REPORT On the Right to Know Initiative JAMAICA SOCIAL SOLUTIONS

REPORT On the 'Right to Know' Initiative JAMAICA SOCIAL SOLUTIONS/UNICEF JAMAICA March 2003 1 Executive Summary Adolescents are gathered in a room mapping service providers in their communities and labelling them according to how they treat young people. From the man who refuses to sell condoms to children, to the woman who encourages them to protect themselves, they create a pictorial of the communities in which they live. They also collect data on the situation affecting young people, analyse it and recommend strategies for addressing the issues identified. It is not the traditional approach to adolescent development: it is the participatory action research (PAR) phase of Jamaica’s “What Every Adolescent Has a Right to Know” (RTK). In Jamaica, the majority of the programmes targeting adolescents are urbancentred, fragmented and unequal in quality and service delivery. While there is a paucity of services for adolescents who are unattached, disabled, illiterate, or living in deep rural communities, information used by programme developers is often not based on local knowledge, thus limiting their effectiveness. This increases the alienation of young people while reducing the likelihood that their real developmental needs will be met. Jamaica is one of 13 countries selected to participate in the global UNICEF RTK initiative. The initiative aims to promote the healthy development of adolescents by providing basic facts for awareness and prevention of HIV/AIDS, to enable them to make informed life choices. The initiative is expected to build on the capacity and efficiency of existing strategies so as to improve adolescent knowledge of and participation in services and activities, as well as to help bridge the gap between knowledge and behaviour change. The participatory action research (PAR) phase was initiated in July 2002 with thirty adolescents drawn from eight government and non-government organisations (RTK partner organisations) working with youth-related HIV/AIDS information and education programmes. They were trained in PAR and conducted the research that has informed the development of communication strategies for Jamaica’s RTK initiative on HIV/AIDS. The research process sought to answer the following questions from other hard to reach teens in urban and rural locations: - Why is HIV a problem in Jamaica? - What is it about HIV that young people in Jamaica need to know? - In what ways can they best receive the information they need? It was expected that in using youth from existing programmes as researchers and 2 using PAR methodologies would lead to local action by and on behalf of the adolescents, and would serve to strengthen the programmes on the ground. A project steering committee was formed to oversee the overall implementation of the RTK initiative in Jamaica. The young people and programme managers from the partner organisations were exposed to PAR concepts and methodologies in a oneweek residential workshop (facilitated by Cornell University, UNICEF/HQ, and a local research institution) and later in a one-day workshop, where the concepts were concretised and the role of adolescents as researcher was developed. The adolescent PAR researchers, representing 8 organisations in 3 parishes, then worked with the programme managers and the local research institution to select the target group from which to draw the sharing team (the research participants). The research team practised the techniques and planned the activities in pre-field sessions and the research sessions were conducted over a 3-day residential workshop. An RTK toolkit was developed to guide the adolescent researchers in the PAR techniques and methodologies for use in the researcher sessions. PAR research findings The research showed that young people, urban and rural, older and younger, all had an overwhelming desire to receive information about HIV/AIDS and its correlates in a clear, precise and non condescending manner. The young people, while displaying high levels of knowledge for the most part, revealed that they did indulge in risky behaviours. Some of the motivating factors for the behaviours differed by gender, in that boys were more motivated by the male group norms and dynamics while girls were more motivated by economic issues, arising from survival needs, family and peer pressure. The research participants drew pictures of their perceptions of HIV/AIDS, and discussed the HIV/AIDS issues surrounding their communities. Most of the participants had positive attitudes about persons with HIV with regard to their rights and needs for care and support, but were constrained to act on these due to community norms that sought to shun them, and display violent attitudes to them. The activity called “Ideal/actual” allowed the researchers and research participants to analyse the gap between the ideal source of information and the information they actually have access to. The ideal source of information varied by geographical location such that urban youth, who had a higher basic knowledge of HIV facts, wanted information in non traditional locations such as by ‘text messaging’, and on the back of tickets or in bathrooms in gathering spots. Rural youth however wanted the information from more traditional sources, in the school environment, and in youth and community clubs. The actual sources of information were in the school setting and through the media. All groups exhibited some level 3 of misconceptions and belief in myths as well as a deep desire for assistance to help them to deal with situations in which they may potentially feel uncomfortable, unable to make or articulate decisions, or unable to stick to their decision due to undue pressure. The adolescents spoke of the need for disaggregating the messages in order to target youth by age and sex. The adolescents also stressed that while information from a variety of sources was good, a very important source of information, guidance and support was from parents, but that this was often not realised in their realities. Capacity building of young people The young people learned new skills and techniques, especially such that they were able to function as seekers of information rather than in their usual role as peer educators or as givers of information. The young people noted however that this was a new and challenging role for them and one in which they did not feel altogether uncomfortable and in which they thought they could benefit from more exposure. The adolescents however did feel that they had benefited greatly from going through the process of training and research as they learned teamwork by working closely with other adolescents, and built an understanding of other ways to work with, and for, other young people. The best practices and lessons learned under this objective were: 1 The merit of using youth to youth interaction to set the stage for research, especially on these topics that may otherwise have been difficult with only an adult researcher present. 2 Having the adolescent researchers and sharing team present for a weekend retreat allowed for increased camaraderie, and interactions outside of the research sessions 3 Building expertise in PAR techniques is a time consuming process and while the adolescent researchers performed very well, the data could have been richer if the young people had had more practice in the process. Capacity building of partner organisations The organisations where the young people were affiliated also benefited from inclusion in the initiative. The concept of adult-youth collaboration was well taken from the beginning of the PAR research phase of RTK. At the end of the orientation workshop, one programme manager said, “I always planned for young people, but now will plan with them.” This sense of adult-youth collaboration was observed in the entire process of the PAR research phase. Subsequently, the role of programme manager was gradually developed. The youth PAR researchers highly 4 acknowledged the fact that the adults never imposed their own views on the researchers, but provided them with proper support when the youth researchers sought advice from adults. The programme managers also noted that they would benefit from further exposure in the techniques, and guidance as to how these could be used to design and implement future programme more closely suited to the needs of their target audience. One programme manager said, “I could now go into a community and have the people there tell us what skills and programmes they need – instead of imposing my thoughts on them.” The organisation's roles in the PAR phase, however, could have been more clearly articulated and developed in order to have supported the research teams more fully. Action in PAR: communication strategy development The major recommendations from the research findings for the development of the communication strategy were: • Disaggregating messages for young men and women such that those for boys focus on decreasing gender stereotypes, while acknowledging the role and influence of the group or ‘crew’. • Developing messages for young women that focus on the antecedents of risky behaviours, including economic influences and the protective role of positive peer models • Working with older men as to their involvement with adolescents, including dispelling certain myths that perpetuate the need for involvement with young girls or virgins. • Ensuring that the messages and the messenger as well as the location of the message are consistent with the needs of target audience to ensure maximum impact. • Developing or strengthening programmes that offer 'hands on' practical skills in areas where young people feel their life skills base is limited. • Ensuring that messages and strategies are consistent with the values and norms of young people singly, in groups, and as members of families and their communities. In PAR, however, research is not just for the sake of research. Research leads to action. In RTK, action is communication strategy development with active youth participation. The experiences of the PAR phase of the RTK initiative have generated different actions at various levels. Because of the skills they gained through PAR, some of the adolescent researchers were recently invited to act as youth facilitators in one of the National AIDS Committee’s semi-annual Parish AIDS Committee meetings, utilising PAR tools with adults and youth to explore fostering youth partnerships. Some are also using PAR tools such as condom mapping for their own activities. Programme managers 5 are also using or interested in using PAR techniques for their own programme improvement. Some of the research participants have become members of the youth organisations, and have been active as peer educators or changing agents. They feel that they learned more about HIV/AIDS and other relevant issues, and it is now their turn to help other young people to make informed choices. UNICEF Jamaica will continue to play a role of fostering active youth participation in the design, planning, implementation, monitoring and evaluation of HIV/AIDS/youth communication programmes. 6 Acknowledgements We would like to acknowledge the work of the many organisations and individuals that helped to make this report possible, Cornell University, especially Sarah and Keiko who facilitated the first training sessions with the young people; Ken, Jude Marie, Penny and Debbie from UNICEF who made presentations at the workshops and helped to set the tone of the subsequent workshops. Also, to the staff and programme officers of the 12 organisations (see Annex 5) that participated in the workshops and who shared their experiences of working with young people around HIV awareness and prevention – thank you. We especially wish to thank the young people who worked hard and tirelessly to understand the research method, the tools and the research guide. They also worked with the sharing teams to ensure their full participation, both at the research retreats and in the research sessions (see list of names in annex 5). Finally, Social Solutions wishes to acknowledge the team members that worked on this initiative. Rhian Holder, for her work on the weekend retreats and the data entry, Clement Branch for his insights into getting to the heart of the communication issues, and the two main officers that worked on this project, Deborah Duperly-Pinks and Brigette McDonald Levy, who also coauthored the final report. 7 Table of Contents A • • • • Introduction Background to Assignment - What is Right to Know? Rationale Context of RTK Jamaica – PAR, Capacity Building, Communication Strategy Objectives Page No. 10 10 10 11 12 B • • • Methodology Research Design Framework design Planning design Fieldwork design Tools Limitations/Research Design Discussion of competing objectives Strategies to overcome limitations Research Process Duration/Structure Overall participation Process & Content Forms Emerging issues/Limitations of Research Process 14 14 14 15 16 16 17 17 19 19 20 20 20 C • Results: I Capacity Building Process Capacity building {Best Practices and Lessons Learned} Results of the Organizational Capacity Building Survey 22 22 25 • II Research Findings Summary of Field Data HIV/AIDS Findings Other Fact Areas findings 10 Facts - comments/recommendations Ideal/Actual Activity Final Research session - Sexual Practices/Motivation 29 29 33 36 38 40 8 D • Recommendations/ Next Steps/ Conclusion Recommendations Guidelines for communications strategy development Project Design Research Design/Process Capacity Building NGO Programmes 47 47 47 47 48 48 49 • Next Steps - Local Action Next Steps/Local Action identified by adolescents Next Steps/Local Action for Programmes Next Steps/Local Action for UNICEF Conclusion 49 49 50 51 52 • Annex • • • • • Adolescent Literature Review Process Form Content Form 10 Facts List of Youth Researchers and Participating Youth Organizations 55 68 71 72-96 97-98 9 A Introduction ____________________________________ Background to the Assignment - What is Right to Know? UNICEF has launched a global initiative to collect data from young people for the production of the information package “What every adolescent has a right to know” or RTK. This package aims to promote the healthy development of adolescents by providing basic facts and messages for the prevention of HIV/AIDS in a manner that ensures that young people not only receive accurate information but are also empowered to make informed choices1. Jamaica is one of thirteen (13) countries selected world-wide to participate in this global initiative. Other countries participating in the Latin American and Caribbean region are Guatemala and Haiti. It is perceived that the information gathered in these research sessions will be used to develop global materials that can then be adapted for use in each country. Rationale Jamaica presents an excellent site for this initiative. The situational analysis of adolescents presented in the UNICEF Jamaica country programme notes that the spread of the HIV/AIDS epidemic is a cause for concern, with a total of 6,038 cumulative cases of AIDS reported by end-20012, which represents an increase of 4% in the year 2001 compared to the year 2000. Amongst adolescents, the spread of HIV/AIDS is of particular concern, with HIV infection rates doubling every year since 1995 and now representing the greatest incidence of new cases amongst all age groups. Adolescent girls are estimated at being 2.7 times more likely to acquire an HIV infection than boys are. Other sexually transmitted infections (STIs), such as vaginal discharges, gonorrhoea and syphilis, are also on the increase in adolescent age groups, despite apparent increases in the knowledge of STI prevention practices and in the prevalence of condom use. Lack of knowledge of the factors that contribute to transmission and the perception of not being at risk, are some of the immediate and underlying causes behind the high adolescent prevalence rate3. A preliminary review of existing HIV/AIDS communication programmes targeting youth revealed that they tend to be: • Urban centred (80% of youth serving organisations are in Kingston and St. Andrew, St. Catherine) 1 2 RTK background information sheet Facts and Figures: National HIV/STD Control Programme (Ministry of Health, 2001) 3 Taken from STIs of adolescents in Jamaica, UNICEF 10 • • • Focused on youth in school or those attached to a youth club/group Reaching “joiners,” i.e. adolescent who are motivated to join organised initiatives, groups, activities, etc. Few target unattached youth (i.e. out of school and/or ‘non-joiners’) The gaps identified can be summarised as follows: • There is still a large disparity between knowledge and behaviour. • We are not reaching “deep rural”, the working, out-of-school youth, the illiterate and the adolescents with disabilities. • We need to reach the “non-joiners” or those adolescents whom are not motivated/do not belong to formal youth organisations. • We need to create/establish mechanisms for active adolescent participation in the planning, development, implementation, monitoring and evaluation of existing/new communication programmes targeting adolescents. Context of RTK Jamaica – PAR, Capacity Building, Communication Strategy In Jamaica, it is hoped that the Right to Know (RTK) initiative will have two main outcomes: 1. Develop existing youth communication programmes UNICEF wants to build on programmes already in existence and use collaboration to bring about youth-friendly services and a supportive environment for youth to avoid HIV infection or receive help if they are infected. 2. Mobilise local action UNICEF has chosen to work directly with youth, believing that this can empower young people to take ownership of their own future, recognise the contribution they make, and mobilise them to reach out to other young people. A central goal is to involve the young people as active creators of information and knowledge4. The sites for the Participatory Action Research phase of the RTK initiative will focus on a wide cross-section of existing youth partners in St. James, St. Catherine and Portland. 4 Notes from Penny Campbell, ADP Programme Officer for inclusion in RTK Toolkit, developed by Social Solutions, to guide the research sessions. 11 Figure 1 - Diagram to illustrate the Context of RTK Jamaica – PAR, CAP Building, Comm. Strategy Youth communication progs. Research (PAR) Knowledge/Information (how best to communicate the message to Jamaicans, especially marginalised groups) UNICEF Communication Strategy (if required) Improve existing youth communication programs Local action Objectives The overall initiative goal is: To provide adolescents (both out-of-school and in school) with information and life skills for the prevention of HIV/AIDS. In order to achieve this goal and related outcomes, UNICEF has organised the initiative in three separate phases. The first phase saw the generation of the 10 facts for adolescents (see Annex 4). Phase two is the Participatory Action research phase, and the third and final phase is the development of the national and global communications strategy. UNICEF Jamaica in establishing the second phase of the RTK initiative in Jamaica, developed a project that had two specific objectives: 1 Capacity building of existing programme partners of UNICEF in the area of Participatory Action Research so as to generate data and contribute to better programme design, (specifically by training adolescents to work as youth researchers). 12 2 The generation of data on HIV awareness and prevention, (captured in the 10 facts), prepared by a global panel of HIV experts, and the identification of recommendations as to how the 10 Facts may be adapted for the Jamaican context. The Jamaican part of the initiative was organised by UNICEF Jamaica, and overseen by a steering committee of critical stakeholders in the areas of Adolescents and HIV. A local research organisation, Social Solutions, working with UNICEF NY and Cornell University was asked to be part of the implementation process. The actions to be carried out in this phase of the initiative were: 1. Prepare an adolescent friendly version of an existing review of literature in order to facilitate adolescent understanding (see Annex 1). 2. Conduct training (in collaboration with Cornell team) for adolescents and programme managers of 10 UNICEF partner organisations 3. Guide the data collection by the adolescent researchers, and have oversight of the data collection process 4. Prepare a final project report, under the guidance of the steering committee, including findings relating to both objectives and recommendations. This report represents a summary of the outcomes of the project. 13 B Methodology _________________________________ Research Design There were two main objectives to be kept in view in designing and implementing the research 1. The capacity building of young people through provision of basic skills as researchers using PAR methodology and tools 2. Collection of research data relevant to the 10 Facts of the RTK initiative Framework Design: • Formation of a project Steering Committee comprised of UN agency representatives, young people, Programme Managers and representatives from Government Health agencies as well as Health NGOs. • Additional framework support came from UNICEF NY and Cornell University. Planning Design A Participatory Action Research approach provided the broad framework for the research. Particular NGOs that were currently operating HIV/AIDS outreach peer education programmes featuring young people were selected as the base groups from which to form research teams. These NGOs represented rural and urban locations, including an urban tourist resort area. The research design was planned in a collaborative manner with young people, UNICEF, Cornell University, NGO programme mangers and the local research institution, Social Solutions. A main 5-day workshop was held, with Cornell University representatives leading the process. The objectives of that workshop were to: • Introduce the young people to the methods and tools connected with PAR • Acquaint them with the RTK initiative and its objectives Figure 2 - RTK Montego-Bay Workshop 14 A subsequent 1-day workshop was held, with Social Solutions, the local research institution leading that process, in order to: • Concretise basic PAR concepts and tools • Develop an understanding with the adolescents of their role as Research Facilitators and especially within the context of the RTK initiative • Decide on a basic field work design • Develop criteria and concretise the roles and responsibilities of the core research group and their support members • Initiate formulation of the composition of the various sharing teams based on the unique characteristics of each community/locale • Develop a preliminary work plan for each group, including the sharing up of RTK 10 facts amongst the various groups (all groups to conduct HIV/AIDS) • Introduce the group to the RTK Toolkit, compiled by Social Solutions, which would act as a resource manual for the groups and help guide the research Figure 3 - RTK Oracabessa Workshop Fieldwork Design: • Distinct geographical area groups linked to the selected NGOs - St. James, Portland and St. Catherine. St. Catherine comprised two groups - Portmore and Spanish Town • Research teams made up of core researchers (research facilitators) and their support group (mobilisation, logistics, scribes) • Sharing teams (participants - composition based on 'hard to reach' youth and other unique characteristics of each locale, as based on local knowledge of young people and programme managers, guided by Social Solutions in terms of gender, age balances) • A Social Solutions research person to be present at each research session for resource and guidance • Use of the RTK Toolkit as a resource manual and field guide • Steps developed for undertaking the research: Pre-field meetings to confirm the sharing teams, materials, acquaintance with theme areas decided on by each group, role-plays, role of Social 15 Solutions at research sessions and any other concerns. A Social Solutions representative would attend and guide these meetings Fieldwork sessions to take place in a residential setting over one weekend due to probable difficulty with logistics of physically reaching a variety of communities within each geographical locale. A Social Solutions representative would attend these sessions for support and as a resource person A mid-term clinic, following initial fieldwork sessions to review emerging trends, issues and/or gaps from the raw data. To decide whether to return to the field and how Data Analysis, including the young people, but led by the country research institution, Social Solutions Presentation of a draft final report to Steering Committee Tools A variety of PAR tools were to be used in the research process. The adolescents were exposed to these tools over the course of the two workshops. Tools included: *Mapping *Myths/Facts *Lifelines *Brainstorming *Ideal/Actual *Problem Tree *Venn/Roti Diagrams *Case Stories *Priority Matrix *Spider Diagrams *Drama Skits *4 Pictures of HIV/AIDS *Songs Figure 4 - from l - r Spider Diagram, Problem Tree, Lifelines Limitations/Research Design Discussion - Research Design and the two (competing) objectives: The two specific objectives were: 1. Capacity building of young people through provision of skills as researchers using PAR methodologies and tools 2. Collection of research data based on the 10 Facts in RTK In pursing both objectives three core challenges were identified - the process relied on 16 young persons who: • • • had never been trained as researchers had been trained as peer educators - persons trained to give/share information, not receive it were at a number of different levels of adolescent development A central challenge, therefore, for the research group was how to collect needed data while ensuring the capacity building objective was still met. Outlined below are the strategies that were developed to ensure useful and relevant data while still providing an enabling environment for the young people. Strategies for overcoming the challenges: • The Development of the RTK toolkit. A toolkit, compiled by Social Solutions, was to serve as a resource manual for the young people and to act as a foundation guide for the research process. Recognising that the young people had to understand and absorb a large amount of information, such as understanding the PAR approach, learning PAR tools and their objectives, it was imperative that they be given some easy references and work books. The Toolkit was designed to: Provide a focus for the research through highlighting the context of the initiative and its objectives The main elements - PAR approach, importance of communication, data generation based on the 10 Facts Delineate and emphasise the role of a facilitator Reminders of PAR tools and their procedures/utility Provision of research Theme Guides for each group area. Theme Guides included suggested PAR tools, and their sequencing, to use for each session The toolkit also included a process evaluation form and all 10 Facts contained in the Annex. The toolkit was developed in an adolescent friendly format with easy to read text and with full use of colourful graphics and photographs. Encouragement was given for the young people to use other tools if they chose or adapt the ones presented. The theme guides tried to explain what outcomes were needed for each session and also highlighted the need for preparation work. The toolkit became a 'mentor' as such. • The need for a second workshop was identified in order to further contextualise the project, give focus to the research and reinforce the role of the young people as researchers, all as detailed earlier. • Process and Content forms were also designed. The Process form was designed to help young people engage in critical thinking in an attempt to inform future sessions and generally to reflect on the research process and outcomes of each sessions; specifically the forms asked for: A profile of the participants 17 PAR tools used/sequence Any adaptations/innovations in PAR tools & why What was particularly successful/not so successful Content Forms were also developed (with input from UNICEF NY) to: Identify the Fact areas under discussion Key areas discussed for each fact Content of participants' information and how used/not Following each research session, debriefing sessions were to be facilitated by Social Solutions representatives, using the Process and Content forms. • Pre-field meetings as detailed earlier, but with the overriding objective of providing an opportunity for the young people to recognise and engage in the need to prepare fully for the field work Attendance at all the research sessions by a Social Solutions representative. This was seen as integral to collection of relevant and useful data. It was recognised and identified as a limitation of the project, that adolescent researchers may not have the experience to fully probe and capture required data. The Social Solutions representative was expected to be available as a resource, to provide unobtrusive assistance and to make judgement calls on when intervention was necessary, given the competing objectives. However, in the true spirit of capacity building, interventions could not be very frequent. Recognition of and provision for a need to return to the field. Given the competing objectives it was realised that the possibility of returning to the field to fill gaps may be necessary and as such was planned for in the design. • • 18 Figure 5 - Front Cover: RTK Jamaica Toolkit RTK Jamaica Tool Kit Developed as a Resource Kit for Adolescents Research Process Duration/Structure The fieldwork took place between September and November 2002 although one group actually did what turned out to be an early trial session in late August 2002. The August session was conducted by the Spanish Town team and held at their summer camp in St. Elizabeth Parish. This team, although noting that they received useful information, decided to conduct another research session following the same procedures as the other teams. The structure of the research sessions took the form of residential workshops over a weekend period. This was decided on to negate the logistical challenges that would be posed were the adolescents to travel to remote or risky communities within their Parishes. Additionally, it was seen as a strategy that would work to reduce the risk of attrition by sharing team members. Small hotels or guesthouses were the venue of choice and this emerged as an important incentive for the sharing team members as many had never been outside of their immediate vicinity nor stayed at a hotel before. It also facilitated rapport building between and among the researchers and the sharing team. • • • Portland session - September 13th - 15th 2002 St. James session - October 11th - 13th 2002 Portmore session - October 11th - 13th 2002 19 • • Spanish Town session - October 11th - 13th 2002 Final combined fieldwork session focusing on areas important to communication content issues - November 30th 2002 Overall Participation For the four residential sessions the overall sharing team participant profile was: Table 1 - Sharing team participant profile Male Female Age Range M Portland St. James Portmore Spanish Town TOTAL 7 8 8 9 32 6 5 6 8 25 12 - 21 16 - 19 14 - 23 13 - 19 12 - 23 F 12 - 18 15 - 17 14 - 23 13 - 18 12 - 23 Total attached to orgs. 10 8 6 17 41 Total unattached 3 5 8 16 Process and Content Forms As indicated earlier these were designed as reflective tools, however due to the structure of the research session (full day/weekend), it was discovered that the adolescent researchers were very tired at the end of each day and their concentration at an end, thus these sessions had to be truncated. This was found across all four groups during the debriefing sessions. Based on that the forms did not produce all the original desired results. In reality they were used as a guide to initiate debriefing reflexive sessions held at the end of each day. Based on the realities, these sessions had as their main objective reflections on how the day went, what went well, what could have been done better, and how the adolescents felt about their performance and what, if anything, they wanted to do differently. Additionally, in some cases there was discussion on teamwork issues. Also noted was that some of the information asked for in both forms was already captured on the process flip chart notes. It is recommended that these forms be reviewed and redesigned based on emerging realities, before being replicated. Discussion - Several issues emerged over the course of the research process that should be kept in mind when replicating this research process and are highlighted below: • Use of adolescent researchers and its consequences in terms of the research process. The concept is an innovative one, which worked well in terms of establishing 20 Emerging Issues/Limitations of the Research Process rapport and trust with the adolescent participants. Additionally, it provided validation to these participants that their views were being seriously sought. In terms of building the capacity of the research adolescents and empowering them, this too has been achieved to some extent. However, care must be taken that overpromotion of this role is not carried out as this could lead to the creation of expectations that can not be met. For instance, one group felt so empowered following the training sessions that they proceeded to implement the research without the benefit of using the Toolkit/guide or from guidance from the research institution. This resulted in a situation where the group, while collecting some data, did not retain a focus on the primary research objectives. It also resulted in the dominance of one strong personality over the other adolescent researchers. Careful handling of the situation had to be employed to ensure that the adolescents did not feel dis-empowered in the process. Given the time to reflect, and the adolescent need for conformity, the group decided to re-enact their research session following the same procedures as the other Parish groups. There was a lack of adequate field preparation on the part of some of the adolescent researchers, especially in regards to re-phrasing and/or sharing the 10 Facts5. This could be linked to the fact that the adolescents were in school over the course of the research process and found it difficult to meet. Although emphasis on the importance of preparation was made during the pre-field meetings this did not always translate into action. A clearly articulated support role from the programme mangers would have been helpful here. Given the fact that all of the adolescent researchers were involved to some extent with peer education programmes, this resulted in some of the young people returning to a teaching/educating orientation rather than a facilitative research position, which resulted in reduced interaction from participants and probable loss of data. Given the lack of social sciences training and different levels of exposure, some of the young people lacked the ability to initiate a range of probing and appropriate questioning of emerging issues, thus resulting in some probable loss of data Given the differing levels of adolescent development amongst the group, this resulted in situations during the research sessions where some of the young people forgot their researcher role and became participants, and some, disruptively so. There were also some occurrences of adolescent type behaviour (rowdyism etc) during the free times at the residential research sessions. • Collecting research data within a capacity building project. Although efforts were made in the pre-field meetings to devise acceptable systems of discrete interventions by the research institution and by other adolescent researchers, this did not always 5 The 10 Facts are more fully discussed in section C II 21 occur during the actual sessions. This was due to a variety of reasons; the need for the adult researcher to keep a low profile - physically and figuratively, forgetting of prearranged signals, hesitancy to break a rhythm and above all, the need for the empowering activity/atmosphere to proceed uninterrupted. Interventions by the research institution in regards to data collection, therefore, had to be kept to a minimum due to the objective of building the capacity of adolescents. During the process, more weight was actually given to the capacity building objective, because of the human element. Attempts were made in the debriefing sessions to discuss how we could have worked better as a team in regards to the data collection process. In an initial capacity building activity such as this, it is more correct to err on the side of the human element than of that of the data. • Limited representation of the 'hard to reach' youth. This objective met with some success although a higher percentage of 'hard-to-reach' youth would have been better. This was mainly due to the decision to not go into community locales, given the distances, difficulty in securing transportation on an ongoing basis, additional logistics and the safety of the adolescent researchers. Holding residential research workshops alleviated most of the above issues but did result in some reduction of the 'hard-toreach6. Research Participants, however, did represent the unique characteristics of each group's communities as well as some representation of the 'hard-to-reach'. Miscommunication/Misunderstandings of roles/expectations of Programme Managers over the research process. The roles of the programme managers needed to have been more fully articulated especially as it concerned their role in supporting the adolescent researchers in preparation activities. This is more fully discussed in the next section. • C I ___________________________________ Results: Capacity Building The first objective of this phase of the RTK initiative is: Capacity building of existing programme partners of UNICEF in the area of using Participatory Action Research to generate data and contribute to better programme design, specifically by training adolescents to work as youth researchers. The capacity building was addressed at two levels, the first was of the youth researchers and the second in terms of the programme managers. The capacity building of the youth researchers was mainly through: 1 Exposure and training in PAR techniques at the 1 week workshop, the subsequent 1 day workshop and the 1 day mid-term clinic. 2 Practice in the PAR techniques and in the pre-field activities 6 'hard-to-reach' being defined as those unattached youth 22 3 4 5 Adapting the Toolkit and conducting the research in the weekend workshops Reflecting on personal experiences in the mid project clinic, with an opportunity to share and question previous experiences Reviewing the results and identifying gaps in the data collection. Did we achieve capacity building of the youth? Yes: • • Young people learned new skills and how to apply them Young people had an opportunity to work with other young people in the role of researcher Did we train youth researchers? Yes and No: • • Young people were more comfortable in the role of teacher and had a hard time listening without teaching – at times compromising the integrity of the data We did not succeeded in creating youth researchers. Perhaps the expectation of developing youth researchers in one week was unrealistic given the complexity of the research process. However, we did succeed on developing a cadre of young people that understand the importance of research, the application of PAR researchers methodologies as a data collection tool and have the capacity to function as data collectors with guidance. There was not enough time allocated to the training of the youth researchers • Discussion The process of capacity building is a time intensive one and the process benefited greatly from having the one-day clinic at Oracabesa, though this was not in the original plan. This workshop allowed the young people, once they had opportunity to assimilate and absorb the information from the intensive one week training, to question some of the concepts and ideas that they were grappling with and to focus on the role of the facilitator. One of the critical learning points in this process is the difference between the peer educator and the researcher. Some of the young people were able to recognise that they prefer to teach rather than facilitate, whereas others embraced the challenges of facilitation and uncovered strengths they did not know they had. The youth researchers also noted that they felt that they had grown though this process, in terms of exposure and building understanding of new ways of working with other youth. The adolescents also indicated that they feel the process promoted self-development through the reflection process, and some of the adolescent researchers noted that upon reflection, they are more aware of what their talents and desires are. 23 Best Practices and Lessons Learned The Best Practices that were identified in this process are: 1 Using adolescent researchers in a youth to youth process increased ease of rapport and trust building. The researchers, based on their peer education work, were used to interacting with other adolescents in a workshop type atmosphere, and as such were comfortable. This in turn increased the comfort level of participants and the age similarities were particularly helpful when discussing issues of sexuality and sexual practices. 2 The use of weekend workshops for the research enhanced the process of rapport building, as the adolescents were able to socialise in the down time and then work together in the research sessions. This also decreased the attrition rate of the sharing team – and this was important as evidenced by the difficulty to get the sharing team members together for the final sharing session. Young people working together in Portland. Young people from Spanish Town working together. The main Lessons Learned were: 1 Training in PAR technique requires more time, perhaps one week for exposure to the techniques, and another week to practice. 2 The selection of the participants to be the adolescent researchers needed to have been based on the criteria of a good facilitator (rather than a good peer 24 3 4 5 educator) Training fewer adolescents, but more intensely, might have led to greater data integrity. Perhaps if we had chosen 12 adolescents and exposed them to intensive training and one on one experiences as research facilitators, they might have been more adept at probing and facilitating the research process, and less likely to revert to their original role of peer educator. A team of adolescent researchers could have facilitated all the sessions with the assistance of the young people in all of the parishes. This would have allowed the adolescents researchers to learn and grow from each experience and so at the end of the four sessions, they would feel more comfortable in their role of researcher. Less emphasis placed on discrete categories of adolescent researchers leading the process as opposed to 'older' support groups (research institution, programme managers). Reduced emphasis would have promoted a more team/collaborative approach, reduced the risk of marginalising the programme managers and allowed the research institution the opportunity to share their expertise to a group (young people) who were willing to embrace it. The emphasis may also have placed undue pressure on the young people, who though inexperienced, were trying to meet expectations of being and leading a research process. Did we achieve capacity building of the partner organisations? Capacity building in the research organisation for the purposes of this project is defined as their familiarity with and use of PAR techniques in programme development and design. This was assessed by a post project evaluation that asked the programme managers to assess their use of PAR prior to the start of the project, whether they are using PAR techniques now, and indicate their willingness and interest in using the PAR techniques in the future. The results of this survey are discussed below. Results of the Organizational Capacity Building Survey All organisations think that adolescent participation is an important aspect in the delivery of programmes for adolescent, and all organisations noted that their policy and mission statement spoke to adolescent participation. In organisations where there was no specific mission statement, the unwritten policy and the range of activities promote adolescent participation. However it needs to be noted that while many of the organisations had policies or underpinning philosophies that call for participation, this participation occurs mainly through solicitation of opinion and feed back on programmes. The programme areas where adolescents participate are: • • • • Development of policy – NCYD Youth Policy and MoE HFLE policy Design of programme – some of the programmes Design of interventions – all programmes Evaluation – 2 organisations 25 Adolescent Participation occurs less so in the formal settings of boards and committees. Only 4 of the 107 organisations had adolescent participation at board level. Children First, Youth Advocates and Youth.Now had active membership on the board, and the MOEYC had adolescent representation on school boards and disciplinary committees. Two organisations indicated that they were looking into inviting youth to sit at this level. Nine of the ten organisations polled responded that they conducted programme evaluations and all stated that they involved adolescents in different ways. Adolescent involvement varied from providing feedback and comments (after training) and though individual questionnaires, to designing the M&E intervention. All the organisations involved stated that their organization provided spaces for adolescents to develop opinions, that information was provided to them in issues and in a simple format, and that their opinions once expressed was then taken into account in the design or reformulation of programmes. When asked to rate the organisations on a scale of one to four, four being very good, on facilitating adolescent participation all organisations rated themselves 3 3.5 or 4. Use of PAR The programme managers were then asked to assess, knowing what they now know about PAR did they used to use it. Seven out of the 10 organisations indicated that they did use some PAR type techniques, although none of them referred to it as PAR. In addition, when asked about their use of PAR techniques, the organisations indicated: • • • • Yes they used PAR, but in an ad hoc rather than in a structured way RTK workshop helped to put structure to mechanisms Used aspects of PAR to help develop messages Used some elements and require consultants that work with the RTK project to use them more The ones who indicated that they were interested in using PAR further in upcoming work cited the following: • Not using PAR to the full extent, and feel that it would add to the integrity of their work • That they felt that they would need to know more to use it better The PAR type techniques were used by both programme managers and young people. When asked whether they would like to use PAR in the future, all organisations said yes, in the contexts of: • Helping restructure the programme to better meet the needs of the target audiences – such as programme volunteers and beneficiaries 7 Ten of 12 organisations completed the survey 26 • • • • Enhance sense of ownership in the programme through active participation Establish new programmes for HIV awareness in new communities such as through Drama Clubs, and community groups Developing new messages for Peer education programme and health education, including pregnancy prevention, and STI awareness Delivery of programmes in the school setting, such as substance abuse, personal development, relationship building, career guidance, HFLE, etc The programme mangers gave examples of resource needs in order to efficiently and effectively implement PAR techniques to enhance their programme delivery. • Further training and exposure • Refresher on facilitation techniques • How To manuals • Ideas for how PAR can be applied in programme development, including strategies, games etc. • Assistance to conceptualize the research phase • Fora for Interagency sharing of information Best Practices and Lessons Learned: The best practices identified were: 1. Adult-youth collaboration The concept of adult-youth collaboration was well taken from the beginning of the PAR research phase of RTK. At the end of the orientation workshop, one programme manager said, “I never thought of using teenagers to actually develop the programme, but now will go back and use the problem tree and other techniques to plan the programmes.” Another programme manager said, “I always planned for young people, but now will plan with them.” This sense of adult-youth collaboration was observed in the entire process of the PAR research phase. Subsequently, the role of programme manager was gradually developed. The youth PAR researchers highly acknowledged the fact that the adults never imposed their own views on the researchers, but provided them with proper support when the youth researchers sought advice from adults. 2. Application of the PAR approach in their own programmes The importance of facilitator’s roles for community interventions was recognized not only by youth researchers but also by programme managers. One programme manager said, “I could now go into a community and have the people there tell us what skills and programmes they need – instead of imposing my thoughts on them.” (Montego Bay orientation workshop). Programme managers are expected to continue using the PAR approach in their programme context. 27 The main Lessons Learned are detailed below: 1 Programme managers need to have a clear and well articulated role in this research process and need to be supported to perform this role well 2 Programme managers needed strengthening in how to support the adolescent researchers and the PAR process 3 Programme managers could have benefited from sessions outside of those with adolescents, especially to allow them to see the value of PAR techniques in their every day work and perhaps exposure to practical applications of the technique in their programme design and implementation 28 II RESEARCH FINDINGS Summary of Field Data In this section the findings relating to HIV/AIDS will be discussed first, followed by findings from the other Fact areas. HIV/AIDS All four groups researched the HIV/AIDS Fact area. The research participants drew pictures of their perceptions of HIV/AIDS, and discussed the HIV/AIDS issues surrounding their communities. In general, the HIV/AIDS findings are consistent with data previously generated from HIV/AIDS research and thus can be seen as validating that data. Similarities HIV/AIDS Research about HIV/AIDS was conducted across all groups and the main similarities that emerged were: • The overriding desire by young people to receive straightforward information on HIV/AIDS. This information should be presented in their 'language' in a direct and honest manner, not necessarily using gross language, but presenting the facts without trying to obscure them. The worst fear in relation to HIV/AIDS was fear of death The best hope in relation to HIV/AIDS is for a cure • • Results of Spanish Town group on best hopes for HIV/AIDS 29 Similar Attitudes/Community: • The community has direct impact on adolescent behaviour. Community attitudes are perceived as hostile towards persons living with AIDS, across all four groups. This communal/environmental attitude, as such, becomes more of a negative than a positive factor in youth behaviour. Examples of the levels of hostility are noted below: Portmore "Very dangerous – death sentence" "Large stigmatisation" "Great persecution of HIV+ person – almost lynching" "Group discrimination" Portland "Community would treat HIV+ badly - e.g. run dem8, stone dem, curse dem, believe they are the worst people on earth" St. James "…avoid, put in home by themselves, kill dem" Similar Attitudes/Individual: • Individually, across groups, there was an expression of sympathy, however, this may exist only on an individual attitudinal level. It is not known if this translates into behaviour, given the collective thrust toward hostility. In addition, there were sotto voce comments made in some groups regarding the belief of HIV/AIDS as still being strongly linked to homosexuality which is consistent with the general beliefs in Jamaica. Male homosexuality is also seen in strong negative terms in Jamaica. 8 'dem' - Jamaican vernacular for 'them' 30 Table 2 - Differences across Groups Younger AGE Older URBAN/RURAL Sources of information *good level of age appropriate knowledge *gleaned from the popular media *less overt interest in sex * more complex understanding of issues surrounding HIV/AIDS * deep interest in sex/activities * want access to information/pro ducts in nontraditional places - hang outs, club bathrooms, street corners * Traditional places have barriers for them attitudes, lectures, prescriptive * more traditional want the information brought to them - classes, youth clubs Male GENDER Female * Older girls more vocal than boys, but boys increase their participation as they become more comfortable with environment For /In Discussions * Boys more vocal than girls in rural areas Levels of Knowledge/Prevention: • Levels of existing knowledge in terms of prevention is good, especially on: • Condom use • General knowledge on HIV/AIDS - How to prevent it • Younger participants (10 -12yrs. ) also displayed basic general knowledge in this area, although the older participants (15 - 19 yrs.) seem to have a greater depth or grasp of the information, as would be expected • The participants from the urban areas overall, seemed to be more wellinformed • This knowledge is predominately gained through the media - both oral (radio) and visual (TV, newspapers). What seems clear is that the messages on prevention are being effectively communicated however, there is an indication that other less common methods of prevention would benefit from wider exposure. For example, there was very little knowledge by participants in one session about female condoms. The participants were given a demonstration, were very interested and indicated a need for more generalised available information. Levels of Knowledge/Transmission: • Levels of existing knowledge in terms of transmission are less sure than on prevention. Participants were generally able to differentiate between the better known facts and the myths, however overall, they were much less confident and assured about what really was true as against false. 31 Myths: • There is still some level of misconceptions, ambivalence and levels of suspicion as noted above. For those groups who completed the Myths/Facts activity the areas where they were unsure are presented below: Table 3 - Participants responses in the 'Don't Know' category of the Myths/Facts Activity Portland Men who are idlers often get STDs A person who is not gay does not need to practise safe sex. You can get HIV infection from food or drink You can tell by looking at someone that he/she has HIV Using a condom is the most sure way for young people to know they won’t get an STD You can catch HIV if someone with the infection sneezes on you Portmore Becoming a Christian will cure a HIV positive person St. James If you kiss a person with HIV/AIDS you will get it HIV cannot be cured Figure 6 - Portmore Research Workshop snippets 32 Other Fact Area Findings Fact > Physical Development • Participants have a fair understanding of what this concept means. There was general agreement that girls mature before boys, but there was some confusion as to what that actually meant. One girl said it meant that girls stop ‘romping’ sooner. There was also an information gap about the biological reasons behind the physical changes of puberty. Fact> Gender • There were general indications of gender stereotyping in both male and female representations and gender stereotypes were often invoked in a heuristic manner during general discussions. Of interest was that for both groups the lifelines ended at the late 20s – early 30s, and only after probing did the participants identify the next stages. The boys disagreed that men stopped having sex in their 60s. The boys also felt that the 16 year old girls were getting pregnant for older men (27+), and most girls agreed with this. • Fact > Livelihood • This concept was not understood in its real sense by the participants as is indicated below and with discussion it was suggested that another, more Jamaican, word be used, something that is more indicative of jobs. What is livelihood? Group 1 Dancing, Singing, Being active, To participate, Being lively, energetic, Having a good and happy life, Working Group 2 Being active, Flexible, Lively, Jovial, Having fun, Enjoyment, Happiness, Being free Since the adolescents sharing team members had differing view as to the meaning of the word livelihood, the team discussed the meaning as presented in the 10 Facts, and the group continued the session using this standard meaning. 33 The meaning that guided the discussions was: Livelihood is everything a person should know has and does to make a living. This includes educational background, capabilities, resources and opportunities that enable people to make money to support themselves. The young people identified obstacles that they faced in being able to achieve the skills needed to attain a reasonable livelihood, as Male Challenges Police brutality Lack of education Lack of ability Preferences Violence Disabilities Neglect by parents Female Challenges Pregnancy Freedom limited Not allowed to have sex until married Not given the opportunity Child abuse Parents regret at having 'she'(i.e. having a female child) The young people (and this Fact was researched within a group that contained street and working children) aspired to be: Teachers Business persons Journalist Bank clerk Singer Computer analyst Criminal lawyer Flight attendant Social scientist DJ Architect They identified that in order to achieve these goals they would need a plan, that had to have certain key elements. Some of the critical steps were: Attend college, 6th form, university Get more professional help Study more – certified. * Pursue subjects that are required Acquire financial help * through student loan 34 Believing in yourself Have a plan “B” The adolescents noted that they needed to get more information and skills about livelihood skills, including: How to involve one-self in vocational (practical) activities Need a mentor (guidance) Mentor should have similar background as yours Exposure to the information and skills that relate in the choosing of future career Job experience Training Have another, well known skill (Plan B) The young people agreed that sometimes adolescents had to work in order to help out the family, but work should not be at the expense of going to school and work should not be dangerous. They could not agree though on the age that it was okay to start to work, some said 12 other 13 but they did agree that by age 15 it was okay for most children to be doing some type of work if the family needed it9. Figure 7 -New Myths: Associated with pregnancy and contraceptive use Stand up after you urinate to prevent pregnancy Squeezing your tummy will get the sperm out, thus pregnancy won’t occur The more condom you use, the lesser your risk of becoming pregnant Pregnancy can cure AIDS Withdrawal can prevent pregnancy Pepsi and Phensic10 prevent/abort pregnancy. (Participant comments that a friend uses them together and it worked, as her period came afterwards. Directions: When you take the pills you jump then you take the Pepsi afterwards) Withdrawal can adversely affect the male. However one male says he tries it and he didn’t have any discomfort 9 10 The legal age of work in Jamaica is 14 years in the home or home industry, and 16 in the formal labour market (Levy and Hardee, 2001). common Jamaican painkiller 35 10 Facts - general comments/recommendations For the most part participants had a general understanding of the concepts enshrined within each of the 10 Facts. There were however some important issues. 1. In most instances the language of the Facts was not simple, clear or easy to understand. In general, sharing the facts took a lot of time, and some participants lost interest. Additionally, it allowed the adolescent researchers the opportunity to return to their comfort zone and once again become peer educators. Whilst educating they lost awareness and sensitivity to the participants who had 'tuned out'. Adolescent Researchers were asked in the pre-field meetings to become familiar with the Facts they were going to use and to discuss and come to agreement on how they were to do this in a participant friendly format. However, the teams showed differing levels of preparation within and between themselves for the activities. Some groups used the toolkits exclusively, others adapted the methodologies to a lesser or greater extent. Some groups and individual members were more familiar and comfortable with the facts than others. On a precautionary note, from a research perspective, use of the 10 Facts in the research sessions introduces another dimension into this already two dimensional project - capacity building, research, and with the facts - peer educating. 2. 3. The following represents a variety of ways that the 10 Facts could be used effectively and should be seen as general recommendations: 1. As a preparatory pre-field activity ensure that Facts are re-phrased into culturally appropriate and adolescent language and then share with research participants. This could be a collaborative task between programme managers and adolescents, thus increasing the participation and ownership of programme managers, as indicated earlier 2. Instead of automatically sharing all the 10 Facts for each session, share the ones that have had particular relevance to issues under discussion in a session 3. As a general recommendation do not use the Facts in research sessions, unless used in a more casual sense and/or based on arising issues 4. As a post project tool, the Facts to be adapted (language) and used in regular peer educator sessions Once meanings were shared and understood several of the participants found many of the facts to be useful and relevant to their realities. 36 Using the 10 Facts • The research team from Portland did make a useful re-phrasing attempt in using the facts. They used the strategy of reading out the facts and asking their group to rephrase it in their own words. This worked fairly well, except it took a long time. The following is an excerpt from this session: Gender: job, but many man always start our woman to look girl before time". Fact #8 – "Yes women have right to have sex and protect themselves but want for a Fact # 10 – "to me you are mentally suffer because you are still a child, your body needed growing up more sexually physically". • The Spanish Town research team asked participants to rank the 10 facts on Human Rights, after educating them on it. Which is more important? Education (16) Survival (11) Health (11) Work [livelihood] (8) Information (5) Security (5) Safe and healthy environments (5) Freedom from sexual violence (5) Free choice Equality Development Keeping in line with the general trend in Jamaica, the participants ranked education as the most important human right. • The Spanish Town team also used the Facts on child's rights to look into cause and effects as noted by the following diagram looking at who violates child rights and what action should be taken against them. 37 GROUP 3 – DOMESTIC VIOLENCE Problem: Parents’ drinking habits Parents should not take out problems on children and stop violence Effect: Solution: Lower grades, physical abuse Parents should react calmly to problems Save money to support family instead of drinking Ideal/Actual Activity • This was an activity that offered a lot of potential in terms of identifying relevant information to inform the development of communication strategies. However, in most instances there was a problem of not enough probing questions being asked by the adolescent researchers. Interventions were made intermittently by the research institution. The activity did yield quite a lot of useful information, but could have had more substance, especially in regards to content for the messages. The absence of these probing questions led to the need for a return to the field to fill some of these gaps. Should there be replication, it is recommended that this activity be an agreed upon site of intervention or co-facilitation by research institution facilitators. Generally, what emerged was: • An emphasis on the delivery and packaging of messages using popular figures • Use of the Internet with highly interactive and colourful graphic sites and the need for these sites to be publicised • Locations were also identified and these ranged from the traditional - guidance classes, youth clubs, church, parents and friends to those considered more nontraditional such as: on the street corners, posters located in hang-out spots, nightclub bathrooms, bus tickets, sex conventions, Expos and so on. • The electronic media (radio, TV and to a lesser extent the Internet) was a main source for information, but the participants noted the need for information to be shared in a more straightforward manner, using plain language and adolescent hosts and participants. Specific references were made to the following Actual programmes/areas as sites that are seen to be worthwhile by the young people and could be strengthened, as they have indicated in some instances: 38 • • • • • • • • • • • • • • Internet - www.healthwatch.com ; www.healthchannel.com ; www.BET.com (Rap it up); www.discovery.com (for information on HIV/AIDS); www.whaddat.com (colourful, exciting, graphic); Publication of websites that offer youth friendly information TV - Health watch, T.L.C.; Health Station/cable; TV - Man Talk TV - 'Teen Seen'. "Teen Seen requires more interaction with persons on the road". "Not straightforward enough – persons get lost, frustrated (don’t’ want to go there)". "If Teen Seen had some adjustments the programme would be more effective (Ideal)" Radio - “Uncensored” Radio programme - Fame FM, Mondays 9p.m. "don’t go round no corners/straight". "Personal", "testimony". "Straightforward, easy to understand, accept information more readily". "Raw – using the current slang (layman’s terms)". Print media - The Star's question and answer column Drama group - “very effective” Health Centres/Guidance Counsellors - but with youth friendly, non-judgmental attitudes, straightforward information, samples, NGOs such as Children First, Red Cross, Addiction Alert, Youth Now Hotlines Youth Groups/clubs - talk as a group in an informal way Posters & signs – colourful Using peers for counselling Personal testimony(s) from own age group and affected persons Some specific Ideal sites would be: • An adolescent information Expo • A Sex Convention/Health Fair • “Carnival Day” , Safe sex fun day • Movie(s)/Film(s) – short flicks at public theatre, shown before the main show • TV - talk show, hosted by young people/or older people who are Open minded, interactive, vibrant, socially aware • Radio programmes - "Straight forward/hardcore/Don’t go around the corner". "Hosted by someone who understands the flex despite the age". • More community walks and talks • Increased interactive sessions with young people to get ideas • Doctors/professionals, PLWA, coming to talk at youth clubs • Organised concerts/ music • Cartoons • Comedy (plays/skits on TV) • Artiste concert on HIV • Youth Rallys (likeness in dress code), Rally to be world-wide • Winners of competitions to do slogan • Slogans “Remember when you start, start with a condom’, ‘Live and let others live’ • 5 minute presentations • Magazines 39 • • AIDS voicemail/text messages Hang-out spots - malls, clubs, cinema Specific reference is made here to particular messengers that continually emerged across the four groups. Messengers: Shaggy, Beenie Man, Oliver, Elephant Man, Papa San, Carlene Davis, Richie Stevens, Damian Marley, Buju Banton. Sports -> use of popular sports personalities. Little has been known about the influence of the media on adolescent attitudes and behavior (de Bruin, 2002). School, radio, TV and peers have been identified as main sources of information for sexual health (Hope, 1998, Jackson et al, 1998, Waszak, 2000). This RTK study revealed young people’s ideal sources of information about HIV/AIDS with concrete examples. The emphasis was on the need for an increased use of teen language, colourful exciting packaging and more teen involvement in delivery of messages. Final Research session - Sexual Practices/Motivation This session was needed in order to fill some gaps in the data gathered. Upon initial analysis it was discovered that the data addressed to some extent, the messengers, the message package, the sites for delivery but did not adequately provide a basis for content. This session attempted to discuss with the participants the nature of youth sexual practices in regards to risky behaviour, stable relationships and underlying motivations and/or situational imperatives that would inform the behaviours. This information could then inform communication strategies for specific areas for targeting. A representative sample of sharing team participants and core researchers were gathered together under the guidance of the Social Solutions researchers. Social Solutions researchers and the adolescent researchers jointly facilitated the sessions. Additionally, one of the sessions involving behaviour motivation was split along gender lines, with the male/female Social Solutions/adolescent researchers facilitating the relevant groups. This promoted the possibility of more honest/forthcoming information, especially among the males. Findings Male/Female: Risky sexual behaviour was defined as having: • Unprotected sex • Multiple sex partners • Sex with high risk groups - prostitutes, homosexuals, promiscuous persons 40 • • • • • • • Sex with strangers Sharing of needles Razors Impulsive sex - 'slambam' One night stands Sexual/physical feelings - Reacting to these feelings Mother to child Given the participants' definition of risky behaviour, it was evident that there was a general understanding of the nature of such behaviour. This provided an opportunity for exploring the motivating factors underlying such behaviour, to attempt to uncover the discrepancy between having sound knowledge but failing to act upon it. We approached it from two perspectives; life experiences, which promote vulnerability and thus become pressures (self-reluctant motivators) for action as opposed to motivators more linked to self-choice behaviours. The life experiences focus strongly on the group and family. The group is linked to the notations of peer pressure, un-cautious behaviour, alcohol and other substance abuse while the family is highlighted through notation of incest and other inter-family conflicts. The experience of incest and other forms of domestic violence can result in negative behavioural patterns for adolescents, especially for girls, in the engagement of sexually selfdestructive behaviours. The family also provides pressure in terms of promoting a need for money as well as a general lack of good guidance values. Male/Female: Life experiences, which make them vulnerable (for engaging in risky behaviour) • Peer pressure • Un-cautious [sic] behaviour • Alcohol/other addictive substances • Curiosity • Ignorance • Incest in homes • Abuse (conflict in family) • Lack of education • Lack of parental guidance • Sexual curiosity • Need for experimentation • Financial reasons - need for money • Lack of communication In terms of the impulsive behaviour (one-night-stands are included here), as more choice related, what emerged was a notation by both males and females of the lack of intimate communication between the sexes. This lack of communication results in the adolescents invoking certain assumptions or false attributions and acting accordingly. Increase in intimate communication and the understanding that this type of communication is acceptable and beneficial may result in the reduction of some forms of engagement as noted below. 41 Other areas of importance that influence choice behaviour are the importance of the groups, especially for young males and the need and/or desire for money, especially for the young girls. For young males, the 'crew' becomes a source of strong social pressure to perform, act and think in specific ways. As such, the 'crew' can also be seen as a situational influence on young boys, exerting pressure in much the same manner as contextual life experiences. The difference however, lies in the fact that alignment with the 'crew' is seen as more of a personal choice than a situational imperative. For young girls the desire for money is a pervasive one. Money provides, for the girls, the opportunity to engage in alternative lifestyles and the commodification of sex is not seen as prostitution, but more as a 'matter of fact' life choice linked to traditional notions of gender stereotypes/roles. Role models (caregivers/others) also feature as influencing factors and in many ways, the Jamaican context provides role models that exhibit social status and success as linked to the concept of 'bigness' and overt wealth. Male/Female: why they might choose to engage in impulsive sexual behaviour • Lack of sex communication in couples - who likes what and if whether it is socially acceptable (females note that they may be bored, relate to lack of technique as well; males speak of oral sex issues and romantic sex with partner while 'raw' sex with outside person) • Lack of technique (female) • Conformity to groups - male/female. This was especially true of the males whose 'crew' or group had significant effect on the attitudes and behaviour of the adolescent males. The group, as a motivating influence, was less important for the females. • Competition - male/female • Males engage in competition for status amongst the other males and are competitive for girls • Females engage in competition to get a 'nice guy'- as competing with other females for this scarce resource 'nice guy' • To keep the guy (females) • Pleasure 'sex feel good' - male/female • To get more experience - male/female • To get money - female/male • Prostitution (female), gigolo (male) • Older men (female)who give money on the 'layaway'11 plan • Sexual feelings • Family pressure to get money - mostly on the females • Role models - parents, siblings, friends, music lyrics Why young males would engage in 'One Night Stands' • no settling • don't want a serious relationship 11 layaway plan - where older men keep paying bills in the hopes of ending up with the young girl, which rarely happens 42 • • • • • • • • • • • • • • • spread out responsibility & consequences peer pressure* competition between males – 'who better'* how you are viewed in group* degrade girls* quantity, numbers are important* idle time, talk increases possibility of risky behaviour* boasting* embarrass, have something seeing how father treated mother lack of parental guidance make father proud macho parents/adult behaviour – many partners mother/father wants 'hardcore' sex outside of home * These motivations are linked to the importance of the 'crew'/group Why young females would engage in 'One Night Stands' • family poor – girl has sex with older man for money* • older men – as a way of getting money. Although they recognise that they have less power with older men they do not see this as greater risk for themselves than with younger men, especially since older men are seen as being better able to deal with risks and consequences such as pregnancy. * • sharing [sexual] knowledge with peers • many partners - coming out of sexual behaviour known • recognition – linked to ‘big man’ /rich man* • seek out money/recognition* • money* • lack of parental guidance • to hold man/keep man • prostitute* • gigolo12, drug mule, pimp to get US visa, money* • rent a dread* • white [male]/recognition • bored with sex with regular partner • wants rough sex outside of home partner *There is a pervasive economic theme that motivates the girls to engage in risky sexual behaviours. 12 NOTE: Gigolos – male who goes with female tourists for sex are noted as 20 30 years old Female Prostitutes (on the street) are in their teens Female gigolos (off the street) are in their teens 43 Male/female: How they say NO to Risky sexual behaviours • knowledge of consequences • male to be strong to resist Male/Female: why they CAN'T say no • Economics • social mobility - status, career • family pressuring teenagers to bring money into the home • Exposure to our social world • GoGo clubs • Parties where there is drugs such as Spanish fly, ecstasy to promote easy sex • Physical • male drive is too hard Male/Female: What they see as defining relationship behaviours • • • • • • • • • • • two persons committed to each other being with someone you know for a period of time13 more protection more careful impacts on the future inner feelings are present partners response compatibility/trust involves supporting each other comfort emotional feelings Note: there were some responses that highlighted other than positive reasons/definitions for a relationship, these are: • relationship could be as a result of bribery so need to look at more than face value • marriage/ring changes relationships for the worst[sic] • Promotes less trust/more suspicion - 'everyone always have more than one partner'. Men have 'bona fide' woman at home and another outside one. 13 no agreement on time, it varied from a year day to a few weeks, 6 months or to 1 44 The following are areas that need to be highlighted as important influencing factors that contribute to adolescent behaviours, and as such, need to be given strong emphasis when formulating communication intervention strategies for adolescents: • The Importance of Groups and Gender Stereotyping: The recognition that gender stereotyping is common and that it works in different ways for boys and girls. In respect of the boys it manifests more in terms of relation to their 'crew', the competitive nature of the crew and what is traditional/accepted behaviour within this crew. As an outcome of the competitiveness, the boys tend to adopt very negative gender stereotypes and operate largely as sexual predators. The group appears to be less important for the girls, however gender stereotypes work for them in a different way. They see sex as often a possibility for a profitable material exchange in favour of the female. They are available for relationships with older men who invariably have more resources than younger men. The concept of Livelihood: The participants linked this concept most often to lifestyles. There is very little understanding of the concept as presented in the Facts, and it needs a different, more Jamaicanised word, with strong linkage to the concept of 'jobs', working or vocation. Additionally, the linkage between livelihood and the prevention of HIV/AIDS is not one that naturally occurs in this population. It is perhaps better to emphasise the linkage between education and jobs as a provider of alternative lifestyles away from the 'crews' and the girls' commodification of sex. The importance of Parental (Caregiver) Guidance: The adolescents, both male and female, understand the strong and positive influence on proper or corrective behaviour from dominant parental figures who also regulate development opportunities for them. Parental guidance, or lack of it, becomes an influencing factor on adolescent behaviour. Overall, the research findings on sexual behaviour reinforced the previous findings that were recently reviewed (de Bruin, 2002). Factors affecting sexual behaviour such as gender stereotyping were also identified in this research. Using PAR, the link between research and action needs to be further strengthened. • • References De Bruin M (2002) Teenagers at risk. High risk behaviour of Jamaican adolescents in the context of reproductive health. Observations and impressions. Youth Now. Hope Enterprises (1998) Report of a baseline knowledge, attitude & practices survey in Bennetland community, Kingston. (Adult population 15 to 49 years). Country Jamaica. Prepared for the Epidemiology Unit Ministry of Health in collaboration with GTZ. Jackson J et al (1998) The Jamaica Adolescent Study Final Report, Family Health 45 International, Research Triangle Park, NC, USA. Waszak C (FHI) and M Wedderburn (Hope) (2000) Baseline community youth survey VIP/Youth Project, UNFPA, Jamaica. 46 D Recommendations/ Next Steps/ Conclusion ____________________________________ Recommendations Guidelines for communications strategy development Building on information gleaned from the research sessions, especially from the Ideal/Actual activity and the final research session, the following are our recommendations for guiding the development of the communication strategies: • The importance of the 'crew'/group as an influencing factor on both the attitudes and behaviour (general/sexual) of adolescent boys The invocation of gender stereotypes by both males and females, especially in relation to adolescent sexual practices The importance of economic influences in determining the sexual behaviour of adolescent girls In Jamaica, in order to influence, one has to be a 'big man' in some clear palpable sense To review the recommendations put forward by the young people in regards to strengthening the existing adolescent programmes that they have highlighted To take account of the youth identified message format in terms of the messengers, location, content and style The importance of community attitudes in relation to adolescent behaviour. It is important to recognise that there is little in terms of community mobilisation or support for a thoroughgoing HIV/AIDS Prevention campaign • • • • • • Project Design • Team Approach - To review approach to the research where it is proposed as a more collaborative team approach with the adolescent researchers, the research institution and the programme managers working together to achieve (both) project objectives. Emphasis will still be placed on adolescents being in the field but the team approach perspective may allow for a more fluid and inclusive implementation style. Training time - Training time should include 6 days for context, role differentiation facilitator/researcher; selected PAR tools and role-plays. Additionally, there should be 47 • a follow up 2.5 day workshop to concretise weak areas, agree on assignments, group roles, sharing teams, programme managers roles and roles of research institutions. Where possible, the training should also allow the adolescent researchers to interact with the sharing teams in order to practice the skills in a live setting • Criteria Development for adolescent researchers - criteria should be developed with the young people prior to the first workshop for core researchers, and they should be selected to participate in the training based on rankings/criteria, which should include characteristics of a facilitator rather than an educator. The time for the process should also allow the young people an opportunity to reflect on their skills and comfort level and if necessary they need to be able to decline to participate as a researcher. Roles of Programme Managers - Programme managers need to have clearly defined role in the process. In order to support them to perform their roles well, they need to have their own training and focus and time spent with them in concretising their roles. They could be used to assist more in day-to-day guiding of adolescents for preparation for the field. Once field assignments have been agreed on, programme managers could work with the team and ensure that preparation work has been completed, together. Programme managers (or their representatives) could also be deployed in the areas of assisting to do the logistics, and to act as chaperones. Review of use of 10 Facts - based on recommendations as stated earlier (pg. 36), emphasise the need to adapt the language of the 10 Facts prior to commencement of Fieldwork. The Programme Manager could be seen as the Facilitator and as integral to this process. • • Research Design/Process • Recognition of the inherent limitations of the project (competing objectives/adolescent researchers) and design for it as proposed earlier in the document [pg. 16 - 17] Use of the RTK Toolkit, as compiled by Social Solutions, to assist the implementation team (adolescent researchers, research institution, programme managers) in maintaining focus and guiding the research during the fieldwork phase, and to act as catalyst for innovation and adaptation of tools/methods. • Capacity Building • Ensure continuation of Best Practices and review for possible implementation the Lessons Learned, as highlighted earlier in the document (pg. 22 - 28). 48 NGO Programmes • Programme Managers to review and address programme gaps as identified (pg. 11) through promoting active youth participation in the development of communication strategies and to ensure evaluation mechanisms, where possible, for the implementation of any such strategies/interventions. Next steps - Local Action Figure 8 - Young People & Programme Managers/Steering Committee discussing Local Action - mid-term Clinic • • Next Steps/Local Action identified by adolescents Local Action was discussed as action that has occurred as a direct consequence of the Participatory Action Research (PAR) process. It was first looked at from the perspective of the sharing team. It was noted that most of the sharing team members expressed the desire for more workshops of that nature where they are able to share their knowledge and experiences with other young people. Specific actions were: Four sharing team members from Portland were now active in the Portland Aids Committee while others have expressed interest in joining. Action was more pronounced by the Adolescent Research Facilitators and this incorporated lessons learned and applied, all as indicated below: All adolescent researchers across the four groups involved in the PAR activities are now using PAR tools and facilitating skills in their regular peer education programmes as well as several persons across the groups have indicated that it has helped them in their personal life and self-development. Additional specific area responses are indicated 49 • below: • • • • Feedback from their members indicate they are relating better to their groups Note their ability to draw on research examples as support for some of their discussions (e.g. using new myths, or information gained). By using research methods learned they feel they are better able to design and target their intervention strategies. Some of the young people have shared facilitating skills they have learned with others in and outside of the organisation Portmore: • • St. Catherine: They have noted that these methods allow them new ways of getting and sharing information with their groups. They feel participating in RTK has increased their motivation to continue their work and reinforced their need to do so. St. James: They feel they are now better able to facilitate getting information and feel they actively listen to their group and talk less. They have incorporated research into social issues in their programme They have learned how to be flexible, 'to switch', if participants are not responding to one method, to move on to another They have learned how to relate better to those persons from different backgrounds • • • • • Next Steps/Local Action for Programmes Local Action arising from the PAR activities, from the Programme/National Perspective, as identified by Programme Managers/ Steering Committee members: • Identified need for co-ordinated mechanisms for sharing information about programmes and issues about communication with young people. An organization that could be explored to assume this role is the expanded BCC committees (MOH). Develop programmes/training on PAR methodologies for programme design. Build on young peoples' personal development in areas of research – did they understand research, and did they want to use it again? Perhaps develop a cadre of youth researchers. Programme managers see need for use of PAR techniques in developing programming priorities, and proactive approach to programming - need capacity building. Children’s First are using this (PAR) methodology to do a detailed condom mapping exercise in Spanish Town, to develop action plans and develop services 50 • • • • • BCC programme would like to use this method to enhance community peer education and targeted community interventions at the parish level NCYD would like their youth empowerment officers to be trained in this methodology Suggestions that the National Students Council members could also benefit from training in this approach • • • Next Steps/Local Action for UNICEF Jamaica The Programme Managers/ Steering Committee members also identified Local Action arising from the PAR activities for UNICEF national office. Many of these are to continue the RTK activities and to support the capacity building of local Youth NGOs to continue the PAR process. Specifically, the recommendations for UNICEF (Ja) are to: • Disseminate approach and findings of this study widely in order to contribute to national planning mechanisms, PAR skills building, inform education strategies, best practice on adolescent participation • Initiate the RTK phase 3 process, supporting the development of innovative communication strategies (maintaining the PAR focus) Support interagency meetings for sharing of information and strategies around adolescents and HIV Develop the generic PAR guide that could be used to facilitate adolescent participation in a variety of settings and programmes. Continue the capacity building of the young PAR researchers in PAR methodologies to complement their existing programmes in 2003, including perhaps application of PAR techniques to their peer education programme development. • • • 51 The RTK initiative has as its main aim promoting healthy adolescent development through the engagement and provision of basic facts based information relevant to the prevention of HIV/AIDS. In the Jamaican context where the spread of HIV/AIDS is a cause for concern and where gaps exist in country programmes addressing this issue, it is hoped that this project, involving both the capacity building of adolescents and data generation, can indeed make a difference. The methodology adopted for the process shows positive potential although there are a number of challenges. Overall, the findings indicate that young people do have basic knowledge about HIV/AIDS and how to prevent it. The data show however, that young people are less aware on the modes of transmission of the disease and the myths surrounding the disease. Also indicated by the data is the need for different types of communications, specifically communication messages that are not only geared at giving information but also in building skills. The skills identified by the research are those that allow the young people to apply the information that they have in order to lead to safe practices and in so doing, maximise their chances for avoiding an HIV infection. What has also emerged strongly is the need to package messages in what the youth have identified as a ‘relevant format’ with attention to: • Messenger advocacy • Message content and style • Social group influences The youth in Jamaica face many challenges and choices that are about opportunities won or lost. Against that background the youth have indicated very clearly the structural barriers that work against behaviour change. While the RTK initiative , in Phase 3, may develop sound communication strategies that incorporate appropriate research findings, Jamaican youth will still face difficulty in making right and safe choices until communities and larger structures are transformed and reduce the impact of those structural challenges. Conclusion 52 Annex Annex 1 Literature Review Annex 2 Process form Annex 3 Content form Annex 4 10 Facts on HIV Annex 5 List of youth researchers and participating youth organizations 53 54 Annex 1 The Literature Review FINDINGS ON RTK ISSUES IN JAMAICA 55 HUMAN RIGHTS HUMAN RIGHTS There is no legislation for compulsory national education Students from the highest income levels benefit the most from government spending. Quality is particularly poor in schools in the rural areas and inner-cities. There is some inconsistency regarding the minimum age for employment (12 years) being lower than the minimum compulsory school leaving age (14 years) by the Minister for Education. In the offences against the person act many of the sections specifically address the sexual abuse of females, but not males. No reliable data exists on the number of working adolescents, many of whom are probably employed in the country areas in agriculture and domestic work. It is difficult to find delinquent fathers and many refuse to maintain their children even where a court order exists. Severe limitations or absence of facilities for developmental activity beyond the level of primary education is an area of concern. Despite the existence of legislation on the treatment of juveniles suspected of being in trouble with the law, children are reportedly held in lockups in the same room with adult offenders, and are subject to emotional as well as physical abuse in some instances. There is generally a lack of knowledge of the CRC and the rights contained in it. 56 PHYSICAL DEVELOPMENT GIRLS’ DEVELOPMENT Older girls have clear coping strategies for dealing with the changes associated with physical development and physical urges. (“Hold a fresh”, masturbate, start dance, etc.) BOYS’ DEVELOPMENT There are myths about the notion of “storing up energy” or getting an “oily back” because of not relieving physical urges (horniness) The majority of Jamaican males are uncircumcised. Many do not know about/understand what circumcision is. Hygiene of the uncircumcised penis is sometimes neglected. 57 GENDER Girls ‘are encouraged to be passive in preparation for their role in the home, while boys are expected to take risks.’ Society expects boys to “run up and down” and not be tied with the obligations of marriage. The self-image of boys a tougher, less cultured, more recalcitrant and rebellious is reinforced by the dominance of female teachers. Some girls perceive sexual activity as a defining characteristic of “real adolescent femininity”. Girls outperform boys in all examinations. Almost all street children in Jamaica are boys. The economic dependence of poor women and their high levels of unemployment are matters of great concern, as they are key factors in determining the reproduction of poverty and its impact on children in the home. 58 SEXUALITY 28% of male teenagers and 2.5% of female teenagers approved of MEN having multiple partners. 9% of make teenagers and 2.9% of female teenagers approved of WOMEN having multiple partners The tendency for young females to seek partnership with older men is increasing. Boys view saying “no” to sex as a girls responsibility; if the male does say no, he may be thought of as being homosexual. Men between the ages of 15 and 19 years typically offer two main inducements to women to have sexual relationships: money and material things. Girls are likely to say that a girl would have sex to make her boyfriend ‘feel good’ or so he would ‘love her more’. “Money”, “fun”, “pleasure”, “curiosity”, and “peer pressure” are also reasons for early sexual activity among girls. Boys emphasize physical pleasure and elevated status among peers as reasons for having sex. There is an increasing documentation of growing numbers of females who practice multiple partnering largely out of economic necessity. Some families have come to rely on members exchanging sex for subsistence: school fees, family meals, day to day support and other basic provisions The majority of young men feel it is normal for a man to have more than one sexual partner. Young men are beginning to support the idea that women can have more than one partner. Most girls’ first sexual partner is somebody in the family (brother, father, stepfather, uncle, cousin) followed by a “big man” in the community. Most boys’ first sexual partner is a girlfriend. 59 PREGNANCY AND CONTRACEPTIVE CHOICES Among the 15-19 year old males, 48% do not always use a condom with their regular partner; 41% do not use a condom with their non-regular partners. Among the 15-19 year old females, 60% do not always use a condom with their regular partner, 46% do not always use a condom with their non-regular partners. The main reason for males not using a condom is that they don’t like them. More pleasure would be had going “bareback”. Many teenage males do not know the correct use of a male condom while many females do not know of the availability of a female condom. The main reason for females not using a condom is that they know their partner well. Before age 20, 40% of the women have been pregnant at least once. The earlier children begin sexual activity, the less likely they are to use contraception. Contraceptive discontinuation is relatively high, especially among women 15-24 who reported discontinuing condoms (48%), pills (43%) and injectables (42%) after 12 months of use. The decision re condom use with REGULAR partners seems ‘much more likely to be made jointly’, while condom use with NON-REGULAR partner was decided by males. Some adolescents regard coitus interruptus (pulling out) as a reliable form of contraception. The absence of a father figure combined with a low self-esteem can be considered risk factors teenage pregnancy in urban Jamaica. The mothers of teenage mothers offered then little factual information about sexual intercourse, contraception or pregnancy. 60 The main sexual education the teenage mothers received were warnings to “stay away from boys”. One in five pregnant youngsters decided to leave home. The majority of girls felt very badly about their first pregnancy and that it was very stressful. The relationship with the baby’s father deteriorates to the point of breaking up among 2-3 out of 10 pregnant girls. There is a lack of easily available contraceptives and there are virtually no youth friendly services. Youngsters are also hesitant to purchase condoms in their communities. Factors discouraging a second pregnancy are: 1. Wanting to continue their education 2. Taking some actions to continue one’s education 3. Living in households in which the mother of the teenage mother was the major wage earner. Factors related to repeat pregnancy are: 1. Perception of one’s socio-economic status as poor/very poor 2. Households in which the teenage mother or baby father/spouse was the major wage earner. 61 SEXUALLY TRANSMITTED INFECTIONS Older teens, females and inner-city residents are disproportionally affected by sexually transmitted infections. 45% of the male teenagers and 53% of the female teenagers said that they do not know the symptoms of STI’s. 33.3% of persons living with HIV/AIDS had STD history in the past. Some believe that STI’s can be caught from casual, nonsexual activities such as sitting on a chair or in a taxi where someone who had lice sat before. Some believe that the pill or an injection can protect against STI’s. Fear of STI’s is one of the main reasons for young people not to engage in sexual activities. Many do not know that infections (like herpes) can be transmitted by deep kissing. Some are not aware that STI’s can be transmitted by oral sex and think of it as a “no risk” activity. 62 HIV/AIDS Nearly 70% of teenagers (both male and female) consider themselves at no risk for HIV. Reasons for feeling safe are: “No sex” and “Use condom all the time”. While knowledge level on HIV transmission was extremely high, 85% of the respondents also preferred to avoid people with HIV. 41% of male teenagers and almost 31% of females (15-19 years old) believed the mosquito myth. Adolescent girls have three times the rate of HIV/AIDS than boys of their age group. Some believe that only “big people” have AIDS. Some believe that HIV/AIDS can be spread from sharing utensils or from toilet seats. In Jamaica, two out of three persons with HIV seek medical care at a late stage of the disease. The number of reported new HIV infections in adolescents had doubled each year’. 63 VIOLENCE ♦ 26% of women aged 15-19 reported to have been forced to have sex. ♦ 30% of teenage males agree with the statement ‘a woman deserves to be beaten if she has sex with another man’. ♦ Adolescents who reported sexual abuse were twice as likely to attempt suicide. ♦ Approximately 7-12% of girls and 5% of boys did not feel safe from sexual harassment in the home. ♦ 16-32% of young women reported that their first sexual experience was forced. ♦ Some pupils feel that teachers either do not want to, or cannot stop violence in schools. ♦ 50% worry about violence in their communities. ♦ Increased migration of adults abroad may mean less socialization of young people. ♦ Teenage males tend to carry out more violent acts than females. ♦ Some teenage males also import the violent mentality into sexual intercourse. They believe that female should be in pain during intercourse and that they may be under-performing if she doesn’t “bawl out fi murder”. 64 ALCOHOL, TOBACCO AND OTHER ADDICTIVE SUBSTANCES Boys consume much more alcohol than girls do; they drink most times outside of the home: ‘on the corner, in bars, or at session’. Girls say most of the time they drink ‘at home’. The latest survey findings showed no report of crack and/or cocaine use for 15-19 year olds. Current ganja use for 15-19 year old boys is 15%, for girls: 3%. Gang membership is significantly associated with the use of alcohol and marijuana. Adolescents are still undecided as to whether or not ganja is a dangerous drug. Drug dealers are no afraid to talk about what they do for a living because they have police friends who are in it. Some drug dealers try to recruit adolescents to smuggle drugs abroad for them. 65 LIVELIHOOD SKILLS Mothers are the main persons that prepare adolescents for life. Nearly 5% of children between the ages of 6 and 16 are working to increase family income. In many households the girls are pressured to gain livelihood skills (stay home and study), while the boys are allowed leniency. 66 References: 1. de Bruin M. (2002) Teenagers at risk High-risk behaviour of Jamaican Adolescents in the Context of Reproductive health – Observations and impressions 2. Kempadoo K and Dunn L. (2002) Factors that shape the initiation of early sexual activity among adolescent boys and girls. .In. meeting adolescent development and participation rights. UNICEF/UNFPA 3. Williams L. (2002) Adolescence and violence in Jamaica. In. meeting adolescent development and participation rights. UNICEF/UNFPA 4. Blank L. (2001) Youth in Jamaica . Inter-American development bank/government of Jamaica youth development program. 5. Ministry of Health (2002) National HIV/STD prevention and control program facts and figures Jamaica AIDS report 2002. NOTES: 1. These findings are not necessarily applied to all the adolescents in Jamaica. 2. Some of the findings may be factors affecting adolescents’ knowledge or practice of the RTK facts 3. Special thanks to Mr. Carrel Kerr for his invaluable contribution to this document 67 ANNEX 2 'Right to Know' Participatory Action Research (PAR) Process Form This form is to help you reflect on your experiences of conducting PAR. By completing one of these forms for each session you will also be able to compare and contrast your progress over the course of the entire fieldwork experience. Team Name___________________ Topic covered ___________________ Date, Place & length of session ______________________________________ Tell us how PAR team roles were assigned ______________________________ Number/Sex of Participants (names on back) _______ M [ ] F [ ] How would you best describe the youth that participated in this session? ______________________________________________________________ ______________________________________________________________ Tools used & in what sequence_______________________________________________________ ______________________________________________________________ For this session, did you make any adaptations/changes in how you facilitated the session? Y [ ] N [ ] If yes, describe the changes ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Did you change up any of the tools? Y [ ] N [ ] If yes - what were the changes, why did you change? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Would you use these changes again? Tell us why ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ What was particularly successful in this session and tell us why _______________ 68 ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ What was not so successful and tell us why _____________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Other comments you want to share with us ______________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ 69 SHARING GROUP INFORMATION NAME 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 M/F AGE ORGANISATION BELONG TO OR IF NOT YOUR USUAL HANGOUT PAR TEAM NAME 1 2 3 4 5 ROLE 70 ANNEX 3 “Right to Know” Participatory Action Research (PAR) Facts Information & Content Form What RTK Facts were the subjects of this session? _______________________ ______________________________________________________________ What were the key issues discussed for each Fact? # ____________________________________________________________ #_____________________________________________________________ #_____________________________________________________________ #_____________________________________________________________ New information learned about RTK Facts Did the participants have the correct information? ______________________________________________________________ If not, what information, myths or stigmas did they have? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ If they did have the correct information, are they using it/acting on it? How? ______________________________________________________________ ______________________________________________________________ If they have the correct information but are not using it, why are they not using it? What stops them? ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ Adapted from Ken Legins/UNICEF NY 71 ANNEX 4 The 10 Facts for adolescents Facts for adolescents The initiative “What every adolescent has a right to know” has identified some basic facts on HIV/AIDS, sexuality, contraception, peer relationships and other related issues that constitute the accepted minimum information to be provided. They address the following topics: 1. Human Rights 2. Physical Development Girl’s Development Boy’s Development 3. Gender 4. Sexuality 5. Pregnancy and Contraceptive Choices 6. Sexually Transmitted Infections 7. HIV/AIDS 8. Violence 9. Alcohol, Tobacco and Other Addictive Substances 10.Livelihood Skills 72 HUMAN RIGHTS Adolescents have a right to know about their own rights. 10 FACTS ON HUMAN RIGHTS 1. Human rights are based on respect for the dignity and worth of each and every person. These rights apply no matter where a person was born or to whom, whether he/she is a boy or a girl, what his/her religion is, what language he/she speaks, what colour his/her skin is or whether or not he/she has a disability. 2. The human rights for everyone under the age of 18 are spelled out in an international legal agreement called the Convention on the Rights of the Child (CRC). All but two of the world’s countries have ratified the CRC. Somalia currently has no recognised government to ratify the CRC and the U.S.A. has shown their intention to ratify by signing it. 3. When a government ratifies the CRC it agrees to respect, protect and fulfil the rights of every child. Respect means that the government recognises the importance of children’s rights. Protect means that the government will take all necessary steps to prevent the abuse or violation of a child’s rights. Fulfil means that the government will create an environment that promotes the realisation of children’s rights. This includes rewriting laws to reflect the general principles of the CRC, ensuring that the laws are followed and making children’s rights a priority on the political agenda. 4. There are two equally important types of human rights. Civil and political rights include the rights to survival, freedom, security and equality before the law. Nations have an obligation to ensure that these rights are respected, protected and fulfilled as soon as they ratify the CRC. 5. The second type of human rights are economic, social and cultural rights. These include such rights as those to education, to the 73 highest attainable standard of health, leisure time, to an adequate standard of living and to enjoy one’s culture, religion and language. When nations ratify the CRC they agree to work toward implementing the rights to the maximum extent permitted by their resources. 6. There are four general principles that guide the CRC: Equal rights and equal protection without discrimination of any kind. The best interests of the child shall be a primary consideration in all actions concerning the child. Children may express their views, have them heard and given due weight, and participate in matters affecting them, in ways that are appropriate to their evolving age. Every child has a right to survive and develop to the fullest. Governments will aim to ensure the survival and protection of every child. Governments shall ensure to the maximum extent possible the physical, mental, spiritual, moral and social development of the child. 7. Non-respect of human rights is a key factor in the spread of HIV/AIDS. Nations, communities and individuals who actively respect, protect and fulfil the following human rights help prevent the spread of HIV/AIDS: The right to survival, freedom and personal security The right to bodily integrity and self-determination The right to equality The right to development The right to freedom from sexual violence The right to work and a livelihood The right to education The right to seek out information The right to the highest attainable standard of health, including family planning education and services The right to a safe and healthy environment. 8. Human rights apply to persons living with HIV/AIDS, without discrimination of any kind. Promoting and protecting the rights and dignity of people living with HIV/AIDS decreases the negative impact of the disease. 9. Anyone below 18 years of age who comes into contact with the law has rights under the CRC. A child who is detained has the rights to legal assistance, contact with his/her family and treatment that aims to promote the child’s constructive role in society. Torture, cruel treatment, unlawful arrest, capital punishment and life imprisonment are outlawed under the CRC. 10. When nations ratify the CRC their acts and practices come under the scrutiny of other nations and an international monitoring body. The 74 Committee on the Rights of the Child monitors the progress made by countries in meeting their obligations under the CRC. Because nations have an obligation to make sure their laws reflect the general principles of the CRC, young people can seek protection under the law if their human rights have been violated. 75 PHYSICAL DEVELOPMENT Adolescents have a right to know about their own development. 10 FACTS ON GIRLS’ DEVELOPMENT 1. Puberty is when children’s bodies start to change into adult’s bodies. These changes usually occur between the ages of 9 and 18, but every person’s body is unique and changes in different ways and at different speed. Some of the changes that girls experience are: the body grows bigger and stronger hair starts to grow on the legs, underarms and in the pubic area genitals mature. 2. Puberty is the beginning of adolescence, the period of growing up to be an adult. Hormones in the body called estrogen and progestin start the changes at puberty for girls. When puberty begins the woman’s body begins to produce the eggs that could be joined with the man’s sperm through unprotected sexual intercourse to make a baby. 3. During puberty the body produces more oil than is necessary, which causes pimples. Young women can fight pimples by washing frequently with soap and water, eating nutritious foods and drinking lots of water. 4. Young women’s breasts grow during puberty and the nipples become larger and darker. They may get sore every month just before a woman menstruates. The breasts get bigger when a woman becomes pregnant and when she breast-feeds milk to feed a baby. 5. The female genitals include the inner and outer lips (the labia minora and the labia majora), which are two folds of skin that protect the clitoris, urethra and vagina. The clitoris is a small, pea-shaped bump that is the centre of sexual sensation for a woman. The urethra is the passageway for urine to leave the body. The vagina is the passageway from the uterus to the outside of 76 the body. Menstrual blood and babies come out of the vagina. Within the vagina is the hymen, which is delicate skin tissue that may stretch or tear the first time a girl has sexual intercourse. 6. A virgin is someone, girl or boy, who has never had sexual intercourse. Virginity can only be lost through sexual intercourse. Many people believe that the presence of the hymen proves that a girl has not had sexual intercourse. This is not a good indicator because the hymen can become stretched or separated during exercise or sports or for no apparent reason, and some girls are born without a hymen. 7. Some young people have been taught that they shouldn’t touch their sex organs and that they are dirty. This is not true. In fact, sex organs must be cleaned to stay healthy. The vagina produces a fluid or discharge to clean itself. To keep the vagina clean and healthy it is important that girls do not wash this fluid out. 8. Women also have sex organs inside the body. They are the ovaries, the fallopian tubes, the uterus and the cervix. Ovulation is when an egg (ovum) is released from one of the two ovaries. This happens once every month. Young women begin to ovulate sometime between the ages of 9 and 16. The egg leaves the ovaries and travels down the fallopian tubes toward the uterus, a process that takes several days. During this time the women could become pregnant if she has unprotected sexual intercourse. If the egg is not fertilised by a sperm cell, it dies and comes out of the female’s body. The egg is too small for people to see. The cervix is the very small opening between the uterus and the vagina. Nothing can get through it except sperm, germs and menstrual blood. The cervix opens to let the baby out during birth. 9. The lining of the uterus is made up of blood vessels and nutrients that would be needed for a baby to grow throughout the nine months of pregnancy. If the woman’s egg is not fertilised, the female’s body realises that there is no pregnancy, and that the soft lining of the uterus is not needed. When this happens the lining of the uterus breaks down and passes through the vagina and out of the body. This is called menstruation, or having a period. Menstruation happens about once a month and lasts about 4 days, although the time varies for each women. 77 10. During menstruation girls can use sanitary napkins, tampons or pieces of cloth to catch the blood. It is important to change them often because germs can grow on the blood and if the germs reach the vagina the girl can become sick. This is especially important for tampons. Sanitary napkins, or pads, are placed under the vagina, between the legs. They need to be changed every four to eight hours. Tampons are made of cotton and are placed inside the vagina to soak up the blood before it leaves the body. A string is attached to the tampon so that it can be pulled out after four to eight hours. Pieces of cloth need to be changed often to be washed and completely dried before being used again. 78 10 FACTS ON BOYS’ DEVELOPMENT 1. During puberty, a boy can expect many changes to occur in his body. These changes usually begin after the age of 12, but every person’s body is unique and changes in different ways and at different speed. Some of the changes a boy experiences are: the body grows bigger and stronger hair starts to grow under the arms, on the face and in the pubic area the voice changes and then deepens the penis grows, and the scrotum begins to hang down. 2. Puberty is the beginning of adolescence, the period of growing up to be an adult. A hormone in the body called testosterone starts the changes at puberty for boys. Many young men get pimples during puberty. Young men can fight pimples by washing frequently with soap and water, eating nutritious foods and drinking lots of water. 3. When puberty begins, a boy’s body begins to produce the sperm cells that could be joined with a woman’s egg through unprotected sexual intercourse to make a baby. Sperm cells are made in the testes, which are two egg-shaped glands that hang in a sac called the scrotum. 4. The scrotum’s function is to keep the testicles at just the right temperature for the sperm to be made. In order to do this the scrotum sometimes tightens up and pulls the testicles close to the body. At other times, the scrotum gets looser and the testicles hang down lower. 5. Millions of sperm cells are made all the time and the body carries them away if they are not used in order to make more. Semen is a mixture of millions of sperm cells plus seminal fluid that leave the boy’s body when he has an erection and ejaculates. 6. Young men start to have erections more frequently during adolescence. Erections are when the penis becomes hard and stands up. Erections can happen when a man feels sexually excited. Sometimes men have erections for no particular reason at all. Many men have erections at night when they are sleeping. This is normal and does not cause the boy any harm. 7. A man may ejaculate when he becomes very sexually excited. Ejaculation is when the muscles in the penis contract and semen is 79 pushed into a tube inside the penis called the urethra, which leads to an opening in the glans (the tip of the penis). Urine also comes out through this opening. 8. Ejaculations can happen when a man is having sexual intercourse, when he is masturbating or when he is asleep. Ejaculation during sleep is called a wet dream. Wet dreams are a normal sign that the body is maturing. Boys stop having wet dreams as they grow older. Wet dreams are not a sign that one should have sex. 9. Pre-ejaculatory fluid forms at the tip of the penis before ejaculation. It is possible to make a woman pregnant from this fluid, or to transmit sexually transmitted infections, including HIV. 10. Male circumcision is when the foreskin of the penis is cut off, leaving the glands exposed. Some boys are circumcised right after they are born, some young men are circumcised during adolescence and some men are never circumcised at all. The knife must be sterilised before circumcision so that germs, such as HIV, are not given to the boy. It is best to have a health worker perform the circumcision. Evidence suggests that boys who are circumcised are less likely to get HIV, but this does not mean that circumcised men cannot become infected. It is important that men who are not circumcised pull the foreskin back and wash underneath to prevent germs from growing. 80 GENDER Adolescents have a right to know about gender roles and equality. 10 FACTS ON GENDER 1. Sex refers to an individual’s biological status as male or female. Gender refers to the socially defined roles and responsibilities of men and women, boys and girls. 2. Cultural values and the way children are raised cause them to think that boys and girls are different in abilities, what is permissible and their rights. Narrowly defined gender roles can deprive both boys and girls of reaching their full potential. Boys and girls have the freedom to make their own choices about how to live their lives, regardless of socially defined roles for men and women. 3. Traditional gender roles can lead to the spread of sexually transmitted infections, including HIV. In many cultures men and boys are encouraged to have many sexual partners and women are taught to be submissive to men. These behaviours increase the risk of infection for both men and women. 4. Gender equality refers to the equal treatment of men and women in laws and policies, equal access to and control of resources and services and equality in decision-making. Gender equality is a human right. 5. Women represent over half of the populations of most countries. Ensuring women’s equal treatment and participation in all decisions that affect them improves development and health for society as a whole. 6. Women are the primary caretakers of all children. Improving women’s access to education and healthcare leads to the overall development and health of the family and community. Ensuring women’s access to education leads to a decrease in families living in poverty and an increase in children’s school attendance. Improving women’s access to and choices for healthcare decreases mother and infant death and the spread of infectious disease, such as HIV. 81 7. Improving women’s economic status leads to a reduction in poverty for society. This can be accomplished by ensuring that women have property and inheritance rights, access to employment and equal pay for equal work. 8. The power imbalance in many societies that values men over women leads to denial of the right to bodily integrity for women. Women have the right to abstain from sex. Women have the right to safety: to freedom from violence, to choose whether or not to have sex and to demand safer sex. 9. Prostitution is exchanging sex for money. Many women and children are forced into prostitution by violence. Many more women and children are forced into prostitution due to severe poverty. Improving the economic status of women can help eliminate forced prostitution. 10. Women who are either expected or forced to marry before they are physically and/or mentally ready miss opportunities for development, including education, and suffer negative physical and mental health consequences. Early marriage also leads to the increased chance of physical and emotional abuse and failed marriages. It is generally recommended that young people don’t marry before the age of 18. 82 SEXUALITY Adolescents have a right to know about their own sexuality. 10 FACTS ON SEXUALITY 1. Sexuality refers to one’s sexual identity and sexual feelings. Young people develop their values about sexuality as part of becoming adults. 2. Adolescence is a time when an individual becomes more aware of him/herself as a person who has sexual feelings, which can lead to falling in love. Falling in love involves getting close to one person in mind, heart and body. It is a very powerful feeling. When two people fall in love they want to be together, talk to each other and touch each other. 3. Sexual feelings are a natural part of growing up. Young people have a choice about whether to show their sexual feelings and in what way. Some people decide to enjoy their sexual feelings without any action at all. This will not cause a person any harm. Some people decide to spend more time with the person they have feelings for. They may express their feelings through kissing or hugging. 4. Some people who have sexual feelings masturbate. Masturbation is the act of touching one’s own sexual organs including the penis, vagina, breasts or other parts of the body that are sensitive to sexual stimulation. Both men and women can relieve sexual feelings and experience sexual pleasure through masturbation. 5. Masturbation is normal and most people masturbate at some time in their lives. It does not cause weakness, blindness, stunted growth or any psychological or sexual problems. Masturbation does not either cause pregnancy or protect anyone from pregnancy. 6. Some people who have sexual feelings may decide to have sexual intercourse with the person they are interested in. When a man and woman decide to have sexual intercourse, a man’s penis enters a woman’s vagina. This is the process whereby male sperm and female eggs join to make a baby. 83 7. When a woman become sexually excited, her vagina becomes wet and her nipples, inner and outer genital lips and clitoris swell and become more sensitive to touch. This sexual excitement can lead to an orgasm, which gives women great pleasure. It is important that women are sexually excited before sexual intercourse, or sex will be painful. 8. Sexual health is when a person expresses his/her sexuality in ways that are not harmful to themselves or to anyone else. Sexual health involves: Making decisions about one’s own body without pressure from anyone else Enjoying one’s sexuality without shame or guilt or fear Deciding when and how to express one’s sexuality Freedom to choose not to engage in sexual activity Protecting oneself from pregnancy and sexually transmitted infections, including HIV Contacting a health worker if one has a problem. 9. Mutual consent between partners is an important aspect of sexual health. Access to free and accurate information about the body, sex and reproduction enables both men and women to make responsible choices about sex. Couples can use information to abstain from sex or to make sex safer. 10.Sexual orientation describes one’s sexual and romantic attraction to the opposite gender, the same gender, or both. People who are attracted to people of the opposite sex are called heterosexual. Some people feel sexually attracted to people of the same sex. This attraction is called homosexuality. People who are attracted to both sexes are called bisexual. 84 PREGNANCY AND CONTRACEPTIVE CHOICES Adolescents have the right to know how to protect themselves from unwanted pregnancies. 10 FACTS ON PREGNANCY & CONTRACEPTIVE CHOICES 1. It is possible for pregnancy to occur whenever a man and a woman have unprotected sexual intercourse. Pregnancy can happen the very first time a couple has unprotected sex if one sperm cell meets with an egg and fertilises it inside the woman. If the egg is fertilised, it can attach itself to the lining of the uterus, and this is the beginning of a pregnancy. 2. Signs of pregnancy include: a missed menstrual period tenderness (soreness) of the breasts nausea (feeling the need to vomit) fatigue (feeling tired) needing to urinate more frequently 3. A woman is not physically ready to begin bearing children until she is about 18 years of age. Becoming pregnant before the age of 18 increases the health risks for both mother and child, and can even result in death. 4. When a couple decides to have sex, both the man and the woman need to plan a method of protection before they begin to have sexual intercourse. Planning ahead can prevent unwanted pregnancies, unsafe abortions and sexually transmitted infections (STIs), including HIV. It is best to consult with a qualified health worker who can help the couple decide which method is right for them. 5. Abstinence is the only 100% effective way to avoid unwanted pregnancy and STIs, including HIV. Abstinence means not transmitting any bodily fluids through sexual contact. 6. Couples can make sex safer by using contraceptive devices. Some different contraceptive methods include male and female condoms, oral contraceptive pills, diaphragms, injectables, implants and intrauterine contraceptive devices. Condoms are the only 85 contraceptive devices that protect against pregnancy and STIs. 7. Oral contraceptive pills (birth control pills) prevent pregnancy by stopping a woman’s ovaries from releasing an egg each month. When taken every day, as advised, they give 97-99% protection against pregnancy. However, they give no protection against STIs or HIV. 8. Withdrawal is when the penis is removed from the vagina before ejaculation. Withdrawal is not recommended because there may be sperm located in the tip of the man’s penis when he has an erection that can cause pregnancy. Sperm cells that are deposited very close to the vagina may still be able to travel into the vagina and cause pregnancy. 9. Some health services give emergency contraceptive pills (ECPs), or “morning after pills”, to prevent pregnancy to women who had sex within the last three days without using a contraceptive, or who had a contraceptive accident (such as a broken condom). ECPs will not work once a pregnancy has started. 10. Faced with the serious consequences of an early, unwanted pregnancy, some girls try to end the pregnancy. Abortion is the ending of a pregnancy. In many countries it is illegal to end a pregnancy for reasons other than medical necessity or rape. Unsafe abortion is the termination of a pregnancy carried out by someone without the skills or training to perform the procedure safely, or in a place that does not meet minimal medical standards, or both. Various complications can follow an unsafe abortion, including: internal organ damage, which can cause the woman to live in constant pain infection, such as tetanus infertility: inability to become pregnant ever again death. 86 SEXUALLY TRANSMITTED INFECTIONS Adolescents have a right to know about sexually transmitted infections. 10 FACTS ON SEXUALLY TRANSMITTED INFECTIONS 1. Sexually transmitted infections (STIs) are spread through contact between two people’s body fluids: semen, vaginal fluid and blood. Some STIs are spread through contact with the genital area, or through kissing. 2. Anyone who has sex with someone who has an STI is at risk of infection. Women get STIs, including HIV, from men twice as easily as men from women. Young women are at high risk to get STIs because their organs are not mature and are easily attacked by germs. 3. Sexually transmitted infections can cause pain and some cause infertility (not being able to have a baby) and death. Anyone who suspects that he or she might have an STI should contact a health worker in order to be diagnosed and get treatment for the STI. 4. The most common STIs are chancroid, chlamydia, gonorrhoea, genital warts, genital herpes, HIV, syphilis, and trichomoniasis. Chlamydia, gonorrhea, syphilis and trichomoniasis can be cured if a person seeks treatment in the early stages of the disease. Genital herpes, genital warts and HIV cannot be cured, but sometimes their effects can be stopped for a time. 5. If someone is found to have an STI, they need to tell their sexual partner(s). If both partners are not treated for the STI, they will keep giving the STI back and forth to one other. 6. Some of the signs of a possible STI include: Sores, blisters, bumps and rashes inside of the mouth or on the genitals Discharge from the penis Discharge from the vagina that has a strange colour or bad smell Pain during sexual intercourse Pain or itching around the genital area Pain or discomfort while passing urine 87 Lower abdominal pain. 7. It is very common that people experience few or no symptoms of an STI. Risk factors for STIs are: A sexual partner who has an STI. More than one sexual partners. The more partners a person has, the greater the risk that one of them will have an STI and pass it on. A new sexual partner during the last three months. The new partner might have an STI from a previous relationship. A sexual partner who has other partners. 8. The only way to be 100% certain of not acquiring or transmitting an STI is abstinence. Couples can make sex safer by having sex only with each other and using male or female condoms. Condoms make sex safer by preventing semen from entering the vagina, mouth or anus. Using latex condoms consistently and correctly can greatly reduce, but not completely eliminate, the risk of contracting sexually transmitted infections, including HIV. 9. Sexually transmitted infections can be spread through one act of unprotected sexual intercourse. Before a couple decides to have sex they must decide how they will prevent STIs, whether through abstaining from sex, practising non-penetrative sex or using condoms correctly every time they have sex. 10. Not every problem in the genital area is an STI. There are some infections, such as candidiasis and urinary tract infections, that are not caused by sexual intercourse, but cause great discomfort in the genital area. Consistent and Correct Use of Condoms Consistently means using a latex condom from start to finish each and every time a person has vaginal, oral, or anal sex. Correctly means following these steps: 1. Use a new condom for each act of intercourse. 2. Put the condom on after the penis is erect and before any genital contact (vaginal, anal or oral). If the penis is uncircumcised, pull the foreskin back before rolling on the condom. 3. Hold the tip of the condom and unroll it onto the erect penis, pinching the tip of the condom to ensure there is no air trapped in the condom’s tip. 4. Withdraw the penis immediately after ejaculation, holding the condom firmly at 88 the base to keep it from slipping off. 5. Stop and replace immediately (with a new one) any condom that breaks or slips off during sex. 6. Dispose of condoms in a safe place after use. Other tips for condom use: Use latex condoms. Use only water-based lubricants, such as glycerine or lubricating jelly. Never use oil-based lubricants, such as petroleum jelly or baby oil because they can cause the condom to tear. Store condoms in a cool, dry place out of direct sunlight. Do not use expired condoms. HIV/AIDS Young people have a right to know about HIV/AIDS. 10 FACTS ON HIV/AIDS 1. AIDS is caused by HIV, the human immunodeficiency virus, which damages the body's defence system. People who have AIDS become weaker because their bodies lose the ability to fight all illnesses. They eventually die. There is no cure for HIV/AIDS. 2. The onset of AIDS can take up to ten years from the time of infection with the HIV virus. Therefore a person infected with HIV may look and feel healthy for many years, but he or she can transmit the virus to someone else. New drug therapies can help a person stay healthier for longer periods of time, but the person will still have HIV and be able to transmit HIV. 3. HIV is transmitted through the exchange of any HIV-infected bodily fluids. Transfer may occur during all stages of the infection/disease. The HIV virus is found in the following fluids: blood, semen (and pre-ejaculated fluid), vaginal secretions, breast milk. 89 4. HIV is most frequently transmitted sexually. That is because fluids mix and the virus can be exchanged, especially where there are tears in vaginal or anal tissue, wounds or other sexually-transmitted infections (STIs). Girls are especially vulnerable to HIV infection because their vaginal membranes are thinner and more susceptible to infection than those of mature women. 5. People who have STIs are at greater risk of being infected with HIV/AIDS and of transmitting their infection to others. People with STIs should seek prompt treatment and avoid sexual intercourse or practice safer sex (non-penetrative sex or sex using a condom), and inform their partners. 6. The risk of sexual transmission of HIV/AIDS can be reduced if people don't have sex, if uninfected partners have sex only with each other or if people have safer sex - sex without penetration or using a condom. The only way to be completely sure to prevent the sexual transmission of HIV is by abstaining from all sexual contact. 7. HIV can also be transmitted when the skin is cut or pierced using an unsterilized needle, syringe, razorblade, knife or any other tool. People who inject themselves with drugs or have sex with drug users are at high risk of becoming infected with HIV/AIDS. Moreover, drug use alters people's judgement and can lead to risky sexual behaviour, such as not using condoms. 8. Anyone who suspects that he or she might have been infected with HIV should contact a health worker or an HIV/AIDS centre in order to receive confidential counselling and testing. 9. HIV is not transmitted by: hugging, shaking hands; casual, everyday contact; using swimming pools, toilet seats; sharing bed linen, eating utensils, food; mosquito and other insect bites; coughing, sneezing. 10. Discriminating against people who are infected with HIV/AIDS or anyone thought to be at risk of infection violates individual human rights and endangers public health. Everyone infected with and affected by HIV/AIDS deserves compassion and support. 90 VIOLENCE Adolescents have a right to know about forms of violence and ways to protect themselves 10 FACTS ON VIOLENCE 1. All young people, including women and girls, have the rights to safety and freedom from violence, including freedom from direct participation in armed conflict. 2. Many young people are exposed to violence in times of war through participation in armed conflict, systematic rape in times of war, sexual enslavement or exposure to land mines. The effects of violence can be physical health problem, disabilities, stunted development and/or mental health problems. 3. Sexual abuse is harmful or unwanted sexual contact. It is done by someone who has power over another person, such as an adult to a child. The abuser makes the victim feel as though s/he cannot say “No”. Sexual abuse can involve threats, humiliation and violence, as well as inducements such as money. The long-term consequences of such acts on children can be extremely damaging to their mental, emotional and physical well-being. 4. Sexual abuse is a big problem all over the world. Sexual abuse can be difficult for young people to talk about because discusssing sexuality is frowned upon in many societies, and many times the abuser is a child’s relative, neighbour or schoolteacher. It is important to remember that the abuse is the adult’s fault, it is never the child’s fault. 5. Sexual harassment includes remarks or physical gestures, made in a sexual manner, that cause physical or emotional pain and discomfort. It is done by someone who has power over another person, such as an employer to an employee. 6. Rape is when one or more persons forces another person to have sexual intercourse against their will. Victims of rape are usually women, although male rape (men forcing men) also occurs. The victim may be threatened by physical violence or death, may be beaten or may be humiliated. Rapists can be complete strangers, but often they are someone the victim knows, such as a boyfriend, 91 friend, neighbour or relative. 7. Young people have the right to freedom from sexual abuse, sexual harassment and rape. Anyone who feels that they have been violated in this manner can go to a friend, relative or health worker and let them know what happened. Many people feel better after they have talked about their feelings about the abuse. Health workers can treat injuries and might be able to prevent pregnancy. In some countries the police can help bring the abuser to justice, but sometimes the police may cause more trauma to the person who has been abused, if they have not been trained to handle sexual abuse cases properly. 8. Violence against women (and girls) is any gender-based act or conduct that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women and girls. Examples of gender-based violence include domestic violence (abuse, harassment or assault used by one member of a family to control another), rape, sexual enslavement, honour killings (murder of women for actual or believed immoral behaviour) and female genital mutilation. 9. Female Genital Mutilation (FGM) is when girls have part or all of their external genitals cut off. The practice of FGM is many times called “female circumcision”, implying that it is similar to male circumcision. However, the degree of cutting is much more extensive, often impairing a woman’s sexual and reproductive functions. Female genital mutilation causes serious health and psychological problems, such as: Severe pain Severe bleeding (Haemorrhage) Infection Injuries to internal organs Shock Urine retention Difficulties during menstruation Difficulties during sexual intercourse Difficulties during childbirth Mental health problems Death 10. Boys and girls are affected by violence differently due to genderbased violence. Violence leads to physical, mental and reproductive health consequences for women. Rape leads to unplanned pregnancies and sexually transmitted infections, including HIV. 92 ALCOHOL, TOBACCO AND OTHER ADDICTIVE SUBSTANCES Adolescents have a right to protection from the use of addictive or harmful substances. 10 FACTS ON ALCOHOL, TOBACCO AND OTHER ADDICTIVE SUBSTANCES 1. Substance abuse is defined as taking legal or illegal substances for non-health purposes and to change the way a person feels, thinks or behaves. 2. Alcohol, cigarettes and inhalants are examples of legal substances that can be abused. When people drink too much alcohol they become drunk. The amount of alcohol taken to become drunk is different for each person. A drunk person may vomit, lose consciousness or forget what happened. Chewing tobacco, cigarettes and cigars all contain tobacco. Tobacco is very addictive and has serious health consequences over time. This is why there are health warnings on cigarette packs. Inhalants consist of petrol, glue, paint thinner and industrial products contained in spray cans. Inhalants are bad for physical health and impair development in young people. 3. Marijuana, ecstasy, cocaine, heroin, hallucinogens and depressants are examples of illegal substances that can be abused. Marijuana is a mind-altering drug that is harmful to the development of young people because it impairs the ability to think and the capacity to memorise. Smoke from both marijuana and tobacco use cause physical health problems. 4. When substances that can be abused are taken in small quantities they can make a person feel happy, confident, relaxed, imaginative or energetic. However, no addictive substance can be considered “safe” because the normal functioning of the human body is altered every time a person takes an addictive substance. 5. Taking substances that can be abused makes it difficult to think clearly and to make good decisions. People lose control of their actions if too much of a substance that can be abused is taken. This increases the risk of accidents and risky sexual behaviour, which can lead to pregnancy and/or sexually transmitted infections, including HIV. 6. If people use substances that can be abused very frequently they develop a 93 tolerance, which is the need for more and more amounts of the drug in order to get the same feeling. 7. Addiction is when a person’s body cannot function without the substance. Sometimes people who are addicted to substances get sick after they stop taking them. The sickness usually goes away by itself if the person continues to not take the substance. 8. The effects of substances have increased in the past century and made the risk of addiction more serious. Injectable drugs are highly addictive and people who inject drugs or have sex with people who do are at higher risk of contracting HIV/AIDS and other deadly diseases such as Hepatitis B and C. 9. Over time addictive substances cause serious physical and mental health problems. Each substance has different long-term effects. Some examples of health problems caused by addictive substances are anxiety, depression, liver damage, heart disease and death. 10. People who think they have a problem with an addictive substance can stop taking the substance if they want to. This can be done by admitting that a person has a problem, deciding to stop use right away and stopping the use. It is easier for people to stop using the addictive substance if they go to a substance abuse program, if they have the support of friends and family and if they don’t give up if they start to use again. 94 LIVELIHOODS Young people have a right to know about livelihood skills and opportunities. 10 FACTS ON LIVELIHOODS 1. A livelihood is everything a person knows, has and does to make a living. This includes educational background, capabilities, resources and opportunities that enable people to make money to support themselves. 2. The timing and way in which young people start working will affect the rest of their lives. The Convention on the Rights of the Child (CRC), a treaty agreed to by almost every nation, states that young people have the right to protection from work that is harmful and work that limits the future life options of young people. Young people are protected from: unsafe or harmful work being paid too little because they are not adults work that interferes with education work that interferes with a young person’s development. 3. It is generally agreed that young people must finish required schooling before they begin to work for wages, which is about the age of 15. Young people under the age of 18 are protected from unhealthy, unsafe or immoral working conditions. Light work, which does not interfere with schooling, can begin from the age of 13. 4. Work that is safe and begins when a young person is ready can increase a young person’s abilities, expose a young person to opportunities and increase his/her future earnings. Some young people feel ready to begin working while they are still in school and some young people choose to wait until after they have finished their schooling. 5. The CRC states that all children have the right to rest. This means that all children must have free time when they are not working or going to school. 95 6. Primary education is necessary for young people to have basic skills for working. Secondary education gives young people more skills they will need for better jobs. Secondary education can be general education or vocational education. 7. Girls and boys have the right to equal opportunities. Girls have the right to the same job opportunities as boys and to equal pay for the jobs they perform. This is true for both young people and adults. 8. Some communities have programmes that help teach livelihood skills to young people. These programmes focus on the abilities and talents that young people have and the contributions they can make to improve themselves and societies. The programmes can be set up by government organisations, non-government organisations, community-based organisations and the private sector. 9. Livelihood programmes include several different types of programmes: School-based programmes link education to work. Microfinance programmes link people who want to start their own businesses to organisations that lend them the money to do so. The loans are then repaid to the organisations. Life skills development programmes teach communication, critical-thinking and problem-solving skills that help young people make decisions in work and life. Vocational training programmes teach students a trade. Entrepreneurship training and support programmes help people start their own businesses through both teaching and loans. 10. Young people can learn livelihood skills on their own by talking to people in their community who have knowledge about working in areas that interest the young person. Some different things young people might ask their elders are: to to to to to counsel or mentor them offer them career guidance and choices teach them marketable skills help them find job opportunities help them access job markets. 96 ANNEX 5 List of Youth Researchers Spanish Town Core Researchers Lisa Mills Sequoia Thomas Tatiana Duncan Natalie Patterson Support Team Damian Brown Portmore Core Researchers Carrel Kerr Kenisha Rhooms Ayisha Robb Deborah Brown Tracy Ann Graham Support Team Kimesha Jemeison Stacy Ann Williams Eton Williams Yolanda Smith St. James Core Researchers Brenda Lee Black Keneil McKenzie Jason Edwards 97 Support Team Tanya Lewis Floyd Hilton Diana Birch Jhnell Reid Bennyon Burchell Portland Core Researchers Kenton Wilson Sandrine Sparkes Kavil Howard Keisha McFarlane Support Team Theresa Holness Kerril McKay Shaneika Thomas List of Participating Youth Organizations Children First Youth Advocates (Jamaica Coalition of the Rights of the Child) Hope Worldwide Jamaica Red Cross Society Guidance and Counselling Unit (Ministry of Education, Youth & Culture) Portland Parish AIDS Committee Youth Arm WESTHELP, Western Health Education Learning Programme (St. James Health Department) Western Society for the Upliftment of Children Youth at the Crossroads (Campus Crusade for Christ) Youth.Now (Ministry of Health) Behaviour Change Communication Team – National HIV/AIDS/STI Control Programme (Ministry of Health) Adolescent Reproductive Health Unit (Ministry of Health) 98