Program

Sep 01, 2016

OVERVIEW

Becoming A Responsible Teen (BART) is an HIV-prevention program designed for African-American high school students. The program combines HIV education with behavior skills training. A 1995 study found that the program decreased the frequency of sex among sexually active youth and delayed sexual activity among youth who had never had sex when they entered the program. Further, the program reduced unprotected intercourse, and increased condom-protected intercourse, sexual communication skills, and knowledge about HIV/AIDS. Another study found impacts for Haitian-American youth on HIV/AIDS knowledge, attitudes about and intention to use condoms, self-confidence with safe sex, and condom skills.

DESCRIPTION OF PROGRAM

Target population: Racial-minority adolescents

The BART curriculum consists of eight sessions, 90 to 120 minutes in length, conducted in community settings. These sessions provide students with information on HIV/AIDS, and train them in relevant behavior skills. Skills-training topics include correct condom use, sexual assertion, refusal, self-management, problem-solving, and risk recognition. Abstinence is discussed throughout the curriculum, and is identified as the only sure way to prevent HIV-acquisition. Program participants are expected to leave the program equipped, not only to make sound choices for themselves, but also to “spread the word” about HIV/AIDS to their friends. Program activities include games, role-playing, discussions, and video-watching.

An adaption of the program, BART-A, has been developed for Haitian-American youth. The adaption includes components that cover several topics: risk education, “triggers” for unsafe sex, condom-use practice, sexual negotiation and refusal, problem-solving to manage risky situations, risks in intimate relationships, and behavior change maintenance. Role-plays use culturally appropriate terms and gender-roles, and the curriculum focuses on developing assertive communication styles over either passive or aggressive styles.

EVALUATIONS OF PROGRAM

St. Lawrence, J.S. et al. (1995). Cognitive-behavioral intervention to reduce African American adolescents’ risk for HIV infection. Journal of Consulting and Clinical Psychology, 63(2), 221-237.

Evaluated population: The study included 246 African-American adolescents between the ages of 14 and 18. Their mean age was 15.3 years. All were patients at a health center in a low-income urban area of Mississippi in the mid 1990s. The majority of participants (72 percent) were female.

Approach: All study participants completed baseline measures assessing their sexual behaviors, attitudes, and knowledge. They also engaged in simulated role-play assessments designed to evaluate their assertion skills and ability to provide information to peers.

After completing these measures, students were randomly assigned to either a control educational program that met one time, or an eight-week implementation of the BART curriculum. The control program consisted of a single, two-hour class on HIV/AIDS. This single-session class was designed to be interactive and culturally appropriate, but was not as sexually explicit as BART and did not include behavior skills training. Group sizes for both interventions ranged from five to 15, and all groups were led by two co-facilitators – one male, one female.

Study participants were reassessed on all measures, and again engaged in role-play assessments two months after baseline (upon the completion of the BART intervention). Participants’ sexual behaviors, attitudes, and knowledge were again assessed six and 12 months after this initial follow-up assessment.

Results: As measured by performance in role-play assessments, participation in the BART program had a positive impact on adolescents’ ability to skillfully handle coercive situations and to provide information to peers. Compared with students assigned to the education-only intervention, students assigned to the BART program were significantly more successful communicators in post-intervention role-plays.

Students assigned to the BART program had greater knowledge of AIDS upon completion of the intervention. This difference remained significant through the 12-month follow-up.

At the 12-month follow-up, students assigned to the BART program were engaging in less frequent unprotected vaginal intercourse than students assigned to the education-only intervention. Further, unlike students assigned to the education-only intervention, students assigned to the BART program had discontinued engaging in unprotected anal sex altogether at this point.

Among those students who were sexually active during the two months before the study began, 42.5 percent of students assigned to the education-only program reported being sexually active at the one-year follow up, whereas 27.1 percent  of students assigned to the BART program reported being sexually active. And, among those students who reported never having had sex prior to their commencement of the program, 31.1 percent of students assigned to the education-only program had become sexually active, whereas only 11.5 percent of students assigned to the BART program reported having engaged in any sexual activity. Thus, the program was successful not only in significantly lowering the rate of sexual activity among sexually active students, but also sin delaying the onset of sexual activity for students who were not sexually experienced when they entered the program.

Malow, R. M., Stein, J. A., McMahon, R. C, et al. (2009). Effects of a culturally adapted HIV prevention intervention in Haitian youth. Journal of the Association of Nurses in AIDS Care, 20(2), 110-121.

Evaluated population: The study was conducted with 246 adolescents, ages 13 to 18, who had a parent or grandparent from Haiti, and who were living in the “Little Haiti” and North Miami areas of Miami-Dade County, Florida. The average age of participants was 15.5 years, with 15 percent in the 7th or 8th grade, 56 percent in the 9th or 10th grade, and the remaining 20 percent in the 11th or 12th grade. Seven in ten of the participants were female. The majority of participants (87 percent) reported that their primary language was English, but that they spoke French or Creole at home.

Approach: Participants were assigned to treatment groups using a randomized block design. Four-week admission cohorts were randomly assigned, 145 to participate in BART-A, and 101 to the control program. Both programs consisted of eight weekly 90-minute sessions, in a group of four to eight adolescents of a single gender, generally led by male and female co-facilitators.

The control intervention consisted of a class that covered basic prevention of various diseases that are disproportionately common among racial minority populations. The class consisted of videos and group discussions and activities, and basic information on HIV was presented in the first session.

Outcome measures included knowledge about HIV, attitudes about condoms and intentions to use them, safe-sex efficacy (belief that they would be able to practice safe sex under different scenarios), and a test of condom skills using a model. Variables were measured before the intervention, and again a month after the intervention was completed.

Results: At post-test, the BART-A intervention was found to have significant impacts on all measured variables. There were large positive impacts on condom skills, safe-sex self-efficacy, and attitudes toward condom use. Smaller, but still positive impacts were found on intentions to use condoms and HIV/AIDS knowledge.

SOURCES FOR MORE INFORMATION

Manual available for purchase at http://pub.etr.org/ProductDetails.aspx?id=270000&prodid=R515

References:

St. Lawrence, J. S. et al. (1995). Cognitive-behavioral intervention to reduce African American adolescents’ risk for HIV infection. Journal of Consulting and Clinical Psychology, 63(2), 221-237.

Malow, R. M., Stein, J. A., McMahon, R. C, et al. (2009). Effects of a culturally adapted HIV prevention intervention in Haitian youth. Journal of the Association of Nurses in AIDS Care, 20(2), 110-121.

KEYWORDS: Adolescents, youth, males and females, high-risk, black/African American, Community-based, manual, skills training, after-school program, sexual activity, STD/HIV/AIDS, condom use and contraception.

Program information last updated on 9/1/2016.