Does peer education work in Europe? - WHO/Europe - World Health

28 Pages·2003·0.73 MB·English

Does peer education
work in Europe?
THE EUROPEAN MAGAZINE FOR SEXUAL AND REPRODUCTIVE HEALTH
No.55 - 2003
No.56 - 2003
CONTENTS
Editorial
The European Magazine for Sexual and
Reproductive Health By Dr Gunta Lazdane and Jeffrey V.Lazarus 3
Entre Nousis published by: Peer education within a frame of theories and models of behaviour change
Reproductive Health and Research Programme By Srdjan Stakic,Robert Zielony,Aleksandar Bodiroza and Greta Kimzeke 4
WHO Regional Office for Europe
Scherfigsvej 8 Peer education and HIV/AIDS:How can NGOs achieve greater youth involvement?
DK-2100 Copenhagen Ø By Lise Rosendal Østergaard 7
Denmark
Tel:[phone]
The work on young people in the WHO Regional Office for Europe
Fax:[phone]
By David Rivett 9
E-mail:[email protected]
www.euro.who.int/entrenous
Sexual health peer education among youth in Samara,the Russian Federation
Chief editor By Jenny Bluhm,Mikhail Volik and Nicola Morgan 10
Dr Gunta Lazdane
Editor Peer education in eastern Europe and central Asia-one way to address young
Jeffrey V.Lazarus people’s vulnerability
Editorial assistant By Greta Kimzeke 12
Dominique Gundelach
Layout Health education and theatre for and by young people
To om bord,Aarhus.www.toombord.dk By Cydelle Berlin and Ken Hornbeck 13
Print
Central tryk Hobro a/s A European training curriculum in adolescent medicine and health:A resource
for professionals working in the field of sexual and reproductive health
Entre Nousis funded by the United Nations
By Pierre-André Michaud,István Batár and the members of the EuTEACH working group 14
Population Fund (UNFPA),New York,with the
assistance of the World Health Organization
Upholding European support for sexual and reproductive health care and rights
Regional Office for Europe,Copenhagen,
Denmark. By Patricia Hindmarsh 17
It is published three times a year.Present distri-
bution figures stand at:3,000 English,2,000 Sex Education in Hungary
Spanish,2,000 Portuguese,1,000 Bulgarian, By István Batár 19
1,000 Russian and 500 Hungarian.
The role of medical students in the prevention of HIV/AIDS
Entre Nousis produced in:
By Henrietta Bencevic 22
Bulgarianby the Ministry of Health in Bulgaria
as a part of a UNFPA-funded project;
New Health Communicators at School:Medical Students
Hungarianby the Department of Obstetrics
By Inon I Schenker 23
and Gynaecology,University Medial School of
Debrecen,PO Box 37,Debrecen,Hungary;
Portugueseby the General Directorate for Resources 26
Health,Alameda Afonso Henriques 45,
P-1056 Lisbon,Portugal; Internet resources 27
Russianby the WHO Information Centre for
Health for the Central Asian Republics;
Spanishby the Instituto de la Mujer,Ministerio Page 5 Page 10 Page 19 Page 23 Page 24
de Trabajo y Asuntos Sociales,Almagro 36,
ES-28010 Madrid,Spain.
The Portuguese and Spanish issues are distri-
buted directly through UNFPA representatives
and WHO regional offices to Portuguese and
Spanish speaking countries in Africa and South
America.
Material from Entre Nousmay be freely translat- Cover illustration © Anne Mette Edeltoft
ed into any national language and reprinted in THEENTRE NOUSEDITORIAL ADVISORY BOARD
journals,magazines and newspapers or placed
on the Web provided due acknowledgement is Dr.Assia Brandrup- Dr Evert Ketting Dr.Peer Sieben
made to Entre Nous,UNFPA and the WHO Lukanow Netherlands School of Public UNFPA Representative and
Regional Office for Europe. Director,Division for Health, Health Country Director
Education and Social Protection Utrecht,The Netherlands Romania
Articles appearing in Entre Nousdo not
German Agency for Technical Co-
necessarily reflect the views of UNFPA Dr Malika Ladjali Ms Vicky Clays
operation (GTZ)
or WHO.Please address enquiries to the Senior Programme Specialist Regional Director
authors of the signed articles. Mr Bjarne B.Christensen UNESCO/Headquarters,Paris International Planned
Head of secretariat Parenthood Federation
For information on WHO-supported activities Ms Adriane Martin Hilber
Sex og Samfund,the Danish European Network (IPPF-EN)
and WHO documents,please contact the Family Technical Officer
Family Planning Assocation Brussels
and Community Health unit at the address Department of Reproductive
given above. Dr Helle Karro Health and Research Dr Robert Thomson
Please order WHO publications directly from the Head,Department of Obstetrics WHO Headquarters,Geneva Adviser on Sexuality,
WHO sales agent in each country or from and Gynaecology Reproductive Health & Advocacy
Ms Nell Rasmussen
Marketing and Dissemination,WHO, Medical Faculty,University of UNFPA Country Technical
Director
CH-1211,Geneva 27,Switzerland Tartu,Estonia Services Team for Europe (in
PRO-Centret,Copenhagen
Bratislava)
ISSN:1014-8485
EDITORIAL Dr Gunta Lazdane Jeffrey
V.Lazarus
BDyo Gesu pnetaer L eadzudacantei oann dw Joerffkre iyn V E.uLraozpaeru?s Photo:Jeffrey Lazarus
Young age has always been More effective means than just teachers yet authority figures out oftouch with
or physcians are needed for reaching young people.Both articles report the
the time in one’s life when
young people and initiatives promoting enormous success ofprogrammes in
many choices must be made. peer education are now spreading across which medical students work to reduce
Europe,led by the UNFPA,UNICEF, HIV incidence.Moreover,the
Some ofthem are mysterious IPPF and WHO.Throughout this issue of International Federation ofMedical
Entre Nousthe argument for peer educa- Student’s Associations is working togeth-
and attractive,perhaps based
tion is reinforced,with examples ofhow er with WHO to jointly scale up educa-
on the experience ofa friend peer education works. tion,empowerment and training on
The first article,on pages 4 to 6, HIV/AIDS for medical students.
or the image ofa moviestar. explains the main theories and models This issue ofEntre Nouscomes on the
employed in peer education,which focus heels ofWorld Population Day,celebrat-
But how to make the choice
on behaviour change,and concludes with ed on 11 July.This year the theme was
with no harm to yourself, an exercise to help understand the appli- "One billion adolescents:the right to
cation oftheoretical and other method- health,information and services",which
your parents and society is
ological approaches to behaviour change highlights the need to support young
in practice.The importance ofpeer edu- people in their efforts to lead safe,
something young people often
cation in a time ofincreasing incidence rewarding lives and contribute to the
cannot figure out,as evi- ofSTIs/HIV/AIDS is the topic ofthe next well-being oftheir families and commu-
three articles,looking at different experi- nities.United Nations Secretary-General
denced by this being the age
ences throughout Europe,from Denmark Kofi Annan put the situation best when
ofthe highest rates of to the Russian Federation. he stated:“…Ifthe world is to achieve
On page 13,the use oftheatre in peer the Millennium Development Goals and
unwanted pregnancies,sexu- education is highlighted.The authors of implement the programme ofaction
the article co-facilitated an advanced peer adopted at the International Conference
ally transmitted infections
education training oftrainers held in on Population and Development in Cairo
(STIs) and HIV/AIDS.This is Estonia,early this year,in which young in 1994,the most effective interventions
people from throughout central and east- will involve young people themselves.It
where peer education can play ern Europe and the former Soviet Union is they who can best identify their needs,
learned how to run peer education ses- and who must help design the pro-
a role.
sions.Icebreakers to get participants grammes that address them”.
comfortable with one another and a Entre Nouswill further review progress
review ofthe theory were combined with on implementation in Europe on the
role-playing and other interactive activi- International Conference on Population
ties that can be adapted to work with and Development Programme ofAction
most groups ofyoung people.A forth- in upcoming issues,as well as look at the
coming manual and CD-ROM on this Millennium Development Goals.
will be presented in Entre Nousupon
completion.
While peer education is key,proper Dr Gunta Lazdane
medical training for physicians attending [[email protected]]
adolescents is also crucial.More than 500 Chief editor
professionals from across Europe have
already used a new training curriculum Jeffrey V.Lazarus
in adolescent medicine and health,focus- [[email protected]]
ing on professionals working in the field Editor
ofsexual and reproductive health.While
physicians are the focus ofthe article on 3
pages 14 to 16,the following article looks
at Hungarys’experiences with sex educa-
tion through the decades.Unfortunately,
after nearly 30 years since “education for
family life”was made compulsory in
schools,adequate conditions for its suc-
JOINEntre Nous' listserve by sending a blank e-mail to:
[email protected] cess are still absent.
The final two articles look at the role
ofmedical students in peer education.
Although often older,they are still not
No.56 - 2003
PEER EDUCATION WITHIN A FRAME OF THEORI
Srdjan Stakic,Robert Zielony,Aleksandar Bodiroza and Greta Kimzeke
What is peer education? demands (student,team member,etc.).
Peer education in youth is the process Another advantage ofpeer education is
whereby well trained and motivated that youth peer educators are less likely
young people undertake informal or to be seen as authority figures “preach-
organized educational activities with ing”about how others should behave.
their peers (as defined by age,back- Rather,the process ofpeer education is
ground or interests) over a period of perceived more like receiving advice from
time,aimed at developing their knowl- a friend "who is in the know”.A success-
edge,attitudes,beliefs and skills and ful peer educator is viewed by his or her
enabling them to protect and be respon- peers as someone who has similar con-
sible for their own health. cerns,is trying to help out,and has an
Peer education can take place in small understanding ofwhat it is like to be a
groups or through individual contact and young person.
can take place in a variety ofset-
Theories and models ofbehaviour change tings:in schools,clubs,religious
settings,workplaces,on the street Peer
are essential parts ofpeer education pro-
or in a shelter,or wherever young refers to a person who belongs
people gather. to the same social group as
gramme proposals and development.Their
Examples ofyouth peer education some other people based on
inclusion alleviates the possibility ofmiss- activities are: age,sex,sexual orientation,
•Sessions with students using occupation,socio-economic
ing an essential component ofthe interven- interactive techniques such as and/or health status,etc.
group brainstorming,role plays or
tion.In addition,peer educators with this personal stories; Education
•A theatre play in a youth club,fol- refers to the development of a
theoretical background are more likely to
lowed by group discussions;and person’s knowledge,attitudes,
•Informal conversations with beliefs or behavior resulting
achieve their desired results through a peer
young people at a disco about risky from the learning process.
education effort.This article is a brief health behaviours and referrals to
service providers.
review ofpeer education and some relevant Peer education can be used with
Behaviour change theory and models
many populations and age groups
theories and models ofbehaviour change.It for various goals.In the past When undertaking a peer education pro-
decades,peer education has been gramme,our overall goal is to develop a
concludes with an exercise on helping peer
used extensively in HIV/AIDS pre- recommended behaviour or to change
vention and reproductive health (risky) behaviour in a target group.In
educators’transition from
programmes around the world. this context it is important to know why
theory to practice. Moreover,it advocates the right of and how people adapt new behaviours.
young people to participate in The fields ofhealth psychology,health
processes which affect them and to education and public health provide rele-
access the information and services they vant behavioural theories and models
need to protect their health. which explain this process.They provide
a rationale for why peer education is
Why peer education?
beneficial and they can guide us in plan-
Peer education has several advantages ning and designing peer education inter-
over other health education and promo- ventions.
tion methods.One important advantage The following theories and models are
4 ofpeer education is the perceived credi- ofparticular relevance for peer educa-
bility ofpeer educators in the eyes of tion:
their target group.Youth exposed to peer 1.IMBR model:Information,motiva-
education often praise this approach tion,behavioural skills and resources
because it is eased through a shared 2.Health beliefmodel
background between the educator and 3.Theory ofreasoned action
his/her audience in areas such as themes 4.Social cognitive theory
ofinterest,tastes in music and popular 5.Trans-theoretical/stages ofchange
celebrities,use ofthe language,family model
themes (brother and sister issues,strug-
gle for independence,etc.),and role
ES AND MODELS OF BEHAVIOUR CHANGE
IMBR model:Information,motiva- mainly through a person’s perceived sus- cept is relevant considering:
tion,behavioural skills and resources ceptibility to a health threat,perceived • That young people’s attitudes are high-
The IMBR model addresses health-relat- seriousness ofthe possible illness,per- ly influenced by their perception of
ed behaviour in a comprehensive,clear ceived barriers or costs ofchanging what their peers do and think;and
manner applicable across many cultures. behaviour,and perceived benefits of • That young people may be highly
It focuses on information (the what), changing the behaviour. motivated by the expectations of
motivation (the why),behavioural skills The Health beliefmodel suggests that respected peer educators.
(the how) and resources (the where, ifa person has a desire to avoid illness or
Social cognitive theory
when and whom) that can be used to tar- to get well (value) and the beliefthat a
get risky behaviours.As an example,ifa specific health action available to a per- Social cognitive theory is largely based
young person knows that proper use of son would prevent illness (expectancy), upon the work ofAlbert Bandura.He
condoms may prevent the spread ofHIV, then a positive behavioural action would states that people learn:
s/he might still need to be motivated to be taken towards that behaviour. • Indirectly,by observing and modelling
use them,need the skills involved in The most salient relevance to peer
using them correctly,and need to know education in the Health beliefmodel is
where,when and from whom to acquire the concept ofperceived barriers,or one’s
them. opinion ofthe tangible and psychological
A peer education programme that costs ofthe advised action.A peer educa-
does not have a comprehensive approach tor identifies and reduces perceived bar-
including the above-mentioned dimen- riers through reassurance,correction of
sions probably lacks essential compo- misinformation,incentives and assis-
nents for reducing risk behaviour and tance.For example,ifa gay man does not
promoting healthier lifestyles.For exam- get tested for the fear ofbeing stigma-
ple,a programme might be strong on tised at the local health clinic for his sex-
teaching information but lack adequate ual behaviour,the peer educator may
emphasis on skills training.Such a pro- provide him with information on a gay-
gramme might explain to young people friendly health centre.
the need for contraceptive use and However,the Health beliefmodel of
describe contraceptive methods,but behaviour change does not account well
might omit demonstrating their proper for habits,attitudes and emotions/mood
use.Participants would then be informed (1).Although good to use,when imple-
about what to do but not how to do it. menting the Health beliefmodel into our
Other programmes may be strong on work,we must consider the effects ofthe
both information and skills,but fail to following factors on behaviour such as
tlnparaecurnkltyt isac ."pirpTpeaharnocethspse"r w iptahirttoeeh igmr kr aanoumotdiwvmiaeleetnisdoc gecneo ab uole lfccdoaw ulmehsapeav toet ht-oey Tcstuhaltteuuosrr eay,n sodof cprieaerla sisononflnaulee denx capece,trsiiooecnnicoe-se.conomic Anne Mette Edeltoft
©
do and how to do it,but without strong This theory states that the intention ofa
emotional or intellectual reasons as to person to adopt a recommended behav- ofothers with whom the person iden-
why they would want to practise certain iour is determined by: tifies (for example,how young people
healthy behaviours.Although resources 1.The person’s attitudes towards this see their peers behaving);and
can be considered part of"information", behaviour:his/her beliefs about the • Through training in skills that lead to
it is worthwhile to highlight the impor- consequences ofthe behaviour.For confidence in being able to carry out a
tance ofproviding youth who are being example,a young woman who thinks particular behaviour.This specific con-
trained with information about how to that using contraception will have pos- dition is called self-efficacy,which
access appropriate resources or services itive outcomes for her will have posi- includes the ability to overcome any
beyond the scope ofpeer education ses- tive attitudes towards contraception barriers to performing the behaviour. 5
sions.Such resources might include use; For example,practising correct con-
youth friendly clinics,counselling ser- 2.The person’s subjective normative dom use in a condom demonstration
vices,HIV/STI and pregnancy testing and beliefs about what others think he/she is an important activity leading to self-
care programmes,and commodities such should do and whether important ref- confidence when talking about safer
as condoms and contraceptives. erent individuals approve or disap- sex methods with a partner.
prove ofthe behaviour.For example:a In the context ofpeer education it means
Health beliefmodel
young man whose male friends engage that the inclusion ofinteractive experi-
The Health beliefmodel was developed in promiscuous sexual relations may mental learning activities are extremely
in the early 1950s and is used to explain accept that behaviour more easily. important,and peer educators may act as
and predict health related behaviour, In the context ofpeer education this con- important role models.
No.56 - 2003
Trans-theoretical/stages ofchange Srdjan Stakic
model (2,3) Exercise:Theory – Practise it [[email protected]]
This model describes a sequence ofstages United Nations Population Fund
in changing health-related behaviour.It Objective (UNFPA) Consultant
uses the stages ofchange from across To help participants understand the
major theories ofintervention,hence its application of theoretical and other
name:trans-theoretical.This model is a methodological approaches to behav- Robert Zielony
preferred design for assessing and target- iour change in practice. [[email protected]]
ing the behaviour ofan individual rather Consultant on Peer Education,
than a group,since people may be at Time Health Promotion & Team Building
enormously varying places with respect 30 minutes
to their attitudes,behavioural experience Aleksandar Bodiroza
and intentions.These are the six stages Materials [[email protected]]
through which a person may go in the Large sheets of flipchart,markers and Adolescent Reproductive Health
process ofchanging a behaviour: tape. and STIs/HIV/AIDS specialist
1.Pre-contemplation (Has no intention United Nations Population Fund
to take action within the next 6 Preparation (UNFPA)
months); After the presentation of theories and
2.Contemplation (Intends to take action models relevant to peer education,the Greta Kimzeke
within the next 6 months); participants are instructed to separate [[email protected]]
3.Preparation (Intends to take action into three groups,each with a sheet of UNICEF Regional Office CEE/CIS
within the next 30 days and has taken flipchart paper and markers. and the Baltics
some behavioural steps in this direc- Project Officer Young People’s
tion); Process Health Development and
4.Action (Has changed overt behaviour Ask participants to choose one pro- Protection
for less than 6 months); gramme in which one of their group
5.Maintenance (Has changed overt members is involved and to analyse all
References
behaviour for more than 6 months); aspects of it:what,where,and how.
and Then ask them to outline it on the 1.www.garysturt.free-online.co.uk/lifer-
6.Termination (Has no temptation and sheet of paper and identify the theo- ev.htm (accessed 7 May 2003).
has 100% self-efficacy (in addictive ries and models (or parts of theories 2.Prochaska,J.O.,& DiClemente,C.C.
behaviour). and models) that are being used in this (1982).Transtheoretical therapy
programme.Explain to them that mul- toward a more integrative model of
Summary
tiple theories and models may be used change.Psychotherapy:Theory,
Inclusion ofbehaviour change theories in the same programme and that only Research and Practice 19(3):276-28.
and models in programme design is some aspects of theories and models 3.Prochaska,JO.,Norcross,JC.,and
essential to a successful peer education may be used.Ask the group to present DiClemente,CC.(1994).Changing for
effort.Moreover,theories and models of their views to the larger group. Good.New York,NY:William Morrow.
behaviour change provide a framework
in which to measure and evaluate pro- Closure
gramme accomplishments and downfalls. Point to the fact that we are all already
Funding,sustainability and the overall using theories and models of behav-
success ofpeer education initiatives thus iour change in our everyday work,yet
depend on the successful use and appli- that we are often not aware of it.
cation ofbehaviour change theories in Initiate a discussion on the topic of
practice by administrators and peer edu- why there is a need for the inclusion of
cators alike. organized theoretical and method-
6 ological approaches to behaviour
change.Emphasize once more that a
theory or a model does not have to be
used in its entirety,and that different
segments from different theories and
models can be used in the same pro-
gramme.
PEER EDUCATION AND HIV/AIDS: HOW CAN
NGOS ACHIEVE GREATER YOUTH INVOLVE-
MENT?
Lise Rosendal Østergaard
The Danish Family Planning Associ- cacy,counselling,facilitation ofgroup a certain group by working on their
ation has compiled experiences discussions,drama,lecturing,distribu- knowledge,attitudes,beliefs and behav-
from young people and represen- tion ofinformation materials and refer- iours.
tatives ofNGOs from Europe,Africa, rals to services. The theoretical base ofpeer education
Asia and Latin America on how peer But why has peer education in particu- is behavioural theory,assuming that peo-
educators can be used at the forefront of lar become so popular over the past years ple make change based on progressive
HIV/AIDS prevention.In particular how in relation to HIV/AIDS prevention,care steps ofunderstanding and interiorising
projects and programmes can be open to and support? It is obvious that the multi- the relevance to their own situation.
youth participation at all levels ofthe dimensional nature ofthe HIV epidemic People do not make change in their per-
project cycle.The message from the and the many challenges that it puts on sonal life because ofscientific evidence
young people was that it takes participa- the communication and behaviour (in that case there would be very few
tion to make a peer-education project change programmes call for initiatives smokers left!).They are much more likely
meaningful.The lessons learned from the that are not only health related but also to modify their practices because ofthe
participants has been published in a cata- societal related.As peer education typi- subjective judgement ofa person that
logue ofideas and now informs the work cally involves the use ofmembers ofa they have confidence in who has adopted
ofthe newly established Danish network given community that is affected by the same changes and who can serve a
ofNGOs and research institutions work- HIV/AIDS,they are more likely to be credible role model.
ing with HIV/AIDS. able to induce changes among members At the international Mahler Forum
Peer education is not only an approach ofthe same group by negotiation,exam- 2001,organised by the Danish IPPF affil-
that for a long time had been a key ele- ple and discussions.They can attempt to iate:the Danish Family Planning
ment in the activities ofmany NGO and modify the sexual risk-taking practices by Organization,the participants all agreed
community-based organizations,it has on the fact that peer education projects
also been acknowledged as an efficient were critical to the level ofactivities in
strategy by the international community their respective organisations.As a matter
and the public sector.At the United offact,many ofthe organizations would
Nations General Assembly Special be unable to maintain the high level of
Session on HIV/AIDS (UNGASS) in out-reach activities ifit were not for the
2001,specific targets and timeframes peer educators.That is not only for obvi-
were set.It was noted that “By 2005,to ous financial reasons:peer educators
ensure that at least 90%,and by 2010 at often work on a voluntary basis where
least 95% ofyoung men and women they receive a limited compensation for
aged 15-24 have access to the informa- their work,but also because ofthe
tion,education including peer-education unique access that the peer educators
and youth-specific HIV education and In May 2003,the Danish Family hold to the intended audience.Young
services necessary to develop the life Planning Association (Sex & peer educators do not only know the
skills required to reduce their vulnerabili- Samfund) published a handy guide whereabouts ofthe targets groups much
ty to HIV infection in full partnership to improve peer education.“Dialogue better than policy-makers and pro-
with young persons,parents,families, in Prevention/Expert in Being Young” gramme managers,they also know how
educators and health-care providers”. addresses the needs of programme to catch their attention and how to initi-
Peer education in the wordings ofthe managers on how to organize a peer ate a dialogue with them.
UNGASS declaration is concerned with education project as well as the That is in particular important in rela-
young people.In reality a peer can be of needs of peer educators themselves. tion to such sensitive issues as sexual and
any age.It is a person ofequal standing It provides practical advice on how to reproductive health,including
as the target groups or someone ‘who recruit,train,retain,bid farewell and HIV/AIDS.As a Finnish Mahler Forum
walks in the same shoes’.It is a person phase out the individual peer educa- participant from the Finnish Family
who belongs to the same societal group tor in order to give the volunteers as Planning Organization noted:“It can be
especially with regards to age,status and much of a professional competency very embarrassing to talk openly about
locality.Total identification is,however, as possible.It also prepares the peer sexuality in general and teenage sexuality 7
rare.People who are likely to invest their educators for the many challenges in particular.Talking about young peo-
time and energy in a project,often on a ahead,including how to safeguard ple’s sexuality is often automatically
voluntary basis,are often those with a integrity.Many peer educators use related to irresponsible and experimental
relative high amount ofresources.Peer personal experiences on sexual debut ‘running around’– how can we,the
education can be young-to-young,when as an icebreaker,but they must be adults,understand young people’s sexual-
the educators match the age ofthe target aware of their own limits and use ity in a broader sense that also includes
group,or young-to-younger when they their skills to tell only as much as they feelings and love?”The obvious answer to
are a bit older.Practical application of feel comfortable with.The booklet is that question was given by many ofthe
peer education varies from one country being distributed by the health young participants,namely to use peers,
to another but most often includes advo- authorities in the Danish counties. as they are closer to the context ofthe
young people at risk and can frame the including factual knowledge on sexual also partners in the project - partners
message in a way that resonates with a health topics but also on issues related to that might raise criticism ofcertain pro-
young audience. lover relationships and gender norms and cedures and practices.In that respect it is
There has been a moral-based tenden- values to overcome the tendency to focus important that the organization is pre-
cy to judge teenage sexuality as promis- solely on technical issues.One ofthe pared for that.
cuous.That attitude has been detrimen- Danish counsellors pointed out that Second,the selection ofpeer educators
tal to proper information.Poor negotia- although they try to adopt what he calls is crucial.There has been a tendency to
tion and communication skills ofadults, “an unbiased approach to condom pro- accept almost anybody who is ready to
be they health care professionals,teachers motion”it has proven to be a rather poor do voluntary work,but to have an effi-
or others,who do not share a common approach to talk about condoms as an cient programme there must be certain
language with young people,can become isolated subject,so they prefer to address criteria for selection including age,skills
a barrier to HIV prevention.For adults it issues ofsexuality in a broader context. and attitudes.
is often a question ofwhich words to use What are the features ofsuccessful Third,training and supervision must
in order to pass a message to young peo- peer education programmes? First ofall, be consistent and regular.It is demotivat-
ple.Experiences gained through a peer the effective youth participation and ing for peer educators to lack technical
education project by the Ukrainian involvement at all steps ofthe project information and up-dated knowledge
Family Planning Association called ‘Be cycle seems to be critical.It has for a long and a two-week initial course will not be
Safe,Be Careful,Be Happy’points at the time been recognized that participation is sufficient.Resources must be allocated to
necessity ofadopting a frank language. a means to achieve greater project effi- conduct supervision ofthe peer educa-
The importance ofbeing careful and pay- ciency and is an end in itselfto improve
ing attention to the needs ofyoung peo- human development.It is,however,not
ple by responding to their expectations always easy for programme managers to
with their own language was underlined “hand over the baton”and to share
by one ofthe participating peer educa- power and resources with the young peer
tors. educators.Youth participation can be
It is obvious that peer education is a defined as young peoples’partaking in
window ofopportunity for face-to-face and influencing processes,decisions and
communication because ofthe peer edu- activities.For that to happen they must
cators’critical access to young people. be fully included at all steps ofthe pro-
Yet,new information technologies pro- ject cycle.Ifthat is the case,peer educa-
vide a whole other variety ofentry points tors can become not only empowered but
for HIV-information.Several participants
at the Mahler Forum had already gained
experience with the use ofnew technolo-
gies to reach a bigger audience with sexu-
al and reproductive health information.
IPPF in the Balkans has set up a regional
youth website to overcome barriers to
young people’s access to confidential
information in Bosnia,Herzegovina,
Croatia,Kosovo,The former Yugoslav The Danish Family Planning The Danish NGO Aids Network is a
Republic ofMacedonia,and Serbia and Association (Sex & Samfund) is the newly established alliance of 18 inter-
Montenegro.In Denmark,the Danish leading association in Denmark in the national and national NGOs working
Family Planning Association supports an field of sexual and reproductive with HIV/AIDS prevention,care,sup-
AIDS telephone hotline as well as youth health and rights.It works for a soci- port and treatment and Nordic
sex telephone hotlines,internet-based ety with sexual wellbeing,wanted research institutions.The aim is to
counselling services for young people and children and no sexually transmitted build a bridge between international
8 class-room-based education services for infections.The mission of Sex & project work and research in order to
school learners.The diversity ofchannels Samfund is the creation of the high- strengthen the capacity of the NGOs
ofinformation has been massively pro- est attainable physical,psychological to undertake evidence-based inter-
moted through advertisements,hands- and social conditions for reproduc- ventions,to build a platform for
outs,posters and streamers in order to tion,to ensure easy access to safe, knowledge sharing and to document
make people use them.A number of affordable contraceptives and safe the policies,strategies and use of evi-
youth counsellors,peer educators,have abortion.It advocates the right to dence by the NGOs.The Danish
been trained,many ofthem medical stu- sexual education,sexual wellbeing Ministry of Foreign Affairs has funded
dents and all volunteers.They receive and reproductive health,including the network for an initial three-year
regular supervision and refresher training family planning as human rights both period.
in Denmark and internationally.
THE WORK ON YOUNG PEOPLE IN
THE WHO REGIONAL OFFICE FOR EUROPE
David Rivett
In recent years,the work ofthe WHO Regional Office in sup- began in February 2002 when the agen-
cies held an inter-country consultation
porting countries in building programmes focused on young
with senior health policy-makers and
people (ages 10 to 24) has extended.The major programme planners,and representatives ofyoung
people and NGOs from Bulgaria,Estonia,
for this age group has been the European Network ofHealth Latvia,Lithuania and the Russian
Federation (Kaliningrad and Saint
Promoting Schools,now active in 43 ofthe 52 countries in
Petersburg).Following the consultation,a
the Region. youth friendly health service (YFHS)
mapping exercise in 18 countries was
undertaken.This provided immensely
This programme assists countries in cre- rich data on YFHS provision and has
ating the conditions for all schools to be prompted another consultation meeting,
able to adopt and sustain health promot- this time in south-eastern Europe:
ing school approaches.Evidence is begin- Albania,Bosnia and Herzegovina,
ning to show that schools adopting these Bulgaria,the Former Yugoslav Republic
approaches are creating safe and support- ofMacedonia,Kosovo,Moldova,
ive living and learning environments Romania,and Serbia and Montenegro.
which assist young people in making This consultation,to be held in
informed choices about their health. September,in Sofia,Bulgaria,aims to
Following the creation ofthe pro- sensitise key policy-makers and advisers,
gramme for the Promotion ofYoung programme managers and young people
People’s Health in 2000,collaboration to the concept ofyouth friendly services
with other United Nations partners on and to share examples ofbest practice,to
activities such as peer education was ini- apply the criteria ofyouth friendly ser-
tiated in order to maximize the advan- vices to existing service provision,to
tages each agency possessed in specific introduce participants to the notions of
fields.The agencies are building a con- mapping,monitoring and evaluation of
sensus on best methods and approaches services,to identify steps for the intro-
in designing and implementing peer edu- duction ofquality in youth friendly ser-
tors.Not only to ensure that they dissem- cation programmes.Participation of vices provision and to review the lessons
inate correct information but also to sup- young people in the learning process is learned and identify strategies for scaling
port them and create a sense ofteam clearly an effective way ofbuilding up best practice in south-eastern Europe.
spirit. knowledge.Peer education is now being Information and reports about all
Finally,the programme must acknowl- used more frequently as a means of these activities are available from the
edge that young peer educators are a very informing young people and building team in the Young People’s Health
diverse group.The programme must be their skills in areas such as HIV/AIDS, Programme:[email protected]
adapted to the fact that they might be in- drug use and conflict resolution.
school and cannot be expected to work at A further programme being developed
certain hours.Furthermore,they must at jointly is one on life skills-based educa-
least be compensated for their out-of- tion.Currently,this programme is school David Rivett
pocket expenses. based and uses the health promoting [[email protected]]
For further information about the cat- school as the most effective vehicle for its Technical Adviser:Health
alogue ofideas “Confronting HIV/AIDS implementation.However,the agencies Promotion and Education
through Youth Involvement:A Catalogue are looking to build programmes for out World Health Organization
ofIdeas for NGOs”please contact the ofschool and peer education is one of Regional Office for Europe
Danish Family Planning Association at the approaches to be used in this context.
[email protected] Life skills-based education builds knowl- 9
edge,attitudes and skills into the learning
process.The programme makes links
with Ministries ofEducation and advo-
Lise Rosendal Østergaard cates for life skills-based education’s
[[email protected]] inclusion in curriculum planning and
Co-ordinator,the Danish NGO Aids teaching and learning methodologies,
Network,Copenhagen especially in health education.
The most recent joint programme is
one addressing the development ofyouth
friendly health services.This programme
No.56 - 2003
SEXUAL HEALTH PEER EDUCATION AMONG
YOUTH IN SAMARA, THE RUSSIAN FEDERATION
Jenny Bluhm,Mikhail Volik and Nicola Morgan
The Russian Federation, Surveys conducted by Population valuable.The PSI/Samara peer education
Services International (PSI) in many coordinator,Doctor Mikhail Volik,gives
Ukraine and Estonia are
Russian cities and regions all yield the new recruits individual attention and
facing the fastest growing same alarming results – while 99% of helps identify their motivations for join-
youth have heard about HIV,and most ing,their expectations ofPSI/Samara,
rates ofHIV infection (80%) consider HIV a problem for and their personal needs and resources.
Russia,very few consider themselves at An experienced volunteer is then
in the world.
risk,believing HIV is a disease which matched to the new recruit to provide
only affects gay men or injecting drug guidance and support.Dr Volik also
users.Though this has been historically invites volunteers’parents to the office to
true in Russia,data collected in recent reassure them that their children are in
years has revealed a significant increase safe hands and are not promoting sex,
in HIV infection through sexual trans- but educating others in STI/HIV preven-
mission,particularly among youth aged tion.
15–25. Week after week the volunteers return
not only for the scheduled training after-
Programme background
noons but also to attend several activities
PSI/Samara has 25 active volunteers,and in HIV prevention held during the week
to date eight have qualified as peer edu- at sports clubs,nightclubs or on the
cators able to provide education without streets.“Very interesting people are work-
supervision.The remaining volunteers ing at PSI/Samara and I am making a lot
work at organized activities held at night- ofnew friends here.”(Nastja,age 17,vol-
clubs,sports clubs,and street events unteer).When asked “Why did you come
where they distribute materials and here today?”replies inevitably include “to
answer questions posed to them.With meet my friends”,“to feel better after a
time and training many ofthe volunteers stressful day at school”and ofcourse “to
go on to become qualified peer educa- get to know more information about
tors. HIV/AIDS”.
The volunteers are predominantly 15- “It is a good feeling to know that you
24-year-old students,and though their personally,with your knowledge and
reasons for becoming involved vary engagement,can do something against
greatly,they all share the same desire to the spread ofHIV:among your friends,
educate other youth about how to protect in your school and in your town”(Jenny,
themselves from STIs/HIV/AIDS. age 22,peer educator).
PSI/Samara has no need to advertise
“We can’t cure AIDS,but we Peer education training
these positions rather volunteers come of
their own initiative,often after reading The training itselfis made up ofa data-
can easily prevent it.
an article in the newspaper,observing the base ofmodules,where one module logi-
Let’s do it together!” current volunteers in their bright yellow cally follows another.Usually,the first
shirts at youth events and in schools,or modules help participants feel comfort-
is the PSI/Samara moto.
having had a first-hand experience as a able together and open to discussing sex-
recipient ofpeer education sessions, ual health.The peer educator at times
which have inspired them to become will separate the groups into male and
involved themselves. female,or older and younger participants
Masha (age 15),a new recruit,took as their information needs are often dif-
part in four peer education sessions held ferent.All modules are interactive and
by PSI/Samara at a local government entertaining.Many ofthe favourite mod-
10 family centre.She gained extensive ules include role-playing and games that
knowledge about HIV/AIDS and safer challenge personal risk assessment.
sexual behaviour that enabled her to talk The training covers many different
more openly with her friends and family. themes relating to technical knowledge of
“Without any problems I can now talk HIV,methods ofprotection from HIV
about different problems ofsexual life”. and STIs (including abstinence,partner
reduction and condom use),HIV myths,
Becoming a volunteer
stigma associated with HIV,and psycho-
Upon arriving at the PSI office for the logical and communication skills (initiat-
first time,each volunteer is welcomed ing conversations with youth at events,
warmly and made to feel included and developing good listening skills,etc).