We are here to promote self-worth for the girls, especially self-esteem to empower them to make good and healthy decisions for the future.

-- Keleigh Matthews, Metro TeenAIDS, Washington, D.C., 2000

We believe that empowering gay youth and building a strong gay community are as important to HIV prevention as teaching them how to use condoms.

-- Gay City, Seattle, Washington, 2001

Communities affected by AIDS also have great strengths. One of the most important strengths is the presence of ordinary people who are willing to help in the fight against AIDS. . . . Interventions developed and carried out not just by professionals but in concert with community members themselves have great potential because they are owned by community members and draw upon their power through the strengths of its people.

-- Jeff Kelly, 2000

Community-based organizations, often in partnership with researchers, grantmakers, and government, are developing innovative HIV prevention programs for youth. This chapter describes several CBO programs and one state health department initiative that translate findings from prevention science into behavioral and community-level interventions for adolescents and young people. Each of the programs highlighted features peer education or social marketing -- two approaches that have been shown to be especially effective with young people -- or combines both strategies.

Program Highlights

AIDS Alliance and AIDS Action spoke with youth-serving and HIV prevention organizations across the country to identify programs that are using peer education and social marketing to reach young people with HIV prevention messages. The examples that follow reflect the rich diversity of such programs in terms of geography, populations of young people served, and sponsoring organization. Three of the five programs profiled are in community-based organizations dedicated to HIV prevention, two are parts of organizations with much larger missions, and one is sponsored by a state health department.

Queercore Peer Education and Social Marketing

Queercore, a program for men under 30, is part of Gay City, a community-based HIV prevention organization in Seattle, Washington, where 75 percent of new infections in the county each year remain among men who have sex with men. Gay City's mission is to promote gay and bisexual men's health and prevent HIV transmission by "building community, fostering communication, and nurturing self esteem."

Gay City's holistic approach to HIV prevention addresses the causes of unsafe behavior, blending grassroots organization, culturally relevant marketing, and empowerment theories to nurture a culture in which gay and bisexual men see their lives as worth living. Gay City creates a variety of innovative ways to do this, including gay summer camp and community forums that attract large, diverse audiences, one fourth of whom are men under age 25. Gay City's HIV prevention programs are constructed from several science-based theories of mass behavior change, including empowerment education (Freire), social marketing (Kotier and Roberto), and diffusion of education (Kelly).

Queercore's goal is to empower young gay and bisexual men to take control of their own lives, health, and future. Rather than offering "HIV 101," Queercore wants to connect young men with others in the community, creating a friendly space to meet new people and make new friends and providing alternatives to the "mainstream gay scene" in Seattle. Retreats, film nights, forums, "Coffee Talks" and other informal discussion nights, and even camp -- which Queercore describes as "a weekend of fun, creativity, and bonding in the bush" -- all provide social alternatives to bars.

Other Queercore activities have included "The Dish," a talk show held at the Broadway Performance Hall at Seattle Central Community College, which used true stories and invited comments and questions from the audience to raise issues of concern to young gay and bisexual men, such as fetishes of older men and meeting guys in chatrooms. A "Queer and Loathing" forum addressed reasons why many young men who know the facts are still having unsafe sex that puts them at risk for HIV and STDs.

Queercore also performs theater pieces at local theaters, including "Fruit Cocktale," a full-length piece in 1999 dealing with interracial dating. The success of "Fruit Cocktale" stimulated interest in the arts among Queercore participants, which resulted in the creation of "Spout," a Web site area that Queercore describes as a "space for gay and bi guys in Seattle under 30 to express themselves through the written and visual arts."

All of Queercore's materials and programs use the vocabulary and communication styles of the young men they want to reach, the kind of frank, targeted approach that characterizes effective HIV prevention. One Queercore outreach flyer to young men reads:

"Today, one young Seattle queer will get infected with HIV. Will it be you? Will you pass it on? Do you even care? Queercore is young fags, queers, bi-guys and gay boys taking action to make this STOP! AIDS is not inevitable. We can change our behavior. We can change our community."

Metro TeenAIDS Peer Education

Metro TeenAIDS is a community-based organization in Washington, D.C., dedicated to preventing HIV infection among youth and improving the quality of life for those already infected. Through a variety of HIV prevention programs, Metro TeenAIDS seeks to empower youth, improve their self-esteem, and make it less likely that they will engage in risky behavior. Believing that youth learn from youth, Metro TeenAIDS relies on peer education as a mainstay of its HIV prevention interventions.

Sisters for Life, targeted to girls between the ages of nine and 14, is a mentoring program serving three public housing communities in Alexandria, Virginia. The program builds the life skills of African American girls, supporting their efforts to develop into healthy, responsible adults who avoid HIV infection, substance abuse, STDs, and other negative consequences. Based on the black sorority model and the seven Kwanza principles, Sisters for Life teaches girls that they have the power to make healthy decisions. It promotes academic accomplishments, as well as self-worth and self-esteem. Girls are offered guidance through homework and tutoring workshops, lectures by peers and elders in the community, and retreats and other small group interactive activities.

Sisters for Life addresses risks surrounding HIV/AIDS indirectly, concentrating on supporting the girls as maturing youth and addressing high-risk behaviors in the larger context of the girls' lives. Each year, girls who complete the Sisters for Life program take part in a ceremony based on African rites of passage that welcomes graduates into the realm of sisterhood.

Project Lifeguard is Metro TeenAIDS's peer-led support program for youth at high risk in the Metro Washington, D.C. area, with three local drop-in centers -- The STOP in Virginia, Freestyle in D.C., and The HOUSE in Maryland, each tailored to the needs of neighborhood youth. Lifeguard conducts case finding and outreach to troubled adolescents, provides prevention case management, organizes recreational activities, and offers both peer-support groups, such as Sister to Sister and Protecting Our Brothas and Sistahs, and professional-led groups, such as Alcoholics and Narcotics Anonymous and teen mother groups.

The centers, open during weekday after-school hours, combine HIV prevention information with general health education, skills building, and empowerment tools. They share a goal of making it possible for youth to express themselves while having fun and to learn to make informed, healthy decisions. Center activities may include small group sessions, community empowerment projects, art and other creative endeavor workshops, field trips, sports, discussions with guest speakers, and psychoeducational skills empowerment. The STOP, for example, offers a job preparation course focused on producing a resume and developing interview skills.

Midwest AIDS Prevention Project Peer Education and Social Marketing

The Midwest AIDS Prevention Project (MAPP) in Ferndale, Michigan, is one of Michigan's oldest and largest community-based organizations dedicated to preventing HIV infection. Its HIV prevention programs -- developed in conjunction with the Michigan Department of Community Health -- include a variety of interventions targeted toward youth. MAPP targets students in middle school through high school, as well as students in alternative education centers and out-of-school youth. MAPP reaches gay and lesbian youth, minority youth, incarcerated youth, runaways, sexually abused youth, and other young people in high-risk situations, as well as the general student population.

MAPP works with school and community organizations to develop and implement its peer education programs, first selecting teen educators and then training these young people to provide HIV prevention information to their peers. MAPP also counsels teachers and school counselors. MAPP advises other CBOs to get youth invested in HIV prevention programs by encouraging them to have as much input into program design and implementation as possible.

MAPP employs a variety of behavior-based workshops, outreach projects, theater programs, and educational programs to reach young people. Alaye -- Yoruba for "Fit to Be King" -- is a MAPP program targeted toward African American youth from 13 to 24 years of age. Alaye emphasizes self-esteem, self-reliance, communication skills, and relationships to help young men make safe and healthy decisions and lead healthy lives. The program is presented over three sessions at local Detroit youth service agencies. MAPP's theater program, "The Many Faces of AIDS," is a 90-minute eight-vignette play shown to students and teachers in school auditoriums, using live theater to help both teens and their teachers understand AIDS. Among the topics covered in the vignettes are: myths and mysteries, Joe Condom, still a virgin, getting tested, AIDS wears many faces, double trouble, what men will say to get what they want, and the news that no parent wants to hear. A discussion period led by a MAPP AIDS education specialist follows the play.

Through its Teen Leadership Corps (TLC), MAPP trains popular teens to serve as endorsers of HIV risk reduction to their friends. TLC translates CAIR's prevention science research on opinion leaders into a program designed to change social norms among teenagers. Teens identified as popular and influential within their social network are chosen to participate in TLC. They learn basic information about HIV and other STDs, substance abuse, ways to assess risk, practical strategies for changing risky behavior, and ways to communicate with peers. The most important prevention messages that TLC opinion leaders deliver to their peers are that unprotected intercourse is not what teens do today, and that there are many ways to safely express sexuality.

Teen ADAPT is MAPP's youth version of its Alcohol and Other Drug Abuse Prevention Training (ADAPT) program. ADAPT was developed to increase the gay, lesbian, bisexual, and transgender population's awareness of the link between drug abuse and increased risk for HIV and other negative outcomes, as well as to increase their ability to get substance abuse services that are sensitive to their needs as a community. Teen ADAPT combines social marketing and peer education approaches to reach this population of teenagers, including opinion leader trainings and a media campaign. An easy-to-use Teen ADAPT field guide offers teen peer educators ideas for starting conversations, signs of substance abuse, barriers to safer behaviors for teens, and other resources. The media campaign, "Out. Proud. Sober." uses posters, postcards, and print advertising to advise youth to "Rebel against the people who want you to stay in the closet, and rebel against those who are trying to talk you into experimenting with alcohol or drugs."

Huckleberry Youth Programs Peer Education

Huckleberry Youth Programs is a community-based organization serving homeless, runaway, and at-risk youth in San Francisco and Marin County. It began 30 years ago with the establishment of Huckleberry House in Haight Ashbury. Since that time, 24-hour services and emergency shelter have been available there for young people in trouble. Over the years other services these young people need grew up around Huckleberry House, including crisis and after care counseling for families of youth seeking services from Huckleberry. In 1992, the Cole Street Youth Clinic was established as a collaborative effort of Huckleberry, the San Francisco Department of Public Health, and the University of San Francisco's Department of Adolescent Medicine. The Clinic, which employs a team of peer educators, has become a national model of adolescent health services, addressing the primary health care needs of adolescents at risk, as well as their psychosocial needs.

With funding from the CDC, Huckleberry Youth Programs was one of the first community-based organizations in the U.S. to develop an adolescent peer counseling HIV prevention program. Huckleberry recruited youth from their target population and trained them to provide HIV prevention information and materials through street outreach and through presentations in the schools and the community. These peer educators were recognized by the National AIDS Commission.

Huckleberry Youth Programs is committed to decreasing high-risk behavior among youth and empowering them to make healthy choices in their lives. Huckleberry does this by creating safe and friendly places for youth, increasing their knowledge of health issues and awareness of HIV/AIDS, providing care, serving as a resource as needed, creating opportunities for youth to work towards self sufficiency, and educating peers. Huckleberry serves primarily multi-ethnic inner-city adolescents in San Francisco, including both in-school and out-of-school youth. The majority are at high risk for homelessness, substance abuse, and STD's -- including HIV infection.

Huckleberry's HIV prevention peer education initiatives began in 1988 and have been adapted and revised over the years. Huckleberry works with the Violence is Preventable (VIP) Girls Collaborative and the Highway 101 Program, which serves youth living in shelters. Among Huckleberry's current peer education interventions are group sessions that run from one to six sessions in length, covering HIV/AIDS risk prevention, negotiating safer sex, and setting limits and boundaries. At the Huckleberry Teen Health Program at Montecito Plaza in San Rafael, these peer-led workshops are provided in middle and high schools, through street outreach, and in community sites such as Planned Parenthood. Creating access to reproductive health care for at-risk youth through linkages to community-based clinics is an essential component of the Montecito Plaza peer education programs.

BASE -- Be Active in Self-Education Peer Education

Be Active in Self-Education (BASE) is a peer HIV prevention education program that focuses on student empowerment, helping high school students teach each other about HIV prevention in youth-friendly, effective, and replicable ways. BASE began in 1991 in the New York City Public Schools; by 2000, 9,000 students in New York City had designed HIV/AIDS peer education projects and presented them to over 500,000 students. The program has been replicated in seven other cities: Atlanta, Kansas City, Los Angeles, Minneapolis, San Jose, Salt Lake City, and Albuquerque.

The BASE Program is founded on four principles:

• An assumption that young people are inherently smart and creative. Given the proper resources and thoughtful supervision, young people will come up with effective solutions to the challenges they face.

• Anyone who has lived through adolescence knows that young people have a tremendous influence on each other, lending strength to the peer education principle for this group.

• Merely providing information about HIV/AIDS is not sufficient to inspire behavioral change among adolescents. Young people must be involved in the learning process.

• HIV/AIDS education must be repeated over a sizable stretch of time. One-shot information sessions are not effective.

BASE works by helping high school students foster positive peer pressure that promotes healthy decision making and discourages HIV risk behaviors. BASE operates as a grantmaking program, with a student-designed and led process for soliciting and funding proposals from other students for innovative prevention projects. The projects address adolescent health issues, primarily HIV prevention, sexuality, peer pressure, STDs, and drug and alcohol abuse prevention. A student advisory committee writes and issues requests for proposals, coordinates a bidders conference with high schools and community agencies to help students write up their project ideas, and -- working with foundation representatives and AIDS service providers from the community -- decides which projects will be funded, with a funding level of up to $1,000 per project. The committee also reviews past projects and evaluates their effectiveness.

Successful student projects have included talk-show format videos, interactive theater presentations, support groups, posters and murals, T-shirts, buttons, comic books, health fairs, conferences, mobile van displays, school assemblies with guest speakers, awards and scholarships, and community service projects. In Kansas City, a BASE project raised awareness among their peers about the consequences of unprotected sex by organizing a student HIV testing campaign with the Kansas City Free Health Clinic. In the previous year, only 169 teens were tested at the clinic all year; the BASE campaign resulted in 112 students being tested in two months. Nine high schools in the Kansas City area now participate in BASE.

Some projects take on a life of their own, as did a BASE project at Monroe High School in the Bronx where a student-run AIDS awareness conference became an annual event. The Teen-to-Teen HIV/AIDS Peer Education Conference is so popular that it is now open to all public high school students in New York City. In at least one school, the BASE team grew beyond a focus on HIV prevention alone. At the LAB school, BASE now encompasses three additional causes: Free Tibet, Stopping Sweatshops, and Stop the Hate. Folding HIV prevention education into other causes popular with and important to youth can reduce the stigma often associated with HIV prevention messages and help ensure its acceptability to young people.

With as little as $7,500, a community-based organization can start a small peer grants program along the lines of the BASE Program. CBOs also can partner with their local public school system to help them develop a BASE program, providing community expertise for evaluating student HIV prevention proposals.

California Department of Health Services Social Marketing

The California Department of Health Services, Office of AIDS partners with local community-based organizations to develop and support a variety of HIV prevention programs targeted to youth, including diverse cultural experiences aimed at delivering community-level HIV prevention messages through social marketing.

• The Lowrider Campaign
  The Lowrider Campaign, launched in April 2000, targets at-risk Latino youth with the prevention messages "Respect Yourself, Protect Yourself" and "Tu Vida Cuenta, Usa Condones," in both English and Spanish. Those messages were incorporated into the Aztec-themed original artwork on a fully restored and customized 1953 Chevy Bel-Air that serves as an attention-grabbing "moving billboard" traveling throughout the state to lowrider car shows and Latino cultural events. Local CBOs were invited to collaborate with the campaign by providing outreach and educational services at each event. A Modesta Lowrider group donated the use of the car and oversaw restoration.

• Rap It Up
  "Rap It Up" Safer Sex Rap Writing Contest and Radio Promotion is a summertime promotion targeting sexually active adolescents and young adults ages 15 to 25 in the San Francisco and Los Angeles urban markets. Rap It Up is designed to raise awareness and acceptance of condom use through a safer sex rap writing contest. Prizes in 2000 ranged from a studio recording opportunity valued at $5,000 to cash prizes of up to $1,000. The promotion capitalized on the credibility of popular disc jockeys as prevention messengers. The deejays invited radio listeners to enter the contest by submitting a one-minute rap on safer sex. Listeners also were encouraged to call the California AIDS Hotline for more information about safer sex and HIV testing and counseling. The promotion included radio spots that played for four to eight weeks, live remotes, appearances at summer concerts and festivals, Web site hyperlinks, studio interviews, public service announcements, and promotional merchandise.

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This article was provided by AIDS Action Council.