Reducing HIV Risk in Urban Women: Soap Opera Videos on Video-Capable Cell Phones
Condition: HIV/AIDS; Sexual Behavior; Woman's Role; Risk Behavior
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      Background: Love, Sex, and Choices (LSC) is a soap opera video series created to reduce HIV
      sex risk in women.

      Methods: LSC was compared to text messages in a randomized trial in 238 high-risk mostly
      Black young urban women. 117 received 12-weekly LSC videos, 121 received 12-weekly HIV
      prevention messages on smartphones. Changes in unprotected sex with high risk partners were
      compared by mixed models.
    

Detailed description: 
      This randomized controlled trial (RCT) aims to evaluate "Love, Sex, & Choices" (LSC), a
      video-based intervention to reduce human immunodeficiency virus (HIV) sex risk behaviors in
      young adult urban women. Consisting of 12-weekly soap opera videos lasting up to 20 minutes
      each, messages about reducing HIV sexual risk are communicated through the drama and context
      of relationships, a strength of the soap opera modality. Based on true stories analyzed from
      focus groups, viewers can identify with the heroines in the videos who suffer tragedy and
      heartbreak and transform their behavior through a new awareness of their value as women,
      their choices, and their potential. Women watch a new video sequel weekly for 12 weeks on
      smartphones. A control group receives text/audio messages concerning HIV risk reduction. If
      successful, the public health impact is that women at risk for HIV will be able to access
      video interventions to reduce HIV risk on personal mobile devices.

      Prior to this work, a 43-minute soap opera video, "A Story about Toni, Mike, and Valerie" had
      been produced and pilot tested by the Principal Investigator (PI) on handheld computers (RO3
      NR009349). Findings had indicated the video was highly appealing and there was a
      statistically significant short-term reduction in stereotypical gender views about the need
      to engage in unprotected sex in the video intervention arm that was not observed in the
      control arm.

      The current RCT seeks to test the effect of the LSC series on sex risk behavior as compared
      to a control receiving HIV prevention text messages. Analysis and story development had been
      guided by Sex Script Theory and the Theory of Power as Knowing Participation in Change; as
      well as, content analysis of focus groups with urban young adult African American and Latina
      women. Consistent with the theories and focus group analyses, the new LSC series elaborates
      on the original story weaving in the stories of four women. In both the RO3 pilot study and
      the related National Library of Medicine funded study (1 G08 LM008349-01), the use of small
      handheld computers to watch the video was found to be enjoyable and promoted a sense of
      privacy. Based on these promising findings concerning the experience of viewing videos on
      small handheld devices, the popularity of cell phones in this age group, and that the use of
      cell phones to watch videos is growing as cell phone technology, multimedia, and Internet
      connections improve, the present study seeks to deliver the weekly series of videos on
      smartphones.

      There are several advantages of viewing videos on smartphones, in particular the freedom to
      watch the intervention videos often and in privacy. This study is also consistent with
      several NINR objectives stated in its strategic plan. These are: to apply findings concerning
      the social and cultural context of health behavior to health promotion, to develop and test
      interactive web-based and wireless technologies to eliminate health disparities, and to
      refine methods in the delivery of health promotion. The overall aim of this study is to
      conduct a RCT to determine whether the 12-week series of theory-based urban soap operas will
      reduce HIV sexual risk behavior. The specific aims of this study are:

      Aim1. Complete final editing phase of LSC, a series of 12, 20-minute soap opera videos, and
      12 HIV health promotion text/audio messages that will be released weekly and viewed on
      smartphones.

      Aim 2. Deploy the web-based applications, specifically: a) integrate voice and text files
      into the audio computer assisted self-interview (ACASI) for access on desk top computers b)
      stream the videos to the video intervention group and send text/audio messages to the control
      group for viewing on smartphones c) maintain password protected availability so the video
      intervention group can watch the videos (or control group view text messages) anytime during
      the 12-weeks d) track how often and how long each video(or text) is viewed, and e) secure
      hardware and networks.

      Aim 3. Conduct a RCT with 250 urban women aged 18 to 29 in two adjacent cities with a high
      incidence of HIV/AIDS. Inclusion criteria are women with high sex risk behavior. Eligibility
      screening will be accomplished by utilizing a previously developed ACASI that functions as a
      decision support system (DSS) to assign a level of risk based on responses to the screening
      interview. If supported by results, promote public access to the videos on the study
      dedicated web site.

      The following hypotheses were tested in the RCT:

      Primary hypotheses 1) The video group will have greater reductions in unprotected sex with
      all high risk sex partners (as measured by the USR score) from baseline to 3 and 6 months
      than will the control group. 2) The video group will have greater reduction in sexual
      pressure scores from baseline to 3 and 6 months than will the control group.

      Secondary hypotheses: Compared to the control group, the video group will have 1) greater
      reductions in USR with high risk main partner/s from baseline to 3 and 6 months, 2) greater
      reductions in USR with non-main and secondary partners at 3 and 6 months, and, 3) The video
      group will have fewer high risk sex partners at 3 and 6 months.
    

Intervention name(s): Love, Sex, & Choices video series; Messages in text
Intervention type(s): Other; Other
Intervention description(s): Love, Sex, and Choices was written and scripted by the study team and underwent pilot testing in the target population. The series was divided into 15-to-20 minute episodes that were streamed weekly. The principles of reducing HIV risk were communicated through the characters and high risk situations. The lead characters model how women become more powerful, meaning more aware of themselves as worthy of respect, making choices intentionally, feeling free to pursue their intentions, and involving themselves in creating change. This process leads to higher power sex scripts in the characters, meaning pursuing intentional choices and health promoting behaviors. The lead characters model open communication about HIV testing with a resistant partner, and initiating condom use.; The comparison group received 12 weekly HIV health promotion written messages over the smartphone. The messages were based on prevailing CDC recommendations and the theoretical framework. An example is: "Sexual health means respecting your own rights and feelings. Feeling pressured to have sex means limiting your choices and your freedom to love safely. …. If he doesn't like you being you, it may be time to walk." Other messages provided instructions on the correct condom use and the importance of HIV testing. The 12 messages were reviewed by ten African American and Latina undergraduate nursing students for ease of comprehension.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention