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Compendium of Evidence-Based HIV Behavioral Interventions

Sistering, Informing, Healing, Living, and Empowering (SiHLE)

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Intervention Description

Target Population
Sexually experienced African American adolescent girls

Goals of Intervention

  • Reduce sexual risk behaviors
  • Reduce sexually transmitted diseases (STDs) and pregnancy
  • Enhance skills and mediators of HIV preventive behaviors (i.e., HIV knowledge, condom attitudes, barriers, and self-efficacy)

Brief Description

The SiHLE intervention is a small group, skills training intervention to reduce risky sex behavior among African–American adolescent females. Through interactive discussions in groups of 10–12 girls, the intervention emphasizes ethnic and gender pride, and enhances awareness of HIV risk reduction strategies such as abstaining from sex, using condoms consistently, and having fewer sex partners. Through the use of role plays and cognitive rehearsal, the intervention enhances confidence in initiating safer-sex conversations, negotiating for safer sex, and refusing unsafe sex encounters. In addition, intervention deliverers model proper condom use skills and emphasize the importance of healthy relationships.

Theoretic Basis

  • Social Cognitive Theory
  • Theory of Gender and Power

Intervention Duration
Four 4-hour sessions delivered weekly on consecutive Saturdays

Intervention Setting
Family medicine clinic

Deliverer
African American female health educator and 2 African American female peer educators

Delivery Methods
  • Demonstrations
  • Group discussion
  • Lectures
  • Role plays

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Intervention Package Information

An intervention package and training are currently being developed with funding from CDC’s Diffusion of Effective Behavioral Interventions (DEBI) project.

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Evaluation Study and Results

The original evaluation study was conducted in Birmingham, Alabama between 1995 and 2002. Of the 522 African–American adolescent girls who participated in the study, 47% had not completed the 10th grade.

Key Intervention Effects
  • Increased consistent condom use
  • Reduced unprotected vaginal sex
  • Reduced number of new sex partners
  • Reduced new chlamydia infections

Study Sample

  • 100% African American
  • 100% Female
  • Mean age of 16 years

Recruitment Settings
Community health agencies

Eligibility Criteria
Participants were considered eligible if they were African American, female, between 14 and 18 years of age, and if they reported vaginal intercourse during the previous 6 months.

Assignment Method
Participants were randomly assigned to one of two groups: SiHLE intervention (n = 251) and a time-equivalent general health promotion comparison intervention (n = 271).

Comparison Group
The general health promotion intervention consisted of four 4-hour sessions that emphasized nutrition and exercise. An African American female health educator and peer educators led the intervention over 4 consecutive Saturdays.

Relevant Outcomes Measured and Follow-up Time

  • Sexual risk behaviors in the past 30 days and past 6 months (including consistent condom use, condom use at last sex, percent condom protected vaginal sex acts, number of unprotected vaginal sex acts, new vaginal sex partner, frequency of applying condom on sex partner, and frequency of discussing HIV-preventive practices with sex partners) were measured 6- and 12-months post-intervention.
  • Incident STDs (including chlamydia, gonorrhea, or trichomonas infection) were measured during the 12 month follow-up.

Participant Retention

  • SiHLE Intervention:
    90% retained at 6 months
    87% retained at 12 months
  • Health Promotion Intervention:
    90% retained at 6 months
    89% retained at 12 months

Significant Findings

  • Participants in the SiHLE intervention reported significantly greater increases in consistent condom use, percentage of condom-protected vaginal sex acts, frequency of applying condoms on a sex partner, and condom use during last sex over the 6- and 12-month follow-up periods than participants in the comparison intervention.
  • In addition, the SiHLE intervention group reported significantly fewer new vaginal sex partners and episodes of unprotected vaginal sex during the 6- and 12-month follow-up periods than the comparison group.
  • Women in the SiHLE intervention group were significantly less likely to acquire a new chlamydia infection over 12 months of follow-up than women in the comparison group.

Considerations

  • Women in the SiHLE intervention group were significantly less likely to report being pregnant (p<.05) relative to the comparison group at 6 months, but this finding was not sustained at 12 months.

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References and Contact Information

  • DiClemente, R. J., Wingood, G. M., Harrington, K. F., et al. (2004). Efficacy of an HIV prevention intervention for African American adolescent girls: A randomized controlled trial. Journal of the American Medical Association, 292, 171–179.

Researcher: Dr. Ralph J. DiClemente
Rollins School of Public Health, Department of Behavioral Sciences and Health Education
Emory University
1518 Clifton Road NE, Room 554
Atlanta, GA 30322
e-mail: rdiclem@sph.emory.edu

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