‘Whatever I was saying, he came up with his opinions as well.' Interaction between HIV/AIDS peer educators and peers: A grounded perspective on Horizontal and Vertical Health Communication

Background: A critical debate within heath communication is the importance of horizontal and vertical components. In South Africa tens of thousands of peer educators have been trained on HIV and AIDS. Typically, such peer educators are utilised within vertical communication programmes as transmitters and translators of health messages. Methods: Thirty workplace HIV/AIDS peer educators from a South African company participated in a five-month action research project. Using dictaphones they documented their communication with peers. Focus group discussions and in-depth interviews further explored these reported interactions. Results: In contrast to the company programme's emphasis on delivering simple messages to peers and avoiding entanglement in complex discussions, many peer educators reported frustrations when peers responded with their own ideas and theories about HIV/AIDS. These differed, in content and behavioural implications, to that they had been trained to deliver. Their inability to respond in the idiom of peers and the alternative of promising to respond later after consulting with a health professional were both regarded as undermining their credibility and effectiveness. Conclusions: Viewed from below, communication between peer educators and peers over HIV/AIDS sheds light on the relative merits of vertical and horizontal communication. The paper argues that greater attention needs to be paid to the nature of peer-to-peer communication, the implication sthis has for health communication, and a need to re-engineer peer educator training to allow engagement both with the beliefs of peers as well as expert knowledge.