Aids community

Edwina Pereira, International Services Association - India (INSA-India), Bengaluru

The Celebrating Life curriculum mentioned in Dr. Maya’s response is adolescent-friendly and systematically allow for internalising and practising lifeskills from the foundations of valuing self. Unfortunately, they are not uploaded on the website as yet. Further, these Modules require a trainer programme to understand the interactive experiential learning approach used.

International Services Association - India (INSA-India) is planning a series of workshops in the coming months for trainers involved with youth reproductive health programmes in order to partner with such organisations and carry forward the agenda of Life Skills Education (LSE) sustainably. We shall let you know when the dates and venues are finalised. In the meanwhile, you could download two other related publications for promoting adolescent health - Experiencing Options, and Sexual and Reproductive Rights - from our website. Please visit http://www.insa-india.org.in/publications.htm to download the PDF versions of the above documents.

Shubhangi Sharma, United Nations Educational Scientific and Cultural Organisation (UNESCO), New Delhi

The issue raised by you is not only pertinent but also quite challenging to deal with, in the social-cultural scenario of India. As per the 2001 census, 30 percent of the billion-strong population of the country is young people. 20 percent of the population would qualify as adolescents, which means that every fifth person in this country is an adolescent. Considering this fact, it is inevitable to focus on the educational and developmental needs of adolescents.

I worked for more than five years with Doosra Dashak (DD), which is known as a pioneering programme on adolescents’ education and development in the country. It is being implemented by the Foundation for Education and Development in the rural areas of Rajasthan since May 2001. DD’s focus was primarily on rural, out-of-school adolescents from most difficult circumstances, including minority communities. Therefore, my response to your questions is based on the experiences which DD as a programme gained, and from what I personally gained during our interventions and interactions with adolescents and their immediate environment. I hope some of these would be useful for your work.

What are your experiences with different approaches to implement the SRH component of LSE for High School students at village level?

As a part of the programme, DD works with students of this age group by organising for them special five to seven days training programme on various aspects of life skills. This, we thought, was important because teachers were finding it difficult to interact on specific issues related to adolescents in the school set up. In addition to teachers’ own inhibitions, and inadequate training, the fear of being misjudged, is one of the primary reasons for their inability to deal with the larger misconceptions prevalent in the community. Obviously text books could not suffice the purpose. Building of understanding on certain issues required activities of various kinds for adolescents to feel comfortable. DD personnel realised this constraint and decided to hold specific trainings for in-school adolescents which are still continued.

To begin with, such programmes are conducted separately for boys and girls outside the school premises in a residential setting, where they could interact freely and seek clarification on their doubts. Gradually, as they become a bit more confident to discuss openly, DD trainers organise joint training programmes where the deeper issues such as sexuality and identity are discussed about.

I have myself been part of a number of such trainings and have interacted with adolescents, formally as well as informally. In the initial stages, even responses of the in-school adolescents who are better exposed to the external environment than their out-of-school counterpart, are quite stereotypical and confused on Sexual and Reproductive Health (SRH). The most disheartening sight was to see the confusions, with which they live with. I can still recall quite a lot of examples like when boys felt that even by touching a woman she would become pregnant. They giggled and looked stunned when for the first time a chart related to basic human anatomy and physiology were shown to them. With girls, they went through a sense of shame in the beginning, even in looking straight to the charts. Many girls and boys left the session as they were unable to sit through. However, rather than showing sense of urgency to deal with the issue or persuading them to stay back, trainers observed restraint. They used alternative strategies to address such children which included small group discussions, and peer interactions.

The trainers developed another strategy whereby after each session, the participants were encouraged to drop in their queries without their names written over, it in the query box placed in the training venue. To our surprise, we received quite a lot of slips asking simple looking questions causing agony in the minds of adolescents. Through this strategy, the trainers were able to clear many doubts, which adolescents would not have otherwise asked.

We also realised that the confidence of the trainer in dealing with such issues was a major catalyst in adolescents feeling comfortable and eager to learn. In places where trainers were well equipped and prepared, their articulation was clear and sensitive, and the participation was much better than in cases where trainers themselves seemed unsure of what they were talking about.

What kind of programmes will ensure the involvement of Teachers and Parents in LSE?

I would suggest that a well planned strategy be deployed if Life Skills Education (LSE) is to be implemented to adolescents. DD had a systematic, ongoing process of interacting with the community and taking them into confidence even while initiating the first round of dialogue with adolescents. The groups of women, village elders, and influential community leaders were invited to residential camps and training sessions for them to be able to understand the educational process as a whole. This yielded results.

In many places where as a result of rumours spreading about the learning that happens in DD camps, several parents had come to take their children back to their villages. However, DD personnel often succeeded in bringing them back after convincing their parents that the education imparted is empowering, and will equip their children to deal with their future life in a more confident and responsible manner.

It is not that no untoward incidences happened during training programmes. During a programme in Kishanganj block, some boys were found engaged amongst themselves. However, the way the then trainer tackled the issue was quite ensuring. This kind of a mature approach from trainers was possible as trainers are given rigorous inputs, again in residential mode, prior to initiating their work as trainers. Before the training team actually gets deployed in the camps, they are expected to spend considerable time in the respective villages of adolescents. It helped them to understand the socio-cultural environment, the concerns and challenges, as well as expectations of the community and children, so that they could appropriately use such input while transacting the curriculum.

DD also put in place systematic strategies to engage with school teachers. One of the strategies was to offer the support of DD trainers to teachers in the course of their interaction with school-going adolescents. In a couple of blocks, special trainings were conducted with school teachers to equip them with necessary knowledge, attitude and skill to address the adolescents’ concerns, especially on SRH. Teachers were also imparted gender training to be able to understand the issues better.

How can we reach-out and ensure access to LSE Programme for out-of-school adolescents and who should take responsibility for this challenge?

There are organisations which work in a big way with out-of-school adolescents, covering a range of issues related to SRH. DD itself is operational in nine blocks of Rajasthan covering hundreds of villages with a well designed strategy. Thousands of out-of-school adolescents have been trained over a period of 10 years, out of whom a sufficient number is capable to perform even the task of trainer for their peers.

DD has also come out with a curriculum on education of out-of-school adolescents, a part of which deals with the issues related to SRH. The curriculum clearly delineates an approach, which is conducive for adolescent learning, treating them as partners in the process of teaching and learning, as well as in the development of curricular material. Easy to understand material is constantly developed in the camps as well, to substantiate the curriculum and contextualise it for out-of-school adolescents in a specific area. The most important fact is that education of these adolescent begins in camps of four to four and a half month duration, after which planned continuing learning processes are adopted to ensure that not only learning is continued but it is manifested through change in personal behaviour, action and social interactions.

I am sure there are NGOs and other organisations in many states who are working on similar lines. In fact, with the technical support and hand holding of DD, organisations such as the Ajmer Adult Educaiton Association, and Urmul Khejdi are working with out-of-school adolescents. They facilitate learning on issues like understating society, governance and accountability, and SRH, in addition to language, mathematics and environment. The work done among older girls and women by organisations like Nirantar could also be studied to derive better strategies for future work with out-of-school adolescents. Details about Nirantar’s Sahajani Shiksha Kendra is available at http://www.nirantar.net/sahajani.htm.

I would suggest that experiences of DD be taken into consideration and studied properly in order to learn on adolescents’ learning in the context of LSE. May be a visit with sufficient time in hand to interact with trainers as well as adolescents could be undertaken by you and your colleagues, to design appropriate intervention for adolescents in your area. Please find more details about DD at http://www.doosradashak.org/

Finally, I would conclude by saying that LSE is much more than SRH as all of us would agree. A deeper understanding of ‘life skills’ will ultimately help in dealing with similar issues in question in the query raised by you. Therefore, the challenge here is to impart fuller life skills training to existing teachers, trainers, and adolescents. Such comprehensive approaches are bound to have an impact on their overall behaviour, actions and interactions.

Sushmita Mukherjee, International Centre for Research on Women (ICRW), New Delhi

Your experience is quite similar to mine while making efforts to implement Life Skills Education (LSE) sessions with students in the school system. While working in Rajasthan in government schools under school AIDS education programme, I had observed that many schools implement it for namesake. They instruct the Resource Persons to run through the sessions without going deep into discussing the issues with the adolescent students. In one district, the District Education Officer shared that “they are school students and we should not expose them to these things; otherwise they will give lesser attention to studies”.

While conducting sessions, we had one activity of secret question box, where we asked students to put their queries anonymously. I must share that the students had so many queries related to Sexual and Reproductive Health (SRH) issues. The teachers need to understand that the more they keep SRH knowledge and information as a mystery, more students will be eager to know this. This at times also results in students falling in wrong hands giving inaccurate information or developing myths around issues related to SRH.

During this time my experience of working with teachers was also quite enriching. Schools used to recommend sports teachers, music teachers, or biology teachers for conducting sessions on SRH and related issues. Even though Life Skills Education (LSE) needs mentors who are close confidante of the students, schools overlook this fact. Most of the times, these teachers have the least time and opportunity to interact with students individually. Counselling to students in rural areas was a totally new thing. For this we need to have a cadre of like-minded teachers or mentors who believe in LSE and trust its effectiveness.

International Centre for Research on Women (ICRW) implemented the Development Initiative Supporting Healthy Adolescents (DISHA) programme in Bihar and Jharkhand. The aim was to empower young people to delay age at marriage and child bearing. LSE approach was the base of the knowledge sharing sessions with young people. Most of the experiences from this programme are with out-of-school young people. Through the sessions with young people, we nurtured peer educators to continue to advocate for better health for young people. The sessions comprised of discussions around gender, age at marriage, early pregnancy, understanding adolescence, communication skills, how to say ‘No’, SRH, and sessions on Sexually Transmitted Infections (STI) and HIV. 

An evaluation conducted following a 24-month intervention, reveals interesting and promising data about DISHA. The programme succeeded in delaying the age at marriage for young girls by two years from an average of 15.9 to 17.9 years. Similarly, married youth who were exposed to DISHA were nearly 60 percent more likely to report current use of a modern contraceptive method than similar youth who were not exposed to DISHA. Please find more details about DISHA in a report titled Catalyzing Change - Improving Youth Sexual and Reproductive Health through DISHA, an Integrated Program in India. The report is available at ftp://solutionexchange.net.in/public/aids/resource/res19071002.pdf (PDF, Size 641 KB). This report and many other useful documents can also be downloaded from the ICRW website at http://icrw.org/taxonomy/term/17?page=2

Hope this will be of some help to you.

Paramita Chaudhuri, Reach India, Kolkata

We would like to share about Learning Games for Girls - a capacity building programme designed by Reach India to improve the health, social and financial empowerment of adolescent girls. The Learning Games for Girls are a set of short sessions designed to meet adolescent girls’ desire for lively, creative activities; games, stories, skits, songs, rhymes, etc. to learn new information and skills. Working in pairs and group work also provides girls with a non-threatening way to talk, address problems and bond around common solutions and actions. Even the quietest of girls can be drawn into the sessions. In the process, Learning Games :

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  develop key life skills, such as decision-making, assertiveness, negotiating and self-awareness;
  
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  give girls a chance to share and improve practical skills related to caring for their health and finances; and
  
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  build a platform for girls’ entry into self-help groups, which are important providers of social networks and financial resources for women.
  

The Learning Games focuses on poor, adolescent girls—both unmarried and married—between the ages of 10 and 19 living in rural areas. Interested mothers and mothers-in-law can also participate. Other adults and young children may show up at the Learning Games, as well. While they can be included, the focus remains on adolescent girls. The girls could be members of a pre-existing group that meets at frequent intervals, such as a youth club; or daughters of members of a pre-existing group, such as a self-help group or women’s club. They could also be students or a group of interested, like-minded individuals who are willing to meet regularly and actively participate in the Learning Games. The Learning Games works best with at least 10 but no more than 25 girls. A trained facilitator, preferably a woman due to the sensitive nature of some topics (particularly “Knowing Our Bodies”), is an ideal person to lead the Learning Games. If possible, the facilitator should group girls by age: 10–14 and 15–19 years of age, in order to conduct the Learning Games separately with each age group.

The Learning Games addresses a variety of topics and can be used as stand-alone sessions based on the expressed interest of the girls or priorities in the region. However, it is important to note that they are designed to build on each other. They progress from “safe” topics, such as nutrition and hand-washing in early sessions, during which they build self-confidence and trust in each other and the facilitator, to more “sensitive” topics, such as Reproductive Health and HIV and AIDS in later sessions. Reach India is currently engaged in imparting learning games to 6000 girls in two districts of Samastipur and Patna in Bihar. The blocks are Samastipur, Maner and Dalsingsarai. This programme is in collaboration with WDC Bihar and engages district level SHG federations and their functionaries to implement the programme. Please visit link for more - http://www.reach-india.net/india/index.cfm/india-service-centers/patna-service-centre/
Community acceptance of the games has been high because of the approach through mothers in self help group. Through this approach it has been possible to reach out to both in school and out of school adolescent girls. However the focus is on out of school adolescents. Impact assessment indicates that the games have a high level of recall as all the activities are through games and songs. During follow up studies the girls have requested facilitators to design more games on different issues.

Saket Sharma, Child In Need Institute (CINI), Jharkhand

As you have mentioned, we are also working on Sexual and Reproductive Health and Rights (SRHR) and HIV with Children and Young people (C & YPs) in age group of 10 – 24 years. The project is known as PRAYASH. It is funded by European Commission and technically supported by IWW UK. The programme has two phases one was the demonstration phase that has been implemented successfully in Bishnugarh Block of Hazaribag District in Jharkhand and second phase is scale up of the programme (in process).

I would like to share something about the project how and what we are doing under the "PRAYASH".  
PRAYASH has been contributing through the provision of quality information on SRHR and improved access to services for SRH and HIV through Youth Friendly Services (YFS). It is facilitating an enabling environment at the community and institutional levels which is facilitating sustained behaviour change. The C&YP reached by the project benefit from increased auto determination and the necessary knowledge and skills to protect their own health.  The health-seeking behaviour has been reinforced by the enabling environment that was created through capacity building and sensitization of key stakeholders.  As a result of community sensitization, and their participation in youth-adult committees and in advocacy, they also experience greater respect for C&YP and their specific needs. 
C&YP are involved in monitoring project activities and results and ensuring that their needs are being addressed appropriately. Parents, teachers, members of village health committees, other NGOs and service providers have been selected for sensitization and capacity building because of their ability to influence policy and community opinion in a way that has been favorable to adolescents Sexual and Reproductive Health and Rights.  Community members and gatekeepers and service providers both public and private benefit from an enhanced understanding of the specific needs of C&YP and an increased capacity to fulfill their leadership roles.
For providing the youth friendly spaces we have established the community based Youth Resource Center (YRC) at the village level with was supported by the community member. The YRC are providing following services -

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  A safe place for C&YP to take part in constructive skill-building recreational activities such as sports, drama and debate (which will reduce the risk of C&YP engaging in risky sexual activities). Some games and sports equipment will be provided.  Wherever, necessary separate times will be allocated for males and females.
  
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  A youth resource library, where C&YP can access IEC materials
  
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  Facilitated discussions led by Peer Educators
  
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  Basic counseling and counseling referral services for C&YP
  
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  Information services for C&YP
  
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  Health referral services for C&YP provided by community based health workers
  
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  Condoms distribution for C&YP – this will be introduced slowly as a result of its sensitive nature
  
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  Participatory learning activities around SRHR and HIV, such as group discussions, games and workshops
  
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  A place for the local youth club to meet.
  

During the demonstration phase we have initiated the school intervention through peer led approach. We have learned many things that should be taken before start the intervention in the school.

For involvement of the teachers and parent in Life Skills Education, following should be ensured -

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   Meeting with Teachers association for introducing Life Skills Education
   
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   Capacity building program for teachers and development of resource pool among the teachers group
   
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   Convergence meeting with parent and teachers and other religious leader and gatekeepers of the society
   
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   Sharing meeting with Education Department on Policy for Youth and provision of SRHR or HIV under the various policy
   
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   Youth Advocacy approach should be initiated
   

For reaching out of school adolescent -

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   Establishing the Community based Youth Friendly Space for insuring conduct of LSE
   
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   Either the VYAC (Village Youth Adult Committee) or the Youth group members should be made responsible for managing the Youth Resource Centre. Youth advocates should be prepared and trained on advocacy for the young people and their related issue
   
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   For insuring the SRH services at the YRC, referral and linkage should be established with Govt. and Non Govt. services
   
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   The provision for Youth and Adolescent Friendly service at every level under the NRHM and under various State Youth policy should be utilized.
   

Ramesh Ganti, Technical Support Unit (TSU) to Andhra Pradesh State AIDS Control Society (APSACS), Hyderabad

It is good to see that you are focussing attention to Life Skills Education (LSE) programme, to address the needs of Adolescents, including their Sexual and Reproductive Health (SRH) education needs. As evident from the responses of other members across the country, LSE approach is the way forward.

In Andhra Pradesh, we have formed Red Ribbon Clubs (RRCs) in high schools and colleges. In high schools, ninth and tenth class students, along with two teachers are members in the RRC. In a year, they will have interactive programmes of around 16 hours. The sessions are divided into seven topics, including personal hygiene, and Sexually Transmitted Infections (STI). Apart from these sessions, on a monthly basis, RRC conducts a meeting with its members, other students and parents. In these meetings we will create awareness among parents too. In addition, parents are represented in school development committees, which give another opportunity to discuss such issues with parents regularly.

Similar to your experience in Karnataka, lots of parents and school teachers in some pockets of Andhra Pradesh raise objections to teaching sexuality and personal hygiene to students. By involving the Government of Andhra Pradesh, and State Education Department, we are addressing this problem. In addition, District Education Officer and Mandal Education Officer are involved in this programme and they are monitoring the programme periodically. To implement LSE successfully, parents’ involvement is very much needed.

In rural areas, stigma is still there for discussing issues like sex and sexuality. Girls and boys in many rural areas are illiterates, and since childhood they are working as child labourers due to their family problems. These boys and girls are especially vulnerable and pose an additional challenge in your work with out-of-school adolescents. Hence, I suggest that you take up the issue of child labour and integrate such issues in your work on LSE. Involvement of Government, and awareness and involvement of parents are very useful factors to overcome this problem.