1. What is good HIV prevention? Ross Boseley Health promotion Coordinator Terrence Higgins Trust Brighton

2. HIV, MSM, Brighton & Hove Highest rate of HIV outside of London Approx 1,550 accessed HIV care in B&H in 2012: 84% MSM. (Top 5 th PCT: 39% CD350, 18% CD200). 50% of the new infections in 2011 were between MSM. 4% increase over 2010 low rates of late diagnosis For MSM More than 4 out of 10 MSM locally are exposing themselves to risk of HIV by having unprotected penetrative sex with partners whose HIV status is either unknown, or one partner is HIV positive and the other is negative. *GMSS 2007, reported in B&H NHS Sexual Health Needs Assessment 2010.

3. So what's good about Brighton's HIV prevention program? Well attended community clinics which identify infection (THT Brighton Centre Positivity rate of 2.81% sauna positivity rate of 4.5 %) Engagement with local stake holders, service users and community Use of web and phone based social / dating sites, for promotion and interventions Integration of health promotion in to outreach, local GUM, substance misuse, social care and counselling services Local research and collaboration with Universities Targeted information and services based on need and insight

4. Partnership and collaboration

5. Consultation and Development What do people want ? On BBRT, it's specific bareback site. If you say anything, You should use a condom youre blocked. They're not there for condoms. Otherwise why are they on BBRT? … You want bareback fuck, you go to BBRT. If you tell me I must be using a condom. Im a bad boy. Fuck off. … What I'm saying is don't contradict the site youre in. You gotta work with within the site. Both younger and older participants felt that messaging needed to be more current and localised As long as it's safe, discrete and confidential, I'd be more likely to accept a test in a sauna than schlepping all the way up to a busy clinic with long waiting times

6. Community Engagement & Outreach

7. DudesNudeFitladsBareback RTSquirt GaydarOuteverywhereReconGrindr ScruffCraigs List

8. Integrating services Poster, referrals, Grindr message, Gaydar intervention, Outreach team HIV & STI tests & Identification of further need Four week structured programme & counselling

9. 45 Minutes Integrated Services

10. HIV: Scheduled Community clinics (office based & Sauna based evenings) 5 Day Walk in PoCT Weekend sauna based clinics STI: Offered to all MSM in sauna Self taken STI swabs Offered with HIV PoCT Community HIV / STI testing

11. Face2Face Four new programmes have been developed where a presenting issue would require more than one initial Face2Face consultation. Fresh Start Programme (Addictions) Choices (Sexual addiction/compulsion) Sex and Relationships Programme Newly Diagnosed Programme The programmes all use MI techniques and aim for the client to explore their feelings and presenting issues with the view that they then can identify and benefit from the programmes.

12. Counselling The more complex clients then work with a counsellor for up to twelve sessions and here themes may include: Learning how to be with their uncomfortable emotions without always choosing avoidance techniques Further help with where their risky sexual behaviour links with alcohol and drug use.

13. Looking forward Expanded community testing Increase substance misuse and sexual health interventions Bringing up to date clinical and cultural knowledge together to develop targeted local approaches. (e.g. VL, PrEP, Harm reduction in the chem sex party) Expansion of digital approaches and online outreach

14. Thank you