Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 33514-33518 691

540*33514 Peer education among factory workers in
Zimbabwe; providing a sustainable HIV prevention
intervention
David Katzenstein', W. McFarland2, M. Mbizvo3, A. Latif3, R. Machekano3,
J. Parsonnet3, M. Bassett3. 'CFAR, Stanford University, Stanford, CA; 2San
Francisco Dept. Public Health, San Francisco, CA, USA; 3Zimbabwe AIDS
Prevention Project, Harare, Zimbabwe
Objectives: To assess the feasibility and to develop strategies to sustain an
effective peer education program in Harare, Zimbabwe.
Methods: 40 factories with a workforce of 10,000 participated in the evaluation
of a work-place-based peer education HIV prevention project (HIVNET 011). Factories were randomized to counseling and testing alone or counseling and testing
plus peer education. The impact of peer education was on HIV incidence was
assessed by monitoring HIV serostatus in a sub-sample of factory workers (n =
2,000). Annual in country costs for the establishment and maintenance of the peer
education program were monitored. Acceptability among workers and willingness
of employers to pay for the peer education was assessed by questionnaire.
Results: HIV seroincidence among workers in the peer education arm was
34% lower than workers in the control arm (2.12 vs 3.20 per 100 person years, p
= 0.036). With program costs of $100,000 per year, a workforce of 10,000 and a
projected reduction in incident HIV infection of 100, peer education costs $10 per
worker per year and a direct cost of $1,000 per HIV infection averted. Employers
and workers found the program highly acceptable and employers were willing to
pay for much of the cost.
Conclusions: Workplace based peer education provides an effective and
affordable HIV prevention program for industrial workers in Zimbabwe. Cost
per infection averted compares favorably with other HIV prevention programs.
Employers are willing to bear much of the cost of sustaining peer education, recognizing the direct benefits of decreasing the incidence of HIV, including savings
from reduction in worker turn-over, sick leave and death benefits.
33515 Long-term impact of community peer interventions on
condom use and STI incidence among sex workers in
Nairobi
Ephantus Njagi1, J. Kimani2, F.A. Plummer3, J.O. Ndinya-Achola2, J.J. Bwayo2,
E.N. Ngugi2. 1Dept. of Medical Microbiology, University of Nairobi, PO. Box
19676, Nairobi; 2University of Nairobi, Nairobi, Kenya; 3 University of Manitoba,
Winnepeg MB, Canada
Background and Objectives: Peer group interventions among sex workers have
been shown to be effective in increasing safer sexual behaviours. To evaluate
the long-term sustainability of such programmes and examine the impact on STI
incidence, we monitored sexual behaviour and STI incidence in a cohort of sex
workers in Nairobi, Kenya.
Methods: The study was based in the Pumwani Sex Worker cohort in Nairobi
which was initiated in 1985 and includes 1860 women. The intervention was
implemented in stages and has evolved over the past 13 years. The initial
intervention in 1985 consisted of development of peer educator networks and
education, and diagnosis and treatment of STI. Condom distribution, and individual and group counselling were incorporated into the intervention in mid-1985.
In 1992, moderated community problem solving meetings were added to the
intervention package. Reported number of sex partners, the frequency of condom
use, the proportion of person-visits positive for gonorrhea and chlamydia, and the
annual incidence of HIV-1 seroconversion (in women newly enrolled) were used
to examine the impact of the program.
Results: From 1985 through 1996, no significant change in the reported number of sex partners per day (4.2 & 4.0) was observed. The proportion of women
reporting always use of condoms increased from <1% in 1985 to >98% in 1996
(p <.0001). The proportion of visits positive for gonorrhea decreased from 48%
in 1985 to 12% in 1996 (p <.0001). The proportion of visits positive for chlamydia
decreased from 15% in 1991 to 2% in 1996 (p < 001). The annual incidence of
HIV-1 decreased from 48% in 1985 to 17% in 1993-1996 (p <.0001).
Conclusion: This program has resulted in a sustained increase in reported
use of condoms by sex workers and has dramatically reduced the incidence of
gonorrhea, chalmydia and HIV-1. The program has in addition prevented many
thousands of secondary STI. Community-based peer interventions combined with
effective management of treatable STI are extremely effective in the control of
STI including HIV-1.
| 533*/33516 Peer education to reduce STI/HIV transmission in
Mutare, Zimbabwe
Simon Mashababel, D. Mclean1, R. Gomo1, D. Wilson2, R. Sabatier3. 'Mutare
City Council, Mutare AIDS Project; PO Box 910, Mutare; 2Project Support
Group Psychology Dept., Harare; 3Southern African AIDS Training, Harare,
Zimbabwe

Introduction: A community and workplace peer education project to reduce
STI/HIV transmission in Mutare, Zimbabwe's third largest city (population 150,000)
was established in 1991. It has played a key training role, supporting 15 other
projects in Zimbabwe and 40 projects in Southern Africa.
Methods: The project has eight components: formative assessment; mapping;
recruiting and training peer educators; community outreach, particularly "hotspots"
or social contexts conducive to casual sex, including bars, transit places including
bus-stops and sex worker neighbourhoods; condom distribution; improving STD

care seeking, access and acceptance; women's associations and monitoring and
evaluation.
Results: In Mutare, from 1991 to 1997, the Mutare project held 87,260 meetings, reached 2,617,089 men and 1,245,785 women and distributed 9,567,133
million condoms. Service delivery unit costs (excluding donated condoms and
opportunity costs) averaged US$1.7 per meeting, US$0.04 per person reached
and US$0.02 per condom distributed. Coverage was surveyed among two priority
groups, sex workers and bar patrons. A sample of 204 sex workers and 508 bar
patrons were interviewed about coverage and behavioural change. Among sex
workers in Mutare, 98% had attended health education meetings, 84% in the last
month and 93% of these had received condoms. Among bar patrons in Mutare,
92% had attended health education meetings, 48% in the last month and 84% of
these had received condoms. Surveys also showed that peer educators were the
major source of condoms. When asked where they got condoms, 93% said peer
educators, 72% said bars stocked by peer educators, 16% said clinics, 10% said
family planning centres and 9% said friends. Behavioural surveillance surveys
were conducted among the same community sample of 204 sex workers and 508
men in bars. Reported condom use in the last commercial sex rose to 78% of
sex workers and 82% of men in bars. 32% of men reported a reduced number of
sexual partners. STD presentations in municipal health centres fell by 41%, from
18,090 in 1990 to 10,611 in 1996, despite a 45% growth in urban population. This
suggests that, from 1991 to 1996, the project help to avert an estimated 27,000
STD cases in Mutare.
Conclusions: These data demonstrate that peer education projects that target
"hotspots" represent an economical and effective strategy to reduce STD, and by
implication HIV, transmission.
38*/33517 Multi cultural peer group project creates effective
AIDS awareness
Christo Greyling', L. Greyling', D. Daniels2. 'Presenter of I Have Hope Peer
Group AIDS Awareness Prigram, Stellenbosch; Peer PO. Box 13100,
Paradyskloof, 7600; 2Co-presenter of of I Have Hope Peer Group AIDS
Awareness Program, Stellenbosch; 3Manager: AIDS Focus Area of Old Mutual,
Pinelands, South Africa
Issue: In South Africa 12.78% of 15-19 year old girls test HIV+ at antenatal
clinics. But in this culturally and socio-economically diverse society the levels of
AIDS information differ greatly. Some communities still don't believe AIDS is real
while others don't regard it as their problem. The challenge is to create AIDS
awareness by the youth (peer leaders) for the youth at the level of that specific
community within our multi-cultural society.
Project: Five natural peer leaders (grade 11) and a motivated teacher from 9
culturally diverse secondary schools are selected to attend a 3-day seminar presented by a PHIV. Day One: they are confronted with their own myths about AIDS
and wrong attitudes towards HIV+ people. The correct facts on HIV/AIDS and sexuality are then provided. Day Two: they are exposed to the realities of HIV/AIDS.
They meet healthy HIV+ people living their dreams and ideals and visit a care
centre for HIV babies. Finally they meet people with full-blown AIDS at a hospice.
Day Three: they are challenged to develop a variety of AIDS awareness and care
projects to creatively address the issue in their communities. The target areas
area: 1) their school; 2) community; and 3) AIDS care centres. These projects run
for at least 6 months on a competition basis between the participating schools.
The PHIV constantly follows-up and motivates. Final evaluation depends on their
effective use of all media to convey their message, a written report and a creative
and entertaining presentation at a prize-giving ceremony in a local shopping mall.
Results: The teenagers' grew in self-esteem. Their projects were creative,
youthful, culture specific and created respect and compassion for people with
HIV/AIDS. The projects were included in the schools' extra-curricular activities.
The awareness thus created, resulted in community owner hip and sustained
commitment.
Lessons Learned: This project is well received, effective and multipliable
across different communities. The following proved to be essential: the involvement of a motivated teacher, the informed consent of parents and all role players
of the multi-cultural society, the careful selection of teenage peer leaders. It proved
to be much more than an AIDS project - it became an exercise in life skills.
41 * / 33518 Baseline evaluation of a school-based peer
education programme in Zimbabwe
Godfrey Woelk, P. Mataure. Department of Community Medicine, UZ Medical
School Box A 178, Avondale, HRE, Zimbabwe
Objectives: To provide baseline data to evaluate a peer education programme
in high schools where teachers have been trained in HIV/AIDS prevention.
Methods: In a quasi-experimental design, 3 schools with a peer education programme (PES) were compared with 3 schools without this programme, (NPES).
Pupils, randomly selected from class registers, completed a questionnaire on
sexual knowledge and behaviour. A short discussion was then held to explore
feelings and attitudes.

Results: The sample size was 135 pupils in PES and 136 from NPES. The
mean age of the pupils was 15.2 (SD: 1.4) years, in the PES and 14.9 (SD: 1.3)
in the NPES. Nearly all the respondents knew a peer educator (PE) and 88% had
had contact with them. Nearly 60% preferred to go to a PE if they had a personal
problem and 40% had already approached a PE. Concerning teacher contact,
more pupils in the PES (62%) than those in the NPES (46%) would discuss their
personal problem with the teacher, (p = 0.014). NPES pupils would not approach