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This post, written by Percilla Obunga, FHI 360 project management specialist on gender and girls’ education in Kenya, originally appeared on FHI 360’s Degrees blog, and can be accessed here.

adolescent girls readingFor the last four years, the Four Pillars PLUS project has been working with girls of primary and secondary school age in Kenya to address the complex barriers to achieving their educational success.  The project is funded by the General Electric Foundation for the years 2008–2015.  Using the Four Pillars strategy — scholarship, teacher professional development, mentoring of girls and community participation — notable changes have been realized in girls’ enrollment, retention and completion at the primary school level and in their improved performance, transition and retention at the secondary school level. The community has gradually accepted and supported the important role of girls in society, and teachers too are motivated to use the gender lens in achieving success in educational programs.

It has been a long journey to work with the girls as they go through so many challenges in life. My personal experience in working with communities has been challenging and rewarding at the same time. Communities — especially those with cultural barriers to girls’ education — need to be involved from day one, and throughout all the stages of project implementation, if support of the girl child is to be effective. Additionally, girls need to be empowered to know and believe that they are not inferior. That is why the Four Pillars PLUS project collaborates with women role models who represent hope and support as they mentor girls on life skills, good decision making, healthy choices and reproductive health issues. This approach has helped girls make greater strides in achieving educational success.

Creating lasting changes in the lives of girls has always been at the forefront for the Four Pillars PLUS team and, indeed, it continues to be a rewarding experience to see future productive women in our society. The girls are working hard in school, teachers are very committed to ensuring good performance and school administrators all join hands to make the school environment friendly to the girl child.

The Four Pillars PLUS strategy is a holistic approach that has proven to work wonders in improving educational outcomes for girls and other vulnerable children in the society.

According to the UNFPA, girls in developing countries who receive seven or more years of education marry, on average, four years later and have approximately 2.2 fewer children.

Emma Brathwaite is a senior adolescent/youth health technical advisor at the Nossal Institute for Global Health (University of Melbourne) with 10 years of experience in HIV, AIDS, and sexual reproductive health. Her expertise focuses on program design and implementation and operational research for advocacy to develop national HIV responses. She specializes in HIV prevention programming with and for most-at-risk adolescents and youth and HIV and adolescent sexual reproductive health integration.

PLAY peer educators

Millions of young people around the world face very high risks of HIV infection and other negative outcomes. In Asia, 95 percent of new HIV infections among young people are in “key populations at higher risk,” who comprise only 5 percent of young people.[1]

Two behaviors of greatest risk for the transmission of HIV are penetrative sex (vaginal or anal) with multiple partners without using condoms, and sharing used needles and syringes to inject drugs. Unprotected vaginal sex is a risk not only for HIV transmission but also for other sexually transmitted infections and unplanned pregnancy.[2]

Kamus Peer Educators

The public health response has focused primarily on risk-reduction behavior change models for HIV prevention, which essentially rely on people being willing and able to change their behavior to reduce their own individual risk.

Sound easy? Perhaps not.

We asked young people in Indonesia what they thought. These young people are peer educators. Many of them sell sex and use drugs (sometimes both), and all of them are actively involved in HIV prevention activities.

PSA Peer Educators

They explain that behavior change is not easy. They say it takes time, practice, and patience. Behavior change takes much more than education alone. There are many characteristics of young people that need to be taken into consideration, especially for programs and also for policy. These include age and sex, whether or not they are attending school or work, what type of work, marital status, economic dependence, family relationships (and support), friendships (and peer pressure), and where they live (in urban or rural environments). All of these factors are interconnected, shape how young people act and interact, and can be a source of both risk and protection.

Adi explains: Sometimes you are the student, the son, the friend, sometimes you have to make money for the family – it’s like being an actor, you know. You play different roles all the time and this can be hard when you’re young because there’s so much going on. You’re not a child but you’re also not an adult – but people expect you to make adult decisions but then treat you like a child!

Adolescence is also a period of curiosity, risk-taking, and first-time experimentation with many things, sometimes including drugs and alcohol.

Ayo explains:

Friends have a really big influence on what we do, how we dress, the music we listen to, the type of phone we have…but also on the things you do—like having sex, trying drugs, motorbike racing. It depends on what group you’re hanging with, like punks, emos, b-boys. It’s not like they are pressuring you by saying “hey, try this” but it is the non-verbal pressure to do things, try things, and keep up. Being part of a group is important.

Perception of risk is a very important factor for adopting protective behavior, and it is critical in applying behavior change HIV prevention models.

Yuan explains:

It’s not just the risk behavior you have to think about. Most of us know the risk factors from trainings—unsafe sex, sharing needles. We know this! Everyone tells us “don’t do this, don’t do that!” But when we think about ourselves and our friends and we really think about whether we are at risk, then it becomes a bit personal and much harder. We might know (deep down) that we are in the “risk” category because of something we do, but it’s hard to admit that to ourselves, and admitting that, really knowing your own risk status means you have to make big changes in your life, and sometimes those changes are hard because it means changing who you are.

AYOMI Peer Educators

There remains much we don’t know about what influences risk perception, especially in youth, and the multi-level influences on behavior and health. Currently, the majority of youth HIV prevention programs operate on a series of overlapping assumptions: that young people are able to assess their own risk and know their risk status; that their individual perceptions of risk fit with program definitions of risk; that young people identify as belonging to an “at-risk” population; and that young people are suitably skilled, resourced, and empowered to access relevant services or attempt behavioral changes. As we work toward effective HIV prevention for young people, we also need to consider the following:

  • Adolescent risk behavior is often less fixed than adult behavior.

Karim explains:

Sex and drug use are sometimes experimental and might not continue. Sometimes young people might try something just to see what it’s like—it might be risky but it’s not permanent.

  • Young people are less likely to identify as a member of a high-risk or at-risk group.

Anyes explains:

Because unprotected sex or selling sex might happen only a few times, we think—it’s only this once…it doesn’t mean I am a “sex worker,” it means occasionally it might happen. Even if you do things and you know it’s risky—like injecting drugs—it doesn’t mean you think, “aha, I am an ‘injecting drug user.’” Being part of a group is important for young people in Indonesia but it doesn’t mean we are grouped as injecting drug users or sex workers. There is still a lot of stigma.
  • Young people are more easily exploited and abused.

Karla explains:

Getting clients [of sex workers] to use condoms is very difficult because the clients have all the power. When you first start working, you don’t even know what you’re entitled to, what your rights are, how to negotiate safety, where to get advice. Sometimes clients are violent, and for young people with less experience, it’s hard to know how to get out of the situation safely.

  • Young people are often less willing to seek out services.

Rahma explains:

Even if you know you need to see the doctor or need some advice, actually knowing where to go can be a barrier for some young people. But also, some things are illegal, like pre-marital sex, and so young people worry that if they go to a health service they might get in trouble or they worry that their parents will be informed and they worry they will bring shame to the family.

Aceh Partnerships in Health

The 2006-2008 Aceh Partnerships in Health (APiH) Facility was a health program designed to develop the capacity of local organizations to deliver quality health services. The first phase of the program commenced in February 2006. The facility focused on HIV, adolescent health, disability, policy, mental health, and organizational development. Phase two and phase three of this program continue its work in adolescent health, with a special focus on including HIV prevention in preparation for a coordinated provincial HIV response; HIV prevention among most-at-risk young people (particularly young transgender sex workers, young female sex workers, male street youth, and young drug users); design and implementation of the Life Skills in Schools Program; and a life skills out-of-school program. For further information: click here.

Peer educators: The youth-friendly medical clinic is co-located with a youth drop-in center (considered the headquarters for the peer education groups) and linked to the peer education programs. Together they provide a safe and supportive environment for young people, helping to increase clinic access, fostering positive peer/adult relationships, building HIV knowledge and communication/negotiation skills, and strengthening protective factors for young people. There are four main groups of peer educators connected to this program. All are actively working in Aceh Province in Indonesia. These young people are critical to the success of the program.

All young people involved in this story have given their consent (for photos and narrative). Names have been changed to protect their identity.

For more information, contact Emma Brathwaite: emmacb@unimelb.edu.au

 


[1] Presented to Mr. Ban Ki-moon, UN Secretary General. Redefining AIDS in Asia: Crafting an Effective Response. Report of the Commission on AIDS in Asia. 2008.

[2] UNICEF Regional Office for South Asia (UNICEF ROSA). Guidance Note: HIV prevention among most-at-risk and especially vulnerable adolescents and young people in South Asia. 2009.

Robyn Dayton is a technical officer at FHI where she works on the research utilization portfolio of youth reproductive and sexual health activities. 

If there were an intervention that helped young people protect themselves from STIs, HIV, and unplanned pregnancy, while increasing the chances that they will grow up to be adults with healthy and fulfilling sex lives, would it be made widely available? 

Since there is such an intervention – sexuality education – this isn’t a theoretical question.  But in many places, the answer is flatly no.  In these locations, a desire to protect future generations is outweighed by the fear that openly discussing sex, including the prevention of some of its harmful consequences, would cause more young people to engage in sexual activity.

What if the intervention were proven not to increase sexual activity or risky sexual behaviors, but instead to delay sexual debut and increase the use of safer sexual practices – would that be enough to assuage any fears and ensure access worldwide?

Again, a look at the response to the evidence on sexuality education leads to an answer of “no, it’s not enough.”  Issues of sexuality, and especially youth sexuality, are so contentious that even data from randomized controlled trials doesn’t carry enough weight to counter strongly held beliefs and visceral reactions.

But what if access to that intervention was considered a human right?

Here, we move to the theoretical, but not for long, as it is an answer that the world is in the process of finding out.

In a July 2010 report, Vernor Muñoz, Special Rapporteur on the right to education to the United Nations, unequivocally proclaimed that sexuality education is a right. 

In the report, he addresses why sexuality education, and specifically comprehensive sexuality education, should be offered to all.  He states that the already established right to the highest attainable standard of physical and mental health “obviously includes sexual health” and that achieving this standard is “possible only if we receive comprehensive sexual education from the outset of our schooling and throughout the educational process.”  He also describes the right to sexuality education as “both a human right in itself and an indispensable means of realizing other human rights.” 

In terms of comprehensive sexuality education, he notes that sexuality education cannot be reduced to reproduction and that there is “no valid excuse for not providing people with the comprehensive sexual education that they need in order to lead a dignified and healthy life. Enjoyment of the right to sexual education plays a crucial preventive role and may be a question of life or death.”

Additionally, he grounds this right in several international conventions, including the Convention on the Elimination of All Forms of Discrimination against Women and the Convention on the Rights of the Child.

Whether the Special Rapporteur’s report will make a difference in how widely sexuality education is made available remains to be seen. 

What I can say at present is that his well-chosen words have reminded me not only how important sexuality education is for young people but also the daily injustice being done when they are unable to access it.   

Read the United Nations Special Rapporteur on the Right to Comprehensive Sexual Education.

Karyn Fulcher is a peer educator at Scarleteen.

A couple of weeks ago, I had the chance to attend sex::tech 2011, a conference in San Francisco about the intersection of sex education and technology. Over those two days, there was a lot of discussion centered around peer education—what it is, whether it works or doesn’t work, how it should or shouldn’t be done, and the major pros and cons. And then I was handed a copy of the IYWG’s Evidence-Based Guidelines for Youth Peer Education, written to provide a framework and some basic concepts for organizations wanting to start their own peer education program.

Being a peer educator myself, albeit online at Scarleteen.com, I was asked to take a look at how realistic these guidelines are from my perspective―the perspective of a peer educator who works in an organization that’s pretty unique in a lot of ways as far as peer education goes.

To make clear how unique Scarleteen really is, think about how we work: there is no set curriculum (pretty much impossible in an online format where participants come and go as they please). We peer educators have got the chance to contribute to any part of the site, whether that be writing an article, answering one of the longer-format “sexpert” advice questions, or doing a piece for the blog. We’re flexible in how we work and do our best to make sure that all the users get exactly what they need, and we always, always put the young people we serve at the forefront. If they voice concerns or problems with the way we do things, we make changes. And we get feedback about everything, all the time; our message boards act basically as one giant ongoing evaluation form, letting us know what’s working and what isn’t for our users.

Even though Scarleteen’s format and structure are clearly different from a lot of peer education programs, it turns out that a lot of the guidelines fit what we do very well. The concept of youth-adult partnerships is key to how Scarleteen functions as a whole. Our executive director is always asking us for our input on things like new content, changes to the message boards, or who we think would be a good fit when we’re in need of new volunteers. I’ve always had the feeling that my opinions and knowledge are valued and appreciated, and that any feedback I give about any topic will be listened to and taken into consideration. (Even our new logo was chosen with input from me and the other volunteers.) I’m a peer not just in the sense of being similar in age to the people Scarleteen serves, but in the sense that I am treated as an equal to our executive director, our assistant director, and any adult doing work for the site.

The idea that youth should be involved in program planning is also important to the way Scarleteen functions. Our director is a former Montessori teacher, and the concept of teaching to what young people say they need and want is a model we all follow. There’s no set curriculum, although we do have thousands of pages of static content we can refer users to, and we do our best to get a good picture of what it is they’re looking for before referring them to that information. I don’t think I’ve ever answered a question with the mindset “this is what you should know.” Rather, I always start off by asking what a given user feels they need and how I can help them. Information doesn’t just go one way at Scarleteen: we learn as much from the people we’re educating about their lives and their needs as they learn from us about contraception and healthy relationships. I would never presume to know what one of our users is looking for without asking them.

While some of these guidelines mesh very well with the work I do as an online peer educator, some of them don’t hold up as well. Two things in particular jumped out at me: the idea that “simple and consistent messages” are the best at helping young people make long-term changes in behavior, and the recommendation that there be a “chain of command”—that peer educators report to a program coordinator who then reports to a program supervisor, and so on. (And, tied into this, the fact that the program participants themselves—the population to be served—seems to be missing in the list of stakeholders.)

First off, the simple messaging. Even though Scarleteen serves people from around the world (one of the many benefits of being an online organization), I can’t remember any instance of someone asking us to make our information simpler—not even someone whose first language isn’t English. Actually, the reverse seems to be true: often our users take offense when we ask if they need the information to be simpler. They’re tired of older people assuming that just because they’re young, they can’t handle complex ideas. Who hasn’t had the experience of hearing “you’re too young to understand” or “maybe when you’re older you’ll get it”? Speaking from experience, if it’s something we’re interested in, something that’s relevant to our lives, young people can handle all sorts of information, and the more there is available, the better.

The second thing that really struck me in these guidelines is the placement of peer educators in the hierarchy of an organization. The participation of peer educators and young people in general is critical in many programs serving youth—young people are, after all, the entire reason these programs exist in the first place. Why, then, are they so far down the totem pole? And why is there a totem pole at all? It might be obvious that Scarleteen is not big on hierarchies. Everyone involved, whether executive director or new volunteer, is important. We’re all part of what makes Scarleteen work, and while we have different roles, there isn’t one that’s seen as better than any other. Each of us—along with the young people we serve—is a stakeholder, and if I had to show the structure of Scarleteen as a hierarchy, I’d put those young people at the top.

I realize that most organizations don’t work the way Scarleteen does. Some might not think it’s possible to get youth involved in every aspect or to be ultimately accountable to the participants of their programs rather than to funders or parents or community leaders. But ultimately, I think it can be done, and it needs to be done. These guidelines are a great starting point, but they need to go further. In the end, young people are people, and we can handle a lot more than you might think. Give us the chance to prove it.

 

Tell us what you think of our peer education guidelines. Check them out here and leave us a comment.

Sarah Forde is the executive director of Moving the Goalposts, a girls’ football (soccer) and development program in coastal Kenya. She is a development professional with experience in sports and development programming, gender, and social justice. She is also a trained radio journalist: she worked with the BBC for six years and is currently engaged in communication work on sexual and reproductive health issues affecting young women in Africa.

I’m sad to say I probably wouldn’t be described as “young” any more. I turn 40 at the end of the year but I still play football every week and have done so since I was about five years old. As a feminist with a love of football, I set up Moving the Goalposts (MTG) 10 years ago. Moving the Goalposts is a girls’ football and development initiative in one of the poorest districts, Kilifi, in coastal Kenya. The aim was to get girls out playing football, challenging gender inequalities, and giving them opportunities to fulfill their potential. In the early days, we had fewer than 100 girls playing football. Now, in 2011, there are close to 3,000 rural girls participating in MTG’s football leagues and tournaments. They organize their own field activities as the coaches, referees, and first aiders, and they have access to information and social support from peer educators and peer counselors.

So in 10 years, MTG has grown quite substantially, but so what? With more girls taking part, is there more impact and more social change? Not necessarily, but we’ve tried to measure change over time with a survey developed by the Laureus Sport for Good Foundation. We piloted the survey in 2009 and administered it again in 2010 to track the same girls 12 months on. We interviewed 167 girls in both years and have some interesting findings. We used the strictest statistical procedures, in which we only claimed that a change could be attributed to MTG if the probability of the change in scores was less than 0.002. In other words, there was only a 0.2% possibility that the change could have happened by chance. The girls reported better-developed life skills in 2010 than in 2009. The life skills questions that made up this score covered being able to identify your own strengths and weaknesses, deciding on short- and long-term plans, taking advice from those with experience, being well-prepared, enjoying challenges, and showing perseverance and self-control. Working well with others was another area that girls reported had improved; this is often a benefit that is attributed to playing team sports such as football. There was a significant difference in the scores regarding speaking; questions about this indicator asked about knowing when to speak, when to be silent, and what to say; explaining to others one’s goals and ambitions; adjusting how one speaks to different people; and presenting information to others.

Another important feature of MTG’s work is peer-educator led sexual health education, which includes learning new ways of thinking about people with HIV/AIDS as well as encouraging members to be more empowered in their sexual relationships. The impact of MTG on beliefs about HIV/AIDS was measured with five items: understanding how people are infected, talking about HIV/AIDS to others, increased confidence to refuse sex, treating those infected with respect, and knowing how to protect oneself from becoming infected. The score increased significantly from 2009 to 2010.

Our monitoring and evaluation efforts are not just to prove we are doing well or to show that our program has significant benefits for girls. They are to let us know where we could improve and where we should direct more of our efforts to achieve our aims in the coming years. I’ll blog again soon about our findings that showed where we’re having least impact and where we need to up our game. Oh, and by the way, we’ve documented more qualitative work in a book called, Playing by Their Rules: Coastal Teenage Girls in Kenya on Life, Love and Football, which is a journey into the teenage world of rural East African girls, whose voices are rarely heard beyond their own small world. It’s available here.

To learn more about how participation in sports can help girls build social networks, challenge gender norms, and enhance their physical and mental well-being, also see the latest IYWG YouthLens: Sports for Adolescent Girls (233 KB).

John Boke Mwikwabe is a peer educator in Naivasha, Kenya.

I have been a peer educator ever since I was 16 years old. I was recruited by a community-based organization known as KNote and took a one-week peer education training. That was in 2001. Since then, I have had 567 different youths in my group. The peer education program works with youth between the ages of 14 and 24 years old. 

In the peer-education sessions, the main aim is to pass basic information on various health issues…with HIV being number one on the list. I have gone far to make the sessions exciting and something to look forward to by doing things like:

  • Providing one-on-one and group counseling for my peers
  • Arranging exchange programs with other peer groups in and outside of Naivasha
  • Playing outdoor sports
  • Visiting homes for children who have either been affected by or infected with HIV
  • Leading discussions on drugs and drug abuse

The composition of the group includes married couples, dating couples, straight single people, and gays and lesbians. It is an all inclusive out-of-school peer group.

The main reason why I keep doing this is because I get to learn something new from my peers all the time; they keep me on my toes! I highly appreciate the responsibility I’ve been given when I realize the difference the group is making amongst my peers. I guess it’s like they say, there’s joy in receiving but the greatest joy is in giving.

A comment on peer education from the IYWG:

For information on evidence-based practices and guidance on how to apply these practices to current youth peer education (YPE) programs, read the Evidence-Based Guidelines for Youth Peer Education.

Robyn Dayton is an Associate Technical Officer at FHI where she works on the research utilization portfolio of youth reproductive and sexual health activities.

I had an opportunity recently to travel to Bogotá, Colombia for the UNFPA Global Consultation on Sexuality Education.  The meeting covered a range of topics, from what works in sexuality education to how to advocate for comprehensive sex ed with national governments.  There were attendees from Asia, sub-Saharan Africa, the Arab states, Latin America, Eastern and Western Europe, and the United States.  Everyone shared their successes and stumbling blocks on the path to ensuring that young people all over the world have the information they need to make safe and healthy choices in their reproductive lives and beyond.

A few key ideas really stood out to me.  First, there was an emphasis on gender throughout the conference.  All acknowledged that if gender isn’t addressed explicitly, young men and women are less likely to be able to use the information they learn in sexuality education programs or classes.  But if we help young people recognize and question gender norms – like “real men are aggressive and don’t take no for an answer,” and “women should be passive and not question men’s authority” – they are more capable of engaging their partners in delaying sex or practicing safe sex. 

Another important point frequently raised at the meeting: if you don’t measure it, it doesn’t count.  It can be difficult to determine what young people gain from sexuality education if we only measure behavioral outcomes like delayed sexual initiation.  We need to think more broadly.  Improving students’ ability to think about complicated concepts like gender constructs also builds critical thinking skills, which improves a student’s overall performance.  Thus, measurements of academic performance generally could be used to indicate the success of sexuality education programs. Another factor to consider is how students engage in sex – is it coerced, transactional, forced, consensual?  The context in which young people have sex affects their mental and physical health and is another indicator of the success of sex education.  If we aren’t collecting information on these kinds of indicators, we’re missing the bigger picture.

Which relates to the final point that I took away from the meeting – sexuality education isn’t only about preventing poor health outcomes.  We need to move away from the idea that sexuality education is just another weapon in the fight to curb HIV.  It is that, but it’s so much more.  Sexuality education gives young people tools to think about themselves and their sexuality, to understand and respect their changing bodies and emotions (and those of their peers), and to mature into healthy and satisfied adults.  Our sexuality should not be viewed simply as a risk factor for contracting diseases, and the meeting emphasized that we all have the right to understand and feel comfortable with ourselves as sexual beings and as people generally.

A full meeting report will be made available in January.  So check back because we’ll be posting the link!

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This blog is brought to you by the Interagency Youth Working Group (IYWG) with financial assistance from the U.S. Agency for International Development and the U.S. President's Emergency Plan for AIDS Relief. The content is managed by FHI, which functions as the secretariat for the IYWG.
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