Research Protocol

Mid-Peninsula YWCA AIDS Prevention Project
Evaluation of an Adolescent HIV Prevention Program Focused on Gender-Based Norms for Sexual Behavior
Principal Investigator: Rafael M. Diaz, Ph.D.
Co-Investigators: Donnovan Somera, M.A. and Carolyn Laub, B.A.
For an outline of the theoretical approach of this project see:
Breakin’ Down Sexual Scripts: Empowering Youth in HIV Prevention Education

Research Protocol

Study Aims and Purpose

The purpose of the study is to evaluate an HIV prevention intervention that targets 9th graders in two different high schools, and focuses on enhancing resistance to peer pressure around sexual risk-taking. The HIV prevention program, designed and conducted by YWCA personnel, is implemented as the mandated HIV/AIDS education program for a large number of high schools in the San Francisco Peninsula, including the two high schools in the Santa Clara Unified School District selected for the evaluation.

Specifically, the evaluation aims to test the hypothesis that the program is effective in changing attitudes and behavior relevant to HIV risk prevention in adolescence, in particular, students’ understanding and resistance of “covert” or “implicit” peer pressure in the form of gender scripted ideals of sexual desirability and prowess. We also aim to examine the differential impact of implementing the intervention either at the beginning (Fall) or the middle (Winter) of the school year, as well as examine the maintenance of program effects during an eight-month period.

Background

The proposed study is an evaluation of one of the central activities of the AIDS Prevention Program (APP) at the YWCA of the Mid-Peninsula. The APP began in 1987 when students participating in the YWCA’s Child Abuse Prevention Project expressed the need to learn more about HIV/AIDS. As a result, the YWCA of the Mid-Peninsula piloted an AIDS Prevention Project which today is the first and only county-wide HIV/AIDS prevention education program. In its first decade, APP has reached over 55,000 teenagers throughout Santa Clara County. The AIDS Prevention Program has earned the trust, credibility, and respect of teens, parents, teachers, and school administrators.

The intervention to be evaluated has been developed and refined through many years of interactions, educational programs, and experience working with youth at risk in the Mid-Peninsula area. The intervention addresses those variables believed to be the most important predictors of sexual risk-taking, and utilizes educational strategies that have proven to engage and impact a wide variety of high school students.

Significance

Approximately one out of four newly diagnosed AIDS cases in the U.S. occurs in persons under the age of 25. Because of an average 10-year period between infection and the onset of symptoms, it is estimated that the overwhelming majority of these young AIDS cases represent HIV infections that occurred during the teenage years. Adolescents, therefore, are an important target for HIV prevention efforts nationwide.

Typically, HIV prevention education efforts aimed at teenagers focus on: (1) creating awareness through increasing knowledge of HIV disease transmission routes, (2) eliciting compassion for those infected with HIV, and (3) teaching HIV prevention skills.

Although these intervention strategies are necessary steps in dealing with the HIV epidemic, and are still just as vital today as ever, published empirical data as well as our experience tell us that they are not sufficient to change risky sexual behavior and prevent further infection. The focus o information assumes that people take risks because they are ignorant of the facts. This is true for some, but it does not explain why well-informed teenagers continue to put themselves at risk for HIV. By the same token, compassion based activities help rally people around the cause of “Fighting AIDS” but lack a real connection to adolescents’ own behavior. Finally, skills-building curricula assume that teenagers want to choose safely but can not, because they lack the skills or because the peer pressure to choose unsafely is too great to resist. This assumption would be correct if peer pressure were only an external force as in “my friends are calling me a virgin or “my boyfriend doesn’t like condoms.” The gap in this logic is the failure t acknowledge that peer, partner, and cultural pressures begin as external force but become internalized; this is why peer pressure actually works. For adolescents who are not sexually active, calling them “a wimpy, scared, immature, little nerd” would only affect their behavior if they both believe in this system of values and believe that this might be true about them.

Guided by prior HIV prevention research and our own experience, the APP has developed classroom activities for teenagers that address gender-based cultural scripts, norms, and personal beliefs that regulate sexual behavior in adolescence. By cultural scripts, we mean the explicit and implicit messages that young people receive every day from family, teachers peers, religion, and the media. These messages about what is sexually desire and desirable become internalized and, consequently, subjectively experienced as “natural and normal.” Furthermore, these scripts motivate behavior (or lack thereof) by inducing fear — fear of being embarrassed, stigmatized, not respected, or being considered abnormal, inadequate, and undesirable by their peers. Gender-based norms and scripts about sexual behavior thus constitute one of the strongest forms of peer pressure in the lives of high school students. The intervention was designed to address this risk-promoting fact. By evaluating the impact of the intervention on adolescents’ ability to think critically about gender-based norms, the present study will contribute to the body or knowledge regarding the effectiveness of school-based HIV prevention programs for adolescents.

Methods

General Study Design and Methods of Data Analysis

The study is designed as a program evaluation, involving the following four steps:

  1. Randomly assign approximately 600 students — 30 students in each of twenty 9th grade classrooms in two different high schools — to receive the 5-hour (one hour a day for five consecutive days) intervention, either at the beginning of the Fall (n= 10 classrooms in October) or the Winter (n= 10 classrooms in February) of the 1997-1998 school year.
  2. Test all study participants (N=600) at three points in time during the school year (October, February, and May) with a self-administered questionnaire that assesses variables relevant to HIV prevention, including students’ ability to identify, critique and counteract peer pressure. Questionnaires will be filled out in the students’ classrooms approximately one week before (pretest) each round of intervention and approximately four months after (posttest).
  3. Using a wait-list control design, evaluate the effectiveness of the intervention by comparing pre-post data of groups assigned to either the Fall or the Winter intervention. By testing all participants at three points in time, we will be able to evaluate also the long-term (8-month) maintenance of effects for the Fall intervention cohort, and the effectiveness of the intervention for the wait-list control group in the Winter semester.
  4. Design and pilot test survey instruments during the Summer before the intervention. The research will be conducted in two phases. First, we will conduct a pilot study to develop and test age-appropriate measures of critical thinking about gender-based norms and cultural scripts for sexual behavior. Second, we will evaluate the five-hour intervention designed to promote resistance to peer pressure.

Phase I: Development and pilot of pre-post outcome measures.

Based on our experience working with teenagers, and after carefully reviewing materials from curricula for sexuality education in adolescence, we will develop tentative measures of the following constructs: 1) Ability to identify and critically evaluate gender-based scripts in the social environment; 2) Self-identification with ideologies of femininity and masculinity; 3) Formulation of multiple strategies to deal with gender-based, implicit peer pressure; and 4) Perceived self-efficacy to behave in ways that are safe, but might be at odds with gender-scripted norms.

The ability to identify and evaluate gender-based scripts will be assessed through students’ ratings and reactions to examples of media campaigns and advertisement directed at youth. Self-identification with ideologies of femininity and masculinity will be based on existing measures of gender role identification for adolescents. The other measures will consist of several vignettes portraying sexually-charged situations often encountered in adolescence, such as being left alone and/or unsupervised with an attractive member of the opposite sex, or physical displays of affection by someone on a first date. In response to the vignettes, adolescents will be asked to identify factors that constitute gender-based peer pressure, formulate strategies for dealing effectively with the sources of pressure, and state their perceived self-efficacy to act contrary to the expected gender-based norm in different situations.

The measures will be tested twice — a first time, and a second time after initial revision -through in-classroom group interviews with adolescents who attend school summer programs. The piloted and revised measures will then be incorporated in the intervention evaluation instrument.

Phase II: Implementation and Evaluation of the Intervention

In full collaboration with school personnel, twenty 9th grade classrooms will be selected for the study; then, parents and/or guardians of all students in those classrooms will be contacted to obtain written consent for participation in the study. After obtaining parental consent, students for whom we have active and positive parental consent will be administered the evaluation questionnaire during one class period in the month of October, approximately one week before the implementation of the intervention. Ten classrooms will be randomly assigned to receive the intervention in the Fall (the Fall cohort) and the other ten classrooms will receive the intervention in the Winter (the Winter cohort).

Both Fall and Winter cohorts will respond to the study questionnaire at three points in time during the school year: October ’97, February ’98 and May ’98. The effectiveness of the evaluation will be tested by comparing changes in students’ responses between October and February, where the Fall cohort is the experimental intervention group and the Winter cohort serves as the wait-list control group. The May data will serve as a test of “maintenance of effects” for the Fall cohort. For the Winter cohort — the wait-list control group — February data will serve as the pretest baseline data, and May data will serve as the posttest. Pre-posttest comparisons will thus be available also for the Winter cohort, helping us ascertain possible differences due to implementation of the intervention at two different points in time during the school year.

Even though the outcome measures of gender-based cultural scripts will be developed and pilot tested as part of the proposed project, other measures — including measures of sexual and pre-sexual behavior — will be modeled after research projects previously approved by USCF’s CHR, including Dr. Barbara Marin’s current intervention in middle schools and a prior YWCA research project, entitled “Effectiveness of peer-led vs. adult-led HIV prevention education in multi-ethnic middle and high school students: A program evaluation,” PI: Olga Grinstead, Ph.D., M.P.H. Because we plan to use questions very similar to Dr. Marin’s middle school questions about sexual activity, we are enclosing a sample of those questions as Attachment 6.

Subject Selection

Who. Approximately 600 students will be invited to participate in the evaluation. The study sample will include all the students in twenty 9th grade classrooms who receive the 5-hour intervention, from two high schools that have agreed to participate, and for whom we obtain both student and parental consent. The two high schools to be targeted are Santa Clara High School (SCHS) and Wilcox High School (WHS), from the Santa Clara Unified School District. Both high schools have 10 classrooms of 9th graders each, with approximately 30 students in each classroom.

Why. The two schools were selected because of strong interest on the part of the schools for YWCA sexuality education programs, because of good contacts with school nurses in charge of health education, and because both schools have good representation of ethnic diversity in the county. In a meeting conducted early March of this year, we obtained verbal enthusiastic agreement for the evaluation from Principals, Assistant Principals, Deans of Counseling and School Nurses form both high schools.

We decided to target 9th graders for the following reasons: First, our data suggest that large increases in the frequency of sexual activity occur during the 10th (sophomore) grade, thus, we decided to target students before this large increase in sexual activity. In addition, reviews of the empirical literature suggest that school-based programs are more successful in affecting the behavior of students who have not yet initiated sexual activity. Second, as newcomers to high school, 9th graders are specially vulnerable to peer pressure through conformity with established teenage norms; thus, our intervention to resist implicit peer pressure will be targeting those who need it the most. Third, logistics of school schedules make 9th graders accessible and easy to test and retest within stable year-long classrooms.

Inclusion/exclusion criteria. We will include all 9th graders in SCHS and WHS who are enrolled in the science class for their grade — the class where the intervention takes place -and for whom we obtain both self and parental written consent for the study. Because students enrolled in these science classes must fulfill a grade-appropriate English language proficiency requirement, we will not need to exclude any eligible student on account of proficiency in the English language.

Subject Recruitment

Ninth grade science teachers in the respective schools will be contacted through individual and small group sessions to explain the details of the study. At that time teachers will be presented all the content and practical details of the study, they will be shown and explained the survey instrument, and they will have the opportunity to ask questions from the investigators, including the two individuals who will be administering the study questionnaire and implementing the intervention in their classrooms (Somera and Laub). After meetings with teachers and all other relevant school personnel, parents and students will be contacted for consent, as detailed below.

Consent process and documentation.

The procedures described below have been previously approved by the CHR for studies in high and junior high schools (Dolcini; Ekstrand; Grinstead).

Because the program to be evaluated is implemented as the mandated school’s HIV education and prevention program parental consent for students’ participation in the intervention is obtained by school officials and does not fall within the scope of this protocol review. The consent process for the HIV prevention program is as follows: Following school policy and procedures, at the beginning of the year, school officials send parents a package detailing the planned health education programs and activities for the year — including alcohol, drug and smoking prevention programs as well as HIV education . The APP/YWCA works closely with school officials in explaining the details of their planned intervention. Parents are then asked to state in writing those programs and activities that they do not want their children to participate (negative consent). We will thus exclude from our study those students whose parents do not want them to receive the HIV prevention intervention. However for participation in the evaluation study. that is for students’ responding to the study questionnaire three times during the school year. we will ask for parental written positive consent as indicated below.

Parents of all eligible students will be mailed a letter describing the study. A phone number will be provided for parents who have questions or concerns they wish to voice. Parents are asked to indicate in written form whether they want their child to participate or not in the evaluation, and are told that their children are not eligible to participate, unless we obtain their written consent. The parental consent letter makes a clear distinction between participation in the intervention and participation in the evaluation indicating that the written consent is for participation in the evaluation which involves filling the questionnaires at three points in time during the school year. The consent letter will be translated into Spanish and other languages spoken in homes of students enrolled in participating classrooms.

Teachers of targeted classrooms will receive a training session that will familiarize them with the study and answer any questions they may have.

Teachers will also be given an information sheet which outlines in detail the procedures of the study.

Students’ written consent will be obtained prior to the start of the project (at minimum, several days before the start of the project) right after a discussion led by APP/YWCA staff (Somera and Laub) in targeted classroom.

In those discussions, APP staff will describe the project and make it clear that any student may decline to participate in the program with no negative consequences on their grade or any other student academic evaluation.

During these in-class discussions, students will have a Student Information Sheet they can refer to outlining the details of the study.

For those students who choose not to participate or for whom we do not obtain parental consent, an independent reading session will be designed, to take place either in the classroom or the school library at the times when the study testing is being conducted in their classrooms.

The above consent process and documentation are recommended by adolescent prevention researchers and follow the standard practices of the Santa Clara Unified School District.

Procedures

Students who choose to participate and for whom we have obtained parental consent, will be given the confidential baseline questionnaire, including measures described under section 4a/b. The questionnaire will be completed individually during a science class period, the week before the beginning of the intervention. The week after the baseline questionnaire, classrooms randomly assigned to the Fall intervention will receive the five day intervention. The intervention — given during five one-hour class periods in five consecutive days — includes content about HIV and its transmission, as well as content about gender-based cultural scripts.

(See Curriculum Outline)

In February 1998, at the beginning of the second semester, participating students will be given the second (posttest) round of questionnaires. The week after this second round of testing, classrooms assigned to the Winter intervention will be given the intervention as described above. The third and last round of testing — which is basically a posttest for the Winter group, and an eight month follow-up for the Fall group — will occur in May 1998, towards the end of the Winter semester.

Risks / Discomforts

There is no physical risk directly attributable to this study. Survey instruments will be designed to minimize anxiety or other negative feelings. Questionnaire topics and text will be appropriate to the developmental age of the students. (Survey instrument is very similar to the one already approved by the CHR) However, it is possible that the questions asked in the study may alert some students to the fact that they are, indeed, at risk for HIV. Students will be encouraged to discuss any concerns they have with the health educators, school nurses, teachers, and their parents. In addition, identifying school and community resources that are available to students, including sites for anonymous HIV testing, is an integral part of the intervention curriculum. The two health educators who will implement both the evaluation questionnaires and the intervention (Somera and Laub) are well trained to address any concerns that the students may have and to alleviate any anxiety that may be caused by the study material. The psychological risk of emotional distress that may result from the personal nature of the questions will be addressed by having trained counselors present at the schools for students who become upset. Students will be informed that they have a right to decline to be in this study, to refuse to answer any question, or to withdraw at any time.

Participants will be informed of the precautions that will be taken to safeguard their confidentiality, and to ensure the security of their questionnaires. Precautions to safeguard confidentiality include coding questionnaires with numbers rather than names. Filing of matched names with code numbers is necessary to ensure the ability to follow students over the course of the study, and because 9th graders might have difficulty in remembering code numbers over a nine-month period time. Participants wild be informed that, to ensure confidentiality, only one master list linking names with the code numbers will be kept in a locked file cabinet in the APP Director’s office at the Mid-Peninsula YWCA in Palo Alto. Students will also be told that although individual questionnaires are entirely confidential, overall findings of the study will be made available to anyone who inquires, but that results are always reported in terms of groups that include multiple classrooms and will be never reported for individuals, nor for individual classrooms. Findings, reported only for aggregates or groups of students, will be stored in the Principal’s office at participating school sites.

Treatment and compensation for injury:Not applicable.

Alternative

For those students who choose not to participate or for whom we do not obtain parental consent, an independent reading session will be designed, to take place either in the classroom or in the school library at the times when the survey questionnaire is being administered in their classrooms.

Cost to subject: There is no direct or indirect cost to the subjects.

Reimbursement of Subjects: Not applicable.

Confidentiality of Records

All data and questionnaires will be identified using code numbers rather than names. Questionnaires will be printed with unique code numbers, printed in all the pages of a given questionnaire. Each questionnaire will have a face sheet, where students will be asked to print their name, birth date, classroom number and teacher name; this front page will be of a different color than the rest of the questionnaire. After this face sheet is filled out, and before students begin answering the survey questions, students will detach the face sheet, which is also uniquely numbered as the rest of the given questionnaire. The face sheet links the student’s identifying information with the questionnaire number, which will be used as the subject identification number. The face sheet will provide the data for the master list linking names and code numbers to be stored at the YWCA. Similar procedures will be used at other times of testing. The detached face sheet will allow us to keep confidential records, and also link the three data points for each subject. In the master list, each student name will be linked to three numbers, representing their October, February and May data. The master list will be destroyed after the May follow-up.

Individual questionnaires, even though only identified by numbers, will not be available to parents, teachers or other school personnel. No individual identities will be used in any report or publications resulting from this study. All data will be kept in locked files so that only the investigators and members of the research team at UCSF will have access to the data. Results will be reported in terms of groups that include multiple classrooms and will never be reported for individuals, nor for individual classrooms.

Investigators

Rafael M. Diaz, Ph.D. is Associate Adjunct Professor in the Department of Medicine and a faculty member at the Center for AIDS Prevention Studies, UCSF. He has had five years of experience working in the field of ~V prevention research and, as a developmental psychologist, has conducted multiple studies in school settings with children ranging from preschool age through adolescence. He brings to the project a great deal of expertise in research with youth that involve obtaining parental consent, expertise in HIV prevention research, and sensitivity about research that involves multicultural, multi-lingual populations.

Donnovan SomeraM.A. is the Director of the AIDS Prevention Program at the YWCA of the Mid-Peninsula. He received his undergraduate degree in psychology and his Masters degree in sociology at Stanford University. Donnovan began working in the field of HIV prevention education in 1992 with the San Mateo County AIDS Program. There he directed the AIDS is Real (A.I.R.) program which targets adolescents in school settings. In addition to his work at the YWCA, Donnovan lectures at colleges and universities through the San Francisco Bay Area. Over the last three years, Donnovan has worked with UCSF/CAPS on a study of the effectiveness of school-based peer education. Donnovan brings to this project a great deal of experience teaching and learning from young people of all ages, a facility in uncovering the gender-based cultural scripts which regulate risk-taking behavior and the ability to educate people about these scripts.

Carolyn Laub is the Assistant Director of the AIDS Prevention Program at the YWCA of the Mid-Peninsula. She received her undergraduate degree in Anthropology from Stanford University where she focused on gender and sexuality in the contemporary United States. She began working in the sexual health field in 1992 conducting rape prevention education workshops and facilitating discussion groups with college students. In 1995, she began her work at the YWCA in HIV prevention education with teenagers in Santa Clara County. In addition to her two years of experience conducting HIV prevention education workshops and outreach to teenagers, Carolyn also facilitates confidential support groups with high school girls and with gay, lesbian and bisexual teenagers. She brings to the project a deep understanding of the role of cultural scripts in regulating teenagers’ gender and sexual behavior, as well as extensive experience working in school settings with youth around sensitive sexual issues.

Letter to Parents About the Study

PARENTAL CONSENT TO PARTICIPATE 1N HEALTH EVALUATION SURVEY Parents must sign attached permission slip for students to participate –

TO: Parents of Ninth Graders

FROM: Name, School Principal Donnovan Somera, M.A., YWCA of the Mid Peninsula and Rafael M. Diaz, Ph.D. Associate Professor, UCSF

RE: Evaluation of HIV Education/Prevention Program

PURPOSE

In collaboration with the YWCA of the Mid-Peninsula, we at (name of high school) have instituted an innovative 5-hour, one-week long, program to educate all high school students about the facts of HIV/AIDS, including modes of transmission and means of prevention. Our program is innovative because it aims to improve students’ ability to protect themselves against direct and indirect forms of peer pressure to have sex.

We would like to evaluate the impact of the program in all our ninth graders. We are interested in evaluating the impact of the program on students’ knowledge, attitudes, and behavior relevant to the prevention of HIV and, in particular, their perceived ability to counteract different forms of peer pressure. As one of (name of high school)’s ninth graders receiving the program, we would like to invite you son/daughter to participate in its evaluation.

PROCEDURES

Students whose parents agree to participate in the evaluation will be administered a 30-minute survey with questions about factors relevant to HIV prevention. ~ The survey will be administered in the classrooms, during their science class and under teacher supervision, at three times during the school year: October ’97, February ’98 and May ’98. The study will include all 9th grade classrooms in two different high schools; ten of the classrooms will be randomly assigned to receive the HIV education/prevention program in October and the other ten classrooms will receive the program in February. All participating students, however, will answer the evaluation questionnaire at the designated three points in time during the school year.

RISKS /DISCOMFORTS

There are no physical risks involved for participants in the study. The only risk associated with this study is possible discomfort in answering sensitive questions about sexual behavior. However, students can refuse to answer any or all of the questions asked, and can stop participation whenever they so desire, with no negative consequences to their academic grades nor any other school evaluation. Trained health educators and school counselors will be available to address students’ concerns and alleviate any possible anxiety related to the survey. Students for whom we do not have parental consent to participate in the evaluation will be given independent work assignments during the time their classmates complete the survey.

CONFIDENTIALITY

Students’ responses to the questionnaire will be handled as confidentially as possible. Students’ identifying information (i.e., names and classrooms) will be kept separate from the questionnaire data. Questionnaires will be identified only by code numbers. No one will have access to students’ individual responses, including parents, teachers, students, or any other school personnel. In order to match the questionnaires given at three different times during the year, a confidential central list (stored in a locked cabinet at the YWCA) will be kept linking student names with questionnaire code numbers; no names, however, will be attached to any questionnaire data. The questionnaires will be stored by code number and physically separated from any identifying information. Results will always be reported in terms of groups that include multiple classrooms and will be never reported for individuals, nor for individual classrooms.

BENEFITS

There will be no direct benefit to parents and/or students from participating in this study. However, the information gathered may help health professionals and educators design better and more effective HIV prevention programs for adolescents.

QUESTIONS?

You can call Donnovan Somera, at             415-494-0972      , Director of the AIDS Prevention Programs at the YWCA, if you have further questions about the study. You are also free to call the person in charge of this study, Dr. Rafael M. Diaz at             (415) 597-9236      . You may also contact the Committee on Human Research, U.C.S.F., which is concerned with the protection of volunteers in research projects. You may reach the Committee office between 8:00 AM and 5:00 PM, Monday through Friday, by calling             (415) 476-1814      , or by writing to the Committee on Human Research, Suite 11, Laurel Heights Campus, Box 0962, University of California, San Francisco, CA 94143.

PLEASE SIGN THE ATTACHED CONSENT FORM, DETACH IT, AND SEND IT TO YOUR CHILD’S TEACHER TOMORROW:

____YES, I WANT MY CHILD TO PARTICIPATE IN THE PROGRAM EVALUATION.

____NO, I DO NOT WANT MY CHILD TO PARTICIPATE IN THE PROGRAM EVALUATION.

STUDENT NAME PARENT NAME PARENT SIGNATURE DATE______________________________________________________

Outline of the intervention curriculum.

Day 1: Students learn statistics about HIV infection rates among teenagers. Students play an interactive game which teaches the facts about the biology of HIV disease, HIV transmission and prevention.

Day 2: Students participate in an in-depth discussion about prevention and healthy sexual decision making, including abstinence, monogamy with HIV testing, and condoms (demonstration). HIV testing is explained and local resources are identified.

Day 3: Students participate in an interactive discussion about the cultural scripts that influence sexual choices, specifically, the pressures on teenagers to be sexually active, and the different expectations placed on females and males.

Day 4: Students are separated by gender. Each group evaluates more in-depth how internalized cultural scripts and gender-specific pressures affect their behavior. Students brainstorm strategies for resisting the internalization of these scripts.

Day 5: After defining sexual intercourse (i.e. which sexual activities are risky for contracting HIV and other STD’s), students participate in an interactive discussion examining how cultural scripts concretely affect our experience in and expectations of sexual/romantic relationships. Students explore the ideas of intimacy, safety, and comfort. Students are given the opportunity to ask anonymous questions.

Santa Clara Unified HIV/AIDS Study Teacher Information Sheet

To: Teachers, Santa Clara Unified School District

From Rafael Diaz, Ph.D., UCSF Center for AIDS Prevention Studies

Donnovan Somera, Program Director, AIDS Prevention Program, YWCA of the Mid-Peninsula Carolyn Laub, Assistant Director, AIDS Prevention Program, YWCA of the Mid-Peninsula

Subj ect: HIV/AIDS Preventicn Workshops and Evaluation

Date: April 24, 1997

We want to thank you for agreeing to participate in this project. We are excited about the opportunity to work with the dedicated and experienced professionals in the Santa Clara Unified high schools as we evaluate our HIV prevention workshop. Please call us at any time before, during, or after the implementation of the study to discuss your questions and/or concerns.

The AIDS Prevention Program (APP) at the YWCA of the Mid-Peninsula has been serving schools in Santa Clara County, including Santa Clara Unified schools, since 1987. As a major component of a grant we received this year, we will be conducting a formal evaluation of our ~V prevention program. SCUSD, APP, and UCSF’s Center for AIDS Prevention Studies (CAPS) will collaborate to determine the effectiveness of our HIV prevention efforts.

As a teacher participating in this study, your role will be to assist us in informing the students about the study and in obtaining student and parent permission for the evaluation. (Parent permission for the 5-day HIV prevention workshops should follow normal school protocols for sexuality education.) You are invited to attend a brief meeting with APP staff at your school at the beginning of the 1997-’98 school year. At this meeting we can answer any questions that you may have.

The following provides an overview of the evaluation process:

a) In order to improve the quality and effectiveness of HIV prevention education, researchers want to leam more about the social world of adolescents. The best way to do that is to ask students themselves about their beliefs, attitudes, and behaviors. Students will be invited to participate in confidential questionnaires before and after the HIV prevention workshops. These questionnaires will be administered in October, February, and May. Half of the classrooms will have the 5-day workshop in the Fall and half will have it in the Spring.

b) All activities related to the research will take place during regular classtime.

c) Students’ responses will be kept confidential and questionnaires will be coded with a number. There will only be one master list connecting names and codes. This master list will be kept in a locked file cabinet in the offices of the YWCA of the MidPeninsula. Overall results or findings of the study will be made available to anyone who inquires.

d) Parficipation in this study is entirely voluntary. Any student who does not wish to participate or who has doubts about participating is asked to approach the teacher with their concerns. Any student who chooses not to participate will still be able to participate in the 5-day prevention workshops. They will be assigned other work while participating students fill out the questionnaires. Note: In terms of the permission processes, the workshops and evaluation activities are considered separate.

e) A consent form and letter describing the study will be mailed home to the parents of students in classrooms which were chosen for the study. Whether or not they want their child to participate in the evaluation, parents must return the consent form. Students who do not receive parental permission to participate in the study will be assigned other work.

Thank you again for your participation in this project and your continued cornmitrnent to stopping the spread of HIV among teens in our county!

Santa Clara Unified HIV/AIDS Study Student Information Sheet

Why are we doing this study?

The AID S Prevention Program at the YWCA of the Mid-Peninsula is interested in finding out how to help people make safer choices so they can avoid unplanned pregnancy, HIV and other STD’s. We want to know if our 5-day HIV prevention workshop is helping students to make safer decisions.

What is going to happen in this study?

All students who are participating in the study will fill out a questionnaire three times during the school year: once in October, once in February and once in May. Half of the study participants will receive our 5-day HIV workshop in October and the other half will receive the workshop in the February.

Who will see my answers?

Parents, teachers and school staff will not see your answers.

Only researchers will see the questionnaires. These researchers will not see your name, only a code number.

In case we have trouble finding you during the follow-up questionnaires in February and May, we wjll keep a confidential master list which connects your code and your name. This list will be kept in a locked file cabinet.

Who will decide if I participate or not?

Your parents will receive a letter describing the study. They caa choose to have you participate or not.

You will also decide whether or not you want to be in the study. YOUR PARTICIPATION IN THE STUDY IS ENTIRELY VOLUNTARY, AND YOU ARE FREE TO DECIDE NOT TO BE IN THIS STUDY. If you choose not to fill out the questioonaire, your teacher will assign you other work.

Who is in charge of this study?

This study is being conducted by Dr. Rafael Diaz with the University of California, San Francisco and Donnovan Somera and Carolyn Laub who work with the AIDS Prevention Program at the YWCA of the Mid-Peninsula.

Last modified: February 24, 2011