Key innovations in outreach services for men who have sex with men (MSM) by Tom Hunt

Posted 26 Feb 2015

Date: 26 Feb 2015

Author: Tom Hunt

This content was originally published on the MEDFASH website as an e-feature on 26th February 2015 and it is reproduced here with kind permission of MEDFASH.

Outreach is a crucial component of HIV prevention and sexual health promotion work for men who have sex with men (MSM). It offers a way of delivering services outside the traditional setting and making contact with people where they meet to socialise and/or have sex. The growing use of online outreach provides further opportunities to access the most marginalised and at risk populations. In this month’s eFeature, Tom Hunt, Local Services Coordinator for Yorkshire MESMAC (Wakefield and Begin), talks about key innovations in outreach services for MSM. He uses examples of local MESMAC work to illustrate how community outreach has evolved to provide ‘easy-to-access’ services to some of the most at risk populations to help reduce transmission of HIV and other sexually transmitted infections.

Yorkshire MESMAC is one of the oldest and largest sexual health charitable organisations in the UK, with bases in Leeds, Hull, Bradford, Wakefield, York and North Yorkshire. One of Yorkshire MESMAC’s key strengths is its community development approach, engaging communities traditionally considered ‘hard to reach’ such as gay, bisexual and other men who have sex with men, African communities and people living with HIV in sexual health issues.

MESMAC rejects the notion that communities are ‘hard to reach’ and instead focuses on developing ‘easy-to-access’ services using community development to enable communities to participate in collective action, take ownership and use their unique perspectives in developing strategies for improving their sexual health and wellbeing.

We start where the people are. We are proud of our ability to access disenfranchised communities and to empower them to take control of improving their health outcomes. We do not work the usual 9am-5pm on week-days; we work over seven days a week, evenings and weekends, to ensure our passion for sexual health is grounded in reducing barriers to access and providing excellent targeted and cost effective services for populations most at risk of HIV and sexual ill health.

Online outreach

Our website gets over 750,000 visits per year with users accessing up-to-date information and news such as shigella outbreaks and local developments. We reach high volumes of service users online with updates about testing services and other news of interest. We know that there is high acceptability of this approach with service users so long as staff are culturally competent and are able to provide tailored information, for example, recruiting MSM who have unprotected sex for pre-exposure prophylaxis (PrEP) as part of the PROUD study. We know that many men are more able to engage online protected by the anonymity of the screen.

Yorkshire MESMAC takes a strong lead in developing online services for those populations most at risk of HIV. We have developed African language podcasts on HIV, breaking down barriers by providing unbiased information for all sexualities in five of the UK’s most popular African languages and English. In terms of African MSM, we have also developed in partnership with Naz Project London to produce a national, online information hub tailored to meet the needs of African MSM and healthcare professionals working with them. Designed as a reliable and extensive source of information on different areas of sexual health, it aims to raise awareness of the benefits of HIV testing and treatment options and to reduce late diagnosis in African MSM.

Online outreach is a growing, high impact and responsive means of accessing MSM particularly those who do not use traditional venues. Yorkshire MESMAC has online profiles with information and offers sexual health advice through messaging on the most popular generalist sites including Facebook and Twitter, instant messaging programmes and the most popular niche websites to target high risk men, ie MSM with multiple sex partners, MSM sauna users, barebacking/unprotected sex dating and African MSM.

There are limitations to online outreach; we have to abide by terms and conditions and agree outreach approaches with the website/mobile app site owners. For example favours a passive approach driven by their service users who do not usually wish to be actively contacted, allowing the service user to approach us to ask questions; and they can be real humdingers! Talking about HIV/Hep C co-infection, chemsex, undetectable viral loads, and more only highlights the need for service users to access non-judgemental and culturally appropriate advice through online outreach.

Mobile apps

Online outreach has evolved to online mobile internet use via mobile apps. Mobile apps such as Grindr, Scruff, GROWLr, Bender provide Yorkshire MESMAC with a means to talk directly to the service user in the comfort of their home. The geo-located apps provide the ability to access local populations with low cost and targeted online advertising. For example GROWLr SHOUT!broadcasts messages in which a worker can send information about our sauna clinic opening times to 700 MSM in Leeds. Signposting, answering questions, sending out postal condom packs, counselling referrals and booking HIV point of care testing (POCT) appointments have been a major evolution from of our traditional offline outreach programmes in MSM saunas, public sex environments (PSEs) and lesbian, gay, bisexual and transgender (LGB&T) scene venues.

Offline outreach

We have developed a strong programme of offline outreach with close partnership links to LGB&T venues, PSE sites and MSM saunas. Our MSM sauna outreach has two models: HIV POCT rapid testing at the Basement Sauna and a full HIV/STI testing clinic, which is nurse-led, delivered in partnership with Leeds GUM services and supported by the Yorkshire MESMAC outreach team at the Steam Complex Sauna.

The Basement Sauna is an extension of our award-winning community based Testing Times service, developed with service user demand to access rapid POCT in the city centre sauna. It is a small sauna which isn’t able to accommodate a full clinic but nevertheless serves a high proportion of young MSM.

The Steam Complex Sauna clinic has identified a positivity rate of 21% for STIs compared to a rate of 14% amongst MSM in Leeds GUM services. 83% of chlamydia & gonorrhoea infections identified through the sauna clinic were in extra-genital sites that would not have been diagnosed through urine screenings alone. Delivering services where MSM are is undoubtedly cost-effective and necessary.

Our Church Peer Educators programme provides education and training workshops on HIV to African-led faith based organisation leaders, including how to provide non-stigmatised messages around HIV testing. Football tournaments for African communities are also organised with integrated HIV training workshops.

Yorkshire MESMAC offers a comprehensive programme of outreach across West and North Yorkshire, expanding into East Yorkshire in 2015. We continue to evolve our innovative approach to outreach offering award-winning community based HIV rapid testing services and other tailored interventions which are all underpinned by the belief that there is no such thing as ‘hard to reach’ communities.