In the last few years, the scale of the HIV epidemic amongst men who have sex with men in Africa, Asia and Latin America has become clearer. There is now a body of data on HIV prevalence and on risk behaviours, but attention is now shifting to the inadequate amount of prevention work that is carried out with men who have sex with men in many countries.
In advance of the main AIDS 2010 conference in Vienna, activists and researchers gathered for Be Heard!, which turned out to be the largest pre-conference meeting organised by the Global Forum on MSM & HIV yet. The sessions covered a wide range of issues, especially human rights, but several workshop speakers highlighted how the internet has become central to their work with men who have sex with men.
For example, Yves Yomb from Alternatives-Cameroun explained how – in a context where homosexuality is penalised, blackmail and police harassment are common, the media are homophobic and funding for work with men who have sex with men is limited (MSM do not figure in Cameroon’s national strategic plan for HIV) – his organisation needed to be creative in finding ways to support men who have sex with men.
The internet is commonly used by men who have sex with men in Cameroon to find sexual partners. Moreover, the net is a relatively safe space where sexuality can be addressed in a frank and honest way. Peer educators surf the most popular websites used for sexual networking, where they befriend and inform men about HIV and other issues which men ask about. As access to condoms and lubricant can be difficult, men met online may be invited to come to the organisation’s centre to get supplies. They may then also find out about the other healthcare services and support groups that Alternatives-Cameroun provides.
Tudor Kovacs of PSI Romania similarly explained how he used a sexual networking site to build a support network of HIV-positive men who have sex with men (an extremely marginalised and, until then, invisible group in Romania). He searched GayRomeo for Romanian profile names which included key words such as +ve or HIV. There were only six, and these men were sent a short private message inviting them to form a group (“a safe corner” to chat and be themselves). Those who joined could invite others in too, and the group slowly grew in this way. The agenda for online discussion and the rules for interaction were developed by the group members themselves, with Kovacs primarily acting to mediate and defuse conflicts.
Although the group began as being online only and with all members’ anonymity protected by pseudonyms, many group members later took up an invitation to participate in weekend meetings. These were described as an “overwhelming experience”, with excellent peer support given. Moreover, group members decided themselves to switch to a system where email addresses were visible. Kovacs suggested that one aspect of the group’s success was that the group was presented as a way of getting to know more people, rather than providing support.
In another example where face-to-face activities intersect with online work, Nada Chaiyajit and Christopher Walsh explained their work with Mplus in Chiang Mai, Thailand. The organisation works with various groups including men selling sex, transgender people and younger men who have sex with men. It lets their existing contacts know that staff will be present on various social networking sites and MSN Messenger at specific times, where they are available to interact and answer questions. This multiplies the opportunities for the group to support their clients and extends the relationship with them.
Mplus has also developed short animated videos covering health issues and legal rights. They can be used as an information referral during online work, but are also loaded onto mobile phones or MP3 players, to be used during outreach at parks, public toilets, go-go bars and brothels. The videos often act as a catalyst for further discussion and questions from the client. Another advantage of the format is that the animated videos have been relatively simple to translate into other languages used by clients (a majority of the men selling sex are migrants).
Moreover, the videos were developed with a lot of user involvement and close attention to local understandings of health and sexuality. As with the projects in Cameroun and Romania, this online outreach work relies on having peer educators with a good understanding of local subcultures and the social environment.
Working on a different scale, Stuart Koe explained how he is incorporating health work into www.fridae.com (a large gay dating and lifestyle site in southeast Asia and China).
He suggested that it was essential for HIV prevention to happen online as, for many men, this is their primary means of meeting sexual partners. In the context of negative social attitudes, the web allows anonymity and confidentiality. Stuart believes that health promoters should not try to create new web platforms, but should work with the commercial websites which are already popular and widely used. Moreover, within social networking sites, micro-communities formed around specific subcultures or sexual interests naturally form, and can be reached with targeted prevention work.
He believes that too many online health activities at present are modified versions of traditional health interventions, and do not take advantage of the potential of the web. He gave as examples static “brochure websites” and outreach work in chatrooms, which he considers too labour-intensive to scale up.
Some of the health work that Fridae has done includes an interactive quiz testing knowledge of sexual risks, an online community for men with HIV, the world’s second-largest sex survey of men who have sex with men and a low-cost service providing condom and lubricant deliveries.
They have also adapted the dating and sexual networking functions of the site so that if someone wishes to declare themselves HIV-negative in their profile, they have to supply the date of their last test. If the test was more than a year ago, their status will appear as ‘not tested recently’. If it was within the last year, their status will appear as ‘negative at last test’. Then a year on from the test date, Fridae will email the man to remind him to test again and give details of local clinics.