JMIR Publications

ABSTRACT

Background:

Men who have sex with men (MSM) and LGBTIQ+ populations bear a disproportionate burden of HIV and other sexually transmitted infections (STIs) due to structural stigma and barriers to culturally competent care. Mobile and other digital health technologies, and more recently artificial intelligence (AI)–based tools such as chatbots and risk prediction models, may help improve prevention, testing, and pre-exposure prophylaxis (PrEP) use in these groups.

Objective:

This review aimed to (1) synthesize evidence from the past decade on the effectiveness and acceptability of mHealth and other digital sexual health interventions targeting MSM and LGBTIQ+ individuals—focusing on HIV, other STIs, and PrEP—and (2) identify the distinctive features and current evidence base of interventions incorporating AI or advanced automation, particularly conversational agents.

Methods:

We conducted a critical narrative review with a systematic search following PRISMA recommendations to identify mHealth and other digital sexual health interventions targeting MSM and LGBTIQ+ individuals. Databases searched included PubMed/MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and the Cochrane Library for studies published between January 1, 2016, and December 31, 2025, complemented by exploratory searches in technology repositories. Eligible studies included MSM and/or LGBTIQ+ participants; evaluated digital sexual health, HIV/STI, or PrEP interventions; and reported quantitative outcomes on behavior, service use, or cognitive/psychosocial variables. Randomized and nonrandomized trials, quasi-experimental, pre–post, pilot, and feasibility studies were included. Two reviewers independently screened records and extracted data. Owing to substantial heterogeneity in designs and outcomes, a narrative synthesis was conducted instead of a meta-analysis. The review protocol was not registered in any public registry.

Results:

Of 12,995 records identified, 15 intervention studies met the inclusion criteria, complemented by 9 recent systematic or scoping reviews on digital and AI-based sexual health interventions. Conventional digital interventions using websites, mobile apps, SMS, social media, and interactive online programs showed modest but relatively consistent improvements in sexual health knowledge, attitudes, HIV/STI testing frequency, and some risk-reduction behaviors among MSM and LGBTIQ+ populations, whereas evidence for PrEP initiation and adherence was sparse and mixed. Interventions explicitly incorporating AI—mainly chatbots for HIV testing support, PrEP decision-making, and sexual health counseling, as well as risk prediction tools often embedded in mobile or web-based platforms—were generally evaluated in pilot or feasibility studies with small samples and short follow-up. These AI-based tools demonstrated high acceptability, perceived confidentiality, and usability, and in some cases facilitated correct HIV self-testing and linkage to services, but robust evidence on sustained behavior change, PrEP uptake and adherence, or clinical outcomes remains very limited. Reporting of equity, data protection, and algorithmic transparency was scarce, and few interventions were specifically co-designed with MSM and LGBTIQ+ communities.

Conclusions:

Digital and especially mHealth interventions are an established and promising component of HIV and STI prevention for MSM and LGBTIQ+ populations, especially for improving access to information and HIV/STI testing. Evidence on the added value of AI-based tools and conversational agents is still preliminary, largely limited to feasibility and acceptability outcomes, and rarely focused on PrEP. Future research should prioritize rigorously designed, co-designed AI-enhanced mHealth interventions that integrate behavior change theory, ethical safeguards, and equity analyses, and that systematically assess their impact on PrEP initiation and adherence, sexual behaviors, and HIV/STI incidence within community sexual health and HIV prevention services