Original articleIs peer education the best approach for HIV prevention in schools? Findings from a randomized controlled trial
Section snippets
Methods
Sample was defined after cross-classification of all public high schools in Rome, according to socioeconomic level of the surrounding area (i.e., low or medium-high) and the type of school (i.e., humanistic/scientific, technical or vocational). We then selected a stratified sample of 18 high schools and a sample of students attending the final 2 years. The number of schools to be enrolled was computed to detect a 20% post-intervention increase in reported condom use at most recent sexual
Results
A total of 1697 students completed the pre-test; 1295 of them completed the post-test. The attrition rate was 20% for the peer-led group and 27% for the teacher-led group; attrition was mainly owing to school absenteeism, and no differences between the students lost to follow-up and those included in the analysis were detected within the two arms in terms of sociodemographic characteristics, percentage of sexually active students or sexual behavior.
Table 1 shows the sociodemographic
Discussion
Both the peer-led and the teacher-led interventions seem to have induced improvements in knowledge, attitudes, risk perception, and prevention skills. According to the most accredited models of behavioral change, improvements in these variables are important in that they are considered to be antecedents for changes in sexual behavior [9], although we did not observe improvements in sexual behavior for either trial arm.
The only significant difference between the two trial arms was that the
Conclusions
The peer-led intervention seems to have had no marked benefits with respect to the teacher-led intervention. Although the peer-led intervention was apparently more effective in improving knowledge, it was significantly more costly, and before recommending its use, cost-effective analyses should be conducted.
Acknowledgements
We wish to acknowledge Mark Kanieff and Madeline Calvello Kanieff for editorial assistance and Paola Maria Montiroli and Luisa Rossilli for data collection.
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The study was partially funded by European Commission, PROJECT n SOC 97 200320 05F02 (97CVVF2 -013-0). None of the authors have any direct interest that could interfere with the results of this work. The project was initiated and analyzed by the investigator.