Sisterhood - Adaptation of an Evidence-Based Intervention

Principal Investigators:  Jury Candelario, Asian Pacific AIDS Intervention Team Los Angeles; Lois Takahashi, University of California Los Angeles
Targeted Theme: Practice Informed Translational and Interventions Research
Community Collaborative Research Award

There are few, if any, interventions that address HIV prevention for monolingual Asian immigrant women who work in massage parlors. However, this population faces severe barriers to existing sexual health and HIV prevention services, as well as very high risk for HIV and STDs. To address the need for culturally appropriate HIV prevention programs for this population, the community investigator, Asian Pacific AIDS Intervention Team (APAIT) implemented in 2007-2009 a pilot adaptation of the EBI SISTA to target Chinese monolingual women who work in massage parlors in Los Angeles County. Preliminary data with 75 participants suggested that Chieh Mei Ching Yi (“Sisterhood” in Chinese) improved condom self-efficacy and knowledge, HIV knowledge, and communications skills, especially concerning sexual negotiation.

APAIT and the UCLA Department of Urban Planning plan to expand the program to enable rigorous evaluation both of the program's whole and its component parts. The proposed project will include 200 monolingual Chinese women who work in massage parlors for the following three specific aims: 1) To rigorously evaluate the Chieh Mei Ching Yi/Sisterhood program to assess its effectiveness in improving HIV knowledge, condom self-efficacy and attitudes, intention to consistently use condoms, and sexual communication/negotiation skills for monolingual Chinese women who work at massage parlors; 2) To examine the programmatic elements of Chieh Mei Ching Yi/Sisterhood to ascertain which program components (e.g. intervention curriculum, implementation processes, others) result in particular behavioral, attitudinal, and knowledge outcomes; and 3) To identify organizational and operational factors that support or diminish implementation of the intervention.

The proposed study design for Aim 1 is a randomized controlled prospective study of 200 monolingual Chinese speaking women who work in massage parlors. Those randomly assigned to the treatment condition will receive skills training to properly use condoms and negotiate condom use with their partners in addition to HIV information. The control condition will be an HIV prevention curriculum delivered in Chinese that has been approved by the Los Angeles County Health Department. Outcome measures will be changes in knowledge, sexual negotiation skills and self-reported condom self-efficacy and intention to use condoms consistently. The proposed study will also include evaluation of program and organizational components (Aims 2 and 3) to examine which program elements result in these outcome measures. Mixed methodology will be utilized for Aims 2 and 3, including analysis of fidelity measures, content analysis of intervention process and implementation documentation, and review of program data.

This proposed project seeks to provide scientific evidence about how the program can work to improve the ability of Chinese women who work in massage parlors to prevent HIV. A rigorous evaluation of Chieh Mei Ching Yi/Sisterhood is the next necessary step in translating and disseminating this promising culturally adapted evidence-based intervention.