Adapting HIV Interventions for

Targeting MSM Online Populations

Joshua Fegley, LCSWNO/AIDS Task Force

New Orleans, LA

Purpose

Discuss agency’s experience with adapting “real world” interventions to online environment Outreach Popular Opinion Leader RESPECT

Discuss Lessons Learned

Issues

There is a need to adapt HIV prevention to changing technologiesAt-risk populations are onlineNo EBIs designed to reach these populations

Adaptation Components

Core ElementsKey CharacteristicsAdaptationTailoring‘Fidelity’ vs. ‘Reinvention’

Outreach

NO/AIDS began online outreach in 2000Conducted 20-30 conversations per weekApproximately 100 people per year came in to get tested because of encounter with online outreachBetween 2000 – 2004 approximately 150 first-time testers came in because of encounter with online outreach

Outreach

Not an EBIOnline outreach must still maintain fidelity to outreach modelsNO/AIDS developed online outreach protocol based on literature and agency knowledge

Outreach

Must create an agency online protocol Can use National Guidelines for Internet-

based STD/HIV Prevention – Outreach as a guide

http://www.ncsddc.org/upload/wysiwyg/documents/IGO.pdf

Website administrators will ask to review your protocol before you can set up an outreach/health profile

Popular Opinion Leader

Community Level InterventionBased on Diffusion of Innovation Theory“Friends Influencing Friends to Instill a Risk Reduction Norm Among Themselves”

Popular Opinion Leader

NO/AIDS funded for POL starting in 2004Forced to take a break in late summer of 2005Online trainings started in Summer 200710 POLs trained in first year Approximately 60 conversations submitted in

first year

Popular Opinion Leader

Core Elements Identifiable target population Ethnographic techniques used to identify

Popular Opinion Leaders (POLs) 15% of target population trained Teach POLs characteristics of effective

behavior change communication messages

Popular Opinion Leader

Core Elements Small group, weekly training sessions POLs set goals to engage in risk-reduction

conversations with friends & acquaintances POL conversations are reviewed, discussed,

reinforced at subsequent training sessions Logos or symbols used as conversation

starters for POL

Popular Opinion Leader

Online POL maintained fidelity to core elements Target population: MSM who frequent chat

rooms in the Gulf South Staff observed chat rooms and documented

observations Goal was to train 15% of chat room users Used POL training guide

Chat Room Estimation ReportChat Room User Estimation

Start Time: End Time: Date: Observer name: Each session one-hour observation Create a folder for each session: Nomenclature: Date-start time to end time If a chat room is not accessible, please observe a different chat room and make a note of the same in this sheet. Check the chat rooms you are observing. Gay.com: Chat rooms:

New Orleans LA Statewide Houston Atlanta

Do the observation through Chattage Maximum chat room users allowed ___ Number of users in Chat room: start, every 30 minutes, end Screen Shot (use print screen on the key board and copy paste to a WORD document): start, every 30 minutes, end Save the chat transcript: via Chattage Nomenclature: website-chatroom- Date-start time to end time initials Read the transcript. Write a summary of what was being discussed (relevant to the project). After reading the saved transcript do you think any one can be a

POL Focus Group Key Informant

Why? Check all that apply Screen Name A Screen Name B Screen Name C Greeted most often Greets others often “The life of the party” Trusted and well-liked by their network of friends Sought out for advice The center of what’s happening Spoken of respectfully by others Interacts with one primary social network Interacts with multiple social networks Elicits apparent interest from others Appears to enjoy the company of others Others appear to enjoy his company Others in the chat room ask him for opinions Others ask him about available HIV services Others ask him about available referral services Others ask him for information/discuss hurricanes Other ____________________________________

Blkgaychat.com and Adam4adam.com: Number of users and individuals: Copy and Paste into WORD document number of individuals in New Orleans area: start, every 30 minutes, and end.

Popular Opinion Leader

Online POL maintained fidelity to core elements Conducted online, small group, weekly

training sessions using distance learning platform

POLs attempted 10 conversations per month POLs used online form to submit conversation

summary Used symbol for conversation starter

Popular Opinion Leader

Popular Opinion LeaderPOL

POPULAR OPINION LEADER CONVERSATION CONTACT FORM

My POL/Screen Name is _______ __________________________

First Name or Screen Name:

Date of Conversation:

Place of Contact:

Age Race/Ethnicity

Summary of Conversation :

First Name or Screen Name:

Date of Conversation:

Place of Contact:

Age Race/Ethnicity

Summary of Conversation :

First Name or Screen Name:

Date of Conversation:

Place of Contact:

Age Race/Ethnicity

Summary of Conversation :

First Name or Screen Name:

Date of Conversation:

Place of Contact:

Age Race/Ethnicity

Summary of Conversation :

First Name or Screen Name:

Date of Conversation:

Place of Contact:

Age Race/Ethnicity

Summary of Conversation :

First Name or Screen Name:

Date of Conversation:

Place of Contact:

Age Race/Ethnicity

Summary of Conversation :

Popular Opinion Leader

Initially had great successOnline community excited about interventionTrained 10 POLsPOLs were having conversationsAnd then two things happened…

Popular Opinion Leader

Evacuation for Hurricane Gustav: “The Mother of All Storms” - Mayor C. Ray NaginGay.com radically revamped their platform

Popular Opinion Leader

As a result Users unable to get online Users quickly abandoned Gay.com Once users left Gay.com, no place to conduct

interventionEquivalent of only gay bar in town closing

RESPECT

Funded in 2010Agency decided there was still a need for online interventionPOL no longer viable option for agencyILI ideal for instant message, private chat format

RESPECT

Individual Level InterventionBrief, 2-session interventionFocuses on client’s personal riskCounselor uses prompts to help guide session

RESPECT

Core Elements 1:1 counseling, using RESPECT Prompts Teachable moments Explore circumstances and context of recent

risk behavior Negotiate achievable step which supports

larger risk-reduction goal Implement & maintain quality assurance

RESPECT

Online RESPECT maintains fidelity to Core Elements 1:1 sessions, using prompts, will be

conducted in chat room in secure, project website

Use teachable moments Explore recent risk behavior Negotiate achievable step Quality Assurance plan in place

RESPECT

RESPECT

Goals for Year 2 200 MSM, age 18+ who find sexual partners

online will complete the 2 RESPECT sessions 100 MSM, age 18+ will access HIV testing via

referrals from RESPECT

Lessons Learned

Interventions can be adapted successfully for use onlineMust carefully consider Core Elements of EBI

Lessons Learned

Must work closely with website administrators Websites have different requirements for

setting up outreach/health profileDo not expect to have an outreach profile established in just a few days

Lessons Learned

Money/Cost Must have up to date technology Cost for Outreach Profile on some sites Do you need a project specific website?

Staff must know how to use the technologyInclude in your budget or find way to get equipment and/or time donated

Lessons Learned

Interaction technology changes fast Chat rooms IM Mobile Apps

Online room/site/app that was hot today may be abandoned very quickly Users in Gulf South quickly left gay.com in

2008, switched to Manhunt & GrindrNot all online venues equally popular in all geographic areas

Lessons Learned

You will have the same challenges online that you have in “real world” Recruitment participants Retaining participants Record Keeping

Lessons Learned

Need to establish legitimacyMust build trust and rapportLet people know you and your agency are for real

Lessons Learned

It takes timeWith knowledge, initiative, and know how interventions can be successful online

Contact Information

Joshua Fegley, LCSW – CAN Project Coordinator joshf@noaidstf.org

Jean Redmann – Director of Prevention jeanr@noaidstf.org