Development and the HIV Epidemic: A forward-looking evaluation of the approach of the UNDP HIV and Development Programme 5. DEEPENING UNDERSTANDING OF PRACTICAL IMPLICATIONS OF A SUSTAINABLE HUMAN DEVELOPMENT APPROACH 5.1 Key lessons learnt This section is based on the results of interactive discussions held in the field between evaluation team members, partners of the Programme and others who have been involved in using similar approaches. It reports on issues of central concern to the evaluation. It is one thing to say that new approaches are needed in development practice. It's another thing to build capacity in situations, like the HIV epidemic, in which no-one knows what will work, in which inappropriate development practices have sometimes already stifled the creation of effective local understanding and action, and in which the people whose lives are affected are often marginalised through poverty, cultural factors and lack of involvement in community and national decision-making processes. In developing better understanding of what does work, it was therefore considered important that the evaluators go out into the field to engage in dialogue with the people whose lives are affected, and to not limit discussion specifially to the approach of just this one Programme. People were able to explain and discuss, with the evaluation team and with each other, what has worked to develop their own capacities, what has led to their own sense of creative engagement with the challenges of HIV and development, and what has resulted from these approaches. Participants talked of their own experiences of capacity development. They often mentioned the need for the new approaches to proceed slowly at first, reporting that their own engagement and empowerment had arisen not from being told what to do, but through working in partnership with others who respected and encouraged gradual development of their own understanding, skills and actions. Central to these processes was the concept of partnership. The evaluation process generated deeper understanding of what sorts of partnerships lead to capacity development. Key themes which arose through interactive dialogue are summarised here and explained in further detail in the text. Many key findings centre on the nature of partnerships which build capacity: - If development and maintenance of partnerships is genuine, then they will follow the usual patterns of human relationships - Effective partnerships take time to establish and essentially involve two-way dialogue and development - Effective partnerships are not always initiated or controlled by donor agencies or by central government authorities - Effective partnerships allow all partners to make choices - Effective partnerships acknowledge the contributions of all parties involved - Effective partnerships are not always easy
Others indicated some immediate effects of such partnerships: - Inclusion of the people whose lives are affected in developing understanding and responses - The development of 'safe spaces' which enable those included to discuss issues of central importance to them - The reflection and sharing of experiences, thus leading to understanding which would not normally be generated
Finally, a set of key findings indicated the longer-term results of the partnership approach to capacity building: - Validation of people's own experiences and perceptions - Development of empathy and deep understanding amongst the people whose lives are affected and thus amongst the people most likely to be able to work together to find effective solutions - Experiences of solidarity which enable people to act together - Empowerment and the releasing of energy, particularly amongst people who previously had felt disempowered and unable to either fully understand their own situations or act to bring about useful change - Ultimately, effective and sustainable outcomes which result in long term and adaptable social change which addresses the challenges of HIV and development Following description of these key themes, a case study is presented which outlines the way approaches based on capacity development worked in practice in an ongoing project of the Programme to enhance national capacity through HIV action research. This case study demonstrates, from the perspective of the Programme, how the approach evolved, what was learnt about what works, what difficulties have been experienced through this practical experience, and thus what suggestions can be made for ongoing work by the Programme and others.
5.2 The process of capacity building within the HIV epidemic The following sections highlight some of what has been learnt through the use of SPR about how the new development paradigm can be realised in practice. They are based directly on the data collected through personal interaction during the evaluation process: dialogues with individuals in the four countries visited, and interactive workshops. Much information was collected in the form of narrative and "thick description" (See Section 2.3). Of necessity, this section includes only the most significant findings, collated and summarised by the evaluation team after further dialogue and shared reflection ("interpretive interactionism": see Section 2.2). One important finding that is almost impossible to convey through a written report was the depth of feeling expressed by many evaluation participants about their involvement in responding to the epidemic. These included feelings associated with grief, loss and pain, but also included equally intense feelings of hope and confidence that they were, indeed, engaged in effective responses to the epidemic which are leading to worthwhile and positive changes. Many participants responded enthusiastically to the very idea of discussing processes which work, noting that such processes are often overlooked in attempts made to understand the global response to the epidemic. Although grouped into sections in order to make the information more accessible, in reality there was much overlap between people's understanding of various concepts. The information is presented here as a further contribution to the discourse about the new development paradigm and its interaction with the HIV epidemic. Central to discussion on sustainable human development, and to the work of the Programme, is the concept of capacity building. This was included in the list of "Concepts UNDP is currently using," which was used to generate discussion during Stage 5 of the evaluation process (see Appendix 2). The HDP aims to build capacity not just of individuals and organisations but of whole nations. Reflecting the need to commence with building capacity to understand, not just to act, the programme uses partnership and processes of shared problem solving, rather than skills transition, to develop capacity. A crucial aspect of capacity building is that it builds on what is already there, even when existing capacity is not recognised by those who have it, as explained by John Musanje, from Zambia: "We need to mobilise the indigenous potential." The resulting enthusiasm expressed by evaluation participants who had been involved with the Programme is typified in the comment of David Chipanta, also from Zambia, that, "They (HDP) helped me see capacities that are dormant, such as the capability to listen, to change and to adapt." What are the features of capacity building which generate understanding and more effective responses to the HIV epidemic? The next few sub-sections explain processes which people have found helpful in developing their own and their nations' capacities. Before these, the report addresses some more general aspects about the nature of capacity building within the context of the HIV epidemic.
5.3 Building capacity to respond in different and changing contexts A central feature identified by evaluation participants is that people and nations now require capacity to quickly understand and respond to changing contexts, not just to familiar or repeated situations. While some people noted that each stage of the epidemic presents different challenges, many noted also the evolving nature of their understanding of what is occurring and what is now required. Consider this quote from Roland Msiska, the former National HIV/AIDS Programme Manager in Zambia, reflecting on both his personal development of capacity and the way his programme now has to work:
The changing nature of the epidemic and of emotional and cultural responses is not widely acknowledged, yet is an important feature of people's own perceptions of reality, and therefore affects their requirements in capacity building. A corollary of the complex and dynamic nature of such capacity building is that capacity must be developed across institutional and state/community boundaries. This requires working with a range of institutions, as is reflected in the Programme's commitment to bringing together governments with NGOs, military with civil organisations, and researchers with users of research. In order that this work be effective, it simultaneously requires an emphasis on working with individuals, as noted by Carlos del Rio, the National AIDS Programme Manager in Mexico:
The challenge of catalysing social change which grows from individual commitment can be met, in part, through working with individuals who act as social change agents. This can sometimes mean identifying people who already play that role, and sometimes mean drawing out the capacity of individuals to act as social change agents. This concept was well understood by many evaluation participants: individuals can catalyse sustainable human development within their own communities, through using processes similar to the concept of process consultation (See Section 4.7), as highlighted in a comment from Teresita Bagasao from the Philippines, who said that, "Being a social change agent is about asking questions." The need for identifying and working with individuals who are potential social change agents was identified early in the Programme's development. The value of doing this was also a central theme in evaluation participants' comments about both their own and others' responses to the epidemic. The importance of individuals' commitment was highlighted in comments made by the National AIDS Programme Managers interviewed; from Zambia, the Philippines and Mexico. All three talked of the complexity of their jobs and the need to work across institutional and professional boundaries, of occasional or regular tiredness, but also of a strong commitment to their work; they had also noted varying levels of engagement and commitment from those with whom they work. Another central requirement of capacity building is that of honesty, especially the honesty of being able to admit when simple solutions are not available or appropriate. Due to the complex and dynamic nature of the epidemic, it is not possible for any one individual or organisation to know how to deal with every problem that arises. During interactive discussions, for example, evaluation participants often responded very positively to being told that the Programme is questioning the nature of expertise. The general feeling was that so many of the problems which people now face are so new, so complex and so different to problems which can be addressed by one professional discipline or another, that there can no longer be "experts" in the traditional sense of the word. However, the nature of honesty and expertise is also relevant in a strategic sense: "Even saying, 'I don't have the answers', you have an answer", was a typical comment (again from Roland Msiska in Zambia). It expressed that working together with people to find answers can build capacity much more quickly than claiming that your own expertise is universally applicable. Rather than focusing on skills transition, the Programme has found that capacity building arises from the development of shared learning through working in partnerships, as explained by Teresita Bagasao with reference to her own interaction with the Programme and the flow-on effects within her own work with NGOs in the Philippines:
5.4 Characteristics of partnerships which develop capacity Consistent with the general approach of promoting sustainable human development, the role of the outsider in identifying social change agents is, to a large extent, indirect. The aim is not to go into other people's contexts (countries, communities) and identify individuals as social change agents but, rather, to establish partnerships which facilitate communities identifying and working with their own social change agents. A primary means of doing this is through bringing people together in groups and networks. Thus, the first consultative meeting to discuss directions for the SPR, in October 1992, determined that a key element of the Programme should be, "To identify and to characterize the necessary and sufficient conditions for the development and maintenance of group and social cohesion". A primary reason for this was that, "The functional group C family, village, community, society C is the ultimate resource for behaviour change, for care and support, and for coping with the impact of the epidemic." One method used to explore what is needed for development and maintenance of group cohesion was the development and maintenance of partnerships, commencing but not limited to partnerships between the Programme and those affected by the epidemic. Many comments were made by evaluation participants about the nature of those partnerships which develop capacity. Some of the recurring themes in these comments are summarised in the following points. If development and maintenance of partnerships is genuine, then they will follow the usual patterns of human relationships. Sometimes partnerships will succeed without effort, sometimes enormous emphasis will have to be placed on maintaining the relationships, and sometimes they will fail. Ultimately, when partnerships work, they result in growth and changes amongst all partners concerned. These sorts of comments were made with reference to the Programme's relationships with its direct partners, to those partners' relationships with others in their own countries and in international networks, and to other partnerships which were identified by evaluation participants as examples of effective capacity building. Effective partnerships take time to establish and essentially involve two-way dialogue and development. Capacity building does not work through patronising relationships, such as when donors have all the ideas and claimed expertise and involve local partners only in programme implementation. An example of this way of operating and the long term result was given by Peter Resurreccion, who works constantly across government/NGO boundaries in the Philippines, as he talked of earlier experience in the Department of Health:
In contrast to this, effective partnerships involve all partners being able to constantly question and challenge themselves and each other. Many participants reported that the HDP, and UNDP in general, often allowed this to occur. For example, Assistant Secretary Antonio Dujua, from the Department of Justice in the Philippines, noted that,
The way effective dialogue can flow on from Programme partners to others was highlighted in comments made by staff of two Filipino NGO agencies which work to build the capacity of others in the Philippines through ongoing partnerships based on approaches identical to that of the Programme. These two people, from Kabalikat and Phansup (Philippine AIDS NGO Support Network) each noted that their own work reflects the way that Programme staff spend time "up front" in identifying potential Programme partners and in working to establish mutual understanding of roles and expectations before rushing into long-term partnerships. Such time consuming work does not always result in effective partnerships, but was reported to be an essential component of those which are effective. The results of such work are not always measurable using traditional measures of cost-effectiveness or project outputs, especially when time spent early on leads to decisions to discontinue potential, but in practice ineffective, partnerships. Effective partnerships are not always initiated or controlled by donor agencies or by central government authorities. Participants in Senegal, Zambia, Mexico and the Philippines noted that many successful initiatives in response to the epidemic had commenced through voluntary activity, often starting with no clear idea of where their initiatives were heading, and receiving external funding only after difficult project development phases were complete. A few NGOs in the Philippines noted initial distrust of government involvement, claimed that successful initiatives almost always commenced with NGOs, and noted that when partnerships between government and NGOs work it is often because, in the words of one workshop participant, "NGOs have taken the pains to involve government." Hearteningly, some government workers in the Philippines also drew attention to this aspect of their partnership with NGOs. Effective partnerships allow all partners to make choices. In provision of external assistance, there must be an ability for recipient partners to choose which aspects of that assistance they want, and what aspects of the external agent's experience they find useful. Partners of the Programme, especially those who had attended HDP workshops, reported that this was most often the case. Outsiders also need to be free to choose which partners they want to work with, but this may be complicated by the requirements of ongoing political challenges as, for example, when international agencies want to work with NGOs which are not close to their own countries' governments. An important element of the importance of choice within partnerships was also noted by a participant from Senegal, when he talked about the importance of involving people with HIV but doing this in ways which enable them to choose when, where and to whom they come out:
Effective partnerships acknowledge the contributions of all parties involved. Some participants reported that donors often assume that direction should be by them because they provide the funding, forgetting that the donation of time and expertise is a large expense for people living in poverty: "Donors and the community are both investing", said one participant, drawing attention to the need for both parties to determine the desired long-term outcomes of that investment. In contrast, effective partnerships engender mutual respect for the dignity and contribution of all involved. Likewise, effective partnerships do not remain in the control of those who initiate them. This was highlighted, again, by Teresita Bagasao from the NGO, Kabalikat, in the Philippines:
Effective partnerships are not always easy. Some partners of the Programme reported that on some occasions they felt they were being presented with rigid views of the epidemic and development, or that their own expertise was not always recognised. This reflects that processes to build consensus on shared senses of purpose, and mutually beneficial learning, must also be ongoing. Others reported difficulties in their ongoing relationships with each other, as when members of networks noted that it was not always easy or productive for NGOs and governments to work together, or even for NGOs from different countries to respect and work with each other. A few participants in the Latin American and Caribbean Council of AIDS Service Organisations (LACCASO) noted that this network had experienced difficulties but had overcome them over time.
5.5 Some immediate effects of partnerships which build capacity Partnerships are important not only for their own sakes, but because of what they achieve. Throughout all stages of the evaluation process, much was said about how working through partnership achieves relevant and sustainable responses to HIV and development. Comments of participants can be grouped in various themes, and these in turn can be grouped into themes about the immediate effects of successful partnerships and what people experience through these processes, leading to more powerful and sustained effects. Amongst the immediate effects are concepts of inclusion, the creation of space, reflection and sharing of experiences. The way people experience these processes is addressed in the next sub-sections. Inclusion Evaluation participants indicated the value of learning through interactive processes. However, such learning does not happen automatically whenever people meet together. An essential pre-requisite to mutual learning is that all participants feel included. Notions of expertise are important to this. In brief, if people feel that their own experience is valued by others, they will be more likely to talk about it and to share both what they have learnt and what they still have doubts about. This leads to others doing the same, and reflective dialogue helps in the development of solutions to newly identified problems. The use of a wide range of available group processes, simulation games and other methods drawn from the fields of adult education and community development is important in these inclusive processes. While often used in local projects, the HDP has demonstrated their usefulness also in international networks and workshops. It is important to include in sustainable development programmes the people whose lives are directly affected by the epidemic, to ensure that their experiences are valued, and to ensure that they feel able to contribute. A classic example is the inclusion of people with HIV in programme and policy planning. Promotion of this has been a feature of the UNDP HIV and Development Programme's work since the beginning. Recognition of its importance is now common on national HIV/AIDS committees and in many (but not all) international forums. However, this inclusion has often been tokenistic, resulting in people with HIV sitting in on committee meetings to which they have been invited at the last minute, not adequately informed of what is going on, and not included as equal partners in problem-solving within those meetings. The HDP has explored ways to improve this situation, by promoting networks within countries, regions and worldwide so that people with HIV could share their experiences with each other before participating in wider networks, by inviting people with HIV to participate in all workshops and meetings held by the Programme, and by exploring within workshops various means of involving people with HIV in ways which enable them to participate and discuss their HIV status as and when they feel appropriate. The value of these types of initiatives was often mentioned by people with HIV who were involved in the evaluation process. The issue of inclusion of people with HIV in workshops has led to much discussion amongst people with HIV, people involved in NGOs working in development, and other partners of the Programme. Gradually, it was reported, people are building up trust and understanding of how to make this work, by acknowledging that the answers are not simple but that they can be found through interactive processes. Likewise, the Programme has promoted the involvement of others affected by the epidemic based on principles of including people affected and recognising expertise which arises from lived experience. Again, evaluation participants often acknowledged the importance of this. The HDP evaluation process itself ensured inclusion of people whose lives are affected by the HIV epidemic, often to the surprise of those people themselves, because they are so often excluded. Reflecting a common experience of internalising lack of power, some participants in Mexico asked, "Why me? Why do you want to interview me?" One woman identified by HDP partners as being an active social change agent said her organisation was "...just a grassroots organisation", and asked, "Why don't you go to the big ones?" Constant experiences of exclusion result in a lowering of expectations about inclusion. The result is that the experiences of some of the people engaged in the most effective responses to the epidemic are often excluded from policy and programme development unless conscious efforts are made to invite their inclusion. The lack of inclusion, or even active exclusion, of some people in many responses to the epidemic was also noted by many participants. Exclusion can be a damaging process which crushes hope and stifles the development of effective responses. Consider, for example, this statement by Eduardo San Miguel from Mexico:
Another group not often included is the next generation. This is often reflected in countries in which it is believed HIV has a low prevalance: for example, when almost all HIV resources are spent on surveillance and education, with little interest in planning for future needs in care and support of people who are ill and the living dependants of those who have died. In contrast, a group of women in Zambia who are caring for the children of those who have died, a group called Kwasha Mukwenu, meaning "Help your friend who is in need", told evaluators that they are now teaching the older children how to care for the younger ones, in the conscious hope that their work will be continued in the years to come when they themselves are unable to continue providing care. The importance of space in enabling inclusion One immediate impact of effective partnerships is the creation of space in which people can think, feel, say and thus share things that are not always possible in the spaces of their everyday lives. The concept of space was recognised as an important component of inclusion. Again, simply being in one spot does not lead to people feeling included, or to them bringing to the sharing the things which may matter most to them. Two considerations are important here: first, having a a space where people are free to talk undisturbed, and where time to reflect is deliberately allocated; second, creating a type of emotional space, in which people feel free to discuss some things they do not normally discuss. The requirements of such space, and the range of issues this enables people to address, are summarised in this quote from As Sy, the Executive Director of the African Council of AIDS Service Organizations (AFRICASO):
The use of space, like many other processes of inclusion, needs to be valued and cherished if it is to be effective. An example of this was learnt directly by the SPR evaluation team in Zambia. A workshop which had led to the telling of many important stories and the sharing of many emotions was joined after lunch by a few people who had not been there in the morning, and who held senior positions in government. The trust and the sense of sharing the same space which had been developed throughout the morning and continued during the lunch break suddenly disappeared, and discussion reverted to common bureaucratic and planning language, with little allowance for the importance of emotion or cultural insight. In retrospect, it would have been important to insist that participants attend for the whole day, or just for the morning, but that they could not arrive mid-way through the workshop. Participants reported that one of the most effective uses of space is to allow people to bring their emotions into discussions: in the words of one participant from Senegal, allowing "...permission to feel." Despite the overwhelming significance of human emotions in enabling people to come to terms with and respond to the effects of the HIV epidemic, this is often not allowed, especially in international meetings. The assumption is, too often, that effective responses arise from scientific insight alone, and that emotions get in the way of good programming. Likewise, discussion about religious beliefs is often excluded in policy making, on the basis that religion somehow interferes with rational responses to the epidemic. Thus, participants in Zambia and the Philippines reported that many outsiders had told them either to make special efforts to "get the church on our side" or, conversely, to make sure the church was not involved because it would interfere with the promotion of condoms. In both countries, efforts to include the church have proved of value. Indeed, both communities and people's religious and spiritual beliefs were central to many of the evaluation participants' own experiences with the epidemic. What is often forgotten is that a faith community in many communities is the only institution which brings people together in groups. If group sharing is an essential component of developing capacity, then the involvement of faith communities is also essential. If action arises from understanding, then no action will arise if key components of understanding are denied: these include religious belief and spirituality, which are often intricately entwined with feelings of hope, empowerment and solidarity. The importance of, and methods for, creation of space in which people can reflect on and share their innermost feelings and beliefs in relation to the epidemic was highlighted in an evaluation workshop in the Philippines. Discussion at one stage addressed the question of the extent to which Filipinos feel able to talk about sex. The experience of many participants was that Filipinos find this difficult, but this was challenged by a Catholic nun, who said that she had found that Filipinos like to talk about sex. Only when asked to explain how she enabled them to do this did she recount that such talk usually occurred, "...at the end of the second day of closed workshops." Thus, the evaluation workshop itself had created space for Filipinos to talk about the circumstances in which they could talk about sex. The result was that all participants learnt how to create space for this, by hearing from someone who regularly does so but perhaps did not realise how rare this is Reflection and sharing of experiences Reflection, on one's own and others' experiences, was another immediate effect of working in partnerships which was reported by many participants. This was noted by Margaret Mutambo, from Zambia, as having obviously occurred amongst staff of the HDP:
The importance of reflection, and the types of insights to which it leads which are different from those which can simply be passed on as knowledge from one person to another, was also highlighted by Sr Marie-Luc, from Senegal:
Like inclusion, reflection does not happen automatically, but can be invoked. Learning this through having participated in workshops which encouraged reflection was, in itself, an important lesson for Margaret Mutambo, from Zambia:
5.6 What people experience as a result of these processes It is the more powerful and sustainable effects of partnerships which lead directly to the types of understanding and action which are required for sustainable, adaptable and effective responses to the HIV epidemic in the context of human development. These include validation, the creation of social learning, solidarity, empowerment and the releasing of energy and, ultimately, sustainable and continuing social change. Validation One of the important effects of inclusion and sharing is the sense of validation that people attain and can give to each other. Validation is about making sure that people are not only included, but also that the value of their experience is acknowledged and affirmed. Validation is important in any work which is attempting to redefine the nature of expertise. Expertise which arises from experience is not always valued, and people whose expertise arises from experience rather than formal education often internalise feelings of inadequacy and lack of expertise. The required validation need not come from external "experts" in a patronising way, but may more often come from people learning to value each others' experience. In Senegal, a number of workshops had been held based on the Programme's workshop in HIV and Development. Evaluation participants reported that within these workshops they had listened to one another and shared their understanding of what might work to bring about change. These processes had been very useful in validating not just their individual expertise, but also the power of sharing and developing that expertise together. One seemingly ironic aspect of validation is the benefit some participants reported could arise from validating uncertainty. Sometimes, coming together with others to share understanding about the epidemic results in sharing doubts, uncertainties and even a sense of despair about what is occurring and what might be done. Rather than stifling responses, participants reported that finding that their own uncertainties were also being experienced by others was empowering, because it enabled people to see that the problems did not just rest in their own individual lack of power or insight. The sharing of uncertainty often leads to identifying ways to move beyond that uncertainty. Developing empathy and deep understanding Many participants spoke about the importance to them of having developed the capacity for social, or community, learning through having first developed a deeper capacity for understanding the complex realities of the epidemic and its effects. Eduardo San Miguel, from Mexico, similarly talked about the nature of understanding which is effective in producing action:
An important aspect of this was the acknowledgement that people must become engaged in understanding emotional aspects of the epidemic. Solidarity The sharing of experiences, amongst people within similar contexts, can result in important developments in people's ability to learn about and understand locally-situated realities in ways which may not always be understood, and certainly cannot be pre-determined, by outsiders. The concept of solidarity which arises from sharing, and supporting each other through, difficult experiences was noted as important by many participants. Solidarity was not always seen as solidarity in action; often, it referred to solidarity in hope. For example, Sr Marie-Luc, from Senegal, noted that she gained an important sense of encouragement in her work from people in France:
Mary Kanene, from Zambia, noted that the evaluation process itself had provided her with a sense of solidarity, simply through allowing interactive discussion:
Solidarity is not something which arises through transfer of skills, but it can be catalysed through programming approaches which promote the sharing of personal experiences. A powerful example of this was provided by Roberto Castro, a member of a research team in Mexico:
The richness of understanding and empathetic feelings experienced by all members of that research team, as a result of the telling of this story, has helped them to develop a much better understanding of the way the epidemic has affected the people with whom they interact through their research, as Roberto explained:
Empowerment, and the releasing of energy Feeling that they are able to understand and respond to the challenges of the HIV epidemic and development was reported as centrally important to people's actual responses. Partnerships which lead to empowerment, which can sometimes be indicated by the presence of such feelings, are far more effective than those which build dependence. Anuar Luna, from Mexico, noted the close links between feelings of solidarity and feelings of empowerment: "The model is the tool, but the solidarity is the energy." Programmes which work to build enabling environments, such as through changing attitudes and laws to make partnership between NGOs and governments easier, are therefore important. The means to develop enabling environments are many and complex, and require the interaction of numerous activities and the development of widespread understanding. Many participants reported that feelings of empowerment, feelings that they can act within their own environments, have come gradually and slowly developed through collective action. Others reported that bursts of energy which enable them to respond to the epidemic are often associated with anger. Sara Longwe and Roy Clarke, from Zambia, were two such participants. They noted that a sense of anger at injustice and at patriarchal systems was an important motivating force, but that their anger at wider structural barriers was separate from the feelings they had working with people in their own lives. For example, Sara said that, "What gives me energy is to have one foot working in the NGOs and one foot in the grassroots." Roy acknowledged that he felt a sense of anger, "But at first when I felt anger it was a patriarchal anger: I am not having my wife treated like that! But later, I understood that the patriarchal reaction was a barrier to change." A good example of how inclusive processes can be empowering was provided through a series of experiences related by Margaret Mutambo, the UNDP HIV and Development national professional officer in Zambia. She noted the value of processes of the Programme which enabled people within her own country to attend inter-country workshops in which they shared experiences with each other and with those from other African countries. The types of processes used within those meetings and workshops had resulted in her feeling able to act with strong commitment in response to the epidemic in Zambia. These processes, she said, were based on a recognition that everyone present had something to contribute, irrespective of levels of education or professional experience. Their very attendance indicated interest, and part of that interest was to learn. What the Programme had done, however, was to ensure that everyone also contributed to that learning, even in ways they had not expected themselves:
5.7 Sustainable results: responsive social change The net result of partnerships, inclusion, solidarity and social learning is personal and social change which slows down the epidemic and minimises its negative impact. The importance of such change was often noted by HDP staff throughout the evaluation process, as was the interim step of change, or even transformation, of individuals and institutions. The importance of transformation was also acknowledged by many evaluation participants. Transformation results in people feeling that they do understand enough to be able to act, that they want to take action, and that they are somehow "changed" as a result of that action. This was highlighted in comments by Anuar Luna, from Mexico:
Evaluation participants reported various types of transformative processes which they found had been personally useful. Most often, these processes involved a combination of having lived through powerful experiences and having engaged in shared reflection about those experiences. As Roland Msiska, from Zambia, said, "You go through these personal changes. Through a state of fear, to hope." Thus, in workshops aiming to enhance understanding, processes which led to emotional responses had been very useful in generating commitment to responding to the epidemic. Likewise, people who said they had lived through traumatic experiences within the epidemic had found it useful to incorporate reflection on those experiences into general dialogue about policy and programme development. In turn, the involvement in policy and programme development had helped them to make more sense of their feelings of grief and loss. Two particular components of the workshops on HIV and Development were mentioned by many participants, either as experiences which had led to changes for them, or as methods they use to help others understand various aspects of the epidemic. One is the simulation game, Wildfire, originally developed for family planning situations by the Family Planning Association of New South Wales (Australia) and adapted for the Programme workshops. Another is an exercise called, The Unfolding of the epidemic, developed by HDP staff to enable people to understand the likely impact of the epidemic on individuals, families, communities and nations. Details of both exercises are available from the UNDP HIV and Development Programme. What is significant to this report is not those details, but a recognition that both of these exercises enable people to learn through shared reflection based on their own experiences, and both exercises enable learning at both an intellectual and an emotional level. Some evaluation participants reported significant effects arising from a single interactive experience, such as a facilitated visit to a nearby country or participation in a single workshop. Transformation can result from single experiences which lead to feelings of, "Aha! Now I understand", or "Now I have changed." An example of this was the reaction of Santhi, from Senegal, to the exercise Wildfire: You overcome your fear of AIDS. It's an adversary, but you've developed an idea of how it uses its tricks. So, it's no longer a fear of the unknown. It's transformation from not knowing, to being part of a network. I was the object of the transformation ... you suddenly realised anyone can get AIDS ... You remember, "That bastard infected me!" A participant reported in a final evaluation note of a workshop in Senegal that it had helped him to realise that:
More often, participants reported that they had sensed changes in their own levels of understanding and commitment over time. This could come from continued involvement in a network, ongoing involvement in the development of training materials, or the repeated running of workshops for people in their own countries. One person in Zambia reported the transformation he had experienced as a result of attending policy meetings on and off over a period of months during which a number of relatives and close friends died. The continual need to think about what should happen in national responses to the epidemic, interspersed with the intense personal experience of having people close to him dying, had resulted in an unshakable commitment to find better ways to help others respond to the epidemic. Similar experiences were reported by others working in UNDP, governments, NGOs or simply in their local communities. Some government officials engaged in policy-making responses to the epidemic reported the importance of transformative experiences leading to changes in their perception of the significance of their work, and to a different type of engagement with their work in relation to HIV than what they had with other work. In helping to develop capacity, it is important to remember that government officials are also people who live in families and communities, and the importance of providing space for sharing of emotions and for validation of lived experience is as important for them as it is for others involved in responses to the epidemic. The ultimate result of processes of capacity building is that people are able to further develop their own understanding and their own collective responses to the HIV epidemic and the challenges of human development. This was summed up well by Gary Engelberg, from Senegal:
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