NA SISTER: Sharing Outcomes of a
three-year HIV/AIDS Prevention
By Beatrice Norton (Hopi Tribe), Frances Cupis (Pascua Yaqui Tribe), and
Gwenda Gorman (ITCA)
• Background – Statistics/SISTA
• Adaptation Process/Tailoring to Tribes
• Next Steps
• America Indians/Alaska Natives (AI/AN) in AZ
have the second highest Chlamydia and
Gonorrhea rates in Arizona among 10-19 years old
• AI/AN in AZ have the third highest HIV/AIDS rates
• The ITCA received a three-year grant from the
Office of Women’s Health to adapt the evidence-
based intervention, Sisters Informing Sisters on
Topics About AIDS (SISTA) for American Indian
women in Arizona
• Discussions and activities to empower women
to praise their strengths and identify role
models in their communities.
• Risk reduction skills building.
• Take home assignments that includes their
• Original curriculum targeted African-American
• A group-based evidenced-based intervention
• Includes 5, two-hour sessions, with two optional
Session 1: Ethnic and Gender Pride
Session 2: HIV/AIDS Education
Session 3: Assertiveness Skills Training
Session 4: Behavioral Self-Management
Session 5: Coping Skills
Women who completed the SISTA
• Increased consistent condom use.
• Greater sexual self control.
• Greater sexual communication.
• Greater sexual assertiveness.
• Increased partners’ adoption of norms
supporting consistent condom use.
To provide culturally appropriate HIV/AIDS
prevention education to AI/AN women in Arizona,
through adapting, tailoring, and implementing the
Sisters Informing Sisters on Topics about AIDS
• Two women were identified from each tribal
site to participate in a four-day SISTA Facilitator
Training by CDC in May of 2010.
• Face to face meetings were held with the tribes
on further discussion of adaptation steps.
• Each tribe conducted feedback sessions and key
informant interviews on how to implement the
project in their respective communities.
• Recruited at least 40 women American Indian
women to receive sessions from original
• Women received gifts cards for participating in
the sessions and were offered an additional gift
card for voluntarily getting an HIV/STD test.
• Feedback from participants were recorded to
make changes to new curriculum, Native
American Sister Informing Sister: Educating,
Talking, and Reducing Risk.
• Capacity building activities were provided to
facilitators (i.e. Program Evaluation, Effective
• Facilitator Training on the new NA SISTER
curriculum held in Phoenix, AZ
• Facilitator observations were conducted to ensure
fidelity of curriculum
• Targets American Indian women
• Group based intervention with six sessions:
Historical Trauma and Cultural Resilience
session added (based on literature review
conducted and feedback)
• American Indian poems added and activities and
role play scenarios were changed
• Modified “SISTAS Assertiveness Model” acronym to
“SISTER Proactive Communication Model”
• New design cover for curriculum
Tailoring to Tribes - Hopi
NATIVE AMERICAN SISTER PROJECT
Na'na tupkom na'nami tunat yaw yungwa
(Sisters helping to protect one another….)
Motto: Women’s Journey
Opening Poem: Written by Hopi woman
Values worksheet: Corn Plant Values Sheet
At the Parking Lot: At the PIKI HOUSE
Props : Cultural items defining Hopi women’s significance in the Hopi Cultural
Tailoring to Tribes – Pascua
Sewa Hamut Program – RESPECT FOR MY COMMUNITY, MY TRIBE,
• Collaborated with the Language and Culture Department and
Elders from tribal communities to assist in curriculum
development of traditional learning techniques.
• Utilized the Language and Culture Department regarding
ceremonial direction in spirituality, historical trauma and
• Utilized our Hiaki language to adapt the Sewa Hamut Program
from NA SISTERS to provide connection with community.
• Integration of symbolism of Sewa Hamut or flower women has
a connection to nature, culture and health.
NA-SISTER Preliminary Evaluation
Age Group of Participants Health & STI Screenings
(in years) – 91% reported Pap Test
– 41% reported Chlamydia
– 26% reported Gonorrhea
– 53% reported HIV test
Note: These are self-reported
from the pre-tests
Confidence or Self-efficacy
Highest Pre-test Highest Post-test
Increased Intention to Use
Condoms (Next Time)
Increased Intention to Use
Condoms (Next 3 Months)
• Share findings of project outcomes with tribes
• Provide Facilitators Training on NA SISTER
curriculum (dependent on additional funding)
• Share curriculum with other tribes
• Identify other funding sources to continue
28% of the participants were between 18 and 24 years. Another 23% were between 25 and 34. The average age of participants was 33 years. When asked if they ever had a Pap test, 91% of the women reported that they had. While 41% had been tested for Chlamydia and 26% reported being tested for Gonorrhea. Over half (53%) of the participants reported ever being tested for HIV. It is important to note that this is self-reported and was not verified through medical records. If asked why Pap and HIV is higher than one might expect, we do not know for certain but could possibly be due to the fact the Pap Test do not generally have as much stigma associated than STI tests. Also, recruited participants were aware that the curriculum was for HIV prevention education, which may have influenced the way they responded to being tested for HIV. Also, (GWEN – there is now an opt-out for HIV testing at IHS facilities right?) If asked, this analysis included about 64 pre-test and about 40 post-curriculum tests.
When asked, “Even if you’ve never used condoms before, how confident or sure are you that you could put a condom on a hard penis?” the highest percentage of responses from the pre-test was “Somewhat Confident.” However, in the post-test, the highest percentage of responses was “Very Confident.” Missing means skipped question or invalid response.
When asked, “The next time you have sex do you plan to use a condom?” the percentage of yes responses increased over 20% from the pre-test to the post-test.
When asked a similar question, “In the next three months, do you plan to use a condom if you have sex?” the percentage of yes responses increased almost 12% from the pre-test to the post-test (from 65.6% to 77.5%).