News :: GLBT
Healthier hook-ups by Ethan Jacobs
associate editorThursday May 7, 2009 David S. Novak brings serious public health credibility to his new role as coordinator of Manhunt Cares, the men’s health offshoot of the Cambridge-based hook-up site Manhunt.net.
From 2004 to 2007, while serving as syphilis elimination coordinator at the Massachusetts Department of Public Health (DPH), he literally wrote the book on online STD outreach to gay men, pioneering the department’s work in doing outreach to Manhunt members and authoring a guide on Manhunt outreach for use by other states and agencies. He moved on to serve as national syphilis elimination coordinator for the Centers for Disease Control and Prevention (CDC) where he continued promoting online outreach as a means to prevent HIV and other STD infections among gay men.
At first glance leaving the CDC to work for one of the world’s biggest gay hook-up sites might seem like an odd transition. But Novak said Manhunt has carved out a role for him to push forward with new strategies for online health outreach without the constraints of red tape and bureaucracy of the public health field.
"I’ve been doing this work for over five years, on the government side, state, federal, and moving into the industry side. ... I can do some things here that public heath would probably take a long time to figure out," said Novak, who joined the Manhunt team at the end of last year.
Manhunt has been working with public health agencies on its site for about the past five years, inviting them to create profiles on the site and provide information and referrals to members with concerns about HIV and other STDs. Under Novak Manhunt has expanded that work, creating Manhunt Cares, a dedicated public health website, and, said Novak, the company is working to strengthen the partnerships it has with public health agencies. Novak also hopes to experiment with new media to do HIV prevention work.
Manhunt users can access the site by clicking the "Health" button on the newly redesigned Manhunt site. Nonmembers can view the site at manhuntcares.com.
One recent collaboration Novak sees as a model for the work he plans to do with Manhunt Cares is the program’s partnership with the New York-based public health research organization Public Health Solutions and New York University on an online video campaign called HIV Big Deal. The campaign features a series of short films about a 26-year-old gay man named Josh who struggles with whether or not to get an HIV test the morning after a drunken hook-up. Mary Ann Chiasson, Public Health Solutions’ vice president for research and evaluation, said the collaboration began in 2005 when she and other researchers on the project began contacting different gay websites to recruit volunteers to do an initial survey about HIV disclosure.
"We had reached out to every gay-oriented website of every size and had mixed response for cooperation in posting banners but have been very successful in recruitment on Manhunt, and they’ve been incredibly cooperative. And the Manhunt subscribers seem to like to participate in surveys, which is great," said Chiasson. She said about 15,000 men in total have participated in research related to HIV Big Deal.
Novak said Manhunt gave the researchers permission to recruit participants on their website, and members responded enthusiastically.
Researchers screened the completed videos for 1000 men recruited online. Chiasson said that surveys of those men revealed that they were 3.5 times more likely to disclose their HIV status to their sex partners after watching the videos. One hundred and twenty of those men also decided to get tested for HIV after viewing the videos, Chiasson also said. The researchers worked with Manhunt to recruit an additional 3000-person sample to conduct controlled trials with the video last fall; the researchers are currently analyzing data from those trials.
Chiasson believes using new media and the web to reach gay men via sites like Manhunt may ultimately prove to be a breakthrough in doing HIV/AIDS outreach. She noted that most of the current HIV interventions found to be effective among gay men are complex multi-session programs that require a significant time commitment from participants and a highly trained professional to lead them. That model is ineffective for reaching large populations of gay men, said Chiasson, but web-based outreach may be a more effective alternative.
"I think the Internet is the perfect setting to provide low-intensity interventions that could potentially reach huge numbers of men at risk for transmitting or acquiring HIV," said Chiasson.
In addition to the HIV Big Deal videos the Manhunt Cares site also links to videos on gay men’s health created by the CDC and other organizations. Manhunt Cares does not create any of the content, but Novak said he wants to use the site as a vehicle for some of the new media health outreach being developed by their health partners. The site has featured a range of videos, including messages about February’s National Black HIV/AIDS Awareness Day, instructional videos on how to clean sex toys, and a Canadian documentary following a young 20-something man going for an HIV test.
"We will never produce any original heath content. We have over 300-400 health partners. ... We don’t want to usurp any of the fine work they do, nor should we ever pretend to be health professionals," said Novak.
Novak said he is working to encourage more collaboration between Manhunt Cares and researchers focused on gay men’s health. Manhunt Cares is in the process of forming an expert volunteer research board that will consider all applications by researchers asking to recruit volunteers on Manhunt, and the board will determine which studies get the go-ahead to do recruitment on the site.
Novak said Manhunt Cares is also working to strengthen its relationship with its health partners. One of the main features of the Manhunt Cares website is a list of health organizations serving gay men across the globe, many of which do outreach using the site. The list, which aims to allow Manhunt members to find local services, includes more than 20 organizations from Massachusetts. It is one of the most comprehensive lists of gay men’s health organizations, said Novak, noting that organizations regularly ask to be added to the site.
"People came in droves saying, I want to be part of this list," said Novak.
But the collaboration with the health partners goes beyond the Manhunt Cares list and allowing them to create profiles on Manhunt. In March Manhunt Cares sponsored a benefit night during the White Party festivities in Palm Springs, California to raise money for the Desert AIDS Project. Closer to home Manhunt Cares has worked to support local LGBT and HIV/AIDS causes, sponsoring both the Boston Gay Men’s Chorus 2009 season and the Boston LGBT Film Festival.
"I think we’re getting a bit more sophisticated in the ways we think about how we can partner with health and GLBT organizations," said Novak.
He also continues to promote Manhunt’s support for allowing public health agencies to do partner notification on the site. Novak helped launch the Massachusetts DPH’s partner notification program through Manhunt back in his tenure at the agency. Currently, he said, 38 state and city health departments and two community-based organizations do partner notification on Manhunt, sending e-mails to people whose sex partners have tested positive for HIV and connecting them to counseling and testing programs.
Kevin Cranston, director of the Massachusetts DPH’s Bureau of Infectious Disease, said the state’s partner notification work online has proven to be particularly effective; he said since the program began in 2006 about half of the men contacted by DPH either requested information about counseling and testing or other services or indicated that they would follow up with their own healthcare provider.
"I continue to be delighted that more than 50 percent of men follow up on their messages. These are not men who would be reachable under traditional partner notification services," said Cranston.
Novak is happy that so many other states and cities have followed Massachusetts’ example.
"It’s amazing to me that over the past five years, since I was the first person to do this, you have 40 programs doing this, and it’s a public health program that has reduced the spread of infections," said Novak.
While Manhunt has earned praise from public health officials for its support for programs doing outreach on the site, it has also been attacked in other quarters for allegedly facilitating risky behaviors. Back in 2005, when the New York Times reported on a supposed HIV "superbug" - a story that ultimately proved to be false - the paper claimed that public health officials were concerned that websites like Manhunt could increase the spread of the virus. And in an Out magazine profile of Manhunt published last year, writer Michael Joseph Gross spoke with the World Health Organization’s Michael W. Ross, who argued that the disassociation Manhunt users feel between themselves and the identity they create for themselves online makes users more willing to engage in risky behavior with other users.
Matthew Mimiaga, a research scientist at Fenway Community Health and psychiatry professor at Harvard Medical School, said research on gay men and online cruising has generally shown that men who meet through online hook-up sites like Manhunt are more likely to engage in risky sex and substance use and to have a greater number of sex partners - and in particular, anonymous sex partners - than men who meet up in other venues. But Mimiaga said it is unclear whether the Internet encourages risky behavior or whether men who are already engaging in risky behavior see the Internet as the most effective way to hook up.
"Were these guys engaging in these behaviors prior to using the Internet to meet sexual partners, or how has the Internet fueled this? That’s a question that still needs to be answered," said Mimiaga.
He said there has been little published research on the efficacy of online partner notification, but researchers have investigated its feasibility, and studies have shown that gay men would find it acceptable both to receive e-mail notification if they have been found at risk for STD infection and to use the web to notify their own partners if they think they might be at risk for an STD.
Chiasson said the research on online-versus-offline cruising is inconclusive, and her own team has conducted studies that found similar risks for men who meet their partners online or in person.
"The bottom line was men were equally likely to report unprotected anal sex with partners met online or offline," said Chiasson.
Novak said that there have long been efforts seeking to link STD risk with hook-up venues such as bars and bathhouses, and that has extended to Manhunt and similar websites. He said he believes research should focus more on what leads individual men to make positive or negative choices about their sexual health, rather than focusing on the influence of the venues where men meet for sex.
"You can do lots of studies that talk about sexual risk behavior, [but] to attribute it to a venue is problematic," said Novak, who argued that Manhunt has led its industry in promoting online health outreach.
Jon Vincent, Fenway’s manager of prevention and education, said that doing outreach on Manhunt has helped drive users to Fenway’s prevention resources, though outreach on the site has only been effective when it has included high visibility. Fenway has a profile on Manhunt, but it doesn’t get much traffic, he said. When a Fenway prevention worker is manning the profile about four or five people may look at it in a two-hour span, but on weeks when someone staffs the profile every day only about two people will actually initiate a conversation with the Fenway profile.
"The return on the actual profile is so minimal that we don’t make it a priority to manage it," said Vincent.
Yet when Fenway has had more exposure on Manhunt, the returns have been much greater. Prior to the launch of the Manhunt Cares site, Manhunt occasionally gave Fenway ad space on the main Manhunt site, said Vincent. The ads doubled traffic to the health center’s "Ask Dr. Cox" site, which provides information on gay men’s health, said Vincent.
Cranston said he views outreach on sites like Manhunt as a natural progression of safer sex outreach at gay bars and bathhouses that began in the early days of the AIDS epidemic.
"I think it’s incumbent on us to bring prevention services to where the men are," said Cranston. "I don’t really make a big distinction between doing that in an online venue and a face-to-face venue, and I’m delighted that establishments like Manhunt have been so open to us doing our work there."
Novak said he believes the CDC must fund research to look at the efficacy of online HIV and STD outreach, and he hopes that such research would make clear that outreach on sites like Manhunt is effective.
"I wonder why CDC hasn’t put more efforts into this. We’ve allowed all these interventions to happen on our site, and we anecdotally know they work, but there are no national studies to show this is how they work and this is why they work," said Novak.
Ethan Jacobs can be reached at ejacobs@baywindows.com
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