“The reason I started doing this work,” Jose Ramos, 37, founder of Impulse Group, explained, “is that my best friend got diagnosed with AIDS. The doctor told us we had a week left.”
Ramos’ friend got treatment and is still with us, but “when he got healthier it really shook me…I had never seen AIDS.”
So in 2009, here in LA, Ramos founded the nonprofit, with the mission to help gay men make healthy lifestyle choices. Eight years later Impulse is a global network in 20 cities around the world, including Atlanta, Bangkok, and London. The two newest chapters are in Buenos Aires and Chicago. Fuel to run Impulse Group comes from the elbow grease of 400-plus volunteers worldwide.
Impulse Group may seem like an odd name. “When you’re being intimate there’s an urge, an impulse, to either be protected, or not,” Ramos said. “We wanted to ensure…when we have that urge, people in the community have information they need to make the best choice for them.”
“A healthier lifestyle” is the tagline on Impulse’s website. Ramos said that while the organization began as one focused on reducing the spread of HIV, “over the years, with…PrEP, PEP, being undetectable…it really became more of a lifestyle” focus.
Several nonprofits focus on HIV reduction and LGBTQ health. What makes Impulse Group different, or even necessary?
“A lot of my friends were becoming HIV-positive,” Ramos said. He believed sero-conversions happened partly because “of how the information [to remain negative] was presented.”
Messaging he saw “was very public health, cookie cutter. We’re missing lifestyles.” In other words, providing crucial information to gay men in the situations they actually find themselves in.
Impulse targets nightclubs, bathhouses and sex parties. “We are at the entrance letting people know about PEP (post-exposure prophylaxis), PrEP (pre-exposure prophylaxis), condom use,” Ramos said. “That’s where the action is happening.”
The nonprofit also educates gay men via events Ramos described as “80% social, 20% educational.” It may be “a three-hour event, but we take 20 minutes to teach about meth addiction. We’re teaching about…viral loads. We package it…in a very social way. I think that makes [what we do] a little more unique than most [nonprofits].”
Social marketing, the implementation of for-profit consumer marketing techniques to encourage the adoption of healthy behaviors, has also been used by British Columbia’s Centre for Disease Control in Vancouver. Mark Gilbert, MD, in the medical journal AIDS, cited campaigns “focused on raising awareness of rapid testing…among gay men” and one “targeted at gay men having risky sex.”
The upshot? Once gay men know their status, or are diagnosed, “behaviour change frequently occurs,” Gilbert writes.
Holding fundraisers and asking for donations is how Impulse Group began. But now it is a fully funded program of AIDS Healthcare Foundation (AHF), where Ramos also works. “[AHF] started to see that we were able to bring [up to] 400 people to talk about HIV,” Ramos said.
Being “fully funded” means “the team spends all of their time on the outreach and advocacy versus recruiting for money.” That outreach includes events in the other 19 cities worldwide. With an annual operating budget of more than $2.4 million, according to Ramos, “AHF has been really willing to fund all of the programs that we have right now.”
Michael Weinstein, AHF’s CEO, stirred up controversy a few years ago. Some in the gay community felt he was anti-PrEP. Ramos says Weinstein prefered to wait until more research came out proving PrEP was indeed effective. Ramos said, “We (Impluse and AHF) think it’s a great tool to use for the high-risk demographic.”
Such demographics need to receive different messages than those considered low-risk. “If you look at the census of who’s taking PrEP…87% of prescriptions are for white males over 30,” said Ramos. “What’s there for transgender sex workers and low-income communities? PrEP isn’t reaching the people that really need it, which is the black community, transgender and Latinos.”
Cultural issues also affect the health of minorities. “The black community tends to stick with the black community…Latino with the Latinos,” Ramos said. “They’re giving HIV what it needs: a high infection rate, they don’t really use PrEP, they don’t really get tested, and they have a lot of sex.”
This is why Impulse believes social messages are instrumental. “Telling people what to do does not work. I’ve seen that. Scare tactics do not work,” those such as “’Use a condom or you will get an infection.’”
“What I think is working is empowerment,” Ramos said. “’Hey! You can do it. You can make the right decision. You can be healthy.’”
The Centers for Disease Control uses this empowerment model. Two current HIV-reduction campaigns “Let’s Stop HIV Together” and “Start Talking. Stop HIV.” encourage behavior change via a knowledge-of-the-facts-is-power model, and by giving potential partners actual safer sex talking points before they engage in sexual activity.
Does Impulse Group know if its efforts are changing behavior? “There’s a couple measurable results,” said Ramos. First, there’s attendance. “At the average Impulse event we’ll bring 200 to 500 people.”
Then there’s testing. “We tend to test about 50 to 70 people [per] event,” Ramos said. That’s “around 4,500 tests a year.” When a positive result occurs (about 60 tests per year), Impulse connects the individual with medical resources for follow-up. “We have a linkage counselor on site. She or he talks to them…ensures they get an appointment either with AHF or their private doctor.”
Information on support groups, like those through LGBT centers across the country, is also provided.
Finally, with a large social network “close to half a million people through all the different Impulse chapters,” Ramos said, “if we push [a message]…it’s seen by [up to] 50,000 people without doing any kind of extra [marketing].”
In Dallas recently, the Impulse chapter there responded to a health advisory from the Texas Department of Health announcing 16 rapidly growing clusters of HIV infections across Dallas, Houston and San Antonio.
Two activations were launched. First, Impulse-branded ads on Grindr and Scruff, the two hookup apps blamed by some in the Dallas LGBT community for fueling the spike in HIV infections, encourage men to get tested and know their status.
Secondly, Impulse Dallas held a Facebook Live event on September 11 to discuss the “rise of HIV infections in Texas as a whole.” Ramos texted me a screenshot showing 2,600 viewers tuned in.
Perhaps the best example of the multi-pronged messaging Impulse uses is in their ads: “Don’t stigmatize HIV. Know your status. Look into getting on PrEP. Incorporate condom usage.”
What about overall goals? “The continued reduction of HIV as a whole,” Ramos replied. But also “bringing awareness to drug use, especially meth.” “Right now, in a lot of our cities, meth is killing a lot more people than HIV.”
According to Craig Sloane, an LCSW in New York City, in his presentation “The Perfect Storm: Gay Men, Crystal Meth and Sex,” use of the drug and spread of HIV are linked. His research supports many of Ramos’ claims. HIV infection can be three times higher amongst gay and bisexual meth users in Los Angeles, and the “meth/sex subculture” is spreading from gay white enclaves to “communities of color.”
Ramos shared a sobering experience. “I’ve lost four friends of mine from meth in the last year-and-a-half.” “I’ve never lost somebody to HIV.”