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?
Oh, absolutely. The guys that we work with have a wide range re how much knowledge they have about new prevention strategies. We make sure that we address differing levels of knowledge by offering different levels of detail about these prevention strategies. Our goal is to make this information as accessible as possible to as many people as possible, so we do [online and in-person education and information dissemination] through a "pyramid approach." What this means is that the actual way that we organize and deliver this information is layered and conscious. For example, in our Check Me Out sexual health check list, which is a campaign for gay and bi men, we focused on a lot of information that the Resonance Project article is talking about. However, we organized the information in a way that men can first access the 'core message' that we are trying to put out about HIV or STI prevention, and leave it at that. But for men who want to go further and deeper into the information, they can keep digging and uncovering more and more layers of information, meaning more and more nuance. They can choose to walk away at any point, but the core message (or more!) has been delivered. We structured the information to allow people to get more and more detail about the topic of sexual health if they have the interest and capacity, but we don't require this of them to get the core message out. For example, if a guy wants to know why we say some prevention approach is effective, they can easily dig a little deeper and find it. We don't just offer simple one-liners any more. We have to make it straightforward, but allow some guys to access the more complex information if they want to.
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.
As much as possible, I try to integrate this new knowledge into all aspects of my programming with gay men. I have to be on top of new HIV prevention knowledge and be prepared to answer questions about new prevention strategies at any moment. For example, PrEP is now becoming the new hot topic of conversation in general, and this definitely comes up when I do online outreach. I have had to upgrade my knowledge on PrEP effectiveness, and on the infrastructure around, and barriers to, PrEP access in Nova Scotia. I have to understand the obstacles guys face in accessing PrEP and how to overcome them. Sometimes, "integrating" this knowledge into my work is as simple as realizing there is an information need -- when a guy asks me a question -- not knowing the answer, and then going to find that answer. With PrEP, I had to dig around and find out the answers guys wanted -- if it works, where to access it, that sort of thing. While I want to be leading the conversation, in online outreach, I am often replying to questions men have about what they are hearing about new prevention approaches "out there," so you need to be prepared.
While I try to integrate knowledge of new prevention strategies into all of my work, I need to see the evidence. Service providers have to make a judgment call about when they start talking about particular prevention strategies -- and it is important that this happens when there is enough evidence behind an approach. For me, I always look to see how many studies have been published on a certain approach (and what kinds), as well as if other organizations are talking about it. PrEP is a great example -- there is research evidence behind it and organizations like CATIE and others are talking about it a lot. Within the past 12 to 18 months, the information on PrEP has really been getting out there. So, while there is not the infrastructure to access PrEP in Nova Scotia yet, as service providers, we need to be on top of this information.
In term of receptivity, because we are often replying to questions from guys (as opposed to leading the conversation), yes, generally men are receptive to the information. There certainly is a spectrum of receptivity, just as there is with level of knowledge. I find that often the least receptive guys are the older gay guys who have lived through the epidemic and who might feel that they know all that they need to know -- they stopped listening to "new" prevention information 20 years ago. But, as a service provider, I need to be ready to respond to any individual, whether they approach me for answers or if I am trying to provide updated knowledge. This takes energy and time. It is a very nuanced and organic process. We really have to listen to know what men are asking for.
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.
To a degree. We don't want to pass on information that is not very reliable, which would have huge implications both for our reputation as service providers and for that person's risk. This is about making sure there is enough research evidence behind a particular approach. As service providers, we need to be gatekeepers to this information in a way, and be able to qualify the information with any caveats that exist -- the evidence behind new prevention strategies like PrEP and undetectable viral load is not always completely straightforward, and we need to be able to explain the nuance of the effectiveness of these new strategies. For example, some guys ask me about undetectability, viral load, and transmission. The nuance that "undetectable" is not a badge that you wear forever, that it is variable and that it doesn't always equal zero risk often does not come up in conversations unless I raise it. It is my role to help guys that want more information understand this -- such as that STIs or the flu can interfere with this designation of "undetectability" and the implications of this designation.
Is more research needed on PrEP and undetectable viral load? Yes, I think there is. For example, it would be great to learn more about different dosing strategies for PrEP. I am always keen to see more nuanced research on these new strategies. Population-specific research is very helpful.
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?
This is definitely an ongoing challenge. There has been so much research that has come out in the past 10 years that has changed the prevention landscape; it is challenging as the front-line program designer and provider to keep up with it. It definitely takes a certain amount of health and research literacy to be able to find this information, absorb it, and figure out how to incorporate it into the work. This is one of the biggest challenges, I think -- having the capacity in our community-based organizations to read original research or understand the implications of a fact sheet from CATIE. While some people, like me, like to go directly to the research, not everyone has the capacity to or interest in doing this, or time. But even for people who do have the capacity to go to the original research, it is important to use organizations like CATIE to access clear and reliable information. It is also helpful to look to see what other providers are doing and learn from how they are approaching things. These are the three strategies I use to stay on top of things.
It takes time to do these three things, however! I work for a small, under-resourced AIDS service organization and my position is only funded part-time. Usually, my plate is pretty full. To keep up with the latest knowledge of HIV prevention takes time and this is often not a funded activity -- my time is supposed to be spent on programs. Having time to just search for and read research summaries is limited. I have come to rely more and more on CATIE's various fact sheets and publications to get easy access to this knowledge.
If we are going to do evidence-based work, which we need to do, it is critical that we have access to the most relevant and up-to-date information. Organizations like CATIE are critical in filling that need. Also important is having opportunities to share knowledge between and among frontline gay men's health service providers.
Related article: For more information on the Resonance Project, see "The Resonance Project: What Service Providers Are Saying About Biomedical Information on HIV Prevention."