"I Have Seen the Changes": People's Stories of HIV/AIDS Behaviour Change in Papua

This 25-page report examines use of the Most Significant Change (MSC) technique to evaluate Mobilising for Life: Protecting Papua (MFL), a peer- education-based HIV awareness initiative conducted in more than 200 remote communities in the highlands of the Indonesian provinces of West Papua and Papua (known here as Papua). The purpose of the present evaluation was to determine the impact of the first year of the MFL project, implemented by World Relief (WR) in Tolikara region, Papua, in 2009, as could be measured by MSC, a tool for exploring changes in communities - particularly those with low literacy rates. MSC collects personal stories and analyses them to reveal change regarded by the community as important. A particular focus of the MSC was the impact of 12 audio programmes, a communication component developed by Health Communication Resources (HCR) that supported peer education sessions.

Six research assistants (RAs) underwent a 5-day MSC design professional development workshop in December 2009 to develop and pilot test a data collection document and an accompanying audio programme, which was designed to give tips to peer educators (PEs), who could access communities the RAs could not due to geographic difficulties. Stories were collected between December 21 2009 and January 27 2010 and translated between January 28 and February 10 2010. All stories were translated from Dani (local language) into Bahasa Indonesia (Indonesian) then into English. Stories were processed through a MSC analysis framework to obtain a story which most appropriately represented the changes observed in the community. A focus group was formed of WR staff; under the guidance of facilitator, the group read all 133 stories and reached consensus on 11 MSC stories. From those 11 MSC stories, the WR project manager selected three stories that represented 3 important changes and then selected one story that she believed represented the MSC story. (Appendices 2-4 of the report contain the English-language transcripts of the 3 representative MSC stories selected by the Project Manager. Appendix 4 is the representative story chosen by the Project Manager in the final step of the MSC selection process).

The most significant change revealed through the MSC story and supported by many of the other stories was that, through the MFL programme, a faith-based network, was empowered and mobilised to disseminate HIV/AIDS health information. Pastors from Christian churches had unexpectedly extended the education materials beyond the original intended audience of peer education groups. This impact was unanticipated at this particular stage of the project. Christian churches, according to the report, influence the daily lives of Papuans and penetrate community rhythms of life, often beyond that of governments and non-governmental organisations (NGOs) in the most remote areas. With established structures offering unique channels of organised communication and resources, the congregations are committed for the long term, whereas other groups and donors often remain only for short-term projects.

Three core themes observed by the research team were:

1. Individual empowerment - 58% of PEs specifically mentioned they had witnessed individuals being empowered to now speak out to their communities about the dangers of HIV/AIDS and how to prevent it. Some of the beneficiaries who contributed stories also mentioned a personal empowerment as a result of the MFL project.
2. An increase in community awareness of HIV/AIDS - "Story after story expressed the view that the community now understood what HIV/AIDS was, how it was transferred, and how they were turning from risky behaviours...[I]t is clear that communities now understand (more so now than before MFL began) the real threat and danger of HIV/AIDS." For example, "bracelet swapping", previously a cultural event for single men and women to find suitable spouses, had become parties where risky behaviour was prevalent. Influenced by HIV/AIDS knowledge, people stopped attending these gatherings.
3. The radio programme was found to have "consolidated understanding of information gained in peer education sessions. An unanticipated impact of the communication component was the decision of churches to play the radio programs before and after worship services." This extended the direct participants in the MFL programme to a larger number of people. "Some MSC stories expressed the hope for the radio program to continue and be extended, with larger players and speaker systems provided to enable the entire congregation to hear more clearly....HCR strongly recommends, however, that any continuation or expansion strategy give priority to...community participation in producing audio material."

On page 16 of the document, 15 core recommendations emerging from the evaluation are proposed to help guide the next stages of the MFL project. For example, it is suggested that the structure of the peer education be revised so that the lessons and accompanying audio programmes are not so information-dense and education-packed. Giving greater priority and focus on community-based participation in the audio project could be accomplished by asking some of those who contributed MSC stories for this evaluation to serve as role models. Increased collaboration with churches is a suggested strategy; for instance, church initiatives to hold HIV/AIDS-related ceremonies or events might generate a greater consciousness of community movement and mobilisation toward an HIV/AIDS-free society. Interactive learning strategies can be developed to encourage active group learning and not passive listening (to radio programmes, played in the congregational context). Also proposed: Move on to stigma and issues surrounding people living with HIV/AIDS, given the suggestion that knowledge and awareness targets appear to be well on the way to being met after just one year.

In accordance with MSC methodology, the final MSC selection and reasoning will be fed back to participants in Tolikara at a monthly gathering; a printed supporting pamphlet will highlight key findings from the evaluation.

To request a copy of this paper, please contact partners@h-c-r.org