We spoke to three service providers to find their views and approaches on the issues related to talking to gay men about new prevention strategies:
- Brook Biggin, Community Education Facilitator, HIV Edmonton, Edmonton, Alberta
- Phillip Banks, Executive Director, Peel HIV/AIDS Network (PHAN), Brampton, Ontario
- Chris Aucoin, Gay Men's Health Coordinator, AIDS Coalition of Nova Scotia, Halifax, Nova Scotia
Do the gay men you work with have varying levels of knowledge and awareness around new prevention strategies? Please explain. How do you tailor your messages to guys with different knowledge and awareness levels?
Of course! Yes, gay men have varying levels of knowledge around new prevention strategies. It's like anything else. To give an example, I read Huffington Post every day, so I am pretty informed (and slightly biased) about numerous world events (ha-ha). But, I don't have a clue who won the Oiler's game last night. It's the same with HIV prevention. Some guys are just naturally interested and so they've read up on PrEP and what it means to have an undetectable viral load. And some guys are reading up on something different or not reading at all, because that's not their thing. It's really about gauging where individuals or certain groups within the community are sitting in terms of their understanding and meeting them where they are.
I also don't treat the members of my community as though the only thing they can process is a one-line statement on the efficacy of PrEP or treatment as prevention. In fact, when we leave them with that, we leave them with incomplete and inadequate information to make decisions regarding safer sex. Many of the guys we serve are pretty bright. I've stood across from guys at the bar over a beer breaking down the Partner Study. Recently I posted a 1,500 word post about PrEP on my Facebook in response to a CBC article. That post pulled together information from various studies looking at not only efficacy, but debunking myths about risk compensation and side effects. That's a book as far as Facebook is concerned but a lot of guys want more than what they're getting. Numerous local guys have engaged with that post! That's some real education. Because of the post, they now have adequate information to determine just how comfortable they are with making x, y, z decision, instead of having them rely on these "low risk, but not no risk" statements that we as service providers so often like to throw out there. What the hell does that mean to me as a guy trying to navigate my sex life in a world where HIV is a reality?!
How have you or your organization integrated this new HIV prevention knowledge into your programming with gay men? How receptive are gay men to this information? Please explain.
You know, I'm not sure I have a great answer for you. Although I'm a poz gay guy who has been well-integrated into the community for years, I have only been working in the field for 11 months. When I started, these developments were already here! It's not like I had a horse in the race already and all of a sudden PrEP came along and upended my central messaging of "condoms are the only way to protect yourself." When I came into this role, PrEP and treatment as prevention were already here. We already knew that they were effective. I think that if someone feels otherwise, there is really a lack of education or personal bias. It comes down to that phrase, "you have a right to your own opinion but not to your own facts." So, you can't be providing sexual health education to gay men and not be including information regarding PrEP and treatment as prevention. Their effectiveness is fact.
But how we integrate this knowledge into programming is a product of how we frame our work. I'm here to see my community thrive. And from a sexual health standpoint, that means ensuring that the guys I serve, both poz and negative, can have fulfilling sex lives -- to have the sex they want to have. And that looks different for different individuals. So, it's really trying to understand a specific individual's needs and helping him choose whatever prevention options work best for him. It's really not about me shoving any sort of agenda down anyone's throat.
Do you feel that we are now in a position to give definitive answers to gay men about the effectiveness of new prevention strategies or is there still need for more research? Please explain.
Yes. I don't think there's any doubt that PrEP and treatment as prevention are extremely effective. We saw this message in CATIE's updated prevention statements! You stated that condoms, treatment as prevention and PrEP, when used as intended, all reduce the sexual transmission of HIV by 90% or more. And yes, we all know there are caveats. But I personally have no problem saying that someone with an undetectable viral load who is adhering to their medication will not transmit HIV. I also have no problem saying that a negative guy adhering to his daily PrEP regimen will not contract HIV. And shifting to a professional capacity those statements would only shift ever so slightly. The tensions come, however, with the fact that many people working in gay men's health are working within AIDS service organizations that face the general population and exist within a larger world of HIV prevention. So, in the same way that the Resonance Project states that gay men tend to be earlier adopters of new information in regards to HIV prevention, I also feel that gay men who work in gay men's health and understand the needs of their community -- from those I've spoken to -- are also more willing to take a bolder stance on new developments in prevention like PrEP and treatment as prevention. Messaging for the general population does not always work for the lives of gay men. We can be more definitive -- this allows guys to have the sex they want, and for some, this means condomless sex.
What are the challenges to keeping up to date with the latest developments in new prevention strategies? Do you have any suggestions for others that are struggling?
I don't have a particularly difficult time keeping up to date. That's due to a few things. First, when I started this role, I probably spent a couple solid weeks perusing online databases looking for everything I could find on PrEP and treatment as prevention. I recognized how big of a game changer it was, that it was a discussion that was happening in other major centres, and that it was only a matter of time before it became central to the discussion here in Edmonton around the sexual health of queer men. In fact, the first presentation I developed at HIV Edmonton was a 75-minute presentation on developments in prevention technologies. So, having laid that foundation already, when something new comes along I can simply sort that into an existing pile of information.
That said, there is concern around capacity -- my capacity and the capacity of my organization -- to meet the needs of gay men and keep up. I am the only person at HIV Edmonton whose work focuses on gay, bisexual, and other men who have sex with men. There are about one million people in Edmonton. Yes, we are smaller than Vancouver, Toronto, and Montreal, but when you compare the number of workers and organizations engaged in gay men's health in Edmonton to those larger centres, we're not just screwed at a pure numbers level but even on a per-capita basis, by a large stretch. So, if I'm neck-deep for two weeks doing research on prevention technologies, as I was when I started here, then those are two weeks that I'm not doing something else, things that are also urgently needed. There's no one to split the work with. So, you have to prioritize. And that often means focusing on one need and waiting to address another. It's not ideal but it's necessary.
This is why we as a national gay men's health movement really need to look at addressing regional disparities, particularly around knowledge exchange. There are guys working in this field who can pull the numbers from seven or eight different studies related to PrEP and treatment as prevention off the top of their head -- I know this because I know several of them, and I am one of them. But if those people exist, there's no reason that one guy working in the middle of Saskatchewan or the Yukon or wherever should have to spend two weeks trying to pull information together at the expense of all of the other things they need to do in order to serve the community. We can do better than this. We need to do better than this!