Podcast: Reaching Transgender and MSM Populations through Social Media

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Know your audience. This cardinal rule of both HIV prevention interventions and social media strategies has been a key to the early success of TLBz Sexperts, a growing HIV prevention program based in Chiang Mai, Thailand. TLBz Sexperts is using social media—including Facebook, You Tube, and online chats—to reach transgender people—a population that is at-risk for HIV infection—with important health messages. In this podcast, you will hear from Nada Chaiyajit, a well-known transgender activist from Chiang Mai, who leads the TLBz Sexpert program.

In 2011, the U. S. President's Emergency Plan for AIDS Relief (PEPFAR) outside link issued technical guidance on pdf Combination HIV Prevention (PDF, 210 KB) outside link. The guidance defines six core components, including Information, Education and Communication. This broad component includes HIV prevention activities, such as peer education; community, small-group, and individual behavioral interventions; and the development and distribution of targeted media that can be used as part of outreach efforts, HIV testing and counseling, behavioral interventions, and social marketing campaigns.

Background

Dr. Christopher Walsh of the Open University outside link, MPlus Thailand outside link, and Bridges Across Borders South East Asia Community Legal Education Initiative (BABSEA CLE) outside link were looking for an engaging way to address sexual behavior at risk for HIV. As Nada Chaiyajit explains, three years ago YouTube was very popular, and transgender people and men who have sex with men (MSM) were using 3G devices, such as iPhones, to share sexual video clips. With this knowledge, this team decided to create similar animations outside link to share knowledge about prevention programs with the hope that they could open minds through peer outreach.

SCC Entrance

Nada Chaiyajit of TLBz Sexperts! joined AIDSTAR-One in the media centre at the 2012 International Conference on AIDS to record this podcast.

These animations were first posted on the MPlus website and were shared in outreach and prevention programs at universities, workshops, bars, saunas, massage parlors, karaoke lounges, and brothels. However, the team was also concerned about getting these animations and relevant information to the hard-to-reach populations: MSM who were not attending outreach sessions, but instead were arranging hook-ups from their computers at home; and transgender people who preferred to engage with their trusted circle of friends.

MPlus Sexperts

The subsequent MPlus Sexperts outside link outreach project was funded through a MSM Initiative Community Awards Grant from amfAR outside link and was based on the RFSL Stockholm program, "We are the Sexperts!" outside link The team adapted this program for the Chiang Mai context, and trained people to become MPlus sexperts.

After just one year of the grant, the sexperts completed over 1000 chats with different at-risk groups, but through careful evaluation of their program, they discovered that they had primarily been reaching the MSM population, and only five (5) chats were with transgender people. In many cases, HIV programming combines health messages for transgender people with those for MSM. As Nada explains, transgender people in Chiang Mai do not identify as male. Because many transgender people do not relate to the type of outreach provided to MSM, they may use their own experience and share myths and misunderstandings about sexual health issues among their friends, contributing to high incidence rates of HIV and sexually transmitted infections in this population.

From MPlus Sexperts to TLBz Sexperts outside link

Realizing that they needed a special program specifically designed for transgender people, when the MPlus grant ended, Nada and her team decided to apply their experience and adapt the MPlus Sexpert program to the transgender context. In September 2011, with support from BABSEA CLE, Nada and Chris Walsh created the TLBz Sexperts. TLBz stands for Thai Lady Boys and is a completely virtual community designed to improve the quality of life and self-esteem of transgender people. The program has a website, TLBz.me outside link; a Facebook page outside link; and a Hotmail address, where people can email the sexperts directly. These resources allow the sexperts to share information that is of interest to their transgender peers, such as hormone use, beauty, boyfriends, sex, gender transformation, and stigma. Through these chats, the sexperts can provide information about safe sex, HIV and STI prevention, and basic human rights—such as transgender rights under the Thai Constitution; they can also provide reference for legal consultations.

While these types of programs are not free, the TLBz Sexperts' use of existing online technology helps keep costs down. Nada reports that they pay approximately $170 US dollars each month, including internet fees. At this point, the TLBz Sexperts is a volunteer program. They are looking to train new Sexperts, drawing from their primary audience—those who have already benefitted from the TLBz Sexpert program—to support future recipients and manage turnover as current Sexperts phase out or more on to new responsibilities.

Lessons learned and next steps

TLBz Sexperts is young and is currently in the implementation stage. Further evaluation will need to help them determine how people are using the information they receive in the TLBz Sexperts chats. Nada and her team are spreading the word about the TLBz Sexperts program by reaching out in spaces where transgender people are already seeking information. A small, early measure of success is that they are getting repeat visitors.

As Nada reports, the best part of TLBz Sexperts is that the Sexperts know themselves and know their audience. "Before you take any kind of intervention or implementation program, sit back to learn about yourself first…try to identify yourself, your community clearly, and then you know what kind of intervention or implementation program in HIV prevention you can take."

The TLBz sexperts use of social media allowed this program to better reach transgender people in Thailand. By investing time to learn about their target audience, they were better able to provide, as Nada describes it: "creative counseling", meaning that the Sexperts incorporate HIV prevention information into discussions of everyday topics that are important to transgender people. For example:

"Yes, you look gorgeous now, you reached the goal, you have whatever you need to be a good transgender woman, but you should maintain it by living healthy."

The TLBz Sexperts program identified its target audience (TG from Chiang Mai), learned where this group was hanging out and what they wanted to talk about, and selected a technology channel that allowed them to effectively reach this target population. This online peer approach used by MPlus and TLBz Sexerts can be incorporated into other HIV prevention programs to promote positive sexuality and share public health messages with most-at-risk communities. In conclusion, know your epidemic, know your response, know your audience, and share information using innovative and effective modes of communication.

Resources & References

"Behavioral Interventions: Peer Outreach and Education." (2011). AIDSTAR-One HIV Prevention Knowledge Base.

Berry, Scott, Maria Claudia Escobar, and Heather Pitorak. 2012. "I'm Proud of My Courage to Test": Improving HIV Testing and Counseling Among Transgender People in Pattaya, Thailand. Arlington, VA: USAID's AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1.

pdf Dennermalm, N. (Ed.) (2009). We Are The Sexperts! A manual on how to use Internet chatrooms and communities to promote sexual health and condom use. Stockholm: RFSL Stockholm (PDF, 1.23 MB) outside link Accessed August 2012.

Chaiyajit, N., & Walsh, C. S. (2012, April 15). Sexperts! Disrupting injustice with digital community-led HIV prevention and legal rights education in Thailand. Digital Culture and Education 4(1). outside link Accessed August 2012.

pdf U. S. President's Emergency Plan for AIDS Relief (PEPFAR). 2011. Technical Guidance on Combination HIV Prevention: As part of PEPFAR's overall prevention strategy, this guidance document addresses prevention programs for Men Who Have Sex with Men. Washington, DC: PEPFAR. (PDF, 210 KB) outside link Accessed August 2012.

Walsh, C. (2011). Mobile and Online HIV/AIDS Outreach and Prevention on Social Networks, Mobile Phones and MP3 Players for Marginalised Populations. In Proceedings of Global Learn Asia Pacific 2011 (pp. 1858-1866). AACE. outside link Accessed August 2012.

Walsh, C. S., Chaiyajit, N., and Thepsai, P. (2010 Jan 22). Mplus Thailand produces animations for HIV/AIDS outreach and prevention. Fridae: Empowering LGBT in Asia. outside link Accessed August 2012.

Walsh, C. S., Lasky, B. A., Chaiyajit, N., & Morrish, W. (2010). Producing & Integrating Animations into Online Outreach to Promote Social Justice, Equity, and Access to HIV. Krishnamurthy, S., Singh, G., & McPherson, M., (Eds.) International Association for the Development of the Information Society. outside link Accessed August 2012.