The purposes of this study were to develop and test the effectiveness of an HIV/AIDS peer education program in improving Nepalese adolescents HIV/AIDS knowledge and self-efficacy in one of the schools in Nepal. A modified format of the program "Teens for AIDS Prevention" (TAP) was used in this study. A quasi-experimental design was used to test the effectiveness of the peer education program. A convenience sample of 121 ninth grade Nepalese students from an urban high school participated at baseline. The final paired sample included 118 students. The results demonstrated a significant positive relationship between HIV/AIDS knowledge and self-efficacy. Nepalese adolescents' HIV/AIDS knowledge and self-efficacy improved after the peer education intervention. Therefore, school personnel, health care providers, and government and nongovernment organizations should consider developing and implementing school-based HIV prevention programs such as the peer education program.
Keywords: HIV knowledge; self-efficacy; peer education; adolescents; Nepal
Over the past decade, the prevalence of HIV/AIDS has grown in South Asia from negligible numbers up to an estimated 4.9 million people living with HIV/AIDS (Commission on AIDS in Asia, 2008). Globally, young people aged 15-24 years old account for 40% of new HIV infections (United Nations Children's Fund [UNICEF], 2009). Nepal, one of the developing countries, is in the midst of a "concentrated epidemic," and in the absence of effective interventions, AIDS will be the leading cause of death in the 15-49-year-old population over the coming years (Singh, Mills, Honeyman, Suvedi, & Pant, 2005).
Young people in Nepal are vulnerable to HIV/AIDS because of their poor knowledge of sexual health, unsafe sex practices, and limited use of condoms (Pokherel, Regmi, & Piedade, 2008). Furthermore, adults do not talk about issues related to sexuality openly, have limited access to information (Poudel, Nakahara, Poudel- Tandukar, Yasuoka, & Jimba, 2009), and inadequate HIV/AIDS content in the school curriculum. As is true of other adolescents, Nepalese adolescents have sexual curiosity that may lead them to risk behaviors. This age group should be targeted for prevention programs because it is possible to modify adolescents' behavior as they may not have developed unsafe practices or if developed, these behaviors are not deeply rooted. It has been well documented that HIV prevention programs, such as peer education programs, can change adolescents' risky sexual behaviors. However, many of these studies are conducted in developed countries. Therefore, the purposes of this study were to develop and test the effectiveness of an HIV/AIDS peer education program in improving Nepalese adolescents HIV/AIDS knowledge and self-efficacy in one of the schools in Nepal.
Nepal is a landlocked country bordered by China to the north and by India to the east, south, and west. The country has diverse cultures, traditions, and languages. The total area of the country is 147,181 sq km. Nepal has a population of 28.9 million people, and 38.3% of them are younger than 15 years old (The World Fact Book, 2010).
The first case of AIDS in Nepal was reported in 1988. The major transmission route of HIV/AIDS in this country is through unprotected sex and injecting drug use (United States Agency for International Development [USAID]/Nepal, 2010). This problem is further compounded by poverty, low levels of education, gender inequalities, stigma, and discrimination. The estimated number of people in Nepal who were living with HIV at the end of 2007 was 70,000 (USAID/Nepal).
Young Nepalese people are increasingly vulnerable to HIV because of changing values and group norms. Although traditional norms oppose premarital sex in Nepal, there are studies that indicate a growing trend toward premarital sexual activities among adolescents (Puri, 2002; Tamang, Nepal, Puri, & Shrestha, 2001). …