HIV stigma is so intense in the Appalachian foothills of western North Carolina that many people walk into the offices of the ALFA Health Center in Hickory having advanced to AIDS.
"When we look at our new clients from last year, 90% came in with an AIDS diagnosis," says Rodney Tucker, executive director of ALFA (Advancing Life. Fighting AIDS). "They've been positive for a long time and they're coming in through the emergency room -- they're coming in very sick."
ALFA, which provides outreach, education, counseling, testing, and referrals though state and federal funding, serves mostly Caucasian men, many of whom have sex with other men but don't identify as gay. Many of these men, often married to women, are driven to extremely risky behavior because of internalized homophobia and shame, according to surveys conducted by ALFA.
"It reminds me of what was happening in the '80s [in other areas]," Tucker says. "A lot of park hookups. Sex in the saunas, the gyms, on Blue Ridge parkway. While they're having all this risky behavior, they're not getting tested."
To reach these men before they're sick, Tucker, along with ALFA's director of education, David Zealy, recently came up with some novel approaches. Using Tucker and Zealy's own pictures, the men, both gay themselves, created profiles on the gay hookup smartphone app Grindr as well as the men-seeking-men section of Craigslist. When people click on their profiles or ads, they see friendly messages about testing and where to go if they have health questions.
The gambit is working -- the very day in September when Tucker spoke to HIV Plus, three people had contacted ALFA through Grindr. Tucker and Zealy tell some of the more skittish men that ALFA representatives can come to their homes to perform testing and services in private.
"Many men are afraid to come in to our office because they think if anyone sees them coming to an AIDS service organization, they're already tagged as being gay or positive," Tucker says.
Seeing success in their approach, Tucker and Zealy hope to expand their outreach to other gay-popular sites. Their innovative method uncovered "an invisible population that we didn't know how to find otherwise," Tucker says.