Mike Kesby, Caroline Maposhere, Irene Moyo,

Irene Tavengwa, Themba Mhlanga,

Unpublished report:

School of Geography, University of St Andrews, KY16 9AL, Fife,

Scotland, UK

February 2002




2.1 Background to the study:

2.2 Research aims:

2.3 Background: the original Tsungirirai run Stepping Stones program:

2.3.1 Location:

2.3.2 Pre-intervention study:

2.3.3 Training of community facilitators: Implementation in the community:

2.3.4 Reported impacts:

3. RESEARCH DESIGN: of the independent evaluation August 2001

3.1 Sample:

3.1.1 Sample frame, selection and recruitment Facilitators – Participants – Non-participants living in the same community – Control group – Elders – Clinic staff Commercial sex workers: Tabulated Summary of Sample:

3.2 Techniques and methodology:

3.2.1 General approach:

Methodology/process through which research was conducted:

3.2.2 Techniques/tools:


4.1 Knowledge Attitudes and Practices (KAP questionnaire)

4.1.1 Younger women

4.1.2 Older women – a mixed group; both Stepping Stones participants and nonparticipants

4.1.3 Younger men

4.1.4 Older men

4.1.5 The control group: Men

4.1.6 The control group: Women

4.2 Results 2: Group diagramming/focus group interviews

4.2.1 Venn diagram – Information on HIV and AIDS The control group

4.2.2 Venn diagram - Membership of community organisations and alternative delivery of Stepping Stones The control group

4.2.3 Pie charts - Attendance and

Focus groups - Peer groups

4.2.4 Wheelbarrow diagram - Things that made Stepping Stones go well

4.2.5 Focus group - Likes and dislikes about Stepping stones

4.2.6 Flow diagram and focus groups - peer groups

4.2.7 Wheelbarrow diagram - Things that made the work of Stepping Stones continue

4.2.8 Flow diagram – contexts for sex The control group

4.2.9 Tree diagram - Strategies to avoid risk The control group

4.2.10 Focus group - Hoped for change and community requests

4.2.11 Flow diagram - positive changes due to Stepping Stones

4.2.12 Stepping Stones diagram – Future sexual health

4.2.13 Focus group - Final comments from focus group participants

4.3 Results 3: individual semi-structured interviews

4.3.1 Perceptions of Stepping Stones among participants

4.3.2 Knowledge of the Stepping Stones program among non-participants with nonparticipating relatives

4.3.3 Knowledge of the Stepping Stones program among non-participants with participating relatives

4.3.4 Reported changes in behaviour among Stepping Stones participants

4.3.5 Impacts of Stepping Stones reported by non-participants

4.3.6 Treatment of those with AIDS

4.3.7 Condoms - Lack of availability

4.3.8 Condom - use/lack of use

4.3.9 The situation among younger people

4.3.10 Activity in and around the bottle stores

4.3.11 Behaviour among Commercial sex workers

4.3.12 Reported instances of rape, sexual abuse, child abuse.

4.3.13 Logistical/organisational problems with the Stepping Stones program


5.1 The success of the evaluation program

5.2 Strengths and weaknesses in program implementation

5.2.1 Acceptance and perceptions of the program:

5.2.2 The benefits and dis-benefits of the key role played by facilitators:

5.2.3 The problem of attendance:

5.2.4 The unfortunate consequences of split training venues:

5.2.5 The failure to sustain peer group activities beyond the lifetime of the program:

5.2.6 Failure to engage with the wider, non-participation community:

5.2.7 The failure to follow up the program:

5.3 Impacts of the Stepping Stones program

5.3.1 Positive impacts were observable:

5.3.2 Improvements in Knowledge:

5.3.3. Improvements in attitudes:

5.3.4 Improvements in practice; Improvements in partner communication Improvements in communication between parents and children: A reduction in multiple partnering and the sale and purchase of sex Greatly improved treatment of those with AIDS

5.4 Areas where Stepping Stones has failed to have the desired impact

5.4.1 Continuation of potentially risky traditional practices:

5.4.2 Failure to adopt condom use: Lack of access to condoms: Knowledge and acceptance of condom in principal but not practice: Failure to transfer all the messages of the program to the younger generation:

5.4.3 Summary:


6.1 Participants and facilitators recommendations:

6.1 Evaluation team’s recommendations:

6.2.1 The need for a reliable supply of condoms:

6.2.2 HIV testing:

6.2.3 The need to engage peer croups in a single community:

6.2.4 Targeted recruitment.

6.2.5 Engagement with local leaders.

6.2.6 Engagement with the youth:

6.2.7 Joint peer group meetings:

6.2.8 Attendance:

6.2.9 The sustainability of peer group activities:

6.2.10 End of program community meeting and program sustainability:

6.2.11 The need for follow up projects and follow-on programs:

6.2.12 The need for a rolling rather discrete program:

6.2.13 Capacity building and facilitating sustainability:




Appendix 1 Techniques and Methodology

Appendix 2 Ballot style, Knowledge, Attitudes and Practices (KAP) questionnaire:

Appendix 3 The version of the ballot utilised by respondents

Appendix 4 Semi structure interview questions

Appendix 5 Interview schedule used when interviewing facilitators







Team leaders :

Dr Mike Kesby, School of Geography university of St Andrews, Fife, Scotland.

Caroline Maposhere, Independent consultant, Harare, Zimbabwe.

Irene Moyo, Independent consultant, Harare, Zimbabwe.

Research Assistants:

Irene Tavengwa, Harare Zimbabwe.

Themba Mhlanga, Harare Zimbabwe.

Elton Chidoni, Harare Zimbabwe.


Background to the study:

The study that took place in Mhondoro North between 20-31 August and on 9

October 2001 was part of a broader program to access the impacts and effectiveness of the “Stepping Stones” participatory HIV learning and action project. While the

Stepping Stones approach has been utilised in a number of communities across the continent of Africa, Mhondoro North is one of only three sites in Zimbabwe 1 where the program has been run in its entirety. Impetus to undertake the review arose from several sources: (1) Dr Kesby is an independent academic researcher interested in the effectiveness of participatory approaches to HIV work in southern Africa. He invited Caroline Maposhere to work with him on the project. (2) Action Aid is the

NGO responsible for developing Stepping Stones approach. Their Africa office in

Harare was interested to undertake an evaluation of the program as practiced in

Zimbabwe and they contracted, Irene Moyo to work with Kesby and Maposhere on a study of the three sites. (3) Tsungirirai entered a partnership with Action Aid in 2000 when they accepted a grant to undertake a Stepping Stones training program in one of their areas of operation. Subsequently they were interested to cooperate with the research team in an evaluation of the program in Mhondoro North. Funding for the

Mhondoro North evaluation came primarily from a research grant awarded to Dr

Kesby by The British Academy, but was supplemented by resources from Action Aid and by Tsungirirai’s provision of accommodation and access to a vehicle and driver.

2.2 Research aims:

2.2.1 Understand the conditions under which the program had been run

2.2.2 Ascertain the attitudes and experiences of the grassroots program facilitators

2.2.3 Ascertain the attitudes of community leaders towards the program

2.2.4 Evaluate the impacts of the program on the attitudes, knowledge and practices of participants

2.2.5 Evaluate the impacts of the program on non-participants in the same community

2.2.6 Compare the attitudes, knowledge and practices of those directly or indirectly exposed to the program, with those of people in a neighbouring but

“unexposed” community

2.2.7 Identify the sustainability of the intervention beyond the limits of the formal program.

1 Another site was Irisvale Resettlement Area, Esigodini in Matabeleland

2.3 Background: the original, Tsungirirai run, Stepping Stones program:

The intervention, which the research team set out to evaluate, had taken place a full year previously. Below is a summary of the report on the intervention produced by

Justin Mucheri (2001) who coordinated the project for Tsungirirai:

2.3.5 Location : The intervention, which was intended as a pilot, took place in

Chivero area of Mhondoro North beginning in March 2000. This is the area of the communal land closest to Norton where Tsungirirai is based. The intervention had three phases; (i) a baseline survey, (ii) a program of training for those who would facilitate the program in the community and (iii) the grassroots intervention itself.

2.3.6 Pre-intervention study : A brief survey was conducted to gauge attitudes and perceptions among the target population that would provide something of a baseline survey against which the intervention might later be judged. Fifteen semi-structured interviews and four focus group discussions were conducted between 7 and 11 March 2000. Informants included the Chief and kraal heads, school heads, teachers, nurses, village health workers, traditional healers, business people, political leaders, the police as well as village youth, women and men. No formal set of study results exist but the general findings are presented below;

Issues articulated

Increasing illness and death

Collapse in the customary system of sex education but parents uncomfortable talking to their own children

Perceived causes

People are succumbing to HIV infection.

Tetes and Sekurus no longer performing traditional roles of educating and counselling youth on sexual and reproductive health issues.


Legal Age of Majority Act

Increasing crime including rape

High drop out rates from school. Grandparents cannot afford high school fees

Sugar Daddies.

Teenage pregnancies

Perceived by the elders as the main cause of traditional system collapse.

Youth unemployment.

An increase in the number of orphans

Unemployment No self-help projects especially for youth

Parents not being role models Parents are no-longer leading by example in the way they live (no dialogue on moral issues).

No spouse communication

Poverty is forcing some young girls to exchange sex for money with older males.

Cultural beliefs prevent communication about sexual issues.

Poverty, especially among households headed by the elderly or orphans

Condoms Perceived by most elders as the main cause of promiscuity (attitudes).

Respondents did not report Gender/domestic violence but members of the research team suspected it existed. Participatory diagramming methods were also used with the focus groups. They identified; (i) Men primarily control household decision-making, (ii) women have longer working days than men and undertake more tasks, (iii) men tend to take leadership roles in

HIV/AIDS initiatives (such as home based care) but women undertake most of the work. Finally, the survey revealed that while people in the area had already been exposed to a number of HIV initiatives, the impacts of these initiatives were not immediately obvious. Nevertheless, respondents to the survey displayed a realisation that the problem of HIV must be addressed and a willingness to support and be involved in the Stepping Stones program as a

means to achieve this. In conducting their pre-intervention study, the survey team experienced delays and problems due to other work commitments, rains and poor roads, parliamentary elections, fuel shortages, poor communications and too short notice being given to respondents (many of these were to affect the intervention itself and the final two also proved problematic our independent evaluation team).

2.3.7 Training of community facilitators : A weeklong program was conducted in

Norton in March 2000 and trained seventeen men and women (roughly a

50:50 division) to be facilitators. Eight were from the Chivero area and were to work on the initial intervention (the others worked for HIV/AIDS groups in

Norton). They had previously been elected to fulfil this role at a community meeting in the area. Two younger women, two younger men, two older women and two older men were trained with the intension that they would facilitate peer groups divided along similar age/sex lines. Those taking part were trained in both single sex groups and whole group sessions using similar techniques to those they would themselves use in the field as community facilitators. They were instructed in the Stepping Stones method, communication skills and the qualities of good facilitation. Because the training venue had power the facilitators-in-training were able to use the video supplied with the Stepping Stones training package, and they found it very useful and stimulating. It is worth commenting that participants felt that abstinence and faithfulness to one partner were preferable to the use of condoms. Through drama presentations, the women highlighted the problem of ‘sugar daddies’: older men who seduce economically disadvantaged girls and young women, while men depicted traditional healers sexually exploiting female patients. Participants also identified ‘Chiramu’ (a man having sex with his wife’s sister) as a traditional practice that would increase HIV risk.

Furthermore, they suggested that young people were engaging in alcohol use and sex activity at an early age. Finally it should be noted that the facilitatorsin-training engaged in several full group workshop sessions at which debate was extremely animated and engaged in a final session in which “special requests to the community” were made. Significantly female participants requested that women should be treated as equals and not as under men.

Participants requested and were given certification of their training. The program of training was somewhat curtailed to fit the 5 day residential format.

Those training to be facilitators were enthusiastic and hardworking and gave evaluations of the training program that were extremely positive. However, it is again worth noting that only two of the facilitators-in-training were able to attend the entire workshop. Nevertheless, further training to strengthen the community facilitators’ skills followed the Norton workshop and took place in the Chivero Community Hall.

2.3.8 Implementation in the community : A community meeting was held to notify people about the project, seek their approval and identify those willing to volunteer to participate in the extensive Stepping Stones program. Two venues for training were established. The younger peer groups met at the community hall (next to Chivero Clinic near the Mauto Business Centre), while the older peer group met under tree near Mupfumira Business Centre

(these sites were some four kilometres apart). Each peer group planned to meet twice a week in an attempt to (i) reduce the total length of the program

(ii) facilitate the attendance of women who feared husbands would object to too extended a commitment (iii) and maintain the motivation of the trained but unpaid facilitators. Approximately eighty people in total attended all or part of the program however average attendance for each peer group were as follows: (i) Older men; sixteen, (ii) older women; seventeen, (iii) younger men; eleven, (iv) younger women; eight. Attendance at each peer group session fluctuated markedly and the progress of the program was frequently interrupted by participants’ need to attend funerals (particularly women and older men). The youth peer groups had to delay their training in order to allow the older peer groups to catch up before full workshops could commence. While facilitators were not able to use the video, due to lack of a


3.3 power source, they followed the Stepping Stones manual closely. The report on the implementation seems to suggest that sixteen training sessions and two full community sessions were undertaken.

2.3.9 Reported impacts : Facilitators reported that among program participants: (i) communication about HIV and related issues such as risk behaviour, had improved, (ii) there had been an increase in enquiries about HIV testing, (iii) requests had been made for information about forming support groups, (iv) there was a growing recognition among older men that individuals should be free to decide whether to use condoms or not, and women urged men at the joint peer group workshops to accept the principle of condom use, (v) analytical /problem solving skills had improved. The facilitators also reported other suggested changes in the behaviour of participants: (i) an increased value placed on relationships, (ii) an improvement in the behaviour of youth including less alcohol abuse, (iii) less drinking among men and more consultative decision-making with wives.

2.3.10 Evaluation and recommendations : (i) The use of community facilitators was successful, sustainable and cost effective. (ii) Small fringe benefits such as certificates and T-shirts helped motivate both participants and facilitators. (iii)

All those involved found that the Stepping Stones manual was easy to follow and use. (iv) Role-plays rather than Tableaus were used because in the absence of the video the concept of the later was difficult to explain. The former substituted for the video stimulus. (v) The peer groups resolved to continue meeting after the end of the formal program. (vi) The women’s peer group started a dressmaking club to improve their economic status and the other groups considered initiating similar income generating activities.

RESEARCH DESIGN: of the independent evaluation August 2001


3.3.1 Sample frame, selection and recruitment – Our research design determined that we draw a purposive sample. Seven target groups were identified: (i)

Facilitators – those trained in the pre-intervention workshops and had facilitated the intervention in the community. (ii) Participants – those who had engaged in the original Stepping Stones intervention, (iii) Non-participants - those who had not participated in the program but who lived in the same villages as those that had, (iv) A control group – people in a nearby and largely similar community, that had no exposure to the Stepping Stones program, (v) Elders - community leaders (vi) Clinic staff – those responsible for treating local people and distributing condoms (vii) Commercial sex workers – operating from local bottle stores. Time and logistical constraints meant that respondent in these categories were not identified using a scientifically random procedure. Those interviewed during the focus group phase were largely self-selecting, representing those people who chose to attend our public meetings, while those contacted during the semi-structured interview stage were identified via a process of snow balling from initial contacts. Both these approaches may have introduced bias into the sample. Faci litators - We interviewed four of the original eight facilitators

(50%) Participants - Ideally the research team would have like to sample

100% of this group. However, like the intervention team before us we had problems co-ordinating meetings and a false start led to a reduction in the number of people who eventually attended the evaluation meetings once they were convened. Nevertheless twenty two (27%) of the original eighty people who had participated in some or all of the intervention were consulted (in focus groups and/or one-to-one semi structured interviews). The figures per peer

group were as follows: young women: five, young men: four, older men: ten and older women; five. While not as high as we had hoped, in most cases these figures represented a significant sample of the average workshop attendance (see section 2.3.4

above). Non-participants living in the same community – we targeted this category in order to assess the impacts of the program beyond those directly involved in training. We met with thirty-seven people

(in focus groups and/or one-to-one semi-structured interviews). The vast majority were women (eighteen younger, sixteen older) with only four men (one older, three younger). Control group – The purposive sampling procedure required us to work with people of a similar background to those we had worked with in the intervention area. However, on the first attempt a misunderstanding between the team and the Tsungirirai field officer led to us meeting forty seven community leaders and activists: people ranging from school teachers to community health workers.

We did not feel that this group would represent the attitudes and knowledge of the more general population. Thus part of the team returned in October to repeat the survey with a control group whose characteristics were more similar to those already interviewed in

Mhondoro North . Two groups were convened on this occasion; one mixed age group of 30 women and the other of 17 men (of which only three were younger men). Elders – in the intervention community. A group of 23 elders and community members was interviewed as a focus group while they awaited the arrival of a local government official who was to address the issue of accelerated land resettlement. The majority were men; the chief and several headmen were present. Clinic staff – in the contact community. Only one such person was interviewed. Commercial sex workers : in the intervention community. We interviewed four women who self-identified as commercial sex workers plus two others that suggested they had now desisted from this activity. We interviewed them in and around local bottle stores. Tabulated Summary of Sample:

Total number sampled in the intervention area (includes individuals interviewed on more than one occasion)

Total number of individuals interviewed



Non-participants living in the intervention area.

Elders (not including older men in other categories)

Clinic staff

Commercial sex workers

Total number of people interviewed in the control area

Control group 1 (‘failed’)

Control group 2












3.4 Techniques and methodology:

3.4.1 General approach : The research team adopted a mixed-method approach to data collection. The research was however, primarily constructed as a qualitative, participatory survey. While a quantitative style survey tool was utilised to begin the research process and to identify knowledge, attitudes and practice, the objective of the research was to generate rich and detailed information on the impacts of the intervention that could act as a guide to help

explain observable patterns of behaviour, attitudes and knowledge. The approach drew on and adapted the research designed utilised during a previous Stepping Stones evaluation in Uganda in July 1998 (Holden, S.


3.4.2 Methodology/process through which research was conducted : The team set out to work both with groups of people and with individuals. Having convened a community meeting at a central venue, explained the evaluation and sought informed consent, the team divided people into peer groups (along similar lines to those used by the initial intervention) with male members of the team working with men’s groups and the female members working with women.

Once established these groups worked together for extended periods on a series of research questions using a number of different research tools. The team provided food and drink to sustain participants and gave respondents

Z$100 expenses for every day they attended the evaluation (making clear this money came from the independent research teams not either of the NGOs).

Later the team moved around the community interviewing individuals wherever they were found. Consent was sought but no expenses were given for these short thirty to forty minute interviews.

Appendix 1 shows the cumulative and rolling nature of the data collection process. Both the research team and those with whom they engaged, were able to develop their understanding of the initial intervention as the evaluation proceeded. The movement between diagramming, discussion and back again, and use of a variety of tools to address separate but related issue, enabled a considerable degree of triangulation of data. The use of one-toone semi-structured interviews also facilitated the corroboration and interrogation of data generated collectively in focus groups. Comparing the responses of participants, non-participants and people from the control group further enhanced rigour. Finally, efforts were made during the individual interview stage to speak to several members of any given family, comparing the responses of husbands and wives and parents and children.

The plan was to have an initial community meeting in the intervention area in order to explain the evaluation and begin the process of data collection, working with both participants and non-participants in the original intervention.

After administering a Knowledge, Attitudes and Practices survey, and undertaking some diagramming and focus group discussions, we intended to let participants go and continue working with non-participants . We intended to return to work with groups of participants on the following two days before working with individual participants and non-participants via interviews on the fourth day. On the fifth and final day we intended to move to the control group community to undertake further group discussions. Unfortunately, poor communications together with the split site nature of the original intervention meant that we had to extend the length of the program, and work simultaneously with participants and non-participants throughout as we operated at the two sites. Nevertheless, we endeavoured to keep the opinions and experiences of the participants and non-participants separate so that they could be compared.

3.4.3 Techniques/tools : Within the multi-methods framework several different but complementary techniques and tools were utilised: (a) Ballot style –

Knowledge, Attitudes and Practices (KAP) questionnaire (see Appendix 2):

This was effectively a questionnaire however it was administered to individuals during in a group meeting. Questions were read out to the whole group and each respondent was asked to privately mark one of the response boxes on their ballot. Only numbers and simple symbols appeared on respondent’s ballot to facilitate the inclusion of the illiterate. The process was explained very carefully so that respondents understood the system. Less than a handful of ballots were spoiled. Not only did this rapidly provide useful data for the team, but also the rapid and collective nature of the data eventually generated enabled the research team to give respondents feedback on a number of Knowledge based questions they had answered.

This gave the team an opportunity to correct incorrect knowledge. We did not

attempt to address the attitudes and practices elements of the ballot for fear of biasing responses to later exercises. (b) Focus group discussions : the research team asked the peer groups specific questions and recorded the ensuing discussion. (c) Participatory diagramming : the peer-groups engaged in the evaluation were asked a number of questions and asked to respond to them by generating visual diagrams using the simple stationary provided and other materials locally available. A range of diagrammatic tools was utilized

(Contact the research team for details) all of which enabled participants to generate group responses that not only revealed their thinking to the research team but also to themselves. Diagrams generated further discussion about what they meant. An instamatic camera was used to enable peer-groups to retain their own copy in addition to the records kept by the research team. (d)

Semi-structured interviewing : during interviews with individuals, the team utilised closed question open answers schedules, to enable comparison between transcripts generated by different interviewers. Several schedules were utilised, specifically targeted at those who were non-participants in the initial intervention, participants in the initial intervention and non-participating members of their families, commercial sex workers and clinic staff (see

Appendix 4). The interview with elders took advantage of their meeting for another purpose and was impromptu and improvised. Finally there were the interviews with the facilitators (see Appendix 5)




The material presented below represents interim results. The quantitative data have not yet been rigorously analysed using statistical methods nor have the qualitative data been analysed using a software package such as NUD*IST.

Knowledge Attitudes and Practices (KAP questionnaire)

4.1.1 Younger women

Basic knowledge of HIV in the group of five was good. However Use of condoms was low. Only two had ever used one and no one had used one in the last three months let alone on a regular basis. None said they had experience basic symptoms of an STD in the last year. Most recognised the symptoms as indicating an infection and all knew that it was best for both partners to seek treatment. Attitudes were mixed and suggested that the thrust of SS had not entirely been adopted. Most felt violence by husbands was wrong, but that it was also wrong for women to refuse sex and that women who got raped were usually asking for it. Also that men who share their money are either weak or under a spell. Discussions with partners and children about sex were seen as a good thing and were taking place

(However discussions on the sources of information diagram – below - suggests that these women remain shy about discussing sex with their children and family members). The women agreed that making a will was a good idea and three of the five had done so. They all claimed to have spoken to non-participants about the program.

4.1.3 Older women – a mixed group; both Stepping Stones participants and nonparticipants

Knowledge on several issues was better among the trained than the untrained older women and they scored better on the questions relating to whether sex with a virgin can cure HIV, if contraceptives make you sterile and which ailments are symptoms of a STD. Only one (un-trained) woman claimed to have experienced a basic symptoms of an STD in the last year.

All the trained women and most of the untrained ones knew both partners

should seek treatment. The trained women also had better knowledge about condoms and were more likely to have ever used one. However, no respondent among either the trained or untrained women had used them in the last 3 month. Nevertheless, in discussion after the questionnaire had been administered, all the women seemed to want to use them but were meeting resistance among men. In the survey the majority in both groups said they had never been beaten by husbands but in the discussion most admitted that they had. The trained women said they had spoken to others about what they had learned from the Stepping Stones program but the untrained women said they had never been told about it. Many of the questions that accessed attitudes did not reveal a significant difference between the trained and untrained women.

4.1.3 Younger men

This was the smallest of the groups (only 4 men) convened during the evaluation; therefore the results need careful interpretation.

The young men’s knowledge of HIV related issues seemed relatively good.

However they were of the opinion that contraceptive make you sterile.

Knowledge and use of condoms seemed good also one man even used them regularly (at least two members of the group claimed to be celibate). None had experienced any basic symptoms of and STD in the last year. The young men’s attitudes were particularly interesting. They did not ; (i) condone the use of violence to discipline partners, (ii) believe that women who were raped deserved it or (iii) feel that real men had many partners. They did however believe; (i) that women had the right to refuse sex and (ii) that parents should talk to their children about HIV and sex. They said that they had discussed

HIV and risk with their partners and spoken to others about what they had learned during the Stepping Stones program.

4.1.4 Older men

This group of older trained men presented a mixed set of results to the questionnaire. Three of the oldest ones failed to fill in the ballot correctly even after careful instruction so the valid results for the group was reduced to eight. Knowledge of HIV was fairly good however there was some lingering feeling among a few that sex with a virgin could cure AIDS and all the men believed that those infected with HIV could be identified by the way they look.

Knowledge of condoms was reasonable but only a minority had ever used one, only one had done so recently. All the older men thought that contraception makes you sterile. In discussion after the survey the men revealed that they believed that condoms contained chemicals that make you sterile. Half the men had experienced a symptom of an STD in the last year, two did not recognise the symptoms as a n STD. Again the men’s attitudes were mixed. Half thought that: (i) it acceptable to use violence to discipline a wife, (ii) that raped women deserved it, (iii) that “real men” had many girlfriends and (iv) that men who shared money with wives were either weak or under a spell. However the majority felt that women did have the right to refuse sex, had discussed HIV and risk with their partners and believed that parents should find ways to talk to their children about sex. While all felt that making a will was a good idea only one had done so. All but one claimed to have spoken to others about what they had learned during the Stepping

Stones program.


4.1.5 The control group: Men

Basic knowledge of HIV was quite good among these men –although half thought, or were unsure if, having sex with a virgin could cure AIDS and that contraceptives make you sterile. They had a good understanding of the benefits of condom use but only three had ever used one; only one had in the last three months. None reported experiencing symptoms of STDs in the last

12 months. All but one felt it was un-acceptable for men to discipline women using violence but the same number felt wives had no right to refuse sex.

The men were equally divided about whether women deserved to be raped but the majority did not believe that real men should have many girlfriends.

4.1.6 The control group: Women

Many of the women had a good basic understanding of HIV, however a third thought, or were not sure whether; (i) those with HIV can be identified by sight

(ii) sex with a virgin could rid someone of the virus (iii) untreated STD do not help transfer HIV (iv) contraceptives make you sterile. Half the women felt it was normal to carry condoms and understood that they protected users from

HIV infection. Interestingly, while roughly half had spoken to partners about possible condom use and most new where to obtain them only a fifth had ever used one although most of these used them regularly. A fifth of the women reported symptoms suggested of STDs in the last year and only two fifth recognised them as such. Most did not accept that men should use violence to discipline women although two fifths had experienced this and less than a fifth felt it was legitimate for wives to refuse sex. Roughly two fifths believed or were on sure whether women who were raped deserved it and that real men had many girlfriends. While all agreed that making a will was a good idea, only a small minority had done so.

Results 2: Group diagramming/focus group interviews

Results in this section are structured and organised on the basis of the research tools used to collect them and the chronological order in which they were utilised.


Venn diagram – Information on HIV and AIDS

This diagramming exercise attempted to evaluate how important Stepping

Stones has been in contributing to participants overall knowledge of issues related to HIV and AIDS, and to indicate the extent to which non-participants have been influenced by the program.

All four peer groups of participants suggested that Tsungirirai had been a very important, usually the most important source information about HIV and

AIDS. However, while given great weight, cards representing Tsungirirai were generally placed at a distance form the centre of the diagram because the training was a temporary “one-off” event rather than an immediate day-today source like routine conversations, radio broadcasts or even church teachings. The control group

Both Men and women’s groups identified a wide range of information sources. Church, radios, clinics and Tsungirirai were the most important sources. Women rated Church more highly than men while men rated clinics much more highly than women. Older women said they rarely used the clinic. A HIV peer educator was active in the area but, not all participants had yet been contacted by them.


Venn diagram - Membership of community organisations and alternative delivery of Stepping Stones

This diagramming exercise attempted to identify organisational structures in the community and to see: (i) if peer groups are listed (ii) what other organisations SS participants belong to (iii) if people identify particular organisations as better entry points for future HIV projects.

Again there was much consistency between the focus groups. No peer group identified peer groups as a major community organisation to which they belonged, although several suggested they were members of Tsungirirai.

Participants identified a range of organisations to which they belonged; while not as immediate and everyday as other structures, they all identified

Tsungirirai as the preferred root for Stepping Stones/ HIV education delivery.

The church was a close second but several groups identified problems with church preaching’s, notably their hostility to the condom. Generally all participants liked the idea of Stepping Stones being created as a new organisational structure and did not favour delivery through some other preexisting organisation. Furthermore, there were repeated calls for the program to return/continue in the area. The control group

Only the women undertook this task. The importance of the church was revealed, as was Tsungirirai, which seems to be well embedded in this community also.

4.2.3 Pie charts - Attendance and

Focus groups - Peer groups

This discussion attempted to assess: (i) level of attendance and reasons for non-attendance (ii) participants views on the peer group system of organisation (iii) whether the peer groups offered a special time and space different to everyday society

Both the women’s groups had a poorer attendance record than the men’s groups. No woman had a 100% attendance record many attended less than half the meetings. Women’s high general workload (training was in the growing season) was blamed, as were Funerals for failure to attend. Women suggested that their duties at funerals were more extensive and required more time than men’s. Some women also had to care for sick family members. Women with migrant husbands also found it difficult to attend weekend meetings because their duty was to be at home caring for husbands.

Men were in a different position. Several young men had a 100% attendance record while older men’s attendance was much higher than both women’s groups. Only personal sickness seemed to have prevented young men from attending. Older men suggested that funerals also affected them, although their pie charts of attendance indicated their commitments in this area were less than women’s. Significantly, older men gave the frequency of funerals as a reason they had decided to attend the program since it made them aware to the HIV/AIDS problem.

All participants were very well disposed to the peer groups structure because it facilitated privacy and allowed “secret topics” to be addressed. Even the older men suggested that they would have been “shy to speak” in front of a more mixed group. On the down side, older women regretted that they were not able to discuss certain issues with men; e.g. the use of condoms. The joint meetings that were held did not address these sensitive but crucial issues. The young men independently corroborated this view suggesting that while mixed group meetings were conducted, the turnout was often poor and

consequently discussions of sensitive issues was limited. Nevertheless the young men did value the joint meetings because it gave them the opportunity to learn from the elders whose opinions they valued.

Participants also liked the special nature of the meetings. When asked how was Stepping Stones a different kind of time and space people pointed both to their willingness to speak about and learn about private issues and to the idea that the meetings were not conducted “in the usual leadership top down wa y”.

The young men identified several problems with the running of the program that are worth highlighting: (i) Some peer groups remained open to new participants throughout the program, but this cause problems with these people having to “catch-up”, (ii) Attendance at meetings was often poor (iii)

One constraint was identified as the long distances people had to travel to the meetings, they suggested as much as 10-12 kms. There solution was more venues and more facilitators.

Additional noteworthy points: (i) many participants, especially those in the young women’s group, suggested that they had a pre-existing connection with Tsungirirai before they volunteered for the Stepping Stones program (ii)

None of the young women had partners who attended although in the other groups there were certainly some who had participating partners.


Wheelbarrow diagram - Things that made Stepping Stones go well

This diagramming exercise attempted to identify participants’ views on the factors that had made the program go well as well as those that may have hindered its progress.

Good facilitation appeared at several point in our evaluation. Here, it was the older men and women’s groups who raised it explicitly: “Teachers were being patient with participants”, explained things well, gave them chance to ask questions or ask for clarification and, “even when attendance was low, teachers came and continued their work”. The older men were very clear that that the facilitators were absolutely key to the success of the program. The quality of the facilitators was demonstrated practically to the evaluation research team during the research. We were working for extensive periods with participants breaking only irregularly for food and drinks. One afternoon those of us working with the young men’s group were all feeling fairly tired, as were the young men. The facilitator of the young men’s peer group suggested that we should do an energiser to refresh ourselves. The research team was embarrassed not to have thought of this themselves, but it did usefully demonstrate the quality of facilitators who had led the Stepping

Stones program.

Significantly, both the older and younger women suggested that permission from their husbands to attend the sessions was a key reason to the success of the project; it would have been difficult for them to attend without it. The younger women pointed out that this was linked to the fact that local leaders had also given their blessing and support for the project.

Other positive point s suggested were “keeping to time”, the use of the local language, the manual, the provision of food and the distribution of tea shirts.

Participants identified several things that had hindered the progress and success of the project, many of which were related to attendance. Low turnout and lack of attendance was a repeated theme in groups and was mentioned here by older men and younger women. These two groups also highlighted the periodic absence of facilitators themselves. Sessions did not

run without them. The older men indicated that on occasion Tsungirirai itself called facilitators into Norton, causing them to miss scheduled meetings.

Both women’s groups identified the attendance problem in terms of its root causes such as domestic work, care for sick relatives, personal sickness and duties and attendance at funerals (which involves women in several days of food preparation, preparation of the body and sleeping at the dead persons house as well as events on the actual days of the funeral). These commitments may have been behind what older women described as a “lack of motivation/interest outside training sessions themselves”. Men mentioned their own illness and attendance at funerals as reasons for poor attendance.


Focus group - Likes and dislikes about Stepping stones

This focus group discussion attempted to identify: (i) elements of the Stepping

Stones program that participants did not like and why, (ii) whether nonparticipants had a negative view of the program, (iii) the good and bad points about joint meetings and the final open community meeting, (iv) the role played by facilitators and whether they had followed up on the program (v) what changes to the program participants recommended.

All participants were very positive about the program. The older men put things most forcefully say they had “ no dislikes of the program!” Once again all the groups were very positive and complementary about the facilitators and their approach. As the young men put it their facilitator “was just like the teacher at school. He could lead us. We could not have done it if we had just been given the manual to work on our own.” Enjoyment of the games was mentioned here by Young women, and by others at other points in the evaluation. Recollection of games was often better than that of particular sessions. Peer groups were mentioned as being good by young women and men because they enabled them to obtain “good information”. Young men suggested that they also liked the mixed groups sessions because they could talk to the elders and ask them about their past lives. Such free communication represented a big change from the situation before the program they suggested. Young men said that the older men had not dominated joint group meetings and corro borated older men’s claim that they had given women and youth chances to speak. Young men suggested that their newfound ability to communicate with elders had continued after the end of the program. Older men recounted that they were happy to discover when talking to other peer groups at joint meetings that they were learning exactly the same things as themselves (and by implication, that the program did not have a hidden agenda).

In terms of problems: young women raised the issue that sometimes in meetings (joint and peer groups) there were relatives present, which made them shy. Young men suggested that while non-participants were not particularly hostile, they did ask them; “why do you want to use those condoms when you are still so young”. This group also related that their attempts to continue meeting after the program and to plan a chicken project had been thwarted because many of the young people moved away (women to get married, men to find jobs) after the program ended. A major problem raised and confirmed by all groups was that no end-of-program, wholecommunity meeting was ever held. As the older men put it: “the program ended suddenly”. They suggested that the problem was the end of the program had coincided with the July 2000 parliamentary elections. At this time it was difficult to hold any community scale meeting that was not a ZANU

PF political rally for fear of it being misinterpreted as an opposition party meeting. Finally, most groups identified that there had been no follow up training or meetings.

The participants had several proposals for improvements in the program:

Young men suggested that if it was impossible to use the video it would be helpful to have a range of picture cards instead as a stimulus. Older men suggested that in future a larger number of facilitators would be beneficial.

Finally, all the peer groups expressed the strong desire for further training and formal follow-ups, both for themselves and for others in their area.

Indeed, our own participatory evaluation was interpreted by the community

(particularly the older men) as the first such instance of this and an indication that Tsungirirai had made good on promises they were perceived to have made regarding follow-up work.


Flow diagram and focus groups - peer groups

These exercises focused more directly on the functioning of peer groups, and allowed development and corroboration of material produced in previous sessions. Specifically, the exercises attempted to discover: (i) whether peer groups had continued to meet and if not why not, (ii) what efforts had been made to continue the work of Stepping Stones within the peer groups structure and outside them, (iii) the factors that had helped or hindered the continuation of the work of Stepping Stones

The extent to which peer groups continued to meet and actively discuss HIV related matters is rather ambiguous. All the groups, except young women, indicated that some post-program meetings had been held, but on closer questioning it seems that not a lot had actually happened after the program.

In particular there had been very little attempt to undertake HIV AIDS related work as a peer group. As the young women put it: “Once the program had ended we felt that thing was finished and there was nothing mo re to do”; and as the young men suggested, attendance dropped and people moved away.

Some specific instances of action were mentioned such as plays being performed by the Youth during worlds AIDS day in December 2000, but after probing the young men indicated that this had been organised independently by the school not by Stepping Stones peer groups. The older men cited an occasion when they had gone to Norton as a peer group, wearing Stepping

Stones tea shirts and calling themselves “Stepping Stones”, in order to beat drums and sing songs they had composed about AIDS. Later in the evaluation we were privileged to participate in a similar musical event. We noted however that the songs had very general lyrics that lamented AIDS and warned it was dangerous, but did not highlight specific risks much less promote condom use. The number and sustainability of post-program peer group activities seemed limited. Only the older women seemed to have had greater success and here their activities were centred on income generation rather than HIV education. This is not an insignificant outcome however, given that some explicitly suggested that this activity displaced activities aimed at raising income from commercial sex work. In addition, the older men said that as individuals, they attempted to make reference to AIDS at funerals, pointing to the need to take action to combat it and the importance of accepting AIDS as a cause of death rather than seeking to consult N’angas to divine spiritual cause. Young men co nfirmed this claim. Both men’s groups suggested that they now frequently talk about AIDS where they did not before, however admitted that, “nowadays every one is talking about it.”

All the groups expressed a need for further backup, particularly further contact with facilitators (as well as financial help, manuals, and other resources) before they would feel able to continue the work of Stepping

Stones within their peer groups.


Wheelbarrow diagram - Things that made the work of Stepping Stones continue

This diagramming exercise aimed to extend the previous one and to explore in detail the factors that helped people continue the work of Stepping Stones once the formal program has ended and those that hindered continuation.

As was suggested above the work of Stepping Stones had not really continued, at least in and through the peer groups. People did refer to their own change of behaviour in response to this line of questioning; older men for example, cited their; “use of the polite language and the I statements.” This was not what we were really addressing in this exercise so the diagrams and discussions really highlighted the factors that had hindered continuation.

Again the role of the facilitator is highlighted: as the older men put it, meetings stopped because “our leader stopped coming.” Older women too suggested that they had wanted the facilitators to continue leading them; “Only the trainer had the manual so the participants were left blank and had no way forward without a facili tator”. Without the manual they felt they had been “left empty handed”. The older women felt that certain resources would have helped them continue their work. They suggested: manuals written in Shona, exercise books to write notes, some kind of Stepping Stones uniform and bicycles to help them visit non participants would all help facilitate the peer groups to have continued beyond the life of the formal program. The women suggested strongly that: “the program should not be introduced and people are trained [only to be] left alone. Teachings should continue and facilitators should keep on their facilitating work”


Flow diagram – contexts for sex

This diagram was intended to enable participants to express the common contexts in which sex usually takes place. The objective was ultimately to compare the diagrams of participants with those of non-participants in the same location and with those from the control location. Those making the diagrams were asked to indicate any changes that they felt had occurred in the last 12 month (since the program).

The diagram produced by older men was extremely interesting and suggested a range of contexts (many of which might be seen as facilitating the spread of HIV). They were: (i) After a fight, (ii) arousi ng your wife’s sisters or a niece, (iii) foreplay with wife, and (iv) raping and lust. We probed the men about their replies, asking if they were talking about other men or themselves. They replied; “all men do this”. Rape, they continued, can arise

“after playing with wife’s relatives if she then refuses”. Sex after a fight was seen as a way to repair a damaged relationship (women suggested that if men withheld sex in this circumstance it was to further punish them).

Notwithstanding their involvement in these practices, older men suggested that while bad practices such as rape had declined recently, their use of foreplay with wives had increased, as had their use of “polite” rather than

“harsh language” when negotiating sex. However, although “lust” had initially declined (because of men’s increased fear and awareness of AIDS during the program, it had recently risen again; “because you cannot prevent lust”. Most interestingly, when asked why they had not put commercial sex work down as one of their contexts, the men responded very strongly that they no longer engaged in that activity: “yes at the beer hall [some do it] but it is dangerous so we did not include it”.

Young men identified similar contexts to the older men and reiterated that there had been an increase in instances of freely negotiated sex and that men of their generation in the community were generally reducing their number of partners because of growing awareness of HIV. However the

majority in the group of trained young men we interviewed currently had no relationships or were abstaining from sex with the girlfriends they did have.

Celibacy seemed to be the strongly preferred option for this group.

Furthermore, they suggested that ritual/traditional practices such as sleeping with wife’s sister were not really favoured among their generation.

Many of the opinions expressed by the men’ groups were corroborated by the two women’s groups. Younger women believed that rape had reduced since

Stepping Stones (over the recent past). While the instance of sugar daddies and commercial sex work was still seen as relatively frequent, they were said to be in decline since the program and the general increased fear of HIV.

Older women also believed there had been a reduction in commercial sex work and the frequency of married women going with other men. Some spoke of their personal experience in this respect. Like the older men they also pointed to an increase in the frequency of mutually negotiated sex between couples. Younger women again pointed to the role of increased fear of HIV in this: “because men now feared AIDS and came home to have it

[sex].” Older women suggested that the communication skills that they had acquired during the program allowed them to communicate better and forgive their husbands for (past?) infidelity. They also said partners now forgave each other after arguments and then had sex. The control group

Women identified three broad contexts for sex: (i) Mutual negotiation between couples, (ii) affairs and (ii) Coersive sex. In the mutually negotiated category, married “sugar daddies” who sleep with schoolgirls and young people having sex with each other were both seen as being common. Married people having Affairs and married men going with commercial sex workers were seen as nearly as prevalent. Within the third category women identified the practice of men forcing themselves on daughters and nieces and suggested that this was relatively frequent. (Stranger) rape did not appear in the diagram and in discussion was seen as uncommon.

While the women did not mention forced sex between husbands and wives in the diagram, the researcher pursued this in discussion.

Only 4 of the 30 women felt that this was rape: “in marriage there is no rape”, “ it is better to comply so that men will not seek sex workers”. They suggested.

In terms of change in the recent past, the women were undecided about mutual negotiation between married couples. Some said it was increasing as men now feared to have sex outside marriage, while others said it was decreasing as women feared to sleep with promiscuous husbands. Commercial sex work had not decreased and affairs were said to be on the rise, both due to economic hardship. Sex work was seen as an easy way to make a living compared to other income-generation activities. There was also a feeling that some commercial sex workers guessed their HIV status and wanted to spread the disease so they “would not die alone”.

The women rationalised men’s interest in commercial sex work by citing both their alcohol consumption and their failure to be satisfied with one woman: “you cannot eat veggies everyday; you must also eat other relishes” one said. The phenomenon of sugar daddies was said to be on the increase because: (i) men thought Schoolgirls were free of HIV (ii) girls needed income and (iii) wives were refusing to sleep with husbands. Interestingly wife inheritance was said to be in decline because of fear of HIV. Meanwhile, the women felt sex between youths was increasing because of the legal age of majority act and their use of condoms to prevent pregnancy. The women themselves however, feared to raise the issue of condom

use with their husbands, principally because they feared divorce.

Most had never asked their husbands to use them. A few had used them when their pills ran out but this was to prevent pregnancy not infection. They had raised the idea indirectly and the husband made the final decision

The men’s group produced a similar set of results. In their diagram, lovers and affairs figured prominently, scoring as highly as sex with spouses. They also highlighted commercial sex being a common context for sex and linked it to heavy drinking. Women engaged in it they believed because of poverty. They were in disagreement as to whether it had reduced recently and if so, by what cause. Some said fear of AIDS was reducing men’s involvement with commercial sex workers, others that it was the poor economic situation and lack of money. Some believed that younger men did not fear AIDS and so were continuing as before. They raise the issue of Chiramu (sex with ones sister in-law), which was driven by lust but was seen as legitimate because it could lead to marriage. The men felt that rape was relatively common, and in their definition they included incest and sugar daddies. These things were caused by men’s lust, which is difficult to control.


Tree diagram - Strategies to avoid risk

This diagramming exercise aimed to identify the strategies participants used to reduce their own risk taking behaviour and that of their partners and to assess Stepping Stones ’ contribution to these strategies.

We were struck by the fact that all the peer groups indicated that the program had led to an improvement in communication between couples. All the groups at this and other stages in the evaluation suggested that Stepping

Stones had: “taught us to talk in a polite way”, and “to use polite language”.

Older men in particular suggested that they used this language (use of the ‘I’ statement etc) as a strategy to reduce the risk of others, e.g. “teaching children” and to “plead for [their partner’s] fidelity to protect the whole family…[and to] encourage wives to restrict their movements”. One mark of the success of this approach wa s that women “now often send their children to the stores rather than going themselves”. This was a change the men said from their past approaches to dealing with others which had often relied on fear and intimidation.

During conversation about their diagram, young men made the following, very significant statement in relation to their own change of perception after the program: “when a woman says ‘no’ she means ‘no’. We now respect their rights”. They were relating the reduction of risk to the previous diagram on contexts for sex, which had identified a reduction in rape/forced sex.

All the groups spoke about the importance of fidelity and sticking to one partner. Significantly the young people were very clear that this was their own practice, although the young men reiterated their preference for abstinence until after marriage. For their part, older men repeated their assertion that they now consciously avoided seeking, and refused offers of, sex from commercial sex workers in the bottle stores. In addition young men said they now tried to avoid alcohol altogether. Some older men also said this although we observed members of the group spending time drinking at the bottle store.

In terms of use of condoms as a strategy to avoid risk (a key element of the

Stepping Stones program) participants’ responses were complex. Young men weighted this strategy most heavily in their diagram, but when

questioned about whether they had any, regularly carried them or could get them easily, it became clear that they were identifying a hypothetically strategy to avoid risk. The young men suggested that it was difficult to get condoms from the clinic, even when they had them, which they had not for many months, because they were rationed and staff disapproved of seeing young people returning every week for more supplies. Older men meanwhile did not mention the use of condoms.

Among the women’s group the situation was further clarified. Young women identified condom use as a key strategy but again discussion showed this was not a reflection on their practice. Older women suggested that they were experiencing a lot of resistance from husbands to the use of condoms within marriage, even among those who were Stepping Stones trained. Both groups identified that their strategy was to convince partners to be faithful or to use condoms if they had sex outside marriage. This strategy was pursued in part by the use of “the polite language”, but other, often more traditional tactics were also utilised. Young wome n mentioned; “handling men well . . . being subject to husbands, cooking good food, not denying him sex”. Older women added that agreeing to have sex with their husband anytime he wanted it was a good strategy to guarantee his fidelity, although some suggested that infidelity might continue even so.

Whilst we discussed with the women the continued potential danger that failure to use condoms put them in, we identified some problematic beliefs, the most worrying was the belief that HIV is not transmitted if a man does not ejaculate. The control group

The women in the control group suggested that their best strategy for avoiding risk was “trust”. Second was condom use (a hypothetical strategy/desire) while avoiding wife inheritance and avoiding used sharp objects such as razors were also suggested.

In terms of trying to reduce their husbands risk behaviour, some women suggested that they gave husbands condoms for use outside marriage, but others said that would only encourage them and asked the others how was it possible to raise the issue in the first place. They suggested it was very difficult to discuss the issue of HIV with their partners.

Men suggested that faithfulness, abstinence, avoiding premarital sex, engaging women in income generating projects to reduce commercial sex and returning to traditional ways and/or those of the church were the best ways to avoid risk. Using condoms was also raised as a possibility but the men had a rather negative attitude towards them, seeing them as promoting promiscuity among the youth.


Focus group - Hoped for change and community requests

The idea here was to see if participants could remember the requests they had made to the community, what the response had been and whether the hopes had been fulfilled.

However, as suggested earlier, no final meeting ever took place and no community requests were ever made.


Flow diagram - positive changes due to Stepping Stones

This diagramming activity attempted to establish: first, participant s’ views on the positive and negative impacts of the program and second, the factors internal and external to the program that were attributed with casing reported changes.

Older women listed a number of positive outcomes of the program: (i) being faith ful to one partner; “people have started being well behaved” (ii) good relationships in the community and the village (iii) reduction in commercial sex work, including their own reduction of sale of sex to raise money and attempts to generate income in other ways (iv) improved knowledge of AIDS and HIV. Young women also felt their knowledge had increased and suggested that Stepping Stones had helped improve communication: (i) between couples, (ii) within the community (iii) and between parents and children. They also felt that there had been a reduction in the frequency of rape and that those with AIDS were less stigmatised by those who had participated in the program. Older men (who had previously talked about improved communication) noted that: (i) “Women are no longer going to the beer halls”, (ii) “people are avoiding night movements” and (iii) “men are attending church with wives”.

Participants identified several root causes of these positive effects within the

Stepping Stones program: (i) Older women mentioned that use of the ‘I’ statement was key, (ii) as was improved education and awareness in general.

Young men highlighted the important role of the facilitator once again as well as the session on ‘saying no’. The general increased awareness and fear of

AIDS external to the program had been raised at several points in the evaluation and older women raised it again here as a root external cause of behavioural change in the community.

When asked to identify negative changes the older men made it very clear that they did not wish to say that there had been any negative changes and that they had been very happy with the program. Having said this they reiterated their strong opinion that giving children and young people condoms would only encourage promiscuity. They suggested that they were against condoms being given out at school and they felt that they were not being given any education with such distribution.


Stepping Stones diagram – Future sexual health

This diagramming exercise aimed to identify: (i) peoples’ goals for their future sexual health (ii) the factors (‘Stepping Stones’) they felt would help them achieve these (cross the river) and (iii) the forces (‘crocodiles’) they believed might hinder their progress. It was followed by a discussion about who or what could help bring about the ‘Stepping Stones’ and/or tackle the


Both groups of women identified condoms as a major means to achieve future sexual health. This re-emphasised previous statements made by women that even Stepping Stones trained men continued to resist the use of condoms, particularly within marriage. Young women suggested that the key to success was getting men to accept the use of condoms with their wives as well as the right of wives to deny husbands sex if they wanted. The older women saw poverty as the biggest problem preventing future health. Both groups pointed to a need for further HIV and AIDS education if men were to adopt condoms. Tsungirirai was seen as the preferred source of such training, indeed all the key forces for change were seen as primarily arising from external support rather than arising from initiatives within the community.

This was especially the case in the fight against poverty.

Among the young men, condoms were recognised as important, but were seen as being complicated. This particular group of young men saw abstinence was their main strategy. They agreed that this strategy was difficult to pursue, but suggested that their facilitator had already done so since before the Stepping Stones program and it was the only method that was 100% effective. Most of the young men declared strong religious convictions but denied that the facilitators had stressed abstinence over the use of the condom during the Stepping Stones program. Finally, while they identified peer pressure as a major problem challenging their chosen strategy for health, they felt confident that the Stepping Stones had given them the stills negotiate and to say “no”.

Despite their resistance expressed elsewhere, older men identified condoms as an important stepping stone to future health. However they identified the most important factors as: faithfulness to one partner, the removal of prostitutes and improved HIV and AIDS knowledge through the Stepping

Stones program. Failure to use condoms was seen as a problem but

‘prostitutes’ were seen as the biggest continuing challenge. When asked the men said they did not think alcohol was a major problem because being drunk was no excuse for going to with commercial sex workers. When asked about traditional practices such as ‘playing with sister-in-laws’, the men insisted that was “OK” and “part of culture”: “having your wife’s sister is no problem because if your wife dies she will become your wife”. . . “This only happens with non-married women otherwise you are getting into someone else’s territory; now it is ‘damage’ (customary fine), you are paying for it”.


Focus group - Final comments from focus group participants

A range of final comments were made, but the most note worthy were as follows:

Older women suggested that people in the community had enjoyed our evaluation and it had reminded them all of the work they had done over a year before with the Stepping Stones program. The older men expressed similar opinions but also asked in relation to our evaluation of Tsungirirai’s program; “did we do well, because we are so strongly against the condom?”

We responded by suggesting that the philosophy of the Stepping Stones program was that it sought to work with communities not dictate to them. The older men spoke for all those we had spoken to when they ended their participation in this part of the evaluation by making the request, “Can the

[Stepping Stones] program continue?”

4.3 Results 3: individual semi-structured interviews

Results in this section are structured and organised on the basis of the themes that arose ‘inductively’ from the data collected.


Perceptions of Stepping Stones among participants

Respondents were overwhelmingly positive about the Stepping Stones program. Participants particularly remembered the games and energisers.

People liked the participatory nature of the program, which they felt made them less likely to forget the lessons they had learned. The facilitators we interviewed spoke about the usefulness of the assertiveness training and the

‘I’ statement. Participants interpreted these new skills as an extension of existing practices: “We were encouraged to go back and practice our traditional customs” (young woman) and to “use a polite kind of language with the elders” (woman late 30s).

Women suggested that the arena of Stepping Stones meetings offered more opportunity for them to give voices to their views than the usual sites and structures of community life. Moreover, several claimed to have maintained the courage to express themselves once they had returned to their households. For their part, men spoke positively both about their own and women’s ability to “speak out” at these meetings. The format of peer groups was said to facilitate openness because people could speak freely without being embarrassed by the presence of people from other cohorts (e.g. men, youth, elders and particularly in-laws whose age and sex was different). In addition, people liked the participatory structure of meetings, which was very different to normal procedure: “Other meetings do not give people a chance to share ideas and be active” (man, 42). This was the case even with older men who suggested that they d id not feel undermined by the approach: “We appreciated that approach”, “We wanted also to hear their [youth, women] opinions when they were talking to us [in joint meetings].” They also suggested that the system continued beyond the Stepping Stones arena:

“Yes we could continue doing that even at the hall when we meet [the

Tsungirirai field officer] we conduct it that way” (Man, 60s).


Knowledge of the Stepping Stones program among non-participants with nonparticipating relatives

The situation was mixed. Some who had not participated in the program and who did not have relatives involved, said they had heard of the program.

Their opinion was that the program was a good one and reported seeing changes in the behaviour of participating friends, such as a reduction in their engagement of commercial sex work, and improvements in their relationships in the community.

However, it was perhaps more common to hear from non-participants that they had never heard of the Stepping Stones program. Some indicated that they had first heard of it the previous week, when we had been in the community undertaking the focus group stage of the evaluation.

Some of women involved in commercial sex work had heard of the program, others had not. Those who had not heard of it lived less than ten minutes walk from the sites that had been used for the training. Some women who sold sex displayed and reported some knowledge of HIV risk and prevention others said they did not have much understanding of HIV and AIDS.


Knowledge of the Stepping Stones program among non-participants with participating relatives

All respondents in this category indicated that they had been told about

Stepping Stones . They were able to tell us that the program taught people: (i) how to have better relationships (ii) to work for the family (iii) to stick to one partner and be faithful (iv) Use the condom to prevent STDs and pregnancy

4.3.4 Reported changes in behaviour among Stepping Stones participants

Participants seem to have picked up several of the key messages of the program and the seemed to have translated some of these into action, changing their behaviour:

Women reported that communication in the home had improved as a result of their training; they spoke less harshly to their children and they argued less with their husbands. They suggested that training had given them greater control over themselves, helping them to control their tempers. Furthermore, women said that they no longer participated in selling sex but instead pursued income-generating projects like gardening.

Men also said that training had greatly improved domestic communication.

Some claimed to have continued to employ the techniques of Stepping

Stones in the way they ran their own families; allowing/encouraging their wives and even children to speak more freely in the home. Furthermore, men reported that they now used the “polite language” when drunk, and when making requests of wives and children and resisting their previous harsh treatment of family members. Women and children reportedly reacted well to what they saw as a more respectful attitude from “the man of the house”.

One man reported: “Her behaviour has now changed. We are now doing our family things together. She tells me every movement she does. If she comes late home she comes and apologies and gives reasons for that”. Another man explicitly suggested he used the “polite language” when asking for sex:

“When I want sex these days I no longer have problems. We now do it in agreement al l the time.” (Man 42yrs). Thus respondents who had participated in the program felt that the training in communication skills had led to better marital relationships and a reduction in disagreements. It was quite common to hear that people felt that the Stepping Stones approach was compatible with traditional behaviours; “respecting elders. . . The SS reminded us of our old traditional customs which were helpful and we had forgotten them” (Man

42 years).

Among older men we recorded assertions that they had desisted from extra marital sex; “What I learned most was to be faithful to your partner” (Man, 56).

Some also reported a reduction of alcohol consumption. Many male respondents gave the heart-felt opinion that commercial sex work was a key factor in the AIDS situation and should be avoided at all costs.

The Stepping Stones grass-roots facilitators we spoke too suggested that people had begun to realise that some traditions, such as “chiramu” (wife inheritance) could facilitate the spread of HIV.


Impacts of Stepping Stones reported by non-participants

When asked directly about the changes that they felt had come about through

Stepping Stones , interview respondents recorded a range of observations.

Non-participants indicated that they had seen changes in the behaviour of relatives who had attended the program: women were said to now have

“better behaviour” and greater knowledge about sexual health. Men were said to no longer go with other women and also now bring home the money they earn. Moreover, respondents indicated that these changes had been sustained. Both male and female participants were said to now talk with children and partners, much more about sex and much more directly than they had before the program. Some respondents reported that discussions with their Stepping Stones trained parents had led them to change their own behaviour. One young man said he no longer slept away from his partner’s house after a beer drink. An older woman meanwhile, said she wanted to trained like her friend so that she too could cut down on her drinking and engagement in commercial sex work.

The focus-group stage of the research had highlighted the claim that Stepping

Stones participants spoke about AIDS at funerals. Respondents to the semistructured interviews had mixed opinions on this claim. Some said that people now talk about AIDS when ever they are gathered together but remain reluctant to talk about it at funerals because of the implication that they are suggesting that the diseased died of AIDS.


Treatment of those with AIDS

This is clearly an “impact of the program” but because of it’s importance we have decided to give this change its own section.

Among untrained people, while attitudes were said to be changing to a more sympathetic perspective, continuing prejudices and myths (e.g. not sharing food or utensils with the infected) persisted. Also there was a general belief within this category of respondent that those with HIV could easily be identified (a typical conflation of HIV and AIDS). Thus the risk from

“seemingly healthy” people was not generally recognised.

Meanwhile, non-participants acknowledged that marked changes in attitudes could be observed among those who had undertaken the Stepping Stones program. One re spondent suggested: “They are now socialising with them and they have learned that you cannot get HIV from eating with them.

Women are even learning they can clean her own son which they never used to do, a mother cleaning her own son” (Woman, 45).

For their part, those who had participated in the Stepping Stones program talked of a significantly changed attitude in terms of how much they mixed and interacted with people with AIDS: “Those two [pointing to a nearby place where a relative had lived] died in my hands. I was giving them food” (Man,

59). Another man suggested: “There is now a change in caring of AIDS patients. Long ago people used to burn their cloths and avoid touching them.

These days people can wash their cloths socialise and share or use their cloths” (Man, 42). There were others however, who said they had never cared for anyone because no one in their family had been ill with AIDS.


Condoms - Lack of availability

Increased use of condoms was clearly a major desired outcome of the

Stepping Stones program, thus we sort to pursue this question directly.

We were not able to identify a store selling condoms. One male storeowner,

(an older man retiring from work in town to his rural nest-egg) was pointedly disinterested in our project and in the prospect of selling or supplying condoms. By comparison several female store-workers had a more positive view of condoms. One reported having operated a very proactive system in the past, obtaining condoms from a vehicle from Chegutu hospital that periodically passed, and distributing these free to bottle store clients. Several female workers also expressed a willingness to distribute condoms in the future if supplies resumed.

We were asked by both young men and by women still involved in CSW for condoms (which we provided where we could) and this gave us some indication of the real demand that exists for condoms in this area.

Many people reported that the clinic had not distributed condoms for many months due to lack of supply.


Condoms - use/lack of use

Those most likely to report the frequent use (depending on availability) of condoms were those either engaged in selling sex commercially or those acting as informal wives. Some of these women reported that their ability to negotiate condom used was made easier by their status, and had they been formal wives they would have been unable to insist on the use of condoms.

There were other women in this category however, who said that they did not use condoms because they trusted that their (married) boyfriends not to see anyone other then themselves and the other (formal) wife.

Women who had not participated in the program but who had participating husbands, generally reported that condoms were not used in their

relationship. Some suggested that men no longer “went outside” (and thus implied that they were safe now this practice had stopped), others reported that their husbands promised to use condoms if they did “go outside” (so did not need to use them within marriage).

This pattern was repeated among non-participating men whose relatives had attended the program. They preferred to trust their partner(s) not to be unfaithful outside their relationship, rather than to use condoms inside their steady relationships.

Women who had participated in the program often suggested they would like it if partners suggested the use of condoms, but they had never requested this themselves, nor had their partners ever offered to use them. As one woman put it when asked what was the most important thing she had learned: “Mostly about the condom appreciation. Even if the husband comes and says lets use the condom I have learned also to use the condom. But I can’t ask him to use the condom. I can’t say it because I will fear he will say:

“Are you ill? What has happened?” (Woman, 36). Male interview respondents who had participated in the program repeated their objection to condoms, raised earlier in the evaluation: “We do not use condoms because we trust each other,” insisted one old man (60) who also said his extramarital affairs had now stopped. On questioning he admitted; “I have never used them with girl friends” but did not seem to acknowledge the potential risk implicit in his position.

Parents who had participated in the program were very much against their children using condoms: “I wouldn’t want to hear that because I will now know that my daughter is mischievous and grown up” (Woman, 36 years).

In an interview with community leaders waiting for a land Meeting with local government officials, we recorded that local leaders were strongly opposed to the promotion of condoms which they felt increased promiscuity. They were particularly concerned that the youth should not be encouraged to use them.

Interviews with those who had facilitated the program revealed that while some participants had pre-existing knowledge of HIV and Aids from previous

Tsungirirai sessions, their knowledge of condoms was poor. Many said they did not know how to use them correctly; some had never seen or touched one. Interestingly, when asked what the main messages of the Stepping

Stones program had been, facilitators failed to mention ‘use of condoms’.

Meanwhile facilitators confirmed that the community in general had resisted the promotion of condom use, particularly by youths. Facilitators had attempted to challenge the elders’ view by asking what they suggested as a means to deal with the situation of so much sickness and death among the youth. One facilitator suggested that the elders replied by reluctantly condoning condom use, however another said the issue was never resolved.


The situation among younger people

The group interview with community leaders identified a rather negative attitude towards the youth. They believed that the Legal Age of Majority Act was a problem; causing adolescent boys to drink more and to steal to pay for drink, and making girls more difficult to control. Chiefs’ powers had been reduced and they could no longer control the youth they said. There was a belief that many young women were engaged in prostitution due to poverty and that health educators in schools were encouraging the youth to experiment sexually. As a result they suggested that Stepping Stones was not very useful. Generally child rights, democracy and human rights education was seen as causing parents and community to fail to control

children. They wanted elderly women to inspect girls for virginity, and this should go hand in hand with AIDS testing (of the youth).

Some young people reported that their parents had never talked to them about the Stepping Stones program; nevertheless, most adults who had participated (or who were members of families where someone had) claimed to be “speaking openly” with their children about sex and HIV/AIDS.

However, conversations seemed rather one-way and the advice given was rather limited and non-negotiable. Both adults and children confirmed that parents told their children (both male and female) the following things: (i)

AIDS kills, (ii) Sex is dangerous, (iii) Avoid/abstain from sex until you are married. In summary, advice was rather conservative: “I will just be saying,

‘you are going to church, be very careful, move very carefully, we want you to have a future good life’” (man, 59). In addition, parents pleaded with their maturing children ‘not to bring them problems’ in their old age such as having to care for them if they fell sick with AIDS or having to take in their orphaned children if they died. Several younger women suggested that they had been told that if they got HIV they would be sent away to live with the man who had infected them (i.e. if they contracted it through premarital sex, then de-facto marriage would be forced upon them).

In parallel with their own reluctance to use condoms, parents were strongly against recommending that their offspring use them. Most parents suggested that they would be shocked to learn that their offspring used condoms; “I wouldn’t want to hear that because I will now know that my daughter is mischievou s and grown up” (Woman, 36). Only one mother claimed to tell her children to use condoms but later qualified her answer to indicate that she would only be happy to see her daughter using condoms after marriage

(woman, 60). We questioned this woman’s daughter (22) separately about how she might protect herself from HIV infection and she indicated that she understood that condoms could be used. However, this information had been received from school, not her mother or father. She had never actually seen a condom. Young men gave a similar account, suggesting information about condoms came from peers not parents who had attended the Stepping

Stones program.

We identified what we believed to be a serious lack of knowledge about SS and about HIV/AIDS among the younger generation. Some with participating parents had dangerously incorrect perceptions; (i) thinking, or not being sure whether, the pill and IDU prevents HIV transmission, (ii) believing that condoms are not 100% safe because they easily break (resulting from a lack of exposure to them and a lack of knowledge about correct storage). Only nineteen young people were trained directly through the program. A much larger group were exposed to the messages of the program via their participating parents, but as suggested above, this exposure was mediated through a very strong moral and cultural filter. Meanwhile, young people who had no direct or family connection to the program appeared to have absolutely no knowledge about the Stepping Stones program. Furthermore, within this group, knowledge about HIV was extremely patchy; some correct knowledge was displayed (e.g. razorblades cuts/blood can transmit HIV), other knowledge was incorrect (e.g. ‘deep kissing’, people coughing on you, washing AIDS patients ’ clothes can infect you). More worryingly still, some appeared to have been (deliberately?) misinformed by adults: (i) a teacher was reported to have suggested that condoms can protect against pregnancy but not HIV which can pass through small holes in the condom, (ii) two girls reported that lovers had told them that that if they withdrew without ejaculating then they would not only be protected form HIV but would also retain their virginity.

4.3.10 Activity in and around the bottle stores

Bottle store workers reported that business was slow, both in terms of selling alcohol and in terms of commercial sex activity in an around their premises.

In particular, fewer women were said to patronise the bars. Evenings, weekends and month-ends were still high-points of activity, but the common practice of afternoon drinking during the dry season was reported to be much reduced. The Stepping Stones program was not given as a causal factor, neither of the two bar workers we spoke to (both women of 50) had heard of the program. They cited the following as the main reasons for the decline in activity over the last 12 months: (i) men’s fear of AIDS, (ii) the poor state of the economy and peoples lack of resources to spend on beer and lovers and

(iii) a reduction in the number of buses, therefore passengers and drivers drinking and staying overnight at the bottle stores. Those reportedly still involved in selling sex were said to be younger, even school age women.

These women were said to be more economically vulnerable and needed money to support young families or their own life/education

We noted with interest the suggestion made by several community members that heavy drinking and commercial sex work/promiscuity may have been displaced not simply/rather than declining. The suggestion was that the rising cost of manufactured beer has resulted in a rise in local brewing of traditional beer. We endeavoured to pursue this idea and to identify the arenas were this took place and the social behaviours prevalent therein. However,

(presumably because of fear of the legal ramifications of illegal brewing) no one identified as a local brewer was willing to admit to this or to discuss related activities.

Just as in the focus groups, we got the strong impression that most people

(both men and women, and those who had participated in the program and those who had not) had formulated the strong opinion that commercial sex workers were dangerous and to be avoided.


Behaviour among Commercial sex workers

We spoke with several women that had been involved in commercial sex work for a number of years (none reported having attended the Stepping

Stones program ). Three reported that they were divorcees the other suggested she was a widow. All reported that fear of HIV/AIDS had caused them to reduce their number of clients or even move to adopt a new strategy of having only a few lovers, rather than ‘clients’. Some only had one boyfriend, often a man who already had a wife, for whom they provided sexual and domestic services/companionship in return for gifts and support

(such relationships have their historical roots in the colonial period when some of the very few women living in male labour compounds adopted such strategies rather than higher volume, more transactional forms of commercial sex work). Some of the women suggested that men had in part been instrumental in instigating this change, insisting that the women be faithful to them and giving them incentives to do so.

Some of these women used condoms as regularly as they could. Sometimes this was their own preference sometimes it was their partners’. One suggested that her lover was a Stepping Stones participant and insisted on condom use.


Reported instances of rape, sexual abuse, child abuse.

The vast majority of respondents in the semi-structured interviews reported no knowledge of any of these phenomena. Those who did mention rape cited particular cases. These phenomena were not raised as significant at any stage in the research.

Young people initially reported no knowledge or experience either of rape or of relatives approaching them for sex. However, on further probing some suggested they had experienced such behaviour from older people they knew who were not relatives.

We were not given the impression either that this phenomena had been more prevalent before the Stepping Stones program or that the program had affected them significantly.


Logistical/organisational problems with the Stepping Stones program

We highlight here specific difficulties raised by those who participated in this phase of the evaluation. Most of the comments arise from interviews with the grass roots facilitators who ran the program.

The Stepping Stones program attempted to cover the whole of the

Mhondoro North area with rather limited personnel resources. A single venue for community training was initially envisaged: the Chivero community hall. Both facilitators and participants suggested to us that it would have been better to have more venues and more facilitators. In the event, because of the wide area covered and the chance fact that most of the older people who volunteered to participate in the program came from near the Mauto Business Centre, 4 km away, facilitators decided to establish a second venue under a tree near the business centre. This satisfied the elders complaints that they could not walk to the community centre and back twice a week. Thus an arrangement emerged organically that the youth would be trained at the community hall and the elders under the tree near Mauto Business centre.

Training sessions were on Wednesdays and Saturdays from 10.00 (could last up to 4 hours). The community had chosen this time to improve attendance. However, some women found it difficult to attend Saturday meetings because migrant worker husbands were in the rural areas at weekends and demanded their attention (the area is close enough to

Harare for men to return home every weekend, if they can afford it). An additional problem identified by the evaluation team was that the chosen times seemed likely to exclude senior school children (who might be/might be about to be sexually active) from at least 50% of the sessions.

However, the community perceived the fact that children were in school at this time as an advantage, not a disadvantage (both because parents were freer to move and because children were excluded).

Many who had not participated in the Stepping Stones program claimed never to have heard of it. One went further and suggested it was run like a private club; “The problems is that the ladies are keeping it to themselves. We thought it was a private meeting” (woman, 45). Such a statement must be interpreted carefully. Certainly this woman was jealous of the food that participants received while undertaking training. However the woman also complained of a lack of publicity. It would seem that the structure of the program means that those who miss the initial meetings are hence forth largely excluded from the program. From a different perspective facilitators suggested it was difficult to integrate people who entered the program late (although this was often done). In a related point, facilitators suggested that attendance of initial volunteers fluctuated markedly and some meetings were less productive or were cancelled because of poor attendance.

A common excuse for poor attendance was the need to attend funerals.

This commitment was greater for women than for men.

The facilitators raised a number of basic logistical problems: (i) the insufficient stationery, (ii) there was no transportation (and a large area to cover), (iii) Food was limited and not enough to stave off hunger in the long meetings, (iii) there was no electricity to use the video (this meant that some key sessions w ere missed e.g. “coming home” – a migrant man returns home and wants sex, and “the long journey” - dealing with making wills). Facilitators (who had seen the video in training) sometimes found it difficult to describe the scenes to participants. They suggested that picture cards would have been helpful to this end. (iv) Several facilitators dropped out of the program. None received any pay in this capacity and the remaining facilitators suggested that some small compensation payments would have done much to motivate the facilitation team.

One facilitator reported that there were problems recruiting young women as facilitators. They are unused to leadership roles and were not forthcoming when approached. Furthermore, young men sometimes found the role-plays embarrassing, and the facilitator had to step in to play certain characters such as commercial sex workers.

Since the formal end of the Stepping Stones meetings of the various age/sex peer-group have been very irregular. The young men finished the program first and have never really met since although the young women claim to have continued to meet. Among the young people an additional problem has been that several of the men have moved away to find work while some of the women have married out of the area. The facilitators admitted that they had not attempted to follow up on the activities of their own peer groups.

Ongoing reviews after meetings had been held by facilitators and minutes were kept and given Tsungirirai. However the facilitators said they had not been involved directly in any post-program evaluation, nor had there been any feedback sessions for community leaders. The facilitators did not feel that Tsungirirai had made any follow up to the program (our own evaluation was seen as the first sign of this). They had been asked to make suggestions for future projects but these have never been reviewed.

For example the young women’s group wanted to start an incomegenerating project and requested funds, but there has been no response from Tsungirirai.

The evaluation team was able to ascertain from a number of different sources that no “final community meeting” was ever held. The peer groups therefore never formulated or delivered their “community requests” and suggestions for future action to the community. Moreover the wider community was never reminded of the existence of the program or exposed to the challenges raised by the peer groups. The cause of this failure seems to have lain outside both the program and the community, stemming rather from the national political context pertaining at the time when the program was running. During the election period all public meetings not directly linked to the ruling party were difficult to organise and people felt that a whole community Stepping Stones meeting might be misinterpreted as an opposition party meeting.

Although community leaders were involved in the early stages of the project, partly because of Tsungirirai’s existing embeddedness in the community, some key figures have recently been resettled on new lands.

The facilitators felt that there was a need to exposed newly appointed leaders to the aims and objectives of the program.




The success of the evaluation program

Our methodology was thorough. It enabled us to probe and interrogate answers, triangulate results and corroborate responses. Moreover, in addition to allowing us to compare the responses of program participants with non-participants from the same community and with control group, our approach also allowed us to compare the responses of individuals within the same family. The evaluation team believes that data we generated using these approaches enabled us to successfully meet our research objectives. We set out to not only to ascertain what the immediate impacts of the program had been on participants but also to assess whether these impacts had been felt in the wider community and whether they had been sustainable over the longer term. Our conclusion is that the Stepping Stones program had many positive impacts on the attitudes and behaviour of participants and some of their immediate family and associates and that to a large extend these changes have been sustained. However, we found that not all the messages of the program were adopted by participants. Moreover, failure in implementation led to limitation in the broader impact of the program, and threatened the long-term sustainability of the changes that the program hoped to initiate.

5.2 Strengths and weaknesses in program implementation

5.2.1 Acceptance and perceptions of the program:

Tsungirirai was an appropriate organisation through which to implement the

Stepping Stones program in this area. The NGO is well embedded in the community, has a considerable history of conducting beneficial programs and is respected by local people. Tsungirirai had already been involved in HIV related activities and Stepping Stones participants felt it was the best organisation through which to deliver future training even though the organisation was not perceived to be at the heart of everyday community life in quite the same way as others like the church were. All participants, but particularly women, felt that it had been important that Tsungirirai had sort the approval of community leaders before beginning the program. This legitimated the scheme and the attendance of women in particular. When interviewed, community leaders themselves gave a somewhat negative retrospective view of the program based primarily on its failure to prevent was they saw as a degeneration of the behaviour of the youth.

Nevertheless, those who had participated directly in Stepping Stones were universally positive about the program; indeed there was a high demand for continued training as well as for repeat programs for those who had missed the first one. People reported that they felt comfortable with the approach and format of the intervention even though it was new quite different to their experience hitherto. They particularly enjoyed the games and these were sometimes remembered more clearly than the sessions themselves. It seems clear from participants responses that the peer group meetings constituted a special time and space in their everyday lives in which they were able to openly address difficult and sensitive issues that usually remained un-addressed. This experience extended to the mixed peer-group sessions, which were seen as far more active and participatory than ordinary public meetings. Significantly, both older women and the youth independently confirmed during focus groups and interviews the older men’s claims that they had not dominated proceedings at joint meetings. Everyone was given the opportunity to speak. Older men suggested that they were actually interested to hear what youths and women had to say while young men young men welcomed the unusual opportunity to speak openly with the elders. Furthermore, the young men reported that the more open and approachable relationship between the two generations of male participants

had continued after the end of the program. Participants suggested that an inclusive approach to public discussion had also been maintained during meetings with the Tsungirirai field officer after the program. Nevertheless, women participants expressed the opinion that more could have been achieved in these sessions, but men refused to engage with particularly central issues such as condom use. Men’s failure to address this issue is a repeated and central finding of our evaluation.

5.2.3 The benefits and dis-benefits of the key role played by facilitators:

It is clear from repeated statements throughout the research that the role of the grassroots facilitators was central to the successes achieved by the program. Participants praised them highly and the evaluation team was also much impressed by their skills. Tsungirirai obviously chose well and the importance of good quality facilitators cannot be underestimated.

The downside to this however, is that we also observed that people felt that they could not do without the facilitators. Clearly, if ordinary folk are to discuss the sensitive issues surrounding HIV openly and constructively, then trained and skilled facilitators are required. However, our evaluation identifies a weakness in the Stepping Stones approach generally and/or a weakness in the way it was implemented in this instance, in that a capacity for independent action does not seem to have been developed among participants. People felt unable to continue meeting once their “ leaders sto pped coming” [our emphasis]. A dependence on outside initiative was particularly evident in exercises when people were asked to consider future goals and means to achieve them. Participants felt further facilitation was essential if they were to be able to actively continue the Stepping Stones agenda at a public level. They expressed a sense of having been “left empty handed” in the sense that they were not given manuals or materials with which to continue the activities of their peer groups. While there may have been an element of a strategic pleading here (people did not make a distinction between our evaluation team the donors who had funded the original program), the lack of post-intervention peer group activities (see below) indicates a lack of capacity among participants build on and sustain public initiatives instigated by Stepping Stones .

5.2.4 The problem of attendance:

Poor attendance was a repeated theme, but was particularly a problem for women given their domestic and caring burdens and commitment to funeral arrangements. Participants took the decision to have two meetings a week to avoid a drawn out program. However, given that the area is close enough to Harare for working husbands to return every weekend, many women did not feel able to attend Saturday meetings. Meanwhile the decision to hold daytime meetings during the week was intended to exclude the school going youth. This was unfortunate because the evaluation team identified a serious lack of knowledge among this generation. Unfortunately attendance

5.2.5 was also often poor for the mixed peer-group sessions despite their central importance to the success of the program. Tsungirirai itself was sometimes responsible for disrupting the program by calling facilitators to meetings in


The unfortunate consequences of split training venues:

The decision to instigate two training venues for practical/logistical reasons had several unintended consequences because facilitators mapped a social division of participants onto this geographical separation of venues. Youths from the area around Mauto Business Centre were excluded from the tree venue but failed to make the hike to the clinic venue. This meant that while age-sex cohorts from the same general community were trained together, the program failed to develop the potential synergies to be gained from training

generations from the same immediate community simultaneously. As a result (see below) youths in the Mauto BC area were exposed to the program only via the mediation of their participating parents.

5.2.6 The failure to sustain peer group activities beyond the lifetime of the program :

The Tsungirirai report on the intervention intimated that peer groups had continued to meet. This was certainly a key desired outcome of the program.

Our evaluation failed to substantiate this suggestion however. In our opinion, the level of post-program activity seems to have been limited. It was interesting to note that while people felt strongly that it had been right to constitute a new social structure of peer-groups as the best way to operationalise Stepping Stones , peer-groups did not feature in diagrams of significant organisations to which participants belonged. There appeared to have been a small number of one-off activities such as singing and drumming in Norton town but nothing more systematic or self-sustaining.

Older men also appeared to be making attempts to raise the issue of HIV during graveside orations at funerals, but many non-participants said they had not experienced this. Such public acknowledgement of the threat faced by the communities at such emotive venues might be seen as something to be encouraged and should perhaps be developed within the Stepping Stones training period as a strategy by which older men’s peer groups can continue the work of Stepping Stones beyond the life cycle of the formal program.


The older women had been the most successful in organising several postprogram meetings of their peer group. They had focused their efforts on developing income-generating projects, rather than promoting HIV education.

This was not insignificant however, given that some had previously engaged in the periodic sale of sex. However, such projects are less lucrative and less able to react to inflation than commercial sex work and thus perhaps require assistance to develop. The women reported that they had requested assistance from Tsungirirai, but did not feel satisfied that they had received the support they desired. If people identify that poverty is a major part of their HIV vulnerability then it would be appropriate for the program to help identify and perhaps assist the development of income generating strategies.

If these projects were developed in parallel with the stepping-stone peergroups they might help sustain both economic and educational activities beyond the life span of the formal project.

The evaluation team found it particularly significant that while both youth peer-groups were enthusiastic and had many good intentions, they suffered from rapid attrition of the their membership as people moved away to find jobs and get married.

Failure to engage with the wider, non-participation community:

The stepping stones program is designed to have impacts beyond simply the group of people who participate directly in the training program. On this count the evaluation team found only limited success. In the KAP questionnaire survey many participants suggested that they had spoken to others about what they had learned. Further probing via the other research tools revealed however that most had only really spoken with spouses, family and close friends. Many of those we interviewed who had no connection to the program had never heard of it. This included people who lived close to the training venues and people who were in vulnerable or potentially influential positions in society (e.g. commercial sex workers and bottle store workers).

This lack of knowledge about the program puzzled the evaluation team, as did the assertion by participants that the program had ended suddenly and their failure to recall their “community requests” that should have been

delivered to a general village meeting at the end of the program. Eventually after speaking to participants, non-participant and facilitators, we established that despite indications in initial Tsungirirai evaluation report that the program had been completed in full, in fact no final inclusive community meeting had been held. The cause of this failure was external to the program (the violence and intimidation surrounding the 2000 parliamentary elections) and highlights the issue that interventions never run in a social, economic or political vacuum. Nevertheless, the result was that the participants never formulated future goals, informed the community what the program had taught them or challenged the community to face the issue of HIV via the mechanism of community requests. The profile, broader impacts and hoped for sustainability of the program was thus greatly curtailed. The scale of the observable positive impacts was limited to participating individuals, their families and close friends rather than reaching the community as a whole.

5.2.8 The failure to follow-up the program :

Participants and facilitators alike identified this failing. The very positive reception received by the evaluation team is perhaps testament both to the desire for such follow-up and its potential benefits. We were told that people had enjoyed being reminded (reminding themselves) of what they learned.

We also met non-participants who informed us that they had only become aware of the Stepping Stones program though our evaluation activities and that they were keen to learn more.

5.3 Impacts of the Stepping Stones program

5.3.1 Positive impacts were observable:

The author of the Tsungirirai pre-intervention survey noted that while other

HIV interventions had taken place in the area of Mhondoro North (as they have in many areas of Zimbabwe) their impacts were not immediately obvious to his team as they prepared the way for the Stepping Stones program. The independent evaluation team is pleased to report that this was not our experience in August 2001. We recorded many significant and positive impacts resulting directly from the Stepping Stones program among participants and their relatives and close friends.

5.3.2 Improvements in Knowledge:

People certainly felt that their knowledge had been improved through the program. Within the intervention area Stepping Stones participants people were observed to have generally higher levels of knowledge about HIV and

AIDS than nonparticipants even though untrained peoples’ knowledge was also reasonably good. Among trained people there remained however some harmful areas of poor knowledge: (a) some women’s belief that HIV can only be transferred in ejaculates, (b) many people’s continued conflation of HIV and AIDS and the proposal that those with HIV can be identified by the way they look, (c) a few men’s belief that sleeping with a virgin can cure AIDS and

(c) the persistent belief among men that use of condoms would make them sterile. In addition it should be remembered that previous academic work

(Kesby, 2000) has suggested that improving knowledge is only one element of the struggle against HIV, and that the crucial factor is finding ways to facilitate people to act on their knowledge. This view is consistent with our

KAP survey results that showed that all peer groups had a good knowledge of condoms but that few individuals used them.

5.3.3. Improvements in attitudes:

In addition to endemic poverty, the rapid HIV transmission in this region is greatly facilitated by unequal gender relations. Stepping Stones aims to facilitate participants’ reconsideration of some of the attitudes that justify and constitute this inequality. In the area of changing attitudes, our evaluation

recorded some impressive results. Interestingly women were more conservative in their attitudes than men and it was often difficult to distinguish between the attitudes of trained and un-trained groups of women. While both groups of women were against wife beating, they also agreed that wives should not deny their husbands sex, women who get raped share blame and that men who shared money with wives were either weak or under a spell.

Perhaps it is still too difficult and dangerous for rural women to be at the forefront of attitude change.

In this regard the attitudes of both the older and younger groups of men is particularly encouraging. The KAP survey results suggested that all the young men and half the older men believed that wife beating was wrong, that women had the right to refuse sex and did not deserve to be raped. Half also believed that real men did not need to have many girlfriends and could share money with their wives and that it was right to try to talk to children about sex and HIV. We were particularly impressed when young men volunteered the idea that when it came to what women said about sex: “no means no”.

Compare this to the control group area, where people felt that there was no such thing as rape within marriage.

Finally it was pleasing to note that most people were positively disposed to the idea of making a will, but disappointing that few had actually done so.

This is definitely an area that would benefit form some follow-up action.

5.3.4 Improvements in practice;

The level of success achieved by the Stepping Stones program can in large part be measured by the impacts it has had on participants’ actual behaviour.

Again the evaluation team was pleased to record considerable success in this area. Improvements in partner communication

The Tsungirirai pre-intervention survey report suggested that communication between spouses in the area was poor. This deficiency has also been identified in academic work conducted in similar rural areas of Zimbabwe

(Kesby, 2000). The failure of couples to openly discuss issues related to sexuality and sexual health are a major barrier to the adoption of safersexual behaviour in the region. The Stepping Stones approach is explicitly designed both to encourage participants to begin to discuss such matters in public and to help them to develop the communication skills necessary to do so in private. The evaluation team was impressed to find evidence that the program had been very successful in this area and confirms the initial

Tsungirirai report’s reading of the program’s impact on communication.

At all points in the evaluation respondents repeatedly stated that the program had helped them improved communication with their partners. The violence, arguments threats and demands previously associated with domestic interaction were said to have declined as participants and their partners began to use the Stepping Stones inspired “polite language”. This stemmed from the use and practice of the ‘I’ statements in the training program.

Interestingly, men suggested they had gained from the shift in approach because wives and children now showed them more respect than when they had relied on “harsh language” and threats of force. For their part, women felt that the approach gave them more self-control over their tempers, which in the end produced better results than frustrated outbursts. The diagramming sessions that addressed contexts for sexual activity revealed that improved commutative interaction was having a direct impact on the quality of people’s sex lives. Both male and female peer groups confirmed that men were using the polite language to ask for sex and couples were engaging in more foreplay. Forced sex between husbands and wives was

hardly mentioned by participants yet academic work elsewhere in Zimbabwe suggests it is a very common context for sexual activity. Data gathered in the control group community tended confirmed the impression that behaviour has changed among those who have participated in the program. In the control group area women suggested it was common for men to force themselves on their wives, but this was so normal that the women had not thought to raise it until prompted.

Our one caveat about the undoubted improvement in partner communication is that semi-structured interview evidence made it clear that people tend to interpret the assertiveness techniques of Stepping Stones via the idiom of tradition. Looked at positively, this means that the techniques are more acceptable to people because they remind them of idealised notions of traditional respectful behaviour; ‘which had been lost’ and could now be regained. A more negative interpretation would be that this assimilation with traditional roles and behaviours might blunt the more radical potential that assertiveness might have in reconstituting gender relations. From a practical perspective however, the reduction in domestic conflict and violence itself represents a major step forward for gender relations. Improvements in communication between parents and children:

The pre-intervention survey suggested that parents were uncomfortable talking to their children about matters relating to sex. Academic work suggests that there has been slow decline in the traditional sex education offered by aunts and other figures from the extended family. Whether or not this approach would have been robust enough for the era of HIV is not clear, nevertheless, parents have not stepped in to fill the gap (the role of schools is not discussed here). The evaluation team was please to find that the various research tools repeatedly revealed that parents who participated in

Stepping Stones are now more prepared and able to talk to their children about sex and HIV. This was reported by both male and female participants and independently confirmed by interviews with untrained youths within participants’ households. Many of the youths reported heeding the messages given by their trained parents. Exactly what constituted this message is more problematic and is discussed below. A reduction in multiple partnering and the sale and purchase of sex

The control area focus groups generated the kind of data about the contexts of sex that might have been anticipated given previous academic work

(Kesby, 2000). Commercial sex work and sugar daddies were seen as very common phenomena and not particularly in decline. Furthermore the men’s group weighted “affairs” and “sex with wives” as similar in frequency. The pre-intervention survey had highlighted similar phenomenon in Mhondoro

North. In particular, parents worried that adults were no longer acting as role models for children in terms of their sexual behaviour.

By comparison, our post-program evaluation seemed to identify significant changes in behaviour. Female participants suggested that while still relatively common, they believed that commercial sex work was in decline.

Independent interviews with female bottle store workers confirmed a decline in both drinking and particularly CSW at their establishments. This tallied with the view among many respondents that participants in the program had generally reduced their night time movements and socialising and that women had even reduced their day-time movements to the townships sending their children on shopping errands instead. Some older women participants suggested that they no longer engaged in any informal sale of sexual services.

For their part, older male participants had very strong opinions about commercial sex and they suggested they now perceived it to be a very highrisk form of sex and avoided it completely. They saw its further reduction in the future as a key means to improve the community’s sexual health.

Several older trained men suggested that they had also desisted from having extramarital affairs too. The men’s statements were independently corroborated via interviews with non-participating family members who suggested that trained married men have stopped going with other women and have sustained these behavioural changes. Nevertheless, the men themselves observed that while lust (seen as an underlying cause of problems such as rape and a ‘drive’ that is very difficult if not impossible for men to control) had declined just after the program it was now said to be rising again. This kind of statement highlights the need for followup/reminder sessions.

Certainly the behaviour of the Stepping Stones participants has had an effect on the overall downward trend in commercial sex in this area. It would be unwise to over estimate this impact however, given the absence of the end of program community meeting. The female bottle store owners (who had never heard of Stepping Stones ) pointed to the declining economic situation and a consequent reduction in men’s disposable income and in commercial and transport activities to and through the township as a major cause. They also identified a growing general awareness and fear of AIDS as reasons for the decline of commercial sex. Women who had been involved in commercial sex and who also had never heard of the training program further confirmed this explanation. Fear of AIDS had convinced them to reduce the number of partners they had; in many cases they had become informal wives of particular men. Nevertheless, it is clear that the Stepping Stones program had convinced participants to permanently desist from engaging in commercialised sex for health, rather than economic reasons.

We were not able to pursue the suggestion that alcohol consumption and commercial sex has simply been displaced to illegal home brewing venues.

But this would be worth pursuing, perhaps through a participatory selfevaluation format to remove the fear of reporting illegal activity to outsiders.

The young men’s group reported that celibacy was their favoured means of self-protection (although some had adopted this strategy even before

Stepping Stones ). This behaviour is precisely what the older generation recommend for the younger generation rather than the use of condoms. This they claimed was still working as a strategy twelve months after the end of the program. In theory, celibacy seems like a very good protective strategy.

In the evaluation teams’ opinion however it has its own dangers. Not only is abstinence difficult to maintain but it might also lead to a lack of preparedness at some future time and place when love and or other circumstances lead to a sexual encounter. None of these young men carried condoms or felt they could get them easily. This analysis might be even more relevant to young women who must face the risk of pregnancy as well as HIV infection on the first potentially unprepared and unprotected sexual encounter. Nevertheless, at least those trained through the Stepping Stones program will have knowledge if not experience of condom use. This is not necessarily so for those who have never heard of the program or who have received messages mediated through their parents (see below). Greatly improved treatment of those with AIDS

Both participants and non-participants living in the same community recognised that those who had undertaken the program had radically changed their attitude to those with AIDS and were now much more willing to nurse and care for them.

5.4 Areas where Stepping Stones has failed to achieve its desired impact

5.4.1 Continuation of potentially risky traditional practices:

There was little or no difference in the attitudes of male participants and those from the control group when it came to the acceptance of the traditional practice of identified ‘Chiramu’ (a man having sex with his wife’s unmarried sister). Both groups suggested the practice was common and justified because it can sometimes lead to marriage. While the group of participant men recognise that the practice can sometimes lead to rape, they did not seem to perceive the danger it presented in terms of HIV transmission. For their part, young men suggested that they generation was less keen on maintaining this practice.

5.4.2 Failure to adopt condom use:

Increased use of condoms was clearly a major desired outcome of the

Stepping Stones program as it is perhaps the most effective way to reduce transmission rates. The pre-intervention study revealed a negative attitude towards the condom among many sections of the community, including influential community leaders and suggested that during the pre-program preparation, the facilitators-in-training expressed a preference for abstinence and faithfulness rather than condom use. The report concluded that the

Stepping Stones program had made the use of condoms more acceptable to the community. Our evaluation suggests that this final statement needs fuller explanation. Lack of access to condoms:

First of all, it has to be said that whatever the community’s views on condoms, they were simply not available for use in this area. We were unable to find a store that sold condoms. Interviews and focus groups indicated that condoms had not been available from the local clinics for several months while clinics’ statistical records confirmed that distribution

(supply) has been extremely erratic and not infrequently, non-existent.

Meanwhile informal arrangements between local bottle store workers and visiting nurses from Chegutu hospital had fallen into abeyance, although the store workers (although the not the owners) remained willing to reinstate it.

We also identified a demand for condoms among those who frequented the bottle stores as people independently approached members of the team in the hope that we had condoms to distribute. It is the evaluation team’s opinion that the Stepping Stones program should have identified a reliable source of condoms before the program was conducted. Furthermore that

Tsungirirai should make it a priority to secure or lobby for a regular and consistent supply of condoms in this area. Knowledge and acceptance of condom in principal but not practice:

When questioned about what they saw as the main aims of the program, facilitators failed to mention “increased use of condoms”. It was clear from interviews that they had undertaken the sessions on condoms and had done their best to argue the case with local community leaders. In the end however, they seem to have been forced to appease the community perspective, which still favours the first two strategies of the ABC approach.

This de-facto outcome seemed to have influenced their retrospective memory of the objective of the program.

The various research tools employed by the evaluation team identified that participants certainly had improved knowledge of condoms. Significantly we also identified a desire among both participating and non-participating women to use condoms with their permanent partners and a willingness not to engage in arguments about what this implied about partners’ infidelity.

However, not even the trained women felt able to suggest this to their husbands, and men were still very resistant to use condoms within marriage.

In addition, diagramming sessions on ‘Stepping Stones to future sexual health’, all peer-groups identified “use of condoms” as an important

(hypothetical) strategy. Young women in particular highlighted the importance of getting men to accept the use of condoms with their wives as the key to future health (as well as the rights of wives to deny husbands sex if they wanted). They recommended that further training was needed if men were to be convinced of this.

However, while the program has got its message across at one level, cognitive understanding about the benefits of condoms has not been translated into practice; indeed men will not yet even give them open discursive support. Mature men’s refusal to use condoms with partners and young men’s avoidance of the issue, is a key feature of the results. The KAP ballots identified that amongst all the peer groups, use of condoms was extremely limited. While trained women were more likely to have “ever used a condom”, none had used them consistently or recently. Semi-structured interviews identified that the people most likely to report fairly consistent use of condoms were women who were involved in commercial sex work or who acted as informal wives. This result is consistent with recent academic work that suggests that such women have a very different relationship with men compared to that of wives which facilitates their ability to negotiated condom use.

The evaluation team identified that none of the men who had participated in the Stepping Stones program had adopted the use of condoms within their stable married relationships despite (a) the general willingness among local women to do so and (b) the fact that most men indicated that multiple partnering has been a normal element of their sexual history prior to the program. In the absence of the use of condoms the sexual health strategy adopted by the vast majority of couples reached by the program was to call for and promise fidelity. Husbands said they no longer went outside their marriages for sex and wives suggested that if they ever did they should promise to use condoms. Again respondents mentioned that the “polite language” that they had learned to utilise during the program, was utilised in the negotiation of these new trust based monogamous relationships.

Significantly women suggested in focus groups that the improved communication techniques “helped them forgive husbands for their past infidelity”. In addition, the trained women used many traditional approaches that were little different to those adopted by untrained women, such as not denying husbands sex so as not to ‘force him to go to prostitutes’. Similarly it was not only those who had been trained in communication techniques that reported the negotiation of trust. Some informal wives did not use condoms but trusted their boyfriends to be faithful only to them (plus their formal wives).

While improved communication and greater fidelity between partners is a great achievement for the program, the evaluation team remained concerned about the failure to use condoms. The preference for trusting partners to be faithful rather than pushing for condom use has been observed internationally and it not particular to this community. Nevertheless, because this country has an HIV prevalence rate of over 25%, this strategy is much more risky here than it might be in other regions. The evaluation team is concerned that the new improved communication and promised changes in behaviour seemed to result in people drawing a line under the past. At least in their verbal comments, respondents did not seem (willing?) to consider the possibility that they or their partner might already be infected. Here we are again reminded of the KAP responses that indicated a continued belief that those infected with HIV can be identified by the way they look. Furthermore, a negative consequence of men’s strong rejection of commercialised sex

(and fully commercial sex workers) might be transference of all responsibility

for the transmission and spread of HIV to “prostitutes” and a failure to recognise themselves as a potential “reservoir of infection”. Yet, in the absence of HIV testing, the second part of the ABC approach remains risking for couples where one or both previously had multiple partners.

The evaluation team attempted to collect questionnaire data that would give some indication of the levels of STDs among respondents and documentary statistical data on STD cases more generally. This data might tell us something: (a) about continuing levels of multiple partnering (although some cases might be chronic rather than recent) and (b) about levels of infections that can act as vectors for HIV transmission among those already infected

(although our list of symptoms was not exhaustive of all possible STDs). The clinic statistics did not indicate very high levels of STD treatment in the area or display any obvious patterns. However, the statistics also did not record that the clinic had treated many AIDS related cases, and the probability is that many people do not seek treatment for STDs or do not do so at their local clinic where they may feel there is a lack of anonymity. Few female respondents admitted having symptoms related to a STD in the last year but half the older men did. These results should be interpreted carefully. They do not necessarily contradict men’s claims to be reducing the number of partners. Nevertheless what they do suggest, in themselves and because

STDs can be vectors of HIV, is that married couples need to revaluate their sexual health strategies. Either condom use needs to be reconsidered, and/ or newly monogamous partners need to contemplate going for HIV testing.

Finally, the evaluation team was very concerned by the attitude among participants (and non-participants) that they did not approve of their children

(including mature unmarried youths) using condoms. Every group interviewed during our evaluation repeated the perception that the public promotion of condom use would lead to greater promiscuity among the youth. Again the evaluation team wonders whether this strongly held opinion acts to deflect the question of whether mature adults should themselves be using condoms. Yet more seriously, it highlights a general negative attitude towards youth sexuality. Over 50% of Zimbabwe’s population is under eighteen and this age group represents the nation’s socio-economic future and best chance for an HIV free generation. Thus it is vital that young people have the fullest sexual health information available and access to every practical means to protect themselves. Unfortunately, such an understanding does not seem to have been fostered by the Stepping Stones program as it has been implemented in Mhondoro north. Failure to transfer all the messages of the program to the younger generation:

The majority of the people trained directly through the program were older men and women. The number of unmarried youths trained was minimal and the community adopted a conscious strategy to exclude younger school aged children from the program. Notwithstanding this a much larger group of young people were exposed to the program via reports from their participating parents. While some participants admitted that they had not in fact spoken to their offspring about what they had learned during the program most said they had. An increased in communication about sex between parents and children is a significant achievement for Stepping Stones , however the evaluation team remains concerned about the process of mediation and reinterpretation involved in this transference of information.

The messages parents transferred were conservative and focused on abstinence. Basically, while being prepared to discuss risk, parents did not wish to acknowledge that their unmarried children might be sexually active and thus were against advising them to use condom. This denial of youth

sexuality is particularly worrying in this region because parents seemed to have this attitude towards their offspring, whatever their age, as long as they were unmarried.

The evaluation team was particularly disappointed by the attitude of community leaders (who had approved the original program). A notion of

“uncontrolled youth sexuality” appears to being utilised as a means to promote a range of grievances that the older generation has about what they see as an erosion of their influence. There is long historical precedence for this strategy, stretching back at least until the start of the colonial period.

The danger is that the elders desire to undermine the Legal Age of Majority

Act, “child rights, democracy and human rights” will not only set back developments in gender relations and reduce women’s already limited ability to negotiate safe sex, but its associated denial of youth sexuality will simply force it furth er “underground”.

While abstinence and “waiting for marriage” play a key part in a strategy for youth sexual health the failure to recognise and engage with youth sexual activity will simply leave this generation dangerously exposed to HIV infection. The evaluation team identified that it was generally accepted that whereas older commercial sex workers were declining in number in the area, those still involved were getting younger. In addition, the phenomena of sugar daddies seeking (HIV free) younger partners was also said to persist.

In the estimation of the team, there remains a pressing need for basic information and condom access among the young people of Mhondoro north.

5.4.3 Summary:

The evaluation team is very positive about what has been achieved by the implementation of the stepping –stones program in Mhondoro North; real and sustained changes in behaviour and attitudes have been observed.

Nevertheless, the team would like to make a number of recommendations as to how the program might be followed up in this area and how it might be implemented in other areas.




Participants and facilitators recommendations:

Several practical suggestions came from this source

6.1.1 Where electricity is not available and the video cannot be used, facilitators should be provided with picture cards with which to illustrate scenes and stories in the video

6.1.2 More facilitators and venues should be available to reduce the distances travelled by participants

(The evaluation team feels this would only be workable however, if the number of participants also increased. Another means to achieve the same thing would be to be more targeted in the communities recruited into the program. In this case reported on here, participants were drawn from quite an extensive area of Mhondoro north but the intervention team had only a handful of facilitators).

6.1.3 Payment/expenses and/or incentives for facilitators to help keep them motivated and improve their post-program follow-up efforts

6.1.4 More program support resources: manuals, stationary, food.

6.1.5 More follow-up: including both further HIV related activities and support with projects and assistance with initiatives that arise from the activities of the peer groups.

6.2 Evaluation team’s recommendations:

6.2.1 The need for a reliable supply of condoms : The condom issue is clearly controversial and a narrow line has to be walked between promoting condoms and being seen as/accused of, forcing them against the wishes of key elements of the community. Nevertheless, a reliable supply of condoms in the intervention area is a basic requirement if the program is to facilitate those in the community who wish to pioneer condom use. Tsungirirai should make every effort to improve or lobby for improvement of supplies in this area and in any area of future work.

6.2.2 HIV testing : Again this is a controversial issue. However, the availability of testing in the area of a Stepping Stones intervention would help raise consciousness that in the absence of a negative test, condoms are the only reliable form or protection for couples in newly monogamous relationships that were previously open.

6.2.3 The need to engage peer croups in a single community: Community is a difficult term to define but every effort should be made to engage the sexes and genders of a fairly well defined community if the benefits of training are to have their full effect. If multiple venues are used then each should recruit its own four peer groups.

6.2.4 Targeted recruitment . While voluntary recruitment must remain at the core of the program, much could be gained from some targeted recruitment. The voluntary approach failed to attract commercial sex workers and bottle store workers/owners into the program. Yet these people are central players in the arenas where alcohol is consumed, commercial sex is commissioned and public discussion of HIV and AIDS takes place. If galvanised by the program

they could play a key role in extending its influence beyond participants themselves.

6.2.5 Engagement with local leaders . This proved to be central to the successes of the implementation in Mhondoro North. Elders were consulted during the pre-intervention, gave it their blessing and some even participated.

However, engagement needs to be on going: Local leaders need to remobilised via the end of program community meeting and through follow-up initiatives. Newly appointed leaders need to be inducted into the aims and objective of the program and its follow-up activities.

6.2.6 Engagement with the youth: The youth needs to be recruited into the program in larger numbers, they are a major population group and their sexual health is key to the nation’s future. Their sexual behaviour is still in formation and thus might be most amenable to the program’s objectives.

Moreover, the program should seek to engage with parents about the youth .

Negative attitudes toward the youth need to be analysed and reconsidered and the denial of youth sexuality needs to be challenged.

6.2.7 Joint peer group meetings: These are key moments and arenas in the

Stepping Stones program and are crucial to the overall success and sustainability of the program. Every effort must be made to ensure they are well attended and well run

6.2.8 Attendance: every effort must be made to facilitate participants’ attendance at the peer group meetings. Attendance will inevitably be disrupted but facilitators need to think through the possible consequences of meeting times and react to and reorganise them if, for example, meeting times tend to exclude women with migrant husbands.

6.2.9 The sustainability of peer group activities: The program aims to stimulate self-sustaining peer group structures. But their sustainability must be planned for and cannot simply be assumed. While the program is underway thought needs to be put into what activities and initiatives will sustain the peer group after the end of the formal program. Resources need to be allocated to this task, to for example, pump prime income-generating projects. Participants suggested they liked the idea of the creation of a brand-new peer group structure but groups might be more sustainable if people were recruited from existing groups in the community. In this way the limited Stepping Stones program could be activated inside a group that had in-built sustainability.

6.2.10 End of program community meeting and program sustainability: This meeting is vital. While its absence in the Mhondoro North intervention was forced by external conditions, this case illustrated well the implications of failing to conduct it. If the program is to impact on the wider community and produce sustainable effects then the end of community program is vital.

6.2.11 The need for follow-up projects and follow-on programs : Agencies tend to think in terms of discrete programs that have a beginning, a middle and an end. Our evaluation was itself part of the normal “project life cycle”.

However, for local people themselves, the problems of HIV and AIDS are on going and continue long after the end of any formal program. Follow-up initiatives, involving input from outside agencies and locally trained facilitators are needed to keep the program’s momentum going. Condom use, will making, and talking to children about condoms are all examples of issues that could be discussed and pursued at follow-up meetings. Moreover, follow-up activities might also be used to galvanise participants to spread the message of the program more publicly

6.2.12 The need for a rolling, rather than a discrete, program : It is tempting to think that the Mhondoro North area has now “been done” by the Stepping Stones program but our evaluation, as well as the clear demand of participants for further initiative in their area, suggests a need for a rolling follow-on program.

The intervention in the Mhondoro area was relatively small scale and its failure to fully implement the program has meant that large parts of the community remain un-affected by its undoubted benefits. Over-and-above this however, the experience of the youth peer-groups illustrated the dynamism of these communities particularly among the numerically large younger generation. A trained cohort of young people might be lost to the community in a matter of months after the program. Follow-on programs are thus particularly necessary among this group. Part of the follow-up activities of the first group of participants might be to be involved in the recruitment and or facilitation of the next group of participants to enter the program.

6.2.13 Capacity building and facilitating sustainability: Sustainability is a key goal of the program, but as suggested above, more needs to be done during and after the program to ensure this achieved. The setting up of parallel projects during the program (e.g. income generation) and follow up sessions afterwards would help wean participants off dependence on facilitators and help build a self-sustaining capacity. The suggestions above obviously have major resource implications but if the desired objectives of the program are really to be attained then the program cannot be allowed to become just another one-off program with a limited life span. While the implementation in

Mhondoro north had very real and very positive impacts, the extent to which they have extended throughout the community has been limited

Ultimately, to defeat the virus, prevention programs must become like the virus, acting as it acts in order to over come it. If it is to be truly effective the

Stepping Stones ethos must become virulent once it is introduced into a community. People must pass its messages one to another; it must spread out from its source and perpetuate itself in the host community.


The research team would like to thank British Academy for the grant awarded to Dr

Kesby (ref. SG-29725) that funded the majority of the work reported here. We would also like to thank Action Aid Africa for providing office space, support and some financial resources to the team. We are especially grateful to Tsungirirai for their help and cooperation and for there provision of a field vehicle. Finally, the review would not have been possible without the hard work, patience and enthusiasm of the many facilitators, participants and villages we spoke to during our time in Mhondoro North.

We dedicate this report to them and hope that its contents will make some small contribution to their struggle against HIV/AIDS.


Holden, S. (1998) Executive summary of Stepping Stones; participatory review in Uganda

(Action Aid: Unpublished document)

Justin Mucheri (2001) Report to Action Aid: pilot Stepping Stones at community level: The

Chivero community experience (Tsungirirai: Unpublished report)

Kesby, M. (2000) ‘Participatory diagramming as a means to improve communication about sex in rural Zimbabwe: a pilot study’, Social science and medicine 50 (12) 1723-1741

Appendix 1: Techniques and Methodology














POP 2-



Open community meeting – introductions – signing of consent forms

Focus group – reasons for non participation

Flow diagram

Contexts for sex

Tree diagram-Strategies for avoiding risk

Stepping stones diagramfuture sexual health

Focus group – who can help create the stones who can tackle the crocodiles

KAP survey with all participants

Venn diagram-sources of information

Focus group discussion

– organisational structures

POP 1-



Focus group reasons for participation

Wheelbarrow – things that made SS go well/made it difficult

Focus group – likes and dislikes about SS

Focus group & flow chart- on peer groups

Flow diagram – Contexts for sex

Tree diagram-strategies for avoiding risk

Focus groups-hopes & special requests

Tree diagram-Positive & negative change since SS

Focus group – everyday strategies for securing positive changes

Stepping stones diagram – to future sexual health



Focus group – who can (i) create the stones (ii) tackle the crocodiles

Semi-structured interviews–Participants/non-parts/facilitators


Last five stages










Venn Diagram - sources of Knowledge

Flow diagram – Contexts for sex

Tree diagram – Strategies for avoiding risk

Stepping stones diagram – future sexual health

Focus group – who can (i) create the stones (ii) tackle the crocodiles
















Appendix 2: Ballot style, Knowledge, Attitudes and

Practices (KAP) questionnaire:

Ballot A: This is the research teams version of the ballot. It shows (a) the question number

(b) the question asked (c) the possible responses and the symbols people should use to indicate their response (d) the question numbers that are knowledge questions (indicated with shading) and the correct response to this question.



Question Yes No Don’t




(TEST QUESTION – ensure participants understand that YES or No can be a correct answer)

Does a dog have four legs?

(TEST QUESTION) Does a cow have two heads?

3 Have you ever heard of HIV

4 K Is HIV a risk in this community (if SS people say no check at end why – do they now protect themselves)

You can tell if someone is infected with HIV because they look sick


5 K

6 K Having sex is the main way HIV is transmitted in this country Yes


7 K

8 K

Having sex with a virgin can cure HIV

If you leave Genital sores untreated they can help transfer HIV Yes


9 K


Contraceptive make you sterile

It is normal and acceptable to carry condoms


11 K Which of these can a condom protect against: HIV











18 K

Have you ever used a condom

Do you know where you could get one if you wanted one

Have you ever asked your partner to use a condom

Has your partner ever asked you to use a condom

Have you used one in the last 3 months

Do you use them regularly (several times a month)

The same condom can be used up to three times




20 K

21 K If you go to get treatment for such problems it is best to advise your partner to do the same

It is acceptable for a man to discipline his partner by using violence 22

23 Women Women: Have you ever been beaten by you partner

Men: Have you ever beaten your partner

24 It is acceptable for a woman to refuse to have sex with her husband if she does not feel like it

25 Women who get raped usually ask for it

26 Have you discussed HIV risk or STDs with your partner in the last year

27 Parents should find ways to talk to their children about sex, pregnancy and sexually transmitted infections

28 Real men have many girlfriends




This year have you experienced a pain or burning sensation when urinating, had genital sores, or an unusual discharge

All these symptoms are signs of a sexually transmitted infection





It is a good idea to make a will so that you know that your family will be secure if anything should ever happen to you

The best time to make a will is when you are feeling happy and healthy

Have you/or your partner make a will

Men who share their money with their wives are either weak or under a spell

Depending on Population group

(i) Have you ever spoken to non-participants about the

(ii) things you learned in stepping stones

Have anyone who did the Stepping Stones program ever told you about the things they learned

Appendix 3: The version of the ballot utilised by respondents

(only the first few questions are shown as an illustration of the whole form.






Appendix 3: Semi structure interview questions

1. Questions for non-participants perhaps at the bottle store – shops – or in their own homes (near the tree and the community hall

1.1 Introduce our selves –evaluation of Tsungirirai work– DO the CONSENT form .

1.2 Have you heard about a training program that went on here called stepping stones?

( Probe when did it take place- what was it about – who told you )

1.3 Do you know anyone who attended?

1.4 What is you opinion of those that attended – and of the program itself?

1.5 Has anyone ever spoken to you about what it was about ? (probe – when – how long ago – was it last week for the first time )

1.6 What did they tell you?

1.7 How have you responded to that – have you changed your own behaviour?

1.8 Have you noticed any difference in those people’s behaviours in the last year?

( probe what differences have you seen – what is your view about that )

1.9 Would you say that there are any commercial sex workers operating in this area?

( Probe - Are there many ?)

1.10 What has the trend been in their activities over the last twelve months (up down)

( probe – what reasons would you give for that )

1.11 What about rape in this area – does it happen much?

1.12 Has their been a change in the last 12 months ( probe – what reasons would you give for that )

1.13 Do people talk about HIV AIDS much ( probe – for example at funerals )

1.14 How do people treat those who have AIDS in this area. ( probe – will they socialise with them – eat with them – care for them )

1.15 Has there been a change in the way people treat those with AIDS? ( probe – what has been the cause of this )

2. Questions for bottle store owners

2.1 Introduce our selves – evaluation of Tsungirirai work– DO the CONSENT form .

2.2 How long have you run this bar?

2.3 How is business ( probe – booming – slow – average – what are the causes of any changes in the profitability of the business )

2.4 What sort of people come here ( probe – men – what ages – women – CSW? – do you get outsiders here – people visiting – bus or lorry drivers )

2.5 Have you seen any changes over the last two years in the number and type of people who come here? ( probe – ages – sex – insiders/outsiders )

2.6 What are the causes of these changes do you think?

2.7 Do any CSW work here? ( probe – how many – do you have any policy on their activities )

2.8 Has there been a change in the number of CSW in the last two years ( probe – what is the cause )

2.9 Have you seen any change over the last two years in the behaviour of some men who come to drink here?

2.10 Particularly have you seen any change in the behaviour of some men and their attitude to CSW? ( probe – what has been the cause of this )

2.11 Have you ever heard of a program called Stepping Stones ( probe – what – when – where – who )

2.12 Do you sell or have you ever sold condoms ( Probe – would you consider it – why not

– why did you stop selling them )

2.13 We would like to talk to some of those women that sell sex at this bar – could you help us by identifying some of them.

3. Questions for Commercial sex workers at the bottle store

3.1 Introduce the project – investigating peoples health – and the work of the NGO

Tsungirirai - we will make no judgement about you - just answer honestly to help us to help those that want to bring development and health to this area.

DO the CONCENT form.

3.2 Do you live in the local area.

3.3 Are you married – divorced – widowed.

3.4 Have you done this kind of work long.

3.5 Why did you enter into it – story of how you came to be involved ( probe – divorce abuse – income generation )

3.6 How does the community treat you

3.7 At the bottle store are there some men who will not go with you – do you know why they refuse.

3.8 How is business – ( probe how many clients a week – what do they pay )

3.9 What has been the trend over the last year or so – are the number of men wanting to go with you increasing or decreasing or staying about the same.

3.10 Have you ever heard of a program called Stepping Stones ( probe – what do you know about it – when did you hear it – who told you )

3.11 Do you know about the risks of catching HIV through the work that you do

3.12 Do you insist on your clients using condoms?

3.13 Do your customers insist on using condoms ( probe – which ones – SS participants ).

3.14 Could you get condoms easily (and affordably) if you wanted to ( probe would men agree to use them )

3.15 Why do you think men go with you ( probe – are you customers married – single – young old – estimate what proportion of each )

3.16 Do you ever experience violence with your customers or is it usually a happy arrangement.

4. Questions for those working at the clinic.

4.1 Do you distribute condoms from this clinic?

4.2 Are they free

4.3 How long have you been distributing them?

4.4 How many do you hand out to any individual at any one time – ( probe – do you set any kind of limit )

4.5 What has been the trend in the number of people coming to collect condoms in the last two years

4.6 What do you think has been the cause of the changes you describe

4.7 What sort of people come and collect them ( probe – ages, sex, marital status )

4.8 When you distribute them – do you say anything to the people – give them advice of warnings

4.9 What is your attitude to young people who repeatedly come to collect condoms

4.10 Do you have many STD cases? – have you seen a change over the last 2 years

4.11 What are the causes of the changes?

4.12 What could be done to reduce the cases?

4.13 Many AIDS cases? – Trend over the last 2 years

4.14 Causes of changes?

4.15 What could be done to reduce the number of cases.

4.16 Rape cases – trends – causes

4.17 Child abuse cases - tends - and causes

5. Interviews with people in families where at least one member of the family attended the SS program




Explain the project and as the participants to sign the consent form

Ascertain who in the family attended the program then select the appropriate box

If it was them then use the top box – if it was some one else in the family use the bottom box


Who took part in SS


Who took part in SS


Who took part in SS

1. Who in your family took part in the SS program.

2. What things most stick in your mind about the program?

3. What would you say was the single most important thing that you learned or gained from the program?

4. How did that thing change the way you live your life

5. The program was conducted in peer groups – in which women and the youth had the opportunity to speak there minds and then to do so to men in the joint peer group meetings

– how did you feel about that

6. Was that different to your every day experiences – and to the way meetings are normally conducted ( probe explain )

7. After the program – when it comes to being back in the household – are you still acting in the ways that you did during the program – do you still give women and youth opportunity to speak

8. People have told us that the SS program trained people to use a polite language when approaching partners – can you explain how you use such language in your everyday life

9. How does your partner react to these kind of approaches

10. Have you spoken to her about the things you learned in SS

1. Who in your family took part in the

SS program.

2. What things stick in you mind most about the program?

3. What would you say was the single most important thing that you learned or gained from the program?

4. How did that thing change the way you live your life

5. The program was conducted in peer groups that gave women time and a place to speak out their views – how did you feel about that approach?

6. Was it different to your everyday experiences as a woman – and to the way that meetings are usually conducted?

7. Did you feel empowered in that setting ( to speak and act freely ).

8. Now after the program - when it comes to being back in the household do you still feel empowered – are you still able to speak so freely? ( probe – if yes – how is she able to maintain this spirit – if no why not – what are the blocks to here continued empowerment )

9. People have told us that the SS program trained people to use a polite language when approaching their partners – can you tell me how use such language. ( probe – situations – examples )

10. How does your partner react to these kind of approaches

11. Have you spoken to him about the

1. Who in your family took part in the SS program.

2. What things most stick in your mind about the program?

3. What would you say was the single most important thing that you learned or gained from the program?

4. How did that thing change the way you live your life?

5. The program was conducted in peer groups that gave you the time and a place to speak out their views – how did you feel about that approach?

6. Was it different to your everyday experiences as a woman – and to the way that meetings are usually conducted?

7. Did you feel empowered in that setting ( to speak and act freely ).

8. Now after the program - when it comes to being back in the household do you still feel empowered – are you still able to speak freely? ( probe – if yes – how is she able to maintain this spirit – if no why not – what are the blocks to here continued empowerment )

9. People have told us that the SS program trained people to use a polite language when approaching their parents – can you tell me how use such

11. Has her behaviour changed since you (he) attended the SS program

12. Men in this are have suggested that they do not like to use condoms – do you use them with your wife

13. Do you use them with other girlfriends that you have

14. Do you now talk openly to your partner about HIV and matters of Sex.

15. Do you now talk with your children about HIV and matters of sex?

16. What do you say? (are you happy if they use condoms)

17. Have people changed the way they care for those with AIDS


Who did not take part in SS

1. Who in your family took part in the SS program.

2. Why did you not attend your self.

3. How did you feel about your partner attending.

4. What did your partner tell you about SS

5. What did your feel about that

6. Have you noticed any significant changes in their behaviour

7. Have they sustained those changes ( probe – if not why not?


8. How have you reacted to this –

(probe - have you begun to change your own behaviour – how)

9. Would you say that your relationship has improved since

SS - ( probe how – why ) things you learned in SS

12. Has his behaviour changed since you (he) attended the SS program

( probe – for example – sleeping with other women – using condoms with them/you – drinking – violence towards you )

13. Men in this area do not seem very keen to use condoms – would you like your husband to use them with you.

14. Have you advised him to use them if he ever “goes outside”?

15. Do you think he does?

16. Do you now talk with your children about HIV and matters of sex

17. What do you say? (are you happy if they use condoms)

18. Have people changed the way they care for those with AIDS


Who did not take part in SS

1. Who in your family took part in the

SS program. Who in your family took part in the SS program.

2. Why did you not attend your self.

3. How did you feel about your partner attending.

4. What did your partner tell you about


5. What did your feel about that

6. Have you noticed any significant changes in their behaviour ( probe – for example – sleeping with other women – using condoms with them/you – drinking – violence towards you )

7. Have they sustained those changes

( probe – if not why not?


8. How have you reacted to this –

(probe - have you begun to change your own behaviour – how)

9. Men in this area do not seem very keen to use condoms – would you language. ( probe – situations – examples )

10. How do your parents react to these approaches.

11. Have you spoken to them about the things you learned in SS?

12. Has their behaviour changed since they (you) attended the program

13. Do you speak with your parents about HIV and sexual issues

14. What do you say – what do they say? (are they happy if you use condoms)

15. Have people changed the way they care for those with AIDS


Who did not take part in SS

1. Who in your family took part in the SS program. Who in your family took part in the SS program.

2. Why did you not attend your self.

3. How did you feel about that person attending.

4. What did they tell you about SS

5. What did your feel about that

6. Have you noticed any significant changes in their behaviour

7. Have they sustained those changes ( probe – if not why not?


8. How have you reacted to this –

(probe - have you begun to change your own behaviour – how).

9. Are you sexually active

10. Do you protect yourself against

STDs, HIV and pregnancy?

10. Men in this are have suggested that they do not like to use condoms much – do you use them with you wife

11. Do you use them with other girlfriends that you might have

12. Do you now talk openly to your partner about HIV and matters of Sex.

13. Do you now talk with your children about HIV and matters of sex?

14. What do you say to them – what do you tell them

15. Would you happy to see them using condoms

16. Have people changed the way they treat those with Aids like your husband to use them with you.

10. Have you advised him to use them if he ever “goes outside”?

11. Do you think he does?

12. Do you now talk openly to your partner about HIV and matters of


13. Do you now talk with your children about HIV and matters of sex?

14. What do you say to them – what do you tell them

15. Would you happy to see them using condoms

16. Have people changed the way they treat those with Aids

( probe – how – do you use condoms )

11. Do your parents talk openly with you about HIV and matters of sex?

12. What do they say to you about that.

13. Would they be happy to see you using condoms.

14. Have people changed the way they treat those with Aids

Appendix 5: Interview schedule used when interviewing facilitators.

The number of lines available for responses has been reduced here for brevity.


Name _________________________________Gender____________Age______

Marital status__________________________Place of origin____________________

Economic background/job___________________________

Why did you want to become a facilitator


_Why were you selected to be one


“Before you began”

Any difficulty finding facilitators – e.g. female or male facilitators?


Did you experience any logistical difficulties in running the program – describe


Any difficulties with the NGO


Did you do a review of condom availability – distribution sites – testing and counselling sites before you began


Use of SS

3.1 Structure

Did you miss out or change any of the sessions out - Which ones and why? -


Which sessions were the most useful - And why


Did you use the video – was it useful – if you didn’t use the video – why not?______


3.2 Timing

What times of day/week did you undertake the sessions?


What were the advantages and disadvantages of this choice?____________________

3.3 Location

Where did you hold your meetings – why____________________________________

Did you find some locations better than others – why___________________________

3.4 Peer groups

How were the participants gathered/who became a participant - and why?__________

Was the use a peer groups a good way to conduct Stepping Stones - explain your answer


Do you think there were particular advantages or disadvantages of excluding the rest of the community once the program was under way____________________________

3.5 The approach of the program

How easy did you find the manual to follow – explain your answer _______________

Did its approach seem natural or foreign to you at first? ________________________

Did it become natural ___________________________________________________

How easy or difficult was it for you to get participants into the Stepping Stones approach – explain your answer____________________________________________

4. Drama

What, do you think, was the purpose of all the acting and practising of behaviour?


How will the drama and role play exercises help people in their everyday lives?

- particularly in terms of avoiding HIV risk _________________________________

5. Facilitation

What do you feel your role was as facilitator?________________________________

How did you facilitate the peer groups ______________________________________

Did you need to intervene to resolve conflicts_________________________________

Was facilitation of mixed and community meetings any different – how - Describe___


How did the final community meeting go ____________________________________

6. The Message

What were the main messages you were trying to get over during the Stepping Stones program? ____________________________________________________________

What message did you try and get over in the following particular sessions

The session on tradition and the need to question and change certain traditions?


The session on money – and the way money is shared at home

The session on saying “NO”


 The session on “I” statements and being assertive


The session on the long journey and making wills


7. Resistance to Stepping Stones

Were participants ever reluctant to do any part of the program?___________________

What did they object to? _________________________________________________

What happened? _______________________________________________________

Did non-participants or community leaders object to any aspect of the program? _____

To what did they object? ________________________________________________

What did they do/say


How did you deal with these situations


8. Knowledge

When you did the session about HIV and AIDS – how much did people already know about the disease and how it is tansmitted?___________________________________

Did you do the condom session? ___________ Describe how it went _____________

9. Ongoing evaluation and review

Did facilitators meet after every session ____________________________________

Were records kept – flip charts – note books _________________________________

Did you do an end of program evaluation review – were records kept? ____________

10. Sustainability

10.1 The community

Were local community leaders involved in the program – explain how


Have they been involved since the end of the program__________________________

Were the special community requests made ____________what were they


How did the community respond to the “community request”

At the time____________________________________________________________

And since then ________________________________________________________

10.2 Peer groups

Did the groups plan to meet again _______________Where and how _____________

Have they met again - If not why not ______________________________________

10.3 Follow-up

What have you or the NGO done anything to follow-up the initial program?


If you have not done anything – why not - what have been the barriers to you doing any follow up work ____________________________________________________

What could be done to remove these barriers ________________________________

Do you have any further comments you would like to make?

Do you have any questions for us? (MAKE NOTES - PTO)