37 HIV/AIDS prevention or reproductive health programs. The few that have been well evaluated suggest that community level approaches can be effective in changing violencerelated attitudes and behaviors. The following programs exemplify this approach: _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, Greene and Murphy, 2003; Guedes, 2004). The initiative includes four components: 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 two-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 put men at increased risk of HIV/AIDS (Pulerwitz, Barker et al. 2004).

_ReproSalud_ (Peru) was lauched by the NGO Manuela Ramos 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 an important problem 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 GBV (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 project coincided with a time of strong investment by the Ministry of Health, which made it difficult to isolate the project’s impact. Perhaps as a result, gender-equitable attitudes and practices increased significantly in both intervention and control communities, though improvements in program sites were slightly higher. The qualitative data suggested a much greater difference in intervention and control sites and documented 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).

# **2.3.6   Individual behavior change strategies**

Many other programs have attempted to produce individual behavior change (rather than change community-level norms) by working with individual men and boys. White, Greene