Community Dialogues as a Method to Discuss and Reduce Multiple Concurrent Partnerships in Lesotho

"During the conversations, participants reflect on how they can improve their relationships and sexual lives without taking on extra lovers. The sessions are spread over 11 weeks. It is important to include the 11 weeks of time to allow people to think about what they are learning and to go through a process of change in their values, attitudes, and behavior."

This report shares the results of a qualitative evaluation carried out to study the impact of a community dialogue intervention designed to improve communication on - and to reduce risk behaviours related to - multiple concurrent partnerships (MCP) and cross-generational and transactional sex. Conducted in February and March 2011, the study examined the programme Relationship: Intimacy Without Risk, which includes a facilitator's guide and training manual and materials to train local Sesotho facilitators to carry out discussion sessions that aim to stimulate deeper dialogue and discussion around relationship issues and HIV prevention to gather and analyse participants' perspectives and assessments of the intervention in the 5 districts: Maseru, Leribe, Butha-Buthe, Mafeteng, and Mokhotlong. The community dialogue programme was adapted, facilitated, and managed by Phela, and the dialogues were co-branded by C-Change and OneLove.

A convenience sample (click here to learn more about this methodology) of 158 women and 107 men ages 18 and older was drawn from among the 485 women and 204 men who had participated in community dialogues between mid-2009 to September 2010 in the 5 districts. In-depth interviews (IDIs) were conducted with 54 individuals in this sample (28 females and 26 males), and 29 focus group discussions (FGDs) were conducted with the remaining 211 individuals in the sample.

According to the report, most study participants viewed concurrency as a driver of HIV and identified several reasons: the ripple effect of concurrency and its widening sexual networks, the practice of unprotected sex, transactional sex as a means of survival, lack of information on HIV, lack of knowledge of one's own HIV status and the status and sexual history of others, the drive for self-gratification, the perceived norm of concurrency as an acceptable common practice, and ignorance of the HIV risk of concurrency or dismissive attitudes toward the risk.

The report also finds that "[a]lmost all participants perceived the community dialogues as an overwhelmingly positive contribution to their communities and their sexual partnerships." Positive effects reported included:

• improved sexual behaviour (reduction in concurrency practices, increased practice of protected sex, and reduction of transactional sex);
• more open communication about sex and other sensitive issues in communities and with sexual partners, spouses, children, parents, families, and peers;
• improved relationships with sexual partners, including strengthened emotional ties, trust, and commitment, improved sexual techniques, and altered gender norms relating to women taking the initiative in sexual relationships; and
• increased information dissemination and knowledge about HIV and AIDS improved health-seeking behavior, including increased uptake of HIV testing increased acceptance of one's own HIV status

Participants contributed suggestions relating to the future use of the community dialogue methodology to address concurrency or other drivers of HIV:

• Community dialogues should focus on communities most in need - those with highest HIV prevalence and with high rates of concurrency and poverty - as well as specific institutions and key opinion leaders.
• Community dialogues should be linked more substantively with strategic cultural and community activities, such as dramas related to concurrency, HIV counseling and testing at local rallies, and sponsored competitions among youth.
• Ample financial, human, and material resources should be provided to support community dialogues.
• Additional feedback and consensus should be obtained from intended populations about the most appropriate timing, duration, and frequency of community dialogues.
• If dialogue groups are sufficiently large, age-specific sub-groups should be organised during some parts of the dialogue process.

Click here for the 8-page Executive Summary in PDF format.
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