A trouble shared. How people are learning to cope with HIV/AIDS the participatory way

What could be more difficult to discuss in public than sex and death? Dealing with HIV/AIDS means facing up to these sensitive topics. After discovering that a close friend was infected with the HIV virus, development researcher Alice Welbourn dedicated her skills in participatory rural appraisal (PRA) towards devising a training process that would help men and women in Africa and elsewhere to cope with the problem of AIDS. The result is a successful training programme using PRA tools and approaches, called the Stepping Stones approach.

HIV has presented a huge challenge to development workers in Africa over the past 10 years. There are three main factors that have prevented many development workers from tackling the issue. First, AIDS means discussing sex, life and death, which is a profound challenge to even the best communicator's skills. Secondly, development projects often neglect the importance of people's psychological, as distinct from physical, well being. And thirdly, people who adopt participatory approaches shrink from tackling AIDS, as they fear they will be imposing an alien agenda on communities where they work. As a result, AIDS projects often take a very top-down informational approach that alienates and distances people. Either that, or development professionals committed to participatory approaches steer clear of 'imposing' AIDS counselling on the community's agenda, and so neglect AIDS altogether.

Welbourn has shown how participatory approaches can help to fill this void. She developed a training package, appropriate for development professionals with good participatory development skills, who have ongoing projects around AIDS in the communities where they work. The training programme consists of 18 carefully sequenced sessions over three to four months. Training alternates between working with peer groups (separated by age and sex) and workshops when the peer groups are brought together to share their views.

The first sessions concentrate on group co-operation and on helping participants to recognise their own perspective on life. After two sessions on AIDS and safer sex, the training helps people to analyse why people behave as they do, concentrating on factors such as alcohol, local traditions, the need for money, social expectations, and people's personalities. The final sessions help participants to think about how they can change their behaviour to be more assertive, and to take greater responsibility for their actions. Sixteen months after completing a Stepping Stones training in Buwenda, Uganda, Welbourn conducted an impact assessment. A few examples of the impacts reported by community members are:

• less wife-beating, less quarrelling between couples and more sharing of household costs
• more sense of well-being and respect for others, notably between young men and young women
• mothers found it easier to discuss sexual matters with their children
• young women felt greater self-esteem and began to attend community meetings
• alcohol consumption fell, especially among older men
• there was a sustained increase in condom use by participants from all peer groups
• young men and women showed greater determination to become economically self-sufficient
• care and support for HIV positive people and their carers within the community increased.

The Stepping Stones experience offers important lessons for policy makers, not least by showing:

• It is possible and important to address the psychological well being (not just the material well being) of people through development interventions.
• Participatory approaches such as PRA may ease communication around sensitive topics like AIDS.
• There are knock-on effects of participatory training around HIV/AIDS. Women gain confidence, and young people gain motivation for improving their future prospects of economic security.

Source(s):
`Gender, Participation and HIV: a positive force for change?` By Alice Welbourn in The Myth of Community, Irene Guijt and Meer Kaul Shah (Eds). (1998)`
`Stepping Stones: a training package on HIV/AIDS, communication and relationship skills`. Alice Welbourn, 1995.

Funded by: ActionAid, Charity Projects, Oxfam, Redd Barna, SCD, UNDP, WHO (1993-95).

id21 Research Highlight: 1998-August-07

Further Information:
Alice Welbourn
For extra copies of the training package:
TALC
P.O. Box 49
St. Albans
Herts AL1 5TX
UK

Tel: +44 (0) 1727 853 869
Fax: +44 (0) 1727 846 852
Contact the contributor: talcuk@btinternet.com

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