Effect of a Peer Group Intervention for HIV Prevention on Rural Adolescents in Malawi

Background: Adolescents are especially vulnerable to HIV and many adolescents tend to rely on peers for information and guidance. This paper describes the impact of a community-based peer group intervention for rural adolescents' personal knowledge, attitudes and practices. Methods: A six session adolescent intervention, designed collaboratively with community leaders and parents, was facilitated by community-approved adults. A quasi-experimental design tested the effectiveness in two rural districts randomly assigned to the intervention/ control condition. Independent random samples of adolescents (10-19) were interviewed in both districts at baseline (n: 315/211) and 12 months post-intervention (n: 415/404). Results: Adolescents in the intervention district scored higher on HIV/AIDS knowledge. Differences in blaming persons with HIV were non-significant, but intervention adolescents had greater acceptance of HIV disclosure and contact with persons with HIV, more positive attitudes toward HIV testing, higher self-efficacy for talking about HIV prevention and practicing safer sex, and more discussion of safer sex with partners. Condom attitudes were not significantly different. Differences in whether currently sexually active or risky sexual behaviors were not significant, but sexually active adolescents in the intervention district reported more condom use (45% always vs. 20%). Intervention adolescents were more likely to have an HIV test and reported more community HIV prevention activities. Conclusions: A peer group intervention for HIV prevention was effective for rural adolescents. Community restrictions hampered full teaching for younger adolescents, potentially decreasing impact especially on sexual behavior, but after the intervention parents became more comfortable with the content for younger adolescents.