|Peer Education and HIV/AIDS: Concepts, Uses and Challenges (Best Practice- Key Material) (UNAIDS, 2000, 43 p.)|
The current literature suggests that peer education is a widely used component of HIV prevention programmes across population groups and geographical areas. The literature also indicates that peer education is seldom implemented alone. Rather, it is often part of a larger, more comprehensive approach to HIV prevention that includes condom distribution, STI management, counselling, drama, and/or advocacy.
Very few of the evaluations of HIV/AIDS peer education programmes found in the literature use rigorous research designs such as randomized controlled trials or STI/HIV incidence as outcome measures. Instead, many programmes collect only proxies of outcome measures, such as HIV-related knowledge, self-efficacy, and/or attitudes and beliefs, through the use of uncontrolled pre-test/post-test or post-test only research designs. Review of some of the studies that have evaluated HIV/AIDS peer education programmes using experimental or quasi-experimental designs, with outcome indicators such as reduction of HIV-related risk behaviour and/or STI/HIV incidence, shows that peer education (in combination with other prevention strategies) is very effective in several populations and geographical areas. However, researchers and programme planners are still faced with the task of determining what the critical elements of peer education are within the context of a comprehensive HIV-prevention strategy that will reduce HIV risk behaviour and incidence in a given population and context. The current review of the literature cannot definitively answer this question because many programmes do not explain in depth: how they select, train, and supervise peer educators; what incentives they provide for peer educators; how stakeholders are involved; what attention they give to gender and sexuality; and how sustainable they are. Apart from a review of the literature, there are several steps that may be taken to help answer this question. These include:
· development of case studies of existing HIV/AIDS peer education programmes that have been shown to be effective using rigorous evaluation designs and outcome measures;
· consult with programme coordinators and researchers to identify the critical elements or best practices related to programme implementation;
· operations research to test the applicability and impact of HIV/AIDS peer education best practices in other contexts and on a larger scale.
Other questions that need to be addressed include: Are more efficacy data needed in order to justify the allocation of resources for peer education in HIV prevention programming? If so, in what contexts and population groups are such data needed? Are more data needed to compare the effectiveness of peer educators with other communication channels such as health professionals or the mass media? Is research needed to compare the effectiveness/cost-effectiveness of peer education to other strategies, such as voluntary HIV testing and counselling or policy-level interventions?
Participants of the International Consultation on Peer Education and HIV/AIDS discussed the above issues, as well as others, as they sought to establish programmatic recommendations and operations research priorities within the context of a comprehensive strategy for HIV prevention and care. The results of the consultation will be forthcoming.