Outreach

The information provided here has largely been adapted from GMSH The Cruising Counts Guide and We are the Sexperts! manual. Be sure to read both of these resources fully, along with the NCSD Guidelines for Internet Outreach, for more in-depth knowledge and expertise on how to build your online outreach program.


Introduction

Since gay, bi, and other men who have sex with men routinely use dating sites and apps to seek partners for social and sexual relationships, outreach programs have often looked for ways to adapt their methods to most effectively reach them.

Before getting into the nuts and bolts of designing and building an online outreach program, it is important to assess whether doing so is worth it. Is it the most cost-effective way for your organization to help MSM online make smart sexual health decisions? And do enough of your community members want it to make it worthwhile? How else might they get the information that you’re providing through outreach.

Many years ago, at one of the first meetings to discuss outreach online, some public health professionals maintained that outreach was necessary in order to tell people where to get tested, give them factual information about the risk of different activities, and to lend an empathic ear.

If sites and apps have easy-to-find links to correct information, users can find out where to get tested and where to get accurate, reliable, up–to-date information on the risk of different activities, as well as everything else about their sexual health. BHOC’s website also has a comprehensive guide to sexual health for gay men.

What Google, links, and information can’t do is lend an empathic ear. And while lending that ear may be important, it’s crucial that public health agencies consider carefully what the impact might be on prevention and increasing access and continuity of care.

There are several limitations to online outreach that should be recognized before spending the time and money into building such a program, including its limited capacity to reach a wide audience and the risk of negative reactions from users and site owners

The results of our research survey published in AIDS and Behavior in 2013 suggested that access to sexual health experts, rather than a live chat with outreach workers, was a prevention strategy supported by a majority of users, as well as a majority of website/app owners and HIV/STD directors. This suggests that what people do want is information that may be more complicated than an average outreach worker can provide.

Other strategies may achieve greater success in reaching a larger percentage of the MSM community at a lower cost. Such methods include purchasing online ads from companies (some like Grindr and SCRUFF offer free or discounted advertising) or directing users to online resources that already have answers to frequently asked questions around MSM sexual health such as the Give Users Good Info section of BHOC’s website, BHOC’s Youtube channel, GMSH’s The Sex You Want website, and Greater than AIDS’ #AskTheHIVDoc sex-ed videos.  Sites providing basic information in easy to access places online, such as Grindr placing information defining PrEP and Undetectable right next to users’ profile options, is also a self-sustaining way to get messages out there, without relying on public health staff and dollars.

If you’re still interested in outreach, then keep reading. The aim of the rest of this article is to help programs that decide to do outreach, regardless of its limitations, to do it as effectively as possible.

Despite the limitations of online outreach, the intimacy and immediacy it provides to MSM online through one-on-one conversations can be a strength. It also has the added benefit of reaching users who may not see online ads because they pay subscription fees to have an advertisement-free online dating experience.

Online outreach certainly has numerous advantages over traditional methods as it is an effective tool to (1) reach people when they are seeking sex partners, (2) offer anonymity regarding sexual questions and problems, and (3) reach populations that are geographically and socially isolated.  Here we provide strategies to help you improve your online prevention outreach program to not only be more effective and efficient, but to also be sensitive and responsible.


Goals & Objectives

Framing your online outreach program with goals and objectives will allow you to measure outcomes and determine whether you are on the path to achieve your organization’s mission. It also allows you to shape something that fits into your program plans and funded deliverables.

Your program’s overall goal may read something like:

“The goal of online outreach is to use dating sites and apps to deliver sex-affirming, harm-reducing, holistic, evidence-informed sexual health information, so that users can make informed decisions and receive referrals that address their sexual health needs for disease prevention as well as linkage to and continuation of care.”

Your objectives, which should be more specific and easier to measure than your goal, will be the foundation by which you create policy and evaluate your program’s performance and success. Some of your objectives may include: (1) increasing knowledge and awareness (around sexHIV & STDs, condom usage, PrEP & PEP, testing, treatment, mental health, wellness & harm-reduction, etc.), (2) making referrals to regionally-specific testing facilities and online resources, (3) reducing HIV-related stigma, (4) promoting specific campaigns and materials, (5) encouraging sex-positive, risk-reducing, health-seeking behaviors around sex, harm-reducing behavior around substance use, and sexual consent, and (6)  providing information and referrals to HIV-positive users to make it easier for them to get linked to and continue with treatment and care. However, you may achieve these goals will greater success by allocating your resources towards purchasing ads online that provide important information, share useful links, and promote campaigns.

For more specific information on how to frame the goals and objectives as well as the principles and roles and responsibilities of your program refer to the Cruising Counts Guide (pages 12-15).


Promoting Cultural Humility

Online outreach workers and health navigators should strive to conduct outreach in a culturally humble and safe manner. It is important to recognize that there is a diversity of guys cruising online. They need to understand how users are looking for partners, and recognize that that is probably their top priority – not looking for health-related information.  They also have to be able to appreciate the racial, ethnic, gender, age, and geographic differences between users.

Because online outreach typically allows for written communication only, it is vital that outreach workers build their competence in the language that men use when they cruise for sex online, whether they are talking to transmen, men of a particular racial or ethnic background, or MSM of a particular sexual scene.


Key Tips to Consider

As you begin to develop a plan and program to support your online outreach programming, here are a few key steps for you to consider for effective implementation:

  1. Decide what you will offer – Take the time to carefully plan out what you’re going to deliver and where. For example, you may want to offer individualized prevention messages, and links to specific services. Or you may decide to use social media as a communication/marketing tool. It is also important to determine whether you’ll be using general-use sites like Facebook or Twitter, or using dating and hook-up sites and apps.
  1. Make sure you have the capacity – Does your organization have the capacity and resources to conduct outreach? Assess your current program staff for internal expertise and determine whether you will need to provide training, seek approval for access to sites and apps from the workplace, or develop new protocols.
  1. Choose your websites/apps – Survey your community to investigate which apps guys seem to be using more often in your area. Your local health department may be collecting data about site usage from among their clinic patients. It’s also quite likely that the guys employed/volunteering through your agency are very familiar with the popular sites in your region; tap into their expertise. It is more than likely that many people will have profiles on more than one app/website, so you may not have to conduct outreach on all sites.
  1. Multi-tasking and confidentiality – Some folks believe that once you begin or log into online outreach that is your sole focus and requires your undivided attention. This is not necessarily the case. Some days can be very quiet and slow online, giving you the chance to work on other tasks. It might be beneficial to set up a notification system that signals when you get a message, question, request, wink, or woof. Make sure your notification system is private and out of sight of other staff. Protecting the confidentiality of the guys you serve in your community should always be a top priority.
  1. Register account – It is a good idea to understand the sites or apps that you are interested in using. Each site/app has its own guidelines or rules about who can use their services and how. Some apps are known to support online outreach work, while others are not. It is important to carefully read, understand, and operate in accordance with these companies’ Terms of Service in order to develop a trusting relationship with these apps and their users, and to avoid having your profile deleted.

BHOC will be working with app/website owners to support them in designing approval processes for outreach workers. In the meantime, it is best to gain the support of the owners by reaching out before setting up a profile.

  1. Design your profile – It is best for guys online that you brand your profile clearly. BHOC’s recent research confirms that users want to see that the profiles include logos from their agencies. Make sure to be clear in your purpose for being online and that you are not there seeking to hook-up. Restrictions or limitations on these profiles vary between different sites and apps. Keep your profiles professional.

Below are two good examples of humanized, yet branded profiles of outreach workers on Adam4Adam and Grindr. The Grindr profile on the right provides a simple and straightforward example of an outreach profile, while the Adam4Adam profile is a more detailed example. Notice how each clearly states their role as health educators through both their screen name and description. They also provide personalized pictures that clearly identify their logo and organization. Both make it clear that they are there to provide help and answer questions.

  1. Membership costs – Most applications will give you free access to essential/basic functions, though some will lock extended features behind a paywall (usually a monthly subscription). These extended features may allow you to reach more guys by expanding your radius or through specific demographic filtering (Grindr Xtra will allow you to display up to 300 accounts at once within a larger radius, as well as filter by age, ethnicity, and other characteristics). It’s a good idea to look into the pros and cons of unlocking these features for different apps to understand how it could impact your outreach capabilities and budgets.
  1. Geolocation – A major benefit to online outreach programs is that they allow you to reach users based on geolocation within a given radius. If your organization is seeking to reach guys in a defined area, there are certain ways to change your GPS location to reach guys without having to be there. A few applications, such as Tinder and SCRUFF, will let you search different geographic areas. However, most will not.
  1. Schedule and timing – Introducing an online outreach program may necessitate altering staffing plans to enable outreach during evenings and weekends, when more users are online. Plan for this ahead of time.
  1. Be prepared – Be prepared to share useful sexual health information with users. A great deal of information can be found in the Good Users Give Info section of this website. Feel free to use this information, either through cutting and pasting or providing a link to it. You can also create a database or Excel spreadsheet of common replies to general HIV/STD and sexual health information, including testing and care referrals. While this is easier to use on web versions of dating sites, you can also store this information or link to it on your smart phone. When you can, maintain an element of personal touch, empathy, support and humor in your replies so that your guys online know whom they can trust. Set up periodic meetings with your online outreach team to improve upon scripts and protocols and discuss revised language or new resources/links. Feel free to contact BHOC with any questions or comments regarding FAQs and responses.
  1. Training – Depending on their base level of knowledge, staff and volunteer training may need to include an introduction to the sites and apps you use for outreach. They will also need to become familiar with any online resources that support your work, and local resources that are relevant (eg. public health departments and organizations, testing locations, needle exchange, PrEP-knowledgeable doctors, care and treatment facilities, etc.). Collecting your most frequently asked questions and maintaining a database of common replies and useful resources and links can help inform your volunteer training. Have outreach staff role play online situations, especially for more difficult-to-navigate situations, to help your volunteers become more comfortable chatting online. Some program training basics include: health promotion basics, confidentiality and boundaries, risk and harm reduction, communication, sexual assault, laws regarding HIV transmission, non-disclosure, and agency programs.

Note: be sure to reference “We are the Sexperts” for guidelines for outreach worker training and knowledge (Training Policy, Appendix 1) and for rules for employees, volunteers, and activists (Non-Disclosure Agreement, Appendix 2) (pages 18-21).

The CDC’s Using Technology as Prevention (UTASP) Workgroup is a good resource for connecting with other experts engaged in online outreach. Reach out to Frank Strona for more training resources.


Conversation Tips and Tricks

Ensure that you will never initiate contact with users and will only answer the questions of those who have actively contacted you. Online outreach should be passive outreach until a user directly reaches out to you.

The aim of one-on-one conversation through online outreach should be to create a feeling of trust, while facilitating a long enough conversation to deliver important facts and individually adapted information.

“We are the Sexperts” outlines how outreach workers can best interact with users and provides practical tips for different scenarios (pages 18-21).

Some of their behavioral guidelines include:

  • Avoid preaching
  • Avoid assuming all enquirers are HIV-negative
  • Take questions and users seriously
  • Ask until you understand
  • Use correct language
  • Be polite
  • Defuse the situation and use a reassuring tone
  • Respect sexuality and feelings
  • Be aware of shame
  • Be aware of power relations
  • Do not assume all users are MSM
  • Do not take gender or gender identity for granted
  • Communicate value and hope

Documentation, Feedback, & Evaluation

In order to continuously improve your program and meet the changing needs of users, it is important to document conversations, provide feedback to outreach workers and volunteers, and evaluate the success of your program.

Online outreach provides a unique opportunity for documentation because of the digital paper trail that is created through online conversations. The data collection process might take the form of outreach workers filling out a log/spreadsheet after each shift. These logs should capture demographic information (age, ethnicity, sexual orientation, gender identity, etc.), the content of the conversation (including links sent and referrals made), and identifying information for future follow-up (such as a personal name or screen name), although identifying information must remain confidential and stored separately from other data (an example of an outreach log used by the Asian Community AIDS Service in Ontario). If more detailed information or feedback for volunteers is sought out, documentation might also take the form of outreach workers making copies of their conversations, which can then be sent to project managers for review. These conversations can be documented by taking screenshots, saving them into a Word document, or letting a project manager know on which app/site a conversation took place so they can review it and provide feedback or inform future trainings.

Providing feedback to outreach workers is important for quality assurance and making sure individual outreach workers are meeting expectations. Feedback can benefit both the managers and the outreach workers, and provide a way to exchange both up-to-date information with frontline experience.  Online outreach workers may also benefit from getting together to share experiences and ideas and talk through challenging conversations.

Evaluation is crucial for measuring the success of your program and how you can improve on its performance. Evaluation of your program should take place both continuously and on an annual basis to review the project year in a more in-depth way. Annual evaluations will determine how well your program is meeting qualitative and quantitative goals and objectives.

Evaluations can either measure the process or outcome of your intervention. They will include indicators such as volume (the number of contacts made, the number of referrals made, increased uptake of services, etc.), reach (number of  guys in different demographics or groups – age, race, ethnicity, status, rural v. urban, substance user, etc.), and quality (duration of conversation, range and depth of information given, referrals offered, etc.). In addition to these evaluation methods, you may also seek to collect feedback and input from online users you make conversation with through online surveys. If guys online have given you their permission and contact information, it might be helpful to follow up after the initial outreach contact or intervention to investigate whether your session was helpful and how you can keep your content up-to-date.


Best Practices

The following groups have successfully communicated healthy sex messages, answered questions, and made referrals through Internet outreach:


Resources

The following resources may be helpful to share with users during online outreach:

The following resources may be helpful for your organization:


Adapted from GMSH The Cruising Counts GuidelineWe are the Sexperts!CATIECDC; Images from StarObserverAdam4Adam

Messaging

Expanding HIV Prevention Options: Implications for Messaging for Gay and Bisexual Men: Report on the “And/Or” Meeting

Building Healthy Online Communities convened a group of HIV and STD prevention leaders and communications experts from around the country on January 30 and 31, 2018, to discuss whether we should promote comprehensive prevention strategies – PrEP and condoms – or promote them separately. How should programs best communicate directly to gay and bisexual men? Should we give these different options equal emphasis, or should we emphasize one more than the other – and when, and for whom?