As a gay teenage boy growing up in South Africa, Jonathan "Jono" McKay didn't know how to explore his feelings about his sexual identity.
He was far too scared to ask anyone in person for support. So he'd log onto gay chat forums at night, always terrified that a family member would barge into the room. "The dial-up modem would screech and howl," he remembers. That was in the 1990s.
Technology has improved since then. Unfortunately, attitudes in a lot of the world haven't.
That's why in 2021, McKay co-founded SameSame, which is testing a WhatsApp-driven program designed to help LGBTQI+ young people, particularly in Africa and Asia.
So they can reach out for help – only they won't be interacting with a human.
"If you're a young person wondering if you should be talking to someone, there's a real risk it could go badly," he says, pointing to harmful policies in many countries. "In Indonesia, government guidance is conversion therapy."
With SameSame, users can gain instant access to mental health resources, including an 8-session cognitive behavioral therapy course developed to reduce stress and improve well-being among LGBTQI+ youth.
"We can't train as many identity affirming counselors as we need," says McKay, who notes that LGBTQI+ youth suffer from depression at four times the rate of their peers.
Tech ideas like this could be key to tackling the planet's massive health disparities, says Alex Amouyel, executive director of MIT Solve, the Massachusetts-based university's initiative to drum up new ways to address international problems. Each year, Solve identifies a set of "Global Challenges" and invites tech entrepreneurs to submit their solutions. Judges then select winners (aka "Solvers") to support with grants of $10,000 each, plus a 9-month mentorship program.
For 2022, one of the challenges was Equitable Health Systems, which is a goal that's endlessly complex, Amouyel says. Even when care becomes affordable and available, that doesn't fix all of the potential glitches. "You still have to get everything else right," she says. In other words, we need workarounds to avoid stigma and bias at the doctor's office.
So she's excited that two members of this year's class of 40 "Solvers" are taking aim at this issue from different angles. In addition to SameSame, there's omgyno (pronounced "oh my gyno"), which offers women anonymous access to gynecology services through at-home testing kits and telehealth appointments. Its origin story can also be traced to uncomfortable memories.
Doreen Toutikian, co-founder and CEO of omgyno, is from Beirut, Lebanon. When a male doctor there diagnosed her with HPV — a sexually transmitted infection — he made it clear he didn't approve that she was a sexually active single woman.
"I was told I had committed this sin," says Toutikian, who then went to a female doctor, hoping a woman would be less judgmental. But she got questions about why she wasn't married with kids yet. "The truth is, I don't think I've had a good experience with a doctor," she says.
After talking with friends and relatives, Toutikian learned she was far from the only person bothered by this treatment. In search of alternatives, she discovered it was possible to test for HPV and other common infections with at-home health kits. These kits were already being marketed in the U.S. and U.K. "In these countries, people are doing it because it's convenient," says Toutikian, who created omgyno to bring the kits to other regions. "Where we're doing it, there's a problem of conservatism and taboos." The service is currently available in Greece with plans to spread throughout southern Europe, the Middle East and beyond.
Both SameSame and omgyno are relatively new concepts, but they've got momentum, Amouyel says. "We select ideas at the prototype or pilot stage," she explains, noting that this is often a critical moment for fledgling projects. Mentorship and coaching can help them adjust or pivot as necessary as they expand. And, as McKay notes, "The money doesn't hurt." (Beyond the Solve grant, teams can win additional prizes. SameSame shared the $100,000 Living Proof Prize, and omgyno was one of five recipients of the Health Access Prize from Johnson & Johnson Impact Ventures, which totaled $175,000 across the teams.)
Broadening options and opportunities is key to Solve's mission. "Where we want to play a role is by ensuring technology is designed for and by underserved communities," Amouyel says. So Toutikian and McKay's personal experiences with these issues really resonate.
"We want to build what we wished we had when we were growing up," says McKay, who had trouble connecting with anyone from his background in those '90s chat forums. He wanted to hear about the lives of other gay South Africans, not people halfway around the world.
So SameSame offers country-specific stories and strives to reflect regional attitudes and vocabulary. "If we just rely on the same terminology used in the West, we'll never break through," McKay says. For example, the phrase "gender is a social construct" might be useful in an academic discussion of sexuality and sociology. "But [that] "is not going to mean something to a 15-year-old in a township in South Africa," he says.
Amouyel points out there's another key similarity between the two entrepreneurs. "They're originally designers, not originally in the health space," she says, which helps them bring creative approaches to the table.
It can be tricky to offer help in a way that doesn't draw unwanted attention. "In the countries we're looking to work in, it's a mistake to call out that this is for queer people. They shouldn't be greeted with rainbows and pink triangles," McKay says — images that could "out" them to others nearby.
Instead, SameSame leans into language about "feeling different" and "feeling alone." The entry point is an "Am I Normal?" quiz. Spoiler alert: "No matter what you answer, you're normal," McKay says. "Right from the first interaction, it's saying it doesn't matter if you've kissed a boy. It doesn't matter if you're attracted to no one."
There's a series of precautions omgyno takes to protect users' privacy when they order a test kit online. "We work with a specific courier, not public post," Toutikian says. "Packaging is super discreet, nothing on it. We deliver it specifically to the person, not a family member."
After the patient performs a vaginal swab and sends in a sample, the person is identified in the lab by code rather than by name. Results arrive via encrypted email.
The secrecy doesn't prevent omgyno from educating users, says Toutikian, who knows many women who've gone to gynecologist appointments without grasping what they were being tested for or why. "[The results] explain quite a lot, not just a positive or negative," she says. "Here you see all the steps your sample went through, how you might have gotten this, options for medication if it's needed."
It's simple to then book an online telehealth appointment with an omygyno-recommended gynecologist, Toutikian explains. "Almost all of the doctors working with us are women and they totally understand," she says. Patients can ask them about pleasure during sexual intercourse as well as gynecological health issues without fear of being criticized. And because it's a video visit, she adds, no one can see the patient coming in or out of a clinic or hospital.
Ultimately, everyone on the planet should be able to get supportive, live, in-person medical care. "Most of the time, I'm a people person," McKay says. But he's also a realist. And he's proud to be part of this tech movement combining anonymity with access. "Because discrimination and stigma keep people away, digital has the edge over face-to-face."
Vicky Hallett is a freelance writer who regularly contributes to NPR.