Group therapeutic change
What is the activity?
There are two basic models for the provision of therapeutic change and skills-building with groups, known as groupwork interventions and as support groups. We describe them each separately here.
Groupwork interventions target and recruit members of sub-groups within a population that are likely to share speciﬁc sets of HIV prevention and sexual health need (such as those with multiple concurrent sexual partners, or people in sero-discordant relationships, for example). Meeting over a pre-determined course of time (for example, one weekend plus four week nights over a six week period), the group is facilitated by qualiﬁed counsellors and / or trainers. The aims of groupwork interventions should be clearly articulated at recruitment, and will involve some mixture of all of the following elements: information-giving, skills development, resolution of psycho-social conﬂict, and an increase in social capacity. Such activities may be regarded as short intensive courses that help people to kick-start broader reﬂective processes regarding speciﬁc behaviours that relate to their sexual health.
Support group interventions offer diverse groups of people safe space to exchange experiences and ideas with peers. Sharing concerns and challenges can help people to begin processes of problem-solving in their own lives. Although the ethos of self-help and empowerment pervades such interventions, professional facilitators with some training in counseling skills are often present. Support groups can provide a vital life-line for those who feel socially isolated.
Although support groups may operate weekly or monthly over extended periods of time, those attending will vary, so the aims are likely to be much less deﬁned than they would be for groupwork, for example. However, they will also include some elements of: information-giving, skills development, resolution of psycho-social conﬂict, and an increase in social capacity - but these will be delivered using relatively informal methods. Facilitators may help to stimulate discussion and personal development by hosting a variety of speakers on topics that will be of interest to attendees.
Groups that provide social or community infrastructure (such as more general youth, social or interest groups) and therefore contribute to the aims of community development are discussed elsewhere.
Strengths and limitations
Due to the high cost of delivery, short-course therapeutic interventions are unlikely to be feasible for more than a very small proportion of MSM. This means that careful consideration should be given to recruiting only those whose unmet need has the greatest impact.
Attending groups requires that participants self-refer, meaning that they have to identify and prioritise their HIV prevention needs. It is possible that those in greatest need of group interventions may be least able to access them because they may feel alienated from them, are unsure of their outcomes, or have other obligations or resource limitations that make engagement unlikely.
Evaluation has demonstrated that these interventions are likely to have a signiﬁcant advantage over other less intensive interventions because their duration encourages identiﬁcation of detailed personally-relevant issues, reﬂection on these factors, and support in ﬁnding acceptable solutions. This means that the potential for behaviour change resulting from skills-based and therapeutic interventions for groups far exceeds what can be expected from some other forms of prevention activity (see the Planning section).
Where does it happen?
Groupwork and support groups are usually centre-based activities. Where agencies lack the necessary facilities, accessible locations (such as commercial venues or community centres) can be hired. Selection will need to prioritise users’ needs to feel welcomed and safe, as well as attending to privacy and conﬁdentiality. To this end, user consultation prior to naming and siting of groups will help to determine their acceptability.
Reception staff should be briefed on the discreet handling of attendees, and a private area off the main room might be useful for those who require 1-to-1 support or space to themselves after an emotive or provocative session.
Frequently delivered alongside ...
Issues to consider
Whereas support groups are traditionally regarded as being the model of service provision for people with diagnosed HIV, many groups of people likely to be involved in HIV transmission can beneﬁt from their provision. Consideration should be given to broadening out support groups for others such as behaviourally bisexual men, or negative partners of people with diagnosed HIV.
Groups of all kinds are most effective when their identity and role are clear. As such, members should be aware of a group’s function, and can be asked to contribute to the development of its identity. Where interventions have an extensive therapeutic element, it is ideal that they are convened by those with professional training, accreditation and appropriate supervision.
Aims and outcomes
The outcomes of therapeutic and skills building group interventions tend to focus on participants’ motivation and skills to avoid participating in HIV transmission. The list below offers some examples of outcomes (dependant on the content of the intervention), but is not exhaustive.
- Increased motivation to avoid HIV exposure and transmission (see associated choice and some of the basic information, opportunities and resources and skills needed).
- Increased conﬁdence to openly discuss sex, sexuality, and sexual health with partners and in social networks, including the resources and skills to share information with partners and to decline sexual contact.
- Increased confidence to decline any unwanted sexual activity or defer having new sexual partners and associated aims, such as knowing the increased risks associated with having higher numbers of male partners.
- Increased control over involvement in HIV exposure and transmission in their lives (see associated choices such as declining or deferring a new sexual partner or choosing monogamous rather than open regular relationships with men) and aims such as knowing the increasing risks associated with having higher numbers of male partners.
Monitoring and evaluation
Access evaluation can be undertaken alongside monitoring activities, to determine the proﬁle of people attending. While this does not address effectiveness, it can be compared with needs data from research samples in order to establish whether those sub-groups most in need are accessing the intervention.
Evaluating the effectiveness of support group attendance could be undertaken through face-to-face interviewing or focus groups with current, past and non-attendees in order to determine reasons for attendance and attrition, and to gain input into future planning. In the case of groupwork, questionnaires distributed at the outset of the intervention should clearly articulate the expected outcomes of the group. Attendees can add information about how they came to hear about the group, and what motivated them to attend. As soon as the intervention is complete, they can also be asked to complete another questionnaire.
A more costly, but more useful means of evaluating groupwork would be to follow-up attendees through face-to-face or telephone interviews (after say, three or six months) to determine any outcomes from the intervention, and what further needs they have identiﬁed as a result.
Page last updated: 17 June 2013
Residential weekend for men in rural areas
A group weekend for MSM in the South West of England was run by Healthy Gay Cornwall and The Eddystone Trust. Men were supported to discuss personal and social strategies for remaining HIV negative. Through exploring emotional and physical well-being, men were encouraged to explore new strategies and discuss them with each other. HIV was discussed in the context of a holistic approach to sex, risk, proximity to HIV, and strategies for maintaining emotional and physical well-being. The group has continued to meet informally, leading to new friendships. One-to-one, follow-up therapeutic sessions were offered, and some men continue to volunteer and participate in local community activities.
Black Gay Men’s Group
Facilitated and supported by a community development worker from Yorkshire MESMAC, a Black Gay Men’s Group was set up in February 2011. It was established following a survey of black MSM in the Yorkshire region, which indicated they were looking for a safe space to meet other black MSM and to receive and build peer support. Initially some men were concerned about being ‘outed’ by joining the meetings but a core group of men were instrumental in recruiting peers and friends. The group addresses the needs men bring, rather than a set programme. This includes support with coming out; learning about gay culture and history; dealing with homophobia and discrimination; sexual health and developing relationships and friendships.