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John Boke Mwikwabe is a peer educator in Naivasha, Kenya. This is the fourth post John has written for our blog. To read more from John, see What It’s Like to Be a Peer Educator, posted on March 18, One Peer Educator’s Biggest Challenge, posted March 21, and Why Are Young People in Multiple and Concurrent Partnerships, Anyway?, posted on March 31.

Lately, I have been thinking about the high rate of HIV among youth. I started to ask myself and my peers some challenging questions. “Why are new cases of HIV and AIDS still persisting? Why are young people still getting infected by the virus? What have we been overlooking all along? Are we not clear enough on HOW TO and HOW NOT TO contract the virus? Is it our ignorance or lack of adherence to these messages that causes new cases of HIV among young people?”

Recently, a regional football tournament was held in my town; the event attracted many young people. The large gathering of young people in our area provided the perfect opportunity to provide information on sexual and reproductive health to a substantial group of people. To take advantage of this opportunity, my organization decided to host a filming and facilitated discussion of the MTV-produced TV series, Shugga.

We targeted all of the youths between the ages of 15 and 24 who had come to the football event. We gave out tickets for the film based on age and convinced young people to attend both the viewing of the film and a 45-minute facilitated discussion afterward in our local social hall. The showings were strategically held immediately after the games at around 4:30 pm.

Our target number was 400 for the whole weekend. The turnout was better than we had expected, and the level of interest in the movie was off the roof. After the film, we split the youths into smaller groups of 25 or fewer for a discussion led by peer educators. The movie, which is in English, Kiswahili and “Sheng” (a local dialect), depicts the lives of youths who are prone to various risky behaviors, the choices they make, and the consequences of these choices.

During these sessions, I gained some really valuable information from the participants about young people’s sexual behavior.

  • Most young people said they use condoms the first few times with a new partner, but stop using condoms once they have been with a partner for some time and “the relationship goes to the next level.”
  • In cases where one spends the whole night with a lover, they only use condoms for the first few rounds.  When I asked them why, the youth responded that they thought it was quite illogical to have the all-night partner and end up using a condom the whole night. One becomes tempted not to use it even though they might not believe the partner is safe.
  • Often, young people do not know about their partners’ sexual networks. The fact that dating couples do not talk about their “MIPANGO YA KANDO” (side dish) and that no party can willingly come out and state they are in a cheating relationship puts both parties in a risky situation that compromises their status and health. Approximately three out of four young men that I talked to said that they had at least two “side dish” ladies that they have sex with without using a condom. It didn’t seem to occur to them that these ladies might also have side dishes at the time.

It seems that despite all of the knowledge we have about HIV prevention, young people are still engaging in risky behavior. So how do we address these challenges before it is too late? Sometimes, trying to get youth to change their behaviors feels as difficult as climbing Mount Everest. While we try to find the answers to these challenging questions we will just have to continue raising awareness about the risks of HIV and help the youths understand the importance of protecting themselves and their partners.

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.

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.

John Boke Mwikwabe is a peer educator in Naivasha, Kenya. This is the third blog post written by John. To read more about John, see What It’s Like to Be a Peer Educator, posted on March 18 and One Peer Educator’s Biggest Challenge, posted March 21.

When the campaign against HIV/AIDS started, all we heard was how abstinence would be the solution to not getting the infection. But the long discussed and argued question still remains: is there a single way to avoid being infected by HIV? What is the connection between an individual’s intention to heed good advice and their actual behavior? Do people know the consequences involved in various risky behaviors and end up indulging in them anyway?

Those are some of the questions that came to mind when we tested new activities from FHI on reducing multiple concurrent partnerships. The activities had been divided into seven sessions, all of which were dealing with two types of sexual relationships/partnerships: sequential and overlapping sexual relationships.

After almost two months working with these activities, here are some of the issues that came out of the discussions that we had:

  • As much as overlapping partnerships are riskier than sequential partnerships, youths still prefer them because they are interesting and “make life worth living.” They believe there is adventure in trying to conquer and have new relationships that are more interesting than the one they are in.
  • Sequential relationships are the best option. But after leaving (or being left by) a lover, it can be hard to wait a long time to start a new relationship, because you might be hurting and wanting to be with someone for emotional and psychological reasons.
  • Young women say they need different men in their lives to do different things for them, namely one for dating, one for financial support, one for one-night stands, and another as a full-time lover.
  • If you are in relationships with a lot of people at once, the chances of being hurt are slim because you have not fully invested feelings in only one person. Then, if a relationship with one of your lovers becomes stressful, it is much easier to leave and move on to another one on the list.
  • Youth feel that when one gets into a relationship with someone, they know them inside out. This leaves no space for new discoveries, and having the same routine over and over again sometimes becomes boring. One tends to want to have that feeling of first love and pursuit rekindled.
  • Young women say that since men will never be satisfied with one person, it’s only fair for women to also have someone else or other relationships on the side just to be safe in case the men leave them for “greener pastures.”

As you can imagine, the discussion was long and heated. Many youth were aware of all the risks involved but still had difficulty seeing themselves with just one partner. The most important thing they took away from the discussion was that if you will not be in just one relationship at a time, then you must have full knowledge about how to protect yourself from various risks that are involved with having an overlapping relationship.

The “use condoms” tune had to be sung again, as well as the need for testing and counseling. The good thing about the activities we tested is the fact that they do state exactly what is going on in our lives today. They bring something fresh to the table and can help equip youth with the knowledge and information needed for sound decision-making.

This post originally appeared in Pathfinder’s Field Journal and can be accessed here. Written by Antonio Massuque, March 2011.

In Mozambique, young people between the ages of 10 and 24 make up one-third of the population. Of all new cases of HIV in the country, 60% are among youth (15-24). Girls and women are especially vulnerable and are being infected three times more frequently than men. In this challenging climate, the leadership of young people is critical to reversing these statistics and building a better tomorrow for Mozambique. The following story highlights one of these young leaders, who took initiative through the Pathfinder-supported Geração Biz program to become a dynamic peer educator for his fellow youth.

My name is Antonio Maria Jorge Massuque. Since I was 19, I’ve been involved in youth and adolescent development in my country, Mozambique.

My passion for social work was born while I was a student at Malhaizine’s Secondary School, located in the suburbs of Maputo. There, a teacher of mine invited me to join a group of ten students to receive training in ethics and civics. In that group, I discovered my love for counseling others. I relished the opportunity to listen to other young people and direct them to the services and institutions that could address their needs. Unfortunately, by the end of the year, I had to change schools and leave the program. But the experience opened my eyes to the importance of caring for and supporting other youth.

Soon after, I was accepted into a graduate school for journalism. There, I found another opportunity to continue counseling when I met the Geração Biz program coordinator for Pathfinder International. Geração Biz supports the training of peer educators, the development of youth-friendly services, and the establishment of school-based sexual and reproductive health interventions throughout the country. Pathfinder’s program coordinator welcomed me into the project with open arms, asking me to apply the Geração Biz model to educate young people in sexual and reproductive health and HIV and AIDS. Together, we trained 30 students, teaching them to facilitate discussions at their schools and other community spaces. Today, Geracao Biz is a national program that the Mozambican government has scaled up to reach more than 3.6 million adolescents every year.

My work with Geração Biz opened up many opportunities for me and allowed me to grow as a leader. I currently manage the Geração Biz Web site, lead the African AfrYAN (a network for the promotion of sexual and reproductive health for adolescents and young people of Africa), and even run a popular radio show on Radio Mozambique. The show runs for an hour, twice a week and focuses on youth and their reproductive health issues. Like much of what I do, the goal of the radio program is to promote discussion and encourage young people to protect their health.

In 2007, my colleagues elected me to be the leader of a new movement called Youth Action Motion. There, I connected with experts in the field of sexual and reproductive health, improving my ability to analyze critical issues, like the need to increase access to services, among other important topics. I’ve been able to take what I’ve learned and share it with other young people.

Now, I’m 28 years old and studying communications sciences at the University Polytechnic on a scholarship from the United Nations Population Fund (UNFPA). When I look back at my life so far, I realize how Geração Biz and my experiences mentoring others played a crucial role in my development. It has become such an integral part of who I am that I think it’s impossible to describe me without mentioning Geração Biz.

Even today, I still act as a counselor for youth. It’s hard not to. I’ve done it for so long that adolescents and young people in my country consider me an expert on matters related to sexual and reproductive health.

I wouldn’t want it any other way.

John Boke Mwikwabe is a peer educator in Naivasha, Kenya.This is the second blog post written by John. To read more about John, see What It’s Like to Be a Peer Educator, posted on March 18.  

So far, the biggest challenge I have faced has been dealing with gay peers. This is mostly because I am the only one in the group who knows about the gay men, while the gay women find it very easy to reveal their status as lesbians. It seems like both straight males and females prefer lesbians as opposed to the gay men. One major reason often aired by peers is that they think the idea of a man sleeping with another man is a “sore sight,” as opposed to that of a woman with another woman, which they perceive as sexy. This leaves me in a sensitive situation: protecting the gay men who are part of the group and who insist on secrecy.

I can recall the first question I asked peers when this concept was brought up. I asked them if they would prefer to have a gay brother or a gay sister. As you can imagine, this was a hot and steamy conversation. All the male peers preferred a gay sister, and the vote was split amongst my female peers who were torn between both. One of the memorable responses came from the men who challenged the gay brother concept, stating that they would prefer a sister because they presumed the sister would always be seen with a hot-looking girl, and the brothers wouldn’t mind imagining what they were doing. When sensitive topics such as these are raised, I try to tell the peers that gays and lesbians are also our brothers and sisters, which begs for the need to respect their status and to be decent with our comments. We all agreed to be civil and open-minded and view others as human beings first.

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.

The IYWG is hosting an online forum to discuss youth peer education.  We’ll be focusing on the recently completed Evidence-Based Guidelines for Youth Peer Education.   Discussion topics include program planning, recruitment and retention of peer educators, training youth to be peer educators, leading peer education sessions, supervision and program management, monitoring and evaluation, and addressing gender in peer education.

The e-forum presents an opportunity for everyone – whether you’re a program manager, a supervisor, a peer educator, or just someone interested in improving youth peer education – to ask questions and share their experiences.

The forum will begin at 9 AM Eastern Standard Time (EST) on Monday, January 10th and end at 5 PM EST Thursday, January 13th.  Beginning on the 10th, you can submit questions to our experts and share your experiences with colleagues working in peer education.  Because our experts live in a variety of time zones, their responses will be posted beginning on the morning of January 11th.

Click here to learn more about our experts or register for the forum.

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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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