Abstract
Sirs: I read with interest the article by Li et al. 1 investigating the effect of a school-based HIV/AIDS peer-led prevention programme. I believe that the title and article are rather misleading as this study does not actually use peers, ‘a person of the same standing or rank as the person(s) in question; a person or thing of the same effectiveness or ability as the one(s) in question; an equal’. 2 Instead, medical students selected for qualities such as ‘personality, credibility, ability in communicating and collaborating with others and school performance’ were used to deliver a novel education package consisting of ‘participatory activities’ to the children (mean age 14.2 years) of migrant workers. An established teacher-led health education curriculum, whereby students are ‘passive listeners’, served as the control. Although the data on improved educational outcomes are very encouraging, the authors' conclusion that peer-led education of HIV/AIDS was effective in improving knowledge and protection self-efficacy seems difficult to justify. Furthermore, quite how much of the effect is due to the new teaching methods used and how much is due to the persons delivering it is difficult to establish.
Within the UK, Sexpression is an independent student initiative where medical students teach sex education in their local communities and schools. 3 The organization has similar aims to the study by Li et al.; however, they do not claim to be providing peer-led prevention. A more appropriate term might be ‘change aide’– led prevention. 4 Change aides (medical students, for example) complement the work done by change agents (sexual health physicians), who in turn work for the change agency (the National Health Service). The potential effectiveness of this strategy lies in the fact that change aides are more similar, or homophilous, to the target population than the change agents, a pertinent fact when thinking about how information is communicated between groups. 5
While school-based, peer-led sex education has been shown to be effective in some settings, 6 I would argue that Li et al. do not use true peers and their study possibly tells us more about the effectiveness of participatory learning than it does about peer-led prevention programmes.