SHOWCASE August 7, 2017

Overcoming Challenges to Set Up On-site HIV Testing in Gay Saunas: Good Practices from AIDS Concern Hong Kong

Hong Kong is a special administrative region in China with a population of seven million people. In 2014 there were 750 new HIV/AIDS positive cases identified, compared with 317 cases in 2004. The number of new HIV cases among MSM has risen over the last few years making up today’s three-quarters of all new infections, with 15 people being diagnosed every week.

The trend of the epidemic has also changed. It is shifting from MSM of the age group of 30 to 50 years old to the lower age group. Today, the MSM who are most at risk of new infections is between 20-29 years old. If the rising rate of infection continues to grow, there is a risk that, in 10 years from now, the epidemic among MSM in Hong Kong could be comparable to many other urban Asian cities with extremely HIV prevalence among MSM.

There are a number of barriers to raising the testing uptake rate among MSM. Many will not go to the public or general hospitals or clinics as they are afraid that the providers will not be gay-friendly and/or the lack of confidentiality and anonymity provided by these healthcare providers. For this reason, AIDS Concern is aware that, in order to elevate the uptake, the testing needs to be provided in an environment that is MSM-oriented, but also confidential and anonymous.

AIDS Concern‘s testing service was the first in Hong Kong to use rapid testing and now this approach is adopted by the government and other NGOs in Hong Kong too. Today, AIDS Concern operates multiple MSM-friendly testing services across various districts. The Kowloon testing centre alone is performing over 5,000 tests among MSM in the past year. Among these sites are the mobile testing clinic at gay saunas. These pop-up clinics make the testing for MSM easy, accessible, and excluded from the unwanted public exposure. On top of that, the testing is free of charge.

However, in their early years of erecting pop-up clinic in gay saunas, collaborating with the sauna’s owner and convincing their clients to get tested is definitely not a walk in the park. Below, AIDS Concern shares the challenges they faced and discusses how they get around them.

 

Challenge #1: Negotiating with the Saunas’ Owners

In the early years of proposing a pop-up testing site in gay saunas, there was a lot of opposition from the saunas’ owners. They are afraid that the existence of HIV testing within their premise will scare away their customers. AIDS Concern responded tactically to their apprehension. AIDS Concern strategically educated the owners with the long-term effect of the rising HIV epidemic among MSM to the business’ reputation and long-term goal. A sauna that cares about their customers’ sexual health surely provides a competitive advantage to the sauna that does not. And less MSM living with AIDS means more or stable market.

Once the owner gave a green light, AIDS Concern engaged the owner throughout the whole process: from the planning until the execution. Through repeated contact and dialogue – a step by step convincing stratagem – the initiative started to bloom. Sex-ed posters grace the premise. The jars of condoms and lubricant along with the leaflet about the free testing services fill every corner of the building. The pop-up testing site gets its own space within the premise. The site is visible but hidden enough to ensure the privacy of the testee. AIDS Concern understands that the assurance of privacy while doing the test helps the client to be more comfortable on opening up their sexual history to the counsellor. The erection of the on-site clinic is then followed by AIDS Concern’s MSM staff scheduling their turn to man the site. A trusting rapport between the owners and AIDS Concern was eventually built. Today, many of gay saunas in Hong Kong see the availability of free, anonymous and confidential HIV testing as part of the complimentary service to their customers.

 

Challenge #2: Convincing the Sauna’s Customers to Take the Test

Having erected a testing site in the sauna is not the finish line. The new challenge arises: how to get the customers of the sauna take the test. While there is a number of customers who actively approach the testing site on their own initiative, there is also a group of visitors who fully ignore the service, or worse, shy away when getting approached by the staff. This brings to AIDS Concern staff repackaging how they “sell” the service. A gentle approach, not hard-selling, is imperative. Starting off with a friendly conversation on casual topics – not related to sexual health – works better than jumping directly to offering the testing service. Over the time, most of the frequent visitors of the sauna understand that the on-site testing is there for their own good and there is less and less “gentle approach” needed to convince them to take the test.

 

Challenge #3: Ensuring the Test Conducted Thoroughly

AIDS Concern operates their testing sites with more than 17 trained staff and volunteers who are able to conduct a rapid test as well as pre- and post-test counselling. The staff and the volunteers understand that a proper clinical and non-clinical environment and assurance of standard procedure is essential to maintain the quality of the testing service. The pre-test counselling is thoroughly conducted by the staff to give the client a glimpse of what to expect in post-test counselling. During post-test counselling, AIDS Concern staff recognizes that delivering a positive test result to a client is a huge responsibility. The staff is fully aware that the way people react to test results depends to a large extent on how thoroughly the counsellor has educated and prepared them both before and after the test. Thus, AIDS Concern’s testing process, particularly the counselling, will be consistently conducted and done in the right pace, even when the client asks to skip the pre-test counseling. More importantly, AIDS Concern arranges for confirmation testing and follow up information and support to the client who tests positive.


About AIDS Concern Hong Kong

Get set, go for equal rights! – AIDS Concern team championing equality at the 2017 Hong Kong Pride

AIDS Concern was established in 1990 as the first non-government charity organisation committed to the service of AIDS care in Hong Kong. The founders were a group of volunteers from different backgrounds dedicated to improving the living standards for people living with HIV/AIDS; and to stop the spread of HIV/AIDS. With their specific MSM Team, AIDS Concern has been conducting HIV services targeting gay men and other men who have sex with men (MSM) across Hong Kong and its bordered area with mainland China.


Header image caption: The MSM Team of AIDS Concern promoting the “Get an Early Test” campaign at the most recent (AIDS Concern, 2017)