Archives of Sexual Behavior

, Volume 46, Issue 4, pp 1035–1046 | Cite as

Development and Open Pilot Trial of an HIV-Prevention Intervention Integrating Mobile-Phone Technology for Male Sex Workers in Chennai, India

  • Beena Thomas
  • Elizabeth F. Closson
  • Katie Biello
  • Sunil Menon
  • Pandiaraja Navakodi
  • A. Dhanalakshmi
  • Kenneth H. Mayer
  • Steven A. Safren
  • Matthew J. MimiagaEmail author
Original Paper


In India men who have sex with men and engage in sex work (i.e., male sex workers; MSW) have a high risk of transmitting HIV. Globally, sex workers have become more spatially mobile due to advances in mobile-phone technology. In 2012 in-depth qualitative feedback was garnered from 40 interviews with MSW and four focus groups with 35 key informants (KIs) who had expert knowledge of the local MSW community to inform the design of an HIV-prevention intervention among MSW in Chennai, India. All MSW were recruited during outreach by employees of a Chennai-based organization for MSM (men who have sex with men). The data were analyzed using a descriptive qualitative approach. MSW and KIs discussed the need for intervention content that went beyond basic HIV psychoeducation. They emphasized the importance of addressing psychological distress, alcohol-related risk, and sexual communication skills. Concerns were raised about confidentiality, privacy, and scheduling. Participants endorsed a combination of in-person and mobile-phone-delivered sessions as well as the integration of mobile-phone messaging. These findings served as the basis for the development of a theoretically driven, manual-based intervention incorporating mobile phones. An open pilot assessed the feasibility and acceptability of the intervention with eight MSW. Assessments and HIV testing were administered at baseline, 3, and 6 months post-baseline. Exit interviews were conducted at the conclusion of the intervention. Retention for session attendance and assessment follow-up was 100 %. There was a high level of acceptability for the format, structure, and content. These data show initial promise, feasibility, and acceptability of the intervention.


Sex work India MSM HIV Sexual risk 



The current project was supported by the Indo-U.S. Joint Working Group on Prevention of Sexually Transmitted Diseases and HIV/AIDS through the U.S. National Institute of Drug Abuse Grant #R21DA033720 (Matthew Mimiaga, PI) and the Indian Council of Medical Research Grant #Indo-U.S/72/9/2010-ECDII (Beena Thomas, PI).


  1. Agarwal, A., Hamdallah, M., Swain, S. N., Mukherjee, S., Singh, N., Mahapatra, S., … Thior, I. (2015). Implementation of a confidential helpline for men having sex with men in India. Journal of Medical Internet Research, 3, e17.Google Scholar
  2. Aral, S. O., St. Lawrence, J. S., Tikhonova, L., Safarova, E., Parker, K. A., Shakarishvili, A., & Ryan, C. A. (2003). The social organization of commercial sex work in Moscow, Russia. Sexually Transmitted Diseases, 30, 39–45.CrossRefPubMedGoogle Scholar
  3. Aral, S. O., St. Lawrence, J. S., & Uuskula, A. (2006). Sex work in Tallinn, Estonia: The sociospatial penetration of sex work into society. Sexually Transmitted Infections, 82, 348–353.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Asthana, S., & Oostvogels, R. (2001). The social construction of male ‘homosexuality’in India: Implications for HIV transmission and prevention. Social Science and Medicine, 52, 707–721.CrossRefPubMedGoogle Scholar
  5. Ayala, G. X., & Elder, J. P. (2011). Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. Journal of Public Health Dentistry, 71(Suppl. 1), 69–79.CrossRefGoogle Scholar
  6. Baral, S. D., Friedman, M. R., Geibel, S., Rebe, K., Bozhinov, B., Diouf, D., … Cáceres, C. F. (2015). Male sex workers: Practices, contexts, and vulnerabilities for HIV acquisition and transmission. Lancet, 385, 260–273.Google Scholar
  7. Bartholomew, L. K., Parcel, G. S., Kok, G., Gottlieb, N. H., & Fernandez, M. E. (2011). Planning health promotion programs: An intervention mapping approach. San Fancisco, CA: Wiley.Google Scholar
  8. Beattie, T. S., Bradley, J. E., Vanta, U. D., Lowndes, C. M., & Alary, M. (2013). Vulnerability re-assessed: The changing face of sex work in Guntur district, Andhra Pradesh. AIDS Care, 25, 378–384.PubMedGoogle Scholar
  9. Bourne, C., Knight, V., Guy, R., Wand, H., Lu, H., & McNulty, A. (2011). Short message service reminder intervention doubles sexually transmitted infection/HIV re-testing rates among men who have sex with men. Sexually Transmitted Infections, 87, 229–231.CrossRefPubMedGoogle Scholar
  10. Boyce, P. (2007). ‘Conceiving kothis’: Men who have sex with men in India and the cultural subject of HIV prevention. Medical Anthropology, 26, 175–203.CrossRefPubMedGoogle Scholar
  11. Brahmam, G. N., Kodavalla, V., Rajkumar, H., Rachakulla, H. K., Kallam, S., & Myakala, S. P. (2008). Sexual practices, HIV and sexually transmitted infections among self-identified men who have sex with men in four high HIV prevalence states of India. AIDS, 22(Suppl. 5), 45–57.CrossRefGoogle Scholar
  12. Buzdugan, R., Copas, A., Moses, S., Blanchard, J., Isac, S., Ramesh, B. M., … Cowan, F. M. (2010). Devising a female sex work typology using data from Karnataka, India. International Journal of Epidemiology, 39, 439–448.Google Scholar
  13. Campbell, R., & O’Neill, M. (Eds.). (2006). Sex work now. Devon: Routledge.Google Scholar
  14. Catalani, C., Philbrick, W., Fraser, H., Mechael, P., & Israelski, D. M. (2013). MHealth for HIV treatment & prevention: A systematic review of the literature. The Open AIDS Journal, 7, 17–41.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Crossley, M. L. (2001). The ‘Armistead’project: An exploration of gay men, sexual practices, community health promotion and issues of empowerment. Journal of Community and Applied Social Psychology, 11, 111–123.CrossRefGoogle Scholar
  16. D’Zurilla, T. J. (1986). Problem-solving therapy: A social competence approach to clinical intervention. New York: Springer.Google Scholar
  17. Hubbard, P. (2004). Cleansing the metropolis: Sex work and the politics of zero tolerance. Urban Studies, 41, 1687–1702.CrossRefGoogle Scholar
  18. Kumta, S., Lurie, M., Weitzen, S., Jerajani, H., Gogate, A., Row-kavi, A., … Mayer, K. H. (2010). Bisexuality, sexual risk taking, and HIV prevalence among men who have sex with men accessing voluntary counseling and testing services in Mumbai, India. Journal of Acquired Immune Deficiency Syndromes, 53, 227–233.Google Scholar
  19. Lindlof, T. R., & Taylor, B. C. (2002). Qualitative communication research methods (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  20. Mahapatra, B., Saggurti, N., Halli, S. S., & Jain, A. K. (2012). HIV risk behaviors among female sex workers using cell phone for client solicitation in India. Journal of AIDS and Clinical Research, S1, 14.Google Scholar
  21. Maher, J., Pickering, S., & Gerard, A. (2012). Sex work: Labour, mobility and sexual services. London: Routledge.Google Scholar
  22. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis (2nd ed.). Newbury Park, CA: Sage Publications.Google Scholar
  23. Mimiaga, M. J., Thomas, B., Mayer, K. H., Johnson, C. V., Menon, S., Chandrasekaran, V., … Safren, S. A. (2010, July 18). Differential HIV transmission risk behaviors among MSM subgroups engaging in transactional sex in Chennai, India. Poster presented at the AIDS 2010-XVIII International AIDS Conference, Vienna.Google Scholar
  24. Mimiaga, M. J., Thomas, B., Mayer, K. H., Reisner, S. L., Menon, S., Swaminathan, S., & Safren, S. A. (2011). Alcohol use and HIV sexual risk among MSM in Chennai, India. International Journal of STDs and AIDS, 22, 121–125.CrossRefGoogle Scholar
  25. Minichiello, V., & Scott, J. (Eds.). (2014). Male sex work and society. New York: Harrington Park Press.Google Scholar
  26. NACO. (2012). HIV sentinel surveillance, 2010–2011: A technical brief. New Delhi: India National AIDS Control Organization.Google Scholar
  27. Narayanan, P., Das, A., Morineau, G., Prabhakar, P., Deshpande, G. R., Gangakhedkar, R., & Risbud, A. (2013). An exploration of elevated HIV and STI risk among male sex workers from India. BMC Public Health, 13, 1059.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Navani-Vazirani, S., Solomon, D., Gopalakrishnan, H. E., Srikrishnan, A. K., Vasudevan, C. K., & Ekstrand, M. L. (2015). Mobile phones and sex work in South India: The emerging role of mobile phones in condom use by female sex workers in two Indian states. Culture, Health & Sexuality, 17, 252–265.CrossRefGoogle Scholar
  29. Newman, P. A., Chakrapani, V., Cook, C., Shunmugam, M., & Kakinami, L. (2008). Correlates of paid sex among men who have sex with men in Chennai, India. Sexually Transmitted Infections, 1, 434–438.CrossRefGoogle Scholar
  30. NMISW. (2005). Pilot study on male sex workers in India: Study of MSW in Kolkata, Ahmedabad, and Vijayawada. Kolkata: Network of Male Indian Sex Workers.Google Scholar
  31. Reback, C. J., Grant, D. L., Fletcher, J. B., Branson, C. M., Shoptaw, S., Bowers, J. R., … Mansergh, G. (2012). Text messaging reduces HIV risk behaviors among methamphetamine-using men who have sex with men. AIDS & Behavior, 16, 1993–2002.Google Scholar
  32. Sandelowski, M. (2010). What’s in a name? Qualitative description revisited. Nursing and Health, 33, 77–84.Google Scholar
  33. Sariola, S. (2010). Gender and sexuality in India: Selling sex in Chennai. Oxon: Routledge.Google Scholar
  34. Schnall, R., Travers, J., Rojas, M., & Carballo-Diéguez, A. (2014). eHealth interventions for HIV prevention in high-risk men who have sex with men: A systematic review. Journal of Medical Internet Research, 16, e134.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Setia, M. S., Brassard, P., Jerajani, H. R., Bharat, S., Gogate, A., Kumta, S., … Boivin, J. F. (2008). Men who have sex with men in India: A systematic review of the literature. Journal of LGBT Health Research, 4, 51–70.Google Scholar
  36. Shinde, S., Setia, M. S., Row-Kavi, A., Anand, V., & Jerajani, H. (2009). Male sex workers: Are we ignoring a risk group in Mumbai, India? Indian Journal of Dermatology, Venereology and Leprology, 75, 41–46.CrossRefPubMedGoogle Scholar
  37. Silverman, D. (2010). Doing qualitative research: A practical handbook (3rd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  38. Swendeman, D. (2013). Are mobile phones the key to HIV prevention for mobile populations in India? Indian Journal of Medical Research, 137, 1024–1026.PubMedPubMedCentralGoogle Scholar
  39. Thomas, B. T., Biello, K. B., Closson, E. F., Navakodi, P., Dhanalakshmi, A., Menon, S., … Mimiaga, M. J. (2015, July 19). Transactional sex and the challenges to safer sexual behaviors: A study among male sex workers in Chennai, India. Poster presented at 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Vancouver.Google Scholar
  40. Thomas, B., Mimiaga, M. J., Kumar, S., Swaminathan, S., Safren, S. A., & Mayer, K. H. (2011). HIV in Indian MSM: Reasons for a concentrated epidemic & strategies for prevention. Indian Journal of Medical Research, 134, 920.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Thomas, B., Mimiaga, M. J., Mayer, K. H., Closson, E. F., Johnson, C. V., Menon, S., … Safren, S. A. (2012). Ensuring it works: A community-based approach to HIV Prevention intervention development for men who have sex with men in Chennai, India. AIDS Education and Prevention, 24, 483–499.Google Scholar
  42. Thomas, B., Mimiaga, M. J., Menon, S., Chandrasekaran, V., Murugesan, P., Swaminathan, S., … Safren, S. A. (2009). Unseen and unheard: Predictors of sexual risk behavior and HIV infection among men who have sex with men in Chennai, India. AIDS Education and Prevention, 21, 372–383.Google Scholar
  43. TRAI. (2014). The Indian Telecom Services Performance Indicators. New Delhi: Telecom Regulatory Authority of India.Google Scholar
  44. UNAIDS. (2014). Report on the Global AIDS Epidemic Geneva, Switzerland. Geneva: Joint United Nations Programme on HIV/AIDS.Google Scholar
  45. Wallerstein, N. (2002). Empowerment to reduce health disparities. Scandinavian Journal of Public Health, 59, 72–77.CrossRefPubMedGoogle Scholar
  46. Ward, H., & Aral, S. O. (2006). Globalisation, the sex industry, and health. Sexually Transmitted Infections, 82, 345–347.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Weber, R. P. (1990). Basic content analysis (2nd ed.). Newbury Park, CA: Sage Publications.CrossRefGoogle Scholar
  48. WHO. (2003). A rapid situation assessment of sexual risk behaviour and substance use among sex workers and their clients in Chennai (Madras), South India. Geneva: World Health Organization.Google Scholar
  49. Williams, M. L., Bowen, A. M., Timpson, S. C., Ross, M. W., & Atkinson, J. S. (2006). HIV prevention and street-based male sex workers: An evaluation of brief interventions. AIDS Education and Prevention, 18, 204–215.CrossRefPubMedGoogle Scholar
  50. Ziersch, A., Gaffney, J., & Tomlinson, D. R. (2000). STI prevention and the male sex industry in London: Evaluating a pilot peer education programme. Sexually Transmitted Infections, 76, 447–453.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Beena Thomas
    • 1
  • Elizabeth F. Closson
    • 2
    • 3
  • Katie Biello
    • 2
    • 4
    • 5
  • Sunil Menon
    • 6
  • Pandiaraja Navakodi
    • 1
  • A. Dhanalakshmi
    • 1
  • Kenneth H. Mayer
    • 2
    • 7
    • 8
  • Steven A. Safren
    • 2
    • 9
  • Matthew J. Mimiaga
    • 2
    • 4
    • 5
    Email author
  1. 1.National Institute for Research in TuberculosisChennaiIndia
  2. 2.The Fenway InstituteFenway HealthBostonUSA
  3. 3.London School of Hygiene and Tropical MedicineLondonUK
  4. 4.Departments of Epidemiology and Behavioral & Social Health SciencesBrown University School of Public HealthProvidenceUSA
  5. 5.Institute for Community Health PromotionBrown University School of Public HealthProvidenceUSA
  6. 6.SahodaranChennaiIndia
  7. 7.Division of Infectious DiseasesHarvard Medical School/Beth Israel Deaconess Medical CenterBostonUSA
  8. 8.Department of Global Health and PopulationHarvard School of Public HealthBostonUSA
  9. 9.Department of PsychiatryUniversity of MiamiCoral GablesUSA

Personalised recommendations