Stepping stones to HIV prevention: working with communities in the Gambia

How can women protect themselves from HIV in a society where they have little control over their own lives?  An innovative Stepping Stones project, based on community workshops, was introduced in the Gambia to try and challenge current attitudes.  The UK's Medical Research Council assessed the effectiveness of the programme in creating change. 

The Gambia is an Islamic society and its economy is based on subsistence agriculture and fishing.  70 per cent of the rural population live in extreme poverty and only 14 per cent of children between the age of 13 and 18 go to school.  In some areas men have an average of 12.8 children due to polygamy.  Many Muslim clerics and men in general, are suspicious of family planning and condoms.  If women are to protect themselves from HIV, it will require male co-operation.  Indeed, for many women to take part in the Stepping Stones programme it first had to receive their family's approval.

The programme included:

The Gambian programme focussed on infertility, a major cause of concern in the region, which can be brought about by sexually transmitted diseases (STDs). 

Following the programme:

These changes were brought about by:

Those communities that had been involved in and appreciated previous community development initiatives tended to get much more from the programme and make greater changes.  

'Before we were sleeping but now we are awake: the Stepping Stones workshop programme in the Gambia', in ‘Realising rights: transforming approaches to sexual and Rreproductive well-being’, A. Cornwall and A. Welbourn (eds), pp128-140, by M. Shaw, 2002

Funded by:  

id21 Research Highlight: 17 December 2003

Further Information:
Matthew Shaw
Health Policy Unit
London School of Hygiene and Tropical Medicine
Keppel St
London WC1E 7HT

Tel: +44 (0) 20 7927 2612
Contact the contributor: matthew.shaw@lshtm.ac.uk

Medical Research Council Laboratories, Gambia

Other related links:
'Planning together: women, decision-making and health in Egypt' >

'Learning to listen: training nurse midwives in India' >

'Voices and choices: speaking-up for HIV-positive women in Zimbabwe' >

'On best behaviour: men's attitudes to sexual health in Cambodia' >

'Surviving the strain: HIV mortality rates in the Gambia' >

See id21's collection of links relevant to sexual and reproductive health.

See id21's collection of links relevant to HIV/AIDS.

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