Stanford-affiliated nonprofit sets standard for AIDS education

By Max McClure

The Botswana female English version of TeachAIDS software features the voice and avatar of cultural icon and radio DJ Jazzelle Kebakile. (Photo: Courtesy of TeachAIDS)

Botswana has one of the highest HIV infection rates in the world. In a country bombarded by billboards and TV programs warning of the virus, more than one in five adults are HIV-positive.

The problem isn't lack of exposure to AIDS awareness campaigns. The issue, scholars say, is "HIV fatigue" – people tuning out the message and winding up with a superficial and fragmented understanding of the disease.

To combat this attitude, the Botswana Ministry of Education approached Stanford-affiliated nonprofit TeachAIDS in 2009. The organization produces interactive, animated AIDS education software that is specifically targeted to individual cultures.

Former Botswana President Festus Mogae praised the organization early on, saying that TeachAIDS tutorials "are quickly becoming the standard in HIV and AIDS education." Mogae is now a member of the TeachAIDS advisory board.

Three years later, TeachAIDS has made great strides in educating Botswana's citizens.

The Botswana government has wholly embraced the curriculum, distributing copies to schools, hospitals and governmental departments, and on June 15, a national "TeachAIDS Day" was held, featuring an address by Mogae, performances by the celebrities that lent their voices to the software and a public airing of the curriculum.

And though the disease remains an epidemic there, studies show that students who are taught using the TeachAIDS curriculum learn more and remember the material better than people who use other educational approaches.

The program

TeachAIDS was conceived by Piya Sorcar, Stanford visiting scholar in communication and adjunct affiliate in the School of Medicine, as part of her graduate work at Stanford. It spun off in 2009 as a partner of the university.

The software produced by TeachAIDS is translated into local dialects, respects taboos and customs and features the voices of regional celebrities.

"Developing something that feels authentic, like it's from your culture, is crucial," said Shuman Ghosemajumder, co-founder and chairman of TeachAIDS. "If it feels like it's made by foreigners, people automatically assume it's not their problem."

Botswana is now one of the 72 countries that use one of 15 TeachAIDS software versions.

Optimizing euphemisms

In a world with more than 33 million infected individuals, AIDS education is of critical importance. But the subject can be tricky to cover – not only because educators themselves may not fully understand the issue, but also because AIDS curricula imported from Western nations often touch on culturally sensitive topics.

"In India, we've seen people receiving materials approved by their own government and burning them in the street," Ghosemajumder said.

During her graduate studies, Sorcar said, India represented a particularly dramatic example of the problems with then-standard AIDS education programs.

"Despite a lot of information being sent to India, knowledge levels were extremely low," she pointed out. "It turned out that, in India, sex education had been banned across multiple states."

When Sorcar, Ghosemajumder, former Stanford master's student Ashwini Doshi and Stanford communication Professor Clifford Nass began developing the first TeachAIDS curriculum, they sought to use what they termed a "biology-based approach."

The tutorials focus on the actual mechanics of the disease – such as how HIV enters the body, or what sorts of fluids it can survive in – giving students a more fundamental grasp of the steps they can take to prevent the disease.

When taboo topics, such as kissing and sex, do come up, the program addresses them with culturally appropriate metaphors and euphemisms.

In India, for instance, where kissing isn't traditionally shown onscreen in movies, the organization took a cue from classic Bollywood films. When it comes time for an animated couple in the TeachAIDS software to kiss, they lean in close – but then the camera pans away to a tree branch, showing two birds kissing instead. In other versions, such as the Mandarin- and Spanish-language curricula, the kiss is shown directly. 

Disney levels

Although the TeachAIDS look – a cartoonish, two-dimensional animation style – seems casual, it was also the result of extensive research.

"It was a very deliberate choice," said Nass, who researches human-machine interactions. "Research has shown that this type of animation is just as effective at getting the information across, and it's a lot less likely to trigger taboos."

In fact, each new version of TeachAIDS requires a new round of painstaking tests to ensure every element of the software – the appearance of the avatars, the accents of the voice actors, the wording of the translation – is culturally appropriate.

New regional celebrities are selected for each version. In India, these are Bollywood stars. In Botswana, they're national radio personalities and singers, such as the East Africa Idol host Scar and hip-hop artist Tref.

"All of these details become extraordinarily important in making the software compelling," Nass said.

The results are what Nass has referred to as "Disney-like levels of acceptance" of the software – unusual for a topic as controversial as HIV – and rates of efficacy and retention that clearly outpace existing curricular or mass media approaches.

"Educators have been really excited about this," said Sorcar. "They can deliver a comprehensive education without really knowing much about the topic."

Into their own hands

By now, the software has taken on a life of its own.

TeachAIDS often has official partnerships with governmental agencies and local nongovernmental organizations. That was the case with Botswana's TeachAIDS Day, put on by the Ministry of Education in collaboration with UNICEF, Stepping Stones International and other sponsors.

Elsewhere, unexpected parties have taken AIDS education into their own hands.

Over the past five years, TeachAIDS users have ranged from the Indian Army to a pastor in South Africa who travels from town to town in his car, burning CDs for schools. The animations have been shown on TV stations during World AIDS Day and on the giant projection screens set up in rural African towns during the World Cup.

"There are stories of people being able to use it despite having no electricity," Sorcar said. "They'll do something creative, like find a car battery and use it to charge a laptop they've brought in."

By 2016, TeachAIDS hopes to have 150 versions in over 80 languages available in more than 190 countries – thereby fully serving the regions that account for more than 90 percent of the world's AIDS cases.

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