Implementation of a Confidential Helpline for Men Having Sex With Men in India

Abstract

BackgroundIn India, men who have sex with men (MSM) often face physical violence and harassment from police and the general society. Many MSM may not openly disclose their sexual identity, especially if they are married to women and have families. Due to pervasive stigma and discrimination, human immunodeficiency virus (HIV) prevention programs are unable to reach many MSM effectively.ObjectiveThe objective of this paper was to describe the design, operations, and monitoring of the Sahaay helpline, a mHealth intervention for the MSM population of India.MethodsWe established the “Sahaay” mHealth intervention in 2013; a MSM-dedicated helpline whose main goal was to increase access to comprehensive, community-based HIV prevention services and improve knowledge, attitudes, and behaviors of MSM towards HIV and sexually transmitted infections (STI) in three states of India (Chhattisgarh, Delhi, and Maharashtra). The helpline provided a 24x7 confidential and easy to use interactive voice response system (IVRS) to callers. IVRS function was monitored through an online dashboard of indicators. The system also provided real-time reporting on callers and services provided.ResultsThe helpline received more than 100,000 calls from 39,800 callers during the first nine months of operation. The helpline maintained an operational uptime of 99.81% (6450/6462 hours); and answered more than 81.33% (83,050/102,115) of all calls. More than three-fourths of the calls came between 9:00 am-12:00 pm. The most successful promotional activity was “interpersonal communication” (reported by 70.05%, 27,880/39,800, of the callers). Nearly three-fourths of the callers self-identified as MSM, including 17.05% (6786/39,800) as rural MSM and 5.03% (2001/39,800) as a married MSM. Most callers (93.10%, 37,055/39,800) requested information, while some (27.01%, 10,750/39,800) requested counseling on HIV/acquired immune deficiency syndrome (AIDS), STIs, and other health and nonhealth issues. There were 38.97% (15,509/39,800) of the callers that were provided contacts of different HIV/AIDS referral services. Many MSM clients reported increased self-esteem in dealing with their sexual identity and disclosing the same with their family and spouse; and an increase in HIV/AIDS risk-reduction behaviors like consistent condom use and HIV testing.ConclusionsNational HIV/AIDS prevention interventions for MSM in India should consider scaling-up this helpline service across the country. The helpline may serve as an important mechanism for accessing hard-to-reach MSM, and thus improving HIV prevention programing.

Mobile phone‐based interactive voice response as a tool for improving access to healthcare in remote areas in Ghana – an evaluation of user experiences

“…Evidence highlights that IVR has proven to be a reliable and inexpensive tool in mobile healthcare. For instance, IVR has been applied in low‐ and middle‐income countries for remote education of health personal, for example in the field of family planning , for diagnostic and treatment support , to enhance medical adherence , for the management and monitoring of psychiatric conditions and mental health as well as for education and behaviour change communication in the field of sexually transmitted infections and chronic diseases . The results of our study contribute essential empirical findings to the neglected area of mHealth user acceptance in sub‐Saharan Africa.…”

Women’s Perceptions of Using Mobile Phones for Maternal and Child Health Support in Afghanistan: Cross-Sectional Survey

“…The effectiveness of using IVR for health education remains uncertain according to the literature. Some studies show the effectiveness of IVR [ 14 ], whereas others describe users’ technical difficulty in using it [ 15 ]. A study in Uganda showed that training a target population on how to use IVR before project implementation was possible only for small projects [ 15 ].…”

Development and Open Pilot Trial of an HIV-Prevention Intervention Integrating Mobile-Phone Technology for Male Sex Workers in Chennai, India

“…93.0% of callers received information about HIV/STI, 39.0% referrals for health facilities and 27.0% counseling from a trained operator. As compared to accessing these services in a physical venue, callers reportedly preferred the mobile phone delivery platform because it was more convenient and provided them with greater flexibility in terms of timing and location (Agarwal et al, 2015). The high levels of acceptability and feasibility of Sahaay suggest that mobile phones may be a valuable delivery tool for HIV prevention interventions targeting MSM.…”