CFAR's expertise in training and capacity building was sought in 2007 when the Mahila Aarthik Vikas Mahamandal (MAVIM) in collaboration with the Maharashtra State AIDS Control Society (MSACS) decided to launch an orientation -cum-sensitization initiative for leading members of Self Help Groups (SHGs). The decision to conduct the initiative was prompted by a survey conducted by MSACS had revealed that women, especially married women, were more vulnerable o HIV infection and that the rate of mother to child transmission continued to remain high. The initiative therefore aimed at changing women's perceptions of their vulnerability to HIV/AID and motivating them to seek health care services through the PPTCT services being made available by MSACS.

MSCAS selected CFAR's module for training SHGs on the issue of HIV/AIDS as the base framework for conducting the training of trainers and gave CFAR the responsibility of facilitating the training of master trainers. These master trainers would in turn train 1200 Sahayoginis to conduct workshops for members of the 40,000 SHGs spread across 34 districts of Maharashtra. In fact 18 of the districts being covered by the Sahayoginis were among the high prevalence districts listed by NACO. Each district has 35-37 Sahayoginis.

Customizing the module

Since the module was in English and prepared with community women in Bhopal during an earlier project CFAR first tested it with four SHG members. Based on our findings from this exercise the module was translated into Marathi and adapted and customized to make it more relevant for SHG members in Maharashtra. Its focus was making women more aware of their environment. The challenges they faced as women, wives, mothers and professionals. And more importantly that HIV was not just a clinical problem but one that was linked to socio-economic and cultural aspects of society- patriarchy, inadequate knowledge about sexual and reproductive health, lack of literacy, unemployment, violence and the lack of forums where they could voice their concerns.

Therefore, while re-designing the module CFAR amalgamated various simulation techniques and methodologies- including audio-visual clips and familiar anecdotes and references- that would enable the women to objectively engage with the problem and even identify, assess and analyze community-centered solutions.

The revised module was then tested with SHG members in Thane and Shahpur and shared with MAVIM and MSACS. Alongside CFAR also created a team of local trainers who were sensitive to and informed about the concerns of women and their vulnerabilities to HIV and with the capacity to use an interactive communications tool.

Engaging with the realities

For instance, "word association exercises" were used during the ice-breaking sessions and the responses that were thrown up by the participants were subsequently linked to the multiple vulnerability that women experience. During one such session in Ambejogai an everyday word like 'rainy season' was associated with the many difficulties they face from ill health to increase in debts, HIV/AIDS and suicides. As Nirmala, a Sahayogini added, "This was a time when no transport services are available in the villages making it difficult for a sick person or a pregnant women to go to the clinic."

Similarly, in the first session which focused on making the women speak up and take on the role of stakeholders the module uses a clip from a Marathi film "Chakori" which showed villagers reacting to a young girl riding a bicycle. While the men were laughing and ridiculing the act the women were shown as encouraging her and looking at her with admiration. Initially the initial response of the Sahayoginis the clip reflected a "feel good" feeling that symbolized the act of breaking traditional bonds, of "the courage to take on traditions and customs" and to the fact that "if you have the will no one can stop you."

But when it was linked to the issue of the girl child opinions was clearly divided. Some felt the rural milieu was indeed responding to the aspirations of the girl child but others thought the reality was that of continuing bias and discrimination against the girl child. One participant spoke of how she had wanted to ride a bicycle. "But with five brothers in my family, I never got any encouragement." Another drew a parallel with their efforts to form an SHG and said "Even our coming together was opposed in the beginning but we persisted in our efforts and formed it."

These personalized responses were also used as examples of how they as trainers must use relevant exercises to enable participants to engage with different aspects of the problem. Strengthen their skills to assess problems from different experiential standpoints. And more importantly to help participants to go beyond spontaneous and gut level observations to help participants to do a rational check of realities.

Thinking anew

Interactive exercises were also used to enable the women to think anew and move beyond the habit of viewing themselves and perennial victims who are constantly "wronged and discriminated against" and re-visit issues, re-examine their milieu and identify and assess the many changes that were happing around them. Going back to the clip from "Chakori" they were asked who they felt was the main achiever - the girl or the bicycle?

Most felt that the bicycle was at best just an instrument and that the real hero was the girl. To support their stance they opined that even if her family was not supportive she had shown the ability to act independently. Mention was also made of a TV commercial in which a girl defies her father an takes part in a beauty contest because she was determined to do so. When asked who made the achievement possible- her mother or her family- responses were divided. Some felt the family mattered as they provide moral support and encouragement others felt it was the girl who took the initiative and learnt to cycle and it was her confidence that enabled her to use an opportunity available to her. To substantiate this they said, "Though we get family support, if we do not have the will and zeal to take it forward then what is the use of that support. It is a true achievement when you have to achieve against all odds."

Participants were asked to create a scenario in which the girl did not get the bicycle and the opportunity to break out of traditional mindsets. Their response was that in such situations it was the boys who would get the opportunity to ride it and explore the world. Girls they said were denied such opportunities and made to look after household chores and even if they went out they would be escorted. The exercise then asked them to compare the two scenarios and the conclusion they reached was that what linked them was the "opportunity factor".

In some groups the Sahayoginis said that while the reality was that the lives of women and girls were shaped by discriminatory practices they knew that over time age-old patriarchal structures would be chipped away only when every opportunity big or small was used to empower young girls and women. However there were some groups that were skeptical about society changing its attitude and becoming more responsive to the girl child.

So yet another set of exercises was conducted to enable them to assess the ground realities on such issues as: who is the villain? Is it men or it is the elders? What are the barriers and what sort of scenario would prevail for the girl child if they were not there? While some identified elders as the main barrier others felt it was due to the attitude of men but the general consensus was that traditional notions of men-women roles was the main barrier. They were then asked to create a dramatically opposite supportive scenario. It helped them to realize that the link between the disparate scenarios was the environment factor and that social change required a supportive environment. Without that it would not be possible for individuals, households or groups to bring about change.

Marriage - it's many faces

The second session aimed at strengthening their problem skills also used a clip, this time from a popular film called "Dharmakanya" in which a young woman finds out that her husband had lied to her about his work. This triggered off an animated discussion on marriage - the role expectations that men, women and families have of each other, the issues of stress and incompatibility and the consequences of dysfunctional marriages. Geetha spoke of how, "My mother-in-law would force my husband to get re-married because I had two daughters and she wanted a son." Or Sangita's accounts of a woman in her village, "who went into severe depression because her husband had a relationship with another woman in the village and of another who left her husband and child for the same reason." Seema meanwhile narrated how, " we were married immediately after we completed matriculation because one of our friends had run away and opted for a court marriage and our parents feared we would do the same. We were not even shown photographs of the person we were to marry."

As they explored the imperatives of marriage in the Indian context and the concerns of security and having to marry at all cost the discussion also veered to acts of violence, abuse and betrayal that often mar a marriage. Again instances were cited like the one by Asmita of "My friend would never go against her husband …but he would often beat the hell out of her" as they listed their expectations and reflected on the challenges and vulnerabilities that women face in marriage.

Enhancing health seeking behavior

The third session focused on creating a common stake in enhancing women's health seeking behavior and yet another clip from "Dharmakanya " was used in which a married daughter confronts her father for being indirectly responsible for her mother's poor health and death. As they reflected on why women neglect their health or were not sufficiently motivated to look after it they spoke of how, "Women are dependent on their husbands. They are not educated…neither do they earn" and that "More children is an indication of masculinity. Besides sons are always preferred…the mother in law decides when we should have the baby and the husband decided when and how to have sexual relations."

This led on to an exercise in which the women were told to search for ways in which these concerns could be addressed. Most of them stressed on the need to make women aware of their reproductive and sexual health and their vulnerability to life threatening diseases like HIV/AIDS. Aasha also felt that with women being "considered as baby producing machines, they should at least be given health advise...and one should also make the family understand this." Others like Sujata stressed that, "women should get the right information…we can do it through SHGs…educate them about the law against violence, human rights etc."

By now the participants were also speaking of the need for women to have more information on sexual and reproductive health and HIV/AIDS. Padma, for one, opined that, "Traditionally women are not expected to talk about sex and sexuality. If she does so she is looked upon as a person of immoral character. This attitude is harmful to her health as she is unable to get correct and timely information on sexually transmitted infections." Similarly Alka felt that, "if a woman can understand her body and control her health conditions she can perform her role as a housewife and mother much better."

Understanding HIV

A word association exercise was then done on the word 'HIV' in which the responses ranged from: HIV means AIDS to it is a dangerous, incurable disease for which there are no medicines. HIV means coughs, continued fever, pneumonia and cancer. It is a result of some 'sin' or unethical behavior-extra martial relationships, multiple partners and paid sex. An issue that concerns sex workers, truck drivers, bar girls transgender, migrant labor, police etc. And of 'stigma' because it is something society does not approve of.

During the discussion that followed many of their misconceptions were cleared by giving them accurate clinical and scientific explanations and in some workshops HIV positive speakers were also brought in to speak to them about how it was possible to effectively managing their lives despite being positive. This interaction challenged their misconceptions about HIV and enabled them to see the link between women's vulnerability and HIV and that HIV can impact anyone and women are also at risk. Consequent to this session some of the participants tested for HIV and also encouraged the community to do so.

The first phase of this initiative of training of trainers was completed in October 2007 with the training of 223 participants in 11 workshops. This included Sahayoginis, district representatives of MAVIN and the local NGO coordinator. CFAR identified women from each workshop who could be future trainers and in phase two of the project these 60 women will be taught the skills of being a facilitator. It is envisaged that a handbook will emerge from this process that Sahayoginis could use for conducting village level orientation on HIV.