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Piya Sorcar

Piya Sorcar

Piya Sorcar

In India, HIV/AIDS is tough to talk about. Even as 2.5 million infected Indians spread the virus, many states have banned sex education in schools, and cultural taboos discourage people from seeking information on their own.

To teach students about HIV in a culturally appropriate manner, Piya Sorcar, a doctoral student in the School of Education, created an interactive, animation-based tutorial that centers on a doctor's conversation with a curious patient. The program is designed to appeal to young adults and focuses on biological, rather than sexual, aspects of HIV transmission.

"We don't try to change cultural values," explained Clifford Nass, professor of communication and one of the project's advisers. "Sometimes you have to accept people's taboos and work around them."

After a year of testing prototypes, Sorcar's team launched the site on Dec. 1, 2007, coinciding with World AIDS Day. Sorcar said she was inspired by studies showing that, despite hundreds of millions of dollars being poured into educational efforts by the Indian government and other organizations, the majority of Indians had no idea how HIV is spread.

"I didn't believe it," Sorcar said. "With all this money, how could people not know that you can't get HIV from coughing and sneezing?"

In the summer of 2006, Sorcar traveled to New Delhi and surveyed 200 young adults and found a devastating lack of basic knowledge. "People thought you could get HIV from contaminated water; they thought you could get it from the air," she said. "The number one question they asked was whether there was a cure."

HIV education in India is patchy and piecemeal, and often comes through billboards and 30-second public service announcements. To learn what messages are getting through, Sorcar interviewed undergraduate and graduate students at Stanford who had recently arrived from India.

One of the questions Sorcar asked was whether HIV is passed through blood. Most of the Indian students answered "yes." But when she questioned them further, she found their understanding was shallow.

"I would ask: 'Do you get it from touching blood? Do you get it from tasting blood? Do you get it from looking at blood?' They didn't know," Sorcar said.

Her tutorial takes HIV education back to basics. A friendly animated doctor explains that the human body is like a country, with a defensive army called the immune system. As the doctor describes how HIV attacks the body's white blood cells, animated viruses fling ninja throwing stars at immune cells drawn as army chiefs.

Next, the doctor presents a "three-point mantra," describing blood, breast milk and genital fluids as the three body fluids that spread HIV. The tutorial explains that HIV can be transmitted only when a high-risk fluid is directly transferred through cuts or wounds or the body's natural openings. Also, a chapter titled, "How Do You Protect Yourself?" addresses the use of condoms.

Wanting to be attentive to the cultural sensitivities of her target audience, Sorcar surveyed Indian students to gauge their comfort level with various images. Depictions of intimacy made the students uncomfortable, so a scene that represents a couple kissing pans up to show two birds kissing instead. A scene meant to represent sexual activity shows a woman dressed as a bride sitting on a traditionally decorated wedding bed.

"People who are familiar with the culture know exactly what's going to happen on this bed," Sorcar said, adding that the majority of HIV infections in India occur heterosexually.

Her team put a lot of thought into the design of the tutorial's less sexual segments as well. The male doctor sports eyeglasses, a generous mustache and a lab coat—all things that Indian students described when asked how a qualified physician would look. The HIV viruses are drawn to look like mythological villains, and the animated immune cells wear the uniform of India's soldiers.

Sorcar went back to India last September to test the application on 423 students in New Delhi and the provinces of Haryana and Punjab. Half of the students watched the animation; the other half received no such intervention. All students took a pre-test and post-test to see what they learned.

"This was gold-standard, quantitative research," said Nass, adding that rigorous controlled testing is often neglected in developing countries.

After all the numbers were tallied, "the response was off the charts," Sorcar said. While students in the control group showed no gains in knowledge, students who watched the tutorial ended up much better informed about HIV/AIDS. The percentage who knew there is no cure for AIDS went from 55 to 93 percent, and the percentage who understood that AIDS could not be spread through coughing went from 65 to 94 percent. In addition, 90 percent of students who watched the tutorial said they went on to share what they learned with someone else.

Along with the Indian version of the program, Sorcar's team has developed a tutorial for a general Asian audience. The storyline is the same, but characters were drawn by a different animator and speak English with American rather than Indian accents. That version was launched in early 2007.

Sorcar's project received support from faculty in the School of Medicine, the School of Education and the Department of Communication in the School of Humanities and Sciences. She credited the tutorial's success to the participation of leading academics at Stanford and the input of the students from India.

Sorcar tapped her own family as well: Her father is Manick Sorcar, an award-winning animator, and he drew the characters for the Indian version of the application. Sorcar herself is the voice of the inquisitive patient in the application's general Asian version.

Sorcar and her colleagues are now working on translating the tutorial into Hindi and other Indian languages, as well as tailoring versions for Africa, China and Latin America. They are exploring the possibility of expanding the curriculum into more formats that could be used on cell phones, in comic books and on Facebook.

In addition to making the tutorial available online, Sorcar's team is developing a distribution model and negotiating the terms of agreement so CD-ROMs can be sent free to nongovernmental organizations and institutes throughout the world. Sorcar said her team also has been approached by numerous organizations that want to partner and help with distribution.

"Many other cultures around the world also have a challenging time discussing issues like HIV/AIDS openly, so I hope we can expand this tool and our approaches to help communicate these messages," Sorcar said. "Second, I hope the research behind this project, as well as the learning tool itself, will motivate educators to innovate in how they teach difficult subjects."

Shelby Martin is a science-writing intern at the Stanford News Service.