Final Draft of Program Hsci 6240

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STD & HIV AMONGST COLLEGE STUDENTS PROGRAM PROPOSAL
STD & HIV Amongst College Students
A Proposal for Prevention, Protection & Education
Isaac Mendez, Jasmine Mitchell, Thomas Roland, Jeffrey Truong, and Paola Zuniga
Department of Health Science and Human Ecology,
California State University, San Bernardino
HSCI 6240: Advanced Health Promotion
Dr. Sen Padilla
December 12, 2020

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Table of Contents
Executive Summary……………………………………………………………………………….3
Mission Statement…………………………………………………………………………………4
Smart Goals and Objectives……………………………………………………………………….5
Program Design and Implementation…………………………………………………….…........11
Assessment……………………………………………………………………………….11
Program Purpose and Rationale.........................................................................................12
Theoretical Justification.................................................................................................................14
Program Purpose and Rationale Literature Review……………………………………………...15
Map of Determinants to Theory………………………………………………………………….17
Program Description……………………………………………………………………………..21
Tentative Timeline.............................................................................................................23
Implemented Changes....................................................................................................................25
Process Evaluation…………………………………………………………………….…………26
Recommendations..........................................................................................................................30
Reflection………………………………………………….………………………..……………31
References………………………………………………………………………………………..34
Appendix………………………………………………………………………………..………..37
SWOT Analysis.................................................................................................................37
Meeting Minutes................................................................................................................38
Stakeholder Feedback........................................................................................................39
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Executive Summary
The purpose of this summary is to present a broad course of action for STD and HIV prevention
among the target population, California State University, San Bernardino (CSUSB) college
students.
In the 1980s many people believed that only certain people were at risk for HIV, when
cases first emerged, many thought it could be contracted only by gay men. Later, researchers
found that anyone can be susceptible regardless of their sexual orientation, race etc. Despite this
knowledge, STD and HIV is still prevalent and an important topic today that we hardly hear
discussions about anymore.
According to the CDC, there has been a varied amount or lack of prevention efforts in
terms of education and programs across the United States (CDC 2020). The lack of programs and
education only furthers the misconceptions and lack of education. Some of the highest STD rates
are among young adults 20 to 24(CDC 2020).What is even more alarming is the reality that
many people in this age group are more likely to engage in health-related behaviors, that experts
say can increase the risk of exposure. These health-related behaviors include substance use, low
rate of condom use and low testing rates. Many of the health-related behaviors overlap, affecting
each other.
The following is the proposal for STD and HIV prevention among CSUSB college
students 18-24. Our program will strive to lessen STD and HIV rates in San Bernardino county,
through our target population The proposal takes preventive measures that includes health
education to raise awareness regarding health services, specifically services on campus. In
addition, we aim to encourage safer sex and increase testing rates. With public health
intervention and prevention strategies we anticipate an increase in knowledge and understanding

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surrounding this topic. Presenting resources and options concerning care and protection for
students is another significant outcome of the program.
To successfully enact this proposal and adequately reach our goals, we must engage our
community and insist on a safe and confidential zone. We understand the sensitivity STD and
HIV topics can hold; it is our desire to implement the program in an appropriate and constructive
way. Our proposal embraces and emphasizes the goals of public health programs, which seek to
invest in health and the wellbeing of individuals.
Mission Statement
Our mission is to educate and empower students of California State University, San Bernardino,
utilizing scientific information to live safer, healthier lives by prevention of STDs and HIV.
Why?
According to the San Bernardino County Department of Public Health, San Bernardino County
saw 15,000 cases of STD’s in 2016 alone, with 60% of all new cases occurring in youth aged 15-
24. With a student population of about 20,000 and an average age of 22, CSUSB a prime area to
execute an intervention aimed towards increasing education of STDs and lowering the rates of
disease. With restrictions of the COVID-19 pandemic, our strategy is to increase student
knowledge on STD prevention by use of a public service announcement video or other form of
electronic content. Our ultimate goal is to reduce rates of STDs and HIV in San Bernardino
County by targeting the student population of CSUSB and raising awareness of available testing
services on campus, use of Pre-Exposure Prophylaxis to prevent HIV, and safer sex practices.
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SMART Goals and Objectives
GOAL 1: Increase awareness of sexually transmitted diseases among current students at
California State University, San Bernardino.
Not-so-SMART objective 1a: Assess students’ knowledge and understanding about
STDs
Key Component Objective
Specific - What is the specific Determine student awareness of STDs and how they
task? perceive their own risk of contracting an STD by
distributing an online questionnaire.
Measurable - What are the Must obtain at least a 70% return rate within 2
standards or parameters? weeks of being administered (Division of HIV/AIDS
Prevention Strategic Plan 2017 – 2020) .
Achievable - Is the task feasible? Yes, when collaborating with the CSUSB Student
Health Center.
Realistic - Are sufficient Yes, the CSUSB Student Health Center provides
resources available? resources on sexual health. More information on this
topic is also provided at the local, state, and national
level.
Time-Bound - What are the start October 2020 through December 2020 – to develop
and end dates? an appropriate questionnaire and to collect and

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analyze the data obtained.
SMART objective 1a: Beginning October 2020 through December 2020, collaborate
with the CSUSB Student Health Center to develop an appropriate STD/Risk
Assessment questionnaire for CSUSB students. Collect and Analyze the data
obtained to determine the proper course of action for increasing STD awareness.
Not-so-SMART objective 1b: Provide additional resources on STDs
Specific - What is the specific Provide additional STD prevention resources (sexual
task? health education programs, brochures, pamphlets)
while also providing access to condoms, vaccinations,
and other preventive measures. Further discuss STD
testing/screening and treatment.
Measurable - What are the Every 3 months determine the number of CSUSB
standards or parameters? students that have utilized these additional services.
Achievable - Is the task Yes, when collaborating with the CSUSB Student
feasible? Health Center.

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Realistic - Are sufficient Yes, the CSUSB Student Health Center provides health
resources available? education and testing for students at no cost. The
student center may have additional information on data
collection for services used.
Time-Bound - What are the December 2020 through December 2021 – every 3
start and end dates? months services will be evaluated to measure the
performance of the program.
SMART objective 1b: From December 2020 to December 2021, the resources
provided will focus on preventing STDs through education and access to preventive
methods. It will also focus on accessing STD treatment.
GOAL 2: Refocus and strengthen HIV prevention and treatment to empower
CSUSB students.
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Not-so-SMART objective 2a: Encourage/normalize HIV testing
Specific - What is the specific Provide educational resources to further understand
task? HIV and the importance of getting tested. Provide
access to HIV testing (at no cost) on campus
throughout the month.
Measurable - What are the Determine the number of CSUSB students that get
standards or parameters? tested throughout the month. Utilization of this service
should exceed 70% (Division of HIV/AIDS Prevention
Strategic Plan 2017 – 2020).
Achievable - Is the task Yes, when collaborating with the CSUSB Health
feasible? Center.
Realistic - Are sufficient Yes, further information on HIV testing is present at
resources available? the local, state, and national level. The CDC provides
evidence-based resources for clinicians, which can also
be implemented by the CSUSB Health Center.
Time-Bound - What are the December 2020 through June 2021 – Each month
start and end dates? services will be evaluated to determine percent of
utilization, quality, and cost effectiveness.

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SMART objective 2a: From December 2020 through June 2021, CSUSB students
will further understand the risk factors associated with HIV transmission and will
have additional access to HIV testing on campus at no cost.
Not-so-SMART objective 2b: Provide further information on Pre-exposure
prophylaxis (PrEP) and Post-exposure prophylaxis (PEP)
Specific - What is the specific Provide CSUSB students with further knowledge on
task? PrEP and PEP while also assisting students with
accessing these medications at no cost.
Measurable - What are the Determine the number of CSUSB students that
standards or parameters? considered the information to be beneficial. Determine
the number of students who were able to obtain PrEP
or PEP at minimal to no cost.
Achievable - Is the task Yes, when collaborating with the CSUSB Health
feasible? Center, local Planned Parenthood Health Centers, and
local health Departments.
Realistic - Are sufficient Yes, health centers like Planned Parenthood, local
resources available? health departments, and federal programs (ex. Ready,
Set, PrEP) may offer these medications at no cost.

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Time-Bound - What are the December 2020 through June 2021 – Each month these
start and end dates? services will be evaluated by the number of students
that were able to gain access to these medications.
SMART objective 2b: Beginning December 2020 through June 2021, CSUSB
students will be provided with further information on the differences between PrEP
and PEP. Students will also receive assistance in accessing these medications.
Program Design and Implementation
A. Assessment
i. Target population, data & summary, provide context, key trends, demographics
ii. At least 2 types (expressed, normative, perceived, relative) of needs assessment for the
target population and if not available, about general college students
Our intervention will be targeting all students at CSUSB between the ages of 18-24. We
will be looking into the demographics of the county itself, as well as the statistics relating to
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health behaviors such as STD prevalence and HIV testing. In San Bernardino County, college
aged students make up approximately 16% of the population. Their population is split
approximately 50% female and 50% male, with 54% of the population being Hispanic.
Following this 28% are white, 8% are black, 7% are Asian, and the remaining 3% are other. In
San Bernardino County, 14.9% of people living there are below the poverty line, with the median
income being $60,164 per household (Census 2020).
San Bernardino County currently has some of the highest rates of sexually transmitted
diseases in the United States. In 2018, 26.9% of College aged students between the ages of 18 –
26 reported having 2 or more sexual partners. This could result in unsafe sex practices that would
increase the number of STD cases in the county. Approximately 60% of all new STDs reported
in 2016 came from youth aged 15-24 in this county. Up to 15.5% of these cases come from
females who were reported pregnant at the time (SB County 2020). In 2018, the County of San
Bernardino stated that there was a total of 13,376 reports of Chlamydia with 64% of female cases
coming from females aged 15-24. There was a total of 3,940 reports of Gonorrhea. Of this
number 54% of the cases were male. In San Bernardino County, the incidence rate for syphilis
has increased dramatically from 13.7 per 100,000 in 2013, all the way up to 69.2 per 100,000 in
2018 (Dulay 2019). Gonorrhea Chlamydia and Syphilis rates have been slowly climbing since
2013. According to the CHIS dataset, in 2018 a total of 33.2% of college aged students have
tested themselves for HIV which is significantly lower than the 41.5% of college aged students
who have been tested across all of California (CHIS 2018). Approximately 16% of HIV+ cases
are unaware that they have contracted it and 23% of new cases develop into full AIDS within 90
days (Dulay 2019).

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The need for more testing and STD awareness can be classified as a relative need since
both HIV testing and Syphilis rates, are significantly higher than the state level. In 2017, the
incidence rate for Syphilis in San Bernardino county was 51.2 per 100,000, whereas the rate in
the United States was 31.4 per 100,000 (Dulay 2019). Alongside this, only 33.2% of college
aged students have been tested for HIV which is lower than California’s rate of 41.5% that have
been tested (CHIS 2018). This demonstrates a significant disparity in testing rates for HIV, as
well as Syphilis which could be attributed to a lack of awareness of the disease, or unsafe sex
practices. Alongside this, there is an expressed need that shows the need for an intervention into
STD and HIV prevention is needed. With rates in San Bernardino County continuing to increase,
the need to inform and prevent these diseases is becoming clearer.
Program Purpose and Rationale
B.) It is estimated that the United States spends 16 billion dollars annually in order to
diagnose and treat sexually transmitted infections (STIs) (CDC). Over 80% of this total cost is
attributed to HIV infection exclusively (Owusu-Edusei et al., 2013). In 2018 The Centers for
Disease Control and Prevention (CDC) reported that there were over 1.1 million people in the
United States living with HIV, including 37,832 new cases. Of these new cases, the CDC reports
that 20 percent occurred in college aged individuals 18 to 24 alone. Additionally, STIs have
increased to dangerous levels in general in the United States. According to the CDC’s STD
surveillance report in 2018, there were approximately 2,457,118 reported cases of STIs. Of these
cases, over half were acquired by youth and college aged individuals 15-24. Previous research
(Rimsza, 2005; James & Ryan, 2018) has demonstrated that college aged individuals are
disproportionately affected by STIs including HIV. There are a multitude of barriers which affect
these individuals from seeking treatment, with the main reason being stigmatization. While a
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cure has yet to be found, HIV and STIs are becoming more arduous to treat, numerous studies
have demonstrated that proper sexual health education shows high efficacy in preventing STI
infection including HIV transmission.
In California alone, the CDC reports that there were around 4,712 new diagnosis of HIV
infection, placing California in the top 10 in the country for HIV incidence as of 2018. As a
result of having more HIV infections, HIV is costing California millions of dollars alone (CDC
2019). According to data collected by the California Department of Public Health in 2018, there
has been a dangerous increase in bacterial STIs in California, corresponding with the national
increase (CDPH 2020). The report found that the highest number of cases are found in young
and college aged individuals at disproportionate rates. In San Bernardino, our focus population,
the county department of public health reported that there were 21,090 cases of STIs in 2018,
this represents an increase of around 3% from 2017. Of these cases, the greatest number was
found again in youth and college aged individuals. STI infection is clearly a substantial risk for
college aged individuals in San Bernardino county.
Numerous studies have demonstrated the efficacy of using sexual health education
programs to mediate STI infection including HIV transmission. As aforementioned, youth and
college aged students are unequally affected by STI infection. Research by Subbarao and
Akhilesh (2017) found that college aged individuals are likely to practice unsafe sex and have
multiple partners. Additionally, they found that these individuals may feel unsure in seeking
treatment or more information on STIs due to stigmatization. Sexual health education has been
shown to have a positive effect in reducing stigma associated with STIs and increasing the
testing rate. James and Ryan (2017) found that increased knowledge about HIV resulted in
higher testing rates among college students. Subsequently, in Subbarao and Akhilesh (2017),
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over 90% of the students interviewed in the study believe that sexual health education was a
necessity. The participants in the study reported that a better sexual health education curriculum
would have helped them better understand STI infection and prevention.
Ultimately the research presented shows that with increased funding and opportunities
for sexual health education we can expect positive outcomes in prevention. STI incidence is on
the rise in San Bernardino county and continues to affect college aged individuals at a rate that is
disproportionate to the overall population. Instituting our health education program will without
doubt decrease the incidence in college students.
Theoretical Justification
As of 2018 the CDC reported that there were approximately 4,712 new cases of HIV in
California alone. This increase places California within the top ten for HIV incidence in the
United States. According to data collected by the California Department of Public Health during
2018, in addition to HIV, there has been a dangerous increase in bacterial STIs in California,
corresponding with the national increase. The report found the highest number of cases were
found in young and college aged individuals at disproportionate rates. In San Bernardino, our
focus population, the county department of public health reported that there were 21,090 cases of
STIs in 2018, this represents an increase of around 3% from 2017 with an expected continual
increase. Of these cases, the greatest number was found again in youth and college aged
individuals. STI infection is clearly a substantial risk for college aged individuals in San
Bernardino county.
Several studies have demonstrated the efficacy of using sexual health education programs
in STI prevention and reducing HIV transmission. A study conducted in 2014 showed that
having an education-based intervention could help prevent STI’s as well as raise awareness of
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HIV. “This review found that school-based sex education is an effective intervention for
generating HIV-related knowledge and decreasing sexual risk behaviors among participants,
including delaying sexual debut, increasing condom use, and decreasing numbers of sexual
partners (Fonner et al,. 2014). The CDC has also found that Sexual Health Education has several
benefits that can positively impact people. “In addition to providing knowledge and skills to
address sexual behavior, quality SHE programs can be tailored to include information on high-
risk substance use*, suicide prevention, and how to keep students from committing or being
victims of violence—behaviors and experiences that place youth at risk for poor health and
academic outcomes” (CDC 2020).
As previously demonstrated, youth and college aged students are unequally affected by
STI infection. The reasons for this disproportionality are numerous, but there are key
determinants at play. Research by Subbarao and Akhilesh (2017) found that college aged
individuals are more likely to practice unsafe sex and will have multiple partners throughout
their time at university. Additionally, they found that these individuals may feel unsure in
seeking treatment or more information on STIs due to stigmatization. Subsequently, in Subbarao
and Akhilesh (2017), over 90% of the students interviewed in the study believed in sexual health
education as a necessity. One common barrier to good sexual health is the stigma surrounding
many sex and STIs. Sexual health education has been shown to have a positive effect in reducing
stigma associated with STIs and increasing the testing rate. James and Ryan (2017) found that
the greater the knowledge a participant had about HIV was related to higher testing rates,
particularly among college students. Of the participants in the study, many reported that they
believed a better sexual health education curriculum would have better prepared them and given
them a better understanding of STI infection and prevention. These studies are also supported by
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the research conducted by Vivancos et al (2012). In this study, the researchers found that STI
diagnoses among university students were lower in those that had received some form of sexual
health instruction. Furthermore, the researchers found that sexual health education was also
instrumental in reducing risky sexual behavior.
Our program has been designed with extreme care and utilizes an understanding of the
Health Belief Model (HBM) and Transtheoretical model to connect with our target population
and educate them. Previous programs make their participants feel lesser, which ultimately has a
negative impact on susceptibility to change. Our model will build upon the strengths of the
previous research but will address the shortcomings in these studies and programs. Regardless of
these shortcomings, the research indicates that proper sexual health education is instrumental in
reducing the risk of STIs and HIV transmission.
Map of Determinants to Theory
Identifying the impact that social determinants of health (SDOH) has on the transmission
and acquisition of sexually transmitted diseases (including HIV) is critical for implementing a
health program. Social determinants are significantly responsible for health outcomes within
populations. These conditions may include healthcare access and quality, education access and
quality, social and community context, economic stability, and the neighborhood and built
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environment (About Social Determinants of Health (SDOH), 2020). Understanding the
relationship between social determinants of health and health outcomes will allow for a more
appropriate application of behavioral theories within the health program. Health disparities are
often the result of social determinants of health. The term health disparity is defined as “a
particular type of health difference that is closely linked with social, economic, and/or
environmental disadvantage” that affect certain groups of individuals (Disparities | Healthy
People 2020, 2020). These health differences can be attributed to race, ethnicity, religion,
socioeconomic status, age, gender, sexual orientation, geographic location as well as many
others. Higher rates of STDs, for example, are more prevalent for specific ethnic/racial groups.
Such disparities result from adverse social determinants of health. Further understanding the
association between both concepts can assist in reducing disparities.
Several adverse social determinants of health, such as lack of access to health education
and health services, contribute to STD/HIV transmission and acquisition. Targeting such adverse
determinants of health could help in reducing STD rates. Access to sexual health education, for
example, provides individuals with the knowledge and skills needed to practice safe sex. A study
conducted by the U.S Preventive Services Task Force (USPSTF) utilized behavioral counseling
interventions with populations who were at an increased risk of acquiring STDs. Those most at
risk were adults aged 18-24 who had an STD, had been diagnosed with an STD within the last 12
months, were not using condoms consistently, and had several sexual partners. The behavioral
counseling intervention methods were comprised of in-person counseling, websites, text
messages, written materials, videos, and telephone support. The methods that proved successful
discussed what STDs are, how STDs are transmitted, safer sex practices, and assessed an
individual’s risk for STDs. It was discovered that behavioral counseling methods did reduce
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STDs in these individuals (USPSTF, 2020). Societal issues such as lack of access to healthcare
have also been continuously addressed. The Center for Disease Control and Prevention has
developed an initiative to improve access to health services for STD prevention. This initiative,
Community Approaches to Reducing Sexually Transmitted Disease (CARS) has been
implemented in Chicago, Baltimore, Philadelphia, and Ann Arbor. These locations experienced
an increase in STD screenings among young adults. The third cycle of CARS has been
implemented in San Diego, California and will be ending this year (CDC Community
Approaches to Reducing Sexually Transmitted Diseases).
More complex adverse social determinants that affect STD and HIV acquisition were
described in a study performed by the CDCs Division of STD Prevention. Social segregation, for
example, is a social determinant that is reinforced by environmental factors. This in turn, may
also be affected by lack of access to healthcare and differences in socioeconomic status.
Migration is seen as a subset of social segregation that is associated with HIV spread. Individuals
who migrate to this country have limited access to healthcare and are more likely to contract an
STD within their communities. These individuals can then spread the disease, among others.
Another social determinant deals with access to healthcare. Obtaining access and utilizing
services is crucial for STD prevention. Individuals who lack access usually are uninsured, which
means that they are unable to receive preventive services. Various disparities associated with
healthcare access are present, such as those involving age, racial/ethnicity, and socioeconomic
status. Social disorganization within communities may further limit access to services.
Socioeconomic status is also a significant social determinant of health. Individuals who lack
sufficient resources and income to meet their basic needs also experience residential instability.
Minority groups are often affected by these factors of poverty, unemployment, and lack
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educational opportunities. Blacks, for example, that face residential instability are more likely to
acquire HIV. Disproportionate allocation or lack of resources has also been associated with
higher risk behaviors. STD rates in areas with increased income inequality seem to continue to
rise (Hogben and Leichliter, 2008). In order to reduce the prevalence of STD/HIV rates, the
initial cause must be dealt with. The health disparities that arise from social determinants of
health must be lessened to avoid further adverse health outcomes.
STD prevention and education can be implemented into a health program by focusing on
behavior change. Several theories that focus on the importance of changing behavior have been
previously implemented and have proved successful in other programs. The Los Angeles County
STD Program describes three important theories. The Health Belief Model (HBM) was created
and developed in the 1950s by Godfrey Hochbaum, Irwin Rosenstock, and Stephen Kegels to
understand what motivates health behavior. It concluded that individuals are motivated by the
following factors: perceived susceptibility, perceived severity, perceived benefits of action,
perceived barriers to action, cues to action, and self-efficacy. In order to for these to take place,
individuals must have knowledge of STD transmission, susceptibility, and severity. The
Transtheoretical Model (TTM) is also utilized. It was created by Prochaska and DiClemente in
the 1970s to understand the process of decision-making among individuals. It focuses on
intentional behavior change while also taking into consideration that these behaviors take time.
Individuals in this model are believed to undergo through several stages of change such as the
precontemplation stage, contemplation, preparation, action, maintenance, and termination. This
model is often utilized in client-centered counseling (motivational interviewing) to focus on the
patient’s concerns and to allow them to take the necessary steps. This form of counseling can
help the patient better understand the risk associated with a certain health behavior and it
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provides support for the patient throughout the process. Social Cognitive Theory (SCT) is also
frequently utilized. This theory was developed by Albert Bandura from Julian Rotter’s social
learning theory. The theory focuses on how behavior is influenced by social experiences. Self-
efficacy, the belief that one can succeed when executing a task, was thought to influence how an
individual approaches a certain challenge. Building self-efficacy can lessen participation in risky
sexual behaviors. By providing the skills and knowledge needed, people perceive themselves to
be better able to succeed. These theories/models have strengths and weaknesses, but when used
together they can prove successful (Applying Behavior Change Theory to STD Prevention &
Education, n.d.).
Program Description
The aim of our program is to raise awareness of HIV and STDs, as well as providing
information and resources that will allow an individual to prevent or reduce their exposure to
HIV as well as Gonorrhea. Primarily we will be focusing on preventive measures that include,
health education, an effort to provide students with the right resources and information, as well
as mitigating the stigma surrounding these conditions to provide individuals with the self-
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efficacy to practice positive health behaviors. The basis of our program is focused on prevention
and education of unhealthy behaviors around sex and how these can be mitigated. We will be
using the transtheoretical model of change and health belief model to aid us in this.
The transtheoretical model of change, also known as the stages of change, is a health
model that looks into the way that people change or create new health behaviors. It goes through
six different stages which are: precontemplation, contemplation, preparation, action,
maintenance, and termination. Each stage is part of a cycle where a person first becomes aware
that a health behavior can be a problem and slowly makes plans and actions to change and
modify it. This model shows how a person may not even be aware that a health behavior is an
issue and can help a person make the changes necessary to cease it. The health belief model takes
a person’s personal beliefs of a health behavior and uses those to explain the likelihood that they
may change the behavior, as well as what can be done to change it through interventions.
Over the course of a year, we will be using these two models to stage interventions
throughout the CSUSB campus at key locations with high traffic. At these locations we will be
giving out free information regarding safe sex practices, as well as the possible dangers that
STD’s can have on a person. This would include providing information on various barrier
methods of sex such as male and female condoms or dental dams. We would also be advocating
distributing brochures, pamphlets, and other information material to students regarding STD
prevention. In partnership with the CSUSB student health center, we will also be promoting
students to get regular testing at no cost using their facilities.
Our main focus would be primarily on Gonorrhea and HIV since Gonorrhea is one of the
most prevalent STDs in San Bernardino County. For HIV part of our goal for this program is to
reduce the stigma that surrounds HIV and let people know that it is not a death sentence like
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many may consider it to be. We would also like to draw attention to the existence of Pre
exposure prophylaxis or PrEP. which is an antiretroviral which is effective at reducing the risk
for contracting HIV through sex or drug use. Our hope is that through this program we will be
able to reduce the stigma surrounding HIV and allow people who are at higher risks for
contracting it to get regularly tested, and for those who are in relationships with people infected
with HIV, they will be able to highly reduce the risk for them contracting it as well.
In many cases, people may not realize they are even at risk of contracting an STD and
therefore do not practice safe sex and/or have regular testing done for themselves. Through this
program we should be able to raise the awareness of CSUSB students regarding STDs and HIV
and be able to move people from precontemplation to the contemplation or even planning stage.
Tentative Timeline
Spring Semester
1. 12/01 - finished proposal and present to cohort
2. 12/11-finalize proposal
3. 1/20-received stakeholder feedback
a. Regroup
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b. Make changes as necessary.
c. Finalize direction of program
4. 1/25- Reach out to CSUSB Health Center
a. Email & introduce program
b. Need to request resources and guidance
5. 1/29 -Contact additional collaborators in San Bernardino County
6. 2/12- Determine what resources we have and our collaborators
a. Do we need to reach out to more agencies?
b. Do we have the resources and support needed to start?
7. 2/22- Upon finalization of collaborators, reach out to CSUSB Faculty
a. Stakeholder assessment
8. 3/15- Meeting to discuss changes that need to be made, before spring break
9. 4/15- Last day to regroup and present changes made before summer
a. Research any data regarding project
Summer
10. 6/18- 1st group meeting of the summer,
a. Present any research findings
10. 6/18- Set 2nd meeting of summer to work on program design and roll out
11. 7/ 11- Program design and roll out

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a. Nurture any existing collaborator relationships and see
if there are any other potential collaborators
12. 8/11- Last meeting of summer before project roll out for fall semester
a. Any final changes or thoughts?
Fall Semester
13. 8/16-Begin our program for CSUSB students *this will be continued throughout
year*
a. Tabling
b. Surveys
c. Education
d. Testing
e. Resources
14. 9/12- check in with stakeholders and collaborators
a. Changes?
15. 11/12- every 3 months we will analyze number of students using resources
a. Survey review
16. 12/7- we will implement changes discussed
a. Grant and additional funding?
b. One on one counseling services?
Spring Semester
17. 4/12-Analyze final data collected
18. 5/8- Final. present program to CSUSB faculty
Implemented Changes
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We will implement one on one sessions for students and direct students to one-on-one
counseling on campus. We have discussed providing group educational programs and tabling;
however, we also would like to give those students who have personal questions and concerns an
outlet to express that in a confidential way. With this implementation we hope to reach more
students at CSUSB, through a sense of trust being established, we hope to eliminate a sense of
fear within a larger setting. The benefits are various attempts being made through our program to
reduce STD and HIV in San Bernardino county.
Not only will we refer students to health services, but we hope to partner with Cal State
San Bernardino’s Counseling and Psychological Services Department. According to many
reputable institutions such as Harvard, benefits of utilizing counseling services in school are
improvement in communication, support for emotional exploration, advocacy, and reduction in
destructive emotional and behavioral outburst. We anticipate that this implementation will lessen
the difficult and uncomfortable conversations about sex and sexual behavior. Counseling is a
way for people to more easily navigate health issues and concerns, and intimate informational
sessions are a way to provide even more information and answer questions, as well as provide
support.
Due to COVID-19 if we are not on campus during our program implementation, we will seek to
virtually implement this change
Process Evaluation
7i. Stakeholder Evaluation (Program Evaluation Guide - Step 1 - CDC, 2020)
Worksheet 1A – Identifying
Key Stakeholders
26
Category
Stakeholders
1. Who is affected by the This program primarily affects CSUSB students whom
program? are our target population for this intervention. However,
all of the staff, students and visitors to the campus will be
affected due to the publicly available postings and
advertised resources.
2. Who is involved in program Those implementing the program (Us), CSUSB Health
operations? Center, volunteers, On-campus organizations, possibly the
San Bernardino Health Department, Any Funder
3. Who will use evaluation Those implementing the program (Us), CSUSB Health
results? Center, other on-campus organizations, and possibly the
San Bernardino Health Department, Any Funder
Which of these are key stakeholders we need to engage?
Increase credibility of Implement the Advocate for changes Fund/authorize the
our evaluation interventions that are to institutionalize the continuation or

27
central to this evaluation findings expansion of the
evaluation program
The San Bernardino CSUSB Health CSUSB Faculty and Charitable
Health Department Center/Campus Staff Fundraising
The CSUSB Health On-campus CSUSB Health Center San Bernardino Health
Center Staff organizations Department
On-campus
Possibly the San Organizations Federal Grants
Bernardino Health
Department CSUSB Students Grants/Funding from
AHRQ, CDC, DHHS,
San Bernardino Health NIH
Department
Grants from
foundations such as the
Bill & Melinda Gates
Foundation
Worksheet 1B – What Matters to Stakeholders
Stakeholders What activities and/or outcomes of this program matter most to

28
them?
1. CSUSB Students That the health program targets their needs. Involves them in the
development of activities.
2. CSUSB Health Sufficient interest in the health program so that screening efforts are
Center Staff worthwhile. A simple process for STD/HIV screenings.
3. On-Campus That the health program integrates different strategies than others on-
Organizations campus. Ability to collaborate in order to further develop the program.
4. CSUSB Faculty and The cost of the program. How will funds be obtained? No monetary
Staff burden on the university system.
5. San Bernardino That those efforts lead to improved health outcomes. Decrease in
Health Department STD/HIV Rates.
6. Funding Groups The implementation of the program and how it will be made
successful. Further evaluation of the health program.
7ii. Description of the process used to design the program

29
The topic and design of this health education program resulted from the significant increase in
sexually transmitted disease (STDs) cases in the County of San Bernardino. This county is
currently ranked one of the highest in the United Stated for continuous cases of STDs. Within
this county, about 60 percent of new cases occur in youth aged 15-24. In order to target a
subgroup of this population, this intervention was created. It would focus on California State
University, San Bernardino (CSUSB) Students that fall within that age group (Sexually
Transmitted Diseases | Department of Public Health, 2020). The California Health Interview
Survey (CHIS) data from 2018 further illustrates the lack of utilization in STD/HIV screenings
among San Bernardino County college aged individuals (CHIS, 2018). From both sets of data, it
can be deduced that individuals in this age group require further knowledge about the
transmission and acquisition of STDs and HIV as well as access to screening and treatment.
The severity of these increasing STD cases demand for prompt action. To implement an
intervention for this subgroup (CSUSB students), the help of various groups will be required.
The CSUSB Health Center, for example, is the principal location that provides health services
and health education for students. It is important to collaborate with the CSUSB Health Center to
develop an intervention that would prove successful in tackling STD/HIV rates. Engaging with
other organizations on-campus could further develop the intervention. The support and guidance
provided by these organizations could ease the process of the implementation. The faculty and
staff would also be involved in the intervention to provide their expertise on the subject. Aside
from the physical support required, funding to obtain the necessary resources to execute the
health program is crucial. Funding could be obtained through fundraising, federal grants,
organizations, or foundations. Once implemented, CSUSB students would have further access to
preventive services such as one-on-one health education, screenings, and information on

30
treatment. To assess the success of the program, data would be collected regarding the utilization
of services, re-infection cases, and patient satisfaction. These factors will allow us to become
aware of elements that must be improved.
Sexually Transmitted Diseases | Department of Public Health.
https://wp.sbcounty.gov/dph/programs/cds/stds/. Accessed 16 Nov. 2020.
Get CHIS Data | UCLA Center for Health Policy Research.
https://healthpolicy.ucla.edu/chis/data/Pages/GetCHISData.aspx. Accessed 16 Nov. 2020.
Recommendations
Our overall goal is to reduce STD and HIV in San Bernardino county. In order to do this,
we will target the CSUSB population of students. It is our mission to raise awareness, provide
services, increase testing and provide education on safer sex practices and Pre-Exposure
Prophylaxis. Our program relies heavily on the CSUSB student population engagement and
participation in the program. We acknowledge that an insufficient number of participants,
hinders the flow of necessary data regarding the effectiveness of the program and we risk not
meeting our goals. In addition, with the COVID-19 pandemic, we anticipate reaching students
either in person or virtually may be another obstacle. From this, we conclude that we must ensure
the participation of CSUSB students in order to facilitate the program.
We recommend one of two courses of action: SMS automatic sign up and adding
incentives. Much of school contact is through email, so we will give students the opportunity to
receive alerts and texts on information regarding testing services, educational awareness, and
other engagement opportunities centered around the program. Text alerts can improve
involvement outcomes, by providing access and convenience for students. They will be given the
“STOP” option if they wish to not receive messages anymore. Incentives, such as gifts and
31
raffles, are another great way to incentivize participation. While we want students to be excited
and interested about our program, studies show that incentives can increase interest and
motivation. Gift and raffles of small dollar gift cards, pencils, pens, etc., will assist in an
interactive target population.
Reflection
Part A
In the development process of any public health intervention, effective teamwork and
time management are crucial. Lessons learned regarding teamwork include understanding the
importance of communication, focusing on goals, even contributions, supporting each other,
having good leadership and being organized. Communication is vital to effective teamwork and
involves everyone sharing their thoughts and taking into consideration what every team member
has to say. Communication is essential for keeping track of progress and working together
efficiently on tasks. Poor communication could otherwise detail our progress leading to work
that is incomplete/incorrect, conflicts between members, and loss of valuable resources.
Effective communication also plays an important part in collaboration and leadership. It is
importance to know when to be a follower verses a leader. It is natural to have people within a
team with more experience or expertise on a certain topic. In these cases, it is better to be a
follower and listen to the expertise of that team member. Likewise, if you are the person with the
most expertise on that topic, speaking up and taking lead on that area is important.
The second lesson learned regarding teamwork is importance of focusing on goals. A
huge component of effective teamwork is goal setting. This is important because all members
must agree on set of goals, rather than just on the amount of work being done. After goal setting
is accomplished, a clear plan can then be set about how to achieve these goals as a group and
32
through individual contributions. The third lesson learned regarding teamwork is importance of
even contribution of work from all members. By including everybody and sharing equal amounts
og work, every member has a sense a belonging to the team and therefore cares more about the
success of the team. The fourth lesson learned regarding teamwork is supporting each other.
Supporting each other is vital to effective team work because teams are more productive when
they are offered support from others. The fifth lesson learned regarding teamwork was that good
leadership is vital to holding the team together. A good leader within the team will also help to
keep us on track, offer encouragement and motivation, and keeping everyone updated on the
project. The last lesson is being organized, which we found to be essential to keeping everything
running smoothly.
In regard to time management, we as a team came to appreciate effective time
management more as we came to realize our limited resources, which included time itself. A few
lessons learned in this regard included staying organized, prioritization, goal setting, delegation,
and stress management. Staying organized is vital to maintaining a clear picture of what needs to
be done and by when. Prioritization was found to be vital to effective time management and
involved assessing everyone’s responsibilities as key. Goal setting is important for everyone to
clearly understand the direction we are going as a team, which allows better prioritization and
therefore effective use of time. Delegation was important especially when managing time within
a team. It was important for everyone for everybody to do their fair share of work and nothing
more. Attempting to do too little or too much may be a waste of time and resources. Lastly, we
learned that stress management was important to effective time management because people who
seem to be handling stress positively seemed to stay more motivated and performed better.
Part B
33
In developing our public health intervention in a team, we developed skills of effective
collaboration and time management. All of us needed to utilize skills of research methodology to
seek out reputable sources of data and facts to substantiate our program. These reputable sources
lead the way to developing finer parts of our program, which included creating a meaningful
mission statement and SMART goals. In addition, we also had to demonstrate our mastery of
skills related to program design and implementation, performing a needs assessment, identifying
key determinants of behavior, performing a SWOT analysis, and Process evaluation.
Part C
New theories and concepts learned and utilized were the health belief model, social
cognitive theory, theory of reasoned action, theory of planned behavior, transtheoretical model,
social determinants of health, health disparities, and factors that influence health behavior. All of
these theories and concepts were vital in the formation of our public health intervention and
provided the theoretical basis required to substantiate every step of our program.
Part D
Other topics we would have liked to see include more information related to disparities
and social determinants of health, as it differs between different ethnic groups and communities.
More practical applications and real-world examples of specific theories and concepts would
have been interesting to see as well.
References:
About Social Determinants of Health (SDOH). (2020, September 30).
https://www.cdc.gov/socialdeterminants/about.html
34
California Health Interview Survey | UCLA Center for Health Policy Research. (n.d.). Retrieved
November 15, 2020, from https://healthpolicy.ucla.edu/chis/Pages/default.aspx
CDC Community Approaches to Reducing Sexually Transmitted Diseases. (2020, June 8).
https://www.cdc.gov/std/health-disparities/cars.htm
CDC. (2020, May 18). HIV and Youth. Centers for Disease Control and Prevention.
https://www.cdc.gov/hiv/group/age/youth/index.html
CDC - Evaluate a CoP - Resource Kit—CoP - OSTLTS. (2019, March 26).
https://www.cdc.gov/phcommunities/resourcekit/resources.html
Census profile: San Bernardino County, CA. (n.d.). Census Reporter. Retrieved November 15, 2020,
from http://censusreporter.org/profiles/05000US06071-san-bernardino-county-ca/
Detailed STD Facts—HIV/AIDS & STDs. (2020, August 5). https://www.cdc.gov/std/hiv/stdfact-std-
hiv-detailed.htm
Final Recommendation Statement: Sexually Transmitted Infections: Behavioral Counseling | United
States Preventive Services Taskforce. (n.d.). Retrieved December 11, 2020, from
https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFina
l/sexually-transmitted-infections-behavioral-counseling#bootstrap-panel--9
Fonner, V. A., Armstrong, K. S., Kennedy, C. E., O’Reilly, K. R., & Sweat, M. D. (2014). School
Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic
Review and Meta-Analysis. PLoS ONE, 9(3).
https://doi.org/10.1371/journal.pone.0089692
HIV knowledge mediates the relationship between HIV testing history and stigma in college students:
Journal of American College Health: Vol 66, No 7. (n.d.). Retrieved November 15, 2020, from
https://www.tandfonline.com/doi/full/10.1080/07448481.2018.1432623
35
Hogben, M., & Leichliter, J. S. (2008). Social determinants and sexually transmitted disease
disparities. Sexually Transmitted Diseases, 35(12 Suppl), S13-18.
https://doi.org/10.1097/OLQ.0b013e31818d3cad
Hollinger, B. S. (n.d.). Applying Behavior Change Theory to STD Prevention & Education. 23.
Identifying and Determining Involvement of Stakeholders. (n.d.). 2.
Knowledge and attitude about sexually transmitted infections other than HIV among college
students :Subbarao NT, Akhilesh A, Indian J Sex Transm Dis. (n.d.). Retrieved November 15,
2020, from https://www.ijstd.org/article.asp?issn=2589-
0557;year=2017;volume=38;issue=1;spage=10;epage=14;aulast=Subbarao
Huggins, R. (CDC/OID/NCHHSTP). (n.d.). Division of HIV/AIDS Prevention Strategic Plan 2017—
2020. 25.
Montano, D., Kasprzyk, D., Glanz, K., Rimer, B., & Viswanath, K. (2008). Theory of reasoned
action, theory of planned behavior, and the integrated behavior model. In Health behavior and
health education: Theory, research, and practice (pp. 67–96).
Owusu-Edusei, K., Chesson, H. W., Gift, T. L., Tao, G., Mahajan, R., Ocfemia, M. C. B., & Kent, C.
K. (2013). The estimated direct medical cost of selected sexually transmitted infections in the
United States, 2008. Sexually Transmitted Diseases, 40(3), 197–201.
https://doi.org/10.1097/OLQ.0b013e318285c6d2
Program Evaluation Guide—Step 1—CDC. (2020, March 25).
https://www.cdc.gov/eval/guide/step1/index.htm
Schafer, C., Prado, B., Barin, N., & Gama, L. (2018). MISSED OPPORTUNITIES OF CHLAMYDIA
AND GONORRHEA DETECTION WHEN NOT USING EXTRA GENITAL SCREENING
AMONG MALES. https://doi.org/10.1101/428706

36
Sexually Transmitted Diseases | Department of Public Health. (n.d.). Retrieved November 15, 2020,
from https://wp.sbcounty.gov/dph/programs/cds/stds/
Sexually Transmitted Diseases Data. (n.d.). Retrieved November 15, 2020, from
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/STD-Data.aspx
STD-HIV-Update-2019.pdf. (n.d.). Retrieved November 15, 2020, from
https://wp.sbcounty.gov/dph/wp-content/uploads/sites/7/2019/05/STD-HIV-Update-2019.pdf
STDs in Adolescents and Young Adults—2018 Sexually Transmitted Diseases Surveillance. (2019,
October 8). https://www.cdc.gov/std/stats18/adolescents.htm
Stds-and-hiv-fact-sheet.pdf. (n.d.). Retrieved November 15, 2020, from
https://www.cdc.gov/STD/hiv/stds-and-hiv-fact-sheet.pdf
Vivancos, R., Abubakar, I., Phillips-Howard, P., & Hunter, P. R. (2013). School-based sex education
is associated with reduced risky sexual behaviour and sexually transmitted infections in young
adults. Public Health, 127(1), 53–57. https://doi.org/10.1016/j.puhe.2012.09.016
What Works: Sexual Health Education | Adolescent and School Health | CDC. (2020, February 4).
https://www.cdc.gov/healthyyouth/whatworks/what-works-sexual-health-education.htm
Appendix
SWOT Analysis
37
Our SWOT analysis analyzes the internal and external components of our proposed
program. Internal components such as strengths and weaknesses, and external components such
as opportunities and threats.
Meeting Minutes: CSUSB Public Health Intervention for STD & HIV Prevention,
Protection & Education
Topic Date Duration
Discussion of Public 09/06/2020 1 hour
Health Areas that need

38
improvement
Brainstorming of 09/13/2020 1 hour
potential Intervention
ideas
Finalize Program 09/20/2020 1 hour
proposal
Propose Structure of 09/27/2020 1 hour
intervention
Design Program 10/04/2020 1 hour
Create Program 10/11/2020 1 hour
Description/Action
Plan/SWOT Analysis
Finalize draft of program 10/25/2020 1 hour
for review
Continue finalizing draft 11/03/2020 1 hour
of program for review
Final thoughts prior to 11/11/2020 30 minutes
submission of draft
Stakeholder Feedback
Our primary stakeholders would be the CSUSB Health Center, the CSUSB students, other
campus organizations, and the San Bernardino Public Health Department. Consensus of
stakeholder feedback dictates the need for a program like ours to help inform, prevent, and
39
reduce rates of STD and HIV infection. Due to limited resources however, all attempts must be
made to not have duplicate programs on campus and in the local area.

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STD & HIV AMONGST COLLEGE STUDENTS PROGRAM PROPOSAL

STD & HIV Amongst College Students

A Proposal for Prevention, Protection & Education

Department of Health Science and Human Ecology,

California State University, San Bernardino

HSCI 6240: Advanced Health Promotion

Dr. Sen Padilla

December 12, 2020

Smart Goals and Objectives……………………………………………………………………….5

Program Design and Implementation…………………………………………………….…........11

Program Purpose and Rationale.........................................................................................12

Program Purpose and Rationale Literature Review……………………………………………...15

Map of Determinants to Theory………………………………………………………………….17

discussions about anymore.

education to raise awareness regarding health services, specifically services on campus. In

intervention and prevention strategies we anticipate an increase in knowledge and understanding

students is another significant outcome of the program.

invest in health and the wellbeing of individuals.

SMART Goals and Objectives

GOAL 1: Increase awareness of sexually transmitted diseases among current students at

California State University, San Bernardino.

Not-so-SMART objective 1a: Assess students’ knowledge and understanding about

Key Component Objective

task? perceive their own risk of contracting an STD by

distributing an online questionnaire.

standards or parameters? weeks of being administered (Division of HIV/AIDS

Prevention Strategic Plan 2017 – 2020) .

resources available? resources on sexual health. More information on this

topic is also provided at the local, state, and national

and end dates? an appropriate questionnaire and to collect and

analyze the data obtained.

with the CSUSB Student Health Center to develop an appropriate STD/Risk

Not-so-SMART objective 1b: Provide additional resources on STDs

Key Component Objective

task? health education programs, brochures, pamphlets)

while also providing access to condoms, vaccinations,

and other preventive measures. Further discuss STD

testing/screening and treatment.

standards or parameters? students that have utilized these additional services.

feasible? Health Center.

resources available? education and testing for students at no cost. The

student center may have additional information on data

collection for services used.

performance of the program.

methods. It will also focus on accessing STD treatment.

GOAL 2: Refocus and strengthen HIV prevention and treatment to empower

Not-so-SMART objective 2a: Encourage/normalize HIV testing

Key Component Objective

Specific - What is the specific Provide educational resources to further understand

task? HIV and the importance of getting tested. Provide

access to HIV testing (at no cost) on campus

throughout the month.

standards or parameters? tested throughout the month. Utilization of this service

should exceed 70% (Division of HIV/AIDS Prevention

Strategic Plan 2017 – 2020).

Realistic - Are sufficient Yes, further information on HIV testing is present at

evidence-based resources for clinicians, which can also

be implemented by the CSUSB Health Center.

start and end dates? services will be evaluated to determine percent of

utilization, quality, and cost effectiveness.

have additional access to HIV testing on campus at no cost.

Not-so-SMART objective 2b: Provide further information on Pre-exposure