Evaluation and lessons learned from a lay health advisor programme to prevent sexually transmitted diseases.

We implemented a lay health advisor (LHA) intervention to decrease rates of sexually transmitted disease (STD) among rural low income African-Americans. Twenty-one women identified by their peers as natural helpers were trained as LHAs to disseminate information, change attitudes, and improve skills among their social networks in the neighbourhoods with the highest STD rates. The behaviours they targeted involved care-seeking and condom use. The outcome evaluation included cross-sectional household surveys conducted before the intervention and after 18 months of activity. The proportion seeking prompt care for an STD increased 60%; those seeking screening for infection after suspecting exposure increased 25%. Consistent condom use with main partners increased by 23%. An LHA intervention in this population appears efficacious for improving STD-related care seeking behaviours but the effect on condom use with main partners is less clear.