Cutting through the stigma

April 17, 2008

Training community members such as barbers as peer educators can be an effective way of spreading information on HIV/AIDS throughout low-literacy, rural communities, say findings published this week in the open access journal Human Resources for Health.

Lead researcher, Koen Van Rompay, and colleagues from Sahaya International, the University of California and READ (India) recognised that rural communities are often neglected when it comes to HIV awareness programs. Such programs tend to focus on high-risk groups in urban parts of India - despite much evidence that HIV has spread to the general population. What's more, education programs aimed at rural populations face particular challenges. Basic health-care infrastructure tends to be minimal, and there is often low awareness and high stigma regarding HIV (and sexual issues in general), fuelled by low literacy, seasonal migration, gender inequality, spatial dispersion and cultural taboos.

In a year-long pilot project, sponsored by the Elton John AIDS Foundation, six non-governmental organisations (NGO) collaborated to build and test an HIV peer education model for communities in the rural district of Perambalur in Southern India. As part of the program, 20 NGO outreach workers, 52 barbers and 102 women's self-help group leaders were trained to be peer educators. Cartoon-based materials including flipcharts, booklets and stickers were developed to teach people about their susceptibility to HIV/AIDS and to suggest practical ways to reduce the risk of infection. Street theatre was used to highlight issues related to HIV and stigma in the community.

Over 30,000 villagers have been reached by the program, which comprised over 2000 activities. The outreach workers and peer educators distributed over 60,000 educational materials and nearly 70,000 condoms. At least 118 people were newly diagnosed as living with HIV and 129 people with HIV were referred to hospitals for extra medical support.

Van Rompay concludes: "In many remote rural communities, there are ordinary people with little or no academic credentials, but who with proper training and equipped with appropriate materials can be empowered to cross their personal boundaries and become extraordinary peer educators and voices for change in their own communities. The current project indicates that more effort is warranted to tap into this large unrecognized force."

Other positive effects of the program were noted. Women trained as peer educators enjoyed a sense of pride and increased social recognition, which the researchers hope could help sustain the peer dialogue on HIV/AIDS. After training on the blood-borne transmission of HIV, the barbers involved began to use disposable razor blades, which led to an increase in customers.
Notes to Editors

1. Empowering the people: development of an HIV peer education model for low literacy rural communities in India
Koen K.A. Van Rompay, Purnima Madhivanan, Mirriam Rafiq, Karl Krupp, Venkatesan Chakrapani and Durai Selvam
Human Resources for Health (in press)

During embargo, article available here:

After the embargo, article available at the journal website:

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

Article citation and URL available on request at on the day of publication.

2. Human Resources for Health is an Open Access, peer-reviewed, online journal covering all aspects of planning, producing and managing the health workforce - all those who provide health services worldwide.

3. BioMed Central ( is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.

BioMed Central

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