign targeting young MSM through social media to encourage them to access HIV testing.

To date, Bangkok has never seen a large-scale, well-coordinated MSM HIV testing campaign. Until recently, traditional prevention campaigns have focused on venue outreach for condom distribution and other behaviour change interventions using the peer face-to-face method in locations perceived to be ‘high risk hot spots’ such as bars, clubs, sex-on-premises venues and massage parlours.

Test BKK – the pilot project

The first phase of this campaign is TestBKK – a pilot based in Bangkok. It was important that TestBKK complement the already existing services in Bangkok.

As a regional organisation, APCOM’s role is not to replicate existing local services, including those online. Thailand already had a popular website used by MSM called Adam’s Love.

There were also many community organisations working on peer-led outreach services, including the Rainbow Sky Association of Thailand, Bangkok Rainbow, and for HIV-positive MSM, the Poz Home Centre Foundation.

Our aim for the campaign was to, where possible, encourage MSM to visit one of the existing MSM friendly clinics or services for additional information and to provide follow up for treatment, care and support. TestBKK explicitly promotes four ‘premium testing services’.

These services were identified during the focus group discussions as friendly or sensitive towards gay men and MSM. They include two main clinical testing services, Thai Red Cross Anonymous Clinic and the Silom Community Clinic @ Tropical Medicine, along with two community-based testing services, Rainbow Sky Community Health Clinic (the National MSM Network’s new community based testing facility) and SWING Outreach Clinic (for male service workers in Bangkok).

Another part of the rationale for this approach was that the specific messaging within the campaign could be tightly focused on HIV testing.

Information did not need to be included on every topic, and the TestBKK website was able to offer specific information designed to be quickly viewed and digested by our readers.

The information we offered focused on the key elements of HIV testing including ‘where to go’, ‘what to expect’, ‘the results’, and ‘staying safe’. Further information was provided via links to existing services.

Having a clearly defined target population

Given the concentration of the HIV infections in young MSM, and the target groups of already existing peer outreach services, we decided to target young gay men (18–24 years) that regularly seek out male sexual partners online.

Therefore, we wanted a message that was considered edgy and relevant to our target audience; it needed to be short, sharp and simple.

After several trial slogans and utilising focus group discussions with the target group, we were able to refine the campaign title to something that was catchy and appealing to our target audience: SUCK. F*#K. TEST. REPEAT.

During the planning and discussions, we were trying to think of concepts that would make TestBKK attractive to young Thai MSM.

Obviously it had to be sexy; that was a given. However, considering we had a limited advertising budget, we wanted to ensure that it was a message that would be widely shared through social media.

At the launch of this campaign, APCOM – a regional health and advocacy organisation – had limited recognition and reputation within the MSM community of Bangkok.

Careful consideration had to be given to how to establish the TestBKK brand within the community. We partnered with a well-known group in Thailand, TRASHER, which hosts a monthly dance party that attracts between 700–1200 young people, mostly gay men.

They are also quite well-known for their music parody videos, each of which has been viewed on YouTube between 500,000 to 1,000,000 times.

Given their experience and the shared target audience, their involvement was critical to the success of TestBKK.

Maximising visibility

Serendipitously, as we were preparing to launch the campaign, it was drawing close to April and the Thai New Year, Songkran, was just around the corner.

This is a festive time for all of Thailand, and has become a key event on the social calendar of the gay community also, with the gay centres of Bangkok like Silom, Ratchada and Or-Tor-Gor being packed for the three nights of the festival, attracting crowds of up to 20,000 people.

At this time, Bangkok also becomes home to the well-known gCircuit parties, which attract approximately 10,000 to 15,000 gay men from all over Asia.

This made for the perfect time to launch our campaign. We approached the party promoters, who couldn’t have been more willing to support the campaign activities such as condom provision, posters in high-visibility areas, and an information booth where party-goers could access additional condoms or information about emergency testing facilities over the Songkran period.

These community outreach messages were coordinated with online messaging through Facebook, generating social interest by posting pictures of evening events, people receiving TestBKK branded condom packages and engaging with the TestBKK campaign.

Alongside testing promotion messages and banner advertising on mobile applications Grindr and Hornet, we reinforced the campaign slogan, drawing people back to the campaign website.

With the support of the National MSM Network, we were also able to mobilise a community outreach team. Teams of 8–10 people visited key community hotspots, wearing the campaign merchandise, and handing out free water-proof bags, temporary tattoos, condoms and information.

During the launch of the campaign, over a period of three days, the team handed out more than 50,000 units of campaign materials. This was certainly the biggest coordinated response that the Bangkok gay community had seen for many years.

Results

With a successful launch and community mobilisation we had generated significant interest in the campaign; in less than a month the campaign website had attracted approximately 35,000 page views.

The four videos released on YouTube ticked over 500,000 views and people were starting to engage with the campaign.

The videos releases by TestBKK have received national and international media attention from nineteen different news outlets including the Huffington Post, The Gaily Grind and Queerty.

While it is early days for the first phase of the campaign, already we have received notification from the clinics they have seen an increase in numbers of MSM testing within the services offered by TestBKK.

The success of the TestBKK pilot – which will hopefully see the campaign rollout in other cities – really depends on how successfully the target audience engage with the campaign and share messages on social media with their peers.

The involvement of the service providers to ensure quality and stigma-free services is also essential. The aim is to create an environment where young people will feel confident about accessing testing – and when they do test, ensuring that their first time testing experience will be a positive one.

In the longer term the campaign will also need to be sustained by the involvement of the local community organisations, as well as private sector partnerships in order to reach other young people who may not already be connected to the HIV organisations.

The campaign was not a one-off activity and needed to be sustained over a period of time to build the brand recognition and trust. This sustained effort needs adequate investment in all these areas to achieve a best result.

Matthew Vaughan is Senior Programme Officer at APCOM.

References

1 Berry, S., Escobar, M., Pitorak, H. (2012). Rapid Testing–Rapid Results: Scaling Up HIV Rapid Testing with Same-Day Results in the Asia-Pacific Region. USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1, Arlington.

2 World Health Organization (WHO). (2013, June). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach, WHO, Geneva.