“Auntie Stella”: A Best Practice Sexual & Reproductive Health Education and HIV Prevention Resource for Adolescents
Table of Contents
The importance of investing in adolescent girls’ education in Sub-Saharan Women and African Economic Development is well documented, especially in relation to the future socio-economic and health gains in their own and others’ lives. Skills such as literacy, numeracy and critical thinking, which are acquired through formal schooling, help a girl navigate and thrive in society. However, in order for education to truly be beneficial it should be comprehensive and cover all aspects of girls’ (and boys’) daily lives such as the socio-economic and cultural background and gender relations. A particularly important aspect of the adolescent girl’s life is sexual and reproductive health (SRH), yet its inclusion in formal school curricula is controversial. This article presents the case for “Auntie Stella” (AS), a reproductive health education and HIV/AIDS prevention resource used by schools and other entities internationally as a component of comprehensive sexuality education for adolescents.
Getting to Know “Auntie Stella”Auntie
Auntie Stella (AS): Teenagers talk about sex, life and relationships is published by the Training and Resource Support Centre (TARSC), which is based in Zimbabwe . AS is a 42-card based question and answer activity which is available in hard copy and online and is based on the agony aunt concept. Agony aunt or helpline columns are popular fora for adolescents and the general population to engage with otherwise taboo or sensitive issues, which are difficult to discuss openly. This kind of forum appeals to adolescents primarily due to the anonymity and freedom, components, which allow them to discuss issues with their peers without fear of judgment or criticism by adults.
Including Adolescents’ Voices in Sexual and Reproductive Health Education
AS is designed for use with in-school and out of school for young people aged 12 – 19 in Southern and Eastern Africa, but it can be adapted for use elsewhere. Adult facilitators must be knowledgeable in adolescents’ SRH concerns and know where to direct them for resources/information. AS limits facilitators’ engagement in adolescents’ discussions so for instance, in a school class setting, a teacher would mainly organise sessions, encourage participation in an informal setting but can also disengage and only provide assistance, not answers when difficulties arise. Limited teacher engagement tackles issues of power-distance disjuncture based on the authority teachers have over students and creates a relaxed atmosphere where students’ self-censorship is less likely, which is optimal for peer-to-peer learning.
Cards are in the form of letters presenting issues adolescents might face. Topics covered include:
- Reproductive development
- Social and economic pressures to have sex
- Gender roles
- Forced sex
- Communication with parents about romantic relationships
- Wanted and unwanted pregnancies
- Cervical cancer
- HIV and AIDS, and
- Sexually transmitted infections (STIs).
Card topic coverage is based partly on adolescents’ stories, experiences, and expressed needs as found by the Adolescent Reproductive Health Project (ARHEP) in 1997. All AS responses are checked for medical and cultural accuracy, a result of ARHEP’s collaboration with multiple actors involved in gender, reproductive health, youth and human rights and other related fields. Questions are read and discussed in small single and mixed-sex groups or individually. After discussing the questions, group members or individuals then read AS’s expert response. Each card takes about 30-45 minutes to complete, especially if used in a group setting.
Kirby et al. developed a matrix of characteristics of effective sex and HIV education programs, based on findings in 83 developing and developed countries.Kirby, D., Laris, B.A. and Rolleri, L. (2005, p27) ‘Impact of Sex and HIV Education Programs on Sexual Behaviours of Youth in Developing and Developed Countries’, Youth Research Working Paper Number 2, North Carolina: Family Health International http://www.ungei.org/resources/files/sex_ed_working_paper_final.pdf (accessed 27 July 2012) Although the programs evaluated focus solely on HIV and STIs preventive behaviour, when applied to AS, most of the characteristics in the matrix prove AS to be an effective program. Key characteristics include inclusion of multiple entities with expertise in different but relevant areas in curriculum design, evaluation of target group’s needs, sensitivity to community values in design, active participation of students in class activities, and obtaining buy-in from relevant authorities. The HIV and STI prevention programs Kirby et al. reviewed had a prescriptive tone with a focus on prohibitions. However, AS seeks to empower adolescents to hone their analytical skills and have access to information and resources in order to make sound decisions.
AS in Zimbabwe and the Southern Africa Region
A 2006 review on AS’s impact in Zimbabwe commissioned by the Community Working Group on Health (CWGH) and the United NationsICEFTARSC & CWGH (2006) Participatory Review on the Impact and Use of Auntie Stella in Zimbabwe, Harare: Training and Research Support Centre found the following:
- Increased SRH knowledge among youth;
- Improved communication among youth, their peers, and their parents; and
- Improved confidence and ability to resist peer pressure and make informed choices curbing unhealthy and risky behaviour.
In fact, AS users in the CWGH programme described the imaginary “Auntie Stella” as “’a great friend’”. Additionally, other organisations that use AS value it for its content and participatory methodology that has at its core adolescents’ experiences and voices. The review found that AS is an important component in young people’s SRH in Zimbabwe. It is particularly important not only in combating HIV/AIDS/AIDS but also for its “empowerment of young people and the enrichment of their health and well-being”.
In a review of “best practice” programs, SafAIDS adopting the Southern Africa Development Community (SADC) criteria classifies AS a “Truly a Best Practice”.SafAIDS (2009, p54) ‘Zimbabwean stories of “Best Practice” in mitigating the HIV Crisis through a Cultural and Gender Perspective’ , Changing the River’s Flow Series: Challenging Gender Dynamics in a Cultural Context to Address HIV, Pretoria/Harare: SafAIDS This achievement was based on:
- Effectiveness (effecting behaviour and attitude change);
- Cost-effectiveness (robustness of tool-kit materials; laminated cards housed in a canvas bag);
- Relevance (e.g. through responding to new medical findings on the importance of circumcision in HIV prevention);
- Ethical soundness (participatory, sensitivity to marginalized groups);
- Innovativeness (adaptation of the agony aunt concept); and
- Reproductive Category:Health
- Reproductive Rights
- Women’s Reproductive Category:Health
AS is an example of a tried and trusted resource for adolescents’ SRH education and HIV prevention whose success lies in its inclusion of adolescents’ voices and emphasis on their realities, its participatory design and facilitation of peer to peer learning, and sensitivity and adaptability in different settings. Ultimately, if adolescents do not receive comprehensive SRH and HIV prevention education, the other skills acquired in their formal education prove only partially useful for their successful transition to adulthood.