On Tuesday, World AIDS Day, a new study in the New England Journal of Medicine of more than 400 men showed that drugs for HIV, the virus that causes AIDS, could be taken intermittently and still protect against transmission of the virus.
What a long way we’ve come from the early 1980s, when an AIDS diagnosis was equivalent to a death sentence. Yet if you ask Rachel Jones, associate professor in the School of Nursing at Northeastern University, we still have a long way to go—particularly regarding HIV and African American women.
According to the Centers for Disease Control and Prevention, the largest number of new HIV infections in the U.S. is among African American women: It’s 20 times that of white women and five times that of Latinas.
Jones, whose research focuses on reducing HIV risk in urban women, has been on a mission for decades to change that—ever since she encountered the AIDS epidemic firsthand as an emergency room nurse in New York City’s Beth Israel Hospital in 1981.
“Love, Sex, and Choices”
In October, she launched her latest effort: A large intervention aimed at preventing HIV infection in at-risk urban African American women between the ages of 18 and 29. She received a nearly $2 million, four-year grant from the National Institute of Nursing Research at the National Institutes of Health to conduct the study.
Called “Love, Sex, and Choices,” or LSC, her intervention comprises a 12-episode soap-opera video series streamed to mobile devices that imparts HIV-prevention concepts, including condom use and HIV testing, through the stories of four female characters. Jones modeled their behaviors on attitudes expressed by women in focus groups she ran in high-risk areas of New Jersey and New York.
“We saw that some women didn’t trust their partners to be faithful, yet they still had unprotected sex with them,” she says. “There were other women who would never—their bodies were citadels and nobody was touching them. And then there were others who were having sex with at-risk partners.”
In October, with project director Lorraine Lacroix and nine Northeastern students as research assistants, Jones began recruiting participants. The team is speaking with women in nearby neighborhoods and running ads on Facebook and Instagram targeted to the study’s demographic. They plan to screen 4,000 women, and select 1,000. Sixty have already enrolled in the program.
The women identified with the characters—they were screaming at them. We knew from their evaluations of the video that we were on the right track.
— Rachel Jones, associate professor
“The ads are relatable to women who might be at risk—those who perhaps are having trouble trusting their boyfriends or not using condoms,” says Akira S. Brown, S’18, who has been helping with recruitment and ad development since September. A psychology major, Brown was drawn to the project, she says, “to help women in the black community.”
“The response to recruitment has been wonderful,” says Jones. “Our technical platform is solid: Women can simply click on Facebook ads and immediately be transported to our website. There they can sign up, be screened via an online interactive interview, and—if they come up high-risk—be randomly placed in either the intervention or control group.” Those in the latter—an essential component of any top-notch study—view a 12-episode Web miniseries with a storyline that promotes respectful relationships.
Bringing the message home
Results of a pilot trial, published in 2013, provided proof of concept. In that study, the control group received weekly HIV-prevention text messages. One example: “Sexual health means respecting your own rights and feelings.”
Both groups decreased risk behaviors, but the LSC group exceeded that of the test-messaging control by 18 percent. Still, the sample size—just 238 participants—was too small to show a statistically significant difference between the two. “What we did see was that the women loved the series,” says Jones. “They identified with the characters—they were screaming at them. We knew from their evaluations of the video that we were on the right track.”
LSC is as much about women loving themselves, and honoring themselves, as it is about HIV prevention.
— Rachel Jones, associate professor
They also learned that the audience often got so involved in the characters’ stories that they “lost the messaging.”
So in the new study, Jones added a guide—viewers choose among five, each with specific characteristics but the same script. At the end of every episode, the chosen guide, positioning herself like a good friend, brings home the essence of the segment. For example, she might question the character Toni’s acquiescing to having sex with her partner, even though she’s suspicious about his fidelity.
“The videos are so realistic,” says research assistant Diana Jacques, BHS’18, a nursing major who heard about the study from a panel at Northeastern’s John D. O’Bryant African American Institute. She was struck by how their authenticity stripped away viewers’ denial about consequences. “To see a character enact the choice, for example, not to use a condom and then have her life altered, rang so true.”
World AIDS Day every day
Jones’ commitment doesn’t stop with this innovative trial. Currently the team is working with outside organizations, including the Boston Public Health Commission Substance Abuse Division, where LSC is being used as an intervention in its Comprehensive Wellness Program. “If the study is successful, our interest is to scale up so that LSC reaches the entire continent and beyond,” says Jones. “LSC is as much about women loving themselves, and honoring themselves, as it is about HIV prevention.”
Jacques, who has been facilitating recruitment and survey testing since the summer, sums up LSC’s influence this way: “By increasing awareness, we can help change the behaviors that endanger people’s health and well-being,” she says. “They can then share that awareness with their friends and family and so spread it through a larger platform than we can reach alone.”