Settings and Interventions

Useful Settings for Interventions Aimed at MSM

Information used is taken from ‘HIV and STI Prevention among men who have sex with men. Stockholm: ECDC; 2015’

Welcome to the section on settings appropriate for interventions aimed at MSM. In this section you will consider both the physical and online settings that can be utilised. You will also be considering the Quality Standards around working with MSM across these spaces, what they do to make the work the best it can be as well as protecting both you as the provider of the intervention, and the person you are working with as the user of the intervention.

To begin with, please make a list of the physical spaces or settings you can think of that are appropriate for interventions for MSM. 

At the same time as doing this please consider and note what interventions you know about would work best in that setting, or be appropriate for that setting. Give yourself 10 minutes to do this.

Compare your list to the information below, did you consider all the suggestions? Did you think of anything else that is not suggested?

Physical

Sex venues

“Sex venues include commercial venues such as saunas, sex clubs, night clubs, health clubs, adult movie houses, adult bookstores, backrooms of bars, etc. They can also include places within the public space, ‘cruising zones’, such as certain parks, beaches, alleys, restrooms or private venue sex parties. 

“A combination of interventions at these venues should offer one or all of the following services: health promotion, condoms and lubricant provision, and HIV/STI-testing, hepatitis A and B vaccination. Key programmatic considerations include building alliances with community agencies and strong relationship between owners of the commercial sex venues and implementers of the intervention.

“Sex venue-based interventions have been effective in reaching MSM with high sexual risk and in testing men who have previously not been tested for HIV/STIs. High acceptability rates have been reported among MSM in different contexts. Sex venues are an important environment to provide services to hard-to-reach MSM who may have a particularly high risk of HIV and STI acquisition and transmission.”

Other venues

“Healthcare, Clinical, Community settings, Bars and clubs can all provide a useful setting for working with gay and other MSM. These are the traditional settings for this type of outreach contact.”

Online

Now make a list of the online settings you can think of and the interventions that are appropriate to use via that setting. You have 10 minutes for this. Now compare what you have considered and noted with the information below. Did you think about smartphone apps? Are you aware of any interventions that use smartphone apps?

Internet and mobile phone-based interventions

“While the internet or mobile-phone based applications are not physical intervention ‘settings’ they are increasingly important for HIV and STI prevention. 

“The internet is now the most popular tool used by MSM to meet sexual partners. It is increasingly common for MSM to meet their sexual partners online and available data indicate that persons with more use of online platforms tended to have higher partner numbers and more UAI.

“While the internet and mobile apps are increasingly key modalities through which to reach MSM, a 2015 ECDC/Terrence Higgins Trust project entitled ‘Understanding the impact of smart phone applications on MSM sexual health and HIV/STI prevention in Europe’ found that although the majority of HIV prevention organisations surveyed reported that they are doing prevention work online, only half reported that they are doing prevention work through mobile phone apps.”

Examples of ways of using internet or mobile phone based interventions
Examples of types of tools/interventions
Examples of internet sites where interventions could take place • Traditional webpages: from NGO’s, public health orgs, health care clinics, news, club owners etc.
• Facebook/other social media sites like Pinterest
• Wikipedia and forums
• General dating sites
• LGBTQ/MSM community sites and forums
• Porn sites 		• Banners
• Sponsored content
• Pop-ups or push messages (informing about testing services, outbreaks in specific areas)
• Testing location services
• Editorial messages
• Peer to Peer chat
• Chat with Health Providers
• Hashtags
• Provision of content to feed social media (infographics, blogs, photos, meme’s, video’s, playlists etc.)
• Monitoring of social media, Wikipedia, news etc.
Examples of mobile based locations where interventions might take place • Twitter/Instagram
• Mobile adjusted webpages
• Apps like Grindr/Scruff
• SMS – reminder
• SMS – chat
• GPS/Maps interventions

Adapted with permission from: Niklas Dennermalm, Swedish Federation for Lesbian, Gay, Bisexual, Transgender and Queer Rights, Sweden.

“Delivering an effective intervention via the web or via a mobile application has many advantages. Importantly, it makes it possible to reach more people potentially increasing access to some populations of MSM who do not access other services. Moreover, it affords individuals the opportunity to access the intervention confidentially, and potentially at critical moments when one is looking for new partners online. Some web- or mobile-based interventions require minimal staffing and can be easily replicated after development, while others require significant human resources and up-keep. Mobile-based HIV or STI testing reminder services, for example, are becoming more widely used by sexual health services in many countries. The internet and smart phone applications allow asynchronous communication, multiple ways to communicate, interactivity, customisation of contents, and flexibility. Mobile phones or ‘push notifications’ can also be used to provide information or alerts to MSM about ongoing outbreaks in MSM in a specific geographic area (e.g. for a local cluster of syphilis).

“Interactive interventions can promote sexual health and provide individualised feedback while promoting active learning. These programmes should be available directly to users and allow independent access without needing expert facilitation.

“Internet- and mobile phone-based interventions are a promising way in which to encourage and promote sexual health. However, so far efficacy data has been unclear, largely due to the lack of evaluation research carried out using internet- and mobile-phone based interventions. Different modes of internet and mobile-based interventions should be developed and evaluated for MSM in Europe.”

There is further reading about online settings and smartphone apps at:

Smartphone apps versus other MSM spaces (Understanding the impact of smartphone applications on STI/HIV Prevention among men who have sex with men in the EU/EEA. THT. 2015) 

“Reaching Out Online” University of Sussex & THT 2014

Online outreach 

ECDC: Use of Online outreach for HIV Prevention among men who have sex wit men in the EU/EEA – An ECDC guide to effective use of digital platforms for HIV Prevention. Stockholm: ECDC; 2017.

“The Cruising Counts Guide” GMSH, Ontario. 2016

“We are the Sexperts” RFSL Stockholm 2009

Quality standards

Quality Standards are defined as documents that provide Requirements, Specifications, Guidelines or Characteristics that be used consistently to ensure that materials, products, processes, interventions and services are fit for their purpose.

So what does this mean for the work done with gay and other MSM in these settings?

Please think about any policies or documentation you have or use at your service that guide the work you do with MSM. Does it cover issues such as:

  • Personal Safety – for both the worker and the user
  • Sexual Boundaries – between worker and user
  • Data Security – how do we collect data in a legal manner?
  • Confidentiality – the MSM you are working with may not be ‘out’, how do you keep their confidentiality?
  • Providing accurate and up to date information

Work through what you know about each of the policies your service has around these issues. 

  • What can you recall about them?
  • Did you have training to support your learning about them?
  • How often are they updated? Are they ‘fit for purpose’?
  • Do you think anything needs to be added to the current Standards?

Next module: Improving linkage and retention in care


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