Community Conversation Among the Maasai: Mainstreaming HIV/AIDS into Natural Resource Management in Tanzania

This 13-page case-study shares experiences of LOOCIP, a community-based organisation founded in 2003 by a group of local Maasai, of using Community Conversation (CC) to facilitate community-wide discussion of difficult issues around HIV prevention. As part of this methodology, community leaders and their people identify factors, particularly cultural practices and beliefs, that influence the spread of HIV, while also participating in HIV prevention activities. According to the case study, the approach has been very effective in breaking the silence around HIV and in engaging local leaders and the Maasai in general in a participatory manner.
As stated in the study, whether in urban areas or in their traditional settlements, the Maasai are now facing increasing risk of HIV because of long-held cultural beliefs and practices that render them especially vulnerable. Specific traditional practices also expose the Maasai, especially young girls and boys, to HIV and other sexually transmitted infections (STIs). The risk is increased by their limited knowledge about HIV, including basic prevention. Since 2010, LOOCIP - which means "people who tell the truth" in Kimasai - has worked in more than 20 villages in the Longido district in Tanzania, implementing an HIV prevention strategy that focuses on behaviour change and reducing sexual transmission.

One of LOOCIP's key HIV prevention strategies is gaining the acceptance, cooperation, and support of influential Maasai leaders. The Community Conversation (CC) methodology used by LOOCIP to gain community support is a nonthreatening methodology developed by the United Nations Development Programme (UNDP) that recognises the capacity of communities to identify problems and design their own solutions. Programme activities are implemented in close consultation and collaboration with community and religious leaders. CC includes focus group discussions, review of existing health records, community meetings, and key informant interviews. The report states that the approach has been very effective in breaking the silence around HIV and in engaging local leaders and the Maasai in general in a participatory manner. It has also helped to create a sense of ownership of change and development efforts.

The report outlines some of the key challenges faced by LOOCIP in HIV prevention implementation as well as challenges that are more programmatic:

• Cultural factors: Changing deeply embedded cultural practices and beliefs about sexual relations among the Maasai is a long and slow process that requires innovation and deliberate strategies. Some cultural practices, such as polygamy and Female genital cutting (FGC), are deeply embedded in Maasai culture.
• Female genital cutting: This is a practice that will take a long time to eradicate entirely, but thanks to LOOCIP, at least it is a safer procedure now, because practitioners (ngaribas) have been convinced to use separate surgical blades for each girl to avoid spreading HIV.
• Unequal gender relations: A fundamental gender bias shapes the entire life span of a Maasai female. Traditionally, little value (if any) is placed on their education. The role of a Maasai girl-child is centered around the home until a husband is found for her. Forced marriages are still taking place, and most girls are married off at an early age, which marks the end of their childhood and their education and the beginning of a series of health problems. Maasai girls and women have no control over their bodies or their sexual lives.
• Widespread poverty: Changes in traditional sources of livelihood have seen a lot of young Maasai men leave their villages for towns to work as watchmen, hairdressers, or tour guides in tourist hotels. Many Maasai feel that, while the move to urban areas may provide a solution to economic hardships, it is a double-edged sword: men engage in casual sex while away from their wives or female partners, and some women whose husbands or male partners are away are forced to trade sex for money or material goods to survive financially.
• Limited access to voluntary counselling and testing services: According to the report, LOOCIP has raised awareness on HIV and AIDS and sensitised communities on the need to get tested for HIV, but it has not been able to link them to reliable pre-and post-test counselling and related services, including family planning, antiretroviral therapy (ART), and Prevention of Mother to Child Transmission (PMTCT). This is due to the long distances from the villages to the nearest health facilities, which can be as far as 50 kilometres. There are also few organisations working in these marginalised areas that could collaborate with LOOCIP to provide HIV services.
• Poor availability and low acceptability of condoms : Because of the long distances between service delivery points, there is a serious shortage of condoms among Maasai communities. In addition, many Maasai believe that HIV is manufactured and inserted in condoms. Religious leaders opposed to condom use also present a challenge to wide acceptance of condom use.
• Denial about the severity of the problem: Despite the education and awareness campaigns that have been conducted, there are some very remote areas where people still believe that the Maasai community is free of HIV and that the disease only affects other people.

Based on the experiences of using the methodology and on the overall experiences of the project, the report recommends the following:

• Scale up gradually: In an area like Longido, where residents are spread out widely, it’s better to scale up community education to cover all villages in the district before expanding to other districts.
• Sensitise and build the capacity of community leaders: Traditional chiefs such as the Maasai community leaders (laigwanan) play a crucial role in facilitating acceptance of an intervention among community members.
• Increase opportunities for community-based and peer education: Peer education is a valuable training approach, especially among young Maasai, who may feel more comfortable talking about sensitive issues with their age mates. For sustainability of community-based project activities, it is important to increase the number of trained community facilitators and have one placed in each village.
• Link awareness to services: In mainstreaming HIV, it is important to create close linkages between awareness creation and provision of HIV-related services such as VCT and care and treatment to provide communities with a holistic package of services that ensures a continuum of care.
• Conduct monitoring and evaluation (M&E): It is important to objectively assess whether educational efforts have translated into behaviour change that decreases risk behaviours and increases adoption of healthier practices within the community.
• Focus on community engagement: The CC methodology empowers community members to identify problems they face without pressure. The involvement of the entire community helps all its members improve their understanding of the problems and creates a sense of ownership that motivates joint action.

The case study concludes that LOOCIP has been successful in raising awareness of HIV among the Maasai and educating communities on how to protect themselves from HIV infection. Most impressive is LOOCIP’s adaptation of the CC approach, which empowers communities to talk about sensitive issues in a non-pressured manner and assess their capability of dealing with them. However, awareness-raising activities must be balanced with other care and support services to ensure a continuum of care.