Aids community

Asheema Singh, National Institute of Open Schooling (NIOS), Noida

The National Institute of Open Schooling (NIOS) is an autonomous institution under the Ministry of Human Resources Development (MHRD) of Government of India. NIOS provides educational opportunities to out-of-school adolescents and other adults through the distance education mode.

NIOS is engaged in addressing issues and concerns of adolescents through Adolescence Educational Programme (AEP). NIOS has opted for an innovative approach of curricular interventions. Life skills enriched materials have been developed and the issues and concerns of adolescents have been integrated within the subject specific content area. Opportunities for skill development have been built-in through activities and test items. Currently it is initiated as a pilot intervention in five subjects - Hindi, English, Science, Social Science and Home Science, at secondary level. Three lessons are chosen in each of these five subjects. Life skills were woven into all the 15 model lessons without compromising the subject content. For example, please have a look at http://www.nios.ac.in/321lesson.htm, where you can find the English and Hindi versions of the online course material for Home Science.

NIOS undertakes this activity with a view to fulfil the larger aim of education of enabling a human being to attain the greatest possible harmony - internal and external, spiritual and material - for the fullest possible development of human potentials and capacities, instead of a rather narrow aim of preparing individuals for livelihood. In this process, advocacy was done with curriculum committees, subject coordinators and lesson writers to emphasise that integration of life skills will not be diluting the curriculum of these subjects, but will only be enriching it. Thus, in spite of the initial apprehensions and resistance, development of sample integrated lessons, and advocacy efforts helped in bringing the different stakeholders on board.

Encouraged by the positive response from the pilot intervention, life-skills integrated curriculum shall be launched in the 2011-12 academic year. Hopefully this would reach out to and help the large number of out-of-school young people who are pursuing education through open schooling.

Apart from the sample lessons mentioned above, you can download some useful resources at http://www.nos.org/aep/download.htm. In addition, at the YouTube Channel - http://www.youtube.com/user/niosaep#g/a, you can view some videos related to Life Skills Education (LSE).

Venkatesh Prasad, Independent Consultant, Mysore

I work as a consultant for grass roots organisations. Thanks to Aarathi for raising one of the most critical and challenging issues in the development scenario. Adolescents are the most important and vulnerable sections in the community. We have a history of preventing activities related to Sexual and Reproductive Health (SRH), citing cultural factors. Hence, taking about it in the general settings could be thwarted in many ways. Our efforts will become useless if we try to or undertake Life Skills Education (LSE) or SRH related activities without considering the sensitivities involved.

Considering your interest to involve parents in this programme, you can consider forming a village-level parents committee as a health intervention. Moreover, existing Self Help Groups (SHGs) might be a good avenue for collaboration. Without involving parents or the community, it is going to be difficult to talk about SRH. Getting the community’s or whole village's consent and support is essential. Having one session with the whole village and explaining to them about the intervention might ensure their understanding of the programme, and thereby bring in their support.

Haridas Shenoy, Independent Consultant, Mumbai

Devashree has talked of involving Parents Teachers Association (PTA) in Life Skills Education (LSE). I had been conducting training programmes on Life Skills, based on my experiences from Corporate Management and Management Education, making it applicable to managing life on a day-to-day basis in all its aspects. I wanted to take the help of PTAs in taking forward this effort. I have known a school teacher and a principal, whom I tried to seek help from. I talked to them about it in detail but with no positive response. I also talked to a parent to take up this subject with the school principal. Nothing came of it too.
I am convinced that involving PTA is one of the important and potential steps in this regard. I am not denying it. However, how does one convince the parents and teachers?

Ragini Pasricha, Vistaar Project, New Delhi

I work with Vistaar, a Maternal Newborn Child Health and Nutrition (MNCHN) project, funded by the United States Agency for International Development (USAID). Vistaar provides technical assistance to the Governments of Uttar Pradesh and Jharkhand. It is working in five districts of Jharkhand on Delaying Age at Marriage, and Adolescent Anemia, and will support the roll-out of Life Skills Education (LSE) by National Programme for Education of Girls at Elementary Level (NPEGEL), Kasturba Gandhi Balika Vidhayalaya (KGBV) Scheme, and para teachers. Data indicates that a significant majority - 75 percent - of women in the state have anaemia, and that the median age at marriage for girls is 15.8 years. The LSE curriculum includes a chapter on delaying first pregnancies and a discussion on contraceptive options.

Trainers from the Child In Need Institute (CINI), Jharkhand - Vistaar's state-based partner - expressed doubts about the teachers' comfort levels with a discussion on contraception. When the curriculum was pre-tested in Hazaribagh, teachers shared their concerns by citing experiences they had during discussions on Sexual and Reproductive Health (SRH) with school-going adolescents. They said they were discomfited with the level of curiosity and interest displayed by their students, so much so that they thought the students would be "distracted" from their studies. However, by drawing the teachers' attention to data on issues like rampant under-age marriages, risk factors for adolescents during pregnancy and childbirth, and high mortality figures, we were able to convince teachers. They realised that providing adolescents with the skills to negotiate contraceptive use with families and spouses and information on methods and services, could make the difference between life and death for their students. Thus, the strategy that has worked here is to discuss what happens, or can possibly happen, when information is denied.

Another strategy is to share data on what happens when information is provided. While working with Avahan-related projects, I dealt with similar conservative attitudes of service providers with regard to promoting condom use. The opinion repeatedly voiced by a majority of healthcare providers was that promoting condom use was tantamount to encouraging sex with multiple partners. In this case, sharing evidence from a meta-analysis that proved condom education did not lead to earlier initiation of sex, more partners, or more frequent sex, was effective in persuading providers to promote safer sex using condoms.

When you position sensitive conversations in the light of evidence, it becomes easier to counter opinions, assumptions, and fears. Subsequently, you can persuade parents and teachers to have relevant conversations on SRH issues with adolescents.

Ashutosh Kandwal, Futures Group, Dehradun

One of the approaches for school-going adolescents in which teachers may also not have much objection is the "Letter Box Approach". Such sessions can be organised any day at the convenience of school authorities with full involvement of the teachers. In this approach, students write their queries related to Adolescent or Sexual Health on paper slips and drop them in a box placed for the purpose. They do not have to write their names on the slips, and hence, anonymity is ensured. Once done, the questions are then placed before a qualified doctor, either from Government hospitals or a reputed private doctor of the region. They pick up the questions one by one and respond accordingly.

This method has the inherent advantage of inviting queries even from the most shy or introvert student. On the other hand, it may also invite wild queries, which can be tackled by a well conversant professional in a very smart manner.

Obviously, the preferred choice would be to have different sessions for the adolescent boys and girls. This in all probabilities will invite discussions, and in a way the group in concern will have the advantage of getting answers to their queries in a healthier atmosphere.

Prof. Jugal Kishore, Maulana Azad Medical College, New Delhi

In our experience, we have observed the same kind of resistance from public health professionals too, whereas there was interest from the side of school teachers. Students are also keen to learn about sexuality. Aarathi rightly said that students who dropped out from school and will never get the chance to get proper knowledge about their sexuality will be more vulnerable and are at higher risk of exposure to diseases and disorders. We need to step up advocacy and by using scientific evidence defy the idea of moral parenthood or teacherhood in the manner it is projected now. We should open ourselves with our children to discuss many such issues which can be useful for protecting them from diseases and death.

Ashok Agarwal, Family Health International (FHI), New Delhi

Let me describe the Life Skills Education (LSE) toolkit developed by Family Health International (FHI). This may be a useful resource for you.

The LSE toolkit was developed by FHI, in collaboration with National AIDS Control Organisation (NACO) and Ministry of Women and Child Development (MWCD), with funding support from United States Agency for International Development (USAID). Printed and published in 2007, the toolkit is available in English and four vernacular languages - Hindi, Marathi, Tamil and Telugu.

FHI has reached more than 50,000 children with community-based LSE interventions in six states of India through local partners. The toolkit is being used by many other agencies and projects beyond FHI. Nehru Yuvak Kendra (NYK) in collaboration with Ministry of Youth and Sports has used the toolkit to train its district coordinators on LSE. FHI has provided technical assistance to Karnataka Health Promotion Trust (KHPT) to implement LSE through link workers in the districts of Karnataka. The Women’s Action Group WAG CHELSEA has trained the members of Positive Women’s Network (PWN+) in implementing LSE. FHI has put together a team of core trainers who can support other agencies.

The LSE Toolkit provides a framework and methodology for children to participate in learning of life skills, and for adults to facilitate this process. It is designed in the context of the societies where the children live in, be it a slum community, a village, a street, or an institution. The Life Skills Approach advocated in this toolkit helps children learn, recognise and integrate the lessons learned to real-life situations. In this way, children are able to practice new, safe and healthy behaviours, and build confidence in day-to-day lives.

The toolkit follows a child participatory approach and deals with the ‘whole child’ including their feelings, beliefs, and development needs. Thus, it equips children with life skills required to make safe choices and lead healthy lifestyles. This toolkit is unique in having a component aiming to develop essential life skills to manage specific situations related to HIV and to cope with difficult circumstances related to care and support including loss.

The toolkit is divided into two sections. The first is a detailed Facilitator’s Guide to help users in understanding life skills and plan the programme. The second section details on ten important issues related to life of children in the context of HIV - each issue described in the form of a module with activities to be practiced with children and tips for the facilitator.

The Facilitator’s Guide provides a rationale for behaviour change through child participation, how children can participate, what facilitation is required by significant adults and the wider community, and various tools that can be used by children themselves in planning, implementing and evaluating programmes. Trained field workers conduct one-hour sessions weekly for 25 to 30 weeks with a group of around 15 children between ages 9-18 years.

Some of the highlights of the approach adopted in this toolkit are:

1. 
   Experiential Methodology: Each life skills lesson builds on previous lessons and influences future lessons. In this way, the learning of life skills is constantly reinforced. Developing new skills is initially difficult and requires a great deal of perseverance and support. Many practice sessions need to be set up to master a skill. In addition, each learner must have opportunities to receive feedback and reflect on how to improve their newly acquired skills.
   
2. 
   Child-centred Active Learning and Participatory Methodology: Young people are involved right from the beginning in assessing their needs and participating in their skill development. The life skills approach recognises the rights of young persons and respects them as individuals. The child-friendly participatory approach uses active learning methods including games, role plays, debates, brainstorming, drama, story telling, group learning, case studies and poster making.
   
3. 
   Supportive Environment Inside and Outside: Life skills have to be practiced and reinforced. Educators and facilitators must build trust and provide a non-threatening environment. Because life skills leads to behaviour change in real life situations, the surrounding community also needs to be sensitized so that they can reinforce the positive behaviour of children.
   
4. 
   Linking Learning to Life: This is a central concept of the Child-to-Child methodology. Linking Learning to Life activities help inform children, create awareness about their surroundings or make them curious to find out what family, friends and community feel and think on various issues. Many of these activities require that facilitators have dialogue with the wider community, and available services, so that they can support children in their attempts to understand themselves and the community better.
   

You may download this toolkit at ftp://solutionexchange.net.in/public/aids/resource/res19071001.pdf (PDF, Size: 4.53 MB) or from FHI website - http://www.fhi.org/en/CountryProfiles/India/indiatools.htm. Please contact us in case if you need a hard copy.

Javed Shaikh, Centre for Development and Population Activities (CEDPA), Ranchi

Your observations based on your experience in working with adolescent groups on the issues of Personal Hygiene, Reproductive Health, and HIV is very relevant. As you said, it is a hard fact that teachers are not comfortable with the idea of imparting Sexual and Reproductive Health (SRH) education to adolescents. We too faced the same situation, which we addressed in our programme - UDAAN: Towards a better future. It addresses the issues of Reproductive Health and HIV in the context of Life Skills Education (LSE) in Jharkhand State.

UDAAN is a Public-Private Partnership (PPP) programme of State Department of Education, the Jharkhand State AIDS Control Society (JSACS) and the Centre for Development and Population Activities (CEDPA). It is being implemented in more than a thousand secondary and senior secondary schools in Jharkhand reaching out to 250,000 students both boys and girls across the state, through trained nodal teachers. CEDPA is providing technical assistance to the Government of Jharkhand (GoJ) to help strengthen LSE for adolescents in the state. UDAAN curriculum has different contents like life skills, domestic violence, goal setting, gender and sexual harassment, growing up, marriage and parenthood, health, early marriage and its consequences, friendship, reproductive health and HIV, moral values, substance abuse, peer pressure and communal harmony.

To ensure greater involvement and energetic participation of teachers at ground level, CEDPA has developed in-school curriculum called UDAAN for class-9 and class-11 students, through a participatory process by involving state education department, the state academic council, teachers, students and civil society organisations. During the course of UDAAN curriculum implementation it has been mainstreamed in the school academic calendar through constant efforts made by CEDPA. Getting it mainstreamed in the academic calendar has been of great help to monitor the programme at ground level.

As far as the accountability of teachers towards the sustainability of the programme is concerned, CEDPA created a cadre of state-level master trainers through intensive capacity building, who in turn train the nodal teachers who conduct UDAAN sessions in the schools. The trained Master Trainers and Nodal Teachers are government teachers from Department of Education who were identified and selected in consultation with school principals, and district and state education department, based on their interest in adolescent education and good rapport with students in their respective schools.

CEDPA facilitated series of residential training programme for selected school teachers covering all issues related to adolescent concern in context of LSE and equipped them with appropriate subject knowledge and session facilitation skills to deal the situation in classroom setting among students. Besides, the department has taken an initiative to ensure quality implementation of the programme at school level by providing a platform to CEDPA for discussing the operational difficulties and key achievements of the programme. These are shared with school principals and nodal teachers during monthly school principals’ meeting at district level organised by District Education Officers (DEOs).

On the other hand, to ensure ownership and buy-in of the key stakeholders and creating enabling environment, CEDPA has been conducting orientation and sensitisation workshops in consultation with district education offices each year at district level. Such workshops involve key stakeholders, decision makers, government officials, implementers, school principals, nodal teachers, parents, media, community leaders, civil society and other adolescent gatekeepers to build consensus on the issues of adolescents and the importance of LSE in the state. As a result, their accountability has been enhanced towards the achievement of programme goal and objectives.

A poster about this programme can be downloaded from http://www.cedpa.org/content/publication/detail/2263. Hope this information will be helpful in your work.

Mary Julie, Buds of Christ, Chennai

We are very happy that such a topic has come for discussion, especially since it highlights the importance of Life Skills Education (LSE) in relation to Sexual Health and HIV. We would like to share our experience from Namakkal district in Tamilnadu, which again is a rural setting. We had been implementing LSE for adolescent children through the formation of community groups. These groups provide a platform for all children in the village including out-of-school children to learn life skills.

We have been using the LSE toolkit developed by Ms. Sonal Zaveri, for Family Health International (FHI), about which it is already mentioned in one of the earlier responses. As the module comprises of life skills in an activity-based approach, the learning is easier and suites the interest of children in the community.

As Aarathi and other members have mentioned, there is always a restriction among adults regarding topics on Sexual and Reproductive Health (SRH). Most of the parents hesitate to converse these issues with their children. Similarly, children too are not comfortable to discuss these matters to parents and teachers. Hence, establishment of community groups for children provides a platform for the trainers and facilitators to handle the topics among adolescents.

Prior to the establishment of children’s groups, sensitisation meetings are organised for parents and village leaders on the physical and emotional changes of adolescents, and the need for adolescent education among children through LSE programme. There has been positive response in two villages that we have worked so far and now it is being scaled up through Vetri Kootam – Community Children’s Groups, with support of MTV’s Staying Alive Foundation in five more villages in Namakkal district.

M. L. Somavarada, Anubhoothi Art and Cultural Trust, Mandya

Life Skills Education (LSE) is a basic learning need for all young people, as it empowers them to face challenging situations and make appropriate decisions. Developing life skills helps adolescents in translating knowledge to positive changes in their behaviour, especially on matters relating to health and development. It means that they acquire the ability to reduce specific risk behaviours and adopt healthy behaviours that improve their lives in general.

Among other things, LSE should definitely include Sexual and Reproductive Health (SRH) component. SRH education is a necessity not only of adolescents, but also for all other sections of the society. In response to Aarathi’s query, please find some of my suggestions:

• 
  For LSE programmes based at schools, it is very important to have adequate focus on the school teachers. Teachers should be perceived as pillars to create the confident environment among students. We should train all teachers about LSE. Teachers who develop negative attitude about the whole concept of LSE are often those who are not properly informed about LSE.
  
• 
  LSE must become a required subject of school curriculum. In addition, school libraries must contain books related to LSE and SRH. For example, books written by experts like Dr. C. R. Chandrashekhar of the National Institute of Mental Health and Neurosciences (NIMHANS), and Dr. Anupama Niranjan who is a doctor and writer, are very informative, yet simple to understand. Teachers could shoulder the responsibility to develop interest among their students in reading such books. Open and enabling environments will of course create productive discussions and a healthy attitude.
  
• 
  Organise Parents meetings so as to help them understand the mental and physical changes of their adolescent children. For such meetings, invite subject experts from institutes like NIMHANS or others who have experience in handling it.
  

Lastly, let me emphasise that NGOs or Governments implementing LSE programmes must focus on the target group and the critical stakeholders, namely teachers and parents. Open environment for discussion will help LSE to be successful. Impractical and unrealistic LSE programmes that do not involve parents and teachers and do not focus on students, will only be leading to waste of resources.

Kaniz Fatima Muneeza, Aga Khan Foundation, New Delhi

I was involved in a programme in rural Bihar for educating adolescents on issues like reproductive health and family planning, about a decade ago. Here are some key learnings that emerged, which drives me in my work till today with young people.

• 
  Adolescence is a time when young people have a lot of anxieties including those related to Sexual and Reproductive Health (SRH). Hence it is the time when programmes should begin to teach them on these issues within a long term agenda for their all round development.
  
• 
  LSE works easier if the parents and elders complement this effort. Leaving it only to teachers makes it a tough job especially in places where adolescents will come with their own preconceived notions.
  
• 
  Appropriate use of terms describing the biological and social aspects of sexuality is required, including for the act of intercourse. It should start with explanations on anatomy and physiology percolating gradually and focusing on the larger agenda of prevention of HIV and other Sexually Transmitted Infections (STIs).
  
• 
  There are differential layers among youngsters, which include the pre-adolescence stage of 12-14 years, adolescents aged 15-19 years, and then further, the young adults in 20-29 years age group. These groups need to be targeted with slightly different approaches. Emphasis on different set of issues needs to be appropriate for the age group with regard to the larger objectives of LSE including SRH.
  
• 
  Above all, it is important to understand the scenario holistically from the perspective of adolescents and plan things around it, rather than being focused to use it as a stand alone strategy for HIV prevention.
  

Hope this helps.