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

692 Abstracts 33519-33523

12th World AIDS Conference

the teacher because they were "shy", 31% vs 14%, p = 0.008. More pupils in the
PES (90%) were happy with the teacher compared to those in the NPES (79%),
p = 0.008. More NPES pupils compared to PES pupils reported themselves to
be sexually active (46% vs 32%), p = 0.020, and 47% of the PES pupils reported
using condoms, compared to 21% of the NPES pupils (p = 0.007).
Conclusions: Peer educators were well accepted in rural secondary schools
where teachers had been trained in HIV/AIDS prevention. The complementary
roles of the peer educators and the teachers have a synergistic potential in terms
of sex education and subsequent behaviour change.
S33519 A peer education project evaluation schema: Inputs,
outputs, unit costs, coverage, behavioural impact and
biomedical impact
N. Dube1, R. Kathuria2, R. Sabatier3, P. Chirenda1, D. Wilson1. 'University of
Zimbabwe, Harare; 3SAT Programme, Harare, Zimbabwe; 2Universtity of
Zambia, Lusaka, Zambia
Introduction: A SAT network of over 50 peer education HIV prevention projects
throughout Southern Africa has designed a comprehensive planning, monitoring
and evaluation framework.
Methods: The framework tracks: inputs; outputs; unit costs; coverage; behaviour impact; and biomedical impact. An integrated set of diaries, forms and
surveys, together with supporting user manuals, have been designed to support
the monitoring and evaluation framework.
Results: The framework has been applied to over 40 peer education projects,
yielding the following results. Over 250 training activities and 5,000 hours field support have been provided to approximately 1,100 peer educators in six countries.
These peer educators have held over 250,000 community education meetings,
reaching 15 million people (including repeat participants) and distributed over
50 million condoms. Unit costs range from US$2-12 per community meeting,
US$0.05-0.5 per person reached and US$0.01-0.8 per condom distributed. Coverage ranges from 35%-98%. Condom use in casual sex has increased from
22% to over 66%. These projects have contributed to declines of up to 75% in
STD rates.
Conclusions: The data demonstrate a compelling association throughout the
results chain, with a clear correlation between intensive inputs, favourable outputs
and unit costs.
133520 Partners in care project: Developing communication
skills in the treatment decision making process
Robert St-Pierre1, James Kreppner2, Ar Schilder3, Claude Lavoie4,
Wayne Rush5, Marcel Dufour6, Wayne Moore7, Pierre Desmarais2. 1625,
President Kennedy, Suite 1210 Montreal H3A 1K2; 2Canadian Hemophilia
Society Montreal; 3Persons With AIDS Society Of British Columbia Vancouver;
4AIDS Calgary Awareness Association Calgary; 5 Community AIDS Treatment
Information Exchange Toronto; 6Comite Des Personnes Atteintes Du Quebec
Montreal; 7PLWHIV/AIDS Network Of New Brunswick Frederiction, Canada
Issue: For most persons with HIV/AIDS, treatment advocacy often begins with
one's own struggle in negotiating adequate treatment and care. This is an issue
of being actively involved in critical decisions affecting one' body and health.
Project: The Project involved the development and implementation of a workshop model aimed at building skills in treatment decision making and treatment
advocacy. The workshop is based on a participant-centered approach and use
active methods that encourage assertiveness, such as experience sharing, simulations and role play. The expected (ultimate) outcome is that, once the participant
has gained practical experience in communication skills and strategies, she/he
will be better able to establish a working relationship (partnership) with the treating
physician and other health care providers. 5 pilot workshops were evaluated using
qualitative methods.
Results: 77 participants attended the 5 pilot workshops (17 women, 60 men).
Qualitative methods included pre-test and post-test measures through an interview grid applied in group discussions. At the pre-test measure, participants were
mostly concerned about the poor quality of communication (interaction, negotiation) with the treating physicians and the lack of sharing of treatment information.
At the post-test measure, participants reported that they: 1) had increased their
understanding of the physicians' decision making process; 2) had increased
their awareness of the importance of becoming more assertive in the relationship with physicians; 3) had increased their skills by learning strategies such as
record keeping (e.g. biological markers); 4) had increased their awareness of the
importance of getting accurate treatment information.
Lessons Learned: Participants agreed that the Partner in Care workshop was
a potent tool for skills building aimed at establishing a constructive relationship
with treating physicians.
532* 33521 Effectiveness of peer education and monitoring of
the condom use by the sex workers in brothel

settings in Bangladesh for prevention of HIV
Ankhi Begum, M.A. Quddus, F.K. Chowdh Ury, Swarup Sarkar, M. Bloem,
Nazrul Islam. Care Bangladesh, Road 7A House 60 Dhanmandi Dhaka,
Bangladesh
Issues: Whether the sex workers themselves can be involved for monitoring
the progress of the behavior change and the effectiveness of the peer outreach

education for HIV prevention in Brothel settings has been explored in this pilot
intervention in Bangladesh as a joint effort between the National Program and
the NGOs.
Project: A pilot project is launched by an NGO and the National Program, Govt.
of Bangladesh to examine the effectiveness of the peer outreach education by
the sex workers to impart knowledge on STD, AIDS and condom use, distribution
of the condom, provision of the STD clinic in the brothel of 600 women. The effectiveness is measured by the change in knowledge of role of condom to prevent
STD, intent to use condom, infrequent use of condom (trial) and consistent use of
condom (practice) during last night. While these data were collected by the project
staff with the help of sex worker guides from alternate women in the brothel in the
beginning, the progress is monitored by the trained sex worker peer educators by
using simple color codes on maps of the brothel showing rooms prepared by the
sex workers themselves and recording the self reported behavior. Monthly data
collected by the workers are posted in the brothel in pictogram and interpreted by
the sex workers for considering alternate actions.
Results: Sixteen months of intervention has shown that the knowledge, intent
trial and practice have gone up receptively from 36 to 87%, 28 to 64%, 12 to
59% and 3 to 36%. In spite of effectiveness of the peer education approach in
increasing condom use 12 times within one year, the progress measured by the
sex workers show that there is need for other intervention for more rapid increase
in the use of condom which include influence through the local power holders,
houseowners and intervention among the lovers of the sex workers
Implication: Sex workers can take a lead in developing intervention among
their colleagues when supported by the Govt. and NGOs. They can monitor the
progress of the project, different stages of behavior change and plan alternative
interventions. For countries in the early stage of the epidemic like Bangladesh, sex
workers could be involved for nationwide initiative and faster results for promotion
of condom for HIV prevention.
33522 1 Development of a district peer health educator
programme in primary schools in Tanzania
Dick Schapink, Z. Mgalla, M. Plummer, M. Maswa. Tanesa, PO Box 434,
Mwanza, Tanzania
Issue: Reaching district coverage for a peer health educator (PHE) programme
for primary schools is difficult because of the sheer numbers of schools involved.
Measuring the impact is crucial in order to be able to advocate replication.
Project: Since 1994 the TANESA project has supported the district education
department in Magu district, Tanzania, with the development of a peer educator
programme. The PHE programme is based on the findings of three narrative research workshops to identify actual sexual practises and risk behaviours. A peer
activity manual with picture codes, stories and interactive exercises and tests was
developed to complement the knowledge based National Curriculum taught by
teachers. The exercises that can be conducted over a period of 6 weeks focus on
risk analysis, the need for behaviour change and responsible behaviour. Training
and follow-up support is conducted by experienced peer educators trained as
trainer of trainers. During 1997 a thorough comparative evaluation was conducted
between 15 schools with and 15 schools without a PHE programme involving 417
students and 50 PHEs.
Results: 97% of the students indicated that the PHE programme had assisted
them in protecting themselves from AIDS. 75% reported that apart from the group
sessions they also had one to one sessions with PHEs. Knowledge in schools
with a PHE programme was higher than in schools with only the national AIDS
curriculum. Boys and girls in PHE schools were able to discuss sexual health
issues more openly. 80% of students from the PHE schools compared to 50%
of schools without, believed that their peers had changed behaviour towards
postponing sex. Boys mentioned mostly postponement as the preferred change
while for girls this is reduction of partners. The youth of the PHE schools were
also more confident that peer pressure, and pressurising for sex were reducing.
70% of the students would like to have condom use included in the programme
and they like their PHEs to teach it.
Lessons learned: Knowledge taught through the AIDS curriculum is increased
by a PHE programme. The changes in attitudes towards more responsible behaviour can also be attributed to the PHE programme. An activity manual with
instructions for formal sessions is very helpful for PHEs. The manual will be
expanded to include other reproductive health issues and give stronger attention
to the different learning styles for boys and girls. Cost sharing and the integration
with the educational system increases the chances of district wide coverage and
sustainability.
233523 The contradictions of peer education as employment for
poor people with HIV/AIDS
Jeff Maskovsky1, J.D. Davis2, A.H. Harley1, J.S. Shull1. Philadelphia
Fight/Temple University 1233 Locust Street Fifth Floor Philadelphia, PA 19107,
USA
Issue: While peer educators plays an important role in the delivery of HIV-related

prevention and care services across the US, it may unthinkingly reinforce employment hierarchies that privilege a professional class of predominantly middleclass, white, and often HIV negative men and women over low-income HIV
positive people of color who are "consumers" of HIV services.
Project: An analysis of a convenience sampling of several peer education
programs across the US was conducted to determine employment conditions for
HIV positive peer educators. Programs were evaluated for by pay rate, positive