WILDFIRE

Rationale and Purpose

This exercise is designed to encourage integration of personal and professional dimensions of participants' engagement with the epidemic.

The exercise requires that sufficient time and attention have been paid to building a supportive climate within the group, through icebreaker activities etc.

Wildfire is neither a game nor `therapy'. It is a participatory exercise which simulates the spread and some of the repercussions of HIV transmission. As such it requires skilled and experienced facilitation. Because of the nature of this exercise, it is critical that no observers be present, and that no one join the exercise once it has begun.

Discussion of participants' feelings whether in plenary or smaller "support" groups should take place throughout the exercise.

A floor space large enough for all participants to stand in a circle is required. Chairs for all participants should also be arranged in a circle. Encourage participants to use these as and when they wish the exercise can be tiring if people stand throughout.

Ample time is required at the end of this exercise for discussion and processing. This may be done in plenary, or in small groups, or both. It is essential to have a break after the exercise.

Questions asked of participants during the exercise should explore not only their feelings about their own (simulated) sexual behaviour (as understood by the mixing of the seeds), but also their feelings about the impact of this upon those close to them: including children, partners and families, and their professional lives.

Materials: Sufficient envelopes for participants with half of the cards reading "Your test is positive", and the other half reading "Your test is negative".
Time: 60-90 minutes

THE STEPS IN CONDUCTING WILDFIRE

Explain the objectives

Briefly outline the purpose of the session to participants. In particular, explain that the exercise is designed to make them experience some of the feelings associated with acquiring HIV infection.

Confidentiality in relation to all aspects of HIV infection is extremely important and the exercise can provide a clear demonstration as to why this is the case (and what the specific obstacles to confidentiality may be within particular contexts and ways of addressing these). Participants should be reminded that the need for confidentiality extends to this exercise and that there must be mutual trust within the group for people to feel they can be open in the exercise. They must respect as confidential, any personal information which is shared by others during the course of the exercise.

Ask the participants to stand in a circle holding nothing in their hands. Distribute among them small sachets with seeds inside.

Approach one participant and share some of the seeds in your sachet. Tell him or her and the rest of the group, that for the purposes of this exercise, sharing seeds is equivalent to having unprotected sexual intercourse. Stress that if during this exchange different kind of seeds are deposited in your sachet, it indicates that the person has had unprotected penetrative intercourse with someone who has had intercourse with an infected person. It does not necessarily mean that the person is infected because the virus is not transmitted during every act of unprotected intercourse.

Tell everyone that this was only a demonstration of the exercise and that no one, at this stage, has been exposed to HIV.

Tell the group that you have distributed sachets with seeds to all of them. They will be asked not to show others the kind of seeds they have. For the duration of the exercise, the person with the different seed (he/she will not know him/herself until the end of the exercise) will be HIV-infected.

After distributing the sachets, ask the participants to open their eyes and see if they can identify the person in the group who is HIV-infected. Emphasise the point that one cannot tell if a person is infected by looking at him or her.

Briefly discuss with the group how they felt as you distributed the sachets. Even in a simulation or a game, people are fearful of being HIV-infected and do not want to have the sachet with the different seeds.

Remind participants that for the purpose of the exercise, one person is HIV-infected. As the exercise begins this person will pass seeds to others without him/herself knowing. In turn, those who received different seeds will pass some of them on to others. Stipulate the maximum number of seed exchanges by participant by counting participants off into `4's. The groups should still mix as before but the 1's should exchange only once (and then close their bags), the 2's should exchange only twice, 3's three times and 4's four. In this way the exercise can demonstrate how in communities where HIV status is largely unknown, even one or two exchanges can have devastating consequences:

Step out of the circle and ask the participants to begin exchanging seeds with whomever they wish, up to the stipulated number allocated to them.

After this first round, ask the 2's and 4's to open their bags. The 1's and 3's do not open theirs. Instead, they stand outside amongst those who know they are not infected. At this stage, the group includes both those who are uninfected and those who assume they are, but in fact are already infected. Another round of exchanges should follow after which all the bags should be opened.

When seed exchange stops, step back into the centre of the circle. Ask all those who had two kinds of seeds and the person who initiated the exchange to step into the middle of the circle. Ask the others to return to the outer circle seats. Seat the inner circle.
Encourage the group to discuss what it is like to be in either position, those on the outside first, followed by those on the inner circle. Possible questions:

Outer circle:

· How was your behaviour different from that of the people in the inner circle?
· How did you end up in the outer circle while the others are in the inner circle?
· How do you feel about the people in the inner circle?

Inner circle:

· What are you thinking now that you realise it is possible that you are infected?
· What are you feeling now that you realise it is possible that you are infected?
· Would you tell anyone you may be infected? Whom?
· How likely do you think it is that your confidentiality will be respected? What can be done to strengthen this?
· Would you tell your sexual partner or partners you may be infected?
· What support would you need at this stage? To whom will you turn?

Outer circle:

· Will you continue having unprotected sexual intercourse?

Inner circle:

· Will you continue having unprotected sexual intercourse?

Outer circle:

· Would you have sexual intercourse again with a person in the inner circle?

If necessary, remind everyone in the inner circle that they have been exposed to the virus but it is not yet known if transmission has taken place. At some stage during the discussion, participants may ask about the possibility of an HIV antibody test. Reassure them that voluntary and confidential testing with counselling is available.

Offer the test, discuss the testing procedure, and the meaning of positive and negative results.

If a participant says that he or she would not want to be tested, the resource person should explore the reasons for this decision. The person could be asked:

· You are possibly infected. Do you have all the information you require to decide what you are going to do in light of this?
· Are you going to ensure that no-one else is put at risk from your behaviour?
· What support will you need to sustain your behaviour?

The person should then be asked to move to the outer ring. Ask people in the outer circle what choice they could have made and why.

Shuffle the test result envelopes and pass them to those in the inner circle, asking participants not to open their envelopes but to hold them. This symbolises the waiting time between taking the test and receiving the results.

· What does it feel like to be waiting for your result?
· What support would you need during this period?
· Would you tell anyone you had taken the test? Whom?
· Would you continue with unprotected sexual intercourse? Why/why not?
· Would you be able to concentrate fully at work and/or home?

Before asking those in the inner circle to open their envelopes, give envelopes to a number of the women in the outer circle telling them that they are pregnant and have been tested without their knowledge or consent. Give envelopes to a smaller number of men telling them that they were tested without their knowledge or consent while being treated for TB or a sexually transmitted infection or when they joined the military.

Explore how these individuals feel about being tested without their consent. Then ask them to open the envelopes.

Ask each person his or her test result.

Discuss with each person with a negative result what impact this has had on her or him:

· How does it feel to get a negative result?
· Are you going to change your behaviour in order to remain uninfected?
· Do you have all the information you require about safe sex?
· Where would you get further information?
· What support will you need to sustain your safe behaviour?

The resource person should discuss the window period for HIV antibody testing and the need for a follow-up test if people have had unprotected penetrative intercourse during the previous three months.

Ask those with a negative result to replace their cards in their envelopes and to pass them back to the resource person. Then ask them to join the outer circle.

Each person with positive results should now be encouraged to discuss his or her reactions. The resource persons could ask questions such as:

· What thoughts crossed your mind when you received your result?
· What is your immediate reaction to the result?
· Will you tell people your result?
· How do you think they will react?
· Will you tell your spouse/partner/sexual partners?
· Will you tell your children?
· Will you tell your work colleagues? Employer?
· What support do you need for all this?
· Do you want to have children? How will this test result affect that?

The positive aspects of knowing one's infection status should be discussed: the possibility of making changes to remain well, the possibility of planning for one's future and that of one's children, the prompt diagnosis and treatment of opportunistic infections. The difference between being infected and having an HIV-related illness, including AIDS, should be made clear. There should be some discussion of how to disclose infection status and the possible consequences of disclosure.

When the discussion has covered all of the concerns, ask those participants who received a positive result to place their results in the envelopes. Take the envelopes back one by one reminding the participants that this has been an exercise only and as they pass the envelope to you they also "pass back the virus."

As you take back the envelopes, ask each participant to stand and step out of the inner circle. Ask them how they feel and whether they need any help. Then ask them to move to the outer circle.

After everyone has moved to the outer circle, ask all participants to stand in a circle again. Explore with the participants some strategies for living with the virus in our midst

Questions could include:

· How can we co-exist with this virus, live with it in our midst without becoming infected?
· How can you help members of your family or friends to protect themselves?
· How can you support those who are already affected?

Ask each participant to reflect on the exercise and say a word or name a colour to express her or his feelings or thoughts. Emphasise that the exercise is now over. At the end, participants may feel like giving each other some kind of support: a word, a smile, a touch, a hug.

A break, preferably a meal break, must be taken after this exercise to give participants time to think about the exercise and how it affected them. The exercise can affect participants profoundly, and it is important to be sensitive to this in the hours and days which follow.

Participants may wish to spend time in "support" groups immediately after the exercise and this option should be offered.

CREATING AN ENABLING ENVIRONMENT

Purpose and Rationale

Having explored both "objective" and "subjective" facts, this exercise is designed to increase capacity among participants to identify broader contextual factors which have the potential positively or negatively to determine the future epidemic.

Procedure

Explain to participants that in any country there are usually a range of contextual factors in operation which have the potential to help or hinder efforts to respond. Such contextual factors can include:

those which fuel the epidemic, for example:

· low status of women
· negative attitudes towards discussion of sex
· ignorance, myths and misinformation
· poverty
· entrenched and of dogmatic religious beliefs
· high STI prevalence
· lack of confidentiality
· unfavorable environment for legal, ethical and human rights.

Those which may help to reduce spread and impact:

· political will to mobilise appropriate programmes and policies
· existence of fora for discussing sex
· sex education from elementary school
· a strong tradition of social care and responsibility
· a supportive environment for people living with HIV and AIDS
· availability of resources for care and prevention
· access to treatment, care and support
· legal and policy protection in the workplace.

Availability and commitment of key actors: -

C PLWHAs and their organisations
C Media
C National AIDS Programmes
C Churches
C Relevant Ministers and policy makers in the areas of for example health, development, labour, tourism etc.

Give participants a copy of the handout. Divide them into small groups (country team groups may be most appropriate) and ask them, in light of the above, to fill in the different circles of the diagram by identifying who needs to be involved and what needs to be done.

These should be shared in plenary.

Materials: diagram
Time: 30 minutes