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Prevention for WomenMichigan HIV News, Winter 2000 IssuePrevention of HIV infection for women is a very broad issue. And HIV 101 just
doesn't cut it to affect behavior change. Having all the information does not
equate with prevention behavior. Some research even indicates that if the
message is fear-based and the audience does not have the skills or the
self-efficacy to carry out the recommended prevention activity (or inactivity),
programs can actually be detrimental. Other research shows that programs based
on behavior change models that do not consider the change within relationship
aspect peculiar to a woman's psychology will fall short of the desired affect. As a gender women tend to process information through relationship with
others. Yet it is the power structure of some relationships that can put women
at risk. To overcome the barriers and obstacles that can get in the way of
prevention for women, whether the risk is sex or injection drug use, requires
much more than knowing HIV is a health risk and the availability of a sterile
syringe or a condom. The programs that are starting to evolve targeting women are getting at the
important underlying issues and are working with small groups that can provide
support. Some are culturally specific. The best, the ones that will have the
most impact, happen over time allowing for relationships to develop within a
group that will support behavior change. The following Michigan programs are
highlighted here: Sisters and Daughters of Sheba Sisters and Daughters of Sheba sm One Michigan program, that the national Centers for Disease Control and
Prevention (CDC) recognized with an award of funding last year, is the Sisters
and Daughters of Shiba sm program in Detroit,
developed by. Debra Ann Brody, Ph.D. Thanks to the CDC funding, SADOS
moved in February into new offices. The CDC funding has also allowed for
additional staff to expand and carry out the programs which started in 1996. The
program has been supported with grants from the Michigan AIDS Fund (MAF) and the
Detroit Medical Center to target African American women. A
true Jungian, Dr. Brody draws on the power of the unconscious to build her
program, which should have lasting effect. It is the archetypal figure of Makeda,
the historical Ethiopian Queen of Sheba, that the Sisters (adult women) and
Daughters (teens) call upon to evoke inner strength, dignity, intelligence, and
sense of noble purpose in life. "Using this Sheba attitude, we can then be
more discriminating in the selection of male partners," said Dr. Brody.
"We give them a variety of techniques and strategies to maintain their
health, and to be able to wait until someone who's wise comes along or to
negotiate for condom use. "What distinguishes the Sisters and Daughters from other prevention
programs is that we approach it more from a mental health perspective. We get at
the core issues of the obstacles that women and teens have to employing the
techniques that they already know." "The fear of losing love and the fear of loneliness are invisible risk
factors for HIV and AIDS," said Dr. Brody. "And that's where we
specialize. We are approaching HIV as an inside job, rather than just having
information." As a practicing therapist for the past nine years, Dr. Brody brings a wealth
of experience to the program. "We emphasize thinking about thinking. It
comes from psychological interventions in which our thoughts affect our feelings
and our feelings affect our behavior. And if we want to change the behavior, we
may need to get back to the original thought." This gets more complicated in relationships, when our feelings become hostage
to someone else's behavior, according to Dr. Brody. "We have brainwashed
ourselves into thinking that our feelings are under the control of someone
else's behavior," she said. The program works on short circuiting this
thinking, bringing about the awareness that it all comes down to choice about
our feelings and our thoughts. This is the true armor of prevention. Sisters and Daughters of Sheba sm
prepares women and teens to take back control of their thinking and feeling in
order to make better choices. Back in 1995, though her psychological counseling work, Dr. Brody saw among
her clients, African American women, who had comfortable middle class lifestyles
and didn't see themselves at risk because they did not fit the demographics.
They were however engaging in risk behavior, unprotected sex with multiple
partners. She realized a need to broaden the scope of the audience for
prevention beyond those targeted at high risk. "If we are going to do prevention
prevention," she said, "then the message needs to get out to as many
people as possible. Sisters and Daughters covers a very wide net, because we
want to catch them long before they have sex with someone who has HIV." There are two programs of four sessions available to adult women and one four
session program for the teens. Along with the "Sheba Attitude tm,"
they both include discussion of a variety of health information for women, not
just HIV issues. And for those who want to be more involved, there is the opportunity. There
are monthly follow-up support groups which are peer-led by volunteers, past
participants in the program. They "help reinforce the ideas that are
covered in the class and promote continued awareness of HIV and how to avoid
transmission." Other volunteers participate as the 'Sheba Angels' who
assist as recruiting agents for the program. Dr. Brody is very appreciative of MAF, which allowed her to start up the
program. She now looks forward to expanding the program and being able to do
more data collection and comprehensive evaluation with the CDC funding. This
will help with further program development as well as reaching out to her target
population. There is already some meaningful outcome from data they have collected.
"One of the results that is statistically significant is that after three
weeks of participation in the class, if there isn't a condom available, women
are more likely to refuse sex." Dr. Brody is very interested in getting
more information on this initial finding. It may be, she said, that the women
who are going through the program are thinking more along the lines of just
abstaining. The additional funding will now allow for follow-up surveys at three, six and
twelve months, as well as redesigning the evaluation tool to be based on a
telephone interview format, which has proven to be more useful than having
participants fill out a written survey. It's a process that will occur over the next couple of years, said Dr. Brody.
The CDC grant is for one year but is renewable for three additional years.
"So we are hoping to be able to fine tune the curriculum, driven by the
evaluation." Dr. Brody also does a two-day workshop, Sheba Attitude tm.
For more information, please contact the staff at the new office in the
Wholistic Development Center on Second Ave. across the street from Detroit Unity
Temple in Detroit. The new number there is (313) 963-6693. Also, see People
on the Move for more on new SADOS staff. One of the original programs to target women in southeastern Michigan was the
Women at War Committee's house parties. These house parties are continued by the
female staff at the Midwest AIDS Prevention Project, Deputy Director, Candice
Moench and Education Coordinator, Kathy Gerus-Darbison and Community Educator,
Reshounn Foster. Instead of Tupperware, these small informal groups gather to
market safer sex. (The hostess gift is no doubt more useful than an empty
plastic container.) Another program using the house parties format was developed in Ann Arbor. The Sisters Playing it Safe Program was the brain child of Jill Michel (and yes, she is related to HAPIS's Francisco Michel), then the education director for Planned Parenthood of Mid-Michigan. Having moved from California, Jill Michel was familiar with targeted interventions for Latinos and women in prison. Realizing that the population to target here was African American women and PP having already collaborated with MAPP's Women at War program, the home party idea evolved for the presentation format.
Rhonda
Williams was hired three years ago, after the funding was secured, and took off
with the program, which serves Washtenaw County. The extensive training program for the educators is quintessential Planned
Parenthood and covers a wide range of sexuality and reproductive health issues
as well as skills building. "We start with anatomy and physiology..the
basics and start building upon that foundation," said Williams. "We
talk about decision making, negotiation skills, barriers that stand in the way
of making safer sex choices and Someone here does a piece on empathic
listening." The program training calls on collaboration with HAPIS and
other agencies. MAPP provides HIV 101 and Safer Sex education. CHOW does a piece
on HIV outreach in the African American community. HAPIS Trainer, Andrea Battle
has talked about Black women and AIDS. HAPIS also provides public speaking and
presentation skills training. In 1999, 247 women received information through the house parties, but in
fact the program reached a much wider audience. The trained educators also take
that information back into their communities to provide informal peer education
as well. Another program currently at MAPP that targets African American women is the Sista Project, part of a national research study on the use of condoms by African American women. Reshounn
Foster is the site coordinator for Detroit and provides all of the training. The Sista Project is about much more than just HIV 101. "We start off
with a session that discusses gender and ethnic pride," said Foster.
"What's it like to be an African American woman; what does it mean to be an
African American woman. We also ask which takes precedence, being black or being
a woman. And it's the being a woman that stands out in most women's minds." The second session gets into the HIV 101 basics and risk reduction. "We
talk about why African American women are at greater risk in our community"
because of the behaviors, injection drug use and men who have sex with men who
also have sex with women. In the next three sessions they discuss the difference between assertiveness
and aggressiveness. "Typically African American women are known for being
very aggressive and having this Sista-girl attitude," said Foster.
"And I always say that the Sista-girl attitude usually falls on the side of
the bed with the clothes, when we get into these sexual relationships. It's the
being assertive that needs to come out a little bit more when we are asking for
what we want in protecting ourselves when we are having sexual encounters."
It is the skills building and the role playing which helps build the confidence
level. They also discuss decision making and coping skills. "What do you do
when you are in a relationship and your partner doesn't want to use condoms? Do
you stop the relationship or do you go on? Where do your priorities lie and how
do you make decisions?" The Sista project is really a support group said Foster. "Each woman has
a story to tell." Discussions arise over multiple partners and the risks
involved there and how do you approach a discussion with your partners about the
other partners and the safety risk of that." The Sista Project, created by Debra Wingwood in Atlanta, GA, is a study of
condom use in African American adult women 18 and over, being done for a
national marketing group called Sociometrics. The project will compare the
behaviors and condom use over time of the women who are participating in the
prevention program with a control group. The study requires that 75 women go through this program and Foster needs
more groups. There is a pre-test taken at the beginning of the five program
sessions. Three months later there is a second survey and a two-hour booster
session, that is like a support group. A third and final survey is given after
another three months. For more information, contact Reshounn Foster at MAPP,
(248) 545-1435. Foster is now developing her own program for African American teen girls. This one is a spin-off of another MAPP program, Alaye', that was created by MAPP's Program Director, Leon Golson to address the special needs of young African American males. Foster's program will target young women (aged 15 - 24), and is called Adelsola, which means "She wears the crown." "We'll talk about the same themes as Alaye', self-esteem, communication,
relationships," said Foster. Again this will be a series of programs, working with small groups over time
that gives young people the opportunity to work with the information and try out
some of the behavior changes. "At MAPP we try to focus on behavior
modification, she said." "And so we will be hands-on with helping them
make decisions, and be available to them to ask questions." Foster is not just taking Golson's program and using for young women.
"What I am doing with Adesola is bringing in more of my own personal
experiences and asking them to meditate, bring in some of the metaphysical or
spiritual aspects of sexuality,"she said. "That's probably the biggest
difference (between the Adesola and Alaye' programs). Adesola will challenge what Foster sees as limiting messages that are given
to girls and young women in lower and middle income African American
communities. Rarely, she said, is anyone telling these girls, (to steal a phrase
) 'Be all that you can be.' "What I want to do with Adesola is to plant the
seed of a broader vision," said Foster. "It all begins with
recognizing your true purpose."said Foster. "We have to make sure that we are bringing up the young women to have
that mind set that their sexuality is not the allness of who they are. It's a
big part of it, but whatever they want to do, it comes through knowing what
their purpose is in life." This program will probably be premiering in the fall. For more information,
contact Reshounn Foster at MAPP, (248) 545-1435. Tapping into the original bonds for women, MAPP's Candice Moench and Kathy
Gerus-Darbison have developed a new prevention program for moms and daughters
called "Moms at Heart." It can be any mom, at any age, and her
daughter they said. "It could be for someone who isn't necessarily
someone's mom, but who serves in the role of someone's mother, guardians, aunts
etc.," said Gerus-Darbison. Kathy Gerus-Darbison"We created this curriculum - which we knew would push a lot of buttons
- and first of all invited our own moms, and our own daughters. That was quite
interesting just from those dynamics......Just being able to talk about those
issues not only with our moms but with other people's moms we found that a lot
of it was generational. It was very different from our mom's generation to us
and from us to our daughters." "It was a challenge for us. It was very personal for us," said Moench. "Everybody walked out of it saying, 'Wow. I'm really glad I did
that.'" said Gerus-Darbison. While this focus group sounds like a very 60's Escalon type of experience, Moench said there were safeguards against not respecting one another's privacy. Having survived it personally, and receiving good reviews from the participants, they will now market "Moms at Heart" to the community. For more information, contact Candice Moench or Kathy Gerus-Darbison at MAPP, (248) 545-1435. |
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