Peer-led interventions to reduce HIV risk of youth: A review

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Abstract

One approach in HIV prevention programming targeting youth is to use peer leaders in what is referred to as peer education programming. This paper critically reviews and synthesizes the results and lessons learned from 24 evaluated peer-led programs with an HIV/AIDS risk reduction component that target youth in the communities where they live and are delivered in low- and middle-income countries. Interventions were identified through a comprehensive search of the peer reviewed AIDS-related literature as well as publication lists of major organizations in the UN family that address HIV and AIDS. Our synthesis of study results finds that these programs have demonstrated success in effecting positive change in knowledge and condom use and have demonstrated some success in changing community attitudes and norms. Effects on other sexual behaviors and STI rates were equivocal. We include an overview of characteristics of successful programs, a review of program limitations, and recommendations for the development and implementation of successful community-based peer-led programs in low-income countries.

Section snippets

Method

Evaluated prevention programs were located by searching literature databases such as Psychological Literature (PsychLit), Population Information Program (POPLINE), Sociological Abstracts, and MEDLINE; the tables of contents of journals that published articles evaluating interventions with an HIV/AIDS content between 1994 and 2008; and publication lists from international organizations such as the United Nations Joint Commission on HIV/AIDS (UNAIDS) and the World Health Organization Global

Interventions

Twenty-five evaluation studies applied to 24 interventions (the intervention Entre Nous Jeunes was delivered and evaluated separately in two different sites) were located. The unit of analysis in this paper is the 24 interventions. Of these, 14 were delivered in countries of sub-Saharan Africa, 7 in countries in Asia and the Pacific, and 1 each in Turkey, Russia and South America. Ten used both quantitative and qualitative evaluation methods, 6 only quantitative and 9 only qualitative. Table 1

Discussion

The purpose of this review was to synthesize what is known about peer-led community based interventions in low-income countries with the intent of informing on-going and future programming decisions. As discussed above, our review of 24 programs indicates that peer-led interventions of diverse forms and content can produce positive change in areas related to HIV prevention, especially knowledge, community norms, and condom use. The mixed results for changing sexual behavior suggest that peer

Conclusions

These results suggest that peer-led interventions are able to reach large numbers of youth when they are delivered at a scale designed for such reach. They can be effective in changing community norms, connecting youth to services, and distributing HIV prevention resources. Those that evaluated specific changes among youth demonstrated success at increasing knowledge and the use of condoms. Changes in other areas of sexual behavior were not as consistent across programs. The ability of programs

Eleanor Maticka-Tyndale is a University Professor of Sociology and holds a Canada Research Chair in Social Justice and Sexual Health at the University of Windsor, Canada. HIV prevention among youth is one of her primary areas of research. She has completed evaluation studies of interventions in Thailand and Kenya.

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    Eleanor Maticka-Tyndale is a University Professor of Sociology and holds a Canada Research Chair in Social Justice and Sexual Health at the University of Windsor, Canada. HIV prevention among youth is one of her primary areas of research. She has completed evaluation studies of interventions in Thailand and Kenya.

    Jessica Penwell Barnett is a graduate student in the Sociology program at the University of Windsor, Canada, and a research assistant in the Social Justice and Sexual Health Research Lab. Her primary area of research interest is positive aspects of sexual health.

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