Strengths and limitations of a community-based sport and peer education program for HIV prevention: A qualitative study, Lusaka, Zambia 2010

Background: Sport and peer education have emerged as popular HIV prevention tools for Zambian youth. Despite program evaluations demonstrating initial success, there remains insufficient analysis of such initiatives. Research is needed to rigorously evaluate such programs to reveal unidentified strengths and limitations. Methods: Field ethnography and semi-structured informant interviews were conducted with a sport for development NGO providing HIV prevention education in Lusaka. Interviews explored the implementation processes and perceived consequences of the NGO's HIV/sport program. Interviews were conducted with program facilitators, teachers, parents, and agency executive staff. Thematic content analysis of qualitative data was conducted. Results: Analysis revealed two program strengths. First, peer educators exhibited high self-confidence and recognized how their roles/responsibilities positively influenced their own HIV prevention behaviors. Second, community and program informants expressed strong conviction that programming was effective in modifying youth's HIV-related knowledge, attitudes, and behaviors. Three overall limitations were identified. First, budget restrictions led to difficulty in employment and retention of talented facilitators and high variability in peer educator training and ability. Second, limited rigorous evaluation of the program's health outcomes hinders program sustainability and ability to attract greater funding. Third, Zambian traditional beliefs about HIV and relationships often oppose the program's explicit emphasis on sexual risk reduction. Conclusions: Despite positive effects on peer educators and the perceived efficacy of programming, there are key limitations that must be addressed. Future research must focus on resources for maintaining and training facilitators, rigorous analysis of health outcomes, and traditional beliefs that might be inconsistent with program messages.