Sisters Saving Sisters is a 5-module curriculum designed to empower low-income African American and Latina patients at family planning clinics who are sexually active, ages 12-19 years old.
Sisters Saving Sisters is a 5-module curriculum designed to empower young, teenage women to change their behavior in ways that will reduce their risk of becoming infected with HIV and other STDs, and significantly decrease their chances of being involved in unintended pregnancies. This curriculum acknowledges that abstinence is the most effective way to eliminate these risks, but also encourages the practice of safer sex and condom use.
The curriculum has 5 hours of content divided into five 60-minute modules, designed to be taught by classroom teachers or family life educators.
The curriculum includes a series of fun and interactive learning experiences designed to increase participation and help young teenage women understand the kind of faulty reasoning and decision-making that can lead to HIV, other STDs and unintended pregnancy.
Activities are designed to address the underlying attitudes and beliefs that many young women have about condoms, make them feel comfortable practicing condom use, address their concerns about the negative effects of practicing safer sex, and build their condom-use skills as well as their ability to comfortably negotiate safer-sex practices. The activities involve viewing culturally and gender-sensitive video clips, playing games, brainstorming, role-playing, engaging in skill-building exercises, and small-group discussions that are designed to build group cohesion and enhance the learning experience. Each activity is brief, and most are active exercises that require the participants to interact with one another. This maintains their interest and attention in a way that lectures or lengthy group discussions do not.
At the completion of the Sisters Saving Sisters curriculum, young women will have:
- Increased knowledge about the prevention of HIV, other STDs and pregnancy
- More positive attitudes/beliefs about condom use
- Increased confidence in their ability to negotiate safer sex and to use condoms correctly
- Increased negotiation skills
- Improved condom skills
- Stronger intentions to use condoms if they have sex
- A lower incidence of HIV/STD risk-associated sexual behavior
- A stronger sense of pride and responsibility in making a difference in their lives
At the 12-month follow-up, participants reported fewer sexual partners and were less likely to test positive for STDs compared with a control group.
The study tested the effects of HIV/STD risk-reduction interventions on unprotected sexual intercourse and the rate of STDs among African-American and Latino female patients in a low-income, inner-city adolescent medicine clinic that provided confidential and free family planning services. Participants were randomly assigned to 1 of 3 interventions based on cognitive behavioral theories and formative research. An information-based HIV/STD intervention provided information needed to reduce sexual risk, but it provided no practice or direct experience with condoms or roleplaying. A skill-based HIV/STD intervention provided information and taught skills necessary to practice and negotiate condom use. A health-promotion control intervention concerned health issues unrelated to sexual behavior.
The participants were 682 sexually experienced African American (n = 463) and Latino (n = 219) adolescent girls, 12 to 19 years of age (mean age, 15.5 years) who were family planning patients at the adolescent medicine clinic in a children's hospital serving a low-income, inner-city community in Philadelphia, Pa. Of the Latinos, 92.7% were Puerto Rican. The participants had volunteered for the “Women's Health Project” designed to reduce the chances that African American and Latino adolescent girls would develop devastating health problems, including cardiovascular diseases, cancer, and AIDS.
The adolescents completed confidential self-administered questionnaires preintervention, immediately after the intervention, and at the 3-, 6-, and 12-month follow-ups. Preintervention and follow-up questionnaires assessed sexual behavior, demographic variables, and conceptual mediator variables. The postintervention questionnaire included conceptual mediator variables and evaluations of the interventions. Biological specimens for STD testing were collected at baseline and at the 6- and 12-month follow-ups.
To increase the validity of self-reported sexual behavior and reduce potential memory problems, the participants were asked to report their behaviors over a brief period (ie, 3 months), and received calendars clearly highlighting the period. To reduce the likelihood of demand from giving their responses to the intervention facilitators, proctors blind to the participants’ intervention assignment collected the questionnaire data. The proctors emphasized to participants the importance of responding honestly and assured them that their responses were confidential. Participants signed an agreement pledging to answer the questions honestly.
At baseline, 87.1% of the respondents reported having sexual intercourse in the previous 3 months. About 52.0% of the respondents had unprotected sexual intercourse in the previous 3 months; 15.8% had sexual intercourse with multiple partners in the previous 3 months; 9.5% had a least 1 child; and 21.6% tested positive for N gonorrhoeae, C trachomatis or T vaginalis. Few respondents (0.4%) reported having same-gender sexual relationships or using injection drugs (0.6%). About 97.6% of the adolescents attended at least 1 follow-up: 94.3% attended the 3-month follow-up; 92.8% attended the 6-month follow-up; and 88.6% attended the 12-month follow-up. The intervention conditions did not differ significantly in the percentage of adolescent participants who attended at least 1 follow-up, 2 follow-ups, or all 3 follow-ups. About 87.8% returned for the 6-month STD examination, and 82.3% returned for the 12-month STD examination. The interventions did not differ significantly in the percentage of adolescents who returned for STD examinations.
No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants or health control-intervention participants. At the 12-month follow-up, skills-intervention participants reported fewer sexual partners compared with health control-intervention participants, and were less likely to test positive for STD than were health control-intervention participants. No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants.
The results suggest that behavioral interventions, particularly those that focus on skills training, may be helpful in reducing unprotected intercourse and STD rate among adolescent girls. This is particularly important for African American and Latino adolescents, whose rate of STDs is considerably higher than the rate among other adolescents. The skills intervention also reduced self-reports of multiple of sexual partners at the 12-month follow-up compared with the health-promotion control intervention. Both unprotected intercourse and multiple sexual partners are important risk factors for STD.
Jemmott, J. B., Jemmott, L.S., Braverman, P.K., & Fong, G.T. (2005). HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: A randomized control trial. Archives of Pediatric and Adolescent Medicine159(5): 440-449.
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