JMIR Publications

ABSTRACT

Background:

The prevalence of HIV/AIDS in China hasn’t declined over the past few years, and people living with HIV (PLWH) are, to a large extent, ostracized by the public. The stigma coming with it adds difficulties to the treatment of HIV/AIDS. Decreasing this stigma is no less urgent than behavioral interventions. Serious games are increasingly adopted as an intervention method to control HIV/AIDS in the global community. Yet, the development and evaluation of such games in China are far from adequate.

Objective:

This research aims to help decrease HIV-related stigma in China via the development and evaluation of a serious game, and propose the Participatory Serious Game Development Model (PSGDM) to promote gamification for health.

Methods:

This research developed a serious game named The Second Kind of Life with HIV, and conducted a randomized controlled trial to evaluate the game’s effect on HIV-related stigma. 167 university students with an average age of 20 joined the trial, and were randomly assigned to four groups: female-game group, male-game group, female-control group, and male-control group. Each subject filled in the HIV-related stigma measurement questionnaire, after playing the game or accessing the material of control groups.

Results:

The Second Kind of Life with HIV was launched in 2019. As a free-of-charge webpage game available both on computer and smartphone, its main target subjects are Chinese youngsters. In this research, HIV-related stigma is measured in three dimensions: morality, everyday contact and intimacy, with the intimacy dimension being the most severe type of stigma. The game group shows an advantage in decreasing moral stigma (mean game=1.35, mean control=1.52, P=.03) and intimacy stigma (mean game=2.41, mean control=2.74, P=.04) compared with the control group, yet no significant difference in deceasing everyday contact stigma (P=.49). Females are more tolerant in moral stigma (mean female=1.34, mean male=1.52, P=.02) and everyday contact stigma (mean female=1.29, mean male =1.49, P=.04) than males, while both genders are conservative in intimacy stigma (P=.52). The interactions are not significant in all three dimensions of HIV-related stigma, indicating that the effect of media interventions will not vary with gender.

Conclusions:

HIV/AIDS education should adopt the appropriate media interventions to break different dimensions of HIV-related stigma, especially using games in decreasing intimacy stigma which is the hardest to break. It is anticipated that the PSGDM, as proposed in this research, can promote the development of more HIV/AIDS educational games. Moreover, interdisciplinary effort and collaboration is needed for HIV/AIDS intervention, and more people can be engaged and share the responsibility of promoting health.