Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

The role of contact efficacy in evaluating sexual health promotion—evidence-based outreach work within a public sex environment

Jamie S. Frankis A B and Paul Flowers A
+ Author Affiliations
- Author Affiliations

A Glasgow Caledonian University, Scotland, UK, G4 0BA.

B Corresponding author. Email: j.frankis@gcal.ac.uk

Sexual Health 3(2) 79-85 https://doi.org/10.1071/SH05032
Submitted: 2 June 2005  Accepted: 8 November 2005   Published: 26 May 2006

Abstract

Background: This paper explores the role of contact efficacy in evidence-based health promotion by evaluating a public sex environment (PSE) based sexual health outreach program. The service operated in situ from a dedicated mobile unit to promote sexual health among PSE users. Methods: A cross-sectional survey (response rate 56%) measured socio-demographics, sexual health behaviours and outreach-service use among men sampled within the PSE (n = 216). Results: Most participants were aware of the service and two-thirds had contacted them. Men who had not completed hepatitis A vaccination (odds ratio (OR) = 2.02), who had ever received money for sex (OR = 2.07) or who reported a diagnosed mental health disorder(s) (OR = 2.38) were significantly more likely to have contacted the service. Although 89% of service users perceived the intervention positively, only 26% felt it had contributed to sexual behaviour changes. Conclusions: The ‘mobile-unit’ outreach model contacted a large proportion of PSE users, specifically men who had greater health needs. We advocate the adoption of this outreach model over traditional PSE-based outreach approaches. Contact efficacy evaluation is useful to assess ongoing health interventions. However, caution must be exerted when interpreting certain contact efficacy results. Since causality may not always be inferred, triangulation with other evaluative methodologies is recommended.

Additional keywords: evaluation, gay men, intervention, outreach work, sexual health promotion.


Acknowledgements

Our thanks go to Tim, Brian and David, whose voluntary research work made this study possible, to Lee and Steven for their help and of course, to the men who took part. This work was funded by City of Brighton and Hove Primary Care Trust


References


[1] Dodds J,  Nardone A,  Mercey D,  Johnson A. Increase in high risk sexual behaviour among homosexual men, London 1996–1998: cross sectional, questionnaire study. BMJ 2000; 320 1510–1.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[2] Elford J,  Bolding G,  Sherr L. High-risk sexual behaviour increases among London gay men between 1998 and 2001: what is the role of HIV optimism? AIDS 2002; 16(11): 1537–44.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[3] Williamson L , Hart G . Changes in HIV-related sexual risk behaviour among gay men in Scotland, UK. In: AIDS Impact: Biopsychosocial aspects of HIV infection, 6th International Conference, 2003, Milan, Italy.

[4] Ekstrand M,  Stall RD,  Paul JP,  Osmond DH,  Coates TJ. Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status. AIDS 1999; 13 1525–33.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[5] Rosser B,  Bockting WO,  Rugg DL,  Robinson BE,  Ross MW,  Bauer GR,  Coleman E. A randomized controlled intervention trial of a sexual health approach to long-term HIV risk reduction for men who have sex with men: effects of the intervention on unsafe sexual behavior. AIDS Educ Prev 2002; 14(3): 59–71.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[6] CDC Increases in unsafe sex and rectal gonorrhea among men who have sex with men. San Francisco, California, 1994–1997. Morbidity and Mortality Weekly Report 1999; 48 45–8.
PubMed |

[7] Fox K,  del Rio C,  Holmes KK,  Hook EW,  Judson FN,  Knapp JS, et al. Gonorrhea in the HIV era: a reversal in trends among men who have sex with men. Am J Public Health 2001; 91 959–64.
PubMed |

[8] Wolitski RJ,  Valdiserri RO,  Denning PH,  Levine WC. Are we headed for a resurgence of the HIV epidemic among men who have sex with men? Am J Public Health 2001; 91(6): 883–8.
PubMed |

[9] HPA. AIDS and HIV infection in the United Kingdom: monthly report (July 2003). Commun Dis Rep CDR Wkly [serial online] 2003; 13(30). Available online at: www.hpa.org.uk/cdr/PDFfiles/2003/cdr3003.pdf [verified May 2006].

[10] HPA., AIDS / HIV Quarterly Surveillance Tables. Cumulative UK data to end December 2003. (April 2004).

[11] Kellogg T,  McFarland W,  Katz M. Recent increases in HIV seroconversion among repeat anonymous testers in San Francisco. AIDS 1999; 13 2303–4.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[12] Frankis JS,  Flowers P. Men who have sex with men (MSM) in Public Sex Environments (PSEs) – a systematic review of quantitative literature. AIDS Care 2005; 17(3): 273–88.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[13] Rhodes T,  Holland J. Outreach as a Strategy for Hiv Prevention - Aims and Practice. Health Educ Res 1992; 7(4): 533–46.


[14] Aggleton P , Jordan S , Stoakes P , Wilton T . Outreach work with men who have sex with men. Report from a national consultation on outreach and detatched work with men who have sex with men. Bristol: Southmead Health Authority; 1992.

[15] Valentine J,  Wright-DeAguero L. Defining the components of street outreach for HIV prevention: The contact and the encounter. Public Health Rep 1996; 111 69–74.
PubMed |

[16] French R,  Power R,  Mitchell S. An evaluation of peer-led STD/HIV prevention work in a public sex environment. AIDS Care 2000; 12(2): 225–34.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[17] GMFA. 1995 Hampstead Heath Report. London: Gay Men Fighting AIDS (GMFA); 1995.

[18] GMFA. Hampstead Heath Project Report, November 1998. London: GFMA; 1998.

[19] Burnell C. A report on the 1999 Finsbury Park Project. London: GFMA and CHAN; 2000.

[20] Andersen MD,  Hockman EM,  Smereck GAD. Effect of a nursing outreach intervention to drug users in Detroit, Michigan. J Drug Issues 1996; 26(3): 619–34.


[21] Broadhead RS,  Heckathorn DD,  Weakliem DL,  Anthony DL,  Madray H,  Mills RJ, et al. Harnessing peer networks as an instrument for AIDS prevention: Results from a peer-driven intervention. Public Health 1998; 113 42–57.
PubMed |

[22] Collins C,  Kohler C,  DiClemente R,  Wang MQ. Evaluation of the exposure effects of a theory-based street outreach HIV intervention on African-American drug users. Eval Program Plann 1999; 22(3): 279–93.
Crossref | GoogleScholarGoogle Scholar |

[23] Latkin CA,  Sherman S,  Knowlton A. HIV prevention among drug users: Outcome of a network-oriented peer outreach intervention. Health Psychol 2003; 22(4): 332–9.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[24] Coyle SL,  Needle RH,  Normand J. Outreach-based HIV prevention for injecting drug users: A review of published outcome data. Public Health Rep 1999; 113 19–30.


[25] Christian J,  Abrams D. The effects of social identification, norms and attitudes on use of outreach services by homeless people. J Community Appl Soc Psychol 2003; 13(2): 138–57.
Crossref | GoogleScholarGoogle Scholar |

[26] Ziersch A,  Gaffney J,  Tomlinson DR. STI prevention and the male sex industry in London: evaluating a pilot peer education programme. Sex Transm Infect 2000; 76(6): 447–53.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[27] Rickard W,  Growney T. Using oral history in peer education for sex workers. Oral history 2001; 29(1): 85–91.


[28] Ronel N,  Gutter N. The Elem Vans: an outreach service for street youth. Hevrah u-revahah 2003; 23(1): 27–52.


[29] Miller D. Outreach work with gay and bisexual men on the Newcastle gay scene and in North Tyneside. Newcastle: Mesmac Tyneside; 1994.

[30] Flowers P , Frankis JS . The Sexual Culture of the Bushes and the Street Outreach Service: a qualitative investigation and experiential evaluation. Brighton and Hove: City of Brighton and Hove Primary Care Trust (formerly East Sussex, Brighton and Hove Health Authority); 2003. Available from J. Frankis, Glasgow Caledonian University.

[31] Williams L. The Street Outreach Service Report 1996. Brighton and Hove: Brighton Health Promotion Unit and Brighton and Hove Health Authority; 1996.

[32] Colon HM,  Sahai H,  Robles RR,  Matos DD. Effects of a Community Outreach Program in HIV risk behaviors among injection-drug users in San-Juan, Puerto-Rico – an analysis of trends. AIDS Educ Prev 1995; 7(3): 195–209.
PubMed |

[33] Wiebel WW,  Jimenez A,  Johnson W,  Ouellet L,  Jovanovic B,  Lampinen T, et al. Risk behavior and HIV seroincidence among out-of-treatment injection drug users: A four-year prospective study. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 12(3): 282–9.
PubMed |

[34] Kumar MS,  Mudaliar S,  Daniels D. Community-based outreach HIV intervention for street-recruited drug users in Madras, India. Public Health 1999; 113 58–66.


[35] Sergeyev B,  Oparina T,  Rumyantseva TP,  Volkanevskii VL,  Broadhead RS,  Heckathorn DD, et al. HIV prevention in Yaroslavl, Russia: A peer-driven intervention and needle exchange. J Drug Issues 1999; 29(4): 777–803.


[36] Hospers HJ,  Debets W,  Ross MW,  Kok G. Evaluation of an HIV prevention intervention for men who have sex with men at cruising areas in the Netherlands. AIDS Behav 1999; 3(4): 359–66.
Crossref | GoogleScholarGoogle Scholar |

[37] Scott P . Blind Spots: A review of the literature on men who make social and sexual encounters in public sex environments and their HIV-related risks. London: Barnet AIDS Education Unit and Brent and Harrow Health Promotion; 1998. Available online at: www.racoon.dircon.co.uk/spots/main.htm [verified May 2006].

[38] Williamson LM,  Hart GJ,  Flowers P,  Frankis JS,  Der GD. The Gay Men’s Task Force: the impact of peer education on the sexual health behaviour of gay men in Glasgow. Sex Transm Infect 2001; 77(6): 427–32.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[39] Rogers EM . Diffusion of Innovations. 2nd edn. New York: Free Press; 1983.

[40] Korf DJ . et al Outreach work among drug users in Europe: Concepts, practice and terminology. Luxembourg: Office for Official Publications of the European Communities, European Monitoring Centre for Drugs and Drug Addiction; 1999.

[41] Frankis JS,  Flowers P. Cruising for sex: sexual risk behaviours and HIV testing of men who cruise, inside and outwith PSEs. AIDS Care 2006; 18(1): 54–9.
Crossref | GoogleScholarGoogle Scholar | PubMed |

[42] Flowers P, et al. Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland? Int J STD AIDS 2002; 13 102–8.
PubMed |

[43] Frankis JS , Flowers P . Process Evaluation of Street Outreach Service provision to men who have sex with men: monitoring and audit of existing services. Brighton and Hove: City of Brighton and Hove Primary Care Trust (formerly East Sussex, Brighton and Hove Health Authority); 2003. Available from first author, Glasgow Caledonian University.

[44] Hickson F . et al Out and About: finding from the United Kingdom Gay Men’s Sex Survey 2002. London: Sigma Research; 2003.

[45] Frankis J , Flowers P . Examining the sexual health experiences of men who cruise public sex environments: sexually transmitted infections (STIs), hepatitis vaccination and STI clinic use. J Psychol Human Sex, in press.

[46] French R . et al The GMFA Hampstead Heath Project Evaluation – An evaluation of a community-based STD/HIV prevention work in a public sex environment. London: The Department of Sexually Transmitted Diseases, University College London Medical School; 1997.