Abstract
We explored gaming elements as a tool to promote engagement in HIV prevention services among Latino men who have sex with men. We conducted thematic content analysis of semistructured interview data that we collected from 12 Latino men who have sex with men (April–August 2022) in South Florida. Themes emerged related to intervention delivery, components, and perceptions. Our findings will guide the development of a game-based intervention to improve preexposure prophylaxis and HIV prevention engagement among Latino men who have sex with men. (Am J Public Health. 2026;116(S1):S10–S15. https://doi.org/10.2105/AJPH.2025.308353)
Preexposure prophylaxis (PrEP) for HIV prevention is available in the United States as a daily pill and long-acting injectable.1 Innovative strategies are needed for Latino men who have sex with men (LMSM), who are not sufficiently reached and engaged by PrEP and HIV prevention services.2
STUDY OBJECTIVE
Game-based strategies and interventions—including gamification (i.e., using gaming elements such as points or badges in nongaming settings3) and serious games designed to entertain and improve real-world knowledge4—offer innovative strategies to promote health behavior change.5 Game-based intervention modalities include tabletop games, mobile applications, and console systems.6,7 When grounded in theory, game-based interventions increase learning and self-efficacy5,7 and improve HIV-related outcomes, including PrEP initiation and adherence and HIV-testing engagement.7 However, few game-based interventions are tailored to the LMSM community; therefore, we explored LMSM’s preferences to inform the development of a future game-based HIV intervention.
RESEARCH QUESTION
We asked LMSM online gamers about their preferences for game-based interventions to improve PrEP initiation and HIV prevention practices.
PARTICIPANTS, SAMPLE, GEOGRAPHIC LOCATION, SETTING, AND YEAR OF STUDY
We conducted semistructured in-depth interviews, in either English or Spanish, with 12 LMSM from April to August 2022. We recruited a convenience sample at gaming-focused outreach events hosted by a community-based sexual health organization in South Florida. Men were aged 18 years or older and self-identified as Latino (Table 1).
TABLE 1—
Demographic Characteristics of Latino Men Who Have Sex With Men: Semistructured Interviews, South Florida, April–August 2022
| Characteristic | Mean ±SD or % (No.) |
| Age, y | 31.4 ±5.5 |
| Race | |
| Black/African American | 0 (0) |
| American Indian/Alaska Native | 9.1 (1) |
| White | 55 (6) |
| Multiracial | 18 (2) |
| Other | 18 (2) |
| Sexual orientation | |
| Gay | 83 (10) |
| Bisexual | 8.3 (1) |
| Other | 8.3 (1) |
| Relationship status | |
| Single | 42 (5) |
| Married | 25 (3) |
| In a stable relationship | 33 (4) |
| Country of nativity | |
| US | 6 (7) |
| Outside the US | 36 (4) |
| Native language | |
| English | 55 (6) |
| Spanish | 45 (5) |
| Educational attainment | |
| Some college | 8.3 (1) |
| College graduate | 75 (9) |
| Postgraduate | 17 (2) |
| Employment status | |
| Full-time | 75 (9) |
| Part-time | 17 (2) |
| Student | 8.3 (1) |
| Annual income, $ | |
| 12 000–15 999 | 9.1 (1) |
| 16 000–24 999 | 0 (0) |
| 25 000–34 999 | 0 (0) |
| 35 000–49 999 | 18 (2) |
| 50 000–74 999 | 55 (6) |
| 75 000–99 999 | 18 (2) |
| Time living in South Florida, y | 24 ±12 |
| PrEP use status | |
| Nonuser | 33 (4) |
| Previous user | 8.3 (1) |
| Current user | 58 (7) |
Note. PrEP = preexposure prophylaxis. Sample size was n = 12. One participant did not report select demographic characteristics certain variables and percentages my not sum to 100% as a result.
METHODS
The interview guide, informed by community-based participatory research8 and the Consolidated Framework for Implementation Research,9 elicited preferences for game-based intervention elements that would be acceptable for future PrEP and HIV prevention interventions for LMSM (Box 1). We asked participants about various game modalities, modality preferences, and perceptions of how these might be received among LMSM as an HIV prevention intervention. We audio-recorded all interviews and then transcribed them and, if needed, translated them into English. Two trained coders independently coded transcripts using a priori codes derived from the interview guide.10 A positionality statement is provided in Appendix A (available as a supplement to the online version of this article at http://www.ajph.org). Emergent themes and supporting quotations are presented in Box 1.
BOX 1—
Interview Guide Questions, Emergent Themes, and Example Quotations From 12 Latino Men Who Have Sex With Men: South Florida, April–August 2022
| Interview guide questions |
| Now, I would like to talk with you about what a potential gaming intervention to increase PrEP uptake might look like if it was offered through a trusted community organization. If an in-person or hybrid gaming program that focused on PrEP and HIV prevention was offered through a trusted community organization, what components would you want to be included? Probes: In-person meetings at the community organization, variety of online games, educational materials. |
| How would the potential in-person or hybrid gaming program that focused on PrEP and HIV prevention that was offered through a trusted community organization compare with other alternatives that you know about? For example, PrEP advertisements/campaigns or other community events. Probes: Advantages? Disadvantages? |
| Is there another program that focused on PrEP and HIV prevention that people would rather participate in? Probes: Can you describe that program? Why would people prefer the alternative? |
| Emergent themes summary and example quotations |
| Theme 1: Perceptions of advantages and disadvantages of a game-based intervention to promote PrEP engagement Description: Participants were excited about the possibility of a game-based intervention as many were not aware of existing gaming HIV prevention programs. There was some hesitance about the willingness of some gamers to engage in this type of program. Key advantages included using shared interests in gaming to bring members of the community together to learn about HIV prevention and the potential capability of the intervention to readily provide resources. Key disadvantages included potential issues among program participants in engaging with HIV prevention education during gaming sessions, excluding other LMSM nongamers, and repeatedly engaging the same individuals. |
|
Acceptability [Gaming] helps bring those people in because maybe they normally wouldn’t take the time out of their day to do that because they won’t necessarily prioritize their health. But now that there’s this draw for gaming it’s like, “Okay that’s more my speed. Let me see, you know, what else I can do while I am there.” (GS14) This would be an event that I think definitely can work, but as long as people are making the appropriate decisions to make sure that people see that this is not a standard event. I would definitely want to see, like, something that that makes you know that this is a queer event and this is a safe space. (GS09) It just depends on what kind of person you’re trying to reach because some people aren’t going to be as open to talk about this kind of stuff and are more reserved. (GS05) I feel like a gaming program would be very nice but definitely to younger audiences. Young audiences would be probably more interested in that type of thing. (GS03) Advantages of game-based program Most of the HIV prevention programs I know, you have to ask your provider. You really have to dig deep for it. This would be more like they give you the resources right in front of you; you don’t have to search for it. (GS03) There’s a lot of advantages to it. I feel like [with] gaming you would be able to reach people who would otherwise be unable to be reached. (GS11) Disadvantages of game-based program For me, when I’m playing video games I kind of want to focus on just that. I don’t really want to talk about HIV, STD [sexually transmitted disease], PrEP. I think that would be difficult. You’d have to find some way to incorporate that into it and make it so people will pay attention. (GS01) With gaming comes a lot of people who are not necessarily part of the [LGBTQ+] community. You could get an event where you are not really providing information to the demographic you want. (GS09) I mean, the only disadvantage I could maybe see is not being able to reach more people. Because I know that when we do the game nights after a while we will see the same people. (GS15) |
| Theme 2: Intervention delivery and component preferences varied in terms of settings and types of gaming Description: Preferences for the intervention format (hybrid vs in-person), delivery settings (e.g., Discord servers, community events, gaming influencers, in-game advertisements), and components were diverse in this sample. This suggests there may be multiple opportunities to engage Latino MSM via game-based interventions. |
| Example quotations |
|
Format and delivery settings It would be attractive if it were an online game where people could play live. (GS15) It would be great to see a partnership between [a community-based organization] and a gaming company that could offer a benefit for people who join and give them something. Maybe have a mini event related to gaming, where they invite people who know about gaming and use that opportunity to inform them about PrEP and part of what they’re offering with gaming. (GS04) Identify like an influencer that might be able to spread the word or if they’re attending these tournaments having like a QR code people might be able to scan. (GS09) Use gamification in your portal that you have to check your results. Maybe after two checkups you get a badge or something like that and they get a game. Like, every time you go get a test you can get badges and earn points, maybe get a reward card. Reading stuff about HIV and the games gives you more points. Make it fun for kids to learn about HIV. (GS03) Partner with an influencer who plays games and is a reference in this area so they can communicate the messages because they already have a strong connection with gaming communities. I feel like that would be, maybe not what I personally want to see, but it would be what could work the best. (GS04) Intervention components Have some sort of an educational component either before, during, or in the middle of that programming. There has to be education with anything that they do, any program that they do. Yes, it’s fun, but we’re also here to learn and protect each other. (GS07) Focus on, like, the gamer aspect of it and use that as a [way] to also give the opportunity to educate for prevention. (GS11) All gamers love free stuff. (GS12) You could incorporate [community submissions] as things people say in the game or aspects of what they’re saying into the interactions of these [multiplayer characters]; get community leaders involved; incorporate HIV/STI testing into the gaming night. (GS13) Have a variety in the types of games that are there (e.g., board games). (GS14) |
Note. LMSM = Latino men who have sex with men; LGBTQ+= lesbian, gay, bisexual, transgender, queer, questioning, asexual, intersex, and other nonheterosexual, noncisgender; PrEP = preexposure prophylaxis; STI = sexually transmitted infection.
KEY RESULTS
Two major themes emerged: (1) perceptions of advantages and disadvantages of game-based PrEP and HIV prevention interventions, and (2) preferences regarding intervention delivery and components in terms of settings and types of gaming.
Theme 1
The first theme reflects the acceptability of game-based interventions and their relative advantages or disadvantages compared with existing HIV and PrEP engagement strategies. Overall, participants perceived game-based HIV prevention programming as acceptable because it would use preexisting interests to foster community building. Participants who had experience as HIV-testing counselors reported that their clients would also be receptive to the integration of gaming interventions into HIV programming. These individuals brought a wealth of knowledge about existing outreach strategies, including social media posts and targeted advertisements in online dating applications. Participants felt that game-based strategies could complement existing strategies, improving the reach of HIV prevention services in the online gaming community. Some participants shared concerns about whether a game-based intervention would fit their HIV prevention education needs and gaming interests.
Participants identified several advantages of game-based interventions: (1) game-based strategies can reach people in the gaming community who may not be engaged in HIV prevention services, (2) these strategies could signal to others that the event is a safe space, and (3) game-based strategies offer a fun environment to learn about HIV prevention. Disadvantages included (1) potential misalignment of intervention goals and recipient expectations, whereby recipients might miss HIV messaging if the focus of the event was on gaming; (2) exclusion of other groups who may also need HIV prevention education (e.g., nongamers; individuals outside the lesbian, gay, bisexual, transgender, queer, questioning, asexual, intersex, and other nonheterosexual, noncisgender [LGBTQ+] community); and (3) repeatedly engaging the same individuals at events. Of note, the hypothetical nature of the interview probes may have created challenges for participants when trying to describe perceived disadvantages or barriers to a future game-based intervention.
Theme 2
Our second theme captured delivery and implementation preferences for a future game-based intervention. Recommendations regarding settings, format, and intervention components were diverse. Participants noted that a hybrid format might be best for fostering engagement. Suggested formats included (1) cohosting in-person community events with community-based organizations, game developers, and streaming platforms (e.g., Discord, STEAM; see Appendix B for more information [available as a supplement to the online version of this article at http://www.ajph.org]); (2) identifying and engaging gaming influencers to disseminate HIV prevention messaging; and (3) providing HIV prevention resources through existing gaming servers.
Participants stated that despite regularly playing video games, they would be unlikely to engage with in-game advertisements, HIV-related storylines, or educational strategies (i.e., facts about HIV prevention integrated via game transitions). Participants suggested that these strategies might be better suited for audiences younger than 18 years or those who engage in casual gaming. Participants felt that community events offering a variety of game modalities were a better strategy to engage people with varying gaming interests.
Participants saw accessibility as key, preferring that PrEP and HIV resources be easily accessible by having either community-based staff at events or links to credible services in one place, such as an event page. Furthermore, having educators from the community provide information and resources was important. Participants advised that when educational components felt forced or were delivered as a PowerPoint presentation, they were undesirable. Moreover, passive educational approaches (e.g., flyers) were considered ineffective strategies. Informational and educational components were perceived to be better integrated with gaming events through scheduled announcements during the event.
Participants noted that incentives would be an important strategy for engaging the gaming community. Suggested incentives included raffles, giveaways, gift cards to gaming platforms, and rewards for reviewing HIV test results. Although we were interested in improving engagement in HIV prevention services among LMSM, most participants’ responses focused on the overall LGBTQ+ gaming community. Greater emphasis was placed on creating inclusive and safe spaces for the LGBTQ+ community to come together, play games, and learn about available HIV prevention resources.
EVALUATION, TRANSFERABILITY, AND ADVERSE EFFECTS
These results demonstrate the acceptability and preferences for future game-based PrEP and HIV prevention interventions for LMSM. As in previous studies, game-based interventions were deemed acceptable,7 and feedback will inform the development of an intervention. Unlike previous efforts in which preferences were elicited in response to an early version of a game, intervention, or prototype,11 our project explored a hypothetical intervention. Our findings also suggest the need for a multicomponent approach that incorporates game-based elements to cater to the diverse interests, implementation contexts, and HIV prevention needs of LMSM. Furthermore, this study has generated new questions about engagement with specific intervention components (e.g., gaming influencers disseminating HIV prevention content, attendance at hybrid events, and incentive structures).
SCALABILITY
We used qualitative interviews as a brainstorming exercise to elicit preferences for a game-based intervention planned for future development. Our findings align with studies that found game-based interventions for health to be acceptable.7 The diversity in recommendations for integrating HIV prevention and online gaming warrants further exploration. Future work should codevelop and pilot test game-based interventions to increase LMSM’s engagement in PrEP and HIV prevention services. Game-based PrEP and HIV prevention interventions have been successfully developed for other communities, which supports the scalability of this approach.7
Scaling efforts can capitalize on the popularity and reach of gaming influencers to disseminate information via online platforms (Appendix B). Among the 212 million video game players in the United States, 19% identify as Latino, and 11% identify as LGBTQ+.12 Engaging LMSM and other priority communities via gaming approaches is a promising strategy to reach communities that are not engaged in HIV prevention services. In-person events serve as community hubs with local accessibility and promote social reinforcement of healthy behaviors, and online gaming events reach a wider audience. Finally, Web 3.0 environments (Appendix B), such as blockchain-based PrEP care platforms,13 offer promising venues for engaging the LGBTQ+ gaming community in HIV prevention, aligning with study participants’ emphasis on incentives and inclusive spaces. Decentralized digital ecosystems could incorporate reward systems while creating safe, inclusive spaces for LGBTQ+ gamers to learn about HIV prevention resources.
The perceived acceptability and potential scalability must be considered in light of some limitations. Some participants said that they would be unlikely to engage with game-based strategies themselves. It is possible that these overt educational strategies may be perceived as too forceful, leading to an unfavorable response, even if an individual’s beliefs about the importance of HIV prevention align with the educational messages.14 To address the ambivalence toward these overt, persuasive strategies, intervention development efforts could apply an embedded design approach. This approach was successfully applied in the development of an intervention to increase HIV testing among young men who have sex with men,15 indicating its utility and the need for further research into this approach.
PUBLIC HEALTH SIGNIFICANCE
As game-based interventions grow in popularity, it is imperative to understand potential recipients’ preferences so that interventions are relevant and appropriate. Our study showcases the diversity in potential game-based approaches to increase PrEP and HIV prevention engagement among LMSM.
ACKNOWLEDGMENTS
The research was supported by the National Institute of Mental Health, National Institutes of Health (NIH; award F31MH138212; primary investigator L. Despres; award R01MH125727; primary investigator M. Kanamori; and award P30MH116867; primary investigator S. Safren, Core Co-Director M. Kanamori).
We extend our gratitude to those who participated in this study, including study staff, community members, and respondents, without whom this research would not be possible.
Note. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
CONFLICTS OF INTEREST
The authors have no conflicts of interest to disclose.
HUMAN PARTICIPANT PROTECTION
The project was approved and monitored by the University of Miami institutional review board (projects no. 20201269 and no. 20240465).
REFERENCES
- 1. Centers for Disease Control and Prevention . Preventing HIV . September 26, 2024. . Available at: https://www.cdc.gov/hiv/prevention/index.html . Accessed June 19, 2025.
- 2. Sullivan PS , DuBose SN , Castel AD , et al. Equity of PrEP uptake by race, ethnicity, sex and region in the United States in the first decade of PrEP: a population-based analysis . Lancet Reg Health Am. 2024. ; 33 : 100738 . 10.1016/j.lana.2024.100738 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Deterding S , Dixon D , Khaled R , Nacke L. From game design elements to gamefulness: defining “gamification.” Paper presented at: Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments. Tampere, Finland; 2011. . [Google Scholar]
- 4. Giunti G , Baum A , Giunta D , et al. Serious games: a concise overview on what they are and their potential applications to healthcare . Stud Health Technol Inform. 2015. ; 216 : 386 – 390 . [PubMed] [Google Scholar]
- 5. Shegog R. Application of behavioral theory in computer game design for health behavior change . In: Cannon-Bowers J , Bowers C , eds. Serious Game Design and Development: Technologies for Training and Learning. Hershey , PA: : IGI Global; ; 2010. : 196 – 232 . [Google Scholar]
- 6. Gauthier A , Kato PM , Bul KCM , Dunwell I , Walker-Clarke A , Lameras P. Board games for health: a systematic literature review and meta-analysis . Games Health J. 2019. ; 8 ( 2 ): 85 – 100 . 10.1089/g4h.2018.0017 [DOI] [PubMed] [Google Scholar]
- 7. Jitmun W , Palee P , Choosri N , Surapunt T. The success of serious games and gamified systems in HIV prevention and care: scoping review . JMIR Serious Games. 2023. ; 11 : e39915 . 10.2196/39915 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Wallerstein N , Duran B , Oetzel JG , Minkler M. Community-Based Participatory Research for Health: Advancing Social and Health Equity. Hoboken, NJ: : Wiley; ; 2017. . [Google Scholar]
- 9. Damschroder LJ , Reardon CM , Widerquist MAO , Lowery J. The updated consolidated framework for implementation research based on user feedback . Implement Sci. 2022. ; 17 ( 1 ): 75 . 10.1186/s13012-022-01245-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Forman J , Damschroder L. Qualitative content analysis . In: Jacoby L , Siminoff L , eds., Empirical Methods for Bioethics: A Primer. Bingley, UK: : Emerald Group Publishing; ; 2007. : 39 – 62 . [Google Scholar]
- 11. Whiteley L , Mena L , Craker LK , Healy MG , Brown LK. Creating a theoretically grounded gaming app to increase adherence to pre-exposure prophylaxis: lessons from the development of the viral combat mobile phone game . JMIR Serious Games. 2019. ; 7 ( 1 ): e11861 . 10.2196/11861 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Entertainment Software Association . Essential facts about the US video game industry. Washington, DC, USA: : Entertainment Software Association; ; 2024. . [Google Scholar]
- 13. Khurshid A , Harrell DT , Li D , et al. Designing a blockchain technology platform for enhancing the pre-exposure prophylaxis care continuum . JAMIA Open. 2024. ; 7 ( 4 ): ooae140 . 10.1093/jamiaopen/ooae140 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Kaufman G , Flanagan M , Seidman M. Creating stealth interventions for attitude and behavior change: an “embedded design” model . In: La Hera T , Jansz J , Raessens J , Schouten B , eds., Persuasive Gaming in Context. Amsterdam, Netherlands: : Amsterdam University Press; ; 2021. : 73 – 90 . [Google Scholar]
- 15. Gilliam M , Jagoda P , Jones IB , Rowley J , Hill B. Embedded game design as a method for addressing social determinants of health . Am J Sex Educ. 2018. ; 13 ( 3 ): 378 – 398 . 10.1080/15546128.2018.1445572 [DOI] [PMC free article] [PubMed] [Google Scholar]