Circle of Life (COL) is a school-based HIV prevention program, developed specifically for American Indian and Alaska Native middle school youth, that uses culturally meaningful messages based on the Medicine Wheel to increase knowledge about HIV, reduce risky sexual behaviors, and delay the onset of sexual activity. Overall, those who received COL scored statistically significantly higher on knowledge questions than the control group at the 3 month follow-up. Knowledge impacts were found for boys and for teens 13 and older. For students ages 10-12, those in the COL group were found to delay sexual activity. No impacts on sexual activity were found for other students. No impacts were found for condom use.
DESCRIPTION OF PROGRAM
Target population: American Indian/Alaska Native middle school youth
Circle of Life (COL) is a school-based HIV prevention program, developed to address the dearth of interventions for American Indian and Alaska Native middle school youth. COL uses culturally meaningful messages to increase knowledge about HIV, reduce risky sexual behaviors, and delay the onset of sexual activity. Qualified community members are hired and trained to teach the 30 hour course during a school year. The curriculum is based on the learning approaches of American Indian and Alaska Native people while integrating theories of behavior change, including social cognitive theory and theory of planned behavior. The curriculum uses the Medicine Wheel, a traditional symbol and embodiment of American Indian and Alaska Native epistemological approaches. The Wheel is divided into four equal parts representing the physical, spiritual, mental, and emotional aspects of life, with volition at the center. The curriculum is an HIV and STI prevention intervention that includes safer sex materials, presented in age appropriate ways.
EVALUATION OF PROGRAM
Evaluated Population: 7th and 8th grade students of a Northern Plains Tribe in a remote and rural area
Students in 7th and 8th grades from all 13 Northern Plains Tribe schools (4 public, 2 private, and 7 federally operated or contracted) participated in the study. Enrollments ranged from 9 to 228 middle school students. To participate in the study, students had to be attending seventh or eighth grade at a participating school, have parental consent, and themselves give written assent. Students’ ages at the start of COL ranged from 11.9 to 17.3 years, with 94 percent between 12 and 14.
Approach: The 13 schools of the Northern Plains Tribe were randomly assigned to receive the COL training during the study period, or were placed on a wait list to receive COL within 12 months. Six schools were assigned to receive COL training in the first year. The regular curriculum was taught at schools that did not receive COL. At baseline, 541 seventh and eighth graders completed the initial survey. At the community’s request, students who enrolled after the start of the study were allowed to participate, with the result that 635 youth contributed at least one survey.
Data were collected before COL was implemented in the fall semester, and then again at 3 and 12 months after baseline. Knowledge of HIV/STI risk was assessed using a series of 12 questions that measured the accuracy of students’ knowledge about HIV/STIs. Data were adjusted for clustering at the school level. There were no statistically significant differences between the groups at baseline.
Results: The study found that random participation to COL significantly increased HIV knowledge in the short term, particularly for boys and for older students. Overall, those who received COL scored statistically significantly higher on knowledge questions (B = 0.718) than did the control group at the 3 month follow-up.
COL was found to delay the onset of sexual activity, with the greatest risk reduction for those receiving COL at an earlier age. Students who received COL when they were 10-12 years old had a statistically significant lower probability of sexual onset compared with those who received COL when they were older and those who did not receive it at all. No impacts on condom use were found.
SOURCES FOR MORE INFORMATION
For further information:
Carol E. Kaufman
Centers for American Indian and Alaska Native Health
Colorado School of Public Health
University of Colorado Anschutz Medical Campus
13055 E. 17th Avenue
Aurora, CO 80045
Kaufman, C.E., Whitesell, N.R., Keane, E.M., Desserich, J.A., Giago, C., Sam, A., Mitchell, C.M. (2014). Effectiveness of Circle of Life, an HIV-Preventive intervention for American Indian middle school youths: a group randomized trial in a northern plains tribe. American Journal of Public Health, 104/6, e106-e112.
KEYWORDS: Children, Adolescents, Middle School, Males and Females (Co-ed), American Indian/Alaska Native, School-based, STD/HIV/AIDS
Program information last updated on 12/4/2014.