Operation Hairspray

What is the Program?

Operation Hairspray engages and trains employees of hair salons and barber shops who serve African and Caribbean communities in Ottawa to deliver basic HIV information to their customers in a culturally relevant way. By training and supporting these employees to become peer educators, the community’s awareness of HIV is broadened in a casual, non-threatening manner that promotes dialogue about these issues and reduces HIV stigma in communities that have historically been difficult to reach through traditional forms of outreach.

This project has been implemented twice: first in a pilot by Ottawa Public Health and again through a partnership between Ottawa Public Health and Somerset West Community Health Centre. The pilot engaged 19 peer educators at 15 barber and beauty shops. The second phase expanded to include a focus on HIV stigma and discrimination and other types of customer-service-related businesses, including a shop and a grocery store. The volunteers at these businesses were trained to educate their customers in the same way barbers and hairstylists were trained to become peer educators.

Operation Hairspray is overseen by a Project Advisory Group, which includes public health staff, members of the African and Caribbean communities (including a barber, hairdressers and a person living with HIV) and researchers from the University of Ottawa. This group advises Ottawa Public Health on how to approach businesses to engage participation, select educational materials appropriate for the community and effectively evaluate the program.

Why Was the Program Developed?

In 2006, Ottawa Public Health developed a pilot project to address the need for HIV/AIDS education among the city’s African and Caribbean communities, which it saw as a population disproportionately affected by HIV that had little to no culturally specific resources to address HIV prevention and support.

Inspired by news stories of pioneering outreach efforts in Thailand through which men receive condoms from local barber shops in their villages before venturing into cities, a Project Officer from Ottawa Public Health hypothesized that engaging African and Caribbean barber shops and hair salons in Ottawa to support HIV prevention efforts would be successful in reaching sometimes hard-to-reach groups of people. Ottawa Public Health brought together a Project Advisory Group to implement a pilot project to assess this theory.

Why barber shops and hair salons? 

Both barber shops and hair salons are intimate social institutions in some African and Caribbean communities where women and men share thoughts and experiences with employees and fellow patrons. Women’s hair salons can be particularly intimate environments, as women may spend five or more hours there during hair weaves or braiding. In both types of establishments there can be a sense of community and patrons often build relationships with their stylists where they can be comfortable enough to gossip and share personal information. The time spent is commonly filled with discussions (and sometimes gossip!) about issues in the community, politics, family, dating and relationships.

How Does the Program Work?

Location

Operation Hairspray coordinates peer-led outreach programming primarily in barber shops and hair salons that serve members of African and Caribbean communities. More recently, it expanded to work with other service-related businesses that serve these communities. To date, Operation Hairspray has collaborated with more than 20 establishments. Each participating business must have at least one employee dedicated to completing program training to become a peer educator.  

Recruitment and Engagement

To engage African and Caribbean communities in HIV education, Operation Hairspray depends on a team of volunteer peer educators who are hairstylists and barbers in local businesses that were identified with input from a volunteer in the Project Advisory Group. Currently, Operation Hairspray engages English-speaking people, but the program planners are exploring opportunities to increase their reach into African and Caribbean Francophone communities.

Project Advisory Group

Ottawa Public Health engages a diverse group of people for the Project Advisory Group to provide support, feedback and evaluation the project. The group includes:

•  a person living with HIV or AIDS from the African or Caribbean community
• a person from the African community
• a person from the Caribbean community
• an academic expert/evaluator in the field of HIV/AIDS
• a hairdresser/barber from the African or Caribbean community
• a Community Health Centre representative
• an Ottawa Public Health representative
• a youth involved in HIV/AIDS awareness

One person may fill two of these requirements. For example, a person who is living with HIV and is from the African community may fill the first two points.

Businesses

To engage hairstylists and barbers as peer educators, project staff must first obtain the support of business owners. Ottawa Public Health initially approached businesses that were identified by members of the Project Advisory Group as being potentially interested.

They also pulled a list of all licensed salons and barber shops from the Public Health Inspector’s lists, which they narrowed down to 50 businesses that served a mostly African and Caribbean clientele.

These 50 establishments were contacted with a letter from the Project Coordinator detailing the purpose of the project, the level of commitment required and the opportunity this project provided for businesses to give back to their community. The letter was printed on Ottawa Public Health letterhead to establish a level of credibility for the project while assuring owners that there was no underlying intent to inspect their barber shops and salons, which may have been a concern to some owners given that Public Health manages the inspections.

The Coordinator followed up in person or over the phone to provide more information and determine if owners of the establishments were interested in collaborating on the project. In the initial phase of the project, 15 salons expressed interest.

Individuals who had a personal connection to HIV were the most interested in participating at first, though as customers of participating peer educators were exposed to the program and word began to spread in the community, other business owners and staff became more readily approachable regarding participation in the program.

While peer educators at a grocery store were recruited to participate in the second implementation of the program, it was eventually determined that the more social environments of hair salons and barber shops are the most appropriate for this type of outreach, so future recruitment efforts for the program are likely to remain predominantly focused on such establishments.

Peer Educators/Barbers/Hairstylists

Peer educators are employed as barbers or hairstylists. After an owner has agreed to participate in the program, the Project Coordinator or Prevention/Outreach Worker makes arrangements to visit the salon/barber shop when staff are unlikely to be busy with clients. As the optimal time to visit depends on the location and type of business, it is always important to check in with owners about this.

The program staff casually approaches the employees, tells them what Operation Hairspray is and assesses their interest and suitability to become volunteer peer educators. To become a peer educator, the employee must be a member of the African or Caribbean community, agree to complete a two-part training, and (after being trained) agree to engage customers about HIV/AIDS as occasions to do so present themselves. For more information on peer educator inclusion and exclusion criteria, please see Program Materials.

An owner who has agreed to the project often encourages employees to volunteer as peers. However, it is important that employee involvement remain completely voluntary to respect the employee’s autonomy and ensure his or her sincere commitment to the program. It is not uncommon for employees to refuse volunteering due to their discomfort with communicating with customers about HIV, especially considering the prevalence of HIV phobia and stigma.

However, as the program becomes integrated into the community through the work of educators comfortable addressing these issues, reluctance to be associated with the project is greatly diminished and volunteering becomes more popular within the community. 

Customers

To engage their customers in discussions about HIV, peer educators may casually broach the topic or simply address issues related to HIV when related topics such as dating and relationships occur naturally in conversation. The key point is to bring up the topic “naturally” and informally.

Candies, combs, condoms and pamphlets with Operation Hairspray information are strategically placed in the businesses to further prompt customers to ask questions regarding the project. In men’s barber shops, these items may be placed almost anywhere, while in hair salons frequented predominantly by women, materials are sometimes best placed somewhere discreet, such as in the bathroom, so that women can take them when they are unlikely to be observed. Operation Hairspray found that men took more condoms and other resources than women.

Candies in particular are a very useful tool in engaging customers and can be placed almost anywhere in hair salons and barber shops. The Project Coordinator asserts that taking a candy (versus a condom) is often considered acceptable by customers, and as such they serve as a discreet introduction to conversations about HIV.

Training

Once business owners and employees have been engaged in the program, the Project Coordinator arranges a time to conduct peer educator training at each establishment.

The training consists of two one-hour sessions in which one or two staff members (often the Prevention Worker and a public health nurse) visit each business at a time that is convenient for the peer educators. Given the unpredictable nature of service-oriented businesses, the trainers must be prepared to interrupt training at any time and return later if a customer should walk in during training.  

Session One

The first session begins with a pre-training quiz to quickly assess the peer educator’s knowledge of HIV to better focus training specifically on gaps in information. Though the program requires no special prior knowledge of HIV, most volunteers were found to be knowledgeable about HIV basics. Results of the quiz were also useful in later evaluation of the overall effectiveness of the training.

The training covers basic HIV-related topics such as: modes of transmission, prevention, harm reduction and common myths and misconceptions, as well as HIV-related stigma and discrimination, using The HIV Prevention Guidelines and Manual: A Tool for Service Providers Serving African and African Caribbean Communities Living in Canada as an accompanying text.

This manual, which is given to each peer educator to later use as a reference, covers the information discussed in the volunteer training as well as more specific and detailed information on a range of HIV/AIDS-related topics, including preventing HIV among men who have sex with men, female genital cutting and dry sex. See Program Materials to access this manual.

The training also includes information on assessment and referrals. The manual contains an invaluable list of phone numbers for HIV/AIDS information and the locations of testing services in Ontario. Should an educator be unable to answer a question from a customer, the manual can be consulted or the educator can get support from the Project Coordinator during the weekly follow-up.  

Session Two

In an informal follow-up visit, the trainers check in with peer educators to review content from the previous session and discuss some suggestions for engaging clients in conversation about health and HIV/AIDS in a way that is comfortable to both the volunteers and their clients (see the Outreach section below).

Follow-up

The Project Coordinator and another person who works with the project, often a nurse, visit peer educators weekly to restock supplies and address any questions or concerns. Common questions include requests for more specific information on HIV testing as well as the specific differences between the transmission of HIV, hepatitis C and other STIs, and how this relates to the proper sterilization of barber equipment.

Educators are reminded each week that they are under no pressure to serve as counsellors to their customers. Any questions they are unable to answer can be brought to either the Project Coordinator or referred to the HIV support line or a specific organization.

Several weeks after finishing the training, educators are asked to fill out a post-training questionnaire, which determines if they have retained the essential information on HIV needed to serve as a peer educator. If they have not and are interested in staying involved, further training is offered. 

After successfully filling out the questionnaire, volunteers receive a certificate indicating that they have successfully completed the Operation Hairspray training. Many of them choose to display the certificate proudly near their work station, which also stimulates discussion with clients.

Outreach

While at work in salons and barber shops, educators provide HIV/AIDS information to their customers using an informal, conversational approach. Educators are encouraged to use whatever means they are comfortable with to engage their customers in discussions about HIV/AIDS. Conversations may vary according to the relationship between the educator and the customer, as well as the social context of the business.

One common method for starting a discussion is for the employee to ask if the customer has heard of the project and then mention having recently completed the training. This ice-breaker usually provides a good opportunity to provide an interesting HIV/AIDS fact learned during the training, which can spark conversation. The educator can also display his or her certificate or any of the materials provided by Operation Hairspray as topics of conversation.  

The discussions between peer educators and their customers about HIV/AIDS are meant to be relaxed and natural. They may take place as one-on-one discussions between the educator and customer or in a group situation, as is commonly the case in hair salons, where women may spend hours discussing life, love and relationships during long treatments such as braiding. There is no pressure on the peers to be health care professionals. They simply provide their customers with some information and refer them to additional services whenever appropriate.

Following a discussion with a customer, the educator may ask the customer to fill out a brief evaluation form of the program. How educators choose who will fill out these forms is based on their assessment of the customers’ comfort level with the topic of discussion.

The staff stop by each week to check in with educators, address their questions and concerns, collect any evaluation forms and replenish supplies of condoms, candies, combs and brochures bearing the Operation Hairspray logo and contact information.

These supplies, when left strategically where customers can access them in an area that is public enough for them to see them but private enough for them to be able to take one without drawing attention to themselves, can be useful in engaging customers in conversations with educators.

Required Resources

Human resources

Staff

Operation Hairspray is implemented with one to three staff members. Staffing needs depend on the number of businesses and peer educators involved: The more people in need of training and support, the more staff required. Given that Operation Hairspray is a project of Ottawa Public Health, a public health nurse who brings expertise in HIV/AIDS is on the team. However, a nurse is not specifically required.

It is very helpful but not mandatory to have a member of the African or Caribbean community on staff. To date, one person (the Project Coordinator) has been responsible for managing the project. She works with the Project Advisory Group to select businesses. Both the Coordinator and the Prevention Worker engage business owners and educators and conduct weekly follow-up and trainings. The public health nurse helps with training.

All staff must:

• be committed to improving HIV/AIDS awareness in the African and Caribbean communities
• be capable of training people with limited HIV knowledge as peer educators
• understand cultural nuances of the community involved and take an appropriately sensitive approach to HIV education
• have strong interpersonal skills

Project Advisory Group

This project is guided by a Project Advisory Group. For more information on this group, please see the Recruitment and Engagement section.

Peer Educators

This project is based on the work of volunteer educators to provide HIV/AIDS education and resources to members of the African and Caribbean communities in Ottawa.

Ideally, peer educators:

• are members of the African or Caribbean community of Ottawa
• are committed to addressing HIV/AIDS and related issues in their community
• have strong interpersonal skills

For more information, please see the Recruitment and Engagement section.

Material resources

• condoms
• candy
• combs
• HIV Prevention Guidelines and Manual: A Tool for Service Providers Serving African and African Caribbean communities Living in Canada
• referrals for counselling and testing services

Financial Resources

• Not including staff time, it costs less than $100 per week to run the program. This cost is associated with replenishing supplies of condoms, combs and candies.

Challenges

• HIV/AIDS phobia, stigma and discrimination can make business owners and employees, as well as their customers, reluctant to participate.
• To serve both the English- and French-speaking African and Caribbean communities, it may be necessary to have a dedicated Prevention Worker for each population if a bilingual candidate is not available.
• Employees of service-oriented businesses may be difficult to train when interrupted by customers or job-related responsibilities.

Evaluation

Operation Hairspray has been evaluated through a series of different evaluation activities. An evaluator developed the various data collection tools used with input from project staff and the Project Advisory Group, and the project staff was responsible for ensuring data was collected.

Peer educators are asked to participate in a number of evaluation activities, including:

• a pre- and post-training HIV-information questionnaire
• a satisfaction survey (six months after they’ve begun volunteering)

In the second phase of the project, some customers were asked by educators to fill out a confidential client impact survey based on their experience.

For examples of the data collection tools used by Operation Hairspray, please see Program Materials.

Peer Educator perspectives:

The pre-and post-training quiz, which each peer educator takes immediately before and four weeks after training, revealed that 1) many volunteers already had some basic HIV knowledge, and 2) the training was successful in bridging those knowledge gaps that did exist.

Additionally, in the six-month satisfaction survey, educators reported experiencing:

• a sense of giving back to their community
• an increase in their knowledge of HIV/AIDS
• an increased comfort level when conversing about HIV/AIDS

Customer perspectives:

The client impact survey completed by 106 customers who came into contact with a peer educator reported an increase in:

• HIV transmission and prevention knowledge
• recognition of the importance of HIV/AIDS awareness in their community
• desire to make conscious decisions to protect themselves from HIV/AIDS

It also revealed that the customers had intentions to spread the word about the importance of HIV/AIDS awareness and prevention based on what they learned from the educator. The project is currently unable to evaluate whether or not customers are acting on these intentions. Respondents said that as a result of the program they were more likely to:

• share information with family and friends (75.5%)
• make a conscious effort to protect themselves against HIV infections (56.6%)
• change thoughts, behaviours and feelings about HIV/AIDS (35.8%)

Lessons Learned

• Training people to serve as HIV peer educators to their customers can reach communities underserved by more formal outreach efforts.
• Strategically placing interesting or eye-catching resources printed with program information can generate customer interest in discussing HIV with peer educators.
• Weekly follow-ups with peer educators to check on supplies provides staff with an opportunity to address their questions and assess the program’s effectiveness in each establishment.
• Soliciting business owners’ participation is a critical first step in engaging employees to become peer educators.
• A very casual, conversational approach to education integrated into a familiar activity such as visiting a barber/beauty shop is essential for maintaining the non-intrusive nature of the project in order to facilitate open discussions on HIV.

Program Materials

• Operation Hairspray Evaluation and Reporting Tools
• Operation Hairspray Recruitment and Engagement Materials
• Operation Hairspray Training Quiz

Contact Information

For more information on Operation Hairspray, please contact:

Zhaida Uddin BSc (hons), M.A.
Program Development Officer
Sexual Health Unit
Ottawa Public Health
179 Clarence Street
Ottawa ON K1N 5P7
(613) 580-2424 ext. 20136
www.ottawa.ca/health