Peer education program trains HIV clients for productive work

Modest funding, big payoffs

In this new economy of doing more with less money, a 17-year-old peer education and skills training program sponsored by AIDS Service Center (ASC) of New York, NY, is a good model.

"It's a great example of a program with modest funding and huge impacts," says Sharen Duke, MPH, chief executive officer of AIDS Service Center.

"I'm proud to say our peer program is nationally renowned and provides skills, job training opportunities, and services for high-risk New Yorkers who are active or recovering substance users," Duke says.

ASC has 1,800 annual clients including ex-offenders and people living with HIV infection, and the center has three service sites in New York City, she adds.

"We have a $6 million budget with 75 paid staff and 50 volunteers and peers, and 95% of our funding comes from the federal government," she says.

ASC's program provides eight weeks of training for clients. When the training is complete, they can apply for one of 40 to 50 paid peer educator internships, which are for six months.

Interns receive minimum wage, and peer educator internships include 10-15 hours per week of volunteer service, including a mandated weekly support group. They also have an individual supervision session with their staff mentors.

"Peer educators who have gone through the internship program become senior peer educators and mentor new graduates," Duke says.

Many of the senior peer educators go on to become fulltime staff for ASC, she adds.

"In 2007, ASC peer educators conducted over 2,000 community outreach and HIV prevention sessions and reached over 13,000 New York City residents through more than 2,000 activities and distributed more than 40,000 condoms and safer sex kits," Duke says. "The services provided by the ASC peer educators was equivalent to work provided by 15 fulltime staff, so that resulted in a net cost savings to my agency of close to $500,000."

The peer educator infrastructure is built around their training, development of professional skills, personal goals, and actual work experiences, Duke explains.

"Each has his or her own peer development plan, and it looks at both personal goals and professional aspirations," Duke says. "They might want to abstain from substance abuse or reunite with their children."

More than 22% of the ASC fulltime staff are peer educators who left welfare and rejoined the workforce, making these people living examples of positive change, Duke says.

"The peers are indigenous to high risk communities, and that makes them both credible and effective messengers and powerful role models of recovery from substance use, HIV risk reduction, and healthy behavior change over time," Duke says.

"We offer clients safety and support and respect in a way that builds over time and allows people to pick and choose what it is they need to move at their own pace," she explains.

The peer educator program also strengthens and extends ASC's reach to community centers where there otherwise would not be adequate staffing, she adds.

Triple threat

The peer program has a triple impact, including these features:

1. Credible messengers: Peer educators are credible messengers of change in at-risk communities, Duke says.

2. Peers benefit directly: ASC clients who become peer educators directly benefit from the program. They often leave welfare and rejoin the workforce, Duke says.

"This attests to the synergistic relationship of helping peers and giving back, and it sustains their own healthy behaviors," Duke says. "They say, 'I can't tell a group of people how to practice healthy sex if I'm not doing it myself,' so it sustains their own behavioral change over time."

3. ASC service extension: "It extends ASC services into high risk communities," Duke says. "We don't have the resources to be in all of those boroughs and places, including treatment programs, homeless shelters, and churches."

There is not enough staff to go around, but the peers can be there to educate people about HIV testing and to build a bridge to ASC services, she adds.

"This ensures wrap-around access to mental health and daily living needs," Duke says.

For instance, there's a peer-run meals service that provides 50-80 hot lunches each day, she adds.

"We have a clothing room called Wonderful Wearables that is completely peer run," Duke says. "It's fueled by community donations, and the peers sort the clothes, work with clients who come in, help people find their size, and they help us make that program function."