Peer Education amongst Vulnerable Youth

CARE targeted sex workers and bar girls in entertainment venues and by the end of the project had reached over 4,000 sex workers with information on sexual and reproductive health. Through trainings, outreach activities and peer education, the project built awareness and understanding of essential reproductive health knowledge and practice. In addition, life skills, gender issues, safe sex be haviour and condom usage were promoted. Links with the Vientiane Youth Centre and the Referral and Counselling Network allow for the provision of counselling and clinical services. Through multi-sectoral district teams, the project worked with bar owners, and local authorities to build a supportive and non-discriminatory environment for one of the first ever projects to work with sex workers in the country.

The overall goal for the project was the same as for RHIYA Lao - Improved reproductive and sexual health of young people and adolescents in Lao PDR. For this target group, there were additional c hallenges t hat needed to be tackled before activities could be conducted. These were, tackling the stigma and discrimination surrounding sex work, establishing trust with young sex workers and reaching a very mobile population.

Strategy: The key strategy used by CARE was to bring together all stakeholders; sex workers, entertainment owners, local authorities and local communities to build a conducive environment in which to address SRH. CARE set up two important mec hanisms for implementing the project, a Project Advisory Committee (PAC), which met monthly and gave the project official sanction and support at local level and a multi-sectoral Project Work Team. This team was led by the Lao Youth Union who received training on A/YSRH, gender and sensitized to the issues of sex work. Study tours, community advocacy events and in-depth workshops were conducted for project teams. These workshops addresses among other things, misconceptions and negative attitudes towards sex workers. Meetings and workshops were also conducted with bar owners.

CARE realized t hat empowering sex workers required training in life skills as well as SRH. Training courses emp hasized confidence building, negotiation skills for safe sex, and recognizing dangerous situations. This was in addition to training on pr evention of unplanned pregnancies, transmission, signs and symptoms of sexually transmitted infections (STIs) including HIV/AIDS. The project undertook a situation analysis which identified some of the broader social issues linked to sex work. From this CARE began to adapt their strategy to tackle emerging issues of violence and the link to alcohol and substance abuse. Training was then provided in self-assertiveness, self-defence and risk identification.

Outputs: 1) Increased political and community support for A/YSRH interventions: CARE conducted a diverse range of advocacy events including study tours and special event days such as World AIDS Day. District Governors and other key political figures attended these events which provided SRH information and activities. These events significantly contributed to drawing attention to the SRH needs of vulnerable youth and mobilising support for improving services. They also provided worthwhile opportunities for marginalised young people to engage with the community and confront misconceptions and negative attitudes about sex, condom use, pregnancy etc. PAC members attended training sessions, youth camps, and official openings for events. They engaged in discussions with young sex workers – this was a new and important opportunity for political figures to hear the issues directly. The project conducted meetings with 542 bar owners to get their support for activities and raise awareness of SRH issues.

2) Increased awareness and improved SRH knowledge and be haviour among youth and adolescents: CARE target groups were not part of the RHIYA baseline and endline survey due to the high mobility of the girls. Hoxever, there is plenty of anecdotal and observable evidence t hat CARE have made an important impact on both knowledge and be haviour of this group. Firstly, during the project period, CARE reached over 8,500 sex workers and community members with information, training and IEC materials. Over 70,000 condoms were distributed. Over 800 peer educators trained by the project were regularly asked for information by their peers on a range of issues. Anecdotal evidence from Peer educators showed increases in information s haring among young commercial sex workers, condom use and assertiveness with clients.

3) Improved access to quality youth oriented sexual and reproductive health services: For many young sex workers, Peer educators are the first port of call for advice and counselling services. Peer educators made over 5,000 contacts. D iscussions focused on the problems of unplanned pregnancy, induced abortion, abnormal menstrual cycle, abnormal vaginal disc harge, lower abdominal pain, STIs etc. Of these contacts, nearly half were referred to the Vientiane Youth Centre clinic and other specialized service providers in the capital as part of the Referral and Counselling Network.

4) En hanced technical planning and managerial capacity amongst Government partners to provide appropriate, adolescent-friendly A/YSRH information and services: This was the first time t hat a multi-sectoral team lead by Lao Youth Union Vientiane Capital City had worked with an NGO and with commercial sex workers. Over 30 members of the Project Working Team (PWT) were trained on a range of topics and skills to build technical capacity on SRH issues, improve the quality of project implementation and most importantly to encourage more ownership over the project activities.

In terms of project management, there were significant achievements in planning. Monthly meetings were held to develop action plans and to discuss feedback, c hallenges and lessons learned from each district team. Issues and constraints were clearly and openly debated to find out team consensus and solutions. In addition, the M&E system was also established and revised periodically in line with project implementation plans and outcomes. New skills and knowledge have been fostered to build on linkages between Government departments, with NGO’s such as CARE and with the PE’s themselves.

CARE established a high media profile for their activities in the national and local press. Linkages with other organisations including PLWHA groups gave extra opportunities to exc hange lessons learned and s hare resources. CARE also participated fully in RHIYA Good Practices Documentation Exercise in August 2006.

Lessons Learned: Building trust between government counterparts and target groups is critical to the outcome of the project. Bringing PWT and PAC members to listen to young service workers’ views and problems helped to gain recognition and strengthen the understanding by the authorities about social issues affecting sew workers.

Advocacy with government authorities is a priority for working with commercial sex workers. In a country like Lao PDR where projects cannot be implemented without government partners and target groups can’t be directly contacted without official approval, developing an advocacy strategy was one of the first key steps of the project. The advocacy messages need to be very simple, clear and related to the context of each district or local situation.

Peer Educators are more than just information providers. Peer educators who became involved in planning, and conducting activities for peers and at community events developed a greater awareness of their value and role in society. They develop confidence and skills to be able to speak out on be half of a traditionally marginalised group, tackling issues of stigma and discrimination head on. This led to community and neighbourhood acceptance and greater public support for sexual and reproductive health activities. Rewards in the form of certificates, T-shirts and bags also acknowledge the contribution of peer educators, thus increasing motivation and reducing turnover.

Contact: Care International, P.O Box: 4328, Vientiane Lao, PDR; Tel : + (856 )21 217727, 215826 ; Fax : + (856)21 214415 ; Email: