Peer education: a key health promotion principle
Peer education has been a cornerstone of effective HIV prevention education. Peer-based education is likely to be more effective than education developed and delivered by other ‘external’ agencies. Peers are effective educators because they understand the culture and language of a population or group and can be accepted by its members:
- Peer education has been effective among gay men.
- Sex worker organisations have also been very successful through their employment of current and or past sex workers as peer educators.
- Peer educators staff some needle and syringe exchange programs, providing a means for connecting with injecting drug users and disseminating prevention and treatment information to people who are often stigmatised, marginalised and difficult to reach.
Health Promotion Principles
There have been significant efforts to develop health promotion programs linked to measurable outcomes so that successive efforts can be built on and improved. Australian HIV prevention and health promotion principles are in line with those summarised by Baxter and McCallum (1998):
- Health promotion projects and programs designed and delivered by peers are likely to be more effective than those developed and delivered by other ‘external’ agencies – especially in marginalised communities suspicious of government and its operations
- Sustained behaviour change on a wide scale is more achievable through a programmatic focus on influencing social and community norms and beliefs, rather than only focusing on changing individuals’ behaviour
- Health promotion programs should involve the affected community/ies in discussion and debate about the range and nature of measures it could take to reduce the impact of the epidemic
- Health promotion should promote and support both behavioural and biomedical approaches to HIV prevention
- HIV-positive people should be involved in all phases of program design, from initial concept through development of content and delivery
- Health promotion should be ‘sex positive’, ‘sexuality positive’ and ‘pleasure positive’
- Health promotion should support intimate relationships and acknowledge different types of sexual partners and partnerships
- Language, images and processes used should be those already existing in the community involved or generated by that community
- Language and images used should be direct, explicit, understandable and simple
- Campaigns should target high-risk behaviours rather than high-risk groups
- The objective of information programs is to provide people from affected communities with sufficient information and support to make their own decisions about safe behaviour rather than providing a prescriptive set of rules
- Health promotion should be based on the principles of harm reduction and risk reduction
- Health promotion programs should take great care to share equally the responsibility for preventing new infections between those infected, those not infected, and those unaware of their HIV status
- Health promotion programs should be vigorous, continuous and have the capacity to adapt flexibly to changes in the epidemic and to changes within communities
- Health promotion program design should be supported by an active, reflexive social research program.
These principles need to be endorsed and supported by the political and community leadership.