Innovative approach to reaching Chinese MSMs using social media and technology

Remarks for Feng Cheng
Social Good Summit Beijing Forum 2012, September 24,  Tsinghua University

Hello everyone. It is my honor to have been invited to participate in this summit, and I am very happy to have the opportunity to discuss with all of you the impact of new media on the field of public service. Like everyone else, I’m a great fan of new media technology – over the last several years I’ve been shocked, and of course very excited, to see the impact of new media on the development of public service activities.

FHI 360 is a nonprofit human development organization. Our staff members work in more than 60 countries around the world in fields including health, nutrition, education, economic development environmental protection and more. We believe that looking at issues that affect people’s lives from multiple perspectives leads to greater and more lasting impact. Our logo clearly expresses our faith in the ability of science to improve lives.

The creation and dissemination of new media technologies has provided us with broad, open and participatory platforms which have already become an integral part of all of our lives and therefore, an integral part of our approach to human development. New media are changing the way people live, and the way we communicate with them, in ways that we could not have imagined in the past. In China, new media have already become an important tool in HIV prevention and treatment work.

As you all know, HIV in China is a low-level epidemic, with a general population prevalence of only 0.058percent. But it is significantly higher among specific groups of what we call most-at-risk populations. Those groups include injecting drug users, sex workers, and men who have sex with men. Today I’d like to use men who have sex with men as an example to discuss the uses of new media technologies to prevent HIV transmission.

Men who have sex with men – which we commonly refer to as MSM. Look at this chart – several HIV sentinel surveillance sites around China have shown that HIV prevalence among MSM is increasing yearly in every part of the country. In some cities prevalence is as high as 14-15%. In 2007, prevalence among MSM nationwide was 2%; in 2011 it has reached 6.3%, a 3-fold increase in 5 years. Of the estimated 48,000 new infections in 2011, 29.4% (about 1/3) resulted from homosexual transmission. We have a great responsibility to prevent HIV transmission among MSM.

FHI 360 began working in Yunnan Province, where the impact of HIV in China has been the most severe, in 2004. In 2005, and with the support of the Kunming Institute for Health Education, we partnered with a gay community-based organization called Spring Rain to launch HIV prevention work for MSM. In the beginning, Spring Rain consisted of two peer educators and 13 volunteers – during the day they conducted outreach in 5 MSM gathering spots including bars, parks, bathhouses etc.; at night they disseminated HIV prevention information through a drop-in center. When they realized that Internet-based interventions were effective at reaching large numbers of MSM, especially those MSM who could not be reached through traditional venues, Spring Rain created the “Xiu Ge Zhi Cheng” website aimed specifically at promoting HIV counseling and testing for MSM. This was an entirely new work model – let me talk a bit about how it works:

Surveys have shown that one of the biggest barriers to seeking counseling and testing for MSM is the perception that the staff at the testing centers wouldn’t understand them, wouldn’t understand their problems, and would discriminate against them. In order to test our counselors’ attitudes, we asked them some questions – like ‘How do you feel about working with gay men?’ – and we videotaped their answers and posted them on the web site. We also recorded the entire process of a member of the MSM community receiving an HIV test, to dispel some of the concerns of the MSM community about seeking testing.

This new, web-based platform enabled us to deliver much richer and targeted information. But getting people in for testing is one thing, getting the right people in for testing is another.

Many members of the MSM community didn’t think that they were personally at risk for HIV, “and if I’m not at risk,” they would reason, “then what’s the point of getting a test. It’s just a waste of time.”

So this was a very important issue. Through one-on-one, face-to-face outreach, it’s sometimes very difficult to talk about very private matters such as sexual orientation and sexual behavior. Just like everyone else, many MSM can be embarrassed to answer these kinds of questions. Even some of our outreach workers are embarrassed asking them. The advantage of a website in solving this problem is anonymity. “Xiu Ge Zhi Cheng” created a professionally designed risk assessment self survey, where users take about one minutes to answer ten personal questions. Based on the answers, the website assesses your level of risk for HIV, tells you why you are at risk, and provides individually tailored information and suggestions.

In fact, our work on the website is closely linked to actual medical services. This free counseling and testing is the entry point for HIV care and treatment. The local centers for Disease Control and Prevention, and the local hospitals, are also partners under the FHI 360 project, providing free HIV testing and free HIV treatment services. So the website is actually getting more people on treatment, and that means we’re saving more lives.

Spring Rain also organized a six-month pilot “digital video” activity. The goal was to encourage the MSM community to care about and improve their own health. “Xiu Ge Zhi Cheng” invited HIV counseling and testing clients to upload a 60-second video explaining, “Why I got tested” and discussing their feelings about being tested, and to share those videos on the Ren Ren website (Chinese version of Facebook) and Weibo (Chinese microblogs). There were 48 videos uploaded to the website, and in the last month of the activity users were able to vote for their favorite videos. More than 6,000 votes helped one participant win the title of “Charming Xiu Boy” and the winner became an ambassador for HIV testing. Additionally, during this activity the website received more than 40,000 visits from 219 cities in China.

And the best part is, during the pilot project we saw a 25% increase in uptake of HIV counseling and testing, and a 20% increase in the number of positive cases discovered. This meant that we were reaching the right people and getting them in for testing. This is a great achievement, because testing is a key step in stopping the spread of HIV. Targeted detection has a multiplier effect – if you are negative, you learn how to stay negative. And if you are positive, there is real hope that you can get the treatment you need to live a longer and healthier life.

Funding from USAID and the Bill & Melinda Gates Foundation has made possible our HIV prevention and treatment project in China, and we have had great support from MSM community based organizations and from health agencies at every level for project implementation. We would like to thank them all again!

The Internet has changed all of our lives, and it has also become an important platform for MSM who are seeking health information. As the number of users continues to grow, Spring Rain will need a better plan for Internet-based projects, and will need a greater investment of funding and of technical support. As Spring Rain Internet Consultant Mr. Xie Bing said, “we greatly need more people to give us the benefit of their knowledge and guidance for our website.”

Thank you all!

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