The Youth for Youth (Y4Y) The Youth for Youth (Y4Y) Program in Western KenyaProgram in Western Kenya

Testing a Comprehensive Testing a Comprehensive Adolescent Education and Adolescent Education and

Services Model to Reduce Services Model to Reduce HIV/STDs and Teen Pregnancies HIV/STDs and Teen Pregnancies

by Paula Tavrow, PhDby Paula Tavrow, PhD UCLA School of Public Health UCLA School of Public Health February 6, 2004 February 6, 2004

Y4YK-

MET/UCLA

AcknowledgementsAcknowledgements UCLA Globalization ResearchUCLA Globalization Research Center – Africa (sponsors)Center – Africa (sponsors)

Edmond Keller, DirectorEdmond Keller, Director Charisma AceyCharisma Acey

UCLA Y4Y Development TeamUCLA Y4Y Development Team Paula Tavrow, PIPaula Tavrow, PI Edith Mukudi, Co-PIEdith Mukudi, Co-PI Rebecca MorrisRebecca Morris Tarik BenbahmedTarik Benbahmed Karen MichailKaren Michail Adesuwa OgiamienAdesuwa Ogiamien Kyle PusateriKyle Pusateri JC WalshJC Walsh

Kenya Y4Y Management TeamKenya Y4Y Management Team Kitche Magak, K-MET Kitche Magak, K-MET Albert ObbuyiAlbert Obbuyi Vidalyne Omollo Vidalyne Omollo

All photos by Rebecca MorrisWebuye division, Bungoma district, Kenya

Adolescents worldwide: Adolescents worldwide: Key factsKey facts

Nearly Nearly one-sixthone-sixth of the of the world’s population is world’s population is between 10-19 years oldbetween 10-19 years old

About About 84%84% of the world’s of the world’s adolescents live in adolescents live in developing countriesdeveloping countries

Nearly Nearly one-halfone-half of new HIV of new HIV infections are occurring infections are occurring among young peopleamong young people

Source: Youthnet (2003)

New HIV infections in 2003New HIV infections in 2003

Problem of HIV/AIDS in AfricaProblem of HIV/AIDS in Africa

29 million29 million Africans Africans estimated to be estimated to be HIV+; half under 25 HIV+; half under 25 years oldyears old

Young women in Young women in Africa Africa twicetwice as likely as likely to get infected as to get infected as young men young men

One in sevenOne in seven children in some children in some African countries African countries have lost one or both have lost one or both parents to AIDSparents to AIDS

Source: UNAIDS (2003)

Risk factors for African youth -1Risk factors for African youth -1

PersonalPersonal Lack of knowledge; belief in low personal risk Lack of knowledge; belief in low personal risk

Low self-efficacy, especially of girlsLow self-efficacy, especially of girls

Low self-esteemLow self-esteem

Belief in low personal riskBelief in low personal risk

Male desire to be “masculine” or virileMale desire to be “masculine” or virile

Belief that abstinence can be injurious to boys’ healthBelief that abstinence can be injurious to boys’ health

Misconceptions or dislike of condomMisconceptions or dislike of condom

Risk factors for African youth -2Risk factors for African youth -2InterpersonalInterpersonal

Peer pressure for early sexual activityPeer pressure for early sexual activity Belief that condoms signify mistrust, promiscuityBelief that condoms signify mistrust, promiscuity High incidence of coerced sexHigh incidence of coerced sex Youths often barter sex for goods or servicesYouths often barter sex for goods or services Multiple sex partnersMultiple sex partners

StructuralStructural Barriers to youths’ acquisition of correct information Barriers to youths’ acquisition of correct information

about reproductive healthabout reproductive health Barriers to youths’ use of reproductive health servicesBarriers to youths’ use of reproductive health services

Due to poverty and lack of life skills, youths are Due to poverty and lack of life skills, youths are vulnerable to older sexual partners, who may be HIV+vulnerable to older sexual partners, who may be HIV+

Location of project: Location of project: Kenya Kenya

Population: Population: 31.3 million31.3 million GDP per capita: GDP per capita: $995$995 Literacy rate: Literacy rate: 84%84% Fertility rate: Fertility rate: 4.34.3 births/ woman births/ woman Roads paved: Roads paved: 12%12% Est’d HIV prevalence:Est’d HIV prevalence: 6.7- 9.4%6.7- 9.4%

(~(~1.5 million1.5 million have died of AIDS) have died of AIDS) Est’d HIV prevalence (15-24 yrs):Est’d HIV prevalence (15-24 yrs):

Girls: Girls: 11-15%; 11-15%; Boys:Boys: 4-9% 4-9% Est’d AIDS orphans:Est’d AIDS orphans: 890,000890,000 Kenyan teens reported being Kenyan teens reported being

pregnant or given birth:pregnant or given birth: 20%20%Sources: World Bank (2002), UNAIDS (2003), Sources: World Bank (2002), UNAIDS (2003), Demographic and Health Survey (1998)Demographic and Health Survey (1998)

BungomaDistrict

<20%Philippines 8.1%Rwanda 14.2%Peru 18.4%

21- 30%

Kazakstan 20.5%Brazil (NE) 22.5%Bolivia 22.9%Guatemala 25.0%Domin. Rep. 26.9%Colombia 29.6%Haiti 29.0%Zimbabwe 29.7%

31- 40%

Paraguay 30.1%Senegal 35.4%

41- 50%Namibia 42.4%U.S. 46.0% Kenya 46.1%Tanzania 49.9%

51- 60%Burkina Faso 54.1%Ghana 59.0%

61- 70%Zambia 60.5%Niger 60.9%Uganda 61.6%Central Afr. Rep. 62.0%Mali 66.0%Côte d’Ivoire 68.1%Cameroon 68.5%

Adolescent sexual activity Adolescent sexual activity

Percent of adolescentswho report ever had sex (10-19)

Sources: Demographic and Health Surveys (1998-2001) ; US data from Advocates for Youth (2003)

<10%Malawi 7.9%Niger 8.4%Rwanda 7.5%Zambia 3.5%Guatemala 6.1%Paraguay 9.2%

11- 20%

Kenya 12.5%Madagascar 13.7%Senegal 15.8%Tanzania 16.5%Uganda 16.9%Bolivia 14.8%Domin. Rep. 14.2%Haiti 14.3%

21- 30%

Peru 22.7%Columbia 25.6%Brazil (NE) 22.5%Zimbabwe 20.5%Namibia 22.5%Mali 25.6%Ghana 22.4%C. AfricanRepublic 20.4%Burk. Faso 21.3%

40% +Cameroon 52.7%U.S. 75.0%

31- 40%Nigeria 30.7%Côte d’Ivoire 34.9%Kazakstan 39.0%

Percent of sexually active 15-19 year olds using any contraceptive method at last sex

Adolescent contraceptive useAdolescent contraceptive use

Sources: Demographic and Health Surveys (1998-2001); US data from Advocates for Youth (2003)

Why Kenyan youth are not gettingWhy Kenyan youth are not gettingreproductive health education & servicesreproductive health education & services

Parents traditionally Parents traditionally do not talkdo not talk about sex with childrenabout sex with children

Teachers Teachers uncomfortableuncomfortable with sex with sex education: pick what to teacheducation: pick what to teach

Government’s latest AIDS Government’s latest AIDS curriculum curriculum excludes condoms excludes condoms

Most churches and elders oppose Most churches and elders oppose contraceptives education for youth: contraceptives education for youth: believe leads to believe leads to sexual immoralitysexual immorality

Catholic churches preach HIV virus Catholic churches preach HIV virus can can pass through condomspass through condoms

Many health providers reluctant to Many health providers reluctant to give youth contraceptives: believe give youth contraceptives: believe encourages promiscuityencourages promiscuity

Challenges in designing programs Challenges in designing programs to reach rural Kenyan youth to reach rural Kenyan youth

Less than 40% Less than 40% of youthof youth enter secondary schoolenter secondary school

About 90% of rural primary About 90% of rural primary schools and 50% of schools and 50% of secondary schools secondary schools lack lack electricityelectricity

Less than 10% Less than 10% of schools of schools have a libraryhave a library

Less than 1% Less than 1% of youthof youth have have access to internetaccess to internet

Health facilities often Health facilities often inaccessible inaccessible to youth to youth (distance, hours, costs)(distance, hours, costs)

Lessons learned from other Lessons learned from other adolescent programsadolescent programs

EducationEducation• Train peers to convey sexuality informationTrain peers to convey sexuality information

• Use structured, comprehensive curriculumUse structured, comprehensive curriculum

• Develop relevant life skills Develop relevant life skills

• Spend enough time and be interactiveSpend enough time and be interactive

• Train older youth to educate younger youthTrain older youth to educate younger youth

• Include out-of-school youthInclude out-of-school youth

Services Services • Combine education with servicesCombine education with services

• Use peers to deliver servicesUse peers to deliver services

• Actively ensure services are youth-friendlyActively ensure services are youth-friendly

• Build on what exists and what youths wantBuild on what exists and what youths want

• Be affordable and replicableBe affordable and replicable

Goals of Youth for Youth (Y4Y)Goals of Youth for Youth (Y4Y)

To test whether a To test whether a comprehensive comprehensive adolescent reproductive adolescent reproductive health education and services model in health education and services model in rural rural Africa can:Africa can:

Increase youth’s knowledge about reproductive health

Reduce unwanted pregnancies and unsafe sex

Increase youth’s use of health clinics

Be sustained and replicated in-country

Main components of Y4YMain components of Y4Y1. Extra-curricular education

Peer sexuality education and skills-building in Peer sexuality education and skills-building in secondary schoolssecondary schools

Peer sexuality education and skills-building among Peer sexuality education and skills-building among church-affiliated out-of-school youth church-affiliated out-of-school youth

Mentor education and skills-building in primary schoolsMentor education and skills-building in primary schools

2. Adolescent-focused service delivery Development of a network of youth-friendly Development of a network of youth-friendly

health clinicshealth clinics Teen peer providers in health clinicsTeen peer providers in health clinics

3. Ongoing monitoring Youth satisfaction with health services Youth satisfaction with health services Regular meetings of peer educators (PALS)Regular meetings of peer educators (PALS)

Y4YK-

MET/UCLA

Conceptual framework of Y4YConceptual framework of Y4Y

ChurchChurch

PALS*Peer

educator

Youth- friendly

health facility

PA

LP

ee

r p

rov

ide

rs

)

Secondary School

Peer HIV/AIDS and reproductive health

education

PALS*(Peer

educators)

PALS*(Mentor

s)

Peer provider health facility

Primary school

Primary school

Features of PALS-led education:

1. 10-week struc-tured curriculum

2. Magic Bag of puppets, games, books

PALS: Peer Advocates for Life Skills

What is unique about Y4YWhat is unique about Y4Y

1. Secondary schools as hub for sustainability PALS are elected, not selected PALS have weekly meetings to discuss questions PALS train new generation each year Magic Bags stored at schools

2. Nearby primary schools & churches reached Time mapping: everything within 30 minutes Nothing required for implementation except Magic Bags,

pens, exercise books and umbrellas

3. PALS curriculum: Comprehensive reproductive health and skills New concepts: dream team, gender benders, top-5 list Fully readable; requires little training Very interactive: dialogues, games, role plays

4. Peers provide services in clinics Youth-friendliness assured New monitoring cards: referral plus exit interview

Y4YK-

MET/UCLA

Does Y4Y achieve significant improvements in Does Y4Y achieve significant improvements in reproductive healthreproductive health knowledge knowledge among youth? among youth?

Does Y4Y reduce high-riskDoes Y4Y reduce high-risk sexual behaviors sexual behaviors among youth? among youth?

Does Y4Y increase youth’sDoes Y4Y increase youth’s use use of reproductive of reproductive health services?health services?

Is Y4Y a Is Y4Y a logistically feasible and potentially logistically feasible and potentially replicablereplicable model for achieving comprehensive model for achieving comprehensive peer-led reproductive health education and peer-led reproductive health education and services for youth in:services for youth in:

Secondary schools?Secondary schools?

Primary schools?Primary schools?

Churches?Churches?

Research questionsResearch questions

Design:Design: quasi-experimental pretest quasi-experimental pretest posttest with a comparison groupposttest with a comparison group

Two neighboring divisionsTwo neighboring divisions from from Bungoma district selected:Bungoma district selected:

Webuye division:Webuye division: interventionintervention

Kimilili divisionKimilili division: : comparisoncomparison

Data collection (pre- and post-)Data collection (pre- and post-) Self-administered questionnairesSelf-administered questionnaires

- Knowledge, practices, self-efficacy- Knowledge, practices, self-efficacy School recordsSchool records Clinic recordsClinic records

Research methodologyResearch methodology

Examples of vignettes used in Examples of vignettes used in questionnairequestionnaire

1. Mary and John have been dating for 3 months. They have been playing sex for two months, but Mary no longer wants to play sex without a condom. She fears to tell John because he likes skin-to-skin contact.

1a. GIRLS: If you were Mary, do you think you could persuade John to use a condom?

□ Yes □ Maybe □ No

1b. BOYS: If you were John, would you think badly about Mary for asking you to use a condom?

□ Yes □ Maybe □ No

2. Josephine does not want to play sex until she is married. She really likes a boy at her church named Thomas. After they go out a few times, he tells her he wants to play sex. Josephine does not want to break up with Thomas, but does not feel comfortable playing sex.

2a. GIRLS: If you were Josephine, could you tell Thomas that you would not play sex, even if it meant you would break up?

□ Yes □ Maybe □ No

2b. BOYS: If you were Thomas, would you break up with Josephine for not wanting to play sex?

□ Yes □ Maybe □ No

Bungoma districtBungoma district

Western Province, KenyaWestern Province, Kenya

Population: Population: 1 million1 million Less than 20 years old:Less than 20 years old: 60% 60% Number of divisionsNumber of divisions: 10: 10 Main ethnic group: Main ethnic group: Luhya (Bukusu)Luhya (Bukusu) Religions: Religions: Friends, Anglicans, Friends, Anglicans,

Pentecostal, CatholicsPentecostal, Catholics Adult literacy:Adult literacy: 70% 70% Occupations:Occupations: Farmers 60%, Farmers 60%,

Employed 22%, Business 18%Employed 22%, Business 18% Main crops:Main crops: sugarcane, maize, sugarcane, maize,

beans, bananas, sweet potatoesbeans, bananas, sweet potatoes

Sources: World Bank (2002), Demographic and Sources: World Bank (2002), Demographic and Health Survey (1998), Moi University dataHealth Survey (1998), Moi University data

BungomaDistrict

Webuye town: Street sceneWebuye town: Street scene

Webuye town: market dayWebuye town: market day

Webuye sub-district hospitalWebuye sub-district hospital

Pan Paper Factory, WebuyePan Paper Factory, Webuye

Transport in Bungoma districtTransport in Bungoma district

Matatu (minibus)

Boda-bodas (bicycle taxis)

Y4Y program timelineY4Y program timeline

Pre-implementation Pre-implementation (June-Dec. 2003)(June-Dec. 2003)

Baseline assessmentBaseline assessment (Jan. 2004)(Jan. 2004)

Implementation Implementation (Jan.-Nov. 2004)(Jan.-Nov. 2004)

Evaluation Evaluation (Dec. 2004-Feb. 2005)(Dec. 2004-Feb. 2005)

Phase 1:Phase 1: Program development at UCLA Program development at UCLA Literature review and dialogueLiterature review and dialogue PALS curriculum designedPALS curriculum designed Selection of other curriculums Selection of other curriculums Baseline questionnaire, sample designBaseline questionnaire, sample design

Phase 2:Phase 2: In-country preparation In-country preparation Hiring of Kenyan staff and office-set-upHiring of Kenyan staff and office-set-up Focus group discussionsFocus group discussions Time mapping of target schools, churches and health centersTime mapping of target schools, churches and health centers Community mobilization and planning meetingsCommunity mobilization and planning meetings Pilot-testing of questionnaires and curriculumPilot-testing of questionnaires and curriculum Youth-friendly training of providersYouth-friendly training of providers

Pre-implementation Pre-implementation (May – Dec. 2003)(May – Dec. 2003)

From focus groups: From focus groups: Misconceptions about AIDS, FP Misconceptions about AIDS, FP

““A friend of mine said: if you don’t want A friend of mine said: if you don’t want to get AIDS, just play sex without to get AIDS, just play sex without thinking about it.” thinking about it.” (Male, 15-19 (Male, 15-19 yrs.)yrs.)

““If a youth wants to prevent getting an If a youth wants to prevent getting an STI, he should eat well-cleaned and STI, he should eat well-cleaned and well-cooked foods.” well-cooked foods.” (Male, 11-14 (Male, 11-14 yrs.)yrs.)

““The best way to avoid pregnancy is to The best way to avoid pregnancy is to swallow aspirin.” swallow aspirin.” (Female, 11-14 yrs.)(Female, 11-14 yrs.)

““To avoid pregnancy you take yellow To avoid pregnancy you take yellow medicine with milk before sex.” medicine with milk before sex.” (Female, 11-14 yrs.)(Female, 11-14 yrs.)

From focus group discussions, Webuye division, Kenya 8/03

From focus groups: From focus groups: Interest in the Y4Y concept Interest in the Y4Y concept

““When a youth teaches you he can teach When a youth teaches you he can teach you deeper, but if a teacher teaches you, you deeper, but if a teacher teaches you, you may not understand it. With a youth you you may not understand it. With a youth you can keep asking questions.” can keep asking questions.” (Male, (Male, 11-14 yrs.)11-14 yrs.)

““Teens understand my problems better than Teens understand my problems better than older people do.” older people do.” (Female, 15-19 yrs.)(Female, 15-19 yrs.)

““With fellow youth, you can tell him every With fellow youth, you can tell him every disease that you have and then he can just disease that you have and then he can just tell the doctor so you get the right tell the doctor so you get the right medicines. Otherwise you might feel too medicines. Otherwise you might feel too shy to tell the doctor all your diseases.” shy to tell the doctor all your diseases.”

(Male, 11-14 yrs.)(Male, 11-14 yrs.)

From focus group discussions, Webuye division, Kenya 8/03

Headquarters of local NGO (K-MET) Headquarters of local NGO (K-MET)

& Y4Y Bungoma staff& Y4Y Bungoma staff

K-MET headquarters, Kisumu

Albert Obbuyi (Y4Y Coordinator), Paula Tavrow (PI), and Vidalyne Omollo (Y4Y Deputy Coordinator)

Y4Y office in Bungoma townY4Y office in Bungoma town

Bungoma

Y4Y office in Wing B of Bungoma District Education Office Interior of Y4Y

office

PALS curriculum: ContentPALS curriculum: Content1: Dreams & Goals

2: Gender Roles

3: Puberty & Relationships

4: Human Sexuality

5: Preventing STIs through Safe Sex

6: HIV & AIDS: Facts & Feelings

7: Contraception: Avoiding Unwanted Pregnancy

8: Resisting Pressure and Being Assertive

9: Saying NO! to Sexual Violence

10: Protecting Your Future

Some pilot testers of PALS curriculum

with Rebecca Morris in Webuye Division, Bungoma

District

PALS curriculum: SkillsPALS curriculum: Skills1: Setting career goals

2. Taking steps to accomplish goals

3: Negotiating fairer division of chores at home

4: Communicating assertively

5: Building self-esteem

6: Using a condom

7: Negotiating condom use

8: Communicating with parents

9: Avoiding date rape

10: Negotiating with health providers

Pilot testing of PALS curriculumPilot testing of PALS curriculum

Bungoma

Pilot testing of the PALS curriculum, using posters and puppets

Interior of Y4Y office

Participating institutions in first year (2004): Secondary schools = 6 Primary schools = 8 Churches = 10 Health facilities = 6

Anticipated # of PALS to be trained: 185 Anticipated # of peer providers to be trained: 32 Anticipated # of youth to be reached: 5500

Y4Y program statisticsY4Y program statistics

Schools participating in Y4Y - 1Schools participating in Y4Y - 1

Primary school, Webuye division, Bungoma district Interior of a primary

school, Webuye division, Bungoma

Schools participating in Y4Y - 2Schools participating in Y4Y - 2

Pan Paper High School, Webuye division, Bungoma

Interior of secondary school, Webuye Divison,

Bungoma

Youth-friendly servicesYouth-friendly servicestraining of health providerstraining of health providers

Content of 4-day Content of 4-day course:course:

Characteristics of youth-Characteristics of youth-friendly servicesfriendly services

Service provider valuesService provider values Adolescent developmentAdolescent development Youth sexual and Youth sexual and

reproductive healthreproductive health Communication with youthCommunication with youth Creating youth-friendly Creating youth-friendly

servicesservices Nurses in Webuye division, Bungoma district

What Bungoma youth told providers What Bungoma youth told providers ““When you go to a clinic, you are treated so harshly. It is When you go to a clinic, you are treated so harshly. It is

like an interrogation: so many questions. If I won’t answer, like an interrogation: so many questions. If I won’t answer, I am told to go away.” I am told to go away.”

““We don’t like it when services are crowded. We youths We don’t like it when services are crowded. We youths are impatient…we don’t want to wait 1-2 hours to talk to are impatient…we don’t want to wait 1-2 hours to talk to someone. It’s a waste of time.” someone. It’s a waste of time.”

““Once I had a sexually-transmitted disease. The doctor Once I had a sexually-transmitted disease. The doctor talked with me and then told me to wait. I overheard him talked with me and then told me to wait. I overheard him tell his son, who is in my class, about my condition. I felt tell his son, who is in my class, about my condition. I felt so betrayed I went away. I waited 2 months before I went so betrayed I went away. I waited 2 months before I went back.”back.”

““When you go to a clinic, the doctor says your parents When you go to a clinic, the doctor says your parents have to come. Even if he agrees to see you, he is not have to come. Even if he agrees to see you, he is not confidential. He passes on anything you say to your confidential. He passes on anything you say to your parents.”parents.”

From panel discussion, Webuye division, Kenya 12/03

Monitoring of youth satisfactionMonitoring of youth satisfactionYOUTH SATISFACTION CARDYOUTH SATISFACTION CARD

Youths have the right to receive reproductive Youths have the right to receive reproductive health services. Here are the facilities in health services. Here are the facilities in your division where providers have been your division where providers have been trained to offer youth-friendly services.trained to offer youth-friendly services.

Lugulu Mission HospitalLugulu Mission Hospital Webuye Health CentreWebuye Health Centre Webuye Sub-District HospitalWebuye Sub-District Hospital Bokoli Health CentreBokoli Health Centre Annetta Annex (Webuye town)Annetta Annex (Webuye town) Pan Paper ClinicPan Paper Clinic

After you have received services, please take After you have received services, please take a moment to fill in the reverse side of this a moment to fill in the reverse side of this card. You can return it to any PAL or to card. You can return it to any PAL or to the Youth for Youth (Y4Y) office in the the Youth for Youth (Y4Y) office in the District Education Office, Wing B, in District Education Office, Wing B, in Bungoma town.Bungoma town.

The answers that you provide are The answers that you provide are

confidential. Please do not write your confidential. Please do not write your name anywhere on this card. Your name anywhere on this card. Your responses will be used to help improve responses will be used to help improve health services here. health services here.

QUESTIONS ABOUT SERVICESQUESTIONS ABOUT SERVICES Where did you go? ________________Date: _______Where did you go? ________________Date: _______ Your age? ______ years Your sex (gender)? _____ Your age? ______ years Your sex (gender)? _____ What services did you receive? (Tick all that apply.)What services did you receive? (Tick all that apply.) □ □ CounselingCounseling □ Family planning □ VCT□ Family planning □ VCT □ □ STI treatment □ Other __________________STI treatment □ Other __________________ Did you feel free to ask any questions you had?Did you feel free to ask any questions you had?

□Yes □Yes □ Somewhat □ No □ Somewhat □ No Did you get the information or supplies you wanted?Did you get the information or supplies you wanted?

□ □ YesYes □ Somewhat □ No □ Somewhat □ No Was any provider harsh or made you feel ashamed?Was any provider harsh or made you feel ashamed?

□ □ YesYes □ Somewhat □ No □ Somewhat □ No Did a PAL provide counseling services to you?Did a PAL provide counseling services to you?

□ □ YesYes □ No □ No About how long did you have to wait? _______ minutesAbout how long did you have to wait? _______ minutes What did you pay for services, if anything? ___ KShWhat did you pay for services, if anything? ___ KSh

Would you recommend this place to other youths?Would you recommend this place to other youths? □ □ Yes □ Maybe □ NoYes □ Maybe □ No

Implementation plan (2004)Implementation plan (2004)

Baseline questionnaire and record reviewBaseline questionnaire and record review (Jan-Feb. 2004) (Jan-Feb. 2004)

Training of PALSTraining of PALS (Jan-Feb. 2004) (Jan-Feb. 2004)

PALS train secondary schools PALS train secondary schools (Feb-April 2004)(Feb-April 2004)

Training of top PALS as peer providersTraining of top PALS as peer providers (April 2004) (April 2004)

PALS train upper primary schools and PALS train upper primary schools and out-of-school youth out-of-school youth (May-July 2004)(May-July 2004)

Peer providers start counseling in clinics Peer providers start counseling in clinics (May 2004- )(May 2004- )

Video taping for replicationVideo taping for replication (June-August 2004) (June-August 2004)

Election of new PALS and in-school trainingElection of new PALS and in-school training (Sept-Nov 2004)(Sept-Nov 2004)

The need is great…The need is great…

Bungoma

Mural on primary school wall concerning sexual harassment, Webuye division, Bungoma district

Interior of Y4Y office

A last word…A last word…

““For people in some of the countries For people in some of the countries we are talking about, AIDS is a real we are talking about, AIDS is a real weapon of mass destruction. And weapon of mass destruction. And what are we doing about that? what are we doing about that? Where is our common humanity?”Where is our common humanity?”

--Kofi Annan, UN Secretary General--Kofi Annan, UN Secretary General

November 30, 2003 in BBC interviewNovember 30, 2003 in BBC interview