Volume 6 [Issue 3], 2014


Innovative programmatic approaches to HIV prevention and care services for gay men, other men who have sex with men (MSM) and transgender persons using information and communication technology (ICT)

Darrin Adams, Kent Klindera, Christopher S Walsh and R. Cameron Wolf


This Special Issue of Digital Culture & Education (DCE) provides innovative programmatic approaches to HIV prevention and care services for gay men, other men that have sex with men (MSM) and transgender persons using information and communication technology (ICT) at a time when these same populations are experiencing an alarming upward trend of new HIV infections. During a successful participatory consultation in Washington D.C. in May 2013 hosted by the U.S. Agency for International Development (USAID) and co-supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), amfAR, the Foundation for AIDS Research, and the National Institutes of Mental Health (NIMH), representatives from Africa, Asia, the Caribbean, Latin America, Europe, Australia and the United States shared innovative uses of communication technology across HIV research, programs, outreach, advocacy and public-private partnerships. Believing it crucial to share their innovations more widely—through open-access channels—led us to working in partnership with these frontline workers, activists, researchers and educators to further document and share their technological innovations in different global contexts. Importantly, we prioritised working with frontline workers and activists by providing cyclical and targeted writing mentoring to assist them in writing about their successful digital interventions. Disseminating this timely work through open-access channels, like Digital Culture & Education (DCE) means that researchers in less resourced institutions, practitioners and activists in the field and the general public can better understand how ICT, particularly mobile technologies, provides unprecedented opportunities to more effectively reach and engage gay men, other MSM and transgender populations across the HIV prevention, testing, treatment and care cascade.


Assessing needs and capabilities: Towards an ICT resource to support HIV-positive gay man and other MSM in Southeast Asia

Benjamin Hanckel, Laurindo Garcia, Glenn-Milo Santos and Eric Julian Manalastas


HIV-positive gay men and other men who have sex with men (MSM) experience sexual stigma, HIVrelated stigma and isolation that can function as barriers to accessing information related to HIV. Little is known about how these men utilise and use technology to overcome these barriers. This study sought to explore technology use and identify key technological concerns of this population through a survey among 119 HIV-positive MSM. This survey was part of a formative assessment undertaken at the initial stage of the development an information and communications technology (ICT) resource and peer-support web-app for HIV-positive MSM in Southeast Asia. In this assessment, we found that HIV-positive MSM lack access to HIV-related support and resources. In particular, we observed that younger MSM (<30) and those diagnosed with HIV within the last year were less likely to report having friends living with HIV compared to older MSM and those without a recent HIV-diagnosis, respectively. These men expressed a need for ICT services that afford opportunities for social connection and resource sharing as well as information related to legal and health care resources. These findings illustrate the capability deprivations experienced by HIV-positive men. Using Amartya Sen’s capability approach we argue that developing an ICT resource can begin to address the deprivations and information deficiencies of HIV-positive MSM by enhancing peer support and increasing access to HIV-related information and resources.


Two internet-based approaches to promoting HIV counselling and testing for MSM in China

Matt Avery, Gang Meng and Stephen Mills


The internet is an increasingly popular among gay men and other men who have sex with men (MSM) in China for finding sexual partners. Gay men and other MSM who meet online are at high risk for HIV infection, but less likely to visit ‘traditional’ venues where they can receive interpersonal HIV prevention interventions. New virtual models are needed to provide HIV prevention messages and services to these gay men and other MSM. FHI 360 and Guangzhou Tongzhi (GZTZ) piloted separate, but complementary, approaches to using information and communications technology to promote uptake of HIV counselling and testing (HCT) among gay men and other MSM in three Chinese provinces (Yunnan, Guangxi and Guangzhou). These approaches included dedicated websites featuring online risk assessment and appointment making, crowd-sourced service promotion messages and dissemination via participants’ microblog accounts and social media profiles. Reach was measured using Web analytics and traditional monitoring and evaluation tools, and government partners provided data on HCT uptake. The FHI 360 and GZTZ interventions reached 7,000 and 2.3 million unique visitors, respectively, and contributed to increases in HCT uptake of 26% and 66% as well as to higher rates of HIV case finding. Internet-based interventions like those conducted by FHI 360 and GZTZ represent a promising channel for engaging otherwise difficult-to-reach gay men and other MSM in China.


Silueta X: Lobbying to establish a LGBTI counseling and medical Center in Ecuador

Diane Marie Zambrano Rodríguez


In this article, I describe Asociación Silueta X and highlight three of it current virtual campaigns: BESOS LGBTI (Kisses LGBTI), Tiempo de Iqualdad (Time for Equality), and Campana Mi Genero en Mi Cedula (My Gender Identity in my ID Card). I specifically outline how Asociación Silueta X uses information, communication technologies ICTs to support advocacy for the lesbian, gay, bisexual, transgender, and intersex (LGBTI) communities in Ecuador. I also outline and describe how Asociación Silueta X engaged in research and advocacy to lobby the Ecuadorian Government to establish the country’s first LGBTI counseling and medical center in Guayaquil, Ecuador. This medical center was created not only to meet the needs of LGBTI individuals, but also to improve access to healthcare among Ecuadorian transgender individuals specifically, due to data showing that this population has particularly low levels of access to services.

Bambucha Media: Using Social Media to Build Social Capital and Health Seeking behaviour among Key Populations

Collins M. Kahema, John Kashiha, David Kuria Mbote and Michael R. Mhando


Recent surveillance data by Tanzania AIDS Commission has shown HIV prevalence among Men who have Sex with Men (MSM), transgender persons (TG) and Sex workers (SWs) to be well above general population estimates. Vulnerability to HIV among the MSM, TG and SWs has been associated with lack of correct and comprehensive information, informed decision, social and internalised stigma, negative legal and policy environment and language barrier. This paper will describe how information communication technologies (ICTs) used by Tanzania Sisi Kwa Sisi Foundation (TSSF), has supported communication and access to the health services especially through outreach and referrals among the MSM, TG, and SWs in Tanzania.


Hidden on the social media”: HIV Education on MSM through Cybereducators in Central America

Jorge Rivas, Jennifer Wheeler, Marcos Rodas and Susana Lungo


Most countries in Central America have HIV epidemics concentrated among men who have sex with men (MSM) and transgender women (TW), with prevalence in these populations ranging from 8% in Nicaragua to 26% in El Salvador. High levels of stigma and discrimination coupled with this heavy HIV burden create a major challenge for efforts to reach these populations and combat the epidemic. The Pan-American Social Marketing Organization (PASMO) developed a combination prevention intervention in Central America that delivers HIV prevention behaviour change communication (BCC) messages, products, services, and referrals to promote improved condom and condom-compatible lubricant use, HIV testing, violence reporting and the use of complementary services. As part of this program, an online “cyber-educator” intervention for MSM, consisting of virtual one-on-one BCC and HIV counseling and testing referrals, was launched through existing chat-rooms and websites. Participants were tracked using a confidential unique identifier code (UIC). In 2013, 7,219 MSM UICs were recorded. Created as a response to social media evolution, this intervention successfully illustrates how innovative HIV prevention education can reach populations most-at-risk for HIV.


Resistance to The Swedish Model through LGBTQ and sex work community collaboration and online intervention

Nicklas Dennermalm


In Sweden, sex workers are often viewed as ‘victims in denial’ by public health authorities. As a result, Swedish sexual health interventions have traditionally focused on women and utilised face-to-face interventions and exit strategies. Unmistakably, interventions targeting male and/or transgender sex workers that utilise harm reduction approaches or low threshold on-line interventions remain marginalised or non-existent. This stands in opposition to recent Swedish research on the sexual health of men who have sex with men (MSM) and transgender people (TG). This research stresses the need for targeted community-based sexual health services. Recent Swedish research also highlights the success of innovative on-line approaches that help male sex workers and TG understand personal risk to HIV and other sexually transmitted infections (STIs), their legal rights and how to access community-based health services. Responding to the research and not viewing sex workers as victims, this paper outlines the design of Sweden’s first bespoke online platform targeting male and transgender sex workers. We outline our unique approach and the steps we undertook to design the Röda Paraplyet webpage (http://www.rodaparaplyet.org1 ) in collaboration with male sex workers and Rose Alliance, a leading sex worker organisation. We argue the voices of sex workers are essential to shifting the Swedish discourse around sex work from one of victimisation that limits sex workers access to Sweden’s extensive evidence-based health care to one that is empowering and increases the safety of sex work, explores how to negotiate condom use and educates sex workers about their rights. In conclusion we illustrate how a broad coalition between organised and non-organised sex workers, LGBTQ organisations, academics and the health care system is essential for creating a sustainable platform of multi-disciplinary knowledge to improve the sexual health and legal rights of sex workers in Sweden and globally.


Ending HIV: An innovative community engagement platform for a new era of HIV prevention

Yves Calmette


ACON is Australia’s largest LGBTI health organisation with a primary focus on the prevention of HIV and other sexually transmitted infections (STIs), as well as health promotion with gay men and other men who have sex with men (MSM). This is the group most affected by HIV in New South Wales (NSW), making up around 80% of all new infections annually (NSW Health, 2013). ACON is a community-based organisation, running a number of programs tailored to gay men’s sexual subcultures, practices, ethnicities and ages. In February 2013, ACON launched Ending HIV, the first large-scale campaign designed to meet the new targets set out in the NSW HIV Strategy 2012-15: A New Era (NSW Health, 2011). This strategy set the ambitious targets of reducing the transmission of HIV between gay and other homosexually active men in NSW by 60% by 2015, and 80% by 2020. Ending HIV was designed to mobilise the gay community to reach these targets. Ending HIV is an interactive social marketing campaign based on peer-education principles that incorporates communication, campaign and community mobilistaion initiatives to reach this goal. Ending HIV has been rolled out nationally and has received a high level of international attention, including winning the 2013 and 2014 Sydney Design Award, Australian Creative Best of the Best, Communication Arts Award of Excellence and the 2014 Graphis Annual Design Award. This article explores the genesis of ACON’s innovative engagement platform, which now drives all of ACON’s HIV and STI prevention work, and discusses the approach’s growing promise for prevention for diverse contexts


Achieving HIV risk reduction through HealthMpowerment.org, a user-driven eHealth intervention for young Black men who have sex with men and transgender women who have sex with men

Kathryn E. Muessig, Nina B. Baltierra,Emily C. Pike, Sara LeGrand and Lisa B. Hightow-Weidman


Young, Black men who have sex with men and transgender women who have sex with men (YBMSM/TW) are at disproportionate risk for HIV and other sexually transmitted infections (HIV/STI). HealthMpowerment.org (HMP) is a mobile phone optimised online intervention that utilises behaviour change and gaming theories to reduce risky sexual behaviours and build community among HIV-positive and negative YBMSM/TW. The intervention is user-driven, provides social support, and utilises a point reward system. A four-week pilot trial was conducted with a diverse group of 15 YBMSM/TW. During exit interviews, participants described how HMP components led to behaviour changes such as asking partners’ sexual history, increased condom use, and HIV/STI testing. The user-driven structure, interactivity, and rewards appeared to facilitate sustained user engagement and the mobile platform provided relevant information in real-time. Participants described the reward elements of exceeding their previous scores and earning points toward prizes as highly motivating. HMP showed promise for being able to deliver a sufficient intervention dose and we found a trend toward higher dose received and more advanced stages of behaviour change. In this pilot trial, HMP was well accepted and demonstrates promise for translating virtual intervention engagement into actual behaviour change to reduce HIV risk behaviours


Reaching men who have sex with men in Ghana though social media: a pilot intervention

Kimberly Green, Philippe Girault, Samuel Wambugu, Nana Fosua Clement and Bashiru Adams


The prevalence of HIV among men who have sex with men (MSM) in Ghana is more than 15 times greater than the prevalence of HIV among adult males in the general population. The prevalence of HIV among MSM in Accra and Kumasi is 34.4% and 13.6%, respectively. In 2012, the USAID Ghana SHARPER project — which supports HIV prevention and care among MSM — reached less than half of the 30,000 estimated MSM at the project sites. In 2013, SHARPER tested the use of social media by MSM community liaison officers to identify unreached MSM networks. We reached 15,440 unique MSM through social media, and 12,804 MSM through traditional outreach activities involving peer educators. The combined total of 28,244 MSM represented 92% of the estimated number of MSM in the country. There was little overlap among the MSM reached by the two methods. The use of social media is a very important avenue for reaching MSM who are not reached by peer educators in Ghana. The method should be adopted as an integral outreach approach for HIVprevention interventions in the future


TLBz Sexperts! Using information and communications technology (ICT) to get to zero HIV infections among Thai transgender people

Nada Chaiyajit


Currently, access to sexual health information that serves the needs of transgender individuals is nonexistent or severely limited. With “Getting to Zero” as the official UNAIDS campaign to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths, this lack of access to information coupled with immense stigma and discrimination among transgender individuals will not allow UNAIDS nor the world to achieve such impressive goals. This paper identifies gaps and challenges in HIV services for transgender individuals living in Thailand. Among other recommendations, the paper recognises the need for the ‘de-coupling’ of transgender services from those serving men who have sex with men. The paper describes an innovative communication technology project, the Thailadyboyz (TLBz) Sexperts! Program, a low-cost, transgender-led, community project offering accurate online transgender-specific sexual health information, social support and legal advice. The paper describes how the TLBz Sexperts! Program exemplifies the power of online communities and social networking platforms in reaching transgender individuals, especially when transgender community members lead in the design, development and implementation of such resources.


Interview with Carl Sandler, CEO of MISTER®

Carl Sandler


Carl Sandler started as the founder of DaddyHunt.com, a website geared towards older men and people who like older men. DaddyHunt.com was founded in 2005 and quickly grew into the largest online community for men over 40 and their admirers. Sandler found that what the community of DaddyHunt users wanted was validation that they were still ‘hot’ and desirable even as they grew older. The interview below is a conversation between Sandler and Diego Solares on behalf of Digital Culture & Education (DC&E) on the role of Apps and HIV in the modern age