The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV

Abstract

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.

Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study

“…The results showed a high prevalence of both cell phone ownership and use in this population. This is consistent with many other studies and surveys of cell phone access and use in Uganda [ 3 , 29 ] and in Africa [ 30 ]. This high prevalence of cell phone ownership may be largely attributed to the ease of use and relatively low cost of cell phones [ 11 , 31 ].…”

Interventions to address the mental health of adolescents and young adults living with or affected by HIV: state of the evidence

“…Mental health interventions that leverage digital technology may also provide increased access for AYA who heavily use social media and other text‐based and internet‐based platforms and be well suited for rapid scale‐up with ongoing studies offering insights for the future development and scale‐up of technology‐based mental health interventions tailored to AYALH [75,76]. That said, many AYA in resource‐constrained contexts in particular do not own mobile phones or share phones with others, and those who do own phones may have limited access to airtime, the internet and reliable electricity [77‐80], requiring different approaches to treatment. Regardless of how interventions are delivered, studies to determine lay counsellor capacity, training and supervision required, and the potential role of digital technology in supporting them are needed.…”

‘This is what is going to help me’: Developing a co-designed and theoretically informed harm reduction intervention for mobile youth in South Africa and Uganda

“…For example, although there is variation between mobile phone ownership between the two sites in reality the higher phone ownership in Northern KZN may lead to an over-estimation of access to being able to easily use mobile phones. In both sites, young people struggle to afford airtime and also with uneven and intermittent reception, even with access to a phone it would not necessarily work (Cele & Archary, 2019;Kreniske et al, 2021;Wanyama et al, 2018). To be able to maximise the value of phone-based peer-support additional investment in improving the infrastructure and supporting costs of engagement is critical (Cele & Archary, 2019;Kreniske et al, 2021).…”

“…In both sites, young people struggle to afford airtime and also with uneven and intermittent reception, even with access to a phone it would not necessarily work (Cele & Archary, 2019;Kreniske et al, 2021;Wanyama et al, 2018). To be able to maximise the value of phone-based peer-support additional investment in improving the infrastructure and supporting costs of engagement is critical (Cele & Archary, 2019;Kreniske et al, 2021). But it also illustrates the value in listening to young people's need for a 'drop-in' centre which can serve as a physical hub.…”