Safe Sex Learning through Safe Reflection and Storytelling

Background:

Twice as many people die of AIDS in Mississippi than the national average, and HIV infection among black Mississippians is more than double the national rate. Mississippi also ranks high in rates of chlamydia infection (4th in the U.S.), syphilis (3rd), and unwanted pregnancies (2nd). Across the South, HIV/STD rates tend to be higher and STD testing rates lower because of discrimination, homophobia, stigma, income and health disparities, and lack of access to basic healthcare and sex education.

Program background:

This exploratory project involves collaboration among two researchers, two classes, and a rural wellness center in Charleston, a small, impoverished town in the Mississippi Delta. It seeks to identify barriers and inroads to preventing unplanned pregnancies and HIV/STDs among black adolescents. A focus group of 12 teachers, nurses, church leaders and other African-American women in Charleston shared experiences and insights about beliefs, attitudes and behaviors of local adolescents that ultimately could inform a local safe sex campaign. To explore safe sex beliefs, attitudes, and behaviors among adolescents, a pilot intervention includes reflective writing and role play, as well as pre- and post-intervention, peer-led focus groups of African-American adolescents ages 10-17.

Evaluation Methods and Results:

An original conceptual framework, which informs the design of the focus group protocols and pilot intervention, consists of eight domains: predisposing and environmental factors, HIV prevention message design, cognitive and normative processes, enabling factors, potential barriers, and outcomes. The initial teen focus group will explore safe sex perceptions, as well as experiences with poverty, substance use, peer pressure, and family/religious life. The pilot intervention includes facilitated writing and role-play. Writing exercises are designed to spark reflections and conversations about risks and resilience factors. One challenges participants to consider what they might say or do in hypothetical situations and to anonymously reply to others’ anonymous answers. They will develop skits, produce simple video PSAs based on this role-play, and talk about lessons learned about safe sex via focus groups. The transcripts of three focus groups, as well as reflective writing responses and skit scripts will analyzed using the constant comparative method.

Conclusions:

The women said the barriers to safe sex among local teens include perceived stigma in obtaining condoms or STD testing, lack of after-school activities and safe places to hang out, and a total lack of sex education in the community. They said local teens are not at risk of using opioids or becoming homeless but can easily obtain alcohol and marijuana. The women felt that dialogue between adults and teens about safe sex could help teens overcome fears and stigma, but only if discussed in normal conversations in “fun” settings such as women helping girls with crafts, sewing or cooking – or men playing sports with boys. To this end, adults could be educated about safe sex facts and casual ways to discuss it with adolescents, while respecting Christian principles.

Implications for research and/or practice:

Findings from the focus groups and pilot intervention will inform a culturally sensitive safer sex campaign for rural black adolescents and identify factors that contribute to risky and protective behaviors.