Kathy Triffitt (Positive Life NSW) describes the development of a campaign which looks at HIV-positive gay men's choices around condom use in pos-pos sex and offers options to minimise risk, manage disclosure and have great sex. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.

2. BACKGROUND
Prevention has become more complex
 With the advent of technologies such as viral load
monitoring (on which to base an assessment of sexual
risk) gay men may have adapted their sexual behaviours.
Challenges
 To develop prevention campaigns that:
- adapt to HIV positive gay men‟s sexual practices [and]
- include the way new understandings of risk and safety
(e.g. non-condom based risk reduction strategies such
as viral load or sero-sorting) are incorporated in their
sexual lives.

3. BACKGROUND
 An external evaluation of „SEX PIGS: Dark and dirty sex
and managing your health‟ (2009) highlighted the
challenges in developing targeted HIV prevention and
education messages for sexually adventurous men.
 It assessed the impact condom reinforcement messages
had on the credibility or believability of a campaign
targeting men who had made a decision not to use
condoms in preference to other risk reduction practices.
 Experienced sexually adventurous men dismissed
campaign messages as they see sexual adventurism and
safe sex as incongruent ideas. Because sexual
adventurism is about “indulging fantasies” and “letting go”,
the association of safe sex lacked credibility.

5. BACKGROUND
GET THE FACTS
 In contrast, these men reported that campaign materials
based on factual information - „GET THE FACTS:
SYPHILLIS‟ and „KNOW THE FACTS: SEX AND HEP C‟-
engage and therefore have the opportunity to persuade.
 They found this approach “hands responsibility” to the
individual and may be harder to reject on the grounds that
it is not “patronising”.
 Information on syphilis and sexually acquired hep C was
seen as “new and highly relevant”.

6. THE FACTS Booklets

7. BACKGROUND
Drawing on formative research (1:1, group interviews) and
campaign development (website, video stories), Positive
Life NSW developed “Wrapped or Raw – POS-POS Sex”
(WoR) which looks at choices made by HIV-positive gay
men about using condoms in pos-pos sex and offers some
options to minimise risk, manage disclosure and have
great sex.
While condom use with casual partners of unknown or different HIV
status is a key message, this campaign also recognises there are
different limits and boundaries (e.g. different levels of knowledge or
communication and negotiation skills) for gay men in different sexual
contexts (e.g. different sexual scenes and networks).

11. Now over 15,000 views

12. DESCRIPTION
Drawing on the recent evaluation of „WoR‟ this paper will
examine :
 the key role of gay sexual/social networking sites to
target „hard-to-reach‟ populations [and]
 some of the current issues affecting HIV positive gay
men and educators

13. Online evaluation
Strategies
 A coordinated email broadcast, banners and blog/video
launched “WoR” across Manhunt, Manhunt Daily, and
Manhunt Cares.
 An email broadcast campaign evaluation consisting of
23 multiple choice and one open-ended question was
sent to all active (past year 2010) Manhunt NSW
members (19,500).
 Analyses consisted of health campaign distribution
metrics and evaluation responses with a focus on type
of media consumed, message type, and perceived
effectiveness across men with and without HIV.

14. Online evaluation
Results
 From 11/2010-7/2011 campaign promotion results
revealed a total of 10,418 unique visits to the WoR
website: 7,345(70.5%) from Manhunt, 2,120(20.3%)
from Manhunt Daily, 953(9.2%) from Manhunt Cares
and nearly 15,100+ views of the video, 13,095(97%)
from Manhunt Cares.
 Campaign evaluation revealed 1,533 unique visits to the
online survey and 1,326(85%) completed responses.

15. Online evaluation
Survey
 13.5% HIV positive (=179 respondents)
 HIV+ respondents were older:
• 41% between 40-49 years old (21% HIV-)
• 25% between 50-59 years old (14% HIV-)

16. Social media
Table 13: How often do you visit the following networking sites?
Respons
Occasional
Answer Options Daily Weekly Monthly Never e
ly
Count
Gaydar 21% 21% 8% 27% 23% 987
Manhunt 50% 34% 6% 10% 0% 1134
Recon 10% 6% 2% 7% 75% 786
Facebook 66% 14% 3% 7% 11% 996
Twitter 11% 6% 4% 11% 69% 805
BBRT 9% 6% 1% 3% 81% 802
Grindr 34% 12% 3% 9% 41% 887
Squirt 15% 14% 7% 17% 48% 883
Scruff 6% 5% 1% 5% 83% 798
PozVibrations 1% 1% 1% 3% 94% 790
Other 16% 7% 2% 3% 73% 599
 HIV+ respondents BBRT is the third most visited website
on daily basis (after Face book and Manhunt)
 Recon is more frequently used by HIV+ respondents

17. Relevance
 70% of survey respondents said the campaign
addressed a relevant or somewhat relevant issue of the
choices HIV positive men make in using condoms during
sex with other men with HIV.

18. Concern among HIV-positive men
 HIV positive survey respondents indicated STIs, syphilis
and hep C are important issues of concern.
 Condom use and HIV re-infection are of lesser concern

19. Manhunt Email Recall
 30% recall HIV positive respondents
 39% recall under 29 year olds
 39% recall men living in rural or regional areas

20. Advertisement Recall
 50% recall among HIV positive respondents
 46% recall under 29 year olds and 30-39 year olds

21. Impact of campaign
 Among survey respondents who visited the website, the
campaign was effective at exploring risk and getting them
to think about their own risk taking.
 77 per cent of survey respondents rated it effective or
somewhat effective at exploring sex and risk taking among
men with HIV.
 72 per cent of survey respondents indicated it was useful
in helping them to think about their own risk taking
behaviour.

22. Responses
Video Stories
 Survey respondents reported the benefits in “seeing real
guys” talking about topics such as disclosure and handling
“no”; negotiating different sexual scenes with new partners;
hooking up on the net; making decisions on whether to use
condoms in pos-pos sex; and what they are or aren‟t
prepared to do during sex and how they communicate this.
 These stories give permission for discussions to take place.

23. Responses
The different stories helped them to identify with the information:
Sex is still part of our life as an HIV-positive gay man.
We have choices to make in a pos-pos sex situation.
The stories are real and while you sometimes may not
agree, the guys are honest and upfront. They talk
about the reality of our sexual lives and relationships.
(HIV positive 40-49 years old)
I like the fact these guys are everyday people, which
makes you feel comfortable and interested in what they
have to say. Putting real stories out there also breaks
down HIV stigma. (HIV positive 40-49 years old)

24. Responses
“They were open and honest... it took a little of
the mystery away from knowing someone with
HIV and how they see themselves as sexual
people!” (HIV negative, 30-39 years old)

25. Recommendations
Continue to:
 address the issue of risk reduction strategies among HIV
positive gay men … the target audience identifies it as a
relevant issue
 address issues related to hep C, syphilis and other STIs
 explore ways to promote access to and views of the video
stories - posting them on a variety of websites, blogs and
social media.

26. Recommendations
Continue to:
 use the video stories as a way of engaging the audience,
as the feedback (from campaign development focus
groups and survey respondents) on the videos was very
positive – they raised awareness and invited conversations

27. SEO (SEARCH ENGINE OPTIMISATION)
Next steps „WoR 2‟- Maximising online presence
 SEO report:
This report analysed „WoR‟s‟ current online presence
and provided feedback on ways to increase visitors to
the website (e.g. increase ranking in search engine result
pages via relevant keywords and terms that describe
„WoR‟).

28. SEO (SEARCH ENGINE OPTIMISATION) REPORT
The current PR (page ranking) for „WoR‟ is 2

29. SEO (SEARCH ENGINE OPTIMISATION) REPORT

30. SEO (SEARCH ENGINE OPTIMISATION) REPORT

31. SEO (SEARCH ENGINE OPTIMISATION) REPORT

32. LESSONS LEARNED
 Video stories reproduce ways of relating and learning
about sex. This approach resonated with both HIV-
positive and negative gay men because it both summed
up parts of their experience and allowed critical reflection
on it. This is particularly significant in prevention work.
 Partnerships with sexual/social networking sites are
critical to the success of campaigns to target populations
such as young gay men and those living in rural and
regional NSW [and]
 SEO (Search Engine Optimisation) analysis is crucial to
maximise campaign reach and online presence.

33. RECOMMENDATIONS
 Significant reductions in HIV-transmission may be
achieved from combining existing prevention
approaches (condom reinforcement campaigns) along
side targeted education (non-condom based risk
reduction strategies such as viral load) with emerging
biomedical and technological innovation.
 New partnerships including sexual/social networking
sites are also integral to this work.
 SEO analysis is crucial to increasing online presence
and providing feedback on ways to target populations.
 Utilise video stories to invite conversations on
negotiating sex and to enhance traditional „information-
dissemination‟

34. RECOMMENDATION
 Do we really know our target ?
- Younger gay men (both positive and negative),
who do not identify as “sex pigs” or “SAMS” or
any other label?
- A scene men move in and out of, not:
> wholly descriptive of the person they are [or]
> characteristic of every time they have sex
occasional (opportunistic)
Current campaigns not seen as relevant ( “not me”)

35. Thank you to all the men who have taken part in
campaign development. It is an act of generosity
on their part to share their stories with us.
www.wrappedorraw.org.au