A peer prevention programme in Tanzania

"…how we could live in order to stay alive"

Von Franziska Lauper / terre des hommes schweiz

In 2001, the self-directed orphans organization Vijana Simama Imara (VSI) started a HIV-prevention programme. Training modules were developed by Humuliza, an organization initiated by terre des hommes switzerland, offering psychosocial support for children and youth people affected by HIV/AIDS. John Kilaka, a Tanzanian artist, created paintings of animals as supporting material for the training sessions. The trainers are peers, members of VSI.

It is Tuesday, four o’clock. The schoolyard in Nshamba, situated in the far northwest of Tanzania, is empty; the primary school children have already left. But one room is filled with 120 young people between 13 and 20 years. All are members of the self-directed orphans organisation called Vijana Simama Imara – Youth Stand Upright. In front, two boys and two girls are getting ready. They are four of the 84 peer educators within VSI.

“Vijana” the peer educators are paroling in front of the 120 members. “Simama Imara” they are all answering - screaming as loud as they can. The prevention session is about to start. “We are coming here because we want to know how we can prevent ourselves from getting ukimwi (AIDS). Even at a young age it is important for us to know what we can do against this dangerous disease.” Nixon, 14 years old, and Joseph, 15 years old, two VSI members, say about their reasons for attending the peer prevention sessions every two weeks.

“Is it true that…”

During training sessions, VSI members confirm that they engage in sexual activity very early. Facts and the voices of the young peer educators show that the demand for information on HIV/AIDS and reproductive health by VSI members is high. However, generally HIV/AIDS education tends to ignore young people, and when information is available, it is often “dry” and far from their own reality and experiences.

People all over the world don’t feel easy talking about issues such as sexuality, love, relationships, their own body, etc. Studies show that sex related information is most effective and best received when imparted by peers in the same age group. Daily life case studies and examples have proven a useful entry point. Using the method of questions and answers has not only attracted the attention of children and youth, but stimulated debate and discussion about the very issues that concern them.

The peer prevention programme started in spring 2001, when a core group of VSI members began discussions about possible topics for peer intervention in the area of sexuality and HIV/AIDS prevention. The group discussed anonymously collected questions around HIV/AIDS as: “Is it true that condoms have small holes on them?” – “Is it true that sharing clothes can transmit HIV?” – “Can a 15-year-old girl get pregnant?” – “Might sharing a razor with an HIV positive person infect me?”

As a result of the discussions, a gender-balanced pilot group of 30 adolescents aged between 14 and 22 years was chosen in June 2001 by fellow VSI members to participate in a week-long seminar on prevention and reproductive health. During the workshop, the following topics were discussed:

  • fears related to talking about sexuality and appropriate ways of dealing with these fears
  • the immune system and HIV/AIDS
  • my body and how I can talk about it
  • sexuality and reproduction
  • physical changes during adolescence
  • introduction to the concept of gender
  • what does it mean to be a boy/girl?
  • how does the opposite sex view me?
  • how is HIV transmitted
  • different strategies for prevention
  • staying with people living with HIV

After the workshop, Humuliza developed training modules based on the experiences of VSI members.

The male-dog and the monkey-girl

The use of pictures is a useful tool to facilitate the discussion with children and young people about HIV/AIDS, love, relationships etc. “Pictures help us to make situations such as sexual harassment or actions such as using of a condom visible and understandable,” mentions Helmeryilda, a peer educator. However, pictures tend to reinforce stereotypes in HIV/AIDS prevention, leading to stigma and discrimination. The people and images in picture work can become a focus of projection – for behaviour, or even attitudes. Participants run the risk of identifying themselves with the picture images, hindering productive discussions.

With these difficulties in head, Humuliza explored with John Kilaka the possibility of using paintings of animals in the prevention work. John Kilaka is a contemporary representative of the Tingatinga style of painting in Tanzania. Together with VSI members he created various paintings on prevention.

The pictures are illustrations of a variety of wild animals that can be vividly interpreted even by young children for easy discussion. There are several topics that have been illustrated with drawings, such as discussions dealing with sexual harassment by boys and teachers, self-assertiveness, counselling, love without sex, the use of condoms, counselling situations etc. Each picture is laminated with simple instructions on the back cover. The instructions always follow the same pattern:

  1. Hints and questions in order to get a comprehensive description of the picture from the participants.
  2. Suggestions for discussion (“Talking points”)
  3. Suggestions for individual actions (“Action points”)

This idea was successfully tested with peer prevention groups of VSI. Today, John Kilaka’s pictures are central to the prevention work of VSI, and also used in some neighbouring primary and secondary schools. John Kilaka’s pictures are very useful to show some risky behaviours and risky situations as well as more responsible behaviours, the peer educators agree. “The Kilaka pictures are very good to talk about subjects which are sometimes difficult to talk about such as the use of condom.” Or as Helmeryilda says: “It opens a subject such as sexual harassment of girls, children then can give their comments and talk about it.” Alex comments that the Kilaka pictures “lay a base for further action on a certain behaviour. If I show them the Kilaka pictures they see a good example of how it should be or what they could do in a certain situation”, he says. “These pictures make a prevention topic visible in a lively way and therefore children can understand it better,” adds 16 years old Tibesigwa who often uses the pictures as a peer educator since they allow him also to educate with humour.

Most reports on children affected by HIV/AIDS mention the risk of sexual harassment and sexual abuse that girls face after the loss of their biological parents. The risks encountered by the female child affected by HIV/AIDS are compounded by their socially defined inferior status. HIV/AIDS in Southern and Eastern Africa has increasingly become a “female” disease. Four out of five HIV-positive adolescents today are girls. It therefore becomes essential that gender issues are addressed in prevention programmes. The experienced peer educator Dennis touches the issue. “If I use the picture where a male-dog is urging the monkey-girl to have sex, the discussions in the group show the girls that it is their right to say a strong ‘NO’. So it shows them to stand for their rights”. Girls from VSI also participate in self-defense courses on a regular base.

“We need to deeply want to change our behaviours”

According to the peer educators and the peers, Kilaka pictures are an important support for youth to get informed about HIV/AIDS, risky factors as well as to develop some steps to take. Results of a recent impact evaluation of VSI confirm that through participation at prevention sessions VSI members have a better knowledge on HIV/AIDS than other young people with a similar socio-economic background in and around Nshamba. Peers and peer educators are aware of the fact that there is more to it than information and education. Nixon says “it is not only the peer prevention itself or the pictures of John Kilaka that make the change. They are an important source of information for us und help us get aware and take other behaviours into consideration. But we need to deeply want to change our behaviours that put us in risk of getting infected.” The individual responsibility is one aspect that is mentioned by several peer educators as an important aspect in order to prevent oneself from becoming infected. Alex, 16 years old, who is sometimes teaching up to three times a week in different VSI groups brings up another point which has an impact on youth being willing to live a less risky life. He is convinced that having a role-model that shows responsible behaviour is crucial for youth to start changing. “Therefore you really have to start by yourself if you want to be a good peer educator”, he adds.

The sun is soon to go down, the children and youth leave the classroom of Nshamba Primary School. Dennis and Alicia are collecting the Kilaka Pictures and are preparing to leave. They will meet in twelve days when they will prepare together the next prevention session in order to give the children more information as a base for discussions and strength to tackle the vicious circle that continues to infect world wide 7’000 youth daily with HIV, and certainly to follow their motivation to “give youth ideas on how we could live today in order to stay alive tomorrow”, as Dennis says.

* Franziska Lauper is desk officer for Tansania at terre des hommes schweiz in Basel. Contact: f.lauper@terredeshommes.ch. Parts of the text are based on individual and group discussions with peer educators and peers from the self-directed orphans organisation VSI held and prepared by Elda Philemon, Humuliza staff member, responsible for the prevention programme, and Michel Ducommun, social worker and Interteam volunteer within Humuliza. The pictures of John Kilaka as well as the instructions can be downloaded from www.humuliza.org. Sources: Kurt Madoerin, Report on the self-organisation of orphans in Nhsamba, Tanzania; Irene Bush, Aufrecht gehen und ausharren, in: terre des hommes schweiz Zeitung, August 2001 Nr. 3.