AFRICAN AMERICAN (AA) women accounted for 69% of estimated new HIV diagnoses among US women from 2000 to 2003, although AAs constitute only 13% of the US population. The rate of AIDS diagnoses for AA women is 23 times that for White women. HIV/AIDS is the leading cause of death for AA women 25-34 years old, with heterosexual transmission (sex with injection drug users, bisexual men, and with an HIV-infected person with an unidentified risk) comprising approximately 78% of HIV exposure. Another 19% is due to women's injection drug use.1

Early prevention messages, targeted primarily at gay, White men, did little to impact the AA community and failed to acknowledge how poverty, institutional racism, a biased criminal justice system, disenfranchisement, and gender inequality contribute to the disproportionate number of HIV infection cases among AA women.2 Culturally tailored prevention programs should, at minimum, emphasize the cultural competencies of researchers and helping professionals and include salient beliefs, language, traditions, worldviews, and values.3 Programs for AA women were developed beginning in the mid-1990s4 and continue to use cultural- and gender-appropriate materials to build ethnic pride and incorporate cultural- and gender-specific themes to promote condom use.5 This report presents the types of outcome measures targeted by an African-centered HIV prevention program as compared to prevention programs targeting behavior change as measured primarily through condom use.

THE AFRICAN-CENTERED BEHAVIORAL CHANGE MODEL

The African-Centered Behavioral Change Model (ACBCM) addresses the totality of the individual's existence by acknowledging "that the best prevention strategy is a plan that promotes positive development rather than prevents a particular dysfunctional behavior."6^(p118) Components incorporate individual and relational responses to oppressive structural forces, including how negative stereotyping and the distortion of one's group weakens self-regard and group pride and creates internalized oppression, which can express itself in depression, sense of disenfranchisement, psychological suppression of risk, silence around sexuality and sexual orientation, and fatalism.

Based on an Africentric theoretical paradigm, the ACBCM6 reinstills traditional African and AA cultural values into African-descent people based on the premise that AAs, for the most part, survived historically based on Africentric worldviews, values, and traditions of interdependence, collectivism, transformation, and spirituality.7 Endorsement of Africentric values has been shown to increase self-worth and racial pride and to decrease depression and substance use among AA youth and adults.6,8-12 Infused in the intervention model, these values form the cornerstone for achieving behavioral change.

THE HEALER WOMEN PREVENTION PROGRAM: CASE EXAMPLE

The Healer Women project is a prevention model for AA women grounded in the ACBCM. The program's objective is to enhance the resilient capacity of women so that they are better able to engage in health-promotion and life-sustaining activities.

Behavioral change is targeted in the context of

* cognitive restructuring (changing the way women think and feel about themselves and the world),

* cultural realignment (reinstilling traditional "cultural" values in women to infuse protective factors), and

* character development (reconfiguring the way women think about health and well-being).

PARTICIPANTS

Participants were 45 AA women (30 in treatment group and 15 in control group) per year over 2 years.

The program comprised 2-hour sessions each week for 16 weeks. Trained AA facilitators deliver the intervention (behavioral skills practice, group discussions, lectures, role-playing, prevention video viewing, and take-home exercises) in a community-based setting. Key program components include the following: Understanding the History and Survival of African Americans; Meaning of Being a Black Woman; Collective Meaning in Community; HIV: Facts, Transmission, and Control; Substance Abuse: Underlying Dynamics and Recovery; Forming an Attitude of Health Promotion and Disease Prevention; and Where Do I Go From Here?-Forming a Path and a Plan.

OUTCOME EVALUATION

The program will be evaluated on a quasi-experimental group pre-post design with an intervention and a comparison group. It is anticipated that program participants will experience the following:

* Increased sense of self-empowerment (as measured in terms of motivation for change, sense of control over one's life, self-worth, and perception of future quality of life)

* Reduction in sense of disenfranchisement and negation (as measured by decreases in depression, sense of fatalism, and sense of hedonism)

* Enhancement of coping skill (as measured by knowledge about methods of HIV transmission, attitudes toward HIV, and perception of present quality of life)

* Improved life management skills (as measured by intentions to change sexual behavior and decrease in feelings of hopelessness)

* Reduction in HIV/STD risk-taking behavior (as measured by decreased sexual risk-taking behavior)

* Reduction in the incidence and level of substance use (as measured by attitudes toward drugs and decrease in the number of days used drugs)

* Positive changes in the behavioral and attitudinal indicators of the character of Black females (as measured by increased sense of human authenticity and sense of veneration)

SUMMARY

Innovative programs are needed to reduce the incidence rate of HIV infection among AA women, particularly marginalized, resource-poor AA women. The strength of the African-centered approach is its reflection of the true life circumstances of AA women. Targeted changes for outcome measures address core barriers to HIV prevention (eg, poor self-worth, fatalism, depression, poor perception of future quality of life) in order to increase a person's vigilance around health promotion and reduce high-risk behavior. Studies documenting the utility of infusing African-centered values in prevention techniques as protective factors against drug use among AA youth and adults support the use of such programs in HIV prevention for AA women.

REFERENCES