Implications for action

Since the issue of gay menʼs health was originally chosen by the community-based organization (CBO) and this project has been carried out as a community-research collaboration, research findings have played a decisive role for the project teamʼs choice and design of new interventions. Although several priorities became immediately apparent upon review of the initial findings in 2003, a step-wise approach has been taken to implement new interventions, addressing gaps by revamping 1) community activities and 2) HIV work and 3) embarking on a new health priority mental health.

Impact on community activities

The very first follow-up activity for GGMHS was to provide feedback to the local gay community by presenting them with a community health profile in the form of an attractive 25-page brochure in 2003. Just as the project team saw most data for the first time, many in the community would also be seeing many findings for gay men across a broad cross-section of health domains for the very first time. The

brochure—available as both paper copy and online pdf—proved to be very popular, and outreach workers confirmed great community interest in the two printings.

During the focus groups, many participants expressed tremendous benefit in listening and talking with other gay men about their lives and concerns. Most spaces for gay

men are sexualized, and the gay press tends to emphasize lifestyle over actual lives. In 2004, Dialogai reorganized their community activities around a new program “Être gai ensemble” (Being gay together) which consciously strives to create events for gay men to share socially with one another about their lives and experiences. The

formats include discussion groups, workshops, talk shows, and lectures, with different thresholds of moderation and participation.

As a response to the long-standing demand for gay-friendly care providers and GGMHS data on communication and coming-out between gay patients and their doctors, Dialogai launched a community-wide call to gather names of trusted providers from gay men in Geneva. Dialogai then interviewed each provider personally, and 130 gay and gay-friendly providers in 30 areas of expertise were included in the mapping for Geneva. Between 2004 and 2009, 150 requests were made annually. Since 2009, the list has been available online with a modern Google maps application.

Revamping HIV work within the context of sexual health

The GGMHS confirmed deficiencies in HIV counselling uncovered in the Zürich Menʼs Survey in 1998: nearly half of gay men (44%) did not receive any counselling at all during their last HIV test. As a response to this missed opportunity, the project team decided to open the first gay HIV and STI testing service in Switzerland which would guarantee best practice in counselling and facilitate the introduction of rapid HIV testing (Determine HIV-1/2) into Switzerland. A counselling manual was created based on state-of-the-art recommendations, and a new computer-assisted self- completed intake form provided a personal and behavioral profile for use in the patient-centered consultation lasting 30 minutes on average.

Checkpoint was a revolutionary re-thinking of HIV services in Switzerland. Until its inception, there had been a strict separation between HIV prevention and HIV testing/care, with the medical health services dominating the latter. Bringing a medical service into a community organization setting was highly innovative in a country with almost no tradition in community health. Furthermore, services targeting a certain sub-population rubs against the French Republican and medical principles of one model (or doctor) fits all. Checkpoint Geneva opened its doors in 2005, and the evaluations have shown high levels of recognition, uptake, and patient

satisfaction with the combination of high medical professionalism and open

communication with gay and gay-friendly providers. Based on its success, the model was adopted by the Swiss Federal Office of Public Health and has been actively replicated in other major cities like Zurich, Lausanne, and Basel. Checkpoints for gay men have also spread to other European cities like Barcelona, Cologne, and Munich.

Based on their first-hand observations, the outreach workers in the gay venues and the staff at Checkpoint have been able to confirm additional health concerns as evidenced in the GGMHS. HIV is simply not the main health concern for most gay men. Rather than using HIV as the vector to explore other health issues, outreach workers and staff have found that men are more responsive to other health issues, with HIV messages being tacked on as needed. As such, outreach workers—whose main mandate is HIV prevention—have been approaching gay men with other

materials from the gay menʼs health project. This development confirms the utility of a gay menʼs health approach for HIV prevention.

Embarking on a new health issue: mental health

It was already apparent in 2003 from reviewing the initial findings that mental health would constitute a major priority, leading to the in-depth analyses and reports in Chapters 3-5. However, at that time, the project team—all with long-standing

experience in HIV—did not have the competencies necessary to conceptualize and launch activities in the new priority area of mental health. As such, the

aforementioned activities were launched in areas closer to available competencies. During this time, however, the core members of the project team received training in mental health—e.g., psychology, psychotherapy, buddhist psychology, and

psychiatric epidemiology. Whereas the topic of HIV was not particularly relevant to lesbians, mental health touched on issues important to both gay men and lesbians and offered a possibility to engage lesbian organizations in health and collaborate jointly on a community intervention.

No community-based interventions in mental health for gay men (and lesbians) was found. As such, the decision was taken to select evidence-based interventions for the general population and adapt them for gay men and lesbians. Australia proved to be a particularly innovative source of research and interventions [Jorm, 2012], and online interventions (including therapies) have been growing worldwide. The mental health project would begin with a depression campaign based on the Alliance Against Depression [Hegerl et al., 2008] model which had been shown to be effective in suicide prevention in Germany and rolled out across Europe. The elements of the depression campaign resembled HIV campaigns which Dialogai was already familiar with and facilitated the transition to a new health issue. After a three-year

preparation, Blues-out—the first evidence-based gay/lesbian depression awareness campaign in the world—was launched in 2009. Blues-out was so well conceived that it actually served as a template for the roll out of the mainstream Alliance Against Depression in the canton of Geneva. Chapter 6 presents the scientific outcome evaluation for Blues-out, and although the campaign accomplished comparable levels of recognition as the general population campaigns, there was no improvement in recognition of depression. Dialogai is capable of achieving much higher