Does Peer Education Work in Europe?

Does peer education work in Europe?

THE EUROPEAN MAGAZINE FORNo. 55SEXUAL - 2003 AND REPRODUCTIVE HEALTH No. 56 - 2003 The European Magazine for Sexual and Editorial CONTENTS Reproductive Health By Dr Gunta Lazdane and Jeffrey V. Lazarus 3

Entre Nous is 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: (+45) 3917 1341 The work on young people in the WHO Regional Office for Europe Fax: (+45) 3917 1850 E-mail: [email protected] By David Rivett 9 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 Nous is 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 Regional Office for Europe, Copenhagen, Upholding European support for sexual and reproductive health care and rights Denmark. By Patricia Hindmarsh 17 It is published three times a year. Present distribution 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 Nous is produced in: By Henrietta Bencevic 22 Bulgarian by the Ministry of Health in Bulgaria as a part of a UNFPA-funded project; New Health Communicators at School: Medical Students Hungarian by the Department of Obstetrics and Gynaecology, University Medial School of By Inon I Schenker 23 Debrecen, PO Box 37, Debrecen, Hungary; Portuguese by the General Directorate for Resources 26 Health, Alameda Afonso Henriques 45, P-1056 Lisbon, Portugal; Internet resources 27 Russian by the WHO Information Centre for Health for the Central Asian Republics; Spanish by the Instituto de la Mujer, Ministerio Page 5Page 10 Page 19 Page 23 Page 24 de Trabajo y Asuntos Sociales, Almagro 36, ES-28010 Madrid, Spain. The Portuguese and Spanish issues are distributed directly through UNFPA representatives and WHO regional offices to Portuguese and Spanish speaking countries in Africa and South America. Material from Entre Nous may be freely translat- Cover illustration © Anne Mette Edeltoft ed into any national language and reprinted in THE ENTRE NOUS EDITORIAL 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 Nous do 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 Dr Gunta Lazdane Jeffrey EDITORIAL V. Lazarus By Gunta Lazdane and Jeffrey V. Lazarus Does peer education work in Europe? Photo: Lazarus Jeffrey

Young age has always been More effective means than just teachers yet authority figures out of touch 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 of programmes 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 of them are mysterious IPPF and WHO. Throughout this issue of International Federation of Medical Entre Nous the argument for peer educa- Student’s Associations is working togeth- and attractive, perhaps based tion is reinforced, with examples of how er with WHO to jointly scale up educa- on the experience of a 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 of a moviestar. explains the main theories and models This issue of Entre Nous comes on the employed in peer education, which focus heels of World 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 of theoretical and other method- health, information and services", which your parents and society is ological approaches to behaviour change highlights the need to support young something young people often in practice. The importance of peer edu- people in their efforts to lead safe, cation in a time of increasing incidence rewarding lives and contribute to the cannot figure out, as evi- of STIs/HIV/AIDS is the topic of the next well-being of their 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 of the highest rates of to the Russian Federation. he stated: “…If the world is to achieve On page 13, the use of theatre in peer the Millennium Development Goals and unwanted pregnancies, sexu- education is highlighted. The authors of implement the programme of action the article co-facilitated an advanced peer adopted at the International Conference ally transmitted infections education training of trainers 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 Nous will further review progress review of the 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 of Action most groups of young 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 Nous upon 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 of sexual and reproductive health. While physicians are the focus of the article on 3 pages 14 to 16, the following article looks at Hungarys’ experiences with sex education through the decades. Unfortunately, after nearly 30 years since “education for family life” was made compulsory in

JOIN Entre Nous' listserve by sending a blank e-mail to: schools, adequate conditions for its suc- [email protected] cess are still absent. The final two articles look at the role of medical 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 of peer 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 of peer 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 of what it is like to be a groups or through individual contact and young person. can take place in a variety of set- Theories and models of behaviour change tings: in schools, clubs, religious settings, workplaces, on the street Peer are essential parts of peer 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 of youth peer education some other people based on inclusion alleviates the possibility of miss- activities are: age, sex, sexual orientation, • Sessions with students using occupation, socio-economic ing an essential component of the 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 of peer education and some relevant Peer education can be used with many populations and age groups Behaviour change theory and models theories and models of behaviour 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 of health 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 of peer education is the perceived credi- of particular relevance for peer educa- bility of peer 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 belief model background between the educator and 3. Theory of reasoned action his/her audience in areas such as themes 4. Social cognitive theory of interest, tastes in music and popular 5. Trans-theoretical/stages of change celebrities, use of the language, family model themes (brother and sister issues, struggle 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 of the possible illness, per- ly influenced by their perception of ed behaviour in a comprehensive, clear ceived barriers or costs of changing 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 belief model suggests that respected peer educators. (the how) and resources (the where, if a person has a desire to avoid illness or when and whom) that can be used to tar- to get well (value) and the belief that a Social cognitive theory get risky behaviours. As an example, if a 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 of Albert Bandura. He condoms may prevent the spread of HIV, 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 belief model is where, when and from whom to acquire the concept of perceived barriers, or one’s them. opinion of the tangible and psychological A peer education programme that costs of the 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, if a gay man does not promoting healthier lifestyles. For exam- get tested for the fear of being 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 belief model 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 belief model into our Other programmes may be strong on work, we must consider the effects of the both information and skills, but fail to following factors on behaviour such as truly "reach" their audience because they culture, social influence, socio-economic lack appropriate motivational compo- status and personal experiences. nents. These programmes could leave Theory of reasoned action

participants with knowledge of what to © Anne Mette Edeltoft do and how to do it, but without strong This theory states that the intention of a emotional or intellectual reasons as to person to adopt a recommended behav- of others 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 of the behaviour. For confidence in being able to carry out a tance of providing 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 of peer 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 of the behaviour. For example: a In the context of peer education it means Health belief model young man whose male friends engage that the inclusion of interactive experi- The Health belief model 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 of peer education this con- important role models.

No. 56 - 2003 Trans-theoretical/stages of change Srdjan Stakic model (2,3) Exercise: Theory – Practise it [[email protected]] This model describes a sequence of stages United Nations Population Fund in changing health-related behaviour. It Objective (UNFPA) Consultant uses the stages of change from across To help participants understand the major theories of intervention, 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 of an 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 of changing 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 behaviour for more than 6 months); aspects of it: what, where, and how. References 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 of behaviour 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 of peer 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 of behaviour 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 programme. PEER EDUCATION AND HIV/AIDS: HOW CAN NGOS ACHIEVE GREATER YOUTH INVOLVE- MENT? Lise Rosendal Østergaard

he Danish Family Planning Associ- cacy, counselling, facilitation of group a certain group by working on their ation has compiled experiences discussions, drama, lecturing, distribu- knowledge, attitudes, beliefs and behav- Tfrom young people and represen- tion of information materials and refer- iours. tatives of NGOs from Europe, Africa, rals to services. The theoretical base of peer 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 of understanding 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 of the dimensional nature of the 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 of scientific 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 of the participants has been published in a cata- societal related. As peer education typi- subjective judgement of a person that logue of ideas and now informs the work cally involves the use of members of a they have confidence in who has adopted of the newly established Danish network given community that is affected by the same changes and who can serve a of NGOs 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 of the 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 of many 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 of activities in strategy by the international community their respective organisations. As a matter and the public sector. At the United of fact, many of the organizations would Nations General Assembly Special be unable to maintain the high level of Session on HIV/AIDS (UNGASS) in out-reach activities if it 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% of young men and women they receive a limited compensation for aged 15-24 have access to the informa- their work, but also because of the 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 of the 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 of the 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 of equal 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 of resources. 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 of the 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 of the 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 of the 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 of certain 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 of the pared for that. cuous. That attitude has been detrimen- Danish counsellors pointed out that Second, the selection of peer 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 of adults, “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 of sexuality in a broader context. and attitudes. is often a question of which words to use What are the features of successful Third, training and supervision must in order to pass a message to young peo- peer education programmes? First of all, 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 of the 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 of adopting a frank language. a means to achieve greater project effi- conduct supervision of the peer educa- The importance of being careful and pay- ciency and is an end in itself to improve ing attention to the needs of young 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 of the 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 of opportunity for face-to-face and influencing processes, decisions and communication because of the peer edu- activities. For that to happen they must cators’ critical access to young people. be fully included at all steps of the pro- Yet, new information technologies project cycle. If that is the case, peer educa- vide a whole other variety of entry points tors can become not only empowered but for HIV-information. Several participants at the Mahler Forum had already gained experience with the use of new technologies to reach a bigger audience with sexual 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 of Macedonia, 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 of channels Samfund is the creation of the high- strengthen the capacity of the NGOs of information 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 of them 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 of the WHO Regional Office in sup- began in February 2002 when the agencies 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 of young people and NGOs from Bulgaria, Estonia, for this age group has been the European Network of Health Latvia, Lithuania and the Russian Federation (Kaliningrad and Saint Promoting Schools, now active in 43 of the 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- of Macedonia, 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 of the pro- sensitise key policy-makers and advisers, gramme for the Promotion of Young programme managers and young people People’s Health in 2000, collaboration to the concept of youth friendly services with other United Nations partners on and to share examples of best practice, to activities such as peer education was ini- apply the criteria of youth 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 of quality 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 of team clearly an effective way of building 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 of ideas “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 of Ideas for NGOs” please contact the of school 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 of Education 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 of youth 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 of PSI/Samara, rates of HIV 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- of new 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 of the volunteers stressful day at school” and of course “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 of HIV: 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 these positions rather volunteers come of Peer education training can easily prevent it. their own initiative, often after reading The training itself is made up of a data- an article in the newspaper, observing the base of modules, 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 of peer 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 of the 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 of protection from HIV about different problems of sexual 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). Each training session combines general really understands their situation techni- their own in-house peer education is also and specific knowledge, communication cally and emotionally. However, gaining proving very successful. skills and tools and games available for initial access to schools to implement “We can’t cure AIDS, but we can easily providing training to other youth. peer education activities can be challeng- prevent it. Let’s do it together!” is the “I have become more communicative ing. In Samara, conducting the first PSI/Samara moto. and self-confident since becoming a vol- training sessions proved difficult, due to unteer” (Anton, 17, peer educator). the anxiety school board members felt Bibliography Dasha, a medical student, says: “I am able that open talks about safer sex could be 1. Report on the global HIV/AIDS epi- to use my knowledge at university - some perceived as promoting promiscuity. To demic, June 2002. Geneva, UNAIDS, of my teachers do not know much about win public support, PSI/Samara began 2002. HIV/AIDS and so they come and ask me educating teachers, parents and local 2. Ebreo A, Feist-Price S, Siewe Y, for information.” authorities to reassure them of the true Zimmerman RS. Effects of peer educa- To become a peer educator volunteers goal of the programme, to protect their tion on the peer educators in a school- participate in approximately 20–30 train- children from disease. PSI/Samara now based HIV prevention program: where ing sessions, and when should peer education they feel ready, complete research go from here? a computer-based test Health Educ Behav. and an oral examina- 2002, 29(4): 411-23. tion. On passing, the 3. Siegel DM, Aten peer educator is deemed MJ, Enaharo M. Long- capable of providing term effects of a mid- independent peer educa- dle school- and high tion in schools, youth school-based human camps, hostels and uni- immunodeficiency versities. virus sexual risk pre- “There are questions I vention intervention. have to answer almost Arch Pediatr Adolesc every peer education Med. 2001, 155(10): session or event. For 1117-26. example: ‘Can I be 4. Stover J et al. Can infected with HIV we reverse the because of an insect HIV/AIDS pandemic bite?’ or ‘Do condoms with an expanded really protect me from response? Lancet, HIV?’” (Aleksej, age 18, peer educator). receives numerous invitations from local 2002, 360(9326): 73-7. authorities and educational institutions 5. World Health Organization. Global Peer education in schools to provide peer education at schools, Programme on AIDS. Sex education UNAIDS highlights school-based youth camps and universities. leads to safer behaviour. Glob HIV/AIDS education as an essential The PSI/Samara peer education strate- AIDSnews. 1993;(4): 1-2. component of prevention intervention in gy has made a shift in recent months, low-income and middle-income coun- rather than carrying out one-off activi- Jenny Bluhm (Population Services tries, and studies conducted among var- ties, it has moved towards the implemen- International Peer Educator) ied populations have revealed that peer tation of recurring sessions, which use Mikhail Volik (Population Services education is one of the most effective structured, robust participatory International Peer Education ways to communicate information about approaches to ensure young people inter- Coordinator) health. As a result, peer education has nalise and personalise HIV/AIDS issues. Nicola Morgan (Population become an important component of In Samara, Dr Volik strives to undertake Services International Acting many behaviour change strategies. ongoing, long-term activities in all the Country Representative, the 11 In Russia there is a lack of sex educa- programme schools, but with limited Russian Federation). tion in schools - for both teachers and resources and access this can prove chal- students it is often easier to talk about lenging. In the time since the PSI Peer For further information, sexuality, HIV, STIs and reproductive Education Programme was initiated in please contact: health with someone external, and stu- Samara there has been a significant Nicola Morgan [[email protected]] dents, in particular, enjoy talking to increase in the percentage of repeat ses- PSI/Russia someone their own age. Often, peer edu- sions, and as a result an improvement in or Catherine Slater cation is the first time youth have the the effectiveness of such training. The [[email protected]], PSI/Europe opportunity to learn about sexual health latest initiative to train volunteers from and to pose questions to someone who other youth programmes to produce

No. 56 - 2003 THEPEER GLOBAL EDUCATION FUND: IN WHICH EASTERN COUNTRIES EUROPE AND OWECENTRAL HOW ASIA-ONE MUCH? WAY TO ADDRESS YOUNG By Tim France, Gorik Ooms and Bernard Rivers. 21 April 2002 PEOPLE’S VULNERABILITY Greta Kimzeke

In the past decades a number tion in central and eastern Europe and mentioned assessment, the IAG – the countries of the former Soviet Union Subcommittee on Peer Education has of factors have dramatically has recently become a popular approach implemented a series of sub-regional increased young people’s vul- to address these issues. There is a global training workshops and supports peer body of evidence that peer education, education networking activities both at nerability in eastern Europe when integrated in other supportive pre- regional and national levels. The UNFPA vention strategies, and when solid train- Division for Arab States and Europe and and central Asia. Overall, the ing and supervision are guaranteed, can the UNICEF Regional Office for CEE/CIS social and economic transi- be very effective in promoting behaviour and the Baltics have taken the lead in this change. Furthermore, there is growing work, in close collaboration with their tion in this region has dispro- recognition that peer education is a field offices. Today, 165 peer educators, strategic vehicle for motivating and project managers and UNFPA and portionately affected young directly involving young people in their UNICEF programme officers have taken people. The collapse of social own health and development. However, part in trainings. Discussion and research also signals a number of chal- exchange of experience and ideas is tak- controls and values and the lenges in the implementation of peer ing place through an electronic network non-emergence of alternatives education, especially in the area of pro- (see page 27 in this issue). In a number gramme methodology, stakeholder of countries (for example, Bulgaria, has led to more pronounced involvement and sustainability. In order Latvia, Serbia and Montenegro, and the to assess the quality of peer-led interven- Ukraine) the joint work of the IAG in the risk behaviours – in particu- tions in the region and to identify possi- area of peer education over the past three lar increased sexual activity ble needs for technical support, in 1999 years has resulted in an increased policy the UN Inter Agency Group on Young support for implementation of peer edu- and experimentation with People’s Health Development and cation both in school and in out-of- Protection, Europe and Central Asia school settings. drugs and alcohol. (IAG) organized a regional assessment workshop, followed by a stocktake of Circumstances contributing to such risk peer education programmes in the region Greta Kimzeke behaviour include increased poverty; (1). [[email protected]] migration and conflict; falling rates of This initial stocktake identified 73 peer UNICEF Regional Office CEE/CIS enrolment and completion of secondary education programmes in 12 countries, and the Baltics schooling; an absence of after-school predominantly initiated by the NGO sec- Project Officer Young People’s recreational activities; and unemploy- tor and conducted both in and out of the Health Development and ment, which is three times higher among school setting. Peer-led approaches in the Protection young people than among the adult pop- region are in particular used in the con- ulation. At the same time, the increasing text of sensitive issues such as sex educa- accessibility of imported illicit substances tion and prevention of substance abuse - References such as opium and heroin has increased subjects which are most often not includ- 1. Peer Education Development in young people’s vulnerability to substance ed in the school curriculum. This assess- CEE/CIS & The Baltics. (2000-2001). abuse. Other risk factors include exclu- ment revealed a difficult working situa- Report in 12 countries as part of the sion and discrimination as a result of tion for peer educators in the region. joint UNICEF, UNFPA, WHO, ethnicity, disability, citizenship status and Programming on peer education UNAIDS Workplan for Support to sexual orientation. appeared to be happening in an uncoor- Peer Education in CEE/CIS and the In the light of the above, it might not dinated, and sometimes even antagonistic Baltics. be a surprise that also in this region, fashion. Projects were (and still are) which currently faces the most rapidly largely dependent on international sup- increasing HIV epidemic in the world, port with little involvement of the gov- 12 the majority of new HIV infections occur ernment sector. In addition, there seemed in young people. They lack the knowl- to be a lack of qualified trainers and tools edge and skills to protect themselves and for peer education. However, this assess- have insufficient access to confidential, ment also identified the potential of good appropriate services. In addition, the practice to build upon. There are strong incidence of sexually transmitted infec- indications for a move beyond a pure tions among young people shows an information approach towards so-called upward trend. “behaviour change interventions”,based Today, investing in HIV, STI and sub- on skills building and using participatory stance abuse prevention among young training methodologies, as discussed else- people is more than ever needed. Just as where in this issue. in other parts of the world, peer educa- Based upon the results of the afore- HEALTH EDUCATION AND THEATRE FOR

Bibliography AND BY YOUNG PEOPLE Bandura A. (1977). Social Foundations of Thought Cydelle Berlin and Ken Hornbeck and Action. Englewood Cliffs, NJ: Prentice- Hall. Berlin C, Berman LA (1995).“Theater, Peers and HIV Prevention: A Model”. FLEducator Fall: 8-14

Dalyrymple L, duToit MK. (1993 ).“The Evaluation of a Drama Approach to AIDS Education”. he use of theatre in education has adolescent is “efficacious” enough, pow- Educational Psychology 13(2): 147-154. been proven to be a powerful tool erful enough, to control his or her own Harding CG, Safer LA, Kavenaugh J, Bania R, Carty for social change. It can strengthen behaviour, and even, to some degree, his T H, Lisnov L,Wysockey K. (1996).“Using Live Theater the emotional and psychological appeal or her future. combined with Role Playing and discussion to of the messages and provide a credible Health education theatre should also Examine what At-Risk Adolescents Think about and compelling vehicle to explore sensi- implement insights of other researchers Substance Abuse, its Consequences and tive issues with young people. Watching a and learning theorists. Research has Prevention”. Adolescence 31(124):783-796 carefully designed educational show can shown that youth tend to model their Patierno C. (1990).“Empowering Teenagers:The alter the way a person thinks and, possi- behaviour most closely on those with Use of Theater in HIV/AIDS Education- New York bly, the way s/he acts. Comprehensive whom they would like to be associated. City Models”. SEICUS Report (1894):15-17. programming is the only way of assuring Therefore, those who provide health edu- Valente TW, Bharareth U. (1999).“An Evaluation of that young people receive a message cation through theatre must be careful to the use of Drama to communicate HIV/AIDS regarding safer sexual behaviour, and craft situations and characters who con- Information”. AIDS Education and Prevention theatre education provides an opportuni- vey: “cool” or “hip” at the same time as 11(3):203-211. ty to get that message across in a com- they demonstrate safe behaviours. pelling and exciting way. At a minimum, Because adolescents are proverbially Given the effectiveness of theatre as a way live theatre provides information, pro- attracted to risky behaviours and those of starting the conversation among vokes discussion and stimulates thought. who exhibit it, this insight is particularly young people about health issues includ- At its best, live theatre can change how useful in the creation of Bandura’s transi- ing protection and prevention, live the- people act: it can lead youth away from tional models: atre intended to address these issues risky, and toward safer behaviours. But • The characters are hip; should be available to young people. how does theatre do this? • They use hip language; Given that the most effective theatre pro- Primarily, by capturing attention: even • They wear hip clothes; gramme for young people is that devel- young people bored by regular classroom • They recognize and may even have suc- oped and acted by young people them- work perk up at the sounds and visions cumbed to the appeal of high risk selves, and that that teen or peer educa- of live theatre. Theatre “hooks” the audi- behaviour; yet tors who participate in these activities are ence, focusing their attention and actively • They show how and why they are con- even more likely than their audiences to involves the audience in an experience. verting to safer sex and other safer have a wealth of information about sexu- Active involvement means that the audi- behaviours. al health and to exhibit safer behaviours, ence’s emotions, and not only their intel- the time is now to place theatre compa- lect or cognitive skills, are affected. It is Culturally appropriate theatre nies in schools and community associa- this ability to touch emotions that allows Finally, for education of any sort to work, tions. theatre to influence attitudes in ways that it must be culturally and developmentally more traditional instruction cannot. But, appropriate. Adolescents will not be mov- Dr Cydelle Berlin [cberlin@chp- for theatre to change the behaviour of ed by theatre designed for primary school net.org] is the founder and execu- young people, it must do more than sim- students; and primary school students will tive director of the NiteStar ply tug at their heartstrings. It must not understand an intervention designed Program, a 16-year-old interna- deliver its messages in ways that young for older students. Theatre that is cultural- tionally recognized theatre for people can understand and that will ly and developmentally appropriate can health and social change, based in impel them to act. dispel myths, provide more accurate New York City. Theatre, like other forms of “entertain- information and change attitudes and Ken Hornbeck [kdh1956@bell- ment education”,does this based on the behaviours through its effective use of south.net], is the former artistic principles of social cognitive theory. models who engage the audience’s atten- director for NiteStar and Founder Bandura, the theory’s author (see page 5 tion and emotions. and Executive Director of ENACTE of this issue), recognized that people Most researchers have concluded that in Atlanta, Georgia. learn how to behave and how to change theatre education about health issues is an their behaviour by watching other peo- effective way to begin to inform young Dr. Berlin and Mr. Hornbeck served ple. In the edutainment show, the actors people about sexual and reproductive as trainers in the use of theatre in 13 model behaviour for the audience. The health including pregnancy prevention, education at the UNFPA advanced audience notes the behaviours of both HIV/AIDS, sexually transmitted infec- training of trainers, which took positive and negative role models depict- tions, domestic/ partner violence, gender place in Estonia in February/March ed in scenes. What may be most impor- issues and much more. Theatre education, 2003. During that training a series tant for health education through the use however, is not a panacea. A single theatre of four workshops were presented of theatre is the “transitional” model: the performance may get a teenager or pre- which gave the peer education adolescent character or model who teen started on the road to safer sexual trainees information and skills on changes his or her behaviour from risky options, but it cannot ensure that he/she how to incorporate role-play and to safer, demonstrating to the adolescent stays there. For that, parental, school and drama into their repertoire of edu- audience that this can be done, that the community involvement are crucial. cational activities.

No. 56 - 2003 A EUROPEAN TRAINING CURRICULUM IN ADOLE FOR PROFESSIONALS WORKING IN THE FIELD OF Pierre-André Michaud, István Batár and the members of the EuTEACH working group

Given the current lack of training programmes and resources adapted to the European context, the Multidisciplinary Unit for Adolescent Health, a university- based training, research and clinical centre in Lausanne, launched an initiative in 1999 for the development of a training curriculum in adolescent health and medicine (EuTEACH for European Training in Effective Adolescent Care and Health). The major goal of the project, Adolescent medicine is an emerging field in most inspired by similar projects (7-10), was to improve adolescent health and wellbeing in the enlarged European countries, which makes the setting up of European community. Specifical1y, the training curriculum’s aims were: 1) to select and propose a structured training mandatory. Moreover, sexual and set of knowledge, attitudes and skills essential for reproductive health constitutes one of the major issue of European professionals involved in the care of adolescents; 2) to gradually develop, implement concerns within this age group. The EuTEACH curricu- and evaluate a training package that covers the lum (www.euteach.com) was developped by a group of selected areas and issues; and 3) to encourage the long-term development of adolescent health mul- European adolescent medicine physicians as a teaching tidisciplinary networks which would promote training in adolescent health in as many European tool available to any physician teacher in charge of deliv- countries as possible.

ering courses at the pre- and post-graduate and Development, structure and content of the CME levels. EuTEACH site In an attempt to develop an agreed curriculum Research is accumulating showing that the training of covering the most important target learning physicians is a crucial factor for the improvement of objectives in the field and to comply with the approach described above, a group of physicians adolescent health care and adolescent health status. In from eleven European countries and with various professional specializations ranging from paedi- the US, Canada and Australia, specific intervention atrics, internal medicine and general practice to strategies and services are being developed, including public health, gynaecology and psychiatry was convened. The group has met biannually since multidisciplinary training for medical and non-medical 1999, initially to outline the purpose and architec- professionals (1-3). In Europe, despite the fact that the ture of the curriculum and then to develop the content of the various modules. Its work is sup- “Health 21” policy framework of the World Health ported by consultants and interested European and international professional associations are Organization (4) includes specific targets aimed at linked to the network with designated representa- improving the general as well as the sexual and repro- tives who have been periodically informed on the progress of the work. Several non-governmental ductive health of young people, training opportunities in organizations officially support or formally col- laborate with the project, including WHO. In adolescent health and medicine for health care providers developing the curriculum, the experts have been are scarce (5,6). guided by two basic questions: 1. What is different about the health and health care of an adolescent as compared with a child or an adult? 2. What 14 does the learner need to know and which kind of skills need to be acquired to adequately assist and treat an adolescent with everyday health burdens or with a specific health problem/disease?” The EuTEACH curriculum is not a distance learning tool, but provides teachers in charge of training activities in the field of adolescent medicine an instrument which assists them in selecting the areas they want to cover, in defining appropriate objectives and in choosing relevant learning techniques and adequate evaluation methods. The curriculum is developed from basic areas to more specific themes, SCENT MEDICINE AND HEALTH: A RESOURCE SEXUAL AND REPRODUCTIVE HEALTH

so that the use of some modules requires ly. Depending on the setting as well as the areas such as sexual and reproductive the coverage of preliminary basic areas. needs and basic knowledge of the audi- health, the use and abuse of substances Each module and each part of the mod- ence, the users can choose much less and issues related to mental health. ule focus on knowledge, attitudes and extensive versions, select the objectives Plenary lectures alternated with group skills, and provides the user with explicit that suit their time schedule and their sessions, including discussions on clinical learning objectives, with corresponding target audience’s needs. cases and role-playing. teaching methods as well as concrete The curriculum provides suggestions The EuTEACH curriculum pro- examples, such as case stories, issues to as to what the top priority objectives are. gramme has also been used in several be debated in small groups or themes for Although primarily developed for “in- other forms and in several other settings, role-playing. For each learning objective, practice” physicians, the curriculum is primarily within western European coun- the user is also provided with suggestions adaptable to the specific needs of profes- tries such as Italy, Portugal, Germany, regarding the way the evaluation of the sionals from different fields and disci- Belgium, Switzerland and the United trainee should be carried out. This plines. As exemplified in the figure, the Kingdom. Special one-day sessions are approach has been greatly inspired by a user is provided with guidelines as to organized one day before each meeting of structured approach to curriculum devel- how to conduct a needs assessment the European chapter of the Internation- opment (11). before the course, a list of basic refer- al Association for Adolescent Health . ences and an introductory document As the module on sexual and repro- focusing on the various evaluative meth- ductive health can be used in an exten- SPECIFIC THEMES ods suggested within each module to test sive version lasting 2 to 3 days, it is possi- acquired knowledge, attitudes and skills ble to run an entire week of training and adaptable evaluation sheets, which specifically addressing the needs of pro- allow for feedback from the trainees at fessionals involved in this field: a one-day the end of each session and at the end of introduction on adolescent growth, BACIC THEMES the course. The site also provides the development and family life is followed users with links to other organizations by a second day focusing on the setting and facilities targeting adolescent medi- and special needs of various populations HOME PAGE cine and health, as well as a direct e-mail of adolescents such as migrants or drop- link to the members of the working outs and then the discussion moves for

LINK LIST group. the three other days to more specific WITH OF THE OTHER GROUPS topic of sexual and reproductive life in a SITES MEMBERS Practical application of the curricu- clinical and preventive perspective. Such lum a course was recently set up by the

TRAINING EVALUATION In July 2002, the EuTEACH working Department of Obstetrics and Gynae- TOOLS LIST OF TOOLS REFERENCES group set-up up a one week summer cology of the Faculty of Medicine, school at Lausanne University. The target University of Debrecen, for representa- audience included practising physicians tives from eastern European countries. involved in adolescent medicine and As shown in the figure, the curriculum health, in-training paediatricians and Perspectives, conclusion includes two major parts, one devoted to general practitioners as well as school Given the special situation of the basic issues that form the foundation of physicians and professionals involved in teenagers living in those eastern care and management of adolescents, and policy-making. The course, run by sever- European countries facing a major soci- the other dealing with more specific top- al members of the working group, cov- etal transition (4), it is of utmost impor- ics such as sexual and reproductive ered eight modules, in their shortened tance to adapt the curriculum to the spe- health, substance use and eating disor- version, and used a variety of training cific needs of those who train the profes- ders. The 17 modules each focus on one methods. Twenty-five physicians from 14 sionals involved, especially those working thematic area: basic modules include eastern and western European countries in the field of sexual and reproductive issues such as definition of adolescence, participated in the course, many of health. It is thus currently foreseen to 15 bio-psychosocial development; an whom worked part-time or full-time in form a group of specialists from these overview of adolescent health; the family; the field of sexual and reproductive countries, to set up a meeting during setting, confidentiality, rights, communi- health. One month before the course the which the content of specific modules cation and clinical skills; risk and applicants were invited to complete a will be reviewed and then to translate it reliance; school health and health pro- training needs assessment sheet, so that into Russian and make it available on the motion. The second part of the curricu- the final programme was tailored to meet internet, using the same approach which lum targets more specific issues such as the expressed needs of the audience: it was used for the implementation of the growth and puberty; sexual and repro- covered both basic themes such as confi- English version . This adaptation should ductive health; mental health; substance dentiality, settings or working with the be available by the end of the year 2004. use; eating disorders and violence. The family, epidemiology, public health and The value of the EuTEACH pro- different themes can be covered separate- school health as well as more specific gramme lies in the fact that it is freely

No. 56 - 2003 and easily accessible online Health Organization Regional Office Pierre-André Michaud, MD (www.euteach.com). The fact that it is for Europe, 1998. Multidisciplinary Unit for modular allows for an easy tailoring, 5. Burgio G, Ottolenghi A. Adolescence Adolescent Health (UMSA) , both in length and content, to the needs and paediatrics in Europe. European University Hospital (CHUV), CH- of the different target audiences. Journal of Pediatrics 1994;153:706-11. 1011 Lausanne, Switzerland However, currently there is uncertainty as 6. McPherson A, Macfarlane A, Donovan to whether all those professionals at C. Adolescent Health: Training GP István Batár, MD whom the programme is aimed, actually Registrars. United Kingdom: Exeter Family Planning Center, Dept. Of possess the skills to use the up-to-date Publications Office, Royal College of Obstetrics and Gynecology Faculty interactive methodologies suggested in Physicians, 1996. of Medecine, the module, and the group is developing 7. Tonkin R, Herbert C, Cole C, Page G. University of Debrecen Medical guidelines and a set of tools (slides, case A Youth Health Curriculum. and Health Science Center, stories, reference papers available on the Vancouver: University of British Debrecwen, Hungary site, etc.) to assist the interested trainer in Columbia, 1998. the use of the different educational 8. The American Board of Pediatrics. approaches suggested. Subspecialty Certifying Examination. Finally, it is important to stress that Content Outline. Subboard of Correspondence to: the European Community is currently Adolescent Medicine. USA: American Pierre-André Michaud, MD defining the content of pre- and post- Academy of Pediatrics, 1997. [Pierre-Andre.Michaud@ graduate training of the medical profes- 9. Kaplan D, et al. Adolescent Medicine inst.hospvd.ch] sion and of the various specialties (5, 12, Curriculum. Denver, Colorado: EuTEACH coordinator 13). It is hoped that in future, adolescent Division of Adolescent Medicine, UMSA, CHUV, medicine and health will be recognized as Department of Pediatrics, University of CH-1011 Lausanne, Switzerland a sub-specialty, as this is already the case Denver, Colorado, 1999. Fax: (+41) 21 314 37 69 in North America and Australia, and that 10. Emans SJ, Bravender T, Knight J, the EuTEACH curriculum could be used Frazer C, Luoni M, Berkowitz C, et al. as one template for the content of the Adolescent Medicine Training in Members of the EUTEACH working training of various professionals in disci- Pediatric Residency Programs: Are We group: plines related to adolescent health. Doing a Good Job? Pediatrics I Batár (Hungary) ; 1998;102(3):588-95. K. Berg-Kelly (Sweden) ; 11. Kern DE, Thomas PA, Donna MH, J.-P. Bourguignon (Belgium) ; References Bass EB. Curriculum Development for H. Fonseca (Portugal) ; 1. American Academy of Pediatrics. The medical education: a six-step WR. Horn (Germany) ; Future of Pediatric Education II Task approach. Baltimore and London: John A. Macfarlane (U.K.) ; Force. The Future of Pediatric Hopkins University Press, 1998. PA. Michaud (Switzerland) ; Education II: Organizing Pediatric 12. European Paediatric Board. Training V.C. Mouli (WHO) ; Education to meet the Needs of for Specialists in Pediatrics: European F. Narring (Switzerland); Infants, Children, Adolescents, and Pediatric Board, 1998. K. Pagava (Georgia) ; Young Adults in the 21st Century. A 13. Association for Pediatric Education SC. Renteria (Switzerland); Collaborative Project of the Pediatric in Europe. European Pediatric Board: S. Stronski (Switzerland) ; Community. Pediatrics 2000;105(1, Training for Specialists in Paediatrics. J.C. Suris (Spain) ; Part 2 of 3):S161-S212. Recommendation for a log book of G. Tamburlini (Italy) ; 2. Centre of Adolescent Health training for the Common Trunc in R. Vinner (U.K.) ; University of Melbourne, Royal Paediatrics, 1999. Australian College of Physicians. The next one-day course will take place Guidelines for the national adolescent in French, on September the 25th. 2003 health physician training and educa- The organization and content of the Professionals familiar with teaching 16 tion program. Melbourne, Australia, EuTEACH website activities and adolescent health who are 1996. The development of EuTEACH is sup- interested to participate in such a process 3. Elster AB, Kuznets N. AMA Guidelines ported by a grant from the University of may connect with the EuTEACH group. for Adolescent Preventive Services Lausanne. A prerequisite would be to be fairly flu- (GAPS). Recommendations and ent in English, as well as, if possible, in Rationale. Baltimore: Williams & Russian. Wilkins, 1994. 4. World Health Organization. Health 21: an introduction to the health for all policy framework for the WHO European Region. Copenhagen: World UPHOLDING EUROPEAN SUPPORT FOR SEXUAL AND REPRODUCTIVE HEALTH CARE AND RIGHTS By Patricia Hindmarsh

Although there were The report, which was drafted by Ms explicitly refer to the ICPD goal as the Sandbaek, Chair of the European mandate for all reproductive health many attempts to stall its Parliament Working Group on actors. progress through the Population, Sustainable Development The amendments Ms Sandbaek intro- and Reproductive Health (EPWG), on duced on the contentious subject of European Parliament, and behalf of the Development Committee, unsafe abortion sought to highlight two drew unwelcome, if unsurprising, atten- key issues. Firstly, to re-affirm the ICPD much heat generated in the tion from “anti-choice” groups and some language on unsafe abortion (paragraph debate, the “Aid for Policies Members of the European Parliament 8.25) which states that “abortion should (MEPs). in no case be promoted as a method of and Actions on Reproductive The report forms the basis of a new family planning”.Secondly, to emphasise regulation which was adopted by the that levels of unsafe abortion will be and Sexual Health and Rights Council of European Union reduced by improving access to repro- in Developing Countries” Development Ministers on 20 May 2003. ductive health care. New language intro- It replaces the 1997 Regulation on duced by the European Parliament now report was successfully Population Policies and Programmes in recognizes that “unsafe abortions threat- adopted this February. Developing Countries, which expired at en the lives of a large number of women, the end of 2002. A new regulation is long and that deaths and injuries could be overdue as previous resolutions and reg- prevented through safe and effective ulations on the European Community’s reproductive health measures”. activities in the areas of population, fam- Improving access to quality reproduc- ily planning, HIV/AIDS and gender in tive health services for vulnerable, under- development did not focus primarily on served groups is of vital importance. Ms sexual and reproductive health. The new Sandbaek therefore drafted new language regulation will provide an important per- recognizing the sexual and reproductive spective on the years since the health needs of refugees and internally International Conference on Population displaced persons. Given that half of the and Development (ICPD, Cairo 1994) world's 6.1 billion people are under the and a reflection of “post-ICPD” priority age of 25, and that their sexual and areas. reproductive health needs are overlooked The Commission’s original proposal in many countries, an amendment was for the regulation was a sound and solid tabled to stress the importance of involv- foundation for the new policy. ing young people in the design and Nonetheless, certain points were missing. implementation of such programmes. One vital amendment which Ms It is unsettling that financial resources Sandbaek introduced aims to reaffirm for population and reproductive health the commitment of the Community and services for developing countries and its Member States to the specific repro- countries with economies in transition ductive health goal, agreed at ICPD, to have actually declined in recent years. “make accessible, through the primary According to the latest information from health care system, reproductive health UNFPA, external assistance and domestic care to all individuals of appropriate ages expenditure for reproductive health ser- as soon as possible and no later than the vices totalled just US $9.4 billion in 2001, year 2015”. well short of the ICPD target of $17 bil- The ICPD Programme of Action pro- lion. However, it is encouraging that the vides the basis for a number of the new regulation will ensure that 73.95 health-related Millennium Development million of the EU development budget is 17 Goals (MDGs) - the ambitious agenda allocated to reproductive health between for reducing poverty and improving lives 2003 and 2006. The Community is also that world leaders agreed at the using its influence to put pressure on Millennium Summit in September 2000. other donors, and an amendment has The eight MDGs include goals to reduce been tabled in Parliament “calling upon child mortality and improve maternal the international community, in particu- health, and yet make no mention of the lar the developed countries, to collective- key reproductive health goal agreed at the ly ensure the appropriate share of the ICPD (see www.developmentgoals.org). financial burden defined in the Cairo The EPWG therefore wanted to ensure [ICPD] Programme of Action”. that the Community’s new policy should These parliamentary amendments

No. 56 - 2003 should be viewed against a backdrop of their European profile over the last year, Poul Nielson stated that, “I would regret frequent and sustained threats to the setting up satellite branches of the US if the development policy of Europe were ICPD consensus. In recent months there organizations, and making alliances with instrumentalised to pursue an issue aris- has been a rapid rise in the number of anti-choice MEPs. One such example is ing predominantly because of a US campaigns aiming to erode support for “euro-fam” which is linked to the organi- domestic policy debate”.The reproductive health and to unravel the zation “c-fam” (the Catholic Family and Commission’s granting of 32 million to Cairo consensus. Human Rights Institute). The euro-fam UNFPA and IPPF, the day after the US The challenges to the ICPD consensus website closely monitors EU policy on decision to de-fund UNFPA, sent an originate from a minority of anti-choice reproductive health and provides tailor- important message of EU support for groups – mainly US based - who seek to made letters which can then easily be ICPD. The Commission has also indicat- subvert the reproductive health agenda sent to MEPs and the Commission. It ed that it may issue a statement re- by focusing on the issue of abortion. In also records roll-call votes, giving MEPs a affirming its commitment to ICPD. US President George W. Bush they have grade, depending on how they have Certainly, the EU statement made at the found a natural ally. Symbolically, on his voted. recent 36th Session of the Commission of very first day in office in January 2001, Not surprisingly, given its subject mat- Population and Development was the President reintroduced the Mexico ter, the Sandbaek report was the target of extremely encouraging (1). City Policy, also known as the “Global campaigns by opposition MEPs. Led by These efforts to re-affirm commitment Gag Rule”.This stringent policy disquali- the Portuguese MEP Ribeiro e Castro the to reproductive health are particularly fies foreign non-governmental organiza- minority group of MEPs failed to win valuable in the run-up to the tenth tions from receiving US funds if they support for its proposed amendments on anniversary of the ICPD. With 10 new provide legal abortion services, lobbying abortion. This was due to the tireless countries joining the EU in May 2004, it or counselling and referral for abortion, support of members of the EPWG and is vital to safeguard European support for even with their own money. Ironically, other non-members, including Irish MEP reproductive health if the ICPD targets this law would be considered unconstitu- Proinsias De Rossa and Spanish MEP and Millennium Development Goals are tional if imposed on US organizations. At Elena Valenciano, who both defended the to be achieved. United Nations international fora, the US ICPD agenda. has also consistently fought to erode the The European Commission has also ICPD language. been targeted by opposition groups who References In the US, so-called pro-life research are stretching its already limited human 1. The Greek Presidency, speaking on organizations, such as the Population resources. Tactics include writing to Poul behalf of the EU at the 36th Session of Research Institute (PRI) and the Family Nielson, Commissioner for Development the Commission on Population and Research Council, achieve their dubious and Humanitarian Aid, and tabling Development in New York in March, aims by disseminating misinformation numerous parliamentary questions 2003, stated that it "reaffirms its com- and distorting the facts. UN reproductive (PQs). Anti-choice MEPs have tabled 20 mitment to the full implementation of health agencies are the prime target of PQs relating to sexual and reproductive the ICPD Programme of Action and their sustained campaigns. PRI, which health and rights to the Commission and stresses that a firm commitment to promotes the view that “family planning Council since March 2000. These ques- population, reproductive health and is inherently coercive in a developing tions encompass many subjects, includ- gender issues is a prerequisite if the country context”,is actively engaged in ing EU funding for UNFPA, the defini- goals and targets of the Conference propagating falsehoods about UNFPA’s tion of population and reproductive and of the Millennium Summit are to role in China. As a result, in July 2002, health, and EU support for sexual educa- be met". Bush blocked the release of a grant of tion programmes which promote absti- $34million to UNFPA, based on unsub- nence only. One PQ even states: “The stantiated claims that it supports coercive term “sexual health and rights” has never Patricia Hindmarsh abortions and sterilisations in China. The been defined and can include paedophilia [patricia.hindmarsh@stopes. Bush Administration has also frozen $3 for example”.The Commission has been org.uk] million to the WHO’s Human obliged to allocate some resources to Director of External Relations 18 Reproduction Programme, which is cur- monitoring opposition and responding Marie Stopes International rently conducting research on women’s to campaigns. Even this has been criti- www.mariestopes.org.uk experience of abortion in China. The cised by the Irish Conservative MEP, good news is that the House of Dana Scallon, who in alliance with PRI is Representatives has recently passed an questioning whether “EU taxpayers’ amendment, which if enacted into law, money” can be justifiably used for these might increase the chances of UNFPA purposes. receiving US funding again. The Commission has made it clear It is alarming that these opposition that it will not be intimidated by these groups are extending their web here in tactics. In reply to a letter from 46 MEPs Europe. They have increasingly raised concerning aid for reproductive health, SEX EDUCATION IN HUNGARY István Batár

Excerpt of a report presented In Hungary, the official name of the sex- method of contraception and was avail- ual education programme is “education able for nearly everyone (the “abortion by István Batár, Head of for family life”,which is more than sim- committees”,brought about to control Family Planning Center, ple sex ed. It is started in the first year of abortions, had practically no effect on primary school, according to the regula- the increase in the incidence of interven- University of Debrecen, tions of the so-called “skeleton curricu- tions). Hungary, at the Conference lum”,to eventually become “real” sex The government decided to interfere education in the direct meaning of the in the second half of the 1960s and tried on Sex Education as the word, i.e. considering the intellectual to stop and reverse the unfavourable ten- level and interest as well as the specific dency by introducing socio-political Implementation of the Sexual features of the different age groups when measures such as extended maternity and Reproductive Rights of choosing the topics each year. leave and financial allowances. Contrary However, if one asks the question, to expectations, those measures were Youth, held in Warsaw, Poland ”How does the school prepare children ineffective. Having recognised the need for family life?”,the frank and straight- for such intervention, the Parliament on 12 December 2002. forward answer is “it doesn’t at all”.This worked out a law describing the objec- is not my interpretation nor my judge- tives of the new population policy, which ment. The citation comes from a text- was introduced in 1973. Some of its most book written by a recognised secondary important decrees were prescribing school teacher, who wrote a methodolog- stricter conditions for induced abortions; ical guide for colleagues to help them broadening contraceptive accessibility with teaching the subject. Before going (introduction of intrauterine contracep- into detail about it, we should go back tive devices (IUD), commercialisation of 40-50 years into the past to understand new contraceptive pills, etc.), the found- the background of the problem. ing of the family planning network, the At the end of the 1940s, or rather the introduction of the premarital coun- beginning of the 1950s, the “baby boom” selling and the launch of “education for was the main demographic feature in family life” in schools. post-war Hungary. One can compare that Although the latter programme era to the 1970s–1980s in Romania, dur- became mandatory in Hungarian schools ing the period of Ceausescu. Although in 1975, there had been voluntary initia- 19 the openly pro-natalist policy applied tives before. Obstetricians-gynaecologists, Draconian severity in prohibiting “infected” with the in-ten-tion to induced abortions, there were no modern improve, offered help to schools and, if contraceptives available. The legalisation those schools were receptive, lectured of abortion took place in a few stages about the once taboo topics in the frame between 1954 and 1956 resulting in the of a weekly assembly called “class mat- “abortion boom”,which reached record ters”.Of course, they met with consider- figures in the early 1960s and was accom- able resistance at the beginning, since panied by never-seen before low birth many of the parents and teachers, rates. Induced abortion had become a brought up in a completely different spir-

No. 56 - 2003 it, did not welcome the idea of educating principles of training for the different age In the mid-1990s, a book of studies (1) youth in “indecent” lifestyles. Such atti- groups valid for the whole of the country. was published about the health and tudes have gradually changed but still A governing principle to be observed health related behaviour of Hungarian have considerable influence and should everywhere would be sufficient since adolescents. In addition to many interest- not be neglected. plenty of material is at our disposal to fill ing issues, the authors presented a After 1975, the introduction and main- the “frames”.Lack of uniformity should detailed description of the adolescents’ tenance of the programme in schools be given special emphasis here, because sexual knowledge, sexual behaviour and remained a problem. Regular training there are, after a long period, church and their habits injurious to health. The book required properly trained staff, which was private schools in Hungary again, and says, “It can be concluded from the data, lacking. As a result, for many years edu- one cannot expect them to be engaged in that the role of families and educational cation was occasionally and arbitrarily explaining about, for example, the differ- institutions in providing knowledge supplied by volunteering “outsiders”.In ent methods of contraception putting the about sexuality is equally unsatisfactory.” almost all schools there were some chil- same stress on every issue. This is the A similar study by the World Health dren whose parents worked as physicians. case with the available training material. Organization (WHO) shows the health The director of the school or the head Some of the books have been a pioneer- and health behaviour of pupils from sev- teacher asked these fathers or mothers to ing work to break down sexual taboos. eral countries, based on a survey con- help the school with presenting some However, they immediately turn out to ducted in 1997/98. Hungarian data are classes in sex education. In general, be “conservative” when they start dis- also included and the document is also although these doctors were not gynae- cussing on contraceptives. available in Hungarian. In addition to cologists, they were more familiar with That is why the initiative by the discussing matters of smoking, alcohol the topic than the teachers were, but, due National Institute for Health Promotion consumption, sports and leisure activi- to lack of experience in school presenta- in 1997 was aimed at the introduction of ties, the publication also contains useful tion, they were sometimes inefficient in an independent school subject entitled information about sexual behaviour. fulfilling such requests. “Preparation for family life”.The Young people “smell powder for the first Such a programme can only be real- Ministry of Education, based on the time” at a very early age: 31.5% of the ized if schools can employ teachers spe- “expert” opinion of the National Institute Hungarian secondary school boys and cially trained in these questions. for Public Education, refused it and 27.9% of the girls have their first sexual Unfortunately, this has not been the case approved only its facultative trial in the experience before they are 15. until now. Teacher training institutions frame of a project. International comparisons also show that (colleges, universities) have failed to That is the situation today, after 30 the 15-year-old Hungarians are at the top launch the training of these specialists. years, and it is being repeated that of the list of starting sexual activity at an Over the past 30 years all the govern- schools “have not prepared to meet this early age. In addition to this questionable ments (before and after the political task yet”.When will they be ready then? reputation, they are the ones (indepen- changes in 1989) kept promising to solve In one of the excellent books mentioned dently of gender), however, whose use of the problem, but there have been no suc- earlier, a whole chapter – entitled “We contraceptives is the lowest. cesses to date. The present situation is need a subject!” (i.e. a subject dealing Our own survey also supports these clearly analyzed in a document published with education for family life) – was data and justifies the ineffectiveness of by the Center for Reproductive Law and devoted to the problem. But it appears education. Recently, 500 women, seeking Policy (New York, 2000) which states, that the only ones to see it (e.g. teachers, abortion at our department, were asked “There is neither a general overall policy, doctors, parents) are those who experi- about some important features of their nor a unified practice, regarding sex edu- ence its lack and the resulting problems sexual lives. Among the 27 questions, the cation for adolescents in Hungary”. in every day life and practice. According most important ones with relevance to The National Basic Educational to the logic of NBEP, the issue of includ- this issue are as follows: Program (NBEP) puts the end of the ing education for family life in the school • When did you have your first sexual programme in education for family life curriculum is not suitable for introduc- intercourse? in the tenth form (16 years of age). As tion as an individual subject. There is, • How old were you when you were first mentioned above, this topic includes after all, some education – in one way or informed about sexual matters? 20 many issues such as personal hygiene, another – because NBEP prescribes a • Who were you informed by? learning about the human body and risk minimum requirement in teaching about • What contraceptive methods do you factors (e.g. smoking, drinking alcohol, “hygiene”.It includes education for fami- know? AIDS, sexual abuse, drugs), but real sex ly life, which should also cover sex educa- • What methods of contraception have education is just part of this training. tion. According to a ministerial decree, you used so far? Several NGOs take their share of the job school doctors and nurses are to do this • What method did you use when the and there are plenty of individual volun- job wherever the programme includes present pregnancy conceived? teers as well. Only the unified policy and information about family planning and • Why do you think you became preg- direction are missing. Excellent textbooks contraception. The efficiency of teaching nant although you used a contracep- (see illustration) have been published but about this “hygiene” is clearly reflected by tive? there is no curriculum to lay down the the facts. The results are as follows: Twenty per million people are found in the age References cent of those questioned were younger group 5-19. Basically, these data should 1. Aszmann A. (ed). Health and health- than 20. By 14 years of age, 76.6% had be considered when the statistics about related behaviour of adolescents. been given some sort of sexual education. the required staff for the proper educa- Budapest, Uj-aranyhid Kft., 1995 [in In only 42.2% the source was a member tion of these schoolchildren is calculated. Hungarian]) of the family, basically the mother The mean size and the approved annual (37.8%). The “share” of the others is number of classes are also important fac- Full references are available from the detailed in the Table tors. But to achieve anything at all, “edu- author upon request. cation for family life” should become an officially recognized, independent subject Source of the first sexual infor- in the school curriculum at last. István Batár, MD mation among Hungarian In summary it can be said that nearly [[email protected]] abortion seekers (a survey of 30 years after “education for family life” Associate Professor, Head of Family 500 cases) was made compulsory in schools, ade- Planning Center quate conditions for its success are still University of Debrecen, Hungary Source (%) absent. Would-be teachers are not given Mother 37,8 proper instruction by training institu- Father 0,4 tions and the government’s educational Sibling 3,4 policies still neglect the conditions for Relatives 0,8 introducing a unified and individual sub- Girlfriend 15,4 ject into the curriculum. Individual per- School 32,8 sonal initiatives are seen and various Physician 0,8 non-governmental organizations also try Book/TV/etc. 8,6 to implement improvements. But disso- nance needs to be turned into nationwide harmony – something that might yield measurable results in only a few years. We strongly hope that we will not have to As for the first sexual contact, 68.4% wait another 30 years to achieve this. claimed to have had it before 17 years of age. The majority (over 70%) knew of contraceptives (knowledge about the condom, the pill and the IUD exceeded 99% each) and many of them were familiar with more than just one. They not only knew these methods but had used them earlier. Despite all of the above, 30% did not use anything when the current pregnancy conceived. Also, the cumulative proportion of those who had never used contraceptives and of those who applied contracep-tive methods of lower efficacy (such as the withdrawal and/or calendar method) was 64%. Among those who used some sort of contraception when the present pregnancy conceived, 48% claimed that they had not used the method according to the 21 instructions. These are telltale figures, also demonstrating the ineffectiveness of the current educational-informational system. Hungary’s demographic situation is best characterised by negative growth. A decrease in the population affects first and foremost the young generation. There are just over 1.2 million young people aged 10-19 and just fewer than 1.9

No. 56 - 2003 THE ROLE OF MEDICAL STUDENTS IN THE PREVENTION OF HIV/AIDS Henrietta Bencevic

n many countries around the world, of time allocated to it in medical school HIV/AIDS prevention and be ready to medical students have felt the need to curricula. It is well known that the pre- timely recognize and help fight back any Iorganize themselves and provide vention of disease is key to ensuring the future epidemics (5). additional training in public health issues sustainable development of communities. to their fellow students and universities. As a matter of preparedness for future The International Federation of Medical physicians to educate populations or to Henrietta Bencevic MD Student’s Associations (IFMSA) has pass on the message of healthy living, [[email protected]] members from nearly 100 countries some skills in this area have to be IFMSA liaison officer for WHO and around the world and, as an organization acquired, for example communication a General Secretariat permanent run by medical students, it helps its skills, health project methodology and officer members to establish trainings and other the ability to see health problems from all 2001/2002 programmes for both medical and other angles: human rights, occupational medi- Public Health Institute, Primorsko students (1). Since 1992, IFMSA has been cine, psychological, etc. Goranska County participating in the fight against Experiences within IFMSA and among Kresimirova 52a HIV/AIDS. And in 2001 it issued a set of its members have shown numerous HR-51 000 Rijeka, Croatia recommendations on HIV/AIDS in med- advantages of peer education led by med- Tel: (+385) 98-9193350 ical education curricula. Moreover, the ical students. The motivation is manifold, first peer education programmes on both professional and generational. HIV/AIDS in some communities were Medical students are often young people References organized through IFMSA members (2). just out of high school. The fact that they 1. International Federation of Medical There are many modes of HIV trans- are medical students means that they are Student’s Associations. SCORA. mission and the disease is often associat- developing themselves to become physi- Introduction, our mission and vision. ed with gender inequality, poverty, a lack cians and does not mean that they www.ifmsa.org/scora/, accessed 7 May of education and substance abuse. The already know how to behave like one. 2003). dominating patterns of transmission dif- This is the task ahead of them. 2. AIDS epidemic update, December fer around the world and in eastern However, they do have an advantage 2001. UNAIDS/01.74E- Europe it is mostly through injecting when compared to physicians, they are WHO/CDS/CSR/NCS/2001.2. Geneva, drug use, while, for example, in Africa it great peers for high school students and Joint United Nations Programme on is mostly sexually transmitted (3). But other university students. They are also HIV/AIDS. wherever HIV and AIDS appears, med- young and a population with a great deal 3. AIDS epidemic update, December ical doctors have a specific role to play in of risk of acquiring sexually transmitted 2002. UNAIDS/02.58E. Geneva, Joint their communities, where they are often diseases including HIV (4). United Nations Programme on role models or health educators, as well One of the main problems that med- HIV/AIDS. as in their working settings, where they ical students face when establishing peer 4. Peer education, concepts, uses and have a leadership position. education project is a lack of qualified challenges. UNAIDS. UNAIDS/99.46E. At medical schools, students, the educators and tools for evaluation of (www.unaids.org/publications/docu- future professionals, gain knowledge and their projects. The enthusiasm is there, ments/care/general/peer.pdf, accessed 7 skills to prepare them for their future but not always the background of proper May 2003). tasks. The occurrence of HIV/AIDS has training and adequate experience. While 5. International Federation of Medical forced us at IFSMA to face some of the it is easy to memorize facts, acquiring Student’s Associations. Introduction to problems of medical education, which communication skills or being able to IFMSA. www.ifmsa.org/about/intro- often focuses too much on the diagnos- handle problems caused by religious duction.html, accessed 7 May 2003. tics and treatment of diseases, at the influence or the denial of reproductive expensive of prevention, which in turn health needs of teenagers by their parents colours the way medical students and teachers requires suitable training. approach health problems. Investing in the education of medical Becoming a physician is a long and students to become well-trained peer 22 expensive process. Taking in mind that educators is vital in this respect. knowledge in medicine is constantly Medical students are an enormous increasing, it is a hard task for decision- human resource and by educating their makers to update medicals school pro- peers, they are important agents of grammes. Implementing the latest dis- change in the prevention of HIV/AIDS. coveries in modern medicine is not real- They make information about HIV/AIDS istic in many settings around the world - accessible and help curb the epidemic and where doctors practise with stetho- and fight stigma and discrimination. scopes as their only tools, it is impossible. Empowered with their skills, knowledge Teaching public health is often already and awareness in public health they can marginalized with only a limited amount be a bridge for a gap of needs in NEW HEALTH COMMUNICATORS AT SCHOOL: MEDICAL STUDENTS Inon I Schenker

“I always enter the classroom Jerusalem branch of the FHEP started to dressed in jeans and a T-shirt. incorporate education When one of the 12-year-old for HIV/AIDS prevention among the topics girls said after a month or so: taught (Schenker, 1988). Since then, ‘to me you’ll always be a training materials, young doctor in a white coat’ I skill-building workshops and training-of- knew the programme would trainer modules for medical students teach- achieved its goals”. ing HIV/AIDS prevention in Israeli schools were developed. Rami (age 24) is one of 42 medical stu- between students and the educators. The Israeli national curricula for pri- dents volunteering in Jerusalem schools They are trying to utilize methods such mary and then secondary schools on as a peer health educator. Every week as role-playing, videos and games that HIV/AIDS prevention and anti-discrimi- they visit primary and secondary school make the learning more meaningful to nation emerged in 1986 out of this initia- classes providing students aged 10-16 the pupils. tive, which was at that time strongly criti- with health education sessions, covering "As a peer educator, you learn to be a cized. Ministry of Education officials, a wide range of topics: infectious dis- better listener, a caring helper, communi- teachers and schoolmasters did not like eases, oral health, non-communicable cate better, and gain confidence in con- the idea of non-certified individuals diseases, sex education and HIV preven- fronting people. You feel good about teaching “sensitive” issues at schools. tion, physical health and nutrition, smok- yourself and your efforts to improve the They also rejected the idea that young, ing and substance use prevention, and lives of those around you”.This message, non-experienced students could ever even mental health. For the pupils they emphasized by the Schiffert Health bring any change in kids’ knowledge, atti- teach they are “a doctor in a white coat” – Center Office of Health Education in tudes or behaviours relating to authoritative, reliable and trustworthy, Virginia, USA, is a leading concept in the HIV/AIDS prevention and anti-discrimi- and at the same time “a bit older peer”. development and preparation of wellness nation. Many considered HIV at that Under the “Perach” (Flower) pro- peer educators: students who positively time to be a non-issue for the general gramme, supported by the Israeli influence other students. school system, being a disease that “only Ministry of Education and the four med- The mission is to provide an effective strikes at gays, prostitutes and drug ical faculties in Israel, several dozens of peer network to encourage, support, and users”.Others argued against a “bio-med- students, mostly in their second or third promote healthful living for all students ical” approach if medical students were pre-clinical year, participate in one of the under the notion that students can play a to teach HIV/AIDS prevention. advanced national health promotion pro- uniquely effective role in encouraging A strong, stubborn, articulated and jects. their peers to consider, talk honestly creative advocacy, over a period of several "When I see those who have been about, seek professional advice, and months, mobilizing decision-makers, taught to spread knowledge about AIDS develop responsible habits and attitudes influential personalities in medicine, edu- among their classmates and friends, I toward the use or non-use of alcohol, cation, public health and parliamentari- have a feeling of success". Ying Zi is a safer sexual behaviours or abstinence, ans led to an official acceptance of the third year medical student in Shanghai healthy eating choices and other related notion that medical students may well be Medical University, and an active partici- health issues. influential peers for primary and sec- pant in an Australian-Chinese Developed in Beer Sheva, Israel, and ondary school children, even – and per- AIDS/STI/Safer-Sex Peer Education launched in the early 1980s, the “Perach”, haps more so – in areas of great sensitivi- Programme for Youth. "At the beginning Flower Health Education Programme ty (e.g. sex education, HIV/AIDS preven- I felt a bit hesitant to talk publicly about (FHEP), is considered among the first tion and substance abuse). The formal 23 HIV/AIDS", she told a local newspaper, national peer educators’ projects in the legislation of the Ministry of Education "but later I was encouraged by the fact world which facilitates the provision of accepted in 1988 the curricula they all liked my teaching". Eighty senior school-based health education by med- “Explaining AIDS to Children” (Schenker medical students have been trained since ical students. While the Perach and Yechzkiyaho, 1987) for national use, 1998 to provide education for HIV/AIDS Programme had begun as a general and stated, among the qualified to intro- prevention at local high schools. health promotion project, covering a duce it into schools, “medical students”. Unlike traditional methods of con- wide range of topics, a strong push for its This became a European landmark in the ducting sex education programmes wide implementation was in the early formal acceptance of medical students as through lectures and leaflets, their days of the HIV/AIDS epidemic. health educators in schools. approach involved more interaction In 1986 the Hebrew University of Parallel to the Israeli initiative, similar

No. 56 - 2003 transfer that knowledge Development Goals documents to others - thus creat- (UNAIDS, 2001). ing a global network of How effective are these initiatives? peer educators on How sustainable are they? How much of HIV/AIDS prevention. a support do they gain from the interna- The Summer School tional and national bodies? was one of the out- Research on the pilot project in Israel comes of IFMSA’s (Schenker & Greenblatt, 1993) concluded General Assembly deci- that the pilot programme has succeeded sions in 1991 in in correcting misleading information, Londrina, Brazil, to adding relevant information and rein- create a new Standing forcing exact knowledge on HIV/AIDS Committee devoted to among junior high school students in HIV/AIDS and STIs: Jerusalem. Further studies (Sunwood et SCOAS – Standing al, 1995, Schenker et al, 1996, 2001) have initiatives (Cohen & Cohen, 1991) in the Committee on AIDS and STDs. SCOAS shown that not only do adolescents United States tried to engage medical stu- was created as the result of medical stu- appreciate, respect and enjoy the new dents as peer HIV/AIDS educators. dents' increasing awareness of the grow- health educators in class, they actually At the University of Missouri, a pro- ing problem of HIV infection and AIDS listen to the medical students’ advices gramme called Students Teaching AIDS and their will to do something about it. and cooperate with the behaviour change to Students (STATS) was proposed The person behind that decision was Ms processes in class. (Haven, 1989). The goal of this project Victoria Dai, then an active medical stu- While very few evaluation studies have was to help train medical students to dent who was with the first groups of been published on medical students as become AIDS educators in the schools, medical students who participated in the peer health educators, and most have churches and youth organizations of Israeli FHEP programme. concentrated around HIV/AIDS and sex- their local communities. The project “We realized from the beginning that uality education, the overall results are involved preparation and distribution of the only way of fighting AIDS is through positive and promising. They stress the a package of materials, which were used prevention and that the best way of pre- message that medical students can do not by medical students to initiate a STATS vention with adolescents is through edu- less – and often better – of a job in edu- program. The curriculum material was cation". Dr Dai is now a practising physi- cating school children on health (and tailored for presentation to students over cian in Israel. particularly sensitive issues like: two school-class periods on separate days In the course of recent years, SCOAS HIV/AIDS, STIs, sexuality) than school and contained age-appropriate informa- added reproductive health and became teachers. Moreover, the literature sup- tion. Another component of the package SCORA (Standing Committee on ports the idea of outsider involvement in was a slide show tailored to explain Reproductive Health and HIV/AIDS). It school sex education. STATS to community stakeholders and a is working within IFMSA as one of its six Dick (1994) describes benefits both to video tape to help answer questions standing committees. It has a Standing pupils and peer educators in a peer-led posed by students. Committee director and in every country school education programme. Wight and In Norfolk, in the spring of 1987, 20 there should be a national coordinator. Scott (1994) had noted that pupils medical students from the Eastern IFMSA took this initiative even fur- express a desire for more relaxed teach- Virginia Medical School of the Medical ther. In a clear statement to the World ers, since teacher anxiety exacerbates College of Hampton Roads were involved Health Organization 109th Executive pupil embarrassment and that outsiders in a pilot program to teach about AIDS Board, Dr Henrietta Bencevic of Croatia, frequently show more expertise, are usu- to high school senior students (Johnson then the IFMSA Liaison Officer with ally easier to talk to and can deal with et al, 1988). The medical students WHO stated: “WHO and IFSMA have problems that teachers often find difficult received instruction about AIDS from decided to work together on scaling up (Forrest J et al, 1994). basic science and clinical faculty mem- education, empowerment and training Medical students at Monash university, 24 bers at the medical school in preparation on HIV/AIDS for medical students, being Melbourne, Australia, providing sex edu- for the project. the next generation of medical profes- cation as quasi-peers in local schools In Europe, the International sionals.” (WHO, 2002). were studied. This programme has sug- Federation of Medical Student’s IFMSA presidents echoed this notion gested that medical students are particu- Associations (IFMSA) led a series of in what became an important World larly suitable because they are closer in “STOP AIDS Summer Schools”.From AIDS Day set of statements over the age to the target audience, are not embar- 1995 to date this annual event (IFMSA, recent years emphasizing the role medical rassed and are generally more open than 2003) is aimed at equipping students of students could have in the global, region- established providers of sex education medicine and other health sciences with al and national campaigns aiming at (Grinzi & Gelperowicz, 1996). So far this theoretical knowledge about HIV infec- reducing HIV infections among youth by scheme has achieved favourable results tion and AIDS and practical skills to 25%, as noted in the Millennium (Wight, 1996). Johnson et al (1988) reported that physicians who are more attune to com- Schenker I. (1989). A Struggle for Life: responses to 10 subjective post-test ques- munity needs and approaches. People, Politics, and the AIDS Epidemic. tions assessing the program indicated Participants in health promoting schools IDF Publishing House, 212 pages (in that the high school students were inter- and healthy cities networks could be in Hebrew). ested in learning about AIDS and having the forefront of supporting and strength- Schenker I. and Greenblatt C. (1993) medical students as their teachers. They ening such programmes. Israeli Youth and AIDS: Knowledge and also concluded that the programme pro- Attitude Changes Among High-school vides an example of how medical institu- References Students Following an AIDS Education tions can develop a collaborative com- Program. Israel Journal of Medical munity education project that con- Cohen MA., Cohen SC. (1991). AIDS Science. 29:10, pp. 41-47. tributes to the education of medical stu- education and a volunteer training pro- dents. gram for medical students. Schenker I. and Sabar-Friedman G., Sy Jobanputra et al (2002) looked at med- Psychosomatics. Spring;32(2):187-90 F. (1996). AIDS Education: Interventions ical students’ lack of teaching experience, in Multi-cultural Societies. Plenum, N.Y. Dick S. (1994). The Peer Education including specific skills such as group Project on Sexual Health at Trinity Schenker I. (2001) New Challenges for work and awareness of key issues (sexual Academy 1990-1993: an evaluative study. school AIDS education within an evolv- abuse) and concluded that these did not Brooke Advisory Centre. ing HIV pandemic. Prospects Vol. XXX: lead to problems in the pilot study they 3, pp 415-434. conducted in Edinburgh. They also Forrest J. et al. (1994).Personal relation- report that the response received from ships and Developing Sexuality. Sunwood J., Brenman A., Escobedo J. et schools was better than had been antici- University of Strathclyde. al. (1995). School-based AIDS education pated. for adolescents. J Adolesc Health. Grinzi P.and Gelperowicz P.(1996). April;16(4):309-15 Several key factors are associated with “Safe Sex in Schools”: Medical students UNAIDS (2001). UNGASS Declaration the success of medical students as as peer educators. Sexual Awakening: of Commitments. www.unaids.org effective health teachers at school: making sex education work. MRC. • An organized group of students, lead Haven GG., Stolz JW. (1989). Students WHO (2002). Proceedings of 109th EB. by a senior medical or public health teaching AIDS to students: addressing www.who.int professional; AIDS in the adolescent population. Wight D. and Scott S. (1994). Mandates • A well defined curriculum, which is Public Health Rep. Jan-Feb;104(1):75-9. and Constraints on Sex Education in the age and gender specific, respecting cul- IFMSA (2003). SCORA Program and East of Scotland (preliminary study for a tural norms and needs of adolescents; activities. www.ifmsa.org sex education initiative). MRC. • Structured, pre-activity intensive train- Wight D. (1996). From theory to prac- ing, which also takes into account Jobanputra J., Clack AM. et al (2002). tice: developing a theoretically based teaching and facilitation skills, not only Adolescent Sex Education: Medical teacher-delivered sex education pro- content; Students As Peer Educators In Edinburgh gramme. Sexual awakening: making sex • Good rapport with the educational Schools A Feasibility Study education work. MRC. authorities and schools; www.medsin.org/~sex/groups/con- • Materialistic incentives (e.g. scholar- densed_feasibility_study.pdf ship, course credits) for participating Johnson JA., Sellew JF., et al. (1989). A Inon I. Schenker, PhD, MPH students; program using medical students to teach [[email protected]] • Strict selection (by pre established cri- high school students about AIDS. J Med Department of Sociology and teria) of participating students; Educ. Jul;63(7):522-30. Anthropology • Ongoing monitoring and process as Hebrew University of Jerusalem, well as outcome evaluation; Schenker I. and Yechezkiahu N. (1987) Israel. • Student-centred approaches when "Explaining AIDS to Children: Senior HIV/AIDS Prevention working in schools; Multimedia Health Education Program Specialist • Team-oriented approaches when work- for Primary Schools." Jerusalem, 25 ing and training participating students; Academon.(Hebrew note: Was culturally • Advocacy and communication strategy modified and translated into: Spanish, as an integral part of the project; German, Portuguese, French,Arabic and • A good project coordinator. Russian). Schenker I. (1988) The Immune System As more schools open their doors to Approach in Teaching AIDS to carefully selected, properly trained and Youngsters: Two Unique Programs for enthusiastically performing medical stu- Schools. In: Fleming A., Mann J., et al dents – we may see an increase in effec- (eds.), The Global Impact of AIDS. A. tive school-based health education and Liss, New York. Pp. 341-346.

No. 56 - 2003 RESOURCES

Hands on! A Manual for Working Resources on peer education with Youth on Sexual and from IPPF Reproductive Health (from Dev. Gateway) In the light of the global HIV/AIDS pandemic and its disproportionate effect on http://www.gtz.de/srh/download/H young people, the International Planned ands%20On%20Publikation.pdf Parenthood Federation European This manual lays out useful methods and Network (IPPF EN) has worked effective- approaches to support people working ly to include youth in its programme with young people in the development planning and implementation and not and implementation of sexual and repro- just as the target of activities. A youth ductive health measures in a practical stakeholder group was set up in different “Peer led sexuality” way. It consists of 16 separate yet comple- countries to design their own strategy on In recent years the situation of HIV- mentary papers written largely by practi- sexual and reproductive health and infected individuals has deteriorated tioners from the field with a focus on rights, which has a special focus on throughout Kazakhstan most likely due giving examples and checklists. Available HIV/AIDS. Below, a few of IPPF EN’s to the increase in drug-trafficking from in English only. (GTZ, April 2002) most recent publications on the subject Afghanistan and the emergence of new are reported. problems such as the trafficking of http://www1.worldbank.org/hiv_aid women. The number of drug addicts s/publications.asp now accounts for more than 300 000 per- This World Bank publication argues that sons throughout Kazakhstan, many of the education of children and youth whom use infected needles. It is very like- deserves the highest priority in a world ly that this core transmitter group may afflicted by the HIV/AIDS epidemic. spread HIV to the general population Education has proven to be one of the through heterosexual contact via so- most effective means of HIV prevention. called “bridge groups”. Countries need to strengthen their edu- Peer-Led Sexuality Education: Learning cation systems immediately in order to from Equals is a regional initiative of the offer hope for escaping from the grip of IPPF European Network field office for HIV/AIDS. Central Asia, funded by UNFPA. The The global HIV/AIDS epidemic has booklet reports on new initiatives in the already killed 20 million people and sub-region, many of which are based on another 40 million people are currently the results of a knowledge, attitudes, infected. The magnitude of this epidemic practices and behaviour survey from requires a response that confronts the 2001. This survey revealed that while it is disease from every sector, but education clear that most young people discuss top- plays a particularly important role. ics relating to sexuality and sexual rela- Education and HIV/AIDS provides a Lessons learnt: The peer educa- tions mostly with their peers, the infor- strategic direction for the World Bank in tion approach in promoting mation exchange is rarely accurate. responding to the impact of HIV/AIDS youth sexual and reproductive However, the report does make clear that on education systems. The central mes- health (2001) although work on the “ground” is impor- sage of this book is that the education of This study focuses on the different peer tant, so is advocacy to influence policy- children and youth deserves the highest education approaches and experiences of makers, religious leaders and the media, priority in a world afflicted by the youth groups based in the five central in order to improve the sexual and repro- HIV/AIDS epidemic. Education has Asian republics. The publication is ductive health and rights of young peo- proven to be one of the most effective designed to be used as a guideline by ple. Given that the relevant skills are pro- means of HIV prevention. This book youth programme managers in family vided, young people often make their 26 finds that countries need to immediately planning associations and other people own best advocates. strengthen their education systems in who what to plan and carry out peer order to offer hope for escaping from the education projects. The best practices grip of HIV/AIDS. and key lessons learnt can be used to start a new project or to integrate peer education into an existing youth project. Although the focus of the document is on non-European countries, it offers a variety of practical ideas and guidelines which may be useful to the European Region. INTERNET RESOURCES RESOURCES

Prepared by Aleksandar Bodiroza and Srdjan Stakic

Y-PEER: The Youth Peer mentation of this Joint Workplan for resource peer education-related infor- Education Electronic Resource – Development of Peer Education. In dis- mation); and Networking in peer education cussions on joint action, UNICEF, • Y-PEER Distance Learning (CD-ROM WHO/Europe and UNFPA have been the on peer education and other distance Peer educators in eastern Europe and agencies expressing a commitment to learning efforts, such as video confer- central Asia can now ask each other ques- lead the process in the immediate future. encing). tions, share experiences and get updates This programme on peer education is on available resources through Y-PEER. closely coordinated with the IAG Joint Y-PEER currently links 370 members, In eastern Europe and central Asia, Workplan to support and develop Life from 27 countries, who are active peer HIV incidence is rising faster than any- Skills-Based education initiatives and the educators who can contribute to, or ben- where else in the world. There were an IAG Joint Workplan on Youth Friendly efit from the availability of resource estimated 250,000 new infections in Services. materials and training programmes. The 2001, and there are now an estimated 1.2 development of Y-PEER will be an on- million people living with HIV. Most of In past two years the project has going, continuous process with constant the infections continue to occur among achieved the following: updates to reflect the expressed needs of injecting drug users (IDUs), and most Assessment: A total of 158 initiatives in peer educators and others involved in the IDUs are young people under the age of 27 countries have been identified, which peer education process in the region. 24. In parts of the region, as many as half is confirmation of the increasing use of The Phase II of the development of Y- of the newly reported cases are in people this strategy and the potential of good PEER includes its translation into younger than 20. The growing awareness practice to build upon. Russian, including the technical informa- of the vulnerability of young people to tion; implementation of a search engine, HIV, STIs and injecting drug use has Training: UNFPA has organized five sub- and other technically advanced improve- brought issues related to young people’s regional and two advanced peer educa- ments to the site, such as a searchable health, development and protection tion-training workshops; trained 165 database of experienced trainers of train- (YPHD&P) higher on the political agen- trainees and 31,000 young people have ers from the region. da. Increasingly, young people are being been reached in roll-out national training The connection of the Y-PEER website considered as not only a vulnerable activities. The training curriculum and Y-PEER distance learning projects is group, but also a resource for changing applied at the workshops has ensured an not only technological. The Y-PEER dis- the course of the epidemic: they are both integration of gender perspective into tance learning project was established in responsive to HIV prevention pro- HIV/AIDS prevention and supported a order to provide the most up-to-date, grammes, and are effective promoters of skills-building approach to work with language-, culture-, and gender-sensitive HIV preventive action. youth. technical and subject materials to those Throughout the world, the past who need it most: peer educators, train- decade’s experiences have presented National Capacity Building: Four ers of peer educators and trainers of youth peer education as a successful national peer education networks for trainers in eastern Europe and central approach to developing young people’s Ukraine, Bulgaria, Bosnia and Asia. The modalities of Y-PEER distance capacities, promoting their active partici- Herzegovina and Serbia and Montenegro learning will be through a CD-ROM pation in the process, and facilitating were created. (which is currently under development), health education, especially in the area of print materials (a peer education manual HIV/AIDS. There is, indeed, a global Guidelines: A manual for peer education for trainers of trainers is in print), and body of empirical evidence that peer gender sensitive training has been devel- via the website, for those with technolog- education can be extremely effective in oped. ical ability to access large Internet files. promoting behaviour change when solid The multiple cutting-edge format of training and supervision are implement- Networking – IT – Information Sharing: information dissemination will only sup- ed. Research suggests that peer education With an intention of producing an alter- plement and support the current on- activities are particularly successful when native and effective mode of information going in-person trainings. they are integrated in other supportive dissemination and internationally avail- prevention strategies. Moreover, there is a able resource utilization for peer educa- Aleksandar Bodiroza 27 growing recognition that peer education tion initiatives in eastern Europe and [[email protected]] is a strategic vehicle for motivating and central Asia, UNFPA has developed a dis- Adolescent Reproductive Health directly involving young people in their tance learning initiative, entitled Y-PEER and STIs/HIV/AIDS specialist own health and development. or the Youth Peer Education Electronic United Nations Population Fund In attempts to foster the development Resource (www.youthpeer.org). Y-PEER (UNFPA) of peer education, the Inter-Agency consists of three main aspects: Group on Young Peoples’ Health • Y-PEER Networking (electronic Srdjan Stakic Development and Protection (IAG) Sub- exchange of information through list- [[email protected]] Committee on Peer Education was servs); United Nations Population Fund formed to develop and guide the imple- • Y-PEER Website (Internet based (UNFPA) Consultant

No. 56 - 2003 The European Magazine for Sexual and Reproductive Health

WHO Regional Office for Europe

Reproductive Health and Research Programme

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