title: Training outreach workers for AIDS prevention in rural India: is it sustainable?
abstract: Through a process of community diagnosis and participation, a non-governmental organization in rural Karnataka state in India selected and trained peer outreach workers to implement and sustain AIDS prevention education activities. This activity was part of a larger AIDS education project that aimed at creating awareness and promoting risk-reducing behaviours in the community. This paper describes efforts of the project to identify and train peer educators during its implementation phase and discusses strategies used to facilitate sustainability. We evaluate the impact of these efforts by conducting an analysis in the project area 2 years after the end of the project. The findings reveal generalized interest among rural communities in HIV prevention issues. The project originally conducted an extensive survey to understand community organization and composition, which helped to identify potential partners and peer educators. Training peer educators was a multi-step process, and one with high attrition. While individual peer educators were an excellent resource during the life of the project, peer educators affiliated with village level institutions had the interest, access to resources and willingness to sustain project efforts. However, the sustainability of their efforts was associated with the quality of interactions with the project implementation team, the strength and leadership of their own institutions, the perceived benefits of implementing AIDS education activities after project life and the gender of the outreach worker. Non-sustainers did not have an organizational structure to backstop their work, were often poor and unemployed persons who later found gainful employment, and overwhelmingly, were female. We present a conceptual model based on these findings to help future projects plan for and achieve sustainability.
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA. ssivaram@jhsph.edu
authors.forename: S
authors.initials: S
authors.lastname: Sivaram
authors.forename: D D
authors.initials: DD
authors.lastname: Celentano
mesh_terms: D003150:Community Health Workers / Q000193:education*; D003159:Community-Institutional Relations; D015658:HIV Infections / Q000517:prevention & control*; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D007194:India; D009938:Organizations; D010379:Peer Group; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration; D000078329:Workforce