Behaviour change remains the key to slowing the spread of HIV/AIDS in East Asia and the Pacific. Even as populations grow more knowledgeable about HIV/AIDS, individuals still take the same risks, because they lack the skills, motivation and/or access to needed services and commodities, for self-protection. With UNICEF help, children, sexually active youth, drug users, street children, sex workers and vulnerable women in East Asia and the Pacific are learning how to lead healthier, safer lifestyles and avoid HIV infection.

UNICEF and Behaviour Change

Healthy living and HIV/AIDS prevention programming under the Mekong Partnership and Beyond strategy seeks to develop target groups' capacity for sustainable behaviour change. This entails a combination of:

• Knowledge of HIV transmission and prevention
• Understanding of how HIV/AIDS impacts their lives
• Personal risk perception and motivation to act
• Psychosocial skills – such as problem solving and negotiation
• Technical skills – such as correct use of condoms
• A supportive environment
• Ability to access to services and supplies

A school-based lifeskills and HIV/AIDS prevention workshop, Yunnan province

The East Asia and Pacific region has already yielded many valuable lessons for successful prevention programs. A combination of frank, well-targeted information, condom promotion and Lifeskills training, particularly in Thailand and Cambodia, has reduced the vulnerability of some important population groups. Working from the Mekong Partnership and Beyond's regional structure, UNICEF is helping other countries learn from these successes.

Lifeskills for Behaviour Change

The Lifeskills approach is an essential component of education for the new century. Lifeskills are basic psychosocial competencies that define how successfully we negotiate the challenges of life. These skills include critical thinking, negotiation, self-esteem and respecting the rights of others, among many others. In the context of HIV/AIDS prevention, Lifeskills equip children and young people to make better decisions where personal health and wellbeing choices are concerned, and help them recognize and avoid situations and behaviours that place them at risk of HIV infection.

Promoting Healthy Living in Schools

Schools provide a good opportunity to reach a large proportion of children and young people, at an age when they are developing patterns of thought and behaviour that will stay with them for most, if not all, of their lives. For many, it is the last organized context in which they can be reached.

The Mekong Partnership and Beyond Strategy emphasizes supporting the training of teachers in the learner-centred, participatory, experiential educational techniques needed to teach Lifeskills successfully, along with building the capacities of curriculum writers and of educational administrators and policy-makers.

A page from Myanmar's SHAPE (School-based Healthy Living and HIV/AIDS Prevention Education) course materials, dealing with father-to-mother-to-child HIV transmission. Using a combination of bright, easy to understand pictures and realistic situations, SHAPE is one of the most successful in-school lifeskills curricula in the region

With UNICEF advocacy, advice and support, countries in the region are working to incorporate skills-based HIV/AIDS/STI prevention education into their national primary and lower-secondary school curricula. In Myanmar, the Government has accepted UNICEF-supported healthy-living modules within the national curriculum, and implementation is steadily expanding towards national level. In other countries, UNICEF supports smaller-scale and extracurricular programs at school, district or province level, often in areas badly affected by HIV/AIDS.

At the same time, UNICEF endeavours to ensure that choices are meaningful, in the sense that condoms, sexual and reproductive health and counselling services are readily available, affordable and confidential.

Lifeskills Out of School

UNICEF also supports a range of Lifeskills and HIV/AIDS prevention programs outside the school setting. Some of these programs are specifically designed to reach children and young people who do not attend formal schooling, while others are for more general groups and complement in-school programs.

Many of the adolescents and young people most vulnerable to HIV do not attend school. They may be working, living on the street, unregistered, linguistically isolated, in the criminal justice system, or just too busy helping at home (perhaps to help care for a family member with AIDS) and are thereby excluded or removed from public-sector education services. Providing prevention education on HIV/AIDS, sexually transmitted infections and drugs for these disparate and often elusive groups can be extremely challenging.

Despite a good deal of progress during the 1990s, many children in East Asia and the Pacific still miss out on school

Viet Nam has made good progress in reaching out-of-school children and youth, particularly through the work of the Viet Nam Red Cross and Australian Red Cross. Among several successful programs, the Viet Nam Red Cross cooperates with the local Committee for Protection and Care of Children to bring Lifeskills education and information on drug use prevention, sexuality and HIV/AIDS to street children, children of poor families, out-of-school children and others.

In China, UNICEF is collaborating with the Australian Red Cross Yunnan and the Yunnan Women's Federation on developing a pilot Lifeskills/peer education program for sex workers and their clients.

Buddhist Leadership

Buddhist monks and nuns in Thailand, Cambodia, Lao PDR and China have received training in Lifeskills-based prevention and care under the UNICEF Regional Buddhist Leadership Initiative. The prevention training workshops are structured as "Dhamma Camps" organized by monks in Thailand under the Sangha Metta Project, in which adolescent boys staying in the temple receive a blend of spiritual instruction, meditation coaching and HIV/AIDS prevention and care education.

Youth Peer Educators

Peer education programs are a proven media for Lifeskills-based prevention, whether designed to reach in school youth or groups of inaccessible out-of-school youth. Peers often have ready access to places and groups of youth that external educators do not. They have greater success in gaining the trust of their peers, who may be too wary or too shy to approach outsiders with sensitive questions.

Peer educators from the Lao Youth Union hold an HIV/AIDS prevention workshop in a rural village

In Thailand's rural Northeast, two UNICEF-sponsored groups of out-of-school youth have linked Lifeskills with community theatre and participatory rural appraisal in their peer education efforts for HIV and drug abuse prevention. The groups have formed their own independent community-based organizations and are now taking their peer education efforts beyond the borders of their own villages and sub-district communities.

Friends Tell Friends

Friends Tell Friends is a popular Lifeskills-based peer education curriculum designed by the Thai Red Cross AIDS Research Centre for young workers. UNICEF is supporting its rapid expansion to factories all over Lao PDR and Mongolia (where it has also been used with railway workers and university students, and planning to modify and adapt materials and approaches for use in other countries.

Keeping Up to Date

Prevention programs need to respond quickly to emerging trends in the spread of HIV and changing patterns in youth behaviour. Under the UNICEF Mekong Partnership and Beyond, UNICEF prioritizes the following issues both in its advocacy work and in Lifeskills programming:

• The role of drug/substance use, including alcohol, in risk behaviours,
• Reproductive health (including general sex education, relationships, etc.)
• Promoting condom use for HIV prevention,
• Risk behaviours of men who have sex with men,
• Promoting acceptance, care and support of people affected by HIV/AIDS,
• Knowledge of, and access to, health services and sources of condoms.

Lifeskills Media

UNICEF has supported production of a range of communications tools that incorporate the Lifeskills approach, from comics to national mass media.

In Lao PDR and elsewhere, UNICEF supports radio magazine programs, competitions and TV or radio dramas that put HIV/AIDS prevention in the context of behaviours that help to avoid risk.

In Cambodia, UNICEF supported the production of two video films aimed at young people and incorporating a lifeskills approach. Snooker and A Quiet Place take common, real-life dilemmas relating to risk behaviour and offer alternative solutions to stimulate discussion.

A still from a lifeskills video aimed at young sex workers from Cambodia's Vietnamese minority

Also in Cambodia, UNICEF and the international NGO Medecins Sans Frontieres have developed a participatory video training package for immigrant Vietnamese sex workers. The video includes tips on a range of topics, including how to handle drunk or violent clients who refuse to use condoms.

Feedback on Lifeskills

In Thailand, follow-up studies with sex workers who had been involved in a Lifeskills-based program reported that they now used condoms in all of their sexual encounters, whereas previously they had generally not used them at all in their personal encounters and only inconsistently with clients.

Another follow-up study with factory workers who had been exposed to the Friends Tell Friends peer education curriculum found that they still discussed HIV/AIDS, drug abuse and other important life issues with their peers two years after the training workshop, while most prevention programs have a half-life of only six months.

Through the UNAIDS Taskforce on Youth Reproductive Health, the Mekong Partnership and Beyond is collaborating on a project to develop new sets of guidelines and tools to help assess the impact Lifeskills education is having on youth behaviour in East Asia and the Pacific.

For more information on country-level activities, see the individual country reports.