HICKORY — The Centers for Disease Control and Prevention estimates that men having sex with men (MSM) account for just four percent of the U.S. male population aged 13 and older, yet the rate of new HIV diagnoses among MSM is more than 44 times that of other men and more than 40 times that of women. In the rural Appalachian Mountains and foothills of Northwestern North Carolina, a few additional statistics caught the attention of local AIDS service organization, the AIDS Leadership Foothills-area Alliance (ALFA). In 2010, a shocking 90 percent of new clients came into medical care with an AIDS diagnosis and almost 70 percent of the clients self-identified their risk factor as men who have sex with men.

ALFA staff members David Zealy, left, and Rodney Tucker have been leading new outreach efforts in a bid

“We just couldn’t stand around waiting for people to come to us for testing. We had to develop proactive tools and strategies to provide targeted testing, build trust and market our services,” said Rodney Tucker, ALFA’s executive director. “While the rest of the country seemed to be moving past gay white men and targeting African-American women as at-risk populations, we realized that our region was trending 10 years behind the national curve with new infections. I was shocked to see the statistics with 40-year-old men self-identifying as having sex with other men coming into care with an AIDS diagnosis.”

Outreach begins

ALFA knew they had to begin better and more strategic outreach to MSM communities. Approaching the situation blindly wasn’t an option. Step one in the group’s outreach plans was to interview MSM and find out where and how they were meeting other men for sex. With a push from Michelle Hudgens, a local disease intervention specialist with the North Carolina Department of Health and Human Services, ALFA hosted their first MSM Taskforce meeting in one of nine rural counties in February 2011.

“Oh, if we could only go back in time and try this one again” said David Zealy, ALFA director of education, with a smile. “We did everything wrong. We tried the straight-up honest approach with our community and called it exactly what it was and who we wanted to attend. We used local gay social groups and even the newspaper to advertise the meeting. Five people showed up — five scared people.”

All wasn’t lost. ALFA learned a great deal from the encounter. Online hookups were a normal way for men to meet other men for sex and some MSM were engaging in sex in public parks, gyms and rest areas. The men’s choices for sexual encounters were limited by their life experiences; many weren’t “out” to friends or family and a lack of gay nightclubs and other outlets were forcing men to drive long distances — as far away as Asheville, Charlotte or Winston-Salem — for social and sexual outlets.

“One client always comes to mind for me,” stated Zealy. “He had been married to a woman for 25 years and had been hooking up with guys for most of the marriage behind her back, he cried in my office saying if it had not been for homophobia and societal pressure to be straight, he might have turned out very different. He might not have been turning to strangers in an adult book store for the intimacy and touch he needed and he could have dated and married the person who he was really attracted too.”

Online outreach offers a rural strategy

With newfound knowledge and information at hand, ALFA’s staff set out to ramp up new outreach efforts. This time, staff took a different tact.

“Well it simply came down to putting your face and name out there where people were looking for sex,” stated Zealy. “From our focus group we targeted Craig’s List as the top pick for anonymous MSM to find partners. Through a fun afternoon of brainstorming, we developed a list of ‘eye catching’ messages to post in the MSM boards and added the ALFA logo as a picture and sent them out.”

Shortly after posting several outreach messages online, ALFA started getting emails with questions and men coming in for tests. One of the first men to take advantage of ALFA’s services tested positive. He identified as MSM, white, was in his 40s, unemployed and symptomatic.

ALFA staff members provided bridge counseling and were able to help this client go from a preliminary positive to his first medical appointment in just 10 days. “It was great to see the process work and help someone access medical care that desperately needed it,” Tucker said.

Getting smart with technology

Concerned about the young MSM population in the region, phase two of ALFA’s outreach project continued with their online strategy, but also integrated use of iPhones as a means to speak to MSM youth.

“We knew we had a growing number of young MSM, but we really didn’t know where to find them. Then one day playing around with our phone we loaded Grindr. This opened us to a new world of MSM in our region,” stated Tucker.

Grindr is a mobile, location-based dating app for men, distributed for use on iPhones and other smartphones.

“On our phones, we could see the next generation of MSM — high school students, college students and young African-American men — who we were previously unable to find,” Tucker explained. “So, David [Zealy] and I decided just to put our faces out there and built profiles that said who we were and invited men to ask questions about HIV, men’s health and volunteering.”

The results were instant. ALFA was able to reach a broader group of men, above and beyond their MSM youth target.

“Our first day on Grindr, we met a married man who was extremely concerned and wanted information and testing,” said Rodney. “He made an appointment and came in that day. We found men that would ask real questions, wanting information about risk behaviors, where to find condoms and how testing worked. One of my favorite clients reported he was in a new relationship, had a sexual desire to perform oral sex to completion and really needed to know what type of risk, if any, he had. After a long chat, he followed up with me several days later to say thank you and that he felt he could come back to me for more advice and testing.”

ALFA staff continues to use Grindr as a key component in its outreach efforts. Each day, staff login to the service, answer questions, make referrals and provide opportunities for testing.

“For a small, rural AIDS service organization, we were excited to find such affordable and effective means to reach what many had already written off as the ‘invisible’ — though still at-risk — population,” said Tucker.

Looking to the future

Homophobia and lower infection rates per capita can be barriers to funding in the South. Financial constraints put a strain on staffers with groups like ALFA, who often find themselves looking for better and more strategic outreach programs that place little burden to the group’s bottom line. ALFA’s prevention department, with only two, full-time staffers dedicated to education and testing, felt many of those pressures. Volunteer engagement has been necessary in order to fill the gaps.

“Our next step is to recruit, train and supervise a crew of MSM who will work the gay chat rooms on gay.com and other websites to answer questions about HIV/STD and refer people for testing,” stated Zealy. “It’s a hard sales job in our region where there is so much stigma about HIV and many MSM live quiet, closeted lives, making it difficult to find those who will put their face out there for our agency and the community; but we are hopeful!”

ALFA’s ultimate goals are simple: Increase testing and decrease stigma. In order to accomplish both, the group is determined to initiate new testing locations where closeted MSM feel comfortable and safe. In doing so, ALFA hopes they can also empower these men to make change in their personal lives and among their friends and peers.

Tucker asserts, “Even though ALFA is not an LGBT organization, we feel a responsibility to help bring MSM together in social settings to decrease the stigma about being gay or positive.”

For more information about ALFA, visit alfainfo.org. : :

— Compiled and written as a community contribution by Rodney Tucker, ALFA executive director. Matt Comer contributed.


Smart ads for HIV prevention

One of the many ways ALFA began their online outreach was through Craig’s List, the group’s staffers say. They tried several techniques and several different ads placed on the site’s “m4m” personals section. Some examples:

Ad one

Headline: Come to my office; Text: Worried about your HIV status? Email for a free confidential test with results in 10 minutes. Free condoms and lube with every test. Call for an appointment Three3 Two2 Three3 One1 Four4 Four4 Seven7 Ext.233

Ad two

Headline: Curious? Text: Curious about your HIV status or other sexually transmitted disease? I have answers for your questions and can test you for HIV with results in 10 minutes. Get rid of your worries today call or email for an appointment. Three3 Two2 Three3 One1 Four4 Four4 Seven7 Ext.233

2 replies on “Reaching the ‘invisible population’”

  1. ALFA is just now realzing this ? Metrolina AIDS Project was involved in this type of program 6 years ago. That’s probably where Rodney got the idea from when he was Development Director there.

  2. Thank goodness Rodney came to ALFA and has been able to help with outreach in Western NC. Hickory is much smaller than Charlotte and needed the expertise of someone from a larger area. Rodney has been one of ALFA’s biggest assets and all who work for him are gratful for his leadership. When a method works it is only smart to repeat it. We all learn from our past and as good advocates take the good and pass it on.

    Ajax, any advancement in helping people is a positive.

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