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Effectiveness of an HIV Prevention Program for Secondary School Students in Mongolia
Global Health Sciences Literature Digest
Published February 20, 2007
Journal Article

Cartagena RG, Veugelers PJ, Kipp W, Magigav K, Laing LM. Effectiveness of an HIV Prevention Program for Secondary School Students in Mongolia. J Adolesc Health. 2006 Dec;39(6):925.e9-16.


To evaluate the effectiveness of a peer-education HIV-prevention program for adolescents attending secondary school in Mongolia; and to assess how the delivery of peer education affects knowledge, attitude, self-efficacy, and condom use.

Study Design

Cross-sectional assessment comparing the knowledge, attitudes, self-efficacy and, condom use of secondary students attending schools with peer-education HIV-prevention programs to those attending schools without peer-education HIV-prevention programs.


Secondary schools in urban and rural settings in Mongolia (Ulaanbaatar and three rural provinces).


A total of 647 students 15-19 years of age were included in the analysis, of whom 320 attended schools with a peer-education prevention program that had been in place for at least three years, and 327 attended schools without a peer-education prevention program. In total, 16 schools were included: three schools with a program and three schools without a program in Ulaanbaatar; one school with a program and one school without a program in two districts of Ulaanbaatar, and eight schools (four with a program and four without a program) in three rural provinces of Mongolia. Schools were selected on the basis of geographic diversity and travel logistics and were matched based on school size, class size, and location in an urban or rural setting. Additionally, schools without a peer-education program that were located near schools with a peer education program were excluded.


In 2000, a sexual-health peer-education program for secondary school students was piloted in Ulaanbaatar, Mongolia. The program has since been implemented in 48 Mongolian schools. Student peer educators attended a three-day training that included:

  1. reproductive health
  2. HIV and STI transmission, symptoms, and prevention
  3. safe sex and condom use
  4. discussions and interactive communication through skills-based learning

Details of the peer-education prevention programs were not discussed in this article. The intervention has been described elsewhere.(1,2)

Primary Outcomes

Students completed an anonymous self-administered validated questionnaire that assessed knowledge (including identification of STI symptoms and methods of transmission and protection), attitudes, self-efficacy, and condom use. Condom use was only assessed among the students who reported having been sexually active in the three months prior to the survey. The authors also assessed the ways in which the delivery of the sexual health peer education affects knowledge, attitude, self-efficacy and condom use. Knowledge, attitude and practice (KAP) scores were calculated on the basis of 38 knowledge questions, nine attitude questions, and 15 self-efficacy questions. The authors exponentiated the beta coefficients from the linear regression analysis to represent "relative increments" (RI) of the peer-education program and school factors associated with a 10% increment in the KAP score.


Of the total 720 students invited to participate, 647 (90%) agreed and completed the survey; 149 (23%) had had sex within the last three months. Students attending schools with peer-education prevention programs were statistically significantly more knowledgeable in the area of sexual health [relative increments (RI) 2.43; 95% CI, 1.37-4.33], had higher attitudes scores (RI 1.78; 95% CI, 1.22-2.61), and had greater awareness of their self-efficacy (RI 4.42; 95% CI, 2.29-8.51) with regard to HIV and sexual health. There were no statistically significant differences in safe-sex practices between students attending schools with and without peer-education prevention programs. This study also found that programs with one to two peer educators for each grade 10 class had a more substantial effect on student knowledge, attitude, self-efficacy, and condom use than programs that had three to four peer educators per class.


The authors concluded that the peer-education program in Mongolia improved self-efficacy perceptions; however, when condom use was assessed, the program did not have a substantial effect.

Quality Rating

The quality of this cross-sectional study was not assessed. Although study staff matched schools with and without programs on the basis of likely confounders, there is a potential bias in the selection of schools, as the study team did not have control over which schools had the peer-education program. To account for potential biases associated with community or media campaigns related to sexual health promotion, the authors met with school principals and headmasters and determined that there had been no safe-sex campaigns within the six months prior to the survey. The use of the RI as the measure of strength of association was difficult to interpret, and obscured how effective the program was overall.

In Context

Since the early 1990s, peer education has been proposed as an effective school-based intervention method for youth.(3,4,5) Mongolia is an extremely low-prevalence country, but it has an emerging STI epidemic and borders Russia and China, countries with growing HIV epidemics. The success of this peer-based educational system in improving knowledge, attitude, and self-efficacy may be useful for other countries. Note that although there was no difference in condom use, condoms had always been used by 49% of sexually active students during the prior three months in schools with programs, and by 39% of sexually active students in schools without programs.

Programmatic Implications

School-based peer-education programs appear to be effective in informing secondary students of the risks associated with unsafe sexual practices; these programs should be implemented more broadly.


  1. Roberts A, Oyun C, Batnasan E, et al. Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion. Soc Sci Med 2005;60:1487-98.
  2. Purevdawa E, Moon TD, Baigalmaa C, et al. Rise in sexually transmitted diseases during democratization and economic crisis in Mongolia. Int J STD AIDS 1997;8:398-401.
  3. Agha S. An evaluation of the effectiveness of a peer sexual health intervention among secondary school students in Zambia. AIDS Educ Prev 2002 Aug;14(4):269-81.
  4. Wolf RC, Tawfik LA, Bond K. Peer promotion programs and social networks in Ghana: methods for monitoring and evaluating AIDS prevention and reproductive health programs among adolescents and young adults. J Health Commun 2000;5 Suppl:61-80.
  5. Hope KR Sr. Promoting behavior change in Botswana: an assessment of the peer education HIV/AIDS prevention program at the workplace. J Health Commun 2003 May-Jun;8(3):267-81.