Also available in [PDF] format. Order publication online.
Research suggests that people are more likely to hear and personalize messages, and thus to change their attitudes and behaviors, if they believe the messenger is similar to them and faces the same concerns and pressures.[1,2] Numerous studies have demonstrated that their peers influence youth's health behaviors—not only in regard to sexuality but also in regard to violence and substance use.[1,3] Peer education draws on the credibility that young people have with their peers, leverages the power of role modeling, and provides flexibility in meeting the diverse needs of today's youth.[1,3] Peer education can support young people in developing positive group norms and in making healthy decisions about sex.[3,4]
Youth Face Serious Sexual Health Issues.
- Around the world each year, more than half of all people newly infected with HIV are between the ages of 15 and 24. Worldwide each day, almost 6,000 youth ages 15 to 24 are infected with HIV5—that is, some 250 youth are infected during every hour of every day and two of them every hour are American youth.
- Worldwide, nearly 12 million youth live with HIV/AIDS; youth under age 25 account for 28 percent of the 42 million people living with HIV/AIDS.[5,7] Sixty-two percent of infected youth are female.
- Experts estimate that more than 15 million sexually transmitted infections (STIs) occur annually in the United States, nearly four million among teens and over six million among youth ages 20 to 24.[8,9] By age 24, at least one in three sexually active people will have contracted an STI.
- In each year in the United States, between 750,000 and 900,000 teenage women experience pregnancy.[10,11] Seventy-eight to 95 percent of teen pregnancies are unintended.[10,12]
Peer Education Reduces Risky Sexual Behaviors.
- Studies show that adolescents who believe their peers are using condoms are also more than twice as likely to use condoms compared to teens who do not believe their peers use condoms.[13,14]
- In the United States, a peer education program targeting mostly black, urban females ages 12 through 19 significantly improved HIV/AIDS knowledge and preventive behaviors. Before the program, 44 percent of sexually active participants reported not using condoms compared to 33 percent after the intervention. Reports of sex in the previous two weeks fell from 21 percent at baseline to 14 percent at follow-up.
- Evaluation of a sexual health peer education program in Peru in 2000 found that, compared to controls, participating males had increased knowledge about pregnancy prevention and reported reduced incidence of sexual initiation and increased use of contraception at most recent sex.
- An evaluated peer health education program in Cameroon showed increased use of modern contraceptive methods and increased condom use at most recent sex among participants versus comparison youth. The program was more effective among in- than out-of-school youth.
- The West African Youth Initiative implemented peer education programs in schools and out-of-school settings in Ghana and Nigeria. Evaluation showed that peer education significantly increased condom use among in-school youth. The proportion of youth reporting use of modern contraception methods increased significantly from 47 to 56 percent while use in comparison areas decreased slightly.
- In an alternative school in Florida, a peer education program resulted in increased reports of condom use at most recent intercourse (up from 45 to 55 percent) and fewer reports of unprotected sex (down from 15 to four percent) among sexually active students.
- A program in the South identified peer leaders in the gay communities of two small cities. The leaders were then trained to talk individually with their peers about HIV risk behaviors. As a result, the proportion of men who engaged in any unprotected anal intercourse in a two-month period decreased from 36.9 percent before the intervention to 27.5 percent after the intervention.
Teens Often Find Peer Educators More Credible Than Adult Educators.
- Trained peer educators are a more credible source of information for some youth than are adult educators because they communicate in readily understandable ways and serve as positive role models while dispelling misperceptions that most youth are having sex.[3,4]
- A study comparing peer-led versus adult-led education programs found that peer counselors produced greater attitude changes in teens' perception of personal risk of HIV infection. Relative to adult-led education, peer-led education also improved teens' inclination to take steps to prevent transmission.
- The same study indicated that adolescents who were counseled by peers were more likely to engage in interactive discussion following the education curriculum than those counseled by adult health care providers.
Peer Educators Themselves Benefit From Programs.
- Studies suggest a number of benefits for peer educators—
- Receiving special training in making decisions, clarifying values, and acting in accordance with those values
- Mastering extensive sexuality information relevant to their own lives
- Being recognized as leaders by their peers and their community
- Having direct involvement, a voice, and some control in programs' design and operation
- Learning important skills, including facilitation and communication
- Committing to responsible sexual behavior.[3,21,22]
- According to the National 4-H Council, programs offering active and meaningful involvement to youth also provide young people with opportunities to increase their self-discipline and self-esteem and to gain positive stature in the community, broader career choices, and a better understanding of diversity.
- In one peer-based intervention, evaluators found that peer educators who entered the program in their early teen years and who remained with the program for one to two years were less sexually active and/or more likely to have protected sex than were comparison youth in the community.
- Finally, studies show that, compared to other youth, peer educators often achieve greater sexual health knowledge, hold more positive attitudes, and report fewer risk behaviors.[15,18,19,20]
- Sloane BC, Zimmer CG. The power of peer health education. Journal of American College Health 1993; 41:241-245.
- Milburn K. A critical review of peer education with young people with special reference to sexual health. Health Education Research 1995; 10:407-420.
- National Hemophilia Foundation. Peer-to-Peer Health Education Programs for Youth: Their Impact on Comprehensive Health Education. New York: The Foundation, 1994.
- DiClemente RJ. Confronting the challenge of AIDS among adolescents: directions for future research. Journal of Adolescent Research 1993; 8:156-166.
- UNAIDS et al. Young People and HIV/AIDS: Opportunity in Crisis. Geneva, Switzerland: UNAIDS, 2002.
- Office of National AIDS Policy. Youth and HIV/AIDS 2000: A New American Agenda. Washington, DC: The White House, 2000.
- UNAIDS. AIDS Epidemic Update, December 2002. Geneva, Switzerland: UNAIDS, 2002.
- Cates W, American Social Health Panel. Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Sexually Transmitted Diseases 1999; 26(4 Supplement):S2-S7.
- American Social Health Association. Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation, 1998.
- Kaufmann RB et al. The decline in US teen pregnancy rates, 1990-1995. Pediatrics 1998; 102:1141-1147.
- Centers for Disease Control & Prevention. National and state-specific pregnancy rates among adolescents, United States, 1995-1997. Morbidity & Mortality Weekly Report 2000; 49:605-11.
- Spitz AM et al. Pregnancy, abortion and birth rates among US adolescents—1980, 1985, and 1990. JAMA 1996; 275:989-994.
- DiClemente RJ. Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: the influence of perceived peer norms and sexual communication on incarcerated adolescents' consistent use of condoms. Journal of Adolescent Health 1991; 12:385-390.
- DiClemente RJ. Psychosocial determinants of condom use among adolescents. In: DiClemente RJ, ed. Adolescents and AIDS: A Generation in Jeopardy. Newbury Park, CA: Sage Publications, 1992.
- Slap GB et al. A human immunodeficiency virus peer education program for adolescent females. Journal of Adolescent Health 1991; 12:434-442.
- James-Traore T et al. Intervention Strategies that Work for Youth: Summary of the FOCUS on Young Adults End of Program Report. [Youth Issues Paper; no. 1] Arlington, VA: Family Health International, YouthNet Program, 2002.
- Brieger WR et al. West African Youth Initiative: outcome of a reproductive health education program. Journal of Adolescent Health 2001; 29:436-446.
- O'Hara P et al. A peer-led AIDS prevention program for students in an alternative school. Journal of School Health 1996; 66:176-182.
- Kelly JA et al. HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis. American Journal of Public Health 1991; 81:168-171.
- Rickert VI et al. Effects of a peer-counseled AIDS education program on knowledge, attitudes, and satisfaction of adolescents. Journal of Adolescent Health 1991; 12:38-43.
- FOCUS on Young Adults. Using peer promoters in reproductive health programs for youth. In Focus December, 1997; http://www.pathfind.org/pf/pubs/focus/IN%20FOCUS/peerpromoters.html
- National 4-H Council. Creating Youth/Adult Partnerships: Training Curricula for Youth, Adults and Youth/Adult Teams. Bethesda, MD: The Council, .
- Park Slope Project Reach Youth, Inc; Hunter College Center on AIDS, Drugs & Community Health. Final Report on Project SAFE Evaluation Study. Brooklyn, NY: The Project, 1992.
Written by Hillary Mason
September 2003 © Advocates for Youth