Brief loss-framed messages improve HSV-2 screening uptake among recently incarcerated women in a court setting: A randomized controlled trial

Background: HSV-2 infection increases risk of HIV acquisition. Given the disproportionate risk for HIV infection among incarcerated women, this is a population that would benefit from HSV-2 control efforts. We evaluated the impact of brief messages on point-of-care HSV-2 screening uptake among recently arrested women. Messages were based on Prospect Theory which posits that in situations of uncertainty emphasizing the risk of infection (i.e., loss framing) encourages screening behavior.

Methods: Participants were recruited from a community court in a large Midwestern city. They completed a survey, were randomized to one of three message conditions (gain-framed; loss-framed; control) and offered a no-cost point-of-care HSV-2 test. Gain-framed messages indicated the participant had a 70% likelihood of testing HSV-2 negative and loss-framed indicated a 30% probability of testing positive.

Results: Participants were 136 women of diverse ethnicities, ages 18-62 (median=31). Over half (51%) had less than a high school education and 68% were unemployed. 64% of participants agreed to be tested for HSV-2. Of these, 60% screened positive. The loss-framed message resulted in significantly higher HSV-2 test uptake than the other two conditions (OR=3.6;95%CI=1.4-9.4), which were not different from one another. Intervention groups did not differ by race, age, education, HSV-2 knowledge or number of sexual partners.

Conclusion: The women in this study had higher than expected rates of HSV-2 infection, suggesting increased risk for HIV. Our findings show that a brief message emphasizing the risk of infection (i.e., loss-framed) was most effective at motivating HSV-2 screening, supporting Prospect Theory.