Promoting Healthier Behavior
PEER EDUCATION Peer education has become one of the most common approaches to addressing adolescent sexual and reproductive health in recent years. Peer education is an approach or strategy that involves the use of members of a given group to effect change among other members of the same group. Increasingly, programme evaluations are being published documenting its impact on target audiences. Still, much stronger evidence exists on the impact on peer educators themselves in such areas as increased knowledge, adoption of safer sex behaviours and improved attitudes.(38)
In Central and Eastern Europe and the former Soviet Union, UNFPA worked actively to implement, supervise, monitor and evaluate multisectoral peer education programmes, to build the status and credibility of peer education in the region, and to strengthen sexual education programmes through life skills education. In the past two years, the project has worked with 158 initiatives in 27 countries, training 165 peer education trainees—ultimately reaching 31,000 young people while integrating gender issues into HIV/AIDS prevention. The project has utilized information technology to produce the Youth Peer Education Electronic Resource (Y-PEER) with listservs, websites, and distance learning. Y-PEER currently links 370 peer educators from 27 countries, allowing them to benefit from convenient access to resource materials and training programmes.
In Nigeria and Ghana, the West African Youth Initiative Project used peer interventions to make reproductive health information, education, counselling and services more accessible for in-school and out-of-school young people. The project operated through grass-roots youth organizations and thus depended on community involvement. It had significant effects on participants’ knowledge and behaviour, including greater condom use.(39)
In Cameroon, Entre Nous Jeunes was designed to increase contraceptive use and reduce STIs, HIV and unintended pregnancies among adolescents. Peer educators offered group and one-on-one activities, providing information and referrals to services. Participating youth demonstrated higher reproductive health knowledge and greater use of condoms.(40) Condom use also increased after a peer education project run by a family planning association in the Dominican Republic.(41)
In Zambia, peer distribution of condoms was compared to the provision of small-business loans to adolescents. Both activities led to safer sexual behaviours, but peer education had a greater impact.(42)
Ethiopia, which has a national HIV prevalence rate of 7.3 per cent (13.4 per cent in urban areas), has trained its first group of 60 youth counsellors to combat HIV/AIDS. They will provide counselling at VCT centres.(43)
Peer education programmes can address the gender inequality that perpetuates poor sexual and reproductive health. A study in South Africa found that programmes have the greatest chance of success if they help young people understand how dominant gender norms undermine their sexual health, and give them confidence in their power to resist those norms.(44) A project carried out by the Australian and Lao Red Cross affiliates is tackling the stigma that prevents young women from purchasing, carrying and using condoms.(45)
Some programmes aim to reduce HIV risk among adolescent girls. One, on a campus in Nigeria, targets young women who use their relationships with older men in exchange for money to pay university fees. Peer activities help them discuss the risks of HIV, the need for condom use and condom negotiation skills.(46) In southern Nigeria, the Girls Power Initiative uses participatory methods to increase female students’ problem-solving skills. When meeting with a male teacher, for example, girls are encouraged to take a friend with them to avoid sexual exploitation.(47)
In Ghana, where HIV prevalence among adolescents is still relatively low (2.2 per cent among those aged 10-19), peer education programmes have successfully reached 75,000 in- and out-of-school youth, including street youth and sex workers. Participants have retained what they learned about prevention, abstinence and condom use, and have passed this information on to their friends. Outreach activities complementing peer education have ensured that thousands of street children have been immunized, counselled, and given first aid and information about their health; many have used shelters linked to the programme.
An evaluation found the programme avoided problems of turnover and low motivation among peer educators that have undermined other efforts. Peer educators encountered widespread ignorance and misconceptions about such topics as pregnancy prevention, menstruation and sexual hygiene, pointing to the need to provide information on broader reproductive issues.(48)
Young people living with HIV/AIDS can be especially effective at peer education and motivating young people to protect themselves against infection. In Haiti, the Association for National Solidarity, an organization of people living with and affected by HIV/AIDS, held meetings for young people. They reacted positively to the HIV-positive leader of the group who urged them not to have early intercourse and to remain faithful to their partners.(49)
PEER COUNSELLING Peer counselling deals with addressing the cognitive, emotional, behavioural, and social needs of individuals (and groups of individuals) similar to the peer counsellor.(50) Peer counselling is designed to prevent and address problems, facilitate positive learning and behaviour, and enhance healthy development of individuals and communities.
While peer education attempts to offer knowledge and skills needed for the target group members to make informed choices, peer counselling creates this effect by additionally challenging the socio-cultural norms through a shared personal experience. With this in mind, peer counsellors require additional skills and training, as well as continuous follow-up with their clients to build on the relationship established during the counselling period.
SOWETO PEER COUNSELLOR
DISPELS FEAR AND MYTHS
Mmagokgoshi Morema, 23, is a volunteer peer educator at a Planned Parenthood of South Africa (PPSA) youth centre in
Soweto. The facility has an after-school “chill room” where teens can listen to
music, read manuals or talk to someone.
“A young girl may come for information
about sexuality or relationships. She feels free when she talks to me rather than an
older person,” Morema says. “If she goes to a clinic, they think she is sleeping
“We teach them about positive life styles, informed choices, STDs, and that drugs kill. But we don’t choose for them.”
Part of her job is to dispel misconceptions. “Many girls believe that when you use the pill, you’ll become infertile, or you will get cellulites. When they realize it
won’t ruin their body, they use it.
“Some believe that if you have sex with someone standing up you won’t fall pregnant.
Or if you jump, or have your fingers crossed. They don’t understand the menstrual
cycle, or know that on certain days in the month you can’t conceive. We teach
them about their reproductive parts and show them charts of male and female
Parents also come to the centre. One mother thought they were teaching children to have sex. “I gave her our brochures
and showed her what we are really telling them. We tell mothers and fathers that if a
youth comes to clinic, it doesn’t mean she is having sex.
“We teach parents how to talk to an
adolescent: you don’t have to scare them,” Morema says. “If you tell them the truth
they will understand you better.
“Most youth know about STIs but not
how harmful they are. When they learn, most are shocked by what they didn’t
know. I’m happy because now they know.
“We teach about ABC. Many young
people believe abstinence is key; they abstain. Some reduce the number of partners.
Many young people come to the clinic to get condoms; they are afraid of
dying. We demonstrate how to use them.” Others resist using condoms. “‘You can’t
eat a sweet inside the plastic,’ some say. But they get STDs and see the light.”
Morema is part of PPSA’s “Million
Voices” initiative, which aims to reach 3 million young people within three years.
“We negotiate with principals to get invited to talk to students. Those out of school, we
recruit outside at places like supermarkets and clubs.”
The work is demanding and the hours
are long. Why does she do it? “I have a son,” she explains. “I didn’t have enough
information about pregnancy. My mom told me in a scary way—‘When you have
sex, it’s painful.’ I didn’t know about clients’ rights. She used to tear apart my room
looking for contraceptives. You have to keep a card to go to a clinic; I was afraid
she would find it, so I was scared to go. Instead I used a menstrual chart; maybe I
made a mistake. I was 20.
“I love working with youth; it’s a passion.
I believed in those myths. My goal is to remove the black clouds from their eyes.
You can see it.”See Source
PEER COUNSELLING IN THE PHILIPPINES Peer counselling is central to UNFPA’s active programme of support for projects promoting better sexual and reproductive health for young people in the Philippines.(51)
St. Mary’s University in Nueva Vizcaya shows how a Catholic school can integrate adolescent reproductive health in its programme, despite sensitivity about the issues. Peer counsellors can be easily reached in their campus hangout with reading materials on reproductive health.
Peer counsellors in Metro Manila organized the first Love Poetry contest on campus. Students participated enthusiastically, talking candidly about issues concerning love and sexuality. In Davao City, several peer counsellors were themselves former beneficiaries of the peer-counselling project. One, Belay, left a youth gang involved in drugs and theft to join the centre’s youth camp. He now uses his artistic talent to assist Kaugmaon’s theatre group.