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FIELD ACTION REPORT
Getting to the First 90: Incentivized Peer Mobilizers Promote
HIV Testing Services to Men Who Have Sex With Men Using
Social Media in Mumbai, India
Anjana Das,
a
Bitra George,
b
Virupax Ranebennur,
c
M. R. Parthasarathy,
b
G. S. Shreenivas,
b
Priyamvada Todankar,
a
Amit Shrivastav,
a
Ajay Kumar Reddy,
b
Christopher Akolo,
c
Michael Cassell,
d
Sandeep Mane,
e
Deepak Tripathi,
e
Jiban Baishya
f
This peer mobilization pilot for HIV and syphilis testing used messaging on gay dating sites, clinic referrals,
and peer recruitment to reach men who have sex with men in Mumbai. In 6 months, the pilot reached a
relatively modest 247 individuals, 244 of whom had never tested for HIV. Challenges included low recruitment
and loss to follow-up for posttest counseling and treatment initiation for individuals with HIV.
ABSTRACT
Recent studies of Indian men who have sex with men (MSM) have shown widespread use of social media for seeking sex partners. We
piloted a peer mobilization approach to explore the feasibility of engaging previously unreached MSM online to link them to HIV testing
services (HTS). MSM were encouraged to seek HTS through messages posted on a popular dating website. Those who visited the desig-
nated HTS site and tested for HIV were recruited as peer mobilizers and given coupons with unique identifying codes to distribute to
other men in their virtual networks. If a network member presented at the site with a coupon and tested for HIV, the peer mobilizer
was given a small monetary incentive. Network members presenting at the testing site were also recruited as peer mobilizers and given
coupons. In a 6-month period, 247 MSM were recruited and tested for HIV and syphilis, of whom 244 (99%) were first-time testers.
Two-thirds were less than 25 years old and about half reported inconsistent or no condom use during the last 10 anal sex acts. Eight
individuals (3.2%) tested positive for HIV, and 22 (8.9%) had a high titer for syphilis; all were referred to tertiary hospitals for treatment.
Our approach was modestly successful in reaching and providing HTS to previously unreached MSM, but challenges included lower-
than-expected recruitment, individuals not returning for posttest counseling, and loss to follow-up of individuals with HIV. The next phase
of peer mobilization will aim to scale up these services through government-supported targeted interventions for this subpopulation of
primarily young, unreached MSM at high risk. The challenges will be addressed by targeting more dating sites, increasing access to
testing using rapid HIV tests at several community-based facilities, and offering peer navigation support for people living with HIV.
INTRODUCTION
The Joint United Nations Programme on HIV/AIDS
(UNAIDS) has set ambitious 90-90-90 targets to ac-
celerate the end of the HIV epidemic—that is, by 2020,
90% of people living with HIV (PLHIV) will know their
HIV status, 90% of people diagnosed with HIV infection
will receive sustained antiretroviral therapy (ART), and
90% of people receiving ART will have viral suppres-
sion.
1
Despite significantly increased access to ART
among PLHIV, reduction in the rates of new HIV
infections has been less substantial (16%) between
2010 and 2016.
2
Various factors explain this lack of
progress, including the possibility that an estimated
30% of PLHIV remain undiagnosed and untreated and
thus continue to transmit the virus to uninfected sexual
or injecting partners. Better testing approaches are need-
ed to reach populations for which HIV risk is highest and
HIV prevention, testing, and treatment coverage is low-
est in order to achieve the first 90 target.
3
India has an estimated 2.1 million PLHIV and a con-
centrated epidemic.
4
The National Integrated Biological
and Behavioral Surveillance (IBBS) conducted in 2014–
2015 among men who have sex with men (MSM) using
cluster sampling showed a national HIV prevalence of
4.3% and 4.9% in the state of Maharashtra.
5
The 2016–
2017 round of HIV Sentinel Surveillance conducted
among a random sample of MSM registered with
a
FHI 360, New Delhi, India. Now an independent consultant.
b
FHI 360, New Delhi, India.
c
FHI 360, Washington, DC, USA.
d
FHI 360, Bangkok, Thailand.
e
Humsafar Trust, Mumbai, India.
f
United States Agency for International Development, New Delhi, India.
Correspondence to Anjana Das (anjanadas944@gmail.com).
Global Health: Science and Practice 2019 | Volume 7 | Number 3 469
targeted interventions showed an all-India preva-
lence of 2.69% and a prevalence of 4.69% in
Maharashtra.
6
Analysis of national-level surveys
of Indian MSM showed that significant factors as-
sociated with HIV positivity were being the recep-
tive partner or both receptive and penetrative as
compared to exclusive penetrative partners; being
more than 25 years old as compared to younger
counterparts; being illiterate rather than literate;
and being employed versus unemployed.
7
An
HIV cascade study in MSM from 12 cities using
respondent-driven sampling showed an HIV prev-
alence of 9.5%, but 70% of PLHIV were not aware
of their status because they had tested more than a
year earlier or had never tested.
8
The national pro-
gram supports targeted interventions for key
populations including MSM; these interventions
are implemented by NGOs and provide preven-
tion services and commodities, referrals to inte-
grated counseling and testing centers (ICTC) for
HIV and syphilis testing, and referrals to ART cen-
ters for PLHIV. Targeted interventions provide ser-
vices to MSM who are physically present at “hot
spots”—sites where soliciting and/or sexual activ-
ities take place, such as public toilets. However,
several studies in India show that many MSM use
social media and other web-based platforms to
seek sex partners.
9–11
The movement from con-
ventional physical locations to virtual spaces poses
a challenge in reaching this “hidden”subpopula-
tion of MSM.
The Linkages across the Continuum of HIV
Services for Key Populations Affected by HIV
(LINKAGES) Project in India works with
government-supported targeted interventions
to promote the HIV continuum of care for key
populations in 6 districts with high HIV preva-
lence in 2 states, including the large metropoli-
tan city Mumbai in the state of Maharashtra. A
LINKAGES baseline survey (October 2015 to
March 2016) in Mumbai showed that 8,684 MSM
were registered and receiving regular services
from targeted interventions, and 209 of these men
were PLHIV (2.4% prevalence). Community dis-
cussions revealed a hidden population that remain
unreached through the traditional hot spot–based
outreach program of targeted interventions. The
reasons included an increasing trend of seeking
sex partners on social media/mobile phones instead
of hot spots and a reluctance to avail targeted inter-
ventions for fear of disclosure of statusand/or iden-
tity leading to social stigma and criminalization. We
piloted a peer mobilization approach to explore the
feasibility of connecting with unreached virtual
networks of MSM in Mumbai who may not visit
hot spots and promoting HTS within these net-
works. This article describes the implementation of
the approach and lessons learned during a 6-month
period from January to July 2017.
METHODS
The network-based peer mobilization approach is
inspired by the successful use of respondent-
driven sampling, a method used to reach a
community-based sample of hidden or hard-to-
reach populations for HIV surveillance.
12
During
implementation of the peer mobilization ap-
proach, MSM were contacted through messages
posted on social media; respondents who made
use of HTS at the designated site were, if willing,
recruited as “primary seeds”or first-wave peer
mobilizers. Peer mobilizers were oriented on moti-
vating peers for HTS and provided 4 coupons each
with unique identifying codes. During physical
interactions, peer mobilizers gave the coupons to
peers who used social media for soliciting partners
and were interested in taking up the HIV services
on offer. If a peer visited the designated site with
the coupon, consented to HIV testing, and under-
went testing, the peer mobilizer was given a small
monetary incentive of 300 Indian Rupees (INR)
(US$5) for his effort. Participants who attended
the HTS site were given a travel reimbursement
of 150 INR (US$2.50). Referred peers, if willing,
were also enrolled as peer mobilizers and provided
a similar number of coupons. In this fashion, sev-
eral waves of peer mobilizers were recruited in
each network generated by a primary seed.
Preparatory Phase
We named the peer mobilization project Mulakat,
a Hindustani word that means “meeting.”The
designated testing site for the project was
Humsafar Trust (HST), an MSM community-
based organization office/drop-in center, clinic,
and ICTC located in suburban Mumbai. HST’s
prior experience with online surveys had shown
that the most commonly used websites of
Mumbai MSM were PlanetRomeo, Facebook,
and Grindr.
13
We decided to target PlanetRomeo
because HST had an ongoing agreement with the
website managers for posting messages free of
cost. A community consultation was organized to
develop messages about Project Mulakat to be
posted on the site. The messages pertained to com-
munity members’roles in maintaining a safe MSM
community and the benefits of availing HTS at
HST.
Many MSM in
India use web-
based platforms
to seek sex
partners, creating
a hidden
subpopulation
that may be
difficult to reach.
We piloted a peer
mobilization
approach for
connecting with
unreached virtual
networks of MSM
in Mumbai and
promoting HTS
within these
networks.
Peer Mobilization Approach for Linking MSM to HIV Testing www.ghspjournal.org
Global Health: Science and Practice 2019 | Volume 7 | Number 3 470
The LINKAGES team designed and printed
coupons with unique code numbers, validity peri-
ods, and contact details of HST, as well as a be-
spoke tool to record participants’sociodemo-
graphic profile and risk behaviors. A coupon
manager based at HST was the point of contact
for MSM attending the clinic. He ensured MSM
fulfilling eligibility criteria received all services
(pre- and posttest counseling, blood tests, clinical
check-up, referrals for treatment of individuals
with positive results for HIV/syphilis), enrolled
peer mobilizers, tracked coupons, and maintained
individual records, which were summarized and
reported monthly. In addition, 3 Internet out-
reach workers from the MSM community created
their own profiles and posted messages on
PlanetRomeo in defined geographical areas and
directed respondents to the coupon manager.
Internet outreach workers were hired for a period
of 3 months; each was given a target of recruiting 7
primary seeds and, in coordination with the cou-
pon manager, followed up with peer mobilizers
for coupon disbursals to peers. The HST and
LINKAGES management teams monitored activi-
ties and results at frequent intervals.
Inclusion Criteria and Client Flow
The client flow is shown in Figure 1. MSM attend-
ing the HST clinic who did not meet eligibility
criteria were provided services as per their re-
quirements but not enrolled in the project (Box 1).
Eligible MSM were asked for information pertain-
ing to sociodemographic profile and risk behaviors
and offered pretest counseling. Those who gave
written informed consent (as per norms followed
by the HST ICTC) were tested for HIV and syphilis
and asked to return the next day for posttest
counseling. Individuals with positive test results
for HIV, syphilis, or both were referred to tertiary
hospitals. All participants received prevention ed-
ucation during pre- and posttest counseling, were
offered assistance for registering with targeted
interventions for ongoing services, and received
prevention messages from the coupon manager
at regular intervals via WhatsApp in which group
members could not view others’contact details. At
the posttest visit, MSM willing to be enrolled as
peer mobilizers were oriented to the project by
the coupon manager and given tips on how to mo-
tivate other MSM to avail HTS. Coupons given to
peer mobilizers had a validity period of 30 days. If
none or only some of the coupons had been used
within the time period, peer mobilizers were con-
tacted and requested to encourage their peers to
attend the clinic.
Laboratory Tests
Syphilis testing was done using the rapid plasma
reagin kit manufactured by Span Diagnostics. A ti-
ter of 1:8 or more was considered as high-titer
syphilis, and individuals with such results were re-
ferred to a tertiary hospital for further evaluation
and treatment as per national guidelines. For HIV
testing, the ICTC at HST followed the national
guidelines of 3 tests for asymptomatic individuals
using different kits in a particular order, with the
subsequent test being performed only if the previ-
ous test result was positive. The first test kit used
was COMBAIDS, followed by MERISCREEN and
thereafter AIDSCAN.
FIGURE 1. Client Flow
Confidenal
test
results
Posest
counseling
HIV and
syphilis tests
Pretest
counseling
CM screens
for inclusion
criteria
Medical
check-
up
HIV/syphilis
treatment
referral, if needed
If willing,
enrolled as PM by
CM
Incenves for PM if
referred MSM aend
clinic and HIV tested
3 Internet
outreach
workers
MSM
view
messages
Respondents learn
clinic ming and CM
contact details
MSM
at
clinic
C1
C2 C3
C4
a
l
s
ts
d
Abbreviations: C, coupons given to PM; CM, coupon manager; MSM, men who have sex with men; PM, peer mobilizer.
Peer Mobilization Approach for Linking MSM to HIV Testing www.ghspjournal.org
Global Health: Science and Practice 2019 | Volume 7 | Number 3 471
The national program approved and issued
guidelines for HIV screening at targeted interven-
tion sites using rapid tests in December 2016.
14
Rapid testing was operationalized after Project
Mulakat was completed.
Data
The results were derived from secondary analysis
of routine service statistics. The protocol for analy-
sis was reviewed by FHI 360’s Protection of
Human Subjects Committee and given a nonre-
search determination.
RESULTS
Process data and outputs of the peer mobilization
intervention are shown in Figure 2. In the period
January to July 2017, messages on social media
were sent to 5,530 MSM and 1,030 MSM made
online inquiries. Through social media and cou-
pon referrals, a total of 274 individuals attended
the clinic, of whom 27 were ineligible because
they either had received targeted intervention ser-
vices (n=23) or were less than 18 years old (n=4).
Thus, 247 MSM were enrolled, which included
22 primary seeds (first-wave peer mobilizers),
subsequent waves of peer mobilizers, and others
unwilling to be peer mobilizers. The numbers of
MSM recruited from each network generated
from the 22 primary seeds (not shown) varied
greatly. The mean size of the 5 largest networks
was 39.8 (range 13–81), while the mean size of
11 networks was 3.8 (range 1–7); 6 primary seeds
did not refer others.
A profile of the participants is shown in the
Table.Two-thirds(69%)werelessthan25years
old and their preferred social media platforms were
Facebook, Grindr, IMO, Instagram, PlanetRomeo,
Tinder, and WhatsApp. Nearly half (44%) reported
inconsistent or no condom use during the last
10 acts of anal sex, and some reported other high-
risk behaviors such as transactional sex, group sex,
and substance use during sex. Among the 247 par-
ticipants, 244 (99%) were first-time testers. The
prevalence of HIV and high-titer syphilis was
3.2% and 8.9%, respectively. Half of those with
HIV diagnosed were successfully linked to treat-
ment, and all but one of those with a positive test
result for syphilis attended the referral hospital for
treatment.
Achievements
Reached Previously Unreached MSM at Risk of
HIV
The peer mobilization approach was able to reach
and provide HTS to MSM who had never tested for
HIV and were outside the ambit of government-
supported targeted intervention services. The
poor testing rates were in contrast to the IBBS in
which 88.2% of Maharashtra MSM reported prior
testing for HIV. We probably reached a different
subgroup by operating online, in contrast to the
BOX 1. Eligibility Criteria for Enrollment of MSM in Project Mulakat
At least 18 years of age
Accessed social media to seek male sex partners in the last 3 months
Had sex with a male in the previous month
Not availing services from or registered with existing government-supported
targeted intervention programs for MSM
FIGURE 2. Peer Mobilization: Process and Output Indicators
Messages sent to 5,530
MSM through social
media
1,030 made inquiries
online
22 eligible MSM aended
HTS site, recruited as
primary seeds
252 MSM aended HTS
site with coupons
27 not eligible
247 total eligible MSM
enrolled (22 primary seeds
+ 225 coupon referrals)
Subsequent waves of PMs
recruited among willing
parcipants
Total 1,018 coupons given
to primary seeds and
subsequent PMs
766 coupons not used
Abbreviations: HTS: HIV testing services; MSM, men who have sex with men; PM, peer mobilizer.
The peer
mobilization
approach was
able to reach and
provide HTS to
MSM who had
never tested for
HIV.
Peer Mobilization Approach for Linking MSM to HIV Testing www.ghspjournal.org
Global Health: Science and Practice 2019 | Volume 7 | Number 3 472
IBBS, which had recruited people from physical
hotspots. Our subpopulation of MSM had a lower
HIV prevalence (3.2%) as compared to that in
IBBS Maharashtra (4.9%), which could be due to
the MSM in our study being younger—69% were
under 25 years as compared to 34.5% in the
Maharashtra IBBS—and thus having fewer years
of risk behavior. Also, as mentioned earlier, Indian
MSM studies showed that being more than 25 years
of age is a significant factor associated with an HIV-
positive status. However, the HIV prevalence in our
MSM sample was higher than among those regis-
tered with targeted interventions (2.4%) despite
the latter being an older group (only 22.2% were
less than 25 years old). MSM reached through
the peer mobilization approach appeared to be at
high risk of HIV because of unprotected anal sex
(44%) and had a high prevalence of syphilis
(8.9%). The program was well received by the
community; some peer mobilizers donated their
incentives to the HST PLHIV support group, saying
their only motive in getting enrolled as peer mobi-
lizers was to help other community members.
Provided Referrals for MSM With HIV or Syphilis
Project Mulakat used the existing HST referral sys-
tems to tertiary care hospitals. All high-titer syph-
ilis cases were referred to a particular government
hospital where an HST staff member was posted;
he ensured that these individuals received further
management. Of a total of 22 persons with high-
titer syphilis, 21 attended the referral hospital
while 1 did not attend, citing inconvenient tim-
ings. Individuals with HIV were referred to differ-
ent ART centers closest to their residence as per
government norms, and they were also offered
support through the HST PLHIV network. Of the
8 MSM receiving an HIV-positive diagnosis,
4 were initiated on treatment.
Kept Costs Low by Using Existing Target
Intervention Services
The direct cost of the intervention for the 6-month
period was 260,000 INR (US$4,333), which in-
cluded personnel, material, and incentive costs.
Indirect costs such as clinic and laboratory staff
time and supplies were borne by HST through the
targeted intervention and ICTC budget.
Challenges
Lower-Than-Expected Recruitment
Project Mulakat was based on the LINKAGES
Thailand program in which incentivized peer
mobilizers recruited 424 network members over a
TABLE. Participants’Sociodemographic Profile and Risk Behaviors and
HIV and Syphilis Prevalence (N=247)
Characteristics No. (%)
Age group, years
<20 70 (28)
20–24 101 (41)
>25 76 (31)
Occupation
Student 111 (45)
Service 63 (26)
Others 73 (29)
Faced violence during/after sex with male partners
Yes 25 (10)
No 222 (90)
Preferred social media platforms
Grindr 161 (22)
WhatsApp 143 (20)
Facebook 139 (19)
PlanetRomeo 65 (9)
Others 218 (30)
Received cash or kind for sex with a man in previous year
Yes 59 (24)
No 188 (76)
Paid cash or kind for sex with a man in previous year
Yes 22(9)
No 225 (91)
Participated in group sex
Yes 27 (11)
No 220 (89)
Uses alcohol and/or drugs during sex
Sometimes/often 73 (30)
Never 174 (70)
Condom use during anal sex (last 10 acts)
Consistent 139 (56)
Inconsistent 87 (35)
Never 21 (9)
Never tested for HIV previously 244 (99)
Positive HIV test result 8 (3.2)
High-titer syphilis (RPR titer ≥1:8) 22 (8.9)
Abbreviation: RPR, rapid plasma reagin.
Peer Mobilization Approach for Linking MSM to HIV Testing www.ghspjournal.org
Global Health: Science and Practice 2019 | Volume 7 | Number 3 473
5-month period. However, the Thailand method-
ology differed in that peer mobilizers recruited
both online and offline contacts. In addition, the
peer mobilizers passed on contact information of
willing peers to trained, salaried outreach workers
(called community-based supporters) who con-
tacted them directly for HTS.
15
The possible rea-
sons for lower numbers in Project Mulakat
include the following:
Limited websites: We initially posted mes-
sages on PlanetRomeo due to an existing service
agreement between HST and PlanetRomeo and
added Facebook at a later stage. However, parti-
cipants stated a preference for other social media
platforms, such as Grindr and WhatsApp.
Low utilization of coupons: Many coupons
issued to peer mobilizers did not convert into
clinic visits by peers; either the peer mobilizer
did not distribute the coupons or the persons
given the coupons did not go to the facility. A
factor that may have affected coupon utiliza-
tion was the use of a single testing site.
Mumbai is a large city, and traveling to the
HST site may not have been convenient for
those living far away. Figure 3 is an administra-
tive zone map of government-supported
Mumbai ICTCs, with HST in zone 3. In addition,
Mumbai has 4 mobile ICTC vans and 24 tar-
geted intervention sites capable of providing
community-based HIV screening that could
also be utilized during the scale-up phase.
Small networks: Another likely factor in the
low recruitment was that most peer mobilizers
were members of small networks. Of a total of
22 networks, only 5 had more than 10 mem-
bers (range 13–81) who attended the HST clin-
ic. Several MSM were unwilling to be recruited
as peer mobilizers, and one of their main rea-
sons was that they did not have enough con-
tacts in the community. The Thailand program
also reported that only 20% of participants
agreed to take on peer mobilizer roles, but a
single super-recruiter successfully reached
149 new clients in 6 months, of whom 93% re-
ceived an HIV test. The next phase of peer mo-
bilization in India should, through community
consultations, attempt to identify peers with
large networks prior to implementation.
Stigma and discrimination: Homosexuality
was decriminalized in India in September
2018, which was after the project ended.
Participants were offered facilitated registration
at targeted interventions for ongoing services,
but very few accepted the offer. Fear of law,
stigma, and discrimination may have prevented
some individuals from participating in the
project.
Individuals Not Returning for HIV Test Results
During the project period, 50 MSM did not return
to the clinic for posttest counseling despite repeat-
ed reminders; among them, 1 had tested positive
for HIV. Of the 50 men, 40 collected their test
results after the project period. The most common
reason given for the delayed visit was that they
were students in Mumbai and had gone to their
hometown for holidays. The challenge can be
addressed by using rapid tests for HIV screening
with same-day test results, which are now avail-
able at targeted interventions.
PLHIV Lost to Follow-Up
Among the 8 MSM who tested positive, 4 were
registered with ART centers and treatment was
initiated. Of the remaining PLHIV, 1 did not return
to collect test results, 2 refused to accept their pos-
itive status in spite of several counseling sessions,
and 1 relocated to his hometown. A review of so-
cial media strategies for promoting HIV service up-
take along the continuum of care within key
populations showed that interventions around
linkages to and retention in care and initiation of
ART need further development.
16
Peer navigation
for facilitating referrals to government-run ART
centers and social support by MSM PLHIV net-
works could help promote treatment linkages and
adherence support for PLHIV.
LESSONS LEARNED
Several factors contributed to the achievements of
the peer mobilization pilot in Mumbai:
Detailed planning with community in-
volvement: The planning exercise for Project
Mulakat took about 2 months and was led by
LINKAGES staff with support from HST staff
from other projects and community leaders.
Operational guidelines were developed for the
entire process with timelines, client flow, clinic
and monitoring formats, and an indicative
budget.
Message development: Involvement of the
community in message development ensured
that messages posted on websites were innova-
tive and caught the attention of the virtual
Many coupons
issued to peer
mobilizers did not
convert into clinic
visits by peers,
which contributed
to lower-than-
expected
recruitment.
Fear of law,
stigma, and
discrimination
may have
prevented some
individuals from
participating in
the project.
Peer Mobilization Approach for Linking MSM to HIV Testing www.ghspjournal.org
Global Health: Science and Practice 2019 | Volume 7 | Number 3 474
MSM community. Some of the online messages
are shown in Box 2.
Data-driven activity modifications: Regular
monitoring of project outputs by the LINKAGES
and HST management teams resulted in some
modifications to activities during the course of
the project. For example, when recruitment of
primary seeds took longer than anticipated, we
decided to post messages on Facebook in addi-
tion to PlanetRomeo. To address the challenge
of coupons not being utilized, 2 community
events were organized at the HST drop-in cen-
ter. Peer mobilizers were informed and asked to
encourage their peers to attend the events and
present coupons for availing services. Through
this initiative, 21 people were reached and test-
ed. In addition, at a later stage, peer mobilizers
FIGURE 3. Government-Supported HIV Testing Services in Mumbai, India
Abbreviations: FSW, female sex worker; MSM & TG, men who have sex with men and transgender women; PWID, persons who inject drugs; G, General HIV
testing services for all; AN: Exclusive HIV testing services for antenatal women.
Source of total population data: Population Census 2011. Mumbai (Greater Mumbai) City Census 2011 Data. https://www.census2011.co.in/census/city/
365-mumbai.html. Accessed July 6, 2019.
Source of key population data: India Health Action Trust. HIV/AIDS Situation and Response in Mumbai City and Suburban Districts: Epidemiological Appraisal
Using Data Triangulation. Bangalore, India: India Health Action Trust; 2010.
BOX 2. Messages Posted Online
HIV tests make me feel sexy and safe. When was the last time you tested for
HIV? To know how to get a test for you and your friends, talk to us.
Don’t lose this opportunity to be a star among your friends. To educate your
friends about HIV, join us today!
Let our confidential services build your trust toward taking a step to being
safe from HIV! To be a part of our mission, please call ...
Peer Mobilization Approach for Linking MSM to HIV Testing www.ghspjournal.org
Global Health: Science and Practice 2019 | Volume 7 | Number 3 475
who said they had a large network were given
more than 4 coupons on request.
Specific measures that can be taken during
scale-up to address the challenges encountered in
Project Mulakat are provided in Box 3.
CONCLUSIONS AND NEXT STEPS
Project Mulakat demonstrated the feasibility of
connecting with unreached virtual networks of
urban Indian MSM to promote HTS and generated
practical recommendations for improving the
effectiveness of the intervention. To provide
follow-up services, global experiences of inno-
vative programs using communication technol-
ogy can be used to develop a combination
package of online-to-offline interventions for
MSM.
17–19
These interventions may include on-
line sessions on risk assessment and reduction
and clinic visits for HTS and tests for sexually
transmitted infections.
The strategic approach for MSM interventions
under the National AIDS Control Organization
(NACO) provides guidelines to targeted interven-
tions for additional technology-based outreach in-
cluding use of MSM dating websites.
20
The peer
mobilization approach can be integrated into tar-
geted intervetion programs for reaching MSM not
found at hot spots but active on social media. In
the next phase, LINKAGES, in collaboration with
NACO, will develop an intervention package for
virtual subpopulations of MSM that can be imple-
mented at a greater scale by targeted interven-
tions. The lessons learned from Project Mulakat,
as well as other experiences with MSM networks
using social media in different regions of India
and peri-urban/rural settings, will inform the
intervention package and help refine national
guidelines to reach and provide services to this
hard-to-reach subset of the MSM population.
Acknowledgments: The authors wish to thank Dr. Navindra Persaud and
Rose Wilcher of LINKAGES/FHI 360 for their inputs on earlier drafts of
this article.
Funding: This publication is made possible by the support of the
American People through the United States Agency for International
Development (USAID) and the United States President’s Emergency Plan
for AIDS Relief (PEPFAR) through the LINKAGES project, cooperative
agreement number AID-OAA-A-14-00045.
Disclaimer: The contents of this publication are the sole responsibility of
LINKAGES and do not necessarily reflect the views of USAID, PEPFAR,
or the United States Government.
Competing Interests: None declared.
REFERENCES
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BOX 3. Recommendations for Scaling Up Peer Mobilization Activities
Through Targeted Intervention
Use trained and salaried outreach workers dedicated for peer mobilization
activities
Partner with multiple popular dating sites to gain access toa large user base
Tap multiple sites for HIV testing services using rapid tests, including existing
integrated counseling and testing centers, mobile vans, and community-
based screening by targeted interventions
Use assisted self-testing at a later stage once kits are available locally
Focus on identifying and tracking large, high-risk networks in which a mem-
ber is positive for HIV/syphilis
Promote treatment initiation and adherence through the use of accompanied
referrals to ART centers, peer navigation/people living with HIV network
support, and referrals to community-based ART centers where available
Peer Mobilization Approach for Linking MSM to HIV Testing www.ghspjournal.org
Global Health: Science and Practice 2019 | Volume 7 | Number 3 476
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Peer Reviewed
Received: March 7, 2019; Accepted: June 11, 2019
Cite this article as: Das A, George B, Ranebennur V, et al. Getting to the first 90: incentivized peer mobilizers promote HIV testing services to men who
have sex with men using social media in Mumbai, India. Glob Health Sci Pract. 2019;7(3):469-477. https://doi.org/10.9745/GHSP-D-19-00094
© Das et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of
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