Title: Opening a virtual door into a vast real world: Communitybased organizations are reaching out to atri
1Opening a virtual door into a vast real
worldCommunity-based organizations are reaching
out to at-risk MSM with creative, online programs
- Alberto Curotto, PhD, Gregory M. Rebchook,
PhD,Susan M. Kegeles, PhD - Center for AIDS Prevention Studies
- AIDS Research Institute
- University of California, San Francisco
2Objectives
- This studys main objective was to learn from
community-based organizations how they are using
the Internet in their HIV-prevention programs for
MSM.
3Significance
- Data from this study can assist CBOs in learning
from others successes and challenges so that
better online intervention models can be
developed to reach at-risk populations more
effectively, especially those that may have been
overlooked by traditional programs. - Nearly all interviewed voiced the need for more
research data about these new online prevention
programs.
4Im really glad that research is being done
about Internet prevention because there are so
many questions from funding sources and other
CBOs, and theres a really big need for support
among people doing this right now we all need
more research to satisfy all these doubts and
questions and suspicions.
5Methods
- We obtained our sample by e-mailing an invitation
to participate in the study to approximately 550
agencies that had previously been in contact with
us, however sporadically, for other projectsin
some cases, the original recipients independently
forwarded our invitation to others, creating a
snowball effect.
6Methods
- In the summer of 2003, we were able to identify
64 organizations nationwide, currently running
online HIV-prevention programs for MSM. - We conducted qualitative interviews by telephone
with 26 of them, with an eye to providing
representation from as many different
geographical areas and communities as possible.
7Methods
- Each participant signed a consent form and was
reimbursed 20 for her/his participation. - Each interview lasted approximately 1.5 to 2
hours. - Written notes of each interview were taken in the
course of the interview itself. - The notes were then coded for emerging themes and
analyzed.
8Methods
- This presentation is a brief summary of the
results of that analysis. - These data are not meant to be exhaustive or to
illustrate all existing online HIV-prevention
programs since the agencies that we have not
interviewed may very well be using different
methods.
9Background
- Online venues are becoming one of the preferred
locales for MSM to socialize with each other and,
consequently, find sexual partners.
- It makes it safer to be bold about ones
preferences and sexual choices and thus find
like-minded individuals.
10Background
- This phenomenon has resulted in the rapid
development of sexual networks, whose spread and
accessibility match those of the Internets
overarching communication structure.
- Our online program was funded because so many
MSM who tested positive for syphilis were naming
the Internet as a venue to find sex partners.
11Background
- Internet use is correlated to MSMs number of sex
partners, potentially increasing their exposure
to HIV risk.
- The biggest thing is that their number of
partners has increased. Most people didnt have
as many partners before the Internet.
12Rationale for Internet-based outreach
- It is overall a cost effective form of outreach.
- It was also a way to figure out a cost-efficient
way to reach our population, which is largely
rural and scattered over a huge area that spans
across 15 counties.
13Rationale for Internet-based outreach
- It facilitates in-depth interventions.
- It turned out these conversations were much
more in depth than those taking place by phone
on a hotline theyre more quality-oriented,
more like counseling sessions.
14- The health departments reaction of surprise
once they got to sit with me and witness an
actual online intervention they could not
believe the depth of the conversations I was
having with strangers online, much more
effective than in other outreach environments
they thought it would be much more superficial
men, online, feel protected by the anonymity of
the environment, they feel no angst and fear no
repercussions, so they open up.
15Rationale for Internet-based outreach
- It reaches a broad range of MSM.
-
- Some MSM are hard to reach by other prevention
programs, either because they do not identify
their sexual behavior with other men openly or
because they do not or cannot assemble with their
peers, making it difficult for in-person,
outreach programs to locate them.
16Rationale for Internet-based outreach
- It overcomes barriers faced by in-person
prevention outreach programs. - Some MSM who socialize online would not do so
in physical venues, for many different reasons.
Our interviews gave us important clues of how the
Internet empowers men to overcome such obstacles
the attendant result being that online prevention
programs can reach them with unprecedented ease.
17- The Internet makes it easy not to identify
yourself as anything They may go into a
chatroom saying to themselves that theyre
looking for a buddy to hang out with but then,
later, it turns out they want to get off with
each other There are rooms called str8 guys
hanging out together or str8 guys in their
underwear. But how many straight guys, in the
real world, would hang out in their underwear
with other guys?
18- It defeats the sense of isolation of MSM in
rural counties who, thanks to the Internet, can
find each other without having to travel to a
city.
19- Because of their age, young men cannot go to
bars and most clubs, so the Internet represents
the only venue where they can meet other MSM. - A lot of guys are very young or in the military
so its very important that they do not get
recognized as MSM.
20- Fear of social repercussions
- The only thing they really care about is making
sure their homosexuality stays secret, for fear
of repercussions in their homophobic
environment.
21- A lot of guys are in relationshipsboth gay and
straightand dont want their partner to know
theyre hooking up and, online, they can do so
anonymously.
22- You dont have to dress up, go to a bar, endure
cigarette smoke if you dont like it, or be in a
drinking environment if you dont care for it
you can stay home and avoid any idle chitchat
it cuts through all the crap and gets you to the
point which, online, is getting laid.
23- Its cheap. At approximately 20 a month, its
cheaper than any other venue available to them,
and its convenient, always there, with hook-ups
available 24/7.
24- Homophobia as agent of social control
- One of the most successful components of our
program has been the online outreach because
there is so much homophobia in this area that,
with in person outreach, it was really
difficult to even locate MSM.
25- Homophobia as agent of social control
- The majority of the youth in this area are
from Haiti, the Dominican Republic, and Cubaso
theyre a minority within a minority. They dont
have anybody to talk to about their sexuality
homosexuality is not accepted in their families
and culture of origin, sex is a taboo in general
and, even in school, when they get sex ed, they
are only taught about hetero sex, theyre taught
how to avoid pregnancy, which really doesnt
help them, and nothing about sex between men.
26- Homophobia as agent of social control
- The Internet is an easy outlet to meet people
unlike their straight counterparts, they dont
have the same opportunities to go on dates or
even find each other to get a date, which is
something that straight people take for granted
at that age. They dont believe they even have a
chance of winning someone over and the only
thing they can hope for, or at least so they
think, is to get some furtive sex or into some
sexual situation with a man as a way to feel
less isolated and affirm their identity.
27Venues for online prevention
- Outreach in existing online venues
-
- AOL and Gay.com chatrooms being the most widely
used but also on free or pay websites with
personal ads, known to be used by MSM, such as
Yahoo! Groups, or ManHunt.net and M4M4Sex.com.
28Venues for online prevention
- Interventions with exclusive Web resources
-
- Either as Web pages hosted on the parent
agencys site or as an independent site
specifically created for the program. In either
case, they are used to distribute information and
referrals, to educate, or to assist in building
behavior-modification skills with a range of
Web-based tools, including video streams about
safer-sex negotiation, testimonials by role
models, online forums, and interactive games.
29Specific goals of online programs
- Providing safer-sex education and referrals to
in-person services -
- Probably the most common form of online
intervention reported since it is the easiest
and, possibly, the least expensive to implement.
It also targets men based exclusively on their
behavior without the prerequisite expectation
that they identify with a publicly stigmatized
sexual minority.
30Specific goals of online programs
- Engaging the participants in a dialogue over risk
reduction -
- To achieve this, some programs are adapting
various theoretical models to the online
environment, such as the Stages of Change and the
Popular Opinion Leader models, or using
role-modeling stories as recommended by Community
PROMISE.
31Specific goals of online programs
- Recruitment of participants into existing
in-person prevention programs -
- This is more typical of outreach programs aimed
at youths. The in-person activities are generally
modeled on the Mpowerment program and seek to
support young MSM in coming together as a
community in which safer-sex norms have been
established and will be diffused.
32- We found that talking to them online was great
but that, if we could talk to them in person, it
would have made a bigger difference. So we
started the Cyber Café, located on our premises,
to which we invite the guys we contact online
they can come here and have free Internet access
(but with a filter for nudie sites, as we call
them).
33How MSM are reached online
- Passive approach
-
- The outreach workers limit their active
interference in the venue to announcing their
presence and capacity to the chatroom then
passively wait to be contacted by Instant Message
or email. -
- Less common is the use of online ads in specific
online venues known to be frequented by MSM.
While only few agencies have the resources for
online advertising, it was frequently mentioned
as desirable.
34How MSM are reached online
- Active approach
-
- While not common, because of the implications of
infringing into someones privacy, this approach
is adopted by few programs outreach workers may
intervene in and steer the conversation in a
chatroom, or even approach someone directly
when they deem he would benefit from the
intervention. In rare cases, outreach workers
may not reveal their role immediately, trying
first to establish rapport and trust with the
participant.
35How MSM are reached online
- Intermediate or mixed approach
-
- Participants are invited to an online venue
specifically created for the intervention, where
the focus and tone of all materials are informed
by prevention models. Initially, participants are
recruited by direct promotion and then encouraged
to forward the information (typically as visually
appealing HTML e-cards) to their friends, so as
to create a snowball effect. This approach is
costlier as it requires the development and
management of exclusive Web-based tools.
36What are the numbers?
- Mean contacts per month 87
- Mean hours online per month 73
- These numbers do not include website hits or
clicks on banner ads. Its probably a
combination of in-depth, one-on-one chats and
broader discussions in chatrooms.
37What are the numbers?
- Nearly half of the agencies did not have any
precise budget information, usually because they
do their online outreach as part of a larger
program. - For the 12 programs that reported some meaningful
financial information, the median yearly budget
was 17,050 (the range being 4,700 to 200,000).
38What are the numbers?
Most of the organizations could not provide any
reliable estimate of the ethnic/racial breakdown
of the men they contact online because, in order
to guarantee the participants anonymity, they
avoid collecting specific demographic information
directly.
39What are the numbers?
- Some of the programs, however, address the needs
of specific ethnic/racial groups by targeting
areas (off- and online) in which certain
populations are known to live and/or hang out.
Out of 26 programs, - 4 were directed at African-Americans,
- 2 programs worked specifically with Latinos, and
- 1 exclusively with East and South-East Asians.
40Successes of current online programs
- Numbers and range of MSM reached online.
- Quality of the interactions.
- Positive reception from the interventions
participants as well as most of the online
community.
41Successes of current online programs
- Outreach to HIV-positive MSM and their inclusion
into prevention programs.
We reach as many HIV-positive guys online as we
do in person. Were very serious about getting
positive guys to receive good treatment and
participate in prevention programs.
42Theres one guy, for instance, who tested
positive after I persuaded him to get tested,
and now he calls me regularly for support and
trusts me in a way he doesnt feel comfortable
doing with his primary care physician. Its the
whole issue of disclosure and the sense of
protection given by the relative anonymity of
the medium.
43Successes of current online programs
- Reducing the spread of STDs among chatroom
participants.
- We had a guy test positive for gonorrhea and we
were able to get 11 guys from the same chatroom
he used to come in and get tested.
44Challenges faced by online programs
- Lack of institutional support and resources.
We had about 8,000 for the development of the
website I was able to afford it only because of
the exceptional generosity of the people who
designed and programmed it ... We had gotten bids
ranging anywhere from 30K to 45K.
45My brother is a web designer so I asked him to
help a good cause and he donated his time to
create our site. If I had more resources, I
could be reaching out to MSM on different hours,
including at night, when its probably the peak
time for online activity and when there is
probably a very different population,
demographic-wise.
46Challenges faced by online programs
- The evaluation component is expensive and,
especially in an anonymous environment, difficult
to develop. - Staying up to date on new Web sites and
technologies.
47Recommendations for success
- Avoid competing with other online programs for
the same population. Pool resources, instead. - Learn to adapt to the different norms and
conventions of the specific online venues in
which you are operating. - Be ready to compromise when working with
commercial Web service providers.
48Recommendations for success
- Learn to straddle the subtle line between
friendly flirting and professionalism so as to
appeal to the online users of highly sexualized
environments as a peer. - Establish rapport and build trust with the
chatroom participants.
49Should you wish to contact us