Making Proud Choices! A Safer Sex Approach to HIV/STD and Teen Pregnancy Prevention
Making Proud Choices! is a community-based program designed for sixth and seventh grade African-American adolescents based on Be Proud! Be Responsible!. Making Proud Choices! stresses that abstinence is the best way to prevent HIV, other sexually transmitted diseases (STDs) and pregnancy, but Making Proud Choices! also teaches that condoms can be effective too. The evaluated program was held in two, four-hour sessions in three Philadelphia middle schools. (The program also could be taught in eight hourly sessions.)
At the 12-month follow-up, sexually experienced teens in Making Proud Choices! reported a lower frequency of unprotected sex than those in the control group.
Teens received $100 ($40 for completing the program and $60 for participating in the evaluation). The curriculum can be purchased for $100, and videos are additional. Training costs are not available.
Insights After the Fact
In order to sustain the effects of Making Proud Choices! over time, it was supplemented with another program entitled, Promoting Health Among Teens (PHAT). PHAT adds a maintenance component to the safer-sex curriculum, includes a three-module “booster” session (either six weeks or three months after the program ends), and distributes six issues of a newsletter that reinforces lessons learned in the program. The maintenance component includes six one-on-one sessions with the teen’s original facilitator to reinforce the safer-sex message and to assess whether the teen is practicing safer sexual behaviors. PHAT is following teens for 24 months to see whether effects are sustained over time.
It is important to ensure the facilitators adhere to the curriculum as it is written and not try to modify it in any way.
This program works best in schools and communities that recognize teens are at-risk for HIV, other STDs, and unintended pregnancies.
The evaluation results suggest that intensive, culturally-appropriate approaches that are based on theory can reduce some risky sexual behaviors among inner-city African American adolescents.
Source: Dr. John Jemmott, University of Pennsylvania, Director, Center for Health Behavior & Community Research.
Making Proud Choices! is designed to increase knowledge about HIV, other STDs, and teen pregnancy prevention among African Americans in middle school. It also teaches participants that condom use is one important prevention strategy.
Population Served and Setting
This program is for Young African-American, Hispanic, and White adolescents, ages 11-13, who attend middle schools and youth-serving, community-based programs. The program can be implemented in schools or in community organizations.
The program aims to reduce the risk of HIV/STDs and pregnancy among youth. To that end, it stresses abstinence and condom use. After completing the program, youth are expected to have greater knowledge about HIV/STD and pregnancy prevention, better negotiating skills, and reduced risk-taking behaviors.
Nature of Intervention
In the evaluated program, small groups comprised of six to eight teens meet for two four-hour sessions. They watch videos and participated in discussions, games, role-playing, and other exercises. Trained facilitators lead each small group. During the evaluation, adult-led groups had one facilitator and peer-led groups had two. Youth received a stipend to participate in the program and to complete surveys at baseline and at regular intervals after the program ended.
Making Proud Choices! presents abstinence as the best way to avoid HIV, other STDs, and pregnancy. The program also discusses condom use as an important option for reducing risks for sexually active teens. Other key messages are that participants should be proud of themselves and their community and that they should consider how taking risks today could prevent them from attaining their future goals.
Length of program: Making Proud Choices! is held over two days in two four-hour sessions. (The program could also be presented in eight one-hour sessions.)
Size of program: For the program evaluation, teens were randomly assigned to the program (218 participants) or the control group (214 participants).
Components of intervention: The intervention has four components:
- Helping teens define their goals and consider how having sex could prevent them from achieving those goals;
- Increasing knowledge about HIV/STDs and pregnancy;
- Discussing attitudes towards abstinence, HIV/STDs, and pregnancy; and
- Teaching skills for negotiating condom use.
Staffing requirements: In the evaluated program, each group had one adult facilitator or two peer facilitators, all of whom were African American. All adult facilitators had prior experience working with youth, and they received 2½ days of training. Peer facilitators were students from Philadelphia high schools, and they received three days of training on small-group facilitation and leadership and four days of training on how the program operated. An observer monitored the small groups to ensure program consistency.
Making Proud Choices! includes eight lessons:
- Lesson 1 – “Getting to Know You and Making Your Dreams Come True” provides a program overview. Participants develop a set of “group rules” to govern the sessions. They discuss their goals and consider barriers that may stand in the way of achieving them. This session includes discussions of unintended pregnancy, STDs, and HIV.
- Lesson 2 – “The Consequences of Sex: HIV Infection” focuses on the consequences of risky-behavior. Teens watch a video, “The Subject is HIV,” and discuss HIV prevention strategies.
- Lesson 3 – “Attitudes and Beliefs about HIV/AIDS and Condom Use” addresses how HIV is transmitted and how to prevent transmission. Teens watch a video, “AIDS Not Us,” and perform a role-playing activity, “Tell it to Tanisha—AIDS Information Hotline,” where they offer solutions to “callers” who have questions about HIV.
- Lesson 4 – “Strategies for Preventing HIV Infection: Stop, Think & Act,” encourages teens to make safe choices regarding sex so they can reduce their exposure to HIV. Facilitators show two video clips, “Nicole’s Choice,” and “Jesse,” to prompt discussion about the importance of thinking about situations before taking action. In another activity, “AIDS Basketball,” participants score points when they correctly answer questions about HIV/AIDS.
- Lesson 5 – “The Consequences of Sex: STDs” explains how STDs affect peoples’ lives. Teens watch a video, “The Truth about Sex,” and play “The Transmission Game,” which emphasizes how easily someone can contract an STD. Participants discuss their attitudes about risky sexual behavior and contraceptive use.
- Lesson 6 – “The Consequences of Sex: Pregnancy” clarifies “myths” and “facts” about pregnancy. The teens also discuss available methods of birth control and attitudes toward contraception use.
- Lesson 7 – “Developing Condom Use Skills and Negotiation Skills” teaches participants how to use a condom and to negotiate condom use. Role-playing helps teens learn how to refuse unprotected sex.
- Lesson 8 – “Enhancing Condom Use Negotiation Skills” uses role-playing to help teens learn how to resist risky behaviors. A video, “Be Proud! Be Responsible! Negotiation Video Clip,” illustrates negotiation skills.
Making Proud Choices! was evaluated using a random assignment experimental design. The control group received a two-day, four-hour program on general health promotion. Approximately 93 percent of the teens participated in the 12-month evaluation. It tested whether students in Making Proud Choices! reported greater condom use than the control group.
Participants were low-income, African-Americans adolescents in sixth and seventh grades. The average age was 11.8 years, and just over half (53%) were girls. The evaluated program was held in three Philadelphia, PA middle schools in low-income communities.
Instruments and frequency: The youth completed a questionnaire before the program, immediately after completing the program, and at 3-, 6-, and 12-month intervals after it ended.
Outcomes measured: The primary outcomes measured were sexual behaviors and condom use (in the past 3-months), including:
- sexual intercourse (yes vs. no);
- frequency of sex (number of days);
- consistency of condom use (always using a condom during intercourse);
- frequency of condom use (rated on a scale of one [never] to five [always]), unprotected sexual intercourse (yes vs. no), and frequency of unprotected intercourse (number of days of intercourse when a condom was not used).
Twelve months after completing the program, participants reported a higher frequency of condom use (4.2 vs. 3.2 on a scale of one [never] to five [always]) than control group members.
Among youth who were sexually active before the program, those in Making Proud Choices! reported a lower frequency of intercourse (1.3 days vs. 3.8 days), a lower likelihood of unprotected intercourse (9.7% vs. 31.6%), and a lower frequency of unprotected intercourse (.04 days vs. 1.9 days) than teens in the control group. Youth who were virgins at the start of the program did not differ on any of the outcomes measured compared to virgins in the control group.