Goteborg, Sweden

19th World Congress for Sexual Health 2009
Goteborg, Sweden
A Clinical and Educational Model
Aimed at Reducing Sexual Behavioral Risks
Associated with HIV/STI Transmission
in Women with Histories of Trauma and Substance
Abuse

Presenter: Germayne Boswell Tizzano, Ph.D.

www.viewsfromatreehouse.com

Session Goals


A Sanctuary for Change
A Curriculum Designed to Prevent High Risk Behaviors for
Women and Trauma
Affected by Alcohol and Drug Abuse

Curriculum authored by: Program developed by:
Views From a Tree House, Inc. Amethyst, Inc.
Westerville, Ohio Columbus, Ohio

Program funded by:
The Columbus, Health Department
Columbus, Ohio

Columbus Medical Association Foundation,
Columbus, Ohio

The Sanctuary for Change Curriculum
was piloted at Amethyst, Inc., an
Alcohol and Drug Treatment
Center, Transitional and Permanent
Supportive Housing Services to
Homeless Women and Their Children
since 1983

Sanctuary Curriculum Piloted 2004 –
2007

Columbus, Ohio USA


Research Regarding High Risk Women and
HIV/STI’s

 Worldwide, almost  Rapid infection
half of all adults rates are being seen
living with HIV are among women and
women.http://www.womenshe girls in all regions
alth.gov/hiv/worldwide of the
world, especially
those aged 15 – 24
years.
http://dawn.thot.net/women_hiv_aids1.html


Research Regarding High Risk Women
and HIV/STI’s

 Violations against  Women’s fear of
women’s basic violence impacts
rights, i.e. sexual their capacity to
assault, human protect themselves
trafficking and early sexually and
marriages violence is
contribute to the emerging as a
spread of major risk factor for
HIV/AIDS.http://www.vitalvoices.org/d mortality in HIV
esktopdefault.aspx?page_id=486
positive women.
(Dennenberg, 1997).

Research Regarding High Risk
Women and HIV/STI’s

 Women with histories of abuse are
far more likely to engage in unsafe
sex practices, have multiple sex
partners, exchange sex for money or
drugs, and be addicted to alcohol
and other drugs. (Dennenberg, 1997).

Theoretical Background
Linkage: Women, Trauma, Risk Behaviors for HIV
Infection & Interventions

TRAUMA

PTSS
> RISK OF HIV WOMEN &
CHILD DISSOCIATIVE
TRANSMISSION
DISORDER
SEXUAL
DEPRESSION
ABUSE

SELF-
HIGH RISK
BLAME
BEHAVIORS
BEHAVIORS

Clinical and Educational Model Adopted
From Piloting Agency - Amethyst


A Sexual Health Curriculum for Women at
High Risk for HIV/STI Transmission
Curriculum Overview
Purpose: Designed to provide women
with histories of trauma and alcohol and
drug abuse with the tools and knowledge
to reduce risks associated with HIV/STI
transmission.

www. viewsfromatreehouse.com

Based on Social Cognitive
Theory, the focus is on building
skills and positive expectations
to make informed decisions
regarding one’s sexual health.
(Bandura, Albert, 1986)


In addition, the curriculum
draws from the works of Miller
and Gilligan, that states that
women are motivated and
geared to grow and develop in
relationship to others.
(Gilligan, C., 1993)


The curriculum, Sanctuary for
Change, encompasses (16)
intact 2 hour modules.
Instructor and student
manuals have been
published.

Replace Guilt & Shame

Shared
Empowerment Learning

Self-
Responsibility

Curriculum Values

A Sexual Health Curriculum for Women at High
Risk for HIV/STI Transmission

Goals
 To enhance personal body image and
awareness

 To describe cultural messages that
impact sexual
values, attitudes, beliefs and
practices

Goals (continued)

 To illustrate the importance of
communication in safe sex practices

 To explore myths and facts regarding
sexual orientation


Goals (continued)

• To define characteristic and attributes of a
healthy relationships

• To recognize ways in which
trauma, addiction and recovery impact
sexual health choices


Goals (continued)

• To identify common warning signs
forSTI’s, and common HIV+ signs

• To communicate sexual boundaries

• To delineate strategies to delay
sexualinvolvement


Goals (continued)

• To demonstrate the skills of refusal,
delay, negotiation, and redirecting the
conversation, when pressured sexually

• To appraise choices in the management
of
AIDSwww.viewsfromatreehouse.com

Target Population: Women Served by the
Alcohol and Drug Agency, Amethyst, and at Risk
for HIV/STI Transmission

Race/Ethnicity

African American
White
Hispanic


70%
100%
Dependent
Children Abuse Large %
Histories were Sex
100% Workers
100% Alcohol
Chronic & Drug
Abuse and Addiction
85% Co-
Relapse Existing MH
Diagnosis

100%
Homeless 70% Involved
Criminal
Women Justice

100% Amethyst
Chronic Target
Physical
Health Group 18 -60
Problems Years

Preliminary Feedback from Curriculum Pilot

At the completion of the course, participants were
asked to rate themselves on a five point Likert
scale.
How convicted do you feel about practicing
safe sex in the future?
 Response:
All women who completed the course
reported being highly convicted to
practicing safe sex.

When asked, what is the most important piece of
information, from this training, that you will put into
practice?
 Responses:
“That I will use protection if I engage in sex ever.”
“To be able to have an open dialogue about safe
sex with a partner.”
“My learning to be assertive and living without my
worrying about what others think of me. Living
my life as being worthy.”

(con’t)

“My feelings are valid and I am in control of my body.”
“I got tested for AIDS, syphilis, hepatitis because I
was inspired to find out about my health and to
maintain myself safe and healthy.”
“I learned some things when we did the bisexual, gay
section. I was surprised to find that I was
misinformed. I was correctly informed.”


Evaluation of the Curriculum Process

 Challenging to discuss sexuality in a group, particularly
with regards to women with histories of sexual and
physical abuse.

 Participant comfort level with the topics varied and was
influenced by age, religious beliefs, norms from family
of origin, history of abuse, sex work
history, understanding of body and sexuality, and
sexual identity.
(Lori Criss, Chief Operations Director, Amethyst, Inc. Columbus, Ohio Final CMAF Report)


Evaluation of the Curriculum Process
(Con’t)
 The educational sessions evoked various
responses from participants, including shame
about past sexual behaviors, feelings of
relapse, confusion about sexual identity, and
embarrassment about naïveté with bodies and
sexuality.

 Team building was critical to establishing trust
within the group. Norms and guidelines were
outlined and reinforced within the classroom
setting.
(Lori Criss, Chief Operations Director, Amethyst, inc.

Columbus, Ohio www.viewsfromatreehouse.co

Evaluation of the Curriculum Process (Con’t)
 A co-facilitator/case manager served as a link to
clinical staff and as an internal resource for
questions that evolved on a daily basis.
 Learning context provided a safe learning
environment for the women to process emotions
and confusions regarding sexuality.
 It is important that facilitators be knowledgeable on
sexual health, highly skilled in group
process, culturally competent, sensitive to the needs
of women with histories of abuse and trauma, and
able to foster an environment of self-
responsibility, mutual respect and engagement.
Lori Criss, Amethyst, Inc., Columbus, Ohio CMAF Final Report


Thank you for your
participation! Enjoy the rest
of your time at the
conference!!

The real magic
lies in not
seeing new
landscapes, but
in having new
eyes.
Marcel Proust

Goteborg, Sweden

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