HIV Prevention Knowledge Base
Behavioral Interventions: Peer Outreach and Education
Peer-led Interventions to Reduce HIV Risk of Youth: A Review
The researchers review 24 youth HIV POE programs in developing nations and report that the programs overall led to improved HIV knowledge and social norms but there was no corresponding increase in condom use, except among subgroups. Similarly, there was no clear evidence of a reduction in symptoms of sexually transmitted infections. The authors note that the “greatest successes were reported in studies with the weakest designs.” They comment on the findings of Kim and Free in which benefit from adolescent POE programs was not found. They suggest some reasons for the lack of positive findings, including the large number of studies from high-income nations, such as the U.S. and U.K., and the attitudes in low- and middle-income nations where program outcome assessments are seen as “unnecessary, costly and time consuming…with little or no benefit to the program itself.” The authors cite other research suggesting that poor monitoring could contribute to weak delivery.
Effectiveness of Peer Education Interventions for HIV Prevention in Developing Countries: a Systematic Review and Meta-analysis
Although peer education for HIV prevention is commonly recommended and used in developing nations, the authors of this meta-analysis (a study of studies) say that the effectiveness of this approach has not been systematically evaluated. The authors analyzed 30 relevant studies published from 1990 through late 2006 and found that peer education programs led to increased knowledge and reduced equipment sharing among injection drug users. However, there was no significant benefit detected in terms of a reduction in sexually transmitted infections. The researchers comment that study heterogeneity limited the strength of this meta-analysis and they recommend a “standardized set of measures for condom use, HIV knowledge, and other behavioral and biological outcomes” for further research.
Reducing Sexual Risk Behaviors and Alcohol Use Among HIV-positive Men Who Have Sex with Men: A Randomized Clinical Trial
The researchers conducted a randomized clinical trial of 253 alcohol-using men who have sex with men (MSM) to see whether POE using a “transtheoretical model” with motivational interviewing would reduce the men’s use of alcohol and risky sexual behavior. A control group was given referrals to standard services. The control group reported taking a slightly greater number of drinks per day and were twice as likely engage in risky sex behaviors compared to the intervention group. There was no difference between groups on the number of drinking days per 30-day period or on the number of days of unprotected sex. The protective effect in the intervention group leveled off over time and was indistinguishable from the control group by the tenth month.
Recent Evaluations of the Peer-Led Approach in Adolescent Sexual Health Education: A Systematic Review
The authors of this systematic review provide a critical analysis of 13 published studies of the efficacy of adolescent POE programs to promote sexual health. Studies were appraised for four critical study biases (selection-, performance-, attrition-, and detection bias). Randomized and quasi-experimental programs from high- and low-income nations were included. The authors found that the methodological quality of the studies was low and they urge caution in interpreting the results of this review. Of the three studies reporting consistent condom use, none showed statistically significant results. Nor was there clear evidence, say the authors, that adolescent POE reduced the odds of pregnancy or having a new partner. Despite their findings, the authors state that POE “should not be abandoned but rather fine-tuned.”
Modeling the Impact and Cost-effectiveness of the HIV Intervention Programme Amongst Commercial Sex Workers in Ahmedabad, Gujarat, India
This article uses mathematical modeling to determine cost-effectiveness of the Jyoti Sangh HIV prevention program in Gujarat, India. The program was initiated in 2003 when HIV prevalence among commercial sex workers was found to be 13 percent. The authors, using multiple assumptions and surrogate markers for the outcome of interest (HIV infections), determine that the intervention “averted 624 and 5,131 HIV cases” among sex workers and their clients respectively. They conclude that the intervention was cost effective at a cost ranging between $56 and $219 per averted case.
Creating Environments that Support Peer Education: Experiences from HIV/AIDS-prevention in South Africa
The author of this editorial reviews her own work and that of others regarding POE among South African youth. She discusses the work of Paulo Freire, the underpinnings of effective POE, and obstacles that have led to mixed results with POE. She cites her own 2001 study in which young people, despite high levels of HIV knowledge, continued to engage in high-risk sex. Barriers cited include low perceived level of personal risk; peer pressure to engage in unprotected sex; limited access to condoms; and poverty that made transaction sex attractive to some young women. The author concludes that program success will be difficult without parallel efforts to change the social environment.
Peer Education for HIV Prevention in the Socialist Republic of Vietnam: A National Assessment
This report on a governmental assessment of HIV peer education programs finds that in 2000 “very limited” numbers of people were reached. Only 20 of Vietnam’s 61 provinces had programs. Most targeted injecting drug users and many targeted commercial sex workers, however, few targeted their sex partners. The nature of education was also incomplete; while some programs distributed condoms, few demonstrated their correct use, and access to clean needles and syringes were often not provided. The authors say that small surveys of clients indicated continuing high-risk behaviors despite repeat contacts with peer educators, suggesting inefficiencies in peer education. The authors end with six recommendations to expand and improve peer education initiatives.
Training Outreach Workers for AIDS Prevention in Rural India: Is It Sustainable?
The authors review a POE program in the rural state of Karnataka in India, two years after external funding was withdrawn to determine factors associated with program sustainability. The program initially trained 5,000 community-based outreach workers (CBOWs). However, only 39 of the 5,000 appeared to sustain POE activities. The authors interviewed program staff and both sustaining- and non-sustaining CBOWs. Several factors were found to be related to sustained engagement: volunteers who were already leaders in community organizations were most likely to become sustainers; focusing on community organizations (which can aid in ongoing support for volunteers) over individual volunteers may improve sustainability; and the withdrawal of stipends to volunteers when external funding ends leads to significant attrition among impoverished volunteers.
The Influence of Peer versus Adult Communication on AIDS-protective Behaviors among Ghanaian Youth
In order to determine who most influences youth’s risk reduction behaviors; peers, adults, or a combination of both, the authors of this paper queried nearly 500 Ghanaian youth aged 11 to 26 years about the people they spoke with about reproductive health and contraception during the previous three months. Overall, 58 percent of youths said they had taken action during the preceding three months to protect themselves from HIV. Those who spoke with adults were no more likely than those who spoke with no one to take precautions. Those who spoke with peers were more likely to have taken a preventive measure than those who spoke with no one, while those who spoke with both peers and adults were most likely to have taken a protective measure. The author state that cause and effect could not be proven by this observational study.
Exploring Similarity between Peer Educators and Their Contacts and AIDS-protective Behaviours in Reproductive Health Programmes for Adolescents and Young Adults in Ghana
The authors examine the similarities and differences between the age, ethnicity, gender, and school status (in or out of school) of peer educators with those of their contacts and how those similarities or dissimilarities affect the outcome of POE. Outcome was assessed by asking contacts: “Have you done anything to protect yourself from AIDS in the past three months?” Unadjusted results showed no statistically significant difference in outcome based on the closeness of peer-contact characteristics. After adjusting for “other potential co-factors,” such as age, whether the program was school-based “and other variables,” peer educators who more closely resembled their contacts had a statistically significant, albeit modest, effect on the outcome.