Impact of a Peer Group Intervention for HIV Prevention on Rural Adults in Malawi

Background: This paper reports the impact of a peer group intervention on the knowledge, attitudes and practices of rural adults in Malawi, where HIV prevention is urgently needed. Trained volunteer community health workers and adults provided a 6-session intervention to over 2200 adults in eight communities.

Method: A quasi-experimental design tested the effectiveness of the intervention in two rural districts randomly assigned to the intervention or control condition. At baseline, there were no significant differences between the two districts. A midterm evaluation of 180 adults in the intervention district and 176 in the control district was conducted approximately 9 months after the initiation of the community intervention.

Results: Adults in the intervention district had significantly higher AIDS knowledge and attitudes more favorable to HIV prevention, including less hopelessness about controlling the HIV epidemic, greater acceptance of casual contact with persons with HIV, more positive attitudes toward condom use and HIV testing and higher self-efficacy for talking about HIV prevention in the community and practicing safer sex. HIV-prevention related behaviors were also more favorable in the intervention district, including more partner communication about safer sex, fewer risky sexual behaviors as measured by an index of six risky behaviors, and greater reported involvement in community HIV prevention activities for the intervention compared to the control district.

Implications: A peer group intervention for HIV prevention can be effectively delivered to rural adults using trained volunteer health worker and community leaders.