Photo by Maria Claudia Guerrero Rosas

Photo by Maria Claudia Guerrero Rosas

Art-based sex education at Planned Parenthood’s Promotores program.

March 2008

Health Centers Train Teens to Teach Their Peers About Safe Sex

By Stacey Palevsky

When Joanna Scott was just 15 years-old she took two buses to get to her health clinic of choice.  Her trek began in Bayview-Hunters Point, where she’d board the Number 44 bus. She’d get off at Silver and Charter Oak avenues, transfer to the Number Nine, and take that bus to her final location, New Generations Health Center, located near Potrero Avenue and 18th Street.

Scott could have waited in her neighborhood clinic’s long lines.  Or saved herself the transportation hassle by seeing her family doctor.  But he also treats her mom, and, according to Scott, that would just be weird.  So she took multiple buses to Potrero; when she got her license she drove to the Center, who’s slogan, “answers not attitude,” made her feel comfortable.

Now 18 years-old, Scott looks like she just stepped out of a Kanye West video. Bubble gum pink plastic earrings dangle like fat tear drops from her lobes. They match her pink fitted T-shirt and accent her tight jeans.  The Independence High School senior is shockingly honest, seemingly lacking any sort of internal filter. She talks openly about bodily fluids, a pregnancy scare, and condoms.

This tell-all attitude comes from what she’s learned from New Generations’ physicians and counselors, as well as her experience as a peer educator.   Scott served as a volunteer educator for three years, and would still be involved if she hadn’t become a legal adult, thereby aging out of the program.  “Teens need more resources about sex, but they don’t need it from, like, a teacher, who is not going to tell it to them straight, you know what I mean?” she said. “I can talk to students in a way that makes sense to them, and they’ll know that I know what they’re going through.”

New Generations has trained 50 peer educators since 2004, through a partnership with Thurgood Marshall High School.  It’s one of several peer-to-peer health education programs located in Southeast San Francisco.  Mission Neighborhood Health Center sponsors the decade-old Latinos en Extasis program, which relies on Hispanic teenagers to work nights and weekends to answer questions from their peers.  Joanna, who preferred that her last name not be used, and who has Puerto Rican and El Salvadoran parents, spent three years as a peer educator for Latinos en Extasis. She hopes to work as a health educator full-time after she graduates from high school.

Good Samaritan Family Resource Center, located at 25th Street and Potrero Avenue, offers a small family planning clinic, which was created in 2000 thanks to a partnership with Planned Parenthood Golden Gate.  Planned Parenthood also sponsors Promotores, a health education program that relies on Latino men, women, and teens to carry-out art-infused community education focusing on healthy living, sexuality and reproductive health services.

Many of the reproductive health programs available in Southeast San Francisco rely on peer educators to teach in formal settings – schools and clinics – and community hubs, like laundromats, where the educators reach hundreds of people through daily interaction and conversation.

Still, the clinics and their posses of educators face an uphill challenge.  “It’s going to take a while until we really see a difference because the monster is so big — the monster being misinformation,” said Luis Vasquez-Gomez, an artists and activist who helped design the Promotores training.

According to health educators, peer-to-peer initiatives are effective because adolescents tend to distrust adults.  “Teens really listen to each other,” said Tino Ratliff, a health educator at New Generations.  Ratliff has worked with hundreds of middle- and high school students over the past half-decade, and has trained peer educators at Thurgood Marshall High School.  “Almost always, they’re more engaged when one of their peers is talking to them.”

Almost half of all high school students have sex, according to a 2005 Centers for Disease Control (CDC) report.   Yet studies indicate that one in four 15- to 17-year olds have never talked with a parent or guardian about how to say “no” to sex, about birth control, condoms or sexually transmitted diseases.  “We live in a society and culture that limits the kind of information young people have and then expects them to make smart choices,” said Elena Flores, Director of Latinos en Extasis at the Mission Neighborhood Health Center.  Roughly a quarter of sexually active young adults ages 15- to 24-years old contracts a sexually transmitted infection (STI) each year, according to the CDC. The most common STI among young people are human papilloma virus and chlamydia.  

“Sex is a big issue for teens, but a lot of them don’t know what they’re getting into,” said Kenita, a Thurgood Marshall High School senior, who preferred that her last name not be used.  “Teens don’t have a lot of opportunities to talk about sex without being judged.”  Kenita sits on a stool next to her friend Andrew in a biology classroom.  Andrew wants to know:  can a girl get pregnant if she’s raped?  

No one laughs at the question, which the teen has asked quite sincerely.   “Definitely,” Ratliff answered. Every Thursday afternoon he trains Kenita and Andrew to be peer educators. “It’s not like the sperm says, ‘Oh, she’s getting raped, let’s not make her pregnant.’”  Andrew nods and adjusts his black stocking cap. His jeans and white T-shirt are so big it looks like he borrowed them from a giant. He’s the newest of New Generations’ 15 peer educators.  “This is good, I like this,” he said.

Ratliff hands him a parental permission slip to come back the following week. Once he completes the training, he’ll join Kenita in making presentations to San Francisco middle- and high school students.

Promotores and Latinos en Extasis were designed to meet the needs of San Francisco’s Hispanic community.  Latinos are a typically underserved demographic with a high need: in Californian Hispanic adolescents are four times more likely to become parents as European-Americans, according to University of California, Davis researchers.  Even in San Francisco, where the birth rate among girls ages 15 to 19-years old declined by 10 percent between 1995 and 2003, pregnancy rates among Hispanic girls remains higher than that of any other ethnic group.   Research indicates that traditional outreach methods often fail with Hispanic teens and adults due to cultural and language barriers.

In an effort to overcome these barriers Promotores uses an arts-based curriculum, Mi Cuerpo, Mi Pais (my body, my country).  Over a period of six weeks, participants learn about anatomy, STDs, HIV, contraception, and how to communicate with friends and family about sex.  The program’s ultimate goal is to teach personal responsibility and self-respect, and raise participants’ self-esteem.  “It’s important to put everyone together because we want to push through the barriers and get them talking with each other,” said Maria Claudia Guererro, who directs the program for Planned Parenthood.

“There are so many laws in our community, and it’s empowering for teens to create their own personal laws,” adds Vasquez-Gomez. “They need to identify: this is who I want to be; this is who I am.”

All the peer-to-peer education programs – New Generations, Mission Neighborhood Health Center and Good Samaritan/Planned Parenthood – are housed within family planning clinics.  New Generations began in 1974 as a part of San Francisco General Hospital. The number of teens it served more than doubled in 1997, its first year in a separate location. The clinic now sees 2,500 teenage and young adult clients a year, a majority of whom live in low-income households located in the Mission District or Bayview-Hunter’s Point, neighborhoods that have the City’s highest teen pregnancy and STD rates.

Good Samaritan Family Resource Center’s Planned Parenthood satellite clinic consists of two small second floor rooms:  a counseling room and an exam room.  Its entrance is marked by dozens of fliers and pamphlets containing information about pap smears, HIV, menstrual cramps and condoms; nonetheless, it’s mostly indistinguishable from the other rooms in the narrow hallway.  “No one walking by would know this is a family planning clinic, and that’s part of our success,” said Mario Paz, Center Director.  “Teens need a safe environment. They need to not be afraid to ask questions so they can make healthy decisions.”


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