Personal risk assessment in Guyana

[Usa Duongsaa]

For some time I had heard about the personal risk assessment exercise being facilitated with different groups in Guyana as part of the AIDS Competence Process (ACP), and I was curious to learn what it was like, how it was
facilitated, and how it fit in with the process. Fortunately I had an opportunity to observe it in action during my second visit to Guyana in late September.


It was during a SALT visit to the fire brigade near the lively Stabroek Market that I had the opportunity to observe Colleen (one of the Guyanese facilitators) facilitate the personal risk assessment exercise for a team of 10 staff of the fire brigade (7 men --inc. 2 with more senior rank-- and 3 women). The exercise came after the introduction (hope & concern), the "Are we human?" exercise, and 2 energizers, but before dream-building. One question was asked at a time, and participants were given some time to reflect and respond to each question
before moving on to the next question. After asking all the questions, participants were told the implications of their answer to the questions, i.e. 1-5 yes = low risk level, 6-11 yes = High risk level, and 12 yes = very high risk level. The participants were not asked to disclose their scores. Participants briefly shared their reflections in pairs.


I did enjoy observing Colleen facilitate this exercise and really liked that she didn't answer questions or correct misunderstandings herself but instead stimulated others to share their opinions and understandings so that
correct information would come out from one of the participants. Colleen did really well in avoiding falling into the expert mode, which made this session stand out in my opinion because I know it can be easy for facilitators
to slip into the expert mode, giving information and correcting misunderstandings etc., while they are supposed to be only listening, appreciating and stimulating.

I think the exercise is interesting and it worked well on this occasion because of several factors:

* it got people to laugh and tease each other a bit because the majority of questions are about sexual practices and people can laugh about it because they don't have to say in public what they do and how many scores
they receive. The laughing and teasing helped lighten up the rather-tense atmosphere and group dynamics, thus creating a friendly and fun atmosphere.

* before facilitating this exercise, Colleen did an ice-breaker first by asking everyone including all the facilitators and all participants to come together and line up themselves in one single line according to their birth date and
month without speaking a word. It worked really well! It was fun to watch people try sign language using their hands and fingers to communicate with each other and moved around to get themselves into the correct position
(although some people still got mixed up at the end). After they finished and everyone was in the correct position, Colleen asked them to sit down in the circle in that order, so she got facilitators and participants mixed together in the circle without making it an issue, before she proceeded to explain the personal risk assessment exercise.

* Colleen also checked periodically whether the participants understood the terms used in the questions, such as 'STIs' and 'blood transfusion'. We found that many people misunderstood 'blood transfusion' . As already mentioned, she didn't answer questions or correct misunderstandings herself but instead stimulated others to share their opinions and understandings so that correct information would come out from one of the participants eventually. If she had corrected all misunderstandings and given proper information herself, it would surely have affected the lively and friendly atmosphere.

* Colleen also wrapped up well by asking participants to reflect on their answers and scores and think for themselves about how they could make themselves safe(r), without giving them a lecture on it.


Having observed this session, I think for the exercise to be successful and relevant to the ACP, it does require a facilitator who can stimulate reflection and discussion, like Colleen did. It can lead to dream building and/or
self-assessment in that case. A facilitator who plays the role of an expert or a service provider by giving knowledge and information, correcting all misunderstandings, etc. will likely kill the fun and equal atmosphere as well as the participants' enthusiasm needed for the participatory activities to follow. The exercise can be improved, I think, by giving a print-out sheet of those questions for each participant to fill in their own answer and scores while doing the exercise, and to take away with them for further reflection and planning on what they will do to be safe(r). The sheet can also give some facts and referral services that participants can read later which will help facilitate their action planning; it will help us provide the needed information without us having to slip into the expert mode.

It was good that Aleta, another facilitator who followed with the dream-building exercise, did refer to this personal risk assessment exercise before she started, saying that their risks could affect their dream. This certainly helped establish the linkage between personal risk assessment with building a personal dream and a group
dream of an AIDS-competence community.

Personal Risk Assessment Jan 2010.doc

Checking birth date and month without speaking a word!

Sharing in pairs at the end

[Autry Haynes]

The origin of Personal Risk Assessment (PRA) is from a manual:

BODYWORK III
“ON THE JOB”
A Manual for Trainers and Workplace Peer Educators


HIV/AIDS Workplace Education Programme
International Labour Organisation, Guyana
Supported by ILO and US Department of Labour


I was introduced to PRA in February 2010, actually, when I wanted to engage the staff of the Ministry of Amerindian Affairs to be more conscious of the threat of HIV on their lives. This had to be done in one hour, the time the administration allowed of activities associated with HIV prevention. It was intended that going through the questions would have taken twenty to thirty minutes, allowing for thirty minutes discussion. After the questions and indication of the meaning of the different levels a discussion ensued. It was intended that people would have reflected on the personal status and after, privately seek out additional information based on their individual level of vulnerability. That was not so successful.

It was introduced by AIDS competence Facilitators doing training and familiar with the exercise. Lorna Harry introduced it in the SALT process with the intention that persons would have privately reflected on their individual risk / vulnerability prior to doing the dream building and as such greater motivation would go into the dreams. This could not be ascertained. It was done at each SALT completed by Team 1. I do however agree that it could stimulate greater reflection for individual / personal risk / vulnerability. In relation to Usa’s suggestion that the one page questionnaire be given out, I agree. In fact that was done for the first exercise with the Ministry of Amerindian Affairs staff.

Usa indicated the effective link to dream building but it could be done during any time of the AIDS Competence process, especially where it will result participants thinking about their own vulnerability. Yes I agree that time should be allowed for reflection and understanding words / phrases / concept before answering each question.

[Ibrahima gaye]

Thank you for the sharing of such experences, we do appreciate the approch and the results.

Best regards