Outreach at Public Sex Environments in Surrey

By Gerard McGuickin, Health Promotion Development Worker — gay men, East Surrey Health Authority.

The gay male population remains the largest at risk group for contracting HIV^1,2, where sex  between men is the predominant route of HIV transmission in the UK ("Twenty Years of AIDS,” 2001).  It is important that targeted approaches to HIV prevention with gay men, bisexual men and men who have sex with men (MWHSWM*), should be utilised and implemented.  Outreach at Public Sex Environments (PSEs) is one approach. 

In a PSE context, outreach is defined as work that takes place at cruising sites, where outreach workers approach men and offer packs containing condoms and lubricants.  PSEs are predominantly divided into cruising grounds (wooded/bushy areas) and cottages (usually public toilets).  Outreach in Surrey takes place mainly on known cruising grounds; there are currently no drop-in facilities for men. 

Packs contain contact details for gay men's workers at both East Surrey Health Authority and West Surrey Health Authority, giving men the option to seek further information.  For example, they may wish to enquire about the Surrey Married Men's Group. 

Men who cruise are usually identifiable at cruising grounds primarily because they are on the site alone, sometimes wearing a suit or work clothes (unusual in a wooded area).  They might loiter or follow other men, make eye contact or use varying forms of body language.

Workers are identifiable either by wearing ID or simply from working several times a week at a PSE.  They will approach men or wait for them to pass, and offer an outreach pack.  There is no one way of conducting an outreach session, and quite often success depends on the willingness of men to take a pack or engage in conversation. 

Outreach workers are not forceful or coercive and in addition to handing out packs, they can offer advice on safer sex, HIV and sexually transmitted infections, GUM clinics, helplines, gay venues, personal safety, dealing with the police and reporting hate crime. 

Another way of personally distributing packs is to use a glo-box or container, sited in a secluded location.  The container is filled with packs to which men can help themselves.  Such a system is currently in use at a PSE in East Surrey, where men have reasonable access to condoms and lubricant, and a bag to dispose of litter.  According to the Council, this has reduced the amount of litter, with no evidence of any additional activity and use of the site as a result of the container.

Although it can be difficult to quantify the effectiveness of outreach work — for example there is no way of determining whether or not men are using the packs provided (follow-up research can give details) — nevertheless, as a means of reducing HIV incidence among gay men and MWHSWM, outreach at PSEs is a relevant and valuable intervention^3,4,5,6.

In order to remain effective, PSE work requires multi-agency co-operation.  In Surrey this involves co-operation between East and West Surrey Health Authorities, the Surrey Police, the Countryside Ranger Service and Surrey County Council.  Sometimes it is also important to work with residents living near to PSEs, to help allay their fears and allow work to continue. 

It must be remembered that the overall aim of outreach is to reduce HIV incidence for gay men and MWHSWM, and to keep them safe — sexually, physically, mentally and emotionally.

* MWHSWM include men, often married, who do not usually identify as being either gay or bisexual

References

1 Aggleton, P.  (1997).  Success in HIV Prevention: Some Strategies and Approaches.  Horsham: AVERT.

2 Teeter, T.  (2001, Winter).  HIV Among Men Who Have Sex With Men: The Persistent Epidemic.  Bulletin of Experimental treatment for AIDS.

3 Aggleton, P.  (1994).  Sexual Behaviour and HIV/AIDS.  A Review of the Effectiveness of Health Education and Health Promotion.  Utrecht: Dutch Centre for Health Promotion and Education and IUHPE/EURO.

4 McKevitt, C., et al. (1994).  Towards Good Practice: Selective Examples of Good Practice in HIV and AIDS Health Promotion with Gay and Bisexual Men, and Other Men Who Have Sex With Men.  London: Health Education Authority.

5 Scott, P.  (1995).  Purchasing HIV Prevention: A No-nonsense Guide for Use With Gay and Bisexual Men.  London: HEA.

6 Oakley, A., et al.  (1996, March).  Review of Effectiveness of Health Promotion Interventions for Men Who Have Sex With Men.  University of London, Social Science Research Unit — EPI Centre.

7 Can HIV prevention make a difference for men who have sex with men?  (1996).  Centre for AIDS Prevention Studies at the University of California. San Francisco.

8 Does HIV prevention work? (1998, December). Centre for AIDS Prevention Studies at the University of California. San Francisco.

 9 Twenty Years of AIDS (2001, June 1).  Public Health Laboratory Service.  [On-line].  Available:  http://www.phls.co.uk/news/bulletins/2001/010601id.htm#Twenty%20Years%20Of%20AIDS