APPS/Web

Sister To Sister

A 20-Minute HIV Risk Reduction Intervention for Women in Primary Health Care Clinics

Evidence-Based. Chosen by the Centers for
Disease Control and Prevention as a “Best-Evidence”
and “REP Project”.

Authors

Loretta Sweet Jemmott Ph.D., R.N., F.A.A.N. and John Jemmott III, Ph.D.

Overview of the Curriculum

The overall purpose of the Sister To Sister HIV Risk Reduction Intervention Project one-on-one 20-minute skill and safer sex Intervention is to provide women with the knowledge, beliefs, motivation, and confidence necessary to help them change their behavior in ways that will reduce their risk for STIs, especially HIV. It is also designed to build self-efficacy and skills to practice these behaviors.

Goal of the Curriculum

The goal of Sister To Sister is to increase participants’ knowledge and vulnerability regarding the impact of engaging in risky sexual behavior and to provide information to reduce those risks. Additional goals are to increase participants’ confidence and skills in negotiating condom use and to insure that condoms are used correctly and consistently.

Specifically, this curriculum emphasizes that participants can reduce their risk for STDs by engaging in safer sex behaviors.

Curriculum Objectives

Women who participate in the program will be able to:

  • Identify the correct information regarding the transmission, etiology and prevention of HIV

  • Identify their feelings of personal vulnerability to HIV

  • Identify the HIV-related risk involved with sharing injectable drug works and strategies for reducing those risks

  • Identify and demonstrate the correct steps for using a condom and demonstrate these steps on an anatomically correct penis model

  • Describe ways to make condom use fun and pleasurable

  • Demonstrate negotiation skills with a partner regarding condom use and/or abstinence in a role-play situation

Strategies/Methods

  • Teach correct information regarding HIV/AIDS, its transmission, etiology, and prevention

  • Provide epidemiological/statistical information regarding incidence of HIV/AIDS in participants’ community

  • Teach negotiation skills through role-playing activities and discussion

  • Assist clients to identify their personal feelings about using condoms

  • Teach how to make condoms fun and pleasurable

  • Demonstrate correct use of condoms via activities and discussions

  • Teach the risk of injectable drug behaviors and strategies for reducing those risks

  • Build self-efficacy through practice, reinforcement, and providing constructive supportive feedback

  • Show educational videos

Content Outline

  • Activity A: Introduction and Overview

    Rationale: To provide the women with a general overview of the program and foster excitement and enthusiasm about their participation.

  • Activity B: Video Clip 1 and Acknowledging the Threat of HIV

    Rationale: To reinforce information about women and HIV/AIDS and to increase participants’ perceived risk of HIV infection.

  • Activity C: The Risk Assessment Inventory

    Rationale: Assessing participants’ personal risk of HIV infection will make the information more relevant and increase perception of vulnerability.

  • Activity D: Teaching HIV Transmission Content

    Rationale: Providing the correct HIV transmission information will enhance and reinforce participants’ knowledge.

  • Activity E: Condom Information and Condom Use Activity

    Rationale: This activity provides an opportunity for the participant to become more comfortable touching condoms and demonstrating how to use them correctly.

  • Activity F: Negotiation Skills and Video Clip 2

    Rationale: To teach negotiation strategies and skills for talking to their partners about using condoms.

  • Activity G: Role-Plays

    Rationale: To help women practice discussing condom use with a partner.

  • Activity H: HIV and Injection Drug Use

    Rationale: Providing correct information about HIV and injection drug use to enhance and reinforce participants’ knowledge.

  • Activity I: Positive Closing

    Rationale: To create a sense of sisterhood between the facilitator and the participant.

Special Considerations

The curriculum requires the use of a monitor with DVD capabilities.

Types of Activities

The Sister To Sister Curriculum involves a review of the Sister To Sister Participant Behavioral Skills Training Pamphlet, 2 videos, “He Said He Loved Me” and “Lets Try Something New”, condom demonstration, practice with an anatomical correct penis model, and role-playing. Curriculum activities are also designed to help women recognize that faulty reasoning and decision-making can increase their risk of HIV infection. The activities help them understand the adverse consequences of participating in unsafe sexual activities and the positive consequences of safer sexual practices, including abstinence.

The women engage in activities to increase comfort with condom use and to allay common concerns about the negative effects of condom use on sexual enjoyment and spontaneity. Participants handle condoms and learn to use condoms correctly. The two brief video clips evoke feelings, thoughts, attitudes, and beliefs about HIV infection, AIDS, and sexual risk behavior while highlighting prevention skills.

The women also participate in role-playing scenarios that allow them to observe, analyze, and practice the skills of negotiating abstinence or condom use in a variety of circumstances.

Theoretical Framework

  • Research shows that curriculum are more effective when based on sound theoretical frameworks.

    The Sister To Sister HIV Risk Reduction Intervention Project draws upon the Social Cognitive Theory (Bandura, 1982, 1986, 1989). Three theoretical components of the Social Cognitive Theory–perceived self-efficacy, outcome expectancies, and modeling–have utility in the reduction of HIV transmission related sexual behaviors. Self efficacy is a participant’s belief that they have the confidence to engage in behavior proposed (ex. using condoms). Outcome expectancy is the belief that the outcome of the behavior the participant is trained to engage in will be positive. Modeling is acquiring skills needed to implement the behavior the participant is trained to engage in.

  • Effects on Sexual Behaviors

    Women who received the one-on-one and group skill-building interventions reported a greater proportion of condom use during sexual intercourse in the previous 3 months compared with women who received the information interventions at 3-month follow up and compared with women who had received either the information interventions or the health control intervention at 12-month follow up. When asked specifically about the last time they had sexual intercourse, women who received the skill-building interventions were more likely to report using a condom compared with those who received the health control intervention at 3-month and compared with either the health-control intervention at 12-month follow-up. Skill-building intervention or the information intervention participants also reported less unprotected sexual intercourse than did the information intervention or health-control intervention participants at 3-month follow-up and information intervention participants at 12-month follow-up. None of the contrasts were statistically significant at 6-month follow-up.

  • Effects on STI Rates

    Although there were no differences at 6-month follow-up, women who had received the skill-building interventions were significantly less likely to test positive for an incident STI at 12-month follow-up than were those who received the health control intervention. In addition, the women who received the one-on-one skill intervention were less likely to test positive for an STI than were health control women at the 12-month follow up.

  • Core Elements

    Implementation by specially trained female health care staff that provides direct service to women.

Recommended Intervention Training

Clinic staff administering the intervention must have completed a six-hour Sister To Sister HIV Risk Reduction Intervention training session.

Intervention

In the research study we tested the efficacy of brief HIV/STD risk-reduction interventions for African-American women in primary care settings.

Research Design

In a randomized controlled trial, 564 African-American women recruited at a Newark, NJ, inner-city women’s health clinic were assigned to a 20-minute one-on-one HIV/STD behavioral skill-building intervention, a 200-minute group HIV/STD behavioral skill-building intervention, a 20-minute one-on-one HIV/STD information intervention, a 200-minute group HIV/STD information intervention, or a 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence.

The one-on-one 20-minute model consists of a risk assessment interview guide, 4 educational posters, a HIV/STI prevention behavioral skills training pamphlet, 2 short, dramatic video role-play clips scripted and professionally acted.

Behavioral Findings

At the 12-month follow-up, participants in the skill-building interventions:

  • Reported less unprotected sexual intercourse than did participants in the information interventions (Cohen’s d ld] = 0.23. P=.O2),

  • Reported a greater proportion of protected sexual intercourse than did information intervention participants (c/=0.21, P=.O5) and control participants (d=0.24, P=.03),

  • Were less likely to test positive for an STD than were control participants {d=0.2Q, P=.O3).

Conclusions

This study suggests that brief single-session, one-on-one or group skill-building interventions may reduce HIV/STD risk behaviors and STD morbidity among inner-city African-American women in primary care settings. (American Journal of Public Health 2007;97:1034-1040. doi:10.2105/AJPH.2003.020271)*

*For copies of the original research please contact Select Media, Inc. at 800-707-6334 or
research@selectmedia.org.

Target Audience

African- American, Hispanic and White adult women.