2001
We are here to promote self-worth for the girls, especially self-esteem to empower them to make good and healthy decisions for the future.-- Keleigh Matthews, Metro TeenAIDS, Washington, D.C., 2000
We believe that empowering gay youth and building a strong gay community are as important to HIV prevention as teaching them how to use condoms.
-- Gay City, Seattle, Washington, 2001
Communities affected by AIDS also have great strengths. One of the most important strengths is the presence of ordinary people who are willing to help in the fight against AIDS. . . . Interventions developed and carried out not just by professionals but in concert with community members themselves have great potential because they are owned by community members and draw upon their power through the strengths of its people.
-- Jeff Kelly, 2000
Community-based organizations, often in partnership with researchers, grantmakers, and government, are developing innovative HIV prevention programs for youth. This chapter describes several CBO programs and one state health department initiative that translate findings from prevention science into behavioral and community-level interventions for adolescents and young people. Each of the programs highlighted features peer education or social marketing -- two approaches that have been shown to be especially effective with young people -- or combines both strategies.
Gay City's holistic approach to HIV prevention addresses the causes of unsafe behavior, blending grassroots organization, culturally relevant marketing, and empowerment theories to nurture a culture in which gay and bisexual men see their lives as worth living. Gay City creates a variety of innovative ways to do this, including gay summer camp and community forums that attract large, diverse audiences, one fourth of whom are men under age 25. Gay City's HIV prevention programs are constructed from several science-based theories of mass behavior change, including empowerment education (Freire), social marketing (Kotier and Roberto), and diffusion of education (Kelly).
Queercore's goal is to empower young gay and bisexual men to take control of their own lives, health, and future. Rather than offering "HIV 101," Queercore wants to connect young men with others in the community, creating a friendly space to meet new people and make new friends and providing alternatives to the "mainstream gay scene" in Seattle. Retreats, film nights, forums, "Coffee Talks" and other informal discussion nights, and even camp -- which Queercore describes as "a weekend of fun, creativity, and bonding in the bush" -- all provide social alternatives to bars.
Other Queercore activities have included "The Dish," a talk show held at the Broadway Performance Hall at Seattle Central Community College, which used true stories and invited comments and questions from the audience to raise issues of concern to young gay and bisexual men, such as fetishes of older men and meeting guys in chatrooms. A "Queer and Loathing" forum addressed reasons why many young men who know the facts are still having unsafe sex that puts them at risk for HIV and STDs.
Queercore also performs theater pieces at local theaters, including "Fruit Cocktale," a full-length piece in 1999 dealing with interracial dating. The success of "Fruit Cocktale" stimulated interest in the arts among Queercore participants, which resulted in the creation of "Spout," a Web site area that Queercore describes as a "space for gay and bi guys in Seattle under 30 to express themselves through the written and visual arts."
All of Queercore's materials and programs use the vocabulary and communication styles of the young men they want to reach, the kind of frank, targeted approach that characterizes effective HIV prevention. One Queercore outreach flyer to young men reads:
"Today, one young Seattle queer will get infected with HIV. Will it be you? Will you pass it on? Do you even care? Queercore is young fags, queers, bi-guys and gay boys taking action to make this STOP! AIDS is not inevitable. We can change our behavior. We can change our community."
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Evaluation Gay City evaluates its events and activities in a variety of ways. Survey data from post-event questionnaires indicate that 70 to 80 percent of participants feel more pride in and connection to the gay community, while 70 to 90 percent report an increased commitment to protecting their health. A random follow-up telephone survey found that in the two weeks following an event, participants, on average, discuss the information presented with eight other people. Annually, that means that in addition to the 2,400 people reached directly by Gay City events, an additional 19,000 are indirectly reached. Contact George Froehle |
Sisters for Life, targeted to girls between the ages of nine and 14, is a mentoring program serving three public housing communities in Alexandria, Virginia. The program builds the life skills of African American girls, supporting their efforts to develop into healthy, responsible adults who avoid HIV infection, substance abuse, STDs, and other negative consequences. Based on the black sorority model and the seven Kwanza principles, Sisters for Life teaches girls that they have the power to make healthy decisions. It promotes academic accomplishments, as well as self-worth and self-esteem. Girls are offered guidance through homework and tutoring workshops, lectures by peers and elders in the community, and retreats and other small group interactive activities.
Sisters for Life addresses risks surrounding HIV/AIDS indirectly, concentrating on supporting the girls as maturing youth and addressing high-risk behaviors in the larger context of the girls' lives. Each year, girls who complete the Sisters for Life program take part in a ceremony based on African rites of passage that welcomes graduates into the realm of sisterhood.
Project Lifeguard is Metro TeenAIDS's peer-led support program for youth at high risk in the Metro Washington, D.C. area, with three local drop-in centers -- The STOP in Virginia, Freestyle in D.C., and The HOUSE in Maryland, each tailored to the needs of neighborhood youth. Lifeguard conducts case finding and outreach to troubled adolescents, provides prevention case management, organizes recreational activities, and offers both peer-support groups, such as Sister to Sister and Protecting Our Brothas and Sistahs, and professional-led groups, such as Alcoholics and Narcotics Anonymous and teen mother groups.
The centers, open during weekday after-school hours, combine HIV prevention information with general health education, skills building, and empowerment tools. They share a goal of making it possible for youth to express themselves while having fun and to learn to make informed, healthy decisions. Center activities may include small group sessions, community empowerment projects, art and other creative endeavor workshops, field trips, sports, discussions with guest speakers, and psychoeducational skills empowerment. The STOP, for example, offers a job preparation course focused on producing a resume and developing interview skills.
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Evaluation Metro TeenAIDS uses an external evaluator to measure the outcomes of its prevention programs. Evaluation data document that Metro TeenAIDS reaches 35,000 youth annually with community/street outreach, peer education, and both individual and group interventions. Sixty percent of these young people are male; 40 percent are female. Seventy-six percent are African American, 7 percent are white, 12 percent are Latino, and 5 percent describe themselves as "other." Almost two-thirds are 16-18 years old; 21 percent are 13-18, 9 percent are 19-21, and 5 percent are 22-24. Metro TeenAIDS' risk assessment survey shows that 90 percent of the 35,000 youth served each year have at least one risk factor. On site group-level interventions are evaluated using the Knowledge, Attitude and Behavior (KAB) Survey, which is administered on a client's first day and at three-month intervals. After one year, youth demonstrate an 85 percent increase in knowledge about HIV prevention, a 50 percent change in attitude, and a 25 percent change in risky behavior. Off-site group-level interventions are evaluated with a pre- and post-test survey. After a six-session series, participants demonstrate an 80 percent increase from pre- to post-test. Contact Keleigh L. Matthews |
MAPP works with school and community organizations to develop and implement its peer education programs, first selecting teen educators and then training these young people to provide HIV prevention information to their peers. MAPP also counsels teachers and school counselors. MAPP advises other CBOs to get youth invested in HIV prevention programs by encouraging them to have as much input into program design and implementation as possible.
MAPP employs a variety of behavior-based workshops, outreach projects, theater programs, and educational programs to reach young people. Alaye -- Yoruba for "Fit to Be King" -- is a MAPP program targeted toward African American youth from 13 to 24 years of age. Alaye emphasizes self-esteem, self-reliance, communication skills, and relationships to help young men make safe and healthy decisions and lead healthy lives. The program is presented over three sessions at local Detroit youth service agencies. MAPP's theater program, "The Many Faces of AIDS," is a 90-minute eight-vignette play shown to students and teachers in school auditoriums, using live theater to help both teens and their teachers understand AIDS. Among the topics covered in the vignettes are: myths and mysteries, Joe Condom, still a virgin, getting tested, AIDS wears many faces, double trouble, what men will say to get what they want, and the news that no parent wants to hear. A discussion period led by a MAPP AIDS education specialist follows the play.
Through its Teen Leadership Corps (TLC), MAPP trains popular teens to serve as endorsers of HIV risk reduction to their friends. TLC translates CAIR's prevention science research on opinion leaders into a program designed to change social norms among teenagers. Teens identified as popular and influential within their social network are chosen to participate in TLC. They learn basic information about HIV and other STDs, substance abuse, ways to assess risk, practical strategies for changing risky behavior, and ways to communicate with peers. The most important prevention messages that TLC opinion leaders deliver to their peers are that unprotected intercourse is not what teens do today, and that there are many ways to safely express sexuality.
Teen ADAPT is MAPP's youth version of its Alcohol and Other Drug Abuse Prevention Training (ADAPT) program. ADAPT was developed to increase the gay, lesbian, bisexual, and transgender population's awareness of the link between drug abuse and increased risk for HIV and other negative outcomes, as well as to increase their ability to get substance abuse services that are sensitive to their needs as a community. Teen ADAPT combines social marketing and peer education approaches to reach this population of teenagers, including opinion leader trainings and a media campaign. An easy-to-use Teen ADAPT field guide offers teen peer educators ideas for starting conversations, signs of substance abuse, barriers to safer behaviors for teens, and other resources. The media campaign, "Out. Proud. Sober." uses posters, postcards, and print advertising to advise youth to "Rebel against the people who want you to stay in the closet, and rebel against those who are trying to talk you into experimenting with alcohol or drugs."
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Evaluation Since it was founded in 1988, MAPP has distributed over a million AIDS education materials and condoms to more than 300,000 people. Until recently, MAPP's evaluation focused on counting services and other documentation measures, as well as on post-event satisfaction measures, which show a high level of satisfaction with services. Recognizing the need for pre- and post-event evaluation, MAPP is now working with the Michigan Department of Community Health to develop these outcome measures. Contact Andrew Yee |
With funding from the CDC, Huckleberry Youth Programs was one of the first community-based organizations in the U.S. to develop an adolescent peer counseling HIV prevention program. Huckleberry recruited youth from their target population and trained them to provide HIV prevention information and materials through street outreach and through presentations in the schools and the community. These peer educators were recognized by the National AIDS Commission.
Huckleberry Youth Programs is committed to decreasing high-risk behavior among youth and empowering them to make healthy choices in their lives. Huckleberry does this by creating safe and friendly places for youth, increasing their knowledge of health issues and awareness of HIV/AIDS, providing care, serving as a resource as needed, creating opportunities for youth to work towards self sufficiency, and educating peers. Huckleberry serves primarily multi-ethnic inner-city adolescents in San Francisco, including both in-school and out-of-school youth. The majority are at high risk for homelessness, substance abuse, and STD's -- including HIV infection.
Huckleberry's HIV prevention peer education initiatives began in 1988 and have been adapted and revised over the years. Huckleberry works with the Violence is Preventable (VIP) Girls Collaborative and the Highway 101 Program, which serves youth living in shelters. Among Huckleberry's current peer education interventions are group sessions that run from one to six sessions in length, covering HIV/AIDS risk prevention, negotiating safer sex, and setting limits and boundaries. At the Huckleberry Teen Health Program at Montecito Plaza in San Rafael, these peer-led workshops are provided in middle and high schools, through street outreach, and in community sites such as Planned Parenthood. Creating access to reproductive health care for at-risk youth through linkages to community-based clinics is an essential component of the Montecito Plaza peer education programs.
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Evaluation In 2000, the Huckleberry Youth HIV/AIDS Prevention Program at Cole Street Clinic reached 287 youth through individualized peer education encounters, 304 youth through multi-session groups, and 591 youth through outreach efforts. The Huckleberry Teen Health Program at Montecito Plaza reaches over 2,000 youth each year. Benefits to the youth and community include increased awareness of HIV/AIDS and prevention methods and, for the youth, the opportunity to learn and talk in a comfortable, supportive setting. Huckleberry does not yet have outcome measures for long-term behavior change, but the California Wellness Foundation recently invested $400,000 in an independent evaluation of Huckleberry Youth Programs at Cole Street Clinic to provide behavioral outcome measures and to determine their potential as a national model. Contact Alexandra Hails |
The BASE Program is founded on four principles:
BASE works by helping high school students foster positive peer pressure that promotes healthy decision making and discourages HIV risk behaviors. BASE operates as a grantmaking program, with a student-designed and led process for soliciting and funding proposals from other students for innovative prevention projects. The projects address adolescent health issues, primarily HIV prevention, sexuality, peer pressure, STDs, and drug and alcohol abuse prevention. A student advisory committee writes and issues requests for proposals, coordinates a bidders conference with high schools and community agencies to help students write up their project ideas, and -- working with foundation representatives and AIDS service providers from the community -- decides which projects will be funded, with a funding level of up to $1,000 per project. The committee also reviews past projects and evaluates their effectiveness.
Successful student projects have included talk-show format videos, interactive theater presentations, support groups, posters and murals, T-shirts, buttons, comic books, health fairs, conferences, mobile van displays, school assemblies with guest speakers, awards and scholarships, and community service projects. In Kansas City, a BASE project raised awareness among their peers about the consequences of unprotected sex by organizing a student HIV testing campaign with the Kansas City Free Health Clinic. In the previous year, only 169 teens were tested at the clinic all year; the BASE campaign resulted in 112 students being tested in two months. Nine high schools in the Kansas City area now participate in BASE.
Some projects take on a life of their own, as did a BASE project at Monroe High School in the Bronx where a student-run AIDS awareness conference became an annual event. The Teen-to-Teen HIV/AIDS Peer Education Conference is so popular that it is now open to all public high school students in New York City. In at least one school, the BASE team grew beyond a focus on HIV prevention alone. At the LAB school, BASE now encompasses three additional causes: Free Tibet, Stopping Sweatshops, and Stop the Hate. Folding HIV prevention education into other causes popular with and important to youth can reduce the stigma often associated with HIV prevention messages and help ensure its acceptability to young people.
With as little as $7,500, a community-based organization can start a small peer grants program along the lines of the BASE Program. CBOs also can partner with their local public school system to help them develop a BASE program, providing community expertise for evaluating student HIV prevention proposals.
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Evaluation An independent external evaluation of the BASE Grants Program demonstrated the following key findings:
Contact Azadeh Khalili |
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Evaluation One way to evaluate social marketing campaigns is in terms of the number of messages that reach the target audience. In 2000, the Lowrider events reached tens of thousands Latino youth at over 12 venues. For every dollar in on-radio air time purchased for the Rap It Up campaign, the Office of AIDS received over six dollars in value, and the promotion delivered over 18 million gross impressions, effectively reaching large numbers of African American and Latino youth in high-risk circumstances. Contact Harold Rasmussen |