1. Refining What Works Focus group sessions to assess IMB sexual health needs of Black college females Rasheeta Chandler, PhD, ARNP University of South Florida College of Nursing September 14, 2012

2. Background  Black women account for 68% of HIV diagnoses in women age 13 and older  College women are at high risk for STDs, including HIV  Few interventions that address HIV prevention needs among black college women

3. HIP Teens  IMB model  Education  Behavioral skills training  Role playing  Communication skills  Motivation for risk reduction

4. Purpose  To identify the HIV prevention needs of black college females in order to design culturally- and age-appropriate HIV prevention interventions

5. Methods  4 focus groups  2 universities (2 focus groups each)  Recruited through undergraduate courses and student organizations  90 minutes  Digitally recorded  $50 incentive + snacks  Semi-structured interview guide

6. IMB Model  Information  “What information do women like you need to protect themselves from HIV?”  Motivation  “What are some of the challenges women face when they want to use condoms during sex?”  Behavioral skills  “What would you do if you want to use condoms during sex, but your partner does not want to?”  Control group health promotion questions  “Besides HIV, what other health information do you and your peers need?”

7. Sample population  N = 30 Black females (~4-6 per focus group)  Aged 18-24 (mean age = 18)  Freshmen and sophomores  Sexually active with a male partner

8. Analysis  Professionally transcribed  Analyzed in NVivo9  A priori and emergent coding  2 coders  Inter-rater reliability  Independent coding  Discussion of discrepancies  Percent agreement was high 90-100%

9. Results  HIV Information  Contraceptive access, options, & resources  Internet  Health centers  School health classes and college classes  Medical mistrust  Early Education  Start early and continue  Need to educate parents also

10. HIV Information  Contraceptive access, options, & resources  Internet  Health centers  School health classes and college classes  Medical mistrust “So going to get tested is not something a lot of black families do. "You're having sex, let's go get you tested." That's so not something we're going to do, because it's one of those, "You don't go to the doctor unless you're about to die. If I got to call 911 that's when you're going. That's it." If you think about the white race they go to the doctor for everything.”

11. HIV Information  Early Education  Start early and continue  Need to educate parents also “I feel like you should start younger than college. I think it should start in middle school because people start having sex early, so if it starts in middle school and you keep it going throughout high school and you keep it going through college... I don’t see why it should stop really.”

12. Results  Motivation  Attitudes about sexual behaviors  Accountability  Stigma  Risk for promiscuity  Normative beliefs  Conversations about sex  Respect/trust  Media influences  Avoidance of pregnancy  Cultural differences

13. Motivation: attitudes  Accountability  Stigma  Risk for promiscuity  Casual attitudes  Her fault/male status  You’re grown “a lot of people feel that it’s the guy’s responsibility. He’s supposed to bring the condom, but I don’t know. I just don’t trust guys ’cause they always just say, “Oh, I don’t have it,” and you’re so caught up in the moment that you’re just like – some people are just like, “Whatever. Okay, go ahead.” So honestly I just think just take the responsibility yourself and have a condom on you or go on birth control. It doesn’t matter. Either way, protect yourself.”

14. Motivation: normative beliefs  Conversations about sex  Parents/family  Peers  Respect/trust  Media influences  Avoidance of pregnancy  Cultural differences “So now they’re expecting this stuff from us because celebrities are saying it, so now some people might feel pressured to do certain things because of the music. I think it does influence your life. Sometimes it’s just the way they sing -- it is just like sex must be heaven because they’re singing really good in these songs.”

15. Results  Behavioral Skills  Safe sex and regular testing  Condom negotiation skills  Communication skills

16. Behavioral skills  Safe sex and regular testing  Condom negotiation skills  Communication skills  Parents, peers, partners “I am in a monogamous relationship, but we all know that guys sometimes don't tell the truth all the time. I trust my boyfriend, I do. But I'm not going to be dumb about it. So I make sure that I go get tested.”

17. Unmet needs  Better access to affordable or free HIV screening/testing services  General STI knowledge  HPV information and vaccine information  Breast self-exams  Condom use skills  Relationship skills  Communication skills (parents and partners)  Self-esteem and empowerment strategies  Stress management

18. Need to reduce stigma “I understand that it's a horrible disease, but we make it so that we don't want to tell anybody that we're at risk. We don't want to go to the clinic and be like “I need to get tested,” because of the way we are taught about it - we are taught that it's so bad. And we are taught that when you do get it it's almost like you're a leper if you will.”

19. Conclusions and Student recommendations  Integration of an interactive sexual health program into University freshmen orientations  Integration of interactive HIV information into existent social activities on campus  Wellness Expos with freebies (condoms, food, etc.)  Social networking – Facebook, Phone apps  Panel with people who have HIV/AIDS to dispel myths  Regular free HIV screening on campus

20. “during the week of welcome having a sex orientation thing ’cause so many people – a lot of people haven’t had sex until – and they’re into college and then they feel all of a sudden that they have to, so it would be a good way to start off – start college for freshmen to have some kind of sex orientation or something like that.” “I wish they would bring back sex ed and put it in schools and make it a requirement.”

21. Next Steps  K award  Develop HIP Ladies  to meet the HIV prevention needs of female black college students  Pilot...

22. Thank you! Rasheeta Chandler, PhD, MS, ARNP, FNP-BC Assistant Professor University of South Florida College of Nursing rchandle@health.usf.edu