Exploring similarity between peer educators and their contacts and AIDS-protective behaviours in reproductive health programmes for adolescents and young adults in Ghana.

This analysis explores the similarity between peer educators and their contacts. To examine interpersonal communication in the context of peer education, this study tested a new approach using multiple semi-structured interviews and network analysis to collect data from 106 peer educators and 526 of their contacts. These evaluation activities were conducted at three sites in Ghana during April 1998, in peri-urban and rural locations, and in in-school and out-of-school targeted settings. It was found that in their peer counselling and peer promotion activities peer educators tend to reach people who are like themselves (53% within 2 years of age, 59% same sex, 70% same ethnicity, and 65% same school status) however, this trend is not uniform among all youth and varies by demographic characteristics and their cultural environment. By examining the social networks of peer educators, it is possible to gain a better understanding of the process of peer education counselling in the context in which it occurs. The study also shows that controlling for other factors, contacts of peer educators who are highly similar regarding age, sex, ethnicity, and school status, are 1.74 times more likely (95% CI: 1.18, 2.56) to have done something to protect themselves from AIDS in the past three months. The results have relevance for programme managers and planners, researchers, and international agencies serving youth.

Peer promotion programs and social networks in Ghana: methods for monitoring and evaluating AIDS prevention and reproductive health programs among adolescents and young adults.

This article summarizes the observations and lessons learned regarding the application of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention and reproductive health evaluation methodologies in the context of adolescent and young adult populations and discusses the use of peer network evaluation to understand the dynamics of peer promotion. To examine the interpersonal communication process of peer education, this study tested a new approach using multiple semistructured interviews and network analysis to collect data on 106 peer educators and 526 of their contacts. These evaluation activities were conducted at three sites in Ghana during April 1998, in both periurban and rural locations in both in-school and out-of-school settings. By evaluating the social networks of peer educators it was possible to gain a better understanding of the process of peer education in terms of (a) defining the composition of peer contacts, (b) identifying the social norms that play a critical role in youth decision making, and (c) observing the range of messages and services transmitted during peer education. The objective of this paper is to disseminate the experience of the Center for Education and Development of Population Activities (CEDPA) and Focus on Young Adult's cooperative development of evaluation methodologies for peer promotion and to highlight utilization of these methodologies in a case study in Ghana. The results will be discussed in terms of their possible implications for program managers, researchers, and international agencies.

Preventive intervention to reduce sexually transmitted infections: a field trial in the Royal Thai Army.

BACKGROUND: During 1991 through 1993, sexually transmitted infections among conscripts in the Royal Thai Army in the upper-northern provinces were common: human immunodeficiency virus (HIV) prevalence at induction was 12%, HIV incidence was 2.4% per year, and incidence of sexually transmitted diseases was 17% per year. We evaluated a behavioral intervention to reduce incident sexually transmitted infections among conscripts inducted into the Thai Army in 1993. METHODS: We developed a preventive intervention that addressed consistent condom use, reducing alcohol consumption and brothel patronage, and improving sexual negotiation and condom skills. Companies were assigned to 1 of 3 groups matched on military mission: 450 men were in the intervention group, 681 were in barracks at the same base but did not receive the intervention (diffusion group), and 414 were in distant camps (controls). Baseline HIV serological testing and behavioral interviews were conducted during basic training in 1993. The intervention was applied for 15 months, and men were followed up at 6-month intervals (with repeated HIV serological testing, sexually transmitted disease assessments, and behavioral interviews) through May 1995. RESULTS: Incident sexually transmitted diseases were 7 times less frequent among men assigned to the intervention than the combined controls (relative risk, 0.15; 95% confidence interval, 0.04-0.55), after adjusting for baseline risk factors (P<.005). There was no diffusion of the intervention to adjacent barracks. The intervention decreased incident HIV by 50% in the intervention group. CONCLUSION: Intensive interventions in structured institutions can successfully reduce risk in settings confronting expanding heterosexual HIV epidemics.

Social network influences on reproductive health behaviors in urban northern Thailand.

Prevention approaches for reproductive health have evolved from an emphasis on individually focused models of behavior change to a recognition that risk reduction occurs within a context of social norms. Prevention programs can be improved by understanding how social structure influences sexual behavior and using that understanding to develop strategies for positive change. In a dynamic, urban context, communities are better conceptualized as informal networks of ties. These network structures may help to protect, or conversely, expose members to reproductive risk behaviors. Using data from a study of social and sexual networks conducted in northern Thailand, this article describes partner relations and social structure in the modern, urban context, and illustrates the links between individual, relational and structural properties and reproductive risk behaviors. Triangulation of ethnographic, survey and social network data collection and analytic tools provide an opportunity to interpret individual behaviors, meanings of relationships and structural properties of networks. Intervention approaches should build on existing networks, and address the complex meanings of romantic and sexual partnerships.