Project RESPECT assesses the translatability of an HIV/STD prevention intervention called RESPECT among American Indian and Alaska Native (AI/AN) youth. RESPECT has been shown to be efficacious in reducing sexual risk behaviors and the incidence of sexually transmitted diseases (STDs) in public STD clinics among ethnically and racially heterogeneous heterosexual adult (ages15-39) populations. Such findings hold great promise for AI/ANs, a group that shoulders 2-4 times the level of STDs nationally. In fact, 11 of the 12 service areas of the Indian Health Service (IHS) show rates of Chlamydia trachomatis (Chlamydia) higher than the US average, with 3 of these service areas at levels 5-6 times higher. AI/AN adolescents ages 15-19 bear a disproportionate share of most STDs, comprising 34% and 28% of all Chlamydia and Neisseria gonorrhea (gonorrhea) cases, respectively, reported in IHS services areas. This is due to a number of factors. Like other adolescents, AI/AN youth have increased biological vulnerability, face transportation limitations (especially in reservation or Village settings where distances are great), and are reluctant to use services designed for adults. Those in rural or reservation settings are especially concerned about receiving confidential care in their often small and close-knit communities. Finally, AI/AN youth experience higher levels of sexual risk behaviors compared to others in their age group nationally. The Centers for Disease Control and Prevention (CDC) have recognized this problem, and recently initiated an effort to implement school-based Chlamydia screening in AI/AN communities.
As noted by the CDC in that effort, STD screening at AI/AN school clinics also provides a critical point of prevention through counseling; RESPECT, a proven HIV/STD prevention intervention, was recommended as a model. As yet, however, no research on the viability, or external validity, of RESPECT in AI/AN communities exists. At the same time, little dissemination research exists to delineate the factors and processes in AI/AN communities which might facilitate the widespread use of any evidence-based intervention, let alone one that may incur particular resistance because of stigma and values surrounding sexual activity. We need to know about the external validity and the dissemination processes in AI/AN communities if we are to address effectively the daunting disparities in HIV/STDs and sexual risk-taking among youth.
To do this, we propose the following:
- With tribal partnerships, regional alliances, and national collaboration, we will use the Theory of Diffusion of Innovations to guide the development of a dissemination plan for RESPECT with AI/AN communities;
- Using the RE-AIM framework of enhancing external validity, we will implement the RESPECT intervention in school-based clinics in a specific AI community; and
- Evaluate the potential diffusion of RESPECT based on the results of 1 and 2.