Background In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective The aim of this study is to describe the current state of AYAs’ phone use in the region and trace out the implications for mobile health interventions. Methods We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention.

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BACKGROUND In East and Southern Africa (ESA), where landlines are used by 1% of the population, and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote adolescent and young adult (AYA) health in the region. OBJECTIVE Our objective was to detail the current state of AYA phone usage in the region and trace out the implications for mobile health interventions. METHODS We identified 2 trading centers that were representative of the region in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19, 20-24), gender, and phone ownership and randomly sampled 31 KII participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYA in the communities of study. RESULTS AYA frequently reported barriers to using their phones such as difficulty accessing electricity sources. Nearly all AYA used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners as well, with many AYA reporting that their sexual partners associated phone use with infidelity. Few AYA reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYA reported that they would like to use their phones for health purposes, and specifically stated they would like to use their mobile phones to access current HIV prevention information. Finally, most participants reported an instance when they used their phone in an emergency, with childbirth related emergencies being most common. CONCLUSIONS The current analysis demonstrates how mobile phones are related to economic practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our prior associations mobile phone ownership and having multiple sexual partners. Mobile phones have great potential to serve as tools for health promotion.

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