Evaluating HIV/STD Interventions in Developing Countries: Do Current Indicators Do Justice to Advances in Intervention Approaches?

Abstract

HIV continues to spread unabated in many developing countries. Here we consider the interventions that are currently in place and critically discuss the methods that are being used to evaluate them as reported in the published literature. In recent years there has been a move away from highly individualoriented interventions towards more participatory approaches that emphasise techniques such as community-led peer education and group discussions. However, this move towards more community orientated intervention techniques has not been matched by the development of evaluation methods with which to capture and explain the community and social changes which are often necessary preconditions for health-enhancing behaviour change. Evaluation research continues to rely on quantitative methodologies that fail to elucidate the complex changes that the newer interventions seek to promote within target communities. In addition, these methods of evaluation tend to rely on the use of highly individualistic and quantitative biomedical indicators such as HIV/STD rates, or knowledge, attitude, perception and behaviour (KAPB) survey questionnaires. We argue that such approaches are inadequate for the task of tracking and measuring important determinants of programme success such as psycho-social changes, features of the community-intervention interface and the degree of trust and identification with which members of target communities regard particular interventions. Rigorously conducted qualitative process evaluations taking account of the above factors could make a key contribution to the development of more successful HIV-prevention interventions.

Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth

“…Peer education has been described as "a method in search of a theory" (Turner & Shepherd, 1999) and it has also been argued that peer education "suffers from an inadequately specified theoretical base". (Milburn, 1995) This dearth of theory is reflected in existing research into peer education, which tends to take the form of quantitative outcome evaluations of interventions (MacPhail & Campbell, 1999). Such studies usually describe the extent to which programs result in changes in target individuals' HIV-related knowledge, attitudes and reported behaviours, with little systematic discussion of the processes whereby peer education has its allegedly beneficial effects on health.…”

HIV/AIDS prevention through peer education and support in secondary schools in South Africa

“…Programmes should be specifically developed to match the culture, age and sexual experience of participants and should address the underlying reasons for high-risk behaviour (Auerbach, Hayes & Kandathil, 2006;Kirby et al, 2006;Logan et al, 2002). Research results indicate that programmes that take into account the social and contextual factors related to HIV risk behaviour of the target population are more successful than programmes that do not (Campbell & Foulis, 2002;Logan et al, 2002;MacPhail & Campbell, 1999). Few interventions have, however, addressed these issues.…”

Creating contexts that support youth-led HIV prevention in schools

“…However, our ability to learn generalisable lessons from these patchy outcomes is limited by the lack of comprehensive theoretical frameworks conceptualising the array of multi-level factors that prevent or hinder the likelihood of health-enhancing behaviour change (MacPhail and Campbell, 1999;Waldo and Coates, 2000). Historically, research has tended to focus on two levels of analysis.…”