Mobilise! is a project by, for and with gay and bisexual men and other men who have sex with men, be they cisgender or transgender and regardless of their HIV status.
Despite the prevention efforts of the past 30 years, gay and bisexual men and other men who have sex with men (gbMSM) remain the population most affected by HIV in Quebec. However, in addition to condoms, we now have a number of other ways to reduce the risk of contracting or transmitting HIV. The arrival of new prevention options such as PrEP (pills taken by an HIV-negative person to prevent infection) and a growing interest in how different options and services can be combined to increase their impact (“combination prevention”) has created an opportunity to “re-think” HIV prevention. In Montreal, a coalition of partners has been working to address these issues since 2012. The coalition reached the conclusion that a process of community mobilization is necessary to bring about improvements in access to HIV and STI prevention services and tools, leading to implementation of the Mobilise! project in 2015. The project brings together a variety of participants (community members, community workers, clinicians and other service providers) to help them take action together.
Initiative Objectives and Goals
· Raise awareness of different prevention options among gbMSM, increase their ability to combine available options in an effective way, and increase their capacity to use health services.
· Reduce barriers in access to prevention and health services for gbMSM in the greater Montreal area and develop a consensus on priorities for action and concerns to communicate to decision-makers in order to reduce the HIV epidemic.
· Bring together community members, public health officials, researchers, clinicians, community organizations, and other stakeholders who provide services that can reduce vulnerability to HIV among gbMSM (addictions, mental health, etc.) in order to strengthen the capacity of service providers, and the health system in general, to offer combination prevention services to gbMSM in a coordinated and integrated way.
The Role of this Initiative to end the HIV Epidemic
Ultimately, Mobilise! seeks to create the conditions that will lead to a significant reduction in HIV incidence among gbMSM in the coming years through a process of community mobilization.
Combination prevention refers to the use of a range of risk reduction strategies at different times to significantly reduce the risk of contracting or transmitting HIV or another STI. Using a number of strategies together as a “combination” can help people and their partners have the best possible protection.
Meaningful Engagement with People with Lived Experience
To better understand the realities of gbMSM and hear the voices of people from diverse communities, we began the Mobilise! project with the creation of “community teams.” One or two peer researchers, known as “team leaders,” led each team discussion. After a training session, leaders recruited 6 to 8 people from their personal networks to participate in an activity aimed at discussing the issues that affect them. Guided by a discussion kit, participants exchanged views on prevention, sex, health, and barriers in access to different prevention options.
During the same period, we undertook an online questionnaire (the Mobilise! Survey) to better understand how gbMSM from the Montreal area make use of prevention strategies and the barriers they face in accessing health services. Between May 2016 and January 2017, 1,028 participants responded to the questionnaire.
Key performance indicators
Participants responded to the survey
Of respondents were HIV negative; 10% of respondents did not know their status
Of respondents were HIV positive, of whom 95% reported an undetectable viral load
Primary target audience
Gay and bisexual men and other men who have sex with men, be they cisgender or transgender and regardless of their HIV status
Secondary target audience
Health care professionals and other service providers
Strategic marketing and support tactics
Website, social networks, email campaign, print pieces, online paid advertising, offline paid advertising, webinar/seminar and radio/web "LGBT in the city."
In order to facilitate community discussions on prevention and sexual health, we developed a toolkit that includes playful and informative educational material.
As a community-based project, Mobilise! made it possible for over 110 MSM to participate in a tailored intervention which has created empowerment among leaders and participants, particularly in terms of participation and competency but also, to a lesser extent, in terms of benefits for self-esteem and critical consciousness. Learn more in our poster.
In October 2016, preliminary results from the survey and the community team discussions were presented at a community forum. Discussions at the forum led to the identification of priorities for action to increase the use of combination prevention among gbMSM and optimize access to prevention and health services. These consultations led to the development of a community consensus statement aimed at challenging public decision-makers to take concrete action to improve service offerings and access to health services.
Strategies that nearly all respondents knew about included condoms and lubricant (98%), standard HIV testing (97%) and low-risk practices (93%). With respect to biomedical strategies, 84% knew about PrEP, 79% about PEP, 57% about treatment as prevention (TasP), and 65% about taking viral load into account. Compared to respondents with unknown and negative HIV status, HIV positive respondents were more likely to know about this last strategy.
"I did everything to make sure people felt at ease and to be sure there was openness about my insistence on there being no judgment. We were there to talk openly without anything being "taboo" and I wasn't there to judge people on their sexual behaviours, but to collect information to improve the quality of services, and above all, the quality of access to information." -Community leader who aced as a Mobilise! facilitator