On 19 June, Usa Duongsaa, speaking for the group, discussed the thinking that sits behind the changes. This is an edited transcript of the interview.

Q. Somebody challenged you to update the Self Assessment, so what were your thoughts about it?

Usa:. A number of us have been using the Self Assessment tool for the past few years and we have come across different difficulties on different occasions. So the Thai coaches met and they thought that the tool should be revised. We have had the suggestion earlier in the Coach’s e-workspace that it was about time to revise and to update the Self Assessment tool because our collective experiences have pointed out that several key issues were missing from the original tool that we used. And at the same time, some of the boxes were overlapping.

So there was a discussion among the coaches in the e-workspace, on and off, over the last 2 years about what might be collapsed together to avoid overlapping and to avoid some confusion.

We thought that sometimes it is complicated to go back and forth in discussion in e-mails and it would be easier to do that when you are sitting around a table talking to each other. So we tried to do that and the Thai coaches came together.

So we looked at the suggestions that the other coaches had made earlier over the past 2 years. And we looked at the several versions of the Self Assessment tools, the original one and the revised ones that Jean-Louis and Fabi worked on. And we looked at some of the comments and suggestions made and also we looked at our own experiences when we tried to facilitate it.

So as a result we added the Gender issue as a separate practise. We felt that it was something very important and it would be very difficult to integrate gender issues into all of the other 9 practises. It would not be very practical to keep refering to men and women every time we talk about the various practises. And so we thought that it deserved its own place, its own practise.

And then we put together ‘Measuring Change’ and ‘Adapting Our Response’ because we thought that the two should go hand in hand; because it would be strange that you measured change and you do not adapt your response. And when you have the two in different practises, there are a lot of overlappings in the small boxes. But basically we kept the framework and the wording. And the practises as they were originally defined, we have tested them and we felt that the practises are still appropriate for the different contexts in the different countries.

Q. And you also made a change in the idea of Inclusion, Practise 2?

Usa: Yes, that’s right. In the original framework, we talked about the inclusion of people with HIV/AIDS and their families. I think that the idea then was that in some of the work, people did not include people with HIV and their families enough. So we put that as the focus of inclusion. But I think in our experiences of trying to facilitate Self Assessment, as well as working with many communties, there have been a lot instances where people with HIV or their families are included but the other sectors are not included, for example, faith based leaders or community leaders or government agencies or NGOs and so on. And so we felt that inclusion should be inclusive, that it should include other sectors as well, and not just be people with HIV and their family.

Q. And the other practise that you’ve made a small change to is ‘Access to Treatment’, Practise Number 4.

Usa: In the original framework, it included all kinds of treatment, all these different levels of access to treatment. But I have no idea why, in the second revision, it just focused on ARVs. But in talking with many groups, we felt that including different levels of access to treatment and having ARV as one of the higher levels, Level 4 and Level 5. And we start with simple treatment, like access to basic medicine, to simple treatment, to treatment for infections as well.

Q. For me, the big change is the introduction of gender as a specific practise. Presumably people have talked about and thought about this before and in the past you’ve decided that we shouldn’t have it as a specific practise. So what has changed?

Usa: In e-workspace, in the coach’s discussion, there have been two ways of thinking. One is that it is not necessary to add gender as a separate practise, but make it in a way so that when you do Self Assessment you include gender into all of the practises. But we felt that it would be a little bit clumsy when you talk about Acknowledgement and Recognition and you would ask, “What about men and women?” And you talk about Inclusion and you ask, “What about men and women?” So we thought that it would be easier to use it as a separate practise..

Q. Can you define for me, can you explain to me what does gender issue mean? So in each of the levels we have the phrase ‘gender issue’.

Usa. We had a lot of discussion about this gender issue and how to put it in the Self Assessment. Earlier on, the AIDS Education Programme put gender as a separate practise in the Self Assessment that we used with our partners. Then we had a lot of details in the boxes (but now we have left them out) because some friends say that those details are too long to put in, so that is why it is not so clear as before.

But when we talk about gender issues with regards to HIV/AIDS work, we think that men and women have different risks and vulnerabilities to HIV/AIDS because of their sex. And also because of the different structures of power and relationships between the two sexes. So men and women have different risks and vulnerabilities, they have different levels, maybe different forms, of negotiating with each other about practising safe sex. Men and women also have differential access to treatment, be it ARV, be it other medicine or be it home and community care, because in our experience, it seems to be the women who shoulder the caring part.

Q. If a community is working at Level 5 in the Practise of Gender, how would that community appear to you?

Usa: I think that we will see that men and women are actively responding to HIV/AIDS. They take protection. And they all have equal access to care and treatment. They have the understanding and the acceptance by the family and by the community without questioning or stigma about who picked up the virus and who passed it onto whom. Or whether this was a good woman or not.

And also that the boys and girls, the children, would also have equal access to the counselling, to the support, maybe to the inheritance of their parents, with no differentiation about who gets more, because who is going to lead a family. And we see men and women taking care of each other, taking care of other people in the family and in the communities.

You asked me about what this Level 5 means; what the people and the community will be doing. But let’s look at Level 5, not for a community but for an organisation; so agencies working with communities and they are assessing themselves. I think we have a different vision of what they will be doing. So here we have said that they have mainstreamed gender issues in our HIV/AIDS work. And this has different implication for organisations than for communities. For example with an agency that has mainstreamed gender issues in their HIV/AIDS work, they have what we call the gender sensitive curriculum in the materials that they have produced. They have this gender sensitivity in how they portray the roles of men and women in HIV/AIDS prevention, care and support. They have, well maybe not exactly equal number, but comparable number of male and female staff. They also work with their partners to promote understanding on gender issues.

Q. The other big change is Practise Number 8. So bringing these two ideas of ‘Measuring Change’ and ‘Adapting our Response’. So can you illuminate again what you would see as Level 5 for this new practise?

Usa: If we look at Levels 1, 2, 3 and 4, they focus only on the present. They make sure that we are keeping ourselves up-to-date with what is happening around us. What is changing in our context and how we should best adapt to respond to it and so on. So that is very much a present day orientation. In order to be at Level 5 you cannot just look at what is happening and adapting to that, but we also need to look further ahead in the future.

For example, you are seeing that there are small places now that start to sell alcohol in the evening and you are starting to see that men stop there after they get back from their work and they stop at this place to take some drinks before they go home. We know what would be coming in the future. Because we know that when people get drunk, they would probably go on further to enjoy themselves and will have sex, unprotected sex especially. And so on. So they might get HIV and they might bring that back to their family.

So when we see these kind of changes we do not just adapt our response by just going to talk to those men, but we should also look at what has to be done to prevent future problems. You know we can start by giving condoms and we can start preparing the wives and we can do more to deal with this issue at the family level so that we can avoid the HIV infection that would be coming. If that doesn’t seem to be very successful, we can start to think about how to provide the support and the care once people start to get infected for example.

Q. Maybe one last question. Is there an issue that you thought about changing, that in the end you decided not to change?

Usa: I don’t think that there is anything that we left out in our discussion. In fact, we felt that the second revision, the one that Jean-Louis and Faby did over a year ago and that we have been using, we felt that it was quite comprehensive and we did not come up with new practises at all, just some changes that we made in the boxes.

And I think that in a way we resisted the temptation from those who come from the interventionist perspective and think that the Self Assessment framework should be directly addressing specific action. But we feel that is too interventionistic and we didn’t want to go that far. We think that this will allow the flexibility to be included in each practise already.