Int J STD AIDS 2008;19:848-850
doi:10.1258/ijsa.2008.008129
© 2008 Royal Society of Medicine Press
Original research articles |
Long-term follow-up study on peer-led school-based HIV/AIDS prevention among youths in Shanghai
Y Cai MSc *,
H Hong MD 
,
R Shi MSc *,
X Ye MD 
,
G Xu MSc *,
S Li MD * and
L Shen MD
* Department of Epidemiology, School of Public Health, Shanghai Jiaotong University;
Shanghai Paediatric Hospital affiliated with Fudan University;
School of Medicine, Shanghai Key Laboratory of Children's Environmental Health, Shanghai XinHua Hospital, Shanghai Children's Medical Center affiliated with Shanghai Jiaotong University, 227, South Chongqing Road, Shanghai, People's Republic of China
Correspondence to: Dr Huang Hong Email: HHong{at}shsmu.edu.cn
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Summary
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The HIV/AIDS epidemic is a major problem around the world and
an increasing percentage of new HIV cases is reported to be
by sexual transmission. Many studies have been carried out in
the field of peer education on HIV/AIDS among young people,
however, few studies focused on the long-term effect of this
education. To evaluate both the short- and long-term effects
of the peer education programme, we conducted a follow-up study
to evaluate the related knowledge, attitudes and behaviour intention
to HIV/AIDS among senior high-school students in Shanghai, China.
We selected 1950 students from 10 senior high schools in Shanghai,
from whom 968 students were selected at random for the intervention
group and 982 students for the control group. The same questionnaires
were carried out before intervention, one month and one year
later in both the groups. In the intervention group, the knowledge
score of reproductive health, HIV/AIDS and sexually transmitted
disease rose from 21.66 to 31.72 one month later (
P < 0.001).
After one year it was still 30.97, and there was no significant
difference between one month and one year (
P > 0.05). The
behaviour intention to HIV/AIDS prevention, such as condom use
during sexual intercourse also changed before and after the
intervention. After both the one month and one-year follow-up
intervention, we found that more students declared that they
would use condoms during sexual intercourse when compared with
the control group (
P < 0.001). No change was seen in either
knowledge or behaviour intention in the control group. These
results showed that peer education on HIV/AIDS prevention among
high-school students is both effective in promoting knowledge
and in changing behaviour intention long term.
Key Words: HIV/AIDS • peer education • follow-up • long-term effects
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INTRODUCTION
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The wide prevalence of HIV/AIDS is the biggest public health
and social problem in the world today. In China, a cumulative
total of 191,565 HIV/AIDS cases had been reported, including
47,713 AIDS patients and 13,632 deaths by the end of 2006.
1 Among new HIV cases, sexual transmission of HIV/AIDS has obviously
increased when compared with the habit of sharing injections
in drug users over the same period. The most important way to
control HIV/AIDS is to provide health education to young people
since this disease is mainly transmitted by sexual behaviour
and neither a cure nor an effective vaccination for HIV/AIDS
is available. Many studies demonstrate that most Chinese youths
lack basic sex information and their attitudes towards sex have
become more and more open. Studies have shown that 5–20%
of college students
2–4 and 3–8% of senior high school
students
5,6 had had sexual experience. So it is very important
to enhance related knowledge and attitudes and decrease high-risk
sexual behaviour in young people. Much research has been conducted
on the short term effects of health education on HIV/AIDS among
young people,
7,9 however, few studies have focused on the long-term
effects and evaluated not only the changes of related knowledge
and attitude but the behaviour intention.
10,11 To evaluate both
the short- and long-term effects of a peer education programme
we conducted a follow-up study among senior high school students
in Shanghai, China from 2004 to 2006.
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SUBJECTS AND METHODS
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Sample
Ten senior high schools were chosen among schools in Shanghai, by cluster sampling. A total of 1950 students were included in the sample, in which 968 students were randomized into the peer-led HIV/AIDS prevention group (the intervention group), and another 982 students were randomized without any intervention curriculum. The 1950 sampled students completed a self-administered questionnaire before the education, after one month and one year's education in both the groups. The students were informed that participation in the survey was voluntary and the survey was anonymous.
Peer educator selection and training
Peer educators were freshmen, selected through interview by teachers from a medical school, and verified by experts. The criteria included charismatic personality, credibility, good communication and ability to establish relationships with the other students. Ten peer educators, aged 18.5–19.2 years old, were chosen and given a week's training on educational protocol design, resources identification and anchoring classroom sessions to improve the knowledge, attitude and behaviour of their classmates towards HIV/AIDS.
Intervention
Our intervention was in order to increase knowledge about the transmission and prevention of HIV; to improve behaviour and behaviour intention to protect youth from HIV/AIDS; to eliminate prejudice and stigmatization towards PLWHA (People Living with HIV/AIDS).
Outcome measures
The questionnaire was designed carefully and consisted of information on individual sociodemographic characteristics; 42 items on knowledge of reproductive health, HIV/AIDS, STDs and five items on attitudes towards PLWHA, premarital and extramarital affairs and condom use during sexual intercourse. Students were asked to respond to the knowledge items with ‘yes’, ‘no’ and ‘not sure’, and attitudes and behaviour intention items with ‘sure’, ‘maybe’ and ‘not sure’. For each item included in the scales for measuring knowledge, attitudes and behaviour intention, a score or a rate was designed for each response. For example, to evaluate participant's knowledge level, correct answers were credited with a score of one and incorrect answers with a score of zero. Then the sum of each question's score was converted into a new score, with the maximum being 42. The higher the score, the greater the knowledge. The same questionnaires were used before education, after one month and one year's education in both the intervention group and the control group at the same time.
Statistical analysis
Changes in knowledge before intervention, one month after and one year after within each group were evaluated by analysis of variance (ANOVA) and comparisons of knowledge among study groups were done by Student's t-tests. Changes in behaviour intention within the two study groups were performed by 
2 tests. Epidata 2.0 (a kind of epidemic software) was used to set up a data bank and all statistical analyses were performed using SPSS for Windows 11.0 (SPSS Inc., Chicago, IL, USA). In the presentation of the results, the statistical significance level was set at P < 0.05 (two-tailed).
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RESULTS
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Demographic characteristics
A total of 1950 students completed the questionnaires before intervention, one month later the total was 1878 and one year later it was 1729. The average age was 17.22 ± 0.89 years. Variances such as age and gender were compared in this section and no difference was found between the two study groups (P > 0.05). The attrition rate was 3.47% for the intervention group, 3.87% for the control group after one month. And one year later it was 7.85% and 8.66% in both the study groups (Table 1).
Short- and long-term effects of intervention
Knowledge
There were statistically significant differences in HIV/AIDS-related knowledge between the intervention group and the control group at one month post-test (short-term effect) and one year post-test (long-term effect) (P < 0.001). In the intervention group, the scores rose from 21.66 to 31.72 one month later (P < 0.001), were 30.97 after one year, and there was no significant difference between one month and one year (P > 0.05). No significant increase was observed in the control groups (P > 0.05) (Table 2).
Behaviour intention
We found a higher percentage of students who declared that in
future they would use condoms during sexual intercourse in the
intervention group. The percentage rose from 46.2% to 65.7%
one month later and it was 61.4% after one year (
P < 0.001).
No significant increase was observed in the control groups (
P > 0.05). There was a significant difference in condom-using
intention when compared with the control group (
P < 0.001)
(Table
3).
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DISCUSSION
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Many studies do suggest that peer education can bring about
short-term positive changes in knowledge, attitude and behavioural
intention regarding condom use,
7–9 attitude towards abstinence,
12 delay in the initiation of sexual behaviour, the frequency of
intercourse and the use of condoms among sexually active teens.
Such effective programmes tend to be theory-based, highly structured
and led by well-trained peers. Although past researches have
found peer education to be effective, few evaluations have measured
long-term effects of this type of programme.
In our study, both short- and long-term effects were observable 12 months following the intervention. Our peer education intervention produced a positive change in students' HIV/AIDS-related knowledge and behaviour intention in HIV/AIDS prevention, such as condom use when having sexual intercourse. For example, after one year, HIV/AIDS-related knowledge scores of the intervention group decreased a little but showed no significant difference when compared with one month after intervention. It was still higher than the control group at the same time.
Several study limitations should be noted. First, the sample was not large; 1950 students from 10 schools were only a small part of Shanghai's students. Secondly, as an anonymous questionnaire survey was adopted, this may have led to loss of some information. Thirdly, our observation period was 12 months, but it was not easy to measure changing behaviour in youths for a period of one year in China; so we could measure only the behaviour intention.
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CONCLUSION
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Peer-led education relating to HIV/AIDS is effective in improving
knowledge and some behaviour intentions of high-school students
in Shanghai. Both short- and long-term effects were still measurable
12 months after the intervention. We suggest that peer-led education
of HIV/AIDS should be popularized among adolescents in China
and related effective strategies and secured supports should
be set-up quickly in the future.
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ACKNOWLEDGEMENTS
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This research was funded by the Foundation of Project HOPE,
Hong Kong (04PH21005). Part of the follow-up study was funded
by general programme of humanities and social studies, China
Ministry of Education (06JC880010). Our sincere gratitude is
due to other members of the research team and all the youngsters
and the schools participating in this research.
(Accepted April 29, 2008)
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REFERENCES
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- Update on the HIV/AIDS Epidemic and Response in China. 2005; See http://data.unaids.org/Publications/External-Documents/RP_2005ChinaEstimation_25Jan06_en.pdf
- Ma Q, Ono-Kihara M, Cong L, et al. Sexual behavior and awareness of Chinese university students in transition with implied risk of sexually transmitted diseases and HIV infection: a cross-sectional study. BMC Public Health 2006;6:232[Medline]
- Gao Y, Lu ZZ, Shi R, Sun XY, Cai Y. AIDS and sex education for young people in China. Reprod Fertil Dev 2001;13:729–37[Medline]
- Chen G, Lin X, Yang Y, et al. A survey of AIDS-related knowledge, attitude and behavior among college students in 4 cities of Fujian, China (in Chinese). Strait J Prev Med 2005;11:19–21
- Huang H, Cai Y, Shi R, et al. Analyze effects of peer education on AIDS among senior high school students in Shanghai. Acta Universitat Medicinalis Secondae Shanghai 2004;24:680–2 [in Chinese]
- Liang X, Yu L, Zeng G, Wu SY, Peter H. Investigation on RTI/sex related knowledge, attitude and performance in senior high school students (in Chinese). Chin J Public Health 2006;22:1028–9
- Kirby D, Obasi A, Laris BA. The effectiveness of sex education and HIV education interventions in schools in developing countries. World Health Organ Tech Rep Ser 2006;938:103–50; discussion 317–41[Medline]
- Smith MU, Dane FC, Archer ME, Devereaux RS, Katner HP. Students together against negative decisions (STAND): evaluation of a school-based sexual risk reduction intervention in the rural south. AIDS Educ Prev 2000;12:49–70[Medline]
- Kirby D, Obasi A, Laris BA. The effectiveness of sex education and HIV education interventions in schools in developing countries. World Health Organ Tech Rep Ser 2006;938:103–50; discussion 317–41[Medline]
- St Lawrence JS, Brasfield TL, Diaz YE, et al. Three-year follow-up of an HIV risk-reduction intervention that used popular peers [J]. Am J Public Health 1994;84:2027–8[Free Full Text]
- Kelly JA, St Lawrence JS, Diaz-Yolanda E, et al. HIV risk behavior reduction following intervention with key opinion leaders of population: an experimental analysis [J]. Am J Public Health 1991;8:171–86
- Aten MJ, Siegel DM. Keeping middle school students abstinent: outcomes of a primary prevention intervention. J Adolesc Health 2002;31:70–80[Medline]
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Summary
INTRODUCTION
