PASOS ADELANTE - A Project for Adolescent Reproductive and Sexual Health

Pasos Adelante (or Steps Forward in English) is a program that was developed by Peace Corps Peru in coordination with Peru’s national Ministry of Health to help youth develop essential life skills to avoid unwanted pregnancies and make healthy life decisions.

The program consists of fourteen lessons on a variety of topics:

1.       SELF-ESTEEM and SELF-CONFIDENCE

2.       POSITIVE VALUES

3.       MANAGING STRESS

4.       ALCOHOL AND DRUGS

5.       DECISION-MAKING

6.       DOMESTIC VIOLENCE

7.       PLANNING FOR MY FUTURE

8.       ADOLESCENCE AND SEXUALITY

9.       GENDER AND SEXUALITY

10.   STIs (Sexually Transmitted Infections)

11.   HIV & AIDS

12.   PREGNANCY

13.   ABSTINENCE & SEEKING AN IDEAL PARTNER

14.   CONDOMS AND MODERN BIRTH CONTROL METHODS

The program is intended to reduce the number of sexually transmitted infections, prevent early pregnancy, prepare adolescents to make responsible decisions about their sexuality, and give them the tools to become leaders in their communities.

The Pasos Adelante program can be adapted to provide opportunities for students to train other students in the aforementioned topics as peer educators.  Research shows that youth more readily trust and retain the information provided by other youth more than information provided by adults.  Multiple research studies have concluded that peer education program are more effective in improving knowledge among adolescents and is recommended as a strategy to reduce the prevalence of pregnancy and STIs among youth.

The Pasos Adelante program was designed with the concept that skills and learned behaviors between peers can be very effective in promoting healthy decision-making among young people.  Expected outcomes of the program are that:

• Fewer young people will become infected with an STI, HIV, or AIDS, and fewer young people will become pregnant during adolescence;

• Young people will take safe and responsible decisions about the best time to start having sex and how best to protect them when they have them; and 

• Young people will develop tools and characteristics to become leaders in their communities, including high self-esteem, assertive communication and healthy decision-making skills.

THE PLAN

My interactions with youth during the diagnostic phase and afterward led me to believe that the high level of timidness around and ignorance of sexual health issues demonstrated by teens in the community may serve as a challenge to finding an adequate number of youth interested in becoming peer educators.  Initially, I utilized the resources and expertise of the health center staff to teach the Pasos Adelante lessons to high school students as a way to provide opportunities for youth to reach a comfort level with the material and to coach the health center staff in using non-formal teaching techniques.

I coached the health center staff, who prepared to teach six of the Pasos Adelante lessons to students in the 3^rd and 4^th year classes.  In the following school year, we planned to select ten of the best 4^th and 5^th year students to develop their leadership and presentation skills, who in turn, would replicate the Pasos Adelante lessons to a new group of 3^rd and 4^th year students.  This process could be repeated each year, and it allowed for students to participate in the lessons two years in a row, which contributed to memory retention and increased comfort level with the material.

During the 2013 school year, the health center staff taught six of the Pasos Adelante lessons to 40 students in 3^rd year and 13 students in the 4^th year classes in the following topics: Decision-Making, Seeking My Ideal Partner, Sexuality and Adolescence, Condoms and Modern Methods of Family Planning, Sexually Transmitted Infections, Alcohol and Drugs, and Planning for My Future.

We observed the interest and leadership skills of the students during the lessons, which allowed us to select the best students to serve as peer educators during the following school year, as these students entered the 4^th and 5^th year of high school.  During the 2014 school year, students were invited to apply to become peer educators and teach lessons to other students.

Among the 14 students who applied, five 4^th year students and five 5^th year students were selected to participate in a training event to develop their leadership abilities.  Eight students attended the training to become peer educators (four 4^th year students and four 5^th year students).  The training consisted of lessons in developing personal values, self-esteem, leadership skills, and managing stress presented by health center staff and by a recommended Psychologist.  Following the training, I worked closely with the students in one-on-one or small group sessions to develop their presentation skills and ability to use non-formal teaching techniques.

The four 4^th year students were paired up and assigned a topic to teach alongside a health center staff member.  The responsibilities were divided such that the health center staff served as the experts on the topics and each presented factual information while the students directed the activities to practice the newly acquired knowledge and behaviors.  The 5^th year students declined to participate further after attending the peer educator training due to school workloads and responsibilities at home.

The students were paired up and trained to use non-formal education techniques to present practice activities for experiential learning.  The presentation topics were Domestic Violence, Condoms and Modern Birth Control Methods, HIV & AIDS, and Abstinence & Seeking an Ideal Partner, which were presented to 53 students in the 3rd and 4th years of high school.

Parents School

In order to improve communication between parents and their children and reinforce the information presented in Pasos Adelante, we developed a Parents School event. It was intended to provide parents with positive communication techniques that would allow them to engage with their children about sensitive issues, such as sexuality and reproductive health, and planning for the future.

Parents School was focused on building trust and respect between parents and children.  After completing the course, parents were able to demonstrate a better knowledge and behaviors for use in supporting the healthy development of adolescents.

HIV Awareness

Once a teen decides to initiate sexual activity, it is essential that s/he has the knowledge and access to the use of contraception and protection against sexually transmitted infections and HIV. A key component in the effort to protect teens from unwanted pregnancy and infection is correct and consistent condom use.

The statistics of the health facility reflect that a very small number of adolescents have sought the services of family planning, probably because of the embarrassment and the risk of gossip.  In order to increase the likelihood that adolescents obtain and use condoms, we launched an HIV awareness event that included a condom demonstration.

The event was designed to normalize the use of condoms and remove at least some shame in obtaining condoms and initiating conversations with partners.  The event included information on the difference between HIV and AIDS, how infection occurs and testing methods, presented by a nurse technician and through educational videos provided by the Ministry of Health.  The demonstrations covered myths about HIV transmission, and challenged teams of students to describe the steps to use a condom correctly in an effort to win prizes.

Given that the Pasos Adelante program initially reached only 53 of the total 612 adolescents in four main villages in the district of El Tallán, we hoped this event could reach a wider audience and bring these messages of health and safety to more adolescents.  It was held after school hours to allow for participation among teens that attend other schools outside the district, or attend the local high school but are not enrolled in the 3^rd and 4^th year classes.

Please continue reading to discover the reality and the challenges of the project.