UF study: Female and minority experts most effective in HIV prevention

May 11, 2006

GAINESVILLE, Fla. — Contrary to popular belief, experts are more effective than peers in successful HIV prevention campaigns, a University of Florida study found. However, the most effective resources are experts whose gender and ethnicity match the patients seeking guidance.

“There were a lot of preconceived ideas about which type of communicator would be better,” said Dolores Albarracin, who with Marta R. Durantini authored the study published in the March Psychological Bulletin. “Generally the idea that comes from community psychology is that community members are better.”

People who want to prevent HIV or need advice after a diagnosis often feel more comfortable talking with someone of their race and gender, Albarracin said. Patients often consult their friends, family, clergy, classmates, people who frequent the same bar or who live in their neighborhood. However, talking with peers may not always lead to the best advice, despite the growing popularity of peer health education since the 1970s.

“We actually found that community members are less effective than experts, which is completely contrary to previous philosophies,” she said. “This has a lot of implications because many of the programs these days are based on the idea that community members are better, so funds are given to community-based organizations, thinking they are going to be better.”

The study involved a comprehensive statistical analysis from 166 HIV prevention interventions, and included published and unpublished works. Interventions consist of programs sponsored by experts and peer leaders, visits to medical professionals and programs led by peers.

“Our study was a large review,” Albarracin said. “We collected everything that had been done, throughout the duration of the AIDS epidemic all over the world, from 1985 to 2005, and we ended up with a really extensive database of results of interventions by community members and experts.”

The study analyzed results of intervention in all population groups, including men, women and children, and all risk groups such as injection drug users and people with multiple sex partners.

The Centers for Disease Control and Prevention recommends peer consultation for HIV prevention, but Albarracin said her findings suggest that a better connection is necessary between community-based organizations and state agencies to make sure programs have both types of sources and that peers are better trained.

A redirection of funds from peer-based prevention groups to expert-led groups could help encourage a wider diversity of experts, which Albarracin said is needed.

“We found that the best experts for prevention among African-American women are African-American and female,” she said. “If you look at physicians, nurses, psychologists and many other health professionals, many of them are white. So to find those experts with racial and gender matching isn’t always easy.”

The study revealed that female and minority experts are necessary to create effective campaigns for women and ethnic minorities. Because of a shortage of health-care professionals in these demographics, policy makers must consider the development of training programs to make the available agents more effective.

A long-term goal is to encourage greater diversity in the health professions among ethnic minorities, which Albarracin said could be achieved through affirmative action programs.

Through broad research on the effectiveness of HIV interventions, Albarracin said it will become apparent which tactics work and which ones don’t.

“Dr. Albarracin’s research syntheses are some of the most systematic and complete of any that have yet been published,” said Blair Johnson, a professor of social psychology at the University of Connecticut. “In the scholarly community, they are certain to stimulate renewed interest in the social psychological mechanisms underlying successful HIV prevention efforts for practically any population at risk for HIV. In the public health and policy community, they offer the hope of better interventions, with the result that fewer people will contract (or transmit) HIV.”