General Articles

Evaluating HIV/STD Prevention Programs in the Classroom

Source: Elaine Borawski, Erika Trapl, Kimberly Adams-Tufts, Laura Hayman, Meredith Goodwin, and Loren Lovegreen. “Taking Be Proud! Be Responsible! to the Suburbs: A Replication Study,” Perspectives on Sexual and Reproductive Health 41.1 (March 2009): 12-22.

Be Proud! Be Responsible! (BPBR) is an HIV/STD-prevention program originally designed for black urban males in non-school settings. Previous research has found the program to be successful with this population. The current study was designed to determine whether BPBR is an effective program for health classes in both urban and suburban schools with diverse student bodies. Between 2000and 2002, 1,357 ninth and tenth graders from ten different high schools participated in the program. Students were then asked a range of questions to gauge their sexual behavior, intentions, beliefs, efficacy, and overall knowledge as a result of the program. Surveys were conducted prior to the program to provide a baseline, then immediately after the program, four months later, and again after 12 months to determine the long-term effects of BPBR. The results were compared with students who received a control curriculum.
Key Findings:
  • Students who participated in the BPBR program reported significantly greater knowledge about STDs and condoms and retained that knowledge for one year after the classes compared to the control group.
  • Students felt more confident in their ability to properly use a condom and negotiate condom use with their partner following the completion of BPBR. 
  • Four months after the prevention program, among those students who reported being less sexually experienced, a higher proportion of students who completed BRBR reported having talked to a health professional about a sex-related matter than those who received the control curriculum.
  • Female students who participated in BPBR reported significantly lower intentions to have sex and greater confidence in condom use than their peers in the control group.
  • Students who received the BPBR curriculum were just as likely to have sexual intercourse and were no more likely to carry condoms 4-12 months following the completion of the instruction than those in the control group. 
  • BPBR had a longer-term impact on black teenagers than on white or Hispanic teens.
SIECUS Analysis:
Be Proud! Be Responsible! is a proven age-appropriate, medically accurate HIV/STD- prevention program. This replication study that it has a positive impact on students’ knowledge about STDs, condoms, and general health even in urban and suburban schools with diverse student bodies. However, results were mixed in regards to behavioral differences and the authors examine what differences may have accounted for this. 
In particular, they highlight the age difference between the young people in the original trials and the students in this study, the changes made to BPBR in order to fit it into health classes, and the possible impact of using the program in classrooms rather than with after school groups. The authors of the original evaluation of BPBR used the program with middle school aged youth, however, in this trial the researchers were forced to run the program in high schools because school administrators thought the content of the program was not appropriate for middle school students. It’s possible that this may have contributed to the lack of behavioral effect, as older students are more likely to already be sexually active.
Other changes to the program may also have had an impact on its effectiveness. Most notably, because of the limited amount of class time, students only received an average of 70% of the BPBR lessons. In addition, a 10-minute activity intended to reduce beliefs that condoms interfere with sexual pleasure was omitted over objections by some school officials. Originally, BPBR sessions were designed for use with small groups outside of schools; young people voluntarily attended these sessions on weekends and were monetarily compensated for their time. The authors hypothesize that the more intimate setting and voluntary nature of the program may have lead to more engagement among participants than would occur in a health class where students’ attendance is required and the class size is larger. 
Despite the lack of behavioral effect in this evaluation of Be Proud! Be Responsible!, the authors conclude that the results still support the idea that schools can be a successful setting for HIV-prevention programming. SIECUS agrees that school-based programming must be a part of the solution, as it is one of the few places where we have an opportunity to reach such a large proportion of young people. However, school-based prevention programs like BPBR should be viewed as one piece of the puzzle.  Ideally, they should be combined with comprehensive sexuality education programs that also address a range of other pertinent sexuality topics such as pregnancy prevention, puberty, gender, relationships, body image, and sexual orientation, as well as non-school based programs that can augment what young people learn in school.