This is a tough time for HIV prevention, and across the statutory and charitable sector: budgets are being slashed, resources are being expended in large scale reorganisations and leadership is changing.
All of this means profound changes for GMFA. Over the last year the majority of our contracts have come to their end and, for a variety of reasons (including budget cuts, reorganisation, commissioning priorities etc.) have not been renewed.
This does not mean that this work is not valued. Since hearing that both the websites and FS magazine are no longer going to be funded (right now, at the very least) I have received emails and messages from other providers of HIV prevention services, from members of the gay community who benefit from them and even from commissioners, about how these services have helped the struggle to prevent new infections and how shocked and saddened they are at the threat of their loss.
We believe that FS and our websites are both hugely valuable in providing gay men with information, advice and motivation to prevent the transmission of HIV. We believe that they should be funded. Our goal over the coming months is to convince those who have the power to fund them (whether those funds come from statutory, charitable or community sources) to agree. If you also value these services, let us know and we will forward your comments to the appropriate person. It may not change the current decision but it may help us in the future.
Whilst this position is obviously a daunting one to find ourselves in, I also believe that it may prove to be a great opportunity for us, an opportunity to re-think what we do and how we do it. I don’t believe that I am alone in thinking that increasing portions of the gay community are considerably less engaged with HIV prevention than in the past.
At the same time, the environment in which we operate has changed enormously, and continues to evolve. HIV is increasingly a manageable condition. Anyone who seeks out this information will find it, so it’s no surprise that the fear which once prevented many people from taking any sexual risks is diminished. Despite these advances, people who live with HIV continue to suffer both physical and emotional disadvantages over the course of their lives as a result of their infection.
And it’s not just the medical situation that has changed. The way that we meet other men for sex has changed too. Back when HIV first hit the UK’s gay community, men would usually meet their sex partners in bars, clubs or cruising grounds. For some years now online dating sites and other social media have replaced that, and now with Grindr and similar apps, a gay man can just as easily hook up with someone in an ostensibly straight bar, or on public transport, or from the comfort of his own home, as ever men could in bars etc.
And this ability to meet up with other men for sex away from bars has also, in part, contributed to the rise of sexualised drug taking. There is an increasing body of anecdotal evidence that suggests that gay men, in large numbers, are getting drawn into drug fuelled spirals of sex. There have been similar moral panics in the past about drug use in the gay community but there are fears that the sexual health impact of Crystal Meth dwarfs any previous drug related threats to our community.
As I say, a huge amount about the environment has changed. Operating outside of contracts for a short time provides us with the space to refresh and renew our work. To ask, ‘if there were no history of HIV prevention, is this how we’d do it? Who are the men we need to reach most, and how do we best reach them?’
We have decided then to realise the assets that we have to continue to fund our work, providing (without contracts or income if need be) the work that we believe to have the greatest value in preventing the transmission of HIV and other STIs. To do this there will need to be changes in the way that the organisation is run, we need to become a leaner, more efficient operation, depending on increasing support and guidance from the community that we serve and which, through the input of our supporters, our volunteers and our staff, we also represent.
We will take this opportunity to look with fresh eyes at the scale of the challenges that we face, both organisationally and in terms of improving sexual health and preventing HIV infections amongst gay men. We have the opportunity to ask the difficult questions, such as how to provide support to the man who has got himself into an unmanageable spiral of sexualised drug use where the majority of his peers don’t use condoms? How do we reach the younger gay man, coming to terms with his sexuality, who may not feel able to make demands about sexual safety to his partners? How do we engage community with the tangible harms that stigmatisation of people living with HIV causes? How do we encourage increased uptake of testing? Should we be encouraging men to have fewer sexual partners, as well as increasing their condom use? How do we meet the needs of men who knowingly engage in risky behaviour whilst, at the same time, supporting those men who consistently use condoms to maintain their strategy of sexual safety?
I know that there is no one group, no single need and so no single message which will have the impact that we aspire to, but we now have the opportunity to think in new and creative ways about harnessing the powers of social media, engaging with new dating technologies, finding new motivators in our messages about testing and condom use, to engage in a way that I believe has not happened for some years.
We are of course interested to hear your ideas. The lack of engagement with sexual health within the community is also a result of the community failing to see how they can shape the HIV prevention work that there is. With fewer resources available to us we may not be able to put every idea into practise, but we want to hear how we can best support you, and we want to hear from you how you think we’re doing, every step of the way, as we work to increase our community engagement.
Gay men still carry a disproportionate burden of HIV infection and poor sexual health. Each year the number of gay men being diagnosed with HIV increases, and the proportion of our community that is living with HIV rises in turn. We believe that we can make a difference. With your support and guidance we believe that we can prevent new infections and improve the health of our community. I hope that you will join with us to be part of this new adventure.
Matthew Hodson is head of programmes at GMFA. He tweets @Matthew_Hodson