***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To reduce risk behaviors which promotes human immuno deficiency virus ( HIV ) transmission among drug users . METHODS A peer education program was implemented among drug users in drug detoxification centers in Kunming from May 1998 to June 2000 . Before and after intervention , through r and om sampling , subjects were recruited to assess the impact of the program . Focus group discussion and a small sample of follow-up in communities were used for evaluation . RESULTS Three hundred and six and 418 subjects were interviewed before and after the intervention program . Rates regarding " sharing needles " had a reduction from 68.3 % to 62.0 % ( chi 2 = 2.61 , P < 0.01 , while " never cleaning a needle " increased from 3.3 % to 15.8 % ( chi 2 = 19.41 , P < 0.01 ) , and " used needles disposal to garbage bin " increased from 58.4 % to 81.8 % ( chi 2 = 40.23 , P < 0.01 ) . Thirty-four drug users were followed in their communities and 67.6 % were no longer sharing needles but none reported using a condom when having casual sex . CONCLUSION Peer education program among drug users in detoxification centers had limited impact . In order to control the epidemic of AIDS in drug using population , more effective strategies need to be explored This study investigated whether there were any changes in knowledge and normative beliefs regarding abstinence and condoms and personal risk perception of acquiring HIV among Zambian secondary -school students who were exposed to a peer sexual health intervention .  Schools were r and omly assigned to intervention and control groups . A baseline assessment that measured knowledge , normative beliefs about abstinence and condoms and personal risk perception was conducted in all schools . Students in the intervention group were exposed for a 1-hour- and -45-minute-long in-class peer sexual health intervention . Students in the control schools were exposed to a 1-hour-long in-class peer water purification intervention . A follow-up assessment of students was conducted after the intervention . Logistic regression analyses were conducted to determine whether significant differences between intervention and control groups emerged at follow-up . Relative to students in the control group , knowledge was higher and normative beliefs about abstinence and condoms were significantly more positive among students in the intervention schools . Students in the intervention schools also had a higher personal risk perception of acquiring HIV than students in control schools . These findings show that a school-based peer sexual health intervention implemented in Zambia was effective in increasing knowledge , positive normative beliefs about abstinence and condoms , and personal risk perception Objective To assess the short- and long-term impact of a 6-month pilot intervention program on condom use among prostitutes in Accra , Ghana . Design The 4-year prospect i ve study follows-up cohorts enrolled in the intervention in 1987 and 1988 , comparing condom use in 1991 with that among a comparison group not enrolled in the intervention . Setting The community-based intervention was initiated in Accra , Ghana in 1987 . Participants Self-identified female prostitutes who volunteered participation . InterventionThe educational intervention used local health workers to train and support selected prostitutes to be health educators and condom distributers to their peers . Outcome measures Self-reported condom use with clients . Results Reported condom use increased dramatically between 1987 and 1988 during the first 6 months of the intervention . In 1991 , after 3 years of program relapse , 107 ( 43 % ) of the 248 women who had enrolled in 1987 or 1988 were still in prostitution and located for interview . Their level of condom use in 1991 was higher than pre-enrollment but similar to use among prostitutes never enrolled . Sixty-four per cent of those followed-up reported always using condoms with clients in 1991 . These ‘ always users ' were more likely to have maintained informal contact with project staff , know that HIV can be transmitted by healthy clients , and report that clients frequently initiate condom use . Conclusions Findings support the development of long-range educational strategies that recognize the career longevity of prostitutes , available channels for informal program diffusion , individual changes in condom use over time , and the role of clients in condom negotiation PURPOSE To determine whether adolescents '  normative beliefs about abstinence and condoms , their personal risk perception , and safer sex practice s changed after the implementation of a peer sexual health education intervention implemented in Zambian secondary schools . METHODS The peer intervention was implemented during the first week of September 2000 in Lusaka , Zambia . A quasi-experimental , longitudinal panel design was used to evaluate its impact . Three schools were r and omly assigned to the intervention condition and two to the control condition . Three rounds of data from male and female adolescents in grade s 10 and 11 were collected at baseline in July 2000 , at first follow-up in the second half of September 2000 , and at second follow-up in early April 2001 . A total of 416 respondents aged 14 - 23 ( at baseline ) were interviewed in all three survey rounds . A mixed-effects logistic regression growth curve analysis was used to calculate adjusted odds ratios to compare intervention and control groups on the outcome variables . RESULTS Student self-reports showed positive changes in normative beliefs about abstinence immediately after the intervention , and these improvements were largely sustained until 6 months after the intervention . Students became more likely to approve of condom use and to intend using condoms immediately after the intervention , but these positive outcomes could not be sustained during the 6 months that followed the intervention . Normative beliefs regarding condom use took longer to develop : these were only observed at 6 months follow-up . Students reported reductions in multiple regular partnerships . There was no change in condom use . CONCLUSIONS A single session school-based peer sexual health intervention result ed in the development of normative beliefs about abstinence that were sustained over a 6-month period . Normative beliefs about condoms took longer to develop . More regular efforts may be required to sustain the approval of , and the intention to use , condoms . The intervention was successful in reducing multiple regular partnerships Summary : To test the efficacy of a sustainable community-level HIV intervention  among sex workers , the Sonagachi Project was replicated , including community organizing and advocacy , peer education , condom social marketing , and establishment of a health clinic .  Sex workers were r and omly selected in 2 small urban communities in northeastern India ( n = 100 each ) and assessed every 5–6 months over 15 months ( 85 % retention ) . Overall condom use increased significantly in the intervention community ( 39 % ) compared with the control community ( 11 % ) , and the proportion of consistent condom users increased 25 % in the intervention community compared with a 16 % decrease in the control community . This study supports the efficacy of the Sonagachi model intervention in increasing condom use and maintaining low HIV prevalence among sex workers The RIPPLE study is a r and omized controlled trial of peer-led sex education in English secondary schools . In 1997 , 27 schools were recruited and r and omly allocated to a programme of peer-led sex education or to act as control schools . In experimental schools peer educators in Year 12 ( aged 16/17 years ) were recruited in two successive cohorts and , having received a st and ardized training programme , delivered classroom-based sex education sessions to Year 9 students ( aged 13/14 years ) . This paper is the first of two focusing on data gathered from these peer educators . Through analysis of pre-(n = 505 ) and post- ( n = 331 ) programme question naire data , the paper describes the profile of peer educators and examines the impact on them of their involvement . Compared to the students receiving the peer-led sex education , more peer educators were female , white , high academic achievers and less socially disadvantaged . Peer educators reported positive changes in sexual knowledge and changes towards more liberal attitudes , and believed the programme would have a positive impact on their confidence in relationships and on their sexual behaviour . There was an increase in confidence about communication and interaction in groups . The paper discusses the method ological difficulties of assessing how involvement in such a programme impacts on peer educators PURPOSE To describe the implementation and evaluation of an  adolescent reproductive health peer education program  in West Africa . The program , known as the West African Youth Initiative ( WAYI ) , was developed to improve knowledge of sexuality and reproductive health , and promote safer sex behaviors and contraceptive use among sexually active adolescents in Nigeria and Ghana . METHODS Between November 1994 and April 1997 , two organizations , the Association for Reproductive and Family Health ( ARFH ) , based in Nigeria , and Advocates for Youth , based in Washington D.C. , supported community-based youth-serving organizations in the two countries to implement peer education projects . Consultants from the African Regional Health Education Centre ( ARHEC ) in Nigeria provided technical assistance in design ing and conducting a quasi-experimental process and outcome evaluation of the projects . RESULTS There were significant differences over time and between intervention and control groups concerning reproductive health knowledge , use of contraceptives in the previous 3 months , willingness to buy contraceptives , and self-efficacy in contraceptive use . CONCLUSIONS Overall , the project provides evidence that  peer education is most effective at improving knowledge and promoting attitudinal and behavior change among young people in school setting The goal of this study was to assess the impact of peer education and single-session educational lectures on HIV/AIDS knowledge and attitude change among university students ( n = 157 male , n = 230 female ; mean age = 20 ) on the campuses of two metropolitan state universities in Ankara , Turkey . The students were r and omly selected to participate in peer education ( n = 204 ) , single-session lecture ( n = 74 ) or wait-list control ( n = 109 ) groups . Statistical analyses reveal significant differences in knowledge and attitudes , personal behavior , and awareness of HIV/AIDS . Both the peer education and HIV/AIDS lecture strategies were more effective in eliciting change in student 's knowledge and attitudes than the control condition ( p > .05 ) . Male and female students in both experimental groups showed higher attitude scores compared with all students in the control group Objective : To assess the impact and costs of adding female condoms to a male condom promotion and distribution peer education programme for sex workers in Mombasa , Kenya . Design : A 12 month , prospect i ve study of 210 female sex workers . Methods : We interviewed participants about their sexual behaviour every 2 months for a total of seven times and introduced female condoms after the third interview . We also collected cost data and calculated the cost and cost effectiveness of adding the female condom component to the existing programme . Results : Introduction of the female condom in an HIV/AIDS prevention project targeting sex workers led to small , but significant , increases in consistent condom use with all sexual partners . However , there was a high degree of substitution of the female condom for male condoms . The cost per additional consistent condom user at a programme level is estimated to be $ 2160 ( £ 1169 , € 1711 ) ( 95 % CI : 1338 to 11 179 ) . Conclusions : The female condom has some potential for reducing unprotected sex among sex workers . However , given its high cost , and the marginal improvements seen here , governments should limit promotion of the female condom in population s that are already successfully using the male condom . More research is needed to identify effective methods of encouraging sex workers to practise safer sex with their boyfriends 
    Output:
    
Meta- analysis indicates that peer education programs in developing countries are moderately effective at improving behavioral outcomes but show no significant impact on biological outcomes .