Background Information to Lesson 15

My Top Tips peer book

1.Introduction

The WSWM course equips students with information about adolescence, sexual development, sexual health, well-being and human entitlements, which they can pass on to other people. Young people learn from each other and listen to each other. This principle, also called peer education, has been successfully used for sexuality education in various countries. The success in HIV reduction, for example, was partly due to the use of peer educators alongside other community-based programmes.[1] It is important to not only educate young people but also to involve them in health and HIV prevention projects, especially if these have been designed for them.

International organisations recognise that young people should have a voice in the community, for example, in needs assessments on youth-friendly health services. Active involvement of young people in programme and policy development that target young people, contributes to their efficacy.

In Ethiopia the existence of Youth Associations and different Youth Clubs have a great contributor to establishment of youth friendly services. The increasing involvement of youth in policy formulation and decision making stems from the view that involving young people directly in planning and implementation is important since young people are among the most effective change agents.

This Background Information provides information about peer education and youth participation, the effectiveness of programmes involving peer education and youth participation, and how these can be incorporated into school programmes on reproductive health. Moreover, it gives some suggestions on how to be a good peer educator and how to set up youth participation schemes. Finally, it gives some tips on how to address this lesson in the classroom.

2.Peer education

What is it?

An adolescent peer group is usually defined not only by age, but also by shared interests, such as participation or non-participation in sports, school activities, clubs or other shared social characteristics. For the purpose of peer education, it does not matter how or why any group is formed; it is important to identify a particular group and select an individual who will act as a peer educator for that group. A peer educator is someone who belongs to such a group as an equal participating member, but who receives special training and information for him or her to bring about or sustain positive behavioural change in the peer group.

Peer education is often used to promote a certain type of behaviour (for example, practising safe sex) or to induce behavioural change (for example, to learn to avoid sexual risk behaviour). Sometimes, peer educators act as role models and promote change by disseminating information and influencing group norms in their community. People may change their behaviour if they can rely on the subjective judgement of close, trusted peers who have adopted changes and who act as persuasive role models for change. Peer education is often part of a more comprehensive programme on access to health, HIV prevention and sexuality education.

In Lesson 14, students are asked to inform their peers about sexual development and sexual health. The section on ‘How to be a good PE’ gives some specific tips for peer education as part of the WSWM curriculum.

Effectiveness

Research shows that peer educators are effective in delivering health promotion to young people, especially messages concerning safer sex and HIV prevention.

  • Studies show that adolescents who believe their peers are using condoms are more than twice as likely to use condoms than teens that do not believe their peers use condoms.
  • Evaluation of a peer health education programme in Cameroon showed increased use of modern contraceptive methods and increased condom use among participants versus comparison youth. The programme was more effective among in school than among out-of-school youth.
  • The West African Youth Initiative implemented peer education programmes in schools and in out-of-school settings in Ghana and Nigeria evaluation showed that peer education significantly increased condom use among in-school youth. The proportion of youth reporting use of modern contraceptive methods increased significantly from 47% to 56%, whereas their use decreased slightly in comparison areas.

Research on the effectiveness of peer education indicates that peer education is usually part of a more comprehensive programme integrating several activities, for example decision making, social marketing of condoms and STI counselling and health services. However, there is no scientific evidence indicating to what extent peer education is effective in reducing HIV incidence.

Advantages and disadvantages

Advantages and benefits of peer programmes include the following:

-Adolescents relate most smoothly with those similar to themselves in age, background and interests, i.e. their peers.

-Peer educators share the same culture and its language.

-Peer programmes can help change social behaviour.

-Peer programmes often reach beyond the target population into families and the community as a whole.

-Peer educators often gain long-term benefits from their experiences. These include an ongoing commitment to responsible reproductive health behaviour, leadership, job training and experience.

Disadvantages and challenges:

-Targeted youngsters may not trust the information they receive from peer educators.

-There is a possibility that young people's relationships with the peer educator may change or that inconsistencies in the peer educator's own behaviour occur. If peer educators set a bad example, the education is not effective.

-Research on the effectiveness of peer education points out that the main reasons for failure are related to poor organisation and management of peer education projects and inadequate training and support for peer educators.

-Cultural norms and the taboo on sexuality and HIV make these difficult subjects to discuss. When peer educators address issues such as HIV prevention and safe sex, they may themselves be associated with people living with AIDS, with the prejudices clinging to them or with sexual promiscuity. See also the Background Information to Lesson 11 about stigma.

In working with peer educators, these challenges need to be anticipated. Both teachers and students should think about these issues and find solutions for avoiding inconsistencies in the peer educators’ behaviour and for dealing with the potential stigmatization of people talking about sensitive issues. See also the section on ‘addressing this lesson in the classroom.

Roles of peer educators

Peer educators can work in various ways in- and outside schools. In schools, they may use the help of school clubs, either for support or to recruit an audience. Outside schools, peer educators can relate to churches or sports clubs or other places where young people gather.

Their educational tasks may include:

  • Distributing information, education and communication (IEC) materials, showing videos, one-to-one talks or theatre performances;
  • Counselling peers on communication and negotiations in intimate relationships and practising safe sex. This requires special training in specific issues and communication and negotiation skills;
  • Organising formal or informal group discussions, for example, about unintended pregnancy, HIV/AIDS, sexual harassment and abuse, gender and rights;
  • Teaching peers how to refuse unwanted sex and how to negotiate safer sex, including condom use;
  • Recommending or referring peers for STI and HIV testing if they are sexually active and have doubts about their health.

How to be a good PE?

Good peer educators need to have sound knowledge of the subject they deal with; they need to have certain skills and the right attitude. Peer educator qualities include the following:

  • the ability to communicate clearly;
  • good interpersonal skills and good listening skills;
  • a non-judgemental attitude;
  • the ability to let other people make their own, informed choices;
  • self-confidence;
  • The potential of being a role model for their specific theme: be it practising safer sex, preventing sexual abuse or equitable gender relations.

In addition, peer educators need to be prepared, which includes having good materials and using the right messages.

How to design messages and information, education and communication (IEC) materials?

-Messages should be simple, clear and direct and be presented in a non-judgemental way.

-Avoid a fear-based approach.

-Make sure messages are objective and correct. Not: ‘you have to use condoms’, but: ‘one way of preventing STI/HIV infection and unintended pregnancy is to use condoms.’ Not: ‘using drugs is wrong’, but: ‘using drugs has negative social and health consequences, such as losing control, increased risk of STI/HIV infection and increased risk of becoming a victim of sexual abuse.’

-Sometimes it helps to have printed materials at hand. The top tips peer book students are making in this lesson may be a start. Leaflets with additional information can also be made or perhaps obtained from local NGOs. Make sure all information is correct and consistent.

-Think about the audience: age, gender, education, and social structure. Messages delivered to 13-year-old girls are different from messages to 18-year-old-girls or to 15-year-old boys. Reflect on gender differences and roles for young women and men (see also Lesson 5, Gender).

-See tips for addressing sexuality, STIs/HIV and sexual harassment in the Background Information to Lessons 8, 10, 11 and 12 for information on dealing with some sensitive issues.

Tips for peer educators

-Choose the right setting: when talking about sexual violence, a group may prefer a closed space, rather than a football field where lots of people can listen in.

-Work with small groups. Establish confidence first by talking about easy subjects before introducing difficult subjects such as sexual relations, HIV prevention and sexual harassment.

-False information and myths may surface in group discussions. Make sure you correct these, without attacking the person who gave out such information. Have facts at hand to counter myths. If peer educators do not know the answer, they should tell people they will get back to them; this will give them an opportunity to find the correct information from another source.

-Use a privacy and confidentiality clause at all times: what is being discussed in a group or between peer educator and another person will not be passed on to any third persons. People need to feel safe to talk about their doubts and fears.

-If a person or group does not accept a message, find out why. Perhaps the language that was used is not adequate or people are too shy to talk about a sensitive issue. Try to find other ways of talking about the issue. For example, when talking about condom use, wrap the information in general information about safe sex and love relationships; or take a human rights approach when talking about sexual harassment.

-Listening is as important as talking.

-Do not ask direct questions about people’s sexual behaviour in a group; if they want to talk about their personal experiences, they will bring them up themselves.

-Do not try to cover too many subjects at once. STI/HIV prevention is a big subject, and so is preventing sexual violence. Take sufficient time to talk about each subject.

-Do not judge people and do not laugh at them. All questions should be taken seriously; there are no stupid questions.

-Do not impose ideas or decisions on other people; the purpose of peer education is to help other people make their own, informed decisions.

3.Youth Participation

Peer education is often used in programmes for youth. Involving youth in all stages of a programme, from design to implementation, has been found to be beneficial for the targeted youth: this is youth participation. UNICEF and other organisations emphasise youth participation as a basic right. If a programme is designed to benefit young people, they should be involved in its development and implementation. Young people can decide on policies and programmes targeting young people. This way of youth participation is gaining increasing popularity.

In the school environment, teachers can use some of the principles of youth participation in sexuality education. It may help teachers to support students as peer educators, which is one of the tasks in Lesson 14. Students can also be involved in preparing lessons, especially those addressing sensitive issues. In addition, youth participation can be used in school in health or sexuality advocacy projects targeting the school, parents or the community. See below for more information about youth participation indecision making and planning, and implementation of youth targeted programs.

Outside school, youth and adults can work together in a number of ways, for example in conducting a needs assessment, writing a grant proposal, raising funds, designing a programme, training staff, delivering services, implementing interventions and projects, overseeing a programme, collecting data, evaluating a programme’s effectiveness, improving unsuccessful aspects of a programme and replicating successful programmes.

Youth participation in Zambia, an example

An example of a youth participation project in Africa is the HEART media campaign in Zambia. This had seven youth on its design team and involved a Youth Advisory Group comprised of 35 young people from 11 youth organizations. Focus group discussions, in-depth interviews and pre-testing of materials with young people who were the target audience helped shape the media messages. A year after the campaign, viewers were 46% more likely to be practising primary or secondary abstinence and were 67% more likely to have used a condom at last sex, compared to non-viewers. In Kenya and Uganda the Straight Talk newspaper shows how a youth-led editorial board can respond to questions from youth with candour that has made the paper highly popular in school clubs throughout the country.

Advantages for both youth and adults

Working in youth-adult partnerships is beneficial for both youth and adults. Youth participation creates a sense of ownership for young people: they will absorb information better, and the odds of achieving actual change are bigger than when young people are excluded from behavioural change projects. In turn, this sense of ownership gives them a greater stake in the project's future and makes them more committed to a project's outcomes.

With respect to the WSWM curriculum, students working alongside teachers are more likely to achieve responsible and healthy lifestyles than when teachers just pass on information. It is important for young people to be aware of the positive roles they can play in development or community programmes. Working in youth participation programmes may improve career opportunities, improve competencies and skills and increase their self-esteem. Adults may gain new ideas about coping with young people and their needs and interests.

However, it may be difficult to start up youth-adult partnerships. Power relations, usually rooted in cultural norms, may make it difficult for young people and adults to feel comfortable working together. Years of formal instruction in schools have often accustomed young people to expecting adults to give the answers. Some young people expect their own ideas to be largely ignored, derided or vetoed.

Adults frequently underestimate young people’s knowledge and creativity. Adults are also accustomed to making decisions without input from young people, even if they are directly affected by those decisions. Therefore, joint problem-solving efforts may be somewhat rough and require deliberate effort to be made on the part of both adults and young people.[2]

Effectiveness

Effective youth-adult partnerships, including teacher-student co-operation should include the following elements:

-Establish clear goals for the partnership. Young people and adults must understand what their roles and responsibilities will be in achieving the goals. Both need to be willing and committed to work together and believe that the partnership will be beneficial for all.

-Decision-making power should be shared between adults and youth. Adults should respect young people’s decisions and vice versa.

-Both adults and youth need capacity building and training. Young people need to be trained in communication, leadership and assertiveness skills, interviewing techniques and specific areas of expertise, such as HIV prevention education. Adults need training in communication, collaborative work, interviewing techniques, working with youth and specific areas of expertise, such as HIV prevention education.

-Young people have other interests, priorities and commitments than adults, such as family, friends and education. Both youth and adults need to be aware of this.

4.Youth Participation in policy influencing

Whereas peer education programmes are generally adult-initiated, young people themselves can participate in initiate them. A group of young people who want to change/improve astrategyor situation can set up their own campaign.