Peer Education Approach
University of Zimbabwe, Project Support Group (PSG)

The PSG originated in 1986, as the community service arm of a University of Zimbabwe (U Z) research programme and has grown into a regional non-profit organisation, with branches in Zimbabwe, Zambia and South Africa.
Its overall goal is to provide partners with cost-effective support that equips them to plan and implement AIDS prevention (and increasingly AIDS mitigation) programmes economically and effectively.
Currently the PSG supports approximately 50 projects in 8 African countries, particularly Zimbabwe, South Africa and Zambia.

On the following pages you will find

I some preliminary observations, remarks and conclusions

II a list of documents with summaries of content, where appropriate

Objectives of the intervention:

Provide STD/HIV/AIDS education and condoms
Reduce STD/HIV transmission
Mitigate the impact of HIV

First priority target group of the intervention:
men and women who engage in commercial sex
single women in low-income areas and
men with highly mobile lifestyle, men who visit bars and men who seek STD care.

Second priority target group:
men and women who engage in casual sex

Intermediaries:
community peer educators and their group leaders

Some contexts and occupations are particularly conducive to both commercial and casual sex and are a particular project focus.STD and HIV rates are highest in peri-urban areas beside major highways, military bases, mines, plantations, timber estates and other migrancy centres.

Major components of the interventions:
rapid formative research, geographic mapping, social network analysis, recruitment and training of site co-ordinators and peer educators, educational outreach, condom distribution, provision of medical, psychosocial and economic support.

The interventions concentrate on work by trained and supervised community peer educators who organise meetings, distribute condoms and support women's groups.

The Project Support Group trains site co-ordinators who are usually nurses or health educators, employed by local partners. They receive intensive training, through skills building workshops, internships and on-site-coaching.The site co-ordinators work full time, training, supporting and supervising peer educators. The site co-ordinators train the peer educators.
The peer educators attend an intensive 2 week course, every year.
Every week, they attend a 4-6 hours training meeting. Finally, they receive field training and coaching when they do outreach activities.

Peer educators are selected as follows:
1. Site co-ordinators conduct numerous community health education meetings among target groups.
2. During the health education meetings, they identify informal leaders and promising peer educators.
3. They invite informal leaders, promising potential peer educators and other community-motivated volunteers to attend health educator training, on a strictly voluntary basis.
4. After 3 to 6 months, the peer educators who find they are not truly interested or motivated drop out voluntarily.
5. The site co-ordinator is then left with truly dedicated, motivated people, and the co-ordinator then introduces allowances.
6. The allowance include: free medical treatment, uniforms, which the peer educators design themselves, meals during training, and allowances of about DM 20 monthly.
Attrition is close to zero

The condoms are provided by the Ministries of Health, and the supply is reasonably secure. The peer educators distribute the condoms personally and directly in their social networks They are also responsible for stocking and restocking fixed distribution points in bars, night clubs, 24 hour service stations and truck shops. They only stock sites where they hold educational and motivational meetings and they also monitor their distribution very closely.

Reduction of STD prevalence:
the project uses two types of data. One is STD presentation at all primary health care centres in the project area, the second is antenatal RPR syphilis rates among pregnant women at all primary health care centres in the project area.
Information on the decline in STD cases is based on the declines actually observed at the public health centres.
The HIV data are based on behavioural and STD data fed into the "Avert" model.
The drops have occured at different project sites at different times, usually a year after the project begins.

External evaluations
have assessed coverage (very good), condom use (very high in last sex act of bar clientele) and other aspects of the project:
1993 data from John Hopkins University, University of Michigan
1998 data from Michigan University and NORAD

Funding
The funders for the Project Support Group and its key project partners include: Anglo American, the Billiton Group, CIDA, DFID, ESKOM, Ford Foundation, The German Population Foundation, GTZ (in SA), Netherlands Government, Norwegian Government, SIDA, UNFPA, UNICEF, USAID, World Bank,

Conclusions
The whole approach of focussed peer-mediated education-cum distribution programmes for sexually vulnerable groups has been appreciated by several institutions and it seems that peer education projects which invest in the energy and voluntarism of low-income women can achieve high levels of efficiency and coverage which are associated with reported sexual behaviour change and declines in STD cases.

Emphasis is on coverage and low costs, and results are measured in process outputs (nr. of meetings, nr of persons reached, nr.of condoms distributed) and proxy indicators (reduction of STDs as reduction of HIV)

The Project Support Group’s work is organised in six result areas:Project implementation assistance, Organisational development support, Training, On-grant fund management, Intervention research, Strategic advocay and provides an outstanding example of effective technical support to a variety of partners in a variety of countries.

1. AIDS presentation
for Minister Jan Pronk, Minister for International Co-operation, Netherlands and Gro Harlem Brundlandt, then candidate for WHO General Secretary, 1997

2.Project Management Modules
for project co-ordinators and trainers of peer educators

Module 1: Overview
Module 2: Logframe
Module 3: Formative Research
Module 4: Participatory Approaches
Module 5: Quality Assurance
Module 6: Field support
Module 7: Monitoring and Evaluation
Module 8: Operations Research
Module 9: Financial Management
Module10: Project Report

3.Workplan 1996 – 2000
The plan contains
description of PSG’s approach
the project planning matrix (logframe)
an overview of project outputs from Bulawayo, Mutare and partially Kariba
an overview about advisory structures of the Project Support Group and a lot of very useful information from project operations,e.g. registers, forms, evaluation sheets, peer educator summary form, interview form etc.
project timeframe

4.Narrative report
for NORAD, 1.6.95 – 31.7.1996
The report contains
the impressive project planning matrix (logframe),
short reports on the six major activities:Project implementation assistance;Organisational development support
Capacity building linkages,Training, Training modules, Project research
and detailed financial summaries on actual expenditure.

5.Progress Report:
January 1997 – July 1998, submitted to Netherlands Embassy, August 1998
This report reflects new ways of the PSG in project implementation assistance
(e.g. development of country criteria, development of informal field support services by fostering mentoring links, grading of projects), growing organisational development support to several NGOs and new challenges in fund management, intervention research and strategic advocacy.

6.Proposal for intervention research, 1998
Targeted versus general population interventions for STD Control
The proposed intervention research would test the concept that high prevalence levels of STDs are sustained primarily by transmission within a subset of the poulation that is more likely to aquire and transmit infections. By focusing more intensive efforts on core groups with high rates of partner change, the research seeks to demonstrate that control of curable STDs is operationally feasible in southern Africa as in other parts of the world.

7.Adolescent Trial, research proposal,1998
The research project seeks to determine whether it is possible to reduce the cumulative incidence of HIV infection, STIs and unintended pregnancy among young people by means of an innovative, adolescent reproductive health intervention.
The intervention will comprise a school-based, peer-assisted sex education progamme in secondary schools combined with provision of youth friendly health services for young people.

8.Sex Worker Trial, research proposal, 1998
Main objective of the study is to test the effectiveness and cost-effectiveness of a combination of presumptive periodic treatment, condom promotion and peer education among a core group of sex workers in reducing the incidence of HIV infection among men working in mines and plantations

10. Peer AIDS Action in Kariba, project report,
1995 – 1996, Lake Kariba Research Station, University of Zimbabwe

11 .Peer Aids Action in Lusaka, project report,
Human Resource Trust, University of Zambia, Lusaka, Zambia, March 1997

12 .Peer AIDS Action in Lusaka, project report,
Human Resource Trust, University of Zambia, Lusaka, Zambia, July 1998
The report describes a set of peer action projects to reduce STD/HIV transmission in three low-income areas in Lusaka.

13. Peer Education to prevent STD/AIDS Transmission in Barbeton, Mpumalanga, South Africa,
project proposal 1998 – 2000 for German Foundation for World Population,
Mpumalanga Province, Peer Education Committee, SA

14. Peer education to improve sexual health among low-income women in Southern Africa,
Project Proposal International Family Health (IFH) in partnership with Project Support Group (PSG), November 1998

15. Impact evaluation of the Kariba AIDS project, August – October 1998, V.M. Valden, University of Manchester
The evaluation showed that behaviour change has taken place: increased use of condoms with casual partners among single women and reduction of sexual partners among men at a workplace.
The monthly RPR rates among antenatal women at the hospital and clinics have been reduced.

16.Regional partnerships to reduce HIV Infection and mitigate its impact in Southern Africa, 1998 – 2000, Project Proposal by PSG,
proposal evaluation by A. Krystall, prepared for the Royal Norwegian Government, June 1998
This report begins with a brief summary of relevant points concerning the PSG, the proposal and the PSG’s previous work in South Africa. It continues with an analysis of the proposal’s relevance, design and sustainability.The final section offers recommendations to NORAD and the PSG.

17. Focused Peer-Mediated Educational Programmes among Female Sex Workers, The Journal of Infectious Diseases 1996

Draft for GTZ Health Department by D.Luke, December 1998, dluke@web.de