Young gay men: capable, resilient and resourceful

HIV Australia | Vol. 11 No. 1 | March 2013

JAMES GRAY, THOMAS MUNRO and MICHAEL YATES discuss peer-driven health promotion approaches to address HIV among young gay men.

The age distribution of the HIV epidemic in New South Wales has been changing in recent years. For most of the last ten years the demographic that made up the highest number of new diagnoses was the 30–39 year age category.

Recently we have seen a spike in the 20–29 age range, which reached its highest level in well over a decade in 2011 – although it is important to note that these age tranches are quite arbitrary and cover men at very different points in their lives.

This recent change in the notification data has prompted a much needed reflection on the state of our prevention efforts with younger gay men. This article will outline some of these health promotion approaches and methods of engagement used by The Young Gay Men’s Project at ACON, which focuses specifically on the health and wellbeing of gay men aged 26 and under.

Although talking about ‘young people’ or ‘young gay men’ as a unified category for targeted HIV prevention and sexual health promotion presents challenges, new methods of approaching health promotion for this demographic are clearly required. We also have a range of opportunities to engage with these men.

We believe that the resilience of young gay men should not be undervalued. Young people have greater access to information than any prior generation and are highly competent at interpreting what is most relevant to them.

Providing accurate, up-to-date information about pleasure and risk is crucial to ensuring that young gay men are equipped to make informed decisions about their sexual health.

We should feel optimistic about our ability to lower the numbers of new HIV infections and permanently turn around the destructive effects of HIV.

Optimism

Indeed, there is far more cause to feel optimistic than pessimistic. Most guys use condoms a majority of the time, and antiretroviral medication is more effective and available than it’s ever been.

The impact of undetectable viral load (UDVL) on decreasing the likelihood of transmission and new prevention ‘tools’, including preexposure prophylaxis (PrEP), are giving gay men more opportunities to reduce HIV transmission.

However, driving down HIV infections in those under 30 provides its own set of challenges and also many new opportunities. Essential to this is our understanding of who young gay men are.

We can’t frame young gay men as one single group of people that all have the same understanding or shared sexual practice. Nor is it helpful to position them as somehow lacking capacity or in need of rescuing from themselves.

Rather we must regard them as diverse individuals who, once empowered with knowledge and information, are highly capable of making responsible decisions in accordance with their personal lifestyle choices and varied sexual needs.

ACON’s Young Gay Men’s Project utilises peer education to engage with guys on their own terms and acknowledges them as partners in our joint effort to improve the health and wellbeing of our community. As with most community-based initiatives, the attitude that is brought to work with young people is a key reason for the success or failure of an intervention.

Young gay men have been an integral part of the response to the epidemic since it began and this involvement will continue into the future. Men under 30 comprised a substantial portion of those who died from AIDS in Sydney in the early years of the epidemic.

Today’s generation of young gay men may not have witnessed the tragedy of what came before us, yet we have inherited this as our legacy. Peer-led responses from young gay men will continue to be an integral part of the fight against HIV until HIV has been eliminated.

HIV testing

The NSW HIV Strategy 2012–2015 has set a number of targets to work towards the virtual elimination of HIV transmission in NSW by 2020. These include reducing the transmission of HIV among gay men by 60% by 2015.¹

The only way that we are going to achieve these targets is by intensifying our efforts with our target populations – in our case this means increasing our targeted messaging to young gay men.

A major priority for the Young Gay Men’s Project, and ACON as a whole, is to increase HIV testing rates. Young gay men report testing rates far below the level we believe is necessary.

There are many reasons for this. Not all young gay men are sexually active and those that are may believe that they don’t need to get tested based on their personal assessment of risk. It is therefore natural for testing rates to be slightly lower than among older gay men.

It is important that we assist young gay men in recognising the need to develop a routine testing pattern relatively early in their sexual lives.

Reasons for not testing can be both psychological and circumstantial – for example, stigma and shame relating to testing, not being aware of testing services, lack of knowledge about how HIV can be passed on, and inconvenience and cost of doctor consultations are some common reasons why testing isn’t happening enough.

The young men that access our services report that the length of time it takes to receive the results of a conventional blood test can be a major source of anxiety. For this reason, many would prefer rapid HIV testing to standard testing methods. Having to come back to the clinic for test results has often been described as a barrier to regular testing.

As rapid HIV testing and other structural innovations are put into place, it is vital that we don’t lose touch with the community’s sexual behaviours and values. We are engaging in frank and reassuring conversations with young people in their own cultural languages about sexual health and testing, and employing peer leaders to reinforce these messages.

This includes the development of new multimedia resources such as sexual health testing videos, and a revitalised emphasis on testing within the curriculum of our peer education workshops.

Getting it online: sex and sexual health information

In recent years, Sydney has ranked fourth globally in the list of cities that have the highest Grindr usage rates, which highlights changes in the ways gay men are communicating and seeking sexual encounters.

In addition to many gay men’s love of mobile ‘dating’ apps, Writing Themselves in 3² has highlighted that the internet is the most important source of information about homophobia and discrimination, gay and lesbian relationships and gay and lesbian safe sex for young lesbian, gay, bisexual and transgender people.

Young gay men are using the internet and mobile apps to both interact and gain information and we need to be aware of the impact that these spaces have on their sexual interactions. It is important that young people learn how to navigate these spaces safely and effectively.

The Young Gay Men’s Project is currently developing a new workshop called ‘Getting it Online’ that aims to teach these skills. We aim to develop and share effective ways of negotiating safety in this context as well as effectively communicating what we want when planning a sexual encounter and how to get it.

Part of the aim of Getting it Online is to provide young people who may access hook-up sites with strategies to make informed decisions allowing them to minimise risk when seeking pleasure.

The workshop is also a great opportunity to challenge other issues affecting young gay men such as discrimination, drug use and physical safety when meeting unknown sexual partners.

Writing Themselves In 3 also indicates that young people are often more comfortable seeking out information online and talking about sex and sexual health through social media platforms such as Facebook.

It is important to recognise that not all ‘young gay men’ are going to respond to the same material, or want to participate in a workshop or engage with our social marketing campaigns. Therefore it’s important to communicate with them in a variety of ways that they find interesting and engaging.

Online communication is a perfect medium for this sort of targeted, easily-digestible information. Online experiences must be dynamic and interactive – with people able to ask the questions they’re interested in, rather than being passive consumers of information.

Social media

Nowhere is online interactivity more evident than through social media. Twitter and Facebook can be used to engage in public dialogues with people around topics that they want to talk about.

These mediums can be used for much more than merely health promotion-related events and activities but can be a site for health promotion themselves. Often the challenge is making people see these issues as relevant and important.

In many cases public health practitioners have been slow to adopt and investigate emerging methods of health communication, such as using YouTube to ‘vlog’ health information.

There is good reason for caution. With little evidence for the efficacy of these communication methods, public health practitioners are rightfully hesitant to spend limited health dollars on interventions that may not be successful.

However, it is also true that change often entails risk and we can’t wait for others to tell us what to do. We need to engage with young men on their own terms. If our interventions fail we need to openly acknowledge that so others can learn from our mistakes.

When exploring new ways to do health promotion in online spaces we need to challenge conventional wisdom around what works, take risks and adapt our practices to emerging technologies. We can’t always control or direct the sorts of interactions that occur online but these provide exciting new opportunities for engagement.

Young gay men are a diverse group of people with many skills, interests and needs and our work with them needs to reflect this. We need to encourage their active participation rather than being didactic and seeing them as incapable of looking after their own health. Young gay men have been, and will continue to be, resilient and adaptive in the face of this health challenge.

References

1 NSW Ministry of Health. (2012). NSW HIV Strategy 2012–2015: A New Era. NSW Ministry of Health, Sydney. Retrieved from: www.health.nsw.gov.au

2 Hillier, L., Jones, T., Monagle, M., Overton, N., Gahan, L., Blackman, J., Mitchell, A. (2010). Writing Themselves In 3. The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne.

James Gray is a Gay Men’s Engagement Coordinator at ACON. Thomas Munro is Community Health Promotion Officer (Young Gay Men’s Project) at ACON. Michael Yates is Community Health Promotion Officer (Young Gay Men’s Project) at ACON.