HIV Prevention: The “hard-to-reach” amongst us
As a volunteer for a gay men’s organisation I am sometimes involved in HIV prevention work in gay venues in central London. The organisation I work for develops posters, adverts and booklets to promote HIV prevention messages targeting a specific audience.
Recently, I was helping pre-testing our latest booklet to which I had also contributed. Therefore I knew what the booklet was about, which is usually not the case since editorial and testing teams are different. Over a period of two hours I interviewed ten people who agreed, some after a bit of persuasion, to answer a few short questions about the booklet. These included, “what do you think this booklet is about? Would you pick it up? Would you read it? Do you pick up booklet like these? What health issues would you like to have more information about?” Nothing requiring too much thinking on a warm evening standing outside a pub in Soho with a pint and a fag (smoking ban obliges). Five other people had refused to take part. Raisons invoked included “I am waiting for a mate” (so why not helping time run faster?), “No thanks, I know it all already” (though not knowing yet what the booklet would be about), and “No thanks I am here to enjoy the evening” (do I look like I am such a bore? I donned a nice sexy shirt for the evening!)
Fair enough. Nobody has to take part in a gay men’s survey or to feel obliged to take part because it is about gay men, gay men’s health issues or HIV prevention. But from a social science, advocacy and prevention perspectives there is as much to learn from those who are not willing to get involved than from those who are. If gay men can’t be bothered to spare 5 minutes of their time whilst waiting, if they think they know all that their is to know or what they need to know or simply can’t be bother about a health issues relevant to their lifestyle, what does it tell us?
It is saying that the “hard to reach” are not always part of a segregated or isolated community; though many are, they are not always the Black men of Chicago, or the MSM of Uganda. They can be right here amongst us, amongst the community that is out and proud, the not-so-discriminated against, me, you, your best friend? Neglected because overlooked, merged with the rest of us, too difficult to identify. Exposed to HIV prevention but oblivious to it, as if it was imperceptible, so much part of the decorum that it seems it has always been there, like this old poster on the wall that you have seen so often but can’t really remember what it is about.
As for those who took part, one was clearly uncomfortable to have to give his view. Another was a charming but helpless 19 years old, who did not have neither a clue nor an interest in providing an answer with more than 2 words (“don’t know”) or identify health issues that mattered for him. His main point was that he had just finished school and had heard a lot about “it” there. Considering that I was showing only the front cover of the booklet which again is about better sex for gay men, I wonder what they are now teaching at school. Have they become that progressive? Most respondents mentioned that they already knew a lot about “what you should do and should not do” which again was clearly not what the booklet was about.
Hence the crucial point here that whatever the message you are trying to put forward, many people will think they already know what you are going to tell them and therefore will not listen, not be interested. They see you coming and think “Here comes the condom and safe sex brigade again…”
Interestingly the 19-year’s old was with a girl-friend, who had a lot of interestingly things to say, but was not my target. Are we neglecting those people who can actually reach other through friendship and who in the case of gay men, do not always have to be other men? At many level, the “fag-hag” may well be the best friend of a gay man, particularly a young one. Peer education could benefit starting to think beyond men when it comes to MSM.
|Under the Carpet – Banksy|
But many respondents made very interesting and relevant comments both about the booklet and how to improve it. They would probably benefit less from the booklet but may act as intermediary to reach other MSM.
As for health issues, there was a general interest in the risk of oral sex and STDs adding to the realisation that there is more than HIV and potentially showing the success of other prevention campaigns addressing STDs. Barebacking becoming more mainstream was raised as an issue a few times by concerned respondents. Some people clearly wanted more info; much more than what I could deliver and it was outside my brief for the evening.
The take home message is that reaching out should not always mean reaching far. HIV prevention needs to re-invent itself; the old poster needs to be torn down the wall and it is not sure at all that a new poster is needed. Maybe a new coat of fresh paint? Maybe a new painter? If Banksy was doing HIV prevention, how would he do it? If Coke was doing HIV prevention, how would they do it? Did someone ask Google? Did someone ask the fag hag?