ARTFULEYES: Stepping Stones Facilitator Guide

Stepping Stones
Facilitator Guide
An adaptation of an Evidence-informed
Behavioral Intervention for Fisher Folk
Stepping Stones
Stepping Stones Facilitator Guide

An adaptation of an Evidence-informed Behavioral Intervention for Fisher Folk
2 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

Facilitator Guide
Acknowledgements
T
he Stepping Stones Intervention (SS) is an adaptation of the Stepping Stones training process which
was developed by a British social scientist Dr. Alice Welbourn, and first piloted in Buwenda village
in Uganda in 1995. A cluster randomized control trial conducted in South Africa, deduced that the
Stepping Stones program did reduce the incidence of herpes simplex type 2 virus and male perpetration of
intimate partner violence.
Funding for the adaptation and revision of Stepping Stones was provided by the President’s Emergency
Plan for AIDS Relief (PEPFAR)) through the U.S. Centers for Disease Control and Prevention and
Co-operative agreement with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF).
This version is as result of the adaptation process under the auspices of Ministry of Health through the
National AIDS & STI Control Program (NASCOP). The adaptation of Stepping Stones was a collaborative
effort of several institutions:
• Kenya’s National AIDS and STD Control Program (NASCOP)

• U.S. Centers for Disease Control and Prevention (CDC)
• Impact Research and Development Organization (IRDO)
• Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)
• International Medical Corps (IMC)
• Pathfinder International (APHIA-plus Nairobi-Coast)
• Programme for Appropriate Technology in Health (PATH)
We acknowledge the contributions of the following individuals who participated in a five day Stepping
Stones Stakeholder Review Meeting at the Merica Hotel in Nakuru from 20th to 24th May 2013:
1. Carol Ngare - NASCOP 17. Nicholas Kweyu - CDC

2. Dr Charles Okal - MoH 18. Rose Ayikukwei - EGPAF
3. Eunice Kinywa - MOH 19. Vincent Ojiambo - USAID
4. Peter Ochich - MOH 20. Obwiri Kenyatta - EGPAF
5. Jeremiah Jawuoro - MOH 21. Phylis Mboi - EGPAF
6. Lawrence Mwikya - MOH 22. Wamalwa Masibo - PATH APHIA-plus Western
7. Patrick Mutua - NASCOP 23. Grace Atieno - IMC
8. Cecilia Wandera - NASCOP 24. Leonard Soo - CDC
9. Naomi Shiyonga - NASCOP 25. Lucie Adagi - IMC
10. Julius Richard - NASCOP 26. Florence Kilonzo - Salamander Trust
11. Japheth Nyambane - NASCOP 28. Annette Gisore - UON
12. Odessy Ishmael - IRDO 29. Inviolata Njoroge - LVCT
13. Godfrey Mwayuli – Pathfinder International (APHIA-plus NC) 30. Winny Langat - EGPAF
14. Immaculate Akello - IRDO 31. Elizabeth Okoth - EGPAF
15. Petronila Odonde - IRDO 32. Alice Ngugi - EGPAF
16. Wycliffe Odera - EGPAF
An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 3

Stepping Stones
We are indebted to the Core Stepping Stones Revision team that integrated stakeholders’
recommendations and finalized the revision:
Eunice Kinywa - MOH Obwiri Kenyatta - EGPAF

Immaculate Akello -IRDO Grace Atieno- IMC
Petronila Odonde- IRDO Godfrey Mwayuli –Pathfinder International
Odessy Ishmael - IRDO (APHIA-plus NC)
Rogers Simiyu –EGPAF Wamalwa Masibo-APHIA-plus Western
Phylis Mboi EGPAF Leonard Soo- CDC
Wycliff Odera - EGPAF Solomon Omariba - CDC
Chris Obongo - PATH Patrick Ndeda - IMC
Any changes to this curriculum should be made under the guidance of the
National AIDS and STD Control Program (NASCOP).
For more information or to submit your comments on this intervention,
please contact:
Head,
National AIDS and STD Control Program (NASCOP)
P.O. Box 1936, Nairobi, Kenya.
Tel: +254 020 2729502, 2714972
Email: head@nascop.or.ke

Facilitator Guide
Foreword
I
n 2012, NASCOP through the national Evidence-informed Behavioral Interventions (EBIs) Technical
Working Group (TWG) commissioned a process to adopt and review existing EBIs as national
interventions for purpose of scale up. One of the interventions earmarked for this review was the Stepping
Stones (SS). In a study conducted in south Africa (cluster randomized control trial), The Stepping Stones
program did reduce the incidence of herpes simplex type 2 virus, alcohol uptake, and male perpetration of
intimate partner violence.
This version has been compiled based on feedback from the National Stepping Stones Stakeholders’
Review Meeting in May 2013 that brought together representatives from the Ministry of Health (MoH), in-
country co-author, United States Government (USG) agencies, and various implementing partners across the
country.
The intervention targets fisher folk. Men and women living in fishing villages across the world have been
found to be between five and ten times more vulnerable to HIV than other communities. Most fishing
people are mobile or migratory, often staying away from their families, and therefore social structures that
constrain sexual behavior in home communities may not apply in the contest of fishing camps or ports.
Their vulnerability stems from the nature and dynamics of the fish trade and fishing lifestyles: the amount of
time spent away from home; access to disposable income; Alcohol use; low education; the ready availability
of commercial sex in fishing ports; and sub-cultures of risk-taking and hyper masculinity. (Allison et al, 2004,
Kissling et al, 2005, Bukusi EA et al, 2006).
The Stepping Stones Intervention aims to enable individuals, their peers and their communities to change
their behaviour and social norms. It is based on the assumption that community-wide change is best
achieved through a personal commitment to change from each of its members and social support. The
intervention is designed to enable people to explore the huge range of issues which affect their sexual
health—including gender roles, money, alcohol use, traditional practices, attitudes to sex, and their own
personalities.
Head NASCOP
Dr. Peter Cherutich

Stepping Stones
Table of Contents
About the Facilitator Guide 7
Intervention Overview 7
FIRST COMMUNITY MEETING 8
THEME: GROUP COOPERATION 11
SESSION 1: COMMUNICATION AND PERCEPTIONS 11

MODULE 1A: LET’S COMMUNICATE 11
MODULE 1B: OUR PERCEPTIONS 15
SESSION 2: LOVE AND PREJUDICES 22

Module 2A: WHAT IS LOVE? 22
MODULE B: OUR PREJUDICES 25
THEME: HIV AND SAFER SEX 27
SESSION 3 : HIV, STIs AND CONDOM USE 27

THEME: WHY WE BEHAVE IN THE WAYS WE DO 27
SESSION 4: OUR OPTIONS 37

FIRST FULL WORKSHOP 44
SESSION 5: EXPLORING WHY 46

THEME: WAYS IN WHICH WE CAN CHANGE 52
SESSION 6: LET’S SUPPORT AND ASSERT OURSELVES 52

GRADUATION CEREMONY 73
SESSION 7: LETS IMPROVE OUR BEHAVIOUR 64
APPENDIX 1: ENERGIZERS 71
APPENDIX 2: FACT SHEETS 78
APPENDIX 3: PRE-POST TEST 92

Facilitator Guide
Overview
About the Facilitator Guide
T
his Stepping Stones (SS) Program Facilitator Guide and the associated SS materials were adapted
from the Stepping Stones training process developed by a British social scientist Dr. Alice Welbourn.
The adaptation was conducted for use in Kenya by a team that brought together representatives from
the Ministry of Health (MoH), in-country co-author, United States Government (USG) agencies, and various
implementing partners across the country. More efforts have been put into making this version of the
Facilitator Guide relevant across all contexts in Kenya.
For example changes were made to:
• The settings used in the picture codes and the role-play exercises
• The characters presented in the story lines and the role-play exercises
• The content and examples used throughout the guide
With this guide in hand, facilitators can bring the Stepping Stones program alive! The Facilitator guide
is specifically designed for use by certified Stepping Stones facilitators to help them in the delivery of
Stepping Stones sessions to fisher folk. It is important for the facilitators to adhere to this guide, and
to deliver all seven sessions and two community meetings as they are described in consecutive weekly
sessions.
Intervention Overview
The Stepping Stones Program is a community –based, group level intervention developed for fisher folk.
The intervention focuses on:
• Enhancing fisher folks knowledge and skills in HIV/STI prevention

• Improving sexual health by enhancing negotiation and refusal skills
• Enhancing communication and better gender relations within and between generations
Using a pair of trained and certified facilitators, Stepping Stones is delivered to peer groups comprising of
12-24 fisher folk through a series of seven weekly consecutive sessions lasting a maximum of three hours
each.

Stepping Stones
FIRST COMMUNITY MEETING

(COMMUNITY ENTRY PROCESS)
Time Needed: Maximum 1 hour
Materials Needed: Poster (Stepping Stones cover page).
Participants: Fisher folk
Purpose: To explain the purpose of the Stepping Stones intervention and recruit eligible participants
List of Activities
A.1 Introduction
A.2 Expectation
A.3 Ground Rules
Description of session
• A public meeting for all the fisher folk community and the Stepping Stones facilitators.
• Ensure that at least four facilitators and a BMU official attend the meeting. The BMU official will chair
the meeting. However, representation from ministry of health and/or Department of Fisheries is
recommended.
• Identify one lead facilitator and a note taker.. The other facilitators should sit with the participants.
Facilitators’ Notes:
1. Thank everyone for sparing time to attend the meeting.
2. Introduce yourself and let your colleagues introduce themselves.
3. Invite the BMU official to talk about the problems facing the fishing community in relation to HIV and
STIs. Thereafter, invite the Ministry of health official /Facilitator to talk about HIV prevalence among the
target population.
4. Show them the Stepping Stones cover page poster, explain the intervention using the text below and
answer any questions they may have.
Day by day, the river of life sustains each of us in body, mind and spirit. Yet as we cross this river, we
need to be aware of its dangers and treat it with respect. Now, the river carries a new danger, a virus-
HIV, which can bring illness, suffering, death and grief to many. In this intervention, we offer you and
your community some “stepping stones” for avoiding the threat of HIV, but also for coping with the
reality of AIDS, as you cross the river of life. We do not offer any simple solutions, because we believe
strongly that communities are capable of developing their own solutions to their particular problems
and concerns. We therefore invite you to join this intervention to find your own ways across the river
of life. This intervention is like a path across a river, the people journeying are the participants, each
travelling in discovery of him/herself (Alice Welbourn, 1995).

Facilitator Guide
5. Explain how stepping stones will be conducted and the points to capture include:
a. Target population – age, composition of the peer groups, size of groups

b. Length of the entire intervention
c. Time allocation for the sessions
d. Use of community venues
e. Address any expectation such as incentives
6. Inform those in the meeting that they are welcome to join if they would like.
7. Explain that those who are joining the intervention should promise to attend all the intervention
sessions. This is because new things will be discussed at each session, which build on what has been
discussed earlier.
8. Ask for further comments or questions.
9. Thank everyone for coming and participating in the meeting.
10. Request those who would like to join the intervention to remain behind for a few minutes for further
instructions.
11. Each facilitator should meet with his/her relevant target group members.
12. Facilitators to each stand in their chosen place and screen for eligible members using the screening
forms. Ensure that the groups have 12 – 24 persons.
13. In case the number of eligible participants is more than the number facilitators can handle, ask the extra
people to give their names and contacts, so that you can reach them at a later date. Fix a date with
extra members for the next meeting..
Settle with the peer group at a designated place and let them know you will be discussing the
expectations and ground rules. Allow them to select their leader, outline his/her responsibilities and
name of the peer group

Stepping Stones
ACTIVITY A.1: EXPECTATIONS (15 minutes)
Purpose: Each participant to express their expectations of the intervention. This will enable
you assess the understanding of the explanations given and correct false
expecta tions and misconceptions.
Facilitators’ Notes
1. Introduce yourself and your co-facilitator. Allow all the participants to introduce themselves.
2. In turns, each participant shares one expectation of the intervention.
3. Do not make any comments about the expectations as they take turns talking.
4. Write all the expectations on a flip chart.
5. Once everyone has stated their expectations correct any misconceptions and clarify any exaggerations.
Ask everyone to remember their own expectation, (N/B remember to keep the flip chart for future
reference) so that at the end of the intervention, you can review them.
ACTIVITY A.2: GROUND RULES (10 minutes)

Purpose: To agree on group rules during the intervention
Materials needed: Flip chart papers, marker pens.
Description: Encourage group members to brainstorm on the rules
Facilitator notes:
1. Explain to the group that they will spend time together and it is necessary to agree
to some ground rules.
2. Ask participants to suggest ground rules verbally as Facilitator writes on a flip chart. These may include,
arranging for a suitable time for their prospective group members to meet, punctuality, respect for other
people’s views, politeness, confidentiality, being non-judgmental, giving everybody a chance to air their
views, not dominating: and so on.
3. Encourage participants to trust one another and maintain confidentiality during and after the workshop.
Emphasize that trust and confidentiality are important because we are going to discuss sensitive health
issues together.
4. Once all the rules have been written on the flip chart, ask the group to go through them so that
everyone is clear.
5. Facilitator will take responsibility for the flip chart during each session.
Wrap up: Remind the participants that we will meet again at the agreed venue and time. That we will
learn other interesting issues that relate to our lives. We will discuss the strategies that we can use to
avoid the threats in our life and live a healthy happy life.

Facilitator Guide
THEME: GROUP CO-OPERATION

SESSION 1: COMMUNICATION AND PERCEPTIONS
MODULE 1A: LET’S COMMUNICATE
Purpose: To facilitate peer group formation and develop

interpersonal communication skills and team work
Time Needed: Maximum 2 hours 15 minutes.
Materials Needed: A roll of flip chart paper, marker pens (assorted colors),
Participants: Four separate peer groups.
List of Activities
A.1 Adjectival Names
A.2 A Knotty Problem
A.3 Body Language
A.4 Guardian Angel
B.1 Fixed Positions
B.2 Ideal images and personal destroyers
B.3 Images of sex and prioritizing problems
B.8 Closing circle and local song
ACTIVITY A.1: ADJECTIVAL NAMES (15 minutes)

Purpose: Icebreaker and introduction.
Description: Each person introduces her/himself to the rest of the group using an adjective which
describes the person best (customize to local settings- e.g. Fatuma Mcheshi).
Facilitators’ Notes
1. Sit in a circle at the same level with other group members.
Thank the participants for taking time to come to the session.
2. Introduce yourself and emphasize that it is important to attend all sessions because
the sessions build on each other. New issues will be discussed at each meeting.
3. Remind the participants about the ground rules developed in the last meeting and ask for concurrence
4. Allow participants to ask any questions that they might have thought about since the
last meeting. Respond to all their concerns.
5. Explain that you would like to learn everyone’s names and something special about
each participant since you are going to be working together for several sessions.
6. Start off by asking everyone to think of an adjective which describes them best.
Explain that it’s not a competition and if anyone can’t think of one, the group could assist them.
7. Begin the game by introducing yourself: e.g. I am Rose Maua and I like travelling.
Cheerful adjectives help everyone to laugh!
8. Starting from your right each group member in turn introduces him/her self to the rest of the group in a
similar way.

Stepping Stones
ACTIVITY A.2: A KNOTTY PROBLEM (15 Minutes)
Purpose: The activity will illustrate that through listening and trust people have solutions
to their own problems.
Directions
1. Ask two people to volunteer to be “professional health workers” and ask them to go away from the
group until called back.
2. Ask the rest of the group to form a big circle by holding hands. Then, keeping their hands held tightly
throughout the exercise (until stage 6 below), the circle of participants should entangle. Remind the
group never to drop their hands and only to follow the instructions of the “professional health workers”
literally, not going out of their way to help them.
3. Call the “health workers” back to the group and instruct them to hold their own hands behind their
backs.
4. Then ask them to unravel the knot of the others, using verbal instructions only, within three minutes.
They can move round the knotted circle of people, but cannot touch anyone.
5. You will find that the “health workers” will move around the group and may manage to change the
positions of a few of the group slightly, but they will fail to disentangle them. After 3 minutes, call stop.
6. Ask the participants to drop their hands and form a new circle including the “health workers” and
yourself. All of you should now join hands in a big circle.
7. Explain to participants that we will now need to do a lot of listening to one another in this exercise. This
exercise will require the skills of good listening.
8. Tie yourselves into another knot. With a team lead giving instructions assist one another to disentangle.
It should take about 20 seconds.
Facilitator note:
This exercise shows the community that outsiders do not have solutions for all problems. But through
their support outsiders can help them think through their problem and eventually find a solution.
Instead the community has a major role in solving its own problems. Sometimes they only need
to trust and listen to one another and a little input from outside to make a great advance in their
achievements.
Encourage the participants to relate this game to their own lives by reflecting on when they had
experienced a situation where their problem could not be solved by an outsider but they were
assisted to think through their problem and came up with a solution.

Facilitator Guide
ACTIVITY A.3: BODY LANGUAGE (10 minutes)
Aims: To help participants understand the role of body language in our relationships.
Description: Through role play, participants are asked to demonstrate how body language can
help onlookers understand what is happening, without their hearing any words.
Directions
1. Ask two volunteers to think of a discussion that they had with someone else, which developed into
an argument. Assist them to decide. The pair should first establish the two characters and their
relationship. Ask the volunteers to demonstrate their scene as a mime in the middle of the circle. They
should only use their bodies and faces without words.
2. Give the pairs a few minutes to work on this. Ensure the scene looks clear.
3. Ask members of the audience to tell the story of this argument. It doesn’t matter if the participants don’t
know the details, but point out how easy it can be for us to know what is going on in general through
what we do with our bodies.
4. Brainstorm with the participants on the kinds of emotion which we can communicate with our bodies:
such as pleasure, dejection, anger, submission, strength, weakness, power and so on. Encourage them
to show different body stances to illustrate each emotion.
5. Point out how different eye levels or position between people can make a big difference to
communication and to power between people - e.g. teachers standing up while their pupils sit down,
elders sitting on chairs while others stand up or sit below them. Ask participants to give examples of this
from their own experiences with their fishing community, describing whether the person who is higher
or lower, behind or in front, has more power and why.
6. Conclude by asking participants to start thinking about how they use their bodies in different contexts
to say things to one another over the next few days and weeks.
Facilitator note
We communicate and listen as much with our bodies as with our words. Some body language
can appear very powerful and aggressive; some can appear friendly and warm, whilst other body
language can appear very weak and submissive. We say a lot with our bodies!

Stepping Stones
ACTIVITY A.4: GUARDIAN ANGEL (5 minutes)
Purpose: To give each person support during the whole intervention and summarize the session
Description: Each person is given the role of looking after someone else in the peer group.
Direction:
1. Ask everyone to stand up in a circle and to join hands. Stand in the middle of the circle.
2. Ask everyone to drop their hands and to turn to their right. This will mean that each person in the circle
is facing the back of someone else.
3. Explain that in this kind of intervention, it is always a good idea for participants to “look after” one
another. Therefore you would like to suggest that each participant becomes the “guardian angel” of the
person standing in front of them in the circle. In this way, each person will be “looking after” somebody
and each person will have somebody “looking after” him or her.
4. Ask everyone to turn back to the centre of the circle.
5. Conclude by explaining that the role of each guardian angel is to keep an eye on the person they are
“looking after”, by asking them at the end of each session, or between each session how they are and
whether all is going OK for them. It also helps people recognise that everyone has something that they
can offer. It helps participants to develop a bond of mutual support.

Facilitator Guide
MODULE 1B: OUR PERCEPTIONS

Purpose: To help participants recognize how much perceptions influence our judgment
Time Needed: 1hour
Materials Needed: Pack of 100 small plain index cards, 1 roll of flip chart paper, assorted marker pens,
masking tape, scissors, notebook, pen.
ACTIVITY B.1: FIXED POSITIONS (15minutes)

Purpose: For participants to realize that our perspectives on things are based on who we are
and our experiences.To encourage participants to be less judgmental about the
actions of others.
Description: Participants stand in a circle and comment about what they see,
from different angles, of someone standing in the middle.
Directions:
1. Form a circle and ask one participant to stand in the middle. Ask her/him to stand firm,
facing the same direction as you ask the questions and receive responses from participants.
2. Ask everyone to answer according to what they can actually see from their own position,
not what they know is there.
3. Ask someone standing in front of the person in the middle: “How many eyes has s/he got?”
4. Ask someone standing behind the person in the middle the same question.
5. Ask someone standing directly to the side of the person in the middle the same question.
6. Finally, ask one participant to walk round the whole circle looking at the person in the middle and
perceiving her/him from all angles. Ask the walker to give a running commentary on what s/he is seeing
and how her/ his vision of the person in the middle changes.
7. Ask the participants to consider how our perspective on a situation shapes our understanding of it.
How can we give ourselves a more complete picture most of the time?
8. In what way can we relate this exercise to our everyday experience?
Feedback and Discussion:

Explain that this is a useful exercise to remind us throughout the intervention that it is often hard for us
to remember that there are more valid views than our own about a situation or a person. We are often
quick to judge others without trying to understand more about them first.

Stepping Stones
ACTIVITY B.2: IDEAL IMAGES AND

PERSONAL DESTROYERS (25 minutes)
Purpose: To explore people’s perceptions of the ideal man, the ideal woman and how these
ideal images vary from their own reality.
Description: Introduction from the facilitator, followed by a drawing exercise and discussions.
Facilitator notes:
1. Explain to the participants how in the last session we looked together at verbal communication and at
body language, which are the two ways in which people relate to one another. We are now moving on
to explore how different people in our society are expected to behave.
2. Add that in the next activity we are going to start to look together at images that we have of the ideal
man and the ideal woman in our society. Ask participants to spend a few minutes before the next
session thinking about short songs they know, which describe how the perfect man or the perfect
woman should behave. Ask them to bring these in their minds with them to share with the group at the
next meeting.
3. Ask the participants if any of them has a song that portrays an ideal woman or man in the community.
One or two of them.
4. After the examples, ask them to break into new groups of three or four and to focus particularly on the
ideal image in their society of their own age and gender. Note that from now on in the exercise, the
discussion will focus only on their age and gender.
• If you are working with the young women, ask them to describe what a young woman is expected
to say and do or not say and not do.
• If you are working with the older men, ask them to describe what an old man is expected to say and
do or not say and not do...and so on.
5. After a few minutes of small group discussion, ask the participants to re-form a large circle and share
with the large group their ideas on the perfect young woman or old man or whichever your peer group
is.
6. Next, ask the participants to discuss (large group) how easy they find it to live up to the expectations
which their society has for them. Encourage the participants to go on to consider what a normal young
woman; normal old man (whichever the peer group you are with) is most likely to be like.
Group Image Reality

OLDER MEN As leaders, decision makers, with young don’t listen to us, not much
many children, grandchildren, authority, too many bills to pay, etc
authority, power, money.
YOUNGER MEN breadwinners, strong, macho, many demands on income,
many kids, good income, one unemployment, too
wife many mouths to feed, several
girlfriends
OLDER WOMEN honoured old lady, looked after too much work, grandchildren to
by children, respected by all, look after, no access to cash.
less work
YOUNGER WOMEN polite, submissive, too many kids, no money to spend,
undemanding, hard-working, no personal freedom.
obeying father or husband,
many kids.

Facilitator Guide

The idea of this exercise is to help people to appreciate that we all have ideal images of how we are
supposed to behave and that there is always a gap between our images and reality. We all find our
images hard to live up to at times. Sometimes ideal images can actually be personal destroyers.
For instance, every time a man gets to a new beach you have to get a new sexual partner. Also
women to get fish at the beach must have a sexual male partner. This can be used as an excuse to
have multiple sexual partners. Similarly the belief that “real men drink ten bottles of beer a night” can
result in a man drinking far more than he feels happy with, or than is actually good for him. Encourage
participants to think about this and to make their own comments about the way some of the examples
they have already mentioned can be personal destroyers for them. Please emphasize to your group
that this is not supposed to be an exercise which reminds them how they should behave! Instead, it is
supposed to help us recognize how difficult and limiting some of the labels which our societies put on
us are to live up to.
If your group finds it a bit hard to think of examples to begin with, here are some suggestions which
you might make to help them start to express their own ideas. Do not impose these ideas on your
group: they need to come up with their own descriptions of their lives. But you could say that in other
countries people have described differences between their ideal and their real lives in the box below,
and how is it here for them?, Again talk only about the experiences of the peer group you are working
with - e.g. if you are working with younger women, talk only about what it is like to be a younger
woman in their community!

Stepping Stones
ACTIVITY B.3: IMAGES OF SEX (30 minutes)
Materials needed: Cards/Papers, Flip chart, marker pens, masking tape, and scissors.
Purpose: To help people to realize that we also have differences

between images and realities of sex.
Description: The peer group will explore different ideas they have about sex and needs which
they have about sex, through drawing them on flip charts,
Directions:
1. Start off with the following explanation; that we have seen how there is a gap between ideal and
real images of ourselves. We are now going to move on to talk about images of sex in our lives. This
exercise will help us share with one another our understanding of the good and difficult things about
sex. We often find it very difficult to talk about sex and our sexual health but we are going to draw it.
2. Give each individual one card and a felt pen. Explain that you would like them to draw one aspect of
sex or something which they feel connects in some way to sex on the card: Explain they can be good
or bad, funny or happy or sad, and the drawings do not have to be skillfully drawn. Check on the table
below page xxx
3. Give up to five minutes for participants to draw on the cards.
4. While the small groups are busy, lay flip chart on the ground across your circle of participants. Label
good on one flip chart and bad on another.
5. Then call everyone back into the big circle, bringing their cards with them. Ask them to put the card
they have drawn on the flip charts labeled either good or bad, depending on how they feel about them.
If they feel that topics on certain cards are similar or are in some way connected, participants should be
encouraged to place these cards close to one another.
6. Once all the cards are placed on the flip charts, all participants should view each card together. The
drawers of the card should describe what they have drawn, so that everyone understands what their
picture means.
7. Ask participants to think about their concerns and needs about sex as younger women/ younger men /
older women or older men depending on their peer group
8. Record their concerns on another flip chart. Ask for one volunteer to help record the issues with you on
the flip charts.
9. Brainstorm on the concerns and needs of the participants about sex. They need not to talk about
themselves but instead can talk about issues which they have heard about others without mentioning
names.
This also gives you opportunity to learn what priorities participants give to HIV/AIDS compared to
other sexual health matters. If HIV/AIDS is not mentioned this is the point to mention it and find out
what they think and feel about it. As well as how it has affected them in their community.

Facilitator Guide
10. Now that we have identified some of the concerns and needs we have about sex. Can we then prioritize
the concerns and needs based on the most pressing to the least pressing. Suggest that the participants
could now divide up the problem cards into different categories, such as:
• issues they would like to be dealt with IMMEDIATELY

• issues they would like to be dealt with SOON
• issues they would like to be dealt with LATER
11. Have additional three flip charts written IMMEDIATELY, SOON and LATER. Retain the flip chart labeled
good with the drawn cards on it.
12. Remove the cards on the flip charts labeled bad and give the cards to different participants, so that
everyone becomes involved in distributing the cards between the three flip charts. They should decide
for themselves which category to put the cards.
13. Listen to the discussions which they have about the distribution, especially regarding any disputes over
which category to place any card in. This will help you to understand a lot about people’s perceptions
and priorities.
14. If HIV has not been placed as a priority (IMMEDIATELY or SOON), it is important to recognize this.
Follow up with the group on why they think HIV is not a priority and ensure to discuss the issue then.
15. Assist the participants to think through the way they would handle the prioritized issues. Once their
prioritized concerns begin to be addressed - by you or by other relevant bodies - their readiness to
respond to your HIV concerns is likely to increase. Often the other sexual health concerns they have will
have an impact on HIV anyway. Ensure you mention safe sex (as appears in the box below) at this point
in relation to the prioritized issues and also let them know there will be a full session on it.
Safer sex can be defined as sex that is pleasurable, free from Infection, unwanted pregnancy and
abuse
16. People can share their worries with one other and you can learn about problems which they have that
are not being addressed
It is likely that some of the things which the participants will be discussing have never been aired
openly before. Now is an ideal time for you to learn by listening to their discussions as they sort the
cards. If there are any disputes about where to place a card which cannot be resolved, agree to let the
card’s number be recorded in both (or more!) columns, in reflection of the disagreement. Participants
are likely to find this exercise very valuable for them also, as a way of sharing experiences amongst
themselves.
17. Explain that you have now learnt a lot together about their needs and concerns - as well as what they
enjoy about sex! Suggest that, if they wanted to, they could together present their concerns about
their health problems to local development agency staff or hospital and health clinic staff, or beach
management unit whoever is concerned, in the area. This information could help these agencies to
provide better services to community members. Suggest that there could perhaps also be issues which
they might like to discuss at a wider community meeting. Perhaps participants could identify together
someone with whom they could take up their immediate concerns, and decide who should go to inform
this person.

Stepping Stones
POSITIVE IMAGE NEGATIVE IMAGE

Older Women Feeling beautiful and attractive No say in sex
Choice between having children Getting blamed for bringing HIV
and reduction of risk of contract- into family when she falls sick first
ing STDs Getting blamed when child is
Having fun HIV-positive
Unwanted sex Getting beaten by husband
Older Men many children authoritarian roledrinking
Enjoying power of sexuality multiple partners
Enjoying being massaged lack of condom use
How to use condoms Fear of impotence
Young Men Having fun Peer pressure of:
macho, bravado image multiple sex partners
authoritarian role Private dilemma of:
discos, bars - wanting children
lack of socially acceptable alter- - cost of condoms
natives - lack of self-confidence in using
virility condoms
Enjoying foreplay - how to mention condom to wife
or girlfriend
Lack of work
Lack of optimism for future
prospects
Young Women Enjoying power of sexuality Pressure from parents to have
Feeling beautiful and attractive rich boyfriend
Idea that motherhood means Peer pressure of:
being grown up - clothes
Having fun - money
Fear of condom getting stuck or - having rich boyfriend,
worse

Facilitator Guide

Sensitize the participants about the services and those who need to be referred can seek advice.
Finally, say that it is now time to close this session, but that at your next meeting together you will be going
on to explore what love means in our lives.
ACTIVITY B.4:
CLOSING CIRCLE AND LOCAL SONG (5 minutes)
Aims: To finish the session on a happy note.
Description: The participants choose a song which they all know, to sing together.
Directions:
1. Explain that the time for this session has now run out and that we are going to finish with a closing circle
to review this session
2. Sit in a circle together. Thank everyone again for coming to this session.
3. Ask each person to say one thing which they have learnt from this session and one thing they are
looking forward to before the next session.
4. Remind participants of the next meeting after one week same time and day for the next session
together. Ask everyone to remind one another again about it.
5. Remind everyone of their role as guardian angel.
6. Ask all the participants to think of a happy song which they all know, which they would like to sing
together now, to finish off the session.
Try to join in with it, especially if it includes dancing!

Stepping Stones
SESSION 2: LOVE AND PREJUDICES

Module 2A: WHAT IS LOVE?
Purpose: To explore what we look for and expect to get in love.
Time Needed: 45 minutes.
Materials.needed: Flip chart and marker pens
List of Activities
A.1 What is Love?
A.2 Sitting on Knees
B.1 Taking Risks
B.2 Who’s labeling whom?
Introduction (10 Minutes)

1. Sit in a circle with the group.
2. Welcome everyone back to the session. Thank everyone for coming and check attendance
3. Ask each participant to reflect and mention quickly something good which has happened to them since
the last session and review the previous session.
4. Thank the participants for actively participating in the previous session.
Explain that we are going to discuss and learn new things in this session,

Facilitator Guide
Activity A.1: WHAT IS LOVE? (20 minutes)
Purpose: To explore what we mean by “love”.
Description: Brainstorming, group work, followed by group discussion.
Directions:
1. Through brainstorming session, ask participants whether they can give you a word or words which mean
“love” preferably in their local dialect/language.
2. Let everyone agree upon one or two words or expressions meaning love between partners (and, if
necessary other words meaning love, between boyfriends and girlfriends, or lovers, or between sisters
and brothers).
3. Divide the group into two. Ask one group to describe three qualities of love between friends, or family
members, with no sex involved and the other group to describe three qualities which they would show
to/ expect from a sexual partner (e.g. a husband or wife and/or boyfriend or girlfriend).
4. Regroup, then let each group share or present their thoughts
5. Finally, if there are some clear differences in the qualities of love described between sexual partners and
those described within relationships that has no intimacy (e.g. brother and sister). Encourage them to try
to explain why these differences exist.
Guiding questions for the discussions include:

• Does love equal to sex, or does love equal to marriage?
• Do they automatically go together?
• If love does not equal to marriage, what at least are the minimum levels of respect which they think
each member of the couple should show each other?
Love is a give and take relationship. What one expects in relationship he or she should be ready to
give the same. It is likely that issues such as trust, sharing, responsibility, sex, money and so on are all
mentioned, love is a complicated thing!

Stepping Stones
ACTIVITY A.2: SITTING ON KNEES (15 minutes)
Purpose: To emphasize on trust and cooperation as key pillars of love.
Description: Everyone sits on another’s knees in a circle
Directions
1. Ask everyone to stand closely in a circle. Then everyone should turn to their right, so that each person in
the circle is facing the back of someone else.
2. Ask everyone to put their hands on the shoulders of the person in front of them. Explain that you are
going to call out “1,2,3, SIT!” Everyone should call out slowly with you. On the word “sit!” everyone
should carefully sit down on the lap of the person behind them, still holding on to the shoulders of the
person in front of them.
3. This really works, reassure the participants, you can kneel, try to shuffle around in the circle together in
this position!
4. This is a fun exercise and creates a good feeling amongst everyone. Afterwards, ask participants
how it felt to do this. Did they think they were able to do? How does the exercise relate to real life
experiences?
Summarize this exercise by telling participants that the activity illustrates trust and cooperation.
Trust and cooperation is an essential ingredient for a good relationship.

Facilitator Guide
MODULE B: OUR PREJUDICES
Purpose: To challenge the judgments which we make about one another.
Time Needed: 40 minutes
Materials Needed: Pre-labeled Manila paper, masking tape, Scissors and Felt pens
CONTENTS:
1. TAKING RISKS
2. WHO’S LABELLING WHOM?
ACTIVITY B.1 TAKING RISKS (15 minutes)

Purpose: To help participants to reflect on their own sexual behavior with regard to
risk-taking in life.
Description: Individual reflection, followed by paired listening.
Directions:
1. Explain that we are now going to do an exercise which will help us to think about how we handle sexual
risks in our own lives.
2. First, ask participants to work alone and consider the following for a few minutes:
“Reflect on your life and identify any occasion when you took a sexual risk. It may be something quite
trivial or it may have had great significance”.
• What factors influenced your decision to take a risk?
• What were your feelings at the time?
• What was the outcome of taking that risk?
3. In the larger group, ask 1-2 volunteers to share an occasion they have reflected on in which they took a
sexual risk. Then the group brainstorms using the questions below as a guide:
• What are some of the sexual risks that the members of our community engage in?
• How do you view sexual risk-taking in others and yourself?
• What does this say about your attitudes towards HIV and AIDS?
Encourage them to draw out any observations on risk-taking behavior and ways in which it may be
related to HIV and AIDS.
• We often tend to feel that it is OK to take sexual risks. If they turn out well we feel proud and
might be praised for our courage. We are also much less harsh in judging ourselves, on the whole,
than we are in judging others. But we tend to blame others if they take sexual risks and things
go wrong. Participants can be encouraged to recognize how judgmental we often are about the
problems of others. It is also worth pointing out that we are all risk takers.

Stepping Stones
ACTIVITY B.2: WHO’S LABELLING WHOM? (20 Minutes)
Materials needed: Pre-labeled Manila paper, masking tape,
Purpose: To develop awareness of differences and the harms of “labeling”.
Description: People treat one another according to the kind of label that is being worn.
Directions:
1. For this exercise, you need as many manila cards as there are people in the group
2. Place folded pre-labeled cards with good qualities like a generous person, someone who is kind and
caring, someone who is a good listener, someone who is always cheerful and bad qualities like a liar, a
thief, a selfish person, a murderer, a wife beater (based on local context) in a box,
3. Each participant randomly selects a folded pre-labeled card, and the facilitator’s walks around sticking it
on their back. (participant should not know what is written on their card)
4. When everyone has a card attached to their back, ask them to stand and move around the place and
mingle reading the label of each other. Treat the person based on the label. The participant should not
reveal the written statement on each person’s back.
5. After the exercise, remove the labels, regroup and brainstorm on the following:
• Based on how you have been interacting previously without the labels,
how did you feel during this interaction with labels?
• Did others treat you differently? How?
• How did that make you feel?
6. What have we learnt from this exercise?
• How can we relate this lesson to AIDS in our community?
• Why is this exercise so relevant to prevention of AIDS and care for people with AIDS?
Often times people will treat you based on preconceived ideas of what they think you are.
The idea of this exercise is to help people to experience in some way the misery that people with HIV
feel when faced with the prejudice of others. Just because someone has HIV does not mean that they
suddenly become less humans or evil. Yet people’s attitudes to them can change radically once it is
known that they are HV-positive.
Session Wrap up: (5 minutes)

1. Thank everyone again for coming. Ask each member of the group in turn to mention one thing that they
have learnt today and one thing that they are looking forward to doing before the next meeting. If not
mentioned the facilitator should re-emphasize the key messages below:
• Always reflect on the possible consequences before taking any sexual risk, however individuals
should not viewed based on the negative outcome of the sexual risks they took in life
• Never judge a person by what you or the community thinks they are.
• Love is two-way. Whatever you give is what you should expect to get.
• The building blocks for a healthy relationship are trust and cooperation.
2. Ask if there are any more questions about today’s session that anyone would like to ask.
4. Remind everyone of the time and place for the next meeting and say you look forward to seeing them
again.

Facilitator Guide
THEME: HIV AND SAFER SEX

SESSION 3 : HIV, STIs AND CONDOM USE
Purpose: To explore our knowledge about “HIV” and “safer sex” and to familiarise
participants with use of the condoms.
Time Needed: Maximum 1 hour 55 minutes
Materials Needed: Four sheets of large (A4) writing paper, Index Cards/pieces of paper, flip chart,
Marker pens, referral directory, penile and vaginal model, female and male
condoms, blind folds.
List of Activities
A.1 Body Mapping
A.2 The Bushfire
A.3 Facts and Misconceptions about HIV
A.4 Folding paper game
A.5 Condom Demonstration
A.6 One new thing
Facilitator note: Try to find out the figures for HIV prevalence, as well as the percentage of orphaned
children, in your area or county.
• You need to be familiar with the issues covered by the HIV quiz before the workshop begins. Refer to
the appendix for the fact sheets.
• If there is a good local place where people can go for counseling, or for HIV testing and counseling, you
should know its location, opening times and any other relevant information.
INTRODUCTION
2. Welcome everyone back to the new session. Thank everyone for coming.
Enquire about late-comers or non-attenders.
3. Ask each participant to recount quickly something good which has happened to them since the last
session.
4. Review the last session. Ask participants to mention what was learnt at the last session - about risk-
taking and our prejudices. Remind them if they have forgotten.
5. Explain that we are going on to discuss other things in this session, but will start with a game.

Stepping Stones
ACTIVITY A.1: BODY MAPPING (15 minutes)
Purpose: To clarify locally acceptable terminology of body parts.
Description: A discussion about terms for different sexual organs and sexual acts.
Directions:
1. Explain that we are now moving on to talk about things which most people find very embarrassing
to discuss in public. But a good way of overcoming the embarrassment is to recognize that we all
experience it.
2. Explain that since there is no vaccine or cure for HIV, the only way we have of preventing it from
spreading is through changes in behaviour and in medical practices. Since one of the main modes
of transmission is sex, we need to be able to talk about sexual attitudes, behaviour and safer sex
techniques.
3. Break into two groups for five minutes and ask the participants in group one to draw a male person
and the second group a female. They should name the body parts including the sex organs in the local
language. They should discuss the body parts that are useful for sexual gratification. They should also
discuss names of other terminologies associated with sex e.g masturbation, semen, vaginal fluids, anal
intercourse, orgasm, breasts, condoms etc.
4. Call everyone back into the large circle.
Ask each group in turn to report back on the words they want to use.
5. Congratulate everyone on the completion of a difficult exercise.
6. There may be some denial that, for example, anal sex or oral sex takes place, if so, it is probably best to
go along with this and just to explain that they are practised elsewhere. But go on including them in any
future discussions, so that participants know about the risk factors involved in practising them.
• In some communities, people may find this exercise really difficult. Some may get angry and
refuse to join in, others may laugh a lot. It would be helpful to explain that this exercise can raise
a lot of emotion in people and this is our way of dealing with our feelings about sex being talked
about publicly. Encourage participants to set aside their fears or anger and to join in to help one
another. In other communities, you may find that you are more embarrassed about using these
words than your participants are! Alternatively, you may feel that you and the participants already
know all the words involved. But this exercise is worth doing anyway, because the mere public
acknowledgement and expression of the words help us to overcome our conventional attitudes
towards talking about sex. Keep using the words decided upon in future exercises!

Facilitator Guide
ACTIVITY A.2: THE “BUSHFIRE” (10 minutes)
Materials needed: Pre-marked slips of paper, one for each participant and one for yourself:
based on the number of participants in the group have 25% marked with
“+”, 75% marked with “-”.
Aims: To help people understand how quickly HIV can spread.
Description: Participants are issued with marked pieces of paper. Then they spend a few minutes
socialising before responding to instructions according to the mark on their paper.
Directions.
1. Ask each participant to choose a slip of folded pie-marked paper from a box or hat. Emphasise that no-
one should look at their slips of paper until the end of the exercise.
2. Ask the participants to move freely around the training area, stopping to greet friends.
3. After each person has greeted four or five friends, stop the activity and ask everyone to look at their slip
of paper.
4. Point out that this is only a game and there is no risk of catching HIV through normal social greeting.
Ask all those who have a “+” on their paper to come forward. Explain that on this session they will
pretend that they are HIV positive.
5. Then ask those who greeted any of those who came forward first to come forward too and join their
friends. Ask the participants to assume that the greeting was an actual sexual intercourse thus making
these people at high risk of being infected with the HIV virus.
6. Next, look to see who is left. Explain that this game is pretending that the status of these people is
unknown. They may have made friends with those infected before they had become infected; but in any
case they are at risk.
7. Finally ask, according to this game:
• how many people were originally infected with the HIV virus?
• how many are at high risk of being infected?
• how many others are at risk of being infected?
• how many remain uninfected?
• what does this tell us about the spread of HIV in our community?
Facilitator Note:
Now is a good time to explain to participants local statistics/health data for HIV and AIDS in your area
or county. These could include figures showing the percentage of orphaned children. Participants
could be encouraged to think what this means for them in terms of the game you have just played.
(Refer to your local health data). Clarify that this is purely a game and does not reflect the status of the
individuals.

Stepping Stones
ACTIVITY A.3: FACTS AND

MISCONCEPTIONS ABOUT HIV (45 minutes)
Materials needed: Flip chart, felt pens (assorted colours).
Aims: To help participants assess their own risk, explore myths, correct misinformation and
accept the limitation of information and learn about how to protect themselves from
exposure in future.
Description: A discussion session – below find a guide to questions that you may ask to prompt
discussions. Ask the questions and give time for the participants to respond. After
they give their responses praise them and build on the knowledge they already have.
Remind them that we are all learning since with HIV there are always changes and
new things are learnt all the time and none of the group members knows everything.
Directions:
1. Refer to the Pre-Test scores and emphasis on the areas with low scores
2. Sit in a circle with the participants. Explain to them that you are going to have a discussion together to
explore facts and feelings about HIV and AIDS. Say that you are going to ask a series of questions and
would like them to add their own questions at any stage of the discussion also. Most of the talking in
this exercise should, as much as possible, be amongst your participants and not from you.
THE QUESTIONS:
Here are some basic questions to prompt the discussion. You can always add extra questions which you feel
may be particularly relevant to your context, such as scarification practices, circumcision practices, injecting
oneself with drugs, and so on. But try to include everything which is already listed here. Note that each
question is as open-ended as possible. (refer to the local health information)
A. What is HIV?
Ask participants to share what they understand about HIV and let the facilitator note on the flip chart.
Points you may wish to cover:

During discussions, if these points do not come up, mention them.
• HIV is a small germ called a virus. This is what people catch.
• HIV makes the body weak.
• People with HIV in their body often go on to become sick with AIDS, but they do not “catch” AIDS.
AIDS only develops after HIV has stayed in the body for a long time.
• The only way we can tell for certain if we have the virus in our body is through a blood test. If the test
shows we have the virus, we are “HIV-positive”. (If the test shows no evidence of the virus, we are “HlV-
negative” - but our negative status is not yet certain, because of the window period.
• Once someone gets infected in three months the virus might not be detected and that is what is termed
as the window period.
• All of us especially those who at high risk for example those who often engage in unprotected sex
should test every three months which is called retesting.
• For any two people in a sexual relationship they are encouraged to test together since one person’s
status will not be other persons status and that is why there is discordancy. Two people can be in a
sexual relationship and yet one might have the virus and the other does not have the virus hence the
need for couple testing.
• People often die of illnesses such as TB, to which they have become more vulnerable because of the
HIV virus in their bodies.

Facilitator Guide
Note: The following analogy can help. HIV invades the body like termites invading a mud hut. To begin
with, there is no apparent damage. But slowly the termites eat up the poles and thatch which hold the
house together. One day a strong wind comes along and knocks the house down. What caused the house
to collapse: the wind or the termites?
B. How do you think people get infected with HIV?

For the virus to be transmitted two things must be present:

• There must be an adequate quantity of virus present to cause infection. This is most likely to occur with
blood, semen, vaginal and cervical fluids, which contain the highest concentrations of virus.
• It is also true of breast milk, but to a limited extent. However, the World Health Organization (WHO)
still recommends that all mothers in developing countries should breast-feed their babies. This is
because the advantages of breast milk (increased immunity against diseases such as measles, polio and
diarrhoea) outweigh the risk of HIV infection and exposure to infection from substitutes given by bottle.
The HIV positive mothers however, need to continue with treatment (ARVs) during the breast feeding
period to avoid infecting their babies.
• There must be a suitable route for the virus to reach the particular cells for which it has an affinity.
Thus:
• Infected blood can spread the virus. This can be from a blood transfusion, or from an unsterilized needle
or blade. Therefore, care needs to be taken with needles for injections and with razors, to make sure
they are sterilized again before each new person uses them. This applies when they are used for medical
reasons, for circumcision, for body scarring or other similar uses, where blood is involved. Open wounds
should be kept covered by all of us, whether we are infected or care-givers - or both.
• Unprotected Sex. When there is penetrative sex without protection such as using condoms.
Some people may like to practise oral sex. However, it is uncertain how much risk this carries. Unprotected
oral sex should certainty be avoided if there are sores present in the mouth or on the genitals. Oral sex on
the penis is safer when a condom is used.
NB: Certain practices can increase the possibility of HIV transmission. For instance, “dry” sex, when herbs
are placed in the vagina to reduce moisture, may lead to increased friction, causing breaks in the wall of the
vagina, and therefore an increased risk of HIV transmission. Open sores on the vagina or penis or sexually
transmitted diseases (STDs) also increase the possibility of HIV transmission.
• Safer sex includes:

- non penetrative sex, such as masturbation, massage, rubbing, and hugging
- using a condom for all penetrative sex (vaginal, anal, oral)
- staying in a mutually faithful relationship, where both partners are uninfected.
If people use a cloth to wipe their genital areas after having had sex together using a condom, it is safer for
them to use separate cloths.

Stepping Stones
Mothers transmission to babies, before or during birth.

This is often the case. Yet it is also possible for an HIV-positive woman to give birth to a child without the
virus being passed on to the child. However, it can take 12-18 months until it is known whether the child is
negative or positive.
It is possible for an HIV positive woman to give birth to some children

who are HIV negative and others who are HIV positive.
• Breast milk: see above and below
How one gets infected How one cannot get infected

Unprotected sex Sharing food and eating utensils
Blood transfusion Sweat
Mother to child transmission through breast milk, Tears
during pregnancy, during delivery Hugging and Kissing
Sharing of sharp objects (unless both partners actually have bleeding gums
when there may be a very small risk)
Sharing sheets, towels or clothes.
Mosquitoes, fleas and bedbugs
Sharing toilets
Vomit, feaces and urine.
The facilitator needs to mention which are high risk and low risk activities during this discussion
C. How can you tell if someone is HIV positive?

• People with HIV can look exactly like you and me.
• On average, about half the people with HIV around the world still have no symptoms of AIDS after
ten years. So even though someone is infected, provided they are well, they can live full, healthy and
productive lives.
• There is a difference between HIV and AIDS. People can carry the HIV virus for many years, without
knowing they have it. They can look and feel entirely healthy before developing any symptoms of AIDS.
• Most of us do not know whether we are infected with HIV or not. Hence the need to take HIV test so
that it is ones responsibility to protect themselves and others from the virus. There is a window period:
up to 3 months between the date of infection and the date when a test result would normally show
positive. So unless we have a negative test twice, spaced three months apart, and we are certain that we
have not been at risk since before the first test, we cannot safely say that we are HIV-negative.
• Couple testing and routine retesting amongst the fisher folk is recommended
• Remaining negative: if we are involved in sexual activity, the best way to remain negative is to adopt
safer sexual practices.

Facilitator Guide
D. Pregnancy and HIV

• Pre conception counseling.
• All pregnant woman should be encouraged to attend ANC and deliver in a health facility.
• The risk of a positive woman having an HIV infected child is about one in three. This can be reduced
significantly if the mother goes through a prevention of mother to child transmission program (PMTCT).
Some children are infected in the womb, some at birth and some through breast-feeding.
• If can take 6 weeks -18 months to confirm whether a baby of an infected mother is HIV positive or
negative.
• It is recommended that mothers in developing countries should breast feed their children, as protection
against diarrhoea and other childhood diseases, which can be of greater risk to children than the
possible positive status of their mothers.
E. Can two individuals in a sexual relationship

have different HIV test results?
• Yes. Discordancy exists and research is still ongoing to establish why this happens. It is advisable that
one does not assume that the sexual partner had tested and that is also their result. It is important that
such individuals in a relationship visit a health care provider and use condoms correctly and consistently.
F. How can one prevent transmission of HIV and other STIs?

Points you may wish to cover.
• Practising abstinence that is, never having sex with anyone, is safe way of avoiding STIs (refer to the fact
sheet on STIs) and sexual transmission of the HIV virus. However, most certainly those who want to have
children or to get married, find this option an inappropriate solution. Abstinence can also be a good.
option for some people, especially those who are away from their steady/usual partners for some time.
• Being Faithful To One Partner Whose HIV Status You Know.
• Using condoms correctly and consistently. (See the next exercise, for more on this).
• PMTCT: Taking HIV preventive drugs for HIV positive pregnant women.
G. What are the common STIs in your community?

(Refer to local health data and appendix on STI Fact Sheet)
H. How should we relate/interact with those

who are HIV positive in our community?
• Any of us or any of our family or friends can be HIV positive.
• If we are shunned and avoided, we could fall sick quickly through depression and neglect. When one is
HIV positive they need to be aware that there are support groups within the area where they can share
with others on their issues in relation to their status.

Stepping Stones
CONDOMS
CONDOM DEMONSTRATION
Facilitator note: You need to have practiced well the condom demonstration.
ACTIVITY A.4: FOLDING PAPER GAME (10 min)

Materials: Four sheets of large (A4) writing paper
Aims: To show in a funny way how easy it is for different people to interpret the same instructions in
different ways.
Description: Four volunteers are asked to close their eyes and fold a piece of paper, according to spoken
instructions. Onlookers see how differently they interpret the same instructions.
Directions:
1. Ask for four volunteers to move out in front of the other participants. Place them where all four
volunteers can clearly be seen. Ask each volunteer to put on a blindfold or to promise to keep their eyes
shut! No participant is allowed to ask any questions during the exercise.
2. Hand each volunteer a piece of writing paper. Each piece should be just the same size.
3. Then ask participants to do the following: they should fold their paper in half. Then they should tear
off the bottom right hand corner of the paper. Then they should fold the paper in half again. Next they
should tear off the lower left hand corner and remind them not to peep!
4. Then ask all four volunteers to open their eyes and unfold their pieces of paper, displaying them to the
other participants. It is highly unlikely that all four pieces of paper will have been torn in the same way.
Facilitator note:
Ask participants what this exercise can show us. One point is to show everyone how even simple
instructions can mean very different things to different people. (It makes no difference in this
game how literate someone is.) We often think we are saying something clearly to someone, only
to discover later that what we meant and what they have understood have been quite different!
Everyone followed the instructions correctly, but the results were very different. This is a useful way of
introducing the rest of this session, emphasize for the need for careful listening during the condom
exercise which is going to give a chance to learn about the condom Encourage them to ask as many
questions about it as they like. They will also all have a chance to learn how to use it for themselves.

Facilitator Guide
ACTIVITY A.5: CONDOM DISCUSSION (30 min)

(Refer to the condom fact sheet)
Materials needed: Penile models, vaginal models, female condoms and assorted male condoms,
lubricants, tissue paper, hand towel.
Aims: To show participants how to use a condom properly and to let them try for themselves
on a model.
Directions:
Sit in a circle with the participants and explain that you are now going to show one another how to use a
condom. Throughout this whole exercise, encourage participants as much as possible to tell one another
the answers to your and their own questions.
Ask those who know something about condoms already to join in and share their knowledge with the
others. Only provide the answer to a question yourself if they don’t know it, or if you think it isn’t accurate
enough. This means that most of the talking in this exercise should, as much as possible, be amongst your
participants and not from you. As you encourage discussion during the exercise, provide each participant
with a penile model and condoms.
Give instructions on how to use a condom and demonstrate as each participant follows and demonstrates
1. Be sure you have one before you need it
2. Check the expiry date
3. How do you open the wrapper: look for the rugged edge and use the rugged edge to tear the wrapper
4. Check that it is not damaged or discoloured
5. When penis is erect, pinch the top, closed end of condom (to remove air
6. Roll the condom down the penis to the base
7. Enjoy your selves then after ejaculation, Move away from your partner
8. Before penis goes soft, using a tissue paper hold on the bottom of the condom and pull the penis out.
As you pull out ensure there is no spilling semen
9. Wrap the used condom in tissue paper or newspaper and dispose in a pit latrine or burn/bury it
Facilitator Note:
Emphasize the following points
Use a new condom every time you have sex and only use one condom
Do not use oil based lubricants like Vaseline instead use water based like KY jelly/ glycerine/
spermicides.
In case of condom burst during intercourse have another new condom on
Store condoms in a dry place, not in the back pockets and away from children.
Discussion on female condoms

1. Show the female condom in the wrapper to the participants.
2. Have the vaginal model and also show to participants
3. Tear the wrapper and show the female condom so that they can see the wider and smaller ring.
4. Indicate that the smaller ring is folded and inserted into the vagina (demonstrate)
5. Ensure condom reaches the base of the cervix
6. During sex the female directs the penis
7. After ejaculation remove the condom and wrap in tissue paper and dispose in a pit latrine
Facilitator Note:
Allow questions on HIV, STIs, condoms, sexual health and safer sex

Stepping Stones
ACTIVITY A.6: ONE NEW THING (5 min)
Aims: Winding down exercise.
Description: Everyone sits in a circle and shares one new thing which they have learnt.
Directions:
1. Explain that this has been a session with a lot of new information. Say that you would now like to bring
the session to a close with a reminder of how much knowledge and experience we already have to share
among ourselves.
2. Ask the participant to your right to share with the group “One new thing which I have learnt today
is.....” Then ask the next person to speak. Go round the circle, finishing with yourself, so that everyone
has made a contribution.
4. Finish off by thanking everyone once more for coming to this session. Remind participants of a local
place where people can go for individual counseling, or HIV counseling and testing, STI Screening and
other Reproductive health services if they would like it (if this service is available in your area).
5. Remind participants of the next session day, time and place for the next session, before saying
goodbye.
6. Remember to check whether there is a good local condom supply established before you move on to
the next session. The session is likely to create or increase demand, so there should be a good supply of
condoms.

Facilitator Guide
THEME: WHY WE
BEHAVE IN THE WAYS WE DO
SESSION 4: OUR OPTIONS

Purpose: To consider different possible choices which we may have in our lives.
Time Needed: 1 hour 30 minutes
Materials Needed: Ball of string,
Facilitator Notes:
1. The next session after this will be the Full Workshop which will involve members of the four peer groups.
2. Ensure the four peer groups have completed all the sessions, including this session, before they hold
the Full Workshop.
3. You also need to liaise between the four peer groups to arrange a convenient time and place for this
Full Workshop..
List of Activities
A.1 Spider web
A.2 Possible futures
A.3 Story Telling: ‘Hopes and Fears’: Young women
A.4 Story Telling: ‘Hopes and Fears’: Young men
A.5 Hand in Hand
INTRODUCTION (5 minutes)
1. Sit in a circle with the group at the same level.
2. Welcome everyone back to the new session. Thank everyone for coming. Enquire about late-comers or
non-attenders.
3. Ask each participant to recount quickly something good which has happened to them since the last
session.
4. Review the last session. Ask participants to remind us what we learnt together at the last session - about
HIV and condoms and our feelings about it. Check some of the main points and remind them it they
have forgotten.

Stepping Stones
ACTIVITY A.1: SPIDER’S WEB (10 minutes)
Materials needed: Ball of string.
Purpose: To remind everyone that each of them is an important part of the group.
Description: A ball of string is unraveled and held tight by everyone, like a spider’s web.
Directions:
1. Make sure everyone is sitting in a circle. Produce a big ball of string. Hold on to the end of the string,
then roll it across the ground to someone sitting opposite you, saying his/her name as you roll it to him/
her. Keep holding on to your end, tightly.
2. Ask the recipient to hold on to the string, so that it makes a tight line on the ground between both of
you. Then ask him/her to roll the ball back across the circle, across the ground, to someone else, saying
that new person’s name as it rolls to him/her.
3. Everyone keeps on with this, until the circle is full of tight lines crisscrossing the circle. Each person
should be holding on tightly to a bit of string. The ball of string should finally be rolled back to you, so
that you hold the beginning and the end of the string.
4. Next ask everyone to look at how the string connects you all, like a spider’s web. You are all dependent
on one another to keep this web firm and supportive. If anyone were to take their hand away from the
web, that part of it would collapse.
5. Ask people to suggest how this spider’s web exercise relates to our real lives.
6. After a few comments, ask everyone to lay their piece of string down on the ground. Gather up the
string in a loose pile, so that it can be rewound later. Ask everyone to think about our dependence on
one another - and our need to support one another - during the course of today’s session.
ACTIVITY A.2: POSSIBLE FUTURES (30 minutes)
Purpose: To help participants think about possible different futures for themselves.
Description: Using a frozen image and role play, participants develop two possible future scenarios
for a typical person like themselves in their own community. One is what they consider
to be their most likely future, the other a less likely future, and perhaps more hopeful
future.
Ensure the facilitator understands this exercise fully to give participants clear directions

Facilitator Guide
Directions:
1. Divide participants into two small groups. Ask each group to make up a character. Give her/him a name.
Point out that this should not be a real person, but rather someone made up by them, who is similar to
themselves.
2. Ask each group then to come up with a story describing this imaginary person
• To start off, what are their ideas about how s/he behaves at present?
(exchanging sex for favours; drinks all his money, having many sexual partners etc).
• Then they should think about what his/her future holds, if s/he continues to
behave in exactly the same way as s/he, has until now.
• What do they see as the likely progression of his/her life?
• What will his/her relationships with his/her friends, partner(s) and children be like?
• What do they think s/he will achieve in his/her life?
• Who will s/he be living with?
• Will s/he have any income? If so, from what kind of work?
3. After discussion, each group creates a frozen visual representation of their ideas about their imaginary
character’s likely future. They will need to decide where they are placing the character. Is s/he at home?
In a bar? On the streets? With friends? And so on. The frozen image merely sums-up their general
understanding about what their character’s future looks like.
Facilitator Note: For example, if the group consider that s/he is likely to end up penniless, having
to beg for money, their frozen image could show him/her on the street in a city, begging. The image
will not necessarily explain why s/he is there - it is up to the audience at the end to find that out by
questioning the participants. Alternatively, the group may want to show what made him/her turn to
begging, in which case they could, for instance, present instead a frozen image of him/her being
thrown out of home for some reason.
Members of the group take up positions in the frozen image, with someone taking the imaginary character’s
position. Encourage as many members as possible to be active participants in the scene.. If their perception
of the character’s future is that s/he is totally alone, and no-one else comes into the picture at all, they could
still use people representing the family and friends s/he has lost - by placing them standing apart from him/
her and looking away, for example.
4. Participants then move on to work on their second scenario. They stay in the same small group. The
second scenario of each group is a representation of the future that their imaginary character could have
if s/he changed direction.
• The groups need to think about what could happen if s/he stopped behaving in the way s/he is at
present.
• What could his/her relationship with his/her partner(s), friends, fellow fisherfolk and children be like?
• How could they be treating each other? What would happen to these relationships if their imaginary
character behaved differently?
• What kind of work could s/he have? What kind of home life?
Encourage each group to think about a future for their imaginary character which is hopeful and fulfilling.
Discourage them from discussing too much how their partner(s) need to change: this exercise should be
focusing on the imaginary character like themselves!

Stepping Stones
5. Each group then creates a frozen image which sums up these ideas. For example they could hope that
their imaginary character gets on well with everyone, has a safe source of income and is respected by
everyone. A frozen image of this could show him/her at home with his/her family and friends. The group
would then decide what the imaginary character is doing in the scene and how to show the rest of the
family relating to her/him in a way which shows that they are getting on well with each other.
6. When all the groups have practiced their two frozen images and are ready (after about half an hour),
7. The two groups demonstrate the two frozen images they had prepared to the rest of the peer group.
Once the audience has seen one frozen image they have an opportunity to ask questions before
proceeding with another group.
8. Encourage everyone to think about the differences between the likely future (where they continue taking
risks) and the possible future (where they change their risk taking behavior) for the imaginary person at
the centre of the frozen image.

Here are some useful lead questions:
• What kind of things would their imaginary character have to do to make sure that his/her life didn’t
follow the less fruitful path?
• What difficulties would s/he be likely to encounter?
• What do the participants think would make the character want to change the direction of his/her
life?
• What one first step could s/he take: one which would take her/him off the path s/he is on and lead
her/him in a new direction?
9. For the last stage of this exercise, all participants together take a few minutes to consider each
imaginary character in turn
A first step for a female character may be that she and other women form a group to generate income
which they themselves keep.
If the participants make general suggestions like “S/he’s just got to change her/his attitude”, help to
turn it into something specific and practical by asking questions. For instance, how would we know that
she had changed her attitude? What would we see her doing?
10. Finally, explain that the next time you will meet will be at the Full Workshop Meeting, where members
of other peer groups will also be present. At this meeting, each peer group is going to have an
opportunity to present one set of two frozen images to the other peer groups.
Explain that there will not be enough time for each small group to present their two frozen images.
Therefore each peer group is being asked to select one of the two sets of frozen images that they have
shown today, for presentation in front of the other peer groups.

Ask participants to decide for themselves now which small group’s work they would like to show to the
other peer groups. Suggest that they choose the one which feels most representative to them of the
kind of concerns which most of the peer group members face.
Participants may feel nervous about presenting their frozen image in front of other peer group
member. However, encourage them by reminding them that every peer group has been working on
the same exercises as their own. Also, every group will be feeling equally nervous! The aims of this
are to encourage participants to think about the possibilities of a better future, and visualize what that
means. The process of doing this can lead participants to an assessment of the choices they have in
their own lives, and empower them to see that they can change the direction of their lives.

Facilitator Guide
ACTIVITY A.3: HOPES AND FEARS: STORY TELLING
Women peer group” (20 minutes)
Purpose: To explore possible futures of the young women in our communities.
Description: Listening to a story, followed by a group discussion.
Directions:
1. Explain to participants that we are now going to listen to a story.
2. Say that while they are listening to the story, you would like them to think about the situations of these
two young women in the story, in comparison with young women in their own community:
• if they are older men or women, they could think of their own daughters or younger sisters
• if they are younger men, they could think of their girlfriends or wives or sisters
• if they are younger women, they can think of themselves!
Story line
Two Young ladies 26 yrs and 27 years both single parents with 3 and 4 children respectively, one
recently widowed and the other never married. They all engage in fish selling business, to make an
income to feed and educate their children with little capital, fish is scarce and has to make tough
choices.
One decides to engage in transactional sex to get fish while the other refuses and most of the times
goes without fish.
The sex worker meets all her needs, sends children to school, food etc but later contracts HIV and
suffers consequent socio-economic problems while the other has a very difficult time raising children
with a lot of school drop outs and lack of food etc however in one way or the other survives through
and children goes to school (poor schools) but makes it later on.
3. Next, ask participants the following four points:

• Summarize the hopes and difficulties or fears of each of the two young women from the story.
• In what ways are the situations of these young women relevant to their sexual health?
• What are the hopes and fears of young women in your own community? In what way do you think
they are similar to or different from those of the young women in the story?
• Can you suggest what could be done in your own community to improve the future for young
women?

Stepping Stones
ACTIVITY A.4: STORY TELLING: HOPES AND FEARS
Men peer group” (15 minutes)
Materials needed: Comic Story
Aims: To explore possible futures of the young men in our communities.
• If they are older men or women, they could think of their own sons or younger brothers.
• If they are younger women, they could think of their boyfriends or husbands or brothers.
• If they are younger men, they can think of themselves!
Story line:
Two young men both successful fishermen. One favours selling fish to women who exchange sex with
him while the other sells fish without sex considerations. The sex worker is reckless with his money,
has many women, inherits women, takes alcohol and although with a lot of money cannot show any
development – collapsing house, poorly kept children, lack of basic needs and later contracts HIV.
The other has a respectful large family, provides for them, invests in other businesses, faithful to his
wife and uses condom whenever he has sex. Has successful future.
1. Next, ask participants the following four points:

• Summarize the hopes and difficulties or fears of each of the two young men from the story.
• In what ways are the situations of these young men relevant to their sexual health?
• What are the hopes and fears of young men in your own community? In what way do you think they
are similar to or different from those of the young men in the story?
• Can you suggest what could be done in your own community to improve the future for men?

Facilitator Guide
ACTIVITY A.5 Wrap up: HAND IN HAND (10 minutes)
Purpose: To summarize the session
Description: To summarize what has been covered in the entire session
Directions:
1. Explain that the time for this session has now run out and that we are going to wrap up by reviewing the
session.
2. Everyone stands in a tight circle. Ask the first person to your left to put their right outstretched arm
into the middle of the circle and say something they have found difficult about the session: and then
something that they have found good about the session.
3. Ask the second person to your left to repeat this, placing her/his tight hand on top of the hand already
in the middle, and also saying one thing s/he found difficult and one thing s/he found good about the
session.
4. Continue round until all the participants have their right hands placed in a tower on top of one another
in the circle, and everyone has said something which they found difficult, followed by something which
they found good about the group.
5. Finish off by thanking everyone once more for coming to this session. Remind everyone that the next
time you meet will be at the Full Workshop Meeting, where each peer group will discuss some of the
emerging concerns and needs about sex.

Stepping Stones
FIRST FULL WORKSHOP

Purpose: To share peer group ideas.
Time Needed: Maximum 2 hours.
Participants: Members of the four peer groups, converge together.

(No general public.)
Materials needed: Flip charts from the session on Images of sex (concerns and needs and prioritized
issues), Pre labeled Flip charts (Younger women/ younger men/older women/ older
men) and marker pens.
Purpose: To enable all members of the four peer groups to meet together and share ideas and
concerns.
Description:
• Members of all four peer groups meet together. Each peer group presents their concerns/issues and
needs related to sex as was discussed in the different peer groups.
• Prepare to have HTC and other biomedical services on site/referrals on this day
Directions: Identified facilitators should;

1. Thank everyone for sparing their time to come to the meeting. Explain that all peer groups have been
working on their concerns, needs related to sex and how they prioritized the problems that are related
to sex. Now they have a chance to see one another’s’ work and to present their own ideas to the full
workshop. Explain that this is not a competition, but an opportunity to share ideas.
2. Explain that you know some groups are feeling nervous about presenting their ideas in public, but
encourage them to be brave and support each presentation.
3. Peer groups should be asked to decide amongst themselves which peer group should go first and so
on.
4. Remind participants to be keen on the prioritized issues per peer group. The younger men peer group
will summarize the issues from the younger women and vice versa. The older women will summarize the
issues from the older men and vice versa.
5. The facilitator will write the issues from each peer group on the pre labeled flip chart
6. Allow all the peer groups to present their problems and concerns that had been dealt with in session
1. The presentation should start with the problems to be dealt with in this order:
immediate, soon and later.
7. After each peer group has presented ask the other peer group who are assigned to summarize the
issues raised
8. Next, ask participants whether they noticed any similarity of themes between all the peer group
presentations. What differences emerged among the peer groups?
9. Ask the larger group to consider their community and based on the issues raised by all peer groups,
they should identify the concerns and problems of the whole community.
10. Allow them to prioritize the community concerns which they can address as a group and which they can
inform the relevant authorities.
11. At this point the facilitator should let the participants know about referral points, available services and
make appropriate referral.
12. Finally thank all participants for their time and participation. Explain that you will next go on to Session
5. Each facilitator should arrange a mutually agreeable time and place for Session 5 with his/her own
peer group.
13. Each facilitator should remind everyone in his/her peer group of their role as guardian angel.

Facilitator Guide
Facilitator notes
This meeting is important because it allows participants to voice their concerns for the first time to
other peer groups. It also enables them to realize that, they have common concerns and needs for
sex. This is valuable groundwork for developing greater trust and cooperation between different
sections of the community. But it is also important for participants to go back to working in their peer
groups.

Stepping Stones
SESSION 5: EXPLORING WHY
DURATION: 2HRS
Module A: EXPLORING WHY
Purpose: To understand why we behave in the ways we do.
Materials Needed: Posters
Participants:
Four separate peer groups.
List of Activities
A.1 Risky Behaviours
A.2 Alcohol
A.3 Traditions
A.4 Money
A.5 Testing the Water
Introduction (5 Minutes)
2. Welcome everyone back to the new session. Thank everyone for coming and check attendance
4. Thank the participants for actively participating in the previous session. Explain that we are going to
explore , discuss and learn new things in this session,
Activity A.1: Risky Behaviours (25 minutes)

Purpose: To help participants consider situations which involve sex and risk-taking in their own
experiences; and to help them think of other ways of handling them through analysis
of the circumstances.

Description: Role plays, followed by plenary discussion and analysis.

Directions:
1. Begin by recalling previous exercises, explaining to participants that in earlier sessions we have
discussed concerns which they have about sex; situations where they have been in arguments; times
when they have felt themselves to be taking risks;
2. Explain that in this session we are going to explore some of these issues in more detail, through thinking
specifically about typical sexual encounters experienced by ourselves in our community.

Facilitator Guide
It would be good to come up with, say, four different examples that your peer groups know of.
Below are some possible examples which each peer group may have mentioned:
OLDER WOMEN:
• widow having to sleep with her dead husband’s brother.
• wife having to sleep with her husband who has come home after a long journey.
YOUNGER WOMEN:
• young wife wanting a child, when her husband sleeps around
• sugar daddies tempting teenage girls.
OLDER MEN:
• old man fearing that he may be impotent.
• man in a bar, approached by a woman.
YOUNGER MEN:
• young man wanting to use a condom but fearing that his girl-friend/wife may be angry.
3. Form 3 groups and ask each group to choose one of the scenarios to design a quick role play, using
words, song, dance or just body-language, which describes a typical scene which could lead up to risky
sexual behavior. Say that you want each group to produce a scene which is a maximum of 3 minutes
long.
It could be anywhere: in the house, shamba, at the beach, in a field, in a bar, outside school, wherever
they think sex or the actions or words leading up to it - takes place in their community.
Reassure participants: explain that they may find it embarrassing to role play, but remind them
that we all feel embarrassed at times. If we accept that we all feel this and try to find the courage to
overcome it, we may help one another to face the issues more effectively.
4. After 10 minutes, call everyone back together. Explain that we are now going to watch one role play
from a volunteer group. The role of others should be to be listen and observe for discussion on the
following issues
• Why did these characters have sex?
• What were the good things (if any) about them having sex?
• What were the bad things (if any) about them having sex?
• Do these things happen in our community?
• What are some of the factors which influence these behaviours?
• How would you have addressed the situation if you were………………….(insert the main character)?
5. Explain that during the rest of this session and the next few sessions you are going to consider together
several different factors which have an influence on our sexual behaviour.
This exercise helps participants to explore the community context under which risky sexual behaviors
take place. It underscores that the role of different risk factors e.g. drinking alcohol, community beliefs
and practices, and community norms etc play in making individuals take risks. It’s the individual who
mainly suffer the consequence of the risk and hence need for each one of us to take precaution.

Stepping Stones
Activity A.2: Alcohol (25 Minutes)

Purpose: To help participants consider the advantages and drawbacks of drinking alcohol (other
drugs).
Materials: Poster on alcohol
Description: Display the poster on alcohol followed by discussion.
Directions:
1. Display the poster
2. Ask participants to
• What they have seen
• Why does the alcohol-maker/seller in your community make/sell alcohol?
• For what reason(s) do people in the community drink alcohol?
• Are there good things about drinking alcohol?
• What are the bad things about drinking alcohol?
• What role do you think alcohol has to play in terms of influencing our sexual behaviour?
Facilitator need to address myths and misconceptions about alcohol. There are good things about
alcohol. Our ancestors used it to make friends. They used it when they proposed or during marriages
or other ceremonies. They responsibly made use of it in everything.’?”
Facilitator Notes: ABOUT ALCOHOL AND RISKY SEXUAL BEHAVIOUR

Here are some points to help you guide the discussion about alcohol
a. ILLEGAL: Many alcohol brewers are women, who sell it to earn an income for themselves, for school
fees and so on. Brewing is legal, but in many places, it is done illegally. If alcohol is banned, what
alternative income is there for the brewers? People continue to make and sell it illegally, often
producing dangerous mixtures. And others go on drinking hence this is not a realistic solution.
b. BLAME: Some people blame the woman for being trapped by drunk men,
c. STIGMA: Some people may say that the woman should have struggled even more and shouted out.
But in many places, women being attacked are afraid of screaming, for fear of being cross-questioned
and blamed, which would bring shame on her family. Is this fair?
d. ALCOHOL AND TRADITIONAL ROLES: In many societies, alcohol has played an important traditional
role in weddings, funerals and other ceremonies as a form of blessing. It has also been an important
way of thanking people who lend their labor to one another. But it would normally be drunk in small
quantities and not over-used, as it often is today. What was the case in your participants’ community
in the past? In some parts of Africa, the drinking of alcohol has been reduced by limiting the times of
weddings, for instance, or bar opening hours, to daylight or early evening hours. But others say that
drinking then just yet more concentrated in a shorter time. There are no simple solutions. But one thing
is clear:
When any of us has drunk loo much alcohol, it is very difficult for us lo act responsibly or keep control
over our actions.
e. ALCOHOL AND PEER PRESSURE: Why do some people drink so much alcohol? In most communities,
drinking alcohol often starts amongst people through peer pressure: as a way of being accepted and
liked by their friends. Alcohol over-use has increased alongside unemployment and poverty. People
often turn to drinking more alcohol through stress, depression or lack of alternative entertainment. They
see drunkenness as a way of escape from their worries. Yet they often then discover that over-use can
lead them into many additional problems. But because of the addictive qualities of alcohol, it is then
very hard for people to stop over-drinking. Is this relevant to your community at all?

Facilitator Guide
ACTIVITY A.3 TRADITIONS (15 minutes)
Materials needed: Flipchart, Flipchart stand, masking tape and felt pens
Purpose to help participants think about local traditions which may influence HIV
transmission: and how those traditions might be changed.
Description:
Brainstorming
Directions
1. Then ask participants to consider the following questions in relation to their own community and their
own traditions.
2. Ask the questions one at a time:
• Are there traditions which we have in our community, which involve sex, which could influence the
spread of HIV or other STIs?
• What are these traditions and why are they risky?
• Are there acceptable alternatives to these risky traditions to reduce the spread of HIV/STIs in our
community?
• In different communities there are very different traditions about sexual practice. Even in one
community there can be a lot of variation in what different groups of people think is the good and
right thing to do.
• In some areas, people believe that it is right for a widow to marry her dead husband’s brother.
In some areas, people believe that a man should always marry his cousin. Yet in some places,
communities have in fact decided to adapt or even break with tradition and permit people to
behave differently, because of the threat of HIV. In this way, the local chiefs have altered the
tradition to cope with modern circumstances. For instance, in some communities in Kenya that
used to practice wife inheritance, they have replaced this with hanging a coat/walking stick in the
widows bedroom.

Stepping Stones
ACTIVITY A.4: MONEY (25 minutes)

Materials needed: (Poster 1: Good ways of spending money;
Poster 2: Bad ways of spending money)
Flipchart, masking tape and marker pens.
Aims: To help participants explore the relationship between money and the spread of HIV,
and how these links might be changed.
Description: Displaying poster and brainstorming.
Directions:
1. Display Poster 1. Ask participants what they have seen
2. Display poster 2. Ask participants what they have seen
3. Brainstorm on the posters and the effect of each to the individual, family and the community.
4. Next ask participants to discuss the following points:
• How is access (having or not having) to money relevant to the spread of HIV?
• What are some things that your community can do to assist individuals who have a lot of money at
hand to invest?
Activity A.5: TESTING THE WATER (15 Minutes)

Purpose: To encourage participants to reflect on their own most common patterns of behaviour.
Description: An individual exercise in personal reflection.
Directions:
1. Explain to participants that we have been looking at a lot at things which happen around us in our
communities, and which shape our lives. We are now going to start to look at things which happen
inside us.
Ask participants this question: “If you went to the sea* or to a river or lake, and you really wanted to get
cool in the water, which is the most likely way for you to get into the water? Would you:
• Just run towards the sea and dive in? (plunger)
• Walk in slowly, wetting your body bit-by-bit and getting used to the temperature? (Wader)
• Dip your toe in the water, and then decide if you’ll go in? (Tester)
• Stand on the beach contemplating the view and surroundings, and considering what you will do
next?” (Delayer).
2. Point to four different corners of the training area, one for each action described above. Ask participants
to move to a certain corner depending on the action which each of them thinks is most likely for him/
herself.
3. Once everyone in the group has moved to a corner, give each type of response a title, such as
“plunger”, “wader”, “tester”, and ‘’delayer”. Ask participants the good and bad things about each of
these types of behaviour.
4. Now ask each participant to consider whether the type of behaviour they chose is their most common
way of behaving. If they find that they behave differently in different circumstances, get them to think
of a particular situation and a response. Once they have thought about this, they could share their
thoughts in groups of three or so.

Facilitator Guide
The assumption here is that a greater awareness of how we respond in different situations increases
our understanding of the dynamics involved in conflict situations. It also encourages attention to the
behaviour of others, and an understanding of the needs underlying their behaviour.
Session wrap up (10 minutes)

Purpose: To remind participants of good things about their community,
Description: Each person describes one thing s/he likes about her/his community.
Directions:
1. Sit in a circle with the participants. Ask each in turn to say “I like my community because.....” Start with
yourself and encourage participants to say anything they like about it. They may like other people, or
the trees, the river or whatever. They just need to mention one thing each to the group.
have learnt today and one thing that they are looking forward to doing before the next meeting.
all again there.

Stepping Stones
THEME: WAYS IN
WHICH WE CAN CHANGE
SESSION 6: LET’S SUPPORT AND ASSERT OURSELVES
Purpose: To develop new skills to change the ways in which we behave and become more
assertive.
Time Needed: 2 hours 20 mins
List of Activities
A.1 Statues of Power
A.2 Attack and avoid
A.3 Taking Control
A.4 Supporting Ourselves to regain control
A.5 Tug of War and Peace
A.6 Role-play: ‘Saying No’
A.7 Opening a fist
A.8 ‘I’ Statements
INTRODUCTION ( 5 minutes)
1. Sit in a circle with the group at the same level.
2. Welcome everyone back to the new session. Thank everyone for coming.
Enquire about late-comers or non-attendees.
4. Thank the participants for actively participating in the previous session.
Explain that we are going to discuss and learn new things in this session.

Facilitator Guide
ACTIVITY A.1. STATUES OF POWER (20mins)
Aims: To look at the emotions we associate with power and how they affect us.
Description: Groups exercise, using frozen images.
Directions:
1. Divide the group into two groups. Both groups are going to produce a frozen image showing one
person in a position of power and the other in a powerless position. Allow them a few minutes to
prepare their frozen image, then ask them to swap around (so that the powerful figure becomes the
powerless and vice versa) and prepare a second frozen image.
2. When they have prepared both frozen images, give both groups the opportunity to show them to the
rest of the group. Ask for quick comments about what people observe. Ask both members of each
frozen image to express what they are feeling in one word (e.g proud, scared, humble, or whatever).
3. Ask the participants the following questions:
• Which of the two positions felt more familiar to participants?

• Can they relate any of the emotions they felt to situations in their lives?
• What did they feel for the powerless person when they were in the powerful position, and
vice versa?
• This exercise can activate strong associations and emotions quickly, and it is recommended
that you are conscious of this. Those who have strong emotional reactions might welcome an
opportunity to talk about them, in which case it can be a good idea to have feedback in small
groups.

Stepping Stones
ACTIVITY A.2 ATTACK AND AVOID 10 mins

Aims: To gain an understanding and practice of assertive and unassertive behaviour.
Description: A group exercise introducing assertiveness, looking at aggressive and defensive behaviour
Directions:
• Ask participants to listen to the list of actions which you are going to read out. If they think they do
something often, they should put both hands in the air.
• If they think they do something sometimes, they should put one hand in the air.
• If they think they never do something, they should keep both hands down.
1. Join in with these actions yourself. (If you feel participants are ready to be more active, you could ask
them to move to different corners of the training area in response. e.g. frequent doers on the right;
never doers on the left; sometimes doers in the middle.) The actions appear in two columns. Read out
the first column, then the second. Ask participants to react after each word.
Facilitator note.
Work through this list beforehand with your co-facilitators, to make sure you all understand these words and
have common words in your local language for them
LIST OF ACTIONS
First column: Second column:
Nagging Withdrawal
Shouting Sulking in silence.
Interrupting Taking it out on the wrong person.
Exploding Declaring that you are being unfairly treated.
Warning (If you don’t do this...!) Talking behind someone’s back.

Correcting (Look at the facts...!) Trying to forget about the problem
Persisting (I am right....!) Feeling ill
Insulting Not wanting to hurt the other person.
Sarcastic Feeling low and depressed
Revenge (I’ll get you back for this!) Being polite but feeling angry

Facilitator Guide
2. Point out to everyone that the words you read out first (in the first column) are attacking behaviour
and the second lots of actions are avoiding behaviour. Ask everyone to note for themselves which they
found they do more often.
3. What? Brainstorm the word attack and then the word avoid, allowing one minute for each word. Ask
participants to call out anything which each word means for them. There may well be good and bad
feelings expressed about each word.
4. Why? Then ask participants to think of one personal reason why they would behave in an attacking or
avoiding way. Ask a few participants to describe their examples to everyone.
5. How? Ask participants to consider how attacking or avoiding would be expressed - what they would say,
how they would say it, and how they would say it with their bodies.
6. For Instance? Ask everyone to think of one word or phrase that they use when either avoiding or
attacking, whichever is their most frequent behaviour. They should consider how it is said and the body
language which accompanies it. An example of avoiding behaviour might be “where are you going?”
said in soft, uncertain way which indicates that the questioner is expecting an angry answer, and
accompanied by hunching the shoulders and turning away the head. Ask how the same phrase could be
said in an attacking way?
7. Ask somebody to give theirs as a practical example.You might point out how the effect of what they say
is very much dependent on what they do - their body language.
With the “where are you going?” example, you could suggest that they try using the phrase without
hunching their shoulders, looking, with a strong smile, straight at the person they are speaking to
and speaking with a loud, certain voice. This will have a big effect on what they say and the message
that is being communicated. In this example, the person may find that when they stop hunching their
shoulders and look straight ahead, what they actually say is interpreted much more positively.
8. In the previous two groups get everyone to give their example white the other two in the group offer
suggestions about how they might alter their body language to make their response an assertive rather
than an attacking or avoiding one. Other examples to try could be their own; or could be “what time are
you coming back?”, “how much does this cost?” and so on.
• What signs can help us to recognise and even predict others’ behaviour?
• What signs can we learn to recognise in ourselves which warn us that we are embarking on an
unassertive approach?
• How can we alter our pattern of reacting and begin to learn a new response?
• How does it feel to change our body position?
Facilitator note:
• Assertiveness has as much to do with body language as with what we say. And what we say is often
consciously influenced by our own body language. If we adopt defensive physical postures, such as
looking down, hunching our shoulders, we are unlikely to speak assertively. On the other hand, if we
adopt assertive by language, this can make it easier for us to speak assertively.
An assertive response is a centred response. We are balanced - not leaning forward in an attack mode,
not falling backwards in an avoiding mode. Although most of our confrontations are verbal rather than
physical, there are often visual signs, even if they are tiny, of our body going on the attack or defence.
This exercise is a step towards using the signs we get and building up a desired response rather than an
immediate reaction.

Stepping Stones
ACTIVITY A.3: TAKING CONTROL (20 mins)

Aims: To explore ways of taking or feeling in control. To increase confidence. To find more
appropriate ways of presenting oneself.
Description: A group exercise looking at ways of using our own power within group and social situa-
tions.
Materials: POSTER the poster will show 3 scenarios, as described below,

1,) a helpless widow, who cannot make ends meet and has to sell sex to get fish
woman, looks not obviously in control.
2) the same woman being advised on oth the not business options and other sources of
financing from other MFI like women finance etc,the woman a bit in control,
3) shows a woman fully in control, has a booming business living comfortably with the
family).
Directions:
1. Display the poster. As you go through the poster, ask them to imagine that they are feeling completely
useless, with no resources, no confidence, no control.Then, slowly, they rise and start to feel better
about themselves. How often do you feel you do this in everyday life? How do you feel as you went
through the different reflective steps?
2. With everyone in a circle, ask volunteers one at a time, to demonstrate how to take control, to feel
confident, to have a presence within the group. It is a good idea to create two gaps in the circle: one
entry point and one exit point. Each individual must decide for her/himself what kind of control s/
he wants to exercise and how s/he will establish it. You could demonstrate to the participants before
encouraging them to have a go.
Facilitator Note:
If participants don’t know what to do, give them a hint using these examples:
• Enter the circle quietly, pause, look round the circle, making eye contact with everyone, and depart
quietly.
• Rush in and, with great excitement, tell us what they have seen.
• Come in with confidence, look at one person and request that they move from one side of the circle to
the other side of the circle. (The request will be followed if it is issued with the necessary control and
authority.)
These are three very different ways of taking control, each of which would suit a different personality, but
they are all effective.

• What difficulties did you encounter when attempting to take control?
• How did you overcome them?
• What did the group members observe and what would they do differently?
• Did people get any new ideas from watching the range of approaches?
• What would participants like to practice or improve?

Facilitator Guide
Facilitator Note
• Some participants may need a lot of challenging and help. For others, being too aggressive may be the
problem. You may need to encourage them to be less aggressive but more assertive.
You could encourage participants to consider how domination and submission relate to colonial
experience in some countries, or the relationship between men and women. Or ask them for more
relevant examples.
By contrast, you could relate the concept of sharing power and responsibilities in a relationship - being
assertive - Being assertive does not mean that you lose control - although many aggressive people do
think that listening to and respecting others would threaten their own power.
ACTIVITY A.4: SUPPORTING

OURSELVES TO REGAIN CONTROL (15 mins)
Aims: To analyse how we can take responsibility for our actions.
Description: Plenary discussion, followed by small groupwork, and then summary plenary.
Directions:
1. Start this exercise with the following explanation:
Once we have done something wrong, we often feel uncomfortable about what we have done, but
don’t really know what we can do about it. It is often much easier to blame someone else, or to say that
things were out of our control, than it is for us to take responsibility for what we have done. Say that you
are sure that we can all think of examples of when we have regretted doing or saying something and
have felt frustrated about it. We have often ended up blaming someone else, in order to try to make
ourselves feel better.
But are we then really in control of the situation, or is the situation in control of us?
2. Remind the group on the activity of “taking risks” and narrate the storyline below.
• Rose is a 42 year old rich woman who owns a fleet of boats at the beach and she hires out for
fishing. Peter is a 22 year old fisherman who is newly married and the wife is expecting their first
child. Peter has just come from paying for the wife’s medical care and has spent all his money.
Peter has been hiring Roses boat for use but during this season, hyacinth has blocked access to
the fishing grounds and he has lost his income. Peter goes to Rose to ask for some loan and she
ushers Peter into her house. Rose goes ahead to seduce Peter and in the process Peter gives in and
engages in unprotected sex. Peter’s wife got to know about the incidence and assumed that the
relationship had been ongoing for a while. She took off to her parent’s home.
3. What can Peter do to regain control?
• What would Peter do?
• Who would Peter blame and why?
• How would Peter feel about it now that the wife has gone back to her parents?

Stepping Stones
4. Once they have made a few suggestions, you can propose the following four point plan which could
help us all to take responsibility for things which we do:
a) ACKNOWLEDGE what we have done.
b) ACCEPT responsibility for it.
c) ACT appropriately to limit the damage done (have any necessary conversations,
sort out the mess, or, in this case, help the young woman with financial support for their child).
d) MAKE SURE you won’t do it again.
This four point plan helps people to change how they react when things go wrong for them.
5. Ask the participants to describe how Peter might have handled it better, using the four point plan
above.
6. Point out that it is often easier for people to discuss things with a friend when they feel they have
handled things badly: and that this four-point plan enables us to think through more clearly to regain
control of the situation for ourselves. Encourage participants to try it out for themselves over the coming
weeks.
ACTIVITY A.5: TUG OF WAR AND PEACE (15 mins)
Aims: To illustrate benefits of working together.
Description: Everyone pulls together on a rope.
Materials needed: Reasonable length of strong rope.
Directions:
1. Divide the group into two teams. Ask these two teams to stand up and hold opposite ends of a long
strong rope. Mark a line across the middle of your training area, over which each team must try to pull
the other.
2. When you have said “1, 2, 3, Go!” the teams should start pulling against each other. Let them go on
until one team has ended up falling over the dividing line.
3. Next, ask everyone to sit in a circle. Now tie the same strong rope in a large circle and hand it to the
participants, so that they are sitting round the edge of it.
4. Ask all the participants to pull together on the rope so that: they can all stand up.
5. Ask participants what this illustrates to them.
• The idea is to show how, instead of people pulling on opposite ends - a tug of war, where only one
team wins, we can use situations in a win-win way, so that everyone benefits and feels good about the
result. True, tug of war might feel more fun for the victors - but how do the losers feel?

Facilitator Guide
ACTIVITY A.6: ROLEPLAY: “SAYING ‘NO’?” (15 min)

Aims: To help participants understand how to say No
Description: Read the scenario followed by discussion. Switch the storyline of Rose and Peter to fit the
different peer groups. For women, Switch Rose to be a sugar Daddy.
Rose is a 42 year old rich woman who owns a fleet of boats at the beach and she hires out for fishing.
Peter is a 22 year old fisherman who is newly married and the wife is expecting their first child. Peter has
just come from paying for the wife’s medical care and has spent all his money. Peter has been hiring
Roses boat for use but during this season, hyacinth has blocked access to the fishing grounds and he
has lost his income. Peter goes to Rose to ask for some loan and she ushers Peter into her house. Rose
goes ahead to seduce Peter and in the process Peter gives in and engages in unprotected sex.
Directions:
1. Point out that young women often find themselves approached by teachers, male relatives, young
men, bosses or other men in the work place, not just by sugar daddies. Young men too at times can be
approached by older women and may find it difficult to refuse them. This technique can work in any
crisis. For instance, shouting “no!” very fiercely can also be a very powerful way of saying NO and may
include running away from the aggressor
• Point out that women often find it very hard to make it clear when they really mean “no”. Therefore
the women’s group should be practising saying “no” in as clear a manner as they possibly could.
Once they had achieved this, they then have more confidence in themselves and could learn next
how to say it in a way which could still be very clear, but less aggressive, and perhaps more
appropriate for those kind of situation.
• Your own participants will have a chance to practise these themselves in a later exercise.
Nevertheless, if a woman is being attacked, she needs to have the confidence to know that she can
say “no!” as fiercely and in as determined a manner as possible.
2. Brainstorming activity: (all peer groups.) Ask your participants
• When a woman says “no”, how does a man know whether she really means “no” or whether she
might mean “yes”?
• What could the man and the woman do to change their behaviour to each other, so that the man
can understand that when a woman says “no”, she means “no”?
3. Then encourage role play of a young man saying “no” to an older woman; or of an older man saying
“no” to a woman of his age or younger. (For instance, you could challenge your participants, by saying:
many men have said they were seduced by a young attractive woman into having sex. Is this really true?
How could they say “no”, if they wanted to?) Role-play whatever situation your participants would like
to practise.
• This is, of course a very sensitive issue. It would be good for you to emphasise that, if we are to
take responsibility for our own actions, we should not be trying to blame others, but should try to
behave as responsibly as we can ourselves. This means that you should ensure that your participants
don’t just say that this is all women’s responsibility; they should challenge one another to think of
different ways of behaving.
• This is an immensely powerful exercise. Participants should use all their bodies to say “no”. Each
person should be standing tall and firmly, they should “stand their ground” the participant should
maintain eye contact and not scared. The participant to use voice as a weapon and should shout,
not whisper, “NO!”
4. Finally, explain to all participants how we are going to see how good we are at persuading others to do
what we ask.

Stepping Stones
ACTIVITY A.7: OPENING A FIST (10 mins)

Aims: To develop persuasion skills
Description: Pairs work on persuasion.
Directions:
1. Explain the following to participants, acting it out as you say it:
We have seen how our body language can influence other people’s response to us. For instance, if
someone is acting aggressively towards us, they may be leaning forward at us, with clenched fists. By
changing our body language, we can improve the situation. For instance, if we are sitting down, we
can relax our shoulders, uncross our arms, open our palms upwards, uncross our legs, hold our heads
straight, look straight at the aggressor.
2. Now ask participants to divide into pairs. First one will act as the aggressor and the other will act as the
persuader; then they will swap roles. The aggressor must hold his/her hand up in a very tight fist and
feel very angry. The persuader has to try to persuade the aggressor to undo his/her fist.
The persuader should use all his/her skills to persuade the aggressor to calm down and to open his/her
fist. The persuader and aggressor must not touch each other, but the: persuader can say or do anything
which s/he thinks will work to calm down the aggressor and persuade him/her to open his/her fist. If the
aggressor thinks that the persuader has done a good enough job, s/he can agree to open his/her fist.
But s/he mustn’t give in too easily!
Give the pairs 3 minutes each way to try out their persuasion on each other.
3. See by a show of hands how many people managed to persuade their partners to open their fists! Praise
and encourage everyone end explain that this gets easier with practice.

Facilitator Guide
A QUESTION OF BALANCE:
SUPPORT NOTES FOR ASSERTIVENESS
We can look upon aggression, assertiveness and passiveness as different points along a line:
AGGRESSIVENESS: PASSIVENESS: ASSERTIVENESS:

Expressing your feelings, Giving in to the will of others Telling someone exactly what
opinions or desires in a way - hoping to get what you you want in a way that does
that threatens or punishes want without actually having not seem rude or threatening
the other person – you are to say it - leaving it to oth- to them - you are standing
insisting on your rights while ers to guess or letting them up for your rights without
denying their rights decide for you. endangering the rights of
others.
DOMINATING, for instance: BALANCED - know what SUBMISSIVE, for instance: -

- shouting - demanding -not you want to say - say “1 talking quietly- giggling nerv-
listening to others feel...”, not “I think...” - be ously - looking down or away
- saying others are wrong specific - use “I” statements - sagging shoulders -avoiding
-leaning forward - looking look the person in the eye - disagreement -hiding face
down on others - wagging don’t whine or be sarcastic with hands.
finger or pointing at others - use your body language
-threatening - fighting. too (stand your ground, be
centred).

Stepping Stones
ACTIVITY A.8: “I” STATEMENTS 20 min

Aims: To practice making non-judgmental statements, and using statement which can open rath-
er than close discussion.
Description: An exercise which explains and demonstrates an assertive but non-aggressive way of ex-
pressing feelings about a problem.
Directions:
1. Introduce the idea of “I” statements to the participants, including clear and clean “I” statements that
have worked. See the next two pages for details of what needs to be said.
2. INFORMATION FOR “I” STATEMENTS EXERCISE:
An “I” statement is a way of expressing clearly your point of view about a situation. It includes an ex-
pression of how it is affecting you, and how you would like to see it change. The best “I” statement is
free of specific demands and blame. It opens up the area for discussion and leaves the next move for
the other person. We should aim for our “I” statements to be clear (that is, to the point) and clean (that
is, free of blame and judgment).
We should beware of “you” statements which place blame on someone else, hold them responsible,
demand change from them or hold a threat.
Two examples of a “you” statement;
“You are so lazy, you never keep the house cleanly swept, you are always late with my food and the chil-
dren are always crying. I don’t know why I married you. You must start to work harder from now on!”
“You are always so drunk when you crash into the house at night. And you never give me any money to
buy any food. I don’t know why I ever married you. You must stop going to that bar from now on!”
These statements are very judgmental and make the listener feel hemmed-in and thus defensive.
Two examples of an “I” statement:
“When I come home I feel disappointed if the food is not ready and the house not swept. I would like
us to discuss how we can arrange things better so that this would be possible.”
“When you come home at night after the bar, I feel disappointed, because I would like to see more
of you, and I would like some money for food for the children. I would like us to discuss how we can
arrange things better together.”
These statements carry no blame and are phrased not to annoy the listener. The expectations within
them are presented in a non-judgemental manner (there is no “you must.”) and are not accusing the
listener. They state the speaker’s expectations or hopes, but they do not demand that they be met.
The action: “When....” Make it as specific and non-judgemental as possible, e.g. “When you come
home at night…”
My response: “I feel...” Say “I feel...” rather than “I think...” and keep it to your own feelings; “I feel
hurt/sad/happy/disappointed/ignored….”, for instance. Not: “I feel that you are being mean!”
Reason: “...because...” If you think an explanation helps, you can add one here. But make sure it is
still non-blarning, e.g. “...because I like to spend time with you.”
Suggestions: “What I’d like is...” A statement of the change you would like. It is OK to say what you
want, but not to demand it of the other person, e.g. “What I’d like is for us to discuss this” or “What I’d
like is to make arrangements that we can both keep”, not “You must stop being so lazy!”

Facilitator Guide
3. With the participants working in pairs, ask them to prepare one “I” statement each, relating to a current
or recurring difficulty which they are facing in their lives. Partners can help each other to make their
statements clear and clean.
4. Ask for a few examples from the participants, giving people an opportunity to comment on them and to
offer suggestions as to how they might be improved.
5. In what ways could the “I” statement formula be useful to participants? What do they think about it?
6. Ask all participants to commit themselves to making one “I” statement to somebody before the next
session.
• This is a useful way of separating feelings and facts in order to clarify what a problem really is. The
formula may seem strange and unfamiliar, but with practice it can become an unconscious reaction
rather than a laboured response. It is a tough discipline and needs practice.
• It is worth pointing out that it can be used at work, at the market or the shops, with friends, on
public transport or at any time when you feel that your needs are not being met. It is not just for use
with a partner!
• Groups, as well as individuals, can use the formula to help them make a statement about something
they feel, strongly about. Group statements will be explored in a later session.
• The use of “I” statements makes the response to the difficult situations more likely to be successful.
Adapt the language to suit your situation.
• Try to use it first in an easy context, with a friend over a small problem. You can begin just by
saying “I feel happy when...” and see how that works.
• Then as you gain practice in using it, you can try it with a friend in harder situations. You can start
to try out “I feel unhappy when...”
• When you feel OK with that, you could try out “I feel happy when...” with your partner.
• Finally, you can try out “I feel unhappy/sad/frustrated when...” with your partner.This sounds very
daunting but, it is possible to learn.
SESSION WRAP UP (5 MINS)

have learnt today and one thing that they are looking forward to doing before the next meeting.
all again there.

Stepping Stones
SESSION 7: LET’S IMPROVE OUR BEHAVIOUR
Purpose: To put the newly acquired skills into practice.
Participants: Peer groups.
List of Activities
A.1 Talking out the difficult things
A.2 Manipulative Skills
A.3 Trust
A.4 The Long Journey
INTRODUCTION (5 minutes)
2. Welcome everyone back to the new session. Thank everyone for coming and check attendance.
3. Ask each participant to reflect and mention something good which has happened to them since the
last session, how they have managed to use the ‘I’ statements in their daily lives. Review the previous
session and thank the participants for having actively participated in it.
4. Explain that we are going to discuss and learn new things in this session,
Activity A.1: Talking out the difficult things (15 minutes)

Purpose: To explore difficult situations and reinforce the use of “I” statement to handle the situation
Description: Interactive work in small groups looking at difficult situations and practicing
how to use the “I” statements.
Directions:
1. Divide participants into 3 small groups
2. Ask each group to think of how to deal with one of the following situation using the ‘I’ statement.
• A woman convincing her husband to join her for ANC visit
• A woman convincing a partner to undergo VMMC
• A partner returns home after a long journey and would like to talk about safer sex to his/her sexual
partner/ use of condom.
3. Ask participants :
• What worked and why?
• What skills or tactics, such as body language, are we already using to avoid the provocative
response?
• The use of “I” statements makes response to difficult situations more likely to be successful.
The facilitator should explore the factors which contribute to making this possible.

Facilitator Guide
ACTIVITY A.2: MANIPULATIVE SKILLS (25 Minutes)
Purpose: To practice facing manipulation and using assertive responses to counter.
Description: An interactive group exercise exploring how to use assertive responses under pressure.
Directions:
1. Divide participants into two groups. Each group will be given two different scenarios whereby they have
to pretend to be the person trying to manipulate someone else to do something that they don’t want.
(See the list of suggested situations below.) Ask each group to present their scenario through role play.
Younger and Older Men’s groups Younger and Older Women’s groups
• being encouraged by your friends to drink • sugar daddy
too much alcohol • partner wanting to have unsafe sex with you
• being laughed at for not having sex with your when you know he has another lover
girlfriend • boyfriend or husband, or new partner
• being laughed at for wanting to use a wanting you to have sex with him without a
condom condom, when you want to use one
• being ridiculed for not having several • school teacher bribing student with higher
girlfriends grades in return for sexual favours
• being laughed at for sticking with one • man at market suggesting sex in return for
woman, or for not wanting a girlfriend groceries
• being ridiculed for wanting to study instead • boyfriend putting pressure on you to have
of idling with your friends sex with him
• being lured/trapped by an older woman; • husband or boyfriend wanting you to have
maybe in return for money or alcohol sex with him when it is late and you are tired
• being lured/trapped by an attractive young • being laughed at for not wanting to have a
woman boyfriend or to get married yet
• young woman not wanting to use a condom • being laughed at for wanting to study,
because she thinks it means you think she’s a instead of loitering with your friends
prostitute. • uncle wanting you to have sex with him, in
return for money
• boss saying you will get promoted if you
have sex with him
• wanting to have sex with someone, but no
condoms available.
2. Ask participants:
• How did people deal with the bait they were offered?
• How do they usually respond to similar situations?
• Which responses are most effective and why
• What could they do differently?
This activity reinforces the use of assertive skills in talking yourself out of difficult situations as
opposed to avoiding the problem or attacking individuals.

Stepping Stones
ACTIVITY A.3: TRUST (20 minutes)

Materials needed:
Purpose: To review the good attributes of a healthy relationship
Description: Role play and discussions.
Directions:
1. Divide participants into two groups
2. Ask each group to develop a role play on the scenario below.

Then ask one group to present their role play.
Role Play: Bernard, a fisherman is married to Anne and they are blessed with two children, John and
James. He is a caring man and provides well for his family. During one of his long fishing trips, Anne,
the wife, is approached by a neighbor for sex and she consents. Meanwhile, due to peer pressure,
Bernard is trading fish for sex at the landing beaches.
3. Then brainstorm using the following guiding questions

• Think of some words which describe the quality of the relationship between the husband and his
wife.
• What are the good things about their relationship?
• What are the bad things about it?
• Was the husband right or wrong to provide for his family and get involved in risky sexual behaviour?
Why?
• If the couple lives within our community, what would be other people’s attitudes to them?
• Qualities of a good relationship include trust, respect, caring for each other, cooperation,
planning ahead, shared support and responsibility.

Facilitator Guide
Activity A.4: THE LONG JOURNEY (15 Minutes)
Purpose: To help people prepare for any eventuality.
Description: Participants reflect on going on a long journey and plans to put in place,
followed by feedbacks and discussions.
Directions:
1. Explain to the participants that you would like them to consider the following situation. They should
imagine that they are preparing to go on a very long journey in a month’s time. They do not know when
they will come back to their homes if ever. Ask them to reflect and answer the following questions:
a. WHO would you like to speak to before you go?
b. WHAT would you like to say to each of them?
c. WHAT would you like to do before you go?
d. WHO would you trust to look after your land and possessions well, while you are gone?
e. HOW would you ensure that your wishes were fulfilled in your absence?
2. Request 3 volunteers to share their responses with the group
3. After they have shared, ask participants:

• What did they learn from this exercise?
• In what way does it relate to real life?
• Did they find the exercise scary? helpful? encouraging? difficult?
Any other emotions can be mentioned
• How would they have felt if they had to go on the journey tomorrow,
without being given any notice?
• The idea of this exercise is to help us come to terms with all forms of loss, including death. In
many societies it is virtually impossible to talk about death. People often believe that talking
about death will make someone die. This exercise is a way of helping us face loss, including
death more calmly, by preparing ourselves for it in some way. None of us knows when we
are going to lose something we value like say our sight, limbs or even die. We may be ill
and expect to die in a month or two, hit by a car or drown in the lake. Therefore perhaps it is
better for all of us to prepare for any eventuality, including our deaths ahead of time, instead
of going on hoping that we won’t die this week or month or year.
• It is often easier for us to believe that death won’t happen to us! This denial is a normal human
reaction to something which is frightening. On the other hand, experience has shown that
helping people to overcome denial and accept the future can bring them enormous relief, can
make them feel much stronger and more prepared to face whatever happens.

Stepping Stones
Session Wrap up & Preparation

for the final Workshop (20 Minutes)
1. Ask everyone to sit in a circle and sing a common song as they clap a rhythm. Join in yourself.
2. Explain to the participants that this is the last workshop session before the Final Open Community
Meeting. Therefore you would like to ask them if they have any interest in the continued existence of
this peer group, as a regular meeting point for future discussions of these kinds of issues.
3. Review the major issues presented during the first full workshop and prepare to present them in the final
open community meeting using the “I” statement.
4. Select a participant who will present during the Final community meeting.
5. Conclude by thanking everyone for attending this session. Check with everyone that they all know the
time and location and can come to the Final Open Community Meeting. Remind them that this meeting
is going to be for all who wants to come from the community - not just for the workshop participants.
Encourage them to bring anyone else who would like to come.
Note: This final open community meeting will also serve as First community for recruitment of new
participants).

Facilitator Guide
GRADUATION CEREMONY

Purpose: To consolidate what has been learned and prepare for the future.
Time Needed: 1 hours.
Materials Needed: A long strong rope, Flip charts (I statements from previous session),
Certificates (of attendance),
Description: Peer groups to share their special requests among themselves and to the key stake
holders. Ensure that the biomedical services are available on this day. Remind
participants about the services.
Participants: All workshop participants and Key stakeholders.
Directions:
• This session should take place after the four peer group’s end with Session 7.
IF IT ENDS ON FRIDAY THEN THE WEEKEND WOULD BE IDEAL NOT A WEEK INTERVAL.
• Your participants may like to turn this graduation ceremony into a bit of a celebration.
You can have songs at the beginning.
• The “I” statements should be summarized and given to the leaders available during this celebration.
• Leaders should be given time to share actions to be taken with regards to the requests.
INTRODUCTION 10 min
Purpose: To complete the workshop and to present some of its findings to the community in
form of special requests.
Description: A presentation from peer groups followed by public discussions.
Directions: As in the previous public meetings, the lead facilitators should do any talking
required. The following points need to be made to the audience:
1. Thank everyone for sparing their time to come to the meeting.

Give a special welcome to any community leaders or other officials who may have turned up.
2. Reintroduce yourself and let each of your co-facilitators reintroduce themselves to the audience.
3. Explain that there has been an intervention called stepping stones workshop running in the community
in recent weeks. This meeting today will provide everyone with an opportunity to see and hear a bit
about what the participants have done in the workshop. It will also present some special requests from
the participants to one another and to the entire community.

Stepping Stones
4. Say that you have often used games during the workshop, to lighten the proceedings and to illustrate
some of the issues which you have been discussing. Say that you would like to ask the participants now
to come forward to play together one of the games which they played (tug of war and peace),
for everyone to see.
5. Ask each peer group to demonstrate one of the exercises that was most captivating and interesting.
Ensure the problems identified in the sessions are the ones demonstrated and discussed.
6. Now ask the community members what this game illustrates to them.
Facilitator note:
That is part of the exercises in the stepping stones. We encourage others to join the sessions
beginning after graduation.
7. The facilitator identifies and informs the senior community leader to remind the participants that they
need continued support and hard work from each other towards behavior change. No-one can change
the habits of a lifetime in a few weeks.
8. The senior community leaders or key stakeholders to make a few remarks and presents certificates to
participants.
9. Conclude the proceedings by thanking all the participants for their great support and hard work
throughout the workshop. Also thank the community leaders for their support. Announce that the
facilitators will be recruiting participants for the next sessions.
Finally, congratulations to you!

You have now completed this workshop.

Facilitator Guide
APPENDIX 1: ENERGIZERS
ACTIVITY 1: THE STRAIGHT LINE
Aims: To help participants experience the value of team support and cooperation.
Description: Participants take it in turn to walk in a straight line blindfold across the meeting
area. First they have silence and no guidance. Next they have a
lot of encouragement and advice.
Directions:
1. Provide a blindfold, a scarf would do.
2. Invite a volunteer to come forward to walk slowly in a straight line across the meeting area.
Put the blindfold on him/her and turn him/her around several times before s/he sets off in a straight line
across the meeting area, to reach an agreed point on the opposite side.
3. Instruct the rest of the group to keep completely silent, giving no encouragement or guidance at all.
They should also not touch her/him.
4. When the blindfolded person reaches the other side, ask her/ him to take off the blindfold.
Compare how close s/he is to where s/he intended to reach.
5. Ask her/him how s/he felt about having no commentary from the others.
6. Ask her/him to replace the blind¬fold and repeat the exercise, this time with the verbal encouragement
ol the others. They should still not touch her/him. Then finally, they could repeat the exercise with the
participants using their hands to guide the blind¬folded person, as well as talking to her/him.
7. On completion, remove the blindfold again and repeat stages four and five above,
this time asking how il felt with commentary.
8. Repeat the exercise with two or three other volunteers.

Group members are enabled to experience how much safer they feel with the support of their group around
them. This exercise emphasizes the importance of trust and mutual support in life.
Encourage them to talk about these issues, by asking them how their experience in this exercise relates to
their real life experiences.
• You may need to explain to participants that this is not intended as a competition.
You can explain how we are exploring the advantages of group work over working alone:
and how useful listening can be to us!


Stepping Stones
ACTIVITY 2: LISTENING PAIRS
Aims: To help people realize the importance of listening skills to good communication.
Description: Participants work in pairs, taking it in turns to speak. As one speaks, the other
first listens carefully to what they say, then stops listening. A plenary session with
discussion and summary follows.
Directions:
1. Describe to participants how we will need to do a lot of listening to one another in this workshop. In this
exercise we are going to look together at the skills of good listening.
2. Describe what you want participants to do. They will be asked to divide into pairs, finding someone to
work with. Then one of them should start by describing to the other an event in her/his life which made
her/him feel very happy. The listener should say nothing, but should just concentrate hard on hearing
what is being said. After a couple of minutes, you will ask the listeners to stop listening. At this stage,
the speaker should continue to describe her/his happy experience, but the listener should stop listening
completely. S/he could yawn, look elsewhere, turn round, whistle, do whatever s/he likes: the important
thing is that s/he should no longer listen, although the speaker should continue to tell the story. After
a couple of minutes again, you will call “Halt”. At this stage, the speaker and .listener should change
roles. The two stages of the exercise should ‘then be repeated, with the former listener now becoming
the .speaker and the former speaker now becoming the listener.
3. Once you are sure that everyone has understood the instructions, ask everyone to break into pairs. Then
call out “Start”, and time each section of the exercise for two minutes. Thus the whole exercise should
take eight minutes.

Ask participants how they felt first as speakers, encouraging them to compare telling their story to a willing
listener and telling it to a bad listener.
Then ask participants to describe and compare how they felt as good and bad listeners. Ask participants to
describe some of the attributes of good listening which they experienced; and then some of the attributes
of bad listening. Ask participants in what other ways we communicate with one another, apart from
through language. When someone mentions body language, explain that by being aware of our own body
language, we can often change it, in order to communicate a different mood to others around us. This is
what we are going to look at next.

Facilitator Guide
ACTIVITY 3: MIME THE LIE
Aims: Warm-up game. Shows also in a funny, obvious way that what people say they are
doing is not necessarily what they are really doing!
Description: Each person in turn mimes an action and, when asked, says s/he is doing something
else. The next person has to mime what the previous person said s/he was doing.
Directions
1. Ask everyone lo stand in a circle. You start by going into the middle of the circle and mime an action,
such as getting dressed Ask the person who was next to you in the circle lo ask you aloud what you are
doing. You reply by saying out loud, for example, “I am digging the ground!” Everyone will laugh! Next,
ask the person who asked you now to enter the circle instead of you and to mime what you said you
were doing.
2. When her/his neighbour asks what s/he is doing, s/he also lies, and so the game continues, until
everyone in the circle has had a go at doing one thing and saying they are doing something else.
• This is a good warm-up exercise, because it makes everyone laugh and includes everyone. It is
also useful to refer back to later in the session: we often say we are doing one thing, while in fact
we are doing else. We may also lead others into problems if they don’t see through our lie.
ACTIVITY 4: FRUIT SALAD
Aims: Energiser.
Description: Person in middle of sitting circle calls out and others have to move their position
Directions:
1. Stand in the middle of the sitting circle. Everyone but you needs to have an established place to sit. For
instance, it participants are sitting on mats, agree how many should be sharing each many before the
game begins.
2. Ask the participants to choose three different fruit names. Then go round the circle, naming each
participant in turn with these fruit. For instance, the first person could be a mango, the next a banana,
the third an orange. The fourth would then be another mango. Go round the whole circle until
everyone, including yourself, has one of the three fruit names.
3. Next explain that you are going to call out one ol the fruit names. Everyone with that name has to jump
up and find somewhere else to sit. You are also going to find a place to sit. The person who doesn’t find
a new place will be lell in the middle and will have to call out the next fruit.
4. Add that if someone calls out “fruit salad’’, then everyone has to jump up and find another place to sit.
• This game is good at making people laugh and waking them up. To end the game finish up in the
middle again yourself try being slow to move. Then say it is time to move on to the next exercise.

Stepping Stones
ACTIVITY 5: PASS THE PICTURE
Materials needed: Flip chart, marker pens
Aims: Fun warm-up game, to illustrate different people’s perceptions of what they hear.
Description: A picture is drawn and described in words to others, who try to reproduce it.
Directions:
1. Ask for five volunteers to leave the training area for a few minutes, until they are called back.
2. Bring out a piece of flip chart paper and ask the remaining people to agree on a picture, and for two or
three people to draw it, it could include, say, a person, a house, a tree and some animals. Do not make
it too complicated.
3. Then hide tho picture and ask someone to call the five volunteers back to the group.
4. One volunteer is then shown the picture. This volunteer must then describe the picture in words to the
second volunteer, who in turn describes it to the third volunteer and so on.
5. When the fifth volunteer has heard a description of the picture, s/he should be handed a new piece of
flip chart paper and some marker pens. S/he should then try to draw the picture as s/he understands it
to look from the description. S/he should receive no help from the rest of the group.
6. When s/he has finished the picture, compare it with the original picture. There should be some
interesting differences!
7. Thank the live volunteers for their willingness to help. Point out that it is often much harder than we
suppose for us all to understand things in the same way.
ACTIVITY 6: PRRR AND PUKUTU

Aims: A quick exercise to make everyone laugh and move. This kind of exercise is
important after such a thought-provoking previous one.
Description: As everyone stands in a circle, they have to react to what you call out.
Directions:
1. Ask everyone to stand in a circle. Explain that you would like them to think of two birds.
One calls “prrr” and the other calls “pukutu”.
2. If you call out “prrr”, all the participants need to rise up on their toes and move out their elbows
sideways, as if they were a bird ruffling its wings. If you call out “pukutu”, everyone should stay still and
not move a feather!
3. Proceed, by calling out “prrr” or “pukutu”. Anyone who moves when they shouldn’t, or who stays
still when they should move, has to fall out of the game. They can then help you to watch the other
participants. Go on until you have just a few people left in the circle. Everyone should have had a good
laugh.

Facilitator Guide
ACTIVITY 7: JUNGLE
Aim: To lighten the mood. To energise everyone with laughter and movement.
Description: Variation on “Fruit Salad”, but with three animal names instead of fruit names!
ACTIVITY 8: O HENRY!
Aims: Energizer, to make people laugh. To help people realize the power of the way in
which we express language to communicate our feelings to others.
Description: Participants each have to say “O Henry” (or appropriate name) round the circle, one
after the next.
Directions:
1. Stand in a circle. Explain that, as we learnt together in our first session, there are many different ways of
communicating with our bodies.
2. Explain how this game will illustrate how different uses of our voices combined with our bodies can also
communicate a lot to others.
3. Take a common name in the community perhaps you could choose a name chosen by one of the peer
group for session G.2. Using this name, and saying “O******” (substituting the name for the stars) show
how you can say it with anger, with fear, with sexiness, with laughter. You give an example of these first.
4. Ask each participant in turn in the circle to say “O *******” using the same name each time. Ask each
one to try to say it in a different way, expressing a different feeling NB: If in your community, a husband,
and wife are not allowed to use, each other’s names to each other, perhaps you could also do this
exercise using the locally acceptable word tor “O wife” or “O husband”.
5. When everyone has had a go, ask participants to analyse what they have learnt from this. Points they
may raise may include loud or soft voices, confident or unconfident voices, emphasis, facial expressions,
eye contact, body language and so on.
6. Encourage everyone again to repeat the phrase in turn. This time they should convey a different
message through the phrase than the one they have previously conveyed.

Stepping Stones
ACTIVITY 10: TOUCH SOMETHING BLUE
Aims: An energiser, to get people moving around and laughing.
Description: A game of tag.
Directions:
1. Ask everyone to stand up. Then explain that you will call out to everyone to find something blue around
them and that they should touch it. This could be someone’s blue shirt or scarf, a shoe - whatever.
2. Then call out “Touch something green!” and everyone should run to touch a green object. Next “Touch
your toes!” or “Touch someone’s ear!”, “Touch that tree over there!” or whatever.
3. Ask other people to join in with their own suggestions.
ACTIVITY 11: THE YES/NO GAME
Aims: Cheerful exercise. To show how many different ways we have of making use of these
two common words which we all use.
Description: Participants have an argument with each other, using one word each.
Directions:
1. Ask participants to stand up and split into two groups. One group should stand in a line facing the
centre of the training area, the others should stand in a line facing them.
2. Explain that one group is the “yes” group and the only word they can use is “yes”. The other group is
the “no” group and this is the only word they can use.
3. Each group needs to try to convince the other group of the truth of its own statement, but can only use
the one word, yes or no, each.
4. After a minute or so, get the groups to swap roles, with the “yes” group saying “no” and vice versa.
5. After another minute, ask participants to describe how they felt doing this exercise, including comments
on body language, use of attacking or avoiding stances, laughter etc. Explain how laughter too is an
important means of expression it can be a good equaliser at times, but at others can be very harmful.

There are so many different ways of saying yes and no, ranging throughout the emotions. It is good for us
to have a go at saying them in different ways. Each different way can have its own separate effect on others.

Facilitator Guide
ACTIVITY 12: I’M GOING ON A TRIP
Aims: Warm-up exercise, fun, laughter.
Description: A memory game, with actions.
Directions:
1. Ask the participants to stand in a circle. Start by saying “I’m going on a trip and I’m taking a hug.”
Hug the person to your right.
2. S/he then has to say: “I’m going on a trip and I’m taking a hug and a pat on the back”.
S/he then has to give the next person a hug and a pat on the back.
3. Go on round the circle, until everyone has had a go, with each person repeating what was said and
done before and adding one new action to the list. If someone forgets the sequence, encourage the
others to help him or her to do it right.
ACTIVITY 13: TRUST GAME
Aims: A fun exercise, involving trust between participants. A re-focusing exercise.
Description: Participants take it in turns to fall blindfold, being caught by their colleagues.
Directions:
1. Ask all participants to stand together in a small circle in the middle of the training area.
2. Each participant in turn should stand in the middle of the circle and then close their eyes or put on a
blindfold. S/he then falls backwards, sideways or forwards, keeping the eyes closed, and will be caught
in the safety of the arms of the other participants.
3. Each participant needs to have live or six quick goes at this before someone else goes in the middle
and puts the blindfold on. It can feel quite scary at first, but should be perfectly safe provided the group
work together.

Stepping Stones
APPENDIX 2: FACT SHEETS

Cervical Cancer
What is Cervical Cancer?
Cancer is a condition in which there is abnormal cell growth in the cervix.
Who is at high risk of getting cervical cancer?

Women who are HIV positive,women who engage in sexual intercourse at early ages,
women with multiple sexual partners and whose male sex partners are not circumcised
What are the symptoms?

• Bleeding after sexual intercourse
Diagnosis/ Screening
All sexually active women should be screened at least once every year
Treatment
Seek medical advise (there are available methods for treatment especially earlier on in the condition)
Prevention
• Vaccination for Human Papilloma Virus protects agains cancer of the cervix
• Delay sexual debut
• Reducing sexual partners
• Encouraging male sexual partners to get male circucision
PMTCT
A woman who is HIV-infected can pass HIV to her baby during:
• Pregnancy
• Childbirth
• Breastfeeding
Can one reduce the risk of transmitting HIV to their baby?

Yes, there are medical interventions that can reduce the risk.
• Attending antenatal clinics
• Adherence to medication
• Treatment to other ailments
When one is pregnant, they:

Need to get tested to learn their HIV status. If they know they have HIV, they can lower the risk of passing
the virus to their baby. They need to:
• Learn about the medicines that can reduce the risk of passing HIV to their baby
from a health care provider.
• Learn about feeding options to reduce the risk.
Will a HIV positive woman still be able to breastfeed her baby?

Yes, there are ways of making breast feeding safer, this include exclusive breast feeding for the
first 6 months and giving the baby certain medicines that can reduce the risk of acquiring HIV.

Facilitator Guide
REPRODUCTIVE HEALTH/
FAMILY PLANNING (RH/FP) FACT SHEET
What is Reproductive health?

RH implies that people are able to have a satisfying and safe sex life and that they have the capability to
reproduce and the freedom to decide if, when and how often to do so
What is family planning?

FP is educational, comprehensive medical or social activities which enable individuals, including minors,
to determine freely the number and spacing of their children and to select the means by which this may
be achieved.
What methods of Family planning are available?

• Hormonal
o Implants
o Pills
o Injectibles
• Non hormonal
o Condoms
o Vasectomy
o Tubal Ligation
• Natural methods
o Lactation ammenorrhea
o beads
What other RH services are available apart from FP?

• Counselling before having a child
• Cervical cancer sreening
• Antenatal care
• Post natal care
• Post abortion care
Who can utilize RH/FP services?

All male and women of child bearing age who are sexually active
Can I afford FP/RH services?

Most of the services are free and available in most of the health facilities
but a few may require payment of a small fee.
Who provides FP/RH services?

Trained health care providers.

Stepping Stones
Contraception/Birth Control Methods
Contraceptive Methods:
There are a variety of methods available for preventing pregnancy. However, with the exception of
the condom, it is important to note that none of these methods protect against HIV or other sexually
transmitted infections. It is recommended that sexually active couples who want to prevent pregnancy use
condoms AND another form of birth control, which will provide additional protection against pregnancy.
Condoms
There are both male and female condoms. The male condom is the most widely used male contraceptive.
A variety of condoms are available as contraceptives, but only those made of latex or polyurethane are
able to prevent the transmission of STIs and HIV. Condoms are relatively inexpensive and can be obtained
without a prescription or doctor’s exam. Condom failure is often the consequence of incorrect use; there-
fore, one should be educated in the proper use of a condom. Condoms must also be used consistently (i.e.
every act of sexual intercourse) to be effective. For more information on condom use, see the fact sheet on
condoms.
Oral Contraceptives/Birth Control Pills

Oral contraceptives, often called “the pill,” are a widely used method of birth control.
They are usually available at public health facilities after medical checkups. A combination of synthetic
hormones in the pill stops the ovaries from releasing eggs, thus preventing fertilization.
The pill must be taken every day at approximately the same time to be effective.
The pill can also reduce a woman’s risk for diseases such as anemia and ovarian cancer.
Yet the pill sometimes has side effects for some women. Anyone taking oral contraceptives should be under
the continuing care of a health provider and receive yearly gynecological exams. This method does not
protect against HIV or other STIs.
Emergency contraceptive pills (ECP)

ECP is a method that can be used AFTER a woman has had unprotected sex. Several pills must be taken
immediately after unprotected sex (or up to 2-3 days) and another set of pills must be taken 12 hours later.
However, it is an emergency measure, and should not be considered as a regular form of family planning.
Diaphragm
The diaphragm is a bowl-shaped flexible cup that is inserted into the vagina to cover the cervix and prevent
sperm from entering the uterus. They are used with spermicidal creams or jellies, since the diaphragm alone
isn’t 100% effective at stopping sperm.
They can be inserted up to 6 hours prior to intercourse, and can be left in place for 24 hours afterward.
Checks for diaphragm fit should be conducted regularly.
Potential side effects of using a diaphragm include irritation, bladder infections, and most significantly, toxic
shock syndrome. This method does not protect against HIV or other STIs.
Depo Provera
Depo Provera is a long-lasting birth control method that involves the injection of a synthetic hormone
(progestin) every 3 months. This drug has been found to be almost 100% effective in preventing pregnancy.
However, some women experience negative side effects such as headaches, weight gain, and change in sex
drive. This method does not protect against HIV or other STIs.

Facilitator Guide
Intrauterine Device (IUD)

The IUD is a plastic object that is medically inserted into a woman’s uterus. The IUD contains copper or a
hormone that prevents sperm from joining with the egg. While often very effective in preventing pregnancy,
IUDs may cause menstrual cramping, tubal pregnancy, and infection. This method does not protect against
HIV or other STIs.
Norplant
Norplant is a long-term birth control method that involves the insertion of six soft capsules (about the size
of a matchstick) under the skin of the upper arm. The implant releases synthetic progestin hormone over a
five-year period that prevents the ovaries from releasing eggs. Norplant may cause a range of side effects.
This method does not protect against HIV or other STIs.
Sterilization
Male sterilization is a permanent contraceptive method. A simple minor operation is performed so that
sperms produced in the testes can no longer travel to the penis. A man can still have sexual intercourse
and release semen (ejaculate), but semen will no longer have sperm. This method does not protect against
HIV or other STIs.
Sexually Transmitted Infections

What are sexually Transmitted Infections (STIs)?
STIs are infections that are spread by having vaginal, oral or anal sexual contact with another person
who has the infection. Some STIs are curable, but some are not.
What are the symptoms of STIs?

Symptoms of some STIs can be painful or uncomfortable, while other STIs may have no noticeable
symptoms at all. The symptoms listed below are commonly associated with STIs.
For women:
• Sores, bumps, or blisters near the genitals, anus, or mouth
• Burning pain with urination
• Pain during sexual intercourse
• Itching, bad smell, or unusual discharge from the vagina or anus
• Pain in the lower abdomen, below the belly button
• Bleeding from the vagina between menstrual periods
For men:
• Sores, bumps, or blisters near the genitals, anus, or mouth.
• Burning or pain with urination
• Drip or discharge from the penis
• Itching, pain, or discharge from the anus
How are STIs treated?

Specific treatment is given for each curable STI. For some, treatment involves taking pills or getting an
injection to kill the organism that caused the STI. Some STIs, such as herpes and genital warts, are viruses
and cannot be cured, but treatment can ease the symptoms and stop more damage to the body. Treatment
for sexually transmitted infections should only be obtained from a qualified doctor.
Are the fisher folk at risk of STIs?

Yes. Many STIs, including Chlamydia, gonorrhea, trichomoniasis, genital herpes and warts are very common
among fisher folk.

Stepping Stones
Why are fisher folk at increased risk for STIs?

Due to frequent use of drugs and alcohol which is common among the fisher folk, they intend to engage
in other risky behaviors, such as unprotected sex, multiple sex partners, exchange of fish for sex which
potentially exposes them to STIs.
Why don’t fisher folk who are having sex protect themselves from STIs?
Fisher folk may:

• Have myths and misconceptions concerning condom efficacy.
• Not have condoms available or not know how to get or use them.
• Be embarrassed about having or getting condoms
• Feel pressure from their partner to have unprotected sex
• Use alcohol or drugs, which may impair their judgment
• Lack knowledge about the risk of STIs
• Be embarrassed to ask questions about STIs or sex
• Not think about the risks ahead of time and so are not prepared
• Believe using birth control pills will protect them
Can you get an STI from kissing someone?

This is possible but not very common. If your partner is infected with an STI such a herpes, which can be
present in the mouth (shown by fever blisters or cold sores), then it is possible for you to contract herpes by
kissing him or her. It is also possible to transmit the infection between one partner’s mouth and the other’s
genitals and vice versa during oral sex. Blood borne infections like HIV or hepatitis B or C can only be
passed through kissing if there is the exchange of infected blood.
Can I have an STI without knowing it?

Yes. It may take weeks, months or even years before symptoms of an STI are noticeable, and sometimes
symptoms never appear. However, transmission can take place even without symptoms being present.
How do I know if my partner is infected with an STI?

You may not know your partner is infected unless he/she tells you. And since some STIs do not show
any symptoms, your partner may not even know if he or she is infected. If you or your partner do have
symptoms of an STI, it is important to get tested and treated immediately, and to notify your sex partners so
that they can get treated as well.
Where do I go to get tested for STIs?

You can go to any public hospital, to a local health center, or to an STI clinic.

Facilitator Guide
Common STIs
Chlamydia
• Chlamydia is caused by bacteria transmitted during sexual contact.
It can be transmitted from mother to child during childbirth.
• Chlamydia is a very common STI, especially among young people
• If left untreated, chlamydia in women can cause a more serious illness called
pelvic inflammatory disease (PID), which can prevent a woman from being able to have children.
• Symptoms: Can include pain or burning with urination in men and women and penile or vaginal
discharge. Also, women may experience lower abdominal pain or pain during sexual
intercourse.
• Treatment: Chlamydia can be cured with antibiotics, and should be treated early.
Gonorrhea
• Gonorrhea is caused by bacteria transmitted during sexual contact.
It can be transmitted from mother to child during childbirth.
• Like chlamydia, untreated gonorrhea can cause serious health problems in women.
• Symptoms: Women often have no symptoms or very mild ones, including pain with urination and/or
vaginal discharge. Men’s symptoms can vary from mild to severe, and can include penile
discharge and/or burning with urination.
• Treatment: Gonorrhea is easily treated with antibiotics or penicillin.
Syphilis
• Syphilis is a bacterial infection spread through sexual contact, and can also be
passed from a mother to a child during birth (congenital syphilis).
• Symptoms: Symptoms of syphilis occur in stages. First, sores appear in the genital area, which are
usually not painful. The disease then reappears as a rash on the bottoms of the feet or
palms of the hands. Blindness or brain damage can occur up to 30 years later.
• Treatment: Penicillin can cure syphilis at any stage of the disease, but damage cannot be reversed.
Trichomoniasis
• Trichomoniasis, or “trich,” is a common vaginal infection.
• Trich is caused by a sexually transmitted protozoan. Protozoa are small organisms made up of a cell or
group of cells which are only visible under a microscope.
• Symptoms: Men rarely have symptoms. In women, symptoms include foul, fishy or musty smelling
discharge; itching, irritation, redness or soreness in or around the vagina, vulva or thighs;
and painful and more frequent urination.
• Treatment: Trichomoniasis can be treated with antibiotics.
Hepatitis
• Hepatitis is a very dangerous virus that affects the liver.
• There are 3 forms of the virus: hepatitis A, hepatitis B, and hepatitis C.
• Hepatitis B is the most common form of the virus, and is often spread through sexual contact.
It is highly transmissible.
• Hepatitis is treatable, but not curable. There are vaccines available to prevent being infected with
hepatitis A and B. Ask a doctor for more information.
• Symptoms: Yellowing of the eyes and skin, abdominal pain, nausea or vomiting, fever, fatigue, and
darkening of the urine.
• Treatment: There is no cure, but pills or injections can treat the symptoms

Stepping Stones
Herpes
• Herpes is transmitted through direct skin-to-skin contact, when an infected area comes into contact with
a mucous membrane, such as in and around the genitals.
• The majority of genital herpes infections are caused by Herpes Simplex
o Virus type II (HSV-2), and the majority of oral herpes by Herpes Simplex
o Virus type I (HSV-1). However, both types can occur in either area.
• Herpes can be transmitted when no symptoms are present.
Some people may be infected and never experience symptoms.
• Herpes can be transmitted from mother to child during childbirth.
• Symptoms: Symptoms can vary widely, but often include pain or burning while urinating, and
groups of small bumps or blisters around the genital area, upper thighs and
buttocks. Other symptoms can include swollen lymph nodes, fever, and flu-
like symptoms. Symptoms are almost always much worse at the initial outbreak than
for subsequent outbreaks.
• Treatment: There is no cure, but various antiviral medications can treat the symptoms or
shorten the outbreak.
Human Papilloma Virus (HPV), or Genital Warts

• HPV is a viral infection, which causes genital warts, and is usually spread by direct, skin-to-skin contact
during vaginal, anal, or oral sex with a partner who has the virus.
• There are many different types of HPV. Some are not dangerous, while others may be linked to the
development of cervical, anal, or penile cancers. Therefore, anyone who is sexually active should receive
a yearly physical exam and yearly STI screening.
• Symptoms: While sometimes the virus is hidden, or latent, other times visible bumps or warts will
develop in the genital area. Some women will have abnormal changes on their cervix,
which is found by a Pap smear.
• Treatment: Sometimes the warts may go away by themselves. There are ways to remove the warts,
including liquids, gels, freezing, or burning.

Facilitator Guide
HIV/AIDS
• HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency
Syndrome). HIV gradually kills the cells in the immune system that fight off infections and diseases.
AIDS is the last stage of HIV infection. Once the immune system is weakened, the body cannot fight
off certain “opportunistic” infections that define AIDS, such as a specific type of pneumonia, certain
cancers and eye infection. Without the immune defense, these infections lead to death.
• HIV is transmitted through blood, seminal fluid (pre-cum), semen (cum),vaginal fluids, and breast milk.
HIV can be transmitted from mother to child during childbirth. Unprotected sex (intercourse without a
condom) is the main way that HIV is transmitted.
• HIV is not transmitted through insect bites or pets. It is not transmitted through sharing food or drink, by
kissing or hugging, swimming together or sharing towels, or using public restrooms.
• Symptoms: Many people do not have any symptoms for up to 10 years after infection with HIV, and
may not feel ill until they develop AIDS. However, HIV can always be transmitted, whether
symptoms are present or not.
• Testing: Many places offer HIV testing, including public health centers and hospitals, youth clinics,
and VCT centers. If you get an HIV test, be sure you choose a place where they offer pre-
and post-test counseling (someone to talk to you about the test procedure beforehand
and discuss the test results with you afterward).
• Treatment: Many new medications are available that can treat and manage HIV, improving an
individual’s health and allowing them to live for many years before they develop
AIDS. However, HIV is not curable but is a chronic disease that can be managed but
requires daily intake of drugs.
Correct Condom Use

• The surest way to prevent STIs, including HIV, is to abstain from sex. However, when engaging in sexual
intercourse, latex condoms, when used correctly and consistently, are the most effective way to protect
against STIs and HIV.
What is AIDS?
• AIDS is a disease that is caused by HIV (human immunodeficiency virus). AIDS stands for Acquired
Immunodeficiency Syndrome. Acquired refers to the fact that the disease is not hereditary but is
contracted from contact with a disease-causing agent (in this case, HIV).
• Immunodeficiency means that the disease is characterized by a weakening of the immune system.
• Syndrome refers to a group of symptoms that collectively indicate or characterize a disease. In the case
of AIDS this can include the development of certain opportunistic infections as well as a decrease in the
number of certain cells in a person’s immune system.
What causes AIDS?

• AIDS is the end result of an infection caused by a virus called the human immunodeficiency virus, or HIV.
Can AIDS be cured?

• Currently, there are no drugs available that will completely destroy HIV or fully restore the immune
system of an infected person. However, there are antiretroviral drugs that can help control the
replication of the virus and immune system damage. Opportunistic infections that come as a result of
weakened immune system can also be managed.

Stepping Stones
How is HIV Transmitted?

• HIV, the virus that causes AIDS, can be transmitted from one infected person to another through
blood (including menstrual blood), semen, vaginal secretions, and breast milk. HIV is spread through
unprotected sexual intercourse with an infected person, and through sharing drug needles or syringes
with an infected person. Women infected with HIV also can pass the virus to their babies during labor,
delivery, birth, or during breast feeding.
Can you get HIV by kissing?

• No. HIV has rarely been found in human saliva, tears, sweat, feces and urine. However, kissing an
infected person with wounds or bleeding gums may increase one’s chances of getting infected.
Can you get HIV from casual contact?

• No. Transmission of the virus takes place during behaviors in which bodily fluids are exchanged
including semen, vaginal secretions, blood, embryonic fluid, or breast milk. People can, for example,
work with others, attend school and public events, eat together, and be around members of high-risk
groups without the fear of getting HIV. Persons caring for family members who have AIDS are not at
increased risk of contracting the virus.
How do I know if I have HIV?

• The only way for a person to know if he or she has HIV is by going for an HIV test.
HIV testing is often referred to as VCT (voluntary counseling and testing).
What are the symptoms of HIV?

It is difficult to know whether or not someone is infected unless they go for an HIV test, since many people
do not show symptoms for a few years.
When symptoms occur, they include the following:
Major symptoms:
• Severe loss of body weight (more than 10% in one month)
• Continuous severe diarrhea for longer than a month
• Continuous coughing for more than a month
Minor symptoms:
• Loss of hair
• Loss of appetite
• Fever
• Headaches
• Drenching night sweats
• Fatigue
• Shortness of breath
• Difficulty swallowing

Facilitator Guide
What can an individual do to keep from getting HIV?

• People can reduce their risk of contracting HIV by practicing responsible behaviors relating to sexual
expression and drug abuse. The sexual precautions include sexual abstinence, being faithful to one
partner, avoiding exchange of bodily fluids by using a condom and avoiding sexual partners who are
engaged in risky sexual behaviors. Responsible behaviors regarding drug abuse include abstaining from
using drugs and avoiding sharing needles and syringes. Men can also reduce their risk of contracting
HIV by getting circumcised. For more information about male circumcision, see the Male Circumcision
Fact Sheet.
What drugs or substances are associated with getting HIV?

• The use of alcohol and drugs is associated with the transmission of HIV. These drugs impair one’s
judgment leading to high-risk activities such as having unprotected sex. Using drugs that are injected,
such as heroine, can also lead to HIV transmission if needles and other sharp objects are shared.
What is done for people who develop AIDS?

• Persons living with AIDS need both medical and social support services to help them cope and live with
their condition. These types of assistance are becoming increasingly available. After receiving a positive
test result, people are referred to patient support centers where there is counseling and management
of opportunistic infections. HIV-positive patients may also access antiretroviral drugs which can improve
health and allow patients to live longer.
What are condoms?

• A male condom is a flexible sheath, usually made of thin rubber or latex, designed to cover the penis
during sexual intercourse to prevent sexually transmitted infections and as a means of preventing
pregnancy.
• A female condom is worn by women in the vagina during sexual intercourse. It is a thin, loose-fitting
pouch that contains a flexible ring at each end. It provides a physical barrier and collects semen and
sperm when the man ejaculates. It also provides protection against sexually transmitted infections.
How effective are latex condoms?

• Laboratory studies show that both male and female latex condoms are very effective in preventing
transmission of HIV and other STIs.
What does “consistent and correct use” mean?

• Successful prevention of STIs and pregnancy depends on proper condom use as most condom failures
are due to human mistakes. Using condoms consistently means using a condom every time a person has
anal, oral or vaginal sex.
Where can I get condoms?

• You can get condoms in hospitals or health clinics, in VCT sites, and in other public places like stores,
vending machines, restrooms, airports, and hotels.

Stepping Stones
Correct Condom Use

• To correctly use a condom, the following steps should be observed:
• Store condoms in a cool dry place. Do not store condoms in your pocket, as heat damages condoms.
• Before using a condom, check the package for the expiration date and for rips or tears. If the condom
has expired, or if the package is damaged, use a new condom.
• Some condoms are already lubricated, but if you plan to use lubrication, use a water-based lubricant, as
oil-based lubricants such as Vaseline can damage a condom.
• The penis should be erect (hard) when the condom is put on. Also, the condom should be put on before
the penis touches the vagina, anus or mouth.
• Carefully open the condom packet—don’t use your teeth, fingernails, or anything sharp that might rip
the condom—and remove the rolled-up condom.
• Most condoms have a nipple-shaped end. Hold that end between your thumb and index finger to
squeeze out the air before placing the condom on the head of the erect penis. Space should be left at
the top of the condom, as this is where the semen will go when the male partner ejaculates (releases
sperms).
• Carefully roll the condom down the erect penis. If the condom will not roll, then it is inside out. Throw it
away and start over. Do not unroll and then reroll a condom.
• The unrolled condom should cover the majority of the penis shaft. Check for air bubbles and squeeze
them out before having sex.
• When sexual intercourse is complete, hold the condom securely at the base of the penis and withdraw
before the penis goes soft. Holding the condom prevents it from slipping or spilling.
• Dispose of the condom carefully. Never re-use a condom.
• Always use a new condom for each sexual act.

Facilitator Guide
Voluntary Medial Male Circumcision (VMMC)

What is VMMC?
• Is the voluntary consent for the removal of male foreskin by a trained health professional
Why VMMC?
• It reduces chances of HIV transmission by about 60%
Who should be circumcised?

• All sexually active males
Where can I be circumcised?

• Most of the health facilities offer VMMC.
I can tell you where where to get one if you need it.
Are there other benefits other than HIV prevention?

• Yes, the female sex partner also gets protected against cervical cancer,
enhances sexual & personal hygiene and reduces risk of contracting other STIs
Can I have sex after VMMC?

• Yes you can after six weeks when complete healing is expected to have occurred
Male Circumcision (MC)
What is male circumcision?

• Male circumcision is the removal of the foreskin. The foreskin is the fold of skin that covers the head of
the penis. Although it can be performed at any age, it is often performed within two weeks of birth or
during adolescence. In many places it has an important symbolic, cultural and religious meaning. For
example, in certain communities of Eastern and Southern Africa young men are circumcised in their
early to late teens as a rite of passage that marks their transition from ‘boyhood’ to ‘manhood’.
• Circumcision may also be performed for medical or health reasons when there are problems involving
the foreskin.
What does Male circumcision have to do with HIV/AIDS?

• Scientific studies have shown that circumcised men are less likely to get infected with HIV than
uncircumcised men. Male circumcision offers additional protection from HIV because it reduces the
possibility of tear and injury to the penis during sex and removes cells that are vulnerable to HIV
infection. A circumcised penis also dries more quickly after sex. This may reduce the life-span of any HIV
present after sex. Male circumcision reduces the risk of ulcerative sexually transmitted infections, such
as syphilis, and reduces the risk of penile cancer. It has also been shown to reduce the risk of cervical
cancer in women.
Does MC completely protect against HIV infection?

• While circumcision reduces a man’s chances (by 60%) of becoming infected with HIV and some STIs, it
is important to know that circumcision is not fully protective. A circumcised man must still take measures
to protect himself and his partner from infections. Proven means of protecting oneself include abstaining
from sex, remaining faithful to one partner whose HIV status you know, using a condom correctly every
time you have sex, and knowing your HIV status.

Stepping Stones
Do I have to undergo an HIV test before I receive MC?

• Male circumcision is not recommended for men who are already infected with HIV. For HIV positive men
there is no demonstrated public health benefit for reduced HIV transmission to their partners and men
with severe immunodeficiency are at an increased risk of complications following surgery. A counselor is
always available at the health facility to test one before accessing MC services.
Risks and Benefits of MC

• While the benefits of male circumcision vastly outweigh the risks, there are some risks. Anyone
considering circumcision for themselves or their male child must weigh the risks and the benefits to
come to an informed decision.
Some benefits of circumcision

Research shows that removing the foreskin is associated with a variety of health benefits:
• 60% less chance of becoming infected with HIV
• It may be easier to use condoms
• Studies have found lower rates of urinary tract infections in male infants who are circumcised
• Circumcision prevents inflammation of the glans and the foreskin
• Men who are circumcised do not suffer health problems associated with the foreskin such as an inability
to retract the foreskin or swelling of the retracted foreskin causing inability to return it to its normal
position
• Circumcised men find it easier to maintain penile hygiene
Two studies now suggest that female partners of circumcised men

• Have a lower risk of cancer of the cervix
• Circumcision is associated with a lower risk of penile cancer
• Circumcised men have a lower prevalence of some sexually transmitted infections, especially ulcerative
diseases like chancroid and syphilis
Risks associated with circumcision

As with any surgical procedure there are risks associated with male circumcision. Complications are rare,
usually minor and quickly resolved when circumcision is performed by trained and well-equipped providers
under aseptic conditions.
However, more serious complications have been reported when male circumcision is performed
by unqualified practitioners without the appropriate equipment or hygienic conditions.
Some risks may include:

• Pain
• Bleeding
• Excessive swelling or haematoma (formation of a blood clot under the skin)
• Infection at the site of the circumcision
• Injury to the penis
• Adverse reaction to the anesthetic (medicine to kill pain) used during the circumcision
Where can I access MC services?

• Male circumcision services may be available at Ministry of Health and other public or private health
facilities in your area.

Facilitator Guide
Quick facts about MC

• Scientific evidence clearly shows that male circumcision reduces the risk of HIV infection – providing
partial protection against HIV for men. Studies show that male circumcision reduces the risk of HIV
acquisition in men by about 60%.
• Male circumcision reduces the risk of HIV infection for men but only provides partial protection.
It is not a substitute for other proven HIV prevention methods.
• Men should not resume sexual intercourse for at least six weeks after circumcision to ensure the healing
process is complete. Ideally sex should only recommence after a medical assessment confirms the
healing process is complete.
• Whether circumcised or not, men are at risk of HIV infection during sexual intercourse. It is important
that they limit their number of sexual partners, use condoms consistently and correctly and seek prompt
treatment for sexually transmitted infections to further reduce their risk of infection.
• Circumcision should be done in health facilities with appropriately trained providers,
proper equipment and under aseptic conditions.
• However, whether the procedure takes place in a clinical or traditional setting, safety is of paramount
importance.

Stepping Stones
APPENDIX 3: PRE-POST TEST

Indicate your unique identifier at the top of this test ..................
HIV and AIDS Knowledge and attitudes
1 Have you ever heard of HIV infection

{ }Yes { } No
2 Can people reduce their chances of acquiring HIV

{ }Yes { } No

If yes how ................................................................
3. Can people get HIV from mosquito or other insect bites?

{ }Yes { } No

4. Can people get the HIV by sharing utensils with a person infected with HIV?
{ }Yes { } No
5. Can people get the HIV because of witchcraft or other supernatural means?
{ }Yes { } No
6. Is it possible for a healthy-looking person to have the HIV?

{ }Yes { } No
7. Is it possible for a healthy-looking person who is infected with HIV to transmit the HIV
{ }Yes { } No
8. Do you think that your chances of getting the HIV are low, medium or high or are there no risk at all?
9. Why do you think you have low/medium/high risk / chance of getting HIV
Is not having sex
• Uses condoms
• Has only one partner
• Limits number of partners
• Partner has no other partners
• Other specify
10. Would you disclose your HIV status if it is positive to your partner?
{ }Yes { } No
11. Does your family know about your HIV status?

{ }Yes { } No
12. Do you know any drugs used to manage HIV?

{ }Yes { } No
13. Can a person be cured from HIV?

{ }Yes { } No

Facilitator Guide
14. Do males have to use other HIV prevention methods even if they are circumcised?
{ }Yes { } No
If yes why...................................................................................................................
15. Does having a sexually transmitted infections lower chnaces of getting HIV?
{ }Yes { } No
16. Can one wash and re-use female condoms to prevent HIV?
{ }Yes { } No

For more information contact:
National AIDS and STI Control Programme-
NASCOP Kenyatta National Hospital Grounds
P.O. Box 19361 -00202 Nairobi Kenya,
Tel: +254-202-630-867
Email: info@nascop.or.ke

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Stepping Stones

Stepping Stones Facilitator Guide

2 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

• Kenya’s National AIDS and STD Control Program (NASCOP)

1. Carol Ngare - NASCOP 17. Nicholas Kweyu - CDC

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 3

Eunice Kinywa - MOH Obwiri Kenyatta - EGPAF

For more information or to submit your comments on this intervention,

4 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 5

SESSION 1: COMMUNICATION AND PERCEPTIONS 11

SESSION 2: LOVE AND PREJUDICES 22

SESSION 3 : HIV, STIs AND CONDOM USE 27

SESSION 4: OUR OPTIONS 37

SESSION 5: EXPLORING WHY 46

SESSION 6: LET’S SUPPORT AND ASSERT OURSELVES 52

SESSION 7: LETS IMPROVE OUR BEHAVIOUR 64

6 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

For example changes were made to:

The intervention focuses on:

• Enhancing fisher folks knowledge and skills in HIV/STI prevention

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 7

FIRST COMMUNITY MEETING

Materials Needed: Poster (Stepping Stones cover page).

Participants: Fisher folk

8 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

a. Target population – age, composition of the peer groups, size of groups

8. Ask for further comments or questions.

9. Thank everyone for coming and participating in the meeting.

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 9

ACTIVITY A.1: EXPECTATIONS (15 minutes)

ACTIVITY A.2: GROUND RULES (10 minutes)

Materials needed: Flip chart papers, marker pens.

Description: Encourage group members to brainstorm on the rules

10 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

THEME: GROUP CO-OPERATION

Purpose: To facilitate peer group formation and develop

Time Needed: Maximum 2 hours 15 minutes.

Participants: Four separate peer groups.

ACTIVITY A.1: ADJECTIVAL NAMES (15 minutes)

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 11

ACTIVITY A.2: A KNOTTY PROBLEM (15 Minutes)

12 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

ACTIVITY A.3: BODY LANGUAGE (10 minutes)

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 13

ACTIVITY A.4: GUARDIAN ANGEL (5 minutes)

14 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

MODULE 1B: OUR PERCEPTIONS

Time Needed: 1hour

Participants: Four separate peer groups.

ACTIVITY B.1: FIXED POSITIONS (15minutes)

Feedback and Discussion:

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 15

ACTIVITY B.2: IDEAL IMAGES AND

Group Image Reality

16 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

Feedback and Discussion:

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 17

ACTIVITY B.3: IMAGES OF SEX (30 minutes)

Purpose: To help people to realize that we also have differences

18 An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk

• issues they would like to be dealt with IMMEDIATELY

An adaptation of an Evidence-Informed Behavioral Intervention for Fisher Folk 19