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HIV Forum Final Report
 

HIV Forum Final Report

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final report for HIV/AIDS education program submitted to grantors

final report for HIV/AIDS education program submitted to grantors

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    HIV Forum Final Report HIV Forum Final Report Document Transcript

    • 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 1 Final Program Report
    • 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]. 2 Final Program Report
    • 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 3 Final Program Report
    • 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. 4 Final Program Report
    • 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. 5 Final Program Report
    • 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 6 Final Program Report
    • 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. 7 Final Program Report
    • 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. 8 Final Program Report
    • Writing Sample: A.M. Hughley 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. 9 Final Program Report