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NA SISTER: Sharing Outcomes of a
      three-year HIV/AIDS Prevention
                  Project

By Beatrice Norton (Hopi Tribe), Frances Cupis (Pascua Yaqui Tribe), and
                        Gwenda Gorman (ITCA)
Overview

• Background – Statistics/SISTA

• Partnerships

• Adaptation Process/Tailoring to Tribes

• Results

• Next Steps
Background

• America Indians/Alaska Natives (AI/AN) in AZ
  have the second highest Chlamydia and
  Gonorrhea rates in Arizona among 10-19 years old
  and adults
• 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
SISTA

Incorporates

  • 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
    partners participation.
SISTA

• Original curriculum targeted African-American
  heterosexual women

• A group-based evidenced-based intervention

• Includes 5, two-hour sessions, with two optional
  booster sessions
   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
SISTA

Women who completed the SISTA
intervention reported:
  •   Increased consistent condom use.
  •   Greater sexual self control.
  •   Greater sexual communication.
  •   Greater sexual assertiveness.
  •   Increased partners’ adoption of norms
      supporting consistent condom use.
Project Goal


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
(SISTA) Project.
Collaboration
Adaptation Process

•   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.
Adaptation Process

•   Recruited at least 40 women American Indian
    women to receive sessions from original
    curriculum.
•   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.
Adaptation Process

• Capacity building activities were provided to
  facilitators (i.e. Program Evaluation, Effective
  Facilitation Skills)
• Facilitator Training on the new NA SISTER
  curriculum held in Phoenix, AZ
• Facilitator observations were conducted to ensure
  fidelity of curriculum
NA SISTER

• 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….)




ADAPTATIONS:
 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 - Hopi
Tailoring to Tribes – Pascua
        Yaqui Tribe
 Sewa Hamut Program – RESPECT FOR MY COMMUNITY, MY TRIBE,
                          MY LIFE.

• 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
  cultural resiliency.

• 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.
Tailoring to Tribes – Pascua
Yaqui Tribe
Results
NA-SISTER Preliminary
Evaluation Select Findings
NA-SISTER Preliminary Evaluation
               Select Findings
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
               (Condoms)



Highest Pre-test               Highest Post-test
Increased Intention to Use
  Condoms (Next Time)
Increased Intention to Use
Condoms (Next 3 Months)


                      Almost 12%
                       increase
Next Steps

• 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
  project
Questions?

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Na Sister Gorman

  • 1. NA SISTER: Sharing Outcomes of a three-year HIV/AIDS Prevention Project By Beatrice Norton (Hopi Tribe), Frances Cupis (Pascua Yaqui Tribe), and Gwenda Gorman (ITCA)
  • 2. Overview • Background – Statistics/SISTA • Partnerships • Adaptation Process/Tailoring to Tribes • Results • Next Steps
  • 3. Background • America Indians/Alaska Natives (AI/AN) in AZ have the second highest Chlamydia and Gonorrhea rates in Arizona among 10-19 years old and adults • 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
  • 4. SISTA Incorporates • 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 partners participation.
  • 5. SISTA • Original curriculum targeted African-American heterosexual women • A group-based evidenced-based intervention • Includes 5, two-hour sessions, with two optional booster sessions 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
  • 6. SISTA Women who completed the SISTA intervention reported: • Increased consistent condom use. • Greater sexual self control. • Greater sexual communication. • Greater sexual assertiveness. • Increased partners’ adoption of norms supporting consistent condom use.
  • 7. Project Goal 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 (SISTA) Project.
  • 9. Adaptation Process • 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.
  • 10. Adaptation Process • Recruited at least 40 women American Indian women to receive sessions from original curriculum. • 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.
  • 11. Adaptation Process • Capacity building activities were provided to facilitators (i.e. Program Evaluation, Effective Facilitation Skills) • Facilitator Training on the new NA SISTER curriculum held in Phoenix, AZ • Facilitator observations were conducted to ensure fidelity of curriculum
  • 12. NA SISTER • 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
  • 13. Tailoring to Tribes - Hopi NATIVE AMERICAN SISTER PROJECT Na'na tupkom na'nami tunat yaw yungwa (Sisters helping to protect one another….) ADAPTATIONS:  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
  • 15. Tailoring to Tribes – Pascua Yaqui Tribe Sewa Hamut Program – RESPECT FOR MY COMMUNITY, MY TRIBE, MY LIFE. • 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 cultural resiliency. • 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.
  • 16. Tailoring to Tribes – Pascua Yaqui Tribe
  • 18. NA-SISTER Preliminary Evaluation Select Findings 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
  • 19. Confidence or Self-efficacy (Condoms) Highest Pre-test Highest Post-test
  • 20. Increased Intention to Use Condoms (Next Time)
  • 21. Increased Intention to Use Condoms (Next 3 Months) Almost 12% increase
  • 22. Next Steps • 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 project

Editor's Notes

  1. 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.
  2. 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.
  3. 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.
  4. 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%).