Written by: Kathryn E. Muessig, Kelly A. Knudtson, Karina Soni, Margo Adams Larsen, David Traum, Willa Dong, Donaldson F. Conserve, Anton Leuski, Ron Artstein & Lisa B. Hightow-Weidman
Abstract: HIV status disclosure is associated with increased social support and protective behaviors against HIV transmission. Yet disclosure poses significant challenges in the face of persistent societal stigma. Few interventions focus on decision-making, self-efficacy, and communication skills to support disclosing HIV status to an intimate partner. Virtual reality (VR) and artificial intelligence (AI) technologies offer powerful tools to address this gap. Informed by Social Cognitive Theory, we created the Tough Talks VR program for HIV-positive young men who have sex with men (YMSM) to practice status disclosure safely and confidentially. Fifty-eight YMSM (ages 18 – 30, 88% HIV-positive) contributed 132 disclosure dialogues to develop the prototype through focus groups, usability testing, and a technical pilot. The prototype includes three disclosure scenarios (neutral, sympathetic, and negative response) and a database of 125 virtual character utterances. Participants select a VR scenario and realistic virtual character with whom to practice. In a pilot test of the fully automated neutral response scenario, the AI system responded appropriately to 71% of participant utterances. Most pilot study participants agreed Tough Talks was easy to use (9/11) and that they would like to use the system frequently (9/11). Tough Talks demonstrates that VR can be used to practice HIV status disclosure and lessons learned from program development offer insights for the use of AI systems for other areas of health and education.
Keywords: virtual reality, HIV, disclosure, men who have sex with men, artificial intelligence