From Scene to Screen: The Challenges and Opportunities of Commercial Digital Platforms for HIV Community Outreach

Smartphone applications (apps) and mobile-optimised versions of dating and sex websites have had an impact on the sexual cultures of men who have sex with men (MSM). There is an ongoing concern that hook-up apps play a role in the transmission of HIV and other sexually transmitted infections (STIs). This article does not position these apps and sex sites as harbingers of disease, but it does pose these questions: How should sexual health agencies respond to digital cultures of sexuality? What opportunities lie within these spaces? And what obstacles complicate possible responses? Drawing on ethnographic research and focus group interviews conducted with digital outreach workers, the article includes data from Reaching Out Online (ROO) [PDF], a collaborative research project that explored the need for, and development of, a digital health outreach service for gay, bisexual men, and MSM in London and Brighton, United Kingdom (UK). However, the researchers believe that their broad findings are relevant across geographical borders.

The discussion begins with a brief mapping of the terrain of community outreach work, identifying the role that such work has played in reducing the incidence of HIV and STI transmission in the UK. The UK National Health Service (NHS) defines community outreach as "activity undertaken in order to contact individuals or groups from particular target populations, who are not effectively contacted or reached by existing services or through traditional health channels" (NHS, 2011). One example of this is the work undertaken Terrence Higgins Trust (THT), which has its roots in the gay community. From the time of its founding in 1982, THT has worked within that community, often in the same spaces that men meet to drink, socialise, hook-up, party, cruise, and have sex. This form of localised intervention continues to be a key strategy in the charity's fight against HIV and HIV stigma, and contemporary outreach activities include "bar blitzes", on-site screening at gay venues and events, rapid HIV tests in saunas, and drop-in services at local cruising grounds. Project workers plan, implement, and evaluate every outreach activity according to the identified needs of the group they are trying to reach.

Outreach in the digital realm centres around THT's NetReach initiative, which does not involve building new digital platforms but relies instead on the ethos of taking resources, support, and information into the (digital) spaces that MSM already use to meet one another. Designed for, and implemented across, a range of pre-existing commercial hook-up sites and apps, NetReach activities are tailored to the spaces in which the outreach worker is operating and the needs of the intended audience. Interventions might, for instance, take the form of individual discussions, conducted via a private messenger service on a commercial dating website. TNT's emphasis is not on curbing sexual activity; instead, NetReach workers answer questions, offer advice and provide support when asked for it, and give information on how to access post-exposure prophylaxis (PEP), for instance. When interviewed for this research, outreach workers stated that men typically disclose unsafe sexual behaviours and sexual anxietities far more easily and far more quickly when talking to workers via a web interface than during other forms of outreach. NetReach has allowed health workers to enter digital spaces and undertake contextually relevant harm reduction work. This work involves providing health information that does not privilege condom use, while also highlighting resources such as gay men's health clinics and drug therapies.

Having highlighted the potential that commercial platforms offer to peer educators in terms of reaching local cohorts of men, the researchers explain that digital outreach is not without its problems or limitations. Three challenges include:

• Accessing the commercial environments in which NetReach operates - For example, the fact that NetReach is dedicated to discussions of sexual matters, even if they are not intentionally pornographic, renders the outreach service "risky" to many apps running on Android or iOS. NetReach has managed to operate under the radar of these regulations, but its situation remains precarious.
• Serving as community gatekeepers - No matter how well NetReach activities are planned and executed, they are an unsolicited intrusion into the spaces of hook-up apps and mobile sites. (As explained here, it is one thing to step into a commercial public space, hand out condoms, and talk to men while socialising. It is quite another to enter into an online forum and start a conversation about sexual health.) Compounding this challenge is the fact that workers reported struggling to "read" and comprehend online spaces as quickly or as easily when compared to the physical space of a bar or a sauna.
• Working around localised app profiles - The focus on nearness and the reinsertion of place into conceptualisations of digital environments result in only very local user profiles being displayed via the interface. Meanwhile, the ability to permanently block profiles in order to narrow one's purview to see only men who match particular criteria of desirability means that NetReach workers can be rendered invisible almost immediately.

In concluding, the researchers consider the fact that "sexual health community outreach services must operate across digital and physical environments, while seeking to recognize both the specificity of each site, and the ways in which these sites merge and stack up in order to create new networked spaces of sexual connection." Furthermore, they "call upon commercial platform developers (and platform providers) to recognize their corporate responsibilities and support organizations such as THT in their work by providing better service integration for community outreach and, in turn, recognizing the role that they are playing within urban (and suburban/rural) gay men's sexual cultures."