The past year has seen the release of a number of remarkable HIV-related documentaries. They include How to Survive a Plague, which guest author Jim Swimm commented on in our pages, and another telling of the story of AIDS activism in the 1980s, United in Anger, A history of ACT UP. Both of these docs were screened at the Toronto LGBT film festival earlier this year, as was Positive Youth, the Canadian-made movie that I reviewed here. More recently released was another Canadian doc, Voices of Positive Women, also reviewed on PositiveLite.com.  

Now we have Vito, documentary filmmaker Jeffrey Schwarz’s story of the charismatic and pioneering gay rights activist, AIDS activist and cultural historian Vito Russo. Born into a loving New York Italian-American Catholic family in 1946, Russo knew as early as age 13 that “gay is good”, even while growing up in an era when homosexuality was universally condemned and most gay men and lesbians were deeply closeted and internally homophobic.

After the Stonewall raid in 1969, which ushered in the modern American gay rights movement, Russo became an influential activist, joining the Gay Activist’s Alliance (GAA) and co-founding the Gay and Lesbian Alliance against Defamation (GLAAD), a watchdog group that monitors the portrayal of queer people in the mainstream media. A life-long movie buff, Russo is, however, best know for his book The Celluloid Closet, an historical survey of how queer characters have been portrayed in film. A movie of the same name was released in 1995. 

As for many others of his generation, Russo’s life was changed forever in the early 1980s, when gay men began to die of AIDS. The HIV diagnosis of his partner Jeffrey Sevcik and his own subsequent diagnosis transformed him from LGBT activist to AIDS activist, to which he devoted his energies until his death from advanced HIV in 1990. Russo’s most significant achievement during these years was his involvement in ACT UP, which he co-founded. This direct action advocacy group fought the Reagan administration and big pharma for access to medical research, experimental anti-retroviral medications and policies to mitigate the loss of health and lives. 

Due to the success of The Celluloid Closet, Russo was an early celebrity of the gay rights movement, hosting his own television show and sought out by the mainstream media as a spokesperson for the LGBT community. As a result, Schwarz has been able to assemble some remarkable video footage and photographs of Russo’s life. These are complemented by some heartfelt yet candid interviews with his brother Charles and cousin Phyllis, as well as with his friend Lily Tomlin and several of his surviving contemporaries, such as Larry Kramer and Armistead Maupin. 

At the beginning of the doc, Russo speaks about why he became an LGBT activist: “I’m doing this for the people who come after me, so those who are 15 or 16 now won’t have to put up with what we did”. Then, towards the end, shortly before his death, he witnesses hundreds of ACT UP members shouting to him in the New York Pride Day parade: “Vito, Vito, Vito, we love you!” At this point, Kramer recounts how he turned to Russo and whispered in his ear, “These are our children”. 

Vito is essential viewing for all of us, not only for the story of a inspiring life, but to remind us of the continuing need for activism. Without activism, the queer and HIV rights that we have achieved will remain under threat - witness the struggles this year of Ontario high school students to form gay-straight alliances and the continuing fight for same-sex marriage in the United States, as well as the concerning state of our response to HIV in Canada in 2012.   

If we don’t keep fighting for our rights, we’ll lose them. 

Vito is being screened this year at LGBT film festivals throughout the world. It is currently being shown on HBO in Canada and the U.S. In Toronto, it is now playing at the Carlton Cinemas.

Vito Russo photo credit: Massimo Consoli. 

For many years, outreach workers and volunteers from community-based organizations have worked with bathhouses to provide HIV and STI awareness, prevention and education services to bathhouse patrons. ACT, a Toronto ASO, has augmented these sexual health promotion activities through TowelTalk. This innovative program offers brief, walk-in counselling sessions in the bathhouse by professionally trained counsellors. The objective is to address the psychosocial issues that can have an impact on HIV risk for gay and bisexual men and other men who have sex with men.

I recently went to ACT to talk about TowelTalk with Marco Posadas, the program’s coordinator. He’s a registered social worker in Ontario and a licensed psychologist in his native Mexico. A psychotherapist for 13 years, with a private practice in Toronto, Marco has international clinical experience working with LGBT communities and with people living with HIV. 

John McCullagh: Marco, I’d like to start by asking you what exactly is TowelTalk.

Marco Posadas: Towel Talk is a community-based mental health intervention program in three Toronto bathhouses, provided by professional counsellors. 

John: And what’s a bathhouse? 

Marco: It’s a place where men who are gay or bisexual or men who don’t identify as gay go to connect with one another, usually, but not necessarily, to have sex. 

John: So why was TowelTalk developed? 

Marco: ACT has been doing safer sex outreach in bathhouses for 15 or 18 years. The outreach workers identified that there was a need for a more in-depth intervention to help those men who want to talk about psychosocial issues but who would be unlikely to seek counselling from an ASO or other community-based organizations. 

John: Let’s talk a bit more about that. Why would some men be comfortable seeking out your help in a bathhouse yet wouldn’t readily make an appointment to see you in your office? 

Marco: For some men, going to a bathhouse can sometimes trigger a lot of anxiety. For example, if I’m married to a woman and I access bathhouses, I might be uncomfortable with what I’m doing there yet not have the language to talk about my feelings. So giving these men an opportunity to talk to a counsellor when they are perhaps feeling most anxious can be helpful. It provides an opportunity for these guys to talk in depth about sexual identity, about relationships, safer sex, anger management, childhood sexual abuse and other traumas, homelessness, immigration. All the social determinants of health basically that surround HIV transmission. Then maybe we can really hit back in the trenches at a decision-making moment.  

John: You just gave the example of a married man who goes to a bathhouse but who doesn’t necessarily identify as gay. Who are some of the other clients that bathhouse counsellors see? 

Marco: We are in three bathhouses out of the six or seven in Toronto so the population that we serve is really wide. What we’re noticing is that most of the men that talk to us are from racialized communities, newcomers to Canada, men who use substances and men who are married to women. The ages of the men is variable too. When I go to a bathhouse in the west end of the city, I might talk to men who are married, retired, older. If I go to a bathhouse here in the gay village, I might talk to younger men, newcomers. 

John: Tell me about the counselling sessions and how you connect with potential clients. 

Marco: Usually interactions happen as interactions in a bathhouse happen. Yet I’m not in a towel, I’m wearing a T-shirt that says “Want to talk?” on the front and “Counsellor” on the back. So guys are surprised, running into a counsellor in a bathhouse. They’re very curious, like, “What are you doing here?”, “Why are you dressed?”, “Are you here to have sex?” It’s often during those those first interactions that there’s a comment that that may lead to a counselling session. 

John: For example? 

Marco: Usually sessions start with somebody saying, “So why are you not wearing a towel?” 

“I’m here to talk”, I reply. 

“Oh, what do guys talk about here?” 

“Well, they talk about many things. They talk about guilt, about relationships.” 

And the guy might say, like, “Oh, I know all about that”. So I ask him if he wants to talk about it. And then, 25 minutes later, he’s disclosing some emotional part of his life that he needs support around. He might not have had this at the top of his brain when he came into the bathhouse but yet it’s something that he’s been wanting to talk with someone about. So we provide him with that opportunity. 

John: So where does the talking take place, exactly? 

Marco: The bathhouse managers are very supportive of the program and they provide a room for the counsellors to use. 

John: How long does a counselling session last? 

Marco: We differentiate between contacts and sessions. Contacts are any conversation that lasts under ten minutes, while sessions are longer conversations that can last up to 45 minutes. So that gives us the opportunity to have three full sessions during a three-hour shift.  

John: Do the clients have to identify who they are or can they remain anonymous? 

Marco: TowelTalk is an anonymous program. If you’ve ever been into a bathhouse you’ll know that the walls don’t go all the way to the ceiling. So, in order to protect the client’s confidentiality as much as possible, the session will be anonymous. If the client wants to provide his name, that’s awesome, but we don’t keep track of those things. It’s completely anonymous. 

John: We’ve talked a little bit about this, but can you identify what are some of the most common themes? 

Marco: Sure. Off the top of my head I think the most common themes are guilt and anxiety in connection with a bathhouse. So whether I’m gay or straight, going to a bathhouse can be a very complicated experience. I might not feel comfortable to disclose it to my gay friends or I cannot even talk about having sex with other men if I’m married to a woman. Relationships? Whether I’m in an open relationship or a closed monogamous relationship or single, divorced or in-between. These things can give rise to a lot of anxiety as well. And sexual health. So, HIV transmission, syphilis transmission. Negotiating condom use, negotiating sexual practices. Those are the main ones. But also we have sessions where we talk about issues like housing and immigration. It’s very wide. 

John: It’s unlikely, isn’t it, that in 45 minutes you can do any more than just touch the surface of these issues? So is there an opportunity for guys to see you in follow-up sessions? 

Marco: Once there’s a need identified in a session, a guy can come and talk to me for up to eight sessions, completely free, here at ACT. But you know what? You’d be surprised how powerful single conversations in a bathhouse can be for someone who’s never talked before with another man about being gay. So, some of the one-time sessions can be very transformative. 

John: I imagine that that there are some issues where a client may benefit from a referral to an agency outside of ACT. I’m thinking of issues like substance use or immigration. And I know those outside agencies often have long waiting lists. So how do you avoid losing that guy, because people often give up in the face of a long wait time? 

Marco: You’re right. Many of the clients we serve are part of a hard-to-reach population that would have a lot of issues with a wait list, which is why they often don’t access mainstream services. That’s why we’ve been able to negotiate some streamlined referral agreements with various community agencies. So, for example, I can literally go with a client to, say, Rainbow Services at CAMH, where we have an agreement that they would at least assess the person sooner than they might otherwise have been able to do. And, in the meantime, they still get to work with me for up to eight sessions, or longer if it’s necessary. So we help them in the transition.

John: Marco, I imagine many of the people in bathhouses are going to be high on substances, they’re going to be partying. How do you manage the challenge of engaging somebody and talking meaningfully with them when they are high? 

Marco: We work from a harm-reduction perspective and a sex-positive perspective so that means that so long as you can engage in a conversation we’re more than happy to talk to you. And what we’ve learned is that some men use these substances to cope with feelings and that it can support, actually, their sense of comfort in talking with someone who’s open-minded enough to be in a session with them while they’re high. So we talk to a lot of guys while they’re high. They might not remember it afterwards. But if they run into the counsellor again, they might remember that sense of comfort they felt with him. And we’ve been able to refer people later for follow-up counselling when they’re not high and talk with them here at ACT. But as long as you’re able to talk, to speak, then we’re there for you. 

John: I’d like to turn this conversation around and ask how you and your colleagues deal with working in such a sexually charged environment. You’ve got guys who are wearing towels or less, you’ve got loud music, you’ve got porn playing, you’ve got men having sex all around you.  How easy or difficult is it for you to work in that kind of environment? 

Marco: Like every other stressful job, it can be very challenging but at the same time it can be very rewarding. So having a healthy lifestyle, having friends and laughing and having outside interests help to balance working in a highly sexualized environment. We also have many supports in place. We can access a clinical consultant with whom we can talk about the clinical challenges and our personal experiences in providing these services. We can can talk with our manager. And there’s also myself, the coordinator of the program, with whom my two fellow counsellors can debrief. At the same time, bathhouses are kind of fun. After all, it’s a perk to have porn in your workplace! 

John: Are bathhouse counsellors allowed to be bathhouse patrons as well, when they’re not working? 

Marco: Yes. We’re working within a gay community to which we belong. And we believe that bathhouses are spaces that all gay men can access. But we have very clear boundaries. So, for example, we can’t go to a bathhouse as a patron 24 hours before and after a shift, to ensure that a client or potential client has left the premises. 

John: So what would happen then if you were in a bathhouse counselling a guy and then you were there on another day as a patron yourself and you bump into this guy, a former client. Are there any issues that would come into play here that you’d be concerned about? Is that then an issue in terms of the client/counsellor relationship? 

Marco: There’s nothing wrong with being in the same space, as long as the boundaries are clear. An issue would be if the patron wanted to have sex with the counsellor. As in any counselling relationship that would be inappropriate. A guy can be either a client or a possible sex partner, but not both. 

John: There’s an evaluation component to TowelTalk, isn’t there? What does it consist of and who’s doing it? 

Marco: Yes, TowelTalk is still a pilot project, so we have an evaluation committee to measure the program’s effectiveness. They analyze the feedback surveys each client is invited to fill out, other data we collect and the notes we make of individual sessions. They also interview the counsellors and bathhouse staff about their experiences with the program. And right now we’re in the second stage of the evaluation, were we are beginning to address the effectiveness of the follow-up counselling sessions. 

John: What has the evaluation told you about what’s good about the program as well as some of the things that need improvement?  

Marco: What works really well?  The T-shirt, the branding, the collaboration, having several counsellors in order to attract different types of client, these are strengths of the program. It raises awareness, and guys actually access and know about TowelTalk. 

We also learned that it didn’t work to be in a bathhouse past 11pm on weekends as it gets very sexualized then so you have to deal more with boundaries than having an actual session. 

Some of the things that we can do better? Speaking more languages and having a greater ability to access more, faster mental health referrals for our clients. We could help address that by providing a longer-term intervention ourselves but we’re restricted by funding constraints. So that’s a challenge.  

John: I’d like to finish with a more personal question. You’re a psychotherapist, an analyst, a social worker, you have a lot of qualifications, you have a private practice. So I’m wondering what motivates you to come out of your office and work in bathhouses. Why do you do that? 

Marco: I love this program. It’s unique. There’s another bathhouse counselling program in the States but they only do HIV and sexual health counselling. So ours is the only one of its kind. I work from a psychoanalytic perspective in my private practice so that means that I’m used to long-term type of work. So this is a very unique challenge for me that helps me to harness a different set of skills. Also, as a psychotherapist, it can be very isolating to work in a private practice on my own. TowelTalk allows me to work in the community, doing short-term counselling, project coordination, project management. 

John: Marco, TowelTalk is an amazingly creative and innovative program and we’re lucky to have it here in Toronto. Thanks for taking the time to talk about it with PositiveLite.com. 

Marco: Thank you very much, John, for giving me the opportunity to do so. 

This interview has been edited and condensed. 

TowelTalk is a collaborative project between ACT and the AIDS Bureau of the Ontario Ministry of Health and Long-Term Care. 

"Recently infected individuals: A priority for HIV prevention" by James Wilton first appeared in Prevention in Focus, Fall Issue 2011, a publication of CATIE. A French language version is available here. 

People living with HIV can potentially transmit HIV to others through unprotected sex at any time during their life. However, emerging research suggests that a disproportionate number of HIV transmissions—perhaps more than half—may originate from people during the first few months after they become infected with HIV. In this article, we explore why recently infected individuals are more likely to transmit HIV to others and how we can help prevent these transmissions from occurring.

 What’s happening in the body after HIV infection?

To understand why recently infected people are more likely to transmit HIV to others, we need to look at what’s going on in the body after HIV infection occurs.

After someone becomes infected with HIV, the virus begins to replicate very quickly and the amount of virus in the body and bodily fluids (such as the blood, semen, vaginal fluid and rectal fluid) rises rapidly. In some individuals, this takes its toll on the body and can cause fever, fatigue, night sweats, headache, diarrhea, sore throat and/or a rash. These symptoms generally appear about two weeks after infection occurs. Other individuals who become infected notice no symptoms at all during this period.

A few weeks after infection, the body’s immune system begins to fight back against the virus. An important part of this immune response includes the production of anti-HIV antibodies—small proteins made by certain immune cells, which can destroy HIV and prevent HIV from multiplying. Once antibodies to HIV have been produced, HIV replication begins to slow down and the amount of virus in the body (also known as the viral load) gradually decreases. Unfortunately, antibodies cannot fully control HIV infection.

Antibodies are not produced immediately after infection. The amount of time it takes for the body’s immune system to produce them varies from person to person. In most people, it is possible to detect HIV antibodies in their blood within approximately 34 days of infection, although this can take up to three months in some individuals. The presence of antibodies in the blood marks the end of the first stage of HIV infection—known as acute HIV infection—and the beginning of the next stage, chronic HIV infection.

The amount of virus in the bodily fluids is highest during the acute HIV infection stage. After antibodies are produced, the viral load slowly decreases but does not stabilize at a lower level until up to six months after infection.

Why do people with recent HIV infection account for a disproportionate number of transmissions? 

Higher infectiousness

The elevated viral load of someone recently infected with HIV is the main biological reason that they are more likely to transmit HIV to others at this time. The higher the viral load, the greater the risk is of transmitting HIV to others through unprotected sex. Researchers estimate that the risk of transmitting HIV to another person from one act of unprotected sex is 26 times higher during the first three months after infection than during the months and years that follow.

More high-risk behaviour

A high viral load alone is not enough to transmit HIV to another person; a recently infected individual also needs to be engaging in activities that can lead to the transmission of HIV, such as unprotected sex. Unfortunately, a person who has recently been infected with HIV is more likely to be engaging in high-risk behaviours than a person who has been infected for a longer period of time. There are two possible explanations for this. First, a recently infected individual is more likely to be engaging in high-risk behaviours because this is what led to their HIV infection. Second, many recently infected individuals are unaware of their HIV status and therefore may not realize the importance of having safer sex.

Reducing the number of transmissions from recently infected individuals: Challenges and solutions

Because recently infected individuals account for a large number of HIV transmissions, identifying these individuals and helping them reduce their risk of passing HIV to others is critical to HIV prevention. Research shows that when people become aware of their HIV infection and are provided with access to prevention and care services, most take measures to reduce their risk of transmitting HIV to others.

There are two major challenges to identifying recently infected individuals:

 1. the low levels of HIV testing in Canada; and

 2. the limitations of certain HIV tests.

As a consequence, many people who have recently become infected are unaware of their infection, as are their partners. Those who are recently infected may therefore continue to engage in high-risk behaviours until they are diagnosed with HIV.

Your organization may be able to play a role in overcoming these challenges, identifying these individuals, and reducing their risk of transmitting HIV to others.

Challenge: Low levels of HIV testing

It is estimated that 26% of people who are HIV-positive in Canada do not know that they are infected and many do not learn of their HIV status until they have been infected for several years.The low levels of HIV testing in Canada means that most recently infected people probably pass through the brief stage of HIV infection when their viral load is elevated without getting tested for HIV.

People who have recently become infected may be unlikely to get tested for several reasons. Firstly, many may believe that they are not at risk for HIV infection despite participating in behaviours that put them at risk. Secondly, there are no definitive signs that someone has become infected with HIV. Only some people who have recently become infected will experience symptoms and those symptoms are not specific to HIV infection. Therefore, many people who experience symptoms may confuse them with those of another illness and not get tested. Furthermore, for people who do believe that they are at risk of infection, there are several barriers that may prevent them from getting an HIV test, including stigma and discrimination, fear of criminalization, and barriers to accessing testing and other health services.

Solutions

 • Outreach and educational campaigns are needed to improve people’s awareness of their risk of infection and of the symptoms associated with recent HIV infection. People need to be encouraged to get tested if they are engaging in behaviours that put them at risk for HIV infection or have developed symptoms (such as fever, fatigue, night sweats, headache, diarrhea, sore throat and/or a rash) after a high-risk exposure.

 • Frontline service providers need to increase awareness of the need for, and benefits of, HIV testing among people who are at risk of infection. It is important that HIV-positive people learn about their HIV status as soon as possible after infection, regardless of whether or not their viral load is still high, so that they can access treatment and support services for people living with HIV and counselling on ways to prevent transmitting HIV.

 • Access to HIV testing, particularly for marginalized populations who are at risk of HIV infection, needs to be improved. Frontline organizations may be able to play a role advocating for improved access.

Challenge: Limitations of HIV tests

The limitations of tests used to detect HIV infection is another major barrier to identifying recently infected individuals.

Several types of HIV tests are available but for each type of test there is a brief period of time after infection during which they are unable to detect infection in a person who is HIV-positive. The time period from when a person becomes infected with HIV to when an HIV test can detect their infection, is known as the “window period.” During the “window period,” an HIV test may find a recently infected person to be HIV-negative. The length of the “window period” is different for each type of test and varies from person to person.

The HIV tests most commonly used in Canada look for antibodies to HIV in the blood. These tests cannot detect HIV infection in someone who has acute HIV infection because the body has not yet produced antibodies. The “window period” for antibody tests varies because some people produce antibodies faster than others. For most people (up to 95%), the window period of the antibody test is approximately one month, but for some individuals it may be as long as three months.

This means that for people at high risk of HIV, testing can be done as early as one month after exposure using standard antibody assays and rapid point-of-care tests. People who test positive will know for certain they are HIV-positive. Of those who test negative, 95% are indeed negative. Up to 5% of people who test negative at one month could later test positive at three months. It is important to ensure that people who test negative at one month are advised to return for repeat testing once the three-month window period is over.

Other HIV tests have been developed which detect the virus itself—such as the HIV RNA or the p24 antigen tests. These have shorter window periods (from seven to 14 days) than antibody tests and so can potentially detect HIV infection during the acute phase.20 Unfortunately, access to these new testing technologies varies across Canada.

Another limitation of HIV tests is the time it takes for many of them to produce results. Most HIV tests do not produce results immediately and require people to wait one to two weeks before getting the results. During this time, people may continue to engage in high-risk behaviours and some people may never return to get their test results.

Tests known as rapid or point-of-care (POC) tests can provide results on the same day that a test is performed. Most rapid/POC tests can provide results within minutes. This ensures that a person receives their results. Rapid tests that detect antibodies are available in some parts of Canada but rapid tests that can detect HIV RNA or the p24 antigen do not yet exist.

Solutions

 • Frontline service organizations need to increase people’s awareness of the different “window periods” for each type of HIV test, and emphasize that a negative result does not necessarily mean that a person is HIV-negative. Messaging should emphasize that a person who has recently tested HIV-negative may be in the “window period” and may be highly infectious. Knowledge of the “window period” and the increased risk of transmission during this time is particularly important for people who base their decisions of whether or not to have unprotected sex on knowledge of their HIV status or their partner’s.

 • People who test HIV-negative within the “window period” should be encouraged to refrain from high-risk behaviours and return for another HIV test at an appropriate time. A second test is important to rule out the “window period” as the reason for the test being negative. In Canada, we encourage people who test HIV-negative on an antibody test to test again at the end of the three-month “window period,” or sooner if appropriate.

 • Organizations should learn if, and where, rapid antibody testing or RNA/p24 testing is available in their area. A person who is suspected of being in the acute stage of HIV infection (for example, if they have recently had a high-risk exposure or they have experienced flu-like symptoms after the exposure) should be referred to a site where RNA or p24 testing is available. Service providers may need to advocate for improved access to rapid antibody testing and RNA/p24 tests in their area.

Conclusion

The goal of HIV prevention is to reduce the number of HIV infections in the communities we serve. A large number of HIV transmissions in your communities may be occurring from recently infected individuals, and therefore represent an important priority for HIV prevention efforts. Although several challenges exist in identifying these individuals and engaging them in prevention services, frontline organizations can play a key role in overcoming these challenges and reducing HIV transmissions.

James Wilton is the Project Coordinator of the Biomedical Science of HIV Prevention Project at CATIE. James has an undergraduate degree in Microbiology and Immunology from the University of British Columbia.

Check out Hottest at the Start  – a campaign by the Health initiative for Men (HiM) in BC to raise awareness on acute infection and transmission and to encourage gay men who have had a recent potential exposure to HIV to get an ‘early’ HIV test.

See PositiveLite.com’s John McCullagh interview HiM’s Jody Jollimore about this campaign here. 

For CATIE's full list of references, with links, to today's article, please go to the original article here. 

Check out CATIE's own blog on PositiveLite.com here.

(left to right Keith Reynolds, Daniel McGraw, Darren Ho)

Earlier this year on PositiveLite.com, we profiled Totally Outright, a program for young gay men who show promise as future community leaders. Today, in a special series of articles by three graduates of the program, we hope to show how, by investing in these and similar young men, we’re able to ensure that the future of Canada’s gay community will be in good hands.

The uplifting stories of Daniel McGraw, Keith Reynolds and Darren Ho illustrate how, with a minimum of resources but with lots of creativity, it’s possible to create the gay leaders of tomorrow. But the program not only forms future leaders. It also provides participants with the chance to build communication skills, practice outreach techniques and strategize solutions for the numerous challenges faced by gay men.

All three of the young men who tell their stories on PositiveLite.com today have found a place in the gay community beyond the bars and clubs. Both Daniel and Keith now work in gay men’s health while Darren, a university student, has started a project to address the lack of visible presence of LGBTQ people among ethnic communities.

Totally Outright has been running in Vancouver for several years and graduates 20-25 young men annually. Created and evaluated by the Community Based Research Centre (CBRC), it’s delivered by Health Initiative for  Men (HiM), a community organization dedicated to strengthening the health and well-being of gay men through a sex-positive, integrated approach to health. The program has been so successful that a Toronto version was launched this spring by the AIDS Committee of Toronto (ACT). 

Read what Daniel, Keith and Darren have to say and be inspired!

If you are interested in starting a version of Totally Outright in your own community, or just want to understand this program in depth, Health Initiative for Men has provided full background information in CATIE’s Programming Connection.