‘Before we were sleeping, now we are awake’: Preliminary evaluation of theStepping Stonessexual health programme in The Gambia

Abstract

Community-based behavioural interventions aimed at reducing risky sexual behaviour have yet to be shown to be effective in the developing world. Stepping Stones is a participatory STI/HIV prevention workshop programme based on empowerment techniques, which has been adapted to an infertility prevention framework for The Gambia. This paper describes a preliminary evaluation in two villages where the intervention was carried out compared to two control villages. Methods used include: participatory evaluation; 84 in-depth interviews; seven focus group discussions; a knowledge, attitudes and practice questionnaire administered to a random sample of 25% of the adult population at three time points; and monitoring of condom supply. The structure of the evaluation is based on the themes derived from the qualitative data. The infertility prevention approach made it possible to overcome resistance to discussing the topics of sexual and reproductive health. An atmosphere of trust was created and men were persuaded to participate in the programme as they felt that their own needs were being addressed. Participants enjoyed the programme and found the content relevant. Knowledge of the modes of transmission of HIV and sexually transmitted infections and levels of risk awareness increased. The value of condoms in particular situations was recognised: for sex before marriage, within marriage (when the woman is breastfeeding) and with non-marital partners. Women reported that they would insist on condom use outside marriage and even ask their husbands to use condoms for non-marital sex. Condom monitoring data suggested that condom uptake had increased. It was reported that there was significant increase in dialogue within marriage with the consequence that there were fewer disagreements and incidents of domestic violence. Diffusion of the messages of Stepping Stones appeared to have taken place with non-participants including children. The evaluation techniques used can now be refined in order to generate further evidence on a larger scale and over a longer period.

Why do we have sex? Reflections from a Stepping Stones participatory action research with youth LGBTI in Johannesburg

“…Though the intervention has been used extensively in sub-Saharan Africa (Hadjipateras et al 2006;Jarjue et al 2000;Paine et al 2002;Shaw and Jawo 2000;Bishaw 1990), tones workshop was facilitated for an exclusively lesbian, gay and bisexual group in South Africa. In this study, we used participatory action research because it allows for better rapport between the researchers and the participants, it also allowed for prolonged engagement with the research participants and it is flexible.…”

“…The intervention was developed by Alice Welbourn in Uganda in 1995 and has been adapted and used in many countries worldwide (Bradley et al 2011;Hadjipateras et al 2006;Paine et al 2002;Shaw and Jawo 2000;Skevington, Sovetkina, and Gillison 2013;Slutkin et al 2006;Welbourn 1995). In South Africa, the adapted Stepping Stones has been used since 1998 (Jewkes and Cornwall 1998;Jewkes, Nduna and Jama 2002;Jewkes, Nduna, and Shai Jama 2010).…”

Prevalence of herpes simplex type 2 and syphilis serology among young adults in a rural Gambian community

“…Most men and women are circumcised in the Gambia (for women this usually involves removal of the clitoris and labia minora). 19 The study described in this paper was conducted in this relatively high STI prevalence area as part of a series of studies to assess the feasibility of evaluating a behavioural intervention (Stepping Stones-Gambia) 20 in a proposed community randomised trial. This intervention works with entire villages and aims to reduce vulnerability to STI/HIV by promoting dialogue about these problems across the community.…”

Promoting vulnerability or resilience to HIV? A qualitative study on polygamy in Maiduguri, Nigeria

“…One example is the Stepping Stones training programme, which uses a participatory adult learning methodology to enable women and men to reflect on the role of gender among other influences in relationships and to identify actions for change (Welbourn, 1995). Impact evaluations have shown that this approach has led to increased condom use, improved inter-personal communication in relationships (Welbourn, 1995;Paine et al, 2002), and changes in male sexual behaviour (Jewkes et al 2008).…”