Summary of the impact

Mowlabocus' research (2006-present) on gay men's social-media-use practices and new sexual-risk behaviours has led to new understandings of the role of media in health interventions. It has also led to changes in the health promotion and intervention practices of sexual health charities including the Terrence Higgins Trust (THT), as well as in statutory services, including those offered within Brighton and Hove City Primary Care Trust, which covers an area with the highest UK percentage LGBT population and a very high incidence of HIV diagnosis and infection. These changes include, in the case of THT, the development and use of a new information website and intervention toolkit — designed to decrease the spread of HIV amongst those engaged in unsafe behaviours — which is being used in training for its staff across its 31 regional offices in the UK.

Underpinning research

Key researcher: Dr Sharif Mowlabocus, Senior Lecturer in Media Studies/Digital Media, at University of Sussex, 2006-present.

One of the most important informing contexts of Mowlabocus' research is the reality that gay and bisexual men, together with non-self-identifying men who have sex with men (MSM), continue to make up the community the most at risk of HIV transmission in the UK. Research by Sigma in 2010 confirmed that transmission rates cannot be comfortably understood as resulting from deficits in the knowledge of harm reduction strategies. This finding suggests that conventional health education methods are either failing to address sections of the community the most at risk of sero-converting or are failing to have the desired result of effecting positive changes in sexual behaviour. Meanwhile, in its 2011 publication Making it Count 4, HPE (formerly the CHAPS partnership), the national HIV prevention programme for England, identified a series of strategic objectives, including pledges to a) investigate whose opinions gay and bisexual men regard the most highly, and b) act to encourage those people to express positive attitudes towards not transmitting HIV infection / remaining uninfected.

In this context, since 2006, Mowlabocus has researched the use of digital media technologies by gay and bisexual men in their negotiation of sexual identities and practices. His key research methodology is based on the textual analysis of a corpus of digital sexual material (including pornography and sexual social-media use), in order to identify common themes, generic conventions and sexual `markers'. These underpin the development of interview questions about sexual identities and practices, in relation to this material, that are subsequently tested using pilot groups with external moderators and, once refined, employed in focus groups whose participants are recruited using on- and offline methods. Newer research has entailed shared action research with THT, developed with EPSRC funding.

Mowlabocus' research has made a contribution to the current health promotional and clinical contexts described above in three specific ways:

• It has identified the central role that digital forms of communication play within gay/bisexual/MSM's negotiation of sexual identities and practice. In so doing, it has articulated the need for sexual health promotion both to acknowledge digital subcultures and to incorporate web-based and social media platforms within intervention strategies.
• It has identified the challenges that gay and bisexual men and MSM face in reporting unsafe sexual preferences and desires within clinical and outreach settings. The research points (i) to the difficulties such men have in articulating desires that run counter to their understandings of how to have safe sex and the (self-)censoring that occurs within health promotion and other subcultural contexts, and (ii) to the consequences of those difficulties.
• It has identified the role that pornographic imagery plays within the lives of gay and bisexual men and MSM and the challenges that the recent rise of `bareback' pornography (imagery that does not include condom use) poses to men who are negotiating sexual desires and healthy sexual practices that may well be mutually exclusive.

References to the research

R5 Terrence Higgins Trust Research Grant awarded to Sharif Mowlabocus for `Informed Passions'. Grant dates: 1 January 2011 to 30 April 2011. Amount: £2,950.

R6 EPSRC Cultures and Communities Network Grant awarded to Sharif Mowlabocus for `Reaching Out Online'. Grant dates: 1 June 2013 to 30 November 2013. Amount: £19,280 (http://www.communitiesandculture.org/news/additional-funding-for-reaching-out-online/).

Outputs can be provided by the University on request.

Details of the impact

Mowlabocus' research has informed and changed the approaches to the health promotion of beneficiaries, including the Terrence Higgins Trust (THT), the UK's largest HIV prevention charity. Through THT, the broader community of gay / bisexual / MSM service-users have also benefited. In particular, Mowlabocus' research has directly fed into the shaping of THT Brighton's policy on addressing bareback pornography — and bareback sex — during health promotion outreach and online intervention work, and has led to the creation of an information website and intervention toolkit (launched in April of this year), which is being used in the charity's training of health promotion workers across its 31 regional offices. As Marc Tweed, Head of THT Brighton, has said, `[Following Porn Laid Bare (PLB) our practice] has changed. We are equipped with the tools to look at this subject and speak about it with authority. The toolkit definitely has provided us with a framework for delivering interventions, and I think it will continue to do so. And as an organisation I think it's our duty — prevention is what the Terrence Higgins Trust does, to reduce infection rates.... It's been invaluable, really' [see Section 5, C1].

The pathway to this research impact was as follows. In May 2010, Mowlabocus organised a dissemination and knowledge exchange workshop timed to coincide with the publication of his research monograph Gaydar Culture — which was already receiving national notice and reviews. This was attended by healthcare professionals, including individuals from the NHS, the Terrence Higgins Trust and UNISEX. Following this event, in December 2010 THT invited Mowlabocus to develop a new research project in partnership with them — Porn Laid Bare. This built on the approach to focus groups used in, as well as findings identified by, Gaydar Culture. PLB was funded via a Big Lottery Grant awarded to THT for its on-going Informed Passions research project (2010-2014). Empirical research was undertaken between April and October 2011.

Project findings were shared with health promotion experts and clinicians from statutory and non-statutory services at a workshop in Brighton on 31 July 2012, which provided an opportunity to respond to the research and develop a new set of approaches to new and existing health promotion work. Drawing on Mowlabocus' research findings that, despite their difficulty in articulating their feelings and attitudes towards (and desires for) bareback pornography and bareback sex, gay men/MSMs are watching bareback pornography and report both enjoying and having concerns about it, the stakeholders recommended that:

• discussions of bareback pornography need to take place during health interventions;
• it needs to be acknowledged that all porn (but especially bareback porn) is an ordinary part of many gay men's lives;
• the popularity of bareback pornography among gay men could be used to open up valuable space for discussions around motivations for having Unprotected Anal Intercourse (UAI) and safer sex, offering the potential to open up discussions and behavioural change work around UAI.

Some stakeholders began to put some of these findings into practice immediately — notably to open up informal, supportive and non-judgemental discursive spaces in which service-users can articulate their desires for, concerns about and questions regarding the consumption of bareback pornography in order to enable them to mitigate unsafe behaviours. For example, Mike Jones, Sexual Health Advisor at the Claude Nicol Centre (Sexual Health) and Lawson Unit (HIV), Outpatients, Royal Sussex County Hospital, Brighton, has testified that, since his attendance at the PLB stakeholders' workshop, a new clinic — Clinic M — had been set up at his centre to enact changes around non-judgmental questioning and the expectation that MSMs are using bareback pornography. His view is that interventions had been transformed by involvement in PLB research and he cited numbers of clients (10k through-put over 12 months) as well as NHS professionals (i.e. the entire Brighton clinic) for whom the service had potentially been transformed over the last 12 months, as a result of the symposium, by using a style of intervention concretised in the PLB toolkit. His colleague at the clinic, Dr Daniel Richardson, Consultant in HIV/GUM, Brighton NHS Trust, has also testified as to how his practice had concretely changed as a result of engagement with PLB (he cited interventions he had made in clinical settings specifically around bareback porn — as a result of attending the PLB stakeholders' workshop [C2]).

In addition, Mowlabocus' findings were cascaded into PLB's development of a `bareback intervention toolkit' — a set of questions and guidance notes to facilitate discussions about porn consumption and the viewing of bareback pornography, hosted on the PLB project website, and freely available to sexual health and LGBT community organisations, and others. This toolbox, which went live in April 2013, provides practical advice and recommendations on how to engage service-users in discussions and behaviour-change interventions that focus on identifying and addressing the challenges posed by pornography in the context of reducing incidences of unprotected sexual activity. The research is thus effecting changes in the way health practitioners approach their intervention methods and engagement with clients. This toolkit is currently being used, inter alia, by health promotion experts and practitioners at the Claude Nicol Clinic in Brighton — one of the leading HIV clinics — and, as part of its health promotion outreach work, by THT Brighton which, because of the size of the city's LGBT population, operates as a test-bed for innovations which are then scaled up to national campaigns, a process that the PLB intervention toolkit is currently undergoing [C3].

Justin Harbottle, Programme Officer for Quality Engagement at THT's national office, has reported that approval has just been given by his organisation to produce a `bareback harm-reduction guide' which `has very much come out [...] of the PLB work'. And that this, `in itself, will have to change the [national THT policy on bareback sex]'. He has testified that this development has emerged from the work that PLB has done in Brighton in which this kind of `harm reduction work was very much [part of] its ethos' [C4].

The success of PLB has also meant that Mowlabocus will continue his collaboration with THT, leading the CCN+-funded project Reaching Out Online (ROO), which began in June 2013. ROO has secured additional funding from the Big Lottery Fund to run a parallel user-centred study to examine the use of online social media tools and platforms by outreach workers during sexual health interventions targeted at gay male and MSM communities, whilst the parallel project will explore user's experiences of online health promotion work [C5].

Sources to corroborate the impact

C1

• The PLB website can be found at http://www.pornlaidbare.co.uk/. It received 2,165 page views between 1 April and 31 July 2013 (Google Analytics reports available);
• Marc Tweed, Head of THT Brighton, Interview August 2013 - audio recording available;
• Justin Harbottle, currently Programme Officer for Quality Engagement at the Terrence Higgins Trust, 314-320 Gray's Inn Road, London WC1X 8DP; formerly Project Lead for the Informed Passions project and Community Development and Volunteer Co-ordinator, Terrence Higgins Trust South and Home Counties). Interview 14 October 2013 - recording available on request.

C2

• Mike Jones, Sexual Health Advisor, The Claude Nicol Centre (Sexual Health) and Lawson Unit (HIV), Outpatients, Royal Sussex County Hospital, Brighton. Interview August 2013 - recording available on request;
• Dr Daniel Richardson, Consultant in HIV/GUM, The Claude Nicol Centre, Brighton NHS Trust. Interview August 2013 - recording available on request;
• See also interviews with Marc Tweed and Justin Harbottle, THT, the latter especially on the rebranding of the Claude Nicol Clinic — Clinic M [as above in C1].

C3 See interviews with Marc Tweed and Justin Harbottle, THT [as above in C1].

C4 See interview with Justin Harbottle, THT [as above in C1].

C5

• Ben Tooke, Health Promotions Team, THT Brighton and Co-ordinator of Informed Passions Project. Interview, Brighton, 4 October 2013 - audio available upon request.
• See also: http://www.communitiesandculture.org/news/additional-funding-for-reaching-out-online/.