Some innovative ideas for preventing HIV

Educators meet women on their turf

Clinicians, AIDS service organizations, and public health officials who are looking for new strategies for reaching African-American women through HIV prevention programs might find useful ideas in how two very different programs handle HIV education.

SisterLove Inc. of Atlanta, started its Healthy Love prevention program informally through a support group for black women, says L. Nyrobi Moss, MA, program coordinator.

"We’ve been doing Healthy Love from the beginning, but it just formalized itself over the years," she says.

The Good Samaritan Project in Kansas City, MO, has HIV prevention and intervention programs for African-American women that draw on the knowledge and experiences of Jean Johnson, an outreach coordinator who also is African-American. "A lot of these ideas are my ideas because I’m African-American, and I know how to communicate with people who look like me," she says. "I place a lot of emphasis on African-Americans with HIV because that’s where HIV is now."

Johnson goes to where she’s most likely to find African-American women, including day care centers, homeless shelters, beauty shops, and African-American bars.

Moss and Johnson describe their different prevention/intervention programs:

• HIV/AIDS 101.

This interactive program developed by SisterLove creates a safe environment in which participants will discuss HIV, sexually transmitted diseases (STDs), and reproductive issues, Moss says. "We talk about risk assessment, saying, Here’s an activity, and where do you stand on high, medium, and low risk?’ We do condom demonstrations with both the female and male condoms."

SisterLove coordinators visits for groups of women who gather at college dorms or in other casual settings. In the context of a party environment, coordinators discuss safer sex in an erotic context, she explains. "We show it can be erotic and sexy and fresh and new when you pick up a condom. We teach women how to put a condom in their mouths."

Moss says she will amaze the women participating in the program by facilitating the whole session with a condom in her cheek, then she will demonstrate how to put on the condom, using a phallic model.

Although the education session may deteriorate into a sorority-type of laughing and shrieking match after this demonstration, it gets the young women’s attention and greatly demystifies condom use and safe sex behavior, she explains.

• Freebies for HIV testing.

Johnson never advertises HIV testing, instead marketing HIV services through the incentives of free bus passes, free gift certificates, etc.

"I use the word free’ a lot because that draws attention," she notes. "We give women a $2 bus pass to get tested for HIV, and then we give them another $5 for getting their test results."

Johnson passes out HIV educational material in African-American bars and will leave condoms in the restrooms.

HIV fliers make it clear that HIV is a risk factor in the community and that HIV testing will be free and confidential. Since women sometimes will object to going to a specific clinic for testing because they know someone who works there, Johnson provides information about different testing locations and she hands out bus passes whenever transportation is an issue.

Likewise, when a woman tests positive for HIV, Johnson offers financial incentives to encourage the woman to make all of her initial doctor’s appointments. For each doctor’s appointment that a woman attends, she receives $20 in gift certificates to restaurants and companies of her choice, she says. These incentives are given out for the first five visits for a total of $100.

Johnson says that CD4 cell counts and viral load counts have improved for all of the women who have completed their five doctor’s visits through the incentive program. When they are finished with the five visits, she sends them a letter that thanks them for participating in the program and says, Hope you’re keeping scheduled medical appointments and staying healthy.’

• Sex and candy game.

When showing groups of women why they might be at a greater risk for HIV than they imagine, Moss often uses a game that simulates transmission of sexually transmitted infections (STI)s.

She will hand out pieces of candy that have numbers written on the wrappers. Each number corresponds to a specific disease. Participants are told to not eat the candy, but to swap candy with other participants. When they’re finished swapping their candy, Moss says they can eat the candy, saving the wrapper. Then she displays a board that describes each disease and the number representing it.

"I use this as an analogy for how STIs are shared," she explains. "Then we go through a discussion of what each STI is." The idea is to show how STIs can be transmitted from one person to another without the original person knowing that he or she has it. This type of game also helps to make the group more comfortable and serves as an icebreaker, Moss adds.

• Color swap game.

This game demonstrates HIV transmission through the use of color swaps that have people’s names on them. Using Post-it notes, Moss gives each person a red, green, and orange piece of paper and asks them to write their names on each piece.

"Then we come into a room and I say we’re going to swap, and the object of the game is to get rid of your name on your three Post-it notes," she adds. "So I swap and stick my notes on people and they stick on me."

When the color swapping is done, Moss asks people to take the notes off their bodies and look at the Post-it notes they have. She tells them that if they have a red note then that means they participated in safe activities like going to the movies or giving a boyfriend a massage.

If they have a green Post-it note, then everybody who has a green note has practiced safe sex during each sexual encounter, Moss adds. But if they have a blue Post-it note then they have participated in unsafe sex, she says.

"Then I say, I have a confession to make: I’m HIV-positive, and I went to the doctor and my gonorrhea is acting up, and I slept with anyone who has a blue Post-it and put it on me,’" says Moss, who is not HIV-positive.

Next, she has the people with blue Post-its to read the names of the people on those until everyone who has been connected through a blue Post-it back to Moss is standing. "Then there are maybe 30 people standing out of 50 people, including myself. And this is how the spread of the virus happens — the one time you didn’t use safe sex."

• Sassy and Safe and outreach programs.

The Good Samaritan Project has begun plans for a community party in its parking lot, Johnson says.

Called Sassy and Safe, the event will increase HIV awareness in the target population of African-American women between 25 and 44, and it will have a local African-American radio station as host, she says. "It will be about prevention, intervention, and testing — pre- and post-counseling."

Johnson locates churches in areas with increased HIV infection rates, and asks these churches to permit her to hand out fliers on risky behavior. She’ll pay the church a stipend when necessary, and in some cases, she’ll visit the church and give a presentation on HIV and AIDS.

"Some of the ministers are very open and say to go all the way — talking about how to use condoms," she notes. "Some will set up women in one prevention class and men in another and teens in another."

When churches are less open to detailed information about safe sex, Johnson will present statistics and information about why HIV is spreading so quickly in the African-American community, including information about men on the down low, men coming out of prison, and people having more than one partner while in a relationship, she explains.

Future programs may include providing HIV prevention information to barber shops, where Johnson says she hopes to reach men who identify themselves as straight and to convince them that AIDS is not just a gay, white man’s disease.

• Empowerment and Healthy Love programs.

Since the reality is that many women are not in a position to demand that their sexual partners use condoms, Moss teaches women negotiation skills through an empowerment program.

"We teach assertive behavior, using I’ statements," Moss says. "The example I use is how I want a lovely ring from my husband, and one month I’ll say to him that there’s a really nice ring that would be fabulous, and then another time I’ll tell him that the ring is on sale."

The idea is to plant seeds for the behavior that the women wish to influence, Moss explains.

"A woman in an abusive situation maneuvers things every day," Moss says. "One woman said, Let them think it’s their idea, and that’s ok."

SisterLove’s Healthy Love program is focused on showing women how they are personally responsible for their own health and choices, Moss says.

"I will go into groups of black upper-middle class women, who will say, I’ve been married for 10 years, and I make sure I tell my kids about safe sex; but I don’t have to worry about that because I’ve been married for 10 years,’" Moss recalls. "So we play a trip down memory lane game with oldies and goodies."

Moss will play a record of an old song and suggest that women think back to when they were young and wild and free, and she will play a song to bring back these memories. Then while playing the song, she’ll ask how many women have had unprotected sex while listening to this song, and when women raise their hands to the various songs, she’ll explain that the incubation period for AIDS is up to 15 years.

[Editor’s note: Moss trains HIV facilitators to use the various HIV prevention programs. For more information, contact Moss at (404) 753-7733 or visit the web site at www.sisterlove.org.]