Peer Outreach and Education

Introduction

I. Definition of the Prevention Area

Peer outreach and education (POE) typically involves members of a specific group to influence and support members of the same group to maintain healthy sexual behaviors, change risky sexual behaviors, and modify norms. Peer educators are thought to be more likely to influence the behaviors of their peers since they are seen as credible and less judgmental role models.

II. Epidemiological Justification for the Prevention Area

Certain populations, such as injecting drug users, sex workers, and out-of-school youth may be difficult to identify and reach through standard programs. They may also be reticent to trust those who are seen as being in a position of authority. Peer educators can bring a variety of assets to the task of HIV prevention; they may be able to contact hard-to-reach individuals, and to wary members of disenfranchised groups; and they may simultaneously be seen as more acceptable as educators and more credible (or less judgmental) than non-peers.

However, there are some limits to the credibility afforded to peers as evidenced by certain studies of youth and prisoners. Some program managers see peer education as a less expensive way to achieve HIV prevention, but other researchers caution that using POE to reduce expenses in HIV education can backfire since programs without a solid investment in development and oversight of peer educators can fail.

III. Core Programmatic Components

The core programmatic components of POE include facilitating discussions using a curriculum, counseling individuals, lecturing on behavior change, distributing materials such as condoms, and making referrals to services. HIV prevention-focused POE may incorporate or offer referral to programs that empower clients more broadly, such as microcredit.

Program design should take into account the context of the target group and its socio-cultural, political, and linguistic needs. Peer activities may be affected by shared characteristics between volunteers and contacts (such as gender, socioeconomic status, education level, ethnicity, and place of residence). Peer-led activities offer opportunities for members of shared networks to collectively define their needs and develop solutions.

Research shows that peer leaders need ongoing training, monitoring, support, and sometimes incentives to avoid high attrition rates. Moderate supervision is essential, but it should respond to the peers' needs or else it may stifle opportunities for empowerment and leadership. Additional support may also result from the involvement of community groups and partnerships. These linkages provide much-needed resources and buy-in and contribute to long-term program sustainability, but such partnerships can create their own obstacles.

POE is one approach to HIV prevention that should be part of an overall strategic plan and linked to other programs and communication channels, such as mass media, community-based interventions, and individual-based projects. Linkages and referrals to HIV/AIDS care, support, and treatment services are also essential elements of prevention programs.

IV. Current Status of Implementation Experience

Markers of effective POE include increased knowledge about HIV and its prevention; enhanced positive attitudes about people living with HIV (PLWH); increased skills related to health-protective actions, such as proper condom use and safer injection drug practices; positive gender and social norms; and maintenance of healthy sexual behaviors. These markers, however, are not always predictive of the desired outcomes as measured by reductions in sexually transmitted infections (STIs), HIV, or pregnancies. This has led researchers to call for more rigorous evaluations of biological outcomes related to POE.

Traditionally, peer-led interventions have been thought to be successful because of their organic nature and peers' abilities to make strong connections with their contacts. However, HIV prevention-focused peer interventions have shown mixed results among various groups, including in- and out-of-school youth, people living with HIV, sex workers, injecting drug users, men who have sex with men, people in the workplace, and incarcerated individuals.

In Thailand, a peer project was launched among young methamphetamine users. The program resulted in reduced methamphetamine use, increased condom use, and reduced STI incidence over a 12-month period. However, the control arm showed a similar decline in STIs. Other programs have failed to show that POE participants reduce their number of sexual partners or that they experience any reduction in STIs or HIV.

One set of researchers compares and contrasts the features of a failed and a successful POE program among commercial sex workers, providing rich detail about the factors that appear to hinder success and that appear to promote successful, sustainable POE projects.

Sustainability of programs continues to be a challenge to this and other HIV prevention, care, treatment, and support approaches.

Updated: March 2011

What we know

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Putting it into practice

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Tools and Curricula

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Learn more

Peer Education for Kinshasa's Sex Workers

Department for International Development, (2007).
This web document gives a brief overview of a Congolese sex worker and her involvement in POE. Links are provided to related articles and reports.

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Young Peer Educators Raise Awareness of HIV/AIDS Prevention in Gujarat Youth
UNICEF (2007)

This short article describes a youth awareness project in India.

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Effectiveness of Interventions to Address HIV in Prison
World Health Organization (2007)

This comprehensive report on HIV prevention efforts and challenges among male and female prisoners around the globe is heavily referenced and provides detailed information about the extent of HIV risk factors in prisons, such as rape or coerced sex, injection drug use, and consensual sex. Study summaries are provided and intervention programs including POE are overviewed. The report concludes with a list of recommendations for effective HIV prevention programs in prisons.

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Frequently Asked Questions on Peer Education
Family Health International/YouthNet, (2002).

This web-based guide answers the following frequently asked questions (FAQs): What are the advantages and benefits of peer programs? What criteria are commonly used when selecting young people to become peer promoters? Is there evidence that peer programs are successful? What are the lessons learned from peer programs? Are peer programs cost-effective? Detailed responses with examples and references are provided. The FAQs guide can be downloaded.

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A Review of the Effectiveness and Appropriateness of Peer-delivered Health Promotion Interventions for Young People
Harden, A., Weston, R., & Oakley, A., Social Science Research Unit, Institute of Education, University of London, (1999).

The authors of this report conducted a systematic review of the published literature regarding youth POE. They examine the claim that POE is superior to more traditional forms of education and prevention. Full reports for 462 studies of POE programs were available for review. The authors provide citations and discuss research methodologies, study outcomes, and recommendations for future program evaluations.
After classifying each study for research design and scientific soundness, they found that only 12 of the 49 outcome evaluation studies were methodologically sound and only 5 of 12 studies directly compared peers and teachers. Of the five studies, "two found peers to be more effective than teachers, two found them to be no more or less effective, and one concluded that neither peers nor teachers were effective." (179 pages)

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World Education Publications, HIV and AIDS
JSI/World Education Center for HIV and AIDS. 

This web-based resource provides numerous publications related to HIV prevention and intervention. Some of the documents are locale-specific for various countries or states in the U.S. Others documents address topics from the care and treatment of pediatric HIV and AIDS to workplace prevention programs and peer education. Other topics include planning services, determining site readiness to initiate antiretroviral treatment, and business coalitions to prevent HIV.

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National Organization of Peer Educators, Kenya
NOPE, Nairobi, Kenya

This website provides information about the Kenyan non-governmental organization, NOPE, which is active in POE programs to prevent HIV in Kenya.

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