Health Education Research Advance Access originally published online on November 23, 2005
Health Education Research 2006 21(4):452-464; doi:10.1093/her/cyh071
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© The Author 2005. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org
HIV prevention outreach in commercial gay venues in large cities: evaluation findings from London
1 Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2 Social Science Research Unit, Institute of Education, University of London, London WC1H 0NR, UK
3 Department of Primary Care and Population Sciences, Centre for Sexual Health and HIV Research, University College London, London WC1E 6AU, UK
4 Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield AL10 9AB, UK
*Correspondence to: C. Bonell. E-mail: chris.bonell@lshtm.ac.uk
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Abstract |
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Human immunodeficiency virus (HIV) prevention delivered in gay venues in US cities has been found to be effective in reducing HIV transmission in the 1990s but effects might not be generalizable to different times and settings. Doubts have been raised about: outreach's ability to address skills and explore personal behaviour; big-city commercial gay venues being appropriate sites for outreach because of gossip and social surveillance; and acceptability of outreach by professionals rather than ‘popular opinion formers’. We evaluated coverage, feasibility, acceptability and perceived impact of venue-based HIV prevention outreach by professionals in London, employing observation, surveys and interviews with venue-users, and focus groups/semi-structured interviews with workers. We found high coverage especially among target groups. Addressing negotiation skills and personal behaviour was feasible but required worker motivation and skill. Social surveillance rarely impeded work. Gay men generally found outreach acceptable and useful, and professionals were not regarded negatively. Impact on knowledge was commonly reported; impacts on negotiation skills and reflection on personal behaviour were more common among men experiencing longer contacts. In conclusion, professional HIV prevention outreach in gay venues in large cities is a feasible and acceptable intervention with significant potential impacts. Workers need to be well briefed and trained to maximize impact.
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Introduction |
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Human immunodeficiency virus (HIV) infection among gay men remains an issue of great public health concern [1]; recent syphilis outbreaks underline the importance of sexual health interventions with this group [2]. HIV prevention delivered by outreach volunteers in gay venues in small US cities in the 1990s was found to be effective in reducing rates of sexually transmitted infections (STIs), a proxy for HIV transmission [3–5]. However, it cannot be assumed that the effectiveness of such work is generalizable to other times and settings [6–8] and there is a paucity of more recent intervention studies from other settings to assess this [9]. A number of factors might impede the effectiveness of such interventions a decade on and in larger gay communities.
Firstly, in the third decade of the HIV epidemic and with the advent of effective
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Methods |
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Results |
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Intervention coverage
Feasibility of addressing negotiation skills and personal behaviour
Acceptability of outreach work
The impact of outreach work
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Discussion |
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