Copyright Naz Male Health Alliance 2013 Reproduction, adaption and translation is authorized throughout Pakistan and worldwide for nonprofit education and health promotion purposes. Publication with permission will be appreciable, however, with due credit given to Naz Male Health Alliance. Hamdam Hamqadam: A Peer Educator’s Handbook was supported by UNDP under the Multi-Country South Asia Global Fund HIV Programme (MSA-910-G02-H).
Hamdam Hamqadam
A peer educator’s handbook 2014
Naz Male Health Alliance
This handbook is an adapted version of "On the Road Again" for which NMHA duly acknowledges DoH London, International Development Cooperation and Nai Zindagi.
Dear Peer Educators, Peer educators can communicate and understand in a way that the bestintentioned persons can't, and can serve as role models for change. Peer education for HIV and STI prevention with MSM and TG, is based on the reality that many people make changes not only based on what they know, but on the opinions and actions of their close, trusted peers. This has been tested globally with astounding results and we, here at NMHA, are confident that such an intervention will certainly be a valuable addition to our program.
Serving as a peer educator provides a challenging, rewarding opportunity to young people to develop their leadership skills, gain the respect of their peers, and improve their own knowledge base and skills. Peer education can foster fulfilling relationships within the community It can give people the legitimacy to talk about sex without the risk of being stigmatized as sexually promiscuous Peer educators can provide a valuable link to health services especially within low income communities where choices are limited; Peer education can be instrumental in increasing information, motivation, behavioral skills, and behavior. As the foundations of our organization, peer educators, together with outreach workers, are of the utmost value to us. You are our soldiers in the fight against HIV and STIs.
Qasim Iqbal
Acronyms:
NMHA
Naz Male Health Alliance
PE
Peer Educator
MSM
Male who have sex with male
TG
Transgender
UNAIDS
United Nation AIDS
HIV
Human Immunodeficiency Virus
AIDS
Acquired Immune Deficiency Syndrome
STI
Sexually Transmitted Infection
BCC
Behavior Change Communication
Why take HIV&AIDS Prevention services for MSM/TGs to the streets? NMHA is the first ever non-governmental technical support agency that exists to improve the sexual health, welfare and human rights for most at risk populations (MARPs) and their partners. In context of HIV prevention, treatment, care and support, NMHA recognizes the need for working with MARPs because it is the right thing to do on humanitarian grounds, epidemiologically
and
from
perspective. Bearing same
a
public
health
in consideration,
we
advocate for the rights of MSM/TG communities in Pakistan. According to UNAIDS (2013), more than 35.3 million people, in the world, are currently living with HIV. The vast majority of people living with HIV are in owand middle-income countries. In Pakistan, like many
there
countries
in
Asia,
the
HIV
epidemic
is
concentrated in marginalized groups of society with high risk behaviors. Among these groups MSM/TGs face a greater threat of HIV explosion not only because of already identified high rates of infections (up
to
7.2%
and
3.1%
among
TG
and
MSM
respectively) but also due to extreme level of Stigma and discrimination associated with same sex behavior. Pakistan is one of the 78 countries where same sex behavior is criminalized that makes it more difficult for MSM/TG community to access prevention or treatment services. There is a considerable need for empowerment of this community to ensure their effective participation in HIV&AIDS program; which is impossible without creating a relationship based on trust and fostering leadership from within the community. With the advent of HIV/AIDS, it is recognized that there will be a high price to pay in terms of public health, social and economic well being, if societies do not acknowledge or address the needs of MSM/TGs
in their day-to-day situation. So the underlying concept is to bring services to MSM/TG from lower socio-economic class, and ensure easy access (lowthreshold) to services and facilitate ownership of services by the community itself. This approach reaches out to the MSM/TGs with prevention services rather than waiting for them to come to Service Delivery Centers, hospitals and/or treatment centers. Street based peer education is important because most of the MSM/TGs who belong to lower socioeconomic class have very little or no access to appropriate health care services. Some are not aware of services or are under the impression that either money or connections are necessary to access help. Many of them believe that if they go for help, the health care [professional will judge them and insist to give up the same sex behavior. Some would need the health care professional to be able to understand and discuss the realities pertaining to their sex work. Equally, some are critically ill, have no friends or family, are unable to make contact and need to be reached out by someone dependable and capable to provide help.
This handbook is an effort to acknowledge the importance of peer educators and to provide them support in carrying out their day to day services on the street. It is based on the learning from program for MSM/TGs working under the umbrella of NMHA across Pakistan. Contributions from all staff at Service
Delivery
Centers
and
NMHA
are
duly
acknowledged. This handbook is dedicated to our MSM/TG clients who have enriched our knowledge in terms of understanding realities of their lives and enabled us to write about it.
Who is a Peer Educator? An MSM/TG who is capable and committed to understanding and responding to needs of his/her community in a helpful way. Someone who is: Able
to
demonstrate
knowledge
about
social,
psychological, geographical and behavioral aspects of MSM/TGs’ lives. Able to gain acceptance without being drawn in. Able to develop a non-threatening position with street people as well as the local community. Willing to work as the scene demands - outside regular hours, in a consistent manner. Able to gain acceptance of the group/individual while maintaining
the
organizational
ethics
in
his/her
responses. Able to identify and adapt to changing dynamics in the streets. Able to negotiate with the community for better understanding and support. Able to maintain boundaries.
Who is not a Peer Educator? Someone who is: Unwilling or unable to listen and learn. Liable to compromise the principles of his/her organization through; Sexual exploitation. Discrimination - Creating favoritism. Mis-utilization of resources. Playing God. Talking down. Inflexibility. Have dispositions which would jeopardize the safety and wellbeing of all concerned. Not recommended by peers. “People cannot benefit from your experiences until they believe that you care”
What will I face on the streets? Principle: In our service delivery centers the client tends to be the guest while in the streets we are the guest and must behave as such. What to expect; Constant
discrimination
of
MSM/TGs
has
led
to
mistrust. Hostility is often the only form of defense. Manipulation has become a means of access to resources. There may be resistance to change; usually community members take time to understand what you actually want to do with them. You
may
be
a
target
and/or
tool
for
mis/dis
information. You may face extremely negative situations and you will feel strong negative emotions. You will be seen as an opportunity for exploitation A soft touch. The community will seek instant gratification which may not be possible for you. “You will not be listened until accepted… be respectful to the community and environment”
How to engage people? Principle: Your understanding about objectives of work and commitment to the cause sets the stage for a long lasting and dependable relationship Approach people with respect at all times. Demonstrate your knowledge about HIV&AIDS and healthy living. Know and prevent your own risks also. Introduce your organization, yourself and Let people know what your intentions are. Have positive regard for the MSM/TGs’ sub culture and sex work. Learn
to
be
comfortable
in
the
sex
workers’
surroundings. Offer practical support immediately. Express genuine concern. Respect confidentiality and communicate this. Carry personal identification from your organization. Work with a fellow street worker as much as possible. Speak to a small number at a time for better communication and attentive listening. Preach less - Listen more.
Don’ts Don't
assume
to
be
the
Savior!
Don't
be
overdressed - Be casual. Don't show shock on learning about any behavior. Don’t say anything that you cannot do. Don't let money be the basis of the relationship. Don't carry weapons. Don't do any kind of trade with the clients. Don't take role of investigator. Don't ask about behavior which may give the impression that you are working for the police. Don't be drawn into sexual propositioning (of any kind). Don't try to convert the dealer or anyone else. Don't
take
photographs
until
you
have
relationship of trust and then ask. “You must be perceived as a person from with-in the community”
a
How do you assess needs? Principle: Client's needs take priority over all others (organization and personal). Practice – You assess needs through; Conversation (understanding the felt needs of the person). Observation (understanding the perceived needs). Matching both you begin to know the real needs. Understanding that a needs assessment is a process and is best developed through continuous interaction. Taking
into
consideration
concerns
of
the
local
community such as: shopkeepers, health care providers, local authorities, etc. Confirm your emerging ideas with other service delivery points and colleagues. Ensuring information is recorded. Identify existing resources and potential partner/family support. “Don’t perform surgery in the dark”
How do you handle crisis? Principle: Remain calm, know your limitations, understand your options and act in accordance. Practice Be street smart in dealing with conflict. Assess if there is a person present who can intervene more effectively than you. In this case follow
their
lead
and
support
the
person
intervening. Be a Peace-keeper rather than a Peace-maker.
“I can change if I have courage that should be based on the understanding what needs to be changed and why”
How to deal with failure? Principle: I have learnt from my failures, my success seldom taught me anything. Practice Accept failure as part of work and openly discuss it with the team so that you can learn from it. Set achievable goals. Know that things will go wrong despite all your efforts Develop personal support systems. Be
willing
to
learn.
Failure
is
the
essential
ingredient for learning - Success rarely teaches. Share lessons learned. Share
your
mistake
before
it
becomes
unbearable burden for you and the organization. “My failure was a mistake until I learned from it!”
an
How to ensure effectiveness of your work? Cardinal Rules Practice what you preach, become a role model for the community members. Remember action speaks louder than words. Use pictorial BCC materials for effective inter personal communication. Do appreciate other people's efforts. Be respectful to people and the environment. Try various strategies at different times, take feedback and modify accordingly. Be impartial, non sectarian and non political. You should know: What your organization is about, but be careful not to oversell your program approach, philosophy and need. Your job description & duties. Your activities, responsibilities and authority. “My job is to ensure that all is done in the
best interest of the clients”
How to ensure institutional support for your organization? Principle: You are not an individual working in the streets. You are a team player. Practice Know
the
communication
procedures
of
your
organization. Know that the quality of support given will depend on your feedback. Know that as a peer educator you are essential to the work of the organization and ensure that; The street work concept is recognized. Your activities are subject to strategic planning. Your activities are endorsed by management and other team member. Provide regular reporting, both verbal and written. Be sure that you have regular supervision with your outreach worker. Be open to feedback and be tolerant of criticism. Don't let apparent success go to your head. Don't be possessive about your contacts. Introduce others. Don't be territorial. “Success comes from working as a team”
BCC Material 1 Condom Demonstration Front
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BCC Material 2 Sexual Transmitted Infection Front
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