evaluations have been conducted (Renton et al., 2000; Shaw, 2000; Shaw, 2002a; Shaw, 2002b; Paine et al., 2002; White, Greene and Murphy, 2003; Interagency working Group, 2003). For example, the Medical Research Council (from the United Kingdom) conducted an external evaluation of program effectiveness in the Gambia using key informant interviews, focus groups, and a KAP (knowledge, attitudes and practices) survey in four villages, including two program sites and two controls. That study found that the Gambia program improved self-reported attitudes and behaviors related to violence against women. Specifically, the program reduced the social acceptability of wife-beating at the community level and appeared to produce a corresponding drop in that behavior. Qualitative findings from other Stepping Stones sites suggest similar benefits.

# _Program H_

( _Bolivia, Brazil, Colombia, Jamaica, Mexico and Peru_ ) is being carried out by four NGOs. It aims to change gender norms and sexual behaviors in Bolivia, Brazil, Colombia, Jamaica, Mexico and Peru (Barker, 2003; White, Green and Murphy, 2003; Guedes, 2004). The initiative includes four components, namely: a) training professionals to work with young men in the area of health and gender-equity using a set of manuals and videos; b) social marketing of condoms; c) promoting health services; and d) evaluating changes in gender norms. In 2002, PROMUNDO and Horizons began a 2-year evaluation to measure the effectiveness of two different approaches, compared to a control site. Researchers have developed a "Gender-Equitable Men" (Leichert) scale with 24 items for measuring attitudes. Methods include pre and post-tests as well as a six-month follow-up community-based survey. In addition, they are gathering qualitative information among men and their female partners. Preliminary results suggest that the program has been successful at increasing gender equitable norms and reducing behavior that puts men at increased risk of HIV/AIDS.

# _ReproSalud_

_(Peru):_ Manuela Ramos launched ReproSalud in 1995 as a USAID-funded rural reproductive health program. ReproSalud used participatory rural appraisal (PLA) to help women's groups identify women's reproductive health needs and to organize community meetings to design strategies to address those needs. Domestic violence and forced sex within marriage emerged as important problems in those communities. In response, ReproSalud organized workshops for women and men on gender issues, carried out community awareness campaigns and established a microcredit program for women. By 2002, ReproSalud had reached over 123,000 women and 66,000 men. Qualitative and quantitative evaluation data suggest that the community-based PLA approach had a positive impact on attitudes and behaviors related to gender based violence (Rogow and Bruce 2000; Ferrando, Serrano, and Pure, 2002, cited in Boender et al., 2004). The quantitative evaluation (using community based surveys) was complicated by the fact that the project coincided with a period of strong investment by the Ministry of Health, which made it difficult to isolate the project’s impact. Gender-equitable attitudes and practices increased significantly in both intervention and control communities, though improvements in intervention sites were slightly higher. The qualitative data suggested a much greater difference in intervention and control sites and gathered evidence of dramatic changes in social relations and men's behavior. Respondents spoke at length about decreased alcohol consumption, domestic violence, and forced sex in all intervention villages studied. In the words of one 35 year-old woman, " _Before, they brutally forced sex. They hit, especially when they were drunk. Now, no more"_ (Rogow and Bruce, 2000, page 20).

# **Individual behavior change strategies**

Many other programs have attempted to produce individual (rather than community-level) behavior change by working with individual men and boys. White, Greene and Murphy (2003) reviewed the literature on such programs aimed at men. That review suggests that less information is available on the effectiveness of individual behavior change strategies compared to community-level approaches. Some 29