Join-In Circuit on AIDS, Love, and Sexuality

Unlike less interactive prevention methods, such as the distribution of printed leaflets and posters, the Join-In Circuit (J-IC or the Circuit) brings prevention experts into direct contact with groups of young people. This participant-centred format reflects prevailing theories of social learning and rational action and emphasises 3 main messages: "Be informed; protect yourself and others; show solidarity." Participants proceed through the Circuit in small groups. At each station, facilitators engage them in conversation, mime, and other lively forms of dialogue about how HIV is transmitted, how to talk about sexuality and love, condom use, non-verbal communication, living with HIV, and so on. Through open, often playful, discussion, each 75-minute session (15 minutes per "station") gives participants an opportunity to obtain potentially life-saving information. Participants are encouraged to examine entrenched attitudes that put them at risk in a non-threatening environment. Games make it easier to deal with taboo topics, while problem-solving exercises help them test new skills of self-protection.

With Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) support, the Join-In Circuit has been adapted for a range of different groups in many countries. Most Circuits strongly advocate for the use of condoms, the delaying of first sexual contact, faithfulness, and open discussion of prevention with sexual partners. Participants are also urged not to share needles or razor blades, to avoid high-risk situations, and to take advantage of HIV counselling and testing.

The use of culturally sensitive, though often explicit, images makes the Circuit highly adaptable. Here is an example of how organisers have tailored the content and format to reflect the experience of the particular group: In Mozambique, the "body language" station gave young people an opportunity to discuss polygamy, drugs, and sexual violence. In Zimbabwe, the term "seducing" was substituted for "prostitution", to open a dialogue about the daily practice of young women bartering sex for goods (transactional sex). In El Salvador and Ecuador, a station called "values, rights, and love" was developed at the request of religious authorities. Church leaders were then willing to support the Circuit, though it also included frank discussion of the use of condoms. Versions of the Circuit vary widely, therefore, to suit different contexts (HIV epidemiology, socio-cultural attitudes, political situation, etc.); successful implementation begins with a careful situation analysis, and follows 10 key steps:

1. Ask for support of national decision-makers: Explain the concept of the Circuit and how it might contribute, if integrated into national HIV programmes.
2. Seek partners: Adaptation is usually undertaken by a team of 15–20, including an expert consultant, ministry officials, health workers, and representatives of international agencies, national non-governmental organisations (NGOs), and young people they intend to reach.
3. Establish objectives: These should be measurable, realistic, and include participant-related objectives (increased knowledge, etc.) and structural objectives (better cooperation among prevention agencies, for example).
4. Adapt and develop content: Agree on which stations of the generic Circuit to include, whether others need to be added, and the content and images in each.
5. Prepare images, stations, and publications: Ideally, hire local artists to create images and local firms to manufacture the displays and dividers for Circuit stations. The Join-In Circuit can be set up in- or out-of-doors, but adequate space is necessary. It is helpful to provide participants with leaflets and posters with key take-home messages.
6. Form a core team: At least one coordinator is needed to ensure continuity of the Circuit; if possible, develop a team that has the time and means to coordinate the project collectively, train facilitators, provide refresher courses, assure quality, etc.
7. Build a team of facilitators: Participants should identify closely with Circuit facilitators. Facilitators - particularly those whose language, dress, and age are consistent with the participants' - are viewed as key to making the Circuit resonate with participants. In the Russian Federation and Latvia, most facilitators were 15 to 25, and in Ethiopia at least 20 young people are always trained as co-facilitators during interventions at schools. Ideally there should be two per station (male and female) who are skilled, non-judgmental communicators and able to overcome didactic problems, content issues, and organisational difficulties.
8. Testing: Before J-IC is rolled out across a country, it should be tested, with focus groups of participants and questionnaires.
9. Quality assurance and evaluation: With a coordinator in place, regular documentation is possible, together with other quality assurance and administrative work such as data gathering, facilitator training, refresher courses, supervisory visits, and advocacy.
10. Sustaining the benefits: Before planning, organisers should secure financing for development and implementation of the Circuit. Good advocacy is needed to ensure that information about the Circuit is widely disseminated and understood.
    

Youth, HIV/AIDS.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) figures (2008), an estimated 45% of new HIV infections in 2007 were among people aged 15–24, yet survey data from 65 countries for 2004–2007 indicate that just 40% of males and 38% of females in this age bracket had accurate knowledge about the disease and how to avoid transmission.

For a detailed, step-by-step handbook for the Circuit, as well as manuals and guidelines for facilitators on CD-ROM, please contact Susanne.Pritze-Aliassime@gtz.de at GTZ Health Section, Sexual and Reproductive Health.