Native Sisters Informing Sisters: Talking, Educating, and Reducing Risk


Updated: 09/19/2023

SISTER (Sisters Informing Sisters: Talking, Educating and Reducing Risk) is a peer-led, social skills-building, group level intervention designed to reduce sexual HIV risk behaviors among heterosexual Native American women, ages 18-29.  The small group sessions consist of 10 to 12 Native American women. The intervention is designed to meet the cultural needs, expectations, and values of the Native American women that it serves.

SISTER is delivered in six, two-hour sessions followed by two optional booster sessions. The topics include: Being A Proud Native American Woman, Historical Trauma And Cultural Resilience, HIV Risk-Reduction Information, Proactive Skills Training, Behavioral Self-Management, and Coping Skills. In the sessions, women participate in facilitator-led group discussions, role-play, and behavioral skills-building activities.

  • Age Group Designed For:

  • LGBT Inclusive:

  • Trauma Informed:

  • Program Setting:

    Community-Based, Flexible
  • Health Topics Covered:

    Sexual Health, Training for Adults
  • Duration:

    Six 2-hour sessions, plus two optional booster sessions
  • Cost to purchase:

  • Teacher Training or Certification Required:

  • Student to Teacher Ratio:

  • Program Outcomes:

    Improved contraception use, Increased knowledge about HIV transmission and risk reduction strategies
  • Endorsements:

    CDC's HIV Effective Interventions

Program Contact Information

  • Gwenda Gorman, Health and Human Services Director
  • Inter Tribal Council of Arizona
  • 602-258-4822


Downloadable Training Materials:

Teacher Training or Certification Requirements:

The intended audiences for this manual are persons, organizations and Tribes who wish to implement the SISTER intervention in the Native American community.  It is recommended that users of the manual have received education and/or training in HIV/AIDS prevention and are familiar with factors and behaviors that can protect and increase risk for Native American women. This manual is distributed as part of the ITCA Facilitators Training and assumes the users of the manual will also complete the original SISTA training.

SISTER is delivered in six, two-hour sessions followed by two optional booster sessions. The topics of the gender-specific and culturally relevant sessions include Being A Proud Native American Woman, Historical Trauma And Cultural Resilience, HIV Risk-Reduction Information, Proactive Skills Training, Behavioral Self-Management, and Coping Skills. In the sessions, women participate in facilitator-led group discussions, role-play, and behavioral skills-building activities.1 Participants will view the video “Breaking the Cycle:  Stories of Alaska Native Women” which is an HIV/STD prevention video for Native communities.2

The SISTER intervention should be facilitated by two peer facilitators. We recommend that the peer facilitators be AI/AN, Indigenous, or the same ethnicity and gender as your program participants. Facilitators should be well versed in HIV transmission and methods for preventing HIV transmission, possess group facilitation skills, and have a nonjudgmental attitude toward people at risk for acquiring HIV and people living with HIV/AIDS.

Supporting Materials

Cultural Relevance

NA SISTER has been adapted and developed as a culturally relevant and gender specific HIV prevention intervention for sexually active, heterosexual Native American women between the ages of 18 and 29. Culture is communicated in various ways in the NA SISTER intervention, including:

  • Discussions of Native American women’s gender and cultural issues from a Native American standpoint.
  • Discussions about historical trauma and cultural resiliency experienced by Native American communities.
  • Cultural concepts and constructs are used to explain and explore relevant topics.
  • Poetry by Native American women.
  • Culturally adapted activities and relevant scenarios.


Evaluation materials are included in the curriculum, including fidelity monitoring worksheets, session feedback surveys, and pre- and post-surveys.

The Native American SISTER Intervention is based on the CDC’s SISTA intervention, which was first implemented and evaluated in an African American community in San Francisco, CA by researchers Gina M Wingood and Ralph J. DiClemente in 1995. In Wingood and Diclemente’s research study1, 128 sexually active heterosexual African American women ages 18 to 29 participated in either a control group or the SISTER sessions that were led by African American women facilitators. The women who completed the SISTER intervention were found to be more likely to report:

  • Increased consistent condom use.
  • Greater sexual self-control.
  • Greater sexual communication.
  • Greater sexual assertiveness.
  • Increased partners’ adoption of norms supporting consistent condom use.

Results indicated a social skill training, which is delivered in a community setting, can positively affect condom use.

In January 2011, ITCA contracted Red Star Innovations, LLC to adapt the SISTA intervention to be culturally appropriate and relevant to Native American women.  A comprehensive literature review was conducted to identify areas for adaptation of the SISTA theoretical foundation and logic model for Native American women.  While the Social Cognitive Theory was found to be relevant to Native American women, there were aspects of the Theory of Gender and Power that were modified to take into account the diversity of Native American communities and cultures recognizing that gender-based power differences in male/female relationships may differ among Tribes (such as among those tribes that are matrilineal or patrilineal).  Although the male/female relationships may differ among tribes, there is a common thread of upheaval and change in the family dynamic (including traditional male/female roles) as a result of European colonization.3,4

SISTA was updated by the Midwest Prevention Intervention Center of the African American Prevention Intervention Network (MPIC-APIN), a partnership between Saint Louis University’s African American Studies program and the Community Wellness Project, for the Centers for Disease Control and Prevention Department of Health and Human Services.

Dissemination of effective interventions is a critical part of building community capacity. The Diffusion of Effective Behavioral Interventions (DEBI) project is a national-level strategy to provide high quality training and on-going technical assistance regarding prevention interventions to HIV/STD program staff. Information about the Centers for Disease Control and Preventions (CDC) SISTA Intervention and other HIV/AIDS interventions and resources can be found at:

Evaluation Tools:


Miscellaneous Reference Items:

1. DiClemente, R.J., & Wingood, G.M., (1995). A randomized controlled trial of an HIV sexual risk reduction intervention for your African American women. Journal of the American Medical Association, 274, 1271-1276.

2. Breaking the Cycle: Stories of Alaska Native Women. Alaska Native Tribal Health Consortium. HIV/STD Prevention Center, 2009. DVD.

3. The Takini Network (March, 2011). Historical Trauma: Boarding School Trauma. Braveheart, M.Y.H. [On-line] Available:

4. Walters, K., Simoni, J. (2002). Reconceptualizing native women’s health: An “indigenist” stress-coping model. America Journal of Public Health. 92(4), 520-524.

5. Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall.

6. Bandura, A. (1986). Social Foundations fo Thought and Action. Englewood Cliffs, NJ: Prentice-Hall.

7. Connell, R.W. (1987). Gender and Power. Stanford, CA: Stanford University Press.

8. Witbeck, L., Adams, G., Hoyt, D., Chen, X. (2004). Conceptualizing and measuring historical trauma among American Indian people. American Journal of Community Psychology. 33, 119-130.

9. Braveheart, M.Y.H. (1998). The return to the sacred path: healing the historical trauma response among the Lakota. Smith College Studies in Social Work. 68(3), 287-305.

10. The Takini Network (March, 2011). Historical Trauma: An Introduction. Braveheart, M.Y. & Daw, R. [On-line] Available:

11. Office of Research and Development, University of Montana. (March, 2011). Visions of Success: Indigenous Theory of Educational Persistence. PrettyPaint, I. [On-line] Available:

12. Research/Practice Newsletter, University of Montana. (March, 2011). Traditional Native Culture and Resilience. HeavyRunner, I. & Morris, J. [On-line] Available:

13. Dennis, M.K. (2009). Risk and protective factors for HIV/AIDS in Native Americans: Implications for preventive intervention. Social Work.

14. Centers for Disease Control and Prevention (April, 2006). Provisional Procedural Guidance for Community-Based Organization. Atlanta, GA: Author. [On-line] Available:

15. Centers for Disease Controls and Prevention (2007). CDC HIV/AIDS Fact Sheet: HIV/AIDS among Women.[On-line] Available:

16. Centers for Disease Control and Prevention (2011). CDC HIV/AIDS Fact Sheet: Among American Indians and Alaska Natives. [On-line] Available:

17. Patton, Q.M. (1997). Utilization Focused Evaluation: The New Century Text (3rd Edition), London: Sage publications.

18. Centers for Disease control and Prevention (August 2005) Capacity Building Assistance (CBA) to Improve the Delivery and Effectiveness of Human Immunodeficiency Virus (HIV) Prevention Services for Racial and Ethnic Minority Populations—CBA Program Guide. Atlanta, GA: Author.

19. Coser, L.A., Nock, S.L., Steffan, P.A., Rhea, B., & Merton, R.K. (1987). Introduction to Sociology (2nd ed.). Chicago: Harcourt, Brace, Jovanovich.

20. Scott, K.K., Gilliam, A., & Braxton, K. (2005). Culturally competent HIV prevention strategies for women of color in the United States. Health Care for Women International, 26, 17-45.

21. Richter, D., Potts, L., Reininger, B., Prince, M., Thompson-Robinson, M., Isoke, S., Karz W. (2000). A national Model for Increasing HIV Prevention Capacity of Community –Based Organization. 2000 American Public Health Association Meeting in Boston, MA.