Peer Educators Manual_Validated Final with HEADSS Approach 06.08.2022 (1) (1)

REPUBLIC OF ZAMBIA
MINISTRY OF HEALTH
Peer Education
Training Manual
For Training Adolescent and Young People’s
Peer Educators on Adolescent Health IL
2022 1
Peer Education Training Manual
2
REPUBLIC OF ZAMBIA
MINISTRY OF HEALTH
Peer Education
Training Manual
For Training Adolescent and Young People’s
Peer Educators on Adolescent Health IL
2022
iii
TABLE OF CONTENTS
ACRONYMS...................................................................................................................................................... iv
ACKNOWLEDGEMENT....................................................................................................................................... v
FOREWORD...................................................................................................................................................... vi
MODULE A: INTRODUCTION TO THE PEER EDUCATOR’S TRAINING ON ADOLESCENT HEALTH..................... 1
Part 1: Module Introduction.......................................................................................................................... 2
Module B: Sexual and Reproductive Health in Adolescents and Young People............................................. 4
Part 1: Sex and Sexuality............................................................................................................................... 4
Part 2: Personal / menstrual hygiene: 30 Minutes........................................................................................ 8
Part 3: Delaying sexual debut...................................................................................................................... 11
Part 4: Safe and unsafe sexual behaviour.................................................................................................... 13
Part 5: Pregnancy prevention (Contraceptives)........................................................................................... 16
Part 6: Care of adolescents during pregnancy and childbirth..................................................................... 19
Part 7: Unsafe abortion............................................................................................................................... 21
Module C: Sexually Transmitted Infections in Adolescents........................................................................... 22
Part 1: Module Introduction........................................................................................................................ 22
Part 2: Definition of Sexually Transmitted Infections (STIs)......................................................................... 22
Part 3: Types of STIs..................................................................................................................................... 22
Part 4: Reasons contributing to STIs in AYP................................................................................................. 23
Part 5: The dangers of STIs in adolescents.................................................................................................. 24
Part 6: Barriers to seeking timely help for STIs treatment by AYP............................................................... 24
Part 7: Prevention of STIs in AYP.................................................................................................................. 24
Module D: HIV/TB and Adolescents/Young People....................................................................................... 26
Part 1: Basic facts of HIV.............................................................................................................................. 26
Part 2: Stages of HIV infection..................................................................................................................... 29
Part 3: HIV Testing Services (HTS)................................................................................................................ 30
Part 4: Anti-Retroviral Therapy (ART) 1 Hour.............................................................................................. 34
Part 5: HIV prevention:................................................................................................................................ 35
Part 6: Positive Living................................................................................................................................... 37
Part 7: Health Facility Visit........................................................................................................................... 39
Part 8: Tuberculosis (TB)/HIV Co-Infection.................................................................................................. 40
MODULE E: Young People and Alcohol/ Substance Use................................................................................ 41
Part 1: Discussion of key terms.................................................................................................................... 41
Part 2: How to tell if someone is using alcohol and other substances........................................................ 43
Part 3 Open question................................................................................................................................... 44
Part 4: dangers of using substances on reproductive health....................................................................... 45
Module F: Gender Based Violence................................................................................................................. 46
Part 1: Module Introduction........................................................................................................................ 46
Part 2: Definition of GBV............................................................................................................................. 46
Part 3: Dangers of GBV................................................................................................................................ 47
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Part 4: GBV Prevention and response services............................................................................................ 49
Module G: Non-Communicable Diseases in Adolescents and Young People................................................ 51
Part 1: Definition of Non communicable diseases (NCDs)........................................................................... 51
Part 2.0: Prevention and control of NCDS.................................................................................................. 52
Module H: Mental health and the young people.......................................................................................... 53
Part 1: Definition of different terms used in mental health........................................................................ 53
Part 2: Reasons for Poor Mental Well-being............................................................................................... 54
Part 3: Common Mental Health Problems.................................................................................................. 54
Part 4: Signs and symptoms of poor mental health.................................................................................... 56
Part 5: Dangers of Poor mental health........................................................................................................ 56
Part 6: Importance of Keeping Good Mental Health................................................................................... 57
MODULE I: ADOLESCENTS WITH DISABILITIES...............................................................................................58
Part 1: Definition of disability......................................................................................................................58
Part 2: Types of disabilities..........................................................................................................................58
Part 3: Stigma and discrimination towards adolescents with disabilities....................................................58
Part 4: Effects of Stigma...............................................................................................................................59
Part 5: The role of peer educators in providing Services for adolescents living with special needs............59
MODULE J: Counselling Skills.........................................................................................................................60
Part 1: Introduction.....................................................................................................................................60
Part 3: Characteristics of a Good Counsellor...............................................................................................61
Part 4: Discuss the characteristics of a good counsellor..............................................................................62
Part 5: Identifying a safe environment for adolescent counselling.............................................................62
MODULE K: Communication and life skills.....................................................................................................64
Part 1: Module Introduction........................................................................................................................64
Part 2: Communication Skills.......................................................................................................................64
Part 3: Behaviour Change............................................................................................................................72
Part 4: Entrepreneurship Skills....................................................................................................................73
Module L: Concluding.....................................................................................................................................76
Part 1: Provision of Comprehensive Adolescent Health Services using The HEADSS Approach..................76
Part 2: Peer Educators TOR and Reporting..................................................................................................83
Part 3: Review of Peer Educators Tools (1 hr)..............................................................................................90
Part 4: Peer Educators Reporting (1hr)........................................................................................................90
Part 5: Graduation & Closing.......................................................................................................................94
ANNEXES.........................................................................................................................................................95
Annex 1: Roles plays on STIs (Module C).....................................................................................................95
v
ACRONYMS
ADHFP Adolescent Health Focal Point

AFS Adolescent Friendly Space
AIDS Acquired Immune Deficiency Syndrome
ARV Antiretroviral
ART Antiretroviral Treatment
BBT Basal Body Temperature
DAHTWG District Adolescent Health Technical Working Group
DHO District Health Office
FGC Female Genital Cutting
FLEA Facility Ledger Extracted Adolescent (Data)
LH Luteinizing Hormone
HIV Human Immunodeficiency Virus
HTC HIV Testing & Counselling
IDU Intrauterine Device
MCP Multiple Concurrent Partners
MOH Ministry of Health
OI Opportunistic Infection
PCP Pneumonia
PE Peer Educator
PEP Post Exposer Prophylactics
PMTCT Prevention of Mother to Child Transmission
Prep Pre-exposure Prophylactics
PTSS Post Test Support Services
Q&A Question and Answer
S&D Stigma and Discrimination
SDM Standard Day Method
SRH Sexual Reproductive Health
STI Sexually Transmitted Infection
T4T Test for the Test
TOR Terms of Reference
VMMC Voluntary Medical Male Circumcision
ZDHS Zambia Demographic Health Survey
vi
ACKNOWLEDGEMENT
The approach and format of this peer educator’s manual have been adapted from the WHO Orientation
package for health care workers in adolescent health. A number of modules have been revised and edited with
inputs from a number of partners and adolescent health trainers, with financial support from UNICEF.
I would like to express my appreciation to all our partners for their unconditional support rendered during the
process of adapting and compiling the Orientation package on adolescent health for health care workers.
Special thanks go to our sister Ministries who include; Ministry of Youth, Sports and Child Development,
Ministry of Gender and Ministry of General Education. Appreciation also goes to the National HIV/AIDS/STI/
TB Council for the technical inputs
vii
FOREWORD
The Government and stakeholders have important contributions to make to promoting healthy
development in adolescents and in preventing and responding to health problems they face. Peer
Educators have important contributions to make in both these areas. However, situation analyses and
needs assessment exercises carried out in different parts of the world suggest that Peer Educators can
benefit from capacity building in order to enable them to effective serve their peers.
Adolescents especially girls face a variety of challenges standing in the way and hinder fulfilment of their
potential. These challenges start with sexual crimes, most often occurring at home, defilements leading
to high rates of HIV and teenage pregnancies, high rates of maternal mortality- young girls dying from
pregnancies for which their immature bodies are not ready; child marriages; poor education with low
transition from primary to secondary school, poor educational qualifications and skills for employability
even when school is completed; contributing to hopelessness; limited access to adolescent and youth-
friendly health services, including sexual and reproductive health. Despite the extensive attention given
to adolescent sexual and reproductive health (ASRH) and teenage pregnancy in the past 2 to 3 years
across the country, many teenagers have still fallen pregnant.
The overall aim of this training package is to equip Peer Educators with appropriate skills and
approaches to utilize in addressing some of their peer’s health needs and problems. The training
package is designed to strengthen the abilities of Peer Educators to respond to the adolescents more
effectively, efficiently and with greater sensitivity.
It is anticipated that the Peer Educators will gain the skills, knowledge and significantly contribute
to building national capacity on adolescent health and development. From our side as a Ministry,
the youthful demographic variable presents an opportunity for national development by harnessing
the potential adolescents and young people have. In line with this, it is critical that Government, in
partnership with key stakeholders provides the adolescents and young people with equal access to
information and health services that enable them to grow, develop and prosper as fully engaged,
responsible, patriotic and productive citizens.
To address this need, the Ministry of Health has worked with the United Nations International Children’s
Emergency Fund (UNICEF) and United Nations Population Fund (UNFPA) to revise the earlier adapted
Training Programme (TP) on adolescent health for Peer Educators from the World Health Organization
(WHO)
It is our belief that the implementation of this package will address the challenges our adolescents and
young people, especially girls are currently facing.
viii
MODULE A: INTRODUCTION TO THE PEER EDUCATOR’S TRAINING ON
ADOLESCENT HEALTH
Module overview
This module introduces the Peer Educator’s Training Programme (TP) and provides a general guidance
on how to prepare and conduct the Peer Educator’s training. Additional instructions are provided in the
respective modules.
Introduction module checklist

The module checklist contains important information including reminders, tips, materials and equipment
you need to run this module. We recommend that you review the following checklists in advance.
● Module advance preparation
● Materials and audio-visual equipment.
Module advance preparation

● Prepare cards (or name tags) for the participants to write their names on
● Make sure you have copies of the hand out (HO) for distribution to all the participants
● Ensure that the flipcharts are ready for the group-work tasks
● Ensure that the facilitators are clear about their respective roles during their designated Parts.
Materials and audio-visual equipment

● Materials:
STANDARD
- Hand-out
- Flipcharts
- Mood Meter
- Matters Arising Board.
● Equipment:
- Flipcharts with blank sheets
- Masking tape, pins, Bostic or glue
- Name tags
- Coloured markers
- Notepads
- Pens
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Part 1: Module Introduction
Time: 1hr.15 minutes

Format: Facilitation – Lecture & Discussions
Materials: Annex 1 – Pre test
Module objectives
● To introduce facilitators and Participants
● To outline the ground rules and expectations for the Training Programme
● To identify the knowledge levels and attitudes of the trainees (pre-test)
Part 1.1 Day One Opening (10 Min)

DMO and/or Representative to make Opening Remarks
• Invite the PHD/DMO or their representative to officially open the training.
Part 1.2: Introduction to the Training (Facilitator – 20 Min)
Explain that the:
● This training is in line with the National Adolescent Health Strategy, which aims at increasing access
and utilisation of HIV, SRH and other health services needed by adolescents and young people.
● Health care workers at our local Health facility(s) have already been trained in adolescent health and
have vast knowledge in HIV, SRH and other adolescent health issues, their role is to assist us by reach-
ing out directly to our fellow peers.
Then briefly explain why we are being trained today, that it is because;
• As Peer Educators, we have a key role in encouraging and supporting our friends out there to access and
utilise HIV, SRH and other adolescent health services. We are also role models in our general and health
life style.
End by: Reminding the participants that they have been chosen by their communities, and are expected to
acquire knowledge and skills needed to support our peers in reducing risk behaviours and increasing the uptake
of health services in their r local facilities.
Explain that by the end of this training everyone will be expected to review their Terms of Reference (TORs) and
sign a volunteer service agreement.
After the above activity pause and ask for questions and clarifications from the participants.
Part 1.3: Training Ground Rules (10 Minutes):
Put up a flip chart on the wall –title it ‘Training Group Rules’
Add the first ground rule – (1) Time Keeping – then explain that it means facilitator(s) and participants should
stick to the allocated times for Part s as well as reporting and knocking of time.
Ask for additional suggestions from the group.
2
Make sure that by the time you complete this activity, rules such as;
• Respect for each other and confidentiality come out and emphasise that –what individuals share about their
experiences in this training–stays in this training room.
Part 1.4: Expectations (10 Mins):
Put up a flip chart on the wall –title it ‘Expectations’
Add the first expectation – (1) Full participation – then explain that it means facilitator(s) and participants are
all expected to fully participate and ask question were its not clear.
Ask for additional suggestions from the group
Part 1. 5: Put up a flip chart of a mood meter
Then explain that by the end of each day, each participant is expected to show by way of floating their daily mood
according to the picture in the flip chart
Mood meter
Part 1.6: Put up a Flip chart and title - it maters arising board or packing lot
Explain that this packing lot shall be used to keep important unresolved issues that may arise and need
clarification at a later stage during the training.
Part 1.7: The Pre Test (35 Minutes)
How to do the Quiz:

• Pre-test – Distribute plain sheets or printed test papers to all participants
• They need to assign a secret number which each participant shall put on the first page of the paper
and their full name to be indicated at the back of paper so you can identify participants who need extra
support.
• Read out each question while they mark (participants) 1, 2, etc. and a T or F (or True or False) against
each number.
End of Part - Ask one or two of the Participants to help you collect the completed tests papers.
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Module B: Sexual and Reproductive Health in Adolescents and Young
People
Module Overview
This module looks at sex and sexuality; importance of personal/menstrual hygiene among adolescents and
young people; consequences of poor hygiene practices on the ADYP; benefits of delaying penetrative sexual
debut in a relationship; safe and unsafe sexual behaviour; pregnancy prevention (Contraceptives); care of
adolescents during pregnancy and childbirth; and unsafe abortion.
Module Objectives
· To discuss sex and sexuality

· To outline the importance of personal/menstrual hygiene among adolescents and young people.
· To discuss the consequences of poor hygiene practices on the ADYP.
· To understand the benefits of delaying penetrative sexual debut in a relationship
· To discuss safe and unsafe sexual behaviour
· To discuss pregnancy prevention (Contraceptives)
· To discuss care of adolescents during pregnancy and childbirth
· To discuss unsafe abortion
Part 1: Sex and Sexuality
Part 1.1 Group Work: How we learn about human sexuality (45 minutes)
The facilitator should start this part by explaining that people get information about sexuality at different times in
their lives and from different people.
• The age at which individuals receive their first information on sex varies.
• People obtain information from various sources; for example, friends, family members, media, school etc.
The facilitator can share his/her own story as an example to help participants understand what they are talking
about
Group work instructions:
1. Divide participants into 3 or more groups by sex (groups of girls and boys).
2. Ask participants to share information with their group members, focusing on the following:
a) What age were you when you first received information on sexuality?
b) What was the source of the information?
c) What message did you get from the information?
3. The group should write down the information on a flipchart.
4. Remind participants to only talk about their own experiences, unless they have explicit permission from their
group members to talk about other people’s experiences.
5. When the groups have finished their discussions, each group can present their flip chart to the larger group.
4
Key points:
· There are various terms which people start to hear about issues related to sex. Some messages give
a positive aspect of sex, while others a negative one.
· As we are growing up, a lot of messages on sexuality are focused on the negative consequenc-
es of early sexual debut and very little positive information is provided.
Point out that even within this group we can find a mixture of ages, sources and types of information. It is the
same in the communities that we live in. People receive different kinds of information, from different sources and
at different ages.
· It is important to keep in mind that even in small groups, people usually are at different levels of
knowledge.
· If young people do not get the correct information about sex early in life, out of curiosity they may
begin to experiment with sex or may end up receiving wrong information from less dependable
sources.
· There is a need to be open about sex and to enable adolescents as well as young people receive
accurate information about sex as this will enable them to make informed choices in their lives.
Note to facilitator: Be aware at this stage of the strong messages that come out of the discussion, as you may
need to elaborate more on some issues.
Part 1.2: Understanding Human Sexuality (30 min)
Write the word SEX in the middle of the flipchart or on the ground, and make a circle around it. Have the participants
stand around the circle.
Ask participants to say what comes to their minds when they see the word “SEX”.
• Let them know that there is no right or wrong answers – all contributions are welcome.
• Maintain good eye contact with the group and encourage contributions.
• Do not force participation; rather assist participants who might need more time to think.
Write the words that the participants say inside the circle on the flipchart or the ground.
Note: You can help participants think of more words by asking the following questions:
1. What are the most important parts of the body with regard to sexuality? (e.g., words for sexual organs
such as breasts, vagina, penis, etc.)
2. What are positive and negative words that describe how people feel about sex?
3. What can sex lead to? (Include both positive and negative consequences).
4. What different sexual identities are there?
Note: At the end of the activity, explain Key points:
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Human sexuality is a central aspect of being human throughout life. Human sexuality encompasses the
following (Please explain each of them):
· Sex
· Gender identities and roles
· Eroticism
· Pleasure
· Intimacy
· Reproduction (producing offspring)
Explain that:
· Sex: A medical term used to refer to a certain combination of gonads, chromosomes, external sexual
organs, secondary sex characteristics and hormonal balances. When talking about sex people frequently
refer to typical’ ‘male’ and ‘female’ biological types, however, there are many different types of sex.
· Gender Identity: Refers to a person’s deeply felt and experienced sense of their own gender. Because
gender identity is internal, it is not necessarily visible or obvious to everyone else, and may not align with
one’s gender expression and/or body.
· Gender Roles: This term is very much related to gender norms – gender roles are the socially prescribed
behaviours that are considered normal based on a person’s real or perceived gender identity and expression,
and/or biological sex. Like gender norms, gender roles vary between different groups and may change over
time. For example, in some societies it is seen as a woman’s role to care for children or clean.
· Eroticism: Can be an erotic theme or quality, a state of sexual arousal or insistent sexual impulse or
desire:
- Eroticism is a quality that causes sexual feelings, as well as a philosophical contemplation concerning the
aesthetics of sexual desire, sensuality, and romantic love. That quality may be found in any form of artwork,
including painting, sculpture, photography, drama, film, music, or literature
- It is sexuality transformed by the human imagination. It’s the thoughts, dreams, anticipation, unruly impulses,
and even painful memories which make up our vast erotic landscapes. It’s energized by our entire human
experience, layered with early childhood experiences of touch, play, or trauma, which later
· Intimacy: It is closeness between people in personal relationships. It involves the feeling of being in a
close, personal association and belonging together. It is a familiar and very close affective connection
with another as a result of a bond that is formed through knowledge and experience of the other. It’s what
builds over time as you connect with someone, grow to care about each other, and feel more and more
comfortable during your time together. It can include physical or emotional closeness, or even a mix of the
two.
· Reproduction (Producing offspring): Refers to the biological process by which new individual “offspring”
are produced from their parents. Reproduction is a fundamental feature of all known life; each individual
human being exists as the result of reproduction
6
A surge of sexual interest occurs around puberty and continues through adolescence. Factors that facilitate the surge
include:
· bodily changes and an awareness of them,
· rise in levels of sex hormones,
· increased cultural emphasis on sex
· desiring to be an adult and the gender roles that come with that
· Healthy sexual development involves more than sexual behaviour. It is the combination of physical
sexual maturation known as puberty, age-appropriate sexual behaviours, and the formation of a posi-
tive sexual identity and a sense of sexual well-being.
· During adolescence, young people strive to become comfortable with their changing bodies and to
make healthy and safe decisions about what sexual activities, if any, they wish to engage in.
· Expressions of sexual behaviour differ among AYP, and whether they engage in sexual activity
depends on personal readiness, family standards, exposure to sexual abuse, peer pressure, religious
values, internalised moral guidelines, and opportunity.
· Motivations may include biological and hormonal urges, curiosity, and a desire for social acceptance.
· There is an added pressure today, especially with girls, to appear sexy in all contexts throughout their
lives—school, leisure time, the workplace, with friends, in the community, and even while participating
in sports or exercises.
§ Note: In the end it should be the individual adolescent who decides when they are mature enough to engage
in sexual activity in ways that are consistent with personal principles and protective of their own health.
7
Part 2: Personal / menstrual hygiene: 30 Minutes
Activity 2-1
• Brain storming on the importance of personal hygiene
• Ask one of the participants to record on a flip chart the points being raised in the group.
Part 2.1 Brainstorming: Personal hygiene
Good personal hygiene is important for both health and social reasons as it helps keep the whole body clean in
order to stop the spread of germs and prevent illnesses.
• Ask the participants to share what they know and do in relation to personal hygiene.
• After getting enough responses, summarise the discussion using the points under grooming routines
Grooming Routines.
Hair
The hair should be washed using soap or shampoo and should be rinsed well and dried after every wash. Apply
hair lotion or Vaseline to avoid dryness.
Teeth
The teeth should be brushed with a tooth brush and toothpaste (The trainer should ask students to give examples
of local toothpaste) twice a day; that is, morning and night (Ask participant to demonstrate the steps of brushing
teeth)
A quality tooth brush should be used and should be changed at least every three months.
People should not share toothbrushes.
Armpits
The armpits should be cleaned with soap and water and dried thoroughly. The hair should be shaved all the time.
Nails
Nails should be cut regularly and kept clean. However they should not be cut so close that they pinch the skin.
Do not use your teeth to cut your finger nails.
Genitals
The genitals and the anus need to be cleaned and shaved well because of the natural secretions in these areas.
If not properly cleaned, irritations and infections can occur. To avoid infections, AYP should wipe from front to
back after urinating or defecating. Underwear should be changed daily and clean ones should be worn after
every bath. Cotton underwear is preferable to other types as they generate less heat.
Feet
The feet should be scrubbed with a sponge, ensuring that in-between the toes are dried and keep toenails short.
The shoes should be aerated regularly to prevent bad odour and a clean pair of cotton socks should be worn
every day.
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Part 2.2 Specific Hygiene issues:
Adolescent Boys
Uncircumcised male AYP may have a build-up of secretions called smegma which forms under the foreskin.
Therefore, the foreskin should be pulled back gently during a bath and cleaned with soap and water. For
circumcised ones, the penis and testicles should be washed with soap and water during a bath.
Adolescent Girls
Female AYP should be encouraged to bath daily to avoid germs and bad body odours. The outside part of the
genitalia should be washed with soap or plain water. Avoid inserting fingers and other things into the vagina
Part 2.2.1 Brainstorm

• Reasons that hinder AYP from practicing good personal hygiene
Part 2.3 What Is Menstruation (Monthly Period)?
Menstruation is a natural process that shows biological development of an adolescent girl with vaginal bleeding
which occurs monthly. Every month as your body prepares for pregnancy and if it does not happen, the womb
sheds its lining and this is called menstruation. In many cultures, it represents not only the ability to have a child,
but also the transition into adulthood. This occurs in a normal female from puberty up to the time the woman
stops having monthly periods.
Menstrual Hygiene
Brainstorming: Discuss ways in which girls maintain hygiene during their menses?
Key points:
· Menstrual hygiene management can be defined as a way in which Female AYP use clean ways to
absorb or collect blood that comes through from the birth canal. These materials can be changed
/washed in privacy as often as necessary for the duration of the menstruation period.
· Soap and water is used to wash the reusable pads while disposable ones can be correctly
disposed of.
· Tampons should be flushed or thrown in the pit latrine
· Change the sanitary material whenever it gets soaked or you become uncomfortable.
· Ensure that you wash your private part before putting on a clean one.
· USE A SOAP on the outside part of the genitalia AND AVOID VAGINAL HYGIENE PRODUCTS.
Summary:
Practicing good personal hygiene is important for both girls and boys as it enhances heath, self-esteem while
as for girls, good menstrual hygiene helps keep girls in school at all times since menstruation is not an illness.
Part 2.4: Why do young people have sex? (30 min)

Ask participants the following questions and list down the responses on a flip chart:
• Why do young people have sex?
• Are there benefits in having sex?
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• Do people always have a choice when they have sex?
• Is sex planned among AYP?
Key points to note

· The reasons why people have sex are different
· The reasons may change with time, age and circumstances people face at different stages in life.
· It is important to be aware that people practice sex for different reasons depending on their circum-
stances and situations.
Part 2.5 Sexual and reproductive organs (30 min)

Group work
Divide the participants into 2 groups (boys alone and girls alone)
Ask each group to draw and label their sexual reproductive organs on a flip chart and present to the group. After
the presentations, ask if there are any questions and clarifications in relation to the sexual and reproductive
organs presented Clarify any issues.
As you summarise refer the participants to Annex 2 where there are labelled pictures of female and male sexual
organ.
Brain storming
Explain that biologically you are defined as male or female based on your sexual organs
Summarise the discussion by stating the points below
· Remind participants that when it comes to having sex, the biggest sex organ is the brain and that it is in
the brain that conscious decisions are made and a person’s arousal starts before the sex organ starts
responding.
· Based on the fact that we are different and express our sexuality in different ways, we need to be
non-judgmental in order to reach out to people in an effective way.
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Part 3: Delaying sexual debut
Part 3.1: Understanding Terms: Delayed Sexual Debut & Abstinence (20 min)
Ask participants to voluntarily answer the following 3 questions – write done key points on a flip chart:
· What does it mean to delay sexual debut?

· What does abstinence mean?
· What is secondary abstinence?
Based on gaps in the participant’s feedback explain these additional key points:
Delay Sexual Debut: A decision to delay or postpone having sexual intercourse until an older age when the
person is married or ready to have sexual intercourse. Delaying includes:
· Deciding not to have sexual intercourse for a particular period of time

· Avoiding situations that could lead to sexual intercourse (related to violence, alcohol and
drugs, being alone with boy/girlfriend)
· Escaping risky situations that could lead to sexual intercourse
· Negotiating with partners not to have sexual intercourse
· Negotiating with partners safer, alternative (non-penetrative) sexual practices
Abstinence: Abstaining from sex is a decision to stay away from sexual activity.
The decision of not having sex can be until marriage or until one is ready. Abstinence (and delayed sexual debut)
is 100% effective against unwanted pregnancy and STIs such as HIV syphilis etc.
Part 3.2: Delaying Sexual Debut - Small Group Discussions (50 min)
Divide the participants into three groups. Each group gets a flip chart paper and a marker. Each group should
be assigned one of the questions and brainstorm responses. Allow adequate time for group work (15 minutes).
Each group should pick one person to write their ideas on their flip chart and one person to present to the larger
group. Allocate 10 min for each group.
After each presentation – find out if the whole group has any additions or need for clarification.
1. Benefits of delaying(postponing) early sexual debut
2. Challenges of postponing
3. Strategies for postponing
After all the small groups present, provide any additional information below which has not been covered.
Benefits of delaying sexual debut
· Allows time for friendship and relationship to develop with your boyfriend/girlfriend
· Is 100% effective in preventing HIV, STIs and unwanted pregnancy
· Promotes acceptance by your community
· Maintains positive relationships with your parents/caregivers
· Respects religious beliefs
· Waiting for the right person – you want the person to truly love you before you start to have sex
· Wait until marriage – you want to feel secure about the relationship and know his/her HIV status
· Makes you a positive role model to friends and family
· Gives you a sense of control and inner-strength
· Allows you to focus on achieving your future goals without being distracted
· Prevents feelings of worry, anxiety, guilt, regret, and disappointment
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Challenges with Delaying Sexual Debut
· Peer pressure – the belief or feeling that “everyone is doing it”

· Risk of losing your boyfriend/girlfriend
· Adult pressure and coercion
· Strong emotions for someone you care about
· Low self-esteem/self-confidence
· Economic situations in which girls and boys are exposed to early sexual experiences in exchange for
money, gifts, and other items
· Lack of information and assertive communication skills
· Being under the influence of alcohol and other substances such as drugs
Strategies for delaying sexual debut
· Maintaining your commitment to abstinence - express your affection in another way – kissing, hug-
ging, body rubbing, holding hands, etc. this means discussing up front with your partner how far you
are willing to go – and that you are not willing or ready to engage in penetrative intercourse
· Be very clear and state that you are not ready for any type of sex - if the person REALLY loves you s/
he will respect you and your decision
· If you go to parties and events make sure you go with a group of friends who will support you against
peer pressure, do not go alone or abuse any substance or even let yourself be alone with someone
you do no trust or know
· Wait to date until a specific age(above 18years) – where you have the skills and ability to deal with
peer pressure
Strategies for delaying sexual debut continued

· Decide your sexual limits before going on a date
· Be clear and honest about your limits from the beginning
· Pay attention to your feelings. When a situation is uncomfortable, leave!
· Avoid “hanging out” with people who might pressure you to have any kind of sex
· Avoid going out with people you cannot trust
· Avoid isolated places where you might not be able to get help
· Do not accept favours from people you do not trust or know who might expect something in return
· Do not accept money or presents from people who might expect something in return
Note: Remind the Peer Educators that they need to help their peers to understand their options and help them
put the options they prefer into practice. They should not push their own ideas about delaying sexual debut and
not judge their peers if they decide to continue to have penetrative sexual intercourse. However, they need to
promote correct and consistent condom use in activities like sports, clubs, hobbies, church and community work.
12
Part 4: Safe and unsafe sexual behaviour
Safe sexual behaviour

· Abstinence
· Using condoms every time, you have sex
Unsafe sexual behaviour
· Anal sex
· Oral sex
· Sex without a condom
Part 4.1: Discussion on safe and unsafe sexual behaviours

Begin by explaining the following points to the participants:
· Positive sexuality involves pleasure, intimacy and experimentation.

· Having responsible sexual behaviour will keep you happy and healthy throughout your life.
· Having normal sexual relationships are acceptable and pleasurable to both partners without
degradation, force or distress.
· Avoid violent sexual behaviours. This is a behaviour that deprives others of their rights or
personal choice, causes injury or takes advantage of a person who does not or cannot give her/
his consent (rape, forced sex, sexual defilement etc.)
Group work instructions:
1. Split the participants into 2 groups

2. Ask each group to make a list of safe and unsafe sexual behaviours.
3. Allow each group to present and post its findings.
Use these following questions to lead participants in a discussion about the safe sexual behaviours, risks and
consequences of unsafe sexual behaviours.
1. How can the unhealthy behaviours you listed put you at risk?
2. What are some benefits of the healthy sexual behaviours listed here?
3. Does being married or engaged mean that each person automatically practices healthy behaviours?
13
Safe Sexual Behaviours: Unsafe Sexual Behaviours:
· Abstaining from sex · Having unprotected sex, even one time

· Condom use · Pressuring your partner to have sex
· Being faithful to one sexual partner · Having casual sex without using condoms
· Limiting your number of sexual partners · Having sex without condoms with someone if you
do not know his or her sexual history
· Waiting to have sex until marriage (and knowing
your partners HIV status) · Cheating on your partner
· Being honest with your partner about your sexual · Not being honest with your partner about your
history sexual history
· Being honest with your partner about your feelings · Misleading a person so that they will have sex with
you (coercion)
· Respecting your partner’s decision not to have sex
or to always use a condom · Not respecting your partner’s decision not to have
sex
· Listening to what your partner is saying about their
willingness to have sex · Forced sex; Rape
· Communicating clear sexual limits to your partner of
what you will and won’t do
Key points:
Benefits of safe sexual behaviours:
· Protection from STIs including HIV and AIDS

· Protection of unwanted pregnancy
· High self-esteem (Feeling good about yourself)
· Leading a healthy life
Risks and consequences of unsafe sexual behaviours:
• Contracting HIV and AIDS

• Contracting STIs (including those that cannot be cured like herpes and genital warts)
• Unwanted pregnancy
• Getting hurt and/or feeling guilty
• Obstetric fistula (an abnormal opening between the vagina and the bladder or the vagina and the rectum
after a difficult process in giving birth)
• Hurting your partner or wife/husband
14
Summary: Remind participants that as Peer Educators they need to give clear information in the community
around safe and unsafe sexual behaviours and emphasise HIV risk reduction behaviours:
• Low Risk - Have a mutually faithful relationship with your uninfected partner. This carries no risk of STIs
and HIV but testing for HIV is necessary at the beginning of the relationship and both partners need to be
faithful and still use condoms for 3 months and then have a second HIV test – and afterwards they can
stop using condoms
• If you are not in a mutually faithful relationship, always use male or female condoms for vaginal or anal
intercourse and PrEP for risky sexual behaviour-e.g. transaction sex.
• If one partner gets infected with a STI, like gonorrhoea, syphilis, both partners should be treated fully and
either abstain from sex or use condoms until treatment is completed
• Prevent unintended pregnancy by using reliable methods of contraception, combined with use of condoms.
NOTE: viral STIs like genital herpes, genital warts, Hepatitis B and HIV cannot be cured, but the symptoms
can be managed. Substance abuse (alcohol or drugs) can lead to loss of self-control and can increase the
likelihood of engaging in unsafe sexual activities
15
Part 5: Pregnancy prevention (Contraceptives)
Part 5.1 Introduction to contraceptives (20 min)

Brainstorm
1. What is contraception (family planning)?

2. What are contraceptives? Can you give examples?
3. Why is the use of contraceptives important to the woman, family, community and the nation?
Contraceptive refers to methods used to prevent pregnancy such as: condoms, oral pills, and injections etc.
The primary objective of contraceptive services is to enable people to control their natural fertility process. This
means it will help them plan when to get pregnant contraception services also provide STI prevention services.
Contraception (Family planning) is important because:

• It improves the lives of women and children and improves the quality of life for all.
• it allows women to avoid unintended pregnancies
• It saves children’s lives by allowing parents to delay and adequately space births.
• The improves the economic state of the nation
Part 5.2 Types of Contraceptives
Activity: Put up 3 flip charts on the wall and ask for one or more participants to assist in writing down the
responses.
Then explain that there are three types of contraceptive services and then ask for participants to give examples of
each type – start with ‘non-scientific’. Write up the tile on the flip chart and then ask participants to give examples
of ‘non-scientific’. Repeat with ‘traditional methods’ and then scientific methods.
Add information on different types of contraception using the concepts below.
Types of contraceptive methods
1. Traditional/Non-scientific Methods
Explain that non-scientific methods are based on the traditional beliefs and practices of a group of people and
that nowadays it is rare that people use this type of method for preventing pregnancy. These include:
• Use of charms
• Use of rings
• Use of amulets
• Use of waist bands
• Use of incantations
• Use of traditional medicines
Remind the participants that as Peer Educators, they should not offend their peers by mocking their beliefs about
non-scientific methods. They should help them to think critically about these methods – and ensure they ‘do no
harm’ – and try as much as possible to combine with scientific methods.
Non-scientific methods are often ineffective and unsuccessful in preventing pregnancies. (Ask participants to
explain why they are ineffective and unsuccessful and then supplement their responses).
16
Rhythm Method (by use of the calendar): This is the most traditional natural family planning method which is
based on knowing the woman’s menstrual cycle and therefore knowing when penetrative sexual intercourse is
unlikely to result in a pregnancy.
Abstaining from sex is a decision to stay away from sexual activity.
Reasons
• Don’t want to have sex

• Lack of opportunity
• Fear of outcomes
• Friends and family values
• Personal values
• Learnt from school/home
• Etc.
2. Scientific methods
a) Natural Scientific methods
These are the methods that have been proven to be effective (if practiced correctly and consistently).
· Withdrawal is a method where the man withdraws his penis before ejaculation
· Body temperature is a method where the daily monitoring of the woman’s body temperature is
done to assess the fertile period. During this period the temperature raises which is an indication to
abstain from sexual intercourse.
· Cervical mucus is a method where the cervical mucus is assessed daily to ascertain the fertile
period. When it is light, then it means the woman is in her fertile period.
· Lactation amenorrhoea is a method where the mother has not yet started her menstruation after
delivery and is exclusively breastfeeding the baby who is less than 6 months
Natural Scientific family planning is often ineffective and unsuccessful in preventing pregnancies (ask
participants to explain why they are ineffective and unsuccessful and then supplement their responses).
b) Modern Scientific Methods
· Hormonal Contraceptives: This is a method that works primarily by interfering with chemicals that
stimulate ovulation. Examples include:
• Oral contraceptives (pills). Pills need to be taken on a daily basis – e.g. Microgynon,
Oralcon-F and Microlut
• Injectable such as Depo Provera and Noristerat
• Hormonal implants, such as Jadelle and Implanon
• Intrauterine contraceptive device( IUCD) such as Copper T
See Annex 11 for additional information on six fertility awareness methods (traditional & modern) that are
used to predict when a woman will be ovulating and at high risk for pregnancy.
Barrier Methods: These are methods that prevent contraception by obstructing the man’s sperm from
getting in contact with the woman’s egg. Examples are male condoms, female condom, and the diaphragm
(which is a soft curved dome shaped latex or silicone device place in the vagina to block the entrance to
the cervix).
17
Permanent Methods: These are also called sterilisation. They are:
• Vasectomy for men in which the sperm duct is tied and cut so that sperms cannot leave the body
and cause pregnancy.
• Bilateral tubal ligation in women where the fallopian tubes are tied and cut.
Dual Protection: Use of condoms combined with other contraceptive methods to prevent unintended
pregnancies and STIs including HIV
Note: Emergency Contraceptives are a scientific form of contraceptive which are used as an emergency
following unprotected sexual intercourse. They are supposed to be taken within 3 days of unprotected
sex but very effective if taken immediately the occurrence.
Part 5.3 Family Planning Services in Our community
Ask participants: In your community, what are the sources of contraceptive services?
Sources of contraceptive services include:
• § Government hospitals/Clinics/Outlets
• § Certain Mission hospitals/Clinics
• § Private hospitals/Clinics
• § Pharmacies/Chemists/Drugstores
• § Non-governmental organisations (e.g. Marie Stopes International and Planned Parenthood
Association of Zambia (PPAZ) etc.)
• § Community Based Distributors (i.e. community members who are trained to provide some
modern contraceptives)
In each community there may be myths and misconceptions about contraceptives. As peer educators
ensure correct information is given and referral to a facility where proper counselling can be done.
Summary: It is very important for Peer Educators to have basic knowledge of contraceptive options
and the services that are available at their local health facility. The Peer Educator does not need to
be an Expert on all the methods, names, etc. They need to know that the most effective methods are
modern contraceptive methods. Remember they can refer their fellow peers to the health facility or
dial to U-report 878 or 990 which are both toll free lines! For many of their peers, they will be con-
cerned with getting pregnant than getting HIV and it will be important that Peer Educators promote
‘dual protection’. For review please clarify that:
· Two types of contraceptive services have been discussed: non-scientific methods/
traditional methods and Scientific Methods. Highlight some of the strengths of the modern
scientific methods.
· The whole community, including children, adolescents, women and men, benefit from
contraceptives. Ask for a feedback on why this would be the case.
18
Part 6: Care of adolescents during pregnancy and childbirth
Mini Lecture
Part 6.1 Adolescent pregnancy
Adolescent pregnancy is pregnancy in a girl aged between 10-19years.
Brainstorming: ask the participant to discuss the reasons why adolescents get pregnant and record the
answers on the flip chart.
Changing circumstances of young people

• The influence of the media, changes in family structure (loss of parents, divorce)
• Increased opportunities to independence (e.g. living alone in boarding houses, job offers etc.). The use
of alcohol and other substances can be associated with unprotected sexual activity (and the possibility of
unintended pregnancy).
Vulnerability of young people

• Sexual assault (including rape and defilement):
• Socio-economic factors: Economic hardship can force young girls to leave home. Sexual exploitation and
prostitution are two frequent consequences, and often lead to early pregnancies.
• Early marriage is still practiced widely in our communities in Zambia despite the fact that there are laws
against it. In many societies pregnancy is expected to follow soon after marriage. If marriage is early, then
early childbirth is almost inevitable.
Other related factors that contribute to adolescent pregnancy;

• Lack of access to sexual and reproductive health information and education to help adolescents learn about
sexuality and sexual health.
• Lack of access to contraceptive services due to run out of contraceptives at health facilities and unfriendly
health care providers
• Lack of services for safe termination of Pregnancy
• Lack of psycho-social counselling.
• Cost of accessing the service
Part 6.2 Care for the pregnant adolescent
Activity 6.2: Discuss with the participants on what a pregnant adolescent should do.
• Immediately one suspects to be pregnant (missed monthly period after unprotected sexual intercourse), go
to the nearest clinic or health centre for confirmation and care.
• It is important that every pregnant adolescent girl starts her antenatal care as soon as they know that they
are pregnant especially within the first 14weeks (3 months)
19
Why is adolescent pregnancy and childbirth risky?
• Pregnancy and childbirth carry more risks in adolescents for both the mother and her baby than in adults.
The risks are high throughout the antenatal period, labour, childbirth and after birth because the body is not
fully developed to undergo all those processes.
• Babies born to adolescent mothers have higher risk of being premature, stillbirth (baby born dead) and of
low birth weight making them at risk of disease and death.
• Adolescent mothers are at a higher risk of pregnancy & birth complications and death.
Complications that come in adolescent pregnancy
• Raised blood pressure due to pregnancy
• Anaemia
• STIs/HIV
• Higher severity of malaria
• Malnutrition
Complications during giving birth (labour and delivery)
• Birth of the baby before time
• Blocked birth passage (Obstructed labour)
• Increased chances of having an operational delivery
• Maternal death
Complications after giving birth
• Severe bleeding after birth
• Anaemia
• Complications of high blood pressure (fitting)
• Depression after delivery
• infections after delivery
• Mental problems after delivery
• Fistulae (an opening between the vagina and rectum and/ or bladder).
• Too early repeat pregnancies
Risks to the unborn/new-born baby
• Low birth weight (less than 2.5 kg)
• Inadequate child care and breastfeeding practices
• Prematurity
Social and economic costs
• Possible drop out of school
• Possible reduced earning Opportunities
• Stigma
• Forced marriage
Summary
• Pregnancy in adolescents is common
• Many factors contribute to adolescent pregnancy
• Adolescents have higher chances of having diseases during pregnancy (maternal
diseases or diseases that come about as a result of the pregnancy) and death than
adults.
• Their offspring also have higher risk of death and diseases
Many of the complications during pregnancy and delivery have worse outcomes in
adolescents
20
Part 7: Unsafe abortion
In many parts of the world, Zambia inclusive, more adolescent girls than adult women will resort to abortion as a
way of solving an unintended pregnancy. Abortion is one of the main causes of maternal mortality. The choice to
have an abortion is not an easy one. Adolescents often state a number of reasons for resorting to an abortion.
Definition
Unsafe abortion is the termination of pregnancy before the age at which the baby can survive outside the womb
by people lacking necessary skills or in an environment lacking minimal medical standards or both.
Part 7.1: Why do adolescents resort to unsafe abortions?
Activity 7.1: Divide the participants into groups and ask them to discuss why adolescents resort to
unsafe abortions.
Categorise their responses in the following categories:
• Educational reasons
• Economic reasons
• Sociocultural reasons
• Service delivery reasons
What are the consequences of unsafe abortion?
• Homelessness
• School drop out
• Vaginal bleeding leading to anaemia
• Tearing of the uterus
• Infections
• Injuries to nearby organs such as the intestines, bladder etc.
• Pregnancy outside the womb (Ectopic pregnancy)
• Increased chances of having other abortions in future pregnancies (not by choice)
• Early labour in future pregnancies
• Infertility
• Depression
• Suicidal attempts
• Death
How can unsafe abortions be prevented?
• Provision of responsive friendly services to adolescents by health care professionals (talk about abstinence,
contraceptives, emergency contraception)
• Educating adolescents on where they can access safe abortion care
• Involvement of parents and communities in protecting and safe guarding adolescents
What is the role of Peer Educators in unsafe abortion services?
The role of Peer Educators is to give correct information on prevention of unwanted pregnancy and dangers of
unsafe abortions and refer adolescents who want safe abortion services to the health facilities.
21
Module C: Sexually Transmitted Infections in Adolescents
Module overview
This module looks at Sexually Transmitted Infections (STIs) in adolescents and the covered areas include:
definition of STIs; common types of STIs; reasons contributing to STIs in AYP; reasons contributing to STIs;
reasons preventing AYP with STIs from seeking help; STI prevention among AYP; and dangers of STIs in AYP.

Objectives
Welcome the participants to the module and share the module objectives in the boxes below
Module objectives Module objectives

· To define STIs · To List the reasons preventing AYP with STIs from
seeking help
· To discuss common types of STIs
· Discuss STI prevention among AYP
· To list the reasons contributing to STIs in AYP
· To name the dangers of STIs in AYP
· To explain the reasons contributing to STIs.
Part 2: Definition of Sexually Transmitted Infections (STIs)

Activity 2.1: Brainstorming - Ask participants to define STIs
After their responses summarise by reading out the statement below.
Define STIs as; infections that people acquire through having unprotected sexual intercourse with an infected
person.
Part 2.2: Activity Open Discussion
Put up a flipchart showing the information below, read out the question and ask the participants to respond to
it.
How common are STIs in your area or community?

List common types of STIs.
Part 3: Types of STIs

Summarise the Types of STIs using the syndromes in the next box
STIs syndromes
· Vaginal discharge (in females)
· Urethral discharge (in males)
· Genital ulcer disease (in males and females)
· Swollen scrotum (in males)
· Lower abdominal pain (in females) Don’t mistake this to period pains
· Inguinal bubo (in males)
· Eye discharge (in babies)
22
Part 4: Reasons contributing to STIs in AYP
Part 4.1: Activity
Ask participants to list and explain the reasons that contribute to AYP acquiring STIs. Summarize the discussion
using the information in the boxes below.
Reasons contributing to STIs in AYP

· Experimentation - as young people we love to try out new things
· For boys there is a heightened desire to prove themselves sexually.
· sexual relationships that happen among young people are often unplanned, random and, sometimes
as a result of pressure or force from older people
Reasons contributing to STIs in AYP (continued)

· AYP’ sexual relations typically occur before they have:
· Adequate information about STIs and how to avoid contracting these infections.
· Experience and skills to protect themselves.
· Access to services and supplies (Such as condoms).
Part 4.2: Brainstorm the following question;

Who is more vulnerable (at higher risk) between a male and a female adolescent/young person?
STIs are likely to have more severe consequences in AYP than in adults
Dangers of STIs in AYP include;
· Infections affecting the female reproductive organs (Pelvic Inflammatory Disease-PID)
· Failure to become pregnant or to impregnate (Infertility)
· Cancer of the cervix
· Stigma and embarrassment
· HIV/AIDS
23
Part 5: The dangers of STIs in adolescents
Activity 5-1 Mini Lecture
STIs are likely to have more severe consequences in AYP than in adults
Dangers of STIs in AYP include;
• Infections affecting the female reproductive organs (Pelvic Inflammatory Disease-PID)
• Failure to become pregnant or to impregnate (Infertility)
• Cancer of the cervix
• Stigma and embarrassment
• HIV/AIDS
Part 6: Barriers to seeking timely help for STIs treatment by AYP
Reasons why AYP delay seeking help

· Some STIs may not show signs and symptoms almost immediately especially in girls and young women.
· Adolescent may not be aware that they have an STI
· Adolescent often lack information about existing services.
· Fear of being laughed at by peers
· Fear of victimization from some health care worker/peers
· Concerns about lack of confidentiality
· Adolescents may be reluctant to seek help for various reasons (i.e. thinking that STIs may heal without
treatment)
· The use of alternate treatment option such as herbs.
Part 7: Prevention of STIs in AYP

Part 7.1: Activity Lecture
Explain that this activity will focus on the special contributions that peer educators can make when working with
peers to prevent STIs.
Preventing re-infection of STIs

· Promote secondary abstinence
· Promote correct and consistency condom use by those who are sexually active
· Promote safer sex as discussed in Module B
· Promote partner notification
· Encourage those who are sick and on treatment to complete their medication and follow instructions
· Encourage male AYP to go for VMMC after treatment as well as encourage them to either abstain or
use condoms correctly and consistently to increase protection against STIs.
· Provide information using IEC Material on STI prevention
24
Part 7.2: Activity - Role play
Prepare and invite two to volunteer to act in the first role play (Role play 1 in Annex 1 Conduct the role play and
then facilitate a debriefing. Repeat the process with the second role play (Role play 2 in Annex 1). Ensure that
you allocate enough time for each role play. Wrap up the discussion by highlighting key points made in relation
to each of the role plays. See annex 1 for role plays
25
Module D: HIV/TB and Adolescents/Young People
Module Overview
Module D focuses on addressing the main issues of HIV and TB among young people. As there is a large age
range in the term young people (10-24 years), the issues around HIV prevention, care, treatment and support
will change within this age range. What is important about HIV for most 10-year-old girls or boys (e.g. delaying
sexual activity) will be different for a 24- year-old woman or man.
Objectives
To discuss basic facts about HIV/AIDs
· To explain modes of HIV transmission
· To understand the dangers/risk factors of acquiring HIV/AIDS
· To explain stages of HIV infection
· To discuss HIV testing services
· To discuss on the HIV treatment and prevention care
· To discuss positive living among AYP
· To explain TB core infection and prevention
Part 1: Basic facts of HIV

Part 1.1 Activity - Open discussion
Ask participants to answer the following questions and give summarized answers
Table 1: Basic facts of HIV
S/N Questions Facts

What does AIDS stand for? Acquired Immunodeficiency syndrome – one has AIDS when HIV has
1 reduced the strength of the body or body’s immune system and you cannot
fight off other illness or diseases – which eventually leads to death.
What does HIV stands for? Human Immune Deficiency Virus - the word ‘human’ emphasizes that this
2.
virus is found in humans and only transmitted by Humans
Can you get HIV from No:
mosquitoes?
HIV cannot live or reproduce in a mosquito. When a mosquito bites some-
3 one, it does not inject its own blood or the blood of an animal or person it has
bitten into the next person it bites. The mosquito does inject saliva, which
acts as a lubricant so that it can feed easily.
Traditional healers can cure Not True:
4 HIV
There is no cure for HIV – but a person on ARVs who takes their medicine
every day can remain Healthy or can get healthy again.
26
S/N Questions Facts
What is window period? Window Period is the period immediately after HIV infection when HIV anti-
bodies may not appear in a person’s blood and therefore, the HIV Test cannot
detect that they have HIV showing a negative results. It takes about two-three
5 months (6 – 12 weeks) for HIV antibodies to appear in the bloodstream.
During this period an infected person will test negative, even if she or he has
the virus and is infectious. There may be some short term flu like symptoms
of infection, but without an HIV test you won’t know for
A healthy-looking person True:
can have HIV
6 Anyone can have HIV, children and adults, skinny or fat – the only way to be
sure is to get tested for HIV – if negative – you need to have a second test in
6-12 weeks as you can be in the ‘window period’.
Can a circumcised man get/ Yes:
transmit HIV?
7. Male circumcision reduces the risk of transmission by 60% - but that means
you still have a 40% chance, hence the need to continue to use condoms
and remain faithful to one sexual partner.
Only promiscuous people Not true:
can get HIV
However, promiscuous people (meaning having many sexual partners) are at
higher risk of getting or passing on the virus especially if they are not using
condoms.
10. · A person who is 100% faithful to one partner can still get the virus from
their partner through unprotected sex if they are infected. Their partner
could also be 100% faithful with them but may have gotten the virus from
their previous sexual relations.
· A mother who has been 100% faithful can get the virus from her part-
ner and then pass it on to her baby.
Condoms can prevent HIV Yes:
11. Infection Condoms are very effective if used correctly and every time a person has
vaginal or anal sexual intercourse.
HIV can be transmitted Yes:
through breastfeeding
12 The virus is also present in HIV positive mothers’ breast milk (and blood),
therefore HIV positive mothers need to be on ARVs and follow all instructions
for their treatment (adhere)
If a person is HIV posi- Not True:
tive, it means that s/he
13 HIV is a virus while AIDS is a final stage of HIV infection where the person’s
has AIDS body defence (immune) system is destroyed such that any diseases can
affect the person
A newly HIV infected Not True:
14 adult will die from HIV
A newly infected person can live for many years if they are commenced on
within 5 years treatment and they adhere to it
Someone infected with True:
16 HIV will be able to infect
They can infect other people if they do not practice safer sex
other people.
ARVs can cure AIDS. Not True:
17
ARVs just improve the immune system thereby improving the quality of life
An HIV person should not Not True:
be doing physical work
18 A person with HIV can still do physical work like any other person
e.g. farming and clean-
ing.
27
S/N Questions Facts
A person who has tested Not True:
HIV negative is free
Having unprotected sex will expose the person to contracting HIV
19 to have sex without a
condom. After all, she/he
does not have HIV.
Once you are HIV posi- Not True:
tive, just continue to have
Having an unprotected sex can expose a person to HIV re-infection as well
21 sex and enjoy yourself. as infecting others
After all you are already
HIV positive.
Note: Ask the participants about whether there are any other HIV related misconceptions apart from those
discussed above
Part 1.2: Brainstorm - Modes of HIV Transmission?
Activity 1.2-Brainstoming on modes of HIV transmission
Ask participants what they know about modes of HIV transmission and summarise the responses using the
points in the following box
· Through unprotected penetrative sexual intercourse with an HIV infected person: Penetrative sexual inter-
course incudes vaginal sex, anal sex and oral sex – and when a male or female condom is not being used
correctly or consistently there is an exchange of body fluids. Please clarify if these sexual practices are
understood and remind the participants that unprotected sexual intercourse is the main way in which HIV
is spread in Zambia. (Remind them that abstinence is still the best way to prevent being infected by HIV).
· Through mother to child transmission: From a mother to her baby, during pregnancy, during delivery and
during breastfeeding - This is more likely to happen when a mother has a high viral load (i.e. When an
HIV positive mother is not on treatment, poor adherence to treatment, treatment failure, and recently
commenced on ART).
· Through blood to blood contact: This can happen through accidental contamination, HIV contaminated
needles and syringes, sharing of HIV contaminated piercing instruments (e.g. razors and needles).
28
Summary – Please go over these points at the end of the Part. Remind the participants that Peer
Educators need to be knowledgeable on HIV transmission. If there are issues they need more infor-
mation – one option is to use u-report (SMS 878) or call 990.
Clarify transmission of HIV.
i. HIV is a virus that attacks a person’s immune system making it difficult for their body to fight off various
infections and diseases. HIV is the virus that causes AIDS.
ii. Although HIV cannot be cured, it can be treated through ‘living positively’. Taking ARVs can delay the
onset of AIDS.
iii. HIV is concentrated in blood, semen and vaginal fluids. The body fluids of an infected person must
enter the body of an uninfected person in order for infection to occur.
iv. The main mode of HIV transmission in Zambia is through unprotected sexual intercourse
Risk factors.
HIV has affected the adolescents from all angles of life; there are some risk factors that predispose the
young people to acquiring HIV/STI infections.
– Lack of information on STIs/HIV
– Substance use/abuse
– Sexually active (Especially multiple partners)
– Anal sex
– STIs ( especially ulcerative)
– Poverty ( especially younger adolescent girls)
– Sexual abuse
– Mental illness ( especially girls- older men take advantage)
– Lack of health services, such as condom use, education.
Explain that
Adolescents need to know about these risk factor in order to make them escape these factors. Not all adolescents
are at risk of getting this series of risks, but a good number of them may be falling under any of the factors.
Not to forget the different age groups of these adolescents also matters in terms of risk factors
Brain Storming
- Ask the peers to mention some of the risk factors mentioned above (mention any risk factors missing
from the above list) available and common in their communities.
Part 2: Stages of HIV infection
At the end of this Part you should able to understand and discuss issues related to HIV and AIDS and understand
and explain the importance of treating opportunistic infections.
Part 2.1 Stages of infection: Asymptomatic and Symptomatic phases
29
Activity 2.1 –Mini Lecture
In plenary read out the following terms and ask participants to provide responses.
Note: This information is found in their participant’s manuals – so they do not have to take notes.
Asymptomatic Stage
· The person may remain Asymptomatic and feel and appear healthy for years, even though he/she is
infected with HIV.
· During this period, the person remains infectious (i.e. able to transmit the virus to others) and as the virus
continues to replicate.
· It causes progressive damage to both the immune and nervous system.
· The person will test positive for HIV antibodies.
· Some individuals will have persistently enlarged lymph nodes during the Asymptomatic stage of HIV
infection
Symptomatic Stage
Explain that:
Many individuals eventually develop a variety of indicators of ill health due to HIV infection without developing
opportunistic infections or secondary cancers.
· These symptoms include complaints such as oral thrush, diarrhoea, weight loss, low- grade intermittent
fever, loss of energy, etc.
· Various fungal or viral diseases may be seen and individuals feel chronically ill during this stage of HIV
infection.
· These symptoms alone cannot determine a person’s HIV status.
Part 3: HIV Testing Services (HTS)
At the end of this Part you should be able to understand the importance and implications of HIV Testing
and Services (HTS)
Part 3.1: Activity - Small group discussion about HTS
Divide the participants into 3 groups and give each group a different question:
· Group 1: Why do people avoid going for HIV testing?
· Group 2: What are some of the barriers in your community that hinder access to HIV Testing and Counselling
(HTC)?
· Group 3: What are some of the advantages of taking an HIV test at individual, family and community
levels?
Allocate 10 minutes for group work. After the discussion, ask a representative from each group to present their
work on a flip chart. Ask the full group if they have any additions. Then facilitate a discussion based on the
reasons the group has given.
Use the following information reinforcing the reasons given by the group (or challenging them) and addressing
any gaps:
30
Group 1: Why do AYP avoid going for HIV testing?
 Not sexually active,  Not adolescent friendly

 Not sick or ill  Judgmental providers
 Always use condoms,  Fear of result (death?)
 Trust my partner  Fear of being rejected by their partner,
friends, or family if found positive
 Concerns about confidentiality of results
 Fear that they will be stigmatized or
 Location and service times (E.g., not open in the that their children and partners will be
evenings so no time to go, etc.) stigmatized etc.
Group 2: What are some barriers in your community that hinder access to HTC services?
 Denial that HIV is a problem  No understanding of long terms

progressors – children and adolescents
 Beliefs that only promiscuous people could have who could be HIV positive from mother to
HIV child transmission
 Attitudes that adolescents and young people should  Facilities are full of people who might
not be sexually active – so why would they need to recognize you
be going for a test
 Operating hours not adolescent friendly
 Belief that parental consent is required – not knowing
that this is only needed from age 15 and under  Belief that providers will tell your parents
you have been sexually active
Group 3: What are the advantages of taking an HIV test at individual, family and community levels?
 HTC helps people know their HIV status, and  If positive, an individual can learn about
whether positive or negative, this helps prevent the how to live positively, which includes not
spread of HIV. transmitting HIV to others.
 If negative, an individual can learn about ways to  HIV positive pregnant woman can ensure
protect himself or herself from HIV infection. that their babies are not born with HIV by
going on ART.
 By knowing their status, people can begin treatment
and positive living if they are HIV positive before  HIV Positive mothers should practice
they become ill. exclusive breast feeding.
 HTC is a form of HIV Prevention.
Summarize by reminding the participants that:
· HIV testing is recommended if someone is concerned that they may be infected because of:
o Unprotected sex
o Transfusion with untested blood
o Sharing needles or other injection material
o An infected sexual partner/s
· HTC is an Entry Point to HIV Treatment and Care with the following benefits:
o With the availability of ARVs, ART programmes and more knowledge one can stay healthy despite their
HIV positive status
o HTC services can link you with other services such as support groups and medical facilities
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Part 3.2: The process of HTS – Pre Test, Test & Post Test
At the end of this Part, you should be able to understand and explore treatment for HIV/AIDS
Ask the participants to say what they know about the HTS process and proceed with the brainstorming activity
below.
Activity 3.2: Brainstorm - use of national testing logarithm
Step One: Group and/or Individual Pre-Test Counselling

• Depending on the volume of clients waiting for HTS at the dedicated space in a health facility – the HTS
counsellor will either do a group pre-test introduction to the service or if there are very few clients waiting,
then the provider will talk to people individually (or with a friend or partner if they prefer) explaining what will
happen during the test, and what the test results mean.
• They will explain about confidentiality, that no one will know about the person’s results, or even that they
have come to have an HIV test if they prefer it that way. They will encourage ‘shared confidentiality’ – so that
the person identifies someone – friend or family member – that they can seek support from if they get an HIV
positive result.
• To proceed with testing, informed consent must be reached between the individual and counsellor. If the
person decides they do not want to take an HIV test after pre-test counselling, they are fully entitled to make
that choice. HIV testing in Zambia is voluntary and there is NO mandatory HIV testing.
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Step Two: The HIV Test & Post Test Counselling
• If the individual chooses to have an HIV test, a small ‘finger pin pick’ sample of blood will be taken safely in
the counselling room. They will usually collect enough blood for the initial and confirmation test – in small
sterilized storage tube.
• The ‘rapid test’ is used for HIV testing – which takes about 15-20 minutes - so the client will get their results
right away.
• While waiting for the result the counsellors will put the clients’ information in an HTS register. They will then
discuss with the client why they decided to come for an HIV test, what their risk behaviours might have been,
their sexual history, and they should promote, demonstrate and distribute condoms. If the result is ‘negative’
– i.e. ‘non-reactive’, this will be entered in the register and the HTC provider will counsel the person about
the importance of HIV prevention behaviours and the need to start practicing consistent condom use and
options for reducing their risk behaviours.
• They will also recommend that the person comes back in 3 months for another HIV test. This is because a
person may be in the ‘window period’
• The counsellor will also ask about their regular sexual partner(s) and encourage the client to try and get their
partner(s) to also come in for either an individual or ‘couples HIV testing’ and counselling Part.
• The HTS provider/counsellor should also discuss with the adolescent the availability of Post-Test Support
Services (PTSS) either at the facility or in the community, or both. The aim of PTSS is to help provide
HIV positive adolescents with linkages to other adolescents or adults living with HIV, so that supportive
partnership can be established quickly as this improves adherence to ARVs.
• A peer network allows negative adolescents to access some training or orientation, to connect with a peer
educator for peer support and have access to condoms, etc. It is important that the HTC provider meets
regularly with the Health Centre Adolescent Focal Point as well as the Peer Educators – so he/she is able to
refer both HIV negative and HIV adolescents to post-test support services.
• If the first HIV test result is ‘reactive’ – this means that the ‘HIV antibody rapid test’ has reacted/detected
in the person’s blood the antibodies that the body produces to fight HIV. The provider will then explain the
outcome to the client and explain that the remaining donated blood sample from the client would be used to
do an additional HIV test – using a different type of rapid test. This is the confirmation test to ‘confirm’ the
result of the first test. If this test result is also ‘reactive’ – this confirms that the person is HIV positive and this
is what is recorded in the register. It the result is negative – the result will be marked as inconclusive and the
person asked to come back again in six weeks for another test. (Some larger facilities have a 3rd test for ‘tie
breaking’)1.
• If the test result comes out positive, immediately refer for ART initiation
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Part 4: Anti-Retroviral Therapy (ART) 1 Hour
Part 4. 1: Introduction to HIV treatment
Note: you should try and invite someone who is HIV positive and open about their status to attend this Part. They
can then share their experience with the participants.
Note: the facilitator should advise the person sharing the experience to focus the discussion around the
treatment, ARVS they are on and living with HIV – not on ‘how they got infected’.
• TEST AND TREAT(test and treat everyone regardless of CD4): All adolescents are eligible to start ARVS the same
day they are tested positive, this in line with MOH/WHO policy of test and treat (same day ART initiation)
Activity 4.1 Open discussion
• What is HIV treatment?
• What are ARVs?
• Where are ARVs available? (Government ART Clinics, private clinics & pharmacies)
• When should someone go on ARVs?
Activity 4.2: Mini lecture and summary
• HIV treatment is when a person has HIV, at some point the person will need treatment.
• HIV treatment is the use of Antiretroviral (ARV) drugs in people with HIV infection to slow and/or prevent the
development of AIDS.
• In most people, use of ARVS helps in reducing the viral load to undetectable levels
• The government target to have many people tested for HIV put those who test positive on treatment
immediately and to monitor those on treatment to make sure that they are doing fine.
• All HIV-infected adolescents and young people will be put on ART when they test positive.
Ask – What is treatment adherence? And then look for:
• This means taking your ARVs every day – at the recommended time of day and attending clinic appointments
as recommended by healthcare workers.
• Good ART adherence is the key to strengthening your immune system and getting healthy.
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Part 5: HIV prevention:
Part 5.1: Understanding Terms - Delayed Sexual Debut & Abstinence
1. Abstinence: (ILICHE)
 Means a decision to postpone sexual intercourse as well as alternative (non- penetrative) safer sexual
practices. The decision of not having sex can be until marriage or until one is ready. Abstinence (and
delayed sexual debut) are 100% successful against unwanted pregnancy, STIs, and HIV and AIDS
(virgins)
 A decision to delay or postpone having sexual intercourse until an older age when the person is married
or ready to have sexual intercourse is known as delaying sexual debut.
 Secondary abstinence: is a term that refers to people who are sexually experienced (not virgins) but
choose to become abstinent (no longer sexually active). Some common reasons people choose to
become abstinent following initiation of sex include contracting an STD, unintended pregnancy, and moral
or faith-related reasons. One important aspect of secondary abstinence is CHOOSING not to engage in
sex until some predetermined endpoint. Someone who simply hasn’t had sex for a while (i.e. doesn’t have
partner) is not a secondary abstainer.
Abstinence
Is
Power!!!
...avoiding risk behaviours and places that may lead to engaging in sex.
2. Being faithful to one sexual partner
Being faithful means having only one tested sexual partner at a time. Faithful relationships are perceived
as ideal in terms of romantic expectations and HIV prevention
3. Condoms (male & female)
 Male condoms are intended to provide a protective barrier to prevent body fluids such as blood, semen,
or vaginal fluids as well as viruses and bacteria from passing from one person’s body to another during
vaginal and anal sexual intercourses.
4. Voluntary Medical Male circumcision

Male circumcision is the removal of the foreskin of the penis.
Benefits of VMMC
 Circumcised males have a lower risk of contracting some STIS, as well as HIV
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5. Pre Exposure Prophylaxis (PrEP) Key Points:
Activity 5.1: Brainstorming by asking if there is someone from the group who knows and can explain
what PrEP is. After this, explain that:
• “PrEP” stands for Pre-Exposure Prophylaxis.

• The word “prophylaxis” means “to prevent or control the spread of an infection or disease.”
• PrEP is a way for people who don’t have HIV to prevent HIV infection by taking a pill every day.
• The pill contains two medicines that are also used to treat HIV.
• If you take PrEP and are exposed to HIV through sex or injection drug use, these medicines can work to
keep the virus from taking hold in your body. Along with other prevention methods like condoms, PrEP can
offer good protection against HIV if taken as advised by the healthcare worker.
6. Post Exposure Prophylaxis (PEP)

Activity 6.1: Brainstorming by asking if there is someone from the group who knows and can explain what PEP
is. After this, explain that:
• PEP stands for Post-Exposure Prophylaxis

• PEP is a method of preventing the uptake of HIV after a person has been exposed to transmission by blood
or other body fluid contact with person who is known to have HIV or unknown HIV status
• PEP, like PrEP is an ARV – but this is where the ARVs need to be taken within 72 hours from the time of
exposure to HIV infection.
• While PEP often refers to a specific medication taken by people who think they have been exposed to
HIV, there are other precautions they can take in cases of exposure before taking PEP drugs or if PEP is
unavailable.
7. Ant Retroviral Therapy (ART)

Good adherence to ART can lead to undetectable levels of HIV in the body (Viral suppression)
Undetectable= Untransmittable.
U=U refers to the concept that
• A person with undetectable viral load (zero viruses active. All supressed) is INCAPABLE of transmitting HIV
infection to their sexual partners
• ART has been shown to decrease the risk of mother to child transmission during pregnancy and breast
feeding.
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Part 6: Positive Living
Explain that the aim is to ensure and promote positive living and prevent new HIV infections
among AYPs
Explain that:
• The number of deaths could be significantly reduced if all AYP knew their status and those on treatment
were living positively and following their treatment as recommended by the healthcare workers (adhering to
their treatment).
• Remind participants that adolescents, especially young adolescents, have unique challenges living positively
with HIV. As peer educators, you have a responsibility to help reduce stigma and discrimination against
people living with HIV in your community.
• If you are acting as a ‘treatment buddy’ for a peer who is living with HIV, your role will be to help and support
them to live positively with HIV.
Note: It is important that peer educators let their peers know that when they go to ART, they should expect to
receive a service that is responsive to their special needs because the Ministry of Health has been training
health workers who provide ART services on how to provide adolescent HIV care and treatment.
Some Key points on Living Positively

A. Positive attitude
• If you are HIV positive, you need to learn to live with and accept your status.
• Note: Young people living with HIV may be able to do this on their own – but their Treatment Buddy has a
role in helping them with this. Their health provider may also be able to refer them to a support group, if one
is available. Peer Educators should find out from the HTC provider if such a group exists in their community
– for referral purposes.
• It is also important to be able to share your status and worries with those you love and trust. Your provider
will ask you to identify someone to support you – a family member or a close friend or your spouse/partner.
They will be your ‘treatment buddy’ and help you live positively with HIV.
• Often it is difficult not to blame yourself or others for getting infected with the HIV virus. It is important to
remember that you should look to the future – and not dwell on the past – what is done is done – and you
cannot go back. It is best to think positively about your future – doing what it takes to stay healthy.
• Make plans for your future: A person living with HIV and on ARVs and adhering to their treatment should
be able to live a normal life. Many people with HIV are happily married, having children, being successful
at school and work. Being infected with HIV does require you to pay attention to your health – and once on
treatment you need to adhere to your treatment. But this does not mean one will die immediately. There are
many people who have been living positively with HIV for many years and they live a long as people who do
not have HIV, provided they maintain their health.
B. Seek support
· Emotional support
• When you first find out you are HIV positive it is important to find someone you can trust to talk to
about your HIV status and worries
• You should also go to the counsellor who will listen to your fears and worries. The counsellor will also
37
help with information on how to take care of yourself
• Talking to somebody who has been living with HIV can also help you cope with stress and ease the
tension.
• Engage in social activities and seek social support.
• When you first find out you are HIV positive you should avoid being alone with your thoughts and
fears. You will need to disclose your HIV status to a family member or a close friend that you can
trust, or the counsellor can introduce you to adherence supporter – someone who is HIV positive in
your community – who will support you to deal with your initial fears and concerns.
• Being able to meet and talk with people who have been living with HIV is very helpful. Many larger
ART sites have special clinic days for adolescents – where you may be able to meet with other
adolescents and young people who are living with HIV and learn from them about living positively
with HIV. Being in the company of a good friend who supports you can also help you feel normal and
avoid depression.
• Spiritual support
• If you are a member of a church or religious organisation you may be able to get counselling and psycho-
social support. This depends on the attitude the religious organization has to people living with HIV, as some
religious organization still stigmatize and discriminate against people with HIV, so it is important to know the
attitude of the organization before disclosing your status.
C. Maintain good health

• Your immune system is already ‘compromised’ by HIV and it will take some time, once you start on
ART, for your immune system to become stronger.
• If you do not adhere to your treatment (take your ARVs everyday) you will not be able to strengthen
your immune system and bring down the amount of HIV in the body (Viral load going down).
• If you suffer from an opportunistic infection, you need to seek treatment as soon as possible, to make
sure that you maintain your immune system.
• Exercising regularly and keeping fit
• Drink clean water
• Sleep under a mosquito net
• Use condoms correctly and consistently
• Eating nutritious food (mixed diet)
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Part 7: Health Facility Visit
Aim: To familiarize the Peer Educator with how the SRH and HIV services are conducted in a health facility.
This will provide them with the skills to undertake a similar exercise when they are eventually deployed to their
operational Health Facility.
This is to be done during the last Part of Day 4 of the training and will be a 2 hour field trip to the local health
facility with one for the trainers.
Introduction Activity: During the facility tour they should meet the Officer-In-Charge – and learn about the
number of clients being serviced and all of the types of services the facility provides. They will then need to be
given a detailed overview of the SRH and HIV services being offered by the facility.
Services visit: This will require them to visit the ‘spaces’ in the facility where the following services are provided:
HIV Testing, ART and family planning. These services will be explained to them and they will also have the
opportunity to see where and how condoms are distributed.
They should be briefed by the health providers on how adolescents can access the services and the procedure
to do so (e.g. group pre-test, individual post-test counselling during the HTC test and how the rapid HIV testing
process is done, etc.)
They should also be shown how to fill out the HTC register and explanations should be given on why it is important
to collect disaggregated female and male adolescents and young adults’ data. Their potential role in assisting in
the monthly extraction of adolescent data should be explained.
As all peer educators will be attached to such a facility, their support role should be highlighted and their possible
roles discussed – (see Annex 3 on the Adolescent Friendly Spaces) – and how it is very important for them to
know:
a) How each service operates, who provides it, when it is provided and how long it will take, what times are
busy and when is the best time for adolescent to come to the facility and what happens, for example, if a
young people tests HIV positive.
b) What should come with the service – e.g. if condoms are provided at the specific service or at another
location, or if there should/would be IEC materials provided during the services, if they use referral cards
and what they look like, etc.
Facility visit closing Part: Participants need to write down in their Participant Manual the services they visited,
and how they operated, and their potential roles in supporting the services.
Facility Visit Notes:
How can they make the service more adolescent friendly?
How can they promote the services?
How can they make sure condoms are promoted and distributed?
How can they ensure that IEC materials are being distributed?
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Part 8: Tuberculosis (TB)/HIV Co-Infection
Overview of TB/HIV Co-Infection
TB remains the leading cause of death among PLHIV. The percentage of identified HIV-positive TB patients on
ART has increased over the years. TB/HIV co-infection programme efforts have ensured systematic enrolment
of all HIV/TB co-infected patients on ART. Reducing the risk of TB in PLHIV is one of government’s priorities.
This part of the module focuses on:
· Defining TB,
· Discussing TB services for AYP, and
· Discussing infection prevention.
Definition of Tuberculosis
It is an airborne infection caused by a germ called mycobacterium Tuberculosis which commonly affects the
lungs, but can also affect other parts of the body such as bones, brain, lymph nodes etc. People with weak
immune system are in danger of getting TB e.g. HIV positive (poor adherence (core infection)), pregnant females,
mental illnesses, malnutrition. Main signs and symptoms include- cough, night sweats, weight loss and fever.
TB services for AYP
TB services are offered in Zambia with the aim to reduce transmission and new cases in TB corners and Chest
clinics around the country. Testing services are done in all government facilities that have laboratories. It is
important for Peer Educators to conduct community mobilization and engage community health workers to
support referral systems of adolescents and young people between HIV and TB programmes.
Prevention of TB.
· TB is prevented from childhood (infancy) up to adulthood by the administering of BCG vaccines at birth,
Tuberculosis Preventive Therapy (TPT) in people that are at high risk such as people living with HIV,
inmates, Health workers, immune compromised people etc.
· Avoid other factors that are social-economical such as overcrowding in houses, public transport, and
schools.
· Ensuring good health to promote good immunity system.
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MODULE E: Young People and Alcohol/ Substance Use
Module Overview
Alcohol and Substance use has become a public health problem all over the world. In resource limited countries
like Zambia, the problem is of no less importance than in developed countries. The use of such substance has
dangerous effects on the individual, family and society.
Module Objective:
To understand and explore the effects of alcohol and substance use in AYP and health-seeking behaviours
Part 1: Discussion of key terms

Activity 1.1: Brainstorm by discussing the definitions of the terms listed in the following box
Definitions;
· Substance/Drug
· Tolerance
· Substance Dependence
· Substance withdrawal
· Substance Craving
· Substance Addiction:
Summarise the definitions using the notes below;
• A substance - is a drug (anything) which when consumed can affect how people feel, hear, taste, smell,
think and behave examples include cigarette (nicotine), alcohol, cannabis (Indian hemp), heroin, cocaine,
spirit, genkem, Bostic etc.
• Tolerance: it is the tendency to increase the amount of the substance taken to get the desired effect. For
instance, if you were taking one bottle of alcohol and you increase to 2 or more for you to get the desired
effect (i.e. feel high).
• Dependence: it is the tendency to rely on the substance in orders to cope with everyday life (for example
people who cannot complete a task without taking a drug or a substance).
• Withdraw Symptoms: these are the strong body (physical) and mental symptoms that occur after sudden
stoppage of continuous taking a substance (those who are dependent on the drug)
• Craving: this is a powerful desire to use a substance.
• Addiction: the uncontrollable desire and need to use a substance.
Activity 1.2: Brainstorming

Distribute pieces of paper and ask each participant to write one or two substances commonly used, where they
are coming from, and how they are used. Encourage them to write in their local languages or any name used
by the AYP around. After this collect the papers and ask for a volunteer to come and help you write on the flip
chart while you read out loud to the group.
41
Activity 1.3: Group discussions
Divide the participants into two groups and allow them 5 to 10 minutes to discuss why some AYP use
alcohol and other substances while others do not.
Summarise this topic by adding the below points in the table below.
Table 2: why some AYP use alcohol and other substances while others do not
Why AYP use alcohol and other substance. Why AYP do not use alcohol and other sub-
stance.
 Peer pressure e.g. influence of friends  Against religious beliefs
 Easy access to drugs  Against personal beliefs

 No need for them
 Out of curiosity - they want to find out about it
 Past bad experience
 As a means of escaping from pressures
 Don’t want to break the law
 To get high  Witnessed bad effect of substance use
 Advertising: youths learn wrong information  Parents say no
from advertisement of tobacco and alcohol
 Risk of losing control
 Social change, Youths moving from rural areas
 Knowledge of its bad effects
to urban centers where they have no social
support, unemployment.

Be Strong... Problems?
Say NO Drugs will not take them away!
To peer pressure Talk to someone
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Part 2: How to tell if someone is using alcohol and other substances
Brain storm
Invite one participant in front to record on the flip chart the list of responses. After the discussion summarise the
topic using the points below;
Explain that there are certain behaviours, which can help us suspect in good time when an AYP is using alcohol
and other substance. These are but not limited to:
• Sudden change in behaviour and mood
• Sudden change and decline in attendance and performance at school or work
• Unusual temper flare-ups.
• Increased borrowing of money from parents and friends
• Stealing at home, school or work place
• Unexplained long absence from home
• Unnecessary secrecy
• Changes in dressing and appearance.
• Presence of items such as syrups, foil paper, lighter and burnt spoon, syringe, etc.
• Needle marks especially where there are veins.
• Selling belongings and personal items.
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Part 3 Open question
Activity 3.1: Discussion on effects of alcohol and substance abuse

Ask participants to discuss the effects of alcohol and substance use.
Summarize this topic by bringing out the points below;
Explain that the effects of alcohol and substance use may be;
• Loss of sense of responsibility

• Expulsion from school
• Family Disruption
• Criminal behaviour
• Lack of achievement
• Promiscuity (indulgence in sexual activities which may result into bad outcomes i.e. STI/HIV infections,
having sex in exchange for money or drugs, )
• Attempted suicide and suicide
• Restlessness or trembling,
• Depression.
• Damage to organs such as liver, brain and pancreas
• Mental dependence leading to cravings
• Mood swings
• Hallucinations (hearing voices; seeing, feeling and smelling things that aren’t there; sayings things to oneself)
• Sleep disturbances (lack of sleep or sleeping too much)
• Memory loss.
• Low self-esteem.
• Sexual disorders such as impotence
• HIV infection for injecting drug users using unsterilized syringes and needles
• Unintended sex (rape, defilement which may lead to unintended pregnancies, HIV/STI infection etc.)
Stay away from Drug and Substance abuse,

They lead to … ...depression, anxiety and poor grades
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Part 4: dangers of using substances on reproductive health
Apart from the general effects of Substance use on the body, alcohol and other substances affect reproductive
health in a very serious and harmful way including; sexual experimentation and unprotected sexual activity
which may lead to:
• Infection with STIs and HIV/AIDS
• Unintended pregnancy
• Unsafe abortions
• Prostitution
• Early sexual debut.
• Poor performance at school, which can lead to dropping out of school
• For married AYP, it may lead to unstable homes, separation and divorce
Part 4.1: When and Where to seek help
All AYP who may notice or realize that they are abusing alcohol and other substances, must seek help immediately
at home, nearest health facility and at school (from a guidance and counselling teacher)
Ask for questions based on the discussion above and if there is none summarize using the following
points
• Clarify alcohol and substance use as a risk factor for AYP life.
• Emphasise the need for us to identify friends who are using alcohol and other substances and assist them
to seek help immediately.
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Module F: Gender Based Violence
Module Overview
This module presents the definition and different forms of Gender Based Violence (GBV) and how to identify
and help adolescent victims. It also explores the consequences of GBV and how Peer Educators can assist
adolescent victims of GBV.
Objectives:
· To define Gender-based violence (GBV) and correctly use all of the key words,
· To describe types of gender-based violence,
· To discuss reasons that contribute to GBV,
· To discuss barriers to reporting sexual violence,
· To discuss dangers of GBV to sexual and reproductive health,
· To outline GBV Prevention and response services
· To describe peer educators role in the prevention and management of gender-based violence.
Part 2: Definition of GBV
Activity 2.1: Discussion
Introduce the topic and ask participants to share what they know or think about GBV.
Summarize the discussion using the notes below;
• GBV is any form of deliberate physical, mental or sexual harm, directed against a person on the basis of their
gender
• GBV is a very common problem, and a violation of human rights in Zambia.
Part 2.1: Types of GBV
Activity 2.2: Brainstorm
Ask participants to mention the types of Gender-Based Violence that they know. Ask a volunteer to be writing the
responses on a flip chart then summarize by listing them and giving a few examples.
46
of GBV
Physical Psychological(mental) Sexual Social/cultural

· Beating · Insulting · Harassment (i.e. touching sexual parts of AYP · Bad cultural
· Biting · Yelling without their consent) norms that
· kicking · Constant criticism · Rape (forced sexual inter course) disadvantages
· Humiliation · Defilement some people
· Discriminating · Forced prostitution
· Sexual trafficking
Activity 2.2: Mini lecture
Reasons that contribute to GBV:

 Lack of power and poverty make some become dependent others who end up abusing them.
 Lack of awareness of GBV
 Some Cultural beliefs and values that support bad gender roles such forced marriage and early marriage,
false belief that being beaten by a partner is a demonstration of love
 Spending a lot of time with people of the opposite sex

 Use of alcohol and other substances may make some people to be abused more especially sexually
among others forms of GBV.
Activity 2.3: Group Work
Ask the participants to divide into two groups for 10 minutes ask each group to list the difference between gender
roles and sex roles. Let them assign a representative to present to the class after 5Minutes
Part 3: Dangers of GBV

Ask the group to discuss what they think are the dangers of Gender-Based Violence. Summarize the discussion
by reading out the notes below that GBV can lead to:
 Physical injury, which at times start from a simple wound to loss of a body part or even death. There are
lots of reported cases of deaths due to GBV in some in of own communities and Zambia at large.
 Verbal abuse which then may bring about things such as fear, anxiety, self-blame, depression and suicidal
thoughts. It is not usually visible (unlike physical trauma) but most AYP suffer a lot from it and the effects
can be long-lasting and life threatening in some instances.
For example, AYP who are sexually abused during their childhood tend to feel guilty about the abuse and usually
take the blame for being defiled. They develop negative feelings about themselves and lose self-esteem. These
bad feelings about themselves often make them to engage in high-risk behaviours such as use of alcohol and
other substance or other bad practices. This makes them to become at risk of acquiring STIs including HIV,
unwanted pregnancies.
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Part 3.2: Barriers to Reporting Sexual Violence
Discuss what makes AYP and adults not to report GBV while a volunteer writes answers on a flip chart.
Summarize the discussion with the statement below that:
There are a lot of reasons why AYP do not report GBV but always remember that such cases if not properly
attended to or unreported can end up really badly.
Activity 3.2 Group work
Divide participants in to two groups and ask them to mention some effects of GBV. Summarise by reading out
the key points on the effects of GBV
Fear of stigma and discrimination;
Girls who have been raped may be seen by others as unclean or as being the cause for the rape or physical
abuse. She will be blamed for what has happened to her and may experience discrimination from her family and
friends.
Blame;
People expects AYP especially girls to be able to avoid sexual violence including rape. If any form of sexual
violence occurs, most of the time people blame the individual for the way she behaves and dresses, saying that
the rape is their fault because they provoked sexual desires in the perpetrator. This is so because of how people
believe.
Fear of disbelief;
Many AYP especially girls do not think anyone will believe them, particularly if they have been abused by
someone they know. For this reason, many who have experienced sexual violence, including children, remain
silent. However this may have serious negative outcomes on them as they have be suffering for a lot of emotional
issues and reproductive health issues.
Fear of more harm;
Many adolescents especially girls and women who are defiled/raped are intimidated by their attacker, who
threatens that they will cause them further harm if they make a police report. They may even make death or
physical threats to them or their loved ones.
Ineffective systems;
Adolescents who report GBV cases to the police may not receive the support they deserve as most of the
causers will go scot free. Sometimes they are subjected to stay with their causers as they may not have safe
alternative places to stay and this will endanger their lives even more.
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Peer Educators’ bad attitudes;
Peer educators are not usually understanding and supportive when someone who has experienced GBV seeks
care from health facilities. They often tend to be judgmental.
Part 4: GBV Prevention and response services

Ask the participants to explain the role AYP have in preventing GBV. After the discussion, summarise by reading
out key points below that:
· AYP often lack information on reproductive health issues, but education gives them necessary knowledge
to defend themselves from harmful cultural practices.
· AYP can also be encouraged to get involved in community-based activities to gain more knowledge that
can be of great benefit to them for many years to come.
· Male involvement in gender activities can be of great importance as they are most of the time the perpetrators
of violence and change should start with them as they are decision makers in households most of the time.
· As most types of GBV are carried out under the cover of culture and tradition, and are deeply rooted in the
community, addressing this issue requires engagement of the community as a whole.
· The communities should be sensitized and engaged to discourage different cultural practices that may
make the male children feel more important than the female children.
Part 4.1 Signs and symptoms of GBV
a) Sexual GBV
Survivors of sexual abuse after a violent act may have physical signs which show that they have been sexually
abused such as:
· Difficulty in walking or sitting

· Torn, stained, or bloody underclothing
· Pain or swelling in genital area
· Lacerations of the hymen, labia or perineum
· Bruises or bleeding in external genitalia, vaginal or anal areas.
b) Physical Violence
· Survivors of physical violence may have injuries which do not connect well with story given (i.e. swelling,
broken or fractured bones, wounds, bruises).
· Survivors of physical violence may have reported injuries such as swelling, broken or fractured bones,
wounds, bruises.
c) Emotional Violence
· Failure to focus on tasks
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· Depression
· Withdraw and suicidal tendencies
· Self-destructive behaviours
· Low self esteem
Ask participant if they know were a GBV survivor can be referred to?
Wait for few responses and tell that GBV services should be referred to;
The Health facilities, Zambia Police Services, Ministry of Education (schools), social welfare for safety, justice,
media houses, and Non - Governmental Organizations such as lifeline/Help line 116/933 for telephone counselling
services, faith-based organizations (churches) and traditional leaders in their respective communities.
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Module G: Non-Communicable Diseases in Adolescents and Young
People
Overview
Addressing non-communicable disease (NCDs) is a global priority especially for young people, now and in the
future. Two thirds of premature deaths in adults are associated with childhood conditions and behaviours, linked
NCD.
Module objectives
To gain knowledge and understanding on Non communicable diseases (NCDs) adolescents and young people
(AYP) encounter and how they can be addressed
Part 1: Definition of Non communicable diseases (NCDs)

Open question;
What are NCDs?
After 2 to 3 responses define NCD according to the statement below;
Non communicable diseases (NCDs) are also referred to as chronic (continual or unending) diseases that are
not transmissible (meaning can’t be transmitted from person to person) and tend to last long.
Part 1.1: How big is this problem of NCD worldwide and in Zambia?
NCDs worldwide and locally
About 1.2 million people under the age of 20 die from treatable NCDs each year (UNICEF, 2019), however
most of the things that contribute to this are preventable and can be changed, particularly in the early
years of life and adolescence.
Information shows that most of the dangers of NCDs are interconnected (linked) and share similar causes
such as; childhood obesity which has a bad outcome on mental health; and mental health in turn has a
bad outcome on eating behaviours and substance use.
Pause and ask if there are participants who can give examples of NCDS, wait for 2 to 3 response, if there
are more allow them to give if you do not get more answers proceed and share the examples of NCDs
from the box below;
Explain that these NCDs are not just common to adults; nowadays they have become common even in AYP.
NCDs
· Heart diseases- (Hypertension, Anaemia, Sickle cell etc.)
· Chronic respiratory diseases (i.e., Asthma)
· Liver disease
· Sugar disease,
· Malnutrition
· Mental disorders (i.e., drug use disorders, depression.
· Brain related disorders,
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As you conclude explain that these NCDs are primarily driven by four major dangerous behaviours such as:
· Tobacco use,
· Physical inactivity,
· Harmful use of alcohol and
· Unhealthy diets.
Part 2.0: Prevention and control of NCDS

Activity: 2.1-
Divide participants into two groups - Each group to come up with a list of how NCDs can be prevented and
controlled.
After their presentations begin the summary by saying; Unhealthy diets and lack of physical activity are among
the leading causes of NCDs contributing more to malnutrition cases worldwide. Zambia is also exposed to an
increase to foods and diets that contribute to dangers of suffering from NCDs.
Table 4: How can NCDs be prevented and controlled?
Prevention Control
· Doing physical Activities · Adherence to medication ( those who al-
· Eating healthy local foods. e.g. groundnuts, ready have one or two NCDs like asthma
millet, sweet potatoes etc. and sugar disease
· Avoid tobacco Use · Stop Tobacco usage
· Avoid alcohol use · Stop Alcohol usage
· Attend medical reviews as advised by the
doctors
· Behavioural change by engage in physical
activities such as sports (Football, netball,
basketball, running, etc.)
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Module H: Mental health and the young people
Module Overview
This module looks at mental health issues that may affect AYP and how they can be addressed. Mental illnesses
are common among the AYP and they present in different ways. A mentally healthy person should have a positive
state of mind and body, feels safe and able to handle the demands of life and have a sense of connection with
the people, environment and the community. Depression is the commonest mental illness in AYP; however, it is
not easily identified because it is hidden in other behaviours such as alcohol and substance use.
Module objectives
In this module, the participants will;
· Define the different terms used in Mental Health
· Identify the reasons for poor mental well-being
· Discuss the reasons that contribute to mental health problems
· Identify the Common mental health Problems
· Identify the signs and symptoms of poor mental health
· Discuss on the importance of keeping good mental health
Part 1: Definition of different terms used in mental health

Write the definitions below on a flip chart and ask the participants to discuss the meaning of each term. Definitions:

1. Psycho
2. Social
3. Psychosocial support
4. Psychosocial Wellbeing
5. Mental Health
6. Mental Illness
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Summarise the discussion with the definition of terms as stated in the box
· “Psycho-” this term is used to refer to the mind and soul of a person (e.g. how you think, how you
feel, what you believe in)
· “Social” this term is used to refer to a person’s outward relationships and the environment (e.g. how
one socialises with others at home, school and in the community).
· “Psychosocial support” this term talks about the on-going emotional, social, and spiritual needs
of people (e.g. people living with HIV, their partners, survivors of GBV, alcohol and substance users
and their caregivers)
· “Psychosocial wellbeing” is when a person’s inside and outside needs are met and s/he is physi-
cally, mentally, emotionally, and socially healthy.
· “Mental health” is a state of well-being in which every single person understands his or her own
potential, can handle the stresses of life and is able to make a contribution to her or his community. A
mentally healthy AYP should have a positive state of mind and body, feel safe and able to cope with
demands and meaning of life and have a connection with family, community and the environment.
· “Mental illness” refers to disturbances in thinking, behaviour and feelings leading to a person’s
failure to cope with life’s everyday demands and routines.
Part 2: Reasons for Poor Mental Well-being

Activity 2.2: Discuss
Ask the participants what they think are some of the reasons that lead to poor mental well-being as one of them
writes the answers on the flip chart.
Summarise the activity by adding some of the things that may not have been mentioned from the box below.
Start by emphasizing that, ALL AYP need support managing the normal developmental issues, such as wanting
to feel normal and accepted and wanting to fit in with peers.
· Risk-taking behaviours
· experimentation
· Sexual desire
· Self-doubt/confusion
· Anxiety
· Criticism of caregivers or elders
· A focus on body image
· A sense of immortality
· A need to dare people in high authority while also still needing their support
Part 3: Common Mental Health Problems

Activity: Ask the Participants to brainstorm the common Mental Health Problems among AYP and summarize
using the following points
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These are some of the common mental health problems:
· Excessive use of Alcohol and substances.
· Causers of Gender Based Violence (GBV)
· Fearfulness of things known or unknown
· Depression or over activity
· conflicting attitudes, behaviours or thoughts HIV related mental health problems,
Reasons that contribute to mental health problems
Discuss with the participants what possible reasons contribute to mental health problems among AYP
(5 minutes Discussion) conclude the discussion by adding some of the following reasons that may not have
come out from the discussion
· Poor living conditions

· Poor family relationships
· Poor relationships between people outside the home
· Difficulties to adjust to changing situations
· Lower self-esteem/negative feelings about self
· Poor performance in school or at work
· Infections such as cerebral malaria, brain infections, syphilis, HIV, etc.
· Damage to the brain due to injury
· Familial inheritance of mental health problems
· Unhealthy lifestyles such as excessive use of alcohol and other substances
· Gender Based Violence (GBV)
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Part 4: Signs and symptoms of poor mental health

Ask the participants to Brainstorm on the signs and symptoms of poor mental health; summarize the activity with
some of the following points that may not have come out during the exercise
Signs and symptoms What to do when you notice these signs

and symptoms
· Withdrawing from people or activities they would normally · Peer educators can provide some
enjoy counselling according to their level
and encourage such a one to seek
· Thinking of harming one’s self or others. professional help
· Feeling as if nothing matters.
· Too much or little sleep
· Too much or little eating
· Excessive use of alcohol and other substances
· Displaying unusual emotions.
· State of confusion.
· Persistent thoughts or memories that reappear regularly
(hallucinations)
· Fixed false beliefs which are contradictory to reality (Delu-
sions)
· Poor personal hygiene.
Part 5: Dangers of Poor mental health
Activity Mini lecture: Explain the dangers of poor mental health with the following points
· Anxiety and stress

· Depression
· Eating disorders (too little or too much)
· Psychosis
· loudly talking to self
· Deliberate self-harm
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Part 6: Importance of Keeping Good Mental Health
Activity 6.1: Mini Lecture
Keeping people more especially AYPs mentally healthy at all times result into:
· Energetic population that contributes to nation’s development

· Fewer young people in juvenile correctional services
· Fewer cases of mental illness and disorders
· less violence
· More young people finishing school and managing their own businesses, and a reduction in HIV cases
associated with excessive use of drugs and other substances
· Reduced early marriages and pregnancies
To summarize the module, Get feedback on what has been covered in this Part, to check for understanding,
summarise using the following points;
· Mental health is the state of well-being in which a person realizes his or her own abilities, can cope with
the normal stresses of life, can work fruitfully, and is able to make contribution to his or her community.
· Promoting mental health among young people prevents mental illness
· The mental health of young people is affected mentally by a number of reasons
· Consequences of poor mental health can be difficult to manage and can take time
· Peers need to be on high alert to identify people with mental health problems and support such people
and encourage them to seek professional help.
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MODULE I: ADOLESCENTS WITH DISABILITIES
Module overview
This module offers a foundation on how adolescents with disabilities are supposed to be treated at both facility
and community level. It further provides an overview of important matters concerning adolescent health and
development in this particular constituency. The module engages Peer Educators to explore and have a deeper
understanding of five main types of special needs in adolescents. Peer Educators will learn to identify the causes
and characteristics of these five main types of special needs and the common challenges they present.
Objective
· To help participants to understand and discuss issues related to adolescents with disabilities
Part 1: Definition of disability

Begin by asking participants what they know or understand by term disability. Wait for 2 to 3 responses and
define the term disability as indicated in the box below;
Any condition of the body or mind that makes it more difficult for the person with condition to do
certain activities and interact with world round them.
Part 2: Types of disabilities

Ask the participants to discuss the types of disabilities they know and let one person write the responses on a
flipchart. Summarise the discussion by relating the participant’s responses on the flipchart with the main five
types of disabilities in the following box:
· Physical disability: May need a special assistant
· Learning disability
· Mental disability
· Visual disability
· Hearing disability
Part 3: Stigma and discrimination towards adolescents with disabilities

Part 3.1: Activity 3.1: Brainstorm
Ask participants what they understand by the term ‘stigma’. Write down their ideas on a flip chart. Then do
the same for ‘discrimination’ write down the ideas on a flip chart. Then ask how they are related to each other.
Write down this on the same flip chart as well.
Summarise what stigma and discrimination means using the simple term in the box below
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Discrimination occurs when a difference is made against a person that results in the person being treated
unfairly and unjustly in the eyes of others.
Stigma is the degrading attitudes of a person in the eyes of others as a result of certain differences such
as illness, colour, and looks disability
Part 3.2: Activity –Discussion
Ask participants to discuss ways they have seen, heard, or have done/do themselves in form of stigma and
discrimination to persons with disabilities
Conclude the discussion with the following information if it has not come out of the presentations;
Some ways people stigmatise others are:
· Isolation, insults, judging, blaming
· Stigma by looks or appearance
· Stigma by type of school, work, level of education.
· Stigma by association – family/friends may be affected by stigma
Disability related stigma comes with a powerful combination of external and internal stigma. For example, AYP
may shun to associate with an albino or someone in a wheel chair, an albino or someone in a wheel chair feel
they cannot play with others on perception that they are not liked as a result of how they look.
Part 4: Effects of Stigma
Tell the participants that if stigma is not addressed, it can result into:
· People being denied services, jobs, friendship, etc.

· Individual and institutional discrimination against adolescents with disabilities (e.g., when you or an
organization refuse to hire a person because they have a disability or they get kicked out of family, house,
work, rented accommodation, a job and an organisation) is a violation of human rights.
· Poor psychosocial health – as an adolescent living with a special needs self-isolation by dropping out of
school or even relationships; they can also begin to have mental health problems by becoming depressed
or to abuse alcohol and other substances, etc.
Part 5: The role of peer educators in providing Services for adolescents

living with special needs
Activity 5.1: Group work
Divide participants in five groups. Give each group a flip chart and ask them to write down any available services
they are aware of both at health facility or community level. This activity should take about 15 minutes.
After group work participants should share their work with everyone through presentations.
Summarise the discussion by building on what has been shared.
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MODULE J: Counseling Skills
Time: 45 Min
Part 1: Introduction
OVERVIEW
Adolescence is a period characterized with a lot of challenges which makes them the most vulnerable individuals
in society. They have many emotional challenges, issues and concerns to deal with on a day-to-day basis. It is
therefore extremely important to provide them with proper emotional care and counselling. This training focuses
on skills for individual counselling and therefore, for the purposes of this training we shall focus on a one to one
counselling type.
Understanding counselling for adolescents
Remember that Counselling means different things to different people. Therefore, it is important to agree what
it is and what it aims to achieve.
Objectives:
Participants should;
· Define counselling
· Discuss the aims of adolescent counselling
· Explain how counselling differs from advice-giving
· Discuss the characteristics of a good counsellor
· Identify a safe environment for adolescent counselling.
Activity 1-Definition of Counselling

Ask participants what they understand by the term “counselling” before giving them the written definition as
provided in the next statement. Wait for 2 or 3 responses and summarise by the statement bellow
Counselling is a process between a client and a counsellor in a professional and trusting relationship to
help the client make informed decisions.
Part 2: Aims of Adolescent Counselling

Adolescent counselling aims to assist adolescents discover their identity or recover their self-esteem (self-
worth), self-awareness and confidence (assertiveness).
· Each adolescent is different from the other, but most of them may require meeting a counsellor
frequently depending on the particular problem they may have.
· Some might need more Part s and if one has a positive counselling experience they are more likely to
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ask for help as need arises.
Part 2.1: Types of counselling

Explain that there are many types of counselling such as individual counselling, family counselling, group
counselling and many more.
Activity 2.2: Group work
Listening Skills
Tell the participants we will now do a group exercise about listening and learning skills. Ask them to number
themselves off by twos (i.e. 1, 2, 1, 2….).
Take all the number 1s out of the room. Outside, give them a topic that should generate a good conversation
(e.g. the best day of my life, the worst day of my life, a news item of local interest, etc.). Tell them that they will
talk about this topic with their number 2 partner for about 4 minutes and ask them to think about what they will
say. Ask them to wait outside until you are ready.
You return to the number 2s. Tell them that when the 1s come back they will start talking to their number 2
partners. At first, the 2s must act like they are not listening. Explain that after two minutes, you (the facilitator) will
clap your hands. This is the signal and the 2s will now start to act as if they are listening.
Quickly brainstorm some ways that the number 2s can show that they are not listening (e.g. looking away,
interrupting, asking inappropriate questions, fidgeting, and no eye contact).
Ask the number 1s to come back and start to talk with their partners on the chosen topic. After two minutes, clap
your hands and allow the discussion to continue for another two minutes. Tell them when the time is up.
Using the following questions, lead a discussion:
· How did the number 1s feel when their partners were ignoring them?
· What were the signs that the number 2s were not listening?
· What did the number 1s notice that showed them the number 2s were listening?
· How does this relate to talking with young people?
Part 3: Characteristics of a Good Counsellor
Activity 3.1 Mini Lecture

We will now look at some qualities, attitudes and behaviour required of a good counsellor. We will also
explore some personal issues that you need to be aware of when providing counselling. A good counsellor
should be:
· Sincere- Meaning that; a counsellor should show genuine interest in an adolescent ‘s problems
· Empathetic – Meaning that; a counsellor should be able to understand and connect with the
adolescents’ feelings and emotions.
· Non Judgmental – Meaning that; a counsellor should be able to listen without being judgemental or
negative
· Warm – Meaning that; a counsellor should show compassion, kindness and genuineness in his/her
facial expression as well as tone of the voice
· Respect – Meaning that; a counsellor should appreciate and respect the adolescent’s rights
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Activity 3.1: Differences between counselling and advice-giving- discuss
Having looked at the definition of counselling above, as the participants to discuss how counselling may defer
from giving advice, while you record their responses on the flip chart. Then summarise with the information in
the following box
Counselling Giving Advice
· Helping people learn to identify their own issues · Telling your counselee what you think is best
· Counselee (person that needs counselling) identi- for them
fies solutions to solve their own problems · Opinion is given by an expert
· Counsellor is non-judgmental · Counsellor is judgmental in nature
Tell participants that much as we have talked about counselling, there are few situations where it is allowed to
give advice, for example:
· Accurate information on medical or legal matters, or on their rights.

· Advice on organisations or departments that can provide assistance or access to resources.
· Advice on how to report incidences of abuse.
· Advice on how to get in touch with networks or organisations that can give spiritual or psychological
support.
Part 4: Discuss the characteristics of a good counsellor

Helpful behaviours should encourage the adolescent you are working with to open up, share their feelings
and assist in building a trusting relationship with you. Unhelpful attitudes and behaviours can damage that
relationship and confuse the adolescent, making them feel more isolated and unwilling to ask for help.
Part 4.1: Discuss the characteristics of a good counsellor
Activity 4.1; Group work
Split the participants into two groups to discuss the characteristics of a good counsellor. After the discussion,
ask the participants to choose representatives to present to the larger group and share their ideas in plenary.
Part 5: Identifying a safe environment for adolescent counselling

Ask the participants to discuss what they think a safe environment is and select one participant to record
the responses on a flip chart. Then summarize by telling the participants that in addition to what they have
presented, the following should be considered in creating a safe place during counselling.
· Privacy
· Confidentiality
· No interruptions
· Seating arrangements
· Avoid physical contact
· Empathy
Explain that
Privacy - Find a quiet, private place to talk with the adolescents, but one where they will feel safe and comfortable.
Don‘t go into rooms where adolescents might naturally feel afraid (e.g. head‘s office or staff room, nurses room,
doctors room etc.). The good place would be one where an adolescent knows that there are other people
nearby, but not close enough to hear.
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Confidentiality (Keeping secrets) – Make sure the adolescent understands the issue of confidentiality before
you start. Explain that, no one will know about what will be discussed during the counselling Part, unless in a
situation where we may need to refer you for further support and care (shared confidentiality)
No interruptions - Make sure there will be no interruptions or distractions (e.g. fellow pupils walking in and out).
Switch off your cell phone. Making the adolescent feel comfortable as soon as s/he arrives. Don‘t keep them
waiting, greet them, smile and chat to put them at their ease. Remember to explain your role and what to expect.
Seating arrangements - Do not sit facing the adolescents or behind a desk. This might make the adolescent
feel they are in a classroom situation. Sit at an angle to each other. Where possible make sure you are seated at
the same height; if you are on a chair, the adolescents should also be seated on a chair. Look at the adolescent,
but give them the chance to turn their head away if they are feeling shy – try to avoid taking notes unless
absolutely necessary. Make sure you appear relaxed and friendly.
Avoid physical contact- An adolescent who has a difficult experience might feel worse being touched by
people – even those they know well. There are other ways of expressing your sympathy.
Empathy – You should be able to understand and connect with the adolescents’ feelings and emotions
(empathetic statements may include; I am sorry to hear about that)
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MODULE K: Communication and life skills
Overview
Life skills are abilities for adaptive and positive behaviour that enable individuals to deal effectively with the
demands and challenges of everyday life. Life skills help the individual to translate acquired knowledge,
attitudes and values into positive behaviours. They are important because they give more control to young
people to improve their lives. These include and are not limited to;
· Communication and communication styles

· Assertiveness
· Self-awareness
· Self-esteem
· Critical thinking
· Decision-making
· Negotiating skills
· Goal setting
· Problem-solving
Module Objectives:
At the end of the Module you should be able to;
· Discuss communication skills
· Discuss behavioural Change
· Discuss entrepreneurship skills
Activity 1.1: Open discussion
Be clear to explain what life skills ARE NOT and guide them on examples that are not part of life skills.
Life skills are not:

· Technical skills, e.g., knowing how to fix cars, mix cement, how to repair shoes,
· Health skills, e.g., knowing how to brush one’s teeth or put on a condom
· Livelihood skills, e.g., knowing how to farm or run a business
· Learning skills, e.g., knowing how to read and study
Part 2: Communication Skills

Activity 2.1: Whisper a message among participants
Instruction
1. Make up a message in English or in any local language
2. You pass a message to one participant at one end having participants seated in ‘U’ shaped form.
3. The second participant conveys the same message to the participant until the last person receives the
message.
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4. Ask the last participant to reveal to the bigger group the message she/he received.
5. Ask the first person to reveal the original message. Messages are compared to ensure whether they are
correctly transmitted or not.
6. Ask participants about factors that may lead to receiving different messages, and whether communication
has taken place or not
7. Use the following discussion points:
o Why was the end message different from the original message?
o How could we have kept the message straight?
o Why is being a good listener an important part of communication?
Activity2.2:
Open questions
Instruction:
Get the participants talking and thinking by asking them to:
F l i p a) Define communication
b) Outline the process of communication
c) State the purpose of communication
d) State effective communication skills
e) List types of communication
Explain that
· Communication is the process of enhancing thoughts, ideas and information among people.
· The process of communication is made up of a Sender, Channel (Passage), Receiver and
Feedback
· The purpose of communication is to inform, educate, convince and entertain.
· Effective communication is when you are able to receive the correct feedback
· Types of communication:
o There are two types of communication namely verbal and non-verbal.
o Verbal communication includes use of spoken words; it deals with talking.
Communication is not always what you say (Verbal) but HOW you say it. We also use non-verbal
communication in our interactions with others. Non-verbal communication includes a wide range of
messages people perceive and assign meaning to such as; body movements, facial expressions,
gestures, tone of voices, eye contact and touch posture.
Activity 2.3: Mini lecture

Talk about communication skills using the taking points below;
Communication skills are the skills that you need in order to communicate effectively. They include being able
to express your thoughts, feelings and opinions clearly and appropriately, and being a good listener. Some
of the skills that are very important in interpersonal and group communication are listening skills, questioning
skills and speaking skills.
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Active listening skills
Active listening means more than just listening. It means listening with the eyes as well as the ears. It means
helping people feel that they are being understood, as well as being heard. By helping people feel understood,
active listening encourages more open communication of ideas and feelings and so improves relationships.
Effective questioning skills
Effective questioning skills are the other half of active listening skills. Asking appropriate questions is essential
to; encourage understanding of problems and issues, Increase participation in group discussions and
encourage problem solving.
Speaking skills
Speaking is the productive skill in the oral mode. Speaking skill is the art of communications and one of the four
productive skills. Good speaking skill is the act of generating words that can be understood by listeners. A good
speaker is clear and informative. It involves more than just pronouncing words. Elements of good speaking
include attitude, rehearsal (Practice), verbal expression and nonverbal expression.
Activity 2.3: Group discussion on barriers of communication
Instructions
Split the participants into small groups, each group to list barriers of communication and how to overcome
them, each group to present their discussion in plenary and guide the discussion based on the information
below
Explanations after their presentations
Common barriers of effective communication

There are many types of communication barriers that prevent the message from being conveyed to the
recipient, which diminish effective communication.
1. Personal Barriers: Personal communication barriers are based on the beliefs and outlook of a person.
If a person has a negative worldview, for instance, then all communication that occurs will be filtered
according to that.
2. Physical barriers: Physical barriers include noises that are created beyond the power of the individuals
communicating. Examples of physical barriers to communication include road construction, loud music,
texting while conversing, poorly arranged desks and uncomfortable meeting places. These create
distraction.
3. Physiological barriers: Physiological barriers are caused by bodily dysfunction. This can include
hearing impairment, vision impairment and speech disorders. For a person who is not able to hear, see
or speak well or at all, communication becomes much more difficult.
4. Cultural barriers: Cultural difference have communication barrier. When we join a group and wish
to remain in it, sooner or later we need to adopt the behaviour patterns of the group. These are the
behaviours that the group accepts as signs of belonging.
5. Religious barriers: There are some religious denominations which do not allow females and young
people not to contribute during discussions/meetings
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Activity 2.4: Mini- Lecture 15 Min
Communication styles
Your communication style is a set of various behaviours and methods of relaying information that impact all
facets of life. There are three main communication styles, passive, aggressive and assertive.
What is passive communication style?
Passive communicating style refers to not expressing your own needs and feelings, or expressing them so
weakly that they are not heard and will not be addressed. This style is about pleasing other people and avoiding
conflict. Behavioural examples include being apologetic (feel as if you are imposing when you ask for what you
want), Avoiding any confrontation, Yielding to someone else’s preferences (and discounting own rights and
needs) etc.
Examples of passive communication are:
· “Oh, it’s nothing, really.”
· “Whatever you think.”

What is aggressive communication style?
Aggressive communication style means asking for what you want and saying how you feel in a threatening,
sarcastic, or humiliating way. Behavioural examples include expressing your feelings, opinions, or desires in a
way that threatens or punishes the other person, standing up for your own rights with no thought for the other
person, willing to achieve your goals at expense of others etc.
Examples of aggressive communication are: “It is going to be my way or not at all”, “Do it my way!” and
Sarcasm, name-calling, threatening, blaming, insulting.
What is assertive communication style?

Assertive communication style means asking for what you want or saying how you feel in an honest and respectful
way. It does not threaten a person’s safety or well-being or put the other person down.
What are the benefits of understanding the different styles of communication?
A good understanding of the three basic styles of communication will help you learn how to react most effectively
when confronted with a difficult person. It will also help you recognize when you are not being assertive, or not
behaving in the most effective way.
Which is the best style?
Allow participants to contribute
All styles have their proper place and use. We all have learned different styles of communication as we have
adapted to the various situations of our lives. Though there are times when it is best to be passive and times when
it is best to be aggressive, in most situations it works best to communicate assertively. Assertive communication
is the healthiest.
Ask participants about the meaning of assertiveness and how they understand it in the real life
Explain that
 Assertiveness is the ability to express needs, desire, and belief and be able to achieve them.
 To stand up for your rights without offending other people’s rights. Saying “NO”
 Ability to know what you want
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1. Self-esteem
Activity 2.5: Open Question
Ask each participant to explain what the word self-awareness means to them.
I want to
learn how to
speak in
public
Self-esteem
Explain that self-awareness is;
· The ability of being aware of one’s own feelings, thoughts, attitudes, beliefs, values and reactions.
· The first personal development skill that enables individuals to have a sense of his or her own
identity, where she/he comes from his/her position in life and in society and his/her strengths
and weaknesses.
· A building block to positive change. Without knowing what you can or cannot do; one cannot possibly
begin to make choices consistent with the opportunities available in the environment.
In day-to-day living, self-awareness enables individuals to examine their own assumptions and their ways of
thinking.
Activity 2.6: Discovering Yourself
Give a piece of paper to each participant and ask them to write: Five things they don’t like about themselves,
five things they like about themselves and to share their answers giving reasons.
Explain that
Importance of self-awareness
Our strength lies in our self-awareness; it allows us to accept ourselves for who we are. Our rejection of
various aspects of ourselves weakens our ability to promote what is in our best interest. It also leads us to
putting all blame and responsibility for who we are on others. Our inability to see ourselves as we are leaves
us incomplete and vulnerable to manipulation by others.
Elements of self-awareness
Many elements combine to make us who we are as individuals. These elements include:
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Our physical selves (the aspects of self that are determined biologically. What we look like, our physical
abilities), our emotional selves (how we feel about life and the manner in which we express those feelings),
our spiritual selves (how we define and express our relationship with a higher power), our intellectual selves
(how we think and reason) and our social selves (how we live and interact with others).
2. Self-esteem
Activity 2.7: Open Questions

Time: 10 min
Instruction
Ask participants to explain what the word self-esteem means to them, Ask participants to discuss how our self-
esteem develops.
Explain that
Self-esteem is the;
· Deep seated/down inside skin feeling about yourself.

· Value you place on yourself and deep seated belief of ones worth.
· Way we feel about ourselves and how we handle situations in our life.
It means that you are able to stand up for yourself, know what you want, and believe that you can get it.
Activity 2.7: Mini Lecture - How does our Self-Esteem develop?

From the moment we are able to perceive the world around us we begin to get messages about how the world
feels about us. So, we ask questions such as; am I loved? Was I wanted as a baby or was I a “mistake? How
does God see me? Etc.
Depending on the answers we get or see, we begin to attach meaning/interpret the messages about ourselves.
We also start to develop certain beliefs and values.
Therefore:
· Self-esteem develops out of the socialization process by family members, the media, time and place,
peers, schools, religion and society.
· Self-esteem develops out of the interpretations (perceptions) that we develop out of the messages we
receive from the socializing agents above.
· It also develops out of the beliefs and values that come out of the perceptions/interpretations that we
attach to the messages from the socializing agents.
How we see ourselves and feel about our own abilities and character is a very important factor in determining
the choices and decisions we make, goals we set, the energy we invest in personal development and achieving
a personal goal.
Activity 2.8: Mini Lecture - High and low self-esteem
High self-esteem is a building block for self-fulfilment, freedom, control and achievement. Low self-esteem is
widespread and deadly to people’s dreams and ambitions. Many adolescents never pursue their goals, dreams
and ambitions because they don’t believe in their potential, don’t love themselves, don’t believe that they
are worthy of achieving high levels of success.” (The deep down feeling/belief of their self-worth) determines
whether or not they will develop their abilities/potential, set a goal and take consistent action Say to yourself.” I
like myself. I like myself.
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Activity
Ask participants in two groups and allow them 5-10minutes to discuss and write the factors that contribute to
high or low self-esteem on a flip chart and ask 1 participant to present the discussed points
Summarize the discussion using the points below;
Table 5: Factors that contribute to high and low self esteem
Factors that contribute to high self-es- Factors that contribute to low self-esteem
teem
· Supportive home environment · Lack of positive environment
· Love & warmth from individuals
· Constant negative feedback or criticism
· Constant positive encouragement for
our achievement · Inconsistency in the nature of one’s upbringing
· Positive support/reinforcement · Rejection and attention to failure
3. Critical thinking and decision-making

Activity: Open question
Ask participants to explain what the word critical thinking means to and to define decision-making
Explain that:
Critical thinking: In order to deal with life’s problems effectively without taking a risk, it is important for
adolescents to be able to figure things out themselves and make good decisions. As an adolescent, you need
to analyze the messages when deciding what is best for you. You should have the ability to think the situations
adequately, weighing the advantages and the disadvantages so that you may make informed decisions.
· Emphasise the need to analyze information and experiences objectively in order to make appropriate
decision concerning our environment.
Decision-making
Time: 15 Min
Explain that decision-making is the ability to make an informed and personal choice;
 Decision-making is a day-to-day activity.
 Be aware of the possible consequences of the choices you made.
 You must be skilled at evaluating the future consequences of your present actions and the actions of
others. You need to be able to determine alternative solutions and to analyse the influence of your own
values and the values of those around you.
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Activity: Role play
Instruction
Ask two volunteers to act the following:

The pupil is trying to influence the other to vandalize school property. Both pupils are writing their final grade
seven examination and see that they will have no more use for the school property, as they will be moving on to
secondary school. Ask participants, using critical thinking, how would they advise their colleagues against such
an act?
Open question
What makes you make good decisions?
Explain that the tools of making good decisions are:

a) Self-awareness: Having high self-esteem helps you in making good decision
b) Clarified values: Understanding and being sure of personal and family values is important for good decision
making.
c) Information: Adequate and vital information and facts about all aspects of the issue give one the opportunity
to weigh the options and make an informed decision.
Show the flip chart below and discuss the steps of decision making
Flip Chart Steps for decision-making process

a) Identification of problems: What exactly is the problem for which a decision needs to
be made? What are the challenges? You have to define the problem.
b) Gathering information: Identify alternative solutions. Consider the various solutions or
alternatives that could be adopted.
c) List the advantages and disadvantages of the various alternatives. There are many
alternative solutions for every problem or situation.
d) Choose a solution: Every decision, including not making a decision, has a consequence.
e) Plan and take action:
4. Negotiating skills
Time: 10 Min
Activity 1: Mini lecture
Key points
 Negotiating skills are a combination of several skills such as assertiveness, critical thinking, problem
solving, decision-making, communication skills,
 It is the ability to analyze the situation and solve a problem at hand
 Good negotiation involves putting yourself in place of the other person and understanding their point
of view. This is good for several reasons: It means that you appreciate and respect the other person’s
point of view. This reduces the risk that you will say something that causes conflict and hurt.
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 If you recognize the other person’s point of view, they will become more willing to recognize yours.
 Good negotiation should result in both people gaining something.
Steps in negotiation
1. Say what you feel using the “I” statements.

2. Listen to what the other person has to say to find out what they need or want.
3. Tell the person what you understood, so you are sure you have understood it.
4. Together think about as many ideas as possible that may bring a solution to the problem.
5. Agree on a solution
6. Try it. If it does not work, start again!
Part 3: Behaviour Change

Activity 3.1:
Brainstorm/Discussion on behaviour and behaviour change
Ask participants what they understand by behaviour and behaviour change, give examples of behaviour
change while a volunteer writes their responses on the flip-chart
Explain that:
Behaviour refers to how one conducts oneself in one’s life; our actions and manners towards ourselves and
others. Behaviour change is the positive reversal gradual transition from an unacceptable lifestyle to an
acceptable lifestyle. It is the way a human being behaves in a certain way and the behaviour is routine.
Activity 3.2: Individual testimony of change in behaviour

Ask volunteers to share examples of behaviour change from their own lives and describe the process of
undergoing change to the group.
Stages of behaviour change
Behaviour change is a process. It is composed of stages or steps an individual will go through in order to
change a particular behaviour pattern. As persons attempt to change their behaviour, they move through a
series of six (6) stages. These are outlined below:
1. Pre-contemplative: Persons in this phase have no intention of changing their behaviour. They may be
either unaware of their risky behaviour (uninformed), believe that their behaviours do not expose them
to risk, or be unwilling to change their behaviours. They don’t see a need to change the behaviour.
2. Contemplative: Persons recognize that their behaviours place them at risk and may be thinking about
changing but have not made a commitment at this time. They see the need to change the behaviours,
but have barriers to doing so.
3. Preparation: Persons see the need for change and are ready to try to make the change. They may be
making plans and gathering support to make a change in the next 30 days.
4. Action: Persons in this stage have just recently changed a particular behaviour, such as using condoms
consistently for a few months. People in this stage have usually changed behaviour within the past 6
months.
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5. Maintenance: People in this stage have consistently performed behaviour for more than 6 months and
are relatively comfortable with the change; it has become a routine part of their lives.
6. Relapse: Behaviour change is seen as a spiral because relapse often will occur and is seen as a normal
part of the process of change. If relapse occurs, it doesn’t mean one has failed and should therefore
give up. Relapse indicates that one may need to continue developing skills, support, self-efficacy, or
other factors that positively affect behaviour to build a solid enough base so that behavioural goals can
be reached and maintained.
Activity 3.2: Mini Lecture - Factors that influence behaviour

There are many things that get in the way of people changing their behaviour. These include:
Environment / life circumstances, Peer groups, Culture, Knowledge and experience etc.
Factors that can hinder behaviour change:
Lack of control over one’s life or destiny, Inability to express or act on what one wants, Lack of information,
Peer pressure, Poor decision making skills etc.
Part 4: Entrepreneurship Skills

Activity 4.1: Open question
Instruction:
Ask participants to define entrepreneurship and entrepreneur and write down responses in the working
definition for the plenary.
What is entrepreneurship?
· Entrepreneurship is an act of going into a business venture aimed at achieving profit. The profit may
be in the form of money, resources, accreditation, recognition and satisfaction, which will ultimately be
beneficial to the entrepreneur. For example: a farmer who wants to sell his maize will investigate the
market instead of relying on somebody (trader or marketer) telling him at what price he is supposed to
sell. Entrepreneurship means that for every action, s/he expects something in return as a reward, which
is PROFIT.
Who is an entrepreneur?
· An entrepreneur is someone who starts or operates a business venture and assumes the responsibility
for it. S/he provides goods or services to individuals or businesses for payment. One who perceives the
profitability of the production of good or service and organizes the production. The entrepreneur directs
the operation of the business or firm and is usually, but not always, considered to be the owner. The
reward of an entrepreneur is profit.
Ask participants which business (es) one can do.

Activity 4.2: Discuss the qualities of an entrepreneur and entrepreneurship skills
Explain that some personal qualities entrepreneurs have include:
· Determination: Entrepreneurs are people who are very determined. They do not give up a struggle
no matter how hard the task becomes. Example: A farmer produced paprika, but the company who
guaranteed to buy his produce have closed. As an entrepreneur, he must ensure that he looks for an
alternative buyer even before he starts to grow the crop.
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· Autonomy: Successful entrepreneurs are also people who value independence. They do not like
authority or being told how they should run their businesses. Example: Some university graduate may
not find formal employment suitable for them because they do not want to be told what to do. They want
to be their own boss.
· Creativity: Successful entrepreneurs are creative. They have good ideas for the business and a strong
sense of marketing. They strive to be different. They can identify a sound unique selling point (USP) for
their business.
· Calculated Risk Taking: Entrepreneurs are not gamblers, nor are they averse like bankers are
sometime said to be. They are calculated risk takers. This means that they will take risks if the odds are
not too great. They will also work hard to try to swing the odds more firmly in their own favour.
· Intuition: Intuition describes making a decision from insights based on research evidence to support a
careful analysis.
· Innovative: Entrepreneurs should do something that nobody has done before and lead. Entrepreneurs
achieve success by creating value in the market place when they combine resources in new and
different ways to gain a competitive edge over rivals.
· Determination to overcome obstacles: Entrepreneurs ‘never take no for an answer!’
· Ability to learn from mistakes: Entrepreneurs should have ability to learn from mistakes that made by
oneself and others.
· Motivation and self-confidence: An entrepreneur that has confidence knows that they are
capable of achieving their goals and they will pursue them with strong desire
· Eagerness to learn: Entrepreneurs must have so much interest in learning new ways of conducting
business resulting growth of their business
· Ability to co-operate: Being able to work as a team and cope with available supervision where
necessary.
These qualities help the entrepreneur to think, analyze, solve problems and take action. Not every
entrepreneur will have all of the above qualities. Many of these qualities are hidden within us and we
may not even be aware that we possess them. They can also be acquired through the learning process.
Activity 4.3: Brainstorming

Ask participants to list down the entrepreneurial skills.
Entrepreneur Skills
Explain that in developing your entrepreneurial skills, you have to understand your environment and understand
how your skills will be relevant to the needs of your community.
There are different types of entrepreneurship skills among others:
· Negotiation skills: As an entrepreneur, you are bound to negotiate deals. You negotiate with customers
and suppliers over goods and services offered.
· Communication skills: Communication is important to success in businesses of all sizes. The ability
to share information with clients, employees and business partners cannot be stressed enough.
· Decision making skills: The ability to make decisions is a core skill that every entrepreneur must
possess if he or she wants to be successful. From the very beginning of your entrepreneurial journey,
you must make sound decisions which business to run. You have to be decisive and learn from mistakes,
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rather than fearing mistakes to the point that you avoid decisions. You have to be creative to solving
problems, making decisions, observing you surroundings, basing actions on needs and opportunities
of the immediate context.
· Human relations skills: Interacting with people (working with others, accepting others irrespective of
their cast, gender, social status, whether they have a disability or not, etc.) is very important in business.
· Leadership skills: Business needs uniting and directing people with different backgrounds, beliefs
and skills to a common cause. You should play a leading role for building people with different skills and
ideologies into a business team.
Summary
Clarify the qualities of entrepreneurship and entrepreneurship skills and summarize
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Module L: Concluding Module
Module overview
This is a concluding module in the adolescent health Training Programme. It asks the participants to reflect on
how they have been working with adolescents and on the ways, they aim to improve (i.e. by consolidating areas
of strength and addressing areas of weakness and opportunities) in providing friendly, responsive and quality
adolescent health services.
Part 1: Provision of Comprehensive Adolescent Health Services using The HEADSS
Approach
Time: 1 hour
Objective: To orientate participants on the screening tool or identifying risk factors that
may require referral among AYP
Materials: Copies of the HEADSS approach tool
Part 1.1: HEADSS Approach Introduction (1 hr.)

In providing adolescent health, Peer Educators (PEs) need to master the act of effective communication in order
to understand adolescents and for the adolescents to develop health literacy and knowledge to manage the
pressures they come across in life as they transition into adulthood.
The HEADSS is a rapid risk mental health assessment and screening tool that can be used by PEs to identify
high-risk Adolescents and Young People (AYP) on a one-to-one encounter with a young person and provide
immediate counselling or link them to support systems when a risk factor is identified. The tool should be used on
all adolescents and young people (AYP) for whatever services they have come to access or utilise at the health
facility or adolescent friendly space.
When implementing this tool, use simple language, preferably in a local language. Do not use technical terms
as this might be threatening or confusing to the adolescent.
NOTE: HEADSS assessment may not be suitable for use with all AYP especially those with an intellectual
disability.
The acronym HEADSS represents the following areas:
H= Home and Environment
E= Education/Employment/Eating/Exercises
A= Activities and peer relationships, social media
D= Drugs (including prescribed medications, cigarettes, Shisha, alcohol and other drugs)
S=Sexuality
S= Suicide, Self-image and Safety
Part 1.2: Detailed HEADSS assessment tool.
Ask participants to read through alternating to make the session participatory as you clarify any questions that
may arise or unclear phrases
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HEADSSS Adolescent Assessment Tool
H=HOME & ENVIRONMENT
You want to know how AYP feel about where they live and who they live with. If the AYP is not living at home,
you want to explore whether they are able to meet their basic life needs.
Suggested Questions:
• Tell me about where you live. Who lives at home with you?
• Are you happy with your living situation? Do you feel safe?
• Are your parents together? If not, where are they?
• Who provides for the home? What is the source of income? Are you on any cash transfer scheme?
Protective Indicators • Has positive relationships with adults

• Identifies people who care for her/his safety
Risk Indicators • No adolescent-adult connections
• The AYP is the Head of household
• Cares for younger siblings
• Reports physical/sexual abuse
• Feels unsafe
Possible Actions:
• Refer to ADH FPP or any health care worker for any risk indicators
E=EDUCATION & EMPLOYMENT

Questions about education and employment are asked in order to discover whether or not the young person
is in school or not and/or working.
• Are you in school? What grade are you in? How are your grades?
• How do you get money for things that you need at school?
• What do you like best and least about school? What is your favourite subject?
• What do you want to do when you finish school?
• Do you work? Have you worked in the past?
• Do you feel comfortable with your eating habits? Do you think of ways to lose or gain weight?
Note that “E” can also stand for Eating and Exercise; questions about these topics should be asked
if you suspect eating disorders.
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Protective Indicators • In school
• Obtaining new skills
• Fills free time productively
• Has hope for the future
Risk Indicators • No time for leisure activities

•No time for school or vocational opportunities
• No vision or negative vision of the future
•Too much free time and reports being bored
• Engages in sex work
•Engages in potentially exploitative labour, such being hired as a bar worker
• Reports fear of exploitation
Possible Actions:
• Refer to ADH FPP or any health care worker for further action
A=ACTIVITIES
The goal of asking about activities is to understand the day to day life of the AYP. Mostly, AYP who are de-
pressed for various reasons do not engage in any physical activities, they are passive.
• What activities, groups, clubs or sports do you participate in e.g. at church, school or community?
• What do you do when you are not at school or working? What time do you spend on phone, TV, Social, media
or radio?
• Do you have one best friend or a few friends? Whom do you trust?
• What are your hobbies? What is your favourite music?
• Have you been charged by the police before?
Protective Indicators • Involved in supervised activities

• Involved in school, church or community activities
• Eats within the household together with family
Risk Indicators • Spends free time in risky ways

• Not involved in any activities and feels isolated
• Not eating enough
Possible Actions:
• refer to the ADH FPP or any health care worker for linkages.
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D=DRUGS AND SUBSTANCE USE
Questions about drugs and other substances may be difficult to ask about and it is often useful to start the
discussion for example, “Many young people have experimented with drugs and alcohol at some point.
You want to find out how substance use has impacted AYP’s relationships at home, school, church and in the
community
It is also useful to ask the young person if they believe they have a problem with substance use and if so, if
they would like help.
• How do you feel about smoking? About drinking? About using drugs? (ask about illegal drugs as well
as those that might be socially acceptable)
• Do you know people who use these substances? Does anyone in your family use them?
• Have you ever used these substances? What types (pills, smoked, inhaled, injected, etc.)? When?
With whom?
Protective Indicators
• Does not know adolescents who have tried smoking, drinking or drugs
• Has not tried smoking, drinking or drugs
• Has a negative attitude towards these substances
• Stopped using drugs/substances and stopped hanging out with friends who abuse drugs/substances
Risk Indicators
• Uses alcohol or drugs
• Reports substances being used in the home
• Substances available in the community
• Absenteeism in class
• Cuts/bruises and swellings etc.
Possible Actions:
• Do not be judgmental! Ask about the reasons that s/he uses the substances and how s/he feels about it.
Explore whether s/he would be willing to give up the behaviour. Link with a mentor or friend who can support
the adolescent.
• Refer to the ADH FPP or any health care worker for further management
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S=SEXUALITY
Sexuality is the most difficult portion of the HEADSSS interview. This may be the first time an adolescent has
ever openly disclosed their sexual feelings to anyone. The goal is to determine whether the AYP is sexually
active or not.
For very young adolescents — 10 to 14 years:
• Have you noticed any changes in your body recently? How do you feel about those changes?
• Are you attracted to boys? To girls?
• Do you have a boyfriend or girlfriend?
• Have you ever had sexual intercourse? If yes, how old were you the first time you had sex? If no, how old
would you like to be when you have sex for the first time?
• Have you ever had sex without using a condom?
• Refer to the ADH Focal Point person or any health care worker for further management
For all adolescent girls (10-19 years old): In addition to those questions asked for the 10 to 14-year-old
adolescents.…. add the following;
• Have you begun to have your menstrual periods yet? If yes, how has that changed your life? Are you still
able to go to school every day? What do you use to keep yourself clean during your menstrual period? If you
use something, how do you clean it?
• Have you ever had sex with someone in exchange for money, food, clothing or a place to stay?
• Have you ever been forced to have sex with anyone against your will? (ask boys as well as girls)
• Have you ever been pregnant?
• Have you ever gotten an infection as a result of having sex? (ask boys as well as girls)
• Refer to the ADH FPP or any other health worker for further help
• Virgin
• Is not currently sexually active. Indicates intentions to abstain from sex.
• Is not currently interested in having a girlfriend or boyfriend
Risk Indicators
• Reports having a girlfriend or boyfriend
• Reports unprotected sex
• Reports selling sex or exchanging sex for money, food, etc.
• Reports history of sexual violence
• Has had a pregnancy or STI in the past
Possible Actions:
• Discuss menstrual hygiene. Ask menstruating adolescents what they use during their menstrual periods
to keep themselves clean. If they use menstrual hygiene supplies, how do they access them? Do they have
difficulty accessing them? If applicable, how do they clean these supplies?
• For those who are already sexually active, do not be judgmental but counsel on safer sex!
• Refer to the ADH FPP or any health care worker for further help
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S=SELF IMAGE
It is important to ask questions regarding self-esteem to determine if an adolescent is assertive and not pas-
sive.
• How do you feel about yourself?
• What do you do when you feel sad or upset?
• Feels valued and important
• Has a caring adult who can help her/him
Risk Indicators
• Reports a consistent feeling of depression and sadness
Possible Actions:
• Explore feelings of sadness, anxiety or depression. Are there any things in particular that make him/her feel
that way?
• Refer to ADH FPP or any health care worker for further management for any risk
S=SAFETY
• Do you feel safe at home or your community (school, church and clinic)?
• If you feel you are in danger, how do you protect yourself?
• Are there places in the community where you can go to be safe?
• safe at home and community (school, church and clinic)
• Is aware of safe spaces available in the community
Risk Indicators
• Worries about sexual abuse at home, school, church or in the community
Possible Actions:
• Explore feelings of danger.
• Refer to ADH FPP or any health care worker for community structures that are available as safe places if
indicated.
S=SUICIDE
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Suggested Questions
• Have you been depressed lately? On most days, do you feel generally happy or generally sad?
• What do you do when you get depressed? Have you been hospitalized?
• Has anyone in your family ever been depressed? Committed suicide?
• Have you ever tried to hurt yourself? How?
• Have you ever felt like killing yourself? What happened?
• Is there any violence in your home, school or community?
• Have you ever been fought on or bullied?
• Refer to ADH FPP or any health care worker for any risks
A protective factor is a characteristic that reduces the likelihood of attempting suicide. Sense of personal con-
trol or determination
· Reasons for living

· Cultural, religious or spiritual beliefs that discourage suicide
· Indicates positive outlook
· Has a caring adult who can help her/him
Risk Indicators
A risk factor is a part of personal lifestyle with an increased incidence of death by suicide.
· Access to harmful means, such as medication or weapons
· Anger, rage, seeking revenge

· Depression
· Divorce trauma or abuse (physical or sexual)
· Excessive or increased use of substances (alcohol or drugs)
· Grief and loss
· Isolation (e.g. lives alone)
· Loss of interest, withdrawal from usual activities, supports, interests, school or work
· On-going exposure to bullying behaviour
· Previous suicide attempts
· Recent death or suicide of a family member or a close friend
· Relationship problems – conflict with parents and / or romantic partners

· Self-harm behaviour
Possible Actions:
· Refer to ADH FPP or any health care worker for any risk indicator for counselling and to be connected to
toll free lines to openly talk about suicide
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Part 2: Peer Educators TOR and Reporting
Time: 3 hours
Objective: To orientate participants on their responsibilities as a volunteer peer educator
Materials: Two copies of the Voluntary Peer Educator’s Agreement TOR for each
participant at the training form and two copies
Part 2.1: Peer Educators Service Agreement and Terms of Reference (1 hr.)
Format: Review of text, information and clarity discussion:
Refer to annex for a copy of the Volunteer Peer Educator Service (VEPS) Agreement. (Sample below).
•
Explain that they will need to sign two copies of the VEPS Agreement. One copy will be kept on file at
•
the Facility In-charge’s office and the other will be kept by the volunteer.
• Ask one participant to read out the 1st paragraph.
• Ask if the information is clear – and clarify any issues.
• Repeat the processes for the next 2 paragraphs (read and clarify).
• Explain that each participant will need to read paragraph 4. Give them 5 minutes to do this.
• Ask for any clarifications – while pointing out that the next step is to review the TOR – and this will clarify
many issues.
• Explain that once they have reviewed the TOR below, they will come back to this section of the Volunteer
Peer Education Service Agreement.
• Clarify that this ‘service standards’ is designed to protect the volunteer status of Peer Educators – who
are supporting the Ministry of Health and that the VPESS is one of a number of tools - like the TOR –
which the Ministry of Health is developing to help formalizing the peer education components of the
National Adolescent Health strategy.
83
National Adolescent Health Programme
Volunteer Peer Educators Service Standard (VPESS)
The District Health Office (DHO) and/or the District Adolescent Health Technical Working Group (DAHTWG)
acknowledge the young person (named below) has agreed to serve as a Volunteer Peer Educator in our
District. He/she will serve as a volunteer, not as an employee and MAY, depending on his or her dedication,
level of activity, and hard work, be entitled to receive some allowances for transport, meals, training and
accommodation (Note: Access to any allowance depends on the availability financial and material resources
to support peer educators with transport, meals, training and accommodation, etc.). The Peer Educator, as
a volunteer, is expected to undertake activities in support of the National Adolescent Health Strategy, of the
Ministry of Health, as described in the attached Terms of Reference (TOR). The DHO or the DAHTWG may
de-select the volunteer Peer
Educator from the National Adolescent Health Programme if he/she does not fulfil his/her Terms of Reference.
I (signature) fully understand that I undertake to serve as a Peer Educator- as a volunteer and not
as an employee. I agree to follow my Terms of Reference, attached, which I have signed. I acknowledge that
as a volunteer the receipt of any allowances for my volunteer activities will be determined by the DHO and/or
the DAHDTWG, based on availability of resources, and in accordance with the programme guidelines. I also
agree that if my performance in implementing my TOR is not satisfactory, I can and will be de-selected as
a Volunteer Peer Educator in the GRZ’s
Adolescent Health Programme by the DHO ADH Focal Point and/or the Chairperson of the DADHTWG.
Peer Educator Information Verification of
VPESS Form
Name: Name:
Date of Birth: Title:
Sex: Office:
District: District:
Signature: Signature:
Date: Date:
Witness
Title: Name:
Date:
Note: This form needs to be competed at the end of the Peer Educators Training5. There should be three
copies (3) of this document. [Please use Carbon Paper or Photocopy) The original should be placed in a
“Peer Educators” file with the DHO ADH Focal Point. The second Copy should be provided to the OIC of the
Health Facility where the Peer Educator is deployed for placement in an individual file for the Peer Educator.
This individual file will provide the information on the Peer Educators performance as per the TOR (reporting,
training, etc.). The content of this file will be used as an objective measure for supervision purposes. 1. Note
– Volunteer Peer Educators already trained and deployed by the DHOs – will still need to sign this agreement
and it needs to be on file at the DHO and Health Facility.
84
Then ask participants to look at the Volunteer Peer Educator – Terms of Reference (TOR) (sample
below) – This needs to be FULLY REVIEWED – as the VPESS above refers to the Key responsibilities
under the ADH Peer Educator TOR below.
85
Format: To ensure that none of the participants will be unfamiliar with their TORs the facilitator will need to
have participants take turns to read out the text in the TOR.
Some Key Points to highlight:
1) There are a 12 key responsibilities listed in the TOR
.
2) These activities can be categorized as:
 Promotional & informational activities - promoting delayed sexual debut, risk reduction behaviours; safer
sex, and use of HIV and SRH services (HTC, SP, STI, ART, etc.)
 Distribution activities - information materials and condoms, etc.
 Organizing activities - game, discussions, talks, dramas, etc. around the health facility, at the local school
and within the community.
 Assistance Activities – e.g. helping Health Facility Staff with the operations of Adolescent Friendly Space
(AFS) [see Annex 3 below], supporting the operation of select services (HTC, condom distribution, etc.)
and helping with reporting activities – peer education activities and service utilization data.
3) Peer Educators are expected to be Role Models - as per the ‘Behaviour with Peers and in the Community’
section of their TOR – and to act as honest , trusted, respectful, reliable, punctual and well organized
volunteers who are committed to helping their peers and their community.
4) Locations – Peer Educators will be assigned to a specific MOH Health Facility – the number of peer
educators per facility will depend on whether the facility has a AFS
- combined with the estimated facility catchment area adolescent population (one in four of the total
population). In large catchment areas – by geography and/or population – Peer Educators may be
deployed to specific zones in the catchment area – to ensure that areas with lots of adolescents are
sufficiently covered. Deployed Peer Educators may be assigned to specific health post or other GRZ
facilities (e.g. Local Government Office, Youth Office, Community Development Hall, etc.).
5) Commitment –Peer Educators, as volunteers, should be willing to commit a minimum of 3 to 4 half days
of peer education activities, per week, in their assigned catchment areas. This is in line with the AFS
model – which requires 8 peer educators (ideally 4 female and 4 males) who would allocate their time to
a weekly schedule. To ensure that there was at least 2 Peer Educators per day for six days a week at an
AFS and at least 2 Peer Educators undertaking community based peer education activities – distributing
IEC materials, condoms, doing health talks and games. Peer Educator also need to be committed to doing
their daily logs and their consolidated monthly reports, as these the monthly report will be the basis of any
consideration for outreach lunch allowances, if funds are available.
6) Among the Peer Educators – two Lead Peer Educators need to be selected. They will be responsible
for ensuring their fellow Peer Educators complete their daily logs and monthly reports and they will
assist the Health Centre Adolescent Health Focal Points with the supervision of the ASF, including the
management of the bicycles and materials. They will also help ensure that the Peer Educators monthly
report on activities is consolidated into one monthly report. They will help the H/C ADH Focal Points extract
the disaggregated adolescent health data from the Family Planning, HTC and ANC ledgers. They will also
be responsible to ensure that condoms and IEC materials are available in the AFS and that the Peer
Educators are doing IEC distribution and condom promotion peer education activities in the community.
They will also represent the Peer Educators in the Health Centre monthly management meetings with
facility providers to review the monthly report and other issues related to the operations of the AFS (like
condom supply and distribution, etc.). (See Annex 13 – which contains the Peer Educator TOR and the
extra TOR activities of the lead Peer Educator).
86
NOTE: the VPESS Form will be signed by the participant, the MOH Peer Education Trainer and/or the
DHO Adolescent Health Focal Point and a ‘Trainer’ as witness, in duplicate. The TOR should also be
signed as well but by the participant only and also in duplicate. This should be done during graduation,
once they have received their certificate. The duplicate needs to be collected, as one version needs to
go on file at the District Health Office (DHO) with the District Adolescent Health Focal Point.
Please remind participants, that once they have graduated and signed the VPES Agreement and TOR
– the DHO can ‘deselect’ them from being ‘peer educators’ allocated to GRZ Health Facility - if they do
not efficiently follow their Terms of Reference.
Part 3: Review of Peer Educators Tools (1 hr)
Format: information sharing and discussion
Explain: that each Peer Educator will keep their Peer Educators Manual – which has been part of the training.
The manual contains key information and activities from all Modules. It also contains the Annexes that cover
the following:
Annex 1. Pre-Post Test

Annex 2. Reproductive organs – Female & Male
Annex 3. Adolescent Friendly Space Guide*
Annex 4. Strategies to Delaying Sexual Debut*
Annex 5. MCP Chart Drawing
Annex 6. How to use a Male Condom
Annex 7. How to use a Female Condom
Annex 8. The Test for the Test*
Annex 9. Some Key Points for Positive Living*

Annex 10. Some Tools for Disclosing your Status*
Annex 11. Information for Preventing Pregnancy - Fertility Cycles*
Annex 12. Additional HIV Information and Peer Education Definitions*
Annex 13. Volunteer Peer Educator Service Standards & Peer Educators and Lead Peer Educators TORs
Annex 14. Peer Educators Reporting Tools including U-report Reporting Information.
Annex 15. Peer Educators Certificate – model (Trainers manual only)
Note: There are a number of Annexes marked with an * (asterisk) that contain information that has
not been covered in depth or gone over during the training. Please note the following:
Adolescent Friendly Space (AFS): Annex 3 contains information on the revised low-cost Adolescent Friendly Space
(AFS) model. This new design is a Peer Educator run model. As a minimum model, it is built on the design of:
• a simple desk/table;
• four chairs for the Peer Educator and Peer client;
• two benches – one for a waiting area for peer clients, the other for group meeting;
• A wooden cupboard or dresser for storing stationary, reports, reporting forms, condoms, wooden penis
display models, and information, education and communication materials (IEC), games, sports equipment
(1-2 footballs, etc.) etc.
Explain: that the AFS can be located in a fixed space – e.g. where a facility has a separate room that can dedicate
as the AFS. It can also be a movable space – where the table, chairs and bench can be moved around to different
locations at the facility – by the entrance gate, under a tree, attached to a specific service, etc.
87
Clarify: that an AFS should be operating all or most of the days of the week. It needs to have a sign on the door or
close to the door – which identifies it as an ASF and provides information on services and operating hours. It also
needs to have a sign at the entrance to the Health Centre to advertise the availability of the AFS. The ‘availability’
of the space and the ‘operating hours’ can also be written up on a number of a A4 ‘notices’ and ‘posted/advertised’
at all of the health facility services and at locations in the community.
Operating hours could be flexible – depending on the number of active Peer Educators and times that are most
convenient for adolescents to access the service (e.g. could be afternoons) – but condoms should always be easily
available at one or two central locations at the Health Centre. As per the Annex 3 guidance, there needs to be a schedule
drawn up to ensure that there are one or two peer educators manning the space during operating days/hours.
The Peer Educators will need to be familiar with all of the HIV and SRH services at the facility. The AFS operates
at the ‘first stop’ for adolescent clients – and a major part of the work of the Peer Educators will be to explain the
available services and to provide guided referral (accompany the client) to the right provider of the right service.
The specific providers will also refer clients to the AFS as well. For example, adolescents who go to HTC,
should be referred to the AFS for ‘post-test support services’ – where they can get additional peer counselling,
access more condoms and be linked up with youth organizations and activities in their own community – for risk avoidance
or risk reduction assistance or access to care and support.
Note: In a facility which does not have a dedicated AFS, the Peer Educators assigned to this type
of facility will need to negotiate with the Officer-in-Charge around how best they can be utilized
by the facility (and in the community) to provide on-going peer education support to adolescent
clients when the visit the facility. A common approach is to assign a Peer Educator to a specific
service – for example – under the HTC service - to do the intake of adolescent clients and the
post-test support services (PTSS – these are for both negative and positive adolescents. It means
providing them with information and linkages to community youth clubs or groups – for positive
and negative adolescents – to help them practice risk reduction behaviours).
Annex 4. Strategies to Delaying Sexual Debut – provides some information on what adolescents should
consider to reduce their risks of being in situations and with people –who might get them involved in sexual
behaviours. A number of these points were covered in the Part – Peer Educators can use this annex as a short
review for discussing the options with adolescents.
Annex 8. The Test for the Test: This is only referred to in the HTC Part – this annex should be used during the
HTC activity Part – it is a set of 6 questions around HIV risk behaviours.
The Peer Educator asks his or her peers the 6 questions (and the 4 supplemental if required). If the response is
‘yes’ to any of the 6 questions (or additional 4) then ‘the test’ is strongly recommending that the person who
did the test - ‘goes for an HIV test’!
Annex 9. Some Key Points for Positive Living – this puts together some key information – on health,
nutrition, etc. - for advising a young person living with HIV – to help them live positively with HIV.
Annex 10. Some Tools for Disclosing your Status – provides the peer educator with some additional
information to help a peer to disclose their HIV status. This annex can be used, if a Peer Educator is approached
for assistance on disclosure.
Annex 11. Information for Preventing Pregnancy - Fertility Cycles– this provides some detailed and
technical information – around the rhythm methods for determining fertility cycles. The Annex also
promotes modern methods and dual protection (condoms) – and does not recommend the cycle
methods.
88
Annex 12. Additional HIV Information and Peer Education Definitions – this contains 3 pages of definitions
and information. Some of the information has been covered in the manual and some is additional information
– e.g. ‘what is a peer educator’ or ‘what age is an adolescent’. The Peer Educators should be shown this annex
LE. – the facilitator does not have to go over each definition - but should encourage the participants to review
them in their own time.
VE
U-report – 878 and Voice counselling - 990 – both these services have been mentioned.
Remind the participants that once they are active Peer Educators that they need to promote these services in
the community.
The 878 is a SMS based service, where once a person subscribed, they can ask, via SMS, any question about
HIV or sexual health and a counsellors will SMS back an answer. In addition, the service will periodically send
HIV and SRH Campaign messages on a number of HIV and health issues, like VMMC or HTC. There is also a
Polling component, where young people will be asked their opinions about different HIV and SRH issues.
TOLL FREE numbers
Ask – how many of the peer educators have signed up to the service. Encourage them all to
do this before the training is over and ask them to promote the service in their communities.
NOTE: U-report can also be used to report on issue at the Health Centre. The SMS message with go to the
933 National AIDS Council in Lusaka. A ‘U-Report – Report SMS’ needs to start with ‘AFS’ and then the ‘name of
the Health Centre’ at the start of the text (sms) message
990
– and then the issues. (Please have participants look at the information in Annex 14). For example, if the peer
educators at the AFS are not able to access condoms for distribution or if there is a shortage of IEC Material,
etc. This can be reported. Ideally, the information from the Monthly Consolidated Report could be sent by SMS
as well. This would be an SMS with the Health Centre Name – number of active Peer Educators, issues with the
operation of the AFS and Outreach – e.g. à the number of adolescents seen (at AFS and at outreach), number
of condoms distributed (at AFS and Outreach); number of IEC materials distributed (at AFS and Outreach), etc.
Once the Lead Peer Educators starts to Report – U-report will start to send messages directly to this user –
asking for information – and will help guide the Lead Peer Educators through the monthly reporting process.

U-REPORT IS A FREE
PROGRAMME FOR YOUNG PEOPLE. Zambia U-Report
SMS “JOIN” TO 878 TO RECEIVE SMS JOIN to
INFORMATION AND SHARE YOU’RE VIEWS
878
ON HIV & AIDS STIs USING SMS
Remind them of the 990 services. This is a voice counselling service. They do not need to sign up. This is also a
useful service for support on a number of health issues; including gender based violence and substance abuse,
as well as HIV and SRH information.
You can also call TOLL FREE numbers
116
933
990
89
Review– Check if there are any other annexes they would like to review or any additional information. Remind
them that they need to read all the Annexes, as they will need to use them on a daily basis and use their manuals
to undertake their peer education activities.
My Safe Space App – Application found on app store, accessible to all android phone users. The app is all
inclusive and provides refer to specialised health services including mental health. This app also opens a window
for peer educators to access certified free online courses. The app further provides job advertisements
GBV toll free line - 933
Child help line - 116
Part 4: Peer Educators Reporting Tools (1hr)

Part 4.1: Peer Educator Monthly Activity Log Book
Explain that as a volunteer Peer Educator, they will have to keep a Log Book of their monthly peer education
activities. A full sample of the design – with the example text can be found in Annex 4 (a). They will be given an
A5 Notebook and this will be their “VPE Monthly Log Book”. They will need copy the first TWO lines (Rows – title
of book, name, facility, etc.) of information on the outside and inside covers
rd
of the note book and on the top of
the page whenever they start a new month. They then need to copy the 3 row/line and the 8 columns in their
notebook. This same 3rd row and 8 column format will need to go on each and every subsequent page. They
then use these columns for their activity reporting.
Explain each of the columns and how to do the reporting – and answer any questions or issues. This can be
done using a flip chart.
90
Peer Educators – deployed to an Adolescent Friendly Space – would use the same format – but indicate that
their location as the AFS – where they write in clinic – ‘AFS Chipata Clinic’.
Clarify: That by using a notebook that this ensures that there will be sustained reporting – as there will be no
issue of not reporting due to lack of reporting forms.
Ask the participants to draw a rough version of the reporting form – when you are explaining the different
columns.
Part 4.2- Consolidated Peer Education Activity Log
Explain that under Annex 4 (b) – there is the ‘Consolidated Peer Education Activity Log’. Explain all the
information that will be collected in the columns.
There is a filled version below for demonstration. Each health facility with peer educators will need to have a hard
covered ledger note book. The reporting format design below will need to be replicate, by hand, in this notebook.
The ‘Lead’ Peer Educators should be assigned
The responsibility of consolidating the information from each individual peer educator’s monthly log – following
the design below.
Once all the data is entered into the table - they would also need to do a consolidation of the data – on the last row
(see example). This would be the total number of active peer educators, number of activities, numbers reached,
numbers of referrals, main referral issues, and condom distributed. This consolidated monthly data – done on the
final row – is the information that Health Facilities will need to report to the District Health Offices when the Health
Facility does their monthly returns reporting to the DHO. The consolidated data could be added as two rows of
information at the bottom of the Monthly Returns form or as part of the monthly disaggregated adolescent HIV
and SRH data reporting form (FLEA forms).
91
Explain that the Lead Peer Educator(s) – will be responsible on a day-by-day basis to ensure that the Peer
Educators are doing their reporting – and will do the consolidation of the daily log information. They will be
responsible for sending the information via U-report – as per the SMS text short form codes in Annex 3 (a).
Explain – Health Facility Focal Point: Each Health Facility will have an Adolescent Health Focal Point (ADHFP),
who collects the monthly data on the utilization of HIV services by adolescents and young people. (See the
FLEA Form in Annex xxx)
This person will also be the focal point for the Peer Educators and the management of the AFS – and will be
responsible for monitoring their activities at the facility and in the community.
The ADHFP will also be able to assign one or two Peer Educators as the Lead Peer Educator(s)
– and supervise the consolidation of the peer education data and be the focal point to ensure that it is sent to
the DHO.
Explain that the ADHFP can assist with the management of the AYFC. They will also be the focal point for helping
the Peer Educators deal with issues at the health facility and in the community.
Note on Disaggregated Data Collection

Explain that under the National Adolescent Health Strategy, in addition to their peer education activity data
collection the health centers/ facilities should also be collecting age and sex data on the use of HIV and SRH
services by young people. One or more health provider at the facility has been trained to do as part of the
Monthly Returns.
The data is supposed to be collected on the number of, for example HTC clients who are female and male – aged
10-14, 15-19 and 20-24. The data is extract from the specific services ledgers and consolidated in a special form
that is sent to the District Health Office on a monthly basis. As part of the Health Facility visit, the participants were
supposed to be shown the different ledgers for the different services – HTC, FP, etc.
Suggest - one role for the Lead Peer Educator(s) could be to assist the health providers to organize and
consolidate this data from each service. It has been suggested that this could be done at the end of each day – on
the bottom of the ledger page – in the margins – where the tally can be recorded – for example - 3 females 10-14;
3 females 15-19, etc. none tested positive.
This would then make the monthly consolidation of this data much easier, as the monthly consolidation would
just have to take the data of the bottom of each page – and would not have to go through, line by line, to try and
collect this information.
Peer Educators, once deployed to a facility, will need to explore their roles in data collection with the facility
OIC. The major concern is ‘confidentiality’- as many ledgers also have client’s names. Seeing the names when
consolidating the data can be a violation of the confidentiality rule between a professional health worker and their
clients. One option is for the provider to cover the names while the peer educator extracts the age and sex data
from the other columns in the ledger. The issue of ‘confidentially’ is also covered in the VPESS – and any peer
educator who violates this ‘confidentially rule’ would automatically be deselected from the programme.
One additional role, once the data is consolidated, should be to have the peer educators to produce some
basic charts and graphs using pen, paper and rulers – to demonstrate the utilization of services at the facility –
including the AYFC.
92
Signing of the Volunteer Peer Educator Service Standards (VPESS) & TOR:
NOTE:
1) The Facilitator should issue each participant with 2 copies of their VPES Standards form and
the Volunteer Peer Educator TOR.
2) They should put up the information for the ‘Verification and Witness’ sections of the VPESS
form on a Flip Chart:
3) Names, Titles, District, etc. of the Verification officer and the Witness.
4) Ask each participant to fill it in neatly.
5) Ask each participant to fill in his or her details.
6) Explain that all 4 copies will be signed – by themselves and the Verification officer and witness
– after they receive their Certificates.
93
Part 5: Graduation & Closing
Part 5.1 Graduation
Note: Each Facilitator and the DHO team have the flexibility around the schedule for this event. They can
make it a very formal or informal activity.
They can have a VIP to come and do a formal closing – or they can shift the lunch to the end of the event and
combine a farewell meal as the closing of the event.
Regardless of the format – the process needs to recognize everyone’s hard work – from the organizers to the
participants.
The participants need to be thanked explicitly for their commitment to become peer educators and recognized
for their volunteer spirit and their dedication to helping their peers in the community.
Allow for some of the participants to explain how they have benefited from the training and how they plan to
use their new knowledge and skills.
End the Part by thanking them but also reminding them of their responsibilities – to be role models, to do their
reporting and their activities and to support their community.
Three Key outcomes need to be covered in this 40 minutes to 1 hour:
1) the participants should receive their completed and signed certificates for the training
2) the participants need to sign two copies of the VPESS form – which will need to be counter
signed and witnessed
3) the participants need to sign both copies of their TOR
It is suggested that after receiving their certificates; a second ‘signing event can be run’ – prior to
closing of the Part and the training
94
ANNEXES
Annex 1: Roles plays on STIs (Module C)
Role play 1
You are a peer educator and you are known in your community by almost everyone. One day as you are going
to the clinic you come across an old friend. In your interaction with him, he informs you that he recently noticed
some urethral discharge and sores on the private part. He tried to use the herbs the other friend told him that
he should use, but then it has not helped the situation, instead but with days it’s getting worse and foul smelling.
However, he has concern is that he doesn’t want any other person to know because if he comes he will be
subjected to queuing up and
Roles: Peer Educator and patient.
Role play 2
You are a peer Educator in your early 20s and working at a Health Center in your community. Your practice is
behaviour and character as a peer educator is very good, and you are well-known by community. The young
woman seated in front of you is someone whom you have known for over some time now. She is now 17 years
old, a school leaver, and is stylishly dressed. She is still single and not thinking of marriage any time soon. She
has come to ask you for help with her pimples. You have dealt with that, and as she is about to leave, you realize
that her mother approach you some a week ago and asked you to talk to her about her unsafe sexual behaviour
and now you think this is an opportunity to talk to her about risks and consequences of “unsafe sexual activity”.
Roles; Peer Educator and 17-year old female patient
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ADHFP Adolescent Health Focal Point

Introduction module checklist

Module advance preparation

Materials and audio-visual equipment

Time: 1hr.15 minutes

Part 1.1 Day One Opening (10 Min)

How to do the Quiz:

· To discuss sex and sexuality

Part 1: Sex and Sexuality

Part 1.2: Understanding Human Sexuality (30 min)

such as breasts, vagina, penis, etc.)

4. What different sexual identities are there?

Note: At the end of the activity, explain Key points:

· bodily changes and an awareness of them,

· rise in levels of sex hormones,

· increased cultural emphasis on sex

Part 2.1 Brainstorming: Personal hygiene

Part 2.2.1 Brainstorm

Part 2.3 What Is Menstruation (Monthly Period)?

Part 2.4: Why do young people have sex? (30 min)

Key points to note

Part 2.5 Sexual and reproductive organs (30 min)

· What does it mean to delay sexual debut?

· Deciding not to have sexual intercourse for a particular period of time

· Peer pressure – the belief or feeling that “everyone is doing it”

Strategies for delaying sexual debut

Strategies for delaying sexual debut continued

Safe sexual behaviour

Part 4.1: Discussion on safe and unsafe sexual behaviours

· Positive sexuality involves pleasure, intimacy and experimentation.

Group work instructions:

1. Split the participants into 2 groups

· Abstaining from sex · Having unprotected sex, even one time

Benefits of safe sexual behaviours:

· Protection from STIs including HIV and AIDS

Risks and consequences of unsafe sexual behaviours:

• Contracting HIV and AIDS

Part 5.1 Introduction to contraceptives (20 min)

1. What is contraception (family planning)?

Contraception (Family planning) is important because:

Part 5.2 Types of Contraceptives

• Don’t want to have sex

Changing circumstances of young people

Vulnerability of young people

Other related factors that contribute to adolescent pregnancy;

Part 6.2 Care for the pregnant adolescent

What are the consequences of unsafe abortion?

Part 1: Module Introduction

Module objectives Module objectives

Part 2: Definition of Sexually Transmitted Infections (STIs)

How common are STIs in your area or community?

Part 3: Types of STIs

Part 4.1: Activity

Reasons contributing to STIs in AYP

Reasons contributing to STIs in AYP (continued)

Part 4.2: Brainstorm the following question;

Activity 5-1 Mini Lecture

Part 6: Barriers to seeking timely help for STIs treatment by AYP

Reasons why AYP delay seeking help

Part 7: Prevention of STIs in AYP

Preventing re-infection of STIs

Part 1: Basic facts of HIV

Table 1: Basic facts of HIV