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?
Yes, but first I think that a little context about where I work is important. Peel HIV/AIDS Network is based in the large Region of Peel in southern Ontario, where we serve multiple municipalities (Mississauga, Brampton, and Caledon) with almost no LGBTQ services. PHAN has one staff position devoted to gay, bi and other men who have sex with men for the entire region. That leads to a lot of work -- there are 1.4 million residents in our region -- with few resources.
Given the lack of services and community spaces for gay men in our region, most gay and bi men who are connecting are doing so online. This is primarily where we connect with them too.
So, having said this, yes, there is no question that the men we work with have varying levels of knowledge. From awareness of HIV in general to awareness of prevention strategies, there is definitely a broad spectrum of knowledge. I think that lots of guys are talking about sero-sorting and sero-positioning in online hook-up forums, but for newer prevention strategies, like PrEP and treatment as prevention, there is far less awareness. That said, we have the sense that knowledge is building.
When we do online outreach on hook-up sites, if we get questions about newer prevention strategies, they tend to be about what some men see in other guys' profiles about new prevention strategies. Men ask us things like "what does 'on PrEP' mean?" or "what does 'undetectable' mean?" because some guys who are more 'in the know' post this stuff in their profiles. So the language is getting out there, but the concrete knowledge is not as up-to-date. Generally, and obviously there are exceptions to this, the poz guys seem to have much higher levels of awareness of newer prevention strategies than the guys who are negative.
But honestly, questions about PrEP and treatment as prevention or viral load are not the most common questions that we receive in our online outreach. Most of our conversations with guys online are more basic -- how HIV is transmitted, where to get tested, that kind of stuff. We are not typically engaging in highly sophisticated conversations about PrEP or other new prevention approaches. For example, people may ask what PrEP is, but we rarely are asked where to find it or the evidence behind it. Men just aren't there yet in our region.
So, we respond with appropriate messages, depending on the questions being posed. We rely on other groups -- like the Ontario Gay Men's Sexual Health Network (GMSH), which develops messaging and campaigns for gay men that we help circulate in our region, and CATIE -- to help link people to other sources to learn more about new HIV prevention strategies. We don't have nuanced messaging.
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.
PHAN has worked hard to get new prevention strategies integrated into our work, but this is relatively new. Perhaps like other organizations, we have spent a lot of time laying the groundwork for integration, and not yet the active integration of the knowledge into programming itself.
Within the past six months, we have worked to get a position from our Board on treatment as prevention/viral load and transmission, and PrEP. For us, there were a lot of mixed feelings about our organization taking a position on these things, as it was not clear to us if there was no risk of transmission with these new strategies. The Board, for example, had to ask some hard questions about risks to the organization (like liability) of putting out messaging on new prevention strategies in the face of uncertainty around the science.
We have also had to work through things related to values in the face of new prevention strategies like PrEP or treatment as prevention. For example, some people who have been in the movement for a long time have struggled a little bit with concerns that embracing new strategies means giving up condoms. But I think that more recently, at an operational level, we have been able to embrace the more definitive scientific position on treatment as prevention and PrEP. We still want a strong endorsement of the board but I understand that this takes time. An endorsement from the Board on new strategies will also help to create more confidence among staff who have also struggled with this shift to new approaches. We also invited a consultant to provide an information session on new strategies, the evidence behind them, and what they might mean for our work. This also seemed to help.
For our organization, we have had to address important questions about new strategies, such as "are they just for gay men?" and "will these really benefit positive people?" These are important questions to ask and conversations to have, and they take time. We are currently focusing on this.
So, have we integrated this new HIV prevention knowledge into our programming with gay men (or anyone else), the answer is, "not quite," but we are really close. We are close to being as comfortable as we can be, collectively and individually, with these strategies to start putting out messaging and working with others, like physicians, to help get the word out about them. We have been talking with public health about partnering to develop CME-accredited training for physicians about PrEP.
It is also important to point out that, for our organization working in this region, this is not just relevant for gay men. It is important to think about how to integrate this knowledge into all of our work.
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.
Oh yes, absolutely. I feel like now, even more than a year ago, we have such a strong sense of confidence as a result of having more study findings and acceptance in the scientific community. This really helps. Its seems that we in the community who want to move forward with new approaches are no longer at odds with the positions of funding agencies, for example. We are all on the same page it seems. There is a more unified position, even within the activist community. Poz and neg people in the gay men's activist community seem to be on the same page. There has been a groundswell that has helped organizations like mine know that there are reliable sources to go to for this information. And that organizations like CATIE finally take a position, well that's huge. Many organizations and individuals that have been on the fence before or non-committal are changing. So yes, we are in a position to give definitive answers.
As a movement, I worry that our funded public health movement, the HIV sector, will be looked back upon as having dragged our feet. For PHAN, we are challenged to dedicate specific resources to focusing on new prevention approaches to reach gay and bi men in our region, say, to create something focused in terms of content and directed in terms of audience. Our audience is so broad (and as I already mentioned, gay men are not our only priority population). But collectively, we are taking time to respond to this and yes, it is important to be cautious, but we know now that we can give definitive answers; we are far behind and we have a lot of catching up to do. Organizations like Health Initiative for Men have really taken the lead on rallying organizations across the country on some advocacy around preventions strategies, like getting Gilead to put in their application to Health Canada to approve Truvada for PrEP, but because PrEP was seen as most relevant to gay men only, organizations that serve a really diverse audience, or don't have gay men as their only priority population, didn't necessarily recognize how important these new strategies have been for them as well. It has taken organizations that have a solid focus on gay men to move this forward; they have just brought the rest of us along.
As a sector, we are challenged to move forward on things that we don't see as applicable to all of the populations that we serve. Sometimes these new strategies are just seen as for gay men. But we have to come together to make this available to all. It will remain inequitable unless we come together to advocate for all the populations that we serve.
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?
There have been so many ways to keep up to date. The GMSH is important in this for Ontario gay men's organizations or programs. It has had various presentations at their symposia on new prevention strategies. Opening Doors had a presentation on PrEP too, and there was a café scientifique event on new strategies before the CATIE Forum. People who speak at these events tend to be known and trusted. I encourage staff to attend and I attend as well.
Some of us also personally and professionally follow these conversations. We also go to various websites for information. There are discussions in social media, discussions with people on PrEP, critical examinations of treatment as prevention, and other discussions; there has been an explosion of conversation on this. We actively seek out this information from places like CATIE and positivelite.com.