SEPA (Salud/Health, Educación/Education, Prevención/Prevention, Autocuidado/Self-care): A Small Group-level Intervention for Heterosexually Active Hispanic Women/Latinas

The Research

The Science Behind the Package
  SEPA is an evidence-based, culturally tailored HIV/AIDS behavior change intervention for heterosexually active Hispanic women/Latinas between the ages of 18 and 44at risk for HIV and STD infection due to unprotected sex with male partners. SEPA is based on Social Cognitive Theory which posits that behavior is influenced by outcome expectancies, interaction with the environment, observation, and self-efficacy. Since individuals who believe they have the capability to perform an action are more likely to engage in the action, SEPA employs demonstrations, role play, and other skills-building exercises to enhance the self-efficacy of Hispanic women/Latinas in condom use, condom negotiation, and partner communication.

Target Population
SEPA was developed for Hispanic women/Latinas between the ages of 18 and 44 who are at risk for HIV and STD infection because of unprotected sex. Although the intervention’s efficacy trial included Mexican and Puerto Rican women, researchers believe SEPA can be of benefit to at-risk women of diverse races and ethnicity if their prevention needs can be addressed by SEPA’s activities. This means that SEPA can be adapted for women who are not Hispanic or Latino if they are in need of information on HIV and STD prevention and domestic violence and if they need to strengthen their skills in communication with male partners, condom use, and condom negotiation. Any adaptation must maintain SEPA’s core elements (see discussion of core elements below).

Intervention
SEPA was designed to educate Hispanic women/Latinas about HIV and other STDs and to help them build the skills necessary for behavioral changes that lead to more healthy relationships and safer sex. SEPA consists of six two-hour sessions that include presentations, group discussions, and practice exercises on male and female condom use, condom negotiation, and assertive communication. Session content covers HIV and STD transmission and prevention, male and female reproductive anatomy, human sexuality, interpersonal communications, and domestic and intimate partner violence.

Research Results
SEPA produced significant outcomes among low-income Mexican and Puerto Rican women between the ages of 18 and 44 in Chicago where the intervention was tested between 1999 and 2001. Compared to members of the control group, SEPA participants showed significant increases in:

• HIV knowledge
• Communication with partners about HIV issues
• Risk-reduction behavioral intentions
• Condom use

In addition, SEPA participants had significant decreases in perceived barriers to condom use.

For Details on the Research Design
Peragallo N, DeForge B, O’Campo P, Lee S, Kim Y, Cianelli R, & Ferrer L. (2005). A randomized clinical trial of an HIV-risk reduction intervention among low income Latina women. Nursing Research, 54(2), 108-118.

The Intervention

A Package Developed from Science
Replicating Effective Programs (REP) is a CDC-initiated project that isupports the translation of evidence-based HIV/AIDS prevention interventions into everyday practice, by working with the original researchers in developing a user-friendly package of materials designed for prevention providers. SEPA is one of the REP interventions and is the product of extensive collaboration among researchers, community based advisors, and health promotion experts. The package was field tested in two community-based organizations by non-research staff.

Core Elements
Core elements are intervention components that must be maintained without alteration to help ensure program success. The core elements of SEPA are:

1. Provide culturally and linguistically appropriate information to sexually active women at risk of acquiring HIV from unprotected sex with male partners in interactive, small group sessions that focus on
   • HIV and STD transmission and prevention
   • Human sexuality and male and female anatomy
   • Interpersonal communications
   • Relationship violence
2. Incorporate skill-building activities into sessions to enhance women’s self-efficacy for safer sex behaviors, including demonstrations and practice exercises on male and female condom use and role plays on assertive communication with sex partners, including condom negotiation.
3. Build self-efficacy and knowledge for safer sex behaviors, and improved partner communication, and violence management through homework exercises and the sharing of personal experiences.
4. Show a culturally appropriate video during the first session that portrays the effects of HIV and AIDS on members of the target population and discuss what is communicated about the impact of HIV and AIDS on the community, including impact on families and women.
5. Use a female facilitator who speaks and understands the language of participants. The facilitator is not a peer of participants but someone who is an experienced professional in health education, disease prevention, and risk reduction.
6. Ask participants to write thank you notes to fellow participants and pledge their commitment to community health during the final session. Present a certificate to each participant who attends at least half of the sessions.
7. Conduct no more than two sessions each week.

Package Contents

• Implementation Manual, including: Monitoring and Evaluation Guide, Quality Assurance Guide, Technical Assistance Guide
• Facilitators Guide (curriculum for implementing SEPA)
• Participant Workbook
• “Mi Hermano” video
• CD containing electronic copies of intervention materials

Timeline for Availability
Development of the REP package is complete. The intervention package and training will be made available in the future.

For More Information on the SEPA Intervention Package
Nilda (Nena) Peragallo, DrPH, RN, FAAN, Dean and Professor, University of Miami School of Nursing and Health Studies, PO Box 248153; Coral Gables, FL, 33124. Phone: 305-284-2107. E-mail: nperagallo@miami.edu.

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