Page 1 THT BRIGHTON HEALTH PROMOTION: UTILISING ONLINE, MOBILE APPS & SOCIAL MEDIA THT Brighton has pioneered the use of online sites, social media and mobile apps for sexual health promotion and also to deliver specific campaigns which raise public awareness of regional and localised sexual health issues and STI outbreaks among Brighton and Hove s MSM population. These have included outbreaks of syphilis and shigella and also the promotion of large city-wide campaigns to encourage regular testing for chlamydia and gonorrhoea which have a local prevalence above the national average. These sit alongside ongoing initiatives relating to the benefits of regular HIV testing, home sampling kits and Hepatitis C / HIV co-infection. THT Brighton also delivers online outreach interventions to MSMs. The sexual health messages information and advice can be delivered simultaneously across mobile apps, online sites and via social media and benefits from directly targeting and reaching those considered to be high-risk or otherwise hard to reach. National campaigns such as National HIV Testing Week are also promoted via these cost effective and innovative digital methods that can generate a large reach of individuals, measurable and evidenced health outcomes that can be evidenced by pathways and direct referrals to sexual health testing services. THT Brighton strives to achieve a balance between identifying and respecting the end user s differing demographic cultures, traits, behaviours and characteristics in relation to each website, mobile app or social media platform. This is achieved through consultation, evaluation and research. There are many subcultures within the MSM community and this also requires a sensitive social and cultural understanding as well as a non-judgemental approach. THT Brighton are seen to bring added value by many end users on the platforms worked on and the presence of sexual health information and support is welcomed and seen as a benefit by the majority of online users. METHODOLOGY MOBILE APPS Terrence Higgins Trust Brighton has been using social media, mobile apps and online sites to deliver specific public sexual health messages to the local MSM community. Through the use of this new technology it has been possible to deliver geo-targeted information which provides the opportunity to provide real-time signposting into local services directly to MSM through online interventions. This is a demographic and audience who are often harder to reach through traditional media. THT Brighton has created specific profiles on the most popular MSM mobile apps, which generate a broad range of enquiries from mobile app users. These profiles work on a passive approach of inviting users to contact THT Brighton to access information or support. Members of the Health Improvement Team can then respond with specific and detailed up-to-date information regarding the enquiry which are tailored to the mobile app user s question or request for further information.
Page 2 Due to the GPS location technology built within the mobile app software, mobile apps can generate a direct pathway for local MSM to relevant services with the use of location maps, associated website links, contact details and the option to speak in person to the user when necessary. MSM are often more likely to be open and honest to the health promotion worker when using mobile apps than perhaps they would in person around certain sexual health issues as a level of anonymity is maintained. Below are examples of the range of interventions, advice and information that THT Brighton delivers to mobile app users during office hours and also during scheduled mobile app outreach sessions in the evenings and weekends. THT Brighton predominantly uses Grindr and Scruff as the main platforms as these are the most popular among the local MSM community. Grindr, a gay dating or hook-up app is the market leader and has approx. 13,000 active MSM users within Brighton & Hove. THT Brighton delivers sexual health information and advice covering a range of issues including: HIV (transmission, viral load, oral sex risks, UAI and harm reduction) STIs (identifying symptoms, transmission, risk and where to test) PEP (advice, information and referrals to GUM for assessment) PrEP (information and advice) Chemsex (harm reduction, associated sexual health risks and pathways to SMS) HIV testing (window periods, benefits of testing and local services) As well as profiles that encourage the mobile app user to engage in real time, THT Brighton also utilises geo-targeted push messages and banner advertising on the mobile apps which are purchased either in bulk packages or by the number of banner impressions with specific rates set by the mobile app developers. THT benefits from having the ability to change the GPS location on Android devices. This is a useful tool when promoting community testing in the city before a specific scheduled event takes place and helps raise awareness and build interest. A huge benefit is that the reach of the device is not positioned statically and in the actual fixed location by the mobile apps GPS software (previously profiles would only have been viewed by users within the immediate vicinity of the device) and outreach can cover any geographic location within Brighton and Hove by positioning THT s various outreach profiles at chosen or desired GPS locations which maximise overall reach across the city. Scruff s Benevolads free banner advertising for LGBT non-profit organisations helps promote services like THT s walk-in rapid HIV testing service with banner ads that click through to a pop up window and then onward to links to a specified website offering further information. Please see examples below:
Page 3 SPECIFIC WEB SITES THT also feature on specific websites that can be used to target harder to reach people within the local community and those considered to be at highest risk of HIV/STI infection. An good example of this is the Bareback RT website which is specifically aimed towards MSM who have a preference for unprotected anal intercourse (UAI) and other higher risk sexual activities. On Bareback RT there has been interest from site users in THT s resources Understanding Bareback and Understanding Chemsex booklets with 28 being requested digitally. This also presents an opportunity to forward additional information to clients online such as information regarding local syphilis and shigella outbreaks as well as other digital resources. Interventions on BBRT are often more in depth and take place over several exchanges over a period of time, often with high risk men who are not otherwise engaging in sexual health services: Example: An HIV positive MSM messaged the Terrence Higgins Trust profile on Bareback RT. His message said that he has decided not to start HIV treatment for personal reasons and wanted to know how long he would live without developing AIDS and dying. We were able to discuss treatment with him and provide general information about how HIV affects people individually and more specific advice that the only way to gain an understanding of how HIV is affecting his health is to have a CD4 and viral load test. THT Brighton also feature on the Squirt web site, which is a hook-up site for high risk MSM who choose to source sex at local public sex environments and cruising grounds. A THT profile has been created while also utilising the functionality of the site user forum that is location specific to local cruising grounds and public sex environments. THT Brighton also uses banner advertising and e-blasts that are delivered to the inbox of users on the site. This can reach large target audiences and as such can be very cost effective. THT Brighton assesses new web sites on the market periodically to identify any MSM not currently engaging with services. It is necessary to explore the overall feasibility of working on a potential new site by exploring the existing parameters while ensuring that this can be achieved without having a detrimental effect on the end user s experience. THT Brighton requests permission from the site owners for a THT profile or presence on any MSM focussed web site they believe could potentially add a value to, by outlining the methodology of THT s approach to offering online outreach to the demographic of it s users.
Page 4 SOCIAL MEDIA THT Brighton uses social media to specifically target key at risk groups, for example the MSM and BME users of any site where this demographic information is available and is utilised in a site s advertising criteria. This is of benefit for targeting advertisements and messages to key specific audiences which can be set by geographic location, age, gender, language, interests and behaviours. THT Brighton has seen an increase in uptake when this social and geo-targeting advertising technique has been used to further promote local campaigns such as Brighton STI Testing Week, rapid HIV testing services and also National HIV Testing Week which were particularly successful in generating an increase in awareness of campaigns and also increasing numbers of MSM accessing testing services over the duration of the promotion. This also has the added benefit of providing an ongoing legacy in uptake due to the key message of regular testing reinforced while the promotion was running. CAMPAIGNS UTILISING ONLINE, MOBILE APPS & SOCIAL MEDIA COLLECTIVELY SYPHILIS OUTBREAK 2014 MSM in Brighton and Hove were advised to be aware of the symptoms of syphilis, following an steep increase in the number of men contracting the infection in the city in the early part of 2014. Between January and March 2014, there were 54 new cases of syphilis diagnosed among gay and bisexual men in Brighton and Hove, more than four times the number of diagnoses during the same period in 2013. A Squirt e-blast was sent out to 5,000 MSM in the Brighton area providing information on syphilis symptoms, treatment and testing centres including the addresses and opening times of the THT and The Claude Nicol Clinic (CNC) testing services. The CNC reported that MSM attended after identifying symptoms from viewing THT s online campaign and was reinforced across a variety on online platforms. A Grindr push message was also generated to the 13,000 MSM users within the Brighton area that provided a link to a THT webpage with information on syphilis, including symptoms, treatment and testing options. A syphilis banner was also featured on the Squirt home page as well as on the Squirt www.dailyxtra.com website in the leader-board position which delivered unlimited impressions to UK visitors. The syphilis campaign was promoted on all MSM specific websites and mobile app outreach profiles, this included ad-hoc and scheduled online outreach sessions. THT profiles were updated with key syphilis campaign information and images and workers engaged via outreach interventions. An example of a syphilis campaign profile is pictured (right) alongside an example of an online intervention to a user delivered via private chat functionality within the Grindr mobile app. Syphilis is not always symptomatic and the campaign encouraged men who may have been at risk of infection to attend a local testing service for a free and confidential test. Testing was promoted at the Claude Nicol Centre at the Royal Sussex County Hospital, and THT Brighton s office on Ship Street, involving a simple blood test, with results available within 2-3 weeks. The partnership between the public health team, PHE, BSUH and THT closely monitored the outbreak; the number of syphilis cases peaked in the summer of 2014 but has declined over time shown in the graph above.
Page 5 BRIGHTON STI TESTING WEEK Following the success of National HIV Testing week this local campaign initiative was developed to address high rates of repeat bacterial STI infection in certain groups within Brighton and Hove, including MSM and BME. Over the course of the week THT Brighton ran pop up community clinics offering STI testing. Brighton STI Testing Week (BSTW) campaign materials were developed to address common misconceptions regarding STI transmission risks, raising awareness via two central messages that inform people of the need to test which targeted MSM and BME users. Facebook and other social media advertising targeted both MSM and BME users. The promotional campaign ads were linked to THT Brighton for testing at the THT Brighton office during the duration of the campaign. Analysis of activity data that was returned showed that the Brighton STI Testing Week advertising to MSM delivered 9,700 impressions with 675 clicks giving a click-through rate (CTR) at 7%. A Scruff banner was designed with a pop-up advert with final URL delivery. Campaign analytics returned shows that Brighton STI Testing Week advertising to MSM delivered a total of 396 pop-up banner impressions with 33 clicks giving a CTR at 8.3%. Squirt featured both banner advertising and also an E-blast to promote the campaign. Analytics returned showed that Brighton STI Testing Week advertising to MSM via E-blast reached approximately 4,000 MSM with 1,145 views with 228 clicks, CTR at 19.91%. Analytics returned for the Brighton STI Testing Week advertising to MSM Did you know STIs can be passed on orally banner delivered 32,058 banner impressions with 99 clicks giving a CTR at 0.31%. The promotion of the campaign was delivered across all online sites and mobile apps that THT Brighton operate on. Mobile app and site profiles adopted the campaign identity, image style and the key campaign messages, information and advice were delivered via online interventions with mobile app users. New techniques were trialled during the campaign of directly messaging users within private chat, when this approach was adopted there was an increase in uptake of STI screening prompted by the direct delivery of private messages from THT outreach workers to the mobile app users. Below is an intervention which was delivered and demonstrates how the campaign s promotional resources were integrated within the mobile app functionality with delivery of information, campaign images and GPS locations sent and delivered of specific testing services for users to find with easily from their location.
Page 6 SHIGELLA OUTBREAK Gay and bisexual men in Brighton & Hove were advised to be aware of the symptoms of shigella following an increase in the number of men contracting the infection in the city. A Scruff banner was designed with pop-up advert with final URL delivery. Analytics returned show that it delivered 2,145 pop-up banner impressions with 38 clicks giving a CTR at 1.7%. Squirt featured a banner to promote and highlight the outbreak. Analytics returned 167,361 banner impressions, with 404 clicks giving a CTR at 0.25%. The promotion of the campaign was delivered across all online sites and mobile apps that THT Brighton operate on. Mobile app and site profiles adopted campaign identities and images focussed upon key campaign messages, information and advice were delivered via online interventions to site and mobile app users. AD-HOC MISCELLANEOUS CAMPAIGNS THT sent out a Squirt e-blast to 5,000 MSM in the Brighton area to promote National HIV Testing Week (NHTW) including a link to a service finder where MSM could locate the nearest testing centre. Squirt confirmed that there was a combined total of 5,061 clicks generated directly to the THT website as a result from both the syphilis campaign banners and NHTW e-blast combined. THT posted a link on the Sexual Health forum on Fitladz to highlight to site users the HIV home testing kit service. Fitladz is a UK based site which is mainly used by younger MSM aged 18-30. This resulted in 30 plus responses discussing home testing and sharing experiences of the services. 14 individual MSM ordered a postal kit following the forum post. The new THT hepatitis C digital pamphlet has been well received on BBRT and has been useful in oneto-one interventions with high risk MSM who are HIV positive and concerned about transmission and co-infection.