Encouraging HIV testing in teens through video games

Trial of a serious video game for HIV testing and counseling.


In 2020, around 20 percent of new HIV cases in the United States were among teenagers. But this number is probably higher since many teenagers don’t know they have HIV and can unknowingly pass it on to others. Only 9 percent of high school students in the U.S. have been tested for HIV.

This is because of reasons like not getting good sex education, facing social and economic challenges, and the stigma and wrong beliefs about HIV testing.

Lynn E. Fiellin, MD, professor of medicine (general medicine) and Yale Child Study Center at Yale School of Medicine, and Public Health (Social and Behavioral Sciences), and founding director of the play2PREVENT Lab said, “Kids in this age group also often feel like they’re immortal and therefore wouldn’t have a condition that would be potentially serious or life-threatening. We’ve also seen a trend in which HIV treatment has become much more effective; some teens and young adults feel, ‘Oh, well, if I get it, I can just treat it, and it’s not a big deal.”

To tackle these misunderstandings and encourage teenagers to get HIV testing and counseling (HTC), Dr. Fiellin and a team of researchers from Yale University conducted a trial using a video game called PlayTest! It’s designed to address the low rates of HIV testing and counseling among adolescents. PlayTest! is an improved version of an earlier video game called PlayForward, initially made for 11- to 14-year-olds to teach HIV prevention.

In this new game, the focus shifted from preventing HIV to promoting healthy behaviors. Instead of teaching refusal skills to avoid risky situations, it teaches persuasion skills to encourage positive actions. It’s about learning to convince people to do healthy things rather than avoid dangerous ones.

In this study, published in The Journal of Adolescent Health, the researchers included 287 participants aged 14 to 18. There were an equal number of boys and girls from different age groups and racial backgrounds. Among them, 145 played PlayTest!, while 142 in the control group played regular video games with no educational value. They each played their game for about an hour weekly after school, spanning four to six weeks.

The research was carried out in partnership with school-based health centers (SBHCs) and special healthcare clinics available in some schools. These clinics offer affordable healthcare and confidential sexual health services to students. If any participants wanted an HIV test after playing PlayTest!, they could easily visit their school’s health center to get one.

In PlayTest!, you make your character go through different stories and challenges. In these stories, you have to play skill-based mini-games and do well to move on to the next part of the story.

At first, the main thing they wanted to see in this study was how many people got HIV testing and counseling within six months. They also wanted to know how people felt about it, what they intended to do, what they knew, and how confident they were about it. But because of the COVID pandemic, they had to change what they were looking at

Fiellin said, “We knew that once schools closed, kids would not have access to their school-based health centers, so they could not ask for testing there. Nobody was going to routinely go to a clinic during the first six months of the pandemic. So, based on the literature, we had to modify our primary outcome not to be actual HIV testing, but attitudes around HIV testing.”

Once the trial was finished, the researchers checked in with 92 percent of the participants six months later. Of those who played PlayTest!, 70 percent said their feelings about HIV counseling and testing had improved.

Tyra Pendergrass Boomer, deputy director of the play2PREVENT Lab, Yale Center for Health and Learning Games, said, “We are extremely proud of the high retention and follow-up rates for this project, especially during the pandemic. Much of this can be attributed to our ability to effectively utilize technology to collect follow-up data in an adolescent-friendly way, our partnerships with the schools, and the rapport that our research team built with study participants.”

The study’s findings suggest that educational video game interventions like PlayTest! have the potential to impact teenagers’ attitudes regarding HIV counseling and testing positively. By harnessing the engaging nature of video games, misconceptions surrounding HIV can be addressed and awareness raised, motivating teenagers to seek testing and counseling services. These results highlight the importance of innovative approaches to address critical public health issues among the adolescent population.

Journal reference:

  1. Tyra Pendergrass Boomer, Lynn E. Fiellin et al., A Serious Video Game Targeting HIV Testing and Counseling: A Randomized Controlled Trial. Journal of Adolescent Health. DOI: 10.1016/j.jadohealth.2023.08.016.