References and Links

REFERENCES to Stepping Stones

On this webpage you will find:

	what people have said about Stepping Stones - "quotes"
	evaluations and reports on Stepping Stones
	articles about Stepping Stones - "about SS", including the adaptation and training guidelines. Also, a link to view some of the optional video, also now available in DVD
	articles mentioning Stepping Stones, and where to find them - "SS mentioned"
	related recommended articles, books and manuals - "recommended"

QUOTES - what people have said about Stepping Stones

Official recommendations
1) Stepping Stones is listed in the UNAIDS best resources for community mobilisation. "...in my estimation one of the most valuable recent additions to the quite scanty written materials available in the area of community mobilization....UNAIDS has included this resource package among the "key documents" recommended for use in innovative community mobilization programmes."
Noerine Kaleeba. Community Mobilization Adviser, UNAIDS. 25.3.97

Stepping Stones is also listed in UNIFEM, UNFPA, UNICEF, World Bank, UNDP and other UN sites.

2) The accompanying video (which will not be replaced in the new edition) won the British Medical Association Silver Medal in 1998.

3) The Royal Tropical Institute of the Netherlands features an article about Stepping Stones in its Exchange magazine, no. 4 of 2006, which focuses on Comprehensive Approaches to HIV prevention. Click on this link to view this magazine, which can be downloaded.

Academic and international conference references
Stepping Stones has been quoted in two key note speeches at International AIDS Conferences:

4) Dr Geeta Rao Gupta, in her key note speech at Durban, July 2000, spoke of Stepping Stones as: an "excellent example" of "approaches that seek to transform gender roles and create more gender-equitable relationships". Geeta Rao Gupta PhD: "Gender, Sexuality and HIV/AIDS: the What, the Why and the How." International Center for Research on Women, Washington. Plenary Address, XIIIth International AIDS Conference, Durban South Africa.

5) Dr Susan Paxton, an academic and also living with HIV, in her key note speech at Melbourne in September 2002, also spoke of Stepping Stones: "Gender relationships can and do change. Last year I saw the profound impact of a peer-education project, "Stepping Stones", in a village in The Gambia, West Africa. The village had high rates of STIs, domestic violence and polygamy before the intervention. By breaching cultural traditions and providing sexual health education to young women, old women, young men and old men, in peer groups over several weeks, and by focusing on the healthy future of the whole village, men and women were able to clearly reassess their roles and relationships. The men took on greater responsibility within the home and wife beating dramatically reduced to one incident in the previous six months. Peer education enabled these villagers to embrace the use of condoms as a way for couples to stay together and continue a healthy and stress-free sexual relationship after the birth of a child." Susan Paxton PhD "PARENT-TO-CHILD TRANSMISSION - Breaking Down the Barriers to Implementing Effective Models." The Key Centre for Women's Health in Society, The University of Melbourne.

6) The InterAgency Gender Working Group, based in Washington, used Stepping Stones as its case study in its "Guide for Incorporating Gender Considerations in USAID's Family Planning and Reproductive Health RFAs and RFPs" October 2000. "This case study shows how one particular training project, Stepping Stones, addressed the eight strategies outlined here long before this Guide was written."

Key Users of Stepping Stones

7) Women living with HIV in Zimbabwe have spoken of the experiences of a Stepping Stones workshop on their lives: "Stepping Stones and the Network of Zimbabwean Positive Women:

"Chipo Mbanje and Rudo Chikukwa, two HIV positive women in Zimbabwe, used Stepping Stones to help them set up the Network of Zimbabwean Positive Women (NZPW+). One of their reasons for choosing the package was that many of the network's potential members were not literate. Stepping Stones requires no reading or writing, using enjoyable participatory methods, enabling people to explore ideas and communicate openly.

Looking back on the formation of the network, Rudo reflected: "The process was emotionally charged - we were talking about very deep issues. This wouldn't have happened without the Stepping Stones methods. There were young women, widows, mothers with sick children, all taking part. People shared some deep experiences they had never told anyone before - it helped everyone to bond as a group."

The work also exposed some misconceptions - for example, just because someone is HIV positive, it does not necessarily mean he or she has all the necessary information about the condition. Members of the Network of Zimbabwean Positive Women agree that Stepping Stones is a powerful tool for people living with HIV and AIDS, as well as for prevention work among those not infected.

People living with HIV and AIDS need knowledge and skills to avoid becoming reinfected, and to practise positive living by playing an active role in HIV prevention, care and support.

As Rudo expressed it, "People living with HIV and AIDS are not involved in HIV/AIDS work as much as they should be. They are often regarded as 'the problem' and not part of the solution, yet it is the they who have the greatest potential to make change by becoming open." (This quote with thanks to ActionAid.)

Other Practitioners and Community Participants

AFRICA:

The Gambia:

"Before the programme, in the village the men used to beat their wives all the time. But now because of the knowledge gained this has changed and you won't hear fighting now." (Woman participant)

"Yes, there are men who used to beat their wives but because of the knowledge gained from the programme they have now stopped. Also, you know if you quarrel or beat your wife the elders of the village will come and talk to you so that you can stop, so maybe that also contributes. But I think it is mainly because of the programme." (Male non-participant)

"She does tell me that if you know that you cannot stick to me alone then you should use condoms because……… if you use them you can see that we cannot infect each other with disease. I also tell her that the condom is good…… and if sometime I want to have an affair with (another) and I suspect that (they) have a disease and I cannot avoid (them) that day, I will then have to use a condom." (male participant)

"Although our husbands would like to give us more money now, they are poor and cannot afford much. But we know that our husbands wish to give us more. If for example, our husbands used to give us D3.00, they now give us D5.00." (Older women, the Gambia)

Uganda:

"I have seen conservative, authoritarian men of the armed forces (Uganda) mellow down to pleasant smiling change agents within a period of only seven days in Stepping Stones training programmes (ActionAid Soroti 2001). This is not solely the responsibility of the facilitators but also the dynamics within the peer group." (Baron Oron, trainer)

"Men have realised that their wives are partners to them and not slaves." Baron Oron, trainer, Uganda

"It's a powerful tool… it's kind of transforming attitudes… I'm enjoying it because it's also helping me enormously. One thing I learnt, I've never listened to people. It made me realise I'm a bad listener, it has tended to help me check on that. And as a facilitator it is important that my listening becomes very, very powerful. It helped me enormously to improve relationships between me and my son. We listen to each other a lot now." (The late Professor Rose Mbowa, Uganda).

Ghana:

"Both of us have learnt and understood how to live good marital lives at the workshop. My relationship has improved because my husband no longer goes out to engage in extra-marital sexual activities. Our sexual life has improved. He stays at home more." (Young woman participant, Ghana)

Tanzania:

"I was giving half my salary to girls, but since I have put a limitation on girls, all my salary goes to my wife." (Young man, Tanzania)

"Currently we are now in 42 primary schools, reaching over 15,000 kids each week, with more and more headmasters calling us and asking why we are not in their schools! Last year we did an evaluation with teachers, students, parents, and headmasters. The results were overwhelmingly positive. In fact the only "criticism" was that all four groups wanted us to implement the curriculum in the lower grades. We are now deciding how to adapt the curriculum to the younger grades. Last year, we also started using the curriculum in a school for the blind and deaf. One of the teachers there, helps our volunteers with sign language translations for the deaf students." Rick Bauer, PASADA, Tanzania.

ASIA:

The Philippines:

"Women felt light and full of enthusiasm upon knowing that men who attended Stepping Stones began to see the importance of change in their sexual behaviour and their outlook towards women. Men in the communities tended to empathise with women's situation and would do something in their personal capacity … to change the existing order and would try to help in the household chores…" (Jun Cristobal, trainer the Philippines)

"Stepping Stones has changed so many lives, including the undersigned, and its principles have been adapted to other activities. What is important is that the people practising it apply participatory approaches, ..even in formal education, in the bureaucracy, etc. If there is a way for me to propagate Stepping Stones, I will do it because I believe in the objectives and results of Stepping Stones." (Jun Cristobal, Philippines.)

See also reports no. 5 and 6, from India, below and no. 11, also below, from Fiji.

LATIN AMERICA:

PLAN and partners are now using "Paso a Paso" in Latin America. For some thoughts about it from practitioners there, click here.

EVALUATIONS AND OTHER REPORTS ABOUT STEPPING STONES

1) The InterAgency Gender Working Group commissioned Gill Gordon and Alice Welbourn to undertake a desk-based review of the effects of Stepping Stones on Men. This document, published in 2003, drew on findings from qualitative evaluations in Uganda, the Philippines, Tanzania, South Africa, the Gambia and Ghana. It found that a reduction in conflict and violence in sexual relationships was common to all communities studied.To view this report, scroll down to the "Three Case studies" link on the website you reach when you click here. You can see a fuller version of this report also through this link to a UNICEF site. For further discussion of this topic, see " Preventing domestic violence". Dr R Jewkes. Director, Gender and Health Group, Medical Research Council South Africa. British Medical Journal 2002; 324:253-254 (2 February)

2) Evaluations of the use of Stepping Stones in Mozambique conducted by UNICEF, ActionAid and participating communities in October 1999 reported similar findings. Here we have two other evaluation reports, one by Estamos in Mozambique, and another, also from Mozambique, of unknown title, author and date, about working with in-school and out-of-school youth, which mentions Stepping Stones in several places. (If anyone knows the author and title, please let us know and we will be glad to credit it properly). This report highlights:

"Evidence from the pilot and from other country experiences in the region suggests that as a personal and community development approach, SS strengthens the links between youth and elders, transforms gender relations as it brings men into active participation in SRH concerns, and brings women into greater participation in household and public decision-making. In Zambezia, the health services (and UNFPA TA/RH –Zambezia) have noticed that there is a marked increase in health service use in the areas where Stepping Stones has been implemented."

3) Two separate reports from the Gambia, one formal and one participatory.

4) SCF Ethiopia review of Stepping Stones 2005

5) Women Centred Health Project Mumbai review of using Stepping Stones with Health Workers

6) Report of using Stepping Stones in prison, Disha Foundation, Nasik, Maharashtra, India

7) ActionAid International review of reviews May 2006

8a) ACORD Stepping Stones study report July 2006

8b) ACORD Stepping Stones workshop report July 2006, incorporating results from Uganda, Tanzania, Angola and the Gambia

8c) ACORD Stepping Stones workshop highlights July 2006

8di) OXFAM Exchange article about ACORD research 2006

8dii) OXFAM Exchange article in french about ACORD research 2006

9) Listen to Professor Rachel Jewkes on Voice of America talk about the South African adaptation of Stepping Stones and its effects on reducing gender violence, by clicking here.

10) March 2007: Policy Brief from the South African Medical Research Council about a randomised control trial of the South African version of Stepping Stones. The policy brief concludes:

"Stepping Stones is the first HIV prevention behavioural intervention to have been subject to the most rigorous level of evaluation in Africa and to have provided some evidence of success in reducing sexually transmitted infections in women and in changing men's sexual risk taking behaviour and reduced their use of violence. If we are to effectively
turn the tide of the HIV epidemic in Africa we have to have confidence that we are implementing interventions that are effective. Our findings provide considerable evidence that Stepping Stones is a useful HIV prevention intervention and is successful in changing a range of different men's behaviours, and thus is deserving of further development
and investigation."

11) July 2007: Evaluation by the Pacific Regional HIV/AIDS Project (PRHP) of the Pilot Stepping Stones Programme, in Fiji. This evaluation of Stepping Stones uses two widely recognised but different forms of evaluation of a pilot Stepping Stones programme. These are the "Gemscale Model" and the "Most Significant Change Technique". Further expansion of Stepping Stones in other Pacific Island Countries will be undertaken by the Secretariat of the Pacific Community (SPC). See link for more information.

"Positive outcomes uncovered from this evaluation include a number of inspiring client and implementer ‘Most Significant Change’ (MSC) stories from Waikubukubu and Sasa village, improvement in gender equitable attitudes among men who participated in SS training, and the creation of a Youth Council in Sasa village, an initiative that was a direct result of young men and women completing the SS program...
Evidence from the fifteen stories collected (10 client and 5 implementer) showed that SS had facilitated improved HIV related behaviour change amongst both clients and implementers of SS. Of the ten client stories collected, six reported an improvement in communication with their
community, family or sexual partner and spoke of new skills and confidence to speak about HIV and sexual health issues. This in-turn led to clients reporting improved relationships with sexual partners, less community fighting and better communication and trust between parents and children. Seven of the ten sampled client stories and three of the five implementer stories reported that SS had facilitated an increase in HIV related knowledge, particularly modes of transmission and prevention strategies. Six client stories also reported an increase in positive HIV related skills such as assertive communication and ‘I statement’ skills."

ARTICLES ABOUT STEPPING STONES

1) Gender Sex and HIV 1999

2) Stepping Stones and young women

3) Stepping Stones and its potential in schools

4) "Man Hunt Intimacy: Man Clean Bathroom"

ALSO AVAILABLE: AN EXTRACT FROM THE OPTIONAL STEPPING STONES VIDEO - also now available in DVD

"Voices from Kenya": video footage of experienced trainers from Kenya talking about their work with Stepping Stones... view this by clicking on the image below, then press play when the video appears.

For adaptation and training guidelines, please click on the links below. NB If you would like to download these documents we would appreciate it very much if you would also contact us and tell us about your plans for using Stepping Stones. This is so we can put you in touch with others in your area of the world, who may have already adapted them and may be ready to share their work with you. It is also for our own monitoring needs. Otherwise, we have no means of knowing who is using Stepping Stones and where! The e-mail to contact us it at the bottom of this page. Many thanks!

1) Adaptation guidelines and SFH policy statement on adaptations and translations.

2a) Appendices for adaptation guidelines

2b) Preface for Bangladeshi edition

3) Training guidelines

4) A chart comparing the Stepping Stones approach to other approaches

5) Lessons from training workshops in Zimbabwe

6) NEW April 2008: Implementing Stepping Stones: a practical and strategic guide for implementers, planners and policy makers ACORD

7) Sessions on Sexual and Reproductive Health from Stepping Stones the Gambia, created by Matthew Shaw, Michelle Jawo and colleagues of the Medical Research Council, in association with the Department of State for Health, Social Welfare and Women's Affairs of the Government of the Gambia, ActionAid, the Gambia Family Planning Association and WEC International, 2002...

NB If you download the SRH sessions from the Gambia please also download, print out and attach at least the first pages from section one of the Gambia manual so that the Gambia SRH pages can be accompanied with proper acknowledgment to their creators and supporters in the Gambia!

ARTICLES MENTIONING STEPPING STONES

1) Brief review of Stepping Stones in the Gambia

2) Bridge Supporting Resources Collection on Gender and Sexuality Talent, who works in Zimbabwe for an organisation whose mission is to enhance community participation in health, shares her experience with using ‘Stepping Stones’:
"Stepping Stones helps us know ourselves; to identify our needs; to analyse our own behaviour in order to know the reasons why we behave the way we do, so that we can change it where need be. For example, it is liberating to the girl child to know that there is certainly nothing wrong with having a desire for sex, because many a time as we grow up, we
are made to feel extremely bad for having sexual desires! Through Stepping Stones, people just open up, for the environment is both conducive and supportive. How liberating to know that you are not the only one who masturbates. For you have kept it a secret all your life. You’ve always thought yourself a right off all this time. Stepping Stones enables us to question “if men can masturbate and its ok, what is so wrong about it if a woman does it?”…Stepping Stones enables the group to debate the very issue of virginity, giving hope to those who have lost it. Replacing the “for the man” tag attached to it, and replacing it with either, “what about me?” and or “for me!”
Source: e-mail correspondence from africaonline – http://www.africaonline.com/

3) Bridge Supporting Resources Collection on Gender and HIV

Stepping Stones is part of the Strategies for Hope series

This web site kindly funded by the Exchange Programme

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