Implementing and scaling-up Stepping Stones in KwaZulu-Natal, South Africa: Lessons from working in informal settlements

KwaZulu-Natal (KZN), a major epicenter of the South African HIV epidemic, has large informal settlements where thousands of people live. The settlements are often underserved by municipal services and lack accessible health care. Given high rates of HIV, there is a critical need to assess the successes and challenges of implementing HIV prevention and treatment in this context. Stepping Stones is a widely used life-skills training intervention focused on curbing gender-based violence and reducing HIV risk. The program addresses issues such as communication about HIV, relationship skills, and assertiveness. The manual-based curriculum encourages participants to engage in critical reflection through role-playing and group dialogue. Previous evaluations of Stepping Stones in South Africa found significant reductions in intimate partner violence and herpes simplex virus-2, and improvements in couple communication and negotiation. Under Project SOAR, the Population Council and the MatCH Research Unit of the University of the Witwatersrand conducted program evaluations in 18 selected informal settlements in KZN. This brief focuses on the experiences, challenges, successes, and perceived effects of implementing (and scaling up) Stepping Stones in the informal settlement setting

Promoting more gender-equitable norms and behaviors among young men as an HIV/AIDS prevention strategy

The Population Council and the Promundo Institute studied the effectiveness of interventions in Brazil designed to change the attitudes of young men in relation to gender norms and reducing the risk of contracting HIV/STIs. One conclusion of the study was the recognition of the importance of engaging young people (men and women) in the issue of gender relations and the risks of HIV contamination. The results of the study indicate that addressing inequitable gender norms, particularly those that define masculinity, can be an important element of HIV prevention strategies. These findings suggest that group education interventions can successfully influence young men’s attitudes toward gender roles and lead to healthier relationships. The findings also provide empirical evidence that a behavior change intervention focused on combating inequitable gender norms is associated with improvements in HIV/STI risk outcomes

Building evidence to guide PrEP introduction for adolescent girls and young women

This document was developed by the Population Council, with support from the Bill & Melinda Gates Foundation, to provide DREAMS country teams with practical guidance on building evidence to guide pre-exposure prophylaxis (PrEP) introduction for adolescent girls and young women (AGYW). The primary audiences for this document are health policymakers and program planners who will be making decisions about how PrEP is introduced and the researchers who will assess AGYW’s specific needs and experiences. Our aim is to complement emerging global guidance on PrEP and ongoing work regarding delivery platforms, marketing, and policy and regulatory frameworks for PrEP introduction more generally. We focus on examining the factors that influence informed choice, demand, and use of PREP by young women and that influence client–provider interactions. Further, this document can serve as a useful guide to gather data on user, community, and provider perspectives as countries move from introduction to broad-based implementation of PrEP

Opportunities for SGBV data collection in the time of COVID-19: The value of implementation science

In this blog post for the Sexual Violence Research Initiative (SVRI), Council researchers highlight the tension between the need to gather data to support women facing unprecedented vulnerability in the COVID-19 pandemic, and the reality that the very act of data collection may heighten risk. They also present opportunities for ethical sexual and gender-based violence (SGBV) data collection during the pandemic

Catalyzing personal and social change around gender, sexuality, and HIV: Impact evaluation of Puntos de Encuentro´s communication strategy in Nicaragua

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change strategy whose objective is to prevent future HIV infections in Nicaragua, through mass communication actions that include educational entertainment programs, strengthening of local capacity, and the development of alliances within the communities. This report presents the results of an interinstitutional evaluation to explore the impact of SDSI on gender equity, stigma reduction, personalization of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and individual and collective effectiveness for HIV prevention. The impact evaluation showed that the SDSI strategy made a great contribution in key aspects of HIV prevention. In addition to individual changes in behavior directly associated with greater exposure to SDSI and changes at the social level identified in qualitative studies, the results validate the conceptual framework, of both the intervention and the evaluation

Looking back, moving forward: Reducing HIV-related stigma, Horizons studies 2000 to 2007

In 1997, the Population Council initiated the Horizons Program—a decade-long USAID-funded collaboration with the International Center for Research on Women, the International HIV/AIDS Alliance, PATH, Tulane University, Family Health International, and Johns Hopkins University—designing, implementing, evaluating, and expanding innovative strategies for HIV prevention and care. Horizons developed and tested ways to optimize HIV prevention, care, and treatment programs; worked to reduce stigma and improve gender-biased behaviors; and greatly expanded knowledge about the best ways to support, protect, and treat children affected by HIV and AIDS. In all its projects, Horizons strengthened the capacity of local institutions by providing support and training to colleagues. This synthesis paper presents lessons learned and best practices on one of the key topics that Horizons investigated: HIV-related stigma

Looking back, moving forward: Promoting gender equity to fight HIV, Horizons studies 1999 to 2007

In 1997, the Population Council initiated the Horizons Program—a decade-long USAID-funded collaboration with the International Center for Research on Women, the International HIV/AIDS Alliance, PATH, Tulane University, Family Health International, and Johns Hopkins University—designing, implementing, evaluating, and expanding innovative strategies for HIV prevention and care. Horizons developed and tested ways to optimize HIV prevention, care, and treatment programs; worked to reduce stigma and improve gender-biased behaviors; and greatly expanded knowledge about the best ways to support, protect, and treat children affected by HIV and AIDS. In all its projects, Horizons strengthened the capacity of local institutions by providing support and training to colleagues. This synthesis paper presents lessons learned and best practices on one of the key topics that Horizons investigated: HIV and gender