Executive Summary

"As HIV/AIDS continues to attack an ever growing proportion of girls and women, particularly in sub- Saharan Africa, the worst affected continent, the need for everyone – men, women, parents, children, households and communities - to join hands in addressing the immediate needs of those already infected and in building the capacity to prevent the further spread of the virus is becoming more and more urgent. ‘Joining Hands: Integrating Gender and HIV/AIDS’ is the report of a project funded by Comic Relief and carried out by ACORD in collaboration with its partners in Africa that was ultimately aimed at reducing the HIV/AIDS vulnerability of young girls and women in Africa.

The project, which was carried out over 2 years (2004-6) in 3 countries - Angola, Tanzania and Uganda – used Stepping Stones – a gender-focussed, participatory process that involves working closely with ‘peer groups’ – based on age and sex in communities over a period of several months. The process has been described as a ‘journey’ that uses a range of participatory methodologies aimed at helping people develop the skills and confidence to understand and challenge prevailing norms and customs that reinforce the effects of poverty and others factors in their environment that make them vulnerable to HIV and AIDS.

Alongside the overarching objective of addressing female vulnerability, specific project objectives included: assessing the effectiveness of the Stepping Stones process; building the capacity of local structures to respond; and promoting communityled responses through effective partnerships and advocacy actions. Another objective was to find out whether Stepping Stones can be effectively used in non-conventional contexts with a range of population groups, such as with the nomadic Mucubai tribe in Southern Angola, internally displaced people living in camps in Northern Uganda and with the army in the 21st battalion of the Angolan armed forces.

A common set of Core Project Indicators based on the desired outcomes were identified and the formed the basis of project monitoring and evaluation in the 3 countries. Key findings in relation to these core indicators include:

• Improvements in the level of knowledge and understanding of HIV/AIDS were found across the board in the 3 countries
• Increased communication around sexual issues was recorded in the 3 countries, as well as better communication generally between couples and within communities
• Some evidence of stigma reduction, but more patchy and in conflict with behaviour patterns, such as low take-up of VCT services
• Certain risky cultural and sexual practices were reduced, including reductions in alcohol abuse, but condom use still low in most of the countries
• The main impact on gender relations is increased respect for women, including self-respect and reductions in gender violence. However, traditional patterns of female subordination in relation to decisionmaking and control over resources unchanged.
• Increased sense of community responsibility for HIV and AIDS is also apparent.

The data collection methods included a mix of quantitative and qualitative data sources. Each of these data-collection methods produced different findings, some of which were contradictory. On the whole, it was found that more in-depth, qualitative methods produce more accurate and reliable results, but these need to be complemented
by additional sources of quantitative data. In terms of sustainability, the project found that this is enhanced by the tendency of those who have been through the SS process to discuss and share what they have learned with family, friends and others in the community. The scaling-up potential of SS is also strong due to the multiplier effect whereby those trained, train others and they, in turn train others, and so on.

In terms of adaptability, it was found that SS can be adapted for use in a wide range of contexts. One of the most striking findings was the success of Stepping Stones in the army context where it has led to dramatic falls in alcoholism, unprotected sex with multiple sexual partners, violence against women and, conversely, resulted in increased condom use and more respectful behaviour towards women. As such, SS can be viewed as a very effective methodology in a post-conflict situation, helping people to overcome the brutalising effects of war and to sew together divided communities bridging the gulf between the military and the civilian community. However, SS proved less adaptable in the case of the Mucubai pastoralists and more thought is needed in developing effective strategies for overcoming some of the obstacles in this area.

The community mobilisation potential of Stepping Stones is strong and enhanced by the active involvement of the local leadership. Close collaboration between communities, local government and traditional leadership structures, NGOs and service providers is required for the effective coordination and harmonisation of policies and services and the establishment of a conducive external environment. To enhance the impact of Stepping Stones, it must be adequately resourced and funding must extend beyond the implementation phase and cater for longer-term follow-up and support to communities. Funding is also required for further in-depth, qualitative research to gain a better understanding of the complex dynamics at work."