Peer education interventions for HIV prevention and sexual health with young people in Mekong Region countries: a scoping review and conceptual framework

Abstract

WHO-recommended rights-based approaches to sexual health emphasise participatory and youth-centred processes. Among these, peer education (PE) interventions are commonly used to promote HIV prevention and sexual health for young people, particularly in low-resource, high HIV prevalence contexts. We conducted a scoping review to identify key characteristics, implementation challenges, and knowledge gaps in the literature regarding PE interventions in Mekong Region countries. Out of 6521 publications identified through database searches, 17 peer-reviewed articles were included in the review ( n = 21,469 participants). Studies from Thailand ( n = 7), Vietnam ( n = 5), Myanmar ( n = 3), Cambodia ( n = 1), and Lao PDR ( n = 1) included adolescent and young key populations ( n = 11) and general population youth ( n = 6). Findings from quantitative (descriptive) and qualitative (thematic) analysis illustrate benefits and challenges of various elements of multicomponent PE interventions in reaching vulnerable young people and improving HIV prevention and sexual health outcomes. Focal knowledge gaps emerged in regard to peer educator outcomes (increased knowledge, skill-building, empowerment); interpersonal processes between peer educators and young people (role modelling, social dynamics); and social-structural contexts (sociocultural influences, gendered power relations), which may affect PE programme implementation and effectiveness. Future research should evaluate the potential benefits of complementing evidence-based intervention approaches – focused predominantly on assessing individual-level behavioural outcomes conceptualised as external to PE programmes – with evidence-making intervention approaches that support rights-based PE programmes: incorporating a focus on dialectical and relational processes between peer educators and young people; assessing salutary outcomes among peer educators themselves; and evaluating the situated implementation of youth-engaged PE interventions in complex sociocultural systems.

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Mapping projects for expanding rapid HIV testing in key populations, Brazil, 2004-2021

“…The international literature lists a series of successful interventions worldwide where peer-educators were a key asset and have been fully incorporated into standard protocols. Newman et al’s 31 scoping review summarize these relevant findings for a pool of countries on the Mekong Region.…”

“…The international literature lists a series of successful interventions worldwide where peer-educators were a key asset and have been fully incorporated into standard protocols. Newman et al's 31 scoping review summarize these relevant findings for a pool of countries on the Mekong Region. Another important strategy that requires further detailed analysis is the distribution of self-tests to adolescents and youth, as in the Live Better Knowing Young project in Recife.…”

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“…These interventions have aimed to leverage the power of social networks to increase awareness, promote education and reduce barriers to accessing PrEP and other forms of HIV prevention (39,40). We encourage researchers and HIV prevention program implementers to explore these approaches, considering that it has been successful in previous studies in reaching MSM for intersectional stigma, HIV prevention, and testing interventions in Ghana (32,(41)(42)(43) and has been successful in contributing to an increase in PrEP uptake elsewhere (44,45).…”