Evaluation of Stepping Stones: A Gender Transformative HIV Prevention Intervention

Published in March 2007 by the South Africa Medical Research Council, this four-page research brief offers an evaluation of a Stepping Stones intervention in the Eastern Cape, South Africa. Stepping Stones is an HIV prevention behaviour change communication (BCC) programme that aims to improve sexual health by building stronger, more gender-equitable relationships with better communication between partners.

Originally developed in 1995 for use in Uganda, the approach has been used in over 40 countries and translated into at least 13 languages. Stepping Stones uses participatory learning approaches, including critical reflection, role play, and drama, in an effort to increase:

• knowledge of sexual health;
• awareness of risks and the consequences of risk-taking and communication skills; and
• self-facilitated self-reflection on sexual behaviour.

Facilitated by project staff of the same sex who are slightly older than participants, the programme is delivered over several weeks through thirteen three-hour sessions and three group meetings that are mainly held in schools. The culmination of Stepping Stones is a final meeting with the entire community.

The primary aim of this study was to determine the impact of Stepping Stones on new HIV infections, and secondary aims were to determine the impact on new genital herpes infections, sexual behaviour, and male violence. The study also used qualitative research methods to understand how youth responded to it and made meaning from the programme in the context of their lives.

As with Stepping Stones itself, community participation was a core strategy in the evaluation process. In schools, parents and interested students were invited to a meeting and the study was explained in detail.

The study consisted of a cluster randomised controlled trial, which was conducted in 70 clusters (mostly villages) in the area around Mtata in the rural Eastern Cape province of South Africa. It involved roughly 20 male and 20 female volunteers aged 15-26. Participants were interviewed face-to-face by a Xhosa speaking interviewer and each participant gave blood for HIV and herpes testing. They were then invited to attend the programme, and then re-interviewed and re-tested 12 months and 24 months after the initial interview.

Although not unequivocal, the findings provide evidence of success in bringing about changes that reduced sexually transmitted infections in study participants. The study also shows Stepping Stones to be effective in reducing sexual risk-taking and violence perpetration among young, rural African men.

The qualitative research showed that Stepping Stones impacted on a range of different areas of participants’ lives. Many of the participants spoke of changes in relationships with their parents and other elders after the workshops, enhanced skills related to talking about sex with older people, and improvements in communication among both men and women with partners. This, according to the study, supports the argument that participants, and particularly men, changed who they were as individuals and how they related to others. The programme brought about changes in attitudes which could critically lessen HIV risk by providing knowledge, generally raising awareness of personal risk, and giving a much greater openness about HIV. In the process it seems to have provided general life skills which made many of them better partners, friends, family members, and citizens.