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流行正在迅速扩大，最近的证据表明性传播加速， 尤其是男男性行为者（MSM）：2008年为10%，2016年为54%。生物行为调查 表明全国MSM人群艾滋病感染率较高（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，归因于无安全套性行为的高水平，艾滋病毒感染率低 除了高风险，马来西亚YMSM有高水平的共病， 导致整体健康状况不佳的条件，包括大量吸烟（78%），酒精和 冰毒抑郁症和性传播感染除了YMSM具有的常见障碍（例如，缺乏 马来西亚青年男男性接触者遭受严重的耻辱， 此外，还存在歧视，难以获得保密的艾滋病毒护理。因此，他们被边缘化， 传统的、基于场所的艾滋病毒预防服务，这破坏了国际机构的建议。 YMSM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，减少 对现有艾滋病预防方法的兴趣，导致更多的危险行为。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参与 马来西亚YMSM提供预防信息，帮助他们匿名做出健康决定， 马来西亚YMSM的伟大承诺。为YMSM设计的游戏化移动健康干预措施尚处于起步阶段， 在马来西亚还没有被改编。因此，我们的目标是调整、扩展和完善现有的游戏化 移动健康应用程序评估可接受性，可行性和影响马来西亚YMSM艾滋病毒的重要因素 预防和共病条件。这项探索性试点研究的结果将为未来的前瞻性研究提供信息。 类型1混合实施科学试验。

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.