Impact of a Peer Group Intervention on Urban Health Workers in Malawi

Background: Health workers (HWs) in Malawi and other African countries have negative HIV knowledge, attitudes and behaviors that need to be improved. A peer group intervention used effectively for rural HWs was introduced for HWs in one of the four large referral hospitals of Malawi. Methods: Trained volunteer health workers and project staff provided a 10-session peer group HIV prevention intervention to 855 workers at all levels at a large urban hospital. Random surveys and observations of workers before (n=366/316) and 6 months after the intervention (n=541/308) assessed the impact of the intervention. Results: After the intervention, the HWs had significantly higher AIDS knowledge and more favorable attitudes, including less hopelessness about the epidemic, greater acceptance of HIV status disclosure, and more positive attitudes toward condom use. Acceptance of contact with persons living with AIDS was at the top of the scale at baseline. Safer sex behaviors did not increase, although other HIV-related behaviors were more favorable, including more partner communication about safer sex, more HIV testing, and greater involvement in community HIV prevention activities. Observed and reported hand washing increased. Workers did not report more glove use but had higher observed glove use. Reported and observed HIV teaching increased for both groups. Observed general teaching, respectful treatment and use of teaching demonstrations also increased. Conclusions: A peer group intervention improved urban workers' HIV-related knowledge, attitudes, some personal behaviors, universal precautions and client teaching. However, the focus on personal safer sex behaviors needs to be strengthened for urban health workers.