1. Reducing the Risk: Building Skills to Prevent Pregnancy, STD and HIV Richard P. Barth, 1993 Trainers: Pam Cupp, Ph.D. Derek R. Lane, Ph.D.

2. AGENDA Introductions HIV Update Overview of Institute for HIV, STDs, and Pregnancy Overview of ISLE Project Fidelity Issues Curriculum Training Scheduling surveys and curriculum, IRB training, protocol Modeling and hands-on application Skills-based curriculum

3. HIV Prevention Update and Overview of Other Research Rick S. Zimmerman

4. Trends in Sexual Behavior of HS Students in US, 1991-2005 Good news: reductions in sexual risk  Slightly fewer having sex: from 54.1% to 46.8%  Reductions greatest in 11 th graders, Blacks, males  Increase in condom use: from 46.2% to 62.8% Bad news: Significant proportions still at risk  One-third of 9 th graders having sex  Nearly 40% didn’t use a condom last time

5. HIV/AIDS Rates in the US Cincinnati: 7.5/100,000 new cases in 2004, ranked 82 nd Louisville: 11.8/100,000 new cases in 2004, ranked 61 st Near national averages of 10-13 new cases/100,000 in urban areas Lexington approximately the same (just too small a city to get on this list) Overall national rate: around 0.3%, 3/1000, or 300/100,000 (prevalence, total # cases) National rate 5 times higher for African-Americans, 1.5% for 18-39 and nearly 4% for 40-49

6. 25 Years of HIV Prevention Some successes:  Decrease in mother-to-child HIV transmission dramatic  Risk for transmission from blood down to 1 / 2,000,000  50% of 15-44 year olds have had an HIV test Remaining challenges:  Still high rates in men who have sex with men  Blacks and Hispanics have much higher rates  Complacency about HIV and stigma still barriers to HIV prevention

7. Male Circumcision Previous research has suggested lower STD and HIV rates for circumcised men A recent clinical trial in South Africa in which men were randomized in an experiment to either be circumcised or not found a 60% reduction in new HIV cases among those who were circumcised Certainly suggests that newborn males might do well to be circumcised in the US

8. Trends in the Global Pandemic 2.8 million people died from AIDS in 2005 4.1 million newly infected with HIV in 2005 38.6 million currently living with HIV Only 10% of the world’s population lives in sub-Saharan Africa, but 64% of those living with HIV live there Relatively new and large epidemics exist in India, China, and Russia/Eastern Europe

9. Some of Our Other Research Efforts Urban and rural studies showing impact of Reducing the Risk Intervention studies with MSM, adolescent females in inner city housing developments, and adolescent males in detention facilities Mass media campaign increased condom use in young adults Alcohol and HIV curriculum in South Africa has decreased initiation of sexual activity

10. Curriculum Training – Day 1 Trainees as students Ground Rules Pregnancy Prevention Emphasis HIV Prevention Emphasis Abstinence: Not Having Sex Refusals Using Refusal Skills Delaying Tactics Avoiding High Risk Situations Getting and Using Protection Knowing and Talking about Protection

11. Intro: Objectives & Ground rules Objectives  Evaluate risks and consequences of sexual activity  Recognize that not having sex or using protection are only effective methods to avoid pregnancy or disease  Factual information is important; skill- building is critical.

12. Guidelines Students must return a signed parental consent form in order to participate in the study. This means they are not allowed to take the survey if they have not returned proper documentation. Schools differ in their policies about teaching about human sexuality. If your school requires a signed consent form in order for the student to participate in the lessons, please do not begin teaching until you have received a separate signed consent form that covers classroom content. Curriculum should be taught as is and should not be augmented or abbreviated. However, you must follow district guidelines regarding acceptable details.

13. Ground Rules Please go over ground rules during the first class session. (Poster in packet). Ask students for additional ideas for ground rules. Students will support that which they help to create. **Volunteer 1 presents ground rules.

14. Lesson 1: Abstinence, Sex and Protection - Pregnancy Prevention Preparation  Read instructor manual pages 10-15.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Lee & Lee #1 role play (IM - p. 17) Lee & Lee #2 role play (IM - p. 25) Paper squares numbered 1-12 (in teacher kit) Pregnancy risk strips (in teacher kit; IM - p. 21) My Risks worksheets (SW - p. 1; IM - p.19)

15. Objectives Introduce Reducing the Risk curriculum Teacher models role play activity Demonstration of refusal skills Students begin to internalize pregnancy risk and prevention strategies Students personalize their vulnerability to pregnancy

16. Sequence **Introduce curriculum and model role play # 1 (IM - pp. 209-210) Role play, debriefing and processing skills Months of the Year Risk Activity  **My Risks Worksheet (part 1)  **Pregnancy Risk activity (part 2) **Model role play # 2 Lesson summary (IM - p. 15)

17. Lesson 1a: Abstinence, Sex and Protection - HIV Prevention Preparation  Read instructor manual pages 25-29.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Lee & Lee #1H role play (IM - p. 31) Lee & Lee #2H role play (IM - p. 35) My HIV Risks worksheets (SW - p. 3; IM - p. 33) Colored Index Cards (in teacher kit)

18. Objectives Further demonstration of refusal skills to help prevent HIV infection Students begin to internalize HIV risk Students personalize their vulnerability to HIV Students symbolically experience modes of HIV transmission

19. Sequence Brief review of previous lesson **Model role play # 1H Role play, debriefing and processing skills My HIV Risks Activity  **My HIV Risks Worksheet (part 1)  **Card Game (part 2) **Model role play # 2H Lesson summary (IM - p. 29)

20. Lesson 2: Abstinence: Not Having Sex Preparation  Read instructor manual pages 37-42.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Lee & Lee #2 role play (IM - p. 43; SW - p. 5) Lee & Lee #2 teacher key (IM - p. 45) Facts about abstinence (IM - p. 40) What Abstinence Means to Me Worksheet (IM - p. 47; SW - p. 6)

21. Objectives Emphasizes the advantages of abstinence Outlines statistics about teenage sexuality Highlights reasons why teens fail to abstain Provides communication types and strategies for discussing sex

22. Sequence Brief review of previous lesson **Role play # 2 **Tips about using student worksheets Facts about abstinence What abstinence means to me Lesson summary (IM - p. 42)

23. Lesson 3: Refusals Preparation  Read instructor manual pages 49-53.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Refusals poster and pamphlets (teacher kit) Talk to Your Parents A (IM - p. 55; SW - p. 7) Talk to Your Parents B (IM - p. 57; SW - p. 9) Your Friend’s Ex-Girlfriend role play (2 versions: IM - p. 59 & 61; SW - pp. 11-12) Trying to Slow Down role play (2 versions: IM p. 63 & 65; SW - pp. 13-14) Observer Checklist: Refusals (SW - p. 15; IM p. 67)

24. Objectives Introduce verbal and nonverbal communication skills Demonstrate important social skills in abstaining Provide opportunities to practice and examine 5 characteristics of effective refusals Participate in first creative role play

25. Sequence Brief review of previous lesson **Talk to your parents **Introduce refusals **Demonstrate role plays  Your Friend’s Ex-Girlfriend  Trying to Slow Down  Disregard role play cards in teacher kit Lesson summary (IM - p. 53)

26. Lesson 4: Using Refusal Skills Preparation  Read instructor manual pages 69-72.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Refusals quiz (IM - p. 73; SW - p. 17) At a Party role play (2 versions: IM p. 75 & 77; SW - p. 19) Observer Checklist: Refusals (IM - p. 79; SW - p. 20)

27. Objectives Assess student refusal skills Provide opportunities for students to role play and practice new skills in difficult situations

28. Sequence Brief review of previous lesson **Refusal Quiz **At A Party  Scripted role play  Unscripted role play  Disregard role play cards in teacher kit Note to Teacher (IM - p. 72)

29. Lesson 5: Delaying Tactics Preparation  Read instructor manual pages 81-84.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Possible Delaying Tactics Handout (IM - p. 85; SW - p. 21) Companion Poster in Teacher Kit Presents and Flowers Role Play (IM - p. 87; SW - p. 23) Observer Checklist: Refusals (IM - p. 89; SW - p. 24) Refusing and Delaying quiz (IM - p. 91; SW - p. 25)

30. Objectives Introduce delaying tactics Provide opportunities to practice effective delay tactics in role plays Assesses student refusal and delay tactics

31. Sequence Brief review of previous lesson **Review Possible Delaying Tactics **Presents and Flowers Role Play Teacher Tips - Using Quizzes **Refusing or Delaying Quiz Lesson summary (IM - p. 84)

32. Lesson 6: Avoiding High-Risk Situations Preparation  Read instructor manual pages 93-97.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Signs of Sex, Signs of Caution Teacher Reference Page (IM - p. 99) and POSTER Handling Crisis Situations Worksheet (IM - p. 101) Protection: Myths and Truths (IM - p. 103)

33. Objectives Discover high-risk situations Practice handling difficult situations Assess STD and HIV knowledge

34. Sequence Brief review of previous lesson (5) **Discuss “Talk to Your Parents” Homework Assignment **Review Signs of Sex, Signs of Caution Teacher Reference Page **Complete Handling Crisis Situations Worksheet Introduce Myths and Truths about Protection Worksheet Lesson summary (IM - p. 97)

35. Curriculum Training – Day 2: (morning session) Getting and Using Protection {7/8} Knowing and Talking About Protection: Skills I {9} Skills Integration II {10} Preventing HIV and other STDs {12} HIV Risk Behaviors {13} Implementing Protection from STDs & Pregnancy {14} Sticking with Abstinence and Protection {15/16} Questions? Final logistics

36. Lesson 7/8: Getting and Using Protection I Preparation  Read instructor manual pages 105-131.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Teacher Lecture Notes (IM - p. 106-118) Birth Control Pamphlets (for each student) How will you avoid pregnancy worksheet (p. 130) How is HIV prevented worksheet (HO 8.4)

37. Objectives Provide information on effective methods to avoid pregnancy, HIV, or other STD infection. Discuss advantages and disadvantages of methods of protection Differentiate between methods that are effective for pregnancy prevention, disease prevention, or both.

38. Sequence Brief review of previous lesson Distribute Birth Control Pamphlets **LECTURE : Birth Control Methods (emphasis on abstinence and condoms) **How Will You Avoid Pregnancy? worksheet **How is HIV Prevented? worksheet Lesson summary

39. Methods that DON’T Work Withdrawal Douching Hoping Rhythm

40. Methods that Work ABSTINENCE  Safest (MOST EFFECTIVE) P & STDs Birth Control PILL  Convenient  Health Risks P (NOT STDs) Depo Provera  Does not interfere with sex; Can last 3 months  Heavier periods; headaches P (NOT STDs) The Latex CONDOM  Skin irritation; No serious health risks  Sex can last longer; prevents cancer, P & STDs

41. Lesson 9: Knowing & Talking About Protection: Skills Integration I Preparation  Read instructor manual pages 133-135.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Teacher Key for Protection: Myths and Truths (IM - p. 137-138) An Important Discussion role play (IM - p. 139) A Lunchtime Chat role play (IM - p. 141)

42. Objectives Practice PROTECTION communication skills Review Myths and Truths activity to assess student knowledge about HIV and other STDs

43. Sequence Brief review of previous lesson (7/8) Review How to Use Role Plays (appendix c) **Review Student Myths and Truths homework assignment **An Important Discussion Role Play **A Lunchtime Chat Role Play TEACHER TIP: Handling role play boredom Lesson summary

44. Lesson 10: Skills Integration II Preparation  Read instructor manual pages 143-145.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Situation A and Situation B Group Handouts Two Hours to Kill and A Small Party role plays Observer Checklist Refusal and Delaying Tactics posters (used in earlier lessons

45. Objectives Practice Refusal, Delay, and protection communication skills

46. Sequence Brief review of previous lesson (9) **Situation A small group discussions **Situation B small group discussions **Two Hours to Kill Role Play **A Small Party Role Play Lesson summary

47. Lesson 12: Preventing HIV and other STDs Preparation  Read instructor manual pages 165-167.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials STD Facts Pamphlet (for each student) Teacher Background Information About HIV (IM - pp. 169-174) How HIV Would Change My Life homework (IM - p. 175)

48. Objectives Inform students of signs and symptoms of most common STDs Provide students with strategies for STD prevention Outline transmission patterns of various STDs

49. Sequence Brief review of previous lesson (10) Distribute STD Facts Pamphlet (1 per student **HIV and other STDs LECTURE How HIV Would Change My Life homework activity Lesson summary

50. Five (5) Most Common STDs Genital Warts Gonorrhea Herpes Chlamydia HIV  How I could get it  How I can prevent it  How I would know I have it (symptoms)  How I would get treatment  How it would change my life

51. Lesson 13: HIV Risk Behaviors Preparation  Read instructor manual pages 177-180.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Risk Behaviors Activity from Teacher Kit Risk Behaviors Answer Sheet (IM - p. 183)

52. Objectives Students will understand which behaviors put them at greatest risk of HIV

53. Sequence Brief review of previous lesson (12) **HIV Risk Behavior Activity Lesson summary (IM - p. 180)

54. Lesson 14: Implementing Protection from STD and Pregnancy Preparation  Read instructor manual pages 185-187.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Steps to Protection Worksheet (IM - p. 189) Steps to Abstinence Worksheet (IM - p. 190b)

55. Objectives Students will create STRATEGIC PLANS for preventing pregnancy and reducing STD by considering steps for protection and steps for abstinence.

56. Sequence Brief review of previous lesson (13) **Steps to Protection worksheet **Steps to Abstinence worksheet **Role Play Lesson summary (IM - p. 187)

57. Creating Strategic Plans Steps to Abstinence 1. Talking about a Plan 2. Preparing an Alternate Plan Steps to Protection (latex condom) 1. Talking about a Plan 2. Preparing for Protection 3. Using Protection

58. Lesson 15/16: Sticking with Abstinence and Protection Preparation  Read instructor manual pages 191-194.  Prepare note card with activity sequence, processing questions, and summary  Make sure you have appropriate materials Sticking with Abstinence and Protection Worksheet (IM - p. 195) Being Careful on the Couch role play (IM -p. 205) Commitment Activity (Teacher Kit)

59. Objectives Students will identify and discuss barriers to “sticking with abstinence and protection” Students develop strategies for overcoming barriers Students will identify commitment level to the curriculum objectives

60. Sequence Brief review of previous lesson (14) Review information about sticking with abstinence and protection (IM - p. 193-195) **Sticking with Abstinence and Protection worksheet (IM - p. 195) Students prepare and deliver “Being Careful on the Couch” role play (IM - p. 205) Commitment Activity (IM - p. 209;teacher kit) FINAL SUMMARY

61. Reducing the Risk... Summary  Curriculum Fidelity  Interactive  Abstinence-based  Reduce the Risk Thanks for all your efforts!

62. Thank you very much for your enthusiasm and commitment to the project!