European guidelines for youth AIDS peer education - University of ...

Peer educationPeer education is an approach whereby a minority of peer representatives from a group or populationactively attempt to inform and influence the majority. Peer education projects have been set up at thegrassroots level by non-government organisations (NGOs), community and spiritual organisations, youthorganisations and educational institutions. Feasibility studies have been carried out by policy makers andresearchers in their search for effective prevention methods. Subjects targeted include smoking, drug andalcohol use, violence, sexual health and HIV-STD risk behaviours.It is in the area of HIV -and sexually transmitted disease (STD) prevention that the use of peer education hasgrown most rapidly. Since the early 1990s, its use has spread throughout the world and is today considered avery attractive approach. In the eyes of critics, the idealisation of peer education has led to its uncritical andover-enthusiastic adoption. This criticism is often based on the lack of scientific evidence for its effectiveness.The question remains as to why peer education has expanded so rapidly despite scant evidence of itseffectiveness. One senses a ground swell behind AIDS peer education’s popularity, and there is no mistakingthe enthusiasm among the young people and adults involved. It is a new approach that challenges thetraditional ‘expert’ role and advocates the right of young people to have access to information aboutsexuality, HIV, STD, condoms, contraception and drugs.Movements that advocate resistance to AIDS peer education are often driven by a reluctance to provideyoung people with encompassing information on sensitive subjects, especially through the use of interactiveand role-playing techniques. Young people trained as peer educators become experts on these subjectsrelative to their peers, and then take action as agents of change. All this can not only unnerve traditionalistsbut can generate unease among adults concerning the accuracy of the information being taught, as well asits implicitly sexual nature.Peer education within HIV preventionAt the beginning of the HIV pandemic there was a strong focus on using information campaigns to increaseknowledge about the HIV virus: how it is transmitted and how to protect oneself. Medical experts took theinitiative in informing the public and neutral medical terms such as ‘bodily fluids’, ‘vaginal and analintercourse’, and ‘risk group’ were used. This language was often used to confirm existing prejudices aboutdifference (ie foreigners), taboos (ie homosexuals), and immorality (ie drug use). Many people becamecaptives to fear and blame. Those working in the fight against AIDS found themselves not only trying toslow the spread of the virus but working with issues of discrimination against HIV-positive people and othergroups such as homosexuals.As the pandemic continued into the late 1980s, an increasing number of scientific studies showed thatincreased levels of knowledge about HIV/AIDS did not lead to reductions in risk behaviours. By this time,many NGOs, community-based organisations (CBOs) and institutions at the local level had become firmlyestablished in HIV prevention, supporting people with HIV, and fighting against discrimination. Concurrently,the health promotion approach was undergoing a re-birth, especially after the adoption of the OttawaCharter in 1986.In the early 1990s, the accumulated results of an increasing number of scientific studies began to show thatsocial and normative influences, as well as partner-to-partner communication barriers, were determinantsof sexual risk behaviours. This had usually been taken for granted by practitioners and volunteers working atthe grassroots level. NGOs, CBOs, clinicians and sex educationalists were well-informed, experienced andoften active in national or international networks where knowledge and problems were shared.Practitioner and scientific journals now began calling for an alternative to top–down, expert-basedinformation models. A commonly held view was that interventions needed to be tailored to each targetgroup and that messages needed to be meaningful to people’s everyday lives. Biomedical vocabulary had tobe replaced with a more user-friendly, explicit language. Dynamic prevention models leading to an increasedunderstanding of sexuality, gender-role, sexual orientation, relationships and drug abuse were called for.European guidelines for youth AIDS peer education 9