Peer Education, Gender and the Development of Critical Consciousness: Participatory HIV Prevention by South African Youth

Drawing on results of a larger empirical study of HIV transmission and prevention among young people in Summertown, South Africa, this study, published in the July 2002 issue of Social Science & Medicine , evaluates the outcome of a participatory, peer education programme that promoted safe sexual behaviour among youth. The authors assert that traditional gender relations constitute a key obstacle to condom use among young people. The peer-education approach is built on an assumption that successful peer education on the interlocking concepts of social identity, empowerment, and social capital would foster new gender dynamics amenable to preventive health behaviours. Peer education is seen as a vehicle to develop critical consciousness of the way in which socially constructed norms of masculinity and femininity place their sexual health at risk. Peer education is also seen to help young people envision alternative gender relations. The study identifies a number of factors limiting the development of such critical thinking and empowerment. The research also highlights the key features of the programme and programme design in light of the broader context of the programme, which posed challenges to the success of peer education.

Evaluation/Research Methodologies:

Summertown, an economically poor township with 150,000 black African people, was facing severe problems of unemployment, education, and violence. The youth in Summertown were identified as at risk. The programme appointed a teacher at a Summertown school to take the role of the guidance teacher, who trained and coordinated the peer education group composed of volunteer peer educators (10 men and 10 women). The primary role of the peer educators was to disseminate health-related information and free condoms to their peers. The peer educators were trained in HIV prevention and participatory techniques such as role-plays and the use of music.

The researchers conducted in-depth interviews of 120 young people, and focus groups with 44 of these interviewees, half men and half women, in the 13-25 age group. Interviews and focus groups explored participants' perceptions of health, sexuality and HIV. The study also involved eight focus group discussions with the peer educators over an eight-month period. Researchers drew selectively on aspects of campaign materials related to the impact of the peer education programme on young people's sexual health. Study participants' responses were analysed using NUDIST (a software program for processing large qualitative data sets). The coding frame used for the analysis assumed mechanisms and context of the intervention as generators of the outcome of the programme.

Key Findings/Impact:

The programme was implemented in a school setting. The researchers found that the highly regulated nature of the school environment severely undermined the effectiveness of the peer education. Vertical, rigid paedagogic methods of the Apartheid era were still alive in schools. In the original design of the programme, the guidance teacher's role was that of offering on-going advice and support to peer educators, in a strictly non-directive way, promoting young people to take control of their health practices. However, the guidance teacher tended to retain absolute control over the activities of the peer educators, antithetical to the goal of youth empowerment. The teacher determined the times that peer educators engage in their educational activities, the content of their educational messages, and their access to resources.

Both the guidance teacher and the peer educators favoured the old-fashioned didactic approach to education, substantially compromising their ability to facilitate critical debate and dialogue that might lead to the development of critical consciousness and alternative constructions of gender among youth. Traditional didactic health education seeks to change the views and attitudes of single individuals. By contrast peer educational settings were intended to promote assimilation or accommodation of a range of individuals' opinions within an evolving group process. Despite their training in participatory techniques, the peer educators drifted to a non-participatory paedagogy.

Messages delivered in peer education were also problematic. The content of the peer educators' lessons was framed in terms of a biomedical discourse of sexual health risks. There was no focus on the social context of sexuality, or of the way in which gender relations might serve as an obstacle to condom use. As a result the communicated messages failed to address cultural norms and habits that confronted healthy sexual habits. Further, gender dynamics among peer educators and negative learner attitudes to the programme among peers mitigated the effectiveness of the peer education.

The study highlighted the importance of context and social factors in determining programme success. Three main areas of contextual considerations were:

• limited opportunities for communication about sex outside of the peer educational setting;
• poor adult role models of sexual relationships; and
• poverty and unemployment, low levels of social capital and poor community facilities.

The findings suggested that the school milieu did not offer many opportunities for peer communication about sex and sexual partners. Communication about sex was mostly restricted to same-sex peers. Therefore, the environment of mixed-sex classrooms was not amenable to facilitate conversations. In addition, there was generally no communication about sex with parents and first time partners. The peer education programme failed to bring sex conversations outside the school into these domains.

The authors also point out that the lack of adult role models in the community interfered with the programme. Almost half of the study participants' fathers were absent, and when they were present, the participants frequently portrayed them as stern, non-caring, and authoritarian. The community also had a social stigma towards single mothers. These conditions suggested that young peoples' expectations of the quality of sexual relationships were not high.

Finally, the findings showed that these problems were compounded by macro-social and community problems such as poverty, lack of educational opportunities, and unemployment. The study participants expressed discontent on these issues, and reported that they were repeatedly exposed to situations where they or family members had been prevented from acting on decisions or achieving their hopes. The authors argue that such social conditions pose significant challenges in the effort to develop independent, critical thinking among young people.