Know the Risks - An Interactive HIV/AIDS Information and Personal Risk Screening Center

Know the Risks: An Interactive HIV/AIDS Information and Personal Risk Assessment Center

Diana Dull Akers, PhD & Tamara Kuhn, MA

Until there is a cure for HIV/AIDS, prevention remains a critical part of our response to this epidemic. With funding from the National Institute of Mental Health, Sociometrics has developed Know the Risks,a computer-based sexual health and HIV/AIDS prevention education application, created in both English and culturally-tailored Spanish language formats. Know the Risks was designed to help support four HIV prevention goals:

To empower patients/clinic clients in diverse clinic settings to take a pro-active interest in learning about HIV/AIDS prevention and other sexual health topics;
To encourage more discussion of these topics between health providers and the patients/clients they serve;
To facilitate increased levels of HIV/AIDS risk screening and testing (referred services or direct) by health providers; and
To support the work of HIV/AIDS prevention professionals by providing an innovative tool for helping them to accomplish their objectives.

Know the Risks was primarily designed for use in waiting rooms or other common areas of diverse clinic settings. These include doctor’s offices, hospitals, community-based health clinics, college health centers, and HIV/AIDS counseling and testing centers. However, because Know the Risks is a client-directed, stand-alone tool, any setting that supports sexual health education goals (e.g., community centers, residential communities, medical libraries, etc.) may find this application of interest.

Know the Risks Features:

When a user first sits down at a Know the Risks computer station, they will see the Know the Risks main screen. This welcome screen has been designed to:

Sensitively represent the subject matter of the application
Demonstrate that the information will be of interest to women and men of diverse ages (18 and older only), racial/ethnic origins and sexual orientations
Provide users with a simple navigational feature for selecting either the English language or culturally tailored Spanish language format
Invite users to watch an introductory tutorial (optional), complete an HIV/AIDS risk survey/create a risk profile, and/or explore the HIV/AIDS Prevention Learning Center

After the User has selected their language format of choice (English/Spanish), they are free to choose either of the application’s two main features: 1) an HIV/AIDS risk survey; 2) the HIV/AIDS Prevention Learning Center.

FEATURE 1: HIV Risk Screening Survey: Know the Risks offers users a voluntary, confidential HIV risk screening survey. The 16-question survey takes 3-5 minutes to complete and includes 4 demographic questions, 2 attitudinal questions about sexual risk, and 10 HIV risk behavior questions. The computer-assisted-survey-interface (CASI) design ensures the survey is simple for those with minimal computer skills. The survey progresses automatically after each answer is selected. Audio and help options are offered.

After completing the survey, users will see a printable Custom Risk Profile on the screen. The two-page profile includes one page for the user, and one page that can be given to the client’s health provider (optional). The profile includes a 0-10 risk score with feedback, plus a list of recommended Learning Center activities based on the client’s survey answers. The profile also includes statements describing the limits of the information provided, and encouraging users to discuss any questions or concerns they may have with their health provider.

FEATURE 2: Know the Risks Learning Center: The multimedia Learning Center offers users interactive educational activities on a variety of sexual health and HIV risk reduction topics. Activities range in length from 1-15 minutes (length of activities depends on user pacing and, in many activities, how many topics/features users opt to view). Activities are offered in engaging multimedia formats (videos, games, select-a-topic activities, etc.) that include audio narration.

Learning Center Activities - English language format. The Know the Risks Learning Center/English language format offers users 19 multimedia activities, categorized by target audience (general audiences and special focus populations). Activities in the Learning Center include: Sample activity

Understanding the Basics about HIV/AIDS
10 Things you Can Do to Lower Your Risk of HIV Infection
Sex and HIV: How Risky are Your Choices?
Condoms: How to Choose Them, How to Use Them
The Story of Non-Oxynol 9
Negotiating Safer Sex with your Partner
When should I be tested? Calculating the “window period”
Finding Out for Sure: Taking an HIV Test
You’ve Got Your HIV Test Results: What Next?
HIV/AIDS and Sexually Transmitted Infections (STIs)
Partner Notification, Counseling and HIV Prevention
Women and HIV: Taking Charge of Our Health
Reducing HIV Risks: Men who Have Sex with Men (MSM)
Reducing HIV Risks: Women who Have Sex with Women (WSW)
Never Too Old: HIV Prevention if You’re 50+
Prevention Focus: African Americans and HIV
Prevention Focus: Asian Pacific Islanders and HIV
Prevention Focus: Latinos and HIV
To the Point: Reducing the Risks for Injection Drug Users

Learning Center Activities - Spanish language format. In creating Know the Risks/Spanish, our goal was to culturally tailor the learning activities in meaningful ways for diverse Latino audiences. To accomplish this goal, we worked with Latino consultants and health professionals with expertise in the area of Latinos and HIV. Three key cultural tailoring decisions were made and integrated into the final application.

Adapt the English language activities by incorporating images, music, voices, art and stories that reflect diverse Latino populations.
Scale back the total number of activities and focus, instead, on a smaller number of core activities that impart key prevention messages.
Integrate characters and narrative storylines to help illustrate key messages, emphasizing the importance of HIV prevention efforts for maintaining healthy relationships and families.

Know the Risks/Spanish offers seven core learning activities. Users are encouraged to first view the introductory activity Prevención: Latinos y el VIH (Latinos and HIV Prevention). This activity includes a video sequence introducing four couples who appear at a dance, each discussing a sexual health/HIV risk concern in their relationship. For example, in the introductory video, users will meet Maria and Ruben, a married couple in their 40s that are grappling with the issue of Ruben’s recent infidelity. While Ruben is apologetic and asks for Maria’s forgiveness, Maria is still upset and concerned that Ruben has put them both at risk for sexually transmitted infections.
The four couples reflect diverse ages, countries of origin, sexual orientations, and relationship histories. The characters and their storylines continue in a series of shorter video segments, each integrated into a relevant core learning activity. Users can select activities/storylines of most interest.

The seven core Learning Center activities in Know the Risks/Spanish are as follows:

Entendiendo los Puntos Básicos sobre el VIH/SIDA (Understanding the Basics about HIV/AIDS)
Sexo y el VIH: ¿Que tan arriesgadas son tus elecciones? (Sex and HIV: How Risky are Your Choices?)
Los Condones: Como Escogerios, Como Utilizarlos (Condoms: How to Choose Them, How to Use Them)
Saber por seguro: Tomando una prueba del VIH (Finding Out for Sure: Taking an HIV Test)
Directo al punto: Prevención del VIH para personas que se inyectan drogas (To the Point: HIV Prevention for Injection Drug Users)
Mujeres Latinas y el VIH: Encargándanos de Nuestra Salud (Latinas and HIV: Taking Charge of our Health)

Know the Risks can be purchased as a 2 CD-ROM set with a printed User's Guide ($59.99) or the program (including a PDF version of the User's Guide) can be downloaded ($29.99). Purchasers receive PDF versions of brochures and signage.

Minimum system requirements: Windows-based PC with a CD-ROM or DVD drive, Minimum of 675MB of free hard-disk space, Minimum of 512 of RAM, 1.8ghz or faster processor; monitor capable of 1024x768 resolution; headset or computer speakers; printer. Sites that offer Know the Risks will need to provide their clinic visitors with a dedicated location and the necessary equipment for using the program.

Note: Know the Risks software can be used on computers not meeting the minimum system requirements but a small number of elements, such as video, may play slowly.