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Issues
Stepping Stones has been used by many organisations to address a wide range of issues. These are issues which are universal and found in any community anywhere. But the manual does not impose imaginary experiences on participants from elsewhere. Instead it encourages participants to think about their own lived experiences in relation to these issues. Therefore each Stepping Stones workshop is unique, depending on the specific lived experiences of the participants in that particular community. This enables participants to develop their own solutions which are specifically relevant to their own concerns, which belong then to them.
The whole Stepping Stones workshop process is divided into
four separate themes. These are:
1) Introductions and group cooperation development
3) Why we behave in the ways we do
4) Ways in which we can change
You can view parts of a workshop for yourself on the optional video, which is also now available in DVD.
Facilitators are strongly encouraged to complete the exercises in each theme with participants before moving on to the next theme. For more info about the structure of the whole process see the HOW page.
The issues which participants are encouraged to address
in the workshop sessions are in some ways covered throughout the whole
workshop. However, at different stages of the workshop, particular issues
are highlighted for participants' special attention.
The first three issues are current throughout the process...
challenging gender inequalities and gender violence - the physical,
sexual, psychological and economic issues relating to gender inequalities
and the relationship of gender inequalities to HIV and STIs, both in terms
of causes and consequences. For instance, you can click
here to see a diagram drawn by schoolgirls in Zimbabwe (as a part
of the Auntie Stella project), which illustrates how gender inequalities
relate to why they have boyfriends, both as causes and consequences.
Throughout the whole Stepping Stones workshop, there is a gendered perspective to all activities. See appendix 4 (page 19) of the "Guide for Incorporating Gender Considerations in USAIDS's Family Planning and Reproductive Health RFAs and RFPs", published by the Interagency Gender Working Group, October 2000 for one example of an analysis of this. For more info about gender and HIV see also the IDS Bridge Pack and various publications from the International Community of Women living with HIV/AIDS (ICW - www.icw.org).
Click here for references page to see how Stepping Stones has worked in different contexts.
Click here to view an extract from the optional video.
challenging violence against children, young people It is often
especially difficult for children and young people to speak out about
the violence against them - and sometimes for them even to recognise that
the way they are treated is wrong. With Stepping Stones we have seen 10
year old girls stand up in their own community in front of the mayor and
officials asking not to be pestered by sugar daddies… you can
read more about this in "Rehearsing for reality"
. Save the Children Fund UK is now trying to develop ways of using
Stepping Stones and related methodologies with young people under 10 years
old in Southern Africa. Please let us know if you are already doing
this, so that we can learn from your experiences. An excellent book
for young people is "Choices"
by Gill Gordon, available from TALC.
Click here for references page to see how Stepping Stones has worked in different contexts.
Click here to view an extract from the optional video.
breaking life-cycles of violence By working with different generations
of participants as well as different gender groups, we are trying to challenge
the ageism inherent in all societies, which belittles the views and rights
of younger people. It is clear from research in Canada and elsewhere that
if young people are brought up in violence they then practise violence
on others when they are older.
http://www.menstuff.org/links/links.html
http://www.nohurt.org/edition%204/voice.html
http://www.ssc.uwo.ca/psychology/faculty/project/yr-project/
http://www.cc-info.net/hiv/hiv_aids.html
After Stepping Stones workshops, communities have reported greater harmony across the community, with older people respecting younger ones more and vice-versa.
Click here for references page to see how Stepping Stones has worked in different contexts.
Click here to view an extract from the optional video.
During Theme 1: (introductions and group cooperation development),
participants are also encouraged to address the following issues specifically:
what is love? Early on in the workshop process, participants are
encouraged to define what love is - what words there are for love in their
language and what the different kinds of love mean in terms of rights
and responsibilities between community members.
challenging stigma and promoting respect,
support for and solidarity with HIV positive people. People with
HIV live in fear of stigma. They fear being thrown out of their homes,
being shunned by their friends and relatives, no longer being allowed
to cuddle their grandchildren, being bullied at school or losing their
jobs. In extreme cases, they have been killed for disclosing their status.
This means that many people who are HIV positive dare not tell anyone
their status. Others dare not even be tested, for fear that the fact they
have had a test might become public knowledge. So challenging stigma is
a hugely important issue in trying to open up people's feelings about
HIV and about people with HIV. Throughout the Stepping Stones workshops,
the approach adopted is one of a human rights base, which recognises that
we are all affected by HIV and that we have equal rights to the
way in which we are treated by others, irrespective of our status. You
can also promote training, employment and involvement of HIV positive
people as Stepping Stones workship facilitators and trainers. Involvement
of HIV positive people in the workforce in this way has the potential
for multiple positive effects - on their colleagues, on participants and
on the positive employees themselves. The UNAIDS
website on human rights, ethics and law has more about this issue. See
also the ICW website (www.icw.org).
For further information about involving HIV positive people in your workforce,
see the publication "Working Positively" from the UK Consortium
on AIDS and International Development.
Click here for references page to see how Stepping Stones has worked in different contexts.
Click here to view an extract from the optional video.
During Theme 2: (HIV
and safer sex),
participants
can address the following issues:
STI and HIV reduction The original manual focused primarily on
HIV. However, over the years, we have realised that it is important to
start work with community members on issues that they are most concerned
about, not necessarily on HIV. For instance, in Uganda, schoolgirls were
most anxious not to fall pregnant, for fear of being excluded from school.
In South Africa and the Gambia, participants were keen to protect their
fertility. Therefore adaptations in those countries have focused on these
issues first. Once participants feel that their own concerns are listened
to and addressed then they become interested in other issues, such as
HIV, also. See the adaptation guidelines for more
on this.
VCT
and Access to treatment update......
Since Stepping Stones was first written, access to treatment for opportunistic
infections has become more widespread and, with the advent of anti-retroviral
therapy and the WHO "3x5"
strategy, (www.who.int), which sought to enable 3 million people to access
treatment by the end of 2005, there has been the beginning to be some
hope for the millions of HIV positive people who are not yet able to access
these drugs. I am myself HIV positive and have been for over 14 years.
I have seen the difference which these drugs have made to my own life
since I started taking them in March 2000. Whilst there are still many
who experience side-effects and much research still needs to be done on
their long-term effects, there is no doubt that ARVs have saved millions
of lives in those countries where we are fortunate enough to access them.
As ARV access starts to become more of a reality for more people, Stepping
Stones workshops have the capacity to provide basic information and interactive
discussion sessions about treatment regimes, compliance issues, dealing
with side-effects etc. in a safe, informal environment with the participants.
Such sessions will in turn contribute to the creation of enabling environments
which will promote a truly informed and truly voluntary
interest in counselling and testing, amongst most of the participants
who take part. In such communities there will be a chance for men and
women to learn of their HIV status with the full support and backing of
their neighbours and openly to access treatment also. Of course, access
to testing and treatment also depends hugely on the availability of
good, unbiased and supportive health services nearby... but if this distant
dream were to turn into a reality, this would be an enormous step forward
in society's capacity to contain this pandemic.
care and support for people with HIV and their carers People with
HIV and their carers are often ostracised by their communities, who fear
that they may be infected by them, or who blame them for the virus. This
is both unjust and unrealistic. Risk of infection through normal social
contact is of course minimal, and once community members have attended
Stepping Stones workshops they also realise the injustice and uselessness
of trying to allocate blame for the virus. In communities where Stepping
Stones workshops have been held, participants have changed their attitudes
towards people living with HIV and their carers. It is especially encouraging
when young men have reported that they have started to show care and support
for their neighbours, since this reflects a significant shift in the young
men's perceptions about themselves and their potential role in their community.
We have now included young men starting to become involved in caring as
a key factor to look out for in successful programmes, because this represents
a clear break from traditional gender norms, where women and girls only
are supposed to adopt the caring roles. See the article about Stepping
Stones and gender, sex and HIV for more on this.
unwanted pregnancy Both teenage girls and older mothers can be
reluctant to get pregnant. Others may also wish not to have children.
The package has been adapted in South Africa, the Gambia and elsewhere
to address pregnancy. There is also the need to think about how to become
pregnant when you want to, without increasing risk of STI and HIV transmission.
We are working on ways of addressing this more effectively in Stepping
Stones.
challenging homophobia and embracing diversity The
original Stepping Stones package did not explicitly address sexual relationships
between people of the same gender, although it has always aimed to promote
a human rights based approach to sexuality. We realised this was a gap
and have wanted to develop something in Stepping Stones programmes which
would help participants to learn about different sexualities and to reject
prejudice. In May 2002, a group of trainers from around Africa visited
Nicaragua, to learn from the work of the Association
of Men Against Violence (AHCV) and Puntos
de Encuentro, in order to learn about challenging homophobia and embracing
diversity. You can read about the results of this exchange programme
here.
fertility protection For many people, having children is a crucial
part of becoming an adult and of being seen by others as an adult. People
who have low or no fertility are often laughed at, shunned at or looked
down on by others and also suffer greatly from a huge sense of personal
loss. Since some STIs can be the cause of some infertility, it is important
for people to be aware of the links and to ensure that they can protect
themselves from losing their fertility in this way. In South
Africa and the Gambia, Stepping Stones has been adapted to address
the links between fertility loss and STIs, and to explain how condom use
can reduce this risk.
condom use Stepping Stones is not just about promoting
condom use. It presents condom use alongside other options, such as abstinence,
only having sex with one person who is only having sex with you, masturbation
and so on. However, it takes care to explain to participants properly
how condoms should be used, by giving each participant the opportunity
to handle a condom for his or her self. All participants are encouraged
to open a condom packet and to place the condom over a banana or a similar
shaped object, so that they can learn for themselves how condoms work.
As female condoms become more widely available, facilitators
can also introduce these into the session here. Participants may also
wish to hear about research into microbicides and vaccines.
Some people and groups have objections to condom use on the basis of religious
or other grounds. However condom use is widely recognised by the vast
majority of those involved in this work as a critical part of an effective
strategy to prevent further HIV transmission. See for instance CAFOD's
website and experience from Senegal.
In the Gambia, after a Stepping Stones workshop, the older male participants elected their Imam, who was also a participant, to become their condom distributor. To see where to find the full article, click here.
Click here for references page to see how Stepping Stones has worked in different contexts.
Click here to view an extract from the optional video.
During Theme 3: (Why
we behave in the ways we do), the following issues are specifically addressed:
hopes and fears for the future We
all have dreams of what might be or what might have been. At this stage
of the workshop young people's hopes and fears particulary are addressed
and all participants consider how young men's and women's dreams in their
own community might be realised.
self-esteem and self-efficacy Feeling better about yourself is
an important first step towards consistently feeling able to do things
for yourself, rather than feeling that things are just done to
you by others. Lack of self-esteem is reported widely by people who have
been divorced, who have lost their jobs, who have failed school exams
and so on, irrespective of their gender. Lack of self-esteem is also felt
especially by women and girls who are brought up to obey and serve others.
Lack of self-esteem can make some people quiet, passive and submissive.
It can make others loud, aggressive and bossy. Therefore it is an important
part of the Stepping Stones workshops for everyone to develop a sense
of their own self-worth, and to understand why they behave in the ways
they do. (for more on this, see theme 4, below
- acting assertively).
substance use There is normally very little discussion about the
role which alcohol and other substances have in the practice of unsafe
sex and in violence. The Stepping Stones workshops enable participants
to explore the good and bad aspects of alcohol and other substances in
people's lives, both culturally and recreationally. This helps them to
think through the links and to develop ways of reducing the risks involved
during their use.
traditions We all have traditions, no matter where we have grown
up. We often do not realise that our way of doing something is different
from another community's way, until we travel or until a traveller visits
us and we realise that there are different ways of doing this in different
places. Traditional ways of doing things can have been for a good reason
in the past, but things may now have changed and the reason may now no
longer be a valid one. Ways of doing things also often change in the same
community over the generations. Thus what happened in our grandparents'
days may often be different from what happens now.
In the Stepping Stones workshops, participants are encouraged to look at their traditions and how they are changing: and also whether these traditions might have negative implications nowadays for people's sexual and reproductive well-being. One example that is quite common is for a widow to marry her former husband's male relative. Traditionally this might have been a good way of providing for the widow and her children (see below), but nowadays this may add to the spread of HIV, if this was the cause of the husband's death. Moreover, the widow may be quite capable of looking after herself and her children independently or may not want to get re-married. There are exercises in Stepping Stones which enable participants to discuss their own beliefs and experiences around such practices and to suggest and consider future options for themselves.
sharing household expenditure and tasks In most
societies, expenditure on food, health care for children, clothing and
school fees is often only covered by or covered mainly by women. Many
men tend to spend their income on themselves rather than on their dependents.
In many parts of Africa there is now extreme poverty and making ends meet
on a day to day basis takes priority over all other concerns. Many women
have no choice but to turn to sex outside marriage as a way of paying
for scarce resources. Indeed in some parts of the world, young women are
instructed by older women, as a formal part of their marriage preparations,
to do this when they are married, in order to make ends meet.
In most societies it is also common for tasks around the household to be defined by a person's gender, irrespective of their workload. Many women are often exhausted at the end of a full day of work, with no relaxation, and often feel too tired to have sex. During the Stepping Stones workshops, participants explore issues to do with households' incomes and expenditures and money in their relationships, as well as the division of labour. Increased contributions by men towards household expenditure and tasks are further reported results of successful Stepping Stones workshops, thereby reducing women's exhaustion levels and reducing household tensions too.
Click here for references page to see how Stepping Stones has worked in different contexts.
Click here to view an extract from the optional video.
Theme 4: (Ways
in which we can change), incorporates the following issues:
acting assertively: Earlier in the workshop, participants have
been encouraged to develop their own sense of self-worth and self-efficacy
through various exercises. During theme 4, participants are also encouraged
to develop, and rehearse for themselves, ways of relating to others which
are assertive, rather than aggressive or passive. This enables them to
express their own needs to those around them, but in a way which is neither
harmful towards themselves nor to others. This includes analyses of the
role of body language, what they say and how they say it in shaping the
ways in which they feel and think about themselves, as well as influencing
how others perceive them. As cognitive behaviour therapy has shown, changing
the way we behave can have a marked shift on our feelings, thoughts and
how we cope with the world. Therefore this assertiveness training is a
critical part of the workshop process.
Young men and younger and older women all reported an increase in their sense of self-worth and an ability to take more control of their lives after Stepping Stones workshops. Older men did not really report this change - but then older men already had more control than did members of other peer groups. Young men in one community described how they used to feel that there was no point bothering about dying from HIV, because they had little in the way of education or skills and therefore had few prospects for the future anyway. However, they explained, once they had been through the Stepping Stones process, they decided that life is worth living and resolved to form their own income-generating group.
trust, honesty Towards the end of the Stepping Stones workshop
process, one exercise looks at trust and asks participants what qualities
they think might form a mutually supportive relationship, and whether
such a relationship might be achieved between sexual partners in their
own communities. Participants have reported an increase in mutual trust
and respect between the genders in communities where Stepping Stones workshops
have taken place. They have also reported an increase in mutual trust
and respect between older and younger community members. In one community
in Zambia, men and women decided to restate their marriage vows to one
another at the end of their Stepping Stones workshop, in a renewed and
revitalised commitment to each other.
preparing for death A key part of HIV and AIDS is sickness and
death, yet talking about death is often even greater a taboo than talking
about sex. This is another reason why people are so scared of HIV, because
none of us likes to be made aware of our own mortality. Yet, particularly
when a man dies, his possessions can often be split up between his brothers
or other male relatives, leaving his wife or wives and children destitute.
His widow(s) may also be taken as wives by his brothers, which may have
traditionally been seen as a good way to support the dependents (see
above). Therefore two important issues are addressed here: preparation
for death itself - which will come to us all one day; and the legal
and financial property and inheritance rights of girls and women, which
are often non-existant or are not recognised in practice. This
part of the workshop enables participants to consider the possibilities
of will-writing.
Many societies now have laws which enable people to write wills, but without local knowledge of those laws, or support for wills from local officials, these wills often go unwritten or unheeded. Successful Stepping Stones workshops have listed will-writing amongst the reported changes. This is a huge step for widows and children, because it can give them the opportunity to stay living in their own homes, working their own land and maintaining access to and control of the produce from these resources, on their own terms, rather than having to share them or hand them over to their husband's relatives. Considering how fearful people can be of death, this move towards will-writing reflects great courage.
coping with grief In Eastern and Southern Africa, where AIDS has
so far hit hardest, there are huge numbers of deaths and funerals and
everyone has been directly touched, psychologically as well as financially.
In parts of the world which have escaped recent wars or high rates of
HIV, it is hard to understand the depth of the effects of this chronic
trauma on day to day existence. The South
African version of Stepping Stones decided to introduce an exercise
to help participants cope with the grief which they are all experiencing
and to think about how that sense of loss can translate itself into the
ways in which they behave - such as anger, sadness, short tempers and
so on. Participants are helped to recognise that grieving is a natural
and important part of coming to terms with the loss of those they love
and that trying to deny grief can lead to long-term problems.
looking to the future - special community requests At the end
of Stepping Stones workshops the participants in the different peer groups
present dramas and special requests in public to the rest of their community
members, asking the wider community to support key areas for change which
the participants feel are important. For instance young women in different
countries have requested an end to being pursued by sugar daddies. Older
women have requested an end to "wife-beating".
Click here for references page to see how Stepping Stones has worked in different contexts.
Click here to view an extract from the optional video.
findings
- some
of the findings from Stepping Stones workshops have been mentioned on
this page. To find out more about them, click here.
Click here to view an extract from the optional video.
 |
Stepping Stones is part of the Strategies for Hope series |
 This web site kindly funded by the Exchange Programme |
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© copyright Alice Welbourn 2002-8
thanks to Petra Röhr-Rouendaal for her illustrations
web site designed by Alice Welbourn with the assistance of Quay Press