Abstract
The longstanding conflict and civil strife in Burma has had significant consequences on the sexual and reproductive health (SRH) of ethnic minority groups, including adolescents. The Adolescent Reproductive Health Zone in Chiang Mai, Thailand promotes adolescent SRH rights and access to services by having peer educators travel to their hometowns in Burma and lead intensive youth-focused trainings on a variety of topics and issues. In order to evaluate the impact of an intensive three-day workshop dedicated to improving knowledge of sexually transmitted infections (STIs) among peer educators through didactic, experiential, and skill-building exercises, we administered a pre-, post-, and longitudinal assessment. All 13 participants completed both the pre-test and post-test; 11 of 13 participants (85%) completed the longitudinal evaluation administered three months after the training. Our results indicate that both individual and aggregate STI knowledge increased from baseline and that this knowledge was retained. Moreover, the training increased participants’ confidence in their outreach abilities, informed changes in the curricular modules, and led to the implementation of new teaching and learning techniques, especially the incorporation of games and activities. Our findings showcase a successful initiative and suggest similar adolescent peer health educator programs could be undertaken in this protracted crisis and conflict setting.
Highlights
Burma has suffered from longstanding conflict and civil strife. (Note 1) Forcing ethnic minorities into slave labour, burning crops, and surrounding villages with landmines are but a few of the factors that have resulted in the displacement of millions in both conflict-affected Eastern Burma and neighbouring Thailand (Sietstra, 2012)
Adolescent Reproductive Health Zone (ARHZ)’s leadership team identified the need for an intensive workshop dedicated to sexually transmitted infections (STIs) after discussion with peer educators and invited a multi-disciplinary team of international collaborators to create, facilitate, and evaluate a training comprised of didactic, experiential, and skill-building components. (Note 2) Our objectives were that participants would: 1) Acquire a more in-depth understanding of STIs, in general, and the five most common STIs in the Thailand-Burma border region, in particular; 2) Learn new ways of communicating information about STIs to adolescents living along the border; and 3) Identify avenues by which access to STI education, prevention, and treatment services could be improved for adolescents in Eastern Burma
Peer health education programs in conflict and crisis settings have long been a mainstay of health-related programming, including programs dedicated to hygiene, tobacco use, and sexual and reproductive health (SRH) issues, the evidence of impact on behaviour change and community empowerment has been mixed (Ehiri et al, 2014; Drummond et al, 2011; Tanaka et al, 2008)
Summary
Burma has suffered from longstanding conflict and civil strife. (Note 1) Forcing ethnic minorities into slave labour, burning crops, and surrounding villages with landmines are but a few of the factors that have resulted in the displacement of millions in both conflict-affected Eastern Burma and neighbouring Thailand (Sietstra, 2012). The political situation has severely compromised the availability of and access to education, food, and healthcare (Back Pack Health Worker Team, 2006). Lack of access to comprehensive, medically accurate, and affordable healthcare including family planning services, abortion care, skilled birth attendants, and sexually transmitted infection (STI) prevention and treatment contributes significantly to heightened maternal mortality and morbidity in the Thailand-Burma border region (Back Pack Health Worker Team, 2006; Lee et al, 2006; Mullany et al, 2008). Among the millions who suffer from non-existent or inadequate health services are adolescents who either reside in conflict-affected Eastern Burma (referred to as ‘cross border’) or in Thailand as refugees or migrants, most of whom are undocumented (Hobstetter et al, 2015; Walsh et al, 2012). Adolescents living along the border are at increased risk of gender based violence and engaging in sex trade and lack of access to information, education, and www.ccsenet.org/gjhs
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