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Sisters, Informing, Healing, Living, Empowering (SIHLE)

Overview of the Curriculum

SIHLE is an adaptation of the SISTA intervention developed by the Midwest Prevention Intervention Center of the African American Prevention Network (MPIC-APIN) in St. Louis. It is a peer-led, group-level, social-skills training intervention designed to reduce sexual risk behaviors among African-American female teenagers who are at high risk of HIV. In addition to HIV prevention, the program addresses relationships, dating and sexual health within the specific context of the female African-American teenage experience, drawing upon both cultural and gender pride to give participants the skills and motivations to avoid HIV and other STDs.

The target audience for SIHLE is heterosexual African-American female teenagers between the ages of 14 and 18 who have had sexual intercourse and are at risk for HIV.

SIHLE is delivered by a team of one adult and two peer facilitators who, like the participants, are African-American and female. Peer facilitators are between the ages of 18 and 21 — slightly older than the participants. Sessions are held in a community-based setting for small groups of between 10 and 12 participants.

Curriculum Objectives

At the completion of SIHLE, participants will have:

  • Gained increased knowledge about HIV transmission and risk reduction strategies
  • Developed assertive communication skills to demonstrate care for their partners and to negotiate abstinence or safer sex behaviors (particularly condom use)
  • Practiced proper condom use skills as well as developed positive attitudes, norms and self-efficacy about consistent condom use
  • Developed an understanding of characteristics of healthy and unhealthy relationships and the triggers that make negotiating safer sex challenging for teens
  • Gained a sense of empowerment and self-efficacy, based on cultural and gender pride

Curriculum Sessions

Session 1: My Sistas, My Girls

Session 2: It's My Body

Session 3: SIHLE Skills

Session 4: Power and Relationships

The sessions all begin with an introduction that reinforces cultural and gender pride, group identity as SIHLE Sistas, and a special SIHLE motto. Each session also begins with a poem by an African-American woman (highlighting themes of pride, strength, and inner beauty), followed by reflection and discussion.

Within each session, activities vary among:

  • Group discussions
  • Lectures to convey information
  • Competitive and fun games to reinforce knowledge
  • Role-playing to practice communication techniques, skills practice of assertive communication and condom use, and
  • Homework assignments that feature both reflection and practice

Reviews of previous information are also built in throughout the sessions to reinforce knowledge and offer opportunities for questions to be answered.

Theoretical Framework

Research shows that curricula are most effective if they are based on a sound theoretical framework. The SIHLE curriculum draws upon two social science theories: Social Cognitive Theory (SCT) and the Theory of Gender and Power (TGP).

SCT views individual behavior change as a result of social processes — i.e., influenced by interactions with other people, particularly influential individuals, and one's social environment. In SIHLE, the tenets of SCT are apparent in the use of peer facilitators (as influential individuals who model behaviors, attitudes, and social norms), the group identity and peer support established among participants, and the way that new skills are built to instill confidence and self-efficacy by preparing for specific, familiar real-life situations (e.g., negotiating with a partner about condoms).

TGP acknowledges that heterosexual relationships occur against a backdrop of unequal power relationships between men and women — power imbalances that often undermine a young woman’s ability to assert herself and insist on safer sexual practices. Economic dependence, social norms reinforcing passive behavior (especially around sex and relationships), and physical and psychological abuse all exacerbate power differences — particularly for minority, female teenagers who are involved with older men.

In SIHLE, TGP is incorporated into the many activities that promote empowerment and cultural and gender pride, including:

  • Introductions
  • Poetry by African-American women, and
  • Specific activities to identify strong African-American, female role models

Activities translate this sense of empowerment and pride into self-awareness and strength, particularly related to assertive communication, condom use (and negotiating condom use), and generally respecting and taking care of oneself.

Ordering Information

Copies of the SIHLE Implementation Manual (which includes background information for facilitators, evaluation materials, references, as well as all the instructions and materials needed for conducting the four sessions), can be obtained from Sociometrics.

Evaluation Fact Sheet

Intervention

SIHLE was implemented and evaluated in 1995 at a health department in Birmingham, Alabama.

Behavioral Findings

  • Participants in the SIHLE intervention were more likely than those in the comparison group to report using condoms more consistently since the intervention and at last intercourse. They also were less likely to have a new sex partner within the past 30 days and more likely to apply condoms to their sex partners.
  • Participants had better condom application skills, a higher percentage of condom-protected sex acts, fewer unprotected vaginal sex acts, and higher scores on measures of mediators of HIV-preventive behaviors.
  • Participants also reported fewer Chlamydia infections and self-reported pregnancies

Research Design

  • In a randomized controlled trial, 522 sexually experienced, African-American teenage girls between the ages of 14 and 18 were screened at four community health agencies between December 1996 and April 1999.
  • The intervention group received the four SIHLE sessions on ethnic and gender pride, HIV knowledge, communication, condom use skills, and healthy relationships. The comparison group received sessions on exercise and nutrition.
  • The 522 participants completed self-administered questionnaires and an interview and demonstrated condom application skills. They also provided specimens for STD testing.
  • Outcome assessments were conducted at 6- and 12-months after the intervention to gauge consistent condom use (condom use during every episode of vaginal intercourse), sexual behaviors, observed condom application skills, STD infection, self-reported pregnancy, and mediators of HIV-preventive behaviors (e.g., HIV knowledge, attitudes about condoms, perceived barriers to using condoms, frequency of communication with partners about HIV prevention, condom use self-efficacy, and condom use skills).

For more in-depth information:

DiClemente RJ, Wingood GM, Harrington KF, et al. Efficacy of an HIV prevention intervention for African American adolescent girls. A randomized controlled trial. JAMA. 2004;292(2):171-179.

SIHLE Adaptation Kit

ETR and the CDC Division of Reproductive Health collaborated to develop adaptation tools and resources for several evidenced-based pregnancy and STD/HIV prevention programs, including SIHLE. The SIHLE Adaptation Kit contains practical tools and resources to guide adolescent reproductive health practitioners in making effective adaptations and maintaining fidelity to the program's core components.

This adaptation kit provides clarity on how SIHLE was designed, its core components, and the types of adaptations that are considered safe and those that should be avoided. For other available adaptation kits, go to Making Adaptations.