title: Implementation of a confidential helpline for men having sex with men in India.
abstract: BACKGROUND
  In India, men who have sex with men (MSM) often face physical violence and harassment from police and the general society. Many MSM may not openly disclose their sexual identity, especially if they are married to women and have families. Due to pervasive stigma and discrimination, human immunodeficiency virus (HIV) prevention programs are unable to reach many MSM effectively.
  
  
  OBJECTIVE
  The objective of this paper was to describe the design, operations, and monitoring of the Sahaay helpline, a mHealth intervention for the MSM population of India.
  
  
  METHODS
  We established the "Sahaay" mHealth intervention in 2013; a MSM-dedicated helpline whose main goal was to increase access to comprehensive, community-based HIV prevention services and improve knowledge, attitudes, and behaviors of MSM towards HIV and sexually transmitted infections (STI) in three states of India (Chhattisgarh, Delhi, and Maharashtra). The helpline provided a 24x7 confidential and easy to use interactive voice response system (IVRS) to callers. IVRS function was monitored through an online dashboard of indicators. The system also provided real-time reporting on callers and services provided.
  
  
  RESULTS
  The helpline received more than 100,000 calls from 39,800 callers during the first nine months of operation. The helpline maintained an operational uptime of 99.81% (6450/6462 hours); and answered more than 81.33% (83,050/102,115) of all calls. More than three-fourths of the calls came between 9:00 am-12:00 pm. The most successful promotional activity was "interpersonal communication" (reported by 70.05%, 27,880/39,800, of the callers). Nearly three-fourths of the callers self-identified as MSM, including 17.05% (6786/39,800) as rural MSM and 5.03% (2001/39,800) as a married MSM. Most callers (93.10%, 37,055/39,800) requested information, while some (27.01%, 10,750/39,800) requested counseling on HIV/acquired immune deficiency syndrome (AIDS), STIs, and other health and nonhealth issues. There were 38.97% (15,509/39,800) of the callers that were provided contacts of different HIV/AIDS referral services. Many MSM clients reported increased self-esteem in dealing with their sexual identity and disclosing the same with their family and spouse; and an increase in HIV/AIDS risk-reduction behaviors like consistent condom use and HIV testing.
  
  
  CONCLUSIONS
  National HIV/AIDS prevention interventions for MSM in India should consider scaling-up this helpline service across the country. The helpline may serve as an important mechanism for accessing hard-to-reach MSM, and thus improving HIV prevention programing.
authors: FHI 360, New Delhi, India. aashok365@gmail.com.
authors: Ashok
authors: http://orcid.org/0000-0003-0792-4102
authors: A
authors: Agarwal
authors: Myriam
authors: http://orcid.org/0000-0001-6282-9250
authors: M
authors: Hamdallah
authors: Suvakanta N
authors: http://orcid.org/0000-0002-0327-255X
authors: SN
authors: Swain
authors: Sonali
authors: http://orcid.org/0000-0003-1703-3506
authors: S
authors: Mukherjee
authors: Neetu
authors: http://orcid.org/0000-0003-3654-3413
authors: N
authors: Singh
authors: Sudip
authors: http://orcid.org/0000-0002-5646-7676
authors: S
authors: Mahapatra
authors: Elizabeth J
authors: http://orcid.org/0000-0001-8465-4607
authors: EJ
authors: King
authors: Julie
authors: http://orcid.org/0000-0001-5177-1508
authors: J
authors: Pulerwitz
authors: Ibou
authors: http://orcid.org/0000-0002-2188-8956
authors: I
authors: Thior
keywords: HIV prevention; India; MSM; helpline; mobile phone