Community mobilization and peer education in a HIV-STI prevention program for university students

Abstract: Slowing the incidence of HIV and STI among young people requires that they change their sexual behaviours. There is evidence that community-based interventions that target multiple levels of influence can be effective. In community mobilization different segments and sectors of a population are directly involved in problem identification and in the design and implementation of programs. The process can also strengthen a community’s capacity to respond to health problems, promote sustainability, and ensure continuation once external assistance is completed. In the case of HIV and STI it is critical that local health services are involved. Research has shown that using peer opinion leaders can have a particularly positive influence on decreasing sexual risk behaviours. A theory-based STI-HIV prevention project was initiated in the student community of Lund University between 1991-95 and was based on community mobilization, use of peer opinion leaders and collaboration with local STI and HIV health services. The general aim was to assess the impact of the project (Projekt 6) on consistent condom use (CCU). Specific aims included the analysis of associations between background, sociodemographic, psychosocial and behavioural factors on CCU. Self-administered questionnaire mail surveys were conducted in November 1992, 93 and 95 using random samples representing the population of full-time undergraduate students. The questionnaire was based upon the published research, behaviour change theories and formative research involving qualitative interviews and focus group discussions. The questionnaire was anonymous. The cumulative response rate was 70% (n=1,429). The project was exposed to 68% of the measured population, including 82% of students living in local student housing. Uptake was associated with behavioral risk indicators, including being sexually active, being single, more lifetime and recent sex partners, early age at first intercourse and a STI history. Project messages were rated as more personally relevant than national campaign messages and had higher approval than mass media messages. However, 20-25% of higher risk students were not exposed though they tended to be older, live farther from the campus, newer to university and in a long-term relationship. Exposure to the project and its components was associated with statistically significant higher CCU when adjusting for confounding in logistic regression analysis and in nearly all population segments. The Projekt 6 organization was sustained through the period of the study and remains in operation after ten years. The thesis study also confirmed the importance of social-normative influences in STI-HIV prevention and contributed new knowledge concerning the importance of action control when CCU is viewed as the capacity to handle a series of situational risks under the affect of individual, dyadic and social influences.