Interactive Card Games for Enhancing HIV Prevention Self-Efficacy and Reducing Stigma Among Adolescents in Indonesia

In the world of public health, a major challenge is helping young people make safe choices about their bodies and their futures. This is especially true when it comes to preventing the spread of HIV, a virus that attacks the immune system. For teenagers, the path to making these choices is often blocked by two invisible walls. The first is a lack of confidence, known in science as self-efficacy. This is the inner belief that a person has the power to say no to risky situations or to use protection correctly. The second wall is stigma, a heavy cloud of shame and fear that surrounds people living with the virus. When teenagers are afraid or embarrassed, they are less likely to learn the facts or to support their peers who are infected. Traditional ways of teaching about these topics, such as handing out brochures or sitting through lectures, often fail to break down these walls because they are passive. The students listen, but they do not truly engage.

Researchers in Indonesia wondered if a different approach could work better. They asked whether an active, hands-on method could build confidence and reduce shame more effectively than a standard educational video. To find out, a team of scientists from several universities and health organizations traveled to a high school in the Banten province. They set up an experiment involving sixty students between the ages of fifteen and eighteen. The goal was simple but profound: to see if turning a serious health lesson into a game could change how these teenagers felt about HIV prevention and the people living with it.

The study took place in March 2025 at a vocational high school in Panimbang. The researchers divided the students into two groups. One group watched a fourteen-minute video produced by the Ministry of Health. The video contained accurate information about how HIV is transmitted, how to prevent it, and why it is important to treat people living with the virus with respect. The other group did not watch the video. Instead, they played a custom-made card game. This game was not just a collection of pictures; it was a structured tool designed to spark conversation. The cards featured real-life scenarios that teenagers might face, such as a friend offering a cigarette or a rumor spreading about someone's health. The students worked in small groups to discuss these situations, decide on the best course of action, and explain their reasoning. The game forced them to step into the shoes of others, practicing empathy and problem-solving in a safe environment. Both groups spent the same amount of time on the activity, ensuring that the difference in results would come from the method of learning, not the length of the lesson.

Before the activities began, the researchers measured the students' starting points. They asked the teenagers to fill out surveys that gauged their confidence in preventing HIV and their feelings toward people living with the virus. The results showed that both groups started with similar levels of knowledge and similar attitudes. There was no significant difference between the students who would play the game and those who would watch the video. This was crucial because it meant that any changes seen later could be attributed to the intervention itself.

Three weeks after the sessions ended, the researchers returned to measure the students again. The difference between the two groups was striking. The students who played the card game showed a much larger increase in their confidence. Their scores on the self-efficacy scale jumped significantly higher than those of the students who watched the video. In fact, the card game group was twice as likely to show a substantial improvement in their confidence compared to the video group. They felt more capable of making safe choices and talking about prevention with their peers.

The results were even more dramatic when it came to reducing stigma. The students who played the game saw their negative attitudes toward people living with HIV drop by a wide margin. The video group also improved, but the change was much smaller. The card game players were nearly three times more likely to show a major reduction in stigma than their peers who watched the video. By actively discussing the scenarios and listening to their classmates, the game players seemed to dismantle the myths and fears that fuel prejudice. They practiced seeing the world from another person's perspective, which is something a video cannot easily teach.

The researchers noted that the card game worked because it required active participation. Instead of passively receiving information, the students had to think, argue, and decide together. This process helped them internalize the lessons and build a stronger sense of agency. The video, while informative and clear, did not offer the same opportunity for social interaction or emotional connection. The study suggests that for sensitive topics like HIV, where fear and shame play such a large role, the way information is delivered matters just as much as the information itself.

This experiment was conducted in a specific setting with a limited number of students, so the researchers caution that the results need to be tested in other schools and over longer periods to see if the effects last. However, the findings offer a clear and hopeful direction. They suggest that in resource-limited settings where high-tech solutions might not be available, simple, low-cost tools like card games can be powerful. By turning a health lesson into a shared experience, educators can help teenagers build the confidence they need to protect themselves and the compassion they need to support one another. The study concludes that embedding these interactive, culturally adapted games into school curricula could be a vital step forward in the fight against HIV, proving that sometimes the best way to learn is not just to watch, but to play.