A03, FGD1. Moreover, participants had some specific suggestions of content and language for potential eHealth interventions. I want to note, for example, that for those who are unfamiliar with the sexual health contents, the messages should be sent via Facebook. Because only they know their FB account, they do not worry about that these messages are seen by other people.
However, for people who are familiar with these contents, or for the messages sent via short message service or smartphone applications, the contents need to be encrypted. A05, FGD3. Some participants recommended that the information for sexual health messages should not be repetitive because they would consider repeated messages as spams according to their previous experience. They were mostly interested in new information in the field:. Repetitive messages, no new information, like advertisement.
One important function that the majority of participants would appreciate is a counseling phone hotline or real-time online counseling such as an online chat room. Via these forums support from medical experts in real-time could be made available. Some participants preferred to have secured and private forums or platforms only available for MSM that could build social networks with other MSM to share experiences and knowledge.
They also advised that the messages delivered via the pictures or infographics were the most important and should be straightforward. In this study, participants were also asked to reflect their concerns in implementing eHealth interventions as well as the manner to promote the use of eHealth interventions among MSM. There were two major issues that raised their most concerns including trust and reliability of interventions and channels for delivering interventions. These messages sent by well-known experts or organizations would increase their trustworthiness.
First, I think I need to look at whether their site [mentioned in the message] is reputable, the second is the contact with the clinic. They were afraid that their private information was disclosed and then more people would know their HIV status. Another participant stated that because he migrated from a rural setting to Hanoi, he did not know much about which information source he should believe in.
Therefore, if he received a message from an unknown organization, he would immediately ignore this message. However, participants noted that if the eHealth interventions were delivered via Facebook or other social forums, it should not be opened for everyone to see. Private forums or groups within online social networks were better venues for information on sexual health to make it comfortable and confidential for the participants to read:.
You can post [the messages] to gay group sites or Facebook pages. But I think that Facebook private groups are the most suitable because if putting on the public page, many people who are not in the MSM community will feel uncomfortable. A01, FGD1.
I recommend [the intervention should be delivered via] the dating app like Jack'D or Blued. For example, they can have a banner about the intervention, so if people are interested, they will click. There are a lot of people using these applications, so it will be effective to implement the intervention.
A01, FGD3. The current qualitative study describes the perspectives and expectations of MSM in Vietnam, which can be used to enable the development of eHealth interventions for this population. This is consistent with a study among young MSM in Thailand [ 51 ].
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Moreover, participants preferred information about testing services location, price, and procedure , and reviews from previous clients, which supported them to make the decision to test. Topics that would also captivate MSM included ways to improve sexual health and well-being or prevent substance misuse, violence, and discrimination. These statements were somewhat contradicting between participants and it seems that there was diversity in preferences around language. However, the information in the messages or websites provided to them should be accurate, practical, short, concise and easy to understand, which have been seen in another study among Black MSM in the United States [ 47 ].
Therefore, careful piloting of eHealth interventions will be of importance to ensure comfortability with the content. It is of uttermost importance to avoid messages causing fear or discomfort [ 52 , 53 ]. The diversity of channels to deliver messages and eHealth interventions are also important to consider. Indeed, with a variety of devices used, several Internet-based approaches might be considered to provide interventions such as websites, social network sites namely Facebook, or even SMS messages.
Regarding messages, the majority of the participants showed interest in receiving information via private groups on Facebook, gay forums or dating applications e. A few participants preferred to receive messages via email because then they could save and read it later, other participants reported they did not use email frequently and therefore would not see such messages.
In terms of devices used, some participants preferred to access websites by using laptops or personal computers because they could process greater volumes of information on a larger screen, especially among MSM with high age.
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Since the prevalence of smartphone owners in MSM in Vietnam is high, particularly in urban areas Smartphone applications were also one preferred platform to enable flexible usage at any time. In literature, this approach has been supposed to encourage behavioral changes in a previous study among Black MSM in the United States [ 47 ].
It should be noted that despite a wide acceptance in receiving eHealth interventions, MSM reported privacy concerns when accessing health information on the Internet and more so when receiving information through their mobile phones. The advantage of the Internet is to increase the accessibility of interventions among MSM in highly stigmatized settings [ 36 , 37 ]. Thus, it is cautious to avoid any sensitive texts when delivering intervention messages.
Possible solutions suggested to address these issues include using code-phrases or neutral contents, which could be complemented by links to further information that could be accessed in a private environment.
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There are several limitations in this study. We recruited participants with a diversity of socioeconomic backgrounds, however, we might not have reached all types of MSM rather only openly gay men and a large group that tested themselves already. In addition, participants lived in Hanoi, a metropolitan in Vietnam. Significant differences in preferences might be observed in MSM living in rural areas, where the stigmatization towards homosexuality may be higher.
It should be cautious when applying the results of this study in other settings. Moreover, the interventions which were developed based on the finding of this study should take into account the disparity in different settings of Vietnam. Lastly, the nature of a qualitative study limits the generalizability of the results. However, measures were taken to ensure the validity of the findings by creating a safe and friendly atmosphere in confidential environments to encourage participants to share their consensus as well as dissonance within FGDs.
Finally, the redundancy of contents in all FGDs indicates the saturation of information on this topic. They preferred to access this information at a time and place of their own choice. Privacy concerns were mostly related to cases of sensitive information being sent in text messages to their phone. The findings might be useful to increase the efficacy and acceptance of eHealth interventions among MSM in Vietnam. The data that support the findings of this study are available from the Hanoi Medical University but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.
Data are however available from the authors upon reasonable request and with permission of Hanoi Medical University. The global north: HIV epidemiology in high-income countries. Comprehensive clinical care for men who have sex with men: an integrated approach.
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Lancet London, England. Google Scholar. Testing the hypothesis that treatment can eliminate HIV: a nationwide, population-based study of the Danish HIV epidemic in men who have sex with men. Lancet Infect Dis. BMC Public Health. PLoS One. Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys. Sex Transm Infect. Systematic review of interventions to reduce problematic alcohol use in men who have sex with men. Drug Alcohol Rev. Binge drinking among men who have sex with men and transgender women in San Salvador: correlates and sexual health implications.
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Estimating the HIV undiagnosed population in Catalonia, Spain: descriptive and comparative data analysis to identify differences in MSM stratified by migrant and Spanish-born population. For four countries — Belgium, France, Sweden, and Switzerland — we only identified published estimates based on earlier national Internet surveys, methodologically very similar to EMIS.
Because of the use of the same sampling methodology these four countries were excluded from further comparison. From the remaining 29 countries, estimates for seven countries Denmark, Germany, Greece, Luxemburg, Netherlands, Norway, and United Kingdom were based on surveillance data and sophisticated Germany, Netherlands, UK or relatively simple modelling approaches. For others, detailed information on methodology was not always available. For six countries data were based on a collaborative European study SIALON I using time location sampling in six cities Barcelona, Bratislava, Bucharest, Ljubljana, Prague, and Verona [ 7 ] , the other estimates are based on respondent driven sampling, snowball sampling, or other less formalized venue based sampling methods.
Among the countries with larger discrepancies were countries with very small EMIS sample sizes Macedonia, Bosnia and low prevalence in direct prevalence studies. However, if for these cities the EMIS prevalence estimates were correlated with the proportion of already diagnosed HIV infections in the study participants the correlation coefficient between the two measures further increased R 2 from 0.
Correlation between prevalence of diagnosed HIV in participants of the six-city. Table 1 presents the surveillance system-derived HIV prevalence estimates among MSM for 29 countries together with a short description of the sources, the proportion of those ever tested who were living with diagnosed HIV, and the calculated SSD factor indicating the discrepancy between HIV prevalence measured in EMIS and pre-existing estimates. More detailed EMIS data are presented in an Additional file 1 : Table S1 and include: 1 total number of participants per country; 2 number ever tested for HIV; 3 number living with diagnosed HIV; 4 proportion of those never tested or not tested within the last 12 months who reported unprotected anal intercourse with any partner of unknown or discordant HIV status.
Self-reported prevalence rates of HIV diagnosis in a large Internet convenience sample of European MSM correlate strongly with prevalence estimates derived from direct prevalence studies using different sampling methods. This argues for at least partly similar self-selection biases in the different types of studies. Discrepancies between EMIS and pre-existing estimates can be due to:. Bosnia-Herzegovina, Macedonia ;. Of particular note, in four of five countries in which self-reported HIV prevalence in EMIS samples is lower than prevalence estimates from direct prevalence studies, these studies used Time Location Sampling in gay venues, suggesting that in those countries MSM visiting such venues might have a higher probability to be infected with HIV than participants of an internet survey.