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factors.

6. Use instructionally sound teaching methods that actively involve participants, that help participants personalize the information and that are designed to change each group of risk and protective factors.

7. Use activities, instructional methods and behavioural messages that are appropriate to the culture, developmental age and sexual experience of the participants.

8. Cover topics in a logical sequence.

Source: Kirby D, Laris BA, Rolleri L. The impact of sex and HIV education programs in schools and communities on sexual behaviors among young adults. Washington, DC, Family Health International, 2006. a STIs = sexually transmitted infections.

5.1.3.3 Adult-led versus peer-led interventions

The choice of educator also represents a balance among pedagogy, prevailing culture and infrastructure capacity. Adults most commonly implement curriculum-based interventions because typically they have more of the experience, knowledge and skills needed. The adults who implement a particular curriculum may include both schoolteachers and others, such as health-workers.

Teacher-led interventions are logistically the easiest to implement in schools once teachers have been adequately trained. Such interventions are also highly replicable. However these benefits may be offset by the limitations of teachers discussed above, including their status in relation to pupils or their discomfort in using interactive teaching methods and discussing sensitive topics such as adolescents' sexual behaviour.

Because of these limitations, people in some communities favour using health-workers or other local experts to teach these curricula. These experts may be more knowledgeable about the sexual topics covered, more comfortable discussing these topics and more comfortable using interactive learning methods. In addition, using health-workers or other trained adults to discuss sensitive matters, such as condoms, in schools may help teachers avoid the internal conflicts mentioned above and may allay fears of community censure. However, limited infrastructure, transportation, time and other resources may prevent health-workers from teaching intensive and lengthy curricula to many students in many schools.

Peer educators have been widely advocated as alternatives or adjuncts to teachers or other adults (22). Many believe that peer educators may be able to relate more closely to other young adults than older adults can. However, peers are less likely to be knowledgeable about these topics and less likely to have the skills needed to teach curriculum activities (23). Furthermore, the inevitable annual student turnover and subsequent requirements for recurring training and supervision raise doubts about the sustainability and cost effectiveness of using peer educators (11).

In order to provide a discussion that is helpful to programme developers, we have categorized all 22 interventions studied according to whether they are based on a curriculum, whether they incorporate most of the characteristics in Box 5.1 and whether they are taught by adults or peers. These three dimensions produced the following six categories with one or more studies per category:

• curriculum-based interventions that incorporate most of the 17 characteristics and are led by adults;

• curriculum-based interventions that incorporate most of the 17 characteristics and are led by peers;

• curriculum-based interventions that lack several of the 17 characteristics and are led by adults;

• curriculum-based interventions that lack several of the 17 characteristics and are led by peers;

• non-curriculum-based interventions that incorporate several of the 17 characteristics and are led by adults;

• non-curriculum-based interventions that lack several of the 17 characteristics and are led by peers.

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