AIDS education often aims at 'giving' people facts. But having more information about HIV does not seem to help people in making changes which reduce their risk of infection. What is going wrong?
One reason may be that, as trainers, we fail to remember that sexual behaviour is like all human behaviour. What people do sexually (and where, why and with whom) is influenced by many factors.
their gender - both sexes are strongly influenced from an early age about how men and women should behave sexually
knowledge and beliefs - what they know and believe about HIV transmission, sex and sexuality
values - what they feel is important in their lives and sexual relationships
attitudes - their negative and positive feelings about sexual relationships and other people
skills - what they know how to do
self-esteem - how they feel about themselves
self-efficacy - their confidence and ability to make changes in their lives
peer pressure and social influences - how their family, friends and other people in the community view sexual relationships
the environment in which they live - cultural or religious views about sex; low incomes; poor health services; lack of condoms or treatment for sexually transmitted infections.
All these factors can affect people's decisions about sex, and their ability to change what they do.
If we accept that this is true, then we need to create more opportunities for people to:
explore all the different influences on sexual behaviour
understand the risks and accept the need to make personal changes
think about how they can change their personal lives and communities to make sex safer.
Instead of telling people what to do and what not to do, trainers are now realising the advantages of using a participatory approach in education. This means involving people actively in discussions and practical activities.
The participatory approach helps good communication. It assists people to think more deeply about their relationships and their lives, and to practise skills for making their lifestyles safer.
It is also important to work with people to create changes in their environment and community which help to make sex safer. This will enable people to make personal changes and to talk about making changes with others without fear of violence or rejection.
Even if people reach a decision to make changes in their lives, they often find it very difficult to keep up the change on their own. Change can only occur if the climate is right. This means that people need:
training and education where they feel able to listen, to enter into discussion and to raise questions when necessary
time to think about their own vulnerability and risk, and what they need to overcome the barriers to change
support from family and friends, the community and key leaders
resources such as regular, affordable condom supplies and access to treatment for sexually transmitted infections
policies that support change at the individual level, in the community and at national level.
Because most people with HIV are infected through unprotected sexual intercourse (anal or vaginal), AIDS education must involve discussion about sex. This is not always easy. Talking about sex can be difficult and embarrassing because:
some cultures have strict rules about how, with whom and when sex is discussed
men and women have different ideas about sex and what it means to them, and partners find it hard to talk to each other
certain activities are disapproved of and never discussed, but may be happening, such as using anal sex to prevent pregnancy, teenage sex, exchanging sex for money, or homosexuality (sex between men or between women).
Talking sex means talking personally
Sex is an important part of everyone's lives and means many different things. For some, sex is linked with the need or desire for children, love, belonging, security and enjoyment. Sex may also mean a sense of duty, fear, secrecy, shame, guilt or anger. Sex can be a way of earning money, or obtaining goods or shelter and companionship. And for some, sex is about power and exploitation.
Men and women have different views and ideas about sex. These depend on what they have learned and been taught as they grow up and on their past experiences. Views about sex, sexual feelings, sexual relationships and how men and women should behave also depend on culture and religion.
For example, in some countries men expect to have many partners outside marriage and feel that they have a right to demand un-protected sex, especially if they pay for it. In contrast women are expected to be faithful and to fulfill the sexual demands of their partners, even when there is little benefit to themselves.
In these circumstances men can feel powerful and in control, but also under pressure to behave in particular ways. Women often feel misunderstood and lacking in choice but afraid to confront their partners for fear of violence or rejection.
People assume many things about sex, and often have strong views about what is right and wrong - about condoms, sex outside marriage, prostitution and homosexuality. But it is important to help them discuss these difficult issues more openly. Talking about making sex safer is not just about avoiding HIV and other infections. It is about talking personally - about our own feelings and experiences.
Finding a starting point for talking about sex and HIV is often difficult. It helps if the trainer listens to what people are saying, and explores what they think, know, feel and value about their sexual lives before trying to get the discussion going. It is important for education to be based on people's concerns and priorities, and on what is actually happening in the community.
The following activities can help in this process:
informal listening surveys
guided discussions with groups of people from the community.
Aim: to find out people's views on HIV, and their different attitudes to sex
Time: 1 day
A listening survey is usually carried out at the beginning of a project. It can also be used later on to find out whether people are saying different things. Listening surveys also provide ideas for developing educational materials and drama.
Carrying out a listening survey involves spending time in public places where people meet and talk, such as on the bus, and in market places, bars, hospital waiting areas, hairdressers, pharmacies and shops. It helps to do the activity with someone else, so that you can discuss what happened afterwards, and offer support if the conversation becomes difficult.
Start a conversation with people by saying something about AIDS or sex which causes them to react and start talking. Listen carefully to what people say, showing interest but keeping silent as far as possible. Try not to interrupt or correct someone, or give your own opinion or argue, but keep the discussion going by asking questions. Try to find out the main issues and problems.
Don't take notes while listening. Remember the main comments, views and ideas, and write them down afterwards.
A listening survey in a rural village showed that men and women of all ages were very concerned about the drought in the area and the shortage of food and other resources. People were also talking about difficulties in caring for sick people at home. AIDS was not mentioned as a possible cause of these illnesses, but it was clear the people were very worried and uncertain about how to approach the problem.
Younger people said that to avoid more illness in the village it would be better if the sick were cared for in hospitals. However, there was a strong feeling among the elders that people with a terminal illness should be cared for at home.
The project workers designed activities to help people acknowledge the problem of HIV and AIDS and provide training and support for home-based care in the village.
A listening survey among 16 and 17 year olds in a secondary school revealed that the young people were very worried about their exams, future careers and lack of money. They were also anxious about their friends' opinions about them - about whether they had sex or were in sexual relationships. Sexual pressure from older men in the community was a particular concern for the girls. Both sexes were much more worried about preventing unwanted pregnancies than sexually transmitted infections or HIV.
The findings helped the workers to design an education programme that provided information about reproduction, contraception and sexuality, as well as HIV prevention. Training sessions included helping both sexes to develop skills in refusing sex, and in taking more responsibility in their relationships. The programme also developed links with the local family planning centre, and made it easier for the students to get contraceptives, and help and advice about their concerns.
Aim: to find out what people think about a specific topic
Time: not more than 2 hours
The person leading the discussion (the facilitator) does not participate in the discussion except to introduce the group members, ask them key questions and record the main points.
See Part 2 for more detail on how to lead group discussions.
Select a group of 8 to 10 people who share similar backgrounds, ages and experiences. People are more likely to talk freely and feel less threatened if they have a lot in common. For example, it is usually better to run separate groups, for women and men. A joint session could be organised if they wish.
Arrange a comfortable meeting place, where people can sit in a circle. Consult the group about a convenient place and time, and arrange transport or child care if necessary.
Prepare a topic guide as a reminder of the main issues to be discussed. For example, the sample topic guide on the next page provides questions about young people's views about sex.
Explain the aim of the discussion, for example that the main points will help in designing a community based project. Assure participants that their role is valued and important.
Use the topic guide to help focus the discussion. Try not to ask personal questions because people are unlikely to talk about private things in public. Instead ask about what friends and others in the community do.
Encourage group members to respond to questions, and to talk as openly as possible. This is especially important in mixed groups when men and women are present and women may feel uneasy about making a point. Try to ensure that everyone is given the opportunity to speak. Listen to and note down what people say. Don't become involved in the discussion, except to remind people of the questions
Summarise the discussion at the end but try not to pass judgement or give an opinion. Explain any misunderstandings and challenge prejudices only after the discussion has finished.
Finally, ask the group about their suggestions for project activities or solving particular problems.
Sample Topic Guide: Young people and sex
What do young people know about reproduction and sex?
What questions do they have?
What do they think about having sex before marriage?
Do young men and women have different feelings about this?
When do they start having sex?
What would help them to delay having sex?
What do they know about HIV, and do they feel at risk of infection?
What do they know about other sexually transmitted infections?
What do they know about safer sex and sexual activities which could be safer than intercourse?
Where do they get information?
From whom would they like to learn about sex?
Should young people have access to condoms? Do they?
Should young people have access to treatment for sexually transmitted infections, and do they?
What do they feel about people with HIV?
How would they like things to change in their communities?
Be there, be aware, but try to remain in the background.