Journal of Community Health

, Volume 45, Issue 1, pp 10–19 | Cite as

Use of Smartphone to Seek Sexual Health Information Online Among Malaysian Men Who Have Sex with Men (MSM): Implications for mHealth Intervention to Increase HIV Testing and Reduce HIV Risks

  • Roman ShresthaEmail author
  • Sin How Lim
  • Frederick L. Altice
  • Michael Copenhaver
  • Jeffrey A. Wickersham
  • Rumana Saifi
  • Mohd Akbar Ab Halim
  • Herlianna Naning
  • Adeeba Kamarulzaman
Original Paper


In settings where stigma and discrimination toward men who have sex with men (MSM) are high or illegal, like in Malaysia, innovative methods to anonymously reach them are urgently needed. The near ubiquitous availability of mobile technology, including smartphones, has the potential to open new frontiers (such as mHealth) to prevent HIV and other sexually transmitted infections (STIs). The extent to which MSM use mHealth tools for HIV and STI prevention in the Malaysia context, however, is unknown. A cross-sectional online survey in 622 Malaysian MSM was conducted between July and November 2017. Participants were recruited via advertisements on mobile apps frequently used by MSM. In addition to demographic, smartphone access and utilization, and other information were assessed using logistic regression to determine factors associated with the use of a smartphone to search for online sexual health information. Nearly all (99.2%) participants owned a smartphone, with 63% reported having used one to seek sexual health information, including HIV/STIs. Overall, 96% used smartphones to find sexual partners, with high levels of HIV risk behavior reported. Independent correlates of smartphone use to seek online sexual health information included older age (aOR 0.943, p = 0.005), higher education (aOR 2.14, p = 027), recent (past year) HIV testing (aOR 3.91, p = 0.026), and seeking sexual partners using geosocial networking apps (aOR 5.58, p = 0.006). These findings suggest high smartphone use by high-risk MSM to seek sexual health information and suggests that mHealth strategies may be an effective strategy to engage MSM in HIV prevention activities.


HIV Men who have sex with men mHealth Smartphone Malaysia 



This work was supported by Grants from the National Institute on Drug Abuse for career development (K24 DA017072 to FLA; K02 DA033139 to MMC; K01 DA038529 to JW).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was approved by the Medical Ethics Committee of the University of Malaya, Malaysia.

Informed Consent

The interviewees provided written informed consent before participating in the study.


  1. 1.
    Adler, A. J., Martin, N., Mariani, J., Tajer, C. D., Owolabi, O. O., Free, C.,… Perel, P. (2017). Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev, 4, Cd011851.
  2. 2.
    Alice, G., Serene, Y., Rachel, S., Hopin, L., Nicole, N., & Luke, W. (2018). Improving the public health impact of eHealth and mHealth interventions. Australian and New Zealand Journal of Public Health,42(2), 118–119. Scholar
  3. 3.
    Anand, T., Nitpolprasert, C., Trachunthong, D., Kerr, S. J., Janyam, S., Linjongrat, D., … Phanuphak, N. (2017). A novel Online-to-Offline (O2O) model for pre-exposure prophylaxis and HIV testing scale up. Journal of the International AIDS Society, 20(1), 21326. Scholar
  4. 4.
    Beyrer, C., & Baral, S. D. (2011). MSM, HIV and the law: The case of gay, bisexual and other men who have sex with men (MSM). Geneva: Global Commission on HIV and the Law.Google Scholar
  5. 5.
    Beyrer, C., Baral, S. D., Van Griensven, F., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., et al. (2012). Global epidemiology of HIV infection in men who have sex with men. The Lancet,380(9839), 367–377.CrossRefGoogle Scholar
  6. 6.
    Bien, C. H., Best, J. M., Muessig, K. E., Wei, C., Han, L., & Tucker, J. D. (2015). Gay apps for seeking sex partners in China: Implications for MSM sexual health. AIDS and Behavior,19(6), 941–946. Scholar
  7. 7.
    Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology,1, 185–216.CrossRefGoogle Scholar
  8. 8.
    Conserve, D. F., Jennings, L., Aguiar, C., Shin, G., Handler, L., & Maman, S. (2017). Systematic review of mobile health behavioural interventions to improve uptake of HIV testing for vulnerable and key populations. Journal of Telemedicine and Telecare,23(2), 347–359. Scholar
  9. 9.
    Cooper, V., Clatworthy, J., Whetham, J., & Consortium, E. (2017). mHealth interventions to support self-management in HIV: A systematic review. The Open AIDS Journal,11, 119–132. Scholar
  10. 10.
    Cutrona, C. E., & Russell, D. W. (1987). The provisions of social relationships and adaptation to stress. Advances in personal relationships,1(1), 37–67.Google Scholar
  11. 11.
    Daly, M. (2013). The meth-fuelled, wee-long orgies ravaging London’s gay sex party scene. Vice 3rd June.Google Scholar
  12. 12.
    Finitsis, D. J., Pellowski, J. A., & Johnson, B. T. (2014). Text message intervention designs to promote adherence to antiretroviral therapy (ART): A meta-analysis of randomized controlled trials. PLoS ONE,9(2), e88166. Scholar
  13. 13.
    Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., et al. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Medicine,10(1), e1001362. Scholar
  14. 14.
    Goedel, W. C., & Duncan, D. T. (2015). Geosocial-networking app usage patterns of gay, bisexual, and other men who have sex with men: survey among users of Grindr, a mobile dating app. JMIR Public Health and Surveillance,1(1), e4. Scholar
  15. 15.
    Grosskopf, N. A., LeVasseur, M. T., & Glaser, D. B. (2014). Use of the Internet and mobile-based “apps” for sex-seeking among men who have sex with men in New York City. American Journal of Men’s Health,8(6), 510–520. Scholar
  16. 16.
    Hader, R. (2011). Education matters: Does higher learning yield higher income? Nursing Management,42(7), 22–27. Scholar
  17. 17.
    Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics,42(2), 377–381. Scholar
  18. 18.
    Head, K. J., Noar, S. M., Iannarino, N. T., & Grant Harrington, N. (2013). Efficacy of text messaging-based interventions for health promotion: A meta-analysis. Social Science and Medicine,97, 41–48. Scholar
  19. 19.
    Henny, K. D., Wilkes, A. L., McDonald, C. M., Denson, D. J., & Neumann, M. S. (2018). A rapid review of eHealth interventions Addressing the continuum of HIV care (2007–2017). AIDS and Behavior,22(1), 43–63. Scholar
  20. 20.
    Holloway, I. W., Rice, E., Gibbs, J., Winetrobe, H., Dunlap, S., & Rhoades, H. (2014). Acceptability of smartphone application-based HIV prevention among young men who have sex With men. AIDS and Behavior,18(2), 285–296. Scholar
  21. 21.
    Kanter, J., Koh, C., Razali, K., Tai, R., Izenberg, J., Rajan, L., et al. (2011). Risk behaviour and HIV prevalence among men who have sex with men in a multiethnic society: A venue-based study in Kuala Lumpur, Malaysia. International Journal of STD & AIDS,22(1), 30–37. Scholar
  22. 22.
    Kitsiou, S., Paré, G., Jaana, M., & Gerber, B. (2017). Effectiveness of mHealth interventions for patients with diabetes: An overview of systematic reviews. PLoS ONE,12(3), e0173160. Scholar
  23. 23.
    Krishnan, A., & Cravero, C. (2017). A multipronged evidence-based approach to implement mHealth for underserved HIV-infected populations. Mobile Media & Communication,5(2), 194–211. Scholar
  24. 24.
    Landovitz, R. J., Tseng, C.-H., Weissman, M., Haymer, M., Mendenhall, B., Rogers, K., et al. (2013). Epidemiology, sexual risk behavior, and HIV prevention practices of men who have sex with men using GRINDR in Los Angeles, California. Journal of Urban Health,90(4), 729–739. Scholar
  25. 25.
    Lim, S. H., Akbar, M., Wickersham, J. A., Kamarulzaman, A., & Altice, F. L. (2018). The management of methamphetamine use in sexual settings among men who have sex with men in Malaysia. International Journal of Drug Policy,55, 256–262. Scholar
  26. 26.
    Lim, S. H., Bazazi, A. R., Sim, C., Choo, M., Altice, F. L., & Kamarulzaman, A. (2013). High rates of unprotected anal intercourse with regular and casual partners and associated risk factors in a sample of ethnic Malay men who have sex with men (MSM) in Penang, Malaysia. Sexually Transmitted Infections,89(8), 642–649. Scholar
  27. 27.
    Lim, S. H., Brown, S.-E., Shaw, S. A., Kamarulzaman, A., Altice, F. L., & Beyrer, C. (2018). “You have to keep yourself hidden”: Perspectives from Malaysian Malay-Muslim men who have sex with men on policy, network, community, and individual influences on HIV risk. Journal of Homosexuality. Scholar
  28. 28.
    Lim, S. H., Cheung, D. H., Guadamuz, T. E., Wei, C., Koe, S., & Altice, F. L. (2015). Latent class analysis of substance use among men who have sex with men in Malaysia: Findings from the Asian Internet MSM Sex Survey. Drug and Alcohol Dependence,151, 31–37. Scholar
  29. 29.
    Lim, S. H., Mburu, G., Bourne, A., Pang, J., Wickersham, J. A., Wei, C. K. T.,… Azwa, I. (2017). Willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Malaysia: Findings from an online survey. PLOS ONE, 12(9), e0182838. Scholar
  30. 30.
    Marcolino, M. S., Oliveira, J. A. Q., D’Agostino, M., Ribeiro, A. L., Alkmim, M. B. M., & Novillo-Ortiz, D. (2018). The impact of mHealth interventions: Systematic Review of Systematic Reviews. JMIR mHealth and uHealth,6(1), e23. Scholar
  31. 31.
    MCMC. (2017a). Hand phone users survey 2017. Malaysia.Google Scholar
  32. 32.
    MCMC. (2017b). Internet users survey 2017. Malaysia.Google Scholar
  33. 33.
    Ministry of Health Malaysia. (2016). Global AIDS response progress report: Malaysia 2016. Malaysia.Google Scholar
  34. 34.
    Ministry of Health Malaysia. (2018). HIV prevalence among men who have sex with men (MSM): Results of the biobehavioral survey. Putrajaya: Ministry of Health Malaysia.Google Scholar
  35. 35.
    Moore, D. J., Jain, S., Dubé, M. P., Daar, E. S., Sun, X., Young, J., et al. (2018). Randomized controlled trial of daily text messages to support adherence to preexposure prophylaxis in individuals at risk for human immunodeficiency virus: The TAPIR study. Clinical Infectious Diseases,66(10), 1566–1572. Scholar
  36. 36.
    Nguyen, M. X., Krishnan, A., Le, G. M., Nguyen, Q. T., Bhadra, N. M., Nguyen, S. M.,… Go, V. F. (2017). The use of technology to find sexual health information online among men who have sex with men in Hanoi, Vietnam, 2016. International Journal of STD & AIDS, 29(5), 505-510. Scholar
  37. 37.
    Oldenburg, C. E., Perez-Brumer, A. G., Reisner, S. L., Mattie, J., Barnighausen, T., Mayer, K. H., et al. (2014). Global burden of HIV among men who engage in transactional sex: A systematic review and meta-analysis. PLoS ONE,9(7), e103549. Scholar
  38. 38.
    Oldenburg, C. E., Perez-Brumer, A. G., Reisner, S. L., Mayer, K. H., Mimiaga, M. J., Hatzenbuehler, M. L., et al. (2018). Human rights protections and HIV prevalence among MSM who sell sex: Cross-country comparisons from a systematic review and meta-analysis. Global Public Health,13(4), 414–425. Scholar
  39. 39.
    Oldenburg, C. E., Perez-Brumer, A. G., Reisner, S. L., & Mimiaga, M. J. (2015). Transactional sex and the HIV epidemic among men who have sex with men (MSM): Results from a systematic review and meta-analysis. AIDS and Behavior,19(12), 2177–2183. Scholar
  40. 40.
    Overdijkink, B. S., Velu, V. A., Rosman, N. A., van Beukering, D. M. M., Kok, M., & Steegers-Theunissen, P. M. R. (2018). The usability and effectiveness of mobile health technology? Based lifestyle and medical intervention apps supporting health care during pregnancy: systematic review. JMIR mHealth uHealth,6(4), e109. Scholar
  41. 41.
    Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement,1(3), 385–401.CrossRefGoogle Scholar
  42. 42.
    Rhoton, J., Wilkerson, J. M., Mengle, S., Patankar, P., Rosser, B. R. S., & Ekstrand, M. L. (2016). Sexual preferences and presentation on geosocial networking apps by indian men who have sex with men in Maharashtra. JMIR mHealth and uHealth,4(4), e120. Scholar
  43. 43.
    Schmidt, A. J., Bourne, A., Weatherburn, P., Reid, D., Marcus, U., & Hickson, F. (2016). Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS). International Journal of Drug Policy,38, 4–12.CrossRefGoogle Scholar
  44. 44.
    Stephenson, G., & Richardson, A. (2014). New psychoactive substances in England: a review of the evidence.Google Scholar
  45. 45.
    UNAIDS. (2017). Global HIV statistics. Geneva: UNAIDS.Google Scholar
  46. 46.
    United Nations Development Programme. (2014). The policy and legal environments related to HIV services in Malaysia: Review and consultation. Kuala Lumpur: United Nations Development Programme.Google Scholar
  47. 47.
    Ventuneac, A., John, S. A., Whitfield, T. H. F., Mustanski, B., & Parsons, J. T. (2018). Preferences for sexual health smartphone app features among gay and bisexual men. AIDS and Behavior. Scholar
  48. 48.
    Zou, H., & Fan, S. (2017). Characteristics of men who have sex with men who use smartphone geosocial networking applications and implications for HIV interventions: A systematic review and meta-analysis. Archives of Sexual Behavior,46(4), 885–894. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Roman Shrestha
    • 1
    • 5
    Email author
  • Sin How Lim
    • 2
  • Frederick L. Altice
    • 1
    • 2
  • Michael Copenhaver
    • 3
  • Jeffrey A. Wickersham
    • 1
    • 2
  • Rumana Saifi
    • 2
  • Mohd Akbar Ab Halim
    • 2
  • Herlianna Naning
    • 2
  • Adeeba Kamarulzaman
    • 2
    • 4
  1. 1.Section of Infectious Diseases, Department of Internal MedicineYale School of MedicineNew HavenUSA
  2. 2.Centre of Excellence for Research in AIDS (CERiA), Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
  3. 3.Department of Allied Health SciencesUniversity of ConnecticutStorrsUSA
  4. 4.Department of Epidemiology of Microbial DiseasesYale School of Public HealthNew HavenUSA
  5. 5.Section of Infectious Diseases, Department of Internal MedicineYale School of MedicineNew HavenUSA

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