HIV/Sexual and Reproductive Health Program for HIV Prevention: The Youth-Adult Partnership with Schools Approach

Published in the Journal of the Medical Association of Thailand (Vol. 89, No. 10, pps. 1721-32), this paper describes the development and evaluation of a programme designed to prevent HIV/AIDS in Thailand by empowering early adolescents through participatory, school-based peer education. The programme was designed to address a communication problem: lack of accurate information about sex and the difficulty in keeping up with changing patterns and values that make it difficult for Thai parents to talk about sex in the family. Under such conditions, the researchers note, adolescents often seek access to information via the mass media and friends - which may be inaccurate, riddled with misconceptions, and/or contain sexually suggestive messages.

The programme described in this resource is theory-based (critical social theory), and reflects the belief that preventive efforts should be developed in response to social and cultural transformations which have contributed to changes in patterns of sexual behaviour among Thai adolescents. The idea is that young people at risk for sexually transmitted infections (STIs) and HIV can be guided - with the help of peers, parents, and teachers - to identify oppressive social forces such as value orientations that prohibit or discourage communication skills and sex education, and then can work to remove the burden of these forces - hopefully contributing to their emancipation, empowerment, and change.

Specifically, as detailed here, a participatory action research (PAR) approach was used in collaboration with 10 schools in Chiang Mai Province, Thailand; this community-based action research method works on the assumption that all stakeholders who live in the
community - including young people - are affected by the problem and thus should be engaged in the process of observation, reflection, and action. Using the PAR approach, adolescents, parents, and teachers together developed a youth-adult partnerships with schools (YAPS) model which included curricula using participatory learning experiences, edutainment approaches, and skills building strategies for enhancing youth leaders' capacities. Through this process, 35 Youth Leader Trainers (YLTs) aged 16-20 and 111 Younger Youth Leaders (YYLs) aged 10-14 were trained to conduct peer-led activities in schools and communities in order to foster increased knowledge of, and improved attitudes about, child rights, duties, responsibilities, and HIV/sexual and reproductive health (SRH).

The programme was implemented in 8 steps, which are delineated and described in the resource. In brief, these steps included:

1. Establishing a partnership between the researchers and 10 schools
2. Organising researcher-teacher workshops to clarify the process of participatory research
3. Recruiting youth leaders and parents
4. Developing curricula for SRH education (YYLs brainstormed with each other to come up with new, interesting and attractive activities, methods and media that would not bore their peers).
5. Holding skills building camps for YLTs and YYLs to enhance their leadership skills (focus was on group processes)
6. Holding skills-building and network development sessions for parents
7. Providing support for youth leaders and parents to advocate for their peers and communities (teachers' support and a parents' network were central)
8. Carrying out both a process and outcome evaluation of the programme

Results showed that the YAPS model was effective in leadership role preparation and in empowering youth leaders to undertake activities on their own, initiate creativity, and share knowledge on sexuality education and HIV prevention messages with students in schools. The researchers observed positive effects for youth on their leadership development, changes of knowledge and attitude toward SRH, and development of communication skills on sexuality and HIV education. Both qualitative results (in the form of quotations from youth leaders) and quantitative results (in the form of several tables) are cited here.

In short, the researchers found that the use of partnerships and the participatory process mobilised parents, teachers, and school administrators to play a proactive role in sexuality education and HIV prevention for early adolescents in schools, resulting in the integration of the programme into the school system. They stress that "adults must take the critical role of providing opportunity, assistance, and guidance so that YLTs and YYLs can develop their capacity in an atmosphere of trust and respect. Furthermore, parents, educators and adults need to act as positive role models; encourage and foster positive, holistic and constructive thought in young people; empower youth to take responsibility
for their actions, future and environment; and re-invent traditional human values suitable to Thai culture for the benefit of themselves, their families, communities and country."

In conclusion, the researchers highlight the importance of providing an opportunity for every party to be involved in each stage of HIV/SRH programme development, implementation, and evaluation. This community-based strategy, according to the authors, made the programme successful and resulted in a sense of ownership and belonging among all participants - as well as a sustainable commitment to among youth, in particular, to advocate for their peers and communities.

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