Testing public health intervention guidance on increasing the uptake of HIV testing among men who have sex with men. Final fieldwork report

This guidance is for NHS and other commissioners, managers and practitioners who have a direct or indirect role in, and responsibility for, increasing the uptake of HIV testing among men who have sex with men. This includes those working in local authorities and the wider public, private, voluntary and community sectors. It will also be of interest to members of the public, in particular men who have sex with men. The focus of the guidance is on increasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission. The recommendations include advice on: planning services, including assessing local need and developing a strategy promoting HIV testing among men who have sex with men, including outreach schemes and providing rapid point-of-care tests offering and recommending an HIV test in primary care, secondary care and specialist sexual health services repeat testing HIV referral pathways

Lambeth LGBT Matters: The needs and experiences of lesbians, gay men, bisexual and trans men and women in Lambeth.

This report presents the findings of a study of the experiences of Lesbians, Gay men, Bisexual and Trans (LGBT) men and women who live, work and socialise in Lambeth. It presents the results of part of a larger study which included analysis of Lambeth’s policies and procedures, stakeholder interviews and staff focus groups. The full report can be found at our website. Here, we present the results of a self-completion quantitative survey of LGBT people who live, work or socialise in Lambeth (Chapter 2) and qualitative focus groups/interviews with LGBT residents of Lambeth (Chapter 3). Chapter 4 contains some conclusions and recommendations arising from this research. The study was commissioned by The London Borough of Lambeth (LBL) to provide the Council with information to improve services for these populations. LBL is the largest and possibly most diverse of inner London’s boroughs. Patterns of UK and international migration ensure that the LGBT population in London is far larger than elsewhere in the UK. Using Census (Office for National Statistics 2006) and other data (Mercer et al. 2004) we can estimate that Lambeth’s LGBT resident population is approximately 18-20,000 adults. This figure does not include people who come to Lambeth to work or socialise. Lambeth also hosts a substantial LGBT social and commercial scene with six Gay saunas / gyms, 12 LGBT social support agencies and at least 17 bars, clubs and cafes in the borough. Lambeth also contains several public areas where men meet for sex (parks, commons and public toilets)

Wasted opportunities: Problematic alcohol and drug use among gay men and bisexual men

This report describes the findings from a qualitative and quantitative study of alcohol and drug use among gay and bisexual men and other men that have sex with men (MSM) in England. The qualitative element describes the experiences and understandings of men who identified themselves as being concerned about their alcohol or drug use. The quantitative element shows the broader picture of use and concern about use among MSM. So we go from a broad picture of the extent of alcohol and drug use and concern about it, to a narrower and more detailed focus on men experiencing concern and problems related to alcohol and drug use. The aims of the study are to qualitatively explore the contexts and attendant needs of men who are concerned about their substance use, to locate that use within the broader MSM population and to suggest ways in which the drug-related needs of MSM might be better met. So we have specifically recruited men who were concerned about their substance use and investigated the way these men used drugs and alcohol, what drugs and alcohol mean to them and the harms caused by drugs and alcohol. Many men, perhaps the majority, use alcohol and other drugs without any mishap or unhappiness. However, the range of experiences described highlight the pervasive and often detrimental role that alcohol and other drugs play in the social and personal lives of many men. Although there is some research which examines the effects of substance use treatments on sexual risk behaviour (that is, do drugs services reduce unsafe sex), there is little or no research which investigates the accessibility, acceptability or effectiveness of current substance use services for gay men and other MSM. So in the qualitative interviews we also sought information about the role services played in meeting drug-related needs, for example information, motivational and practical support

Relative Safety 2: Risk and unprotected anal intercourse among gay men diagnosed with HIV

In 1999 Sigma Research published Relative safety: an investigation of risk and unprotected anal intercourse among gay men diagnosed with HIV (Keogh et al. 1999). This study explored the social, psychological and cultural meanings associated with unprotected anal intercourse (UAI) among men with diagnosed HIV. It highlighted both the complexity of sexual interaction for men with diagnosed HIV, and the many potential costs and benefits perceived by them. Now, with more than 24,000 homosexually active men diagnosed with HIV in the UK (Health Protection Agency 2008), a figure that is set to increase in years to come, it is vital that agencies involved in HIV prevention interrogate their own beliefs about UAI and ensure that their interventions meet the needs of men with diagnosed HIV. . . . . The following chapter explains how the study was undertaken, outlines the broad topic areas addressed during the interviews, and describes the sample of men who took part. Chapter 3 outlines the range of harms that men with HIV perceive when engaging in UAI. Chapters 4 and 5 explore the ways in which men responded to these perceived harms, firstly those relating to the risk of onward HIV infection, or superinfection, and latterly those concerning the potential for harms to their personal and social identities. Chapter 6 considers the implications of these findings for health promotion interventions targeting men with HIV, and with homosexually active men more broadly

The Field Guide: Applying <i>Making it Count</i> to health promotion activity with homosexually active men

This Field Guide considers a range of methods used to carry out health promotion with homosexually active men. It is a companion document to Making it count: a collaborative planning framework to reduce the incidence of HIV infection during sex between men (Hickson et al., 2003). Like Making it count, this document will be reviewed every two to three years and accompanied by training opportunities. The authors welcome comments and suggestions on this document and its use. These can be sent to: [email protected] or [email protected]. "Briefing papers" that add to the content of this guide will be produced as part of the CHAPS sector development programme. These will be available periodically from www. chapsonline.org.uk. Making it count describes a co-ordinated national framework to reduce HIV incidence occurring as a consequence of sex between men. It is intended for workers, managers, policy makers, legislators, health professionals or anyone with an investment in reducing HIV incidence among homosexually active men. This Field Guide is written for gay men's HIV health promoters. It places the theory, goals and strategic aims contained in Making it count in the context of day-to-day health promotion activity. It was developed through a range of formal interviews and informal discussion with more than 40 managers and key workers with experience and expertise in specific areas of HIV health promotion for homosexually active men. It concentrates mainly on direct contact work (Chapters 3 to 7), but also considers other types of health promotion that benefit homosexually active men by influencing the structures they live within (Chapter 8). Section one (Chapters 1 and 2) provides an overview of Making it count and the relationship between this document and that main framework. It outlines the key strategic aims of Making it count and contextualises what follows. Section two concerns direct contact with homosexually active men. Chapters 3, 4, 5 and 6 deal with different methods of carrying out direct contact work with this population. Chapter 7 considers the different target groups within the entire population of homosexually active men. It examines how to prioritise target groups using epidemiological and needs data and how best to target different groups in various settings. Section three (Chapter 8) addresses other types of health promotion interventions that are necessary including policy, community and service interventions. These are the interventions needed in order to facilitate direct contact interventions and attend to the broader determinants of sexual health for homosexually active men. It is anticipated that some (NHS) commissioners would benefit from reading this document in order to further their understanding of the range of work that they could fund. However, this document is not an implementation plan for the NHS in relation to HIV incidence among homosexually active men. Rather, Terrence Higgins Trust are currently in discussion with the Department of Health concerning further work to support the use of Making it count as the basis for Primary Care Trusts' planning and purchasing of HIV prevention activity for homosexually active men

The growing challenge: a strategic review of HIV social care, support and information services across the UK.

This report appears 10 years after the widespread introduction of anti-retroviral therapies. Availability of effective HIV treatment has transformed the UK epidemic, producing a dramatic reduction in mortality and, for many people living with HIV, an increase in health and well-being. Yet, in spite of medical advances, many services seem to continue to follow a historical pattern. Against this background we commissioned Sigma Research to review service commissioning in the HIV sector in order to inform members’ future grant making strategies. Results in the report indicate that commissioners and providers of services believe that people from ethnic minority backgrounds, migrants, children, carers and people from different age groups have unmet needs. Other findings in this research indicate that many more services have been commissioned recently for Africans, on the basis that Africans make up a significant part of the current UK epidemic. We believe this is a valid focus but are discouraged by the approach to these varied communities as one homogenous population. It seems timely to ask whether configuring services to follow broad epidemiological categories without any further refinement is sufficient. The report further suggests that commissioners and providers believe the needs of gay men are well met. This is a surprise and does not accord with the views and experiences of many gay men living with the virus. A significant minority of HIV positive people are neither gay men nor Africans. Even within these two groups the experience of living with HIV varies by age, geographical location and length of infection. HIV positive individuals may look at their needs from another starting point – for example, as a woman or an injecting drug user. The picture appears to be, increasingly, one of fragmentation and isolation. This poses the question: do we have the service models to meet the needs of HIV positive people in the third decade of the epidemic? The report further shows that many of the problems with access to services – including housing and welfare rights – are structural problems, present across health and social care, and are not unique to HIV. HIV support services are funded from budgets which must also contain the increasing costs of anti-retroviral drugs and other medical interventions, and which are therefore subject to continuous attrition and dissaggregation. Also highlighted is the lack of needs-based planning, the diminishing levels of knowledge and expertise among commissioners and the lack of a national strategic vision. In view of the fact that the Government has established a cross-departmental task force to address the epidemic in developing countries this lack of a national strategic vision is lamentable and has the effect of keeping the issue off the political agenda and almost invisible within local funding priorities. This is a concern both to us as funders and to agencies working within the HIV voluntary sector

An exploratory review of HIV prevention mass media campaigns targeting men who have sex with men.

BACKGROUND: Men who have sex with men (MSM) are at increased risk of HIV infection in both high- and low-income settings. Mass media campaigns have been used as a means of communicating HIV health promotion messages to large audiences of MSM. There is no consensus on which designs are most appropriate to evaluate the process and outcomes of such interventions. METHODS: An exploratory review was conducted to assess research examining awareness, acceptability, effects on HIV testing, disclosure and sexual risk, and cost-effectiveness of HIV mass media campaigns targeting MSM. We searched for quantitative and qualitative studies published between 1990 and May 2011 via the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Psych Info, ISI Web of Science, OpenGrey and COPAC, and contacting experts. No exclusions were made on the basis of study design or methods because our primary aim was to map evidence. We appraised study quality and present a narrative synthesis of findings. RESULTS: Sixteen reports from 12 studies were included. All were from high-income countries and most examined multi-media interventions. Half of the studies were single cross-sectional surveys. Three repeat cross-sectional studies collected data pre and post the campaign launch. The remaining three studies monitored routine data. Three studies included a nested qualitative component. Campaign coverage was the most commonly reported outcome (9 studies). Imagery, tone of language, content and relevance were identified in the qualitative research as factors influencing campaign acceptability. HIV testing rates (or intention to test) were reported by five studies. Two studies reported that testing rates were higher among men who had seen the campaigns compared to men who had not, but this may reflect confounding. Findings were less consistent regarding reductions in sexual risk behaviours (4 studies). None of the studies examined cost-effectiveness. CONCLUSIONS: Campaigns aim to provide MSM with information to help prevent transmission of HIV and to address increasing motivation and changing norms towards precautionary behaviours. However, the limitations of mass media in imparting skills in effecting behaviour change should be recognised, and campaigns supplemented by additional components may be better-suited to achieving these goals

HIV testing history and preferences for future tests among gay men, bisexual men and other MSM in England: results from a cross-sectional study.

OBJECTIVES: The British HIV Association's (BHIVA) testing guidelines recommend men who have sex with men (MSM) test annually or more frequently if ongoing risk is present. We identify which groups of MSM in England are less likely to have tested for HIV and their preferences for future tests by testing model, in order to inform health promotion programmes. METHODS: Data come from the Gay Men's Sex Survey 2014, a cross-sectional survey of MSM, aged 16 years or older and living in the UK. Only men who did not have diagnosed HIV and were living in England were included in this analysis. We used logistic regression models to understand how social determinants of health were associated with not testing for HIV in the past 12 months, and never having tested. We then cross-tabulated preferred testing location by demographic characteristics. RESULTS: Younger men, older men and men who were not gay identified were least likely to have tested for HIV. Higher educational attainment, migrancy, Black ethnicity and being at higher of risk were associated with greater levels of HIV testing. Men who were less likely to have tested for HIV preferred a wider range of options for future HIV testing. CONCLUSIONS: If the BHIVA's HIV testing policy of 2008 was used to guide testing priorities among MSM focus would be on increasing the rate of annual testing among MSM at less risk of HIV (ie, younger men, older men and non-gay identified MSM). Instead the promotion of more frequent testing among the groups most at risk of infection should be prioritised in order to reduce the time between infection and diagnosis

HIV Self-Testing among Men Who Have Sex with Men (MSM) in the UK: A Qualitative Study of Barriers and Facilitators, Intervention Preferences and Perceived Impacts

INTRODUCTION: Innovative strategies, such as HIV self-testing (HIVST), could increase HIV testing rates and diagnosis. Evidence to inform the design of an HIVST intervention in the UK is scarce with very little European data on this topic. This study aims to understand values and preferences for HIVST interventions targeting MSM in the UK. We explore the acceptability of HIVST among MSM in the context of known barriers and facilitators to testing for HIV; assess preferences for, and the concerns about, HIVST. METHODS: Six focus group discussions (FGD) were conducted with 47 MSM in London, Manchester and Plymouth. HIVST as a concept was discussed and participants were asked to construct their ideal HIVST intervention. OraQuickTM and BioSureTM kits were then demonstrated and participants commented on procedure, design and instructions. FGDs were recorded and transcribed verbatim, then analysed thematically. RESULTS: Convenience and confidentiality of HIVST was seen to facilitate testing. Issues with domestic privacy problematised confidentiality. HIVST kits and instructions were thought to be unnecessarily complicated, and did not cater to the required range of abilities. The window period was the most important element of an HIVST, with strong preference for 4th generation testing. Kits which used a blood sample were more popular than those using saliva due to higher perceived accuracy although phobia of needles and/or blood meant some would only access HIVST if a saliva sample option was available. A range of access options was important to maintain convenience and privacy. HIVST kits were assumed to increase frequency of testing, with concerns related to the dislocation of HIVST from sexual health care pathways and services. DISCUSSION: Utility of HIVST arises from relatively high levels of confidentiality and convenience. Until 4th generation assays are available HIVST will be seen as supplementary in a UK context

HIV diagnosis and disclosure

For those we interviewed the knowledge that either they or their partner had diagnosed HIV needed to be managed on both an individual and collective level. It impacted on how each partner saw themselves and also how they perceived the future of their relationship. This report begins by exploring how participants with diagnosed HIV became aware of their HIV status, and how they have tried to come to terms with it, before describing their decision making about sharing this status with their partner and their means of doing so. The thoughts and experiences of participants who had not disclosed their status are described. Finally it explores the reactions of the HIV negative or untested partners to disclosure, its impact on a personal level and how they sought to come to terms with this news