Ethical Issues in the Use of Smartphone Apps for HIV Prevention among Men who Have Sex with Men in Malaysia: A Qualitative Study (Preprint)

BACKGROUND The use of smartphone apps can improve the HIV prevention cascade for key populations, such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, mHealth app-based strategies have the potential to open new frontiers for HIV prevention efforts. However, little guidance is available to inform researchers about ethical concerns unique to the development and implementation of app-based HIV prevention programs. OBJECTIVE This paper aims to fill this gap by characterizing the attitudes and concerns of Malaysian MSM regarding HIV prevention mobile apps, particularly on ethical aspects surrounding their use. METHODS We conducted online focus group discussions (FGDs) with 23 MSM between August and September 2021. Using in-depth semi-structured interviews, participants were asked about the risks and ethical issues they perceived to be associated with using mobile apps for HIV prevention. Each session was digitally recorded and transcribed. Transcripts were inductively coded using Dedoose software and analyzed to identify and interpret emerging themes. RESULTS Although participants had a high willingness to use app-based strategies for HIV prevention efforts, they raised several ethical concerns related to their use. Prominent concerns raised by participants included privacy and confidentiality concerns, including fear of third-party access to personal health information (e.g., friends or family, government agencies), issues around personal health data storage and management, equity and equitable access, informed consent, and regulation. CONCLUSIONS Study findings highlighted the role of ethical concerns related to the use of app-based HIV prevention programs. Given the ever-growing nature of such technological platforms that are intermixed with a complex ethical-legal landscape, mHealth platforms must be safe and secure to minimize unintended harms, safeguard user privacy and confidentiality, and obtain public trust and uptake. CLINICALTRIAL