Youth Serving Youth - Phase 1 : Origin and Content of the Peer Outreach Program (POP) at the AIDS Committee of Toronto

by: Danielle Layman-Pleet, Marlene Ham, Winston Husbands
May 2003

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Acknowledgements

We would like to thank John Maxwell, ACT’s Director of Community Development, for his interest and support. Humberto Carolo, ACT’s Youth Community Development Coordinator, facilitated the project.

Gareth Redmayne graciously helped to organize a consultation with POP volunteers and later facilitated the consultation. Special thanks are also due to Alex McClelland, Coordinator of Positive Youth Outreach, who filled in for Humberto at some points in the project.

In addition to the POP volunteers, Danielle and Marlene, who authored this report, Shani Campbell and Amina Jabbar are the other volunteers who planned and executed the project with diligence and enthusiasm.


Executive Summary

This report is the first phase of an evaluation of the AIDS Committee of Toronto’s (ACT) Peer Outreach Project (POP). In the mid-1990s, ACT responded to a rising trend in HIV infection among young gay and bisexual men by establishing an HIV prevention education program targeting young gay and bisexual men. After a process of consultation with the target audience, in 1999 ACT instituted a peer-based model of HIV outreach and education known as POP (i.e., a program for youth, delivered by youth).

POP is engaged in information sharing and education about HIV/AIDS, sexuality, sexually transmitted infections, and drug use. The volunteers are a diverse group of young women and men who deliver outreach activities and workshops at venues and events that attract lesbian, gay, bisexual, transgender, questioning (LGBTQ) and straight youth. Workshop venues include university campuses, group homes, community centres, and other venues. Similarly, outreach activities take place at cultural, religious, political and entertainment events. Some of this work is done through partnerships with other youth-serving agencies and organizations.

POP volunteers experience a number of challenges and barriers to their work. Some challenges, such as difficulty reaching some populations, are familiar to all HIV/AIDS outreach programs. Others, such as the common misconception that young people are not “knowledgeable”, are perhaps specific to peer-based youth programming. Nonetheless, POP has developed its own identity within ACT and, to a large extent, within its main target population.

Introduction

In the summer of 2001 ACT’s Youth Community Development Coordinator and volunteers in the Peer Outreach Project (POP) decided that the POP program should be evaluated. However, in the initial discussions to design and plan the evaluation, it was evident that the development of ACT’s youth-focussed programming had never been adequately documented. Therefore, the first step in the evaluation was a process to document the development of youth-focussed programming culminating POP. This report, which is the first phase of the evaluation project, discusses the origins and development of POP since the mid-1990s.

The approach that we have taken for this phase of the evaluation incorporates the principles of participatory research. A sub-committee of POP volunteers conceived and executed the project, with advice and assistance from the POP coordinator and ACT’s Director of Research and Program Development. The report draws on two sources of primary data and information. First, the POP volunteers interviewed ACT’s Director of Community Development, who began his career at ACT working on outreach and community development among gay men and youth. Second, the volunteers participated in a consultation to discuss their understandings of and involvement in POP. Gareth Redmayne facilitated the consultation. At the time, Mr. Redmayne was a management trainee with Britain’s National Health Service (NHS) and graduate student at the University of Birmingham. These data sources were supplemented with research reports published by ACT and others on several aspects of youth and HIV/AIDS.

Origin of POP

Youth and HIV in the Early 1990s

In the early 1990s, reports in the media and the HIV/AIDS literature indicated that the risk of HIV infection among young gay and bisexual men was increasing. For example, a Canadian government report stated that by 1985-1990 the median age of HIV infection in Canada had fallen from 29.6 years in 1975-1984 to 24.5 years in 1985-1990. Health Canada (1996). The Experiences of Young Gay Men in the Age of HIV: A Review of the Literature. Ottawa. The report further stated that, “youth are driving … new infections in gay men,” and noted that close to three-quarters of AIDS cases in the 15-29 age group were men who have sex with men (MSM). ibid. p. 8.

ACT’s Response

ACT decided to respond to this situation by developing a brochure and campaign on HIV prevention targeting young gay and bisexual men in Toronto. A team was formed for this purpose, which included staff and an advisory committee comprising youth. The team found that there was no HIV prevention education for young gay men in Canada at the time. Consequently, the team organized a series of focus groups with young men from the target audience to ascertain their knowledge of HIV and AIDS, their sources of information about HIV and AIDS, and issues of healthy sexuality among young gay and bisexual men (e.g., the barriers to being “out” in an environment that focuses on perspectives and issues concerning adult gays and bisexuals). Lehman, A. and Maxwell, J. (1994). Safer Sex and Young Gay and Bisexual Men: A Focus Group Report. AIDS Committee of Toronto.

Based on the focus group research with young gay and bisexual men in 1994, ACT implemented a media campaign in March 1995 targeting “at-risk youth”, specifically young gay and bisexual men. This campaign, themed “Go deeper into safer sex”, replaced an earlier campaign organized in 1991 as “Safer sex generation”. The 1995 campaign promoted HIV awareness and prevention messages using the information from the focus groups (e.g., using diverse images rather than strictly sexual ones).

At about the same time (i.e., the mid-1990s), ACT was also delivering workshops in collaboration with the Sex Ed Centre of the University of Toronto, and Lesbian, Gay, Bisexual Youth Toronto. However, these activities were not “youth-driven” in the sense of being developed and implemented by youth. The idea that youth programming should be “peer-driven” was one of the results of a research project on youth and HIV that ACT conducted in 1998. Maxwell, J. (1998). Young Gay and Bisexual Men and HIV. AIDS Committee of Toronto. Part of this research was also an evaluation of the earlier “Go deeper into safer sex” campaign. Based on this research and evaluation project, John Maxwell (ACT’s Gay Men’s Health Promotion Coordinator at the time) recommended that ACT should develop a “peer-youth” volunteer outreach program.

ACT hired a full-time staff person to support youth involvement in all aspects of program development and implementation. This staff person initiated the Peer Outreach Project (POP) in 1999. POP therefore started as a peer driven HIV education and prevention project. The POP volunteers were young people from diverse communities. The volunteers and the program coordinator prioritize the issues that are important to youth, and design and conduct community outreach to youth in the places where youth congregate. The POP coordinator also works to develop collaboration between youth-serving organizations and AIDS service organizations through the creation of the Youth and HIV Network.

Funding

Funding has consistently been a problem in HIV/AIDS work because the amount of money available from governments has not kept pace with program needs. In early 1998, after the Federal government had renewed its National AIDS Strategy, ACT applied for federal funding but was denied. The government’s rationale was that ACT had not historically focused on youth, and that youth HIV/AIDS programs should come from an already youth-focused organization. ACT therefore decided to fund POP from its own resources. POP is now funded through the annual Purchase of Service (POS) Agreement with the City of Toronto. To make this possible, ACT removed some programs from its POS agreement with the City of Toronto and replaced them with POP. The programs that were removed from the POS were not eliminated; they were funded from other sources. Given the current state of government funding for HIV/AIDS prevention, there is much competition for funding. However, some of this competition is alleviated through partnerships and collaboration with other organizations that serve youth. One example of this trend is the Youth and HIV Network, through which service providers collaborate on programs for youth.

Content of POP

In November 2001 the POP coordinator and five volunteers participated in a facilitated group discussion to share their perspectives on POP (i.e., what it is, and how it works). This section of the report is based on the group discussion.

What is POP?

POP is a peer-based model of information sharing, education and outreach. Youth volunteers share information with other youth about issues such as sexuality, drug use, sexually transmitted infections, and HIV. Volunteers have found this peer outreach approach is an effective means of sharing information in a way that is non-judgemental and relevant to youth’s real lives and everyday experiences. POP values a harm and risk reduction approach rather than an abstinence-only approach when discussing issues, and aims to support youth in making informed decisions, not telling them what to do or not to do.

POP volunteers observed that they are themselves a very diverse group of people and this is important to the group’s identity and outreach practices. A typical POP outreach event will find POP members meeting and talking to other youth of similar backgrounds to themselves in terms of culture, ethnicity, age and sexual orientation. The POP group also creates a safe context for youth to explore issues related to their own sexuality.

Volunteering with POP

In the Fall of 1999 ACT’s Youth Development Program Coordinator established a specific objective to recruit and train young gay and bisexual men to do outreach to other young men who have sex with men.

In November 1999, a consultation involving youth and various community partners was organized to determine the direction the project was to take. The community partners were the YMCA Youth Substance Abuse Program, Asian Community AIDS Services (ACAS), the Alliance for South Asian AIDS Prevention (ASAP), the Black Coalition for AIDS Prevention (Black CAP), the University of Toronto Sex Ed Centre, and LGBYT. After several subsequent meetings, a working group was formed, which included youth volunteers and community workers from the partnering agencies.

The working group placed advertisements in community newspapers (Xtra! and fab) to recruit more youth to become POP members. At first, service providers had a key role in the development of POP outreach strategies, but as more youth became involved POP moved increasingly toward peer based education and outreach. Gradually, the volunteers became entirely comprised of youth, both young men and women. As more women began to volunteer, the outreach target group evolved to include not only MSM but other groups of youth such as young women.

Training began in February 2000 when there were enough volunteers. The initial training was done through guest speakers and peer run workshops that prepared the volunteers for outreach and educated them with up-to-date information on relevant issues. Topics in the training included HIV/AIDS 101, sexually transmitted infections (STIs), risk reduction, harm reduction, psychosocial issues, and group facilitation.

All of the volunteers in the Peer Outreach Project are youth ranging in age from mid-teens up to the mid-twenties. POP volunteers are very diverse in terms of gender identity, sexual orientation, cultural and ethnic backgrounds. Many youth who volunteer are establishing or questioning their sexual identities. Between 1999 and 2001, 45 youth volunteers have been involved in POP. At the time of the volunteer consultation for this report (November 2001), 23 young men and women were volunteering with POP (about 15 of whom volunteered regularly for outreach and other activities).

What POP Does

POP outreach and educational activities are displayed in Figure 1. Outreach activities comprise the most visible work that POP volunteers undertake. POP volunteers go to places frequented by youth, especially queer youth. But besides frequenting “gay” venues, POP volunteers also go to “mainstream” places and events like malls and concerts where youth who are not connected to lesbian, gay, bisexual or transgender communities can be reached. Typical outreach means setting up a booth with various pamphlets and service information, talking to people, giving out condoms and giving referrals. In this way, POP acts as a “stepping stone” to other services.

POP also delivers workshops on HIV/AIDS and harm reduction. Workshop venues are as diverse as the University of Toronto Sex Ed Centre or group homes. Currently, POP volunteers are in the process of evaluating the program (of which this report is the first instalment). A sub-committee of volunteers has been conducting original research through interviews, focus groups and literature searches on the background of POP. Another sub-committee is developing more clearly defined roles for POP volunteers. By participating in the Peer Outreach Project, volunteers gain valuable training and skills, some of which have helped many “POPers” (a nickname for POP volunteers) in their career and school goals.

Figure 1. POP outreach and educational activities, 2001 and 2002

2001
Location or EventTopic
WorkshopsDarcy/Megan Group HomesHarm Reduction
Lawrence Heights Community CentreEffective Peer Outreach
Univ. of Toronto Sexual Ed CentreComing Out and Cultural Identity
Rainbow Triangle SchoolHIV/AIDS 101
YAAHA ForumPeer Educators and Needs of Youth
OutreachHomo Hop
Pope Joan’s – Fetish Night
Homo Hop
Church Street – Valentine’s Day (Queer Scouts)
Ryerson University – Sex Fest
Transfusion Crew Rocket Launch Party (with SOY)
Homo Hop
Pride 2001
Homo Hop
Area One concert
Ozzfest concert
MTV TRL concert
Watcha Tour concert
2002
WorkshopsCentennial College ECE ProgramHIV/AIDS 101
Sir Wilfred Laurier High SchoolSafer Sex
World Youth Day “Challenge the Church”Sexuality and Religion
Touchstone Youth CentreHIV/AIDS 101; Harm Reduction
OutreachHomo Hop (monthly January-May)
World Youth Day “Challenge the Church”
SOY: Supporting Our Youth organization


It is important to understand that POP volunteers are not trained counsellors; they offer peer support to other youth and referrals when needed. Another important distinction is that POP does not have an office like other youth services; clients cannot make appointments or ask to see a specific POP volunteer. POP volunteers go out into the community to reach people.

Outreach Venues and Locations

POP has targeted its outreach to communities that are “at-risk” in terms of HIV and other STIs, drug use, and homophobia. Though young gay, bisexual and MSM communities have been targeted the most, outreach does not exclude trans-youth and women. Outreach can occur at any event where LGBTQ youth might congregate. Past venues have included fundraising events for the Pussy Palace Legal Defence Fund, bars, women’s bathhouses, post secondary institutions (such as University of Toronto), alternative schools, groups homes, homo hops, “Homo Hops” are monthly “all ages” social gatherings for LGBT youth organized by the LGBT student group at the University of Toronto (LGBT-OUT). They are probably one of the oldest LGBT dance events in the city. malls, community fairs, community events (such as Gay Pride), street outreach, Gay Life and Style Show, Everything to do with Sex Show, and music concerts.

Challenges and Barriers

It can be difficult to reach communities whose members may not see themselves as being at-risk. These communities include lesbians as well as MSM who do not identify as gay or bisexual. As the demographics of HIV infection change, outreach will increasingly target young heterosexual women.

Another barrier for POP volunteers is that they are not always viewed as having accurate knowledge or authority on the issues that they are presenting to the community. This perception is perhaps related to more common assumptions about the capabilities and capacity of young people. Also, high schools have not been very accessible for outreach because public health authorities take a lead role in this sector.

At times it has been difficult for POP volunteers to commit their time to outreach opportunities, as they often have other commitments like work or school. This is also a barrier in the sense that the volunteers want to make sure that this is a youth run project, which means they cannot allow the program to be represented by older adults.

There are occasions when the principles of POP may be interpreted as barriers. For example, POP is committed to health promotion, and harm/risk reduction strategies. These commitments sometimes mean that POP has to forego partnerships with other agencies that are not committed to the principles of harm/risk reduction.

POP recognizes that it is difficult to meet the HIV prevention needs of youth outside of downtown Toronto. As well, POP does not yet have a strategy to target some communities that have not been reached in the past. These include men who do not identify as gay or bisexual, women, transgender/transsexual people, lesbian and/or bisexual women, and straight-identified youth.

More recently, the previously independent Positive Youth Outreach (PYO) has become a program of ACT. This development may expand the opportunities for and scope of ACT peer-based sexual health and HIV services for young people. However, without careful thought, it is also possible that POP and PYO could both suffer if the goals and objectives of each are not articulated clearly, and if they are forced to compete for scarce resources.


The Social Side of POP

POP volunteers work together, but they do not necessarily play together. There is a noticeable lack of opportunities for social interaction separate from outreach and other program-related activities. Such opportunities may promote positive team-building and strengthen the volunteers’ commitment and dedication to the group and the program. In addition, informal social interaction may also present opportunities for POP volunteers to connect with LGBT communities. To date, one social event was held in 2001, and another in December 2002.

Conclusion

ACT developed youth-focussed programming as a response a rising trend of HIV infection among young people, particularly young gay and bisexual men and other young MSM. The peer outreach model, which came to be known as POP, was conceived as a way for young people to engage their peers about sexual health.

Over the past four years, POP has grown from an idea into a program. The peer-based model appears to have attracted a very committed corps of volunteers. Moreover POP has developed an identity within ACT and among its main target population. The next phase of this evaluation will look more closely at the work being done by POP and how it is received among its main target populations.