Peer education training for sexual health and well-being in public high schools in South Africa: Is it enough to change peer educators themselves?

Objective: To evaluate the effects of a high school peer educator training programme on the sexual behaviour and related psychosocial outcomes of peer educators.

Method: A total of 728 students from 15 randomly selected public high schools in the Western Cape, South Africa, with a peer education programme and 15 matched comparison schools were recruited, comprising 295 students in the intervention group and 433 students in the comparison arms of the study respectively. Age of sexual debut, use of condom at last sex and psychosocial outcomes such as decision making, goal orientation, critical thinking and self-esteem were measured at baseline and follow-up 18 months later.

Results: At follow-up, there were no significant differences in the age of sexual debut, use of condom at last sex, goal orientation, critical thinking and self-esteem scores of the peer educators compared to students in the comparison group. Decision-making scores were significantly higher in the peer educators, compared to students in the comparison group (adjusted difference between means 0.14, 95% CI 0.02 to 0.26).

Conclusion: Even a highly intensive peer education training programme had limited effects for the peer educators themselves. It is clear that community factors, gendered power relations and poverty need to be addressed to have a lasting impact.