Abstract
Introduction
Unaccompanied asylum seeking young people are at increased risk of sexual exploitation and sexual ill-health, compounded by difficulties in accessing sexual health services. They have had varying access to relationships and sex education (RSE) in their countries of origin and little or none in the UK. A research study carried out with a group of separated asylum seekers in East London (Sinha, Uppal and Pryce, 2008) highlighted two themes:
Access to relationship and sex education is important in terms of protecting this group of children and young people from the risks of sexual exploitation, and ensuring access to sexual health and contraceptive services. It is essential to deliver sexual health education that is sensitive to cultural and religious differences.
Much of the research into the area of sexual health and unaccompanied asylum seeking young people highlights sexual health risks and issues of accessing sexual health services rather than the delivery of sexual health education. Historically this approach has been adopted in sexual health education generally in the UK where research into the views of young people repeatedly show that they are not satisfied with the quality or quantity of sex education and often characterise that delivered as ‘too little, too late and too biological’ (Hoyle, 2014).
In a study exploring how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands defined ‘sexual health, search for sexual health information and perceived sexual health determinants’, participants pointed out that the asylum system brought about ‘stress, sadness and frustration’, which they perceived as negatively affecting their sexual health (Keygnaert, et al., 2014).
Background
In Brighton, in 2010, the specialist nurse for looked after young people became aware that several young asylum seekers had become involved with the police after allegations of inappropriate sexual behaviour. It was recognised that RSE was key in addressing the recognised vulnerabilities of this group of young people and that a specific programme was needed for them, taking into account the complex ways in which culture, gender and religion combine with relationships and sexual activity. Various methods of providing RSE to young asylum seekers were explored; for example, delivering basic information about consent, sex and the law and how to prevent sexually transmitted infection (STI) (including a condom demonstration) at an initial health assessment for looked after children. A combination of one-to-one consultations and a peer education group was facilitated by a young people’s sexual health adviser and sexual health nurse at a weekly drop-in for young asylum seekers. However, both of these methods were unsatisfactory in that they did not deliver a consistent education programme that could be evaluated. A six-week programme of RSE was subsequently devised, comprising a two-hour, weekly session with a certificate of attendance given at the end. Separate sessions were delivered to male and female young asylum seekers (as requested by the young people) with a male and female facilitator and interpreters for the respective groups. The emphasis was on learning about normal anatomy, the reproductive system, sexually transmitted infections, contraception and local services, sex and relationships, legal aspects including consent, cultural differences and female genital mutilation (FGM). The young people were taught how to use condoms and offered testing for chlamydia and gonorrhea. They were able to be fast-tracked to local sexual health clinics and had access to methods of contraception including contraceptive implants and contraceptive injections.
The course was well received and attracted positive feedback from young people as well as social workers, foster carers and key workers: I found the course really helpful, this is really useful for us. Now I know lots of things about health and how to protect myself from pregnancy and infection. I can’t thank you enough, I really appreciate it. (16-year-old female asylum seeker from Eritrea) First, thank you for this course … I learned so many things I didn’t know about sex and the law and condom and everything. (17-year-old male asylum seeker from Iraq)
Aims
The aims of the programme were to:
provide good quality RSE to young asylum seekers that is sensitive to religious and cultural differences and in their own language; improve evaluation of the programme and ensure young people have a voice in shaping it; provide a safe environment where young people can have open discussions about issues to do with relationships and sex and support them to develop a vocabulary to help them talk about these issues; help build resilience and recognise healthy and unhealthy relationships and the nature of child sexual exploitation; have a good understanding of consent and sex and the law; ensure that young people have a broader understanding of sexual health, not just the absence of disease or dysfunction, including the possibility of having pleasurable and safe sexual experiences; provide access to contraception and testing for sexually transmitted infections.
The refined programme uses the 15 domains of healthy sexual development identified by Mckee and colleagues (2010). The areas we need to develop in order to flourish and mature in our sexuality and sexual lives include: understanding consent; maintaining safety; celebrating sexuality; pleasurable sex and healthy relationships; understanding anatomy, physiology and fertility; and developing a positive attitude to self. It is based on the DO … programme which provides quality RSE in schools and in particular, the expertise of Alice Hoyle, RSE advisory teacher, writer and consultant for DO…RSE for Schools (www.dorseforschools.com). DO… believes that giving young people the skills to make informed choices about their relationships is not only good for them but also good for society.
The lesson plans were put together with the help of the WISE (What is Sexual Health) project in Brighton:
Starting with you; Communicating about sexual health; Consent and sex; Sexual and reproductive health and rights; Safer sex; Problem-solving.
The sessions are now more interactive and use different methods such as active experiential learning, collage and comics, and structured discussion. They also focus more on building self-esteem, resilience and a positive attitude to self.
Outcomes
At the end of the programme the attendees:
are part of the evaluation process and have a voice in shaping the programme; understand that people have different needs according to their sexual development stage; are able to understand consent and issues around sex and the law; are able to see the diversity of sexuality; recognise sexual and reproductive health rights as basic human rights; recognise healthy/unhealthy relationships; have access to contraception and STI testing; know how to use a condom; are offered referral for FGM examination.
The future
The RSE programme for unaccompanied young asylum seekers is ready for evaluation and the next stage of the project is a feasibility trial which is due to start in November 2018 with a group of young male asylum seekers in Brighton; hopefully this will help with the long-term sustainability of the programme. In addition, discussions are being held about the possibility of delivering it in the town’s main further education college.
Footnotes
These notes were prepared by