For six years, David Dickinson, formerly with Wits Business School’€™s HIV and the Workplace project, now a sociology professor at Wits University in Johannesburg, studied HIV peer education programmes in various industries including the mining, manufacturing, retail and banking sectors. Drawing on a number of projects which include a national survey of 600 peer educators in South Africa and a smaller survey with a group of peer educators in the North West province, Professor Dickinson, decided to put the information he has gathered over the years in a book called ‘€œChanging the Course of AIDS’€.

‘€œI’€™ve written a number of articles, I’€™ve done a few presentations and I really wanted to explore in a deeper way what I felt peer educators are doing. We have a lot of peer educators. We tell them what to do. We tend to put them into these’€¦ what I call in the book ‘€œvertical programmes’€, where we give them messages to pass to other people ‘€“ unthinkingly, if you like – as ciphers or as translators. And what I’€™ve picked up in my work, and especially, in my discussions with peer educators and listening to them talk about their work, was that they were engaging in these debates ‘€“ they are complex, messy debates ‘€“ and I wanted to try and move away from this idea of an expert telling a peer educator to give this message in Sesotho or Zulu to a worker to actually say what’€™s happening on the ground; what were peer educators talking about; what were they struggling with; how were they trying to bring about change. Then that took a book’€, Dickinson explains how the book came about.

In ‘€œChanging the Course of AIDS, we learn that work-place peer educators are often the link between workers, HIV and AIDS programme managers and prevention and treatment services. They are selected to the role from amongst the rank and file of the work-force, with little or no background in health and HIV care.

‘€œThat, of course, can be seen as a weakness in that they don’€™t understand cell biology or how diseases are transmitted and so on. But, of course, the strength that they have is that people will listen to them in the sense that most people actually don’€™t listen to their doctor or their nurse or their university professor on important matters around health and life. Peer educators are at the coalface’€¦ at the front-line of the fight. We are not there and we can’€™t even get there as outside experts’€, says Dickinson.      

Dickinson says peer educators’€™ involvement is ‘€œnot limited to the work-place’€. They often interact with colleagues and even community members beyond working hours and are often confronted with myths, misplaced norms and beliefs and well-established falsehoods about HIV infection.

‘€œThese are snatched moments on the bus back to the township, playing football in the community because, of course, although these are work-place peer-educators they live in communities’€¦

What the research in the book finds is that actually 40 ‘€“ 50% of the informal activity takes place outside of the work-place. It’€™s a very tense, complex space. I use illustrations in the book of tensions over race, tensions over traditional healing and tensions over gender. We’€™re asking a lot of people. We’€™re putting a heavy burden. Some of the peer educators are carrying heavy loads of people who have talked to them about terrible things in their lives around HIV/AIDS and other issues as well’€, he says.      

But they are often ill-equipped to be more effective. With an infection where the body of medical and scientific knowledge changes all the time, Dickinson says ‘€œthe problem is that peer-educators often find themselves in the deep end as companies do not do enough to refresh or update their peer-educators’€™ knowledge and understanding over time’€.            

‘€œTypically, a peer educator gets five days of training and, often, they are just thrown out there and then they’€™re expected to cope with those five days of training receiving quite complex questions from peers. About 30% of the peer-educators in the large study we did, who had been peer-educators for over two years, had received no follow-up training whatsoever. So, it’€™s very much sink or swim. In addition to the numerical ‘€“ how many days’€™ training ‘€“ it’€™s about the type of training that you do, and I think all too often what we’€™re doing with peer-educators and, indeed, with the general public, we’€™re repeating the same old boring messages over and over again, and that’€™s not training’€, he says.

In the book, Dickinson argues that business must invest more in peer-educators.  

‘€œWhat business needs to do is not just about protecting the bottom line of business. This is a way of contributing to South African development and a national response to the epidemic. What I would like to see them do is to recognize the unique contribution that they, through their peer-educators, are able to offer, whether it’€™s to the national testing that’€™s going on at the moment or whether it’€™s through   prevention or support of treatment. This is an incredible resource. It does mean that they have to provide some money and time in terms of training these peer-educators and giving them regular support and so on, but if they could then balance that against the huge potential benefit or the huge benefit to the nation as a whole in terms of reducing infections and getting people to test and so on, then I think that we would really make significant advances in our responses to HIV/AIDS’€, Dickinson says.          

Changing the Course of AIDS is available through the Wits University Press, in Johannesburg. The contact number there is 011 484 5974.