The emergence of the human immunodeficiency virus (HIV) in Britain in 1982 coincided almost exactly with my reaching sexual maturity as a gay man. It was therefore difficult not to be interested in HIV at this time. However, my academic interest in HIV was fostered during a psychology degree at Reading University, resulting in an undergraduate thesis in 1988 on social understandings of HIV and public policy endorsement. Following two years at the Terrence Higgins Trust and the AIDS self-help group Frontliners, my academic research career began in 1990 and has since then remained focused on the sexual transmission of HIV and its prevention. I argue that the behavioural and biological factors determining HIV infection, the psycho-social prevention needs associated with those factors, and the range of community, service and policy actions determining those needs, are together so diffuse and diverse that no single agency or authority can be expected to have control over HIV incidence. Conversely, all agencies, authorities and individuals are able to make a contribution to minimising new infections.

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This thesis aims to examine the effectiveness of a mobile phone based SMS game as a learning intervention for the Peer Educators of the Males having Sex with Males (MSM) groups in Kolkata, India. MSM groups are marginalised and are at higher risk of HIV/AIDS, falling under the core groups for the National AIDS Control and Prevention programmes in India. Peer to peer education for behaviour change in HIV/AIDS prevention projects is a bottom up approach to reach out to this marginalised population for HIV prevention. Training is in place for MSM peer educators but research shows gaps in their support and learning needs. This project developed a mobile game based learning tool to address the peer educators’ learning and support needs. Using a participatory research approach a multiplayer SMS based simulation game was developed, deployed and evaluated, using an existing game engine called ‘Day of the Figurines’. In an effort to enhance experience sharing and peer learning the real life experiences of the peer educators were captured and incorporated through a participatory and iterative process as scenarios of the game. A SMS game on mobile phones was chosen to be in keeping with the marginalised, secretive nature of the MSM identity of the peer educators as well as be in keeping with the mobile nature of their work. The SMS game was piloted in Nottingham and Kolkata and the final intervention was deployed and evaluated in Kolkata with a group of sixteen peer educators from MANAS Bangla, a network of community based MSM organisations in Kolkata, India. Evaluation of the game showed it to be useable, relevant to peer education, interesting and entertaining but in some cases slow, uninteresting and confusing. The game play was affected by technical faults but players still exchanged SMS messages with the game and communicated between players using the ‘chat’ feature of the game. Playing the game enabled players to acquire better communication skills and increased confidence, it gave them a feeling of self-efficacy and influenced their work practices. The intervention was instrumental in increasing the peer educators’ critical consciousness, it created a space to address the practical barriers faced by the peer educators by providing dialogic methods for developing knowledge, encouraging and facilitating collaboration, developing communication skills and increasing access to learning opportunities. This research contributes an exploration of peer educators’ problems, evaluation of mobile game based learning and account of participants’ experiences in a mobile-health development context in resource constrained settings.