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When you imagine the latest weapon in the war against AIDS, the image that comes to mind isn’t likely to be a soap opera.
But that’s exactly what nursing professor Rachel Jones has produced—and it works.
Love, Sex, and Choices went live in November (watch here) after being tested among a group of 5,000 women, half of them at high risk for contracting the HIV, the virus that causes AIDS. The project, which is funded by a $2 million grant from the National Institutes of Health, involved the creation and testing of a 12-episode soap opera that follows four African-American women as they navigate the challenges of modern relationships.
Interwoven in their dramatic stories are a variety of HIV-related issues, including condoms, cheating, HIV testing, multiple partners, drug use—and most of all, self-image.
Data analysis of the study results won’t be completed until early next year, but the preliminary results are promising. A pilot study with a much smaller sample size showed a significant decrease in at-risk behavior, and anecdotal evidence from participants has been overwhelmingly positive, according to Jones.
“Every woman should see this series of videos,” said one participant in her written comments. “I learned so much. I saw myself or my friends in the women and they reminded me that I am worth more. I deserve so much more, and from now on I will not settle for less.”
“Will there be any more episodes?” wrote another participant. “They were like hood soaps. I want to see more!! Please.”
The theory behind the soap opera is straightforward:
Unlike many deadly diseases (cancer, malaria, Ebola), AIDS is a sexually transmitted disease spread almost entirely by poor personal health choices. Therefore, prevention is based largely on persuading people to make healthier decisions—and the most powerful form of persuasion is a good story.
“When you tell a story, people become more engaged and less threatened by the message because they are so transported by the drama,” said Jones, who produced the series with a team led by project manager Lorraine Lacroix-Williamson, who is now a full-time PhD student at Bouvé in population health.
The target audience for this health intervention is young black women, who account for the largest number of new HIV diagnoses worldwide and the fourth largest in the U.S., according to the Centers for Disease Control. To understand the personal challenges faced by young black women in the U.S., Jones, conducted focus groups with women in poor neighborhoods and constructed the soap opera out of their real-life stories.
“This is a romantic story about the lives and relationships of four women,” said Jones. “There was tremendous identification with the lead characters and they didn’t want the video series to end.”
“Bodies were strewn all over the ER,” she recalled. “At first it was the men, but soon their women partners and wives started coming in. The numbers for women continued to grow and grow.”
What Jones saw—and is still true today, according to the Centers for Disease Control—is that HIV/AIDS is spreading fastest among black men and that puts black women at enormous risk.
“It quickly became clear to me that this was a civil rights issue,” said Jones, who dedicated her career to stemming the rise of AIDS among young black women. She chose this group because there was already considerable attention being paid to gay men and intravenous drug users.
“When a group is not addressed in the health promotion efforts, the problem boomerangs and that group becomes the biggest risk population. If we don’t pay attention to young black women, the numbers are going to increase dramatically.”
Since AIDS was first diagnosed in the U.S. in 1981, more than 600,000 people have died from the disease, according to the CDC. Today, 1.1 million Americans are living with the HIV virus—and 15 percent don’t they’re infected. One of the goals of the soap opera is to encourage women and their partners to get tested.
The soap opera strategy occurred to Jones in the 1990s while she was working in a high-risk labor and delivery unit in the El Barrio (East Harlem) section of northern Manhattan. She noticed that every day at noon, one of the clerks would watch her favorite soap opera on a tiny television she kept on her desk.
She began working on the project in earnest while a professor at Rutgers University and continued that work when came to Northeastern as a tenured professor in 2012.
“Our goal is to change the way black women view themselves and their bodies,” said Jones. “This is another aspect of the Me Too movement. A lot of actors have been courageous to speak out against sexual power dynamics, and those same dynamics are part of the romantic lives of young black women. Our goal is to show them that their lives and their bodies are important.”
In addition to the story itself, viewers choose one of four “guides” who help them think about the central issues in each 20-minute episode. The series ended with several unresolved plotlines—“cliffhangers,” as Jones refers to them—that force viewers to consider what they would do in that situation.
Jones said the video has already been used by several health organizations including the Boston Public Health Commission, Northeastern’s Health in Motion community outreach van, and an organization for Hispanic students at Florida International University.
“People have an image of nursing as a profession that takes place primarily at the hospital bedside,” said Jones. “But we are also at the frontlines of health communication. We’re on the streets in the cities and in the heartland.”