Report of Workshops on Counselling and Outreach Skills Conducted During Year 2002 at Bandhu Social Welfare Society’s (BSWS) Offices in Dhaka, Sylhet, Chittagong.
Facilitating Agency: Vision, Lahore Pakistan
Period of Workshops: 2002
Facilitator/Co-facilitator: Naheed Khilji (Ms)
Tahir Khilji (Mr)
Funded by: Family Health International (FHI)
Who is Vision?
Vision is
non-governmental organization based in Lahore, Pakistan specializing in
capacity building of NGOs working on male sexual health in South Asia.
We provide
technical assistance, capacity building, training and support to NGOs and
Community Based Organizations (CBO) working on male sexual health.
Since 1999 we
have assisted in capacity building of the following organizations:
Bandhu Social
Welfare Society, Bangladesh
Bharosa Trust,
Luknow, India
National
Network Against Girl Trafficking, Khatmandu, Nepal
Action Against
Sexual Exploitation of Children, Dhaka, Bangladesh
Shakti Samuha,
Khatmandu, Nepal
Report of Workshops on Counselling and Outreach Skills Conducted During Year 2002 at Bandhu Social Welfare Society’s (BSWS) Offices in Dhaka, Sylhet, Chittagong.
1. Executive Summary
1.1 Background
Strategies to prevent the spread of HIV/AIDS in
South Asia have gained momentum over the past decade. The reason for this sudden focus on the virus/disease is
explained well through the staggering numbers of infected people who have died
or will be dying in this region by contracting the Human Immuno Deficiency
(HIV-the causative agent of AIDS), if they remain unaware of the modes of
contracting it.
Where the modes of transmission of HIV through
unprotected sexual contact between a male and female (if not monogamous) has
been targeted as one of the prime risk behaviours for contracting HIV virus,
the sexual contact between two men is still a taboo subject in most of South
Asian societies, making it difficult to be included effectively in mainstream
Information, Education and Communication (IEC) materials on HIV/AIDS.
The main objective of the following workshops is to
identify and develop team of trainers within the BSWS set up, who can then
train their own program staff as well as other NGOs and CBOs providing
counselling and outreach services to populations that are at higher risk of
contracting HIV or other Sexually Transmitted Infections (STIs).
Since BSWS and Vision are Naz Foundation
International (NFI) affiliates therefore, these workshops is also a step
towards creating a common resource pool through which one partner NGO can take
advantage of another NGOs’ technical expertise for capacity building purposes
in required areas such as counselling, qualitative research and outreach
protocol.
1.2 Scope of Work
Goal
To identify and develop a team of trainers within
BSWS’ set up, who can then train their own program staff as well as outside
NGOs and CBOs providing counselling and outreach services to populations that
are at higher risk of contracting HIV and other STIs. This effort is to strengthen the existing counselling and
outreach component of BSWS.
Purpose
To strengthen and sustain BSWS’ existing counselling
and outreach component.
Objectives
The objectives of the workshop are as
follows
·
To assess
the level of understanding and capacity of counselling skills amongst
participants and its use for counselling on HIV/AIDS and STIs
·
To develop
and practice individual and group counselling
·
To
sensitise participants on issues related to MSM, and explore possibilities of
initiating channels of communication between the non-MSM and MSM groups working
on HIV/AIDS prevention
·
To assess
participants level of knowledge on issues related to HIV/AIDS and STIs
·
To reflect
upon peer counselling as an effective technique in HIV/AIDS & STI prevention
·
To provide
a forum to non-MSM counsellor for better understanding of MSM issues
·
To identify
and develop a core team of trainers
·
To develop
a framework of training the core team of trainers
2. Methodology
The methodology used to facilitate the workshop
mirrored the process used in the “Manual for training Community workers in MCH
and Nutrition” developed for mothers on counselling for Maternal and Child
Health (MCH) by MotherCare, The Asia Foundation and partner NGOs in Pakistan,
the goal is to evolve appropriate guidelines for counselling on HIV/AIDS &
STIs prevention.
3.Workshop Proceedings
Following remain the focal areas in the
workshops
3.1 Assessment of Counselling Skills
Participants reflected upon the essentials of
counselling. This was done through
numerous exercises, role-plays and discussions. Facilitator/co-Facilitator reinforced positive aspects of
counselling and suggested changes in the areas that needed to be improved.
3.2 Outreach Protocol
The entire outreach protocol was discussed and
assessed. The methodology used for
assessment was mainly role-plays.
Participants developed role-plays from the actual situations that they
face each day in the field while conducting outreach activity. Suggestions to improve some of the
activities emerged from the reflection sessions and discussions initiated by
participants.
3.3 Developing Appropriate & Need-based Counselling and Outreach Activities
Different processes were evaluated to develop
Counselling and outreach activities that complement the existing
protocols. Participants discussed their
needs at the field level and proposed different improvements that emerged from
the reflections on role-plays and exercises.
3.4 Addressing Issues around Stigma
Stigma and labelling were discussed as part of
understanding the needs of clients in counselling as well as in outreach. This was done through a set of games and
exercises that are taken from a life skill manual especially designed for men
who have sex with men.
3.5 Self Esteem and Self Respect
Exercises and games highlighting issues around
self-esteem and self- respect were conducted in the workshops. Post exercise reflection sessions assisted
participants to understand the role of self-esteem in person’s evaluation of
self.
3.6 Behaviour and
Dress code of Outreach Workers
Reflection exercises and discussions were held to
understand the importance of professional behaviour by outreach workers at the
cruising sites. Role-plays were used to
emphasize the need of dressing up in a professional way while conducting
outreach activities.
3.7 Islam and Male to Male Sex
In each workshop male to male sex was analysed in
context of Islam. Quran and other
religious sources were used to examine how Islam perceives sexual relationship
between two males. Processes were
developed from the discussions and brainstorming sessions for future use in
similar workshops.
4. Conclusion
The workshops were conducted to facilitate
participants to evolve a framework for counselling and outreach work that was
most suited to their conditions and environment. It was encouraging to see that
perspective about counselling changed in this entire process and
participants started viewing counselling and outreach work as integral part of
their program rather than just a job description. These workshops stimulated participants and they innovated
techniques that would make counselling and outreach work more effective and
holistic in future.
5. Recommendations
5.1 BSWS is expanding both programmatically and
geographically and counselling as well
as outreach work are two of the most important features of its program. Such training may be more sustainable for
BSWS if it develops its own core team that would conduct such trainings at its
new and existing sites. However, the
core team will have to go through a process of training itself before it starts
training others. These workshops have
been helpful in selection of core team members and their orientation but a more
consistent effort is needed to help build a BSWS core team of trainers.
5.2 Processes need to be developed to address issues
such as castration amongst Hijra community.
The post castration trauma and the sense of loss have to be made part of
counselling framework too.
5.3 Processes have to be evolved to address issues
around male to male sex and Islam. The
need of such processes are highlighted in most workshops.
6.1 Introduction
Participant and facilitators introduced themselves at the beginning of
each workshop.
6.2 Expectations of Participants
Participants were requested to share with the group their
expectations from the workshop. They
responded as follows
·
How to work better with male sex workers (MSW) and male who
have sex with male (MSM) at the site
·
How to make people understand about modes of transmission of
HIV/AIDS and other sexually transmitted infections (STIS) inside and outside
the office
·
How to initiate the process of community formation amongst
Hijras. How to make them understand
about HIV/AIDS and the reason of our involvement with Bandhu’s work
·
Will learn the ways of effective counselling on site
·
Will learn to asses the services we are providing
·
We have a Guru Chella relationship in our community, there
is not much we can do without the approval of our Guru. I expect to learn ways of communicating with
my Guru so that I can do my work more effectively
Will learn to talk effectively
and conveniently to the vulnerable groups about MSM and MSW
6.3 Norm setting for the Workshop:
Workshop norms
to facilitate the learning process were developed by the participants. These were
· To be patient throughout the workshop
· To be tolerant of each others point of
view
· To be cool headed during the workshop
· To speak on turn
· To raise hand before speaking
· To speak politely and nicely
· To be attentive during the sessions
· To be punctual
· To participate fully during the sessions
· No gossiping
· No side talking
· No cross talking
· To maintain confidentiality
·
To talk
about relevant issues only and maintain a focussed approach
6.4 What is counselling:
Purpose: To gauge participants’ perceptions regarding
counselling
Methodology: Brainstorming
Following were
the responses of participants when they were asked to define counselling:
·
Counselling
means to keep confidentiality of the client.
I consider counsellor to be the person who would be able to solve my
problems for me
·
Counselling
is referring clients to the right place for the services they need
·
Counselling
means talking to the client on site and making her/him understand the
importance of services that we provide in our program
·
To motivate
the client to come to the clinic
·
It is a
process that includes talking to the client.
It also means building rapport with the client.
·
It is
motivating client to come to the clinic
·
It is making
the client understand all about disease and infections
·
It is
providing the services to ones client
·
It is giving
out correct information to the client
·
It is the
knowledge of the subject matter
·
It is
receiving feedback from the client
6.4.1 Preparing a checklist of essentials of
counseling:
Methodology: Role-play
A cruising site
where there are four kothis who are trying to attract panthis. Two Bandhu outreach workers are trying to
disseminate information on safe sex to the kothis.
6.4.2 Reflection:
Participants reflected upon the role-play as follows:
·
The clients
were distracted and not paying attention to the outreach workers
·
The outreach
workers did not know how to handle the situation
·
There is no
way that a counsellor/outreach worker do her/his work properly in a crowded
park or a cruising site
·
The outreach
workers just went up to the kothis without introducing themselves. The kothis kept on thinking of them as
prospective client. They were actually
disappointed when they found out that these were outreach workers from Bandhu
·
One of the
outreach workers was too friendly.
Actually the panthi started harassing the outreach worker taking him for
a sex worker. The gestures and
expression of the outreach worker were similar to the kothis in the park
The kothis were very difficult clients and threw away the literature as
soon as the Bandhu people left the site
6.5 Open-ended
versus Close-ended questions
This activity
was done to distinguish between open-ended and close-ended questions. This was done through a small exercise,
where one participant asked a close-ended question and the other formulated an
open-ended question out of the same, for example:
Q. Are you
studying in class 8 (close-ended
question)
Q. What class
are you studying in (open-ended question)
The
participants were asked to reflect upon the usefulness of open-ended versus
close-ended questions in a counselling session. The group concluded that more information arose from the
open-ended questions whereas, close ended questions generally created a barrier
between the counsellor and the client since the client, responds by a yes or
no.
6.6 Role-play
Participants
were divided in small groups of three and each group was given 15 minutes to
play the role of a counsellor, client and observer. Participants who acted the role of client selected a topic of
her/his choice to be counselled on. The
counsellor, using the skills that had been discussed up to that point, would
counsel the client. Whereas, the
observer would observe and later give feed back in the larger group.
6.6.1Feedback
Feed back: ·
Counsellor
was unable to give clear information ·
No
solution came out of the conversation ·
Counsellor
was unable to satisfy the client ·
The
counsellor used a rather commanding tone of voice ·
Counsellor
was able to resolve the problem ·
Counsellor
was unable to handle the situation since the client was more knowledgeable ·
Counsellor
did not give enough time to the client to explain his problem ·
The
counsellor gained knowledge through observing the client ·
Client
asked question that made the counselor uncomfortable ·
Counsellor
was not knowledgeable enough and the client started showing signs of
boredom ·
There
was no effort of building a rapport between the counselor and the client ·
Counsellor
was unable to create a comfortable environment ·
Client
was not consistent. He was moving
from one issue to another ·
Counsellor
was unable to give appropriate information ·
It was
difficult to understand the conversation of the counselor and the client ·
Client
was not cooperating ·
Suggestions
of the counsellor were not acceptable ·
Counselor
asking too many personal questions and causing discomfort to the client
6.7 Brainstorming
Session
Following the
feed back session the participants brainstormed on how to resolve some of the
problems that arose during these counselling role-plays. The group suggested several ways to overcome
the problems that emerged during the counselling role-plays. All strategies were equally important and
they were
·
The counsellor
should have full knowledge of content of the matter that he is going to use for
counselling purposes
·
The
counsellor should be clear in her/his mind about different concepts that he is
providing counselling on, e.g. if an MSM is coming for HIV/AIDS counselling,
then the counsellor should be able to provide information in sexual health that
is appropriate and arises from MSM concerns and needs.
·
The
information shared by the counsellor should be accurate and in simple language
·
It is most
important that a counsellor should build rapport between her/himself and the
client, initially putting the client at ease by reinforcing some of her/his
positive behaviour that is visible or simply beginning by general open ended
questions
·
When client
begins to show signs of boredom then the counsellor may wish to end the
counselling session with client’s consent and make appointment for another time
or change the topic to something more interesting for the client to come back
to the initial discussion later
· Clients are not duty bound to cooperate or be consistent. The counsellor has the responsibility to develop client’s interest and have him focus on issues to be addressed.
6.8 Role
Play
Role-play
consisted of a counselling session where a person was to be counselled on post
HIV testing.
6.8.1 Reflection Exercises
Following the
role-play a reflection exercise was conducted which highlighted as under
·
Advice was
being given, whereas the counsellor should have informed the client
·
The
information given should be correct and to the point
·
No
greetings between the counsellor and the client
·
Counsellor
was assuming all the time
·
Some
information that was given to the client was incorrect
·
There was
no eye contact between the counsellor and the client
·
The
counsellor did not have enough knowledge on the subject of HIV/AIDS
·
The client
was showing anxiety and the counsellor was unable to calm the client
· Counsellor did not ask any questions from the client
·
Counsellor
was interrupting the client
·
The time
span for counselling was very short
·
Counsellor
was being judge-mental
·
Client was
in a hurry
·
Counsellor
directly asked the client about his HIV status
· Counsellor did not talk about the results of the testing
In the
discussion for purposes of reflection, the group felt that the counselor could
have handled the situation in a far better way if he was non judge-mental
because his being judge-mental created a barrier of discomfort and lack of
confidence in the client. It also led
to a rise in anxiety level of the client as he started feeling helpless.
The group also
felt that if the client had faced a counsellor with more empathy towards him,
he would have felt less anxious.
Thus, the
participants suggested that the initial rapport building, making the client
feel comfortable and giving all attention to the client (i.e. listening
attentively) were the essentials of any counselling session.
6.9
Active Listening
Participants
were asked to divide themselves into groups of three. The objective of this
session was to evaluate the skills of listening. The groups were to conduct counselling sessions amongst
themselves. Where each participant
rotated as a counsellor, client and an observer. The topic of counselling would come from the client.
Participants were asked to listen without using any words or body movements when playing the role of listener.
6.9.1Reflection Exercises
Following the
role-play reflection session was conducted, the participants shared that:
·
It was
difficult to just sit and listen
·
It was not
natural to not say anything when somebody is looking at you and talking to you
·
It was good
to sit back and listen
·
It was
boring to listen
·
It was good
to be listened
·
There had
to be some interruption from the other side for me to know that the listener
was understanding what I was narrating
·
My listener
was looking elsewhere and not listening to my problem.
·
5 minutes
is too much of a time for a person to speak and the listener to listen
In the second role-play the participants were paired. Where one played the role of counsellor and the other client. The roles rotated after five minutes. The client selected the issue for counselling. This listening role included body movements and use of reflection techniques.
The following
responses were given to the question that what happened when a listener
repeated what a speaker was saying?
·
Speaker
feels well listened to and is encouraged to speak more
·
Listener
finds it easy to understand speaker
·
Gets more
confidence
·
Speaker’s
point of view becomes clear to her/him
·
Speakers
talk more
·
Speaker
feels the sympathy of the listener
· It increases the comfort level
6.10
MSM and Islam
Several
questions were raised in previous sessions regarding Islamic perspective on
male to male sex. Does it allows or
condemns it. The group decided that
this matter of MSM and Islam would also be discussed in the counselling
framework.
6.10.1The
first brainstorming session
Self
respect:
Participants
were asked to reflect upon what they understood about self-respect. The responses were:
·
Understanding
self better
·
Realization
of one’s status in world and society
·
Rights as
human beings
·
Respecting
self
·
Respecting
other human beings and being respected in return
·
Personal
values
As part of
this session, participants were asked to highlight factors that shaped opinions
and could lead to respecting one’s self.
The responses were
·
Personal
values
·
Culture
·
Society
·
Education
6.10.2 The second brainstorming session
In this
session the MSM participants were asked how they felt about their identities
and behaviour, why did they feel the way they did? The response was that they
felt proud of themselves and the pride was linked to their discovery of what
they termed their “real self”.
6.10.3 The third brainstorming session:
The participants were then asked to describe their
feelings when somebody passed a derogatory remark about their sexual
orientation. The feelings described
were as follows:
·
I feel
ashamed
·
I get
confused about my identity
·
I want to
react to the injustice
·
I feel
guilty
·
I feel that
the other person is undermining me
·
I do not
feel good
·
I get
nervous and then cannot talk
· I feel shy
6.10.4 The fourth brainstorming session:
The
participants were then asked to connect their feelings about their sexual
desire and identities, (which was that of pride) to how they felt when somebody
passed derogatory remark about their mannerism. While making this connection they were also asked to think about
how to minimize the impact of the derogatory remarks upon themselves.
The responses
enabled the facilitator to discuss issues around Islam and MMS as most of the
participants felt that the feelings of guilt and shame were to do with their
religious beliefs and what they were taught about Islam and MMS.
The participants were then asked to identify the sources of their knowledge about what Quran said on male to male sex.
6.10.5
Sources of information on MMS and Islam:
The sources
described by the participants were
·
Mullahs
·
Newspapers/periodicals
·
Family
elders
·
Hearsay
·
Quran
(selective portions)
·
Sex
partners
·
Bengali translation
of Quran
All the
participants were educated, where most of them had a Master’s degree. They were asked if they had read Quran with
Bengali translation. One person had read selected portions of Quran primarily
those Surahs that spoke of male to male sex.
Participants
were asked to elaborate upon the process of accountability, was it individual
accountability or was there a concept of an intermediatery between Allah and
his people which would make that intermediatery responsible for the deeds of
other people?
The response
was that in Islam there is no concept of an intermediatery and that what ever
deeds, good or bad, are judged by Allah alone and, each individual is
responsible to Allah for her/his good or bad deeds.
The facilitator asked the participants to highlight the factors that are socializing elements for each person’s personality formation. The responses were:
·
Values
·
Culture
·
Society
·
Education
·
Religion
The
facilitator then asked the participants to identify some of those factors that
were commonly used to validate or authenticate the mainstream thought
process. The majority of the
participants felt that the legitimacy to mainstream thought process came
through:
·
Religion
·
Education
When the
participants were asked how they developed their ideas regarding “good deed”
and “bad deed”, while responses varied in nature they could all be grouped as:
“We
were told as a child that a certain act was good and certain other acts were
bad”
6.10.6 Information Seeking Session
The
participants were then asked to identify their sources of information that made
them feel that they were sinning by having sex with other men. They repeated the same sources as before
i.e. family elders, Mullahs and etc.
The
facilitator then asked the participants that hypothetically if they all were
given an assignment to find out whether the act of men having sex with men was
a sin and condemned by Allah where would they go to find it out. Mostly the participants felt that they would
go to someone who knows about Islam and Quran.
When the facilitator asked them to name those sources they once again
divulged that they would ask the:
·
Learned,
who has through knowledge of Quran
·
Mullah,
since he knows about religion
·
Older
people, since they have learned through their experience and knowledge of
religion
The
facilitator then asked the participants that for the same question if they got
an answer in yes or no from the above sources and performed the act or
abstained from performing the act and supposedly if the non-performance was
also a sin, would they then be able to use it as a defence before Allah,
meaning that they did this sin because the Mullah told them to stay away from
this or do it (whatever the case may be).
The answer was
in negative and was supported by the over arching theme in Islam that each
person is responsible for her/his deeds and would be answerable to Allah
accordingly.
Following these questions and responses participants were asked to think about the original question of MSM and Islam, and asked the group that keeping all the above in mind how would they want to resolve any conflict and issue.
6.10.7
Facilitating to create linkages:
Through
personal sharing the participants were asked to generate some options that the
group needed to address the issue of Islamic perspective and MMS
behaviour. The responses were:
·
To research
the subject by reading about it
·
To read
Quran and form a better understanding of Quran
·
After
reading the Quran, to discuss amongst themselves what each understood from the verses
of Quran
Following this
discussion the facilitator talked about his views on the matter. He shared with
the group that as a Muslim male he had no definite answer whether the activity
was condemned or promoted in Islam, but he made it clear that it was his own
understanding of Quran and how he read it.
He felt that as an educated Muslim adult, he had a better frame of
reference to understand Quran and find answers for different issues as they
arose. He believed that if more people
would read Quran and research they would find appropriate answers that are
relevant to them.
6.11Final checklist of the elements of counselling:
·
Greetings
with a pleasant expression
·
Rapport
building by asking some initial questions/ observing the mood of the client/ reinforcing
client’s positive behaviour/ complimenting the client for something nice he is
wearing
·
Asking open
ended question
·
Counsellor
sharing information and keeping away from the advice mode
·
Information
given to the client should be accurate and concise
·
No
overloading the client with information
·
Counsellor
if unable to answer should not provide incorrect information but can always say
that she/he would check on this and come back with the answer next time
·
Counsellor
should be non-judgmental
·
Counsellor
should maintain client’s confidentiality
·
Counsellor
should not interrupt while client is talking, although the client may be doing
something wrong. However, at the end
the counsellor can politely describe the right way of doing the same thing
·
Counsellor
should listen to the client attentively
·
Counsellor
can share some of his similar experience and how she/he was able to overcome
the problems, or someone else who had experienced the same problem but was able
to resolve it through some strategy
·
The
counsellor should manage his time properly
·
The
messages from the counsellor should be short, clear and understandable
·
Counsellor
should behave in a culturally appropriate way and should use the right kind of
language (avoid using street language)
·
The
counsellor should recap the conversation of the client to give her/him the
feeling that her/his problem was well understood
·
Ask the
client at the end of the session if she/he has any questions for the counsellor
to address
·
Make
appointment with the client before ending the session for a follow-up session
·
Counsellor
should maintain confidentiality of the client
6.12 Identity Formation & Dealing with Self:
Participants
were asked to enact some of those childhood memories that they cherished
most. In addition to this they were
also asked to think about what they liked about the entire memory and something
that they did not like about this specific childhood happiness.
After different memories were acted out, a discussion was
initiated around some of the things that were generally liked during childhood
and they were as follows:
6.12.1What I liked!
·
I loved the wedding because I was able to dance my heart out
·
It gave me an opportunity to dance and sing
·
It was nice to play like that with my peers
·
Nice to play freely with my friends
·
I enjoyed sitting with my mother in the kitchen
·
It was nice when my sister and I played with dolls
·
I liked it when my mother sometimes dressed me in a frock
·
Going out and playing was fun
·
I liked doing the household chores such as washing dishes
and cleaning the house
·
I liked the school and my friends there who were both boys
and girls
6.12.2What did I not like!
·
It is not linked to any specific incidence but what I did
not like in my childhood was when I was called Chaka, or Maghya
·
I did not like when boys forced themselves on me
·
I did not like some of the boys in the school, who would
always tease me calling me half man and half woman
·
It was embarrassing for me when I was called a Chaka in
front of my sisters one day on the street
·
I felt bad one day when I was discovered by my brother
wearing my mother’s sari
Facilitator asked participants to reflect on their feelings
linked to situations that they did not like.
Following were some of the responses:
·
Sad
·
Terrible
·
Awful
·
Bad
·
Embarrassed
·
Ashamed
·
Guilty
·
Sad
·
Sad
·
Embarrassed
·
Sad
·
Bad
·
Bad
·
Embarrassed
Feelings in
connection with certain incidence in life were discussed in the group. Participants shared some more memories that
triggered certain feelings. Facilitator
asked them to also discuss some of the ways they used to express their
feelings. Following were some of the
ways that the feelings were generally expressed
6.12.4Expressions:
·
I cried
·
I cried
·
I hid myself behind a tree till my parents found me
·
I was scared and started crying
·
I did not know what to do.
I guess I was confused
·
Scared and started crying out of fear
·
Cried
·
Yelled back
·
Cursed the boys
Some of the responses to this question were as follows:
At this point the facilitator linked the feelings after
expressing oneself to the feelings before expressing oneself and reflected
upon people’s experience to emphasize the importance of expressing
oneself. Connected to this the
facilitator asked participants to brainstorm and make a list of things that
would help them in expressing themselves in front of another person.
Following were some of the responses of participants:
·
Person sitting in front of me should be a friend
·
I would not talk with another person till I trust him
completely
·
I can only express myself in front of another person if I know
him completely
·
I will only talk to another person about my problem/issue if
the other person is trustworthy and willing to listen and advise
me
·
I will only trust the person with my feelings if I
know that the person will not tell anyone else and will not joke
about me with others
·
I think I will not express myself in front of another person
because I would have to trust the person and also the person should
be a friend. Since all my friends
are kothis and kothis have big mouths.
They can never keep anything inside they discuss it with other kothis. They use such information for gossiping.
·
I have to trust a person to express myself. That person should not discuss my
problems with other people and should listen carefully so that he can help me
in solving the problems otherwise why would I go to anyone.
·
I will only
talk to a non kothi friend as kothis have a reputation of gossiping and
before one knows the matter becomes public and that is humiliating
The
facilitator suggested the group to pick out words from their responses that
would become characteristics of a person that they would want to talk to or in
front of whom they would want to freely express themselves. Following was the list of some of those
words
6.12.6List of
words:
·
Trustworthy
·
Friend
·
Someone who
maintains confidentiality
·
Friend and
confidante
·
Willing to
listen
·
Someone who
does not gossip
·
Someone who
could advise
·
Listen to my
problem carefully meaning a good listener
·
Does not
make a joke of my problems
Participants
were asked to reflect upon the list of words that they had developed before
lunch. The facilitator asked them to
analyse the list from the perspective of an outreach worker and pick out words
that they felt described them well in their outreach work.
· I do try to create a friendly atmosphere when I am talking to people in my outreach work
· I take the client separate from the group and try to build friendship before telling him about Bandhu and our work
· I do my best to be friendly with the client. Generally I would behave like a Kothi and that would encourage the client to talk
· Trust is built immediately when I behave like a kothi because then the client opens up without any hesitation.
· I do agree that we kothis have a big mouth and we do generally gossip but I never do that in front of my clients.
· I joke with my clients and that helps in creating trust between us. Sometimes I jokingly tell them that I will help them find a nice panthi. All this helps in trust building and brining us closer to our clients.
· If I behave like a kothi, our work becomes a lot easier. Generally the Kothi clients immediately get interested and start sharing their problems with us.
At this point
the facilitator described that the group was not only looking at the words that
were applicable upon them as outreach workers but also were discussing
different strategies that they used in their work and it was essential that
these strategies should be reflected upon before proceeding any further. Participants agreed to the suggestion.
The facilitator asked the group to describe the objectives of BSWS. Following were some of the responses
·
BSWS works
for prevention of HIV/AIDS. It provides
information to MSM on HIV/AIDS prevention
·
BSWS is a
male sexual health project that addresses the sexual health issue of men who
have sex with men
·
BSWS works
to protect kothis and their panthis from HIV/AIDS
· BSWS provides counselling services to men who have sex with men
·
BSWS is an
organization that works for male sexual health and their protection from
HIV/AIDS
·
BSWS is an
organization that provides counselling and medical services to kothis in
addition to the information on HIV/AIDS prevention
·
BSWS is a
male sexual health project and it provides services such as medical and
counselling
Summing it up the facilitator made two columns and asked the group to say yes or no to the services that the facilitator was going to name.
Services Yes No
Medical assistance x -
Social meetings x -
Meetings for
socializing with Panthis* - x
Meetings for
getting Panthis - x
Providing
information on HIV/AIDS x -
Providing condoms x -
Telling men to
have sex with other men - x
Telling MSM not
to have sex - x
Telling MSM to
have safe sex x -
Developing
responsible behavior in MSM x -
Provide
counseling services to MSM x -
Provide
information on HIV/AIDS at CS* x -
Once the
objectives were clarified the facilitator suggested to the group to do a little
role-play of how they would generally behave when they would try to build
rapport by behaving like a kothi.
At the end of 3
different role-plays the facilitator asked the group to reflect on the
role-plays as someone who was passing by the cruising site. Following was some of the reflection:
·
It seemed as
if two kothi friends were having fun
·
It looked
like as if two kothis were cruising and looking for a good looking panthi
·
It is a good
way of making friends. Once they were
good friends the outreach worker would have easily talked about BSWS
·
To me it
looked as if two kothi friends were gossiping and attracting clients
·
It was very
clear that two kothi friends were looking for a panthi
At this point the
facilitator told the group to divide themselves into pairs. Each pair will think about the objectives of
BSWS and the services that BSWS provides and then think of the role-plays and
reflection. Discuss the entire
situation with each other and with consensus come up with three things that
were compatible with the objectives and services of BSWS and three things that
were not compatible with the objectives and services of BSWS.
Some of the
common factors in the presentations were as follows:
·
To act as a
kothi was good as it immediately created a comfort level between the outreach
worker and the client
·
I think to
act as a kothi was not good because the client was in no mood of discussing
anything rather he was more interested in gossiping and looking at the panthis
·
Our
objective as the BSWS workers is to provide information on HIV/AIDS prevention
and this way we were wasting time and were talking about other things that had
no connection with HIV/AIDS prevention
·
There was no
seriousness in the conversation. If
there had been police around they would have taken the BSWS’ worker for a sex
worker and could have arrested the worker too
·
We think
that one should start the conversation as one kothi to another but once we have
the trust of person then we can deliver our messages and do our work, it is
more effective.
The facilitator
wrapped up the discussion by saying that BSWS’ objectives are best carried out
in a professional way otherwise outreach staff may face problems. He added that one does not have to behave as
a kothi to get the trust and confident of the other person. There are ways to build rapport and trust
without imitating and mirroring other person’s behaviour.
6.13
Counselling Group Work
The
facilitator asked participants to divide themselves in groups of three. All three would act as a counsellor for five
minutes, client for five minutes and observer for five minutes. In each sitting the client would choose the
topic and the counsellor would talk to him on the issue. The observer would keep the checklist from
yesterday’s role-play in front of him and would observe how it helped to be
friendly, pleasant and etc.
6.13.1Reflection:
Following was the reflection of participants after the group work:
·
It helped
the client to speak more openly when the counsellor was friendly
·
The
counsellor was too friendly and therefore the client was not taking him
seriously
·
I think it
was a friendly atmosphere and that was very good for client as client started
talking to the counsellor immediately
·
Counsellor
was trying to be friendly but the client was too agitated to notice that
·
I feel that
counsellor could have been more friendly because the client was scared
·
I think the
exchange of greetings and shaking hands helped a lot. It helped in developing trust in the client
·
In my case,
I liked my counsellor because he was willing to listen to my problem with all
his attention. In the beginning he was
smiling and offered me a glass of water, I felt good because I was treated very
well. After that the counsellor started
listening to me with lots of attention
·
It was a
little strange because the counsellor was constantly telling the client to
speak sometimes he was harsh too. It
looked like as if the counsellor wanted the client to speak on any cost
·
When I was
observing, what I saw was that the counsellor was making notes of each and
everything. The client started looking
at the writing pad and then the client also started looking at what he was
writing making sure everything was written down
·
As a client
I felt good when my counsellor said that he would solve my problem
·
My client
was very difficult, he was totally distracted and would not listen to anything
no matter what I did
·
It was
difficult for me to handle my client because he was very angry. His boyfriend had snatched his money and the
police had treated him badly. He was
not listening to what I was saying and that created a difficult position for me
·
My client
was just not talking. He kept on
looking at me. Even after I introduced
myself he still kept on looking at my face.
I was angry and told him to talk instead of looking at my face
·
I think, I
observed a perfect counselling session.
The client was very cooperative.
The counsellor was listening and willing to help the client.
At this point the
facilitator wrapped up the session on counselling by linking discussions from
yesterday to the group work and its reflection. He suggested that while interaction during outreach may have some
of the similar protocols as counselling but the objectives are different. He added that in outreach the objective is
to provide information, make contacts, motivate the community to access the
services and provide condoms.
Counselling has a
different objective. It is mostly done
in situations where the client may be facing problems for which he may need
outside assistance to resolve such as psychosexual issues, family pressures and
problems arising out of it, violence, low self esteem and identity issues.
The facilitator
re emphasized the role of BSWS as an agency providing mental and physical
health support to MSM. He made it clear
that BSWS does not provide space, facilities or support for:
·
Sexual
activity
·
Finding sex
partners
·
Providing
space for sex
He added that the
outreach officers should not make any promises that they know is beyond their
scope of work.
6.14 Growing
Up Years
Participants
were divided into groups of 5 and each group was asked to draw a picture that
showed the things that each participant did in his adolescence.
Upon the completion
of pictures each group was asked to come and present their work to
participants.
Generally, the
pictures showed a wide range of activities, from cleaning the house to cooking,
dancing at weddings, wearing women clothing, idealizing a class fellow and
playing with dolls.
The facilitator
asked each group to talk about their feelings around the activities showed in
the pictures. Following were some of the comments:
·
I enjoyed
dancing but I use to do it with my kothi friends in the village. We kothis have a way of finding each
other. There were three or four of us
who would dance at all the weddings
·
I use to
play with my mothers saris. What I mean
is that I would take away her saris and tie them around me. I would do this secretively. Why did I do it secretively was because I
was caught once by my older brother who called me a maghya
·
I use to
help my mother a lot. I loved sitting
in the kitchen with her. It used to be lots of fun. I would cut vegetables for her and do other chores around the kitchen. My aunt use to tease my mother that I was a
little daughter and not a son. I do not
know how my mother felt about these remarks.
She would just laugh it off
·
I used to
play with girls. My brothers would get
annoyed. They would tease me and call
me names such as chaka, maghya. I used
to feel really bad. See this is my
picture I am crying because my brothers have hit me as I am dressed in a sari
·
I enjoyed
putting nail polish on my nails. I
would use color pencils for that. Once
my mother caught me doing it and she beat me.
The picture shows the nails with red color on it. I always wanted my nails to grow and would
picture them with bright red polish on them
·
I loved the
way my mother would wear the sari and all the jewelry and I would sometime take
away her sari to another room and tie it around myself
The facilitator
talked a little more about socialization process and how it impacts the
identity formation of a person.
6.15 Identity
Issues:
The
facilitator asked the group to say the first thing that came to their mind when
the facilitator said the following four words.
Following were the responses
Handsome Mother Man who is not a
man Handsome
Panthi Mother Half male/half female Panthi
Man Sister Hijra Handsome
Strong Weak Half male/half female Sex partner
Family head Mother Kothi Panthi
Strong Mother Half male/half female Sexy
Father Mother Half male/half female Sex partner
Family head Pretty Pretty Sex
partner
Good looking Kind Gossipy Man
Man Gentle Quarrel Strong man
Father Mother Sister Sex
partner
Strong Mother Rude Cruel
Love Sister Friend Love
Human Human Human Human
6.16 Roles and Labels
The
facilitator asked the group to separate the roles from labels in the above
list. There was a discussion in the
group. They were facilitated through
the process that how roles as well as labels are given to each individual by
the society. Labels emerge from
characteristics and gender roles and finally become part of identity processes.
Participants
were asked to brainstorm on how comfortable were they with their roles and the
labels given to them by the society.
Following were some of the responses:
·
I do not
like when people call me Chakka or Maghya in front of my family. It does not matter if they call me these
names when my family is not around. The
reason that I do not like them calling me such names in front of my family is
that I feel embarrassed. I am a grown
up man and I feel humiliated.
·
I do not
mind anything. I am proud to be
gay. What I do not like is that why
cannot people accept me as I am. Once a
friend (girl) said that you may be good looking than me and boys may chase you
more than they chase me but remember that you cannot have children at which I
said that thank Allah that he has not given me uterus otherwise I would have
had million abortions by now so still I am better off that I can have as much
sex as I want without thinking of consequences
·
I do not
face any problems. I am a married
man. I do not think that my wife knows
about my sexual life with men. I have not
had any marital problems till now and am sure will not have any in future
too. I am proud of what I am
·
Sometimes I
feel very bad. I constantly question
Allah that why did he give me a woman’s feeling and a man’s body. I want to be a woman but cannot be one. I am confused and sad. I am very sad when
people call me names. In my childhood
it used to happen a lot more but now things have slowed down and people
generally do not notice me still when someone call me these names I feel ashamed
and humiliated
·
It is not
easy to live our kind of lives. From
childhood I have thought of myself as a female. When the boys at school and neighbourhood used to call me chakka
and maghya I use to be confused and ashamed. Now I do not care. I
think my family knows what I am up to.
They know that I dance and they have tried to stop me but after all the
beating and harassment I have not stopped.
·
I know that
I am a man but I have always felt like a woman. Joining Bandhu has changed many things for me. First I used to think that I was sinning
and was a bad person but after coming here I have understood that my
feelings are something that is beyond my control. It is natural because from childhood I have felt this way.
·
I let people
call me whatever they want to. I used
to get disturbed when I was a child but not anymore. I know what I am and I am proud to be what I
am.
The facilitator
asked the group to make a list of words from the above responses that reflects
guilt or shame and think that why were these words used in these
responses.
A reflection
session was conducted to talk about the list of word. The facilitator wrapped up the discussion by suggesting that
generally people coming as a client would be facing the same confusions and
guilt in their lives and it becomes the duty of the counselor to work through
such feelings of the client and facilitate her/him to free her/himself from
such feelings of guilt, shame, embarrassment and humiliation.
Bandhu Social
Welfare Society has been very persistent in strengthening its program component
on counselling. Due to BSWS’ consistent
efforts of holding counselling workshops, these workshops were a step
forward. The content of the workshops
graduated from essentials of counselling to more substantial issues such as
identity, socialization and religion.
The framework of these workshops were also different from the previous
workshops. The idea was to inculcate
thought process that could start linking different aspect of human psyche.
The important
underlying theme of these workshops is that sexual health cannot be seen in
isolation of other aspects of lives of MSM.
Issues such as non- acceptability by the mainstream society, fear of
loosing the family support structure, pressures from the society and family to
conform to the distinct gender role are few of the numerous that MSM daily face
in South Asian societies. This adds to
the anger, guilt and confusion of MSM populations in South Asia. Thus, promoting sexual health becomes meaningless
if all or some of these issues are not resolved. The protocol of counselling looks at the larger picture and
sexual health as part of the larger context.
However, this
does not mean that the importance of promoting sexual health or safety is compromised
at any point in these trainings. What
it actually means is that each exercise and role-play reinforces the sexual
health messages but in a more holistic and complete sense where the client
feels that he is needed and is very important as an individual and therefore he
needs to keep himself sexually safe.
The messages are linked with other messages that help in improving the
self-esteem and sense of self of the client.
The entire
process is passed on to the group through experiencing different
situation. Each exercise and role-play
is some experience that participant may have been through. The resolution of the issue/problem is
generally through motivating the group to finding alternatives to resolve the
problem within the social constraints.
Mental and sexual health is intrinsically linked with each issue and its
resolution.
As this process
is constantly evolving, innovation and experimentation will only bring richness
to the entire process. Following are
some of the recommendation in this regard:
8.1 Due to the regularity in the follow-ups of
these workshops, the thought process of participants is gradually getting
oriented to a more disciplined way of addressing the issues. It is therefore recommended that regular follow-ups
are continued
8.2 BSWS’ commitment to set up a strong
counselling component within its service package is self-evident. However, what needs to be kept in mind is
that for community counselling and process training a team has to be built. Workshops for entire office staff as well as
outreach staff is a good effort but any extensive training should only be
restricted to the core counselling teams.
For general office staff and the outreach staff one day orientation
workshops and their follow up would suffice
8.3 BSWS’ is expanding and with its expansion
the service packages have to be standardized.
Counselling services should be at par at each Bandhu centre. A criteria has to be evolved for selection
of people who are going to do counselling and that criteria should be followed
at each site for appointing counsellors
8.4 Quality monitoring and evaluation is very
essential in counselling. The services
should be regularly evaluated through some kind of feedback from the
client. This can be done through two-step
evaluation of the client’s feeling. One
pre-counselling and second post counselling.
This feedback will help the administration to improve their counselling
services and make them more effective.
8.5 BSWS is expanding both programmatically
and geographically and counselling as
well as outreach work are two of the most important features of its
program. Such training may be more
sustainable for BSWS if it develops its own core team that would conduct such
trainings at its new and existing sites.
However, the core team will have to go through a process of training
itself before it starts training others.
These workshops have been helpful in selection of core team members and
their orientation but a more consistent effort is needed to help build a BSWS
core team of trainers.
8.6 Processes need to be developed to address
issues such as castration amongst Hijra community. The post castration trauma and the sense of loss have to be made
part of counselling framework too.
8.7 Processes have to be evolved to address
issues around male to male sex and Islam.
The need for such processes are highlighted in most workshops.