Implementing Multiple Gender Strategies to Improve HIV and ... - ICRW

Evaluation Results • Project reach: The program has reached 2,772 youth ages 15–26
years (1,412 women and 1,360 men).
• Evaluation study: There was no evidence that Stepping Stones
lowered the incidence of HIV (adjusted incidence rate ratio 0.95,
95 percent confidence interval 0.67 to 1.35). The program was
associated with a reduction of about 33 percent in the incidence of
HSV-2 (0.67, 0.46 to 0.97; P=0.036)—that is, Stepping Stones
reduced the number of new HSV-2 infections over a two-year period
by 34.9 (1.6 to 68.2) per 1,000 people exposed. Stepping Stones
significantly improved a number of reported risk behaviors in men,
with a lower proportion of men reporting perpetration of intimate
partner violence across two years of follow-up, and less transactional
sex and problem drinking at 12 months. In women, desired behavior
changes were not reported, and those in the Stepping Stones
program reported more transactional sex at 12 months. Conclusion:
Stepping Stones did not reduce incidence of HIV but had an impact
on several risk factors of HIV – notably HSV-2 and perpetration of
intimate partner violence. (Abstracted from Jewkes et al., 2008: 1).
Replication and
Scale-up Activities
Stepping Stones originally was developed for use in Uganda and over the
last decade has been used in more than 40 countries, adapted for at least
17 settings, and translated into at least 13 languages (Wallace 2006).
LESSONS LEARNED AND CHALLENGES
Key Findings and
Lessons
• Matching the facilitator to the participants by age and sex is important
so that they may feel free to communicate.
• Rural communities will support such a program if it addresses an
issue that they are concerned about and will be of value to them.
Researchers must invest time in explaining the proposed study and
should build a strong Community Advisory Board.
• Community mobilization should be seen not as a discrete task, but as
a process. Though the latter requires more resources, this activity
should be prioritized because it is key to establishing the program
locations and obtaining community cooperation.
• Research instruments validated in other settings must have their
validity established in the local settings. Involving field workers in
validating and translating instruments greatly increases their depth of
understanding of the instrument and resultant data quality.
• Informed consent is a process, not merely a written agreement to
participate. The program first used a group consenting process
where the study was fully explained. Later, individual participants
also had opportunities to address private questions and concerns.
• All training in the program should be ongoing; continual training of
fieldworkers and intervention facilitators is recommended. Facilitators
had consistent training support that also provided them a means to
raise concerns, and the coordinators helped resolve facilitation
problems before more sessions were implemented in other areas.
This occurred monthly.
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