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.
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
HIV Prevention Update and
Overview of Other Research
Rick S. Zimmerman
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 11th graders, Blacks, males
Increase in condom use: from 46.2% to 62.8%
 Bad news: Significant proportions still at risk
One-third of 9th graders having sex
Nearly 40% didn’t use a condom last time
HIV/AIDS Rates in the US
 Cincinnati: 7.5/100,000 new cases in 2004, ranked 82nd
 Louisville: 11.8/100,000 new cases in 2004, ranked 61st
 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
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
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
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
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
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
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; skillbuilding is critical.
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.
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.
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)
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
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)
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)
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
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)
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)
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
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)
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)
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
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)
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)
Objectives
Assess student refusal skills
Provide opportunities for students to
role play and practice new skills in
difficult situations
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)
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)
Objectives
Introduce delaying tactics
Provide opportunities to practice
effective delay tactics in role plays
Assesses student refusal and delay
tactics
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)
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)
Objectives
Discover high-risk situations
Practice handling difficult situations
Assess STD and HIV knowledge
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)
Curriculum Training – Day 2:
(morning session)
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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
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)
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.
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
Methods that DON’T Work
Withdrawal
Douching
Hoping
Rhythm
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
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)
Objectives
Practice PROTECTION communication
skills
Review Myths and Truths activity to
assess student knowledge about HIV
and other STDs
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
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
Objectives
Practice Refusal, Delay, and protection
communication skills
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
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)
Objectives
Inform students of signs and symptoms
of most common STDs
Provide students with strategies for
STD prevention
Outline transmission patterns of various
STDs
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
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
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)
Objectives
Students will understand which
behaviors put them at greatest risk of
HIV
Sequence
Brief review of previous lesson (12)
**HIV Risk Behavior Activity
Lesson summary (IM - p. 180)
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)
Objectives
Students will create STRATEGIC
PLANS for preventing pregnancy and
reducing STD by considering steps for
protection and steps for abstinence.
Sequence
Brief review of previous lesson (13)
**Steps to Protection worksheet
**Steps to Abstinence worksheet
**Role Play
Lesson summary (IM - p. 187)
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
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)
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
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
Reducing the Risk . . .
 Summary
Curriculum Fidelity
Interactive
Abstinence-based
Reduce the Risk
 Thanks for all your efforts!
Thank you very much for your
enthusiasm and commitment
to the project!