HIV Australia | Vol. 13 No. 1 | April 2015
By James Gray and Brent Mackie
Within New South Wales, the adoption of bold targets has been considered a critical force for recent change in the HIV response. Establishing clear HIV targets has provided important opportunities to refocus HIV prevention and treatment work. Engendering support and engagement in response to the targets has played a critical role in much of work to achieve those goals and targets.
Introduction
Within New South Wales, the adoption of bold targets has been considered a critical force for recent change in the HIV response. Establishing clear HIV targets has provided important opportunities to refocus HIV prevention and treatment work. Engendering support and engagement in response to the targets has played a critical role in much of work to achieve those goals and targets.
Community mobilisation strategies utilised across HIV prevention and education efforts allow gay men to actively participate, engage with and lead changes in safe behaviour, testing and the early uptake of HIV antiretroviral therapies.
Understanding the motivations gay men have when considering their sexual health and developing ways to engage with these motivations, requires a deep understanding of gay men’s sexual culture and a willingness to engage with that culture in an open and direct dialogue. It is by utilising that dialogue to mobilise community and respond to targets that peer-based community organisations have demonstrated leadership.Indeed, harnessing gay men’s motivations and building a collective sense of a community movement towards achieving the HIV targets such as increasing HIV testing, has been a key component of the success of the much of the recent work.
Through social engagement and communication strategies that ensure regard is had to the sexual, cultural and community motivations of gay men (both HIV-positive and negative) in program development, peer-based community organisations have effectively mobilised men to continue to think and act directly in response to the HIV goals and targets.
ACON has sought to mobilise the community in a range of ways, from engaging with HIV prevention messages through to actively becoming rapid HIV peer testers, both in community-based settings or in an outreach capacity. This includes engaging community in peer education programs and ensuring that the latest developments in HIV prevention technologies are widely understood. It also involves supporting community to actively question and debate the implications of new HIV prevention strategies and their role in preventing new HIV infections.
Outlined below are three examples of successful community mobilisation initiatives that show how a deep understanding of gay community culture can refocus the work of HIV health promotion programs.
Test More and a[TEST]
A key goal of the current NSW HIV Strategy is to both significantly increase the number and frequency of gay men being tested for HIV.11 The Test More campaign and a[TEST] are two crucial, complementary areas of focus in NSW aiming to increase access to, and uptake of, HIV and sexual health testing.
The highly successful Test More campaign was an integrated part the Ending HIV communication platform, launched by ACON in 2013, and subsequently adopted by the NSW Ministry of Health and by HIV organisations across Australia. Test More focuses on the frequency of testing and the availability of rapid HIV testing in NSW.
By mobilising gay men and by updating their knowledge about access to testing, leveraging off access to new rapid HIV tests, it became possible to offer fast, confidential and effective HIV testing to gay men in community settings. Test More provides gay men with tools to facilitate rapid testing, such as online tools that identify the nearest providers that specialise in sexual health for gay men, and reminder services. The campaign also destigmatises testing by having these messages and services in a wide range of locations, including public spaces.
The Test More campaign aims to build community norms around regular HIV testing that may be easily accessed through community settings. Working in parallel with the Test More campaign, the a[TEST] services also aim to increase HIV testing, by mobilising the community to engage with peer-based rapid HIV testing services.
In an effective demonstration of community mobilisation, a[TEST] uses trained peer workers who are gay community members, to provide rapid HIV tests to other gay men in a non-clinical setting. Under clinical supervision peers obtain informed consent for the test and discuss any risk factors, then perform the test and give the result.
The success of these two programs can be seen through, firstly, the high numbers of gay men using the service that had never previously had an HIV test, and secondly, the willingness of gay men to return for regular testing; and positive client satisfaction results for the service. The success of both Test More and the a[TEST] service demonstrates the critical role of community mobilisation in developing effective responses to HIV targets.
Community mobilisation, campaigns and social media
In February 2013, ACON launched the Ending HIV campaign, the first large-scale campaign to embody the NSW HIV Strategy and to mobilise the gay community around ending the HIV epidemic by the end of the decade.
I’m In (phase one of Ending HIV) focused on engaging gay men in NSW to help end HIV transmission and took a historical approach to the idea of creating a movement. This initial campaign phase laid the groundwork for the campaign by introducing the Ending HIV equation to the community: [TEST MORE] + [TREAT EARLY] + [STAY SAFE] = ENDING HIV. This communication platform has provided ACON with a multi-stage communication plan, allowing us to engage in a longer-term, more detailed conversation with our community.
I’m On (Ending HIV phase two) focused on reinforcing the importance of condom use and was launched in September 2013, while Easy As (phase three) was launched in February 2014, promoting rapid HIV testing and the impetus to test more. The fourth phase of the campaign, Treat Early, was launched at Mardi Gras 2015 and focused on the health and transmission benefits of having an undetectable viral load. In addition to these main phases there have also been reruns of the I’m On campaign, with the latest featuring the high profile giant condom covering the obelisk in Hyde Park, Sydney.
Each phase of the campaign has been evaluated, with a sample size in excess of 500 guys being surveyed after each execution, with the evaluation of Treat Early currently in progress. Each phase evaluated exceptionally well across a range of key indicators: recall, persuasiveness, and engagement.
The campaign evaluation survey also tracks the attitudes and intentions to behaviour of NSW gay men. The survey shows how gay men view HIV prevention, testing and treatment, adding weight to the argument that mobilising and focusing the community around the goals of HIV strategies and building community awareness and engagement is having an encouraging impact. For example, the evaluation survey asked gay men whether they agree or disagree with the statement, ‘HIV treatments significantly reduce the risk of passing on HIV’; in February 2013, just 33% of gay men surveyed agreed, but by April 2014 that number had risen to 64%, an overall increase of 31%.
Furthermore, the survey asked gay men if they agree with the statement, ‘early HIV treatment is better for your health and can help protect your sex partners’; in February 2013, 74% of men agreed, by April 2014, 91% of men agreed with the statement, an increase of 17%. Importantly, the survey also asked men if they agree that ‘everything has changed, we can now dramatically reduce HIV transmission’; in February 2013, 48% of men agreed, by April 2014, 67% of men agreed with the statement, an increase of 19%.
The ACON campaign evaluation survey points to changing community attitudes and readiness to take on new information. The survey also shows engagement with strategy objectives, including by mobilising the community around new prevention technologies, increasing access to rapid testing and engaging gay men with HIV prevention programs that effectively utilise peer-led responses.
Community mobilisation and new technologies
The ACON position statements2, released in mid-2014 to coincide with the Melbourne AIDS 2014 conference, outlined new understanding of what is safe sex, pre-exposure prophylaxis (PrEP), the importance of treating HIV early and home-based testing. The statements further outlined that gay men should have access to the full range of proven prevention technologies in order to reduce HIV transmission and ultimately meet the HIV prevention targets.
In order for gay men to effectively engage with and utilise these new technologies and strategies, community mobilisation is critical. There is much talk of PrEP in the gay community and ACON, like other peer-based organisations, has embarked on the process of informing, educating and mobilising the community. This process has included successful PrEP community forums which have highlighted both the interest in as well as the complexities for gay men of utilising PrEP in prevention. Importantly, these forums have engaged the community in discussing and coming to an understanding of what PrEP is, and how it contributes to the suite of prevention strategies available to gay men.
While PrEP is not going to be the prevention option used by all gay men, those who will benefit from it need to be involved in the advocacy processes to help guarantee its availability. Community mobilisation is essential to the effective uptake of innovative new prevention strategies, and ultimately their effective contribution to achieving targets.
Likewise the complexities of treatment as prevention – i.e., reducing to undetectable viral load so as to significantly reduce the risk of onward transmission of HIV infection in sex without condoms – is both an important strategy in HIV prevention and one that will require significant community engagement and mobilisation.
ACON is both embarking on a major social marketing campaign regarding treatment as prevention, and also a community engagement strategy that includes talking directly to the community through community forums and meetings to build community support. Critical to the successful impact of these new prevention strategies and technologies will be community mobilisation, led by peer-based organisations engaging gay men.
Conclusion
The gay community in NSW is demonstrating they are listening to HIV prevention messages and are willing to act in order to end the HIV epidemic. Unprecedented HIV testing rates and earlier HIV diagnoses are signs of success on the long road to ending HIV. Gay men are willing to act in the public and community’s health interest and increasingly want to be in control of their health – including through the timely access to new technology. It is essential that community not only is brought along with these new messages, strategies and technologies but are mobilised to engage with them in order to achieve those targets.
References
1 New South Wales Ministry of Health. (2013). The NSW HIV Strategy 2012–2015: A New Era. NSW Ministry of Health, Sydney. Retrieved from: http://www.health.nsw.gov.au/publications/Publications/nsw-hiv-strategy-2012-15.pdf
2 The ACON position statements are available at: http://www.acon.org.au/advocacy/Taking-Action/Policy-Statements
Brent Mackie is Manager of Community Partnerships and Population Programs at ACON. James Gray is Manager of Gay Men’s Sexual Health Programs at ACON.