Application of the Transtheoretical Model

1. Applying the Transtheoretical Model to
Promote Sexuality Education and Safer
Sex Behaviors of Older HIV-Infected
African Americans in Nevada
By
Philip Danquah, MSW, ASW

2. Sexual Risk Factors
• Many older Americans are sexually active, including those who are infected with
HIV, and have many of the same risk factors for HIV infection as younger
Americans, including a lack of knowledge about HIV and how to prevent
transmission, inconsistent condom use, and multiple partners.
Older people also face unique issues, including
• Many widowed and divorced people are dating again, and they may be less
knowledgeable about HIV than younger people, and less likely to protect
themselves.
• Women who no longer worry about getting pregnant may be less likely to use a
condom and to practice safer sex. Age-related thinning and dryness of vaginal
tissue may raise older women’s risk for HIV infection.
• The availability of erectile dysfunction medications may facilitate sex for older
men who otherwise would not have been capable of vaginal or anal intercourse.
• Although they visit their doctors more frequently, older Americans are less likely
than younger Americans to discuss their sexual habits or drug use with their
doctors, who in turn may be less likely to ask their older patients about these
issues.
(CDC, 2013)

3. Statistics
Nevada
• Roughly 25% of people living with HIV/AIDS are African Americans
• 1 in 16 Black or African American men will be diagnosed with HIV/AIDS at
some point in his lifetime, as well as 1 in 30 Black or African American
women
(Southern Nevada Health District, 2011)
Nationwide
• 1.2 million persons aged 13 and older were living with HIV infections in the United
States (CDC, 2012)
• An estimated 47,500 new HIV infections that occurred in 2010, 2500 were among
Americans who are aged 55 and older (CDC,2013)
• 36% (900) of new infections were in White men and 4% in White women, while the
24% (590) of new infections in Black men and 15% (370) in Black women is still
considered high
(CDC, 2013)

4. Diagnoses of HIV Infection among Adults and Adolescents,
by Race/Ethnicity, 2010–2014—United States and
6 Dependent Areas
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have
been statistically adjusted to account for reporting delays, but not for incomplete reporting.
a Hispanics/Latinos can be of any race.
(CDC ,2016)

5. HIV Infection in Blacks/African Americans
United States and 6 Dependent Areas
Total 222,185 diagnoses of HIV infection in 2010–2014
 Blacks/African Americans: 45% of total
 Black/African American women: 62% of women
 Blacks/African Americans: 64% of infections attributed to
heterosexual contacta
 Black/African American children: 64% of children aged
<13 years
In 2014, 44% of diagnoses of HIV infection among
adults and adolescents were in blacks/African
Americans.
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data have
been statistically adjusted to account for reporting delays and missing transmission category, but not for incomplete
reporting.
a Heterosexual contact with a person known to have, or to be at high risk for, HIV infection.
(CDC, 2016)

6. Precomtemplation Comtemplation
Preparation Action
Maintenance
Transtheoretical Model- Stages of Change

7. Application of the Transtheoretical Model
Core Construct Applications
Precomtemplation • Validate lack of readiness to engage in
safer sex behaviors
• No intention to seek sexuality information,
and not currently considering a change in
his or her behavior
• Participants had no intention to engage in
safer sex behavior and understand their
sexuality within the next six months
Interventions
• Encourage reevaluation of sexual
behaviors, self-exploration of what kind of
sexual activities participants are currently
engaging and help them to personalize the
risk of unsafe sex behaviors

8. Application of the Transtheoretical Model
Core Construct Applications
Contemplation • Participants are not considering change
within the next six months
Interventions
• Again validate the readiness to engage in
safer sex behaviors and understand their
sexuality
• Clarify that the decision to change their
sexual behavior and assess if the sexuality
information is theirs
• Encourage the participants to evaluate the
pros and cons of the behavioral change
process
• Identify and promote new or positive
expectations to change risky sexual
behaviors

9. Application of the Transtheoretical Model
Core Construct Applications
Preparation Interventions
• Focus on informational interventions
• Assist participants towards problem
solving
• Help participants to identify obstacles
• Help with the development of skills such
as self-efficacy, avoidance techniques,
right use of contraceptives, ability to
understand sexuality health risks,
communication techniques, etc.
• Help participants to engage in initial steps
and report back through a self-reported
survey

10. Application of the Transtheoretical Model
Core Construct Applications
Action • Check how participants have utilized the
educational information
• Check how they have made explicit
changes to their risky sexual behaviors in
the last six months
• Check if participants are utilizing the
interventions and actually practicing safer
sex behaviors within three to six months
after giving the educational information to
them
Interventions
• Focus on restructuring cues and social
support from their sexual partners
• Reinforce self-efficacy for dealing with the
risky sexual behaviors and other obstacles
• Emphasize the long-term health benefits

11. Application of the Transtheoretical Model
Core Construct Applications
Maintenance • After six months of giving the educational
information
Interventions
• Follow up on the behaviors that are
working, provide support and reinforce
behaviors that are highly successful
• Encourage internal rewards and discuss
issues on coping with relapse
• Evaluate what is triggering any relapse and
plan a support system to help maintain the
behaviors
• Encourage participants to maintain
behaviors to prevent relapse, provide
incentives so that participants are able to
stay within the maintenance stage

12. Thank You

13. References
Pictures are just for illustration purposes and does represent any HIV-infected person
Center for Disease Control and Prevention (2012). HIV Prevalence Estimate. Retrieved from
http://www.cdc.gov/hiv/statistics/overview/index.html
Center for Disease Control and Prevention (2013). HIV among Older Americans. Retrieved from
http://www.cdc.gov/hiv/pdf/library_factsheet_HIV_%20AmongOlderAmericans.pdf
Center for Disease Control (2013). HIV among People Aged 50 and Over. Retrieved from:
http://www.cdc.gov/hiv/group/age/olderamericans/index.html
Center for Disease Control and Prevention (2014). Diagnosis of HIV Infection. Retrieved from
http://www.cdc.gov/hiv/statistics/overview/index.html
Center for Disease Control and Prevention (2014). HIV Surveillance by Race/Ethnicity (through 2014)
Retrieved from http://www.cdc.gov/hiv/library/slideSets/index.html
Center for Disease Control and Prevention (2016). Slides Sets. Retrieved from
http://www.cdc.gov/hiv/library/slideSets/index.html
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education:
Theory, research, and practice (4th ed.) Jossey-Bass.
Lieberman, R. (2000). HIV in older Americans: An epidemiologic perspective. Journal of
Midwifery and Women's Health, 45(2), 176-182. doi:10.1016/S1526-9523(00)00002-7
Southern Nevada Health District (2011). News Release- National Black HIV/AIDS Awareness Day, Feb.
7. Retrieved from http://www.southernnevadahealthdistrict.org/news11/020311.php