This case study demonstrates the theory of change working in practice. Through their engagement with their communities, alignment with the sector and their adaptation, Health Equity Matters was able to achieve increased reach, increased effectiveness, increased efficiency, and stronger partnerships – all of which, led to better outcomes for their communities.
Health Equity Matters is the peak national organisation for Australia’s community HIV response. Health Equity Matters’ members are the AIDS Councils in each state and territory and peak national organisations representing key populations in Australia’s community response, including the National Association of People with HIV Australia (NAPWHA); Scarlet Alliance, the Australian Sex Workers Association; the Anwernekenhe National HIV Alliance (ANA) and the Australian Injecting and Illicit Drug Users League (AIVL). Health Equity Matters combines insights from the community, research and policy environment and draws on its organisational relationships to simultaneously provide leadership, coordination and support to our members; provide timely and accurate policy advice to government; provide a voice for the national community response to HIV and implement programs to prevent HIV and reduce its impacts.
As the national federation of a network of community-embedded organisations, Health Equity Matters is in a unique position to collect and collate insights drawn from communities affected by HIV across Australia. This positions Health Equity Matters optimally to identify national trends and respond rapidly at the community-level through AIDS Councils located around the country.
The issue of young gay men’s HIV risk and health promotion needs is one that was identified by our members and brought to the attention of Health Equity Matters through member meetings. The information our members were receiving from their communities (engagement) raised questions about the nature and degree of young gay men’s HIV risks relative to their older counterparts, but the information was not conclusive. Health Equity Matters closely monitored surveillance data and analysed behavioural research looking for indications of young people’s HIV risk (alignment). Between 2010 and 2012, epidemiological data appeared to reflect an increase in HIV diagnoses among young gay men. Health Equity Matters responded rapidly to this emerging trend by conducting a comprehensive research and consultation process to better understand the nature of this risk, and the health promotion needs of young gay men. Health Equity Matters analysed and consolidated findings from epidemiological data, social and behavioural research, laws and policy mechanisms and targeted programs and services (alignment) to create the discussion paper “Are young gay men really so different? Considering the HIV health promotion needs of young gay men”. As a highly credible organisation, Health Equity Matters was able to bring together experts in the field and convene a seminar on young gay men and HIV risk at the 2014 ‘Promises & Limitations’ Social Research Conference on HIV to raise public profile and debate of the issue.
Both the discussion paper and expert presentations during the seminar suggest that the increase in HIV diagnoses appears small and is probably a ‘glitch’, although future surveillance data will be monitored closely. Health Equity Matters’ research found that young gay men have greater vulnerability to HIV due to a number of factors, such as their inexperience with sex and relationships, including negotiating safe sex; less exposure to education on sex and HIV prevention; reticence to commence HIV testing; reduced profile of HIV within gay communities; and differences in their social relationships that mean the ‘gay community’ is not a central connection point. In response to these findings Health Equity Matters drew on its membership network and strong relationships in the sector (alignment) to conduct a thorough consultation process with the Health Equity Matters and NAPWHA membership and youth and mental health service providers to explore current health promotion practice aiming to address young men’s HIV health promotion needs and identify best practice. This process led to the creation of Health Equity Matters’ Guiding Principles of Young Gay Men’s HIV Health Promotion, which aims to support HIV and other health promotion workers to effectively target health promotion messages and activities to young gay and same-sex attracted men. Health Equity Matters’ work to strengthen the sector builds their credibility and fosters stronger partnerships.
Health Equity Matters brought together its member network of community-embedded organisations and key LGBTIQ youth organisations to design a health promotion campaign targeting young gay and same-sex attracted men. The nation-wide campaign, “OUTspoken”, is based around the website www.outspoken.org.au, which features a series of videos about the experiences of five young gay men. The campaign strategy responds to the findings of Health Equity Matters’ research and consultation processes, which indicated that to be effective, HIV prevention messaging must be linked to the priorities of young gay and same-sex attracted men and must meet them where and how they live their lives (adaptation). This strategy also empowers young people to take ownership of, and lead, HIV prevention in their communities (peer leadership).
Fifteen videos are featured on the campaign website (www.outspoken.org.au), which also hosts educational material about the key topics raised in the videos, including coming out; relationships, sex and meeting people; disclosing your status; having a positive partner; sexual health; testing; and HIV. The campaign was advertised on dating apps such as Grindr, Facebook and other social media by Health Equity Matters and state and territory organisations. Health Equity Matters also produced a range of promotional materials, including posters and banners to support state and territory organisations to promote the campaign. The campaign aims to: 1) increase HIV awareness among young gay men, 2) increase the number of young gay men who engage with HIV and sexual health testing, 3) increase HIV risk reduction knowledge of young gay men, 4) increase knowledge of youth services relating to mental health and sexual health, and 5) reduce stigmatising language and attitudes amongst young gay men.
Health Equity Matters received excellent feedback about the campaign through their networks. In the three months after the launch of the campaign, the website had been viewed 6,894 times and gay and same sex attracted men were sharing the videos through their social media accounts, evidencing that the campaign was relevant to the target audience. Further, one of the videos was selected to screen as a short film before a youth themed movie at the 2017 Mardi Gras Film Festival in 2017.
The community-embeddedness of Health Equity Matters’ membership network was critical to the success of this campaign (increased effectiveness). Their deep knowledge of young gay men and their needs informed the design of the campaign; their reach into this community enabled them to test campaign messages with diverse young gay men across multiple jurisdictions, in both metropolitan and regional areas – ensuring campaign relevance despite the enormous diversity of young gay and same sex attracted men and the existence of many different ‘youth cultures’. It is because of the trust that Health Equity Matters and our member organisations have earned with their communities that this project was successful in recruiting five young gay men to feature in their videos and so openly discuss very personal and sensitive issues. Further, the community-embeddedness of Health Equity Matters’ membership enabled us to promote the campaign nationally and within existing community networks (increased efficiency).
