"Hey baby, you OK?" Mike asks his girlfriend as she sits down next to him.
"Yeah, I'm OK," Toni says, and she puts her head on his shoulder. Mike thinks it's safe to move in for a kiss.
"Slow down," she says, pushing him back. "Just because I've decided to take you back, it doesn't erase the fact that you cheated on me." He looks away sheepishly.
"Look, we're going to be using condoms from now on," Toni says. "And tomorrow, we're getting tested. And that's that."
She kisses him, and Mike manages a little smile.
The scene is from a soap opera with a purpose: to use short videos to go beyond pamphlets on safe sex and deliver the message to women who might otherwise tune it out.
Nurse educator Rachel Jones developed the education campaign, using professional actors and scripts based on focus groups with women in Newark and Jersey City. Mike and Toni and the "other woman," Valerie, are in a pilot video available online.
"Women who watched the first pilot were getting upset, angry, exacerbated," said Jones, who teaches at Rutgers University's College of Nursing in Newark. "Women really saw themselves in that video. We're really resonating with urban contemporary themes that we believe are relevant to women."
Viewable on cell phones
Jones filmed a series of 12 soap opera vignettes with a Healthcare Foundation of New Jersey grant, and recently received a $2 million National Institutes of Health grant to test the campaign's effectiveness.
Women in the federal study will watch the 20-minute episodes on their cell phones. Their risk-reduction behavior will be measured against a control group that will receive text messages urging condom use, but no video. A total of 250 women will participate.
"What we believe will happen is that knowledge alone is not effective at changing behaviors," Jones said. "We believe that women in the community will so identify with heroines in the story their own behaviors will change as well."
The scripts feature "nitty gritty stories of risk and risk reduction" that women can identify with, she said, adding that cell phone viewing ensures privacy and offers the viewer the chance to watch again and again as desired.
Jones has dedicated her career to reducing HIV/AIDS among young, urban black and Latina women, who are being infected at an epidemic rate. Some 82 percent of the infections affecting 18- to 29-year-olds are transmitted through heterosexual sex with an HIV-infected partner, she said.
"It is astounding, it is a completely preventable infection," said Jones. "In New Jersey, we have the highest proportion of women living with AIDS in the United States."
Focus on changing behavior
Jones said she thought she had spent enough years working in urban health settings to be able to explain why young female patients engaged in unprotected sex despite the known risks, but that even she was surprised when she started looking for ways to change their behavior while earning a doctorate as a family nurse practitioner.
"I had very bright, wonderful patients who would come to me again and again with sexually transmitted infections," she said. She said the women understood that they were being exposed to HIV/AIDS, sexually transmitted diseases and pregnancy, but engaged in unprotected sex anyway; even those who knew they weren't in monogamous relationships didn't insist their partners wear condoms.
"We have to normalize condom use," she said.
Jones said women experience pressure to have unprotected sex and that their partners often consider insistence on using a condom as sign of distrust.
"These relationship concerns can feel much more important in the moment for some women than reducing HIV/AIDS, which can feel more distant," she said.
At the end of the study, all the participants will get a DVD with all the soap opera videos, she said. The videos will also be available on the Web.
"If we know we're effective, we're going to dedicate ourselves to getting them out," Jones said.