Study on peer-led school-based HIV/AIDS prevention among youths in a medium-sized city in China

HIV/AIDS epidemic is crucial in China; however, few studies were performed on youths. This study was performed to examine the effectiveness of peer-led HIV prevention intervention on HIV-related knowledge, attitudes and behaviour intention in senior high-school students in San-ming, a medium-sized city in Fujian province. Three thousand and sixty-eight students completed self-administered questionnaires before and after intervention, of which 981 students (the intervention group) accepted peer-led HIV/AIDS prevention intervention and others (the control groups) continued the usual teacher-led health education curriculum. Significant increases were observed in the intervention group in HIV-related knowledge, in attitudes and in behaviour intention after intervention. The results of this research also indicated an inconsistent level of HIV/AIDS knowledge and attitude among students, with a significant gender, health education history and style difference in session delivery. More concerted efforts in HIV prevention are needed to improve young people's sexual health.     

乡镇中学生开展艾滋病性病知识同伴教育效果评估

目的探讨针对乡镇中学生采取同伴教育措施预防艾滋病的策略。方法在广东省珠江三角洲某市,随机选择2所乡镇中学,共征募并培训20名同伴教育员在校开展同伴教育工作,组织开展多种形式的艾滋病知识宣传活动。在干预前后用相同的调查表对学生进行问卷调查。结果干预前后(相隔6个月)分别调查192名和191名在校中学生,艾滋病知识总知晓率从干预前的22.92%提高到干预后的66.49%(P<0.05);最近半年有性行为的比例从干预前的18.23%下降到干预后的9.95%(P<0.05);最近一次性生活中采取安全措施的比例从干预前的52.71%增加到干预后的94.74%(P<0.05)。结论在乡镇中学生中开展同伴教育活动能显著提高中学生对艾滋病知识的知晓率,减少对艾滋病的歧视,减少危险性行为,对发挥中学生在控制艾滋病蔓延的作用具有重要作用。     

Peer-led HIV prevention among gay men in London: process evaluation

A peer-led HIV prevention initiative, based on a diffusion of innovation model, was developed for gay men attending gyms in central London. Peer educators were recruited from people who used the gym regularly according to standard selection criteria. After initial training, peer educators agreed to talk to gay men at their gym about HIV prevention, focusing on sexual risk and steroid injecting behaviour. Outcome evaluation revealed that the peer education programme had no significant impact on the risk behaviours of gay men using the gyms. Process evaluation, based on interviews with peer educators, the health promotion team and gym managers threw light on this finding. While it was feasible to set up a peer education programme among gay men in central London gyms, attrition was an important factor. Only one in five potential peer educators initially identified remained with the project throughout, thus limiting the potential for diffusion. Those who did work as peer educators reported barriers to communication within the gyms further limiting the extent to which diffusion occurred. In fact, it appears that the critical mass required for diffusion was never established. This could explain why the intervention had no significant impact on gay men's risk behaviours. A person-time analysis demonstrated that the peer education programme required a substantial input from the health promotion team, equivalent to one team member devoting 2.5 days a week to recruit, train and support peer educators over 18 months. Peer education should not, therefore, be viewed as a low-cost approach to prevention. Many of the insights gained through this process evaluation can inform others planning peer education programmes in other settings.     

Factors associated with peer HIV prevention outreach in drug-using communities.

Peer education is a critical approach to HIV prevention. The current study evaluated 156 peer outreach educators 6 months after their 10-session training. Specifically, we examined factors associated with talking to network members about HIV-related topics as well as distributing risk reduction materials. Overall, current drug users were less likely to report engaging in HIV-related conversations in the prior month but were more likely to provide bleach to drug-using network members. Older participants (aged 41 and older) were more likely to report HIV prevention conversations, and women were marginally more likely to report providing condoms to network members. HIV-seropositive participants were significantly more likely to report talking to sex partners and family members about HIV. These data suggest that demographic characteristics, drug use, and HIV status are associated with HIV prevention conversations among network members. These characteristics should be considered when designing peer outreach HIV prevention programs.     

Effectiveness of peer education in HIV/STD prevention at different types of senior high schools in Shanghai, People's Republic of China

The epidemic of HIV/AIDS greatly threatens Chinese youth. Our study was intended to examine the effectiveness of the peer education method in HIV/AIDS prevention in different types of senior high schools in Shanghai. A peer education intervention was conducted in 10 different types of senior high schools, including three key senior schools, four ordinary senior schools and three vocational schools in Shanghai for three months. A cohort of 1910 students was surveyed (n=976 intervention group, n=934 control group) through anonymous questionnaires, both pre- and postintervention. There were significant differences in the results among these different types of senior schools. Peer education is an efficient method of increasing the knowledge of AIDS/sexually transmitted diseases in senior school students. However, the contents and the schedule should be different between different types of schools, and students in vocational schools require more health education.     

Engagement in HIV Care Among New York City Transgender Women of Color: Findings from the Peer-Led,TWEET Intervention,a SPNS Trans Women of Color Initiative

Transgender women (TW) have higher HIV prevalence rates than cisgender (i.e., non-transgender) women. However, utilization of healthcare for transgender people in the U.S. is low. As part of a multisite initiative to facilitate entry and retention in HIV care for TW of color, we compared health outcomes between participants who became Peer Leaders and those who did not. From 2013 to 2016, 163 New York City, mostly Latina, TW enrolled in the Transgender Women Engagement and Entry to Care Project (TWEET). The TWEET intervention included peer-led, group-based educational sessions called Transgender Leader—Teach Back; 39% completed Peer Leadership requirements. Comparing pre-post change by Peer Leader status, Peer Leaders had a significant decrease in viral load and significant increase in CD4 at the last HIV care visit compared to the first. In multivariable logistic regression, predictors associated with Peer Leadership included having at least some college education, being in a relationship, stable housing, receiving legal assistance for political asylum, and having two or more HIV care visits during the intervention. Findings suggest that, for trans women who have completed at least secondary school education, participating in a peer-led intervention can lead to improved HIV care engagement. Understanding which program components lead to becoming a Peer Leader, and how to better engage non-Peer Leaders, are important next steps.

     

职校学生预防艾滋病同伴教育干预的过程评价及结果分析

目的探索适应于职业技术学校(职校)学生的同伴教育模式。方法采用观察法和问卷调查的方式,对同伴教育实施过程进行评价。结果同伴教育者培训后,艾滋病知识和态度得分明显提高(P<0.01)。过程中目标人群参与率接近100%,参与者对同伴教育者教学质量评分均高于4.5分(5分制),对同伴教育方法的喜欢程度评分为4.67分。学生担任同伴教育者在现场控制、培训深度等方面还存在不足。结论同伴教育的方式适用于职校的艾滋病健康教育。     

同伴教育在改善武汉市血吸虫病流行区小学生知信行中的效果

目的 探讨同伴教育对武汉市血吸虫病流行区小学生血吸虫病防治知信行的干预效果。方法 2021年以武汉市江岸区育才汉口小学为研究现场,整群抽取该校所有4～5年级学生为研究对象,进行血吸虫病同伴教育干预。比较干预前后小学生血吸虫病防治知信行变化,评价同伴教育干预效果。结果 干预前,所有小学生血吸虫病防治知识总知晓率、血防态度和相关行为正确率分别为51.50%、93.70%、92.99%,干预后分别上升至86.50%、98.98%、98.72%,差异均有统计学意义(χ²=149.457、21.692、20.691,P均<0.05)。干预前,四年级小学生血吸虫病防治知识知晓率、态度和相关卫生行为正确率分别为49.19%、92.20%和92.72%,五年级小学生分别为53.83%、95.21%和93.28%,四、五年级小学生血吸虫病防治知识知晓率、态度和相关卫生行为正确率差异均无统计学意义(χ²=1.214、2.034、0.096,P均> 0.05);干预后,四年级小学生血吸虫病防治知识知晓率、态度和相关卫生行为正确率分别上升至75.93%、...     

Latinos en Extasis

The Mission Neighborhood Health Center (MNHC) in San Francisco offers a Latino youth program, Latinos en Extasis, focusing on HIV, sexually transmitted disease (STD), and pregnancy prevention. The youth-focused, peer intervention program works to increase risk prevention, improve self-esteem among Latino youth ages 13 to 18, and improve communication skills for negotiating birth control and condom use. Based on Diffusion of Innovation Theory (DIT), the program builds on the social influence of community leaders and peer educators. Peer educators, chosen based on their presentation skills and desire to be community activists, are trained on HIV/STDs and reproductive anatomy. The peer educators, who come from a variety of socioeconomic levels and backgrounds, recruit participants at community events, health centers, and high schools. Participants enjoy the role-playing and games that peer leaders use to encourage participation and facilitate education.     

Differences in altruistic roles and HIV risk perception among staff, peer educators, and students in an adolescent peer education program.

This qualitative study examines how adolescent peer educators understand and communicate HIV prevention messages. Semistructured ethnographic interviews were conducted with 21 program participants, including staff, peer educators, and students. Interviews were transcribed and analyzed using concept analysis, a method for identifying shared concepts among interview subjects. We found (a) similar beliefs about HIV transmission and risk reduction across groups; (b) different, but strong, altruistic roles among staff and peer educators; and (c) differences in HIV risk perception across the three groups. Altruistic roles took two forms. Staff acted as life skills mentors, whereas peer educators acted as HIV educators. Students were more passive, receiving counseling but not passing it on to others. Staff contextualized HIV risk, whereas peer educators and students emphasized risk. Although similar HIV knowledge across groups suggests program efficacy, stronger altruistic roles or contextualization of HIV risk may affect how prevention messages are delivered.     

Workplace peer educators and stress

Peer educators form an important component of company responses to HIV and AIDS. Based on interviews with peer educators working in and around a mining company in South Africa's North-West Province, the study examines the relationship between involvement in peer education and stress. The paper discusses how becoming a peer educator can be a response to the often personal stress brought about by the HIV epidemic. In addition, structural difficulties, skills deficiencies and other obstacles to effective communication with their peers can create stress. The stress that active peer education brings to individuals is discussed, particularly in regard to the embeddedness of peer educators within their communities. The need for confidentiality also magnifies stress in the case of individuals who disregard peer educators' advice. Peer educators face many stresses in managing and supporting their own lives, thus their (voluntary) work as peer educators should not be taken out of context. Using this approach, we discuss how the role of peer educator should be conceptualised and how they can be organised and supported in order that their stress be minimised and effective engagement maximised.     

Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland?

This paper evaluates the effectiveness of a bar-based, peer-led community-level intervention to promote sexual health amongst gay men. The intervention consisted of peer education within bars, gay specific genitourinary medicine (GUM) services and a free-phone hotline. Data were collected at baseline (1996) and at follow-up (1999) in gay bars in Glasgow (intervention city) and Edinburgh (control city). During the intervention peer educators interacted with 1484 men and new clients increased at the gay specific GUM service. However, the hotline was under-utilized and abused. The outcome measures were: reported hepatitis B vaccination; HIV testing; unprotected anal intercourse (UAI) with casual partners; negotiated safety; and amongst men reporting UAI with a regular partner, the proportion who knew their own and their partner's HIV status. Significant differences in sexual health behaviours were observed across locations and across time, but the only significant intervention effects were amongst men who had direct contact with the intervention, with higher uptake of hepatitis B vaccination and HIV testing. The intervention did not produce community-wide changes in sexual health behaviours. These results question the replication and transferability of peer-led, community-level sexual health promotion for gay men outwith the USA and across time.     

HIV/AIDS prevention through peer education and support in secondary schools in South Africa

The implementation and evaluation of a peer education and support programme in secondary schools to prevent and reduce high-risk sexual behaviour amongst adolescents is discussed. The aims of the programme were to provide accurate information about HIV/AIDS, discuss and reconsider peer group norms, and establish support for learners. In the programme that was implemented in 13 secondary schools in Tshwane, South Africa, peer educators were identified, trained and supported to implement the programme in their schools with the assistance of a teacher and postgraduate students as facilitators. Peer educators organised HIV awareness activities, facilitated class discussions on risk behaviour and gender relationships, and supported learners in solving personal problems. Process evaluation included weekly reports and focus group discussions with peer educators and teachers. A quasiexperimental design involving an experimental and control group, as well as pre- and post-assessments, was used to evaluate the impact of the programme on psychological well-being, personal control, school climate and reported high-risk behaviour of learners aged between 13 and 20 years. The results showed that the percentage of learners in the experimental group who were sexually experienced remained unchanged over the time period of 18 months. In contrast, a significantly increased percentage of learners in the control group were sexually experienced after the same time period. The control group also perceived more of their friends to be sexually experienced. No differences were reported in condom use in either of the groups. The findings of this study suggest that peer education can contribute to a delayed onset of sexual activity, and can therefore contribute to the prevention of HIV/AIDS amongst adolescents.     

Peer acceleration: effects of a social network tailored substance abuse prevention program among high-risk adolescents

OBJECTIVE: To test whether a social network tailored substance abuse prevention program can reduce substance use among high-risk adolescents without creating deviancy training (iatrogenic effects). METHODS: A classroom randomized controlled trial comparing control classes with those receiving an evidence-based substance use prevention program [Towards No Drug Abuse (TND)] and TND Network, a peer-led interactive version of TND. Students (n = 541, mean age 16.3 years) in 75 classes from 14 alternative high schools completed surveys before and approximately 1 year after curriculum delivery. Past-month use of tobacco, alcohol, marijuana and cocaine were assessed. RESULTS: Overall, TND Network was effective in reducing substance use. However, the program effect interacted with peer influence and was effective mainly for students who had peer networks that did not use substances. Students with classroom friends who use substances were more likely to increase their use. CONCLUSIONS: A peer-led interactive substance abuse prevention program can accelerate peer influences. For students with a peer environment that supports non-use, the program was effective and reduced substance use. For students with a peer environment that supports substance use, an interactive program may have deleterious effects.     

Condom Use During Commercial Sex Among Male Clients of Female Sex Workers in Sichuan China: A Social Cognitive Theory Analysis

There has been little theory-based research focusing on condom use among male clients of female sex workers (CFSW) in China. The current study applied social cognitive theory to condom use behaviors of CFSW in China. Face-to-face structured interviews were conducted among 584 CFSW recruited through snowball sampling. Bivariate and multivariate logistic regression models were applied to examine factors associated with consistent condom use. A minority (30.65 %) of respondents reported using condoms consistently with FSW, and 7 of 12 social cognitive dimensions/subdimensions were found to be significantly influential. The most significant factors were self-efficacy [adjusted prevalence ratio (APR) = 2.11, 95 %, CI = 1.74–2.43] and personal pleasure reduction (APR = 0.3, 95 % CI = 0.15–0.6). HIV-related knowledge, perceived HIV susceptibility, condom cost, condom efficacy, and embarrassment of carrying condoms were not associated with consistent condom uses with FSW. Findings from the current study suggest future prevention programs should target sex venues, and condom access should ensure both quantity and quality. Peer education should focus on knowledge education and peer norms, and knowledge education should include information on HIV infection severity and how to increase pleasure with condom use.     

沈阳市西塔地区娱乐场所服务员预防AIDS/STI行为干预研究

目的 使目标人群预防艾滋病／性传播感染(AIDS／STI)相关知识水平提高30％以上，增强自我保护意识，进而改变高危行为，推广使用安全套，降低和减少AIDS／STI的危害。方法 按教育对象的年龄、教育程度、来源，随机分为教育组和对照组，教育组的干预方法采取同伴教育形式。干预前后通过问卷形式对各组进行干预效果评估。结果 教育组预防AIDS／STI知识知晓率提高36．5％，而对照组无明显提高，安全套使用在干预前后未见差异。结论 同伴教育可以提高高危人群预防AIDS／STI知识的知晓率，但行为干预工作应在不同人群、从不同层面开展，以保证行为干预成果的持续性。     

A controlled-study of preventive effects of peer education and single-session lectures on HIV/AIDS knowledge and attitudes among university students in Turkey.

The goal of this study was to assess the impact of peer education and single-session educational lectures on HIV/AIDS knowledge and attitude change among university students (n = 157 male, n = 230 female; mean age = 20) on the campuses of two metropolitan state universities in Ankara, Turkey. The students were randomly selected to participate in peer education (n = 204), single-session lecture (n = 74) or wait-list control (n = 109) groups. Statistical analyses reveal significant differences in knowledge and attitudes, personal behavior, and awareness of HIV/AIDS. Both the peer education and HIV/AIDS lecture strategies were more effective in eliciting change in student's knowledge and attitudes than the control condition (p > .05). Male and female students in both experimental groups showed higher attitude scores compared with all students in the control group.     

Process evaluation of school-based peer education for HIV prevention among Yemeni adolescents

In 2005, a survey was conducted among all the 27 high schools of Aden, which revealed low levels of knowledge on major prevention measures, and a high level of stigma and discrimination towards people living with HIV (PLWH). The results served as a baseline for implementing a school-based peer education intervention for HIV prevention in the 27 schools of Aden. In 2008, and after 3 years of implementation, a quasi-experimental evaluation was conducted, which revealed that the peer education intervention has succeeded in improving HIV knowledge and skills; and in decreasing stigmatization of PLWH. This process evaluation aims to give a deeper understanding of the quasi-experimental evaluation which was conducted in the 27 high schools of Aden, and to highlight the factors that facilitated or inhibited school peer education in such a conservative Muslim setting. Qualitative methodologies were pursued, where 12 focus group discussions and 12 in-depth interviews were conducted with peer educators, targeted students, school principals, social workers, and parents of peer educators. Results revealed that school-peer education was well received. There was an apparent positive effect on the life skills of peer educators, but the intervention had a lesser effect on targeted students. Key enabling factors have been the high quality of training for peer educators, supportive school principals, and acceptance of the intervention by parents. These findings are important for improving the life skills and peer education intervention at the school level, and in better planning and implementation of life skills and peer programmes at a national scale.     

Can Peer Education Make a Difference? Evaluation of a South African Adolescent Peer Education Program to Promote Sexual and Reproductive Health

Peer education is popular both with governments and with young people. The purpose of this quasi-experimental study was to evaluate the effectiveness of a government-led peer education program on the self-reported sexual health behavior and related psychosocial outcomes of adolescent students in public high schools in the Western Cape of South Africa. Grade 10 students (n = 3934), at 30 public high schools (15 intervention, 15 comparison) were recruited to the study. In the intervention schools, peer educators were recruited and trained to provide information and support to their fellow students. Sexual health behaviors and related psychosocial outcomes of students were measured at baseline and at follow up 18 months later. Comparisons were made between those in the intervention and comparison group schools. We were unable to detect a significant difference in the age of sexual debut, use of condoms at last sex, goal orientation, decision-making or future orientation for students in the intervention group as compared to students in the comparison group. The findings suggest that the peer education program was not effective in reducing the age of sexual debut or condom use. Issues around the implementation of the program suggested that this was sub-optimal. Governments who advocate widespread use of peer education as an approach need to recognise barriers to implementation and ensure ongoing monitoring and evaluation of effectiveness and cost effectiveness.     

Community interventions double condom use among African-Americans

A follow-up study was conducted in San Francisco, CA on low-income African-American women who completed a five-week assertiveness and gender empowerment training program. Three months after the course, 47 percent of the women reported consistent condom use. Nearly half reported never having used a condom prior to the training. The women given traditional HIV intervention reported no significant attitudinal or behavior changes. This trial was unique because it used African-American women from the community as peer educators. The intervention, based on the theory of gender empowerment, contains five components: understanding of HIV risk, self-assertiveness and self-empowerment, sexual communication, partner norms, and condom use. The study model can be implemented in community-based or public health settings with few barriers and at relatively little expense.