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Anchoring Awareness in the Community - Handicap International

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LESSONS FROM EXPERIENCE:<br />

KNOW-HOW ANALYSIS<br />

October 2009<br />

<strong>Anchor<strong>in</strong>g</strong> <strong>Awareness</strong><br />

<strong>in</strong> <strong>the</strong> <strong>Community</strong><br />

Issu<strong>in</strong>g from an learn<strong>in</strong>g-from-experience process on <strong>the</strong> project<br />

“Improvement of HIV/AIDS prevention and treatment <strong>in</strong> <strong>the</strong> cross-border<br />

regions of Djibouti, <strong>in</strong> Ethiopia and <strong>in</strong> Somaliland”


Author: Julie de Lamarzelle<br />

(Capitalization Support for <strong>the</strong> HI Ethiopia Program)<br />

Contributions: <strong>Handicap</strong> <strong>International</strong> Team <strong>in</strong> Ethiopia and Partners<br />

Methodological support and edit<strong>in</strong>g: <strong>Handicap</strong> <strong>International</strong> – Professional Publications Center<br />

Graphic creation and layout: Webcastor<br />

Contact: cdixon@handicap-<strong>in</strong>ternational.org<br />

Cover photo: © Julie de Lamarzelle for <strong>Handicap</strong> <strong>International</strong><br />

This document may be used or reproduced only if <strong>the</strong> source is cited and only for non-commercial purposes.


Contents<br />

Introduction 04<br />

P a r t<br />

1<br />

P a r t<br />

2<br />

Context and Methodology 05<br />

d THE HIV/AIDS REGIONAL CONTEXT 06<br />

d AN AMBITIOUS PROJECT 07<br />

d LEARNING-FROM-EXPERIENCE PROCESS 10<br />

Implement<strong>in</strong>g Know-How 13<br />

d DARING AN ORIGINAL AWARENESS PROGRAM 14<br />

d BRINGING LONG-LASTING CHANGE 22<br />

d CREATING AN AWARENESS ENVIRONMENT 31<br />

d CARRYING OUT MORE PRECISELY TARGETED ACTIONS 39<br />

To learn more… 43<br />

3


Introduction<br />

This document provides an analysiss of <strong>the</strong> know-how implemented <strong>in</strong> <strong>the</strong> framework of a<br />

community awareness program aim<strong>in</strong>g to decrease denial and stigmatization of HIV/AIDS and to<br />

<strong>in</strong>form communities of ways to prevent <strong>the</strong> disease.<br />

Its purpose is to serve as a source of <strong>in</strong>spiration for o<strong>the</strong>r current or future projects <strong>in</strong>volv<strong>in</strong>g<br />

awareness actions. Most of <strong>the</strong> know-how presented below can be transposed or adapted<br />

and reused <strong>in</strong> a different context. Some of this know-how can be directly generalized; <strong>in</strong> o<strong>the</strong>r<br />

cases, it is more specific to our project and <strong>the</strong> project context. This latter know-how can<br />

none<strong>the</strong>less <strong>in</strong>spire o<strong>the</strong>r awareness projects on o<strong>the</strong>r <strong>the</strong>mes.<br />

This document thus addresses both persons wish<strong>in</strong>g to design a project <strong>in</strong>volv<strong>in</strong>g development<br />

of awareness and on-site teams implement<strong>in</strong>g awareness activities.<br />

Us<strong>in</strong>g <strong>the</strong> experience of <strong>Handicap</strong> <strong>International</strong>, this document was put toge<strong>the</strong>r dur<strong>in</strong>g <strong>the</strong><br />

learn<strong>in</strong>g-from-experience process of a project for improv<strong>in</strong>g HIV/AIDS prevention and treatment<br />

<strong>in</strong> <strong>the</strong> Djibouti-Ethiopia-Somaliland cross-border region between 2006 and 2009.<br />

It <strong>in</strong>cludes two ma<strong>in</strong> parts:<br />

d A first part present<strong>in</strong>g <strong>the</strong> context of <strong>in</strong>tervention, <strong>the</strong> project and <strong>the</strong> learn<strong>in</strong>gfrom-experience<br />

process (also called “capitalization”);<br />

d A second part present<strong>in</strong>g <strong>the</strong> know-how employed dur<strong>in</strong>g <strong>the</strong> project.<br />

This document is <strong>in</strong>cluded on a DVD-ROM conta<strong>in</strong><strong>in</strong>g:<br />

d A film present<strong>in</strong>g <strong>the</strong> project<br />

d Learn<strong>in</strong>g-from-experience documents (<strong>the</strong> present document, as well as two sheets<br />

identify<strong>in</strong>g different types of know-how: “Facilitat<strong>in</strong>g <strong>the</strong> establishment of Long-Last<strong>in</strong>g<br />

Cross-Border L<strong>in</strong>ks” and “Streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> Health System”)<br />

d A toolbox with <strong>the</strong> ma<strong>in</strong> documents and tools used dur<strong>in</strong>g <strong>the</strong> project.<br />

4


Context and Methodology Part<br />

1<br />

This first part of <strong>the</strong> document presents <strong>the</strong> context <strong>in</strong> which <strong>the</strong> different<br />

types of know-how described later were developed.<br />

We will first discuss <strong>the</strong> HIV/AIDS regional context, <strong>the</strong>n <strong>the</strong> project and its<br />

different components and, f<strong>in</strong>ally <strong>the</strong> methodology used for <strong>the</strong> learn<strong>in</strong>g-fromexperience<br />

process.<br />

1. The HIV/AIDS regional context 06<br />

Mobile populations and a denial of <strong>the</strong> disease 08<br />

Alarm<strong>in</strong>g rates of prevalence 08<br />

2. An ambitious project 07<br />

Ma<strong>in</strong> projects elements 07<br />

A strong awareness component 08<br />

3. Learn<strong>in</strong>g-from-experience process 10<br />

Multiple learn<strong>in</strong>g-from-experience goals 10<br />

Choice of a ma<strong>in</strong> <strong>the</strong>me for learn<strong>in</strong>g-from-experience 10<br />

A variety of learn<strong>in</strong>g-from-experience products 11<br />

Hybrid learn<strong>in</strong>g-from-experience methodology 11<br />

5


1. The HIV/AIDS regional context<br />

Part<br />

1<br />

MOBILE POPULATIONS AND A DENIAL OF THE DISEASE<br />

The border area shared by Djibouti with<br />

Ethiopia and Somaliland is characterized by<br />

highly mobile local populations who are<br />

traditionally nomads, and a well-developed,<br />

cross-border commercial activity. Along <strong>the</strong><br />

railway and road corridors that connect <strong>the</strong><br />

city of Djibouti to <strong>the</strong> major cities of Ethiopia<br />

and Somaliland, <strong>the</strong>re is a concentrated<br />

population of truck drivers, prostitutes and<br />

merchants. A lack of <strong>in</strong>formation, risky sexual<br />

behavior and poverty are determ<strong>in</strong>ant factors<br />

<strong>in</strong> <strong>the</strong> propagation of HIV/AIDS. The strong<br />

stigmatization and denial of <strong>the</strong> disease<br />

among <strong>the</strong> Somali and Afar populations of<br />

<strong>the</strong>se regions is an aggravat<strong>in</strong>g factor.<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

ALARMING RATES OF PREVALENCE<br />

In Djibouti, <strong>the</strong> rate of prevalence for HIV/<br />

AIDS is 2.9% for <strong>the</strong> overall adult population<br />

and is over 5% <strong>in</strong> <strong>the</strong> 20-35 year age group.<br />

In Ethiopia, <strong>the</strong> latest estimates show a<br />

prevalence of 2.2% 1 for <strong>the</strong> adult population,<br />

but at Dire Dawa, sent<strong>in</strong>el surveillance<br />

data show a seroprevalence of 12.6%. In<br />

Somaliland, prevalence is 1.4% 2 .<br />

Because of demographic and geographical<br />

characteristics, <strong>the</strong> situation of <strong>the</strong> entire subregion,<br />

which is strongly exposed to HIV/AIDS<br />

propagation, is alarm<strong>in</strong>g. An average rate of<br />

prevalence of 5% for <strong>the</strong> overall population,<br />

which is <strong>the</strong> critical threshold from which<br />

epidemic growth rate is exponential, could be<br />

rapidly atta<strong>in</strong>ed <strong>in</strong> <strong>the</strong> region.<br />

1. Prevalence for <strong>the</strong> 15-49 age group - Source: S<strong>in</strong>gle Po<strong>in</strong>t HIV Prevalence Estimate, Federal HIV/AIDS Prevention and Control Office, June 2007<br />

2. 2005 data<br />

6


2. An ambitious project<br />

Part<br />

1<br />

Although <strong>in</strong> this document we will specifically<br />

discuss <strong>the</strong> community awareness aspect, <strong>the</strong><br />

project for improv<strong>in</strong>g HIV/AIDS prevention<br />

and treatment <strong>in</strong> <strong>the</strong> Djibouti-Ethiopia-<br />

Somaliland cross-border region, which this<br />

awareness program is part of, is extremely<br />

vast. Here, we will merely summarize details<br />

available from <strong>the</strong> different six-month activity<br />

reports 3 .<br />

MAIN PROJECT ELEMENTS<br />

In spite of <strong>the</strong> context of populations that are<br />

highly mobile between <strong>the</strong> three countries, <strong>the</strong><br />

public health authorities of Djibouti, Ethiopia<br />

and Somaliland have not yet developed a<br />

cooperative action plan to fight <strong>the</strong> epidemic.<br />

Implemented by <strong>Handicap</strong> <strong>International</strong> <strong>in</strong><br />

Ethiopia and Somaliland, this project thus<br />

complements ano<strong>the</strong>r project: “Support for<br />

<strong>the</strong> Fight aga<strong>in</strong>st HIV/AIDS <strong>in</strong> Djibouti,” which is<br />

f<strong>in</strong>anced by <strong>the</strong> French Agency for Development<br />

and implemented by <strong>the</strong> Health M<strong>in</strong>istry of<br />

Djibouti. It aims to implement cooperative<br />

actions between <strong>the</strong> three countries <strong>in</strong> order<br />

to mitigate HIV/AIDS propagation and<br />

encourage long-term patient care and<br />

follow-up of <strong>in</strong>fected <strong>in</strong>dividuals on both<br />

sides of <strong>the</strong> border. In addition, awareness<br />

actions and <strong>the</strong> re<strong>in</strong>forcement of counsel<strong>in</strong>g<br />

and voluntary test<strong>in</strong>g are be<strong>in</strong>g implemented<br />

<strong>in</strong> each country along <strong>the</strong> traffic corridors.<br />

Area of <strong>in</strong>tervention:<br />

d Ethiopia (Dire Dawa, Somalia region, Afar<br />

region)<br />

d Somaliland (western area, between Hargeisa<br />

and Togwajaale)<br />

Targets:<br />

d The adult population (over 15 years old) of<br />

<strong>the</strong> regions concerned: this group benefited<br />

from awareness activities and an improvement<br />

<strong>in</strong> <strong>the</strong> availability of counsel<strong>in</strong>g and test<strong>in</strong>g<br />

services.<br />

d Persons diagnosed with HIV/AIDS: <strong>the</strong>y<br />

benefited from an improvement <strong>in</strong> <strong>the</strong> extent<br />

and quality of treatment, <strong>in</strong>clud<strong>in</strong>g cont<strong>in</strong>ued<br />

access to treatment <strong>in</strong> <strong>the</strong> areas covered by<br />

<strong>the</strong> project.<br />

d Local partners: community organizations,<br />

religious and community leaders and<br />

associations of persons liv<strong>in</strong>g with HIV<br />

were tra<strong>in</strong>ed <strong>in</strong> <strong>the</strong> techniques of <strong>in</strong>creas<strong>in</strong>g<br />

community awareness of HIV/AIDS and how<br />

to communicate about <strong>the</strong> disease. Health<br />

workers were tra<strong>in</strong>ed <strong>in</strong> counsel<strong>in</strong>g and test<strong>in</strong>g<br />

techniques, as well as <strong>in</strong> how to treat persons<br />

<strong>in</strong>fected with HIV.<br />

3. General project documents (reason<strong>in</strong>g, activity reports, etc.) are available <strong>in</strong> <strong>the</strong> Project Documents directory of <strong>the</strong> Toolbox on <strong>the</strong> Capitalization<br />

DVD-ROM.<br />

7


Project goals<br />

General goal<br />

Contribute to reduc<strong>in</strong>g HIV/AIDS transmission<br />

and improv<strong>in</strong>g <strong>the</strong> quality of life of persons<br />

liv<strong>in</strong>g with HIV/AIDS <strong>in</strong> <strong>the</strong> northwest region of<br />

Somalia and <strong>the</strong> nor<strong>the</strong>ast region of Ethiopia.<br />

Specific goal<br />

Re<strong>in</strong>force HIV prevention and provide access<br />

to cont<strong>in</strong>ued, comprehensive treatment for<br />

persons liv<strong>in</strong>g with HIV <strong>in</strong> <strong>the</strong> neighborhood of<br />

<strong>the</strong> Hargeisa – Jijiga / Dire Dawa – Djibouti /<br />

Djibouti – Loggia corridors.<br />

Expected results<br />

1. Availability of and access to objective and<br />

culturally appropriate <strong>in</strong>formation for <strong>the</strong><br />

migratory and sedentary populations of <strong>the</strong><br />

target areas.<br />

2. Availability of voluntary counsel<strong>in</strong>g and<br />

test<strong>in</strong>g services <strong>in</strong> four secondary health<br />

structures and re<strong>in</strong>forcement of <strong>the</strong>se services<br />

<strong>in</strong> three reference centers.<br />

3. Improvement <strong>in</strong> and better performance of<br />

comprehensive care services, <strong>in</strong> particular<br />

treatment services, <strong>in</strong> <strong>the</strong> reference hospitals.<br />

4. Effective implementation of skill exchanges<br />

on <strong>the</strong> regional scale and promotion of<br />

experience capitalization.<br />

<strong>Handicap</strong> <strong>International</strong> is <strong>in</strong> charge of<br />

<strong>the</strong> implementation of <strong>the</strong> project <strong>in</strong> <strong>the</strong><br />

two countries: Ethiopia and Somaliland.<br />

The <strong>in</strong>tervention logic is ma<strong>in</strong>ly based on<br />

partnership through <strong>the</strong> coord<strong>in</strong>ation and<br />

re<strong>in</strong>forcement of local <strong>in</strong>itiatives.<br />

A STRONG AWARENESS COMPONENT<br />

At <strong>the</strong> different sites of project <strong>in</strong>tervention,<br />

development of awareness represented a<br />

fundamental aspect of <strong>the</strong> project, with its<br />

implementation entrusted to local partner<br />

associations.<br />

“House-to-house” awareness action<br />

In each community concerned, awareness<br />

was developed at different levels, <strong>in</strong> different<br />

contexts and through target<strong>in</strong>g different<br />

groups. First, a “house-to-house” awareness<br />

action, implemented daily, enabled contact<br />

with persons present <strong>in</strong> <strong>the</strong> home dur<strong>in</strong>g <strong>the</strong><br />

day, ma<strong>in</strong>ly women. This method consisted<br />

<strong>in</strong> mak<strong>in</strong>g <strong>the</strong> contact aware of <strong>the</strong> HIV/AIDS<br />

problem by provid<strong>in</strong>g <strong>in</strong>formation and creat<strong>in</strong>g<br />

a discussion on <strong>the</strong> topic with<strong>in</strong> <strong>the</strong> <strong>in</strong>timacy<br />

of <strong>the</strong> home. To do this, animator would make<br />

several visits to a home; dur<strong>in</strong>g <strong>the</strong>se visits, <strong>the</strong><br />

animator would talk about different subjects<br />

that enabled know<strong>in</strong>g <strong>the</strong> disease better<br />

and how to prevent it. At each <strong>in</strong>tervention<br />

site, a team of five animators was <strong>in</strong> charge<br />

of a daily program of awareness development<br />

throughout <strong>the</strong> three project years.<br />

Involv<strong>in</strong>g community leaders<br />

In parallel to this “house-to-house” program,<br />

extensive collaborative work with <strong>the</strong><br />

community was carried out to make <strong>the</strong><br />

project possible. Religious and community<br />

leaders were actively <strong>in</strong>volved <strong>in</strong> <strong>the</strong> project<br />

through <strong>the</strong> creation of “Project Advisory<br />

Committees” responsible for promot<strong>in</strong>g <strong>the</strong><br />

project with<strong>in</strong> <strong>the</strong> community, giv<strong>in</strong>g advice<br />

on project orientations and resolv<strong>in</strong>g <strong>the</strong><br />

conflicts encountered by <strong>the</strong> organizers.<br />

Without <strong>the</strong> support of <strong>the</strong>se leaders, project<br />

acceptation with<strong>in</strong> <strong>the</strong> community would have<br />

been difficult.<br />

Creat<strong>in</strong>g an environment<br />

of comprehensive awareness<br />

In addition to develop<strong>in</strong>g awareness <strong>in</strong><br />

8


homes and imply<strong>in</strong>g community leaders, an<br />

environment of comprehensive awareness was<br />

implemented <strong>in</strong> <strong>the</strong> community us<strong>in</strong>g different<br />

communication tools: from stickers to a film<br />

on prevention, by way of pa<strong>in</strong>ted walls, posters,<br />

T-shirts, etc. Also, <strong>in</strong> some regions where<br />

collective exchanges are part of <strong>the</strong> everyday<br />

culture (community conversations, coffee<br />

ceremonies), <strong>the</strong>se exchanges were used<br />

to present <strong>the</strong> topic of HIV/AIDS prevention.<br />

In <strong>the</strong> same way, collective awareness was<br />

developed through <strong>the</strong> organization of festive<br />

events (circus, concert, etc.) dur<strong>in</strong>g which<br />

awareness messages were communicated.<br />

Specific actions for groups at risk<br />

F<strong>in</strong>ally, some groups considered to be at<br />

greater risk (prostitutes, truck drivers, young<br />

men, etc.) were particularly targeted by<br />

specific activities, such as educational<br />

programs, sem<strong>in</strong>ars, and even condom<br />

distribution, but only where it was culturally<br />

acceptable.<br />

The object of this document is to list pert<strong>in</strong>ent<br />

know-how identified dur<strong>in</strong>g <strong>the</strong> learn<strong>in</strong>g-fromexperience<br />

process for all <strong>the</strong>se different<br />

methods of develop<strong>in</strong>g awareness, which<br />

are complementary to each o<strong>the</strong>r.<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

9


3. Learn<strong>in</strong>g-from-experience process<br />

Part<br />

1<br />

MULTIPLE LEARNING-FROME-EXPERIENCE GOALS<br />

The learn<strong>in</strong>g-from-experience process<br />

(sometimes called “capitalization”) took<br />

place over three months dur<strong>in</strong>g <strong>the</strong> last six<br />

months of this three-year project with <strong>the</strong> help<br />

of an outside person act<strong>in</strong>g as a facilitator.<br />

We def<strong>in</strong>ed three goals for this learn<strong>in</strong>g-fromexperience<br />

process:<br />

d Provide knowledge of <strong>the</strong> overall project<br />

d Describe <strong>the</strong> activities implemented and<br />

<strong>the</strong> tools used<br />

d Provide reusable elements for <strong>the</strong> def<strong>in</strong>ition<br />

and implementation of future projects<br />

CHOICE OF A MAIN THEME FOR LEARNING-FROME-EXPERIENCE<br />

Given <strong>the</strong> scope of <strong>the</strong> project, both <strong>in</strong><br />

geographical terms and concern<strong>in</strong>g <strong>the</strong><br />

diversity of actions undertaken, we thought it<br />

best to limit our choices and to concentrate on<br />

some aspects of <strong>the</strong> project where <strong>in</strong>terest<strong>in</strong>g<br />

know-how had been developed.<br />

Also, s<strong>in</strong>ce <strong>the</strong> goal of learn<strong>in</strong>g-fromexperience<br />

process is to share experience,<br />

<strong>the</strong> topics chosen should allow produc<strong>in</strong>g<br />

reusable know-how for o<strong>the</strong>r projects.<br />

In consequence, <strong>the</strong> choice of capitaliz<strong>in</strong>g on<br />

<strong>the</strong> know-how developed for implement<strong>in</strong>g<br />

community awareness activities was a logical<br />

choice. The development of awareness for this<br />

project was considerable and <strong>the</strong>re is thus<br />

a large amount of know-how to capitalize.<br />

Above all, develop<strong>in</strong>g awareness is a central<br />

aspect of numerous projects <strong>in</strong> different fields,<br />

<strong>in</strong>clud<strong>in</strong>g topics that are far removed from HIV.<br />

Thus, <strong>the</strong> production of knowledge on this<br />

topic can serve as a source of <strong>in</strong>spiration for<br />

many o<strong>the</strong>r development projects.<br />

In addition, we have created two summary<br />

sheets (just a few pages for each) to identify<br />

know-how on two o<strong>the</strong>r aspects of <strong>the</strong><br />

project: establishment of long-last<strong>in</strong>g<br />

cross-border l<strong>in</strong>ks and re<strong>in</strong>forcement of <strong>the</strong><br />

health system. These sheets are also meant<br />

to be sources of <strong>in</strong>spiration for future regional<br />

or cross-border projects or for o<strong>the</strong>r health<br />

projects.<br />

10


A VARIETY OF LEARNING-FROM-EXPERIENCE PRODUCTS<br />

Learn<strong>in</strong>g-from-experience products are varied<br />

and are all found on <strong>the</strong> DVD-ROM, where<br />

<strong>the</strong>y are classified <strong>in</strong> three parts:<br />

d A film present<strong>in</strong>g <strong>the</strong> project to fulfill <strong>the</strong><br />

goal of knowledge<br />

d Learn<strong>in</strong>g-from-experience documents:<br />

- A document analyz<strong>in</strong>g <strong>the</strong> know-how<br />

implemented on <strong>the</strong> topic of “<strong>Anchor<strong>in</strong>g</strong><br />

<strong>Awareness</strong> <strong>in</strong> <strong>the</strong> <strong>Community</strong>” (<strong>the</strong> present<br />

document)<br />

- Learn<strong>in</strong>g-from-experience sheet provid<strong>in</strong>g<br />

know-how on <strong>the</strong> topic of “Facilitat<strong>in</strong>g <strong>the</strong><br />

establishment of long-last<strong>in</strong>g, cross-border<br />

l<strong>in</strong>ks”<br />

- Learn<strong>in</strong>g-from-expere<strong>in</strong>ce sheet provid<strong>in</strong>g<br />

know-how on <strong>the</strong> topic of “Streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong><br />

health system”<br />

d A “Toolbox” conta<strong>in</strong><strong>in</strong>g <strong>the</strong> ma<strong>in</strong> documents<br />

and tools used for <strong>the</strong> project (rationale,<br />

activity reports, communication tools, followup<br />

formats, photos, etc.).<br />

HYBRID LEARNING-FROM-EXPERIENCE METHODOLOGY<br />

Most of <strong>the</strong> work of learn<strong>in</strong>g-from-experience<br />

process was dedicated to analyz<strong>in</strong>g<br />

community awareness activity know-how,<br />

which is presented <strong>in</strong> this document. For this<br />

analysis, <strong>the</strong> methodology chosen <strong>in</strong>cluded<br />

three phases, which sometimes occurred <strong>in</strong><br />

parallel.<br />

Observation, documentary research and<br />

collection of useful tools:<br />

This phase consisted <strong>in</strong> read<strong>in</strong>g different<br />

project documents, which were produced<br />

both at <strong>the</strong> moment of project design (logical<br />

framework and associated narrative) and<br />

dur<strong>in</strong>g project implementation (activity reports,<br />

reference terms and o<strong>the</strong>r reports, mid term<br />

evaluation, etc.).<br />

In addition, for more knowledge of <strong>the</strong> project<br />

and to feed <strong>the</strong> “Toolbox,” <strong>the</strong> different tools<br />

used and produced were reviewed, selected<br />

and classified.<br />

In parallel, observation of activities was<br />

carried out.<br />

On-site activities<br />

This phase consisted <strong>in</strong> collaborat<strong>in</strong>g with<br />

animators on <strong>the</strong> field to provide support<br />

for identification of <strong>the</strong> know-how <strong>the</strong>y used<br />

for <strong>the</strong> project. To do this, we used different<br />

methods:<br />

d Learn<strong>in</strong>g-from-experience workshops,<br />

ei<strong>the</strong>r with animatoranimators teams or with<br />

project advisory committees. The goal of<br />

<strong>the</strong>se workshops was to identify <strong>the</strong> different<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

11


types of know-how by fill<strong>in</strong>g out toge<strong>the</strong>r a<br />

simple learn<strong>in</strong>g-from-experience process<br />

file (<strong>in</strong>clud<strong>in</strong>g four parts: context specificity,<br />

<strong>in</strong>itial conditions required and success factors,<br />

know-how implemented and lessons learned).<br />

d Topical discussions with members of <strong>the</strong> HI<br />

teams and partner associations (for example,<br />

on partnership with <strong>in</strong>stitutional participants,<br />

on partnership with associations, design of<br />

awareness tools, monitor<strong>in</strong>g of activities, etc.).<br />

d Individual <strong>in</strong>terviews with key persons, <strong>in</strong><br />

particular <strong>in</strong>stitutional partners of <strong>the</strong> project<br />

or health professionals who had undergone<br />

tra<strong>in</strong><strong>in</strong>g.<br />

Analysis and preparation<br />

The phase of analysis and writ<strong>in</strong>g, which was<br />

begun <strong>in</strong> parallel with on-site activities, ended<br />

with a series of discussions with persons<br />

outside <strong>the</strong> project. This enabled enrich<strong>in</strong>g our<br />

th<strong>in</strong>k<strong>in</strong>g and led to preparation of collective<br />

know-how materials to enable reuse by<br />

o<strong>the</strong>rs <strong>in</strong> o<strong>the</strong>r contexts.<br />

12


Implement<strong>in</strong>g Know-How Part<br />

2<br />

1. Dar<strong>in</strong>g an orig<strong>in</strong>al awareness program 14<br />

Adapted awareness method 15<br />

A new method 16<br />

Appropriate messengers 17<br />

<strong>Community</strong> leaders as facilitators 19<br />

2. Br<strong>in</strong>g long-last<strong>in</strong>g chance 22<br />

Acceptance of <strong>the</strong> animators 23<br />

Animators and awareness development know-how 25<br />

Invaluable double support for animators 27<br />

Involv<strong>in</strong>g local stakeholders for long-last<strong>in</strong>g change 28<br />

Streng<strong>the</strong>n<strong>in</strong>g partner associations 29<br />

3. Creat<strong>in</strong>g an awarenness environment 31<br />

Varied visual communication tools 32<br />

Popular radio broadcasts 34<br />

Use of traditional group exchange 36<br />

Festive events to convey <strong>the</strong> messages 37<br />

4. Carry<strong>in</strong>g out more precisely targeted actions 39<br />

Special target<strong>in</strong>g of populations at risk 40<br />

Promot<strong>in</strong>g condoms… where it is acceptable to do so 41<br />

13


Part<br />

2<br />

1. Dar<strong>in</strong>g an orig<strong>in</strong>al awareness program<br />

1. Adapted awareness<br />

d Know <strong>the</strong> context very well to chose<br />

<strong>the</strong> appropriate awareness method<br />

d Delimit awareness<br />

d Rely on exist<strong>in</strong>g bases<br />

d Adapt prevention to <strong>the</strong> context<br />

2. A new method<br />

d Become a daily presence<br />

d Promote private di<br />

d Provide complete <strong>in</strong>formation<br />

d Adapt session rhythm<br />

d Measure what is acceptable<br />

3. Appropriate messengers<br />

d Us<strong>in</strong>g pioneers for an <strong>in</strong>novative approach<br />

d Facilitate acceptance by <strong>the</strong> community<br />

d Use <strong>the</strong> expertise of <strong>the</strong> sick as a base<br />

d Demonstrate that this is not just someth<strong>in</strong>g<br />

that happens to o<strong>the</strong>rs<br />

d Tell how a positive life is possible<br />

d Show will<strong>in</strong>gness to discuss<br />

d Social status for HIV + animators<br />

4. <strong>Community</strong> leaders as facilitators<br />

d Respond to a perceived problem<br />

d Conv<strong>in</strong>ce leaders to support <strong>the</strong> project<br />

d Rely on local authorities<br />

d Make <strong>the</strong> project accepted through<br />

<strong>the</strong> leaders<br />

d Call on <strong>the</strong> advisory committee <strong>in</strong> case<br />

of conflict<br />

d Decrease stigmatization us<strong>in</strong>g <strong>the</strong> behavior<br />

of leaders<br />

d Communicate on a large scale through<br />

<strong>the</strong> leaders<br />

d Let <strong>the</strong> project advisory committee<br />

def<strong>in</strong>e priorities<br />

Us<strong>in</strong>g prelim<strong>in</strong>ary studies as a basis for<br />

decision, we chose to carry out an awareness<br />

program with<strong>in</strong> <strong>the</strong> community by means of<br />

an orig<strong>in</strong>al <strong>in</strong>tervention method: “house-tohouse”.<br />

This method is based on <strong>the</strong> activity of<br />

animators who go from house to house, often<br />

spontaneously, to discuss <strong>the</strong> <strong>the</strong>me of HIV<br />

with family members. <strong>Awareness</strong> is thus very<br />

personalized s<strong>in</strong>ce it is encouraged with<strong>in</strong> <strong>the</strong><br />

<strong>in</strong>timate context of <strong>the</strong> home and targets only<br />

a few persons. It enables reach<strong>in</strong>g persons<br />

who are not normally covered by traditional<br />

awareness campaigns, such as young girls<br />

and housewives.<br />

The animators visit each home often, from three<br />

to n<strong>in</strong>e times, depend<strong>in</strong>g on cultural contexts,<br />

<strong>in</strong> order to furnish <strong>in</strong>-depth <strong>in</strong>formation<br />

on <strong>the</strong> disease and ways to prevent it. The<br />

different subjects to be discussed are listed<br />

<strong>in</strong> <strong>the</strong> detailed guide used as a support by<br />

animators.<br />

To carry out this awareness program, animators<br />

were chosen as nearly as possible from with<strong>in</strong><br />

<strong>the</strong> community. In Ethiopia, animators are<br />

<strong>the</strong>mselves HIV +, which was not possible <strong>in</strong><br />

<strong>the</strong> Afar region (Ethiopia) or Somaliland, where<br />

stigmatization is too strong for people liv<strong>in</strong>g<br />

with HIV (PLWHIV) to reveal <strong>the</strong>ir status.<br />

To enable this awareness program to function<br />

at <strong>the</strong> sites chosen, community leaders<br />

served as facilitators for <strong>the</strong>ir communities.<br />

14


ADAPTED AWARENESS METHOD<br />

The choice of this <strong>in</strong>novative method of rais<strong>in</strong>g<br />

awareness by go<strong>in</strong>g from house to house was<br />

based on <strong>in</strong>-depth prelim<strong>in</strong>ary studies. In<br />

addition, subjects targeted by <strong>the</strong> awareness<br />

program were carefully selected. F<strong>in</strong>ally, before<br />

start<strong>in</strong>g <strong>the</strong> program, a guide giv<strong>in</strong>g details on<br />

<strong>the</strong> messages to be delivered for each subject<br />

was drawn up <strong>in</strong> order to serve as a basis for<br />

<strong>the</strong> animators.<br />

Know <strong>the</strong> context very well to chose<br />

<strong>the</strong> appropriate awareness method<br />

Before <strong>the</strong> start of <strong>the</strong> project, we took <strong>the</strong><br />

time to carry out prelim<strong>in</strong>ary studies <strong>in</strong> order<br />

to precisely def<strong>in</strong>e needs, elaborate an<br />

appropriate <strong>in</strong>tervention strategy and collect<br />

data enabl<strong>in</strong>g us to measure project impact.<br />

These studies concerned <strong>the</strong> knowledge,<br />

attitudes, practices and behaviors related<br />

to HIV/AIDS and reproductive and sexual<br />

health, an analysis of prevention and<br />

tra<strong>in</strong><strong>in</strong>g tools, tra<strong>in</strong><strong>in</strong>g needs <strong>in</strong> <strong>the</strong> HIV/AIDS<br />

area <strong>in</strong> health structures and, f<strong>in</strong>ally, HIV/TB<br />

(tuberculosis) co-<strong>in</strong>fection <strong>in</strong> Somaliland.<br />

Thus, <strong>the</strong> choice of carry<strong>in</strong>g out a “house-tohouse”<br />

awareness program rested on solid<br />

knowledge of <strong>the</strong> context and was <strong>in</strong>spired<br />

by recommendations from <strong>the</strong>se studies.<br />

Delimit awareness boundaries<br />

Once <strong>the</strong> awareness strategy was chosen and<br />

before actually start<strong>in</strong>g <strong>the</strong> activities, we carried<br />

out extensive work to choose <strong>the</strong> topics<br />

that would be concerned by <strong>the</strong> awareness<br />

program. In this way, some subjects related<br />

to HIV were withdrawn for cultural reasons,<br />

because <strong>the</strong>y were not pert<strong>in</strong>ent <strong>in</strong> <strong>the</strong> chosen<br />

context or because <strong>the</strong>y were not socially<br />

acceptable.<br />

Once <strong>the</strong> subjects were chosen, a manual was<br />

put toge<strong>the</strong>r to precisely def<strong>in</strong>e <strong>the</strong> notions<br />

to be taught and <strong>the</strong> level of detail required<br />

for each topic.<br />

This manual <strong>the</strong>n served as <strong>the</strong> basis for all<br />

community awareness activities and for tool<br />

production and communication on HIV/AIDS.<br />

Rely on exist<strong>in</strong>g bases<br />

The manual was written at <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />

of <strong>the</strong> project <strong>in</strong> Ethiopia by a project team<br />

committee. For its preparation, group<br />

members chose to use already exist<strong>in</strong>g<br />

analyses and documents written by experts on<br />

<strong>the</strong> subject. To beg<strong>in</strong> with, <strong>the</strong>y were <strong>in</strong>spired<br />

by Ethiopian specifications for <strong>the</strong> tra<strong>in</strong><strong>in</strong>g<br />

of peer educators on <strong>the</strong> topic of HIV. After<br />

select<strong>in</strong>g n<strong>in</strong>e priority awareness topics, <strong>the</strong><br />

writ<strong>in</strong>g committee turned aga<strong>in</strong> to exist<strong>in</strong>g<br />

documents, such as communication<br />

supports collected from different stakeholders<br />

<strong>in</strong> <strong>the</strong> fight aga<strong>in</strong>st AIDS, <strong>in</strong> order to describe<br />

each topic <strong>in</strong> detail for <strong>the</strong> manual.<br />

Adapt prevention to <strong>the</strong> context<br />

To create a tra<strong>in</strong><strong>in</strong>g manual for animators<br />

that was adapted to Somaliland, it was<br />

necessary to use <strong>the</strong> orig<strong>in</strong>al manual<br />

written <strong>in</strong> Ethiopia. But for this manual to be<br />

accepted <strong>in</strong> Somaliland, it was necessary<br />

to withdraw some topics that would not<br />

have been accepted <strong>in</strong> <strong>the</strong> country’s cultural<br />

context (promotion of condom use, mentions<br />

of homosexuality, etc.). In addition, so that <strong>the</strong><br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

15


animators and <strong>in</strong>habitants of <strong>the</strong> region would<br />

feel concerned by <strong>the</strong> <strong>in</strong>formation delivered,<br />

a number of case studies were <strong>in</strong>vented to<br />

illustrate <strong>the</strong> manual, us<strong>in</strong>g local place names<br />

and Somali first names that are common <strong>in</strong> <strong>the</strong><br />

region concerned.<br />

A NEW METHOD<br />

Become a daily presence<br />

By do<strong>in</strong>g this house-to-house work <strong>in</strong> an<br />

everyday environment, with animators present<br />

three times a week for three years, not only did<br />

<strong>the</strong> awareness program become accepted,<br />

it even came to be considered as a normal<br />

activity <strong>in</strong> <strong>the</strong> community.<br />

Promote private discussion<br />

In contrast to <strong>the</strong> methods of mass awareness<br />

programs, this house-to-house work enables<br />

meet<strong>in</strong>g with people <strong>in</strong> <strong>the</strong>ir homes, <strong>in</strong> a<br />

context where <strong>the</strong>y are at ease and surrounded<br />

by close relatives <strong>in</strong> front of whom <strong>the</strong>y can<br />

talk freely and ask <strong>the</strong> questions <strong>the</strong>y want to<br />

ask.<br />

“When people are at home, <strong>the</strong>y speak more<br />

openly and dare to ask questions; <strong>the</strong>y dare<br />

to confide <strong>in</strong> <strong>the</strong> animatoranimator. They have<br />

noth<strong>in</strong>g to hide.” 4<br />

Provide complete <strong>in</strong>formation<br />

We decided to provide <strong>in</strong>-depth <strong>in</strong>formation<br />

that was as complete as possible on <strong>the</strong><br />

topics chosen to persons who were be<strong>in</strong>g<br />

made aware. Rais<strong>in</strong>g awareness <strong>in</strong> a home<br />

was done <strong>in</strong> various sessions <strong>in</strong> order to cover<br />

<strong>the</strong> n<strong>in</strong>e chapters on <strong>the</strong> disease (<strong>the</strong> bases of<br />

HIV/AIDS, ways of transmission, how <strong>the</strong> virus<br />

cannot be transmitted, ways of prevention,<br />

etc.). Br<strong>in</strong>g<strong>in</strong>g complete <strong>in</strong>formation on <strong>the</strong><br />

disease enabled people to feel truly <strong>in</strong>formed<br />

and to have enough knowledge to choose<br />

<strong>the</strong>ir prevention method by <strong>the</strong>mselves,<br />

request test<strong>in</strong>g, etc.<br />

SUCCESS STORY:<br />

THE COMMUNITY DEMANDED<br />

ANIMATORS WHEN THEY WERE<br />

ABSENT!<br />

When <strong>Handicap</strong> <strong>International</strong> changed<br />

its partner association <strong>in</strong> <strong>the</strong> Somali<br />

region, animators were <strong>in</strong>active for a<br />

period of three months. At Ayesha,<br />

a small village near Dire Dawa, <strong>the</strong><br />

animators were scolded by everyone:<br />

“Well, where have you been? Why<br />

aren’t you work<strong>in</strong>g any more? You must<br />

cont<strong>in</strong>ue to act for <strong>the</strong> community!”<br />

The community obviously missed<br />

<strong>the</strong>m and had become accustomed to<br />

<strong>the</strong>ir presence!<br />

Adapt session rhythm<br />

Depend<strong>in</strong>g on <strong>the</strong> area, house-to-house<br />

awareness strategies differed accord<strong>in</strong>g to<br />

cultural habits. For example, at Dire Dawa <strong>the</strong><br />

animators went n<strong>in</strong>e times to each house but<br />

stayed no longer than 20 m<strong>in</strong>utes. O<strong>the</strong>rwise,<br />

people became bored. In contrast, <strong>in</strong> <strong>the</strong> Afar<br />

region animators went no more than three<br />

times to each home, often rema<strong>in</strong><strong>in</strong>g for<br />

more than an hour. In part of this region, it<br />

is difficult to set up appo<strong>in</strong>tments because <strong>the</strong><br />

people are very mobile (nomad culture, need<br />

to travel some distance to obta<strong>in</strong> water, etc.).<br />

In addition, Afar residents are very culturally<br />

attuned to receiv<strong>in</strong>g <strong>in</strong>formation; <strong>the</strong>y can<br />

rema<strong>in</strong> for hours listen<strong>in</strong>g to a animator who<br />

4. Legesse Mulisa, member of <strong>the</strong> Dire Dawa Project Advisory Committee with <strong>the</strong> status of village elder.<br />

16


has come as a “dagou” (mean<strong>in</strong>g “bearer<br />

of <strong>in</strong>formation” <strong>in</strong> <strong>the</strong> Afar language). This is<br />

<strong>the</strong> opposite of Dire Dawa residents, who tire<br />

easily if a conversation takes too long.<br />

Measure what is acceptable<br />

In Somaliland, <strong>the</strong> house-to-house awareness<br />

program was supported by community<br />

elders, who accepted HIV/AIDS to be spoken<br />

about because <strong>the</strong>y knew it was a problem<br />

for <strong>the</strong> community. They strongly supported<br />

awareness, on <strong>the</strong> condition that <strong>the</strong>re would<br />

be no promotion of condom use. Contrary<br />

to what was done <strong>in</strong> Ethiopia, <strong>the</strong>re was<br />

no mention or promotion of condoms <strong>in</strong><br />

Somaliland, s<strong>in</strong>ce this was not considered as<br />

socially acceptable.<br />

APPROPRIATE MESSENGERS<br />

Once <strong>the</strong> outl<strong>in</strong>es of <strong>the</strong> awareness effort were<br />

well def<strong>in</strong>ed, it was necessary to choose <strong>the</strong><br />

most pert<strong>in</strong>ent animators for this task. At all<br />

<strong>in</strong>tervention sites, <strong>the</strong>y were selected as nearly<br />

as possible from with<strong>in</strong> <strong>the</strong> community itself.<br />

However, <strong>the</strong>ir profile could vary accord<strong>in</strong>g<br />

to <strong>the</strong> context. For example, <strong>in</strong> Ethiopia,<br />

animators were all HIV + and often older than<br />

forty. But <strong>in</strong> Somaliland <strong>the</strong> disease rema<strong>in</strong>s<br />

highly stigmatized and very few persons reveal<br />

<strong>the</strong>ir status; it was thus difficult to f<strong>in</strong>d HIV +<br />

animators. In consequence, leaders were<br />

chosen from young people <strong>in</strong> <strong>the</strong> community.<br />

In all countries and regions, animators carried<br />

out <strong>the</strong>ir activity part-time for a few days a week<br />

and received a salary. At all sites, it was decided<br />

to encourage an almost daily presence of <strong>the</strong><br />

animators. Thus, <strong>in</strong> Somaliland new animators<br />

were recruited from with<strong>in</strong> <strong>the</strong> community<br />

after <strong>the</strong> program had started to streng<strong>the</strong>n<br />

<strong>the</strong> exist<strong>in</strong>g team, who were too few to ensure<br />

daily awareness <strong>in</strong>itiatives simultaneously at all<br />

sites.<br />

Us<strong>in</strong>g pioneers for an <strong>in</strong>novative approach<br />

In Ethiopia, animators were often among <strong>the</strong><br />

first <strong>in</strong> <strong>the</strong>ir community to declare <strong>the</strong>ir HIV<br />

status and take responsibility for <strong>the</strong>ir status.<br />

For <strong>the</strong> <strong>in</strong>novative house-to-house approach,<br />

we could thus count on <strong>the</strong>se brave people,<br />

who were pioneers <strong>in</strong> declar<strong>in</strong>g <strong>the</strong>ir HIV<br />

status. In Somaliland, where <strong>the</strong> PLWHIV do<br />

not reveal <strong>the</strong>ir status, young people were<br />

chosen because <strong>the</strong>y accepted to talk about<br />

AIDS, which was still taboo for <strong>the</strong>ir elders.<br />

Facilitate acceptance by <strong>the</strong> community<br />

The fact that <strong>the</strong> animators were <strong>the</strong>mselves<br />

members of <strong>the</strong> community where <strong>the</strong>y<br />

worked greatly facilitated <strong>the</strong>ir acceptance<br />

by families for carry<strong>in</strong>g out <strong>the</strong> awareness<br />

program, s<strong>in</strong>ce <strong>the</strong>y came “as neighbors”. In<br />

Somaliland, for example, <strong>the</strong> community had a<br />

benevolent view of this project, which allowed<br />

some of <strong>the</strong> younger members to work. It was<br />

thus well received, whereas <strong>the</strong> community<br />

would probably have refused to listen to<br />

strangers speak<strong>in</strong>g on <strong>the</strong> subject of HIV.<br />

Use <strong>the</strong> expertise of <strong>the</strong> sick as a base<br />

In Ethiopia, persons liv<strong>in</strong>g with HIV were <strong>the</strong><br />

ones who educated <strong>the</strong> community. Be<strong>in</strong>g<br />

HIV + made it legitimate for <strong>the</strong>m to speak<br />

about <strong>the</strong> disease, its consequences and <strong>the</strong><br />

ways it is treated, s<strong>in</strong>ce <strong>the</strong>y live with it every<br />

day. Animators were thus liv<strong>in</strong>g witnesses<br />

and for this reason were listened to very<br />

attentively. Their experience was a conv<strong>in</strong>c<strong>in</strong>g<br />

17


SUCCESS STORY:<br />

AWARENESS THAT ALLOWED A REAL DROP IN STIGMATIZATION<br />

Before, people <strong>in</strong> <strong>the</strong> village rejected us, especially on market days when a lot of<br />

people who knew noth<strong>in</strong>g about <strong>the</strong> disease came <strong>in</strong> from <strong>the</strong> country. They refused<br />

to come near us and threw stones at us. People were afraid to get AIDS just by<br />

look<strong>in</strong>g at us! But now that people know about how <strong>the</strong> disease is transmitted, <strong>the</strong>y<br />

are no longer afraid of us and even shake our hand without a problem.<br />

testimony to <strong>the</strong> reality of <strong>the</strong> disease and<br />

<strong>the</strong> effectiveness of treatment, and thus of<br />

<strong>the</strong> importance of know<strong>in</strong>g one’s status.<br />

“It’s my own experience, <strong>the</strong> fact that <strong>the</strong>y saw<br />

me very sick and that now I am healed thanks to<br />

<strong>the</strong> medic<strong>in</strong>es: this is what opens <strong>the</strong>ir doors.<br />

It’s one of <strong>the</strong> ma<strong>in</strong> reasons <strong>the</strong>y believe me.” 5<br />

Demonstrate that this is not just someth<strong>in</strong>g<br />

that happens to o<strong>the</strong>rs<br />

In a context of strong denial of <strong>the</strong> disease,<br />

enabl<strong>in</strong>g community members to talk about<br />

<strong>the</strong>ir HIV status has demonstrated that<br />

everyone can be affected, <strong>in</strong>dependently of<br />

religion, sex or physical appearance:<br />

“By hav<strong>in</strong>g <strong>the</strong> fat, <strong>the</strong> young and <strong>the</strong> old,<br />

Muslim or not, tell about <strong>the</strong>ir experience,<br />

we showed to what extent everyone can be<br />

affected and conv<strong>in</strong>ced accord<strong>in</strong>gly.” 6<br />

Tell how a positive life is possible<br />

The animators <strong>in</strong>fected with <strong>the</strong> virus told<br />

about <strong>the</strong>ir own lifestyle and how it is possible<br />

to live with <strong>the</strong> virus <strong>in</strong> a positive way, to be<br />

<strong>in</strong> good health, active and self-esteemed,<br />

with a satisfy<strong>in</strong>g trade. These personal stories<br />

allowed strongly decreas<strong>in</strong>g <strong>the</strong> fear of be<strong>in</strong>g<br />

tested and of discover<strong>in</strong>g that one carries<br />

<strong>the</strong> virus, because persons who were made<br />

aware no longer saw HIV status as <strong>the</strong> end of<br />

everyth<strong>in</strong>g.<br />

“People realize that you can live with HIV. When<br />

<strong>the</strong>y listen to us tell about our disease, about<br />

our life, <strong>the</strong>y learn many th<strong>in</strong>gs from us. Some<br />

will follow up by be<strong>in</strong>g tested, <strong>the</strong>n reveal <strong>the</strong>ir<br />

status and take antiretroviral medic<strong>in</strong>es.” 7<br />

Show will<strong>in</strong>gness to discuss<br />

Dur<strong>in</strong>g <strong>the</strong>ir house-to-house work, <strong>the</strong><br />

animators must also be available to talk about<br />

<strong>the</strong> disease with anyone who wants to. For<br />

this reason, <strong>the</strong>y wear a T-shirt stat<strong>in</strong>g: “I am<br />

a animator: if you have questions about AIDS,<br />

just ask me!”<br />

Social status for HIV + animators<br />

Because of <strong>the</strong>ir participation <strong>in</strong> <strong>the</strong> awareness<br />

program, animators enjoyed a new social<br />

status. In Ethiopia, most of <strong>the</strong> leaders had been<br />

rejected by <strong>the</strong> community when <strong>the</strong>y revealed<br />

<strong>the</strong>ir HIV status. Through <strong>the</strong>ir work, <strong>the</strong>y were<br />

recognized for <strong>the</strong>ir role as educators who<br />

provided <strong>in</strong>-depth knowledge of <strong>the</strong> disease.<br />

In addition, be<strong>in</strong>g a leader meant earn<strong>in</strong>g a<br />

salary and be<strong>in</strong>g able to support a family.<br />

5. Aynaiem Tamirat, animator at Dire Dawa, Kebele 05<br />

6. Hassen Duale, animator at Ayesha<br />

7. Hana Mamo, , member of <strong>the</strong> partner association of persons liv<strong>in</strong>g with HIV and of <strong>the</strong> Dire Dawa project advisory committee<br />

18


COMMUNITY LEADERS AS FACILITATORS<br />

To be able to talk about such a sensitive<br />

subject <strong>in</strong> a cultural context of denial<br />

and stigmatization, we needed to rely on<br />

community leaders to support <strong>the</strong> animators.<br />

To do this, community leaders were called<br />

on to form “project advisory committees”<br />

at each <strong>in</strong>tervention site. Composed of<br />

<strong>in</strong>fluential members of <strong>the</strong> community, <strong>the</strong>se<br />

committees were responsible for help<strong>in</strong>g to<br />

def<strong>in</strong>e <strong>the</strong> <strong>in</strong>tervention strategy that was<br />

most appropriate locally, <strong>in</strong>form<strong>in</strong>g <strong>the</strong><br />

community about <strong>the</strong> project and its activities<br />

and support<strong>in</strong>g animators <strong>in</strong> case of conflict.<br />

In Ethiopia, <strong>the</strong>se committees were made up<br />

of a dozen members designated by a local<br />

authority (<strong>the</strong> “kebele”), who was careful<br />

to <strong>in</strong>clude representatives of each religion,<br />

women’s associations, young people, and<br />

local political personalities. In Somaliland,<br />

<strong>the</strong>se advisory committees were made up of<br />

<strong>the</strong> two most <strong>in</strong>fluential community leaders.<br />

Whatever <strong>the</strong>ir form, <strong>the</strong>se committees enabled<br />

project acceptance by <strong>the</strong> community and<br />

made possible <strong>the</strong> daily house-to-house<br />

activity of <strong>the</strong> animators.<br />

Respond to a perceived problem<br />

The different community leaders had become<br />

<strong>in</strong>creas<strong>in</strong>gly aware that it was necessary to fight<br />

aga<strong>in</strong>st AIDS; however, <strong>the</strong>y found <strong>the</strong>mselves<br />

powerless to do so s<strong>in</strong>ce <strong>the</strong>y did not know<br />

how to make <strong>the</strong> community aware. Thus,<br />

<strong>the</strong>y received this project very favorably<br />

and were happy that it enabled gett<strong>in</strong>g rid<br />

of <strong>the</strong> taboo and <strong>the</strong> silence surround<strong>in</strong>g <strong>the</strong><br />

disease. In addition, <strong>the</strong> project allowed <strong>the</strong>m<br />

to participate without be<strong>in</strong>g on <strong>the</strong> front l<strong>in</strong>e,<br />

s<strong>in</strong>ce <strong>the</strong> animators were responsible for<br />

awareness <strong>in</strong> <strong>the</strong> field. For <strong>the</strong>se reasons,<br />

community leaders became actively <strong>in</strong>volved <strong>in</strong><br />

support<strong>in</strong>g <strong>the</strong> project and mak<strong>in</strong>g it accepted<br />

by <strong>the</strong> community.<br />

Conv<strong>in</strong>ce leaders to support <strong>the</strong> project<br />

In Somaliland, tra<strong>in</strong><strong>in</strong>g was proposed to motivate<br />

community leaders who were designated to<br />

become part of an advisory committee. Dur<strong>in</strong>g<br />

two days, <strong>the</strong>y acquired basic knowledge of<br />

HIV/AIDS and of <strong>the</strong> project itself; this was<br />

followed by a period of discussion on <strong>the</strong><br />

topic, “What can you do for your community<br />

concern<strong>in</strong>g <strong>the</strong> HIV/AIDS problem?” Next, we<br />

proposed that <strong>the</strong>y play a support<strong>in</strong>g role for<br />

animators <strong>in</strong> <strong>the</strong>ir community by form<strong>in</strong>g a<br />

project advisory committee. All participat<strong>in</strong>g<br />

leaders accepted do<strong>in</strong>g this and proved to be<br />

effective channels for promot<strong>in</strong>g awareness<br />

with<strong>in</strong> <strong>the</strong> community.<br />

Rely on local authorities<br />

In Ethiopia, we called on <strong>the</strong> “kebele,” <strong>the</strong><br />

local authority at <strong>the</strong> neighborhood level, to<br />

select community leaders to make up <strong>the</strong><br />

project advisory committee. We advised him<br />

to choose <strong>the</strong>m so that different segments of<br />

<strong>the</strong> population would be represented: women,<br />

young people, each religious community,<br />

elders, etc. However, <strong>the</strong> f<strong>in</strong>al decision<br />

concern<strong>in</strong>g <strong>the</strong> composition of <strong>the</strong> project<br />

advisory committee would be up to <strong>the</strong> kebele<br />

himself.<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

19


SUCCESS STORY:<br />

LEADERS THAT LET THEMSELVES BE CONVINCED<br />

At <strong>the</strong> start of <strong>the</strong> workshop with community leaders, one of <strong>the</strong> Muslim leaders<br />

affirmed that <strong>the</strong> disease could not affect Muslims by say<strong>in</strong>g to <strong>the</strong> o<strong>the</strong>rs, “This<br />

disease is your problem; you are <strong>the</strong> ones who are <strong>in</strong>fect<strong>in</strong>g yourselves. You need<br />

only dr<strong>in</strong>k camel’s milk to keep it away.” Then, at <strong>the</strong> end of <strong>the</strong> day, conv<strong>in</strong>ced by <strong>the</strong><br />

different <strong>in</strong>terventions, testimonials and discussions, he asked <strong>the</strong> group’s forgiveness<br />

for his reaction dur<strong>in</strong>g <strong>the</strong> morn<strong>in</strong>g. In addition, after this awareness workshop, six of<br />

<strong>the</strong> leaders present went to be tested over <strong>the</strong> follow<strong>in</strong>g days.<br />

Make <strong>the</strong> project accepted<br />

through <strong>the</strong> leaders<br />

Even <strong>in</strong> <strong>the</strong> presence of strong denial, people<br />

will accept <strong>the</strong> awareness program because of<br />

<strong>the</strong> presence of <strong>the</strong> project advisory committee.<br />

S<strong>in</strong>ce <strong>the</strong> members of this committee are<br />

leaders, <strong>the</strong>ir arguments are listened to and<br />

respected.<br />

To ensure project acceptance, project<br />

advisory committee members sometimes<br />

accompanied <strong>the</strong> animators on <strong>the</strong>ir houseto-house<br />

visits, ei<strong>the</strong>r to conv<strong>in</strong>ce <strong>the</strong> family to<br />

welcome <strong>the</strong> animator or to provide translation<br />

services at <strong>the</strong> start, if necessary, or simply to<br />

express <strong>the</strong>ir support of <strong>the</strong> project.<br />

In addition, project advisory committee<br />

members prepared communities for <strong>the</strong><br />

project by speak<strong>in</strong>g to <strong>the</strong>m, <strong>in</strong> particular<br />

when animators wished to visit a “hostile”<br />

area, where stigmatization was very strong or<br />

where people refused to open <strong>the</strong>ir doors to<br />

HIV + animators.<br />

“Now that we have conv<strong>in</strong>ced <strong>the</strong>m, people say<br />

<strong>the</strong> animators can come any time, whenever<br />

<strong>the</strong>y want to.” 8<br />

Call on <strong>the</strong> advisory committee<br />

<strong>in</strong> case of conflict<br />

As <strong>in</strong>fluential persons <strong>in</strong> <strong>the</strong> community,<br />

advisory committee members were very useful<br />

for resolv<strong>in</strong>g conflicts encountered by <strong>the</strong><br />

animators. If a person at home was reluctant<br />

to speak with a animator, <strong>the</strong> conflict was<br />

generally resolved through <strong>the</strong> <strong>in</strong>tervention of<br />

one of <strong>the</strong>se leaders, who accompanied <strong>the</strong><br />

animator to <strong>the</strong> home to discuss <strong>the</strong> importance<br />

of awareness and to provide support.<br />

“When <strong>the</strong> project advisory committee was<br />

created and signed an agreement with HI, all<br />

doors were opened.” 9<br />

Decrease stigmatization us<strong>in</strong>g<br />

<strong>the</strong> behavior of leaders<br />

Daily behavior of leaders around PLWHIV<br />

persons served as an example and was enough<br />

to lower <strong>the</strong> rate of fear and stigmatization.<br />

For example, <strong>the</strong> fact that community leaders<br />

accompanied animators or shook <strong>the</strong>ir hand<br />

was enough to demonstrate that <strong>the</strong>se<br />

animators were not dangerous to be around<br />

and that say<strong>in</strong>g hello to <strong>the</strong>m would not cause<br />

<strong>in</strong>fection with AIDS.<br />

Communicate on a large scale<br />

through <strong>the</strong> leaders<br />

The leaders communicated on <strong>the</strong> project<br />

as part of <strong>the</strong>ir activities: dur<strong>in</strong>g religious<br />

services for religious leaders or dur<strong>in</strong>g<br />

associational or social activities for <strong>the</strong> o<strong>the</strong>r<br />

leaders. For example, at project launch, <strong>the</strong><br />

religious leaders spoke about <strong>the</strong> project to<br />

<strong>the</strong>ir different congregations and encouraged<br />

8. Yusuf Hassen, Dire Dawa Project Advisory Committee member and mosque representative<br />

9. Hiwot Taddess, animator at Dire Dawa, Kebele 06<br />

20


people to receive <strong>the</strong> animators by expla<strong>in</strong><strong>in</strong>g:<br />

“Five animators tra<strong>in</strong>ed by <strong>Handicap</strong><br />

<strong>International</strong> will be com<strong>in</strong>g to visit your homes;<br />

dp not close <strong>the</strong> door to <strong>the</strong>m.” 10<br />

In a similar manner, dur<strong>in</strong>g public events <strong>the</strong><br />

leaders relayed <strong>in</strong>formation on program<br />

dates, location and reasons for participat<strong>in</strong>g <strong>in</strong><br />

order to motivate <strong>the</strong> people present.<br />

Let <strong>the</strong> project advisory committee<br />

def<strong>in</strong>e priorities<br />

At some sites, leaders carefully monitored <strong>the</strong><br />

areas covered by <strong>the</strong> awareness program.<br />

Three morn<strong>in</strong>gs a week, advisory committee<br />

members met with <strong>the</strong> animators and <strong>in</strong>dicated<br />

<strong>the</strong> neighborhoods to cover, preferably<br />

choos<strong>in</strong>g risky areas (with lots of hotels, bars<br />

and bus<strong>in</strong>esses).<br />

10. Hiwot Taddess, animator at Dire Dawa, Kebele 06<br />

21


2. Br<strong>in</strong>g<strong>in</strong>g long-last<strong>in</strong>g change<br />

Part<br />

2<br />

1. Acceptance of <strong>the</strong> animators<br />

d Be patient<br />

d Do not become discouraged<br />

about contact<strong>in</strong>g people<br />

d Discourage criticism by stay<strong>in</strong>g<br />

d Encourage identification of <strong>the</strong> animator<br />

as a “peer”<br />

d Negotiate without forc<strong>in</strong>g<br />

d Rely on community leaders<br />

<strong>in</strong> case of conflict<br />

d Ma<strong>in</strong>ta<strong>in</strong> an on-go<strong>in</strong>g relationship<br />

with leaders<br />

2. Animators and awareness development<br />

know-how<br />

d Smooth <strong>the</strong> approach and <strong>the</strong> first moments<br />

of discussion<br />

d Choose ears that are ready to hear<br />

d Choose <strong>the</strong> best time for develop<strong>in</strong>g<br />

awareness<br />

d Conv<strong>in</strong>ce at least one person<br />

d Separate men and women to speak<br />

with more freedom<br />

d Listen well and discuss without be<strong>in</strong>g<br />

d Adapt <strong>the</strong> level of <strong>in</strong>formation to <strong>the</strong> level<br />

of exist<strong>in</strong>g knowledge<br />

d Use <strong>the</strong> guide and adapt it as needed<br />

d Be sure each word is understood<br />

d Use chance encounters to identify<br />

persons at risk<br />

3. Invaluable double support for animators<br />

d Ma<strong>in</strong>ta<strong>in</strong> regularity and coherence<br />

with double monitor<strong>in</strong>g<br />

d Get an overall view of neighborhood<br />

awareness<br />

d Be an available partner<br />

d Support animators with regular shar<strong>in</strong>g<br />

d Use experienced animators to tra<strong>in</strong><br />

new ones<br />

4. Involv<strong>in</strong>g local stakeholders<br />

for long-last<strong>in</strong>g change<br />

d Encourage adoption of <strong>the</strong> cause<br />

by community leaders<br />

d Anchor <strong>the</strong> topic permanently<br />

by <strong>in</strong>volv<strong>in</strong>g community members<br />

d Streng<strong>the</strong>n community<br />

d Reach o<strong>the</strong>r social areas through <strong>the</strong> leaders<br />

5. Streng<strong>the</strong>n<strong>in</strong>g partner associations<br />

d Use partner knowledge<br />

d Provide partners with reusable tools<br />

d Provide tra<strong>in</strong><strong>in</strong>g adapted to needs<br />

d Tra<strong>in</strong> by do<strong>in</strong>g<br />

d Know how to say what’s wrong<br />

d Delegate more or less<br />

d F<strong>in</strong>d regular occasions for discussion<br />

d Jo<strong>in</strong> forces to enable ambitious action<br />

22


Through house-to-house awareness<br />

development, as it was done on this project,<br />

<strong>the</strong> number of persons contacted could seem<br />

ra<strong>the</strong>r low. However, after three years of <strong>the</strong><br />

awareness program, change <strong>in</strong> <strong>the</strong> community<br />

was palpable: stigmatization and denial of <strong>the</strong><br />

disease had strongly decreased, knowledge<br />

of <strong>the</strong> disease had become generalized and<br />

PLWHIV had rega<strong>in</strong>ed a social status.<br />

The daily activity of <strong>the</strong> animators allowed<br />

contact<strong>in</strong>g a large number of persons <strong>in</strong> an<br />

efficient way, thanks to <strong>the</strong> know-how <strong>the</strong>y<br />

had developed throughout <strong>the</strong> project.<br />

In addition, <strong>the</strong> effectiveness of <strong>the</strong>ir work<br />

was <strong>in</strong>creased as <strong>the</strong>y were followed and<br />

supported by <strong>the</strong> association of PLWHIV , a<br />

local partner of <strong>Handicap</strong> <strong>International</strong>, as well<br />

as <strong>the</strong> project advisory committee of <strong>the</strong><br />

village where <strong>the</strong>y <strong>in</strong>tervened.<br />

This double implication also had <strong>the</strong> great<br />

advantage of rais<strong>in</strong>g <strong>the</strong> awareness of and<br />

implicat<strong>in</strong>g community resource persons,<br />

<strong>the</strong>reby creat<strong>in</strong>g long-last<strong>in</strong>g change for<br />

<strong>the</strong>se persons concern<strong>in</strong>g <strong>the</strong> disease and its<br />

portrayal.<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

ACCEPTANCE OF THE ANIMATORS<br />

In a context of disease denial, mak<strong>in</strong>g multiple<br />

visits to each home to speak of HIV/AIDS was<br />

not easy, particularly <strong>in</strong> Ethiopia, where <strong>the</strong><br />

animators were <strong>the</strong>mselves HIV +. Thus, one<br />

of <strong>the</strong> biggest difficulties encountered by <strong>the</strong><br />

animators was to succeed <strong>in</strong> be<strong>in</strong>g accepted<br />

<strong>in</strong>side <strong>the</strong> homes.<br />

Be patient<br />

Project acceptation was not easy. Very often,<br />

<strong>in</strong>habitants did not want to talk about <strong>the</strong><br />

subject; some of <strong>the</strong>m refused to even get<br />

close to or talk to <strong>the</strong> HIV + animators. In many<br />

homes, <strong>the</strong> animators were obliged to return<br />

patiently a number of times before be<strong>in</strong>g<br />

able to start a discussion.<br />

“At <strong>the</strong> start of <strong>the</strong> awareness program <strong>in</strong> <strong>the</strong><br />

village, it was hard, but we stayed with it. Little<br />

by little, we were accepted. No one chases us<br />

away any more, and <strong>the</strong>y accept open<strong>in</strong>g <strong>the</strong>ir<br />

doors to us and listen<strong>in</strong>g to us.” 11<br />

Do not become discouraged<br />

about contact<strong>in</strong>g people<br />

To establish contact with a home, it was<br />

sometimes necessary to be very persever<strong>in</strong>g,<br />

because people were not necessarily available<br />

at <strong>the</strong> proper time.<br />

“If we set up an appo<strong>in</strong>tment, <strong>the</strong>y didn’t keep<br />

it because we weren’t a priority for <strong>the</strong>m. So,<br />

we went by from time to time unannounced<br />

and didn’t become discouraged if <strong>the</strong>y were<br />

absent or busy. We went as often as we had to<br />

until we were able to contact <strong>the</strong>m.” 12<br />

Discourage criticism by stay<strong>in</strong>g calm<br />

At <strong>the</strong> start, animators were accused of<br />

participat<strong>in</strong>g <strong>in</strong> <strong>the</strong> program for <strong>the</strong> money<br />

only, but <strong>the</strong>y chose to ignore <strong>the</strong>se dismissive<br />

remarks. They cont<strong>in</strong>ued to carry out <strong>the</strong><br />

program for <strong>the</strong>se persons as if <strong>the</strong>y had made<br />

no comments. By stay<strong>in</strong>g calm and strongly<br />

committ<strong>in</strong>g to <strong>the</strong> program, <strong>the</strong>y managed to<br />

11. Bezuye Shiferaw, animator at Sh<strong>in</strong>ile<br />

12. Aynalem Bekele, animator at Togochale<br />

23


w<strong>in</strong> <strong>the</strong> trust of <strong>the</strong> skeptics.<br />

“Before, nobody would come close. We were<br />

even rejected because of our HIV status. But<br />

<strong>the</strong>y realized how brave we were <strong>in</strong> reveal<strong>in</strong>g<br />

our status and work<strong>in</strong>g on <strong>the</strong> program. This<br />

gives us <strong>the</strong> right to be part of <strong>the</strong> community<br />

aga<strong>in</strong>.” 13<br />

Encourage identification<br />

of <strong>the</strong> animator as a “peer”<br />

So that animators would be well perceived and<br />

thus listened to <strong>in</strong> <strong>the</strong> home, <strong>the</strong> team tried to<br />

ensure that a animator would be of <strong>the</strong> same<br />

orig<strong>in</strong>, or, if necessary, be accompanied by<br />

a person from <strong>the</strong> same region as <strong>the</strong> family.<br />

Thus, <strong>the</strong> animators held sessions as frequently<br />

as possible <strong>in</strong> <strong>the</strong> language of <strong>the</strong> home.<br />

Negotiate without forc<strong>in</strong>g<br />

If a home refused to meet with <strong>the</strong>m to<br />

talk about <strong>the</strong> disease, <strong>the</strong> animators<br />

attempted negotiat<strong>in</strong>g to conv<strong>in</strong>ce <strong>the</strong>m, but<br />

without <strong>in</strong>sist<strong>in</strong>g too much <strong>in</strong> order to avoid<br />

confrontation. In <strong>the</strong> case of a refusal, <strong>the</strong>y were<br />

sometimes led to term<strong>in</strong>ate <strong>the</strong> discussion to<br />

avoid aggravat<strong>in</strong>g <strong>the</strong> relationship or produc<strong>in</strong>g<br />

total rejection on <strong>the</strong> part of <strong>the</strong>ir contacts.<br />

Animators <strong>the</strong>n <strong>in</strong>formed <strong>the</strong> contacts that <strong>the</strong>y<br />

would come by <strong>the</strong> follow<strong>in</strong>g day to talk about<br />

<strong>the</strong> subject. Little by little and thanks to calm<br />

discussions, most homes f<strong>in</strong>ally accepted to<br />

meet with <strong>the</strong> animators.<br />

Rely on community leaders<br />

<strong>in</strong> case of conflict<br />

In <strong>the</strong> case of total refusal or conflict with<br />

a family <strong>in</strong> spite of negotiation efforts, <strong>the</strong><br />

animators would call on members of <strong>the</strong><br />

project advisory committee. As community<br />

leaders, <strong>the</strong>se persons often found a way to<br />

lessen reluctance on <strong>the</strong> part of <strong>the</strong> family,<br />

for example by act<strong>in</strong>g as mediators and<br />

accompany<strong>in</strong>g <strong>the</strong> animator on visits and by<br />

expla<strong>in</strong><strong>in</strong>g to <strong>the</strong> family <strong>the</strong> importance of<br />

awareness.<br />

Ma<strong>in</strong>ta<strong>in</strong> an on-go<strong>in</strong>g relationship<br />

with leaders<br />

The support of <strong>the</strong> project advisory committee<br />

was fundamental <strong>in</strong> mak<strong>in</strong>g <strong>the</strong> project accepted<br />

<strong>in</strong> <strong>the</strong> community and <strong>in</strong> resolv<strong>in</strong>g conflicts<br />

encountered by <strong>the</strong> animators. For <strong>the</strong>se<br />

animators it was thus important to ma<strong>in</strong>ta<strong>in</strong><br />

an on-go<strong>in</strong>g relationship with community<br />

leaders on <strong>the</strong> committee. Depend<strong>in</strong>g on <strong>the</strong><br />

site, this relationship was more or less formal<br />

and ma<strong>in</strong>ta<strong>in</strong>ed ei<strong>the</strong>r by regularly scheduled<br />

weekly meet<strong>in</strong>gs or by unplanned encounters.<br />

But <strong>in</strong> all cases, <strong>the</strong>se exchanges between<br />

animators and <strong>the</strong> advisory committee were<br />

frequent and enabled ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g strong<br />

commitment from <strong>the</strong> leaders.<br />

13. Emebet Yosef, animator at Hurso<br />

24


ANIMATORS AND AWARENESS DEVELOPMENT KNOW-HOW<br />

We have seen that <strong>the</strong> animators were selected<br />

accord<strong>in</strong>g to educational level atta<strong>in</strong>ed, with<br />

PLWHIV <strong>in</strong> regions where it was possible.<br />

These animators were <strong>the</strong>n tra<strong>in</strong>ed to acquire<br />

<strong>in</strong>-depth knowledge of <strong>the</strong> disease, as well as<br />

on how to monitor <strong>the</strong>ir activities. But it is most<br />

certa<strong>in</strong>ly through <strong>the</strong>ir work experience that<br />

<strong>the</strong>y acquired <strong>the</strong>ir awareness development<br />

know-how. In this chapter, we will have a<br />

closer look at this know-how.<br />

Smooth <strong>the</strong> approach<br />

and <strong>the</strong> first moments of discussion<br />

To put people at ease, <strong>the</strong> animators were<br />

careful to adopt <strong>the</strong> same cultural codes<br />

as those <strong>the</strong>y visited and greet <strong>the</strong>m <strong>in</strong> an<br />

appropriate manner. For example, <strong>the</strong>y would<br />

say “salamalekum” when address<strong>in</strong>g a Muslim<br />

family. Then <strong>the</strong>y would present <strong>the</strong>mselves<br />

and wait to be <strong>in</strong>vited <strong>in</strong>side <strong>the</strong> home.<br />

Next, to gradually start <strong>the</strong> discussion, <strong>the</strong><br />

animators first talked about <strong>the</strong>mselves and<br />

<strong>the</strong>ir personal experience before beg<strong>in</strong>n<strong>in</strong>g to<br />

develop awareness.<br />

Choose ears that are ready to hear<br />

In <strong>the</strong> Somali ethnic group, it is easier to<br />

approach women than men. Thus, animators<br />

generally spoke to women. Through <strong>the</strong>m, it<br />

was eventually possible to approach <strong>the</strong> men,<br />

ei<strong>the</strong>r because <strong>the</strong>y were nearby at <strong>the</strong> moment<br />

of conversation or because <strong>the</strong>ir wives told<br />

<strong>the</strong>m what was said dur<strong>in</strong>g <strong>the</strong> conversation.<br />

Choose <strong>the</strong> best time<br />

for develop<strong>in</strong>g awareness<br />

There are times when people are more<br />

available for discussion than o<strong>the</strong>rs, when<br />

<strong>the</strong>y are ready to take time to talk. Animators<br />

must choose <strong>the</strong> moment when people are<br />

receptive to <strong>the</strong> awareness messages and<br />

ready to discuss <strong>the</strong>m.<br />

“In <strong>the</strong> morn<strong>in</strong>g, men are <strong>in</strong> a bad mood<br />

because <strong>the</strong>y chewed khat <strong>the</strong> night before.<br />

But <strong>in</strong> <strong>the</strong> afternoon, when <strong>the</strong>y start chew<strong>in</strong>g<br />

khat aga<strong>in</strong>, <strong>the</strong>y are <strong>in</strong> a good mood and we<br />

can talk to <strong>the</strong>m.” 14<br />

Conv<strong>in</strong>ce at least one person<br />

To enter <strong>in</strong> contact with a reluctant family, <strong>the</strong><br />

animator tried to conv<strong>in</strong>ce at least one family<br />

member. Then, this person ei<strong>the</strong>r conv<strong>in</strong>ced<br />

<strong>the</strong> o<strong>the</strong>r family members to participate <strong>in</strong> <strong>the</strong><br />

awareness program or participated alone. But<br />

at least one member had been made aware of<br />

HIV and was <strong>in</strong>formed about it. Consciously<br />

or not, this person later served as a relay for<br />

transmitt<strong>in</strong>g this <strong>in</strong>formation to <strong>the</strong> rest of <strong>the</strong><br />

family.<br />

Separate men and women<br />

to speak with more freedom<br />

In some families, it was easier to speak by<br />

rais<strong>in</strong>g awareness of <strong>the</strong> men on one side<br />

with a male animator, and of <strong>the</strong> women on<br />

<strong>the</strong> o<strong>the</strong>r with a female animator. Discussion<br />

was easier with a person of <strong>the</strong> same sex and<br />

everyone felt free to ask questions.<br />

Listen well and discuss<br />

without be<strong>in</strong>g didactic<br />

To encourage people to ask questions, <strong>the</strong><br />

program leaders tried above all to put <strong>the</strong>m<br />

at ease <strong>in</strong> order to facilitate talk<strong>in</strong>g. This was<br />

made possible by demonstrat<strong>in</strong>g that <strong>the</strong><br />

animator listened to each one.<br />

“We didn’t start right away by tell<strong>in</strong>g everyth<strong>in</strong>g<br />

we knew. First of all, we asked people what<br />

<strong>the</strong>y knew already. This allowed creat<strong>in</strong>g a<br />

dialog and putt<strong>in</strong>g people at ease, as well as<br />

show<strong>in</strong>g that our goal was to discuss <strong>the</strong> topic<br />

of <strong>the</strong> disease.” 15<br />

14. Wuhatem Abebe, animator at Ayesha<br />

15. Trsit Selemen, animator at Togochale<br />

25


“To be a good animator, you need above all to<br />

be a good listener. First, we ask <strong>the</strong>m what <strong>the</strong>y<br />

know about HIV because this enables see<strong>in</strong>g<br />

how much <strong>the</strong>y know. In this way, we can<br />

adapt our message accord<strong>in</strong>gly.” 16<br />

Adapt <strong>the</strong> level of <strong>in</strong>formation<br />

to <strong>the</strong> level of exist<strong>in</strong>g knowledge<br />

In <strong>the</strong> context of this personalized awareness<br />

program, animators adapted <strong>the</strong> level of<br />

<strong>in</strong>formation transmitted to <strong>the</strong>ir contacts for<br />

each home. If family members had only a few<br />

notions about <strong>the</strong> diseases, <strong>the</strong> animators<br />

supplied <strong>the</strong>m with basic <strong>in</strong>formation only. If<br />

families already had a basic knowledge of HIV/<br />

AIDS, animators would provide more complex<br />

and <strong>in</strong>-depth <strong>in</strong>formation.<br />

Use <strong>the</strong> guide and adapt it as needed<br />

All topics to be discussed and <strong>in</strong>formation to<br />

be transmitted dur<strong>in</strong>g <strong>the</strong> awareness program<br />

were described <strong>in</strong> <strong>the</strong> work guide. On <strong>the</strong><br />

night before a visit, most animators reread<br />

<strong>the</strong> <strong>in</strong>formation <strong>the</strong>y wanted to discuss on <strong>the</strong><br />

follow<strong>in</strong>g day <strong>in</strong> order to refresh <strong>the</strong>ir memory.<br />

If necessary, <strong>the</strong>y made notes <strong>in</strong> a notebook<br />

but did not read <strong>the</strong> guide dur<strong>in</strong>g an awareness<br />

session <strong>in</strong> order to promote free discussion.<br />

In addition, <strong>the</strong> animators also knew how to<br />

improvise: <strong>the</strong> guide did not specify us<strong>in</strong>g<br />

one’s personal experience, but <strong>in</strong> practice, <strong>the</strong><br />

animators used it systematically.<br />

Be sure each word is understood<br />

In surround<strong>in</strong>gs where HIV knowledge was<br />

lack<strong>in</strong>g, <strong>the</strong> fact of be<strong>in</strong>g declared HIV +,<br />

and <strong>the</strong>refore with a “positive” status, risked<br />

be<strong>in</strong>g <strong>in</strong>terpreted as someth<strong>in</strong>g positive, <strong>in</strong><br />

opposition to someth<strong>in</strong>g negative! It was thus<br />

important to expla<strong>in</strong> with simple words what<br />

it means to be “positive” (HIV +) or “negative”<br />

(seronegative) and to be sure that <strong>the</strong>se notions<br />

were properly assimilated.<br />

Use chance encounters<br />

to identify persons at risk<br />

Dur<strong>in</strong>g house-to-house awareness activities,<br />

some animators met or heard about o<strong>the</strong>r<br />

key persons to educate. For example,<br />

raiseed awareness at <strong>the</strong> home of a woman<br />

who took care of <strong>the</strong> children of women<br />

prostitutes enabled meet<strong>in</strong>g with some of<br />

<strong>the</strong>se prostitutes to make <strong>the</strong>m aware of HIV/<br />

AIDS and encourage <strong>the</strong>m to use condoms to<br />

protect <strong>the</strong>mselves.<br />

16. Ardo Adem, animator at Togochale<br />

26


INVALUABLE DOUBLE SUPPORT FOR ANIMATORS<br />

Although animators developed most of <strong>the</strong>ir<br />

know-how by participat<strong>in</strong>g <strong>in</strong> <strong>the</strong> awareness<br />

program, <strong>the</strong> effectiveness of <strong>the</strong>ir work was<br />

<strong>in</strong>creased by double monitor<strong>in</strong>g: on <strong>the</strong> one<br />

hand, by <strong>the</strong> partner association of <strong>Handicap</strong><br />

<strong>International</strong>, which <strong>the</strong>y belonged to, and on<br />

<strong>the</strong> o<strong>the</strong>r, by <strong>the</strong> project advisory committee<br />

composed of village leaders. Advice from <strong>the</strong><br />

association, which had awareness rais<strong>in</strong>g<br />

and follow-up/evaluation skills, and from <strong>the</strong><br />

committee, which had detailed knowledge<br />

of <strong>the</strong> community, were complementary,<br />

and both were <strong>in</strong>dispensable to successful<br />

completion of <strong>the</strong> project. Therefore, <strong>in</strong><br />

this chapter we will present <strong>the</strong> knowhow<br />

perta<strong>in</strong><strong>in</strong>g to community awareness<br />

activity follow-up which enabled project<br />

effectiveness.<br />

Ma<strong>in</strong>ta<strong>in</strong> regularity and coherence<br />

with double monitor<strong>in</strong>g<br />

On <strong>the</strong> one hand, double monitor<strong>in</strong>g enabled<br />

ensur<strong>in</strong>g regularity and <strong>the</strong> ma<strong>in</strong>tenance of<br />

an activity level through <strong>the</strong> monthly report<br />

supplied by <strong>the</strong> person <strong>in</strong> charge of animators.<br />

This report listed <strong>the</strong> number of homes<br />

with <strong>in</strong>creased awareness, which should<br />

correspond to <strong>the</strong> goals set <strong>in</strong> terms of number<br />

of monthly visits. On <strong>the</strong> o<strong>the</strong>r, monitor<strong>in</strong>g<br />

enabled ensur<strong>in</strong>g project coherence with<br />

needs expressed by community through<br />

regular meet<strong>in</strong>gs with <strong>the</strong> project advisory<br />

committee, which chose <strong>the</strong> areas to be<br />

covered.<br />

Get an overall view<br />

of neighborhood awareness<br />

To facilitate monitor<strong>in</strong>g and identify <strong>the</strong><br />

neighborhoods already covered by <strong>the</strong><br />

awareness program, <strong>the</strong> animator put a<br />

special mark on <strong>the</strong> outside of <strong>the</strong> house, for<br />

example a cross drawn with chalk, to <strong>in</strong>dicate<br />

that <strong>the</strong> program had been completed. In this<br />

way, it was easy to see <strong>the</strong> extent of houseto-house<br />

activity of <strong>the</strong> animators.<br />

Be an available partner<br />

To follow activities, <strong>the</strong> <strong>Handicap</strong> <strong>International</strong><br />

team planned weekly visits to <strong>in</strong>tervention<br />

sites that were geographically close, as well<br />

as unplanned visits, <strong>in</strong> such a way as to<br />

accompany animators almost daily, share <strong>the</strong>ir<br />

problems and resolve eventual conflicts. Thus,<br />

animators felt supported, <strong>the</strong> importance of<br />

<strong>the</strong>ir work was valued and <strong>the</strong>ir motivation<br />

was ma<strong>in</strong>ta<strong>in</strong>ed.<br />

Support animators with regular shar<strong>in</strong>g<br />

S<strong>in</strong>ce <strong>the</strong> activity of <strong>the</strong> animators with<strong>in</strong> <strong>the</strong><br />

community was ra<strong>the</strong>r solitary and sometimes<br />

difficult, it was important to create a spirit<br />

of mutual aid and provide <strong>the</strong>m with moral<br />

support. To do this, a follow-up meet<strong>in</strong>g was<br />

organized each month by <strong>the</strong> association<br />

of persons liv<strong>in</strong>g with HIV, which <strong>the</strong>y were<br />

members of. Dur<strong>in</strong>g <strong>the</strong> meet<strong>in</strong>g, <strong>the</strong>y were<br />

<strong>in</strong>vited to talk about problems encountered<br />

and to discuss toge<strong>the</strong>r possible ways of<br />

solv<strong>in</strong>g <strong>the</strong>m.<br />

Use experienced animators<br />

to tra<strong>in</strong> new ones<br />

When new animators were recruited for <strong>the</strong><br />

project, <strong>the</strong>y received tra<strong>in</strong><strong>in</strong>g. Dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g,<br />

experienced animators came to tell about<br />

<strong>the</strong>ir daily activity, share <strong>the</strong>ir experience<br />

and present future animators what <strong>the</strong>y felt<br />

to be <strong>the</strong> <strong>in</strong>dispensable know-how needed<br />

by a good animator, <strong>in</strong> particular <strong>the</strong> need for<br />

patience every s<strong>in</strong>gle day.<br />

27


INVOLVING LOCAL STAKEHOLDERS FOR LONG-LASTING CHANGE<br />

The community was doubly active <strong>in</strong> carry<strong>in</strong>g<br />

out this project: on <strong>the</strong> one hand, because <strong>the</strong><br />

project animators were <strong>the</strong>mselves members<br />

of <strong>the</strong> community, and on <strong>the</strong> o<strong>the</strong>r, because<br />

<strong>the</strong> project advisory committee was made<br />

up of community leaders.<br />

This double <strong>in</strong>volvement of local stakeholders<br />

encouraged <strong>the</strong> development of long-last<strong>in</strong>g<br />

changes with<strong>in</strong> <strong>the</strong> community.<br />

Encourage adoption<br />

of <strong>the</strong> cause by community leaders<br />

Because <strong>the</strong>y participated <strong>in</strong> <strong>the</strong> project<br />

advisory committee, <strong>the</strong> different community<br />

and religious leaders adopted <strong>the</strong> project.<br />

Hav<strong>in</strong>g to propose solutions to <strong>the</strong> problems<br />

of <strong>the</strong> animators or advis<strong>in</strong>g on project<br />

orientations favored <strong>the</strong>ir jo<strong>in</strong><strong>in</strong>g <strong>the</strong> cause.<br />

They realized <strong>the</strong> importance of develop<strong>in</strong>g<br />

HIV/AIDS awareness.<br />

Anchor <strong>the</strong> topic permanently<br />

by <strong>in</strong>volv<strong>in</strong>g community members<br />

Choos<strong>in</strong>g and tra<strong>in</strong><strong>in</strong>g local animators for<br />

rais<strong>in</strong>g awareness enabled <strong>the</strong> community<br />

to acquire knowledge of <strong>the</strong> disease and<br />

educational know-how. Even after <strong>the</strong> project<br />

is over, <strong>the</strong>se animators will still be considered<br />

as resource persons for obta<strong>in</strong><strong>in</strong>g <strong>in</strong>formation<br />

on <strong>the</strong> disease.<br />

In a similar way, <strong>the</strong> leaders <strong>in</strong>volved, who have<br />

been made aware of HIV, will cont<strong>in</strong>ue after <strong>the</strong><br />

project to have an attitude that contributes<br />

to dim<strong>in</strong>ish<strong>in</strong>g stigmatization and promot<strong>in</strong>g<br />

prevention <strong>in</strong> <strong>the</strong> different social networks<br />

where <strong>the</strong>y have an <strong>in</strong>fluence.<br />

Streng<strong>the</strong>n community capacities<br />

In <strong>the</strong> field, <strong>the</strong> awareness program was<br />

entirely implemented by community members:<br />

<strong>the</strong> animators for house-to-house education<br />

and <strong>the</strong> partner association and <strong>the</strong> leaders for<br />

SUCCESS STORY:<br />

UNEXPECTED PARTNERS JOIN IN<br />

The Dire Dawa University of Psychology<br />

called on animators to carry out a jo<strong>in</strong>t<br />

research project, where <strong>the</strong> reaction of<br />

<strong>the</strong> community to this type of houseto-house<br />

awareness development<br />

was <strong>in</strong>vestigated. Ano<strong>the</strong>r research<br />

project concerned <strong>the</strong> reaction and<br />

<strong>the</strong> feel<strong>in</strong>gs of persons who discover<br />

<strong>the</strong>ir HIV status.<br />

monitor<strong>in</strong>g <strong>the</strong> project. Thus, at <strong>the</strong> end of <strong>the</strong><br />

project <strong>the</strong> community has all <strong>the</strong> capacities<br />

for implement<strong>in</strong>g a similar project <strong>in</strong> <strong>the</strong> future<br />

on its own. Also, <strong>the</strong> choice of carry<strong>in</strong>g out an<br />

<strong>in</strong>-depth awareness program with a number<br />

of sessions per household participated <strong>in</strong> this<br />

re<strong>in</strong>forcement of community knowledge,<br />

s<strong>in</strong>ce <strong>the</strong>se households benefit from <strong>in</strong>-depth<br />

knowledge of <strong>the</strong> disease.<br />

Reach o<strong>the</strong>r social areas<br />

through <strong>the</strong> leaders<br />

The choice of creat<strong>in</strong>g <strong>the</strong> project advisory<br />

committee from <strong>in</strong>fluential leaders <strong>in</strong><br />

different doma<strong>in</strong>s (religious and political<br />

leaders, representatives of women’s<br />

associations, young people, persons liv<strong>in</strong>g<br />

with HIV, etc.) enabled strongly <strong>in</strong>volv<strong>in</strong>g<br />

respected personalities who are active <strong>in</strong><br />

different associations and different social<br />

areas. Thus, with<strong>in</strong> <strong>the</strong>ir associations, <strong>the</strong>se<br />

leaders highlighted <strong>the</strong> awareness project by<br />

promot<strong>in</strong>g it and mentionn<strong>in</strong>g it frequently as<br />

an example.<br />

28


STRENGTHENING PARTNER ASSOCIATIONS<br />

Ano<strong>the</strong>r way to permanently anchor project<br />

effects <strong>in</strong> <strong>the</strong> region was by streng<strong>the</strong>n<strong>in</strong>g<br />

<strong>the</strong> capacities of local partner associations,<br />

who acquired expertise on rais<strong>in</strong>g awareness<br />

of HIV/AIDS through <strong>the</strong> project. Throughout<br />

<strong>the</strong> project <strong>the</strong>re was also an on-go<strong>in</strong>g effort<br />

to streng<strong>the</strong>n <strong>the</strong>ir project management<br />

capacity.<br />

Use partner knowledge<br />

Partner associations, who know <strong>the</strong> context<br />

very well, enabled us to have a critical<br />

appreciation of <strong>the</strong> project. At <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />

of <strong>the</strong> project, numerous meet<strong>in</strong>gs with <strong>the</strong>m<br />

enabled us to discuss <strong>the</strong> pert<strong>in</strong>ence of<br />

actions planned and to re-def<strong>in</strong>e <strong>the</strong>m if<br />

necessary.<br />

In addition, <strong>the</strong> particular skills of <strong>the</strong> partner<br />

associations enabled enrich<strong>in</strong>g project<br />

activities. Thus, <strong>the</strong> partner association <strong>in</strong> <strong>the</strong><br />

Afar (Ethiopia) region had already organized<br />

community discussions on different topics. For<br />

<strong>the</strong> project, once <strong>the</strong> animators were tra<strong>in</strong>ed<br />

on <strong>the</strong> HIV topic, <strong>the</strong>y were able to organize<br />

community discussions on this topic.<br />

Transmit methods by work<strong>in</strong>g toge<strong>the</strong>r<br />

To streng<strong>the</strong>n <strong>the</strong> capacities of partner<br />

associations, <strong>Handicap</strong> <strong>International</strong><br />

sometimes chose to support <strong>the</strong>m by<br />

work<strong>in</strong>g daily with <strong>the</strong>m at <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />

of <strong>the</strong> partnership, until <strong>the</strong>y were able to<br />

function <strong>in</strong>dependently. In this way, <strong>Handicap</strong><br />

<strong>International</strong> was at <strong>the</strong> side of some partners<br />

for writ<strong>in</strong>g <strong>the</strong> terms of reference of some<br />

activities, plann<strong>in</strong>g, follow-up, etc. When<br />

<strong>the</strong> methods were assimilated and habits<br />

formed, <strong>the</strong> partners were able to carry out<br />

activities <strong>the</strong>y were responsible for on <strong>the</strong>ir<br />

own, while cont<strong>in</strong>u<strong>in</strong>g to ma<strong>in</strong>ta<strong>in</strong> an on-go<strong>in</strong>g<br />

<strong>in</strong>terchange with <strong>Handicap</strong> <strong>International</strong>.<br />

“With <strong>Handicap</strong> <strong>International</strong>, we had a very<br />

strong partnership. We did everyth<strong>in</strong>g toge<strong>the</strong>r,<br />

from plann<strong>in</strong>g to follow-up. In this way, we<br />

learned a lot and acquired good work<strong>in</strong>g<br />

methods.” 17<br />

Provide partners with reusable tools<br />

Because some partner associations had never<br />

developped, we proposed monitor<strong>in</strong>g tools<br />

and <strong>the</strong>n worked toge<strong>the</strong>r on <strong>the</strong>ir adaptation.<br />

Us<strong>in</strong>g <strong>the</strong>se tools, <strong>the</strong> person responsible<br />

for <strong>the</strong> animators collected daily data on <strong>the</strong><br />

activity of five team animators and ga<strong>the</strong>red it<br />

toge<strong>the</strong>r <strong>in</strong> a monthly report.<br />

Provide tra<strong>in</strong><strong>in</strong>g adapted to needs<br />

After identify<strong>in</strong>g needs for re<strong>in</strong>forcement of<br />

skills, specific tra<strong>in</strong><strong>in</strong>g was organized for <strong>the</strong><br />

partners. For example, follow<strong>in</strong>g a mid-project<br />

evaluation, gaps were noted <strong>in</strong> <strong>the</strong> monitor<strong>in</strong>g<br />

and evaluation carried out by animators<br />

and partner associations. Because of this<br />

observation, we organized a general tra<strong>in</strong><strong>in</strong>g<br />

program around monitor<strong>in</strong>g and evaluation<br />

for <strong>the</strong> animators and project managers from<br />

partner associations <strong>in</strong> <strong>the</strong> three countries.<br />

SUCCESS STORY:<br />

Ethiopian associations declared<br />

<strong>the</strong>mselves pleased to be so well<br />

“tooled” by HI, s<strong>in</strong>ce <strong>the</strong>y had felt<br />

<strong>in</strong>adequately equipped to correctly<br />

monitor projects f<strong>in</strong>anced by o<strong>the</strong>r<br />

<strong>in</strong>vestors. Some have even adapted<br />

<strong>the</strong>se follow-up tools to make <strong>the</strong>m<br />

useable for some of <strong>the</strong>ir o<strong>the</strong>r<br />

projects.<br />

17. Getahun Mekonen, project manager for <strong>the</strong> Shama Brihan Association <strong>in</strong> Ethiopia, a partner<br />

29


Tra<strong>in</strong> by do<strong>in</strong>g<br />

Dur<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g for animators <strong>in</strong> Somaliland,<br />

<strong>the</strong> goal was not to ask <strong>the</strong>m to learn by<br />

heart <strong>the</strong> contents of a thick guidebook, but<br />

to know how to use it for <strong>the</strong> house-to-house<br />

awareness program. In this way, <strong>the</strong> animators<br />

<strong>the</strong>mselves “taught <strong>the</strong> lesson”. They were<br />

divided <strong>in</strong>to small groups and each group had<br />

a subject to work on. They were given time<br />

to prepare, <strong>the</strong>n each small group presented<br />

a complete awareness session before <strong>the</strong><br />

entire assembly. The assembly was expected<br />

to react to <strong>the</strong> proposed session and discuss<br />

how to improve its contents.<br />

Know how to say what’s wrong<br />

Dur<strong>in</strong>g <strong>the</strong> project, conflicts or communication<br />

difficulties were sometimes encountered with<br />

partner associations. Discussion and listen<strong>in</strong>g<br />

allowed overcom<strong>in</strong>g <strong>the</strong>m. In particular, after a<br />

series of misunderstand<strong>in</strong>gs with <strong>the</strong> partner<br />

association <strong>in</strong> <strong>the</strong> Afar region (Ethiopia),<br />

a meet<strong>in</strong>g was organized dur<strong>in</strong>g which<br />

<strong>Handicap</strong> <strong>International</strong> was able to present<br />

all <strong>the</strong> po<strong>in</strong>ts it considered unsatisfactory<br />

<strong>in</strong> <strong>the</strong> implementation of activities and <strong>the</strong><br />

partner relationship. All remarks were <strong>the</strong>n<br />

taken <strong>in</strong>to consideration by <strong>the</strong> partner and<br />

fur<strong>the</strong>r relations with <strong>the</strong> partner were based<br />

on mutual trust and exchange.<br />

Delegate more or less<br />

L<strong>in</strong>ks with <strong>the</strong> partner association depended<br />

heavily on <strong>the</strong> context and on geographical<br />

proximity. In <strong>the</strong> regions where <strong>the</strong> <strong>Handicap</strong><br />

<strong>International</strong> team was present, it worked<br />

very closely with <strong>the</strong> partner association<br />

and supported it <strong>in</strong> daily management of<br />

activities. It was not possible to ensure <strong>the</strong><br />

same level of assistance <strong>in</strong> <strong>the</strong> Afar region<br />

(Ethiopia), located at a distance requir<strong>in</strong>g many<br />

hours to reach by car. Therefore, <strong>in</strong> this region<br />

<strong>the</strong> partner association implemented activities<br />

with a great degree of <strong>in</strong>dependence with<br />

regular visits from <strong>Handicap</strong> <strong>International</strong><br />

every quarter.<br />

F<strong>in</strong>d regular occasions for discussion<br />

Each month, <strong>the</strong> partner association sent<br />

<strong>in</strong> a monthly activity report for all animators<br />

and each quarter, a narrative and f<strong>in</strong>ancial<br />

report describ<strong>in</strong>g activities undertaken. After<br />

receiv<strong>in</strong>g <strong>the</strong> quarterly report, <strong>the</strong> <strong>Handicap</strong><br />

<strong>International</strong> project manager visited each<br />

site, even those that were far away, <strong>in</strong> order<br />

to spend time <strong>in</strong> <strong>the</strong> field with <strong>the</strong> animators<br />

and <strong>the</strong>ir managers. Each quarterly visit was<br />

<strong>the</strong> occasion for <strong>the</strong> partner association<br />

and <strong>Handicap</strong> <strong>International</strong> to discuss<br />

toge<strong>the</strong>r strategy, problems encountered and<br />

perspectives.<br />

Jo<strong>in</strong> forces to enable ambitious action<br />

At Hargeisa (Somaliland), a number of NGOs<br />

participated <strong>in</strong> <strong>the</strong> creation of a youth center,<br />

which offered a leisure area with different games<br />

(table soccer, billiards, p<strong>in</strong>g-pong, sports field,<br />

etc.). The participation of different association<br />

stakeholders, both local and <strong>in</strong>ternational,<br />

enabled <strong>in</strong>stall<strong>in</strong>g a library, a dozen computers<br />

with Internet access, education on health<br />

topics and, <strong>in</strong> particular, <strong>in</strong> <strong>the</strong> framework<br />

of a project led by <strong>Handicap</strong> <strong>International</strong>,<br />

development of awareness on <strong>the</strong> topic of<br />

AIDS, with <strong>the</strong> presence of leader-advisors.<br />

30


3. Creat<strong>in</strong>g an awareness environment<br />

Part<br />

2<br />

1. Varied visual communication tools<br />

d Use exist<strong>in</strong>g tools that have shown<br />

<strong>the</strong>ir worth<br />

d Communicate where o<strong>the</strong>rs are not already<br />

present<br />

d Choose media adapted to lifestyle<br />

d Make <strong>in</strong>formation available to all<br />

d Target priority subjects without try<strong>in</strong>g<br />

to be exhaustive<br />

d Have <strong>the</strong> tools validated<br />

by different partners<br />

d Test <strong>the</strong> process before generaliz<strong>in</strong>g it<br />

d Promote broad distribution of tools created<br />

2. Popular radio broadcasts<br />

d Test <strong>the</strong> impact of <strong>the</strong> first broadcasts<br />

before cont<strong>in</strong>u<strong>in</strong>g<br />

d Transmit messages us<strong>in</strong>g community voices<br />

d Respect gender to reach women<br />

more effectively<br />

d Vary broadcasts to avoid boredom<br />

d Make <strong>the</strong> message a “habit” by giv<strong>in</strong>g<br />

it a story l<strong>in</strong>e<br />

d Choose prime-time broadcast<strong>in</strong>g<br />

d Evaluate impact from <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />

3. Use of traditional group exchange<br />

d Use cultural habits for <strong>in</strong>creas<strong>in</strong>g awareness<br />

d Leadership techniques to make people th<strong>in</strong>k<br />

d Choose busy public places<br />

4. Festive events to convey <strong>the</strong> messages<br />

d Involve health authorities for greater impact<br />

d Announce to attract<br />

d Use <strong>the</strong> know-how of exist<strong>in</strong>g associations<br />

for animat<strong>in</strong>g <strong>the</strong> event<br />

d Mix modernity and tradition<br />

to raise awareness<br />

d Adapt awareness events to <strong>the</strong> audience<br />

d Encourage test<strong>in</strong>g through “positive life”<br />

testimonials<br />

d Use humor to raise awareness<br />

d Make realer than real by demonstrat<strong>in</strong>g<br />

d Use high-impact testimonials<br />

d Ask questions to make sure<br />

d Use powerful symbols<br />

In parallel to <strong>the</strong> house-to-house awareness<br />

program, designed to raise awareness by<br />

br<strong>in</strong>g<strong>in</strong>g <strong>in</strong>-depth knowledge of <strong>the</strong> disease<br />

to <strong>the</strong> home, an environment of collective<br />

awareness was created <strong>in</strong> <strong>the</strong> community.<br />

First, various communication tools were<br />

designed so that awareness would be visible <strong>in</strong><br />

different places and contexts. At <strong>the</strong> same time,<br />

<strong>in</strong> some regions <strong>the</strong> project took <strong>in</strong>spiration<br />

from collective traditions of exchange,<br />

which are anchored <strong>in</strong> <strong>the</strong> culture, <strong>in</strong> order to<br />

adapt <strong>the</strong>m to <strong>the</strong> awareness program. F<strong>in</strong>ally,<br />

festive events centered on musical concerts<br />

or circus shows were used to create animated<br />

ga<strong>the</strong>r<strong>in</strong>gs for attract<strong>in</strong>g crowds. These were<br />

ideal for rais<strong>in</strong>g awareness <strong>in</strong> playful, varied<br />

ways.<br />

31


VARIED VISUAL COMMUNICATION TOOLS<br />

For extend<strong>in</strong>g awareness, numerous IEC<br />

(Information Education Communication)<br />

communication tools were developed. Their<br />

elaboration was based on <strong>the</strong> analysis of IEC<br />

tools already exist<strong>in</strong>g <strong>in</strong> this area.<br />

First, tools were created to “be seen”:<br />

T-shirts for <strong>the</strong> team, animators and those<br />

who distributed Stickers were designed and<br />

widely distributed and stuck on cars and<br />

public transportation vehicles <strong>in</strong> group areas<br />

and adm<strong>in</strong>istrations. In addition, to <strong>in</strong>form<br />

by leav<strong>in</strong>g material with <strong>the</strong> <strong>in</strong>habitants,<br />

brochures and leaflets were designed <strong>in</strong><br />

different local languages and distributed.<br />

Based on a prelim<strong>in</strong>ary study, radio also proved<br />

to be a very pert<strong>in</strong>ent media. Thus, a series of<br />

40 radio programs <strong>in</strong> <strong>the</strong> Somali language<br />

were produced and broadcast on local radio<br />

as a complement to <strong>the</strong> visual tools.<br />

O<strong>the</strong>r long-term elements were created at<br />

some <strong>in</strong>tervention sites, such as <strong>in</strong>formation<br />

boards and pa<strong>in</strong>ted walls <strong>in</strong> Ethiopia and <strong>in</strong><br />

Somaliland.<br />

F<strong>in</strong>ally, audiovisual tools rounded out <strong>the</strong><br />

variety of communication tools, with <strong>the</strong><br />

elaboration of an HIV/AIDS prevention film <strong>in</strong><br />

Somaliland, <strong>the</strong> video clip of a song promot<strong>in</strong>g<br />

voluntary counsel<strong>in</strong>g and test<strong>in</strong>g <strong>in</strong> Ethiopia<br />

and a film present<strong>in</strong>g <strong>the</strong> project.<br />

Use exist<strong>in</strong>g tools<br />

that have shown <strong>the</strong>ir worth<br />

Before develop<strong>in</strong>g its own tools, <strong>the</strong> HI team<br />

met with o<strong>the</strong>r NGOs work<strong>in</strong>g on AIDS and<br />

collected <strong>the</strong>ir communication tools to<br />

use as a base. These tools were a source of<br />

<strong>in</strong>spiration for enrich<strong>in</strong>g discussions on <strong>the</strong><br />

choice of awareness messages and <strong>the</strong> way of<br />

present<strong>in</strong>g <strong>the</strong>m.<br />

O<strong>the</strong>r types of tools were <strong>in</strong>spired by tools that<br />

had shown <strong>the</strong>ir worth <strong>in</strong> o<strong>the</strong>r situations.<br />

Thus, <strong>the</strong> idea of produc<strong>in</strong>g a song with a<br />

video clip was <strong>in</strong>spired from an idea used<br />

<strong>in</strong> Ghana. In Ethiopia, this type of tool was<br />

proposed by local artists, who created a song<br />

and an associated clip <strong>in</strong> a typically Ethiopian<br />

version, with lyrics promot<strong>in</strong>g test<strong>in</strong>g.<br />

Communicate where o<strong>the</strong>rs<br />

are not already present<br />

A prelim<strong>in</strong>ary study showed that <strong>in</strong> <strong>the</strong> Somali<br />

region (Ethiopia), numerous IEC tools, which<br />

had been developed on HIV/AIDS, ma<strong>in</strong>ly<br />

brochures and leaflets, had little impact. This<br />

was primarily due to <strong>the</strong> fact that <strong>the</strong>y were<br />

almost all written <strong>in</strong> Amharic <strong>in</strong> a region where<br />

people speak ma<strong>in</strong>ly Somali! This gave rise to<br />

<strong>the</strong> idea of produc<strong>in</strong>g brochures <strong>in</strong> Amharic, as<br />

well as Somali, and leaflets <strong>in</strong> both languages.<br />

In a similar way, <strong>in</strong> Ethiopia many radio<br />

programs on AIDS had been developed <strong>in</strong><br />

Amharic. None were <strong>in</strong> Somali. For this reason,<br />

40 radio broadcasts were produced <strong>in</strong> this<br />

language.<br />

Choose media adapted to lifestyle<br />

Knowledge of <strong>the</strong> context obta<strong>in</strong>ed from<br />

prelim<strong>in</strong>ary studies on exist<strong>in</strong>g tools and<br />

practices enabled identify<strong>in</strong>g that <strong>the</strong> ma<strong>in</strong><br />

means of <strong>in</strong>formation was <strong>the</strong> radio <strong>in</strong><br />

regions where few adults are literate and<br />

where television is rare. It was thus decided<br />

to communicate on HIV/AIDS through a series<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

32


of 40 radio programs broadcast over five<br />

months.<br />

Make <strong>in</strong>formation available to all<br />

The variety of communication tools produced<br />

for <strong>the</strong> project enabled communicat<strong>in</strong>g<br />

with different audiences and mak<strong>in</strong>g <strong>the</strong><br />

awareness messages available to everyone. In<br />

<strong>the</strong> brochures, most messages were presented<br />

as draw<strong>in</strong>gs, with a few written explanations<br />

<strong>in</strong> Amharic and Somali. In addition, <strong>the</strong> song<br />

clip promot<strong>in</strong>g test<strong>in</strong>g <strong>in</strong>cluded a simultaneous<br />

translation <strong>in</strong> sign language <strong>in</strong> order to reach<br />

hear<strong>in</strong>g-impaired <strong>in</strong>dividuals.<br />

Target priority subjects<br />

without try<strong>in</strong>g to be exhaustive<br />

Possible subjects for HIV/AIDS awareness<br />

were many. Dur<strong>in</strong>g creation of tools, it was<br />

necessary to target <strong>the</strong> message precisely,<br />

without try<strong>in</strong>g to talk about everyth<strong>in</strong>g, <strong>in</strong><br />

order to avoid drown<strong>in</strong>g <strong>the</strong> <strong>in</strong>formation. For<br />

example, one of <strong>the</strong> brochures used draw<strong>in</strong>gs<br />

to focus on decreas<strong>in</strong>g stigmatization by<br />

rais<strong>in</strong>g awareness of disease transmission<br />

modes, as well as on how <strong>the</strong> disease cannot<br />

be transmitted (by eat<strong>in</strong>g toge<strong>the</strong>r, by shak<strong>in</strong>g<br />

hands, by talk<strong>in</strong>g, etc.). Ano<strong>the</strong>r brochure<br />

highlighted positive ways of liv<strong>in</strong>g with <strong>the</strong><br />

virus by choos<strong>in</strong>g a HIV + man and woman<br />

of different religions and from different social<br />

areas.<br />

Have <strong>the</strong> tools validated<br />

by different partners<br />

Before validat<strong>in</strong>g <strong>the</strong> tools for production, we<br />

asked <strong>the</strong> different partners to give us <strong>the</strong>ir<br />

op<strong>in</strong>ion of <strong>the</strong>m. For <strong>the</strong> film on HIV/AIDS<br />

awareness produced <strong>in</strong> Somaliland, we<br />

met a number of times dur<strong>in</strong>g edit<strong>in</strong>g with<br />

government and association partners to collect<br />

<strong>the</strong>ir comments, which were <strong>in</strong>valuable for<br />

creat<strong>in</strong>g a f<strong>in</strong>al version that was coherent with<br />

Somali culture and pert<strong>in</strong>ent for all <strong>in</strong>habitants.<br />

They suggested we hide <strong>the</strong> faces of PLWHIV,<br />

moderate some topics that were too direct,<br />

<strong>in</strong>clude more well-known images of <strong>the</strong> city<br />

and country, etc.<br />

For <strong>the</strong> <strong>in</strong>formation boards, health authorities<br />

and community leaders were consulted<br />

on what <strong>the</strong>y felt to be <strong>the</strong> most effective<br />

type of contents. They suggested <strong>in</strong>clud<strong>in</strong>g<br />

photographs of <strong>in</strong>fluential people <strong>in</strong> <strong>the</strong><br />

community, accompanied by an awareness<br />

message.<br />

Test <strong>the</strong> process before generaliz<strong>in</strong>g it<br />

For pa<strong>in</strong>ted walls and radio messages, we<br />

started by produc<strong>in</strong>g “samples” <strong>in</strong> order to test<br />

<strong>the</strong> level of comprehension and satisfaction<br />

of different audiences. This enabled not only<br />

adapt<strong>in</strong>g our way of communicat<strong>in</strong>g, but also<br />

test<strong>in</strong>g <strong>the</strong> logistical organization required<br />

and improv<strong>in</strong>g it for communicat<strong>in</strong>g later on a<br />

larger scale.<br />

Promote broad distribution of tools created<br />

To enable broad and rapid distribution of<br />

stickers, half-day contracts enabled us to<br />

hire a few people to paste stickers on public<br />

build<strong>in</strong>gs or <strong>in</strong> busy places, as well as on<br />

“bajaj” taxis (<strong>the</strong>se are small, three-wheeled<br />

Ethiopian taxis) and public m<strong>in</strong>ivans. Us<strong>in</strong>g<br />

this approach, <strong>in</strong> less that two hours over half<br />

of <strong>the</strong> public transportation <strong>in</strong> mid-size cities<br />

featured a project sticker!<br />

In addition, to <strong>in</strong>crease <strong>the</strong> impact of posters<br />

and <strong>the</strong> awareness film <strong>in</strong> Somaliland, an<br />

official ceremony was held when <strong>the</strong>y were<br />

launched. This ceremony brought toge<strong>the</strong>r<br />

all local partners <strong>in</strong>volved <strong>in</strong> <strong>the</strong> fight aga<strong>in</strong>st<br />

HIV/AIDS. Next, <strong>the</strong> film and <strong>the</strong> posters<br />

were widely distributed to all <strong>in</strong>terested<br />

organizations and to hospitals. Each festive<br />

event with<strong>in</strong> <strong>the</strong> project framework presented<br />

an opportunity to show <strong>the</strong> film, which<br />

conta<strong>in</strong>ed footage of local celebrities, creat<strong>in</strong>g<br />

even greater impact <strong>in</strong> terms of awareness.<br />

33


POPULAR RADIO BROADCASTS<br />

In Ethiopia, prelim<strong>in</strong>ary studies showed<br />

that <strong>the</strong> most effective media for reach<strong>in</strong>g a<br />

large audience was <strong>the</strong> radio. However, all<br />

exist<strong>in</strong>g radio programs on awareness were<br />

<strong>in</strong> Amharic. None were <strong>in</strong> Somali, which is<br />

<strong>the</strong> ma<strong>in</strong> language of <strong>the</strong> Somali region<br />

concerned by <strong>the</strong> project. It was thus decided<br />

to produce 40 radio programs, each one<br />

last<strong>in</strong>g 20 m<strong>in</strong>utes; <strong>the</strong>se were broadcast on<br />

local radio <strong>in</strong> Dire Dawa twice a week for five<br />

months.<br />

Reach isolated <strong>in</strong>dividuals<br />

through a popular medium<br />

Radio is a medium that is very popular with<br />

families. It enables reach<strong>in</strong>g everyone at<br />

home, even housewives and mo<strong>the</strong>rs who do<br />

not often go out. In addition, s<strong>in</strong>ce FM radio<br />

<strong>in</strong> Ethiopia is very recent, it is considered<br />

“trendy” and is <strong>the</strong>refore very popular. This<br />

was thus <strong>the</strong> local radio used to broadcast <strong>the</strong><br />

40 HIV/AIDS prevention programs.<br />

Test <strong>the</strong> impact of <strong>the</strong> first broadcasts<br />

before cont<strong>in</strong>u<strong>in</strong>g<br />

After <strong>the</strong> production of five programs and<br />

before <strong>the</strong>ir broadcast, we chose to “test”<br />

<strong>the</strong>m <strong>in</strong> order to measure <strong>the</strong>ir pert<strong>in</strong>ence and<br />

<strong>the</strong> impact of <strong>the</strong>ir contents. To do this, at each<br />

site where project activities were be<strong>in</strong>g carried<br />

out, a representative group of around thirty<br />

persons was assembled <strong>in</strong> order to listen to<br />

and comment on <strong>the</strong> broadcasts. In parallel,<br />

<strong>the</strong> same process for ga<strong>the</strong>r<strong>in</strong>g comments was<br />

carried out for health authorities. All <strong>the</strong>se<br />

comments were taken <strong>in</strong>to account for <strong>the</strong><br />

production of <strong>the</strong> next 35 broadcasts.<br />

Transmit messages<br />

us<strong>in</strong>g community voices<br />

When people hear members of <strong>the</strong>ir own<br />

community speak, <strong>the</strong>y feel more concerned<br />

by <strong>the</strong> message. Thus, when <strong>the</strong> “test” groups<br />

heard <strong>the</strong> first five radio messages <strong>in</strong> <strong>the</strong><br />

Somali language but spoken by persons from<br />

a different community and thus with a different<br />

accent, <strong>the</strong>y made it known that <strong>the</strong>y wanted<br />

to hear people from <strong>the</strong>ir own community with<br />

<strong>the</strong> same accent: “People wanted to hear<br />

about <strong>the</strong>mselves.” 18<br />

Respect gender to reach<br />

women more effectively<br />

Even though <strong>in</strong> <strong>the</strong> Somali region women<br />

speak little <strong>in</strong> public, <strong>the</strong> producers made<br />

sure that <strong>in</strong> <strong>the</strong> radio broadcast contents,<br />

parity was respected. Women very positively<br />

perceived <strong>the</strong> fact that <strong>the</strong> broadcasts let<br />

women do most of <strong>the</strong> talk<strong>in</strong>g, whe<strong>the</strong>r this<br />

was personal testimony from PLWHIV women<br />

or <strong>in</strong>terventions by experts, journalists or<br />

<strong>in</strong>stitutional leaders.<br />

Vary broadcasts to avoid boredom<br />

To make <strong>the</strong> broadcast of 40 programs<br />

more attractive, it was decided to do <strong>the</strong>m<br />

<strong>in</strong> <strong>the</strong> form of a “radio magaz<strong>in</strong>e”, i.e., by<br />

<strong>in</strong>clud<strong>in</strong>g different types of contents <strong>in</strong> <strong>the</strong><br />

same program: “like a buffet, with different<br />

choices.” 19 Thus, radio messages featured<br />

<strong>in</strong>terviews with health authorities and medical<br />

experts, testimonials from PLWHIV, pop<br />

voices (a succession of different voices giv<strong>in</strong>g<br />

<strong>the</strong>ir op<strong>in</strong>ion <strong>in</strong> a few short sentences), diary<br />

extracts, short plays, etc. F<strong>in</strong>ally, songs on<br />

18. Tigist Kassa, Director of Guishen Ethiopia Radio<br />

19. Tigist Kassa, Director of Guishen Ethiopia Radio<br />

34


HIV/AIDS <strong>in</strong> Somali, which were well-known<br />

and very popular, were broadcast between<br />

pauses <strong>in</strong> speak<strong>in</strong>g.<br />

Make <strong>the</strong> message a “habit”<br />

by giv<strong>in</strong>g it a story l<strong>in</strong>e<br />

One of <strong>the</strong> keys to success of <strong>the</strong> radio<br />

messages was <strong>the</strong> use of <strong>the</strong> fictitious “diary”<br />

of a PLWHIV. With each radio message, <strong>the</strong><br />

audience discovered <strong>the</strong> daily worries of this<br />

person by “read<strong>in</strong>g” <strong>the</strong> diary: confrontation<br />

of discrim<strong>in</strong>ation, treatment, etc. In addition<br />

to mak<strong>in</strong>g <strong>the</strong> testimony more alive, this way<br />

of present<strong>in</strong>g it had <strong>the</strong> advantage of mak<strong>in</strong>g<br />

listeners want to hear <strong>the</strong> next episode of <strong>the</strong><br />

story, thus mak<strong>in</strong>g it a habit.<br />

Choose prime-time broadcast<strong>in</strong>g<br />

Around Dire Dawa, prime broadcast<strong>in</strong>g time<br />

is <strong>in</strong> <strong>the</strong> afternoon, because people are at<br />

home, chew<strong>in</strong>g khat and listen<strong>in</strong>g to <strong>the</strong> radio,<br />

especially on Saturday. Although it was first<br />

scheduled as a morn<strong>in</strong>g show, <strong>the</strong> program<br />

was changed to a later time. Arguments<br />

presented to <strong>the</strong> radio station on <strong>the</strong> fact that<br />

HIV/AIDS awareness is an important topic<br />

allowed obta<strong>in</strong><strong>in</strong>g a better broadcast time:<br />

Wednesday and Saturday at noon, right after<br />

<strong>the</strong> news.<br />

SUCCESS STORY:<br />

RADIO BROADCASTS ACCLAIMED<br />

BY HEALTH AUTHORITIES<br />

After listen<strong>in</strong>g to some of <strong>the</strong> radio<br />

broadcasts, <strong>the</strong> Somali Region Health<br />

Office, an Ethiopian government<br />

partner <strong>in</strong> <strong>the</strong> project, asked <strong>Handicap</strong><br />

<strong>International</strong> for copies of <strong>the</strong><br />

broadcasts and <strong>the</strong> right to use <strong>the</strong>m.<br />

The idea was to broadcast <strong>the</strong> set of<br />

messages at <strong>the</strong> regional level.<br />

Evaluate impact from <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g<br />

When <strong>the</strong> project of produc<strong>in</strong>g 40 messages<br />

was be<strong>in</strong>g developed, it was decided to set<br />

aside budget for evaluat<strong>in</strong>g <strong>the</strong> impact of <strong>the</strong>se<br />

messages. This was done after <strong>the</strong> broadcast<br />

of <strong>the</strong> 40 messages at two sites <strong>in</strong> order to<br />

measure <strong>the</strong> impact of radio messages<br />

and provide recommendations for <strong>the</strong> next<br />

steps. In this context, two focus groups were<br />

organized, as well as <strong>in</strong>terviews with key<br />

persons, such as members of <strong>the</strong> <strong>Handicap</strong><br />

<strong>International</strong> team and <strong>in</strong>stitutional partners.<br />

People from <strong>the</strong> village were also questioned at<br />

random at <strong>the</strong> two sites. From this evaluation, it<br />

was clear that <strong>the</strong>re was a unanimous desire,<br />

expressed by both <strong>in</strong>habitants and authorities,<br />

that <strong>the</strong> program should cont<strong>in</strong>ue!<br />

35


USE OF TRADITIONAL GROUP EXCHANGE<br />

In certa<strong>in</strong> regions, group meet<strong>in</strong>gs or<br />

<strong>in</strong>formation exchanges are cultural traditions.<br />

We thought it would be <strong>in</strong>terest<strong>in</strong>g to use<br />

<strong>the</strong>se to promote awareness actions. Thus, <strong>in</strong><br />

Ethiopia, coffee ceremonies were organized<br />

on <strong>the</strong> HIV/AIDS topic. In <strong>the</strong> Afar region,<br />

community conversations were <strong>in</strong>spired<br />

from liv<strong>in</strong>g tradition, and <strong>the</strong> “dagou” culture<br />

<strong>in</strong>spired awareness activities.<br />

Use cultural habits<br />

for <strong>in</strong>creas<strong>in</strong>g awareness<br />

In <strong>the</strong> Afar tradition, a cultural habit known<br />

as “dagou” exists; <strong>the</strong> word means “transmit<br />

<strong>in</strong>formation.” Before even say<strong>in</strong>g hello,<br />

someone will ask: “Do you have dagou?” In<br />

o<strong>the</strong>r words, “Do you have any <strong>in</strong>formation to<br />

transmit?” <strong>Community</strong> conversations <strong>in</strong> <strong>the</strong><br />

framework of <strong>the</strong> project were designed us<strong>in</strong>g<br />

this culture. Animators went to a busy public<br />

place and shouted, “I have dagou!” People<br />

came immediately to ga<strong>the</strong>r around and listen.<br />

Dur<strong>in</strong>g <strong>the</strong> conversation, which could last up<br />

to two hours, <strong>the</strong>y participated actively, s<strong>in</strong>ce<br />

debate is also a cultural habit. At <strong>the</strong> end of<br />

<strong>the</strong> conversation when people returned to <strong>the</strong>ir<br />

homes, <strong>the</strong>y transmitted <strong>the</strong> <strong>in</strong>formation<br />

<strong>the</strong>y had received to <strong>the</strong>ir families. In this<br />

case, <strong>the</strong> “dagou” concerned HIV/AIDS.<br />

In a similar way, <strong>the</strong> coffee ceremony <strong>in</strong><br />

Ethiopia was used to organize a group<br />

exchange on awareness. Coffee ceremonies<br />

were organized right on <strong>the</strong> street <strong>in</strong> order to be<br />

available to all passers-by. As usage requires,<br />

while <strong>the</strong> coffee was be<strong>in</strong>g roasted and ground<br />

before be<strong>in</strong>g prepared, different PLWHIV<br />

talked about <strong>the</strong>ir condition and, above all,<br />

discussion and debate took place. Once <strong>the</strong><br />

coffee was drunk, <strong>the</strong> group dispersed.<br />

Leadership techniques<br />

to make people th<strong>in</strong>k<br />

Dur<strong>in</strong>g community conversations <strong>in</strong> <strong>the</strong> Afar<br />

region, group leaders use techniques to<br />

<strong>in</strong>cite participants to th<strong>in</strong>k personally about<br />

<strong>the</strong> subject under discussion. They do not<br />

give f<strong>in</strong>al <strong>in</strong>formation; ra<strong>the</strong>r, <strong>the</strong>y question<br />

<strong>the</strong> audience about how to solve a problem,<br />

s<strong>in</strong>ce <strong>the</strong>y feel that <strong>the</strong> solution should come<br />

from <strong>the</strong> community. By tradition, people<br />

participate easily <strong>in</strong> debates <strong>in</strong> this region and<br />

thus easily share <strong>the</strong>ir ideas to f<strong>in</strong>d a solution<br />

to <strong>the</strong> issue presented.<br />

Choose busy public places<br />

To carry out awareness activities <strong>in</strong> public<br />

places, <strong>the</strong>se places should be carefully<br />

chosen to attract as many people as possible.<br />

For example, for community conversations,<br />

animators chose <strong>the</strong> market area, water<br />

supply po<strong>in</strong>ts or places <strong>in</strong> <strong>the</strong> city where coffee<br />

ceremonies are popular <strong>in</strong> <strong>the</strong> even<strong>in</strong>g.<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

36


FESTIVE EVENTS TO CONVEY THE MESSAGES<br />

Festive events were regularly organized<br />

dur<strong>in</strong>g <strong>the</strong> project at all <strong>in</strong>tervention sites. Their<br />

contents were adapted to <strong>the</strong> local cultural<br />

context, but <strong>in</strong> all cases, <strong>the</strong> pr<strong>in</strong>ciple was <strong>the</strong><br />

same: attract an audience with festive shows,<br />

musical concerts or circuses and <strong>in</strong>clude HIV/<br />

AIDS awareness activities <strong>in</strong> <strong>the</strong>se spectacles<br />

us<strong>in</strong>g skits, quizzes or personal testimony.<br />

When possible, a mobile VCT (Voluntary<br />

Counsel<strong>in</strong>g and Test<strong>in</strong>g) center was set up<br />

near <strong>the</strong> show.<br />

Involve health authorities<br />

for greater impact<br />

Before each public event, health authorities<br />

were notified of <strong>the</strong> date and place and asked<br />

to send a representative to give <strong>the</strong> open<strong>in</strong>g<br />

speech for <strong>the</strong> event. In addition, when a<br />

mobile VCT center was planned for, authorities<br />

provided a counselor and a laboratory<br />

technician to ensure test<strong>in</strong>g.<br />

Announce to attract<br />

To ensure a large audience, festive events were<br />

announced beforehand. This announcement<br />

was made by community leaders from <strong>the</strong><br />

project advisory committee <strong>in</strong> <strong>the</strong>ir respective<br />

areas of <strong>in</strong>fluence. In parallel, on <strong>the</strong> day of<br />

<strong>the</strong> event, professional announcers passed<br />

through <strong>the</strong> streets to advertise <strong>the</strong> com<strong>in</strong>g<br />

event. F<strong>in</strong>ally, a banner announc<strong>in</strong>g <strong>the</strong> event<br />

was hung at <strong>the</strong> place where <strong>the</strong> event was to<br />

take place.<br />

Use <strong>the</strong> know-how of exist<strong>in</strong>g associations<br />

for animat<strong>in</strong>g <strong>the</strong> event<br />

For public events, o<strong>the</strong>r local associations<br />

with specific know-how provided valuable<br />

assistance, especially for creat<strong>in</strong>g and<br />

present<strong>in</strong>g skits on <strong>the</strong> HIV/AIDS topic or for<br />

musical animation.<br />

Mix modernity and tradition<br />

to raise awareness<br />

In <strong>the</strong> Afar region of Ethiopia, festive events rely<br />

on an important cultural specificity, “kasso”.<br />

This is traditional music featur<strong>in</strong>g respected<br />

elders who s<strong>in</strong>g about different subjects.<br />

People play close attention to messages<br />

transmitted <strong>in</strong> this way. Dur<strong>in</strong>g concerts,<br />

modern music for danc<strong>in</strong>g alternates with<br />

calm periods and attentive listen<strong>in</strong>g to kasso<br />

s<strong>in</strong>gers, who conveyed awareness messages<br />

<strong>in</strong> <strong>the</strong>ir songs.<br />

Adapt awareness events to <strong>the</strong> audience<br />

Festive awareness events were adapted to<br />

<strong>the</strong> context of each region, as well as with<strong>in</strong><br />

a given country. At Dire Dawa (Ethiopia),<br />

festive events <strong>in</strong>cluded testimony of persons<br />

liv<strong>in</strong>g with <strong>the</strong> virus, quizzes and mobile VCT<br />

centers, whereas <strong>in</strong> <strong>the</strong> Afar region (Ethiopia),<br />

only traditional kasso music was used to<br />

transmit awareness messages.<br />

In Somaliland, public events did not <strong>in</strong>clude<br />

testimony by PLWHIV and, above all,<br />

condoms were not mentioned, s<strong>in</strong>ce <strong>the</strong><br />

authorities preferred to <strong>in</strong>form about <strong>the</strong><br />

disease only. Accord<strong>in</strong>g to <strong>the</strong>se authorities,<br />

denial is so strong that <strong>the</strong> population risked<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

37


throw<strong>in</strong>g stones if condoms were mentioned.<br />

Because of denial and stigmatization, test<strong>in</strong>g<br />

was not offered.<br />

Encourage test<strong>in</strong>g through “positive life”<br />

testimonials<br />

In Ethiopia, each time test<strong>in</strong>g was offered<br />

dur<strong>in</strong>g a festive event, a number of<br />

persons volunteered to be tested. Personal<br />

testimonials by PLWHIV who cont<strong>in</strong>ue to live<br />

a full and healthy life thanks to antiretroviral<br />

medic<strong>in</strong>es, allowed <strong>the</strong>m to dare to be tested.<br />

Hear<strong>in</strong>g <strong>the</strong>se stories decreased <strong>the</strong> fear of<br />

discover<strong>in</strong>g HIV status and showed why it is<br />

necessary to know one’s status <strong>in</strong> order to be<br />

treated.<br />

Use humor to raise awareness<br />

In Somaliland, circus acts and small skits<br />

on <strong>the</strong> subject of HIV/AIDS were designed<br />

to make people laugh, enabl<strong>in</strong>g awareness<br />

of some topics. Subjects were varied:<br />

prenuptial test<strong>in</strong>g with a couple about to<br />

marry, stigmatization with a person who<br />

doesn’t want to shake hands with a HIV +<br />

friend, risky sexual activity with a man who<br />

gets drunk <strong>in</strong> a bar and <strong>the</strong>n goes to see a<br />

prostitute, etc.<br />

Make realer than real by demonstrat<strong>in</strong>g<br />

It is not enough to promote condom use;<br />

men must know how to use it! Thus, dur<strong>in</strong>g a<br />

public event organized <strong>in</strong> a military camp, <strong>the</strong><br />

animators brought along a replica of a penis <strong>in</strong><br />

wood to demonstrate condom application.<br />

that a very attractive and healthy-look<strong>in</strong>g<br />

young woman could carry <strong>the</strong> virus!<br />

Ask questions to make sure<br />

Dur<strong>in</strong>g festive events, a quiz (questionnaire)<br />

enabled show<strong>in</strong>g people that <strong>in</strong> spite of<br />

th<strong>in</strong>k<strong>in</strong>g <strong>the</strong>mselves well <strong>in</strong>formed on HIV,<br />

<strong>the</strong>y were often unable to answer <strong>the</strong> questions<br />

asked. The quiz thus made <strong>the</strong>m attentive to<br />

awareness messages that followed it.<br />

“At <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>g of <strong>the</strong> event, young people<br />

were bored because <strong>the</strong>y had heard talk<br />

about HIV <strong>in</strong> <strong>the</strong> media and thought <strong>the</strong>y knew<br />

everyth<strong>in</strong>g about it. But dur<strong>in</strong>g <strong>the</strong> quiz, <strong>the</strong>y<br />

realized that <strong>the</strong>y couldn’t answer <strong>the</strong> questions<br />

and <strong>the</strong>refore didn’t know everyth<strong>in</strong>g. This<br />

made <strong>the</strong>m pay attention to what <strong>the</strong>y were<br />

told later.” 20<br />

Use powerful symbols<br />

For rais<strong>in</strong>g awareness, us<strong>in</strong>g symbols was<br />

effective for re<strong>in</strong>forc<strong>in</strong>g messages. World<br />

AIDS Day on December 1 was, for example, an<br />

excellent occasion for organiz<strong>in</strong>g festive vents<br />

<strong>in</strong> partnership with o<strong>the</strong>r stakeholders work<strong>in</strong>g<br />

on <strong>the</strong> same topic. In <strong>the</strong> same way, dur<strong>in</strong>g<br />

<strong>the</strong> project a festive event was organized<br />

on <strong>the</strong> strip of land separat<strong>in</strong>g Ethiopia and<br />

Somaliland, us<strong>in</strong>g <strong>the</strong> symbol of <strong>the</strong> border<br />

to <strong>in</strong>sist on <strong>the</strong> fact that “HIV/AIDS knows no<br />

borders”, which is <strong>the</strong> major message of <strong>the</strong><br />

project.<br />

Use high-impact testimonials<br />

For an audience made up of young Ethiopian<br />

soldiers, a pretty young woman came to tell<br />

about <strong>the</strong> fact that she was liv<strong>in</strong>g with <strong>the</strong><br />

AIDS virus and that she used condoms dur<strong>in</strong>g<br />

sex to avoid contam<strong>in</strong>at<strong>in</strong>g her partners. For<br />

<strong>the</strong>se soldiers, this woman was liv<strong>in</strong>g proof<br />

20. Tensig Gimariam, represent<strong>in</strong>g a youth organization on <strong>the</strong> Dire Dawa project advisory committee<br />

38


4. Carry<strong>in</strong>g out<br />

more precisely targeted actions<br />

Part<br />

2<br />

1. Special target<strong>in</strong>g of populations<br />

d Meet with groups at risk<br />

d Discuss with target populations<br />

dur<strong>in</strong>g workshops<br />

d Raise awareness of <strong>the</strong> young<br />

<strong>in</strong> familiar surround<strong>in</strong>gs<br />

d Create a climate of trust before talk<strong>in</strong>g<br />

about a sensitive subject<br />

d Carefully orient <strong>the</strong> conversation<br />

d F<strong>in</strong>d <strong>the</strong> proper relays<br />

2. Promot<strong>in</strong>g condoms…<br />

where it is acceptable to do so<br />

d Locate <strong>the</strong> most pert<strong>in</strong>ent places<br />

d Make condoms available daily<br />

d Go beyond skepticism to <strong>in</strong>novate<br />

d Educate young people through o<strong>the</strong>r<br />

young people<br />

d Pay attention to appearances<br />

In <strong>the</strong> geographical area covered by <strong>the</strong><br />

project, some populations were identified as<br />

be<strong>in</strong>g more vulnerable to HIV/AIDS, such<br />

as prostitutes, young men or truck drivers.<br />

For <strong>the</strong>se persons, specific awareness<br />

actions were implemented. For prostitutes,<br />

workshops on disease awareness and <strong>the</strong><br />

use of preservatives were organized. Truck<br />

drivers were approached dur<strong>in</strong>g awareness<br />

activities and condom distribution on <strong>the</strong><br />

traffic corridor. Concern<strong>in</strong>g young men,<br />

distribution of condoms was organized <strong>in</strong><br />

Ethiopia <strong>in</strong> front of some bars on weekend<br />

even<strong>in</strong>gs. In Somaliland, where it is difficult to<br />

mention condoms, young people were made<br />

aware through <strong>in</strong>terventions at schools, but<br />

also outside schools for those who were not<br />

students, and through <strong>the</strong> implementation of<br />

activities at a youth center.<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

39


SPECIAL TARGETING OF POPULATIONS AT RISK<br />

Meet with groups at risk<br />

For some groups at risk, go<strong>in</strong>g to meet<br />

with <strong>the</strong>m can enable develop<strong>in</strong>g collective<br />

awareness. Thus, at Jijiga (Ethiopia), festive<br />

events were organized for audiences deemed<br />

to be “concerned” by <strong>the</strong> AIDS topic: soldiers<br />

and young men. A public event was organized<br />

with<strong>in</strong> <strong>the</strong> military base at Jijiga for 1,500<br />

soldiers, with music, testimonials by PLWHIV,<br />

quizzes, etc. For students, <strong>the</strong> same type of<br />

event was organized for students of <strong>the</strong> Jijiga<br />

School of Higher Learn<strong>in</strong>g.<br />

Discuss with target populations<br />

dur<strong>in</strong>g workshops<br />

<strong>Awareness</strong> workshops were organized for<br />

discussions with ei<strong>the</strong>r populations at risk,<br />

such as prostitutes, or <strong>in</strong>fluential members<br />

of <strong>the</strong>ir community, such as political and<br />

religious leaders. Dur<strong>in</strong>g <strong>the</strong>se workshops,<br />

<strong>the</strong> goal was to provide basic knowledge of<br />

<strong>the</strong> disease and its means of transmission and<br />

prevention. Follow<strong>in</strong>g an overall presentation,<br />

workgroups were organized. Each group<br />

had time to prepare for answer<strong>in</strong>g a certa<strong>in</strong><br />

number of questions (i.e.: How is <strong>the</strong> virus<br />

transmitted? How can you protect yourself?<br />

How can you make a prostitute’s clients use<br />

a condom? How do you treat someone who is<br />

HIV +?). Then, <strong>the</strong> group representative gave<br />

<strong>the</strong> responses <strong>in</strong> front of <strong>the</strong> entire ga<strong>the</strong>r<strong>in</strong>g<br />

and all participants discussed and developed<br />

<strong>the</strong> answers.<br />

Raise awareness of <strong>the</strong> young<br />

<strong>in</strong> familiar surround<strong>in</strong>gs<br />

Build<strong>in</strong>g a center for young people at Hargeisa<br />

(Somaliland) enabled offer<strong>in</strong>g <strong>the</strong>m a place<br />

to meet with different leisure activities, such<br />

as billiards, table soccer, p<strong>in</strong>g-pong, outdoor<br />

activities, Internet connection or a collection<br />

of books. In this center where young people<br />

came regularly, two HIV/AIDS counselors<br />

were tra<strong>in</strong>ed to make young people aware of<br />

this topic and provide detailed and confidential<br />

advice to those who wanted it.<br />

Create a climate of trust<br />

before talk<strong>in</strong>g about a sensitive subject<br />

In <strong>the</strong> youth center at Hargeisa, <strong>the</strong> counselors<br />

gradually came <strong>in</strong>to contact with <strong>the</strong> young<br />

people and got to know <strong>the</strong>m <strong>in</strong> order to<br />

progressively w<strong>in</strong> <strong>the</strong>ir trust. They took<br />

advantage of daily activities and conversations<br />

to talk about VCT centers and give all <strong>the</strong><br />

basic <strong>in</strong>formation about <strong>the</strong> disease. Then, for<br />

more <strong>in</strong>-depth and personalized counsel, <strong>the</strong><br />

young people met with <strong>the</strong> counselor <strong>in</strong> <strong>the</strong><br />

counselor’s office. If <strong>the</strong>y wanted to cont<strong>in</strong>ue<br />

by be<strong>in</strong>g tested, <strong>the</strong>y were directed to a nearby<br />

hospital.<br />

Carefully orient <strong>the</strong> conversation<br />

S<strong>in</strong>ce <strong>the</strong>y wanted to reach populations at risk,<br />

<strong>the</strong> animators sometimes approached truck<br />

drivers by choos<strong>in</strong>g heavily traveled areas.<br />

The animators ei<strong>the</strong>r sat with <strong>the</strong> drivers <strong>in</strong> a<br />

restaurant or bar or went to see <strong>the</strong>m <strong>in</strong> <strong>the</strong>ir<br />

trucks. The discussion was first about o<strong>the</strong>r<br />

topics and <strong>the</strong> animators began by jok<strong>in</strong>g with<br />

<strong>the</strong> drivers before mention<strong>in</strong>g AIDS and <strong>the</strong>ir<br />

© Julie de Lamarzelle pour <strong>Handicap</strong> <strong>International</strong><br />

40


SUCCESS STORY:<br />

BAR OWNERS ACT AS RELAYS<br />

At Jijiga (Ethiopia), bar owners were tra<strong>in</strong>ed about HIV/AIDS and its means of<br />

transmission and prevention. After this tra<strong>in</strong><strong>in</strong>g, one of <strong>the</strong> owners was particularly<br />

militant concern<strong>in</strong>g <strong>the</strong> prostitutes who worked <strong>in</strong> her bar. She obliged <strong>the</strong> prostitutes<br />

to systematically offer condoms and, above all, supported <strong>the</strong>m when customers<br />

were reluctant to cooperate.<br />

role <strong>in</strong> prevention. Us<strong>in</strong>g humor was important<br />

to show <strong>the</strong>ir friendl<strong>in</strong>ess before <strong>in</strong>troduc<strong>in</strong>g <strong>the</strong><br />

topic. Introduc<strong>in</strong>g <strong>the</strong> subject of HIV/AIDS too<br />

rapidly <strong>in</strong> <strong>the</strong> conversation risked anger<strong>in</strong>g<br />

<strong>the</strong> drivers, who would <strong>the</strong>n say th<strong>in</strong>gs like,<br />

“Who told you I was concerned by AIDS? Who<br />

are you to talk to me like that?”<br />

F<strong>in</strong>d <strong>the</strong> proper relays<br />

Sometimes, for mak<strong>in</strong>g some persons aware,<br />

it was useful to identify those who had an<br />

<strong>in</strong>fluence over <strong>the</strong>m, whe<strong>the</strong>r for f<strong>in</strong>ancial<br />

or social reasons. Thus, mak<strong>in</strong>g prostitutes<br />

aware of <strong>the</strong> usefulness of us<strong>in</strong>g condoms for<br />

protection risked be<strong>in</strong>g <strong>in</strong>effective if <strong>the</strong> owners<br />

of <strong>the</strong> bars where <strong>the</strong>y worked required <strong>the</strong>m<br />

to refuse noth<strong>in</strong>g to customers. These owners<br />

were thus <strong>in</strong>vited to tra<strong>in</strong><strong>in</strong>g sessions and made<br />

aware of <strong>the</strong> importance for prostitutes and<br />

<strong>the</strong>ir customers to use condoms to mitigate<br />

propagation of <strong>the</strong> disease.<br />

In a similar way, a workshop for community and<br />

religious leaders enabled rais<strong>in</strong>g awareness<br />

of <strong>the</strong> topic. Afterwards, <strong>the</strong>se leaders were<br />

very active with<strong>in</strong> <strong>the</strong>ir communities as relays<br />

for <strong>the</strong> prevention messages. For example,<br />

<strong>the</strong>y repeatedly <strong>in</strong>vited PLWHIV to present<br />

<strong>the</strong>ir testimony dur<strong>in</strong>g religious ceremonies.<br />

PROMOTING CONDOMS…WHERE IT IS ACCEPTABLE TO DO SO<br />

In most areas covered by <strong>the</strong> project, it was<br />

difficult to mention condoms and even more<br />

difficult to distribute <strong>the</strong>m. Therefore, condom<br />

promotion was done <strong>in</strong> Ethiopia <strong>in</strong> urban<br />

areas only or with populations at risk, such<br />

as prostitutes or truck drivers. In Somaliland,<br />

it was culturally not possible to talk abut<br />

condoms <strong>in</strong> public or to promote <strong>the</strong>m; it was<br />

also very difficult to f<strong>in</strong>d <strong>the</strong>m, except <strong>in</strong> some<br />

pharmacies.<br />

Locate <strong>the</strong> most pert<strong>in</strong>ent places<br />

To distribute condoms to truck drivers, towns<br />

on <strong>the</strong> routes where <strong>the</strong> drivers habitually<br />

stopped were chosen. In <strong>the</strong>se towns, <strong>the</strong><br />

places where drivers most frequently went<br />

to relax or see prostitutes were identified.<br />

Condoms were left next to a lavatory <strong>in</strong> one<br />

of <strong>the</strong> restaurants most appreciated by truck<br />

drivers <strong>in</strong> one of <strong>the</strong> towns. In ano<strong>the</strong>r town, a<br />

popular store was chosen, which was next to<br />

<strong>the</strong> places where drivers got toge<strong>the</strong>r to chew<br />

khat.<br />

Make condoms available daily<br />

At <strong>Handicap</strong> <strong>International</strong> and at partner<br />

locations, <strong>in</strong> offices and more <strong>in</strong>timate places<br />

such as restrooms, condoms are available for<br />

employees and for passers-by. In addition to<br />

be<strong>in</strong>g part of <strong>the</strong> project <strong>the</strong>me, this <strong>in</strong>itiative<br />

also followed <strong>the</strong> governmental policy of<br />

fight<strong>in</strong>g AIDS <strong>in</strong> <strong>the</strong> workplace.<br />

41


Go beyond skepticism to <strong>in</strong>novate<br />

The idea of distribut<strong>in</strong>g condoms <strong>in</strong> front of<br />

bars on <strong>the</strong> weekends first had little support<br />

from partners on <strong>the</strong> project team, who were<br />

afraid that young men and bar owners would<br />

f<strong>in</strong>d it vulgar and irritat<strong>in</strong>g. But after <strong>the</strong> first<br />

weekends of distribut<strong>in</strong>g condoms, success<br />

was apparent: condoms were distributed<br />

massively. Bar owners even came to thank<br />

HI for this <strong>in</strong>itiative and express <strong>the</strong>ir wish that<br />

it cont<strong>in</strong>ue.<br />

Educate young people<br />

through o<strong>the</strong>r young people<br />

To reach young people <strong>in</strong> <strong>the</strong> bars on weekend<br />

even<strong>in</strong>gs, condom distribution was done by<br />

people of <strong>the</strong> same generation. This group<br />

of volunteers, made up mostly of young<br />

girls, was tra<strong>in</strong>ed on <strong>the</strong> topic of HIV/AIDS<br />

<strong>in</strong> order to provide <strong>in</strong>formation on <strong>the</strong> disease<br />

while ensur<strong>in</strong>g distribution. S<strong>in</strong>ce <strong>the</strong>y were<br />

both young and considered to be educated<br />

because <strong>the</strong>y were university students, <strong>the</strong>ir<br />

message had a strong impact on o<strong>the</strong>r young<br />

people.<br />

Pay attention to appearances<br />

The young condom distributors wore very<br />

identifiable smocks with <strong>the</strong> project logo<br />

and a message promot<strong>in</strong>g use of condoms.<br />

In addition, condoms were presented on a<br />

beautiful traditional tray to create a sort of<br />

“stag<strong>in</strong>g” for distribution. F<strong>in</strong>ally, a project<br />

sticker was applied to each box of condoms,<br />

on <strong>the</strong> one hand to communicate about <strong>the</strong><br />

project and on <strong>the</strong> o<strong>the</strong>r, to underl<strong>in</strong>e <strong>the</strong> fact<br />

that <strong>the</strong> condom was not offered for free by<br />

<strong>the</strong> manufacturer.<br />

42


To learn more…<br />

In this document, a number of types of know-how used for community awareness have been<br />

presented. This know-how aims to provide <strong>in</strong>spiration for o<strong>the</strong>r awareness projects and is not<br />

exhaustive.<br />

For those who would like to <strong>in</strong>vestigate fur<strong>the</strong>r, we propose o<strong>the</strong>r project references that give<br />

an overall view of <strong>the</strong> project, s<strong>in</strong>ce only its community awareness aspect has been discussed<br />

here. These references will allow compar<strong>in</strong>g what can be done <strong>in</strong> o<strong>the</strong>r contexts and will provide<br />

methodology and ideas for implementation of learn<strong>in</strong>g-from-experience process.<br />

PROJECT: “IMPROVEMENT OF THE PREVENTION AND TREATMENT OF HIV/<br />

AIDS IN THE CROSS-BORDER REGIONS OF DJIBOUTI, IN ETHIOPIA AND IN<br />

SOMALILAND”<br />

d Logical framework of <strong>the</strong> project and its narrative<br />

d Six-month reports, nos. 1, 2, 3, 4 and 5<br />

d Mid-project evaluation<br />

Learn<strong>in</strong>g-from-experience sheet: “Facilitat<strong>in</strong>g <strong>the</strong> establishment of long-last<strong>in</strong>g<br />

cross-border l<strong>in</strong>ks”<br />

Learn<strong>in</strong>g-from-experience sheet: “Streng<strong>the</strong>n<strong>in</strong>g <strong>the</strong> health system”<br />

These documents are available on <strong>the</strong> project DVD-ROM <strong>in</strong> <strong>the</strong> Toolbox <strong>in</strong> <strong>the</strong> Project Documents<br />

directory. A number of o<strong>the</strong>r project documents are listed <strong>in</strong> <strong>the</strong> o<strong>the</strong>r Toolbox directories.<br />

COMMUNITY AWARENESS<br />

d Approche communautaire et projet d’appui au Burundi : l’expérience de la mise en place des<br />

comités de santé dans le cadre du projet d’accès aux so<strong>in</strong>s pour les personnes vulnérables dans<br />

la prov<strong>in</strong>ce sanitaire de Ngozi. DUBAND Agnès. Lyon: <strong>Handicap</strong> <strong>International</strong>, 2006, 3 p.<br />

http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/AppCommunautaireBurundi.pdf<br />

d As It Is Research: F<strong>in</strong>d<strong>in</strong>gs on <strong>the</strong> knowledge, attitude, practice and access to HIV and AIDS<br />

<strong>in</strong>formation and services amongst persons with disability. <strong>Handicap</strong> <strong>International</strong> Kenya. Nairobi:<br />

<strong>Handicap</strong> <strong>International</strong>, 2007, 20 p.<br />

http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/SummaryDisabilityHivKenya.pdf<br />

43


LEARNING-FROM-EXPERIENCE (”CAPITALIZATION”)<br />

d Learn<strong>in</strong>g-from-experience: a manual for organis<strong>in</strong>g, analys<strong>in</strong>g and document<strong>in</strong>g field based<br />

<strong>in</strong>formation / Du terra<strong>in</strong> au partage : manuel pour la capitalisation des expériences. CHAVEZ-<br />

TAFUR Jorge; HAMPSON Karen; INGEVALL Anita; THIJSSEN Rik. Amersfoort : ILEIA, 2007.-<br />

47 p. (Localisation 516.CHA)<br />

English: http://documentation.leisa.<strong>in</strong>fo/Documentation%20Manual.pdf<br />

Français: http://documentation.leisa.<strong>in</strong>fo/Du%20terra<strong>in</strong>%20au%20partage.pdf<br />

d Les démarches de capitalisation cont<strong>in</strong>ue dans le réseau des membres et partenaires de<br />

Coord<strong>in</strong>ation Sud, COORDINATION SUD. Coord<strong>in</strong>ation Sud, 2004, 5 p. [onl<strong>in</strong>e]<br />

http://coord<strong>in</strong>ationsud.org/IMG/doc/tab_capit_perm_reduit_02_09_04.doc<br />

d Note de synthèse du module de formation : « Introduction à la capitalisation d’expériences ».<br />

GRAUGNARD Gilbert ; QUIBLIER Véronique. Lyon: Ciedel, 2006.- 24 p.<br />

http://evaluation.francophonie.org/IMG/pdf/download.pdf<br />

d Learn<strong>in</strong>g and shar<strong>in</strong>g experience: lessons for learn<strong>in</strong>g processes <strong>in</strong> NGOs / Capitalisation<br />

d’expériences... expérience de capitalisations : comment passer de la volonté à l’action ?<br />

VILLEVAL Philippe. <strong>in</strong> Traverses, no. 15, October 2004, 46 p. (Localization: 516.VIL)<br />

English: http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/TraversesUK.pdf<br />

Français: http://www.handicap-<strong>in</strong>ternational.fr/fileadm<strong>in</strong>/documents/publications/Traverses.pdf<br />

d Appui à la mise en œuvre et au suivi d’une démarche de capitalisation d’expériences, ZIEGLE<br />

Cécile. Coord<strong>in</strong>ation Sud, 2004, 5 p.<br />

http://www.coord<strong>in</strong>ationsud.org/IMG/pdf/demarche_capi_site_15_07.pdf<br />

44


<strong>Handicap</strong> <strong>International</strong><br />

14 avenue Ber<strong>the</strong>lot<br />

69361 Lyon cedex 07 - France<br />

<strong>Handicap</strong> <strong>International</strong><br />

Programme Éthiopie<br />

Kirkos Sub City<br />

Kebele 01 - House N° 407/11/02<br />

Po Box 1160 - Addis Ababa - Éthiopie

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