Online film successful in reducing certain HIV risk behaviors

At-risk people watch 9-minute video

Internet-browsing men who have sex with men (MSM) apparently will respond to a dramatic, online short film with a message about reducing sexual risk behaviors, new research shows.

Investigators created a 9-minute video drama called "The Morning After" available for viewing online at www.hivbigdeal.org. They recruited more than 1,000 men through banner ads on a popular MSM Web sites: www.manhunt.net.1

"We had recruited men for other studies from that site, and we used a banner that was put on an exit page, so virtually everyone saw it," says Mary Ann Chiasson, DrPH, vice president of Medical and Health Research Association in New York, NY.

Participants completed a baseline behavioral questionnaire, watched the video, and then answered additional survey questions.1

There also was an online consent form that explained the study, Chiasson adds.

Researchers also requested that participants include their email address, and 971 responded with a working email address, Chiasson says.

This request apparently did not turn off potential participants, and 522 men, or 54 percent, responded to a follow-up survey at three months, she notes.

"This was the first time we've done a follow-up online," Chiasson says. "We were extremely pleased with the results because we didn't know if people would be willing to watch the movie or complete the follow-up survey."

Investigators were not permitted by the institutional review board (IRB) to ask participants about their HIV status on the first questionnaire because of confidentiality concerns regarding the simultaneous request for email addresses, Chiasson says.

"So, we didn't ask about their HIV status until the second survey," she adds.

From that data, they found that 6.7 percent of the men who self-identified as HIV negative had developed a new HIV infection within the three months after viewing the video, Chiasson explains.

"I think probably the men who were really concerned about their risk behavior were motivated to test," she says.

Other findings were that after viewing the intervention video, the men were three times more likely to disclose their HIV status to their sexual partners, Chiasson adds.

"I think disclosure is an area that needs to be looked at a lot more," Chiasson says. "To us, these findings were quite important."

The survey asked participants, at the three-month follow-up, questions about their thoughts about the video and how it affected them.

"One of the most striking findings is that men found the video provocative," Chiasson says. "This was the whole point of the video's structure, to initiate critical thinking in the men who viewed it."

The video begins with an attractive young man named Josh looking at dating profiles of other men via the Internet. It shows him instant messaging one man and arranging a date. They meet at a bar, drink, and end up in bed. The next morning Josh wakes up first and heads to the bathroom to wash his face. He opens the medicine cabinet to find toothpaste and spots a pill bottle. It's a prescription for an HIV antiretroviral pill.

Josh makes an excuse to his partner and leaves, immediately calling his best friends who meet him at a café. He tells them what happened and that he doesn't even remember if his partner Eric had used condoms the night before. They tell Josh that he has to cut back on his drinking and start asking partners about their HIV status. Then Eric spots Josh from the street, crosses over to his table at the café, and the two men have their own conversation about HIV disclosure, responsibility, and protection.

The video ends with the message that HIV still is a big deal, and the Website provides a list of resources, referrals, and links for more information.

The video was designed to set up a situation that might happen to MSM and to encourage them to think about it, she adds.

"We asked them if they had ever been in a situation like that, and 50 percent of the men said they had," Chiasson says. "Our pre-design focus groups had tapped into a situation that does happen to people."

The video has been available online since June, 2006, and through 2007, there were more than 30,000 hits to view it. The video is also available on YouTube, and it's had 16,000-plus hits there, Chiasson says.

"We're going to be starting a marketing campaign in the spring of 2008," she says.

First, investigators need to complete enrollment for a randomized, controlled trial that features a second episode to "The Morning After," titled, "The Test," Chiasson says.

In the second episode, the same characters appear, and Josh gets tested for HIV.

"We're very pleased with this intervention and hope to be continuing it in the future," she says. "There is room for all kinds of HIV interventions, and I think an inexpensive intervention that may not be as intensive, but can reach many people, has the potential for changing behavior."

Since making the video available online and discussing it at national conferences, investigators have been asked by HIV providers and clinics for DVD copies, Chiasson says.

"People want to use it in small groups for discussion and counseling," Chiasson notes. "It stimulates conversation and critical thinking."

[Editor's note: For those who would like to obtain a copy of "The Morning After," it is available on-line for a free download at www.hivbigdeal.com, or they can contact Mary Ann Chiasson, DrPH, at MAChiasson@mhra.org.]

Reference:

  1. Chiasson M, et al. Increased HIV disclosure and HIV testing after an online intervention for men who have sex with men (MSM). Presented at the 2007 National HIV Prevention Conference, held Dec. 2-5, 2007, in Atlanta, GA. Abstract: C15-3.