James Pang HE522 Professor Kilty 12/14/11

AIDS/HIV Peer Education Awareness: A Pilot Program

I) OVERVIEW
The HIV/AIDS epidemic in the district of Columbia is one of extreme severity and cause for concern. According to a city report released by Washington, D.C.s Department of Health in 2008, 3% of residents currently suffer from HIV/AIDS. Though this figure may seem small, it is important to note that the benchmark for a health issue to be considered a severe epidemic is actually accepted at 1% (as determined by the World Health Organization), a value that pales in comparison to the 3% of residents impacted by HIV/AIDS in the District of Columbia. Moreover, with 179.2 cases per 10,000 people, the District of Colombia actually has the highest rate of AIDS within the nation. One of the populations that is heavily influenced by the issue of HIV/AIDS within the District of Columbia is their youth. Various reports and studies have shown that the youth within the District of Columbia are generally unaware of the issue of HIV/AIDS even though it is so prevalent within their community. In hopes of combatting this issue, I have compiled a proposal for a three phase pilot program that aims to increase awareness through the means of peer education. Phase 1 will start small, with only nine schools, and will be followed by an evaluation. Phase 2 and 3, which will also be evaluated, are ultimately aimed towards expansion until we reach a total of 51 schools within the DC community.

II) COMMUNITY ASSETS AND NEEDS ASSESSMENT

The HIV/AIDS epidemic in the District of Colombia has significantly impacted DC youth. There are estimated to be 10,000 youth in the district ages 13-24, with one out of every hundred youth being infected or already suffering from full-blown AIDS. Since 1984, youth under the age of 25 have represented five to six percent of all the reported DC AIDS cases. The rate of AIDS incidence among youth unfortunately has only continued to grow, with sexually active young men from ages 13 to 24 experiencing a 900% increase of reported HIV infection and young heterosexual women of color by more than a third when compared to HIV rates among youth during the years 2001-2005. Sadly, only about half of all districts and young adults under 25 are even aware of their HIV status or have actively sought an HIV test.

According to DCs Department of Health, HIV infection among district youth is mostly due to unprotected sex, as few adolescents in DC engage in intravenous drug use. Though most of the HIV infections among youth are due to behavioral reasons, perinatally infected youth are also increasingly starting to represent a significant portion of those infected. Of the adolescents and young adults served at the Childrens National Medical Center Burgess Clinic, 57% acquired HIV perinatally, half of which are chronically ill. These perinatally infected adolescents often exhibit the same risky behaviors as their uninfected peers, and with a higher viral load are more likely to transmit infection within the community. This in combination with youth who lack awareness of their own HIV status, or may not even consider themselves at risk for HIV, proves to be extremely dangerous as perinatally infected youth may engage in unprotected sex with their peers. All in all, it is extremely important that youth receive proper education on the subject of HIV/AIDS, allowing for the maturation of perinatally infected youth and others who are ignorant of the subject. Seeing as HIV/AIDS among youth has been a long standing problem of the District of Columbia since 1984, there are already many organizations and health departments that are already active that may be utilized. It is most likely that this program will involve working closely with DCs Department of Health (DOH), which is where the majority of data for this proposal was collected, as well as the HIV/AIDS Administration (HAA). Both of these organizations have been collecting surveillance data for years, an asset that we cannot afford to ignore. Besides the obvious asset of using schools as an educational medium, it may also be wise to reach out to the parents or parent teacher associations (if they exist) of school communities for aid. Further community assets we may wish to seek out include forming partnerships with organizations as listed below: Department of Mental Health Maternal and Primary Care Administration Family Services Administration DC Public Schools DC Public Charter Schools Childrens National Medical Center Department of Human Services Metro Teen AIDS Sexual Minority Youth Assistance League Planned Parenthood DC Unity Health Care Steppin Up, Moving On Transgender Health Empowerment City Year La Clinica del Pueblo Street Corner Foundation Community Education Group American Psychological Association United Negro College Fund Special Programs

 National Network for Youth Figure 1: Proportion of Adults and Adolescents Diagnosed and Living with HIV/AIDS by current Age, District of Columbia, 2009 (Department of Health)

Figure 2: Living HIV/AIDS Cases and Rates among Adults and Adolescents by Sex, Race/ Ethnicity, and Current Age, District of Columbia, 2009 (Department of Health)

Figure 3: Pediatric HIV/AIDS cases by Year of Diagnosis, District of Columbia, 1999-2009 (Department of Health)

Figure 4: Perinatal HIV/AIDS Infections by Year of Birth, District of Columbia, 1999-2009 (Department of Health)

Figure 5: Proportion of Newly Reported AIDS cases by Age of Diagnosis and Persons Living with AIDS by Age at Diagnosis and Current Age in the District of Columbia, 2009 (Department of Health)

III) PROGRAM DEVELOPMENT AND PLANNING

Our mission for this program is to prevent AIDS incidence cases among youth through the means of peer education and increasing awareness. In completing our program, it is our hope that students of the community will all gain a firm understanding of the underlying causes of HIV/ AIDS and spread awareness as well as reduce any existing AIDS stigma or discrimination among the DC community. In particular, we hope that students will learn to understand the risks of unprotected sex and its role in spreading HIV/AIDS as it is the leading cause of HIV infections. Why Peer Education? Peer education is an approach to health promotion that involves placing students in the role of an educator, a method that is already widely used across the globe for the purposes of HIV/AIDS education. Not only has peer education been effective in the field of HIV/AIDS but it has also had many applications in helping drug abusers, sex workers, and other at risk youth. Peer education is based off the behavioral theory that many people may not necessarily make changes to their lives based on what they know but rather are impacted by the opinions and actions of their close peers. Other qualitative evaluations of school-based peer education have also shown that: Young people tend to be more positively influenced by a peer-led intervention Young people serving as peer educators are provided with a challenging and rewarding opportunity that will further aid their leadership and knowledge base skills. Moreover, it is highly likely that a peer educator will adopt his newly found knowledge to his/her own life. Peer educators can communicate and relate to students in a way that an adult or authoritative figure simply could not Peer education has had a positive impact on reported attitudes towards people living with AIDS. By utilizing members of the student community, peer education also tends to be a cost-effective strategy in spreading AIDS awareness. A cost-effective analysis was conducted on a Connecticut needle-exchange program for intravenous drug users in which a professional outreach model was compared to a peer-driven model of needle exchange over a two year period. Although both intervention models produced significant results, the study found that the peer driven model had actually reacher a larger population of injecting drug users and did so at one-thirtieth of the cost (Broadhead et al. 1998). Moreover, in a study conducted by the Population Council in Mexico, the program Prosuperacion Familiar Neolonesa (PSFN) was able to provide sexual health education through the method of peer education for one-third the cost of a fixed youth center model (Townsend et al., cited in Senderowitz, 1997). As one can see, the merits of peer education are quite numerous and hence a cost effective strategy that should be utilized in the District of Columbia.

Figure 6: Studies conducted by UNAIDS administration on the effectiveness of peer education towards AIDS related behaviors.

Program Plan: The concept of this AIDS awareness proposal is quite simple. Our aim is to increase AIDS awareness among the student community through the means of peer education. However without proper training, peer educators may distribute inaccurate or even completely incorrect information. Therefore, the first step in creating our program is to design a training system for these peer educators. At the most basic level, our plan is to send a representative, who will be a experienced health worker, to each school where he/she will recruit 6-10 students through an application process. After that, the representative will be responsible for meeting with these students once a week to educate and discuss on the topic of AIDS/HIV. Moreover, the representative will assign the students with a project, aimed towards educating their own school and peers, that is to be created and designed entirely by the students themselves that will be completed by the end of the school year. It is highly encouraged that the students be creative and use some form of artistic medium to spread their message. By the end of the year, it is our goal that we will have a group of students highly educated on the subject of HIV/AIDS as well as a student-created project that will be effective in educating the student community.

The pilot program will occur over three phases with each phase ending with some form of evaluation. Seeing as the program is new, it would be wise to start off small by only working with nine schools within the District of Colombia. Additional research may have to be done in deciding which schools should implement the program, however since AIDS is such a prevalent problem within the district, it would be hard to find a school that couldnt use some form of AIDS awareness program. The decision of which school should be picked will ultimately be the responsibility of the program director (staff will be discussed later within this proposal). This proposal suggests hiring three health workers experienced with HIV/AIDS education to work

with these nine schools, with each health worker being responsible for three schools. A sample schedule of what these health workers would be doing over a typical work week is as follows: Day of the Week Monday Tuesday Wednesday Thursday Friday Saturday Sunday Duties Preparation Preparation Work with students in School 1 Work with students in School 2 Work with students in School 3 Break Break

Further responsibilities of these health workers include designing a curriculum for the training of selected students from each school as well as supervising students in making sure they stay on task with their final project. Health workers should mainly utilize, though not necessarily limit themselves to, the method of discussion in educating students on the subject of AIDS. They should aim to foster a personal relationship with their students so that they may collaborate better and perhaps work together again in the future. It is further suggested that these three health workers also meet once a month and submit a report on student progress so that they may learn from each other and hence evaluate their own approach towards the educating of their students. Although the health workers are completely responsible for the training of the students, it is important to note that they must NOT play too active of a role in the final project that the students will be working on. Rather, it is their job only to review their project in making sure that the information they present is accurate and well-informed. Basic funding will be provided for the students but it is up to the students to manage their own budget. If a student group is to exceed their budget and find themselves in need of more money, it is their responsibility to come up with any additional funding whether it be through the means of a bake sale, donations, etc. Furthermore, the venue by which students will present whether it be a school assembly or some other location is also up to the students to organize. There is no doubt that the final project students will working on is quite demanding and it is up to the health worker working with each school to determine which students will be able to handle the workload and pressure. Some of the characteristics the health workers should be looking for in students include: Leadership skills which may be fostered and grown upon throughout the program Creativity and adept skill at some form of art whether it be visual, auditory, etc.

 Socially active students that are considered reliable sources of information by the student community. Willingness to be challenged. The procedure mentioned above concludes the general plan of phase 1. If phase 1 is found to be effective (through the evaluation plan that will be discussed later), phase 2 and 3 can then be initiated. The final two phases share the same basic strategy as phase 1 in increasing AIDS awareness but are ultimately geared towards expansion. Phase 2 involves reaching out to 21 additional schools, with evidence of program success from phase 1, while phase 3 involves reaching out to another 21 schools eventually leading to a total of 51 schools which is our final goal. Note that each phase will last the duration of a year. Staff Requirements and Responsibilities: Now that the basic strategy of the program has become clear, it is important that a plan for staff and management be formulated to ensure success. In phase 1, the number of staff should remain small as to save on costs and reduce the quantity of needed funds, thereby increasing the chances of getting a grant approved. However, seeing as staff size is to remain small it is critical that we place great emphasis on the quality of staff members. All staff members thereby should be experienced, able to adapt, and ultimately qualified for the job. At the management level, we will only need one staff member to monitor the three health workers, also known as a program director. The program director will be responsible for communicating with health workers in constantly trying to evaluate this proposed program and in doing so make changes along the way to better accommodate our objectives. Moreover, it will also be the program directors responsibility to work closely with the faculty of participant schools, including people like school principles, school boards, parents, and teachers. All in all, the program director will play a major role in program design and it is up to him/her to determine which nine schools to approach and work with. Moreover, the program director will also be the one who visits these schools in pitching the program to various school administrations, thereby also making him the marketer of the program. Methods in which the program can be marketed by the program director will be elaborated on later. Besides the program director and the three health workers, it is also important that we employ a survey company, which will be our main form of program evaluation. The following table summarizes the needed staff members for phase 1 of the program as well as their necessary qualifications and duties.

Phase 1: Staff Member Program Director (1) Qualifications - Adept leadership skills - Financial skills - Confidence/Ability to present project to schools - Enthusiasm - Public Health Experience - Experience with subject of HIV/ AIDS - Relatable, relaxed attitude for students - Passion - Marketing during phase 1 will be dictated by the program director as the program is still small and does not necessarily require any additional marketing - Experience with surveying students within school communities. - Utilizes survey strategy of sample populations Duties - Manage three health workers - Pitching program to school administrations (Marketing) - Evaluating the proposed pilot program - Working closely with schools to promote pilot program among students. - Training/educating students that are later to be peer educators - Monitoring student progress in terms of their final project - Responsible for working with students of three separate schools each - Not Applicable

Health Worker (3)

Marketing Team (0)

Survey Company (1)

- Survey sample populations both before and after program on the subject of HIV/AIDS to evaluate program success

As we expand the pilot program in phases 2 and 3, staff requirements also change drastically. With the addition of more health workers, it becomes impossible for program directors to both manage staff and promote the pilot program, thereby necessitating the employment of a marketing team. The need for any additional survey companies however tends to be highly variable in phases 2 and 3. If the program director decides to employ a small local survey company during phase 1, as to strengthen community partnerships and collaboration, he/she may find that the small company will not have the available resources to accommodate additional schools, in which case the program director will have to employ additional survey companies for the sake of program expansion. However, if the program director decides to utilize a large and well funded corporate survey company during phase 1, he/she should be able to employ the same company for phases 2 and 3. The downside to employing a large corporate company though lies in the fact that employing an outside company does not actually serve to strengthen community

cooperation. A third option that a program director may have is to utilize a small local company for phase 1 and then replace the company with a larger corporate one to reduce costs. This is not recommended however, as continuing the program by replacing a local company may be frowned upon by the members of the community. The employment strategy of using a survey company in phases 2 and 3 ultimately lie with the discretion of the program director. In the event that this pilot program is highly successful and worthy of even further expansion, it is possible that this program may foster a local survey company, helping them to expand as the peer education program grows also. Such an idea though is ultimately out of the scope of this proposal. Below we have two more tables, outlining the staff requirements, as well as their qualifications and duties for phases 2 and 3. Phase 2 Staff Member Program Director (1) Qualifications - Adept leadership skills - Financial skills - Confidence/Ability to present project to schools - Enthusiasm - Public Health Experience - Experience with subject of HIV/ AIDS - Relatable, relaxed attitude for students - Passion for promoting health - Experience - Creativity - Flexibility Duties - Managing ten health workers - Working closely with schools - Evaluating the proposed pilot program - Monitoring the marketing team

Health Worker (10)

- Training/educating students that are later to be peer educators - Monitoring student progress in terms of their final project - Responsible for working with students of three separate schools each - Pitching program to school administrations - Working closely with schools to promote pilot program among the students themselves - Survey sample populations both before and after program on the subject of HIV/AIDS to evaluate program success

Marketing Team (1)

Survey Company (1 or more)

- Experience with surveying students within school communities. - Utilizes survey strategy of sample populations

Phase 3 Staff Member Program Director (1) Qualifications - Adept leadership skills - Financial skills - Confidence/Ability to present project to schools - Enthusiasm - Public Health Experience - Experience with subject of HIV/ AIDS - Relatable, relaxed attitude for students - Passion for promoting health - Experience - Creativity - Flexibility Duties - Managing ten health workers - Working closely with schools - Evaluating the proposed pilot program - Monitoring the marketing team

Health Worker (17)

- Training/educating students that are later to be peer educators - Monitoring student progress in terms of their final project - Responsible for working with students of three separate schools each - Pitching program to school administrations - Working closely with schools to promote pilot program among the students themselves - Survey sample populations both before and after program on the subject of HIV/AIDS to evaluate program success

Marketing Team (1)

Survey Company (1 or more)

- Experience with surveying students within school communities. - Utilizes survey strategy of sample populations

Funding: Projected Cost Allocation Annual Cost Program Director $100,000 Health Worker 1 Health Worker 2 Health Worker 3 $50,000 $50,000 $50,000 Benefits Cost (60% of Annual Cost) $60,000 $30,000 $30,000 $30,000 # of Months 12 12 12 12 Total Cost $160,000 $80,000 $80,000 $80,000

Annual Cost Survey Company $60,000 Equipment Miscellaneous costs Office Rental Student Budget Phase 1 Totals Health Worker 4 Health Worker 5 Health Worker 6 Health Worker 7 Health Worker 8 Health Worker 9 Health Worker 10 Marketing Team Equipment Miscellaneous Costs Student Budget Phase 2 Totals Health Worker 11 Health Worker 12 $3000 $5000 $60,000 $6300 $384,300 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $50,000 $100,000 $6000 $7500 $21,000 $868,800 $50,000 $50,000

Benefits Cost (60% of Annual Cost) N/A N/A N/A N/A N/A $150,000 $30,000 $30,000 $30,000 $30,000 $30,000 $30,000 $30,000 $60,000 N/A N/A N/A 420,000 $30,000 $30,000

# of Months 2 12 12 12 12

Total Cost 60,000 $3000 $10,000 $60,000 $6300 $534,300

12 12 12 12 12 12 12 12 12 12 12

$80,000 $80,000 $80,000 $80,000 $80,000 $80,000 $80,000 $160,000 $10,000 $23,000 $21,000 $1,288,800

12 12

$80,000 $80,000

Annual Cost Health Worker 13 Health Worker 14 Health Worker 15 Health Worker 16 Health Worker 17 Equipment Miscellaneous Costs Student Budget Phase 3 Totals $50,000 $50,000 $50,000 $50,000 $50,000 $9000 $10,000 $35,700 $1,273,500

Benefits Cost (60% of Annual Cost) $30,000 $30,000 $30,000 $30,000 $30,000 N/A N/A N/A $630,000

# of Months 12 12 12 12 12 12 12 12

Total Cost $80,000 $80,000 $80,000 $80,000 $80,000 $9000 $10,000 $35,700 $1,903,500

The two tables above represent the projected costs as well as their allocations for all three phases of this pilot program. Note that these projected costs may be subject to further change as this program is evaluated and revised in between phases. Moreover, the table above also makes some assumptions such as the employment of only one survey company through all three phases even though that is really up to the discretion of the program director. For the first phase, the majority of funding should come from government grants, which may be applied for online at www.grants.gov. Ideally, we would want to apply for a grant from Washington, D.Cs own department of health in hopes of strengthening community bonds, though applying for a grant on a federal level (such as the CDC), would be acceptable as well. As the program moves past phase 1 and starts gaining momentum as well as recognition within the community, other sources of funding should start to be explored too. In particular, the program director should aim to stir public interest by presenting program success from phase 1 to various other local community agencies, such as the ones listed on page 2. And in doing so allow the whole community to become involved as well as receive additional funding from local organizations and sponsorships. One organization that the program director should definitely consider approaching are the parent-teacher associations, if they exist, of the schools involved in

phase one. Having already worked closely with these schools, it is very likely that these schools will be more than willing to support our program. Members of the PTAs who are particularly active may even decide to take it one step further and start their own fund-raising initiatives, an asset that we cannot afford to lose. When the program reaches phase 3, it is assumed that the program will have much better access to community assets to draw funds from as the program did initially in phase one. It is at this point that the program director should consider exploring funding opportunities outside of the community. Although there are many, I believe that the most effective method would be to invest in a public website that will not only function as a source of AIDS education but also as a source for receiving donations across the nation. This of course would require that the program director hire some form of website design company as well as the purchase of an online domain space. Both of these costs can prove to be quite expensive so this course of action should only be explored under the ideal conditions of having received ample funding from local community agencies and government grants. Below is table summarizing the costs of each phase as well as their possible sources of funding. Phase # 1 2 Cost $534,300 $1,288,800 Sources of Funding - Government Grants - Government Grants - Local Funding - Donations from Community Agencies - Parent-Teacher Associations - Student organizations - Other community fund-raising initiatives - Government Grants - Local Funding - Donations from Community Agencies - Parent-Teacher Associations - Student organizations - Other community fund-raising initiatives - Website donations - Government Grants - Local Funding - Donations from Community Agencies - Parent-Teacher Associations - Student organizations - Other community fund-raising initiatives - Website donations

$1,903,500

TOTAL (Over Course of Three Years)

$3,726,600

IV) PROMOTION AND SUSTAINING THE INITIATIVE

During phase 1 of this pilot program, promotion and marketing will fall under the jurisdiction of the program director. It will be up to the program director to arrange meetings with school administrations, where he/she will pitch the program to the school. Although phase one aims for nine participant schools, it is likely that the program director will have to make appointments with at least 15-20 schools as not all will be willing to accept a new program. After the program is approved by a school administration, the program director should then work closely with higher ranking members of the school, such as the principle, to arrange a school faculty meeting where school staff can be briefed on the program. From this second appointment, the program director can then determine which staff members are willing to be involved. In particular, the program director should seek out the aid of the schools health department, as health teachers are more likely to promote the program among students. Note that health workers that are to be training the students should also be present at these faculty meetings. The next step after the program director and health workers figure out the logistics of working with a specific school is to promote the program among the students themselves. Promotion among students should be simple and relatively cheap during phase I as we will not necessarily have the resources of extravagant advertising. The promotion of the program among students should be the responsibility of the health workers. Health workers should work with the school to organize a school assembly at the beginning of the year where they are encouraged to utilize creativity, ingenuity, and fun to prepare a presentation for the students. In particular, health workers should highlight the leadership opportunities of choosing to be part of the program as a peer educator as our main objective is to draw in students. Although the topic of HIV/AIDS is very serious, health workers should aim to make their presentation light hearted and accessible to students. Whether the three employed health workers decide to do these presentations together or individually is entirely up to them. At the end of the assembly, health workers should wait outside the doors of the assembly hall or classroom to answer any questions students may have as well as hand out applications (designed by the program director) for signing up as a peer educator for the program. Health workers should also set up a drop box in the main office of a school so that interested students have a convenient place to hand in their applications. Additional ways of promoting the program may be through the means of morning announcements, posters, fliers, and the distributing of AIDS awareness ribbons at the entrances of schools on the morning of the assembly. Note that some parents may actually be upset that their child is to be educated on the subject of sex and drugs in discussing the issue of HIV/AIDS, which can lead to disrupted development of the program. To minimize this, the program director should only approach high schools where most parents are okay with their children learning about adult topics. Moreover, health workers should also work with participant schools a few weeks in advance to the assembly in distributing signatory parent approval forms for students to take home so that they receive a parent/

guardians permission in attending the assembly. It is also important to have a signatory parent approval slip as a part of the peer education applications. The above paragraphs describe the method in which the program should be promoted within participant schools. However, as we move on to phase 2 it becomes important that the program also be promoted among local agencies so that we can gain the proper resources for the purposes of expansion. Rather than promoting education, it now becomes the program directors job to promote community progress. Seeing as there are so many agencies to be approached, it is now essential to hire a marketing team. Members of the marketing team should formulate some form of formal presentation and arrange meetings with the appropriate agencies in trying to gardner community interest. Their presentation should focus on the objectives as well as strategies of the program instead of the subject matter of HIV/AIDS itself. Moreover, the presentation should also place heavy emphasis on the progress made in the nine schools from phase 1 and include a statistical analysis. Additional promotion strategies the marketing team may wish to explore include distributing fliers on the street to stir public interest or even advertising through media such as radio and television. As the program progresses into phase 3, it becomes no longer possible for the program director alone to promote the program among schools as there are 51 schools and thereby 51 appointments and collaborations to be done. The program directors next course of action should then be to promote able and qualified health workers that were hired during phase 1 and 2 to approach the bulk of interested schools. More importantly, health workers should aim to maintain ties with the schools that they had already worked with so that the program can be implemented once more with greater productivity. Although promoting newly hired health workers in phase 3 is also an option, this is not preferable as they lack the experience that previously hired health workers have. It is up to the program directors discretion as to how many and which health workers deserve to be promoted. Promotion of course entails increased salary and benefits, another factor that the program director should consider. Note that after a health worker is promoted, their workload will be significantly increased, as they must still remain active in training students to become peer educators. Therefore, it may be wise to present students who have completed the program with an internship opportunity to aid these health workers, further fostering leadership skills among community youth. To lessen the workload pressure that newly promoted health workers experience with program expansion, the marketing team should aim to make local schools aware of the programs existence. In doing so, health workers need not necessarily seek for schools but can have the interested schools approach them instead. The only way that this can really be done is advertising through various social media including school newsletters, television, and radio. If the program director decides to invest in a website as mentioned above then that can also be used as a means of promotion. Moreover, local community agencies that see promise in our program can also become involved in promotion.

V) EVALUATION
As with any community health program, it is highly important that we form a program evaluation plan. This program can be evaluated from the three vantage points of 1) the students being educated, 2) peer educators, and 3) health workers. In order to assess the level of success of the program itself, it is critical that we employ a survey company to survey students on the subject of AIDS both before and after each successive phase. The survey companies are also going to have to coordinate with participant schools to determine the method of taking the survey, whether it be online or on paper, a survey taking time period, and how to assure parent/guardian approval on taking the test as it will deal with the subject of sex and drugs. Although the questionnaire that these survey companies come up with should pertain to the whole subject matter of HIV/AIDS in a comprehensive matter, it is important that they place a heavy emphasis on the subject of sex and how it relates to HIV/AIDS seeing as the leading cause of HIV/AIDS infection among youth is due to risky sexual behavior. Questions dealing with the science and history of AIDS should be minimized as they are not necessarily that important in reducing transmission among youth. Another aspect of HIV/AIDS that the survey companies should place greater emphasis on is the subject of transmission. Not only does knowledge on HIV transmission prevent infection but it also serves to reduce AIDS stigma as people begin to realize HIV/AIDS is not immediately contagious. The survey company should design several different questionnaires using these guidelines and should use a different questionnaire in testing students before and after they have been educated by their peers. Moreover, the survey company will also be responsible for conducting a statistical analysis to determine whether the difference between the test scores of the questionnaires can actually be considered significant. In further evaluating this pilot program, it is also important to receive the opinions of the students who are being trained to become peer editors. To do so, the program director should design an anonymous teacher evaluation form in which students can assess the health workers that are training them. The evaluation form should focus on things such as teacher accessibility outside of the classroom, relevance of readings that a health worker may assign, and the level of communication between students and health workers. In addition, the evaluation form should also include a series of questions pertaining to the effectiveness of the program itself. Questions such as: In your opinion, what were the strengths of the program? Did you feel that it was effective in educating your peers on the subject of HIV/AIDS? In your opinion, what were the weaknesses of the program? Did you feel that there were any particular factors that got in the way of educating your peers? If you could make any changes to the program? What would they be? After having completed and compiled these evaluation forms, the program director should be able to learn what works and what doesnt work in the training of peer educators and implement those observations into changing the program for the better. These evaluation forms should be conducted at every school at the end of each successive phase.

Finally, it is also critical to receive feedback from the health workers who are training the students in evaluating this pilot program. As mentioned earlier, health workers should meet once a month and discuss student progress as well as what teaching strategies they find to be particularly effective. They should also discuss any potential problems that they find with program design and compile all of these into a report, that is to be submitted to the program director. The program director is then responsible for reviewing these reports and making any changes that he/she finds appropriate.

References Broadhead R et al. The impact results of a peer-driven intervention to combat HIV among drug injectors. XII International Conference on AIDS, Geneva, 1998. Busayawong W et al. HIV/AIDS peer education for Northern Thai single migratory female and male adolescent factory workers. XI International Conference on AIDS, Vancouver, 1996. Davids J et al. Adapting treatment education trainings for three populations of people with HIV/ AIDS. XII International Conference on AIDS, Geneva, 1998. Fee N, Youssef M. Young people, AIDS and STD prevention: experiences of peer approaches in developing countries. Geneva, World Health Organization, Global Programme on AIDS, 1994. Flanagan D et al. Peer education in projects supported by AIDCSAP: a study of twenty-one projects in Africa, Asia and Latin America. AIDSCAP/FHI, 1996. Flanagan D, MAhler H. How to create an effective peer education project: guidelines for prevention projects. AIDSCAP/FHI, 1996. Maclaren-Ross S, Baker H. A training program for HIV/AIDS peer support counselors. XII International Conference on AIDS, Geneva, 1998. Rossi P, Freeman H. Evaluation: a systematic approach. Newbury Park, Sage Publications, 1993. Svenson G. European guidelines for youth AIDS peer education. European Commission, 1998. Sweat M. Cost effectiveness of HIV prevention in developing countries. NIMH First Award Grant Application, 1996. United States of America. Washington, D.C. Department of Health. HIV/AIDS, Hepatitis, STD, and TB Administration. District of Columbia Annual Report 2010. Ed. Michael Kharfen, Jeffrey Coleman, and Tashrik Ahmed. HIV/AIDS, Hepatitis, STD, and TB Administration, 2010. Web. 14 Dec. 2011. <http://dchealth.dc.gov/doh/frames.asp?doc=/doh/lib/doh/services/ administration_offices/hiv_aids/pdf/2010_Annual_Report_FINAL.pdf>. United States of America. Washington, D.C. Department of Health. HIV/AIDS Administration. District of Columbia Annual Report 2010. Prevention and Intervention Services Bureau, 27 June 2010. Web. 14 Dec. 2011. <http://dchealth.dc.gov/doh/frames.asp?doc=/doh/lib/doh/services/ administration_offices/hiv_aids/pdf/hiv_youth_prevention_initiative_4.pdf>. UNAIDS Technical Update: Cost-effectiveness analysis and HIV/AIDS. Geneva, 1998.