2. Introduction PRO(TECT) is a partnership project between Terrence Higgins Trust and The Claude Nicol Clinic (CNC) GUM in Brighton. It provides a new tailor-made service created to engage high risk men who have sex with men (MSM) – namely male sex workers (MSW) living or working within the city of Brighton & Hove Service launched June 2014 PRO(TECT) online survey was launched simultaneously.

3. What does PRO(TECT) offer? A ‘one-stop shop’ sexual health service Fast-track POCT, 3 site and BBV screening (GUM and THT) Safer sex resources Non-judgmental advice and support delivered via face-to-face sessions and structured support programmes (MI) Access to local and national ‘Dodgy Punters’ listings Signposting and referrals to partner organisations Building trust and good working relationships between local MSW and THT Brighton.

4. PRO(TECT) aims To engage local high-risk MSW’s to prevent onward transmission of STI/HIV infections by increasing access to testing and treatment To engage with MSW using MI sessions to implement behaviour change with regard to: ‐ UAI ‐ HIV/STI transmission risks ‐ Drug/IVDU/alcohol harm reduction ‐ Maintaining and valuing sexual health Develop support and trust within local MSW community.

5. Locating & contacting MSW Online ‐ Gayswap, GPScort, Grindr, Scruff, Gaydar, Friday Free Ads, BBRT, SleepyBoy etc… PSE site outreach (Duke’s Mound/saunas) Venue outreach Internal/external referrals Local press releases Word of mouth

6. PRO(TECT) results to date PRO(TECT) clients18 POCT administered13 3 site screens33 Condoms distributed450 Referred to CNC for BBV screens18 MI sessions delivered41 Clients attended ‘Fresh Start’ MI programme7

7. PRO(TECT) CNC results to date 17% (3/18) Disclosed they were MSW to GUM staff 39% (7/18) were HIV positive –3 had detectable viral loads (42,000 to 307, 000 copies/ml) –CD4 counts ranged from 6-698 x 106/l 85% were hepatitis B immune 1 was hepatitis C co-infected (viral load 100,4492 cp/ml).

8. PRO(TECT) CNC results to date 33 STI screens were performed in the last 12-months, with an average of 3 screens/person 39% had an acute STI: 4 rectal, 3 pharyngeal, 1 urethral gonorrhoea; 2 rectal chlamydia; 1 latent (early/late) syphilis PEP was used by 2 HIV negative MSW a total of 5 times in 12-months.

9. PRO(TECT) MI outcomes “My knowledge on sexual health has improved” 27% STRONGLY AGREE53% AGREE20% N/A “My confidence to look after my sexual health has improved” 27% STRONGLY AGREE53% AGREE20% N/A “My motivation to look after my sexual health has improved” 60% STRONGLY AGREE33% AGREE07% N/A “My knowledge on ways I can test for HIV/STIs has improved” 40% STRONGLY AGREE29% AGREE31% N/A “My confidence to manage/abstain from drugs/alcohol and to make better choices to these relating to sexual health has improved” 27% STRONGLY AGREE53% AGREE20% N/A

10. Challenges Chaotic lifestyles Transient community Stigma Trust HIV+ MSW Opportunistic MSW Privacy and confidentiality Can be cautious to engage with services

11. PRO(TECT) online survey

12. PRO(TECT) initial findings 72% meet clients online 35% have diagnosed HIV 77% have had UAI in the last 12 months 54% had receptive UAI in the last 12 months 35% have been diagnosed with an STI in the last 12 months 41% are under the influence of alcohol/drugs while selling sex 35% have injected (slammed) drugs 33% had self harmed in the last 12 months 39% have made a pornographic film

13. Case study ‘Clive’ was referred to the PRO(TECT) Service from our Outreach Team who had met ‘Clive’ at a PSE. ‘Clive’ had only just moved to the area and disclosed that he was sex working, HIV+ (diagnosed for over ten years) and had never accessed HIV care or treatment after diagnosis and frequently engages in UAI with clients. ‘Clive’ presented additional complex issues which included: untreated long-term HIV infection syphilis, gonorrhoea and chlamydia infection drug/alcohol misuse mental health domestic violence legal homelessness.

14. An overview Unprotected sex is common among MSW MI outcomes show good improvement in knowledge and risk taking behaviour High levels of drug and/or alcohol use and self-harm require close links to SMS and mental health services There is a high burden of STIs in this group and a significant risk of onward transmission to partners and clients PRO(TECT) acts as a gateway into mainstream services - including access to PEP PRO(TECT) is unique in accessing this ‘hard-to-reach’ local population and offers a holistic service of harm reduction.