STAND: a peer educator training curriculum for sexual risk reduction in the rural South. Students Together Against Negative Decisions.
BACKGROUND
The incidence of AIDS in rural areas continues to increase rapidly, with teenagers continuing to report high rates of sexual risk behaviors. Unfortunately, there is a dearth of effective HIV prevention programs targeting youth in rural settings where there are often formidable barriers to sex education programs. This paper describes a theoretically based intervention designed to meet the needs of rural youth.


METHODS
Students Together Against Negative Decisions (STAND) is a 28-session teen peer educator training program implemented in a rural county in a southeastern state, promoting both abstinence and sexual risk reduction. The theoretical foundation of the curriculum includes both Diffusion of Innovations Theory and the Transtheoretical Model, focusing on both individual and community norm change. STAND is teen-centered and skills-based; activities focus on active learning. Educator trainees are selected on the basis of their opinion leadership within their peer group, resulting in a training group of both virgin and sexually active teens, balanced for gender and matched to the racial proportions of the school.


RESULTS
Acceptance and participation in STAND suggest that adolescents in rural communities can be accessed through community-based interventions, that they are willing to participate in such intensive programs, and that they perceive the intervention as valuable and enjoyable. Moreover, the STAND program has thrived in a relatively conservative rural environment, and has had a positive impact on adolescents' sexual risk taking. Results from a pilot study showed significantly greater increases in condom use self-efficacy (16% vs a 1% decrease among controls) and in consistent condom use (+28% vs +15%). Adolescent trainees also reported a sevenfold larger increase in condom use (+213% vs +31%) and a 30% decrease in unprotected intercourse compared to a 29% increase among controls.


CONCLUSIONS
STAND represents a new genre of HIV prevention program, one that utilizes complementary theoretical models to develop a program that targets both individual- and community-level change for rural adolescents.
Smith
M U
MU
Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia 31201, USA. SMITH_MU@MERCER.EDU
DiClemente
R J
RJ
D000293:Adolescent; D003479:Curriculum; D005260:Female; D005845:Georgia; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education; D006801:Humans; D008297:Male; D010379:Peer Group; D012423:Rural Health; D012725:Sexual Behavior