Looking to Ourselves For Leadership

The HIV Forum, a group of activists at work for the past 18 months on reducing or eliminating the spread of HIV in the gay community in New York, is seeking nominations for Popular Opinion Leaders.

Just what is this method of prevention that has proved to work so well in small cities and towns across the nation? Can it be successful here in New York?

The problem of getting gay men to continue practicing safe sex continues to bedevil health care specialists, counselors and AIDS activists. Individual counseling, however effective in the lives of many gay men, seems an improbable way to change the group behaviors that are always important in the spread of a contagious disease. Most gay men already know the rudiments—the HIV virus causes AIDS and condoms are effective in preventing the transmission of the virus. Yet many gay men refuse to use condoms, or fail to do so consistently. Experts have long recognized that prevention work must be done at the community level.

Dr. Jeffrey Kelly of the Medical College of Wisconsin has been addressing this problem for more than a decade. His ideas have generated enthusiasm at the Centers for Disease Control and been featured in the prestigious British medical journal, The Lancet. In New York City, Bruce Kellerhouse of the Callen-Lorde Community Health Center is working with his HIV Forum colleague Dan Carlson and others to introduce programs based on Kelly’s work.

That’s where the idea of Popular Opinion Leaders (POLs) comes in as an innovative attempt to practice risk reduction at the community level.

Rather than viewing sexual risk takers as obstacles, Kelly believes such men can nurture innovations in behavior. Sales and marketing professionals promoting commercial products have long recognized that certain members of a group set styles in food and drink, so Kelly posed the question whether individuals in a target group—in this case, perhaps, gay men on the nightlife circuit in New York—can play a similar role in supporting norms for safer sex. His program has produced measurable gains—in terms of a reduction in unsafe sexual behavior—in smaller cities and towns where gay bars serve as vital social centers, sponsoring bowling and baseball teams, for example.

New York City bars are less effective core social centers in a city where gay social outlets are varied and diverse and nightclubs and bars often serve as locations for anonymous cruising more than gathering points for networks of friends. Still, Kellerhouse is excited by the prospect that the POL program can be successfully adapted to have a positive impact in New York.

The Popular Opinion Leaders, as explained by Kelly in The Lancet, have sufficient social standing among their friends hat their “views, attitudes, and behavior can influence others.” They are popular with their friends and their opinions are respected, and therefore have greater impact than their numbers would suggest.

The key dynamic at play here is one of “sharing.” The POLs are not sex educators; they are people struggling with the same dilemmas as their friends. They are able to say that they would like to observe safe-sex practices and to ask their friends for help in making that possible. Or equally important, they can tell their friends what they tried that didn’t work. The POLS are both starting conversations among networks of men and they are trying and modeling the behaviors they are talking about. This is a dramatic difference between a POL and a sex educator. The POL not only has a certain social standing within the group, he is also struggling with the same behaviors and challenges as his peers.

The most important problem facing AIDS prevention right now is insuring that programs like the POL effort and other effective interventions receive sufficient funding to actually make a difference. In their pilot programs, Kelly and his researchers reached the conclusion that 15 percent of a target group had to participate as POLS in order to influence the group. That is 300 persons for every 2,000 people in the group, which is a very tall order indeed in a gay male community as large as New York’s. Government funding—a challenge in the public spending climate of the Bush administration—will have to be leveraged by the active support and cooperation of the gay community to make a go of this endeavor in New York.

The HIV Forum effort is only just beginning. Nomination forms were distributed at a recent panel discussion on the super-HIV virus and we can expect to hear a lot more about how this program will be launched during the next several months.

Even if successful, a POL program here is but one part of a comprehensive prevention effort. Other HIV prevention organizations must continue and enhance their existing efforts, targeting both individual and community behavior. But POLs are hopefully one way to reach the community of men who are sexually active on the bar scene and at sex parties. It is vital that the program receive adequate funding and be given the time and the community support it needs to be effective.