Gamification to enhance engagement in HIV prevention and co-morbid conditions in young men who have sex with men

摘要

Abstract Malaysia’s HIV epidemic is rapidly expanding with recent evidence suggesting accelerated sexual transmission, especially among men who have sex with men (MSM): 10% in 2008 to 54% in 2016. Biobehavioral surveys suggest high HIV prevalence in MSM being nationally (21.6%). Among these, Young MSM (YMSM) bear a substantial burden of new HIV cases in Malaysia, attributed to high levels of condomless sex, low uptake of HIV testing, and limited access to PrEP. Besides heightened risk, Malaysian YMSM have high levels co-morbid conditions that contribute to poor overall health, including high use of cigarette (78%), alcohol and methamphetamine, depression, and STIs. Besides the common barriers that YMSM have (e.g., lack of knowledge in HIV prevention and misperception of risk), Malaysian YMSM experience high stigma and discrimination and also difficulty in accessing confidential HIV care. Consequently, they are marginalized from traditional, venue-based HIV prevention services, which undermines recommendations by international agencies. HIV prevention fatigue among YMSM can also undermine gains in this group because of boredom, diminishing interests in existing HIV prevention methods, which lead to more risk behaviors. To address stigma, discrimination and HIV prevention fatigue, gamified mHealth integrated HIV prevention strategies can engage Malaysian YMSM with prevention messages and help them make health decisions anonymously, and thus hold great promise for Malaysian YMSM. Gamified mHealth interventions designed for YMSM are at its infancy and have not been adapted in Malaysia yet. We therefore aim to adapt, expand, and refine an existing gamified mHealth app to assess acceptability, feasibility and important factors that affecting Malaysian YMSM’s HIV prevention and co-morbid conditions. Findings from this exploratory pilot study will inform a future prospective Type 1 Hybrid implementation science trial.