For many teenagers, the high point of an interactive video game is being as bad as they can be—crashing the most vehicles or squashing the most opponents. Between them, Lynn E. (Sullivan) Fiellin, M.D. ’96, HS ’00, and David A. Fiellin, M.D., HS ’95, have five children ranging in age from 11 to 20, and as Lynn Fiellin watched them play their video games she realized that she could tweak that concept. She envisioned an interactive game in which kids score points not by pulverizing opponents but by making choices that could help them reduce risk behaviors and avoid HIV infection.

This year the Eunice Kennedy Shriver National Institute of Child Health and Human Development gave the School of Medicine a five-year research grant to develop and test such a game. Fiellin, assistant professor of medicine, has gathered a team of like-minded experts, including her husband, an associate professor of medicine and an addiction researcher, and other Yale faculty. Fiellin is working with such experts as Alexander Seropian, executive producer of the popular Halo science fiction video game, on game design and development. Ben Sawyer, co-founder of the Games for Health Project, funded by the Pioneer Portfolio of the Robert Wood Johnson Foundation, is assisting as a consultant working with other game designers.

“Harnessing technology for health behavior games is a vastly growing area,” said Fiellin, an attending physician in Yale’s Primary Care Center and Nathan Smith HIV Clinic.

The game is still in its earliest stages of development, but Fiellin envisions an interactive world in which the player, using an avatar (virtual character), “travels” through life, making decisions that bring different risks and benefits. The players will be able to see how their choices affect their lives and can move back in time to see how different actions might lead to different outcomes. By negotiating challenges in a highly repetitive and meaningful way, the player should learn skills that equip him or her to avoid real-life situations that increase their risk of HIV. “Through the video game play we can evaluate in real-time how our players are acquiring skills to help them make better choices,” Fiellin said.

She plans to conduct a randomized clinical trial with 330 ethnically diverse children between 11 and 14 years old at an after-school program in a New Haven community center in order to study the game’s impact on delaying the age of initial sexual activity. She expects eventually to distribute the game to schools throughout the country, although teen-agers can also play it at home, on cell phones, or on personal digital assistants. The game has international implications, as access to the Internet is on the rise in developing countries that have growing HIV epidemics but only limited access to targeted risk-reduction strategies.

In 2006, more HIV infections occurred in individuals between the ages of 13 and 29 than in any other age group in the United States, according to the most recent figures available from the Centers for Disease Control and Prevention. “If we start teaching kids about risky behaviors early,” Fiellin said, “maybe we can prevent some cases of HIV.”