Our goal was to adapt a video-based HIV/STI intervention for AI/AN teens and young adults (15-24 years old), and evaluate its impact among Native youth living in urban and rural communities. Native VOICES is currently the only intervention purposefully designed for AI/AN youth included in the CDC’s compendium of effective HIV interventions. The study was funded by the IHS Native American Research Centers for Health (NARCH).


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The Native VOICES intervention was adapted from two evidence-based interventions (EBI) recognized by the Centers for Disease Control and Prevention (CDC): Video Opportunities for Innovative Condom Education and Safer Sex (VOICES) and Safe in the City.

During the first two years of the project, the Northwest Portland Area Indian Health Board partnered with two NW Tribes and one Urban Indian clinic to carryout focus groups and key informant interviews with teens and young adults, to better understand their knowledge and attitudes towards sexual health. Young men who have sex with men (MSM) and young women who have sex with women (WSW) were also consulted, to ensure their perspectives and concerns were reflected in the video. Personnel at tribal health departments, tribal clinics, schools, and other youth-serving programs were also consulted to ensure the resultant intervention could be practically implemented and sustained over time.

During the third year of the project, AI/AN teens and young adults from across the U.S. read or reenacted iterative drafts of the adapted script, and provided feedback on the characters, scenes, tone, and dialogue. The adapted Native VOICES video was shot on location in Oklahoma City in August 2013.

The 23 minute video shows Native actors in situations that AI/AN youth can find relatable – playing basketball with friends, at a party at a private home, traveling between urban and rural environments, and seeking advice from older family members and friends. The video demonstrates condom negotiation and acquisition, as well as the importance of talking about STIs with sexual partners.

A toolkit was designed to support the intervention’s dissemination and implementation in diverse tribal settings. The toolkit includes the Native VOICES video (23 minutes), a condom demonstration video (1:40 minutes), a dental dam demonstration video (1:08 minutes), a selection of condoms and dental dams, and a users’ guide.

The toolkit can be ordered free of charge at

  • Native VOICES YouTube Channel:
  • Native VOICES Users Guide
  • Native VOICES – Parent Information Letter
  • Intervention Recruitment Flyer – Template
  • Answering Sensitive Questions – Tips for Facilitators
  • STD/HIV Fact Sheets
  • Viewer Satisfaction Survey Results
  • Viewer Satisfaction Survey – Blank Template

In 2014, the NPAIHB partnered with nine tribes across the U.S. to evaluate the effectiveness of the Native VOICES intervention. The sites included schools, youth centers, and tribal centers in Oregon, Minnesota, California, Mississippi, Montana, Arizona, Idaho, and Washington.

The sites were randomized into one of three study arms:

  • Arm 1. Fact sheets alone (standard of care)
  • Arm 2. Fact sheets plus the Native VOICES video (intervention)
  • Arm 3. Fact sheets plus the Native VOICES video plus a facilitated discussion (intervention+)

Together, the sites recruited and consented nearly 800 AI/AN youth 15-24 years old to participate in the study.

Youth who watched the video (n=443 respondents) expressed high levels of satisfaction with the Native VOICES intervention. Over 90% felt the video was culturally appropriate for AI/AN people. Over 75% found it to be entertaining or highly entertaining. And 86% felt the characters, scenes, and situations in the video were realistic. After watching the video, 78% of participants indicated that they were more likely to use condoms, 61% felt more likely to use dental dams, and 82% felt more likely to get tested for STDs/HIV. Statistically significant improvements in sexual health knowledge, attitude, intention, and self-efficacy occurred across all three study arms, many of which were retained 6 months later.

To quantify the impact of the Native VOICES intervention on risk and protective behavior, additional analyses are now underway to correct for differences in baseline knowledge, attitude, and intention that were present between the three study arms.

  • Native VOICES Phase 1 Focus Group Report
  • Native VOICES Phase 2 Evaluation Report

  • Craig Rushing, S., & Gardner, W. (2016). Native VOICES: Adapting a video-based sexual health intervention for American Indian teens and young adults using the ADAPT-ITT model. American Indian and Alaska Native Mental Health Research, 23(1), 24-46. See:
  • Gardner, W., & Craig Rushing, S. (2013). Native VOICES: Developing an evidence-based HIV/STD intervention for Native teens and young adults. The IHS Primary Care Provider: Vol. 38, No 4: 74.

  • CDC’s compendium of effective HIV interventions:

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