Let's Talk About Sex, Baby

I walked into our makeshift classroom last Thursday afternoon with a plastic bag overflowing with green plantains. It was week 5 of our Sexpertos class and the topic of the day was STIs and prevention. At first, I was met with nothing but confusion, but smiles soon began to spread across the students' faces as they slowly realized what activity was on the day's schedule. Some of the smiles showed a tinge of apprehension, others showed a more sadistic excitement for the madness that they knew would ensue, but most simply reflected an appreciation for the hands-on lesson that they knew was coming. After a full class on STIs, the importance of getting tested, and an activity involving putting 11 steps for using a condom correctly in order, it was finally time. I reached for the bag of plantains, and, as I did, a mixture of laughter and shouting overtook the room. I announced that now that we all supposedly knew the correct way to use a condom, it was time to put that knowledge to the test, and the students were split into pairs and given a plantain and a condom. We went through the 11 steps, one by one, making sure that each pair was following along, pausing a handful of times for a broken plantain, a ripped condom, and whenever there were a few too many laughs. The laughter was constant, but it was always respectful, which made it the perfect tool with which the students could overcome the natural awkwardness of trying to put a condom on a phallic piece of fruit.

I was proud to see how willing the students were to put themselves in this uncomfortable scenario and how supportive they were of one another in trying to make sure that they actually learned the material. Behind all of the madness of this class, the issues that Cata, our psychologist here at Project Limón, and I are attempting to address with the Sexpertos program are very real. According to the World Bank, Nicaragua's adolescent fertility rate, the number of births per 1000 women aged 15 to 19, is one of the highest in the Western Hempisphere at 89.6. While the HIV infection rate is one of the lowest in the region at 0.2%, it has risen slightly in recent years, and it is thought that this increase in HIV incidence might be due to low condom use as condom use reported by women of reproductive age has been as low as 4% in recent years. Gender norms and roles within the cultural context of Nicaraguan machismo typically limit women's access to information and reproductive health services while also increasing the incidence of high risk sexual activity. For these reasons, a class such as ours is especially valuable, and doing an activity as simple as putting a condom on a plantain can go a long way for providing adolescent men and women a safe space where they can learn about contraceptive options and ask questions candidly. 

My name is James Davis, and I am originally from Gainsville, Florida. I finished my undergraduate degree in Biology at Georgetown University in Washington D.C. last May and have been working with Project Limón in Las Salinas, Nicaragua for the past 5 and half months. I was initially drawn to the Internship Program because I wanted to spend an extended amount of time doing internahional public health work and was looking for an organization that was well established in the communities that it served. I also wanted a balance between structure and autonomy, and with FIMRC that is exactly what I have found. While I've been responsible for assisting with the facilitation of our day-to-day clinical operations, I've also had the freedom to develop my own projects, such as the Sexpertos class that I described above, and thanks to the strong network of relationships that FIMRC has within Las Salinas, getting the Sexpertos program up and running has been a relative breeze.

As for the success of the class, it has been well received thus far by the group that Cata and I have been meeting with for six weeks now. Class attendance ranges from 10 to 25 students depending on the week, but the fact that we've been meeting with the same group repeatedly has given us the opportunity to build relationships and trust with the kids involved. That consistency alone has been incredible in helping them open up and really enjoy the lessons. We've had to make some changes in scheduling to work around regular power outages and their school schedule, but fortunately, we've been able to adapt to every obstacle that has come our way. At first, we were also nervous about the large age range of the students in the class, 12 to 18 years of age, but by being conscientious of how we phrase our lessons, we have been able to avois issues on that front as well.

Sustainability was the primary focus in planning this project. I didn't want to start a project without first identifying a need in the community, and it wasn't until about a month in, after conversations with my host family, talking with other staff here at FIMRC, and learning more about Nicaraguan culture, that I finally felt confident in the idea of starting a class focused on sexual health and healthy relationships. It's difficult to measure impact with projects like this, but given that the students seem to be retaining the information that we're sharing with them from week to week, we believe that the format of the classes has been effective. A summary of each class with descriptions of what worked well, what didn't, and what might be good potential changes might be has also written so that the program can be replicated by future interns. Additionally, our maternal health coordinator and a nurse from the Las Salinas health post have observed some of our classes so that they can offer the classes in local schools. Lastly, the group that we've been working with for the past six weeks has a student ambassador program in which certain students are assigned to be the "sexual health ambassadors" for their classes at school. It is our hope that with future groups we'll be able to replicate this system, as it empowers the students to become leaders among their peers and promotes self-sufficiency.

This week, Cata and I are starting two new Sexpertos groups in the nearby town of Astillero. As we introduced ourselves to a group of 43 new students on Monday, I couldn't help but feel excited for the weeks to come. We've already learned so much about how to improve the program, and I know that because of that, these next classes are going to be even better. I anticipate some challenges due to the size of these new groups, 43 students on Mondays and 53 students on Fridays, but I think there are a lot of positives that will come from teaching this many kids as well. The energy in the classroom was palpable on Monday, and I can only imagine what it's going to be like when I walk in carrying that big bag of plantains in a few weeks!