Program

Aug 07, 2014

OVERVIEW

Project IMAGE is a behavioral intervention for African-American and Latina women with a history of abuse and a high risk for sexually transmitted infections (STIs). This small-group intervention is organized around three objectives: recognition of personal susceptibility to STI, commitment to behavior change, and acquisition of STI risk-reduction skills. The intervention is adapted from Project SAFE 2. An experimental evaluation of Project IMAGE among Latina and African American adolescents with a history of non-viral STI and abuse revealed positive program impacts on new STI.

DESCRIPTION OF PROGRAM

Target population: African American and Latina women with a history of STI and abuse.
Project IMAGE is a behavioral-cognitive intervention based on Project SAFE 2. It consists of two small-group, multi-component workshops, each lasting between three and four hours, and occurring a week apart.  The program, which is led by trained female facilitators, involves open discussion, videos, behavior modeling, and role playing. It also includes five optional weekly support groups following the workshops that focus on HIV/AIDs risk; emotional, physical, and sexual risk; gender roles; and love, trust and intimacy. Additionally, individual counseling sessions are available by request, as well as referrals to appropriate help for current abuse. Project IMAGE is a culture- and gender-specific program geared towards minority women.

The program is organized around three components: recognition of personal susceptibility to STI, commitment to behavior change, and acquisition of STI risk reduction skills.  The first component (recognition of risk) involves developing an awareness of minorities’ increased risk for STI; addressing myths about STIs, STI risk, and the selection of sex partners; and improving understanding of personal STI risk. The second component (commitment to change) involves providing the women with information about STIs and STI treatment and well as STI preventive strategies (including condom use, abstinence, mutual monogamy, and reduction in numbers of sexual partners) as well as by developing realistic relationship goals and decision-making skills. The final component (acquisition of skills) focuses on building communication and negotiation skills within the context of sexual relationships, encouraging communication around condom use, identifying triggers to unsafe sex, setting realistic goals, and sharing information within the group.

EVALUATIONS OF PROGRAM

Champion, D. C. & Collins, J. L. (2012). Comparison of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: Results of a randomized controlled trial. International Journal of Nursing Studies, 49(2), 138-150.

Evaluated population: The evaluated population consisted of 559 minority adolescents (342 Mexican-American and 67 African-American women) ages 14 to 18, who were recruited from public clinics at a metropolitan health district in the Southwestern United States.  All of the adolescents enrolled had a history of STI as well as a history of abuse. This sample had a number of other indicators of high risk: more than half had previously been arrested (215), and they had, on average, had seven sexual partners in their lifetime, and three in the past year. Forty-five percent had been pregnant. In nearly one third of cases, the participant had been sexually molested (120).  A large portion of the sample had used drugs – 83 percent had used marijuana, 41 percent had used cocaine, 45 percent had used benzodiazepine, and 13 percent had used heroin.

Approach: After consent was obtained, all participants were re-screened for abuse. If there was an indication of current abuse, they were given information on resources available; if the participants were willing, the interviewer called the appropriate agencies, scheduled an appointment, or even transported them to a battered women’s shelter. A baseline examination on all participants included a physical screening, STI screening, pregnancy testing, and a Pap smear. This was followed by a 1-2 hour interview that included questions on sexuality, substance use, abuse, and mental well-being. Afterward, the intervention was scheduled within the next two weeks. Similar examinations were conducted at 6 and 12 months after the intervention were completed. Medical records for the intervening time were also obtained by consent.

Adolescents in the control group received only enhanced clinical counseling, which included questions on whether they had taken all of their medicine, if they had had sex before completing treatment for their STI, and other questions of similar nature. Along with the enhanced clinical counseling, those in the treatment group participated in two, weekly small-group workshops, each lasting approximately 3 to 4 hours. Additionally, the teens were given the option of attending three to five weekly support group meetings. Participants were provided with a $25 incentive for their participation in the workshops and $15 for their participation in each of the support group sessions.  If requested, the girls were given access to two more individual counseling sessions with the facilitator of their support group, with referrals made as indicated.

Results: At both the six and 12-month follow-ups, intervention participants were significantly less likely to have been infected with an STI than control group members. The intervention was found effective for those with and without a history of sexual abuse, and for those with both low and high rates of drug use.

SOURCES FOR MORE INFORMATION

Program information and curriculum materials available at:  http://www.socio.com/hap10.php

References:

Champion, D. C. & Collins, J. L. (2012). Comparison of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: Results of a randomized controlled trial. International Journal of Nursing Studies, 49(2), 138-150.

KEYWORDS: Adolescents (12-17); Young Adults (18-24); Females Only; High-Risk; Black/African American; Hispanic/Latino; Urban; Clinic/Provider-based; Manual is Available; Skills Training; STD/HIV/AIDs; Sexual Activity; Condom Use and Contraception

Program information last updated on 8/7/14.