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The statistics are grim: Nationwide, one in four black girls ages 14 to 19 will contract an STI. In Chicago, black girls and women have higher STI rates than any other racial group, with 13- to 29-year-olds accounting for 56% of new HIV diagnoses.
Natasha Crooks, an assistant professor in the UIC School of Nursing, wants to improve the sexual and reproductive health of Black girls by empowering an often-overlooked resource: a girl's male caregivers. A male caregiver can be a girl's father, brother, uncle, cousin or any other caring man in a girl's life.
Supported by a five-year, $4 million grant from the National Institute on Minority Health and Health Disparities, Crooks is piloting a two-day workshop for girls and their male caregivers designed to help them better understand and feel more comfortable discussing women's reproductive and sexual health.
Natasha Crooks (Photo: Martin Hernandez/UIC)
“There are literally no other programs that engage male caregivers when it comes to girls' sexual and reproductive health,” Crooks says, “fathers and boys, mothers and girls. But that's a disservice. What about the fathers who really want to be involved? It shouldn't be this awkward, uncomfortable conversation.”
I want to hear from men
Development of the curriculum, called IMAGE, grew out of Crook's doctoral dissertation project, in which she interviewed black women and developed a theoretical framework to explain the process of becoming a sexual black woman.
“Women often spoke about how their childhood experiences had influenced their sexuality, so I decided I needed to interview girls,” she said.
When she did, the girls told her they wanted more support and protection, and “many specifically wanted to hear from men about how they could be better protected.”
From that work, IMAGE was born.
Crooks adapted IMAGE from another curriculum developed by UIC School of Medicine instructor Jeri Donenberg called IMARA. IMARA (Information, Motivation, Awareness, Responsibility) is a two-day workshop for Black girls and their female caregivers to help them prevent HIV infection. Crooks customized it for male caregivers.
Programs like IMARA and IMAGE (IMARA stands for Black Male Caregivers and Girls Empowerment) focus on black girls who are at higher risk for STIs and HIV. This is because while girls are starting puberty earlier than in the past, black girls often reach puberty around age 9. This leads to adultification, where black girls are treated as older than their chronological age and are approached by older men as sexual partners, Crooks said. Having older sexual partners correlates with increased risk of sexual violence, STIs and HIV, she added. There are also cultural norms that may discourage protective behaviors like birth control use and condom use, increasing black girls' risk of STIs and HIV.
Crooks says men often know more about women's reproductive health than they're given credit for, yet IMAGE includes lessons on female reproductive biology — what a uterus is and how menstruation works — that many men say they don't fully understand.
A big part of IMAGE is focused on improving communication and becoming more comfortable when talking about potentially problematic topics like sex, bodies and relationships.
Crooks and her colleagues Donenberg, Phoenix Matthews, formerly of UIC and now at Columbia University, and Crystal Patil, formerly of UIC and now at the University of Michigan, piloted IMAGE with 40 pairs of girls and their parents at the North Lawndale AMACHI mentoring program two summers ago. Both boys and girls who participated said IMAGE helped them overcome a lot of the discomfort of talking about these topics.
“They're able to communicate a little bit more now and their relationships have improved,” Crooks said.
Crooks learned that the men in the program wanted to address topics that stem from structural racism, like disproportionate incarceration rates and a lack of positive male role models for Black men. So, for example, IMAGE includes discussions of how incarcerated men can help guide and protect girls in their lives.
And after the pilot program, many of the men said they wanted to continue talking to each other about mental health and other issues in a space they felt was safe, like the one Crooks helped establish at the North Lawndale facility.
New project this summer
Starting this summer, Crooks and his colleagues will partner with six community organizations that serve black neighborhoods on Chicago's South and West Side. To further test IMAGE's effectiveness, they hope to recruit 300 girls and their male caregivers and randomly assign them to participate in either IMAGE or another health program. Both two-day programs will be held on Saturdays and Sundays.
The researchers will compare outcomes for the two groups of girls – looking at STI risk factors, such as condom use and number of sexual partners, and STI incidence six and 12 months after the program began. They aim to use what they learn to improve IMAGE and to help community partners continue to deliver it.
“The goal is for the community to own the program and continue to run IMAGE without us,” Crooks said.
More information about the study can be found on the IMAGE website, and those interested in participating can email the researchers at image@uic.edu.
