Project ORE

Project ORE is a primary intervention that targets urban African American adolescent girls at high risk of contracting HIV/STDs. The project is designed to integrate cultural and social influences into a sexual health education program delivered to young African American girls. The researchers incorporate friendship-based groups in order to influence social norms.

Four neighborhoods in San Francisco were selected for the study. Participants enrolled based on their interest in the study and were further selected based on eligibility factors including being female, sexually experienced, African American race, aged 14 to 18 years and willing to appoint a few close female friends to participate. Two neighborhoods served as controls, in which the participants and their small friendship groups received a nutrition and exercise health promotion intervention. The other two neighborhoods were placed under the Project ORE intervention, in which the friendship groups participated in a five hour session led by a trained African American female educator. The session focused on local HIV/STI rates, sexual behavior and other aspects of sex and HIV education as implemented by interactive group discussions and exercises. Project ORE also produced a series of DVD clips consisting of interviews with adolescents from target neighborhood on issues of HIV/STIs which were used to encourage group discussion. An African rite of passage ritual was performed at the start of the intervention in order to connect cultural influences to sex education and set up a collaborative atmosphere within the friendship group. Throughout the intervention, seven modules based on an AIDS risk reduction model were presented to the participants. The intervention ended with all participants signing a pledge to protect each other from HIV/STIs.

The goal of Project ORE is to use a friendship-based sexual education intervention to prevent HIV/STI transmission in high-risk urban African American adolescent girls.

A randomized controlled trial was used to evaluate the efficacy of the Project Ore experimental intervention. The study consisted of a total of 264 adolescent females between the ages of 14 and 21 (n=131, experimental; n = 133, control). Baseline measurements were made using a pre-questionnaire and compared with an identical post-study questionnaire approximately 3 months after the intervention. The participation rate for eligible subjects was 90% and 93% for eligible friends, while 95% of subjects completed the follow-up questionnaire.

The four primary outcome variables analyzed included subjects’ sexual risk, multiple sexual partners, HIV testing, and STI testing. Without stratification, there were no statistically significant differences between the experimental condition and control condition for the 4 primary outcomes. However, three of the primary outcomes (HIV testing, multiple sexual partners, and sexual risk) varied significantly by age, but not by prior sexual risk or friendship quality. Following the intervention, among 14-15 year olds, the experimental group (18%) was more likely to have been tested for HIV than those in the control group (3%) (p=0.05). Among 16-17 year olds, the experimental group (20%) had a lower proportion of respondents report multiple sexual partners compared to the control group (5%) (p=0.04). Finally, among 18-21 year olds, the odds of engaging in risky sexual behavior were lower for the experimental group compared to the control group (p=0.01). The results suggest that an effective friendship-based HIV/STI prevention intervention for African American female youth residing in a community with a high STI burden should be varied in order to emphasize different components based on the age group of the participants in order to maximize the intervention’s efficacy.