How three days’ training can make a difference

Link Up in Ethiopia has shown how confident, young women who sell sex can also be community role models providing HIV advice and support for other young people selling sex.

A project in Ethiopia has demonstrated the value that peer educators can bring to sexual and reproductive health and rights (SRHR) and HIV education and services for young people.  

In its first 12-month period, the peer education and outreach project, led by the Organization for Social Services, Health and Development (OSSHD), saw 469 young people who sell sex aged 15 to 25 trained as peer educators and more than 16,000 young people who sell sex reached with peer education sessions.

Thirty-five per cent of the young people who sell sex attending the sessions received referrals for clinical services, with 30% of these taking up or completing services with health providers who had signed agreements with OSSHD. The most common reasons for referral were voluntary HIV counselling and testing, cervical and breast cancer screenings, sexually-transmitted infections (STI) check-ups and treatment, opportunistic infection check-ups and treatment, and safe abortion.

The project is part of Link Up, an Alliance-led initiative which improved the SRHR of nearly 940,000 young people affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. This project in Ethiopia was implemented in January 2014 to address the following concerns, identified in a Link Up exploratory study:

  • The significantly higher HIV prevalence among female sex workers in Ethiopia compared with the national prevalence for women (15%-33% according to one study, compared with 1.9%).
  • High rates of unintended pregnancies among sex workers.
  • Inconsistent condom use of sex workers with their non-paying partners.
  • Sex workers were frequently unable to access adequate SRHR information and services.

Peer educator training

Peer educators were selected to take part in the project in part because of their good social skills and ability to get along well with peers. Training was over three days and covered relationships, pregnancy, contraceptive methods, STIs, HIV and violence. It also covered life-skills, such as dealing with self-esteem issues, assertiveness, negotiation skills and decision-making.

condoms and drink

The peer educators went on to lead seven-week sessions for other young women who sell sex, supported and encouraged in their role by peer supervisors, peer educators who were specially selected for their leadership skills.

Importantly, nurse counsellors provided back-up, for example to respond to any questions peer educators were unable to answer.

Role of nurse counsellors

Monitoring data and information provided by OSSHD, as well as observations from nurse counsellors, showed that the peer educators were often seen as role models by their peers.

They played an important part in identifying session participants as well as setting appropriate times and locations for sessions. For example, sessions were held in restaurants, bars and other places of work, and often in the early evening, before the young people worked but once they were rested and had completed day-time activities.

The role of the nurse counsellors was found to be essential to the intervention’s success too – and resources to pay for nurse counsellors were identified as important for the sustainability of the project. In particular, nurse counsellors’ role supporting and encouraging peer educators in their leadership role was critical if groups failed to bond.

They also stepped in if peer educators missed sessions because business had taken them elsewhere.

Health and social services

Findings also showed that participants’ need for housing, food, employment opportunities and education needed addressing, and so collaboration with organisations providing health and social services was also vital. In some towns, peer educators referred people to partner non-governmental organisations (NGOs). When this was not possible, the sessions became a space to share problems. In particular, psycho-social support to respond to violence, stigma, discrimination and other issues was identified as important.

As the exploratory study states: “Female sex workers experience violence by a range of perpetrators. This demands a comprehensive and multisectoral response, including sensitisation of law enforcement officials; peer-led mobilisation to prevent and respond to such abuse; and psycho-social services for women who experience violence.”

In Ethiopia, Link Up is led by OSSHD in partnership with Marie Stopes International Ethiopia, Family Guidance Association Ethiopia, National Network of Positive Women in Ethiopia, Nikat Charitable Association, Talent Youth Association, the Ministry of Health, and the Ministry of Women, Youth and Children Affairs.

The Link Up project is funded by the Ministry of Foreign Affairs of the Government of the Netherlands.

For more information read: Empowering each other: young people who sell sex in Ethiopia. A case study from the Link Up project.