final report for HIV/AIDS education program submitted to grantors

1. Implementing the Making Proud Choices! curriculum with a group of
young adolescent females from Northeast Washington, DC
Background
While the overall incidence of AIDS in the U.S. has declined, there has not been a
comparable decline in newly diagnosed HIV cases among youth. This is a significant
observation because researchers believe that cases of HIV infection reported among 13-
to 24-year-olds are indicative of overall trends in the incidence of HIV infection. Findings
from recently reported studies§ reveal that 47% of 13- to 24-year-olds diagnosed with HIV
infection from 34 confidential reporting areas around the country during the year 2000
were female and 56% of this same group were African-American. This latter statistic is
indicative of the more alarming observation that the HIV virus disproportionately infects
young women of color. In fact, the prevalence rate of AIDs in African American women
is 18 times greater than the prevalence rate among white women. As information on risk
categories continue to be update, researchers are finding that unprotected
heterosexual contact seems to pose the greatest risk to women. More specifically, 38%
of women reported with AIDS were infected through heterosexual exposure to the virus
HIV.
The Xi Omega Chapter of Alpha Kappa Alpha Sorority, Inc. used this new information
regarding population groups highly at risk for infection in targeting its audience for the
HIV/AIDS/STD Awareness Forum, Choices and Consequences. Recent studies by the
CDC have suggested a need to refocus prevention efforts in some of the following ways.
Firstly, prevention programs must be tailored to youth and female audiences. School-
based programs are critical for reaching youth before behaviors are established. Efforts
to reach out-of-school-youth must continue to be made by community-based programs.
Parents, schools and community programs must address the relationship between sexual
and drug-related risks, while STD treatment must be harnessed as another opportunity for
prevention interventions targeting young people. Such findings point to the critical
need to reach young women early and provide them the information and skills needed
to protect them from infection. Many of these young women are likely infected by men
older than themselves, so programs must also include a focus on building self-esteem,
confidence, and communication skills necessary to delay sexual intercourse.
Additionally, they must acquire communication and technical skills necessary to
negotiate correct and consistent condom use.
Methods
To that end, the Xi Omega Chapter of Alpha Kappa Alpha Sorority, Inc. tailored its health
promotion and disease prevention forum, Choices & Consequences: Increasing
HIV/AIDS and STD Awareness to incorporate these strategies. The forum targeted young
adolescent African-American women attending schools in urban and economically
depressed neighborhoods in Washington, DC. The daylong forum incorporated many of
the CDC’s recommendations. Firstly, invitations were extended to adolescents as young
as 10 years of age in the hope of reaching girls before they have made choices
regarding sexual activity and other risk behaviors leading to HIV infection. Secondly, the
forum incorporated concepts from the Girl Power! campaign and the Making Proud
Choices! curriculum. The Girl Power! campaign developed by the Department of Health
§
CDC Fact Sheets: Young People At Risk: HIV/AIDS Among America’s Youth, May 2002; HIV Among US
Women: Minority and Young Women at Continuing Risk, May 2002; and HIV/AIDS Among African Americans,
May 2002 at http://www.cdcnpin.org
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2. Writing Sample: A.M. Hughley
and Human Services (DHHS) emphasizes messages to build confidence and self-esteem.
Making Proud Choices! is a comprehensive curriculum designed especially for young
inner-city adolescents of color. More importantly, the CDC has identified it as an
effective program.t In addition to providing traditional information on HIV/AIDS and
other STDs, it uses innovative techniques to influence attitudes towards risk behaviors and
increase knowledge and skills necessary to for healthy decision-making. The curriculum
integrates individual activities, small and large group activities, educational games, and
video material to illustrate and teach these skills. All activities used a high-level of
facilitator-participant interaction. Metro TeenAIDS, the organization that presented the
Making Proud Choices, addressed the following modules! curriculum: Getting to Know
You and Steps to Making Your Dreams Come True; The Consequences of Sex: HIV
Infection, Attitudes and Beliefs About HIV/AIDS and Condom Use, Strategies for
Preventing HIV Infection: Stop, Think, Act; The Consequences of Sex: STDs and Correct
Condom Use; The Consequences of Sex: Pregnancy and Contraception. Many of these
concepts were enforced in the video presentation, Time to Wait for Sex. The lecture
presented by the animated, former school nurse, Pam Stenzel emphasized abstinence as
the best strategy for avoiding pregnancy, sexually transmitted disease, and infertility.
Finally, a discussion by Victoria Garriet a pediatrician from Children’s Hospital
emphasized sexually transmitted diseases and included a game that illustrated the
random nature and the ease with which anyone can contract sexually transmitted
diseases (see Attachment A).
Materials
Figure 1
Forum attendees received several
MATERIALS
materials that were age-
Resource Guide
appropriate and culturally specific Sticker Page
to reinforce the messages Channing-Bete Publications
presented throughout the day. The Teens And Abstinence Kit
Resource Guide was a 42-page Pregnancy – Save It for Later
booklet providing an overview of all What You Should Know About Genital Warts
sexually transmitted diseases with Chlamydia A Hidden Danger
the exception of HIV/AIDS and a About Pelvic Inflammatory Disease
comprehensive listing of contact What’s Up with HIV and AIDS Workbook
information for metropolitan DC, On Beating HIV Workbook
The HIV Quiz - Find Out What You Know
surrounding Maryland and Virginia
What You Should Know About HIV and AIDS
areas. Students also received a
What Everyone Should Know About HIV Testing
page of bright, colorful stickers to AIDS: An African-American Woman’s Story
reinforce forum messages (Making HIV/AIDS, To Women in their Teens and Twenties
Proud Choices! and Girl Power!) and Condoms: What Women Need to Know
contact information. Finally, several Sex, Lies, and Staying Alive
colorful booklets and pamphlets Getting Him to Use A Condom
produced by the Channing-Bete Drinking, Drugging, Sex, and Sickness
Company including additional
information on HIV/AIDS, proper
condom use, and specific STDs were also included to elaborate on STDs as well as risk
behaviors and strategies for refusing sex or refusing unsafe sex as detailed in figure 1. The
complete curriculum for the forum was selected for continuity and consistency with CDC
recommendations and standards.
tCompendium of HIV Prevention Interventions with Evidence of Effectiveness. Atlanta, GA: Centers for Disease
Control and Prevention; November 1999 Revised, [1-20].
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3. Writing Sample: A.M. Hughley
Results
We set out to accomplish the following three
Figure 2
primary objectives with the implementation of
the Choices and Consequences Forum: 1) to Age Distribution of Forum Participants
present education information highlighting the Age 13
prevalence and disparities of HIV/AIDS and 2%
Age unknown
other STDs in the African-American female Age 12 2%
11%
population (influence knowledge); 2) to Age 10
present prevention information scientifically
16%
Age 11
proven to reduce the risk behaviors 69%
associated with contracting HIV, the virus
which causes AIDS and other dangerous STDs
(influence knowledge attitudes, and
behaviors); and 3) to present prevention skills
scientifically proven to reduce the risk of contracting HIV virus which causes AIDS and
other dangerous STDs (influence attitudes and behavior).
The students who attended the forum were between the ages of 10 and 13 with a
distribution detailed in figure 2. The majority (69%) were 11 years of age, 100% were
female and African-American. In
Figure 3 addition, 100% attend school in urban
and economically depressed
Have you ever had sexual intercourse?
neighborhoods located in Northeast
Washington, DC. To ascertain
Unknown
2%
students’ base risk level, we
Yes
administered several questions from
4%
the 2003 Youth Risk Behavior Survey
No
administered by the National Centers
94%
of Heath Statistics. There were
differences between per-forum and
post-forum responses. Ultimately, we
discovered that 4% of the 45 students
were already sexually active (see
figure 3). Among these students, all
reported their first sexual encounter to take place at age 11 or younger and to have only
one lifetime partner with whom they used a condom. Finally, students also stated that
they did not drink alcohol or use drugs before having sex at the time of their most recent
encounter (see figure 4).
Figure 4
To evaluate the
accomplishment of Choices
and Consequences Forum’s Post Forum YRBS Questions (N=2)
How old were you when you had sex for the first
stated goals and specifically 11 years old or younger
time?
the influence of the curriculum During your life, with how many people have
1 person
you had sex?
on attendees’ knowledge,
Did you drink alcohol or use drugs before you
attitudes and behaviors, a No
had sex the last time?
multi-part questionnaire was The last time you had sex, did you or your
Yes
partner use a condom?
administered immediately prior
to and following the daylong
event. The instrument was organized as follows: HIV/AIDS Knowledge Regarding Risk
Behaviors (Attachment B), Attitudinal Dimensions Related to HIV-Risk Behaviors
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4. Writing Sample: A.M. Hughley
(Attachment C), and Intentions regarding HIV-risk behaviors and their precursors
(Attachment D.)
Influence on HIV/AIDS knowledge was
Figure 5
accomplished by presenting educational
information regarding the risk among young
female African-American adolescents of HIV Knowledge Score HIV Knowledge Score
acquiring HIV/AIDS and other STDs. This Pre Forum Post Forum
knowledge dimension was evaluated with a Mean 4.52 5.84
five point Lickert Scale instrument that SD 1.44 1.57
yielded a pre-forum mean score of 4.52
T Test 0.001
(SD= 1.44) out of a maximum 10 and a post-
forum mean score of 5.84 (SD= 1.57). With a
p value of 0.001 the goal of increasing knowledge regarding HIV/AIDS was successfully
achieved, as there was only one chance in 1000 that the difference between the mean
score of the group before the forum and the group after was due to chance alone (see
figure 5). Since the maximum score that could be attained was ten and the group
averaged nearly six, there is additional opportunity to improve the basic knowledge in
this population.
The instrument used to evaluate the Figure 6
dimension of attitudes related to HIV-risk
behaviors (also using a five point Lickert Attitudes Towards HIV Risk Attitudes Towards HIV Risk
Behavior Score Pre Forum Behavior Score Post Forum
scale) yielded a mean score for student N=44 N=45
attendees of 41.59 (SD= 7.18) pre-forum Mean 41.59 42.02
and 42.02 (SD=7.03) post-forum out of a
SD 7.18 7.04
maximum 55. There is no statistical
significance (p= 0.926) in the difference T Test 0.926
in attitudes before and after the forum
(see figure 6). However, attitudes are more difficult to change than knowledge.
Repeated exposure to the interventions over time would aid in making such a change
since many attitudes can generally be altered over time.
Attitude towards abstinence from sex was one subscale of this instrument. The mean pre-
forum score was 15.57 (SD= 2.84) while the mean
Figure 7
post-forum score was 14.73 (SD= 3.10) out of a
maximum of 20. Again, there was no statistical
significance (p= 0.123) in the difference in attitudes
towards abstinence from sex before and after the
Pre Forum Post Forum
Abstinence Score Abstinence Score
forum (see figure 7). While it will take more than
one exposure to an intervention to influence
Mean 15.57 14.73
attitudes, a positive observation from this group of
SD 2.84 3.10
forum attendees is the relatively positive and
T Test 0.123
healthy attitudes they posses towards avoiding HIV-
risk behaviors as a whole and specifically, employing abstinence from sex as one specific
strategy.
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5. Writing Sample: A.M. Hughley
The last instrument measured forum attendees’ intended behavior with a multiple choice
question format. For a full comparison of pre-forum and post-forum responses, refer to
the chart in figure 8. Of particular interest, were responses to the fifth and sixth questions
because they possessed the most variation. To question 5, “In the next three months,
which one of the following do you intend to do”, 93.18% responded, “I don’t intend to
have sex” pre-forum and post-forum, 91.11% responded in the same manner. Another
6.82% responded “I intend to use condoms with my sexual partner/s (risky behavior)” pre-
forum and post forum that increased to 8.89%. Finally, to question 6, “In the next three
months, which one of the following do you intend to do” 43.18% responded, “I intend to
be tested for HIV because I think I may be infected” pre-forum and that decreased to
20% post-
Pre Forum (N=44)
forum. Nine In the next 3 months, which one of the following do you intend to do?
and nine Question 1 Question 2 Question 3 Question 4 Question 5 Question 6
tenths No Risk Response 100.00% 100.00% 100.00% 97.73% 93.18% 43.18%
percent
Risky Response 0.00% 0.00% 0.00% 2.27% 6.82% 9.09%
responded,
High Risk Response 0.00% 0.00% 0.00% 0.00% 0.00% 47.73%
“I don’t
Did not answer question 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%
intend to be
tested for
Post Forum (N=45)
HIV even In the next 3 months, which one of the following do you intend to do?
though I Question 1 Question 2 Question 3 Question 4 Question 5 Question 6
think I may No Risk Response 97.78% 95.56% 93.33% 93.33% 91.11% 20.00%
be infected Risky Response 0.00% 2.22% 4.44% 6.67% 8.89% 8.89%
(risky High Risk Response 0.00% 0.00% 0.00% 0.00% 0.00% 71.11%
behavior)”
Did not answer question 2.22% 2.22% 2.22% 0.00% 0.00% 0.00%
pre-forum
and Figure 8
decreased
to 8.89 %
post-forum. Finally, 47.73% responded, “I don’t intend to be tested for HIV because I am
unlikely to be infected (high-risk behavior)” pre-forum increased to 71.11% post-forum.
Discussion and Conclusions
Implementing the Making Proud Choices! curriculum supplemented with materials and
exercises consistent with these program goals in the format of a daylong forum is
successful in increasing the knowledge of young adolescents regarding risk behaviors
related to HIV and other STDs. Working with girls as young as ten and eleven is optimal
and not premature. In our sample of 45 students, 4% reported being sexually active (see
figure 3). Despite this fact, the mean scores measured by the Attitudes towards HIV-risk
behaviors instrument as a whole and the abstinence subscale suggests relatively positive
and healthy attitudes towards avoiding HIV-risk behaviors as a whole and specifically,
employing abstinence from sex as one such strategy. The goal over time would be to
keep the scores at this level if not raise them higher as the students mature and possibly
become more interested in having sex. Expanding the implementation period to cover
a longer time period in order to increase the ability of the curriculum to positively
influence attitudes and intended behaviors can enhance interventions such as the
Choices and Consequences Forum.
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6. Writing Sample: A.M. Hughley
Attachment A
AGENDA
Registration and Pre-Forum Questionnaire 8:30 am
Occasion 9:00 am
Welcome 9:10 am
Video: Time to Wait for Sex with Pam Stenzel & Brief Discussion 9:20 am
Making Proud Choices with Metro TeenAIDS 10:00 am
~ Getting to Know You and Steps to Making Your Dreams Come True
~ The Consequences of Sex: HIV Infection
~ Attitudes and Beliefs About HIV/AIDS and Condom Use
~ Strategies for Preventing HIV Infection: Stop, Think, Act
~ The Consequences of Sex: STDs and Correct Condom Use
~ The Consequences of Sex: Pregnancy and Contraception
~ Developing Condom Use Skills and Negotiation Skills
~ Enhancing Refusal and Negotiation Skills
Working Lunch 12:00 noon
Negotiating the Risks of Disease with Victoria Garriet, MD 1:00 pm
Wrap-Up 3:00 pm
Post-Forum Questionnaire & Forum Evaluation 3:30 pm
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7. Writing Sample: A.M. Hughley
Attachment B
YOUR KNOWLEDGE OF HIV AND AIDS [maximum score = 10]
DIRECTIONS: This section asks you to say whether you agree or disagree with a set of statements. Please read
each statement, then indicate whether you Strongly Agree (SA), Agree (A), are Not Sure (NS), Disagree (D), or
Strongly Disagree (SD) by circling the answer you want. Some of the questions use the phrase quot;having sex.quot; This
means sexual intercourse.
Examples
Strongly Not Strongly
Agree Agree Sure Disagree Disagree
SA A NS D SD
1. People should eat a nutritious breakfast to give them
SA A NS D SD
energy through the morning.
2. Teenagers don't need more than five hours of sleep
SA A NS D SD
each night.
____________________________________________________________________________________________________________
Strongly Strongly
Agree Agree Not Sure Disagree Disagree
1. Someone with AIDS can spread HIV by
SA A NS D SD
coughing and spitting.
2. In the United States, your chance of
SA A NS D SD
getting HIV when you get a blood
transfusion is extremely small.
3. You can get HIV from being in a
SA A NS D SD
swimming pool.
4. There is no way you can find out if you
SA A NS D SD
are infected with HIV.
5. You can get infected with HIV by having
SA A NS D SD
sex with someone who shares drug
needles.
6. It is not dangerous to hug a person with
SA A NS D SD
AIDS.
7. One way to avoid getting HIV is by not
SA A NS D SD
having sex.
8. quot;Lambskinquot; condoms do not protect
SA A NS D SD
against HIV as well as latex condoms do.
9. People infected with HIV do not
SA A NS D SD
necessarily look sick.
10. You can be cured of HIV if you are
SA A NS D SD
careful to take the medicine the doctor
gives you.
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8. Writing Sample: A.M. Hughley
Attachment C
YOUR VIEWS [overall maximum score = 55], [subscale maximum score = 20]
BEFORE STARTING, PLEASE READ THE FOLLOWING: Some of the statements in this section about HIV. HIV is the
virus that causes AIDS.
Strongly Strongly
Agree Agree Not Sure Disagree Disagree
SA SD
A NS D
1. If your friends want you to do something that you think
SA A NS D SD
might not be safe, you should at least try it.
2. It's okay not to have sex while you are a teenager. SA A NS D SD
3. It's okay for teenagers to have sex without a condom
SA A NS D SD
if they know each other well.
4. To keep your friends, you should go along with most
SA A NS D SD
things your friends want you to do.
5. People who don't have sex before they get married
SA A NS D SD
are strange.
6. It's okay to have sex without a condom because your
SA A NS D SD
chance of getting infected with HIV is very low.
7. It's a good idea for teenagers not to have sex. SA A NS D SD
8. When friends want you to do things you don't feel like
SA A NS D SD
doing, there's no harm in going along.
9. Teenagers should be more willing to resist pressures
SA A NS D SD
from their friends.
10. Teenagers who don't have sex are wasting their teen
SA A NS D SD
years.
11. People who use condoms during sex don't trust the
SA A NS D SD
person they're with.
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Attachment D
YOUR INTENTIONS
DIRECTIONS: This section asks you personal questions about your intentions during the next three months. Read
each question and circle the answer that is MOST true for you.
Examples
No. 1: In the next three months, which one of the following do you intend to do?
A. I intend to gain weight.
B. I intend to lose weight.
C. I intend to stay the same weight.
No. 2: In the next three months, which one of the following do you intend to do?
A. I intend to walk to school.
B. I intend to take a bus to school.
C. I intend to get to school in another way.
___________________________________________________________________________________________________________
1. In the next three months, which one of the following do you intend to do?
a. I don't intend to use alcohol.
b. I intend to use alcohol.
2. In the next three months, which one of the following do you intend to do?
a. I don't intend to use drugs.
b. I intend to use drugs.
3. In the next three months, which one of the following do you intend to do?
a. I don't intend to inject drugs or steroids.
b. I intend to inject drugs or steroids.
4. In the next three months, which one of the following do you intend to do?
a. I don't intend to have sex.
b. I intend to have sex with one person.
c. I intend to have sex with two or more people.
5. In the next three months, which one of the following do you intend to do?
a. I don't intend to have sex.
b. I intend to use condoms with my sexual partner(s).
c. I don't intend to use condoms with my sexual partner(s).
6. In the next three months, which one of the following do you intend to do?
a. I intend to be tested for HIV because I think I may be infected.
b. I don't intend to be tested for HIV even though I think I may be infected.
c. I don't intend to be tested for HIV because I am unlikely to be infected.
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