Sexual Health Education - Respecting the Circle of Life

Adolescent Health, Alcohol & Drug Abuse Prevention, Behavioral Health, Infectious Disease Control, Sexual & Reproductive Health

On some tribal reservations, sexual health education is not part of standardized school curriculum. Adolescents in these communities suffer high rates of sexually transmitted infection and unintended pregnancy. Focus groups completed with adolescents from a tribe in the American Southwest indicated sexual health knowledge including HIV/AIDs prevention and transmission knowledge is low, peers readily influence youth’s decision to engage in sexual risk behaviors and skills necessary to reduce risk behaviors including communication skills and proper condom use are lacking. Innovative programs that fill this educational gap and are easily transportable are essential.

About Respecting the Circle of Life

Respecting the Circle of Life is a comprehensive sexual and reproductive health program culturally adapted for American Indian communities. It provides teens with comprehensive knowledge and teaches skills to help them make healthy choices regarding sex and communication with their partners. Respecting the Circle of Life:

  • Consists of 8 sessions each lasting 90 minutes
  • Is taught to small same-sex groups of friends by 2 adult facilitators
  • Teaches reproduction, anatomy, prevention, and transmission of sexually transmitted infections
  • Promotes problem-solving strategies and healthy communication
  • Enables youth to practice condom use skills
  • Prevents alcohol and drug use, especially before sex

The Respecting the Circle of Life program is embedded in a two-week summer basketball camp. Educational sessions blend with basketballs skills training and competitive play, and provide youth with a recreational outlet that enhances overall program participation. 


Respecting the Circle of Life was evaluated with 267 adolescents aged 13-19 from a tribe in the American Southwest. One year after receiving the program, teens had:

  1. Improved prevention and transmission knowledge about sexually transmitted infections and HIV/AIDS
  2. Increased confidence in their ability to use condoms correctly and consistently
  3. More conversations about sexual and reproductive health with their parents and other trusted adults

Promoting Reproductive Health Equity Nationally

Starting this month, the Center is disseminating RCL through ETR, a nonprofit organization that helps scale up science-based solutions in sexual and reproductive health and other areas. Communities can purchase the program through ETR’s catalog, which only includes programs with proven evidence. This will be the first program developed for Native American communities in ETR’s catalog. A starter kit is $569—which will cover everything needed for two facilitators to deliver RCL to 12 youth and 12 parents or trusted adults. As part of the kit, the Center for American Indian Health created a comprehensive implementation guide including recruitment materials, camp schedules, and a month-by-month planning guide.

Funders and replication partners

This project has been supported by the Native American Research Center for Health of the National Institutes of Health.

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