Malaysia mHealth study highlights potential of mobile technology to support marginalised people living with HIV
Transgender women and men who have sex with men living with HIV show concerning levels of treatment adherence and condom use but above-average mobile ownership and acceptance of mHealth.
A ‘micro-study’ with 150 transgender women and men who have sex with men living with HIV in Malaysia has found concerning levels of both treatment adherence and condomless sex but higher-than-average mobile use – suggesting technology could be part of the solution.
Mobile health (otherwise known as ‘mHealth’) uses mobile technology to manage healthcare, improve health outcomes, and promote healthy behaviours.
In countries like Malaysia, where homosexuality and gender expression are stigmatised and criminalised, mHealth has the potential to provide cost-effective support while reducing LGBTI people’s exposure to the discriminatory treatment they can experience when visiting health clinics.
But mHealth initiatives are often introduced without an understanding of how useful they are likely to be for their intended audience. This is particularly the case when it comes to marginalised groups, such as transgender women and men who have sex with men.
To shed light on this issue, researchers enrolled 114 men who have sex with men and 36 transgender women in Kuala Lumpur via a clinic where they were patients or through community outreach. All study participants were 18 or older, living with HIV, and had been prescribed antiretroviral treatment (ART) for at least 6 months.
Participants had a mean age of 35; 59% were college-educated, and 82% were employed full-time. Most (63%) identified as homosexual, 21% as heterosexual, and 15% as bisexual.
Despite the study being restricted to people on ART, one fifth of participants were not currently taking HIV medication. Among those who were on ART, one-fourth were not taking it correctly.
The study’s authors describe these gaps as an “indirect measure of healthcare stigma”. Indeed, stress, depression and experiences of HIV stigma were high among participants, with 42% assessed as having moderate to severe depression.
Participants had high levels of understanding about health issues and high levels of social support.
But a third had not used condoms the last time they had sex or within the past six months. Around 7% reported alcohol misuse and 11% drug misuse.
Participants reported excellent access to technology, with mobile phone ownership higher than among Malaysia’s general population. Around 80% had internet access and 75% had smartphones.
Participants also had higher-than-average acceptance of mHealth. This was especially true for people who struggled to take their HIV medication, suggesting that mHealth could be an effective way to improve adherence.
Treatment reminders and receiving information about HIV and sexual health were seen as the most helpful things mHealth could provide.
Despite its small sample size, these findings suggest that transgender women and men who have sex with men in Kuala Lumpur and in similar settings could benefit from interventions to improve ART adherence among those living with HIV and condom use. Given how many participants had mobile phones, mHealth could play a significant role in providing this life-saving support.