Culture and Development

Country/region: The Gambia

Project focus

Stepping Stones is a participatory HIV prevention programme based on a Freirian approach to empowerment. It combines Participatory Learning and Action techniques (PLA) such as role-play with “non-formal” education on prevention.

Background

The Gambia is a predominantly Muslim country with relatively low rates of HIV infection. There was increased prevalence of HIV and syphilis in the project area. There was a lack of detailed knowledge about HIV, scepticism about its existence, and ambivalence towards family planning. Unwanted pregnancy and fertility were major social problems. The programme’s emphasis on HIV was adapted to infertility prevention/reproductive health to suit local needs.

Stepping Stones supplemented school-based sexual health promotion, radio-based promotion and peer education. It was implemented in partnership with the Department of State for Health, Gambia Family Planning Association, World Wide Evangelisation for Christ Mission and the Medical Research Council. It is a UNAIDS-recommended resource for community mobilisation.

Level of cultural intervention

Culture as context

Culture as method (drama) – process-based

Activities

Drama was used to present ways in which relationship problems cause sexual and reproductive health difficulties. Common themes were: money love (transactional relationships), support from husbands, poor parenting and teenage pregnancy. The programme helps participants to increase control of their sexual and emotional relationships by working in single-sex peer-groups, usually 4 groups comprising older and younger men and women. Workshops cover relationship skills, assertiveness, information on sexually transmitted infections (STIs) and condom use. Peer-groups come together for joint meetings and present dramas to the village to mobilise the whole community to support behaviour change. Participants are also encouraged to involve themselves in peer education.

Outcomes

• Increased risk awareness of HIV and sexually transmitted infections.
• Value of condoms recognised before, within and outside marriage.
• Women insisted on condom use in and outside marriage
• Condom monitoring data suggested that condom uptake had increased.
• Dialogue within marriage-fewer disagreements; less domestic violence.
• Diffusion of messages took place with non-participants including children.

Beneficiary feedback (reported)

• The techniques are good and some are very funny, such as the role-plays which we really liked and found easier to understand.... for people like us who have never been to school (female)
• Some say it is transmitted through sex and some say it is transmitted by walking over dog or horse or donkey’s urine or some-one's urine who is infected, but finally (we) came to know that it is through sex (male)
• You should use (a) condom. If someone is infected with the disease he will not transmit the disease to you because every thing will stop in the condom, but if you do not use the condom he will transmit the disease to you (female)
• We have learned – the women have learned, the men have also learned. It has made us able to get on with our husbands well in the matters of our marriage and with the people we live with in the compound (female)
• It only brought (good) things to us. Before we did not know how these diseases are acquired, but now we know because of the lessons of the Stepping Stones programme. Before we were sleeping but now we are awake. (female)

Stepping Stones consultant (interviewed in Rwanda):
“It is a very powerful programme, very inclusive because people own the programme. It is both, cultural and creative, cultural because it starts from where the people are and creative through its use of drama, discussion following videos and other participatory methodology. It gives people hope where they never had any – I’ve had feedback from previous participants about how it has helped them solve some of their problems, improved their lives because they have started small income generating activities which have given them better living conditions, including nutritional status, increased their motivation and will to live, thus extending the lives of people living with HIV/AIDS”.

Sources

• ActionAid evaluation report of Stepping Stones in The Gambia.