The Australian Gay Community Periodic Survey (1998-2010) tells us that 1 in 8 sexually active gay men have never tested. Michael Atkinson (WA AIDS Council) talks about a strategy to address barriers to testing and to promote testing culture - the MClinic. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.

1. Introduction
Name: Michael Atkinson
Organisation & Project: WAAC – Coordinator M Clinic
Topic: The Role of Peer Educators in addressing Barriers & Motivations to HIV
Testing
The goal of infectious diseases screening is to test the asymptomatic population, find cases before they
become symptomatic or are passed on; treat them and in doing prevent spread amongst high risk groups.
A key objective of sexual health screening is for high risk populations to test appropriately according to their
sexual health behaviour. A regular testing pattern needs to be established according to number of partners
and types of behaviour including UAI and sharing injecting equipment.
Asymptomatic screening can reasonably seem paradoxical to those being tested. Without symptoms there is
no strong call to action and potentially little or no perceived benefit. For example, at your average sexual
health clinic with a HIV yield of 1% ‐ 99 out of 100 people leave the clinic with little more to show than relief
or piece of mind.
Therefore, for screening to work we need to make it as easy as possible by removing physical, structural and
psycho‐social barriers. We need to provide accessible services, ideally including a variety of options that
work to engage different testers.
On the surface the testing process is not particularly complex (slide #1):
• One makes an appointment
• They make their way to the clinic
• Talk about their sexual behaviour
• Provide specimens
• Return for their results
• Schedule next appointment
• And on it goes…
However, if testing is truly this easy why does the Australian Gay Community Periodic Survey (1998 ‐ 2010)
tell us that 1 in 8 sexually active gay men have never tested?
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2. ‐ These rates are much higher for Under 30 year olds.
The reality is people can encounter a range of complex personal, lifestyle, social and psychological factors
that intervene in the testing process (slide #2):
• Stigma and discrimination associated with HIV status and sexuality –
‐ I recall a client who took ten years to test after a night of passion. He said he wasn’t prepared to deal
with a positive HIV result – his main concern being the shame associated with telling his family. The client
spoke about the significant impact this decision had on his sex life and frame of mind over the 10 years. The
client tested negative and left the clinic a very different person.
• Anxiety – most clients experience some degree of anxiety at some point along the testing process –
whether it’s fear of needles or swabs, having to do the pre‐test discussion, or getting the result. Some level
of anxiety can actually work as a positive motivator to test ‐ however we have certainly witnessed our share
of clients who put off testing due to anxiety.
• Guilt & shame – guilt for having potentially infecting others, and we also still regularly talk with
clients who express shame about having been a “bad” gay citizen for slipping up and enjoying UAI.
• Relationship dynamics – notions of trust
• Lifestyle barriers ‐ people are busier than ever
• Physical barriers – distance from services
• Culture and religion
The M clinic was set up specifically to address barriers to testing and to promote testing culture (slide #3).
• Community setting
• Gay Friendly ‐ Staffed by a mix of peer and clinical staff
• Same day appointments
• Convenient open times and location
• Free & quick service
• Attractive branding
• Neutral setting ‐ increase MSM comfort
• Good parking and public transport
• Confidential
Establishing a community based screening facility is quite an involved undertaking. Luckily for me, WAAC has
a long history of providing community based screening services which hugely assisted with the process of
establishing the M Clinic:
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3. 1) We have ran an outreach clinic in the 2 sex on promises venues for the last 21 years; and
2) We have run an asymptomatic clinic from the WAAC office in West Perth for the last 5 years.
Essentially the M Clinic arose from these two projects where a lot of the leg work was already done. WAAC
had formed excellent working relationships with laboratory service providers, the Department of Health,
contact tracers, numerous physicians in the sexual health sector and most importantly the client group.
They had already established the testing algorithm, the risk assessment tool and policy guidelines all of
which Have been adapted to the M Clinic setting.
Today, the M Clinic is a screening clinic with all the usual bells & whistles much like tertiary and other clinics.
The key point of difference at the M Clinic is the engagement of qualified peers (gay men) who are involved
in all aspects of the clinics operation which works to ensure the service is acceptable to the target group
(slide #4):
• Clinic coordination
• Service delivery
– Reception: greet clients, triage, informal education
– Pre‐test discussion: hand over to nurse/doctor
– Post‐test discussion: education and referral, giving positive results
– Specimen collection
– Treatment
• Administration and Data Collection
• Clinical Governance including research
Peer educators are trained to conduct pre & post‐test discussions, which involve motivational interviewing
techniques that are used to address the aforementioned motivational barriers that can interfere with
establishing appropriate testing regimes, and to some extent impact risk behaviour.
Peer Educators make clients feel comfortable by providing no judgement and an intrinsic understanding
which allows clients to talk openly about an age old sensitive subjects – including sex, mental health,
substance use etc.
Since establishment in July 2010 the M Clinic has reported the highest number HIV notifications among
MSM from a single clinic in WA. We have diagnosed 18 cases in a 17 month period. Since November 2011
the M Clinic has diagnosed 50% of WAs MSM HIV cases. We started 2012 with an alarming 9 diagnoses in 9
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4. weeks – all of which were incident cases. WAAC has responded by teaming up with the Kirby Institute to
explore whether this recent surge in HIV infections is due to changes in risk behaviour and/or testing
behaviours – of interest we are keen to establish the role of the community or peer model in identifying this
high case load.
As a part of the research, the Department of Health provided an analysis of all MSM HIV infections in WA
between 1 July 2012 and March 31 2012. One conclusion relates to the reasons for testing:
 Newly diagnosed MSMs were more likely to test at the M Clinic than any other setting
because of risky behaviour – suggesting that the men preferred to talk to a peer about their
behaviour.
It is also the goal of peer educators to create a positive spin to get people into an appropriate testing
regime. Being members of the community helps peer educators to appeal to client’s sense of altruism and
to contribute to community and public health outcomes.
Peers are also involved in developing appropriate social marketing concepts which aim to influence
normative testing behaviour. Peers use their understanding of their community to develop messages that
promote the benefits of testing with a view to changing their views of testing norms.
Anecdotal evidence and feedback some clients suggests they see it as a ‘badge of honour’ to test regularly
and contribute to the community good.
In summary, the peer model is an empowering approach in and of itself, which translates to the community
in a positive way. A peer lead service speaks volumes to the clientele.
The M Clinic has attracted strong support from the community and is generating excellent yields. At the
moment we are participating in several research projects (Namely the WA Sexual Health Services Survey
being conducted by the Kirby Institute), that will potentially validate the effectiveness of the
community/peer model. In the mean time I will be bold to say I believe the peer model works (biased
much). However, I am not claiming we have found the panacea for testing and am quick to say that I also
believe the model does not suit everyone.
It would be convenient for service providers if gay men were a homogenous group and we could develop a
one‐size‐fits‐all service. I don’t believe this is possible. One thing WAAC has learnt over the years is there are
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5. a variety of testers requiring different approaches to get them across the line. Some will always prefer the
traditional medical setting, others prefer to test in the privacy of their home, while others who are fortunate
to have an understanding GP prefer to access a holistic medical service.
I believe the successful application of the peer model to sexual health screening presents a unique
opportunity to re‐engage gay men in broader health promotion programs. Furthermore, I also think it can
be explored as a platform for delivery for innovations such as combined prevention – particularly treatment
as prevention and PrEP.
Thank you for listening
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