< In Rural Alabama, Fighting HIV With A Game

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AUDIE CORNISH: HIV used to be seen as an urban disease. Now the rural South has some of the highest rates in the nation. There stigma is strong, but resources and education are not. Well, one researcher is hoping to change that. She's teaching young people in Alabama about the risks of HIV by using video games. Dan Carsen, of member station WBHM in Birmingham, has the story.

DAN CARSEN: Alabama's Black Belt was originally named for its rich, dark soil. Today, it's predominantly African-American - the poorest part of a poor state. And here, young black men make up a rising share of new HIV cases. Across the state, they're 10 times likelier than average to get HIV. Hoping to slow that trend, nursing professor Comfort Enah, of the University of Alabama at Birmingham, has turned to videogames.

COMFORT ENAH: Gaming is particularly appropriate for adolescents because of where their brains are.

CARSEN: Enah, a native of Cameroon, says young people are more likely to act impulsively.

ENAH: So we have a scenario where we have hormones, but they don't have the brain capacity to anticipate long-term consequences. So gaming can tap into that mismatch and kind of force them to see consequences right now.

CARSEN: She's matched disease experts with coding experts and together they're making a role-playing game they hope to have ready next fall. Players create their character - an avatar- then use it to respond to risky situations and there are consequences - points, praise, good health, unemployment, HIV, even death. But how do you make something kids will actually play, especially in rural Wilcox County, one of the nation's poorest, where talk of HIV is still largely taboo?

ETHEL JOHNSON: This is home. It has its ups and downs as all places, but this is home.

CARSEN: Local health advocate and parent Ethel Johnson stepped in. She managed to set up a dozen confidential youth focus groups to get game feedback and gauge HIV knowledge.

E. JOHNSON: I knew it was a great need because they don't talk about it a lot at school. People don't like to talk about it because you're being labeled as why are you interested in HIV? Are you a bisexual, homosexual? What is going on with you? They don't want to discuss it.

CARSEN: Johnson's first recruit was her daughter, 16-year-old Wilcox Central High homecoming queen, Clanlethia Johnson. She says she wants two avatars.

C. JOHNSON: One that would kind of be a model of myself and what I would do and sometimes I can go to - transition to my other character - my wild character - so I can just see the outcomes of being - doing the opposite of what I would normally do.

CARSEN: The focus group feedback wasn't entirely upbeat. One beta tester, 17-year-old Jacob Perryman, like the idea, but...

JACOB PERRYMAN: To me, the game was pretty boring. I feel like it could've been a little bit more graphic, put a little bit more detail. To me, it was a 1990s game, like a Mario - "Super Mario."

CARSEN: To be fair, Comfort Enah's team is still ironing out the kinks. Meanwhile, Debra Lieberman, director of UC Santa Barbara's Center for Digital Research, says character games, when done well, show prominence.

FOREIGN MINISTER AVIGDOR LIEBERMAN: There have been studies that have found that when your avatar engages in health behaviors then you are more likely to then go out into your daily life and adopt those behaviors.

CARSEN: That's what Comfort Enah wants to see, and not just in Alabama. If future studies show her game is effective, she plans to tweak it for cultural differences, change the platform and get it to Africa with its almost a billion mobile phones. For NPR News, I'm Dan Carsen in Birmingham.

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