"Because individuals' lives are multifaceted and embedded within their societies and cultures at multiple levels, community-based approaches, which involve all stakeholders, can be powerful tools for advancing gender equality and integrating gender to increase HIV prevention, care, and treatment for all. This technical brief describes the essential theoretical and practical elements of programmatic approaches to strengthen community platforms to address gender equality and harmful gender norms."
Several studies have reported that girls' and women’s risk of HIV infection is associated with gender inequality and violence. This technical brief from AIDSFree describes the elements of programmatic approaches to strengthen community platforms to address gender equality and harmful gender norms, which can lead to risky behaviours, violence, substance abuse, pursuit of multiple sexual partners, and domination of women. It draws examples from successful community platforms for addressing gender-based violence (GBV).
As understood within this brief, communities function as agents by providing resources and addressing challenges through "units of solution" that comprise community institutions themselves: families, informal social networks, neighbourhoods, schools, the workplace, businesses, philanthropic organisations, and political organisations or groups. Identifying harmful gender norms and gender inequalities in a community is the first step in intervention planning. Ethnographic interviewing and mapping, in-depth interviews, and immersion in the daily lives of community members can provide insights into community characteristics and links between individuals, groups, and institutions. The Gender Strategy articulated by the United States (US) President's Emergency Plan for AIDS Relief (PEPFAR 2013) specifies that the analysis should identify age-specific gender roles and norms that affect: (a) access to and control over resources; (b) access to and use of HIV prevention, treatment and care, and support; and (c) differences in power among and between women, men, girls, and boys.
Guiding principles for mobilising communities include, among others, a human rights framework to create a legitimate channel for discussing gender norms (e.g., women's needs and priorities) and to hold the community accountable for treating members as valuable and equal human beings. This framework invites community members to examine and assess their value system and empowers them to make sensible and sustainable change. Another guiding principle is promoting community ownership, given that effective community-based projects aimed at changing harmful gender norms must engage and be led by members of that community.
According to the technical brief, successful gender-transformative community-based HIV programmes have several characteristics in common:
- Broad-based, multisectoral engagement;
- A tailored, well-structured, well-monitored, phased set of community capacity building activities
- Use of theory-based models to guide formative research and development of appropriate interventions; and
- Implementation by individuals, groups, and organisations based in the communities to increase effectiveness in addressing community needs, monitoring interventions activities, developing trust, and building relationships.
- Designed by Raising Voices, SASA! is a community mobilisation intervention aimed at preventing violence against women and HIV in 20 sub-Saharan Africa countries. It seeks to change community attitudes, norms, and behaviours that result in gender inequality, violence, and increased vulnerability for women. SASA! community mobiliation was organised in 4 phases, each entailing 4 corresponding strategies (local activism; media and advocacy; communication materials; training) that engage different groups in the community, increase community ownership, and improve the sustainability of positive change (see Table 1). The evaluation of SASA! showed a significantly lower social acceptance of interpersonal violence (IPV) among women and a lower acceptance of IPV among men. Women who experienced violence in intervention communities were more likely to receive supportive community responses, and reported sexual concurrency by men in the past year was significantly lower in intervention compared to control communities.
- The Safe Homes and Respect for Everyone (SHARE) project, developed from Raising Voices' first programme tool, was implemented within the ongoing HIV prevention and treatment activities of the Rakai Health Sciences Programme. SHARE was designed to reduce physical and sexual IPV and HIV incidence through two main approaches: community-based mobilisation to change attitudes and social norms that contribute to IPV and HIV risk; and a screening and brief intervention to reduce violence following HIV disclosure and sexual risk in women seeking HIV testing services. Individuals in the SHARE intervention groups had fewer self-reports of physical and sexual IPV and a reduction in HIV incidence as compared to the control groups.
Both the SASA! and SHARE projects used the ecological model to guide their formative research, and adapted the stages of change theory, scaling it up to the community level, to develop their interventions. Figure 1 on page 6 is a multidimensional ecological model that shows different HIV behavioural factors, including gender-related factors. The idea is that, because norms are perpetuated and reinforced by numerous institutions, changing them requires interventions at different levels: individual, relationship, community, and societal. The phased nature of change is a key element of the transtheoretical model (TTM), which describes a sequence of stages in successful behaviour change: pre-contemplation (no recognition of need or interest in change), contemplation (thinking about changing), preparation for action (planning for change), action (adopting new habits), and maintenance (ongoing practice of new, healthier behaviour).
SASA!, SHARE, and other programmes have used similar domains, or a combination of them, to strengthen community platforms to address harmful gender norms, including:
- Community activism (resource mobilisation): Activists selected for training should be respected males or females of different ages (both young and older) who live and work in the community and represent the major local ethnicities (if relevant). Activists can be part of watch groups (e.g., GBV watch group), community volunteer networks, and community action groups, and can engage in outreach activities like open discussions with couples or community members and community dialogues. They are encouraged to interact informally with community members wherever they find people (workplaces, marketplaces, homes, and so on).
- Asset-based approach: This approach mobilises institutions or individuals with an established reputation in community leadership, to act as leaders or community change agents. Programmers using this approach should engage community systems (or individuals associated with them) that are connected with cultural norms, such as traditional marriage counselors. In addition, the asset-based approach should include professionals like health care providers and police officers, who provide prevention and response services, and institutional leaders, who have the power to implement policy changes that address harmful gender norms at national and local levels.
- Strengthening capacity (learning opportunities and skills development): This training can take the form of community activism courses, seminars, workshops, learning tours, specialised training for community activists and health care providers, and structured ongoing dialogues with various decision makers. Training sessions can examine links among gender, power, and health (alcohol abuse, violence, HIV), as well as concepts of masculinity in the local context.
- Advocacy/leadership: Advocacy engages community and institutional figures - religious leaders, other non-governmental organisations (NGOs), community leaders, professional associations, teachers, traditional healers, and local and national governments - to support and/or promote awareness. Activities could include collaborating with community-based organisations, lobbying local leaders, developing community newsletters, reaching out to schools, and facilitating workplace dialogues. In the ecological model, advocacy is very useful for reaching the community and social circles of influence. Collaborators should be located close to communities and should be prepared to commit to the long process of community mobilisation programming.
- Partnership/linkages/networking: These linkages help to build relations and find synergies with other organisations and also to ensure that both formal support systems (e.g., shelters, health services to handle GBV cases) and informal systems within the community (e.g., local councils, peer support groups, watchdog or faith-based groups) are in place and functional by engaging and partnering with health service providers, police officers, and neighborhood committees.
- Media, events, and learning materials (communication/diffusion): Media activities - including soap operas, films, television, comics, newspapers, and radio programmes - can impart facts and present stories to communities and to leaders and policymakers: for example, to increase understanding of how gender inequality and harmful gender norms (such as expressing manhood as toughness, dominance, risk-taking, and heterosexual success) could lead to GBV and increased HIV risk. Events can include marches, community theatre (edutainment), music, dance, exhibitions, and seminars. Programmes have used learning materials such as booklets, posters, murals, story cards, and games to engage community members. Communication materials are useful in drawing attention of individuals or when working with institutions and professional and community groups. They can also function as a learning tool to promote personal reflection and critical thinking.
Typical monitoring and evaluation (M&E) measurements for community-based mobilisation or capacity building could include tracking the number of activities conducted and people reached. Also, tools have been developed. SASA! has developed several M&E tools for community mobilisation activities (see Box 1 on page 14 and the Resources section). In addition to monitoring community activists' work, it is noted here that it is critical to hold planning meetings to discuss successes and challenges, build activists' confidence by reviewing activities within the current intervention stage, help them develop their monthly plan for community activities, and review new communication materials. Furthermore, PEPFAR recommends that while monitoring gender-related outputs and outcomes, programmers should consider including indicators that are gender-sensitive.
The technical brief concludes with a series of recommendations. For example, take the time and develop the trust needed to build strong relationships with community members, who can be key players in fostering local acknowledgment and discussion of sensitive issues such as beliefs about GBV and sexual orientation (men having sex with men, transgender) that centre on fundamental concerns about power and rights.
Email from Vanessa Miranda to The Communication Initiative on March 17 2016.