'Before we were sleeping, now we are awake': preliminary evaluation of the stepping stones sexual health programme in The Gambia

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 (Sexually Transmitted Infection)/HIV prevention workshop programme based on empowerment techniques, which have been adapted to an infertility prevention framework in Gambia. This paper describes a preliminary evaluation in 2 villages where the intervention was carried out compared to 2 control villages. Methods used include: participatory evaluation; in-depth interviews; focus groups discussions; a knowledge, attitudes and practice questionnaire administered to a random sample of 25% of the adult population; 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 STIs 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 breast-feeding) 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.

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Medical Research Council, PO Box 273, Banjul, The Gambia