Last week saw the 5th Scottish Gaycon. That’s the Scottish conference on sexual health of gay and bisexual men to you and me. The GMI partnership was present, through a representative from one of our partners, the Metro centre. It was a great event with over 200 delegates came together to participate in workshops, discussions, presentations and workshops, which allowed us to share innovative practice, discuss current research and think about key priorities for those working in the field of MSM sexual health. Although a wide-range of topics were discussed over the two days some of the key notes are summarised below in the notes made by our representative:
- UK and Scottish data showing an increase in STIs over the last decade, with a possible flattening over the last few years (Scotland but not England) although too early to tell if this is a pattern.
- New diagnoses of HIV are increasing slightly, predominantly amongst MSM.
- The UK has the highest rate of those diagnosed with HIV in care in the world – 96%, this is even more impressive north of the border, 98% (and has been slowly increasing over the last decade).
- As would be expected HIV and STI rate are higher in urban centres e.g. central belt, compared with rural areas.
- Late diagnosis is still a key barrier, although there has possibly been a slight decrease from 40% ’04 to 35% ’14 (Scottish figures).
- Emerging problems: gonorrhoea resistant to treatment, HEPC and co-infection with HIV and other STIs.
- May ’14 CDC guidelines updated regarding PrEP and WHO now recommends it as ‘an additional HIV prevention choice’. European Disease Control (EDC) not recommended it yet.
- iPrEX study and others have shown that PrEP can be extremely effective, although it is not 100% effective, largely for reasons of adherence.
- Consensus of the urgency of being prepared for the introduction of PrEP, especially now the Proud study has been fast tracked due to the high efficacy of PrEP with the first group of participants.
- 48% of MSM said they would use PrEP (SMMASH study), 30% of HIV negative men have heard of PrEP.
- Awareness of PrEP is much higher amongst positive men (75%) than negative men (30%), and higher amongst cities compared with rural areas.
- But most data considers barriers to PrEP is from the US – There is a lack of data from elsewhere and most data focuses on willingness to take PrEP, rather than exploring why or how.
- Focus group data on perceptions of PrEP by Dr Ingrid Young – Glasgow University: interpreting effectiveness (and concern that not 100% effective) managing adherence (establishing a routine, social barriers and side effects), low perceptions of risk, moral concerns (that others would stop using condoms, irresponsible decision).
- Trust of community regarding trials appears to be a factor in certain instances e.g. VOICE study efficacy much lower compared with iPrEX trial.
Home HIV testing
- In a hand poll, everyone present agreed that home testing for HIV could be a successful part of an HIV prevention strategy, the question then, appears to be on the specific approach taken.
- Self-testing can help normalise testing, reach the unreachables and reduce late diagnoses, as well as increasing testing numbers (e.g. SMMASH study: 29% of high risk men have never tested).
- THT Scotland data showed 62% of HIV negative respondents said they would be more likely to test for HIV if they were available – awareness that this might not mirror real behaviour.
- Effective self-test return rate: 75% returned in Scotland to THT amongst MSM (although lower return rates for BME communities. This raises questions about which approach is best for different communities.
- Need for more sharing of ideas about what works for a successful online HIV/STI prevention approach, including online sexual health outreach and promotion.
- Online health promotion brings possibilities of varied, interactive and tailored approach on unique sexual cultures.
- Need to recognise that MSM who use online sites + apps , are different to those who are out on the gay scene g. SMMAASH study data: MSM on the gay scene testing more and having less unprotected sex compared with men online., 42% men surveyed online never socialise on the gay scene., 37% have never tested for HIV.
- Passive outreach more acceptable than active, but this maybe throws up more questions than it solves i.e. why is this the case? What sort of active approach would be more acceptable?
- Professor Paul Flowers: Importance of taking a sexual and social network approach to HIV/STI prevention, rather than focusing on the physical space of the gay scene, including better understanding and awareness of the use of apps.
- Networks is one way of using social media to deliver sexual health promotion e.g. reaching and targeting very specific communities – it is useful to be more savvy about this and to use online resources innovatively and to their full potential.
- SMMASH study shows gap between available apps and complexity of relationships that looking for, inequalities of online access e.g. money for internet, smartphones etc.
- For recruitment: banner adverts not affective, shout outs were.
Working with those with disabilities
- Little attempt to target HIV/STI prevention approaches, or even tailor them, to those with disabilities.
- Literacy, lack of autonomy perceived asexual + perpetual child status are big barriers to doing this, which must be tackled.
- Research review by Alan Middleton – Glasgow Cali: knowledge following interventions increased, but lost if practical skills not appropriate.
- Individual (literacy, internalised discrimination, understanding feelings/relationships, travelling independently, lack of role models), social (lack of autonomy, disabledism) and organisational barriers (geographical, pace of groups etc.) pervasive.
Effective sexual health interventions with BME communities
- Godwyns – Justice for Gay Africans: Family honour is hugely important for African communities and this must be recognised by those providing HIV prevention services.
- SAAM Scottish African MSM study: religion, identity and immigration are key barriers to engaging Africans in sexual health.
- Importance of acknowledging the difference of MSM and gay/bisexual male communities and their needs. E.g. in SMMASH study MSM are older, have less unprotected sex and test less frequently than gay and bisexual identified men –the challenge is recognising these differences and ensuring that the needs of these different communities are met.
- Importance of fairer policy discussions (involving and empowering BME communities), targeted outreach (establishing trust and respect of cultural background).