Is peer education the best approach for HIV prevention in schools? Findings from a randomized controlled trial

doi:10.1016/j.jadohealth.2004.03.005

Journal of Adolescent Health

Volume 36, Issue 6, June 2005, Pages 508-516

https://doi.org/10.1016/j.jadohealth.2004.03.005 Get rights and content

Abstract

Purpose

To evaluate the effectiveness of peer education when compared to teacher-led curricula in AIDS prevention programs conducted in schools in Rome, Italy.

Methods

Eighteen high schools were randomly assigned to one of two prevention programs: one led by teachers and the other by peer leaders. A sample of students attending the last 2 years (n = 1295) completed pre and post-intervention questionnaires. Changes in sexual behaviors, knowledge, prevention skills, risk perception and attitudes were first evaluated within each intervention group. Afterwards, changes in knowledge, prevention skills, risk perception, and attitudes total scale scores (post-test scores minus pre-test scores) were compared between the two groups, through linear regression models, in order to control for confounders, taking into account the within-school correlation in score changes. As for sexual behaviors, number of sexual partners and frequency of condom use in the 3 months before post-test were compared by intervention group through ordinal regression models, also taking into account behaviors reported before pre-test.

Results

For both groups, we observed significant improvements in skills, knowledge, attitudes and risk perception. The peer-led group showed a 6.7% (95% C.I. 1.9–11.5) scores greater improvement in knowledge, compared to the teacher-led group. In neither group were improvements observed in condom use or number of sexual partners.

Conclusions

The only apparent benefit of the peer-led intervention, compared to that led by teachers, was a greater improvement in knowledge of HIV. Neither of the interventions induced changes in sexual behavior. However, the role of possible biases and methodological problems must be considered when interpreting these results.

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.

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Original articleIs peer education the best approach for HIV prevention in schools? Findings from a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgements

Lancet

Lancet

Comput Methods Programs Biomedicine

Prev Med

Increasing gonorrhoea reports-not only in London

Lancet

Increase in high risk sexual behaviour among homosexual men, London 1996–8cross sectional, questionnaire study

BMJ

Increases in unsafe sex and rectal gonorrhoea among men who have sex with men-San Francisco, California, 1994–1997

JAMA

Are advances in treatment changing views about high-risk sex?

N Engl J Med

Prevention of HIV infection

AIDS

Behavioural Interventions for HIV/AIDS prevention, AIDS

Sexual health education interventions for young peoplea methodological review

BMJ

School-based interventions to prevent unprotected sex and HIV among adolescents

An impact evaluation of project SNAPPan AIDS and pregnancy prevention middle school program

AIDS Educ Prevent

Comparing peer-led to teacher-led youth alcohol education in four countries

Alcohol Health Research World

The efficacy of peer leaders in drug abuse prevention

Journal of School Health

Community-level prevention of human immunodeficiency virus infection among high-risk populationsthe AIDS Community Demonstration Projects

MMWR Morb Mortal Wkly Rep

Community-Level HIV Intervention in 5 citiesfinal outcome data from the CDC AIDS Community Demonstration Projects

Am J Public Health

HIV risk behaviour reduction following intervention with key opinion leaders of populationan experimental analysis

Am J Public Health

Community AIDS/HIV risk reductionthe effects of endorsements by popular people in three cities

Am J Public Health

Healthy Oakland Teens Peer-led AIDS Prevention Curriculum

Original article
Is peer education the best approach for HIV prevention in schools? Findings from a randomized controlled trial