Dramatic Intervention

When Rachel Jones joined the faculty at the Rutgers College of Nursing in Newark in 1997, she was also a family nurse practitioner. Though many of the young urban women in her practice were aware of the causes of HIV infection and AIDS, some still continued to engage in risky sexual behavior. As the epidemic grew, it became clear that traditional counseling alone would not promote a change in behavior. Relationship concerns overrode safer sex practices.

Delivering the Message

After earning her Ph.D. in 2002, Jones received funding from the National Institute of Nursing Research to conduct a series of focus groups in Newark and Jersey City, and together with nurse practitioner Marsha Brown, she recorded and analyzed their stories. One common story was that women felt pressured to show their trust by forgoing the use of condoms.

These stories became the basis for writing a soap opera story designed to communicate the messages about reducing risk. “With the soap opera format, the viewer identifies with the heroine as she experiences realistic relationship issues and undergoes a process of change toward a more powerful way of being,” Jones explains.

Based on the focus group stories and her theory, Jones spearheaded the production of a 43-minute, grant-funded video entitled A Story about Toni, Mike, and Valerie. Compared to responses from a control group, the responses from the soap opera viewers indicated the stories might be a persuasive way to reduce behavior that could put women at risk for contracting HIV.

Measuring Change

To measure changes in behavior, Jones’s Rutgers-based team applied for, and received, two more grants, including one for $2 million from the National Institutes of Health. With funding from the Healthcare Foundation of New Jersey, the team created a 12-episode video series that could be streamed to cell phones. Love, Sex, and Choices features the stories of four women “who experience realistic relationship issues that can get in the way of using a condom. Each resolves the dilemma differently,” Jones says. “It’s realistic.”

This winter, her team will recruit 250 women and split them into two groups—those watching weekly, 20-minute episodes and those receiving HIV-prevention text messages. They’ll also complete a series of computer-assisted self-interviews that will help track changes in behavior. If the soap operas and the method of individually accessing the videos on cell phones are effective, “this may change the paradigm for how public-health interventions are delivered,” Jones says.

Rutgers is an ideal setting for Jones, who says her work is “part of the international efforts to fight HIV/AIDS, specifically its reduction in urban women. So I could never have asked for a better place to work than Rutgers–Newark.”

HIV/AIDS and New Jersey Women

Women accounted for about one-third of the adult and adolescent HIV/AIDS diagnoses in New Jersey in 2006, according to the New Jersey Department of Health and Senior Services. Women of color have been especially hard hit and represent the majority of infections among women. Many women with HIV/AIDS are residing in poor areas and face limited access to health care providers.

As of December 2008:

  • New Jersey had one of the highest proportions of females among people living with AIDS.
  • Sixty-five percent of women living with HIV/AIDs are currently 20–49 years old.
  • Heterosexual contact appears to be an increasing exposure category for women.
  • Essex County has the state’s highest number of adult/adolescent women living with HIV/AIDS among New Jersey’s 21 counties.