By Eric Levy
AS A GROUP OF FEMALE STUDENTS AT JFK SENIOR HIGH SCHOOL in the Bronx are concentrating on their multiple-choice pre-test, many of the students have confused looks on their faces, baffled by the task before them. A few girls whisper to each other; others erase their first choice and guess at another. It's a difficult assignment, since these 10th through 12th graders have never been taught the information they are being tested on. Yet, answering correctly could mean more than a passing grade it could have a major impact on their health and the prevention of disease.
The exam is part of the first day of a six-session course called GIRLTALK (Girls In Real Life Tackling A Livid Killer: Minority Girls Talk Back to HIV/AIDS), which aims to shatter myths about the disease and prepare girls, ranging in age from 12 to 18, to spread the truth about sex and its consequences among their peers (called "Girl Talking"). Once they complete the course, some of the girls will become peer leaders and join Columbia family medicine residents in teaching future classes.
Later that day, Dr. J. Nwando Onyejekwe, chief resident in family medicine, sits down at her desk and looks over the answers to the multiple-choice test. GIRLTALK is her creation, one that began during medical school at Ohio State University. Dr. Onyejekwe anticipated a lack of knowledge about sexuality among the students, but was surprised at the number of incorrect answers and the misinformation communicated during class. She was particularly surprised that most of the girls didn't know what a Pap smear was. Some didn't know about the usefulness of a condom in preventing sexually transmitted diseases. One student thought you could get HIV if someone cried on you.
During Dr. Onyejekwe's last year of medical school, she received an Arthur Ashe Fellowship at the Harvard AIDS Institute in Boston. The fellowship's goal was to expose minority medical students to issues surrounding HIV in minority populations. It was there, she says, that she saw the need for physicians to give accurate information to young females, especially young women of color. She matched the need with an idea, and GIRLTALK was born.
Dr. Onyejekwe soon began to work on a curriculum that would become the basis for GIRLTALK sessions during her residency in New York City. Topics cover sexual health: understanding how to take care of your body and having enough information to make informed decisions; responsibility for potential outcomes of sexual activity; STD causes, signs, symptoms, treatment, prevention, risk factors, and consequences of not receiving treatment; HIV life cycle, symptoms and treatment; epidemiology of the HIV epidemic; the influence of the hip-hop and popular culture on HIV/AIDS; and AIDS advocacy.
Three schools in high-risk minority areas were selected for the first GIRLTALK sessions: the Frederick Douglass Academy in Harlem, the Health Opportunities Secondary School in the Bronx, and JFK Senior High School.
In October 2002, Dr. Onyejekwe taught her first class at Frederick Douglass. She began to show transparencies of the statistics she had collected to the class of eighth through 11th grade girls, but after a few minutes, she knew she had lost the class they looked terribly bored. So she switched tactics and had the girls form a discussion circle.
"They then opened up very quickly," says Dr. Onyejekwe, "asking questions about things they've heard about HIV. This changed the tone from a lecture to a discussion. I never used transparencies again. I was very surprised about what I heard. A lot of the girls don't feel they can talk to their doctors. They were talking about physical and mental abuse and some admitted they were sexually active. At the end of the class, they were excited to come for the remainder of the sessions to participate in the discussion format."
A major goal of GIRLTALK is to have students who have excelled in class become peer leaders and help teach classes in other schools. Dr. Onyejekwe knew from the start that effectively communicating to students required relating to them on their own level. Dr. Onyejekwe, only 10 years or so older than the girls, uses language the students normally use when speaking to each other about sex and STDs. Having girls the same age lead a class in discussion had even a greater impact, as she predicted.
In February 2003, Dr. Onyejekwe brought student peer leaders from Frederick Douglass to the Health Opportunities Secondary School. The student leaders spoke to the class about healthy sexual behavior, breast exams, and STDs. "The students really related to the peer leaders," Dr. Onyejekwe says. "I had them lead the class as much as possible. They spoke their language, which is so important. It was so rewarding to see one of our peer leaders, who said that before she took the course she didn't even know what a Pap smear was, and now she was describing STD prevention methods to the class. Another peer leader said to me, ‘Nwando, I made a GIRLTALK intervention today,' providing advice to a friend who had gonorrhea."
After teaching the first class alone, Dr. Onyejekwe was joined by another resident in family medicine, Dr. Yira DeLaPaz. "It's a very rewarding experience," says Dr. DeLaPaz, who is teaching her own GIRLTALK class this year at JFK. "I was so surprised by the myths out there that need clarification. But there's genuine interest from the girls and they're open to learning about what GIRLTALK has to offer them."
Bringing other residents with her, says Dr. Onyejekwe, "is a good chance for them to get out of the hospital and clinics and into the community."
The community link is no accident. Dr. Onyejekwe and other residents in family medicine are required to create a project of benefit to the communities in the medical center vicinity. "Since Nwando developed GIRLTALK while in medical school, she was driven to get it going at Columbia," says Dr. Anita Softness, assistant clinical professor of medicine and coordinator of the community medicine curriculum. "She already had a lot of it done before our sessions began. It's meeting an important need; there's not enough education on these issues. It works because accurate information is reaching these students through a physician. The peer leader aspect enriches the project by giving the girls ownership and empowerment."
During the GIRLTALK classes at JFK, which were introduced in October 2003, Raymond Cusranie, the health class teacher, turned his class over to Dr. Onyejekwe. "This is the best thing. We teach sexuality to some extent and about HIV, but when the girls are separated from the guys, they feel freer to express themselves. Some of the questions I've heard would never have been uttered with guys in the classroom."
In the classroom next door, the males of the class are participating in a routine health class. "The guys are jealous," says Mr. Cusranie. "They ask ‘Why don't we have such a class?'" In fact, the boys will have such a class, GUYTALK, currently being developed by Dr. Eamonn Vitt, a second-year family medicine resident.
Dr. Onyejekwe also has plans to expand GIRLTALK beyond the New York area and turn it into a national and international project. She's already incorporated GIRLTALK and is the CEO. She wants to implement the program as an optional teaching course for U.S. medical students during their community health elective. Celebrities and their companies, including Iman Cosmetics, NFL athletes, and Baby Phat's Kimora Lee Simmons, have donated items or time to support the efforts of the students when they graduate from the program through the efforts of GIRLTALK's vice president for public relations, Emeka Onyejekwe, Nwando's brother.
The next step is to validate GIRLTALK as a research project worthy of publication in a medical journal. It's currently being evaluated by CUMC's Institutional Review Board.
Support for validating GIRLTALK comes from three faculty members in family medicine Dr. Silvia Amesty, assistant clinical professor of medicine, assistant director of research, and a mentor for Dr. Onyejekwe; Dr. Daria Boccher-Lattimore, director of research; and Dr. Pablo Joo, associate residency director. Dr. Amesty advised Dr. Onyejekwe on the need to develop a survey to evaluate GIRLTALK's effectiveness by doing pre- and post-testing with a control group. "This is an education program," says Dr. Amesty, "but it is important to establish whether the program achieves its goals." The M-GAHRAP survey Minority Girls Assessment of HIV Risk and Prevention was developed as an instrument to assess the usefulness of this intervention in changing attitudes, knowledge, and behavior.
The evaluation of GIRLTALK, says Dr. Boccher-Lattimore, is "the missing piece. We believe it's working the kids are more attuned to the prevention of STDs and are more knowledgeable about HIV/AIDS. Now we have to document it to the research community."
Before that happens, the anecdotal evidence comes in the form of what the girls themselves at JFK Senior High School have to say about what they've learned. "I learned AIDS ain't no joke, AIDS is like drugs, it grows," says student Yulissa Majia. "There are so many diseases out there. It didn't hit me as much until this class. I learned how to take care of my body, look out for symptoms of STDs."
Another student, Annette Barraza, acknowledged that she didn't know about STDs and contraception before the classes. "I learned every year to go get a checkup and take tests to see if you have a disease. Girls don't go for checkups. I tell them to go. They're afraid their parents will find out they're having sex. I tell them they can have a checkup that's confidential. The teacher can recommend a clinic."
With this knowledge in hand, the girls at JFK have now joined the boys in Mr. Cusranie's health class, where he's teaching about sexuality. He says that even with the boys present, "the girls are more open. They're way ahead of the guys."