TRANSFORMING

HIV PREVENTION & CARE

FOR MARGINALISED POPULATIONS
Using information & communication technologies
(ICTs) in community-based & led approaches

____________________________________________________________________________

Edited by Christopher S Walsh

Transforming HIV Prevention and Care for Marginalized Populations: Using information &
communication technologies (ICTs) in community-based & led approaches by Christopher S
Walsh is licensed under a Creative Commons Attribution 4.0 International License.

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Original cover artwork by Liam Kenny

All chapters have been double blind peer-reviewed by members of the Digital Culture &
Education (DCE) Editorial Board
 Contents
Preface i
Kevin Osborne

Forward ii
Susannah Allison

Introduction 1
Christopher S Walsh, Darrin Adams, Kent Klindera and R. Cameron Wolf

Part 1
1 The HIVe: Harnessing digital technologies to challenge the dominant HIV and AIDS 14
paradigm
Judith D. Auerbach, PhD

2 Local languages, global exchange: Digital networking, communication and 20

collaboration for the health and human rights of men who have sex with men
Jack Beck, Lily May Catanes, Pato Hebert, Goldie Negelev & George Ayala

3 The use of the Internet in male sexual encounters by men who have sex with men 40
in Cameroon
Emilie Henry, Yves Yomb, Lionel Fugon & Bruno Spire

4 ICT & HIV prevention: Experiences from a biomedical HIV prevention trial among 53
men who have sex with men (MSM) in Cape Town, South Africa
Andrew Scheibe, Ben Brown & Linda-Gail Bekker

5 Digital media and the Internet for HIV prevention, capacity building and advocacy 65
among gay, other men who have sex with men (MSM), and transgender (TG):
Perspectives from Kolkata, India
Rohit K. Dasgupta

6 Innovative digital HIV and AIDS education and prevention for marginalised 89
communities: Philadelphia’s Frontline TEACH
Val Sowell, Juliet Fink & Jane Shull

7 The social technographics of gay men and other men who have sex with men 106
(MSM) in Canada: Implications for HIV research, outreach and prevention
Dan Allman,Ted Myers, Kunyong Xu & Sarah Jane Steele

8 Sexperts! Disrupting injustice with digital community-led HIV prevention and legal 126
rights education in Thailand
Nada Chaiyajit & Christopher S Walsh

9 When in Ghana, do as sexual minorities do: Using Facebook to connect gay men 148
and other men who have sex with men(MSM) to HIV
Benjamin Eveslage

10 YouTube viral videos and HIV prevention among African-Americans: Implications 174
for HIV prevention
Jocelyn D. Patterson & Khiya J. Marshall
11 Variations in recruitment yield, costs, speed and participant diversity across 186
Internet platforms in a global study examining the efficacy of an HIV/AIDS and HIV
testing animated and live-action video among English- or Spanish-speaking
Internet or social media users
Winnie Shao, Wentao Guan, Melissa A. Clark, Tao Liu, Claudia C. Santelices,
Dharma E. Cortés& Roland C. Merchant

Part 2
12 Achieving HIV risk reduction through HealthMpowerment.org, a user-driven 211
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 & Lisa B.
HIghtow-Weidman

13 Assessing needs and capabilities: Towards an ICT resource to support HIV- 231
positive gay men and other MSM in Southeast Asia
Benjamin Hanckel, Laurindo Garcia, Glenn-Milo Santos & Eric Julian Manalastas

14 “Hidden on the social media”: HIV Education on MSM through Cyber-educators in 246
Central America
Jorge Rivas, Jennifer Wheeler, Marcos Rodas & Susan Lungo

15 Reaching men who have sex with men in Ghana through social media: A pilot 259
intervention
Kimberly Green, Phillip Girault, Samuel Wambugu, Nana Fosua Clement, & Bashiru
Adams

16 Two internet-based approaches to promoting HIV counselling and testing for MSM 266
in China
Matt Avery, Gang Meng & Stephen Mills

17 Resistance to the Swedish model through LGBTQ and sex work community 281
collaboration and online intervention
Nicklas Dennermalm

18. Bambucha media: Using social media to build social capital and health Seeking 295
behaviour among key populations
Collins M. Kahema, John Kashiha, David Kuria Mbote & Michael R. Mhando

19 Silueta X: Lobbying to establish a LGBTI counseling and medical Center in 309

Ecuador
Diane Maria Zambrano Rodríguez

20 Interview with Carl Sandler, CEO of MISTER ® 323

Interview with Carl Sandler

Author Biographies 329

Introduction: Transforming community-based and
community-led HIV prevention and care through ICTs
Christopher S Walsh
Darrin Adams
Kent Klindera
R. Cameron Wolf

Introduction

Information and communication technology (ICT) is transforming

community-based and community-led HIV prevention and care services for
gay men, other men who have sex with men (MSM) and transgender
people. This book celebrates and shares crucial work of frontline HIV
workers, activists, researchers and educators whom are using innovative
ICT. The book builds on, and extends the work included in two earlier
issues of Digital Culture & Education (DCE), e n t i t l e d ‘Prevention is a
solution: Building the HIVe’ (Singh and Walsh, 2012) and ‘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)’ (Adams, Klindera, Walsh
and Wolf, 2014). It also includes three additional articles published by the
journal.
Over 60 prominent HIV activists, scientists, researchers, entrepreneurs
and public health leaders have contributed as authors within Using
information and communication technologies (ICTs) to transform community
based and led HIV prevention and care for marginalised populations. This
book was published under a Creative Commons Attribution-NoDerivatives 4.0
International License t o complement academic and biomedical publishing
through introducing a dynamic writing mentorship process with academics,
researchers and activists to assist frontline and community-based
organisations publish their innovations, results and ‘lessons learned’. The
editor drew on a cadre of experienced professionals who provided pro-bono
writing mentorships for those individuals with less experiencing writing up
their successful programmatic approaches into journal articles. Multiple
rounds of editing and peer reviewing were conducted, as well as access to
critical resources often unavailable to individuals working in community-
based and led organisations. Recognising the diversity of authors across
professional, academic, and English language profciencies, this Special
Issue highlights community-led eforts through this unique publishing
opportunity. An important goal of this book is to publish successful
interventions through an open-access channel in their entirety, not just the
abstracts. This book showcases a rich and representative sample of
innovative programming, fndings and recommendations from diferent
globakk contexts.
The concepts and programs described in this book acknowledge that

1
 Introduction

evidence-informed combination HIV prevention strategies (e.g., the

simultaneous use of complementary behavioural, biomedical and structural
strategies) can efectively address the contextual and diverse needs of gay,
other MSM and transgender populations (UNAIDS, 2010). The recent global
commitment from UNAIDS, PEPFAR 3.0 and The Global Fund to achieve the
following 90-90-90 goals now aim to:

• ensure at least 90% of those who are HIV-positive know their status;

• promptly enrol at least 90% of those diagnosed HIV-positive in

antiretroviral therapy; and

• ensure at least 90% of those enrolled in treatment are retained, so

that they are virally suppressed.

As a result, it is now understood that the days of HIV prevention programs

standing alone are over. In order to ‘turn the tide on HIV’, we must ensure a
linked continuum of prevention, care and treatment services, also known as
“the cascade”. ICTs therefore, have only just begun to be applied and the
future will bring countless new possibilities to expand access across the
prevention, care and treatment cascade.
Part 1 of this book began in 2010 when Christopher S Walsh and Gurmit
Singh frst organised the seminar entitled, ‘Hear Us’ at the Global Forum on
MSM and HIV’s (MSMGF) Preconference a t t h e 2010 XVIII AIDS
Conference in Vienna. The forum shared innovative digital HIV prevention,
education and care interventions from and with frontline workers, activists,
researchers and educators working with, and in, communities of gay men,
other MSM and transgender persons. Drawing on the robust conversation
at the seminar, Walsh and Singh invited presenters to share their
community-based and led interventions and practices using the Internet and
other digital media for HIV prevention, care and support. Within this
framework and process, Walsh and Singh facilitated two years of rigorous
online and face-to-face mentoring, multiple rounds of editing and peer
reviewing and providing access to critical resources not often available to
individuals working in community-based and led organisations. Then in
2012, DCE published the Special Edition with an introduction by Judith D
Auerbach, eight global case studies, a public ‘health perspective’ piece by
Professor Jonathan Elford and ‘funder’s perspective’ by Kent Klindera.
A year later, Part 2 of this book emerged from a successful technical
consultation entitled ‘Innovative Use of Communication Technology for HIV
Programming for MSM and TG Populations” held in Washington DC in May
2013. Hosted by the U.S. Agency for International Development (USAID)
through the President's Emergency Plan for AIDS Relief (PEPFAR) and co-
sponsored by amfAR, The Foundation for AIDS Research and the National
Institute of Mental Health (NIMH). Forty-four participants shared and
debated how the internet, social media, and other forms of ICT are
improving—or have the potential to improve—the impact of HIV programs
for gay men, other MSM and transgender people. Meeting participants

2
Walsh et al.

included representatives from Africa, Latin America, the Caribbean, Asia,

Europe, Australia and the US. The goal of the meeting was to provide a
forum for key stakeholders in HIV research, programming, implementation
and evaluation to take stock of important developments in the feld and
develop key recommendations to enhance the use of ICT in the delivery of
HIV prevention and care for gay men, other MSM and transgender persons
(Allison et al., 2014). Following the consultation in Washington D.C., all
participants were invited to submit manuscripts for a second Special Issue
o f DCE. The call for manuscripts was broadened to include other
community-based organisations and partnerships leveraging ICT
productively in the fght against new HIV infections. The consultation and the
articles presented in Part 2 recognise the strong synergy between
biomedical and social science approaches to HIV for gay men, other MSM
and transgender people that work by:

• understanding emerging trends in ICT use;

• identifying innovative programmatic approaches and lessons learned
for using technology for outreach;
• informing strategies for future programming and research; and
• working to engage the private sector and public health partners in the
use of ICT to better reach for HIV prevention and care messages and
linkage/referrals to social and health services.

As a result of the technical consultation, nine important recommendations 1

emerged from discussions among diverse frontline workers, activists,
researchers and educators (Alexanderson, Chintalova-Dallas and Cornman,
2013):

1. Develop targeted content that specifcally addresses transgender

people’s needs
2. Foster intersectoral collaboration
3. Understand the strengths and limitations of virtual and physical
spaces and identify opportunities to incorporate both into HIV
programs
4. Present the human face of HIV
5. Think of health providers as users too
6. Improve monitoring and evaluation for ICT programs
7. Know the audience
8. Respect and protect
9. The time to prioritise ICT is now

The articles presented in Part 2 take up, exemplify, illustrate and provide timely
1
For more information see: Innovative Uses of Communication Technology for HIV Programming for
MSM & TG Populations: May 2-3, 2013, Washington, DC. Meeting Report

3
 Introduction

guidance on current innovations and lessons learned across diverse cultural

contexts. They focus on the above recommendations in order to stem the tide of
new HIV infections among gay men, other MSM and transgender people.

Leveraging ICTs to transform current HIV research,

prevention, treatment, care, support services and programing

Transgender persons and men who have sex with men (MSM), including
gay-identifying men, face an alarmingly high burden of HIV globally. This is
confrmed by high HIV prevalence and where available, incidence rates
(Beyrer et al., 2012; Sullivan et al., 2009; Baral et al., 2013). In available
global HIV incidence rates among MSM, HIV infection is signifcantly higher
for MSM than in the general population over a one-year period. For example,
in Kenya, Malawi, and Thailand, HIV incidence over a one-year period
among MSM is reported to be 5.8 percent, 7.1 percent, and 5.9 percent,
respectively (Baral IAS 2013; Sanders et al., 2012; Van Griensven et al.,
2013). HIV prevalence among MSM in high-income settings surprisingly
mirrors their low- and middle-income country counterparts. Overall new
infections are on the rise in the United States, particularly among young
black MSM (Sullivan et al., 2009; CDC 2012; Maulsby et al., 2013; Sullivan et
al., 2014). The UK, Western Europe, and Australia have also experienced
recent increased HIV incidence increases among MSM (Phillips et al., 2013;
Sullivan et al., 2009; Murray et al., 2011).
Insufcient data on HIV prevalence or incidence exists for transgender
persons worldwide. A recent global systematic review (Baral et al., 2013)
reports transgender women are nearly 50 times more likely to be living with
HIV, than adults in the general population and their pooled HIV prevalence
was reported at 19.1 % for the countries were data was available. These
data indicate a high burden of HIV in transgender women globally.
Currently, HIV prevention, treatment, and care programs still remain
largely unreachable and often unavailable for many gay men, other MSM
and transgender persons (Wheeler et al., 2015). Online sampling of over
3700 MSM in 140 countries reports only 35% had access to HIV testing,
43% to treatment, 35% to condoms and less than 25% to condom-
compatible lubricants (Ayala et al., 2013). A global review reports that MSM
are recipients of a small proportion of total HIV prevention interventions
(Sullivan et al., 2012). Little is known on the use of and accessibility to HIV
services among transgender persons globally, as scarce data exists
evaluating evidence-based HIV interventions among this population (De
Santis et al., 2010; Garofalo et al., 2012).
HIV research, services and programs for gay men, other MSM and
transgender persons are often lumped together under the umbrella term
‘MSM’, yet these populations’ sexual behaviours, practices and HIV risk
behaviours difer considerably. Gender identity, gender expression, sexual
behavior and sexual orientation are factors that need to be considered
separately (Wolf et al, 2013). These categories and their local understanding
shift—in scope and perspective—at the global, regional, country, and even
municipal levels. The ubiquity of ICTs and new and emerging applications—

4
Walsh et al.

including geo-social apps (Grindr, Jack’d, Hornet, MISTER, etc.)—provide

unprecedented opportunities to complement, even transform, current HIV
research, prevention, treatment, care and support services and programing
to fll the data and service provisions’ gaps for these key populations. Gay
men, other MSM and transgender persons use apps on smartphones and
websites to fnd romantic and sexual partners (Allman et al., 2012; Beck et
al., 2012; Chaiyajit and Walsh, 2012; Dasgupta, 2012: Henry et al., 2012;
Scheibe, Brown and Bekker, 2012; Singh and Walsh, 2012; Shenck and
Singh, 2012; Allison et al, 2014). The articles in this book take a step forward
in further addressing these issues and reporting on successful and
innovative programmatic approaches.
Guest Editors and authors who contributed to Part 2 attended the 2014
International AIDS Conference in Melbourne Australia and shared their work
at the 2014 MSM Global Forum Pre-Conference: ‘Setting the Pace: Gay
Men, MSM, and Transgender People in the Global AIDS Response’. All of
the articles from this book have also been added to The HIVe, an open-
access networked ecology of HIV activists, practitioners, researchers and
scholars.
This book further develops, explores and substantiates the creative and
efective merging of HIV and ‘e’ around socio-sexual practices, networks
and service delivery systems, which can shape and infuence the future of
interdisciplinary and interconnected public health, human rights and
education programs and policies (Singh and Walsh, 2012).

Diverse voices, unprecedented innovation

With 20 contributions from diverse settings working across HIV research,

prevention, treatment, care and support the book is organised into two
parts. The frst part, ‘Building the HIVe’ presents articles from the 2012
Special edition as a whole. Part 2, ‘Networking to build the HIVe’ has four
sections. Section one presents formal research from Asia and the US with
HIV positive MSM which has implications for scale up of HIV services for
MSM and transgender persons. The next section highlights the successful
work of international NGOs working in collaboration with community-based
organisational partners in Central America, Ghana and China. The third
section showcases three community-led interventions in Sweden, Tanzania
and Ecuador. Section four provides a new perspective on the potential
application of public-private partnerships in the use of ICTs, particularly geo-
social apps, in reaching gay men and other MSM with important HIV health
related information in the US.

Part 1: Building the HIVe

The chapter by Jack Beck, Lily Catanes, Pato Hebert and George Ayala,
“Local languages, global exchange: Digital networking, communication and
collaboration for the health and human rights of men who have sex with
men”, reports on a global efort by a key civil society non-state actor to build
the digital platform, www.MSMGF.org. This unique user network

5
 Introduction

strengthens the capacities of front-line civil society organisations around the

world. Using data from user feedback, they argue for the need to move
beyond expanding access to resources to enabling grassroots actors to
deploy these digital resources efectively in their work to impact on the
health outcomes of minority MSM populations.
Emilie Henry, Yves Yomb, Lionel Fugon and Bruno Spire critically take up
the issue of risk and sexual practices in Cameroon, Africa in “The use of the
Internet in male sexual encounters by men who have sex with men in
Cameroon”. Their study draws on data from a survey on MSM sexual
practices and from a pilot online HIV outreach and prevention programme
run by a community-based organisation in a very harsh legal environment
where MSM face extreme violence. Their work points to the urgent need to
confront the wider contextual factors that afect HIV risk and the potential of
digital approaches to be expanded for this goal, particularly in contexts
where MSM face disempowering legal and socio-cultural contexts that
pathologise their right to be who they are.
Working within a larger global biomedical HIV prevention trial, the study
by Andrew Scheibe, Ben Brown and Linda-Gail Bekker from the Desmond
Tutu HIV Foundation in South Africa explores their use of information and
communication technologies (ICTs) to mobilise participation from the MSM
community. In “ICT & HIV prevention: Experiences from a biomedical HIV
prevention trial among men who have sex with men (MSM) in Cape Town,
South Africa” they argue that the rise of digitally mediated sexual practices
of MSM in Africa needs to be better understood and used to address the
structural barriers to HIV prevention.
Rohit Dasgupta employs a postcolonial queer lens to describe his
experience working with an HIV prevention charity, Solidarity and Action
Against the HIV Infection in India (SAATHI) in “Digital media and the Internet
for HIV prevention, capacity building and advocacy among gay, other men
who have sex with men (MSM), and transgender (TG): Perspectives from
Kolkata, India”. He describes SAATHI’s use of ICTs for HIV advocacy and
capacity building across the country, with a focus on Kolkata. Dasgupta
points out how what could on the surface be perceived as an ordinary
capacity building initiative supplemented by a web presence, can be re-
theorised through the lived experience of not only the colonising structures
of MSM and transgender people, but through ‘kothi’ and ‘hijra’. His work
provides important implications for the practical use and design of digital
technologies for HIV prevention and education in ways that valorise the
subjectivity of the multiplicities of gay men, other MSM and transgender
people that are present in the global South.
Val Sowell, Juliet Fink and Jane Shull from Philadelphia FIGHT present
evidence and insights on designing a successful open distance fexible
learning (ODFL) programme called Frontline TEACH. Their chapter,
“Innovative digital HIV and AIDS education and prevention for marginalised
communities: Philadelphia’s Frontline TEACH” highlights how traditional
AIDS Service Organisations can use open access digital technologies to
design digital HIV education that serves the needs of marginalised
communities from lower socioeconomic backgrounds. Frontline TEACH has

6
Walsh et al.

signifcant implications for the theory and practice of using open-access

community-based digital HIV education and prevention programmes
because it not only widens access, but also improves health and literacy
outcomes.
Dan Allman, Ted Myers, Kunyong Xu and Sarah Jane Steele interpret gay
men and other MSM’s social media usage in Canada drawing on socio-
technographics and Web 2.0 theoretical frameworks in their chapter, “The
social technographics of gay men and other men who have sex with men
(MSM) in Canada: Implications for HIV research, outreach and prevention.”
Their work foregrounds the issue of age and other demographics in
structuring the digital behaviours of gay men. Their analysis clearly shows
that something more than spreading safe sex messages online and on
mobile phones needs to be done to work creatively with gay men’s socio-
technographics. This chapter poses the question, “what kinds of specifc
digital individual and community support systems would gay men and MSM
value that could increase their capacity for agency to make changes to their
sexual practices?”
Nada Chaiyajit and Christopher S. Walsh present their work on designing,
implementing and analysing two Sexperts! Programs with community-based
groups in Thailand. Their chapter, “Sexperts! Disrupting injustice with digital
community-led HIV prevention and legal rights education in Thailand”
documents how social networking and instant messaging were used to
provide HIV prevention and education to communities of gay men, other
MSM and transgender people. These unique digital interventions explicitly
focus on sexual pleasure and health, legal rights, and where to go to access
justice when individual rights are violated. Through contextualised online
and mobile platforms, both programmes refreshingly highlight digital
interventions that aim to reduce stigma and discrimination around gender
identity, sexuality, sex work and gender reassignment.
The article “YouTube viral videos and HIV prevention among African-
Americans: Implications for HIV prevention” by Jocelyn Patterson and Khiya
Marshall focuses on the potential use of viral videos for HIV/AIDS prevention
activism and education. Patterson and Marshall present a content analysis
of YouTube member responses to viral videos featuring African Americans
that had a theme of HIV/AIDS prevention. This detailed analysis of user
comments suggests that the motivation to share and view such videos
includes a spectrum of emotional responses, ranging from anger and
frustration, to heartfelt encouragement and support.
“Variations in recruitment yield, costs, speed and participant diversity
across Internet platforms in a global study examining the efcacy of an
HIV/AIDS and HIV testing animated and live-action video among English- or
Spanish-speaking Internet or social media users” by Winnie Shao, Wentao
Guan, Melissa A. Clark, Tao Liu, Claudia C. Santelices, Dharma E. Cortés
and Roland C. Merchant presents a world-wide, Internet-based study on
HIV/AIDS and HIV testing knowledge that compared the yields, speed and
costs of recruitment and participant diversity across free postings on 13
Internet or social media platforms, paid advertising or postings on 3
platforms, and separate free postings and paid advertisements on

7
 Introduction

Facebook. Platforms were compared by study completions (yield), time to

completion, The study results highlight the need for researchers to strongly
consider choice of Internet or social media platforms when conducting
Internet-based research.
Benjamin Eveslage’s chapter, “When in Ghana, do as sexual minorities
do: using Facebook to connect gay men and other men who have sex with
men to HIV services”, chapter highlights how social stigma and
discrimination, compounded by the criminalization of homosexuality,
infuence gay men and other MSM to avoid in-person peer-networks and
settings where HIV prevention and care services are available. He argues
that Facebook is uniquely well suited for connecting these at-risk
populations to sexual health interventions and services. Drawing on fndings
from an ethnographic study, Eveslage outlines how CBOs and NGOs
delivering sexual health services could possibly improve HIV prevention and
care outreach within these subpopulations of gay men and MSM by
mimicking how they use social media. He also outlines a number of logistical
considerations and specifc methods sexual health CBOs and NGOs could
implement using social media for HIV prevention and care, arguing they
have the potential to improve outreach to underserved subpopulations of
gay men and other MSM in contexts where discrimination, fear and stigma
prevent them from accessing these vital resources.

Part 2: Networking to Build the HIVe

Section 1: Scaling up HIV services for MSM and transgender communities

I n t h e i r c h a p t e r “A c h i e v i n g H I V r i s k r e d u c t i o n t h r o u g h
HealthMpowerment.org (HMP) 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 succinctly illustrate how young,
Black men who have sex with men and transgender women who have sex
with men (YBMSM/TW) who are disproportionately at risk for HIV and other
sexually transmitted infections (HIV/STI) can be reached through an online
mobile platform. HMP’s platform is an innovative 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 young black men who have sex with men and transgender
women who have sex with men.
Benjamin Hanckel, Laurindo Garcia, Glenn-Milo Santos and Eric Julian
Manalastas present work that confronts the sexual stigma, HIV-related
stigma and isolation HIV-positive gay men and other men who have sex with
men (MSM) experience when accessing information related to HIV. Their
study, “Assessing needs and capabilities: Towards an ICT resource to
support HIV-positive gay men and other MSM in Southeast Asia” presents
the human face of HIV by exploring the technology use of HIV-positive
MSM. Their research 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

8
Walsh et al.

in Southeast Asia. Hanckel, et al.’s work tentatively illustrate how the

capability deprivations experienced by HIV-positive men can be overcome
by mobilising Amartya Sen’s capability approach to developing an ICT
resource that addresses the deprivations and information defciencies of
HIV-positive MSM by enhancing peer support and increasing access to HIV-
related information and resources.

Section 2: Working in collaboration with community-based partners

In their chapter, “Hidden on the social media”: HIV Education on MSM
through Cyber-educators in Central America”, Jorge Rivas, Jennifer
Wheeler, Marcos Rodas and Susan Lungo present how they worked with
The Pan-American Social Marketing Organization (PASMO) to develop a
combination prevention intervention in Central America that delivers HIV
prevention behavior 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. This innovative online “cyber-educator”
intervention for MSM provides virtual one-on-one BCC and HIV counseling
and testing referrals launched.
Kimberley Green, Phillip Girault, Samuel Wambugu, Nana Fosua Clement
and Bashiru Adams describe the ‘Strengthening HIV/AIDS Response
Partnerships with Evidence-Based Results (SHARPER)’ intervention which
reached 92% of the estimated number of MSM in Ghana with HIV
prevention interventions. Achieving this signifcant reach at scale was the
result of changing their earlier approach using face-to-face traditional
outreach activities which only reached and estimated half of MSM in Ghana.
By being innovative, resourceful and collaborative with MSM afliated with
CBOs, they began using social media to reach an additional 15,440 unique
MSM in addition to the 12,804 MSM they reached through traditional
outreach activities involving peer educators.
In China gay men and other MSM who use ICT to meet up are less likely
to visit ‘traditional’ venues where they can receive interpersonal HIV
prevention interventions. In their chapter, ‘Two internet-based approaches
to promoting HIV counselling and testing for MSM in China’, Matt Avery,
Gang Meng & Stephen Mills present how FHI 360 and Guangzhou Tongzhi
(GZTZ) piloted separate, but complementary, approaches to using ICT to
promote uptake of HIV counselling and testing (HCT) among gay men and
other MSM in three Chinese provinces: Yunnan, Guangxi and Guangzhou.
Both interventions included dedicated websites featuring online risk
assessment and appointment making, crowd-sourced service promotion
messages and dissemination via participants’ microblog accounts and
social media profles.

Section 3: Community-led interventions

Nicklas Dennermalm introduces how the Swedish Federation for Lesbian,
Gay, Bisexual, Transgender and Queer Rights (RFSL Stockholm) designed
th e Röda Paraplyet webpage in collaboration with male sex workers and
Rose Alliance, a leading sex worker organisation in Sweden. His chapter,

9
 Introduction

‘Resistance to the Swedish model through LGBTQ and sex work community
collaboration and online intervention’ stresses the need for targeted
community-based sexual health services in Sweden because sex workers
are often viewed as ‘victims in denial’ by public health authorities.
Dennermalm critiques the ways Swedish sexual health interventions
traditionally focus on women and utilise face-to-face interventions and exit
strategies over interventions targeting male and/or transgender sex workers
that utilise harm reduction approaches or low threshold on-line
interventions. His work with Röda Paraplyet illustrates how a broad coalition
between organised and non-organised sex workers, LGBTQ organisations,
academics and the health care system can creating a sustainable platform
of multi-disciplinary knowledge to improve the sexual health and legal rights
of sex workers in Sweden and globally.
Collins M. Kahema, John Kashiha, David Kuria Mbote and Michael R.
Mhando’s chapter describes how Tanzania Sisi Kwa Sisi Foundation (TSSF)
used online HIV peer education and outreach methods, particularly with
Facebook, to increase HIV prevention knowledge and encourage the use of
health services, condoms and lubrication among MSM in Tanzania. Their
chapter, “Bambucha Media: Using social media to build social capital and
health seeking behaviour among key populations” describes how TSSF
launched educational campaigns using various social media that pre-
existing members reported using for social and sexual networking, or
“hooking up”. As a community-based organisation with limited resources,
TSSF’s Bambucha Media (in Swahili ‘bambucha’ means cool) is innovative
in the way it has designed a non-traditional avenue to provide HIV and AIDS
information and referral. In a country where sexuality remains a major taboo
subject, providing health messaging and forum discussions to educate
about HIV, alert users when safe sex supplies are in stock or not, facilitate
online discussions and sharing and provide direct peer counselling via
private messages when needed and requested not only allows them to open
up communication lines with gay men, other MSM, transgender persons and
sex workers in the frst place, but also enables TSSF to provide needed
follow-up on specifc and targeted HIV services.
Diane Marie Zambrano Rodríguez’s chapter, ‘Silueta X: Lobbying to
establish a specialised LGBTI counseling and medical center in Ecuador’
presents Asociación Silueta X which is working to creating accessible living
conditions for lesbian, gay, bisexual, transgender and intersex (LGBTI)
individuals with an emphasis on the transgender and intersex population In
Ecuador. Silueta X engages social media via social networking sites and
apps—especially Facebook—to provide its LGBTI members with updates
about its organisational and advocacy activities. Silueta X leverages the
powerful role of social media and has created specifc sites and accounts
for diferent activities.

Section 4: Forging public-private partnerships

Carl Sandler, a gay social networking entrepreneur and the developer of the
geo-social networking app for gay men, MISTER, discusses the enormous
reach and untapped potential of private sector geo-social networking. He

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Walsh et al.

makes the case for better coordination and fexible funding between the
public health sector and the private sector for nimble, timely responses to
public health crises while building a sense of community among users of the
MISTER app. He argues the public health sector can work efectively with
app developers becasue apps can reach thousands of users a day.

Thinking diferently about the future of HIV prevention and

care with ICTs

We anticipate Using information and communication technologies (ICTs) to

transform community based and led HIV prevention and care for
marginalised populations will motivate and inspire diverse community-based
actors, researchers, educators, scientists and frontline workers to continue
to be creative and innovative in their endeavors to further the use of ICTs for
HIV services. Individually—and collectively—the chapters illustrate the
potential impact of using information and communication technologies
(ICTs) for HIV prevention and care services for gay men, other MSM and
transgender persons at a time when these same populations are
experiencing an alarming upward trend of new HIV infections.
With the urgent HIV public health crisis growing amongst gay men, other
MSM and transgender people, these innovative programmatic approaches
ofer models to be further tested and shared for ‘scale-up’. We hope
funders can work collaboratively and creatively to fll the anticipated
resource gap for HIV funding for 2015 (UNAIDS, 2013), so that populations
disproportionately at risk of HIV can continue to beneft from programmatic
approaches similar to those presented in this book. We also acknowledge,
congratulate and celebrate the innovative work and dedication of frontline
workers in community-based organisations, who, despite forecasted
shortfalls in funding, continue to be innovative programmatically through
ICT. We believe the profound changes brought about by ICTs on sexual
practices can increase the efectiveness of social and biomedical HIV and
AIDS research, prevention and care. Let us not forget, ‘the time is now’ to
continue improving access to health and human rights for marginalised gay
men, other MSM and transgender populations.

Acknowledgements

Digital Culture & Education (DCE) acknowledges the success, dedication

and hard work of all the contributors to this book. Importantly the editors
also acknowledge the cadre of writing mentors, peer reviewers and advisors
who provided essential pro-bono services to assist us in making the
publication of this book possible. We also acknowledge and thank Jesse Ko
for copy editing all of the chapters and Leon Kenny and Darren Taljaard for
the book’s cover design. We also acknowledge the work of Gurmit Singh on
the 2012 Special Edition of DCE as many of this book’s chapters are from
Volume 4, Issue 1, which he co-edited.
Importantly, we acknowledge the organisations whose support and
funding—of many of the innovations presented in this book—actually make

11
 Introduction

this work possible, including The United States Agency for International
Development (USAID), the USAID-funded Health Policy Project, with support
from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and
amfAR, The Foundation for AIDS Research. We would like to acknowledge
and thank Diego Solares, Thomas Apperley, David Kuria Mbote, Ben
Clapham, Joanne Keatly, Tonia Poteat, Billy Pick, Tisha Wheeler, Tim Mah,
Cameron Hartofelis, Suzanne Leclerc-Madlala, Ken Morrison, Ron MacInnis,
and Javid Syed for their ongoing collaboration and support.

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