Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study

Abstract

BackgroundAs Internet and mobile phone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men (MSM) and hijras (transgender women), hesitant to access traditional health care systems.ObjectiveThe purpose of this study was to determine if an mHealth intervention was acceptable to MSM and hijras living in Mumbai, and if so, what features would be useful in targeting the prevention of HIV acquisition and to increase the quality of life among persons living with HIV/AIDS.MethodsData from 4 focus groups with MSM and interviews with 4 hijras, 10 health service providers, and 8 mHealth developers were thematically analyzed.ResultsOnce the need for an mHealth intervention was confirmed, comments about features were organized into 3 themes: content, interface, and retention. Content subthemes included providing sex education for younger community members, providing information about STIs, and providing information and social support for persons living with HIV. Interface subthemes included presenting content using pictures; using videos to present stories of role models; using push notifications for testing, appointment, and medication reminders; using geolocation to link to just-in-time services; and using telemedicine to increase access to health service providers and community services. The 5 retention subthemes included keeping it fun, using gaming mechanics, developing content in regional languages, protecting confidentiality, and linking to social networking apps.ConclusionsThese findings may help inform mHealth development in India.

Using Digital Communication Technology to Increase HIV Testing Among Men Who Have Sex With Men and Transgender Women: Systematic Review and Meta-Analysis

“…Second, interactive interventions—those that allowed participants to engage directly with online content or other users—demonstrated greater impact on HIV testing uptake compared with the overall pooled estimate. Interactivity in digital interventions has been associated with achieving a greater impact on behavior change across a range of health areas [ 75 - 77 ] and has been identified as a desired feature of digital HIV prevention interventions among MSM and TW [ 43 , 78 ]. Third, our subanalysis also identified that interventions that used mainstream social media platforms, such as Facebook, were also associated with greater uptake of HIV testing.…”

“…However, all interventions that utilized social media platforms were also categorized as interactive, making it difficult to isolate the source of the enhanced effect. Social networking–based interventions are commonly used for sexual health promotion [ 79 ], and the use of existing social media platforms has been identified as a way to enhance retention among young MSM and TW in online HIV prevention activities [ 43 ]. Using existing and well-utilized social media platforms may also enhance the reach of digital HIV prevention interventions [ 80 ] compared with those that are delivered through new or separate platforms.…”

“…TW may use social and sexual networking apps less frequently than MSM, which may reflect the limited number of social and sexual networking sites specifically catering to TW relative to MSM [ 87 ]. However, factors such as TW’s reported reliance on online sources of sexual health information [ 88 ], perceived acceptability of digital approaches to HIV prevention [ 43 ], and examples of real-world applications of digital communication technologies to HIV prevention among TW [ 87 ] suggest that TW also stand to benefit from digital approaches to HIV prevention and their inclusion in future trials should be prioritized. Finally, the majority of studies were conducted in high- or middle-income settings.…”

“…Evidence pointing to higher rates of condomless sex [ 31 - 33 ] and diagnoses of sexually transmitted infections (STI) [ 27 , 28 , 34 , 35 ] among MSM and TW who use online platforms to find sex partners suggests that online platforms may be appropriate targets for sexual health promotion. It has been suggested that internet-enabled technology can provide a discrete means for HIV health promotion in locations where same-sex behaviors are highly stigmatized or illegal [ 36 ], while the acceptability of HIV prevention interventions delivered through digital communication technologies has been noted among MSM and TW [ 37 - 43 ]. Together, these findings enhance the potential of using digital technology to reach those at high risk of HIV and serve as an important platform for health promotion outreach.…”

Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study

“…Most men, including a substantial number of firsttime testers, claimed the app gave them a "nudge" to test for HIV. Other studies have shown the potential of a digital intervention to support early HIV diagnosis in men (Rawat et al, 2018;Wood et al, 2019;Zhao et al, 2018). However, individuals' autonomy to test for HIV was shaped by factors other than the app, suggesting that digital applications like EPIC-HIV1 may be most effective for men when used to support effective decentralised HIV care (Li et al, 2017;Liu et al, 2016;Nakanwagi et al, 2016;Nhassengo et al, 2018).…”