This 12-page case study discusses the experience of a peer education project in Ethiopia, which trained young people who sell sex to reach out to their peers and lead sexual and reproductive health and rights sessions, supported by trained nurses and a referral system for services. The project was led by the Organisation for Support Services for AIDS (OSSA) as part of Link Up, a five-country programme working to improve the sexual and reproductive health and rights (SRHR) of one million young people most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda. The Ethiopian initiative was created to fill both knowledge and service gaps to ensure that young people who sell sex have access to both adequate information and services about their SRHR in order to stay healthy.
The case study outlines a number of challenges faced by the peer educators and nurse counsellors. This includes group dynamics in which some groups did not bond and in other cases group members did not always respect their peer educator. Group members also sometimes requested additional refreshments (beyond the coffee and bread already provided) to come to sessions. In addition, the priorities of young people who sell sex are often not SRHR-related, but rather the need to provide housing, food, and clothing for themselves and their families, plus the need to attend school or start a business.
The case study offers a number of lessons learned:
- Role of peer educators -“ Peer educators speak the same language as their peers, are good at facilitating conversation, can answer questions clearly, and talk openly about sensitive issues. They play an important role in identifying session participants as well as setting appropriate times and locations for sessions. They are often seen as role models by their peers”
- Role of nurse counsellors – “The nurse counsellors are critical to this intervention. They provide peer educators with support, enhance their knowledge and instil confidence in them. Nurse counsellors provide a critical service by assisting young people who sell sex to health facilities”
- Locations and times of peer education sessions – “It is important to hold sessions at times convenient to, and agreed by, group members otherwise this may become a barrier to participation”
- SRHR and HIV must be integrated – “During the project, a significant number of young people who sell sex reported experiences of unplanned pregnancy and STIs as well as living with HIV. These stories remind us of the importance of integrating SRHR and HIV information and services. This means addressing a range of SRHR and HIV issues in the peer education sessions and ensuring that information, education and communication materials speak about dual protection and the use of condoms for protecting against both pregnancy and HIV and other STIs. It also means ensuring young people who sell sex know they can access a range of services at health facilities”
- Recognising the priorities of young people who sell sex – “It is important to recognise that young people who sell sex may share a range of experiences and needs during peer education sessions including the need for housing, food, employment opportunities and education plus psychosocial support to respond to violence, stigma, discrimination and other issues”
- Promoting good experiences – “When young people who sell sex have experienced sensitised and supportive health providers, it is useful to encourage them to share their experience with their peers in order to dispel the fears others may have around accessing care in health facilities and as a way to respond to questions about which services”