‘The Heat of the Moment’.

1. ‘The Heat of the Moment’. An innovative resource to address risk reduction with gay men at post HIV test discussion Melanie Ottewill – Senior Health Adviser, BSUH Alex Pollard – Terrence Higgins Trust

2. Outline of session • Rationale for resource development • Evaluation partnership • Methods/recruitment • Results • Conclusions & recommendations

3. Rationale for resource development • MSM – knowledge vs behaviour • Information vs individualistic approaches • Self-justifications (‘Hot-thoughts’) • Post test intervention

4. ‘The Heat of the Moment’

5. Evaluation Partnership A Bio-Psycho-Social approach to health promotion: • GUM Service – Claude Nicol Centre for Sexual. Health • Clinical Psychologist (HIV Specialist) – • Sussex Partnership Trust • Community Organisation – Terrence Higgins Trust

6. Methods / Recruitment • Planning • Target audience • Two stage evaluation: HA’s telephone follow-up Clinical Psychologist telephone follow-up

7. First stage Results • Demographics 48 men invited to participate 38 men agreed to participate 22 were able to be contacted. 21 completed evaluation • Educational level: (Total 38) Degree+ 10. Diploma 3. A level 4. GCSE/O 6. Not Recorded 2. • Age: Range 17 – 61 Average 34 Mean 36 • Numbers of previous HIV tests: Range 1 – 11 Average 2.3 Mean 2

8. First Stage Findings (page 1) • Average length of time to read: 25 minutes • How easy to Understand? Very Easy. Easy. Neither. Difficult. Very Difficult 9 12 - - - • How Relevant to your risk taking? Very Relevant. Some Relevance. Not at all relevant. 10 11 -

9. First Stage Findings (page 2) • Effective in prompting reflection on own use of Hot Thoughts? Yes No 18 (86%) 3 (14%) • Did you find it useful? Very Useful Useful Not Useful 4 16 - • Can you apply anything you’ve learned? Yes No 20 1

10. Second stage Results • Clinical psychology follow up was qualitative, using verbatim transcripts from semi-structured telephone interviews. • ‘What do participants make of the booklet as part of post test discussion?’ produced salient (not counted) themes. • Interpretative Phenomenological Analysis (IPA): to gain insight into participants’ assumptions, feelings, meanings and actions as reflected in their verbal responses. • 12 participants agreed to further interview, but only 3 are reported here.

11. Second Stage Participants • Alan, 45 2 previous HIV tests Read the booklet the day after seeing the health adviser. • Bob, 54 3 previous HIV tests Read the booklet 5 days after seeing the health adviser. • Chris, 37 7 previous HIV tests Read the booklet 10 days after seeing the health adviser. • All: White, educated to diploma or degree level. None had heard of ‘hot thoughts’ before. Read the whole booklet, felt it was useful, and would apply what they had learned to future sexual situations in future.

12. Preliminary Findings - Theme 1: • Written material enhanced post test discussion and reinforced information and thoughts. • ‘Because that’s what the book did. The whole booklet, really, is like to reinforce the thought that’s going through my head … It’s nice to see it in writing’ (1:19) • ‘It was about 12 lines down … the difference between safety and passion – somewhere round there. It was one of the characters wasn’t it? There was definitely something in the booklet, yes, definitely. It was, you know, written in those few lines – a moment of [pause] lust’ (5:16) • ‘Like there it is, in your face, like’ (6:5) Alan • ‘It’s like it’s … brought it into focus’ (2:10) • ‘Yes, the booklet’s good and she [the health adviser] was good, but the two together made a focus. I needed her to point out what I’d been doing with most people, and then how I’d been doing with a regular partner was like the thoughts in the booklet’ (5:21) Bob • ‘It’s having it in front of you in black and white’ (1:9) • ‘It basically highlighted things which I already knew’ (1:18) Chris

13. Theme 2: • Illustrating the gap between thoughts and behaviour • Use of the booklet in post test discussion led to reflection, bringing thoughts and behaviours from the past – and risk taking – into participants’ awareness. • ‘I think it’s a simple case of we all go and miss sometimes, with our morals, if you like … actually did that for me, it did make me reflect on times when I’d been somewhat out of order’ (1:8) • ‘ … and that is what the booklet, and coming up to the clinic, has actually done for me this time’ (5:22) Chris • ‘ … it’s that reading the booklet made me realise that, you know, you can’t just keep going on and on. The same old, “Not this time, not this time, not this time”, and, er, it just helped me realise’ (1:5) Alan • ‘It’s hard to say exactly … some of the situations in the leaflet. It makes you look back on what you’ve done and think in a different way, that … maybe I wasn’t as safe as I wanted to be’ (1:14) Bob

14. Theme 3: • Declaration of intent to change • A commitment to change was expressed, but two participants were not in a position to test this out with new sexual contacts at the time of interview. • ‘… it won’t ever happen again. It’s stopped me completely … Yeah, I think I can, hand on my heart, yeah. It won’t ever happen again’ (1:12) • ‘Simply I’ve made the decision that it won’t ever, ever happen again’ (4:2) Alan • ‘Well, I would like think so [that his ability to avoid unwanted risks has changed] but my • circumstances at the present time – I am in a regular relationship, so the “hot thoughts” scenario is not as prevalent as when I am a single man on the club scene and out partying’ • (2:14) Chris • ‘Yeah, now I do recognise times when I might have to use condoms, when I wouldn’t have before’ (3:1) • ‘…I’ll be thinking about how even people you’ve known a long time may not be safe’ (4:15) Bob

15. Issues • Small numbers - difficulties of telephone follow up and lack of resources • Participant criticisms (hot thoughts concept; booklet alone insufficient; influence of alcohol/drugs needs higher profile) • No clear evidence of use of ‘hot thoughts’ strategy for behaviour following post test discussion • Indications of • Post test discussion enhanced by Heat of the Moment resource. • Dissonance/ambivalence created by gap between thoughts and behaviour. • At least shift from pre-contemplation to contemplation.

16. Conclusions and Recommendations • Effective Partnership Working • Action research: where testing carried out, by those who provide the service • Cognitive Behavioural and MI effectively transferred to paper • Booklet is Accessible, Acceptable and Effective • Significant enhancement of post-test discussion • Possibility of affecting testing practice and policy • We advocate further study of people’s experience of HIV negative post test discussion

17. Thanks and Questions • Thanks to: Dr Heather George Consultant Clinical Psychologist THT Campaigns Volunteers Health Advisers Claude Nicol Centre for Sexual Health (Brighton) Dr Ron Gold Deakin University, Australia Evaluation participants

18. Contact us • Melanie Ottewill – Claude Nicol/Lawson Unit, Brighton. melanie.ottewill@bsuh.nhs.uk • Alex Pollard – Terrence Higgins Trust alex.pollard@tht.org.uk Copies available here!