Transmasculine People Report Acceptance of Mobile App With Sexual Health Information, Resources

Mobile apps, such as Emory University’s Transpire app, were found to be an acceptable intervention in providing access to information on sexual health and resources in transmasculine individuals, according to a study published in JMIR Formative Research.

An increased risk of HIV and other sexually transmitted infections (STIs) is found in transgender people in the United States compared with cisgender individuals. App-based interventions in cisgender gay and bisexual men have been associated with increased HIV testing, but it is important to note that transmasculine individuals often have substantial barriers to accessing care. The researchers created a version of HealthMindr, which they named Transpire, to provide an app that contains information on pre-exposure prophylaxis (PrEP), HIV, and STIs. The aim of the study was to “assess the experiences and recommendations of transmasculine research participants based on these interviews.”

Participants were invited to participate in in-depth interviews individually. Participants were eligible if they were aged 18 to 34 years; identified on the transmasculine spectrum; planned to remain the study areas of Atlanta and Washington, DC; owned an Android or iOS smartphone, could read and understand English; reported having sex within the past 12 months; and reported being HIV negative or never testing for HIV. Recruitment took place from November 2020 to October 2021. All participants had access to the Transpire app for 3 months before being asked if they would like to participate in an in-depth interview.

Hand holding smartphone with colorful app icons | Image credit: ra2 studio - stock.adobe.com

Interviews were held over Zoom before being recorded and transcribed. All participants were asked the same questions. Participants were asked about history of HIV and STI testing, overall experience with the Transcribe app, their experiences with PrEP, whether they used the PrEP locator tool in the app, and whether the app had an influence on starting PrEP and receiving care. Lastly, they were asked about using the Transpire app to order test kits, condoms, and lube.

There were a total of 25 transmasculine individuals who participated in the study who had a median (IQR) age of 25 (21-29) years; 22 individuals identified as a transgender male and 8 identified as gender nonbinary or genderqueer. Non-Hispanic White participants were the most represented with 21 participants and 16 participants had private health insurance. There were 13 individuals still enrolled in school.

Participants reported that the app helped to expand their knowledge of certain sexual health topics, even as most were knowledgeable of sexual health when entering the study. These topics included STI information, PrEP, and HIV testing. Information on frequency of testing and authoritative information about STIs were the most helpful aspects to participants.

Most participants had taken an HIV test before through their primary care physician or gynecologist. Participants reported needing the right provider and appointment availability to access these health services. Others reported having negative experiences with testing in the past. Some participants felt empowered by being able to order at-home tests.

Participants noted that the app also helped to clear up prior misconceptions of PrEP. Having information on the app made some participants reconsider taking PrEP and their testing frequency. However, only a few participants thought that the app influenced them to start PrEP treatment, as most felt they did not engage in activity that would put them at risk of HIV. The participants felt that it was useful that they would be able to locate a PrEP provider with the tool provided in the app should they ever want to start. The language in the app was also praised as being trans-competent and straightforward.

Participants suggested that the resources section would need updating to remain relevant, a chat feature should be added, and more comprehensive health information should be included.

There were some limitations to this study. Most participants were non-Hispanic White, had college education or higher, had private health insurance, and were from 2 urban settings in the southern United States, which could make these results ungeneralizable to other populations. Sexual risk behavior was also very broad in terms of requirements for inclusion and may not have represented those at highest risk of HIV. The participants also used this app for only 3 months during a period when most reduced their sexual activity due to the COVID-19 pandemic, which could have influenced the results.

The researchers concluded that there were high levels of interest in the app among transmasculine individuals, writing that “apps have the potential to improve both sexual and overall health of transmasculine people by providing accurate health-related information…that empower them to conduct screenings in the privacy of their home.”

Reference

Jones J, Butler G, Woody M, et al. Preferences for and experiences of an HIV-prevention mobile app designed for transmasculine people: pilot feasibility trial and qualitative investigation. JMR Form Res. 2023;7:e51055. doi:10.2196/51055