Educating Youth in Knowledge of HIV/AIDS in Lesotho, Southern Africa: A Pilot Comparison of Peer-Led and Adult-Led Approaches

Purpose: Lesotho is part of eight countries in Southern Africa that comprise the global epicenter of the HIV/AIDS epidemic. In 2007, 23.2 percent of population had HIV/AIDS in Lesotho. Young women between 15-24 years were 2.39 times more likely to have HIV/AIDS than males, and accounted for 57 percent of cases. Disturbingly, knowledge about HIV/AIDS still lags among youth. World Health Organization (2006) noted that youth aged 15-24 are at the center of all new infections. Recently, Lesotho's Ministry of Health and Social Welfare implemented a National Adolescent Health Promotion program with goals to raise awareness and increase knowledge of HIV/AIDS and other health issues among youth through workshops in schools. This study gauged effectiveness of this program by empirically comparing Peer-led versus Adult-led delivery of this sex-education. Based on prior research, the study hypothesized that Peer-led approach would show more impact than Adult-led approach on knowledge of HIV/AIDS and attitude toward abstinence, while controlling for youth self-efficacy, and demographic factors.

Method: Social Learning Theory framed the study. The design included a randomized quasi-experimental pre-post comparison of Peer-led and Adult-led education in two Lesotho high-schools. These schools were conveniently selected through collaboration with local Mafeteng-district authorities. One-hundred-eighty students were randomly selected from grades 11 and 12, thus each school provided 90 youths, who were then randomized into Peer-led and Adult-led education. Instruments included HIV-Knowledge Questionnaire (Carey & Schroeder, 2002), Attitude toward Abstinence (Miller, et al., 1998), and Risky Situation Self-Efficacy Scale (Reese & Vera, 1995). Although English is used in schools, all measures were pretested with similar students in another school using focus groups to assure cultural-linguistic salience. Informed parental consent and youth assent were obtained through expected local education channels. University-IRB approved the study. Statistically, measures of central tendency and variability described youth-participants. Three ANCOVAs [GLM model] tested each outcome by type of education while controlling for the effects of pre-tests, and all other variables. Analytical assumptions including regression of slopes were met. Bonferonni correction set alpha at .017 of statistical significance.

Results: One-hundred-seventy-two youths completed education workshop; 52% were girls; 56% were 16-19, rest, 20-22 years. Demographics did not show significant variance. Findings showed that modeled-ANCOVAs significantly explained 18 percent of variance in post-knowledge, 39 percent of post-self-efficacy, and 24 percent of post-attitude. Youths significantly improved their knowledge (p<.001) and self-efficacy (p<.001), but not attitude toward abstinence (p=.11) from pre-test to post-test. Peer-led education showed slightly more increase in knowledge than Adult-led (borderline-significance, p=.051) approach. Gender and age showed significant interactive effects (p<.01). Masentle-school girls had gained more knowledge than boys, while JB-school girls had less knowledge than boys. Girls had gained more self-efficacy than boys, but boys became more pro-abstinence than girls. Younger students showed less self-efficacy but more pro-abstinence than older youths. Results' limitations are considered.

Implications: Findings suggest that peer-led application of this curriculum may have more salience but further research is needed. Social workers need to be informed of the potential benefits and limits of this curriculum and assessment instruments.