Sister to Sister is a one-on-one, 20-minute skill and safer sex intervention designed to provide women with the knowledge, beliefs, motivation and confidence necessary to help them change their behavior in ways that will reduce their risk for STDs, especially HIV. It is also designed to build the self-efficacy and skills to practice these behaviors. Sister to Sister TEEN is an adaptation of the program intended for use with adolescents.
The Sister to Sister HIV Risk Reduction Intervention Project is a one-on-one, 20-minute skill and safer sex intervention designed to provide women with the knowledge, beliefs, motivation and confidence necessary to help them change their behavior in ways that will reduce their risk for STDs, especially HIV. It is also designed to build the self-efficacy and skills to practice these behaviors. Sister to Sister TEEN is an adaptation of the program intended for use with adolescents.
The goal of Sister to Sister is to increase participants’ knowledge of the impact of engaging in risky sexual behavior and build the knowledge and skills to reduce those risks. In particular, the intervention focuses on increasing participants’ confidence and skills in negotiating condom use and ensuring that condoms are used correctly and consistently. The curriculum emphasizes that participants can reduce their risk for STDs by engaging in safer sex behaviors.
Women who participate in Sister to Sister will be able to:
Adolescent women who particpate in Sister to Sister TEEN will be able to:
The Sister to Sister curriculum involves a review of the Participant Behavioral Skills Training Pamphlet, two videos, a condom demonstration, practice with an anatomical correct penis model, and roleplaying. Curriculum activities help women recognize that faulty reasoning and decision-making can increase their risk of HIV infection, understand the adverse consequences of participating in unsafe sexual activities, and identify the positive consequences of safer sexual practices, including abstinence.
Participants engage in activities to increase comfort with condom use and to allay common concerns about the negative effects of condom use on sexual enjoyment and spontaneity, including handling condoms and learning to use condoms correctly. The two brief video clips evoke feelings, thoughts, attitudes and beliefs about HIV infection, AIDS and sexual risk behavior, while highlighting prevention skills. Participants also participate in roleplaying scenarios that allow them to observe, analyze and practice the skills of negotiating abstinence or condom use in a variety of circumstances.
Strategies and methods include:
The Sister to Sister curriculum is designed to be used with women ages 18 through 45 who are attending family planning clinics, or in other communithy settings. Sister to Sister TEEN is designed to be used with adolescent women ages 13 to 18, also in a clinic or community-based setting.
Loretta Sweet Jemmott, PhD, RN, FAAN, is one of the nation’s foremost researchers in the field of HIV/AIDS, STD and pregnancy prevention, with a consistent track record of developing evidence-based sexual risk-reduction interventions. As an expert in health promotion research, she has led the nation in understanding the psychological determinants for reducing risk-related behaviors and how best to facilitate and promote positive changes in health behaviors. Her research is devoted to designing and evaluating theory-driven, culturally competent sexual risk-reduction behavioral interventions with various populations across the globe.
An outstanding translational researcher, Dr. Jemmott’s work has had global impact and changed public policy. She has partnered with community-based organizations, including churches, clinics, barbershops and schools, and transformed her NIH-funded evidence-based research outcomes for use in real-world settings. She has presented her research to the U.S. Congress and at the NIH Consensus Development Conference on Interventions to Reduce HIV Risk Behaviors. Dr. Jemmott has received numerous awards for her significant contributions to the field of HIV/STD and pregnancy prevention research, including the U.S. Congressional Merit Award, Sigma Theta Tau National Honor Society’s Episteme Award and Hall of Fame Award, and election to membership in the Institute of Medicine, an honor accorded to very few nurses.
John B. Jemmott III, PhD, received his PhD in psychology from the Department of Psychology and Social Relations at Harvard University. He holds joint faculty appointments at the University of Pennsylvania as the Kenneth B. Clark Professor of Communication in the Annenberg School for Communication, and as Professor of Communication in Psychiatry in the Perelman School of Medicine. He is also the director of the Center for Health Behavior and Communication Research at the Annenberg School for Communication.
Dr. Jemmott is a Fellow of the Association of Psychological Science, the American Psychological Association and the Society for Behavioral Medicine. He has published more than 100 articles and book chapters, and has received numerous grants from the National Institutes of Health to conduct research designed to develop and test theory-based, contextually appropriate HIV/STD risk-reduction interventions for a variety of populations in the United States and sub-Saharan Africa.
The program is implemented in one 20-minute session.
Core intervention materials include:
The Sister to Sister implementation set for both the adult and teen editions includes the facilitator's guide, a set of 25 participant guides, a set of 3 posters and 1 handout, and a DVD with both film clips. The curriculum requires the use of a monitor with DVD capabilities.
This intervention is designed to be implemented by clinic staff who are comfortable with the program content. It is recommended that staff who will be providing the curriculum complete a 6-hour Sister to Sister HIV Risk Reduction Intervention training session.
Sister to Sister was developed, pilot-tested, implemented and evaluated in a study funded by the grant RO1–NR-03123-01 from the National Institute of Nursing Research. This study was designed to identify the most effective ways to reduce the sexual transmission of HIV among African-American inner-city women.
In a randomized controlled trial, 564 African American women recruited at a Newark, New Jersey, inner-city women’s health clinic were assigned to a 20-minute, one-on-one HIV/STD behavioral skill-building intervention (Sister to Sister); a 200-minute group HIV/STD behavioral skill-building intervention (Sister to Sister group); a 20-minute, one-on-one HIV/STD information intervention; a 200-minute group HIV/STD information intervention; or a 200-minute health intervention control group. Primary outcomes were self-reported sexual behaviors in the previous 3 months; secondary outcome was STD incidence.
Both of the HIV/STD information interventions consisted of a single session delivered by female African-American nurses to increase knowledge about HIV/STD transmission and prevention and personal vulnerability to HIV/STD. The interventions were delivered to groups of women (3 to 5 women per group) or individuals. The intervention lasted 200 minutes for the group format and 20 minutes for the one-on-one format. The intervention activities were similar to those in the Sister to Sister group and individual skill-building interventions, except there was no behavioral skill demonstration or practice.
Women who received the one-on-one and group skill-building interventions reported a greater proportion of condom use during sexual intercourse in the previous 3 months compared with women who received the information interventions at 3-month follow-up, and compared with women who had received either the information interventions or the health control intervention at 12-month follow-up. When asked specifically about the last time they had sexual intercourse, women who received the skill-building interventions were more likely to report using a condom compared with those who received the health-control intervention at 3-month, and compared with either the health control intervention or the information intervention at 12-month follow-up. Skill-building intervention participants also reported less unprotected sexual intercourse than did the information intervention or health-control intervention participants at 3-month follow-up and the information intervention participants at 12-month follow-up. None of the contrasts was statistically significant at 6-month follow-up.
Although there were no differences at 6-month follow-up, women who had received the skill-building interventions were significantly less likely to test positive for an incident STI at 12-month follow-up than were those who received the health control intervention. In addition, the women who received the one-on-one skill intervention were less likely to test positive for an STI than were health control women at 12-month follow-up.
The results demonstrate that culturally sensitive, theoretically grounded, skill-based interventions can reduce HIV-risk-associated sexual behavior and STIs among women. The skill interventions resulted in positive changes on mediators of condom use (hedonistic beliefs, self-efficacy and impulse control), increased self-reported consistent condom use, condom use at most recent sexual intercourse, and reduced reported days on which women had unprotected sex over the entire follow-up period compared with the control group. What the results show is that many women have the potential to be helped by intensive brief individual interventions that provide them with the opportunity for practicing condom use and sexual negotiation skills. This study, with a 12-month follow-up period and excellent retention rates, also showed that nurses are effective in changing sexual-risk-associated behavior.
Jemmott, L. S., Jemmott, J. B. & O'Leary, A. (2007). Effects on sexual risk behavior and STD rate of brief HIV/STD prevention interventions for African American women in primary care settings. American Journal of Public Health, 97 (6): 1034-1040.
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For over 30 years, ETR has been building the capacity of community-based organizations, schools, school districts, and state, county and local agencies in all 50 states and 7 U.S. territories to implement and replicate evidenced-based programs (EBPs) to prevent teen pregnancy, STD/STI and HIV. Our nationally recognized training and research teams work in partnership with clients to customize training and technical assistance (TA) to address the needs of their agencies and funding requirements.
Providers interested in implementing Sister to Sister should be skilled in using interactive teaching methods and comfortable with the program content. It is highly recommended that clinic staff or other educators who will be providing the curriculum complete a 6-hour Sister to Sister HIV Risk Reduction Intervention training session.
Training on Sister to Sister and Sister to Sister TEEN is available through ETR's Professional Learning Services.
ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.
To support a holistic approach to teen pregnancy and HIV prevention programs, ETR offers a number of additional training and technical assistance opportunities, including content-specific workshops, skill-based trainings, organizational development consultation and much more. To learn more about these opportunities, visit our Training & TA pages >>
Adaptation support materials, training and/or TA are available to assist educators in meeting the needs of individual communities by implementing EBPs effectively and consistently with core components. All adaptation support is based on ETR's groundbreaking, widely disseminated adaptation guidelines and kits for effective adaptations.
ETR also provides evaluation support for EBP implementation. ETR uses well-established tools for measuring fidelity and outcomes. ETR's evaluation support blends participatory approaches with cutting-edge evaluation science. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.