DOCUMENT RESUME SP 034 840 ED 364 511 Infection Peer to Peer: Youth Preventing HIV TITLE Together. Washington, DC. Center for Population Options, INSTITUTION 93 PUB DATE 23p. NOTE Vermont Avenue, Center for Population Options, 1025 AVAILABLE FROM 20005. N.W., Suite 210, Washington, DC Non-Classroom Use (055) -- Reports - Guides PUB TYPE Descriptive (141) MF01/PC01 Plus Postage. EDRS PRICE Making *Acquired Immune Deficiency Syndrome; Decision DESCRIPTORS Promotion; *Peer Skills; Disease Control; *Health *Program Design; Teaching; Program Descriptions; *Program Implementation; Secondary Education; Education; Student Secondary School Students; Sex Methods Attitudes; Student Behavior; Teaching *Sexually Transmitted Diseases IDENTIFIERS ABSTRACT safer sexual To meet the challenge of teaching teaching others in behavior to teens, peer education--individuals effective teaching method. their own or similar age group--is an likely to listen and talk to Teenagers report that they are more than to their parents, guardians, their peers about sexuality issues able to change providers. Effective peer educators are or health care risk-taking behavior and help themselves as peer norms concerning decisions about their lives. This well as other youth make healthy to peer education in four publication examines the method of peer information on the need for sections. Section 1 provides background developing Section 2 presents five steps in peer education programs. the education program. Section 3 presents and implententing a peer lists peer programs highlighted conclusion to the guide and section 4 in the publication. (LL) *********************************************************************** best that can be made Reproductions supplied by EDRS are the from the original document. *********************************************************************** e ° I DEPARTMENT OF EDUCATION U °ace 04 EducatanaI Rsealth ahd Impromws01 "PERMISSION TO REPRODUCE THIS EDUCATIONAL RESOURCES INFORMATION MATERIAL HAS BEEN GRANTED BY CENTER (EM) f Cl This document has been reproduced as reoloree from the Oeffoo of Cepemzetoon u<-4-444,51-" of roinanng o !Amor chancieS hart bale made tO @fere Owe reprocruotion guide), Pornts of view IN 015,1,13n stated tttlere (WOO- ment do not neCesSioly represent OffiCrill OERI posttron or policy TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC)." 2 BEST COPY AVAILABLE Youth Preventing HIV Infection Together BEST COPY Am I API F peer to peer 1m I Table of Contents AMNOWLEDGMENTS 5 BACKGROUND OF NEED I. FOR PEER EDUCATION PROGRAMS 8 Introduction to HIV/AIDS 8 1. Assessing Youth Vulnerability 8 ?. Peer Education: Theory and justification 3. 10 DEVELOPING AND IMPLEMENTING II. A PEER EDUCATION PROGRAM 11 Introduction 1. 11 Getting Started 2. 12 Training 3. 14 Educational Techniques for Peer Leaders 4. 15 Evaluation 5. 18 CONCLUSION III. 20 PEER PROGRAMS HIGHLIGHTED IV. ?? IN THIS PUBLICATION REFERENCES V. 23 4 peer to peer ) 1 ACKNOWLEDGMENTS This publication would not have been possible without the hard work and dedication of CPO interns Kristin Felch and Cora Shiroyama. From every phase of the publication's production, from the early research (Cora) through the writing and final editing (Kristin) their efforts were tireless. CPO would also like to thank all of the individuals and organizations who responded to the survey and spent time with us in our follow-up conversations. Although we were not able to include by name all of the wonderful programs we discovered, your responses to the survey contrib- Finally, CPO would like to thank peer educators everywhere uted to the final result. you truly made this publication possible! Executive Director: Margaret Pruitt Clark Director, HIV Education: Jennifer Hincks Reynolds Research and Writing: Kristin Felch Jennifer Hincks Reynolds Cora Shiroyama Design and Layout: Stephen Reynolds Christina Biddle Editing: Susan Messina Geri Peak Marijke Velzeboer °Copyright 1993. The Center for Population Options 5 peer to peer , ill Aig) , I I Peer to Peer: Youth Preventing HIV Infection Together THIS PUBLICATION WILL... examine the urgent need for effective FBI and seKuality education and the development of skills among teens to prevent lily infection present an overview of the theory and justification behind teens teaching their peers suggest some important elements of peer programs and offer descriptive ex- amples of these elements drawn from select peer education programs across the nation provide suggestions and resources that can be effective in designing and imple- menting a peer education project for teens fighting to prevent lily/AIDS 6 peer to peer , I I. BACKGROUND OF NEED FOR PEER EDUCATION PROGRAMS 1. Introduction to HIV/AIDS Since 1981, when the first case of acquired immuncxleficiency syndrome (AIDS) was reported, health care providers and educators worldwide have been engaged in an extraordinary struggle against the threat of the human immunodeficiency virus \1). the virus that causes AIDS. Despite early misconceptions that HIV was confined to certain groups of people based on sexual orientation or ethnic group affiliation, it is now certain that all individuals can become infected, given exposure to the virus. it is also dear that most people can avoid infection, given knowledge of how viral transmission occurs and the skills to modify behavior. Methods of Protection Abstinence from oral, anal or vaginal intercourse is the only way to completely eliminate the risk of exposure to IRV through sexual contact. Using latex barriers to avoid contact with blood, semen and vaginal condoms and dental dams secretions significantly helps reduce the risk of exposure to IBA' during oral, anal and vaginal intercourse. Avoiding sharing needles for ear-piercing. tattooing or injection drug use, or cleaning needles and paraphernalia between users to destroy any virus present are also reliable methods for avoiding blood to blood contact. Adolescents and HIV Prevention Simply providing the facts about 111V transmission and prevention or promoting abstinence is not enough, and it is especially inadequate for reaching adolescents who often engage in behaviors that place them at high risk for pregnancy and lily infection. To understand what makes adolescents particularly vulnerable to I IIV infection, and particularly resistant to prevention efforts, the realities of adolescent beliefs and behaviors must be considered. 2. Assessing Youth Vulnerability Adolescence is traditionally a time of growth, as young men and women seek to stretch beyond the protective shelter of family and begin to create art independent vision and life. Developmentally, this time of frantic self-definition is full of experi- mentation, spontaneity and limit-testing, frequently in the arenas of sexual activity and drug use. Both substance use and emotional unpreparedness for sexual intimacy can impair judgement in risky situations, putting youth at increased risk for unplanned preg- nancy and infection with iilV and other sexually transmitted diseases (STDs). Additionally, youth frequently receive incorrect information from their peers which Thus, may give them the false sense that they are invulnerable or already protected. risky behaviors among youth persist, and frequently young people, even with the information they need, lack the practical skills to affect a change in their lives. Alcohol and Other Drug Use Among Youth According to a national survey conducted by the American School Health Association, approximately one-quarter of eighth grade students and nearly forty percent of tenth grade students report having had five or more alcoholic drinks 8 peer to peer IIII , 1, 1 on one occasion during a two week period and one Out of eveiy 15 adoles- cents has tried cocaine.' l'.ven when drug use does not involve needles, alcohol and other drug consumption impairs judgement, which may lead to unprotected sexual activity. Unplanned and Unprotected Intercourse As with alcohol and oilier drug use, many young people do not consider the consequences of unprotected sexual intercourse. For most adolescents, the decision to have intercourse is spontaneous only 17 percent of young women and 25 percent of young men report planning their first act of intercourse.' Consequences: STDs and HIV/AIDS Unprotected sexual intercourse causes serious consequences for youth. Each year, three million young adults contract an STD about one teenager in every A recent study shows that people with a history of STDs, and the resulting five. open sores which can facilitate the transmission of I ilV, have a higher rate of 111V infection than those with no such history.' As of December 1992, 946 cases of AlDS among teenagers had been reported to the Centers for Disease Control and Prevention (CDC).' Although this number may seem relatively small, the long latency period between HIV infection and the onset of symptoms, approximately ten to thirteen years, suggests that most of the people living with AIDS who are in their twenties one fourth of all AIDS cases became infected with 1 IIV in their teen years. This point is illustrated by looking at numbers of AIDS cases among young adults ages 20-21. In December 9,582 cases of AIDS in this age group were reported to the CDC.' 1992, Misinformation In addition to living in a world where the consequences of substance use and unprotected sexual activity can be deadly, teens exist in an environment where most of their information, attitudes and behaviors are profoundly affected by their peers. Young adults frequently have a wonderful peer communication network and can be very effective at exchanging correct information and positive support. lowever, youth often receive incomplete and technically inaccurate information about sexuality from the media, parents or health care providers, and frequently pass potentially dangerous myths and inaccurate information along to their peers. In fact, teens report that other teens are a primary source of their sexual informa- tion, whether or not the information is accurate." Although most high school students know the major modes of I LIV transmis- sion, misconceptions about the risk of contracting I IIV from toilets, donating hkxxl, and insect bites still remain. Other misconceptions persist, including the efficacy of oral contraceptive use in preventing the transmission of HIV and the ability to identify those who are 1 IIV positive by looking at them.'" These false beliefs are problematic because they mislead teens almt the proper precautions to take to prevent HIV infection, and thus, put them at greater risk of infection. 9 8 BEST COPY AVAILABLE peer to peer ,, " , ) A Sense of Invulnerability Common among youth (and many adults) is the belief that 1 IIV will not affect them, regardless of whether or not they are engaging in risk-taking behavior. Due to the long incubation period of HIV, youth rarely see their friends sick and dying, even though they may have already been infected with the virus. Addition- ally, the misperception that risk of HIV infection is limited to certain "risk groups" rather than a result of risky behaviors is an obstacle to teens' realistic perception of their vulnerability. (Intil young people see for themselves that AIDS has many youth someone like them affected someone in their own age group will continue to believe that AIDS does not concern them. Risky Behaviors Persist Despite studies that have determined that the majority of young people have much of the information they need about the dangers of alcohol and other drug use and unplanned and unprotected sexual intercourse, risky behaviors among youth are still resistant to change." For example, adolescents frequently know the importance of using latex condoms in preventing HIV transmission, and in fact, condom use is higher among adolescents than any other age group. How- ever, actual rates of condom use reamin low. In a 1990 CDC study, only 49.4 percent of sexually active males and 40 percent of sexually active females in high school reported that they used a condom during their last act of sexual inter- course.'2 Clearly information alone is not sufficient for teenagers to feel personally outh perceptions of vulnerability at risk and these statistics suggest that targetit.c. is necessary to motivate behavior change.'° Teenagers Lack Skills and Access to Health Services Two factors that increase youth vulnerability to 111V infection are a lack of negotiation skills and insufficient access to condoms. Schools, community service organizations and families often do not teach and practice the concrete communi- cation and decision-making skills that youth need to negotiate abstinence, use of contraceptives and safer sex. As well as lacking lx)sitive role models and educa- tion, many teens cannot or do not know how to obtain condoms, contraceptives and reproductive health services. "Ille combination of teenage risk-taking, misinformation, a sense of invulner- ability, a lack of skills and often poor access to condoms, puts adolescents at high risk for HIV and other STD infection as well as unplanned pregnancies. Ilowever, one strategy for effectively combatting these youth misperceptions and risky behaviors is peer education, or training youth to teach their peers new strategies for living safely. 3. Peer Education: Theory and Justification individuals teaching others in their own or similar ige group Peer education has been recognized as an effective teaching method since Greek and Roman times." Peer helping programs teach individuals to support and assist their peers in a variety of styles, such as peer counseling and support groups, peer teaching 10 or tutoring, and peer mediation and buddy programs. 9 I I Mutual Benefits Through peer education, both the peer educator and the recipient of the information benefit. 11 le experience of learning becomes an exchange of ideas, rather than a transfer of know ledge. Peer educators improve their communication and presentation skills, develop leadership lx)tential and are more likely to engage in the safer behaviors they are committed to advocating.".'s Training teenagers to educate other youth creates expertise and estalAishes resource people within peer groups. Frequently, youth educators can become positive community role models, resource people and special advocates for their peers. These aspects of peer leadership confirm research that has found that peer education benefits the attitudinal and academic development of the peer educa- tors and the participants."'.'' A peer who understands a teen's fierce need for independence and maturity, and can temper those needs with responsibility and thoughtfulness, is in a crucial position to correct misinformation, and shape group values and behaviors without losing credibility among youth. Peer education is particularly effective among young people, including "hard to reach" teenagers, many of whom discuss their problems and concerns more openly with peers who are perceived as safer and more understanding than are teachers or parents. I" Thus, adolescents are the best candklates to win the respect and trust of their peers, and they have the proximity to exert a positive social influence, Research suggests that the discrep- ancy between knowledge and behavior in teens is possibly due not only to their limited identification with adult educators, but also to their difficulty in resisting peer pressure." Adolescents can be extremely influential in shaping the behavior and values of their friends, particularly in risk-taking situations.".1'."." Conclusion With the challenge of teaching safer behaviors to teens, increasing their skills and combatting myths and stereotypes, peer education harnesses the power and influence of youth to encourage informed, supportive and respectful youth interaction and responsible decision-making. II. DEVELOPING AND IMPLEMENTING A PEER EDUCATION PROGRAM 1. Introduction To illuminate the challenges facing those developing or implementing a peer education program and to isolate some elements that make peer groups across the nation successful, the Center for Population Options (CPO) created a survey to gather information about various aspects of peer program design, implementation and evaluation. Following are some important considerations and suggested tech- niques to use when starting a peer program, training peer educators, developing new educational techniques and evaluating the program. important concepts of program design and implementation are exemplified by brief descriptions of peer programs. Many more excellent peer education programs exist than can be described 11 1 0