By now, you may have read elsewhere on PositiveLite.com about the classifications of risk profiles of men who have sex with men (MSM) drawn from an analysis of data from the SPOT study in Montréal. I propose to give you a different look at SPOT, put together from my own observations (I’ve been in the space) and from information that SPOT shares freely on its web site.
The first thing you will notice when you approach SPOT is that if you don’t know where you’re going, you might walk right past it. It’s a small storefront on a commercial side street in Montréal’s gay village that shares a recessed doorway with a business on the other side of the building. You go in through the SPOT door and find yourself in a pleasant waiting room, with nice furniture and some bold modern graphics on the walls. You’ll be greeted by someone from RÉZO, a Montréal gay men’s health promotion/HIV prevention organization, and this person may be a staff member or a volunteer.
You might have booked an appointment in advance (a good idea if you’re travelling a distance to get there) or you might just be walking in during the opening hours, which go well outside the usual 9-5 Monday to Friday that you might be expecting from a health service. In either case, the wait is not likely to be long — the whole idea is to make it easy — and you will either be going in beyond the reception desk or maybe heading out with an appointment for a more certain time that you can be seen.
There’s a nurse there, provided by the local Health and Social Services Centre, and a person working for RÉZO. One or the other of them will go through the pre-test counselling with you and then you’ll choose whether you would like the rapid test or the standard one. There are reasons in favour of each of those: if your last risk event was quite some time ago, you might want to choose the rapid test to have results more quickly; if your risk was more recent, the standard test might be more appropriate, because the test used can also detect p24 antigens, which are an earlier indication of HIV infection that will appear before your body has time to produce HIV antibodies (which is what the rapid test and the standard test will also detect).
You will hardly have noticed what an excellent collaboration is going on between the community worker and the nurse, it will have been so smooth. That’s one of the big successes of the project.
You’ll have a chance to discuss the results (if it was the rapid test) and do some follow-up. If you had been there in the first phase of the research project, there might have been some questionnaires inserted into the process, some done with the nurse or community worker, some done on your own. I have a friend who went there and found that part to be a bit long, but it did give him an opportunity to get that rapid test, for free and much faster than he might have been able to elsewhere.
That part of the research is over now, and there is a new aspect underway, testing the impact of short-term motivational interviewing (a particular approach to counselling). Another project seeking funding now will explore the possibilities of an accompanied self-testing for HIV. I’m sure I’ll want to write about that more if and when the project gets approved and funded.
For now, we can appreciate the impact that the site itself has had. It managed to have a rate of HIV detection that proved it to be a good investment (our cash-strapped health care system doesn’t need to spend a lot of money testing people who don’t have a real risk of HIV infection — a higher rate of positive tests shows you are reaching the right people). It also managed to reach a much higher proportion of MSM who were born outside Canada — more than a third of those tested — which is more than double the rates of other research projects in the same population. Perhaps surprisingly, the only statistically significant difference between those born outside of Canada and those born inside Canada was their experience of not having a doctor (a barrier to testing).
The challenge for RÉZO now — and this is more of a challenge to the health care system as a whole — is to figure out how to continue to fund SPOT as a service, apart from the research project. It has succeeded in showing that it can provide a useful and needed service in a setting that makes those who go there feel comfortable. Now let’s make sure that it has the means to carry on and continue doing that work.