Becoming a Responsible Teen (BART)
An HIV Risk Reduction Program for Adolescents

• Curriculum Overview
• Curriculum Objectives and Lessons
• Unique Features of the Curriculum
• Theoretical Framework of BART
• Research Results at a Glance

Becoming a Responsible Teen: An HIV Risk Reduction Program for Adolescents
(BART) is an HIV prevention curriculum designed primarily for African-American adolescents, ages 14-18, in non-school, community-based settings. It consists of eight sessions, 1.5 to 2 hours each, and includes interactive group discussions and role plays that have been created by teens. Teens learn to "spread the word" to their friends about HIV risks. They are encouraged to practice skills outside the group and share the results. The group provides creative solutions to reported problems.

Although the focus of BART is HIV/AIDS prevention, the curriculum includes topics and activities relevant to teen pregnancy prevention. Teens learn to clarify their own values about sexual decisions and pressures as well as practice skills to reduce sexual risk-taking. These include correct condom use, assertive communication, refusal techniques, self-management, and problem solving. Also, abstinence is woven throughout the curriculum and is discussed as the best way to prevent HIV infection and pregnancy.

BART has been used in a variety of settings with youth from different cultures.

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Youth who participate in BART will be able to:

• State accurate information about HIV and AIDS, including means of transmission, prevention, and current community impact.
• Clarify their own values about sexual decisions and pressures.
• Demonstrate skills in correct condom use, assertive communication, refusal, information provision, self-management, problem-solving, and risk reduction.

BART is comprised of the following eight sessions:

Session 1: Understanding HIV and AIDS
Session 2: Making Sexual Decisions and Understanding Your Values
Session 3: Developing and Using Condom Skills
Session 4: Learning Assertive Communication Skills
Session 5: Practicing Assertive Communication Skills
Session 6: Personalizing the Risks
Session 7: Spreading the Word
Session 8: Taking BART with You

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The features that distinguish BART from other HIV prevention curricula are:

• Teens had an active role in developing all aspects of the curriculum.
• It focuses on the needs of African-American adolescents, aged 14-18.
• It was implemented in non-school, community-based settings.
• It was designed to be used with gender-specific groups, each group facilitated by both a male and a female group leader.
• It has been demonstrated to be effective with both sexually experienced and sexually abstinent youth.

BART is based on Social Learning Theory and Self-efficacy Theory. These theories are reflected in BART in four major ways:

• First, information is provided that increases adolescents' knowledge and their awareness of risk.
• Second, training is provided in the skills adolescents need to translate the information into action.
• Third, adolescents are given opportunities to practice and receive corrective feedback, using skills in a safe environment with their peers before they face the challenges of using them in risky situations.
• Fourth, social support is provided for the desired behaviors, to help make them the norm in the outh's social environment.

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Intervention

African-American adolescents, separated by gender, attended eight (8) weekly sessions of a sexuality education program that included behavioral skills training. In addition to information about AIDS and prevention of HIV infection, the youth participated in activities to build skills in correct condom use, assertive communication, refusal, information provision, self management, problem-solving, and risk recognition. Group sizes ranged from 5 to 15, and sessions lasted from 90 to 120 minutes each. Fourteen sets of sessions were conducted over three years in a comprehensive community health center serving predominately low-income minority residents in a Southern urban area of 400,000.

Behavioral Findings

Of the youth who were sexually abstinent prior to the intervention, only 11.5% were sexually active one year later compared with 31% of participants in the control group. Among those sexually active prior to the intervention, 42% of the control group remained so after one year versus only 27% of the intervention group. In comparison to their behavior before the intervention, and in comparison with those in the control group, youth who participated in the intervention were more likely to use condoms and less likely to engage in unprotected vaginal or anal intercourse.

Despite the fact that both groups received the same basic information component, the intervention group scored higher on the AIDS knowledge test than the control group and maintained that lead across the 12-month follow-up period. Moreover, youth from the intervention group were more skillful than those in the control group in handling pressures to engage in unprotected sex and in providing information to peers.

Two hundred forty-six adolescents were randomly assigned either to a control condition or to the experimental intervention. The control condition consisted of a single two-hour session that provided information about HIV/AIDS including its nature, prevention, and impact on the local community. Interactive discussions were interspersed with games, activities, and problem solving. The first session of the experimental intervention was identical to the control condition.

Participants completed questionnaires before, immediately after, and at 6-month intervals for one year after the intervention. Of the original 246 participants, 91.5% completed the 12-month follow-up. Measures included HIV risk, sexual behaviors, self-efficacy, attitude toward condoms, and HIV/AIDS knowledge.

For more information about BART, see the references below:

Fisher & Fisher (1992). Changing AIDS Risk Behavior, Psychological Bulletin 111: 455-474.

St. Lawrence JS, Brasfield T, Jefferson KW, Alleyne E., O'Bannon RE, Shirley, A (1995). Cognitive-behavioral intervention to reduce African-American adolescents' risk for HIV infection. Journal of Consulting and Clinical Psychology 63(2): 221-237.

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