By Ikirimat Grace Odeke

Volunteering can be exciting & relaxing

My exciting assignment as a UNV ended after one year (2008 after the project ended). But I felt the contentment and fulfillment that I had made a contribution to other people by sharing my skills and experience with this people (though indirectly). I had always wanted to contribute to young peoples lives and attempted to do personal projects in secondary schools even while persuing this UNV assignment but due to tight work schedule could not do a lot.

Upon my return home, it was yet another opportunity for me to pursue my ambition of making a difference in someone’s life. Our leaders have pledged to make adolescent sexual and reproductive health a priority and the MDGs made it critical to support integrated, comprehensive programs that holistically address adolescents' reproductive health. But it should be noted that a country's ability to meet the MDGs regarding poverty, HIV and AIDS, and maternal and child mortality rates is integrally linked to the reproductive health and well-being of its youth.

These are the Trainers of the SHEs posing for a photo with one of the SHE Trainees (3rd left) at Nyabitete Secondary school

The Sexual Health Improvement Project (SHIP) is a dream conceived following our training course on Adolescent Sexual and Reproductive Health (ASRH) and HIV/AIDS prevention in Israel in 2007, attended by me and my other colleagues (Catherine Promise, Abraham Omaren, Liz Nansubuga and Eva Nakimuli). The SHIP project started on a voluntary basis with a high spirit of commitment. This is a personal initiative we are passionate and enthusiastic about sharing, transferring and imparting the knowledge and skills acquired to others as a way of making a contribution to improving the quality of life of young people. We work with small groups of 10-15 adolescents of the same sex within both formal and informal surroundings (schools, churches, communities). Holding 10 – 15 weekly meetings with each group.

Uganda is renowned worldwide for scoring highly in the fight against HIV/AIDS. The country’s HIV/AIDS prevalence rate dropped tremendously from 31% in the 1980s to 6.4% in 2006. The HIV/AIDS prevalence stands at 3% among young people aged 10-24, with prevalence among girls being 4% compared to 1% among their male counterparts (2004). Furthermore, the teenage pregnancy stands at 24% (UDHS, 2006) implying that several teenage girls are dropping out of school due to pregnancy and those girls are more vulnerable to social economic hardships resulting from a lack of education.

These where some of the descriptions the boys had about girls.

In order to improve the sexual health status of young people and curb socio-economic problems such as teenage pregnancy, HIV/AIDS, school dropouts and delinquency, several interventions have been put in place by the Government of Uganda and other actors to give sexual health education to young people both in and out of school.

This model provides non-judgmental and supportive environment for the youth and is characterized by culture-sensitive and interactive sessions which equip and empower young people with communication skills, knowledge, and tools they need to make appropriate decisions regarding their sexuality.

Although the school curriculum has incorporated Sexual Health Education in Uganda, in both primary and secondary school level, studies reveal that due to several factors, the education system has not provided children with; accessible and accurate knowledge and information about the process of sexual maturation, essential facilities to ensure that children, especially girls are not excluded from full participation in the system because of their maturing bodies and an adequate and appropriate value system through which boys and girls can be guided into safe and healthy adulthood.

In addition, the topics recommended for teaching are limited in scope and several issues pertinent to the sexual health of young people are hardly addressed. Furthermore, students approach sexual health education like any other subject that they must read thoroughly in order to pass their exams. This approach towards sexual health education inhibits their ability to internalize what they are learning.

The Sexual Health Improvement Project (SHIP) seeks to complement efforts already in place and fill these gaps through innovative, non formal, interactive and participatory approaches to sexual health education. The project also incorporates issues such as self esteem and gender stereotypes among the topics to be taught in order to ensure that the subject of sexual health is comprehensively covered.


*A SHE conducting a"Decision Making" session with the girls in Nyabitete*	*Sec*

We have been conducting sexual health education session in 4 selected secondary schools but due to our busy schedules in our places of work, it they were not able to be available in all the scheduled days to conduct the sessions to the adolescents. It was at this point that we decided to train Sexual Health Educators (SHEs) from the community and attach them to selected schools to provide the sexual health skills to adolescents as a strategy for continuity and sustainability of the programme. The trainees are people of integrity willing to work as volunteers. They were identified from youth groups, training institutions such as nursing training schools, health centers, education institutions, and religious institutions as well as the business community.

It is so discouraging and disappointing to have a wealth of knowledge and skills yet you can not share and transfer them to someone you know would have utilized them to improve on his life.’ The most difficult thing we had to do was to mobilize resources to conduct the training. Much as we were able to secure facilitation for the other Israeli expert from the Israeli government, the local costs were to be covered by other sources. I can assure you that if it was not for our passion and commitment; it was at this point that we would have given up. Thank God, after so much effort, Government of Uganda secured funding for training of 25 SHEs. The SHEs is a multi disciplinary team of committed young SHEs from various cultural and professional backgrounds to suit the youth.

25 SHE were equipped SHEs with knowledge and skills on how to effectively communicate to young people in school in order to address sexual and reproductive health issues including HIV/AIDS. They were provided with basic information/facts about human sexuality: human reproduction, anatomy, psychology, sexual orientation, HIV/AIDS/STIs in cognizance of their culture. This also provided an opportunity for sharing and interacting with the SHEs and trainers. The SHEs revealed that it was interesting and enriching to share experiences and learning from the culturally sensitive model of Sexual Health Education which they said was positive. In this way we were sure that the sustainability of SHIP was enhanced and will also facilitate roll out of the life skills, communication skills, decision making skills and knowledge on a culturally sensitive model of sexual health education with confidence and enhance acceptability.

This is what the adolescents think

In a bid to making sexuality education comprehensive and effective, we took in mind the need to provide young people with age appropriate, culturally relevant and scientifically correct information. This would eventually provide opportunities for young people to explore their attitudes and values, and to practice the skills they need to be able to make informed decisions about their sexual lives.

Some of the areas covered in the training include:

· Sexual and gender-related stereotypes

· Strengthening self esteem and assertiveness

· Warning signs and the need of boundaries in relationships

· Sexual relations, conception, contraception and drug abuse

· Male-female relations in adolescence

· Male and Female reproductive systems

· Gender sexual stereotypes and self-esteem

Boundaries in relationships, sexual harassment and abuse.
Healthy relationships and sexual behavior
Sexually transmitted infections and HIV/AIDS
Skills development and personal empowerment (decision-making, interpersonal communication, coping with dilemmas in female-male relations)
Development of educational projects on Sexual Health and AIDS prevention in Uganda using a health promotion approach
Development of culture-tailored educational tools (activities, games, role play) tailored to Uganda's different cultural and social contexts. The training also had a practical component where trainees visited a service delivery point (Nyakibale Hospital and Nyabitete S.S) where some of the issues that they learnt about are being handled.

Addressing specific situations that may lead to risky sexual behaviour or unwanted or unprotected sexual intercourse, how to avoid and get out of these situations; Assessing the reproductive health needs and behaviours of young people e.g. Youth friendly health services, contraceptive use; Addressing cultural and personal values and perceptions of family and peer norms about engaging in sexual activity and having multiple partners; Focusing on specific risk and protective factors that affect particular sexual behaviours and that are amenable to change by the curriculum-based programme. The most prevalent sexuality education curricula are designed to reduce risks related to STIs, HIV and AIDS or unintended pregnancies. These programmes are often too medical-oriented, fear-based and seldom address the varied needs of young people.

The curricula rarely address relationships, social and cultural factors and positive aspects of sexuality, such as sex as a natural, pleasurable, life-affirming event. Research has suggested that abstinence as a behavioural goal is not the same as the abstinence-only education programmes. To bring about a behavioural change among young people, comprehensive sexuality education strategies should be adopted to increase knowledge and skills of young people in making healthy and informed choices rather than limiting their rights and choices. Furthermore, comprehensive sexuality education needs to be paired with programmes aiming at providing access to comprehensive sexual and reproductive services for youth.

It was at this moment (training and practicum) that we came face to face with reality of adolescent’s confessions. They confessed that very little is known by their parent’s about what they go through in their sexual life as adolescents. Some of them could not be bold to ask questions in a group, so for privacy we asked them to write their questions on a piece of paper and submit to us (trainers and SHEs); ‘what do I do now that I am already infected with HIV/AIDS?; why do boys get attracted to girls and vice versa?; why do girls experience pains when they are in their menstrual periods? They were cautioned to always bear in mind that there may be some adolescents who are already infected with HIV/AIDS. Therefore, the SHEs should always avoid statements and situations which may make such infected adolescents offended.

The is one of the messages on the school compound

The trained Sexual Health Educators (SHEs) were divided into 6 teams of 4 persons each (2 male and 2 female). The SHEs shall conduct sexual education sessions in the selected secondary schools. Each team shall hold an hour’s session with its target group once every two weeks for three school terms. We are playing a coordination, monitoring and evaluation role while continuing to conduct sex education sessions in schools near us.

The District leadership has embraced this initiative because we involved then right from the planning stage to implementation. They tirelessly coordinated the selection and mobilization of SHE trainees. The district leadership has pledged to support the initiative to cover all the sub counties of the district, since the 24 trainees had come from only 6 sub counties. continued collaboration and ownership of the project by the district leadership as a way of ensuring sustainability in form of resources to facilitate the trainees with transport and lunch, as they set out to do SHE in schools was called for. This minimal contribution by the leaders would make a great contribution in the lives of the adolescents who are the future leaders of this country.

Dr. Karyabaakabo the District Health Officer- Rukungiri, in the opening session noted that the sexual situation of young people in Rukungiri is bad. He explained that in a recent study carried out in Rukungiri, it was evident that the majority of young people both in and out of schools were engaged in sexual relationships, many of which were casual. He added that it is no longer good to burry heads in the sand as young people ruin their lives, but rather it is high time to dialogue with the young people. He presented that because of the improved services, young people who were born with HIV have grown and if left to engage in adolescent sex, they will also spread it further to fellow youngsters.

The DHO applauded the good policies in place but also decried the low levels of operataionalization and implementation due to financial impediments. He thanked the schools in Rukungiri which had accepted to readmit young girls after delivery. He mentioned such schools as Immaculate Heart, St. Gerald and Katojo. He concluded his remarks by calling on the trainees not to disappoint the goal of the training, but give the necessary information to the young people without engaging them in sexual relations.

The opening of the training was graced by the area Member of Parliament Hon. Major General Jim Muhwezi who expressed his interest in the programme of SHE training. Hon. Muhwezi acknowledged that sexual health education in schools is not easy, as some parents misinterpret it for attracting their children into sex. He thanked Population Secretariat for having realized the need for sexual health education in rural schools, and for particularly taking it to Rukungiri.

He added that Uganda has so many good policies on paper, but are not put into action because of financial limitations. On this note, he retorted that birth control in Uganda can be achieved if there is high level political commitment. He therefore appealed to the people of Rukungiri to have children whom they can afford to look after.

Adolescent girls (13-16 years) in a group session discussion

Given the value that he attaches to the training, Hon. Jim Muhwezi promised to find ways of seeing this training scaled up to the other sub counties of the district. On this note, he pledged to solicit funds, offered free air time on Radio Rukungiri- where the activities of SHIP can be communicated to the people of Rukungiri, and also promised to talk to fellow Parliamentarians to forge a way forward on how the lives of the vulnerable young people can be protected. As he crowned his remarks, he appealed to the trainees not to sit on the information that they were going to get from this training, but to pass it on to young people wherever they may be; be it in schools or in their communities. He implored the trainees to lead by example as they exhibit good behavior before the young people.

The SHEs visited areas such as St. Karoli Lwanga Hospital- Nyakibale where they interfaced with the realities of HIV spread, transmission, prevention, treatment and care. The purpose of this visit was to give the SHEs evidence-based information and facts about HIV in Rukungiri and also to equip them with a referral area in case they meet young people infected with HIV.

Mr. Zedekia Karokora- District Chairperson welcomed this new innovative and interactive approach that helps young people to open up. He acknowledged that sexual health education is not an easy topic to handle as it is a purely private matter and culturally, a taboo to talk about it in this community, yet the truth is that it actually happens among young people. He added that the district has all the evidence that young people are engaging in sexual activity and he cited the example of young mothers who had recently reported in the media.

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