‘I know I can get it over and done with real quick’ – exploring Aboriginal gay men’s HIV testing needs

HIV Australia | Vol. 13 No. 3 | December 2015

By Brent Mackie and Steve Morgan

In 2012, the ACON Aboriginal project, in response to the need to encourage Aboriginal¹ gay and homosexually active men to test for HIV more frequently, commenced planning to develop the Aboriginal Gay Men’s HIV Testing Campaign.

Aboriginal people in New South Wales (NSW) suffer a greater burden of ill health than other populations.

The impacts of colonisation and dispossession, poverty, poor nutrition, low educational outcomes, the geographic remoteness of some communities and other factors  including high mobility, lower health literacy, and  the concept of ‘shame’ around discussing sexual health contribute significantly to underlying poor health status.²

In 2013, around a third of all newly diagnosed HIV cases in the Aboriginal population nationally were diagnosed in NSW .³

As with the broader Australian population, among Aboriginal communities, gay and other homosexually active men are disproportionately affected by HIV.⁴

Previous research has found that Aboriginal gay men in Australia are more likely than non-Indigenous gay men to report recent unprotected anal intercourse with casual partners as well as a higher rate of injecting drugs. ⁵

Additionally, in NSW, the rate of gonorrhoea notifications among Aboriginal people is approximately double the rate in non-Aboriginal people,⁶  the significance being that untreated STIs can increase the risk of HIV transmission.

It was in response to this surveillance data and research that the ACON Aboriginal Gay Men’s HIV Testing Campaign was developed, as an extension of the highly successful ACON Ending HIV campaign.

At the launch of ACON’s Aboriginal men’s testing campaign.

ACON’s work with Aboriginal and Tories Strait Islander LGBTI people

The ACON Aboriginal Project (the project) is a key element of ACON’s community development and engagement program.

The project was established in 1997, in recognition of Aboriginal people as a priority group for prevention, education, care and support services, as noted by successive State HIV/AIDS Strategies.

The project works directly with HIV-positive and negative Aboriginal gay and other homosexually active men , and with sistergirls/transgender people, lesbians and other same sex attracted women.

The project works primarily through culturally sensitive HIV and sexual health education, community development activities, annual health retreats for Aboriginal people living with HIV, outreach to community events and partnership activities with Aboriginal health organisations.

The project led the development, market testing, community consultation and production of the ACON Aboriginal Gay Men’s HIV Testing Campaign.

In 2014, ACON re-established the ACON Aboriginal Advisory Group. The Advisory Group provides leadership in developing programs targeting Aboriginal people LGBTI (lesbian, gay, bisexual, transgender and intersex people).

The Aboriginal Advisory Group includes representatives of key community organisations targeting Aboriginal people, research organisations and Aboriginal community members.

The Advisory Group has played a central role in the development of the ACON Aboriginal Gay Men’s HIV Testing Campaign and supported the campaign’s strategic and creative direction.

Market research

The development process for the ACON Aboriginal Gay Men’s HIV Testing Campaign has been rigorous. The campaign material was tested through three separate rounds of focus testing, which included in-depth interviews and small focus groups.

The campaign focus testing was overseen initially by a campaign advisory group and subsequently the ACON Aboriginal Advisory Group. The Advisory Group, including the AH&RMC worked closely with ACON to ensure the focus testing was rigorous.

Indeed it was Advisory Group and more specifically the AH&MRC who insisted that the campaign be tested by Aboriginal specialist market researchers, employing Aboriginal focus testing facilitators.

The initial focus testing, conducted in 2012, explored the behaviour and sexual health needs of Aboriginal gay men, their life experiences and health seeking behaviours.

The research found that Aboriginal gay men’s connections to the general gay community varied considerably; and that Aboriginal gay identity was complex, dependent on context and layered between sexual and cultural identities.

While Aboriginal gay men generally accessed HIV testing through sexual health services or GPs, many were very concerned about the confidentiality of test results.

Importantly, there was an acknowledgement that the campaign’s creative direction needed to incorporate a sophisticated approach in talking to Aboriginal gay men and should not necessarily rely on Aboriginal representation as a hook.

‘You gotta be private and discrete and make it subtle if you bring up something like an HIV test.’

– Aboriginal gay male during the focus testing process.

‘Our culture is not traditionally homophobic, it’s learned homophobia.’

– Aboriginal gay male during the focus testing process.

The second round of focus testing, which took place in 2014, also used a series of focus tests and one-on-one interviews with Aboriginal gay men.

This market research found that the creative design was seen as salient and easy to understand, and that ease of testing and confidentiality were seen as the most compelling messages to communicate.

‘Yeah that’s important [confidentiality] ya know because you need to let people know that you don’t need your Medicare or ID or nothing – you just test totally confidential.’

– Aboriginal gay male during the focus testing process.

In 2015, in response to feedback from community partners, a final round of focus testing was commissioned from a market research group specialising in working with Aboriginal communities which ensured that the focus groups would be facilitated by an Aboriginal man.

This final round focus testing found that confidentiality was seen as the most important theme. Participants said they preferred to attend sexual health services, as they felt these services were discrete and anonymous and because they knew they did not need to present their Medicare card or other identification.

This market research also noted that while participants acknowledged there was a place for tailored health campaigns for Aboriginal people with recognisably ‘Aboriginal’ visuals, they all felt that HIV testing campaigns should not be specifically tailored to Aboriginal gay and other homosexually active men. This was because it was considered that a tailored campaign could single out and alienate Aboriginal gay men.

Campaign creative development

In keeping with the feedback from the market research, the campaign communicated messages relevant to the needs of Aboriginal gay and other homosexually active men that clearly state testing is free, confidential and fast while simultaneously positioning the campaign as a component of the overall communication platform for ACON’s Ending HIV campaign

It is important to understand that while the Aboriginal men wanted to have HIV testing material targeted to them, they also did not want to be singled out or identified as needing to be tested for HIV.

In order to achieve this, the messaging and media placement for the campaign were designed to target Aboriginal gay men, whereas the creative design used was not identifiably aboriginal but an extension of the ENDING HIV Campaign. This in turn allowed the campaign to maximise the impact, providing relevant and appropriate information.

The creative strategy was impactful, bold and straightforward; promoting free, confidential and rapid HIV testing (results within 30 minutes).

The campaign material was designed to be utilised in a range of settings, from gay community venues such as sex-on-premises venues and street posters, to mainstream Aboriginal community media outlets, such as the Koori Mail and Aboriginal Health Services.

The creative execution sought to engage men using a recognisable campaign for all gay men in NSW, but differentiated sufficiently to attract the attention of Aboriginal gay men.

In line with community feedback, the semiotics employed by the campaign were identifiable by and inoffensive to Aboriginal gay men, suitable for use in mainstream community contexts, and were not stigmatising.

‘It makes me keen for starters coz I know I  can get it over and done with real quick.’

– Aboriginal gay man during the focus testing process.

‘Just say confidential quick test and result in 30 minutes. Totally anonymous. No paperwork. Set it all out clearly.’

– Aboriginal gay man during the focus testing process.

‘It’s encouraging gay men to get an HIV test more often.’

– Aboriginal gay man during the focus testing process.

Campaign implementation

The campaign was successfully launched in June 2015, running from 15 June to 6 September.

Importantly and in keeping with the focus testing recommendations the campaign media placement was designed to specifically target Aboriginal gay men with messages related to HIV testing. The campaign media consisted of a mix of online, print, outdoor street posters and social media executions including:

• billboards in Redfern and Blacktown railway stations
• press advertisements in the Koori Mail
• outdoor street posters in Redfern and Blacktown
• Facebook advertising and banner advertising on key gay dating apps Grindr, Recon and Squirt
• Aboriginal pages within the Ending HIV website.
• A key element of the campaign was the development of Aboriginal gay men’s component of the Ending HIV website. This included specifically-developed Aboriginal HIV information and imagery.
• A social media campaign via the ACON Aboriginal Project.

Conclusion

Developing and delivering HIV testing campaigns to Aboriginal gay men presents complex challenges to HIV educators. A relatively small and highly mobile community, lower health literacy and concerns about confidentiality mean that HIV testing education materials need to consider a range of different strategies.

Health promoters must therefore consult closely with members of the target community to develop materials that specifically meet the needs identified by Aboriginal gay and other homosexually active men.

ACON’s Aboriginal Gay Men’s HIV Testing Campaign is an initial start in targeting HIV education and prevention materials to Aboriginal gay men. ACON plans to repeat the campaign over the summer of 2015/16.

Once this work is complete, a formal evaluation of the campaign’s impact will be undertaken, utilising the Ending HIV evaluation framework.

The outcomes of the formal evaluation will be used to inform and refine future iterations of the campaign.

References

1 In recognition of NSW as Aboriginal land and consistent with NSW Health guidelines informed by consultation with Aboriginal communities, this article refers to ‘Aboriginal people’ or ‘Aboriginal gay and homosexually active men’ but is inclusive of Torres Strait Islander peoples.

2 The Kirby Institute. (2015). Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: Surveillance and Evaluation Report 2015. The Kirby Institute, UNSW Australia, Sydney.

3 ibid.

4 ibid.

5 Lea, T., Costello, M., Mao, L., Prestage G., Zablotska, I., Ward, J., et al. (2013). Elevated reporting of unprotected anal intercourse and injecting drug use but no difference in HIV prevalence among Indigenous Australian men who have sex with men compared with their Anglo-Australian peers. Sexual Health, 10(2) 146-155, CSIRO Publishing, Victoria. doi: http://dx.doi.org/10.1071/SH12097

6 The Kirby Institute. (2014). Bloodborne viral and sexually transmissible infections in Aboriginal and Torres Strait Islander people: Surveillance and Evaluation Report 2015. The Kirby Institute, UNSW Australia, Sydney.

7 Ending HIV is campaign, launched by ACON in 2013 which has subsequently been rolled out in other states and territories, which aims to educate gay men about advances in testing technologies and HIV treatments, and the opportunities this presents to virtually eliminate HIV transmissions by 2020 as a result of these advances.

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Brent Mackie is Manager, Community Partnership and Population Programs at ACON. Steve Morgan is Aboriginal Health Promotion Officer at ACON.