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:

• drama workshops
• assertiveness training
• peer group discussions about sexual health. 

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:

• people were less likely to have casual sex because of the fear of STDs
• men began to provide more financial support for their families so women stopped having sex for money to feed their children
• women talked to their daughters about the risk of AIDS and other venereal diseases
• women felt able to insist on using condoms
• young people's attitudes began to change and they were more likely to practice safe sex
• wife beating stopped completely as many men were ashamed to be seen hitting their wives. Older men trusted young wives to be faithful.

These changes were brought about by:

• peer group discussions which allowed women to share their experiences with other women of a similar age in a safe environment. Men also did the same
• involving the community in analysing its own problems so they felt ownership of the programme, rather than it being something imposed by outsiders
• greater awareness about STDs
• husbands and wives communicating more than before
• assertiveness training (for women) and peer pressure (for men).

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.  

Source(s):
'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
UK

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

Medical Research Council Laboratories, Gambia

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'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.

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