Effective peer education in HIV: defining factors that maximise success.

UNLABELLED: Background Peer education is considered an effective health promotion and education strategy, particularly to populations traditionally resistant to conventional forms of health information dissemination. This has made it very applicable to HIV education and prevention, where those who are affected or at risk are often amongst the most vulnerable in society. However, there still remains uncertainty as to the reasons for its effectiveness, what constitutes an effective methodology and why a consistent methodology can often result in widely variable outcomes. METHOD: Between 2008 and 2010, three separate reviews of peer education were undertaken across more than 30 countries in three distinct geographical regions across the globe. The reviews sought to identify determinants of the strengths and weaknesses inherent in approaches to peer education, particularly targeting young people and the most at-risk populations. RESULTS: By assessing the implementation of peer education programs across a variety of social environments, it was possible to develop a contextual understanding for peer education's effectiveness and provide a picture of the social, cultural, political, legal and geographic enablers and disablers to effective peer education. Several factors were significant contributors to program success, not as strategies of methodology, but as elements of the social, cultural, political and organisational context in which peer education was situated. CONCLUSION: Contextual elements create environments supportive of peer education. Consequently, adherence to a methodology or strategy without proper regard to its situational context rarely contributes to effective peer education.

Pilot of non-invasive (oral fluid) testing for HIV within a community setting.

BACKGROUND: The present study sought to determine the level of undiagnosed HIV infection within a community setting of men who have sex with men (MSM) and identify any associated sexual risk behaviours. METHODS: A total of 427 MSM were recruited in sex-on-premises venues (SOPV) and gay bars within the inner city of Brisbane. An additional 37 MSM were recruited in a smaller, regional centre (Toowoomba). Oral fluid testing for HIV antibodies was undertaken using the Orasure collection system and assay. Each participant was invited to complete a brief behaviour questionnaire and submit an oral fluid specimen. Confirmed serology results were linked to reported sexual behaviours, testing patterns and HIV status. RESULTS: Of the 464 men surveyed, 33 identified as HIV-positive, and all of these were reactive by the Orasure assay. A further eight people who identified as negative or unknown serostatus, had confirmed Orasure reactive results, resulting in 1.9% of the 'non-HIV positive' MSM sample unaware of their positive HIV status. Therefore, 19.5% of the total confirmed HIV-positive individuals were not aware of their true serostatus. CONCLUSIONS: A significant minority of HIV-positive MSM are currently unaware of their positive serostatus. However, an analysis of their risk behaviour does not seem to indicate any significant difference to those who are HIV-negative. Interestingly, 86% of those who were unaware they were HIV-positive identified that they had been tested in the previous 6 months and all of them claimed to have been tested in the previous 2 years.

Sex on premises venue (SOPV) health promotion project in response to sustained increases in HIV notifications.

BACKGROUND: Due to increases in HIV notifications in Queensland, a health promotion outreach project was developed with sex on premises venues (SOPV) in Brisbane. METHODS: A health promotion officer (HPO) promoted safer sex behaviours among SOPV patrons over 14 months, including providing information, counselling and skills to enhance safer sexual behaviours and providing referrals. Surveys were introduced to facilitate discussions regarding HIV/sexually transmissible infections, testing and safer sex practices. RESULTS: The project demonstrated feasibility within this highly sexualised environment, and was enhanced by careful monitoring and revising the procedure to improve patron/staff responses to the project. The introduction of a survey instrument was a significant contributor to the project's effectiveness, providing opportunities for patrons to discuss a variety of key sexual health issues. CONCLUSIONS: This initiative reflected effective partnering between the Health Department, a community HIV/lesbian, gay, bisexual and transgender organisation and private industry. Despite initial difficulties, the presence of a health worker within an SOPV was acceptable to patrons and allowed for brief interventions to be conducted. This project was deemed effective for a limited time period and within certain constraints.