Peer education improves uptake of sexual health services

A team of researchers from the University of Glasgow and Glasgow Caledonian University have studied the effects of a peer education intervention among gay men who frequent the gay bars of Glasgow.

In the United States peer education has been shown to encourage the uptake of safer sexual behaviours among gay men. In Scotland, men who have sex with men represent the group most likely to contract HIV. Over one third of gay men in Scotland reported recent unprotected sex, and new diagnoses among gay/bisexual men in Scotland have remained fairly constant over the past 10 years with between sixty and eighty new infections being diagnosed annually. In the United Kingdom, research has yet to demonstrate the effect of peer education on sexual behaviour.

In 1997 a number of agencies in Glasgow combined their preventive efforts to form the Gay Men’s Task Force (GMTF). In total, 42 peer educators were trained and employed and dispatched to gay bars to encourage gay men to reduce their sexual risk behaviour for HIV and increase their uptake of sexual health services, in particular, hepatitis B vaccination.

The intervention lasted nine months, during which time the educators reported contact with 1484 men in all five of Glasgow’s gay bars. The educators would hand out printed material on sexual health and behavioural issues, and strike up conversations with the customers in the bar. The conversations would cover sexual health issues such as HIV testing, hepatitis B vaccination, sexually transmitted infections, condoms and lubricants.

Seven months following the completion of the intervention a team of trained researchers returned to the bars and asked customers to complete a short questionnaire which explored their recent sexual behaviour, sexual health service use and recollection of contact with the GMTF initiative.

Questionnaires were completed by 1442 men. Half of the sample were aged between 26 and 36 years. The sample was sexually active with 93% reporting some sexual contact and 75% reporting anal sex with at least one man in the previous year. One third had reported use of a sexual health clinic in the previous year, with 45% having visited the Steve Retson Project (Glasgow’s gay-specific sexual health clinic).

The GMTF symbol was recognised by 42% of men and almost a third reported talking with a GMTF educator on at least one occasion. The intervention reached men of all ages and social classes. Men who came into contact with one of the peer educators were significantly more likely to report GUM clinic use than non-contact men. Men who reported talking to peer educators more than once were more likely to report hepatitis B vaccination, HIV testing and sexual health service use.

Sexual risk behaviour was only lower among men who reported multiple contact with peer educators.

The peer educators themselves reported that it was easier to discuss sexual health matters than safer sex behaviour, and this may account for the failure of the intervention to effect sexual behaviour change, but also its success in increasing the uptake of sexual health services.

Service uptake at the Steve Retson Project increased significantly after the intervention started and was maintained after the intervention ended.

The authors concluded that “it is clear that continuing sexual risk behaviour among Glasgow’s homosexual men requires further targeted prevention strategies if reductions in this behaviour are to be achieved”.