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Vulnerability and Needs
The Alliance works with the concept of ‘vulnerability’ to encompass the varying factors that contribute to the spread of HIV and the range of responses that they necessitate. Prevention efforts that focus solely on individual decision-making are inadequate in the face of behaviours that result from complex interactions between individuals and their environments. The idea of vulnerability, which may be applied at the level of individuals, families or societies, seeks to illuminate the importance of these environments and the differential risk of exposure to HIV infection that they create.
The experience of the Alliance and its partners in conducting participatory assessments of community vulnerability in order to design more effective HIV prevention projects has helped to refine the traditional idea of the ‘needs assessment.’ In Bangladesh, the scope of the assessments was broad, asking communities about their general needs and life concerns. Assessment of these general needs was important in two ways to the elaboration of more relevant HIV prevention strategies. Firstly, it helped NGOs and communities explore the links between the HIV epidemic and the reality of people’s lives, allowing for a more complex understanding of why and how HIV transmission occurs. Secondly, it highlighted the immediate and important concerns and aspirations of communities, responding to which could enhance the NGOs’ credibility and relationship with their target communities.
Objectives of Assessment
The Voluntary Association for Rural Development (VARD) in Bangladesh listed the following objectives for its participatory assessment with rickshaw pullers in two villages in Sylhet:
1. To find out the way of living of the rickshaw pullers.
2. To get information about their income level, marital status and social position.
3. To identify the needs and problems of the rickshaw pullers.
4. To carry out a qualitative and participatory action research on the prevailing values, social, personal, environmental, gender issues as well as superstition, misconceptions …. of the rickshaw pullers.
5. To assess the health problems of the rickshaw pullers including common disease pattern and their access to health facilities.
6. To find out the behaviour pattern, including sexual behaviour pattern, of the target community.
7. To obtain information about the knowledge of the community on STDs/AIDS and condoms.
But there were problems with this approach too. Asking communities about their perceived, priority needs raised expectations that the NGOs were not able to respond to. As the Voluntary Association for Rural Development, in Bangladesh, noted: “It was a problem that the community had different expectations regarding the project activities which was solved through highlighting clearly the objective and goal of the project to them.” The explicit HIV/AIDS funding for the projects necessarily constrained their scope and mandate. Alliance technical support now emphasises the importance of clarifying both the objectives and scope of the assessment and the expectations of communities, and of finding a “fit” between the two.
As the practice of Alliance-supported participatory community assessment has evolved, the ‘needs’ focus of the assessments has come to be defined in relation to the question: What needs to be done to reduce vulnerability to HIV infection? Typically, this has involved an exploration with communities of their perceived needs in relation to their sexual health and HIV prevention, discussion of issues relating to gender and sexuality, as well as an identification of resources and discussion of priorities. The scope of assessments has specifically related to understanding factors of vulnerability and possible responses to them. There are two aspects of the assessment process that are especially important to understanding of vulnerability:
- The type of assessment tools used; and
- The sequencing of those tools.