HIV stigma is so intense in the Appalachian foothills of western North Carolina that many people walk into the offices of the AIDS Leadership Foothills-area Alliance with full-blown AIDS. 'When we look at our new clients from last year, 90% came in with an AIDS diagnosis,' ALFA executive director Rodney Tucker tells HIV Plus from his office in Hickory, N.C. '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, federal, and private funding, has a client base that is 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.' It's extremely rare that these men would talk to their primary care physician about HIV concerns, Tucker says. And when considering visiting a clinic like ALFA, their fear over their reputations often outweighs their health worries. 'Many men are afraid to come into 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. 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 men-seeking-men section of Craigslist and through gay hookup smart phone app Grindr as well. When people click on their profiles or ads, they see friendly messages about testing and where to go if they have health questions. 'Most people have a blank screen as a profile,' Tucker says, describing the patients. 'The last two that came in were married and had been having sex with men for the majority of their lives. One was 50, another in his 30s.' Many of those reached through Grindr and Craigslist are out of work and have ample time to cruise for unsafe sex. 'Most people are very poor and unemployed,' Tucker says. 'Hitting Craigslist gives them something to do during the day.' Tucker and Zealy's unusual gambit is working'on the fall day that Tucker spoke to HIV Plus, three people contacted them through Grindr. Tucker and Zealy tell some of the more skittish men that ALFA representatives can come to their homes to provide testing and services in private. 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.