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

摘要 马来西亚的艾滋病毒疫情正在迅速扩大，最近有证据表明，性传播加速， 尤其是在男男性行为者(MSM)中：2008年为10%，2016年为54%。生物行为调查 提示全国男男性接触者中HIV感染率较高(21.6%)。其中，青年男男性接触者(YMSM)承担着 马来西亚新增艾滋病毒病例的巨大负担，归因于无避孕套性行为水平高，艾滋病毒感染率低 测试，以及对PrEP的有限访问。除了高风险外，马来西亚的YMSM还存在高水平的共病 导致整体健康状况不佳的条件，包括大量使用香烟(78%)、酗酒和 甲基苯丙胺、抑郁症和性传播疾病。除了YMSM拥有的共同障碍(例如，缺乏 艾滋病毒预防知识和对风险的误解)，马来西亚基督教男同性恋者经历了高度的耻辱和 歧视，以及在获得机密艾滋病毒护理方面的困难。因此，他们被边缘化了 传统的、以场地为基础的艾滋病毒预防服务，这破坏了国际机构的建议。 青年男性接触者中的艾滋病毒预防疲劳也会破坏这一群体的成果，因为无聊，逐渐减少 对现有的艾滋病毒预防方法感兴趣，这导致了更多的危险行为。为了解决耻辱问题， 歧视和艾滋病毒预防疲劳，游戏化的mHealth综合艾滋病毒预防战略可以进行 马来西亚的YMSM提供预防信息，帮助他们匿名做出健康决定，从而保持 马来西亚的YMSM大有希望。为YMSM设计的游戏化mHealth干预措施还处于初级阶段， 还没有在马来西亚改编。因此，我们的目标是调整、扩展和改进现有的游戏化 MHealth APP评估马来西亚青年男性接触者艾滋病毒的可接受性、可行性和重要因素 预防和并存的情况。这项探索性先导研究的结果将为未来的 类型1混合实现科学试验。

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.