Peers teaching peers to prevent HIV
Many schools across the globe are offering a life saving learning opportunity to their students. They are placing students in the role of educator, for the very important task of preventing HIV among themselves and their classmates. Peer education is based on the reality that many people make changes not only based on what they know, but on the opinions and actions of their close, trusted peers. Peer educators can communicate and understand in a way that the best-intentioned adults can't, and can serve as role models for change. (Note that peer education is not exclusively for school-based programmes, but has been used in a wide range of contexts with a diversity of populations, including street youth, factory workers, sex workers, drug users, prisoners, etc.)
Peer educators are typically the same age or slightly older than the group with whom they are working. They may work alongside the teacher, run educational activities on their own, or actually take the lead in organizing and implementing school-based activities. Peer educators can help raise awareness, provide accurate information, and help their classmates develop skills to change behaviour. Some of the ways they are doing this in schools around the world include:
- leading informal discussions
- video and drama presentations
- one-on-one time talking with fellow students
- handing out condoms, leaflets and brochures
- offering counselling, support and referral to services.
Peer education is rarely used alone in HIV-prevention efforts, but is one strategy in a school-wide or community-wide effort. For example, it often complements skills-based health education led by teachers, condom promotion, youth-friendly health services and local media campaigns. Program experience shows that the presence of a teacher or adult coordinator improves the quality and general flow of programs.
Why use peer educators?
Qualitative evaluations of school-based peer education have shown that:
- Young people appreciate and are influenced in positive ways by a peer-led intervention if it is well-designed and properly supervised;
- Serving as a peer educator provides a challenging, rewarding opportunity to young people to develop their leadership skills, gain the respect of their peers, and improve their own knowledge base and skills. Peer educators often change their own behaviour after becoming a peer educator;
- It can foster fulfilling relationships between teachers and students;
- It can give girls legitimacy to talk about sex without the risk of being stigmatised as sexually promiscuous (particularly when peer led activities take place in single-sex groups);
- Peer educators can provide a valuable link to health services;
- Peer education has had a positive effect on reported attitudes toward persons living with HIV/AIDS;
- Peer educators have shown in some cases to be more effective than adults in establishing norms and in changing attitudes related to sexual behaviour. However, they are not necessarily better in transmitting factual health information. Peer educators and adult-led education can thus complement each other. One study showed that a mixture of classroom-based and peer-led education is more effective than one or the other in isolation. The combined condition showed the greatest gains in information, motivation, behavioural skills, and behaviour.
Tips for building a successful peer education component into your HIV prevention programme
- Link the peer education program (content and methods) with other programs to form a comprehensive strategy
- Ensure that a quality control process is in place
- Ensure that a trained adult or teacher facilitates and supports the peer educators
- Evaluate the results of using peer educators, including:
- monitoring the activities of the peers (process evaluation), for example: progress reports submitted by the peer educators on number of people expected compared to reached, who they were and what was discussed; and satisfaction surveys; as well as
- measuring the impact of the education (outcome evaluation), for example: looking at HIV-related knowledge, attitudes, skills and behaviours, and/or health outcomes such as STI incidence.
- Consider incentives for peer educators to attract and maintain their participation. For example, recognize their contribution through: public recognition; certificates; programme T-shirts; food; money/credit stipends; or scholarships.
- Establish criteria for the skills and qualities that peer educators should have, and then have students volunteer or nominate others for the peer educators.
- Have clear and achievable expectations for the peer educators.
- Provide thorough training and regular follow-up workshops and practice sessions (this is particularly important as turnover of peer educators can be high).
- Be flexible when scheduling training and feedback sessions to maximize participation.
- Monitor the needs of the trainers and educators.
- Involve young people as active participants in the project planning, implementation and assessment. Planning processes, such as developing and pre-testing the materials, curricula or training manual, can serve as valuable opportunities for young people to practise facilitation skills and to gain HIV prevention knowledge. It can also ensure that you are reflecting the audience"s cultural background and educational level.
- Make sure ample supply of educational materials and condoms are available.
- Consider the different needs of male and female educators. For example, there may be different social expectations about how girls should behave and what they should talk about in public. Also, some girls may stop serving as educators after they get married. Try to support their involvement and aim to keep a gender balance among the educators. (One study found that young women were more able to "express an opinion and ask questions in girls-only HIV/AIDS peer education groups as compared to mixed-gender groups")
- Prepare the peer educators for community resistance and public criticism, should it arise. At the same time, inform and involve the community in the programme, to alleviate any fears and to garner their support (e.g., the mothers and fathers of the peer educators, grandparents, aunts and uncles, religious leaders, community advisory committees, etc.)
- Ensure that mechanisms are in place to replenish the supply of peer educators (who will get older and mature out of the program).
Examples of peer education programmes such as Namibia's My Future is My Choice, Ghana's Peer Promotion Programmes, and Botswana's Tsa Banana can also be found under LSBE country experiences.
Peer Education and HIV/AIDS: Concepts, Uses and Challenges, UNAIDS, 1999.