YouTube viral videos and HIV prevention among African-Americans: Implications for HIV prevention

Jocelyn D. Patterson & Khiya J. Marshall

Published Online: December 15, 2012
Full Text: HTMLPDF (675 KB)


A viral video is a video which gains widespread distribution through the process of Internet sharing, typically through email, blogs, and other media-sharing websites, such as YouTube. Given the popularity of YouTube with African Americans, a content analysis was conducted to examine the characteristics, content, and YouTube member responses to viral videos featuring African Americans and focusing on HIV/AIDS prevention. The top two most frequently viewed videos elicited in our search generated strong viewer comments that were grouped under three major themes: threats and insults toward the maker of the video, questions about the authenticity of the video maker’s claims, and positive comments supporting the statements made in the video. The motivation to share HIV-related videos may be related to the video’s elicitation of emotions like anger and frustration or the inspiration of feelings of encouragement or support.

Keywords: African-American, Black, HIV, YouTube

YouTube ( is a free Internet-based video sharing and storage website launched in February 2005. The website is designed to publicly store short video clips which visitors can view and share with others. The website’s users have the ability to connect and communicate with other users by posting responses and written comments. Videos uploaded to YouTube can be accessed across the Internet through the YouTube website, links embedded in other websites, mobile devices (e.g., Smartphones), email, or social networking sites, making it easy for video clips to be shared and quickly circulated around the world.  According to YouTube statistics, every minute 48 hours of video are uploaded to the website. With an audience of over 800 million unique visitors per month (YouTube, 2012), YouTube should be considered an important resource for gauging health information available to the public. However, despite the extensive viewing audience and potential reach of YouTube video clips, the public health impact of viral videos has yet to be measured (Freeman & Chapman, 2008).

Among the millions of videos housed on the YouTube site, there are certain videos that “go viral.” Viral videos are video clips that are widely disseminated and become popular due to large scale social transmission in the form of email, embedding in webpages, and sharing on social network sites.  Viral videos are unique phenomena that offer a special opportunity to communicate a discrete message with thousands, perhaps even millions, of people. These videos have the potential to capture the attention of mainstream culture without large financial investments in video development and distribution. Yet, little is known about what motivates online video consumers to disseminate videos to others. In light of the scalability and low cost of viral videos, it is important to learn more about how to maximize this resource.

Previous research exploring video health messages posted on YouTube has included issues related to prostate cancer (Steinberg et al., 2010), tanning beds (Hossler & Conroy, 2008), tobacco (Freeman & Chapman, 2007), and immunizations (Keelan et al., 2007; Ache & Wallace, 2008). Internet-based video sharing sites like YouTube are a new platform for healthcare providers and public health officials to consider when conveying health messages. However, few studies have examined how YouTube can be used to disseminate and promote HIV prevention. In order for public health officials to maximise this medium for video-based HIV prevention messaging, research needs to be conducted on existing HIV-related videos to explore the content driving their popularity.

The incidence of HIV among African Americans is nearly eight times that of their white counterparts (HIV Incidence Surveillance Group, 2011).  African Americans comprise 14% of the United States population, but represent 44% of new HIV infections (HIV Incidence Surveillance Group, 2011). The disproportionate impact of HIV among African Americans sheds light on the need to identify innovative prevention efforts targeting this population.  Previous research suggests that video-based HIV/STD interventions are a promising tool for HIV prevention among African Americans (Calderon et al., 2011; Downs et al., 2004; Healton & Messeri, 1993; Kalichman et al., 1999; O’Donnell et al., 1998). The success of existing video-based HIV prevention interventions implies that videos will continue to be useful in future prevention efforts. A better understanding of Internet video-based sharing communities, like YouTube, may be a key step in maximising the creation and dissemination of effective HIV prevention initiatives for African Americans.

African Americans are central consumers of Internet-based mobile technology. An estimated 71% of African Americans use the Internet, which can be accessed through various mediums such as personal computers and cell phones (Radio One, 2008). Visiting YouTube and other video-sharing websites is among the most common online entertainment activities for African Americans (Radio One, 2008).  In fact, African Americans are 51% more likely to use YouTube than the general online Internet-using population as a whole (Quantcast, 2012). Because of its widespread use and accessibility, YouTube may be an important venue for reaching African Americans at high risk of acquiring or transmitting HIV.

This paper describes the results of a content analysis that was conducted to identify and describe the most popular videos posted on YouTube related to HIV/AIDS and African Americans/Blacks. We further examined the content and comments posted in response to the viral videos identified in our search to explore what made people share those particular videos.


The YouTube community consists of video viewers and website subscribers. YouTube requires video owners to subscribe to a free membership in order to post and comment on videos. However, subscriptions are not required to view videos. When posting, video owners enter keywords called “tags” to help users find certain videos or search for particular types of videos. YouTube operates in real time and therefore the content is constantly changing with videos being added and removed. Search strategies were implemented at two different time points to observe changes over time.

Video clips were determined to be eligible if: content focused on HIV/AIDS and video included images or discussion with African Americans or Blacks. Videos were excluded if there was indication that the video clip was filmed outside of the United States or focused on the HIV/AIDS epidemic outside of the United States.

On June 1, 2009 (T1), search strategies were entered into YouTube’s ( search engine to capture videos tagged as African American/Black. The two search terms were limited to the English language.  The first search used the keywords African American and (HIV or AIDS) and the second search used Black and (HIV or AIDS). The results of each search were sorted by the number of times the videos were viewed. The top 50 viewed videos in search one and the top 50 in search two were entered into an Excel spread sheet.

YouTube displays each video’s popularity as measured by the number of times the video link has been accessed, commonly referred to as number of “hits”. The number of hits was used as a representation for number of times the video has been viewed as well as an implication for the number of times the video was shared with others. Two researchers independently reviewed all videos for eligibility and coded content of the video according to the following variables: category (YouTube’s pre-defined topic areas), date posted, tags (keywords video posters used to identify their video), duration of video (in minutes), popularity (number of times viewed), rating (based on a five-point scale [five being the best and one being the worst] by video viewers), number of comments, and identified common themes in video content.

Discrepancies were reconciled through discussion. The preceding search strategy and data collection procedures were repeated again five months later on November 16, 2009 (T2).  For the purposes of this study, viral videos were defined as videos that had been viewed over 100,000 times. In order to identify the characteristics of viral videos; additional content analyses were conducted on viewer comments posted for the viral videos identified in our sample.  Again, two researchers independently reviewed the original comments on the videos for common themes and discrepancies were reconciled through discussion.


After combining the top 50 videos for African American/Black and HIV/AIDS there were 35 unique and eligible videos identified at T1 and then 35 again at T2. Only the videos that overlapped at T1 and T2 were included, leaving a total of 28 eligible videos (Table 1). Videos covered a broad range of topics and specific target populations. These 28 videos in the sample were posted between June 24, 2006 and March 16, 2009. The range for the number of views per video was broad (T1 range: 1,061 to 181,299, M=16,288; T2 range: 1,382 to 202,199, M=17,524).

YouTube gives video owners the option of selecting one of 15 pre-established categories to group their video. The videos in our sample represented nine of those categories: Entertainment (N=6), People/Blog (N=5), Education (N= 4), Film & Animation (N=3), News& Politics (N=3), Non-profit (N=3), Music (N=2), Science & Technology (N=1), and Comedy (N= 1). The top two categories that video owners chose for their videos pertaining to HIV/AIDS were Entertainment and People/Blogs. Our analysis of video content identified the following themes: HIV testing (N=10), HIV transmission and exposure (N=8), HIV treatment and living with HIV(N= 7), compassion and advocacy (N=6), HIV education and awareness (N=6), safe sex and using condoms (N=4), youth (N= 4), gay men (N=2), men (N=3), women (N= 2), and HIV/AIDS conspiracy (N=2).

The top two most frequently viewed videos identified at both T1 and T2 were Trashman gives 15000 women/Girls hiv aids virus and Know Your Status, each with over 100,000 views. Details on the content and data abstracted for these videos are reported in Table 1. Further examination of these videos shed light on characteristics and possible reasons for their rise in number of hits. Review of the number of views over time reveals that there was an initial explosion of number of hits on both videos that later levelled off. However, the number of views for both videos remained consistent at T1 and T2. Furthermore, other videos identified in our search, although posted prior to the top two videos, never reached their level of popularity. Therefore, the length of time a video is posted did not appear to directly impact the number of views or its popularity.

Table 1. YouTube Videos that Overlap at Time 1 and Time 2 (n=28) (See PDF for full chart)

T1 Rank

T2 Rank

Title of Video

Description of Video Content

Original Date Posted on YouTube



Duration (minutes)

No. of views

No. of comments



Trashman gives 15000 women/Girls hiv aids virus. Masked African American man who calls himself Trashman, lists some of the 15000 of the women, by name, who he claims to have knowingly infected with HIV.

April 23,  2008

People & Blogs

trashman  aids  hiv

virus girls  women  15  000  chronic  central  black Latino  sex  awarenessprevention  protection


T1: 181,299                T2: 202,199

T1: 837     T2: 917



Know Your Status A former African American adult film actress makes a video documentary of getting tested for HIV.

February 4, 2008


HIV Get Tested AIDS Know Your Status Blood  Black  HIV/AIDS  day  February 7th  Feb


T1: 152,426    T2: 154,709

T1: 459                 T2: 467



GurlTalkkTV-The Game of Death – – 1500 Infected Response to Trashman video- confessions of a black man explaining how he does not respect women but women should respect and protect themselves from black men like him.

January 31, 2008


GurlTalkkTV  The  Game  of  Death  AIDS sex           Sexually  diseases  STDs     virus Hepatitis condoms  protection  HIV  Blood       safe semen


T1: 48,469              T2: 51,308

T1: 215                T2: 215



Loony-T – She Got It Remix (Parody) Music lyrics about a man who thinks his girlfriend has an STD/HIV and now he thinks he is infected.

May 15,   2008


Loony  Looney  the  and  for  Toonz  Tunes  She  Got  It  Remix  Parody       Pistols  TPain  Lil  Wayne  Plies  Young  Jeezy  STD   AIDS  Condom  SEX        Booty Shake  Carter  Dolla  Fight  Punch  Kick  MTV  Bet Crank  Dance  Diss  New  Obama  Barack  Georgia


T1: 18,614            T2: 21,428

T1: 59                 T2: 67



Vivica Fox & Bill Duke Interview Vivica Foxx and Bill Dukes promote a new independent film Cover about men on the down low (DL), which was inspired by the prevalence of HIV/AIDS in the black community.

March 4,  2008

Film & Animation

interview  trailer  filmmaker reel  Vivica  Fox  Bill  Duke HIV  AIDS  Down  Low  Independent  film


T1: 13,803           T2: 16,112

T1: 28                  T2: 28



Mr. Del (Rain Cry) Music Video -From WEEKLY page A music video with an African American rapper in the rain showing images of woman dancing in rain, washing away all infirmities and God giving new life.

November 29, 2007


Mr  Del  EGM  ethno  graphic  rap  Rain  Cry  Music  Video  Miss  HIV


T1: 12,798           T2: 15,486

T1: 82                    T2: 82



All of Us – Trailer A Trailer of the documentary ALL OF US where a young doctor in the South Bronx embarks on a research project to find out why black women are becoming infected with HIV at alarming rates.

January 3, 2008

Film & Animation

documentary  trailer  African  Ethiopia  hiv/aids  women  black  abt  emily mehret


T1: 11,376             T2: 13,265

T1: 7                    T2: 8



ChingoBling : Keep Your Torta Clean Rap artists encouraging safe sex in a pre performance interview.

July 26,    2006


rap  hip  hop  dj  screw  ccmhiv  djscrew  chingo  bling torta  clean


T1: 11,291            T2: 12,109

T1: 4                     T2: 4



The Present An African American woman returning from trip tells her girlfriend about wonderful guy she just met. During the trip he gives her a present to open when she gets home. The present is a box with “welcome to the world of HIV” written inside.

October 11, 2006


Chyna  Layne  Rayan  Lawrence  Darrell  Smith  HIV  AIDS  young  black  females  girls  males  african  american  african-american


T1: 10,837            T2: 12,522

T1: 27                  T2: 27



Joe Biden Discusses AIDS, Al Sharpton gives the evil eye Joe Biden discusses HIV prevention during a debate of the 2008 Presidential Election. He mentions working to reduce HIV in black neighbourhoods by holding rallies and telling black men to wear condoms.

June 30,   2007

News & Politics

joebiden  alsharpton  pbs    hiv  aids  policy  politics  election08  debates  howarduniversity


T1: 8,467             T2: 8,795

T1: 40                   T2: 40



Fake AIDS / HIV Diagnosis For Black People pt1 The accuracy of HIV tests is discussed.

April 13,   2008


black  history  central  park jogger  rape  racism  slavery antisemitism  malcolm        pamshouseblend  ybf


T1: 8,118                T2: 10,864

T1: 314                    T2: 479



Skorpion Interviews BET’s Baldwin Hills Cast Member Etienne Maurice Etienne, from the television show Baldwin Hills talks about a range of topics, including HIV/AIDS.

March 16, 2009


The  Skorpion Show  BET  entertainment news reality TV show  Baldwin  Hills    Etienne  maurice  sheryl  leeralph  hiv  aids  activist       divas simply  singing  star  moesha  dee  mitchelle        gerren  vs  tyler  black         version  of  the  hills           viacom  d


T1: 7,097               T2: 8,862

T1: 155                T2: 162



Sen. Obama on Homophobia and Stigma A 2008 Presidential debate in which, Senator Obama discusses CDC’s report regarding young African-Americans and HIV/AIDS.

July 6, 2007

People & Blogs

African  American  Homophobia  Black  Gay  Stigma  HIV/AIDs  Free  Speech


T1: 5,914                 T2: 6,263

T1: 11                     T2: 12



SistahGirl: Black Women & HIV/AIDS Documentary First Look A documentary project that profiles the lives and experiences of HIV-positive black women from the United States who will journey to sub-Saharan Africa to meet other HIV-positive women activists.

November 29, 2007

Film & Animation

SistahGirl  Black  Women  HIV  World  AIDS  Day   DryerBuzz  Sistributions


T1: 5,686                 T2: 7,219

T1: 9                     T2: 14



I just got a phone call from a young lady… You have to watch this video!! A young African American male decides to get tested for HIV/AIDS after learning that a previous sexual partner’s HIV/AIDS test results came back UNDETERMINED. He explains the difficulty he had finding a testing location. He tested negative.

September 8, 2008


condoms  sex  porn  teen   Asian  Latina  booty  black  African  condom  white      young  people  girls  lesbian gay  breast  anal  oral  ass     tit  fuck  get  fucked  cunt   dick  pussy  porno  fucking  naked  lingerie  horny  milf  hot  mom  babe  fetish       AIDS  HIV  naisha  testing  beef


T1: 5,354                T2: 7,229

T1: 36                    T2: 38



Justin’s HIV Journal First Entry Justin B Smith chronicles his experience being HIV-positive to help educate everyone, young, old, black, white, red, yellow, straight and gay.

May 27, 2008

People & Blogs

Justin’s  HIV  Journal JustinB.  Smith  HIV/AIDS blackgay  sex  GBMNews           Baltimore  MD


T1: 5,190                T2: 6,413

T1: 37                      T2: 44



HIV/AIDS Documentary Trailer A documentary showing the  effects that HIV/AIDS has on the African American community. It provides statistical information as well commentary from various movie, television and radio personalities, sports figures.

May 30, 2007

News & Politics

HIV  AIDS  Documentary  Creflo  Dollar  Mase  EX  Ministries  Craige  MTV     BET  NEWS  Program  Mo Stegall  The  SELF SHOW  BISHOP  CHURCH


T1: 3,993                T2: 4,553

T1: 17                    T2: 17



AIDS 60 Minute report focusing on an African American woman who is HIV-positive.

January 28, 2007

News & Politics



T1: 3,932               T2: 4,505

T1: 4                     T2: 4



HIV Research: Beyond the Vaccine – KQED QUEST Chronicles HIV/AIDS in the United States over the past 15 years since the peak of the HIV/AIDS epidemic. It closely examines HIV/AIDS among the African American community and possible reasons for the high prevalence in certain communities. Also discusses the history of HIV/AIDS.

October 16, 2008

Science & Technology

kqed  pbs science hiv quest AIDS african american race vaccine california  san  francisco


T1: 3,703                T2: 6,270

T1: 1                       T2: 2



Living with HIV African-Americans discuss living with HIV.

July 31, 2007

People & Blogs

AIDS  HIV  Health African-American  Blacks  Illness


T1: 3,194                         T2: 3,642

T1: 0                      T2: 0



Who Can I Talk To, Who Can I Tell – WombWork Productions Performance of “Who Can I Talk To, Who Can I Tell” by the Nu World Art Ensemble. Based in Baltimore, Maryland, the Nu World Art Ensemble shows through dance and lyrics, the experience of a woman who was told that she was HIV positive.

July 25, 2006


wombwork  nuworld  nu   world  art  ensemble  hiv     aids  prevention community  outreach          performance  kids  teens     youth  baltimore


T1: 2,526                T2: 2,687

T1: 2                      T2: 2



A Need to Know CDC TV – Health Matters discusses how young, old, men, women, gay, and straight can be at risk for HIV/AIDS. HIV/AIDS poses a great risk for African American community men who have sex with men. Promotes getting tested for HIV.

March 16, 2009

Nonprofits& Activism

AIDS  GayMen’sHealth     HIV  HIV/AIDS               LGBTHealth  Men’sHealthMensHealth                       MinorityHealth                   SexualHealth  STD             SubstanceAbuse  TB         GayHealth  LesbianHealth  TransgenderHealth  Gay    Lesbian


T1: 2,250                 T2: 2,448

T1: 0                      T2: 0



fearful TRUTH Discusses HIV/AIDS in the African American community of Oakland, California.

June 24, 2006

People & Blogs

HIV.  African  American   Oakland  California  Alameda  County  Black  Stigma   Secrets  lies  fearful  Truth


T1: 2,202               T2: 2,405

T1: 1                       T2: 1



Deeply Rooted Dance Theater – Jagged Ledges A lyrical dance performance depicting the plight of people living with HIV/AIDS.

April 15, 2008


Deeply  performing  arts    modern  dance  african       american  drdt  deeply         rooted  jagged  ledges


T1: 2,166               T2: 2,885

T1: 7                    T2: 7



The Barbershop A PSA with two African American men who discuss HIV prevention in a barbershop.

March 16, 2008

Nonprofits& Activism

Trae  Tha  Truth  grassrootsoutreach  nonprofit  public  service  announcements     HIV  Tattoos  AIDS


T1: 1,497               T2: 2,814

T1: 2                      T2: 2



The Closing Argument (a video book) The first 10 minutes of a 150-minute video book of an African American man accused of spreading AIDS in Connecticut.

March 26, 2007


AIDS  The  Closing           Argument


T1: 1,472               T2: 1,634

T1: 0                      T2: 0



Stomp A PSA by the AIDS Community Resources. African American adolescent girls stomp about being knowledgeable, getting tested, and assertive regarding HIV/AIDS.

January 3, 2007


Commercial  PSA  Aids     HIV  Condom  use


T1: 1,454                T2: 1,608

T1: 0                      T2: 0



Standing-n-Truth This video discusses sex, sexuality, and HIV/AIDS in the African American community.

June 10, 2008

Nonprofits& Activism

Sex  Sexuality  and             HIV/AIDS  in  the  Black  community


T1: 1,061              T2: 1,531

T1: 1                       T2: 0a

* The numbers not listed for Time 1 (T1) and Time 2 (T2) did not appear at both T1 and T2, n=14 total)
*T1 search was conducted on June 1, 2009 and T2 search was conducted on November 16, 2009
a Comments are sometimes removed, which may account for zero comments at T2

At the time of analysis, the most viewed video, Trashman gives 15000 women/Girls hiv aids virus had an identical video entitled, Aids man ‘trash Man’ fitting Name, which was not yielded in our search, this video was posted on YouTube by another host. At time two, this duplicate posting had over 1.5 million hits and over 3,000 comments. The content of both the number 2 (Know Your Status) and number 3 (GurlTalkkTV-The Game of Death –1500 infected) ranked videos made direct references to the Trashman video posting. This suggests that the popularity of one video may influence the number of hits on other related videos. As a result, one video’s popularity may not be independent of another.

Community reaction to the top two videos was assessed using a content analysis of comments posted by viewers (Table 2). The Trashman video yielded written comments (N=837) under three major themes: angry threats and insults toward the maker of the video, questions about the authenticity of the video maker’s claims, and positive comments supporting the statements made in the video. A number of respondents questioned the authenticity of the video and found it mathematically unlikely for Trashman to have had sex with thousands of women. In contrast, a smaller portion of respondents (approximately 10%) had positive reactions to the video. Some felt the video was an effective tool for educating African American and Latina women about the dangers of unprotected sex. Others supported Trashman’s video because they felt the women mentioned in the video were guilty of being promiscuous and not using condoms.

There were 474 comments posted for the Know Your Status video (Table 2). Miss Jia, a YouTube blogger and former African American adult film actress, takes viewers with her as she is tested for HIV.  Most of the comments posted by viewers were positive. Some shared that they were motivated to be tested for HIV or actually received an HIV test after viewing the video. Several of the viewers asked questions related to HIV.

Table 2. Major themes and examples of relevant quotes for of Trashmangives 15,000 women/girls HIV AIDS virus and Know Your Status comments section

Trashman Quotes N=966
Anger and negative threats

N=498 (63%)

I am Pissed somebody lock this dumb JERK up what the heck I wannaloose all my Christianity and KILLLLLL HIM!!! (kingdomchild22, 11/2009)

This is one sick f[—] he needs to be put somewhere and tortured until he dies I mean slow torture who could so that he has to be a sick sick person and needs to be put under the jail (sweetthang9488, 2009).

Wow this dude needs to be castrated. Pathetic. It’s people like him that makes us have an imperfect society (saiyyru14, 2009)


N=158 (21%)

This is fake cause how is he going to remember all of the firsts and lasts names of all those girls.  He is sick cause he made this video. Hopefully this is not true (SHAR383, 11/2009)

This man is fake I don’t believe this (NyFin3st11, 2009)

This had to be a joke cuz if he had sex with a girl everyday it would take him 41 yrs  to reach 15,000 girls (TheCharleycat, 2009)

I look betta than this [n word] and I drive a jaguar and I don’t get that much ass so I know he lyin’ (Keezy59, 11/2009)

Support for Trashman

N=83 (11%)

I don’t feel sorry for any of these women because they put themselves in this position, with the aids rate steady increasing why would anyone sleep with anyone unprotected they don’t know from Adam?!? they are getting exactly what they deserve (MissOakCliffUSA, 3/2009)

That’s bad but that will teach them sluts to have unprotected sex with random guys (Straightgenius, 3/2009)

Man has a point, women need to learn how to respect themselves and close their damn legs. Not saying I agree with his methodology (stracinsrt4, 2009).

“Most people here can’t read between the lines to see that you were just giving advice to young women. I understand clearly, it also reminds me that I need to talk to my daughter even more about not having unprotected sex. Thanks. (justin5551212, 2009)

Know your Status N=474


Kudos to you and Nicole…it takes guts to show something this personal (sprat10, 2008)

Thanks for the video jia, people need to know (enjoi3s, 2008)

God Bless, you could have saved lives (reese3005, 2008)

Jia I’m so proud of you for steppin up and makin this video. You attract a large audience, and you used that for a good cause. Yay, you!! (homemadegravy17, 2008)

Motivation to get tested

N=28 (9%)

wow this has inspired me to get test. I just searched a local testing clinic in the area. Thanks a lot ;] (emjayoath, 2009)

I honestly just left a testing site about 2.5 hours ago. This video along with advertisements motivated me to get test.

Knowing your status is the business…and I’m glad I am sure of mine now. Also, being negative is the business!!!! J Take care. (reneikad, 2008)

Forgot to tell you…I went the week I say this…I’m negative!! (Ceci247, 2009)

Thank you for making this video. I watched it so many times. This vid[eo] along with my best friend’s encouragement I did it. I’m 38 and go my first test today (negative). WHOO HOOO! (nunya33763, 2009)

Questions about HIV and testing

N=15 (4%)

negative means you don’t have HIV and positive means you do right? (sacabuchi, 2008)

Quick question. How much did it cost you to get tested (racso329, 2008)

Do you have to be 18+ to get tested (iTRUTHperiod, 2009)

isn’t he suppose to tell u that u need to come back in 6mo after the last time u had sex to kno[w] if one is truly negative? (bow2jade, 2009)

do condoms help prevent HIV? (bow2jade, 2009)


The purpose of this study was to identify and describe viral YouTube videos addressing HIV/AIDS and African Americans/Blacks in order to learn more about the characteristics of and community response to the most popular videos. Our primary findings were related to the content of the videos found, the characteristics of the most popular or viral videos, and lessons learned in searching YouTube to find videos related to HIV/AIDS and African Americans/Blacks.

There were several themes that emerged from the video content. The major themes included the continuum of prevention, from HIV testing, to HIV transmission and exposure, and finally HIV treatment. The videos focused less on specific target groups (youth, gay men, heterosexual men and women) or HIV/AIDS conspiracy theories. The most frequently viewed videos, Trashman and Know your Status, included negative and positive feedback. Trashman had threats, insults, and questions regarding the authenticity of his claims, while Jia had positive feedback and support in the Know your Status video.

There were several important lessons learned about searching YouTube.  Because the assignment of tags is left to the discretion of the video publisher, videos may be labelled with irrelevant tags or missing key words. There is limited direction and no systematic oversight in the assignment of tags. Additionally, flexibility and search controls are limited in YouTube videos when compared to science-related search engines. As a result, we conducted two separate searches to meet our study objectives (African American and HIV/AIDS; Black and HIV/AIDS).

The comments section was a key mechanism for identifying community responses to the video. The viral videos generated the most viewer comments and the amount and content of comments posted on these videos may be a reflection of the emotion generated by the video. Having a strong reaction to the video content may have inspired viewers to pass the video along to others or motivated them to post comments. For the two viral videos identified in our study, the most common sentiments generated in video comments were anger towards Trashman and positive support for Know your Status. Previous research suggests that situations, news, or information (both positive and negative) which heightens arousal boosts social transmission (Berger, 2011). Eckler and Bolls (2009) found that college students reported having the strongest intent to forward viral video ads with pleasant emotional tone. In another recent study by Berger and Milkman (2011) examining how content characteristics impacted the “most emailed” New York Times articles, researchers found that content evoking high positive arousal (awe) or negative arousal (anger or anxiety) were more likely to go viral. These findings suggest that HIV-related videos that elicit anger and frustration or those that inspire encouragement and support may motivate people to share the videos.

One feature that makes online video viewing sites unique and novel is the reliance on user-generated content. As a result of online video sharing sites like YouTube, anyone has access to a worldwide audience. In the past, health-related videos could only be circulated and disseminated by organisations and agencies. This user-generated online video market has reshaped possible forums for delivering health messages. Perhaps the popularity of top videos measured in terms of numbers of views and viewer comments can be attributed to a video blogger featured in the video. It is possible that video bloggers like Trashman and adult film actors like Ms.Jia draw or capture the attention of a broad audience. Internet video bloggers may be an untapped resource for accessing high-risk target populations.

Our study has the following limitations. This research was conducted in 2009 amidst the initial surge in social networking sites like Facebook and Twitter. The introduction of these mediums vastly increased the ability to share the video beyond the traditional YouTube community members, forwarded emails, and blogging sites. The growth in these social networking sites created new and different pathways for going viral. It is important to also note that the definition of viral video in this study is specific to the videos identified in our sample. Within the larger sample of all YouTube videos the most popular viral videos have hits/views in the millions.


YouTube provides a new opportunity, resource, and venue for the widespread dissemination of public health messages. The site continues to introduce new features to enhance interactive capabilities and descriptive information collected about the video viewers. This information could be used to learn more about the demographics of a population (age, location, gender) who watch a particular video, and the types of videos that appeal to specific audiences.

New forms of media and technology, like the Internet-based social networking sites that are accessible via smartphones (e.g., Facebook and Twitter), have introduced a different landscape for communicating and connecting with people. The potential impact of these media for HIV prevention messaging has yet to be fully understood. In light of the disproportionate impact of HIV on subgroups in the US population, such as African Americans, it is imperative that we consider new and innovative HIV prevention approaches for this population. Moreover, given the current economic climate of sparse resources, free and accessible resources like YouTube should be considered for public health initiatives. Future research that focuses on developing video-based health messages that evoke strong emotions may be useful in creating HIV prevention videos that the public is motivated to share.  There is still more to learn about how web-based resources like YouTube can reach persons at the highest risk of acquiring and transmitting HIV/AIDS.


The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.


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Biographical Statements

Jocelyn D. Patterson is a behavioural scientist with the Centers for Disease Control and Prevention in the Division of HIV/AIDS. She has a Master of Public Health degree from Emory University and a Master of Professional Counselling degree from Georgia State University. Her previous research includes waiting room videos for STD clinic patients and HIV behavioural interventions for African American men who have sex with men. Her most recent work focuses on HIV prevention and medication adherence using New Media and technology.


Khiya J. Marshall received her DrPH in Social and Behavioural Sciences and MPH in Community Health from the University of North Texas Health Science Center- School of Public Health. She is currently a behavioural scientist within Centers for Disease Control’s Division of Violence Prevention. Her research has included HIV/AIDS, focusing on HIV prevention for populations disproportionately impacted by HIV (African American women, African American heterosexual men, and HIV-positive men who have sex with men (MSM) in the United States), medication adherence interventions, and new media and technology related to HIV prevention.

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