Article

The social conditions for successful peer education: A comparison of two HIV prevention programs run by sex workers in India and South Africa

School of Nursing, Midwifery and Community Health, Glasgow Caledonian University, Glasgow, UK.
American Journal of Community Psychology (Impact Factor: 1.74). 07/2009; 44(1-2):123-35. DOI: 10.1007/s10464-009-9254-8
Source: PubMed

ABSTRACT Peer education is a community-based intervention being implemented worldwide as an approach to HIV prevention. However, its results are inconsistent, with little consensus on why some projects succeed while others fail. Considering peer education as an 'intervention-in-context', we systematically compare the context and the implementation of two peer education interventions run by sex workers, one in India and one in South Africa, which produced contrasting outcomes. In so doing, we aim to identify key factors in the projects' successes or failures that may inform future peer education efforts. The Indian project's relative success was facilitated (1) by a more stable and supportive social, material and political context, and (2) by a community development ethos which devoted significant resources to sex workers' involvement, ownership and empowerment, as opposed to a biomedical approach which marginalised sex workers' concerns. We conclude with lessons learned and implications for current trends in peer education.

0 Followers
 · 
136 Views
 · 
2 Downloads
  • Source
    • "Peer education among in-school adolescents is not a new concept; it has been extensively used in places like South Africa [5] [7] [12] [20] [21], but the story in Nigeria is a little different . Research efforts into this area are still relatively little in Nigeria; therefore, there is a need to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and preventive practices among in-school adolescents in Osun State, Nigeria, with a view to making recommendations that will ultimately help in combating the menace of HIV/AIDS among Nigerian adolescents. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction. Young people are at the centre of the global HIV/AIDS epidemic. This study therefore aimed to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and preventive practices among in-school adolescents in Osun State, Nigeria. Methods. This was an intervention study that was carried out among in-school adolescents attending mixed secondary schools in Osun State, Nigeria. The study was in three stages: before intervention, intervention, and after intervention. The impact of peer education was evaluated twelve weeks after intervention. Data were collected using pretested semistructured questionnaires and data analysis was done with SPSS version 16. Results. At the preintervention stage, the study and control groups were similar in their sociodemographic characteristics, HIV knowledge, attitude, and preventive practices, including high risk behaviours for HIV/AIDS transmission. After the peer education intervention, those with good knowledge and positive attitudes towards HIV/AIDS increased significantly from 50.0% to 86.7% and from 49.0% to 85.6%, respectively (P < 0.05). Conclusion. The study showed that peer education is effective in improving knowledge, attitude, and some preventive practices towards HIV/AIDS among in-school adolescents. Educational programmes about HIV/AIDS should therefore be designed to target this age group putting into consideration their unique characteristics.
    AIDS research and treatment 11/2014; 2014:131756. DOI:10.1155/2014/131756
  • Source
    • "The socio-political context in which empowerment interventions are implemented is also likely to be a key determinant of their success; differences in the characteristics and organisation of sex work and the overall socio-political context in Africa, compared to India, may therefore limit the effectiveness of activities aiming to mobilise communities, as well as the impact of community mobilisation itself. Cornish and Campbell [159] provide a useful conceptual framework of ‘interventions-in-context’, based on an ecological perspective of community psychology, to examine inconsistent outcomes in peer-education programmes between different settings [159]. Whilst FSWs worldwide have historically been marginalised and disenfranchised, it is arguable that the social fabric, infrastructural, economic and political context in many African settings is exceptionally disempowering [159]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritised community mobilisation and structural interventions, yet little is known about similar approaches in African settings. We systematically reviewed community empowerment processes within FSW SRH projects in Africa, and assessed them using a framework developed by Ashodaya, an Indian sex worker organisation. Methods In November 2012 we searched Medline and Web of Science for studies of FSW health services in Africa, and consulted experts and websites of international organisations. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analysed with reference to a four-stage framework developed by Ashodaya. This conceptualises community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community. Results Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW ‘hotspots’ were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilisation as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioural and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations. Conclusions Most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.
    Globalization and Health 06/2014; 10(1):47. DOI:10.1186/1744-8603-10-47 · 1.83 Impact Factor
  • Source
    • "Community-based approaches have been used to reach MSM and other marginalized populations with HIV-prevention services in many settings [18–21]. These programmes utilize peer education and the facilitation of safe social spaces to provide HIV education, address stigma, address behavioural risks and link individuals into HIV testing or care [18–25]. Similar strategies have been used to reach Southern African MSM with HIV research, HIV-prevention information, and HIV counselling and testing [26–32]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Men who have sex with men (MSM) in Cape Town's townships remain in need of targeted HIV-prevention services. In 2012, a pilot community-based HIV-prevention programme was implemented that aimed to reach MSM in five Cape Town townships, disseminate HIV-prevention information and supplies, and promote the use of condoms and HIV services. Methods Convenience sampling was used to recruit self-identified MSM who were 18 years old or older in five Cape Town townships. The six-month pilot programme trained five community leaders who, along with staff, provided HIV-prevention information and supplies to MSM through small-group meetings, community-based social activities and inter-community events. After the completion of the pilot programme, in-depth interviews and focus group discussions (FGDs) were conducted with a subset of conveniently sampled participants and with each of the community leaders. Qualitative data were then analyzed thematically. Results Overall, 98 mostly gay-identified black MSM consented to participate, 57 community-based activities were facilitated and 9 inter-community events were conducted. Following their enrolment, 60% (59/98) of participants attended at least one pilot activity. Of those participants, 47% (28/59) attended at least half of the scheduled activities. A total of 36 participants took part in FGDs, and five in-depth interviews were completed with community leaders. Participants reported gaining access to MSM-specific HIV-prevention information, condoms and water-based lubricant through the small-group meetings. Some participants described how their feelings of loneliness, social isolation, self-esteem and self-efficacy were improved after taking part. Conclusions The social activities and group meetings were viable strategies for disseminating HIV-prevention information, condoms and water-based lubricant to MSM in this setting. Many MSM were also able to receive social support, reduce social isolation and improve their self-esteem. Further research is needed to explore factors affecting attendance and the sustainability of these activities. Perspectives of MSM who did not attend pilot activities regularly were not equally represented in the final qualitative interviews, which could bias the findings. The use of community-based activities and small-group meetings should be explored further as components to ongoing HIV-prevention interventions for MSM in this setting.
    Journal of the International AIDS Society 12/2013; 16(4(Suppl 3)). DOI:10.7448/IAS.16.4.18754 · 4.21 Impact Factor
Show more

Preview

Download
2 Downloads
Available from