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HIV/STD Prevention in Rural America

 
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Programs Tailored to Youth
 

Sexually active young people in the U.S. are at persistent risk for HIV infection and other STDs. About 18% of those diagnosed with HIV in 2008 were young people 13-24 years of age.[1,11] This number most likely under-represents the number of youth actually infected since many will not be diagnosed until they become symptomatic years later. Young males are infected twice as often as young females. Studies in urban areas show that young MSM, especially young men of color, are particularly at risk.[12] One study of over 5,500 young MSM ages 15-22 found that many young men kept their sexual attraction to men a secret. MSM who do not disclose their sexual orientation are less likely to access HIV testing and are more likely to have a female sex partner who is unaware of her partner’s male-to-male sexual experiences. As a result, young MSM may not know if they become HIV infected and may unknowingly transmit it to other young men and/or women.[13]

Another disparity is that African Americans account for 55% of all HIV infections among youth ages 13-24. [14] Poverty, dropping out of school and lacking access to reproductive health care all contribute to the vulnerability of youth for HIV/STD infection. Programs that address these structural risks through youth development can be equally effective in delaying sexual debut and increasing abstinence. Programs that provide awareness of HIV/STD risks and teach negotiation and partner communication skills as well as condom use skills help to protect youth when they do become sexually active.[15]

Target Behaviors and Behavioral Determinants
Early debut of sexual intercourse; lack of refusal skills and condom negotiation skills; lack of information about HIV/STD and unintended pregnancy prevention.

Target Audience
Ninth grade rural youth

Description
An evidence-based behavioral HIV prevention program for youth (not a DEBI)
This 12-session, group-leve,l skills-based program was presented to 9th graders attending rural Kentucky schools to increase knowledge of HIV, STD and pregnancy risks, help students build refusal skills, delay initiation of sex, correctly use condoms and contraceptives when they become sexually active, and avoid high-risk situations. The intervention included videos, power-point presentations, contemporary music, interactive discussions, and role plays. It is based on Social Learning Theory and Social Cognitive Theory.

Evidence
Those who completed the 12-session intervention were less likely to initiate sexual intercourse compared to a control group. There was no impact on condom use.

Recommendations
A modified version of Reducing the Risk was tested that included extra videos, music and involvement of peer educators in 9 of the 12 sessions. The modified version was equally as effective as the 12-session version of the original curriculum.

Where Implemented
Rural Kentucky public schools

Contact Information
Reducing the Risk

 

IMSexED – Instant Message Sex Education

Target Behaviors and Behavioral Determinants
Lack of knowledge about HIV/STD risk behaviors, disease symptoms, HIV testing, clinic and testing locations, local resources.

Target Audience     
Internet users, especially men who have sex with men (MSM) who use     online chatrooms and sexual hook-up sites.

Description
IMsexED builds on the current popularity of the internet to reach rural MSM and engage them in HIV-prevention education in a cost-effective way. “Ed” is personified as a condom-like caricature and has a profile which informs viewers that his function is to provide sexual health related information and referrals. The IMsexED character currently makes itself conspicuously available on gay.com, adam4adam, lifeout.com, blackgaychat.com, Yahoo Messenger, Facebook, Twitter and can be e-mailed at IMsexED@arcw.org. Depending on the limitations of each particular internet site, IMsexED will typically and proactively provide information (in the form of bullet points) on common sexual-health-related topics such as HIV/STD risk factors, disease symptoms, HIV testing, clinic locations, breaking news/studies, links to helpful sites, statistics, etc. In addition to posting important information, SexED invites folks to ‘Instant Message’ or ‘Private Message’ for more detailed information on sensitive or personal matters.

Evidence    
There is extensive anecdotal evidence that “clients” are using IMSexED to get useful information and find resources.

Recommendations
Nine months of planning went into the creation of the IMsexED protocols, which include specific information regarding; ISP negotiations, message content, resource/referral lists, internet terminology, internet etiquette and program documentation/evaluation techniques.

Where Implemented
Wisconsin AIDS Resource Center of Wisconsin

Contact Information
Paul Jacob,
, HIV Prevention Specialist
AIDS Resource Center of Wisconsin
920-437-7400, ext. 3110

paul.jacob@arcw.org

 

 

Students Together Against Negative Decisions (STAND)

Target Behaviors and Behavioral Determinants
Early debut of sexual intercourse; lack of communication and negotiation skills; lack of consistent and correct condom use skills; lack of information about HIV/STD and unintended pregnancy prevention.

 

Description
STAND is a 32-hour course to prevent HIV/AIDS, STDs, and unintended pregnancy in rural teens 18 and younger. The course trains teen opinion leaders to be role models and peer eduicators who promote abstinence and risk reduction with their friends. STAND focuses on empowering teens and developing mutual support systems. After the focused in-school training, student opinion leaders plan educational activites for local teens. The goals of the program are abstinence, reduction of risk for those who do not abstain, and developing norms that oppose sexual risk taking. A parent module is available to supplement the peer activities.

Evidence
STABD peer leaders were 100% abstinent during the training. Compared to a control group at six months, STAND participants showed a 60% decrease in unprotected intercourse, 2-times more consistent condom use, a 7-fold increase in condom use, and 4-fold gain in HIV/AIDS risk knowledge.[16]

Recommendations
Developed for rural youth so needs little adaptation. Shown to be effective in rural schools. Best if there is a long-term commitment of
school administrators, parents, teens and adult program coordinator. Requires funding for program coordinator and incenctives for peer educators. STAND is currently being adapted by Indian Health Services (IHS) for Native American youth.

Where Implemented
Georgia: Sandersville, Brunswick, Macon and other counties.

 

Contact Information
Mike U. Smith, Ph.D.

Director of AIDS Education and Research

478-301-5832

Smith_mu@mercer.edu

 

Native STAND - Students Together Against Negative Decisions

Target Behaviors and Behavioral Determinants

Unprotected sex, multiple sex partners, substance use preceding sexual activity, lack of self-efficacy, lack of communication skills to avoid date violence, lack of  knowledge and skills to set and achieve goals.

 

Target Audience
American Indian and Alaska Native adolescents

Description
Adapted from STAND, a popular opinion leader intervention for rural high school students, Native STAND provides comprehensive peer education that is culturally relevant for Native American and Alaska Native adolescents. Topics covered include HIV/STD and unintended pregnancy prevention, drug and alcohol use, and dating violence. Sessions for peer educators focus on diversity, self-esteem, goals and values, decision making, negotiation and refusal skills, educator skills, and effective communications.
Peer educators learn to communicate one-on-one with teens in their school and community about these topics.

Evidence
Pre and post-test data collected using audio computer-assisted self-interviews (ACASI) from four pilot sites showed increased knowledge, more positive attitudes, increased intention to use condoms, and higher condom use self-efficacy.

Recommendations
Used a multi-disciplinary workgroup that included Native youth, elders, public health professionals, youth development experts, and representatives from National Coalition of STD Directors, Mercer University, Centers for Disease Control, and Indian Health Services. The final curriculum will be available online at no charge.

Where Implemented
Pilot programs in off-reservation Bureau of Indian Education boarding schools in four geographically diverse states.

 

Contact Information
Dana Cropper Williams

(202) 842-4660

dcropper@ncsddc.org

 

Talkin' Smack - Adaptation of Street Smart (DEBI)

Target Behaviors and Behavioral Determinants
Unprotected sex, multiple sex partners, substance use preceding sexual activity, lack of negotiation skills, lack of awareness of triggers of unsafe behavior, inadequate problem solving skills.

 

Target Audience
Homeless and runaway youth ages 11-18

Description
Adaptation of Street Smarts (DEBI)
The 8-session program is based on social learning theory which links feelings, attitudes, and thoughts to behavior change.
Sessions focus on improving youths' social skills, assertiveness and coping through exercises on problem solving, identifying triggers, and reducing harmful behaviors. Sessions are primarily group sessions but also include one individual counseling session and one visit to a community-based resource such as a health center.

Evidence
After participation in Talkin’ SMACK, youth report lower rates of substance use and unprotected sex; 93% report feeling very or completely confident in their ability to talk to partners about using condoms, to put a condom correctly on themselves or their partner. Participants also report increased confidence in their ability to refuse unsafe sex when being pressured by their partner.

Recommendations
Offering free HIV counseling, testing and referral for participants and other at-risk youth increases HIV testing and awareness of status.  Spectrum worked with a local design agency to advertise the free testing on buses and through flyers posted throughout the city.

Where Implemented

Burlington, Vermont
Spectrum Youth and Family Services

 

Contact Information
Spectrum Youth and Family Services

     Lauren Vessella

(802) 864-7423 ext208  lvessella@spectrumvt.org

Bridget Everts
(802) 864-7423 ext 222
beverts@spectrumvt.org

 

**Please see Male to Male Sex Programs for a Youth Program called YEAH!

**Please see Minority Programs for a Youth Program called Informate.

 

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