1. Delivery of integrated services for vulnerable adolescent girls through a safe spaces approach, including enhancing their access to sexual and reproductive health (SRH) education and services.
2. Support for the elimination of harmful traditional practices (HTP).

The overall objective of this assignment is a focus on component one and ensuring that SAGE redesign and implementation plans are based on a thorough understanding of the evidence base on adolescent girls’ empowerment and the Sierra Leonean context.

The methodology used combined a desk review of documentation and extensive stakeholder consultations to collect information about adolescent girls’ programmes. Eliciting the views of the adolescent girls themselves was a priority.

Together with information gathered at national level, five programmes (delivered by BRAC, Concern Worldwide, Matei Empowerment Programme for Sustainable Development, IRC and Save the Children) in various areas of Sierra Leone were used as case studies, explored extensively through two field missions. Insights into smaller relevant programmes are provided through findings from a round table conversation with civil society members of the Salone Adolescent Girls Network and the results of a short follow-up questionnaire.

Some key findings of the report are:

• Each of the case study programmes demonstrates different strengths and weaknesses, varying points of emphasis, and some interesting innovation.
• The quality of LST is variable, with some facilitators and safe space/club mentors demonstrating more knowledge and skills than others. Influencing factors are the experience and age of the individuals, the training they have received, and the LST materials they have to hand.
• Some programmes are investing in interventions such as community conversations and outreach to secure broad based engagement in adolescent empowerment processes, including interventions to address HTPs.

Overall, rather than seeking to create a totally new programme, our recommendation is that SAGE build on and broaden existing programmes and structures, introducing additional or new approaches and interventions where there are gaps either in geographical coverage or approach.

Annexes, which include additional data analysis from the short questionnaire and consultations with stakeholders, can be accessed here.

Suggested citation:
Roseveare, C. M. and Lavaly, S. (2018). Support to Sierra Leone Adolescent Girls’ Empowerment (SAGE) Programme: Scoping and Design Report. London, UK: High-Quality Technical Assistance for Results (HEART).

According to the UNAIDS AIDS Pandemic Global Report of 2013, there were an estimated 35.3 million people living with HIV in 2012 and about 25 million of this population was in Sub Saharan Africa. Malawi has a total population of 15 million with 1 million of this population infected by HIV.  Out of this population, 170,000 are children between the ages of 5 and 19 years old. Usually, 13 to 15 year old youths are in junior secondary school with sex education being promoted through a subject called Life Skills HIV-Based Education (LSBE). Malawi, a patriarchy society, particularly makes girls vulnerable to HIV infections with its cultural practices like forced marriages, wife inheritance and puberty initiation ceremonies. In the absence of a cure, education is seen as the only ‘social vaccine’ as it is believed that educated people are more likely to make informed choices (see the 2012 Global Monitoring Report) even though 13.7% of HIV infected people in Malawi are educated. LSBE aims to equip learners with information on how they can protect themselves as a way of reducing HIV infection.  Sex is not something that is easily talked about in Malawi as traditionally talking about it is seen as a ‘taboo’. Hence the teachers are left with the onus responsibility to educate children (albeit in a ‘sanitised’ way) on such matters (without getting into more detail about the mention of sexual body parts or any sexual activities).

The average age that young people first encounter sexual intercourse in Malawi is 13 years old. Most parents do not talk about sex with their children let alone ask what the children know about sex.  Some of these children have been vertically infected with HIV and are not aware of their statuses and just like other teenagers, they want to experience sex (which is mostly unprotected in the first encounter). There are several myths and misconceptions that fly around about condom use like ‘getting skin-to-skin for full pleasure’, ‘issues of trust’, etc.  In the schools, they are only taught about abstinence.  So, this means that whether they are already having sex or not, they are expected to ‘abstain’. The structural drivers of HIV in Malawi include poverty (which created vulnerability); multiple concurrent partnerships; low/inconsistent condom use; and low comprehensive knowledge about HIV and AIDS. HIV & AIDS is also intimately linked to other issues like maternal mortality, gender based violence and illiteracy.

This is why, as much as I appreciate sex education in that context, I still feel that we are not equipping our youth with the desirable self-efficacy skills which they can use to prevent further HIV transmission, i.e. efficacy to: refuse sex; negotiate for safe sex; refuse unprotected sex.  I guess if you were a youth in that context, you would not expect anything more (despite seeing various messages advertising condom use be it through the radio or TV) but at least there are people like you and me who can make a difference to such programmes as a way of making them more appropriate and more targeted.  This is food for thought for those not working in this area.  And this is why I am undertaking research in this area to question the rationale behind LSBE as a health promotion intervention.

LSBE has some strengths, including: the attention to building skills; the effort to address social context issues (such as gender, social inequalities, social norms and human rights); and excellent use of interactive activities and case studies to explore and reinforce key concepts.  At the same time, it has some areas which can be improved on: the expansion of information on human development reproduction, sexuality, STI and HIV risk; greater depth of questioning and critical thinking activities; further teaching guidance; re-ordering of some topics and a stand-alone unit on gender (in addition to the gender-sensitive content in other units); and more specificity to ensure that statements do not unintentionally transmit misinformation or harmful gender norms. More on this can be found in the UNESCO & UNFPA review of Sexuality Education, published in 2012.

Having a sanitised sex education is politically wrong if we do want to raise the country’s economy.  We need to be practical and accept that these youths are becoming sexually active much too early with little preparation for HIV prevention.  I think teaching children explicitly about sex is not encouraging them to explore further into sex (after all they will do it anyway) but if we are to equip them with the necessary skills, we will indeed have an HIV negative free generation.  We need to get out of our comfort zones and allow teachers to say it as it is. Fortunately, there are positive initiatives taking place in the country like the reviewing of the LSBE curriculum altogether; the Theatre for a Change initiative (with support from Medicor Foundation, Christian Aid, DFID, GTZ, and The Saving Grace Foundation). Other organisations like UNICEF, UNESCO, UNAIDS and lots others are also doing work around the area of educating children and young people about HIV & AIDS.

Blog by Wezi Mwangulube, Development Assistant, Institute of Development Studies and PhD student at the University of Sussex