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Improving the assessment of HIV and STD vulnerability
A critical challenge faced by many of the NGOs conducting the project design assessments was their staff’s limited or non-existent experience in sexual health work. The ability of the assessment process to generate an understanding of HIV and STD vulnerability which could inform the design of a more sophisticated project response was sometimes constrained by staff’s relative lack of familiarity with key concepts, such as vulnerability, social and behavioural change, and of gender and sexuality. There were several ways in which these gaps in understanding were manifest. For example:
- The inability of some NGO staff to extend or deepen a discussion with appropriate probing questions;
- A sometimes unclear understanding of what to focus on with the tools (e.g. what trends to assess? what criteria to use to rank factors of vulnerability? what to plot on the map?); and
- Difficulties in drawing meaningful connections between, and conclusions from, the tools used and the information they generated.
The graphic quality of many of the tools made them accessible to both NGO staff and community alike. There was sometimes insufficient attention to the use of questions to guide the discussion being stimulated, however. One lesson learned by the Alliance is that technical support to train NGO staff in the use of participatory assessment tools to assess HIV related vulnerability must prioritise building their conceptual understanding of vulnerability and sexual health along with developing the questioning and facilitation skills needed to effectively use many PRA tools.
It is also clear that the Alliance, Linking Organisations and partner NGOs must pay more attention to the analysis of information about vulnerability that comes out of the assessment process, and its implications for design of more effective responses. In part, this is a matter of connecting individuals, behaviours and contexts more meaningfully. For example, Cambodian NGOs made frequent reference to poverty (“poor living conditions”) as a factor of vulnerability but rarely described the links between poverty and increased risk of HIV infection. Without this analysis, it is hard to identify specific problems that can be addressed in the project design.
NGO staff also need to help communities think through the implications of the assessment and possible responses to the problems identified. In some cases, this may mean being able to challenge the moralism and conservatism of some communities, evident in the suggestion made by several groups in Cambodia that brothels should be abolished. This suggestion is not surprising given the frequent blaming of sex workers for the epidemic and the fact that the Cambodian government itself has periodically and publicly suggested this approach. NGO staff need skills to be able to both critique the potential effectiveness of such a response, as well as be sensitive to its human rights implications.
This does raise the question of how useful it is to simply ask communities for their solutions to the problems that are being identified by the assessment, rather than engaging in a discussion with communities about possible responses and the range of criteria by which they might be judged appropriate. This is certainly not to say that communities should not be involved in discussions and decisions on strategies and project designs, but merely to emphasise the value of enriching these discussions with the experiences and lessons that NGO staff can draw from elsewhere.
The nature of the project designs that ensued from the assessment process also suggest that the full implications of community vulnerability were not sufficiently understood or translated into strategic project responses. Most of the NGO strategies remained focused on individual behaviour change and relied on educational approaches, rather than strategies to promote social change. One reason for this is undoubtedly the limited experience and capacity of the NGOs themselves. It will be important for NGO support organisations to also support other groups which complement these educational approaches with organisation and advocacy strategies which respond to the social policy issues often raised in the assessments. Ideally, these can build and draw on the collective strength of communities, which the assessment process itself may have helped to mobilise.