Empowering Each Other: Young People Who Sell Sex in Ethiopia

“HIV prevention programs are increasingly recognizing the different ways in which sex workers organize themselves and how they prefer to access information and services. However, existing programs are taking place on a small scale and often in larger towns. They need to be nationally scaled up.”

A Case Study From the Link Up Project

This 12-page case study discusses the experience of a peer education project in Ethiopia, which trained young people who sell sex to reach out to their peers and lead sexual and reproductive health and rights sessions, supported by trained nurses and a referral system for services. The project was led by the Organization for Support Services for AIDS (OSSA) as part of Link Up, a five-country program working to improve the sexual and reproductive health and rights (SRHR) of one million young people most affected by HIV in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda. The Ethiopian initiative was created to fill both knowledge and service gaps to ensure that young people who sell sex have access to both adequate information and services about their SRHR in order to stay healthy.

This case study was developed using information from the project’s monitoring data and with information provided by branches of OSSA. As part of the project, young people who sell sex were selected and trained to become peer educators. The 3-day training included modules on relationships, pregnancy, sexually transmitted infections (STIs), HIV and violence, as well as life-skills such as how to address self-esteem issues, be assertive, and make decisions. Over seven weeks the peer educators led sessions in their places of work, including bars, hotels, restaurants, and homes, supported by OSSA nurse counselors. Any group member wanting access to contraceptive methods, STI or HIV services, counseling or other support receive a referral slip. When a young person who sells sex arrives with a Link Up referral slip at a designated health facility they are offered free services (which OSSA then pays for) and are often fast-tracked, meaning they do not have to wait.

According to the case study, over a 12-month period (January to December 2014), OSSA and its partners trained 468 young people who sell sex as peer educators, and reached 16,087 young people who sell sex with peer education sessions in the community. Of these, 35% (5,635) received referrals for clinical services, of which 30% (1,707) went to health facilities where they took up or completed services. As stated in the case study, “This intervention focuses on building the capacity, knowledge and self-efficacy of young people who sell sex. The knowledge and self-confidence they develop through this approach feeds into future work, projects and individual lives. This approach invests in people, who in turn share information to their friends, peers, family members and children.”

The case study outlines a number of challenges faced by the peer educators and nurse counselors. This includes group dynamics in which some groups did not bond and in other cases group members did not always respect their peer educator. Group members also sometimes requested additional refreshments (beyond the coffee and bread already provided) to come to sessions. In addition, the priorities of young people who sell sex are often not SRHR-related, but rather the need to provide housing, food, and clothing for themselves and their families, plus the need to attend school or start a business.

The case study offers a number of lessons learned:

Role of peer educators -“ Peer educators speak the same language as their peers, are good at facilitating conversation, can answer questions clearly, and talk openly about sensitive issues. They play an important role in identifying session participants as well as setting appropriate times and locations for sessions. They are often seen as role models by their peers.”
Role of nurse counselors – “The nurse counselors are critical to this intervention. They provide peer educators with support, enhance their knowledge and instill confidence in them. Nurse counselors provide a critical service by assisting young people who sell sex to health facilities.”
Locations and times of peer education sessions – “It is important to hold sessions at times convenient to, and agreed by, group members otherwise this may become a barrier to participation.”
SRHR and HIV must be integrated. – “During the project, a significant number of young people who sell sex reported experiences of unplanned pregnancy and STIs as well as living with HIV. These stories remind us of the importance of integrating SRHR and HIV information and services. This means addressing a range of SRHR and HIV issues in the peer education sessions and ensuring that information, education and communication materials speak about dual protection and the use of condoms for protecting against both pregnancy and HIV and other STIs. It also means ensuring young people who sell sex know they can access a range of services at health facilities.”
Recognizing the priorities of young people who sell sex – “It is important to recognize that young people who sell sex may share a range of experiences and needs during peer education sessions including the need for housing, food, employment opportunities and education plus psychosocial support to respond to violence, stigma, discrimination and other issues.”
Promoting good experiences – “When young people who sell sex have experienced sensitized and supportive health providers, it is useful to encourage them to share their experience with their peers in order to dispel the fears others may have around accessing care in health facilities and as a way to respond to questions about which services.”

Click here to download the case study summary in PDF format.

Click here to download the full case study in PDF format.

Source: The Communication Initiative Network
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