Youth Peer Education Programme on Life Skills, Reproductive Health, STIs, and HIV/AIDS

A. ORGANIZATIONAL INFORMATION

1. Organizational profile

The Life Skills Training Youth Peer Education Programme on Reproductive Health, Sexually Transmitted Infections, and HIV/AIDS was launched by the Asian Red Cross/Red Crescent AIDS Task Force. It has now been established in 12 countries: Cambodia, China, India, Indonesia, Lao People's Democratic Republic, Malaysia, Myanmar, Nepal, the Philippines, the Republic of Korea, Thailand, and Viet Nam. This case study focuses on programme implementation in China and Myanmar. In China, the programme is implemented by the Australian Red Cross, in collaboration with the Red Cross Society of China, the Yunnan Provincial Red Cross, and the Xinjiang Uygur Autonomous Regional Red Cross. In Myanmar, the programme is implemented by the Myanmar Red Cross Society, in collaboration with UNICEF Myanmar.

A wide variety of agencies, including national Red Cross and Red Crescent organizations, AusAID, UNICEF, the Government of the Netherlands, and local donors have provided funding to the programmes in China and Myanmar. Since June 2001, the Australian Red Cross has provided financial and technical support to HIV interventions in the Chinese provinces of Yunnan and Xinjiang. It has also provided technical support to HIV projects run by the Red Cross Society of China and the Red Cross organizations of Fujian, Guangxi, Hainan, and Jilin provinces. The Australian Red Cross supports one delegate in Yunnan Province, and a small group of project staff. The Yunnan and Xinjiang Red Cross organizations each support three full-time staff working on HIV issues. As of June 2001, more than 125 young volunteers have provided HIV education to other Chinese youth under the management of Red Cross.

The Myanmar Red Cross Society operates almost everywhere in the country, in both urban and rural areas. The vast majority of workers in the Myanmar Red Cross Society are volunteers. The Red Cross is funding only one professional staff member, who coordinates HIV/AIDS activities at the Myanmar Red Cross.

2. Goals and areas of activity

Staff in Red Cross organizations are committed to the seven fundamental principles of the Red Cross and Red Crescent Societies, which are humanity, impartiality, neutrality, independence, voluntary service, unity, and universality. These principals are particularly germane to HIV prevention and care.

The Australian Red Cross's mission in China is to support Red Cross partners at the national, provincial, and local level to develop and manage effective and sustainable HIV interventions. The Australian Red Cross aims to promote new responses and provide technical and practical support for HIV/AIDS issues. The major activities of the Australian Red Cross in China are self care workshops for people living with HIV/AIDS and youth peer education on reproductive health.

The Myanmar Red Cross Society carries out activities in three major areas: the promotion of health services, prevention of communicable diseases, and rendering help to those in distress.

B. GENERAL INFORMATION ABOUT MODEL

1. Model profile

In Myanmar, the target population of the youth peer education programme is youth aged 15 to 24 years, while in China it is youth aged 15 to 30 years. The programme operates in both rural and urban areas, and includes university and vocational students, out-of-school youth, drug users, and workers in the entertainment and service industries. In Xinjiang, China, special attention is given to members of the Uygur ethnic group.

The programme began in mid-1990s. Its continuation depends on the availability of funds.

2. Problem addressed

HIV/AIDS is having a major impact on youth in Asia and the Pacific. Youth are at risk of HIV infection because of economic and social demands, because of changing norms, and because traditional education methods neglect responsible decision making and discussion of sensitive issues such as HIV/AIDS. Young women are at risk of HIV transmission through entertainment work and through spouses who engage in extramarital sex.

The HIV/AIDS epidemic has made child sexual abuse and commercial sexual exploitation more damaging than ever. The belief that youth are unlikely to be infected with HIV has raised the demand for younger sex workers in many countries. Youth who are subjected to commercial sexual exploitation often become infected with sexually transmitted infections such as gonorrhoea, syphilis and cancroids, which, by damaging the surfaces of the reproductive tract, increase the risk of contracting HIV. The problem is compounded by the lack of health care services meeting the sexual and reproductive health needs of young people.

3. Objectives and activities

The objective of the youth peer training activities is to promote informed decision-making and care-seeking behaviour among youth. The training imparts detailed and accurate information on sexuality, birth spacing, and HIV/AIDS and other sexually transmitted infections. It also aims to provide participants with skills to help them cope with their daily lives and become proponents of community mobilization.

The key training tool for the programme is a core manual, which was originally developed by the youth peer education project in Myanmar. The contents of the manual were chosen after consulting young people, including commercial sex workers, on what they thought would be useful. Five young people then participated extensively in the writing. It is adapted and rewritten in each country, reflecting the country's language, culture, and socio-economic circumstances. The country manuals are repeatedly pre-tested and revised before they are used for training.

Although the exact implementation varies from case to case, the broad outlines remain the same. In each country, a group of young people aged 15-24 is selected to be core trainers. They are given approximately one week's instruction on life skills, HIV/AIDS, and participatory training methods, which include games, role-playing, and the identification and discussion of behaviours which the young people perceive as risky. The core trainers then train further groups of young people in the same age group who in turn train the target groups. In Myanmar the target group is youth aged 15-24, with equal attention to males and females. Participants in the course are recruited by visiting households and inviting members of the target group. No more than one person per household may attend. Workshops are usually supported and monitored by core trainers or project staff, who assist when necessary. Support from staff ensures that the workshop content is complete, consistent, and correct, and that the young facilitators have feedback and support to increase their confidence and enhance their facilitation skills.

In Myanmar youth training has been held on Saturdays and Sundays to enable the youth attending school to participate. The number of trainees in each session is limited to 40, with the class divided into four groups of 10. In China, all training sessions and workshops have a maximum of 20 participants. The programme in Yunnan began in June 2001 to train young people living with HIV/AIDS as peer educators.

C. EVALUATION

1. Relevance

The youth peer education programme makes youth less vulnerable to commercial sexual exploitation by giving them life skills. In focusing on HIV/AIDS, the programme helps combat one of the worst side effects of commercial sexual exploitation.

Significant attention has been paid to socio-economic and cultural conditions at each place. In China, for instance, Information, Education, and Communication materials were developed in Chinese by Chinese. The category 'youth' covers many diverse groups. Training manuals have been designed to be appropriate to each group's educational level, language, and needs. For example, workshops for entertainment workers included detailed information about sexually transmitted infections and referrals for diagnosis and treatment. In every setting, careful attention is given to using socially acceptable terms when discussing sensitive topics.

Workshops use participatory methods. Trainees are asked to reflect on risks in their own lives such as peer pressure, drug use, and early sexual activity. They are then asked to develop strategies to reduce these risks.

The programme emphasizes confidentiality and safety for its participants, including people living with HIV/AIDS. In China and Myanmar, the workshops include sessions on non-discriminatory behaviour and on the provision of care and support to people living with HIV/AIDS.

2. Efficiency

The workshops use very low technology tools, such as paper and pens, rather than overheads, videos or other electronic equipment. This means that the workshops are easily transported, can be held anywhere, and are inexpensive. Staff costs are also low since the programme relies heavily on volunteers.

Project staff recognize that they must monitor the needs of youth core trainers and facilitators continuously if they are to provide appropriate incentives and rewards. Evaluations of core trainers and follow-up workshops and practice sessions are conducted regularly.

The workshops have been evaluated by participants and by facilitators and the contents have been revised accordingly. In China, regular monitoring and audit visits, monthly local meetings of young facilitators, and semi-annual local peer education managers' meetings have helped ensure quality control, information sharing, and volunteer retention. A participatory evaluation was conducted in Myanmar from August 1997 to March 1998, allowing programme coordinators to identify areas needing strengthening and to respond to issues raised. A review of the training manual is currently underway in Myanmar and future revisions will reflect the review's findings and recommendations.

The Australian Red Cross and the Myanmar Red Cross Society share information and collaborate with key partners such as government agencies to minimize overlaps and gaps in services.

3. Innovation

The youth peer education programme has taken the innovative approach of not just asking young people to participate, but asking them to take responsibility for the programme. As the programme has progressed, young people have increasingly taken the lead in developing manuals and documentation, in designing activities, in training, and in monitoring.

When launching new project sites, the Australian Red Cross in Yunnan has worked closely with local leaders to win their support and cooperation. Prefecture-level youth peer education has always been always organized and managed by the local Red Cross, with oversight and monitoring provided by the provincial and Australian Red Cross. The Yunnan and Xinjiang Red Cross societies have eventually taken full responsibility for management of the projects. The programme has avoided conventional top-down approaches as far as possible.

4. Impact

The youth peer education programme is often the first education on sexuality, decision-making for sexual issues, and life skills that youth at the project sites have ever received. The workshops give the people taking part confidence to deal with pressures affecting them. The increase in confidence is particularly apparent among the facilitators and project volunteers.

Evaluations show that the majority of participants - as high as 90 per cent in some sites - have acquired a good understanding of HIV/AIDS, pay more attention to self-protection, and have improved their attitudes towards people living with HIV/AIDS. The programme has a strong multiplier effect in that people who have been through the workshops help spread life skills and AIDS information to their peers, friends, families, and colleagues.
Due to the absence of baseline data, it has not been possible to conduct a formal pre-test/post-test evaluation of the broader impact of the programme in Myanmar. However, the participatory evaluations which have been conducted suggest that the impact has been similar to that at other programme sites. Large numbers of people have been reached. Between 1995 and 1999, 28,800 young people aged 15-25, 1.5 million school children aged 7-17, 40,000 young married women aged 20-40 years, 64,960 teachers and 11,500 parent-teacher association members received life skills training.

Meanwhile in China approximately 6,000 youth have been attending workshops each year. It is estimated that these 6,000 provide informal HIV education to 30,000 of their colleagues, family, friends, and peers. From 1997 to 2000, 693 workshops have been conducted.

Programme staff have given presentations on the programme model and activities at national and international meetings, with coverage by local, national, and international media. The Asian Red Cross/Red Crescent AIDS Task Force has given priority to sharing experiences of the programme at its annual meetings. In addition, the youth peer education programme has been documented as a UNAIDS Best Practice and has support from several international organizations.

In China, capacity-building among local Red Cross societies which the Australian Red Cross has carried out for the youth peer education programme has had beneficial effects for other programmes. It has, for instance, led to improvements in quality control and the monitoring of first aid training

5. Sustainability

The success of the programme demonstrates that peer education techniques can be used to bring messages about HIV/AIDS to very large numbers of young people in resource-poor settings.

In China, both the Yunnan and Xinjiang provincial governments have recognized the effectiveness of the youth peer education programme, and they fully support Red Cross activities. At the local level, recruitment of people from the area who speak the local dialect and are familiar with local customs has strengthened grass-roots commitment.

In Myanmar the project would have had greater reach and impact if there had been an earlier acknowledgement of the scale of the epidemic from the decision makers, and if the media had done more to attract young people. In January 2001, however, a leading government official stated that the epidemic was a "scourge that will destroy entire nations", which suggests that more government commitment will be forthcoming in future. UNICEF has so far been the sole external provider of technical and financial support to the youth peer education programme, though national and local NGOs have contributed in kind by organizing training, providing transport, and allowing their buildings to be used as training centres. With UNICEF support, the training programme is scheduled to continue to 2005. The overall funding environment in Myanmar is, however, unfavourable, with many traditional donors and international financial institutions not operating in the country. Retention of programme staff and volunteers varies between programme sites, but currently there are no signs of recruitment difficulties. Volunteers join for personal reasons such as wanting to help others, or to gain work experience.

6. Conclusion

The youth peer education programme builds life skills and imparts knowledge about sexually transmitted infections including HIV/AIDS among youth in a highly participatory and cost-effective way. The multiplier effect of the programme means that whole communities benefit indirectly from the training. The programme is sustainable, since relatively modest funding is required for people who have been trained under the programme to continue conducting workshops.

The programme has been implemented in a diverse range of cultures and in complex political environments, using very basic materials such as paper and pens. It therefore seems likely that, as long as there are sufficient volunteers, the programme can be replicated anywhere in the world.

Experience with the model has provided a few practical lessons on implementation. For instance, it seems to be possible to recruit volunteers through one-day AIDS awareness workshops in which programme staff select participants with the potential to be core trainers and facilitators. Advertising and posters have also proved to be useful means of recruiting. When working with volunteers, flexible timing for training sessions is essential, since participants may have difficulty rescheduling other activities. It is important to have realistic expectations and time frames.

Involving youth in planning processes such as the development and pre-testing of training manuals gives them an opportunity to practise facilitation skills and to learn about HIV/AIDS prevention. These skills and knowledge are necessary if the trainees are to extend the programme to a larger scale.

The success of the programme requires active, voluntary participation of young people and the local community, in collaboration with governmental and non-governmental organizations. The odds of success are greatly enhanced when young people are involved in the decisions that affect them, when adults listen and respect them, and when the young people's tremendous creativity and energy is harnessed. Successful responses to youth issues depend on the involvement of youth.

Source:
Text extracted from the report: ASIA-PACIFIC ANSWERS: Good practices in combating commercial sexual exploitation of children and youth. UNESCAP 2001. Download pdf-version of full report (1,168 kb)