Peer education and HIV/AIDS : concepts, uses and challenges

The literature also indicates that PE is often part of a larger, more comprehensive approach to HIV prevention that includes condom distribution, sexually transmitted infection (STI) management, counseling, dramatic presentations, and advocacy. However, very few evaluations of HIV/AIDS PE programs utilize rigorous research designs. Instead, many collect only proxies of outcome measures such as HIV-related knowledge, self-efficacy, or attitudes and beliefs through the use of uncontrolled pre-test/post-test or post-test only research designs. Some evaluations that have used experimental or quasi-experimental designs with outcome indicators such as reduction of HIV-related risk behavior or STI/HIV incidence show PE, in combination with other prevention strategies, to be very effective in several populations and geographical areas. However, it is still necessary to determine the critical elements of PE within the context of a comprehensive and effective HIV-prevention strategy in a given population and context. This question cannot be answered definitively, since many programs do not explain in depth how their PE program selects, trains, and supervises peer educators and provides them incentives; involves stakeholders; deals with gender and sexuality; and is sustainable. Steps that may be taken to help answer this question include: developing case studies of existing HIV/AIDS PE programs that have been shown to be effective by evaluations that use rigorous designs and outcome measures; consulting with program coordinators and researchers to identify the critical elements or best practices with regard to HIV/AIDS PE; and conducting operations research on the efficacy of HIV/AIDS PE best practices in other contexts and on a larger scale. Other key research questions include: are more effectiveness data needed in order to justify the allocation of resources for PE in HIV prevention programming? If so, in what contexts and for what population groups are such data needed? Is there more need for data comparing the effectiveness of peer educators to other communication channels such as health professionals or mass media? Is research needed to compare the effectiveness/cost-effectiveness of PE to other strategies, such as voluntary HIV testing and counseling or policy-level interventions? Includes references.