Innovative health promotion interventions engaging men who
have sex with men (MSM) in south east Asia through social media, apps, online
marketing, video tools and phone services were highlighted at the 22nd
International AIDS Conference (AIDS 2018) last week. In contexts where same-sex
behaviour often remains stigmatised, digital connections are increasingly
important.
Lord-Art Lomarda said that in the predominantly Catholic
country the Philippines, campaigns typically use stigma and fear to educate the
public about HIV. His organisation, LoveYourself,
wanted to create a sex positive campaign that used the internet and social
media to engage young MSM. They adapted a Thai campaign, maintaining its simple
and direct language: “SUCK. F*#K. TEST. REPEAT.”
The campaign
translated online engagement into ‘offline’ testing at eight MSM-friendly
clinics. The clinics reported that they tested over 7000 young MSM, 62% more
than in the same month of the previous year.
Tham Thi Tran of PATH said that there are estimated to be
around 330,000 men who have sex with men in Vietnam, but previous face-to-face
outreach work was reaching less than a tenth of them. PATH’s research suggested
that 89% of MSM owned a smartphone, 98% had at least one social media account
and 74% met sexual partners online.
Believing that it would make more sense to meet men where
they already are, PATH and a group of MSM community organisations partnered
with Xóm Cầu Vồng
(Rainbow Village), a Facebook group with over 230,000 members. Key MSM
influencers were trained to interact with Xóm Cầu
Vồng followers, again with
the aim of translating social media outreach into use of physical services. A website and mobile app allowed people to
book appointments for HIV testing, sexually transmitted infection care, pre-exposure prophylaxis (PrEP)
and other services.
In a two-year period, 3626 were counselled about HIV testing,
of which 2808 (77%) took a test. The positivity rate of 11.8% is around twice
that of MSM testing through other channels.
The Silom Pulse
Clinic in Bangkok reported that three-quarters of its PrEP users are ‘PrEP
tourists’ who travel from other countries in the region (especially Hong Kong
and Singapore) to get PrEP. This is a private-sector, fee-charging clinic which
promotes its PrEP services through a number of Facebook groups centered on MSM
and PrEP, dating websites, a sex workers’ webboard and other social media.
Appointments can be booked online. After an appointment, support is available
again online, through the clinic’s Facebook page and online chats with doctors
and nurses.
“This form of access requires special online-to-offline
measures and a counselling procedure that is tailored to the needs of foreign
clients,” reported Natthakhet Yaemim. A key challenge is to ensure ongoing
follow-up and monitoring of patients in the months after they get hold of the
medication.
Jureeporn Jantarapakde reported on a model of online
supervised HIV self-testing provided by the Thai Red Cross. This involved a
peer worker having a video link with a person using a self-testing kit, with the worker able to provide support on how to use the test,
interpreting the result and the implications of the result. A group of 472 MSM
and 99 transgender women had the option to choose between conventional ‘offline’
testing, supervised online self-testing and a mixed approach (online
counselling and offline testing). Slightly fewer chose the mixed approach than
the other two.
The fully online approach was the most popular, enrolling
significant numbers of people who had not tested before (47%) with a very high
HIV prevalence (16%). However, linkage to care was poorer in the online group
(53%) than in the offline group (84%).
Her colleague Chattiya Nitpolprasert reported on a study
which randomised Thai MSM engaged through the Adam’s Love website to
either receive a series of online educational interventions or to form a
control group. The interventions used a platform called Vialogues in which users watch YouTube videos and
are invited to discuss the content with a health educator and other users in a
private chat room.
Retention was high – 33 of 37 men in the intervention arm
completed all 12 monthly sessions. There were statistically significant
differences in condom use, numbers of sexual partners and seeking partners
online between the intervention and control arms.
Sereyvisith Sokhan of FHI 360 in Cambodia had concerns
about the ability of outreach in physical locations to reach large numbers of
people, but argued that internet interventions still have limitations in terms of being unable to reach people who
have low literacy, are less engaged with social media or have limited internet
access. He described a project using a telephone-based interactive voice
response system, which can be accessed from any mobile phone.
Leaflets and social media promoted a hotline which offered
three services: MStyle (for men who have sex with men), SreySros (for
transgender women) and SMARTgirl (for female entertainment workers). Users
could then listen to health information communicated through quizzes and short
messages; listen to edutainment using mini-dramas, songs, and testimonials; or speak to a counsellor.
The edutainment was the most popular option, chosen on over half of calls. In an eight-month period, over 67000 calls were received from 8500 unique numbers.
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