Responding to an alarming rise in HIV incidence among MSM in Thailand, Mplus, a community-based organisation formed to improve the sexual health of men that have sex with men (MSM), produced animations for their HIV/AIDS outreach and prevention programs. The animations are new educational resources produced to increase understandings of safe sex practices and address low perceptions of personal risk to HIV/AIDS among Chiang Mai’s diverse MSM population.
Mplus works to provide HIV/AIDS outreach and prevention to the diverse community of MSM in Chiang Mai. This includes men who identify as gay or bisexual, transgenders, Thai and migrant male sex workers and “hidden” MSM who can be homosexual, bisexual or straight. Reflecting the community to who they provide outreach, Mplus produced animations to be used as an educational resource in each of the communities identified above. The animations are context specific to needs of Chiang Mai’s MSM community as identified in the research, but Mplus is using them in regional HIV/AIDS outreach and prevention. The animations will expand Mplus’ innovative HIV prevention, where outreach workers take condoms and safe-sex information to places where MSM meet for sex to make their use more acceptable and less stigmatised.
Mplus understands organised responses to HIV/AIDS must begin at the community level and that community engagement is an essential part of HIV/AIDS prevention. To produce the animations, Mplus first researched the sexual practices of young MSM, transgenders, Thai and migrant male sex workers (MSW) to focus on understanding their sexual practices as they are socially produced. Then, using the data generated from the research, they co-authored narratives, drafted storyboards and produced animations making use of powerful context-specific, stories generated through interviews with MSM, MSW and transgenders in their local community.
The animations will help MSM understand the risks associated with various sexual activities and the consequences of unsafe sex for themselves and their partners/spouses. The animations will also attempt to provoke emotional reactions from viewers as they become closely familiar with the thoughts and feelings of characters, some of who became HIV+ in contexts and situations familiar to those of their local community.
Jit Srichandorn, an Mplus outreach worker says: “It is not easy to get our clients to change their behaviour, but the animations offer a screen-based resource with sound and moving images that provokes them to think differently about their risk to HIV. It also gives us a new educational resource to use in our peer- outreach that generates a lot of discussion.”
The first animation warns of the danger of connecting for sex on the Internet and drinking alcohol at local disco and ‘forgetting” to use a condom. The animation helps viewers—specifically young MSM—understand the risk associated with alcohol and unprotected sex as well as the proper use of a condom to prevent HIV/AIDS.
Mplus produced the second animation to empower transgender individuals to negotiate condom use with their partners. The narrative resonates with their lived experiences and provides a catalyst for informed discussion in outreach to this population that goes beyond simply advocating condom use. It is about raising awareness and self esteem.
Mplus produced the third animation to be used in their outreach to male sex workers and then translated it into three local dialects (Karen, Shan & Burmese). They are currently using this animation in site-based peer-education programs to help migrant sex workers understand personal risk to HIV before they engage in sex work. Learchai Keawyoo, who provides outreach to this population says: “I don’t speak the Shan dialect, but having this animation in Shan provides me with a resource that is engaging and easy for MSW to understand. After they view the animation, they have safe sex information in their own language.”
The fourth animation was produced for ‘hidden MSM’. Thailand has a ‘hidden’ subgroup of MSM who do not identify themselves as gay or bisexual and it is difficult to target them with HIV prevention outreach. It is believed these men meet in a secretive and marginalised fashion in parks, restrooms, or other public places. Frequently, the male-to-male sex between these often masculine-identified MSM happens quickly and furtively due to the location. This lack of time often leads to unsafe sex without condoms. It is important to point out that HIV epidemics move from vulnerable groups to the general population when there are links between the two. The link between MSM, MSW and women in Thailand is well established. This animation aims to educate ‘hidden’ MSM about their personal risk to HIV as well as the risk the pose to the women they have sex with. These often cohabitating, primarily heterosexual, female partners/spouses now represent one-third of all new HIV/AIDS cases in Thailand.
Mplus is incorporating the animations into a locally-adapted and community-based Popular Opinion Leader program. This is an HIV/AIDS risk-reduction program in which groups of trusted, well-liked people are recruited and trained to conduct a particular type of peer outreach. Mplus+ choose this model because it has shown evidence of being effective in decreasing risk behaviours in racially and ethnically diverse groups of MSM. By using animations in their outreach, popular opinion leaders will be able to provide a compelling visual educational resource that can also be shared via Bluetooth technology. Mplus hopes individual MSM will begin to share the animations on mobile phones in their networks to raise awareness to personal risk to HIV/AIDS. Additionally, Mplus is incorporating the animations into an online peer education program. Mplus shows the animation in their current site based HIV/AIDS outreach and prevention programs at universities, workshops, bars, saunas, massage parlors, karaoke lounges, and brothels.
Mplus’ animations will help MSM and MSW understand HIV prevention through descriptions of bodily fluids that transmit the virus, how bodily fluids are transferred into the human body, and various context-specific scenarios where risky behaviour may lead to HIV infection. Importantly, the animations will also model practical ways of increasing the ability of MSM and MSW to negotiate safe sex with potential partners or clients. This kind of collaborative research built stronger alliances between MSM and MSW (of all genders) and is improving advocacy efforts around sexual health and rights, particularly in relation to HIV/AIDS prevention in Chiang Mai.
Mplus produced the animations with the help of a grant from The Australian Association of AIDS Organisations (AFAO) in collaboration with researchers from The Open University (UK) and The McCormick Faculty of Nursing, Payap University (Thailand). Mplus is currently working in collaboration with The Open University (UK), The Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights (RFSL) and Bridges Across Borders South East Asia (BABSEA) to expand their outreach and prevention programs in a new project funded by The Foundation for AIDS Research (amfAR). For more information visit Mplus at www.mplusthailand.com. The animations were made by Lanna Media in Chiang Mai.
Dr Christopher S Walsh is a Senior Lecturer in Educational ICT and Professional Development at The Open University (UK) and works as a volunteer with Mplus. Nada Chaiyajit is a transgender activist and volunteer at Mplus, and Pad Thepsai is Mplus’ drop-in manager.