The proposed research will characterize the processes creating and sustaining beliefs about herpes and the stigma associated with it, as a basis for an intervention designed to produce more rational herpes-related decision-making. Stigma can interfere with the sort of instrumental cost-benefit and risk-benefit thinking that many informational interventions attempt to augment. An intervention that decreased the stigma associated with genital herpes may result in better communication with sexual partners, more rational decision-making, and better quality of life for the 200,000 to 500,000 persons who contract genital herpes each year. This project will examine young adults' mental models of genital herpes infections, including transmission, treatment, symptoms, peer detection, medical diagnosis, and prevention. Particular attention will be given to perceptions of stigma. Such beliefs and emotions will be explored among individuals with three different personal relationships to the disease: (a) recently diagnosed with genital herpes, (b) long-established infections, and (c) no known genital herpes. We will develop two standardized instruments related to genital herpes, based on interview results. The first will provide a measure of the stigma associated with herpes injections. It is expected that the key elements of this instrument will include personal feelings of self-worth, perceptions of outside opinion about people with herpes, both psychologically and sexually as well as fear of transmitting (or contracting) herpes. The second instrument will cover knowledge of genital herpes. It will concentrate on those issues that are most critical to making herpes-related decisions (as revealed in a formal analysis), and those misconceptions or knowledge gaps revealed in the interviews. We will develop and evaluate an intervention designed to decrease the stigma associated with herpes diagnosis. It will use interactive video technology, in order to provide the intensity and personalization that such topics require. Its evaluation will test whether the intervention succeeds in (a) decreasing stigma in newly diagnosed individuals, (b) decreasing the stigma associated with herpes in uninfected individuals, and (c) increasing social functioning in infected individuals, including increased communication with their sexual partners about potential STD infections. The decrease in stigma and increase in communication are expected to result in more condom use when engaging in sexual behavior.
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