Vhutshilo Example

In 2007, with funding from PEPFAR/USAID, CSPE began to develop and test a model of prevention and support adapted from work its founder, Dr. Charles Deutsch, conducted in Massachusetts in the 1970's with children of alcoholics. With five PEPFAR partners, CSPE designed and implemented a structured, curriculum-based 13-session group called Vhutshilo (Venda for "Life") in which 16-19 year old peer educators provide opportunity for highly interactive health learning (life skills and HIV prevention) and mutual psychosocial support to 10-13 year old orphans and vulnerable children (OVC). The 2007 pilot in 10 urban and rural drop-in centers demonstrated that the groups are able to establish access to OVC (that is, they like the groups and attend eagerly and regularly), and that peer educators can conduct the groups with fidelity and sensitivity under the oversight of the available drop-in center personnel.

We can test and determine effective ways to help a population learn specific facts, examine attitudes and norms, and acquire and practice skills. But it is a worthwhile pursuit only if we have adequate access to that population and a delivery system that can use that access. As a method of access and delivery, peer-led groups show promise.

Indeed, in having peer educators rather than adult professionals deliver a structured group intervention something important is almost certainly gained. Children, and people of any age, don't usually show up for things they need; they show up for things they like or want. With enough fanfare, events can be mounted that attract large numbers of young people to a space where information and awareness messages can be transmitted. But there is ample evidence that information is far from sufficient. Our goals are more complex: to actively engage vulnerable children in informed thinking, preparation and practice for tough decisions and high-risk situations; to help them reconsider traditional behaviors and observed norms; to improve their coping skills in the presence of strong feelings that can derail healthy choices; and to provide emotional support in a world that provides too little. These goals require sustained access and repeated exposure to people who can be trusted, in conditions that feel both safe and fun. In any setting, and especially in one with limited human resources, youth peer educators represent a valuable, and often underestimated, addition to the existing workforce seeking to address the needs of highly vulnerable children (Deutsch et al, in press).

In 2008, the Vhutshilo groups were expanded to some 30 sites, and evaluated at 7 by South Africa's Human Sciences Research Council (HSRC) with encouraging results. HSRC's forthcoming study, With a Little Help from My Friends, concluded:

The main objective of the study was to evaluate the feasibility of training and supporting South African community-based programmes to reliably deliver a peer-led group intervention for orphaned and vulnerable children in township and rural settings. Based on our investigation, we can confidently conclude that the Vhutshilo model is capable of helping to address the plight of children made vulnerable by HIV/AIDS (Swartz et al, in press).

Also in 2008, CSPE developed a curriculum for Vhutshilo2, a similar peer-led group intervention for 14-16 year olds that is being implemented and evaluated in 2009 with continuing support from PEPFAR/USAID. Some ten PEPFAR-funded and other partner organizations, operating drop-in centers in 7 of 9 provinces, are now implementing one or both of the Vhutshilo programs under CSPE guidance. CSPE is also exploring the feasibility of conducting Vhutshilo groups in schools and faith-based organizations.