R
EVIEW
M
ONITOR AND EVALUATE
ASSESSMENT
PLAN AND
SUPPORT
R
ND EVALUATE
INTRODUCTION
R
R
R A P S P R O C E S S
HIV Prevention Series
Risk Reduction, Assessment, Planning
and Support Toolkit for HIV Prevention
FHI 360
FHI 360 is a global development organisation with a rigorous, evidence-based
approach. Our professional sta includes experts in health, nutrition, education,
economic development, civil society, environment and research. FHI 360
operates from 60 oces with 4,400 sta in the United States and around the
world.
We have worked with 1,400 partners in 125 countries, forging strong
relationships with governments, diverse organisations, the private sector
and communities. Our commitment to partnerships at every level and our
multidisciplinary approach enable us to have a lasting impact on the individuals,
communities and countries we serve–improving lives for millions.
Capable Partners (CAP) project
Capable Partners is a USAID-funded project that supports the Botswana
government’s eorts to mitigate HIV. The CAP project promotes organisational
development and capacity building through networking and technical support.
CAP partners with non-governmental organisations (NGOs), faith-based
organisations (FBOs) and community-based organisations (CBOs) on HIV
prevention services under the U.S. President’s Emergency Plan for AIDS Relief
(PEPFAR) and Peace Corps engagement in PEPFAR programmes.
The CAP project also supports monitoring and evaluation of grantees and
sub-grantees, routine training on HIV prevention interventions, and the
development and dissemination of behaviour change tools. Strengthening
communities towards sustainability is the over-riding goal of the CAP project.
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
1
Contents
Contents
Overview 2
Purpose of manual 2
Who is the manual aimed at? 3
How to use the manual? 3
Stages of Change Theory for Behaviour Change 4
Note for facilitators 5
Structure of the manual 6
Symbols to guide you 7
Risk Reduction Assessment, Planning, and Support (RRAPS) Stages 8
RRAPS Flow Chart 9
SECTION 1: Introduction 11
GUIDANCE ON IDENTIFICATION OF CLIENTS 13
STEP 1: INTRODUCTION OF RISK REDUCTION PROCESS AND
OBTAINING VERBAL CONSENT 14
Part A - Intoduction of Risk Reduction Tool 14
Part B - Background Information 15
SECTION 2: Assessment 17
STEP 2: KNOWLEDGE ASSESSMENT [SECTION 1] 19
Part C - Knowledge Assessment (Section 1) 19
KNOWLEDGE ASSESSMENT [SECTION 2] 20
Part C - Knowledge Assessment (Section 2) 20
STEP 3: BEHAVIOUR ASSESSMENT 21
Part D - Behaviour Assessment 21
Part E - Risk Status 21
SECTION 3: Review 23
STEP 4: WRAP UP AND ASSESSMENT 25
Part F - Knowledge Assessment Review 25
Part G - Behaviour Assessment 27
STEP 5: INFORMATION PROVISION 28
Part H - Information Checklist & Table 29
STEP 6: MOTIVATION TO CHANGE 30
Part I - Prioritisation and Motivation to Change 31
SECTION 4: Planning and Support 33
STEP 7: RISK REDUCTION PLANNING FOR PRIORITISED RISK BEHAVIOUR 35
Part J - Risk Reduction Plan 1 35
Key Components for Steps Towards Behaviour Change 37
STEP 8: GOAL CARD 39
Part K - Goal Card
STEP 9: FOLLOW-UP 40
Part L - Risk Reduction Plan 2 40
Completion Of Risk Reduction Plan 1 41
SECTION 5: Monitoring & Evaluation 43
STEP 10: MONITORING & EVALUATION 45
Overview of M&E Forms 45
RRAPS M&E Tool 47
Data Storage and Management 50
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
2
Overview
The Standard Operating Procedures (SOP) Man-
ual for Risk Reduction Assessment, Planning
and Support (RRAPS) was developed as an HIV
prevention tool by the Capable Partners Project
(CAP) Botswana as part of its capacity build-
ing mandate to strengthen current behaviour
change programs implemented by civil society
organisations (CSOs) supported through the
project. The RRAPS tool provides the oppor-
tunity for individuals to assess their personal
risk for HIV transmission based on their current
behaviours, better understand how these be-
haviours put them at risk and to then develop
a risk reduction plan with relevant strategies to
encourage healthier behaviours.
The RRAPS process integrates individualised
assessment, planning and support with com-
munity outreach activities to provide in-depth,
personalised education and support to indi-
viduals in various community settings, includ-
ing homes, clinics, schools, workplaces and
churches.
In Botswana, the spread of HIV is primarily
through heterosexual sex (National Strategic
Framework II). In the absence of a cure for AIDS,
HIV prevention eorts must engage eective
communication tools, directing the right mes-
sage to the right people.
According to the Botswana AIDS Impact Sur-
vey (BAIS II), HIV prevalence is 24.8% amongst
15 to 49-year-olds. HIV prevalence rates among
young people are particularly high, especially
among young women, who out-number young
men living with HIV by more than two to one. It
is therefore crucial that young people (and es-
pecially girls and young women) are provided
with HIV prevention education and skills to help
protect themselves from infection and promote
positive behaviour change.
FHI 360 has collaborated with the Government
of Botswana to develop this manual and its ac-
companying tools, working closely with the Be-
haviour Change Information and Communica-
tions (BCIC) Unit and the Department of HIV and
AIDS Prevention and Care, Ministry of Health. At
the time of print, discussions were on-going as
to whether this tool can be applied more widely
and adapted to dierent contexts.
FHI 360 commends the eorts of its CAP proj-
ect partners who tested the risk reduction tool
in their respective communities. Their feedback
has been invaluable in improving and rening
the RRAPS process and developing this manu-
al.
Purpose of the manual
The SOP manual provides guidance to or-
ganisations implementing HIV prevention
interventions at the community level for risk
reduction implementation.
It aims to assist organisations implementing
HIV prevention programmes to think through
the elements of risk reduction and apply them
in their own settings. It encourages a target-
ed behaviour change approach for those who
are setting out to:
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identifying and then supporting
those who are vulnerable or at risk
(referred throughout the manual as
‘clients’) in the community; and
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information and education, taking
into consideration the structural and
social factors that impact behaviour,
as well as increase access to services.
The aim is to empower
individuals to sustain,
healthier behaviours.
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
3
The risk reduction process is as follows:
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behaviour support) of the client;
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implementing the risk reduction
plan; and
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sessions.
Who is the manual aimed at?
The manual targets those implementing or
planning to implement the RRAPS. It is simple
to use and utilises a step-by-step process to
understand how to assess, identify, and en-
courage behaviour change for an individual.
The contents of this manual are user-friendly,
to enable facilitators to think through what
risk reduction implies for community or-
ganisations and how to eectively address
the key drivers of HIV. The RRAPS process
and tool can be used by individuals includ-
ing peer educators, counsellors, community
health care workers, clinic sta and other in-
dividuals who work in a community setting.
How to use the manual ?
The manual provides instructions to the facili-
tator on how to complete the RRAPS process.
Facilitators should use the accompanying risk
reduction tool during implementation with cli-
ents.
To complement this toolkit, FHI 360 has pro-
duced a set of nine (9) Communication Guides
on HIV Prevention on dierent risk topics for
use by facilitators including:
Alcohol Use
Condoms
Cross Generational Sex
Delayed Sexual Debut
Gender-Based Violence
Multiple and Concurrent Sexual
Partnerships
Positive Health, Dignity and Prevention
Relationship Enrichment
Safe Male Circumcision
The Communication Guides are designed to
spark discussion on the key drivers of HIV, and
helps participants think through and discuss
strategies towards safer behaviours. They also
provide facilitators with a better understanding
of each risk topic, and give guidance on how
to eectively work with individuals to promote
behaviour change.
The RRAPS tool and the Communication Guides
are produced in both English and Setswana to
suit the needs of the target audience.
This manual and its
accompanying tools
aim to empower
communities
to promote HIV
prevention through
assessing and
identifying risk, to
then encourage
behaviour change.
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
4
Stages of Change: Overview
Stage 1: Pre-contemplation (unaware)
The client has a problem but is not aware or has no intention to change.
Stage 2: Contemplation
The client is aware of the problem, is concerned and is seriously thinking about changing.
Some clients get stuck in this stage (chronic contemplation).
Stage 3: Preparation for action
The client is motivated to change behaviour soon. He/she has a plan of action and has
started implementing it e.g. visited a counsellor, joined a support group, or introduced
condoms into a relationship.
Stage 4: Action (modifying behaviour)
The client has displayed behaviour change e.g. having one sexual partner, or consistent
condom use - but only for a short period (still needs support).
Stage 5: Maintenance (practicing sustained behaviour change)
The client maintains the new behaviour for six months or more.
Stages of Change Theory for Behaviour Change: RRAPS Foundation
The foundation for this tool is based on the Stages of Change Theory. Understanding and applying this the-
ory will help the facilitator to use this tool, and assist the client in developing behaviour change goals and
steps to prevent HIV infection, unwanted pregnancy and/or TB. The Stages of Change Theory for Behaviour
Change states that for one to move from ‘unwanted’ to ‘wanted’ behaviour, he/she must go through the
following 5 stages:
Stage 1: Pre-contemplation
No, denial, unaware
Stage 2: Contemplation
Maybe, ambivalence
Stage 3: Preparation for action
Yes, let’s go! Motivated
Stage 4: Action
Doing it, go
Stage 5: Maintenance
Living it
Relapse/Recycle
Start over! Urgh!
Start Over
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
5
Note for facilitators of the RRAPS tool and users of the manual
Through this
process, the
facilitator meets
the client as a
peer, oering
encouragement
and
empowerment.
Peer educators from the
Young Women’s Friendly
Centre in Mahalapye at a
brieng session.
P
d
This manual is designed to help guide facilitators to provide education,
information and support in an equal, non-judgemental and non-force-
ful manner. To successfully implement the RRAPS process the facilitator
should have completed the RRAPS training. Key qualities that a facilitator
should have include: being a good listener, ability to be empathetic, non-
judgemental and have basic knowedge about HIV and AIDS including key
drivers. Equipped with knowledge and skills, the facilitator, through this
process, can eectively reach people who may not otherwise be exposed
to or have access to HIV prevention services.
This process facilitates a peer-based relationship between the facilitator
and the client. The facilitators role is to oer encouragement and empow-
erment to the client to take control and ownership over the process and
outcomes to improve their health, with an ultimate goal to sustain be-
haviour change.
As a facilitator, you will:
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knowledge, skills, and support to reduce risk behaviour; and
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counselling and health care.
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
6
Structure of the manual
This manual is divided into ve main sections as follows:
Section 1: Introduction of the risk reduction assessment, planning and
support process
Section 2: Assessment of knowledge, risk status, sexual behaviour as well
as information needs
Section 3: Review of assessment results with client
Section 4: Planning and support to reduce risk by targeting risk behaviours
or maintaining minimal risk
Section 5: Monitoring and evaluation
Each of these sections is color-coded for quick reference as shown above.
Each color represents a new section, and provides easy-to-follow instructions on how to eectively use
the risk reduction tool.
Simple explanations and guidance notes are provided to help your question and answer sessions.
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
7
Symbols to guide you
The following symbols are used to guide you throughout the manual:
Stop!
Indicates when you do not have permission from the client to
continue.
Remember!
Draws your attention to something important.
Note:
Identies where you must pay special attention and be aware of
relevant information at that time.
Tip!
Helps you carry out your assessment more eectively.
Time
Helps to outline how long each section of the tool will take to
facilitate.
Tip!
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
8
Risk Reduction Assessment, Planning and Support (RRAPS) Stages
STEP 2
Knowledge Assessment
Helps client feel comfortable.
Opportunity to assess how much the client already
knows about HIV (basics and transmission).
STEP 3
Behaviour Assessment
Opportunity to clearly understand if the client’s
behaviours put him/her At Risk or Not At Risk for HIV
transmission, STIs and/or unwanted pregnancy.
STEP 4
Wrap Up,
Assessment Results
Closes the session and summarises the issues
discussed during the Knowledge and Behaviour
Assessment section. Opportunity for misconceptions
and misinformation to be claried and corrected.
STEP 5
Information Provision
Opportunity to discuss how current behaviours
put client at risk for HIV. Allows client to learn
more about their risky behaviours, to clear up
misconceptions about HIV transmission.
STEP 6
Motivation to Change
Helps you and the client gauge commitment to
change behaviour and prioritise one behaviour for
risk reduction planning.
STEP 7
Risk Reduction Planning for
Prioritised Risk Behaviour
(including referrals)
Opportunity for client to develop a plan to
reduce their risk of contracting HIV for one
identied risk behaviour at a time.
STEP 8
Goal Card
Provides a reminder to client about their goal
and steps in their commitment to change.
STEP 9
Follow-up
Support provided to client to monitor
implementation of risk reduction plan - behaviour
change takes time.
STEP 10
Monitoring and
Evaluation
Captures data for risk reduction sessions.
STEP 1
Introduction of Risk
Reduction Process (RRP) -
get verbal consent
Inform client about the risk reduction process.
Opportunity to ask the client for permission to
undertake the assessment.
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There are 10 key steps/stages that guide the risk reduction, assessment, planning and support process.
These are colorfully illustrated below and are highlighted at each stage of the process throughout the
manual.
OVERALL PROCESS: APPROXIMATELY 70 MINUTES
5 mins
10 mins
10 mins
10 mins
10-15 mins
depending on
risk assessed
5 mins
15-20
mins
5 mins
INITIAL ASSESSMENT PERIOD
FOLLOW-UP
VISITS 2-6
WEEKS LATER
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
9
Go back to Knowledge Assessment
Section and provide correct
Information
Risk Reduction Assessment, Planning and Support (RRAPS) Flow Chart
Identication of client for RRAPS
Introduction of RRAPS process – get verbal consent
Gives verbal consent
Does not give verbal consent
Knowledge & Behavioural Assessment
STOP!
DO NOT CONTINUE
WITH PROCESS
Sexually Active
Not Sexually Active
Skip to Q21 - Ask HIV Counselling and
Testing, continue to Q23 (TB), and
if male, continue to Q24 (Safe Male
Circumcision)
Assess RISK STATUS
Responded correctly and completely
to ALL questions in Knowledge
Assessment Section
Responded incorrectly, partially or not
sure to ANY questions in Knowledge
Assessment Section
Inform client of his/her RISK STATUS
Identied as NOT AT RISK
Identied as AT RISK
STOP! Congratulate
client on health-related
decisions. Encourage him/
her to maintain current
health
STOP! Encourage client to
seek your support from a
counsellor or health care
worker if they change their
mind
Prioritise one behaviour to work on
and assess MOTIVATION TO CHANGE
NOT READY
READY
Develop RISK REDUCTION PLAN
for Prioritised behaviour
(use sample Goals and Strategies)
Make referral as
needed
Give GOAL CARD
Complete M& E Forms
ARRANGE Follow-up VISIT at 2 & 6 weeks after assessment (other
follow-up appointments depending on plan and support needed)
Document progress, adapt strategies as needed
Go to INFORMATION TABLE and
provide information on identied
risk behaviours
STEPS
2 & 3
STEP 4
STEP 5
STEP 6
STEP 7
STEP 1
STEP 8
STEP 9
STEP 10
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
10
Section 1: Introduction
11
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section I
Introduction
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section I
Introduction
Section 1: Introduction
12
Section 1: Introduction
13
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
GUIDANCE ON IDENTIFICATION OF CLIENTS
The rst, most important step for the Risk Reduction Planning, Assessment and Support (RRAPS) process is
to identify clients.
There are three major methods for identifying a client for RRAPS as illustrated below:
Group session
As mentioned earlier, the risk reduction process is designed to provide more individualised education and
support to an individual about how their personal behaviour may put them at risk for HIV transmission. It is
designed to complement current community outreach sessions. Risk reduction support can be advertised
after conducting a community outreach session such as a small group session at a school. It is important to
inform individuals on where they can nd you for this support, i.e. by providing the physical address of your
organisation. It is also benecial to stay after a community outreach session and get contact information
for individuals who would like support through risk reduction and arrange a time and place to meet for an
initial assessment. If you already have a pre-established relationship with another service provider i.e. at a
clinic, consider asking for space to conduct risk reduction sessions and set days and times individuals can
come to you for the support, and then provide this information to individuals.
Referrals
Community service providers understand the need of individuals who come for their services. Therefore,
referrals provide a good source from which clients can be identied for risk reduction support.
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counsellors by explaining your role, your risk reduction training and how you would like to sup-
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of HIV infection.
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time(s) (for example, once a week on Tuesday afternoons).
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counselling.
Home visits
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reduction planning, assessment and support.
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Follow-up to a
group session
Referral from
service provider
Home visit
Person identified
Guidance on Identification of Clients
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 1: Introduction
14
S
(SOP) MANUA
ARD OPERA
G PROCED
or RISK R
P) MAN
Client ID No:
ONE-ON-ONE RISK REDUCTION ASSESSMENT,
PLANNING AND SUPPORT TOOL
Hello, my name is ..............................................................................................................................................................................
I am a (insert name of position) ...................................................................................................................................................
from (insert name of organisation) .............................................................................................................................................
I would like to talk to you about your daily life and to help you with information and skills about HIV. Is that
alright? For me to understand how I can best help you, we rst need to go through a Knowledge Assess-
ment to understand what you already know about HIV. Next, we will go through a Behaviour Assessment to
see what you are currently doing to protect yourself against HIV. Depending on how your risk assessment
goes, we will work together and set goals to assist you with steps to ensure that you are protected from HIV
infection. I will ask you questions that are personal and may make you feel uncomfortable because they
relate to sexual behaviour, but please be assured that the issues we talk about will remain condential. I
will take down some notes just for my reference to keep track of what we have talked about, and to assist
with the goal setting we will do together. Your name will remain anonymous and will not appear on any of
these documents. I will simply use an ID code that identies you. Are you comfortable with that? Just so
that we both feel comfortable during our conversation, what would you like me to call you? I will help you
based on the information that you provide, therefore, for this process to work, I need you to be as open and
honest with me. Again, whatever we talk about will remain condential and I will follow up with you based
on your needs. Remember that the purpose of this exercise is to help you reach the goals you have set for
yourself. This process will take about an hour. Does this process sound alright to you?
Note for Facilitator:
Take down the client’s information in the rst box at the top of the page, and then continue to the Knowledge
Assessment section.
STEP 1: INTRODUCTION OF RISK REDUCTION PROCESS
AND OBTAINING VERBAL CONSENT
(Refer to page 1 of Risk Reduction Tool)
Part A - Introduction of Risk Reduction Tool
Do not continue the process if the individual does not give verbal consent.
Client Number (red cir-
cle)
: Client ID No. This
is your rst two initials
(you being the facilita-
tor) plus the number of
the risk reduction client
for you. For example,
if you are Samuel Kagi-
song and this is your rst
risk reduction client, the
client ID number will be
SK-01.
Client ID No:
nt I
D No
Purpose
To provide an overview of the risk reduction process to the client, get consent and document rel-
evant background information.
1. Introduce yourself and clearly explain the purpose of your organisation and help the client
understand what to expect from the process and you as a facilitator using the introduction
script below.
2. Building rapport with clients is important right at the beginning. Not only does it help the
facilitator to explain the overall purpose of risk reduction, but it also ensures that the client
is fully informed about the process, feels comfortable and is willing to participate.
15
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 1: Introduction
ASSESSMENT, PLANNING and S
RISK REDUCTION A
Facilitator’s Name: Name of Organisation:
Client’s Preferred Name: Client’s Phone No:
Gender: Female
U Male U Age: 10-14 U 15-17 U 18-25 U 26-35 U 36-50 U ≥50 U
Village/Ward: Date of Assessment:
Individual Type: New
U Repeat U
Part B - Background Information
Tip!
Confidentiality agreement
Assure the client of the condential nature of this process, and that his/her name will remain anonymous.
Also remind the client that they should feel comfortable at all times.
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sensitive issues.
Carry relevant identication with you so that participants are reassured that you
are working on an HIV prevention programme.
Be aware of your facial expressions and body language – avoid portraying reac-
tions that could be perceived as judgemental when participants disclose risky
CFIBWJPVSTBUUJUVEFTPSWBMVFTUIBUEJòFSGSPNZPVSPXO
Use appropriate language and terms that your clients can understand.
Only provide information that
you feel comfortable disclosing. You do not have to answer
FWFSZRVFTUJPOBOEZPVDBOTUPQUIFQSPDFTTBUBOZUJNF
The information will not be shared with
anyone else. It will be led and locked up
for sake-keeping.
After the script is read to the client, if consent is given, the facilitator should document
background information to help with record purposes in the space provided on the top of the
tool (below).
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 1: Introduction
16
S
(SOP) MANUA
ARD OPERA
G PROCED
or RISK R
P) MAN
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 2: Assessment
17
Section 2
Assessment
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
S
(SOP) MANUA
ARD OPERA
G PROCED
or RISK R
P) MAN
Section 2: Assessment
18
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
ASSESSMENT, PLANNING and S
RISK REDUCTION A
Section 2: Assessment
19
KNOWLEDGE ASSESSMENT: SECTION 1
Response
Yes U
No U
Not sure U
Yes U
No U
Not sure U
Yes U
No U
Not sure U
Yes U
No U
Not sure U
Correct response
N/A
U
Unprotected sex with HIV-infected individual
U Mother-to-Child Transmission during pregnancy,
delivery or breastfeeding
U Exchange of HIV-infected blood
U Correct and consistent condom use with all partners
U Abstain from sex
U Having sex with one partner at a time whose HIV
status you know
U Knowing your status and that of your partner’s, and
disclosing to each other
N/A
1
2
3
4
Question
Are you personally worried about HIV and AIDS?
(Probe: What are your concerns?)
Note concerns:
Do you know how HIV is transmitted from person to
person?
(Probe: Please tell me how you think it is passed from person to
person?)
Do you know how to prevent yourself from
contracting HIV or transmitting it to someone?
(Probe: If person only indicates one prevention method, then ask:
do you know any other prevention method/s?)
Do you think you are personally at risk of contracting
HIV?
(Probe: Please explain your response)
Explanation:
STEP 2: KNOWLEDGE ASSESSMENT (SECTION 1)
(Refer to pages 2-3 of Risk Reduction Tool)
Probing questions (highlighted) are:
t 0QFOFOEFERVFTUJPOTBSFEFTJHOFEUPTVQQPSUUIFGBDJMJUBUPSUPPCUBJOGVSUIFSJOGPSNBUJPOUIBOXIBU
JTBMSFBEZQSPWJEFECZUIFDMJFOU
t "XBZUPDMBSJGZBOECFUUFSVOEFSTUBOEUIFDMJFOUTLOPXMFEHFBOEJOGPSNBUJPOMFWFMTPO)*7BOE"*%4
t 6TFGVMUPBMMPXFYQMPSBUJPOPGQFSTPOBMCBSSJFSTUPIFBMUIJFSCFIBWJPVS
Part C - Knowledge Assessment, Section 1
Purpose
To build rapport with the client and to assess how much information the individual has on HIV
and AIDS.
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
S
(SOP) MANUA
ARD OPERA
G PROCED
or RISK R
P) MAN
Section 2: Assessment
20
KNOWLEDGE ASSESSMENT: SECTION 2
No.
1
2
3
4
5
6
7
8
9
Statement
5IFSFJTBEJòFSFODF
between HIV and AIDS.
Only people who have
sex with many people can
contract HIV.
&YDFTTJWFVTFPGBMDPIPM
does not impair an
JOEJWJEVBMTBCJMJUZUPNBLF
decisions to use condoms.
Correct, consistent condom
use can protect a person
from HIV.
.BMFTXIPBSFDJSDVNDJTFE
are more likely to get
infected by HIV.
Having only one partner
at a time will help reduce
your risk of HIV.
,OPXJOHPOFT)*7TUBUVT
can lead to a better quality
of life.
Having sex with a person
whose status you do not
know will not put you at
risk of HIV.
Only people living with HIV
need to use condoms to
protect their loved ones.
Correct
Answer
True
False
False
True
False
True
True
False
False
Information to provide after assessment
if respondent answers incorrectly or
responds as Not Sure
5IFSFJTBEJòFSFODFCFUXFFO)*7BOE"*%4
HIV refers to the virus that causes AIDS.
&WFOJGZPVIBWFVOQSPUFDUFETFYXJUIPOMZ
one person, you are at risk of contracting
HIV.
Having sex after drinking alcohol
FYDFTTJWFMZEPFTJNQBJSBOJOEWJEVBMT
BCJMJUZUPNBLFEFDJTJPOT5IJTNBZ
increase chances of using a condom
incorrectly.
Correct, condom use can protect someone
from HIV.
Safe male circumcision refers to the process
of removing the foreskin from the penis.
5IJTSFEVDFTDIBODFTPGDPOUSBDUJOH
)*7CZ5IFSFGPSFTPNFPOFXIPJT
circumcised is less likely to contract HIV.
However, correct and consistent condom
use is still necessary after circumcision.
Having one partner at a time can reduce
ZPVSSJTLPG)*75IFNPSFQBSUOFSTZPV
have at one time, the higher your risk of
acquiring HIV. You still however, need to
use a condom during every single sex act.
Once you know your HIV status, you will be
able to make informed decisions regarding
your life.
Having sex with a person whose status you
do not know will put you at risk of HIV. HIV
is transmitted through unprotected sex. If
you do not know the status of your partner
and you have unprotected sex, you at risk
of HIV.
&WFSZPOFTIPVMEVTFDPOEPNT
consistently and correctly, even if you are
HIV negative.
True False Not
Sure
STEP 2. KNOWLEDGE ASSESSMENT (SECTION 2)
Tick the appropriate column depending on how the respondent has answered -
either True, False or Not sure (sample above).
"TUIFJOEJWJEVBMJTHJWJOHIJTIFSSFTQPOTFOPUFJODPSSFDUBOTXFSTXJUIBDJSDMFUPLFFQUSBDLPG
UIFJOGPSNBUJPOZPVOFFEUPQSPWJEFUIFDMJFOUBGUFSUIFBTTFTTNFOU4FFUIFBCPWFFYBNQMF
IJHIMJHIUFEJO4UBUFNFOU/P
Tip!
5IFSF
JT
B
EJòFSFODF
CFUXFFO
)*7
BOE
"*
%4
H
IV r
e
f
e
r
s
to
t
h
e
vir
us
t
h
at
causes
AID
S.
&
W
F
OJG
ZPV
IBWFVOQSPUFDUFETFYXJUIPOM
Z
o
ne person,
y
ou are at risk o
f
contracting
HIV.
H
avin
g
sex after drinkin
g
alcohol
F
YDFTTJWFM
Z
EPFTJN
Q
BJSBOJOEWJEVBMT
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
ASSESSMENT, PLANNING and S
RISK REDUCTION A
Section 2: Assessment
21
No.
1
2
3
4
5
6
Questions
In the past 3 months,
have you drank alcohol?
If yes, on average how
many days a week do
you drink alcohol?
If yes, how many drinks
do you usually drink in
a day?
In the past 3 months,
have you used drugs
(marijuana, cocaine,
etc)?
Have you ever
experienced peer
pressure to have sex?
Are your friends
currently having sex?
Response
Not At Risk
No
Skip to Question 4
2 or less days a week
Continue to Question 3
3 or less for women
4 or less for men
Continue to Question 4
No
Continue to Question 5
(individuals 10-17 years)
OR
Skip to Question 7
(individuals 18+years)
No
Continue to Question 6
No
Continue to Question 7
Response
At Risk
Ye s
Continue to Question 2
3 or more days a week
Continue to Question 3
4 or more for women
5 or more for men
Continue to Question 4
Ye s
Continue to Question 5
(individuals 10-17 years)
OR
Skip to Question 7 (individuals
18+years)
Ye s
Continue to Question 6
Ye s
Continue to Question 7
Refused to Answer
Refused to Answer
Skip to Question 4
Refused to Answer
Skip to Question 4
Refused to Answer
Continue to Question 4
Refused to Answer
Continue to Question 5
(individuals 10-17 years)
OR
Skip to Question 7
(individuals 18+years)
Refused to Answer
Continue to Question 6
Refused to Answer
Continue to Question 7
Behavior to
Prioritize
Alcohol/Drugs
Peer Pressure
Peer Pressure
ALCOHOL AND DRUGS
Questions for All
CURRENT SEXUAL STATUS
Questions for Youth (Age 10-17 years)
Note for Facilitator:
Say, “The next few questions are on the topic of sex and your sexual experiences. Is that all right with you?”
Tip!
STEP 3: BEHAVIOUR ASSESSMENT
(Refer to pages 4-6 of Risk Reduction Tool)
Instruction: Based on the client’s response, circle the responses in the box under either Not At Risk ,
At Risk or Refused To Answer.
?
No
Sk
i
p
to Question
4
2 or less da
y
s a wee
k
Continue to
Q
uestion 3
Ye
C
o
n
3
o
C
o
n
for
Facilitator:
for Facilitator:
CUR
CUR
CUR
REN
REN
REN
TS
T S
EXU
EXU
AL
AL
STA
STA
TUS
TUS
TUS
X
X
Q
uestions
f
or Youth (Age 10-17
ye
ars)
ihifdliIh
r
r
A
lcohol/Dru
gs
1SFQBSFUIFDMJFOUGPSBOFXTFUPGCFIBWJPVSRVFTUJPOTXIJDINBZTFFNQFSTPOBMBOEJOUSVTJWF
3FGFSUPUIFJOUSPEVDUPSZTUBUFNFOUBOEDPOöEFOUJBMJUZBHSFFNFOUBTPGUFOBTZPVOFFEUP
5IJTXJMMSFNJOEUIFDMJFOUUIBUJUJTUIFJSDIPJDFUPSFTQPOEUPUIFRVFTUJPOTCVUPOMZJGUIFZBSF
DPNGPSUBCMFXJUIUIFN
Note that the last
column indicates
behaviour to
prioritise. This column
will assist you as
the facilitator when
reviewing with the
client behaviour(s)
that may put him/her
at risk and developing
according risk
reduction plans.
Follow instructions
carefully and note
when you need to skip
questions. Also note
when to ask questions
directed at specic
individuals i.e. youth
only.
Part D - Behaviour Assessment
NOT AT RISK
AT RISK
t *GALLPGUIFDMJFOUTSFTQPOTFTGBMMVOEFS
column the Response Not At Risk,
circle NOT AT RISK.
t *GANYPGUIFDMJFOUTSFTQPOTFTGBMMVOEFS
the column Response At Risk,
circle AT RISK.
RISK STATUS
Part E - Risk Status
At Risk or Not At Risk?
Purpose
To summarise if the client is At Risk or Not At Risk based on the responses provided in the Behav-
iour Assessment Section.
Purpose
To explore the client’s behaviours and identify those that put the client at risk.
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
S
(SOP) MANUA
ARD OPERA
G PROCED
or RISK R
P) MAN
Section 2: Assessment
22
Section 3: Review
23
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 3
Review
Section 3: Review
24
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 3: Review
25
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Part F - Knowledge Assessment Review
Review all responses made by the client and follow either option below:
OPTION 1
Use this option if the client has responded incorrectly, has
indicated ‘not sure’ or partially answered some questions.
Follow this process for all incorrect, partial or not sure
responses and for Knowledge Assessment sections 1 and 2 …
OPTION 2
If a client has responded correctly
to all questions, congratulate them
and move on to the Behavioural
Assessment boxes …
Let’s rst go back to the
Knowledge Assessment section. You did a great
job in responding to … [READ STATEMENTS
PERSON RESPONDED CORRECTLY TO]. But
if we review some of your other responses,
to question [insert question individual
responded incorrectly] you responded [insert
the individual’s response]. However, this is not
correct. The correct response is
You responded well
to all questions. You have
done a great job and are well
equipped with information to
protect yourself from contract-
ing HIV. Well done and keep it
up!
WRAP UP &
ASSESSMENT
Purpose
To review all responses with client to clarify misconceptions, correct misinformation and help cli-
ent understand which behaviours put them at risk for HIV transmission, unwanted pregnancy and/
or TB, and why.
STEP 4: WRAP UP AND ASSESSMENT
(Refer to page 7 of Risk Reduction Tool)
Section 3: Review
26
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
KNOWLEDGE ASSESSMENT: SECTION 1
Response
Yes U
No U
Not sure U
Yes U
No U
Not sure U
Yes U
No U
Not sure U
Yes U
No U
Not sure U
Correct response
N/A
U
Unprotected sex with HIV-infected individual
U Mother-to-Child Transmission during pregnancy,
delivery or breastfeeding
U Exchange of HIV-infected blood
U Correct and consistent condom use with all partners
U Abstain from sex
U Having sex with one partner at a time whose HIV
status you know
U Knowing your status and that of your partner’s, and
disclosing to each other
N/A
1
2
3
4
Question
Are you personally worried about HIV and AIDS?
(Probe: What are your concerns?)
Note concerns:
Do you know how HIV is transmitted from person to
person?
(Probe: Please tell me how you think it is passed from person to
person?)
Do you know how to prevent yourself from
contracting HIV or transmitting it to someone?
(Probe: If person only indicates one prevention method, then ask:
do you know any other prevention method/s?)
Do you think you are personally at risk of contracting
HIV?
(Probe: Please explain your response)
Explanation:
For KNOWLEDGE ASSESSMENT: Section 2:
U
Unprotected sex with HIV-in
f
ected individua
l
U
Mot
h
er-to-C
h
i
ld
Transmission
d
u
ring
pregnanc
y
,
d
elivery or breast
f
eeding
U
Exchan
g
e o
f
HIV-in
f
ected blood
U
Correct and consistent condom use with all
p
artner
s
U
Abstain
f
rom se
x
U
Havin
g
sex with one partner at a time whose HI
V
status
y
ou
k
no
w
U
Knowing your status and that o
f
your partner’s, and
d
isclosin
g
to each o
ther
N
/A
Yes
U
No
U
N
ot
su
r
e
U
Yes
U
N
o
U
N
ot
su
r
e
U
Y
es
U
No
U
Not
su
re
U
o
n to
t
o
a
sk:
cting
PARTIAL RESPONSES
Client identied 1 of
the 3 methods of HIV
transmission from
person to person.
Client identied 2 out
of the 4 prevention
methods.
KNOWLEDGE ASSESSMENT: SECTION 2
No.
1
2
3
4
5
6
7
Statement
There is a dierence
between HIV and AIDS.
Only indivuduals who have
sex with many people can
contract HIV.
Excessive use of alcohol
does not impair an
individual’s ability to make
decisions to use condoms.
Correct, consistent condom
use can protect a person
from HIV.
Males who are circumcised
are more likely to get
infected by HIV.
Having only one partner
at a time will help reduce
your risk of HIV.
Knowing one’s HIV status
can lead to a better quality
of life.
Correct
Answer
True
False
False
True
False
True
True
Information to provide after assessment if
respondent answers incorrectly or responds as
Not Sure
There is a dierence between HIV and AIDS. HIV refers
to the virus that causes AIDS. AIDS refers to the most
advanced and severe stage of HIV infection.
Even if you have unprotected sex with only one person,
you are at risk of contracting HIV.
Having sex after drinking alcohol excessively does
impair an indvidual’s ability to make decisions. This may
increase chances of using a condom incorrectly.
Correct, condom use can protect someone from HIV.
Safe male circumcision refers to the process of
removing the foreskin from the penis. This reduces
chances of contracting HIV by 60%. Therefore someone
who is circumcised is less likely to contract HIV.
However, correct and consistent condom use is still
necessary after circumcision.
Having one partner at a time can reduce your risk of
HIV. The more partners you have at one time, the higher
your risk of acquiring HIV. You still however, need to use
a condom during every single sex act.
Once you know your HIV status, you will be able to
make informed decisions regarding your life.
True False Not
Sure
RESPONSE REVIEW
Again, congratulate
the client on correct
responses.
Note areas where
the client has answered
incorrectly. Read out
the correct information
to those particular
questions, including all
responses where the
client was ‘Not Sure’.
e
e
e
Not
Sure
T
here is a di
erence between HIV and AIDS. HIV re
f
ers
to
t
h
e
vi
rus
t
h
at
cau
ses
AID
S.
AID
S
r
e
f
ers
to
t
h
e m
ost
a
dvanced and severe sta
g
e of HIV infection
.
E
ven i
f y
ou have unprotected sex with o
nly
one person,
y
ou are at risk of contracting HIV.
H
aving sex a
f
ter drinking alcohol excessively does
impair an indvidual
’
s ability to make decisions This may
Ag
t
he
r
e
s
N
N
No
th
e
i
n
c
th
e
For KNOWLEDGE ASSESSMENT: Section 1:
Response Examples
Section 3: Review
27
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Part G - Behavioural Assessment
Depending on the risk status identied in the previous section, provide the client with information on their
risk status.
To those NOT AT RISK
To those AT RISK
“Based on our conversation,
you are doing a great job to ensure you are
not at risk for HIV, TB, and/or unwanted pregnancy.
You are making healthy decisions for your life!
Continue to look after yourself and have
accurate information about issues relating to your health,
and apply them daily. If you ever need more information,
please visit your local clinic, or you can see us
(insert name of org center).
Thank you for your time.”
“Let’s reect on the
things we have discussed. We have talked
about a lot of dierent issues including alcohol use,
condom use, etc. Based on the responses you gave, it seems that
you need some further information and support. To the question
(select question that the individual has been identied AT RISK,
you responded (insert individual’s response). Based on this response,
you are at risk of contracting HIV due to (insert Risk Behaviour)
because (refer to relevant information as outlined in the Risk Reduction Tool:
Information Table Section on pages 10-12), then continue to
provide information about risk behaviour as indicated in
the table). Do this for all identied behaviours.
Do you agree?“
Section 3: Review
28
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
STEP 5: INFORMATION PROVISION
(Refer to pages 10-13 of Risk Reduction Tool)
Purpose
To provide information to the client on behaviours that were identied as AT RISK , and to ensure
that the client fully understands how specic behaviour/s may put them at risk of contracting
HIV. This will also help the client prioritise behaviour/s they want to change.
Note for Facilitator:
Say, “Now we will go back to talking about alcohol”.
No. Question Response: Response: Refused to Behaviour to
Not At Risk At Risk Answer Prioritise
8
9
10
11
12
In the past 3 months, have you ever had sex
after drinking alcohol and/or using drugs?
In the past 3 months, have you ever been
unable to remember what happened the
night before after drinking or using drugs?
In the past 3 months, have you ever not
used a condom after drinking and/or using
drugs?
In the past 3 months, have you ever
been forced to have sex unwillingly after
drinking or using drugs?
In the past 3 months, have you had more
than one sexual partner?
No
Skip to Question 12
No
Continue to Question 10
No
Continue to Question 11
No
Continue to Question 12
No
Continue to Question 13
Ye s
Go to Question 9
Ye s
Continue to Question 10
Ye s
Continue to Question 11
Ye s
Continue to Question 12
Ye s
Continue to Question 13
Refused to Answer
Skip to Question 12
Refused to Answer
Continue to Question 10
Refused to Answer
Continue to Question 11
Refused to Answer
Continue to Question 12
Refused to Answer
Continue to Question 13
Alcohol and
Drugs
Alcohol, Drugs
and Condoms
Alcohol, Drugs
and Gender
Based Violence
Multiple and
Concurrent
Sexual
Partnerships
ALCOHOL/DRUGS AND SEXUAL BEHAVIOUR
Questions only for those who drink alcohol or use drugs and responded Yes to having sex.
SEXUAL BEHAVIOUR
Questions for all
Remember: After you have identied the behaviour(s) that puts a client AT RISK in the behaviour
assessment section (an example circled below), provide information for all identied risk
behaviours using the information table on pages 10-12 in the Risk Reduction Tool (example circled
in blue on page 23). Then, tick the appropriate column on the information checklist on page 13
of the Risk Reduction Tool (example ticked in red on page 23) to indicate if the information was
provided for each key driver.
Behaviour Assessment
we
r
13
M
u
l
tip
l
e an
d
Co
n
cu
rr
e
n
t
Se
x
ua
l
P
artnerships
Ye s
C
ontinue to
Que
stion 1
3
R
e
f
C
ont
i
Section 3: Review
29
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Part H - Information Table & Checklist
KEY DRIVER INFORMATION PROVIDED
YES NO
ALCOHOL and DRUGS
DELAYED SEXUAL DEBUT
MULTIPLE AND CONCURRENT SEXUAL PARTNERSHIPS (MCPs)
CROSS-GENERATIONAL SEX
TRANSACTIONAL SEX
TUBERCULOSIS
PEER PRESSURE
GENDER-BASED VIOLENCE
INCONSISTENT, INCORRECT, CONDOM USE
CLIENT HAS NOT TESTED
PARTNER HAS NOT TESTED
MALE CIRCUMCISION
FAMILY PLANNING
BEHAVIOUR INFORMATION TO PROVIDE
ALCOHOL and DRUGS
DELAYED AND/OR
EARLY SEXUAL DEBUT
MULTIPLE AND CONCURRENT
SEXUAL PARTNERSHIPS
(MCPs)
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INFORMATION CHECKLIST (Refer to page 13 of Risk Reduction Tool)
INFORMATION TABLE (Refer to pages 10-12 of Risk Reduction Tool)
Section 3: Review
30
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
STEP 6: MOTIVATION TO CHANGE
(Refer to page 14 of Risk Reduction Tool)
Purpose
1. Helps client to prioritise the behaviour that they want to work on rst, helping them to
‘own’ their decision and the plan that will be developed.
2. Helps assess a client’s willingness and motivation to take steps to change their behaviour.
Only continue with planning if the client accepts this and is ready to change at least one
behaviour.
Discuss this with them.
One approach could be as follows...
V. MOTIVATION TO CHANGE
Here is a reminder of all the identied risk behaviours we just talked about: (List all identied behaviours again). Are you willing to
change some of your behaviours?
If no, state: “I encourage you to keep in mind how your behaviour may be aecting you and others. I have provided you with some
information, and feel free to seek support from us (state name of org, physical location, give phone number if available), at the clinic,
local NGO or support group, when you are willing to change your behaviour.
If yes state: “I am glad you are willing to change some of your behaviours. Changing a behaviour is a process. To be realistic we should
start with one behaviour you would like to work on rst. Which of the behaviours we just listed would you like to work on changing?”
Section 3: Review
31
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Part I - Prioritisation and Motivation to Change
For those who agree to change their risk behaviour(s), prioritise one behaviour (as shown in
blue circle below) and then go through the following table and circle the client’s responses.
Where probing questions are asked, write the client’s response in the box provided.
So that I can prevent myself from
contracting HIV. I have not tried before.
V. MOTIVATION TO CHANGE
Here is a reminder of all the identied risk behaviours we just talked about: (List all identied behaviours again). Are you willing to
change some of your behaviours?
Note for Facilitator:
Write the prioritised behaviour the client would like to work on in the space provided below.
Prioritised Behaviour: ______________________________________________________________________________________
Note for Facilitator:
SAY: “Now I am going to ask you a series of questions to further explore if you are really prepared and motivated to change your
behaviour .”
Circle the client’s responses in the boxes below and also note any explanations for responses in the spaces provided for each
question.
Question Response
How IMPORTANT would you say it is for you to change your
behaviour? Is it….?
Why do you want to change this Behaviour? Have you tried before?
What prevented you from doing so?
NOT at all
condent
Condent
EXTREMELY
condent
In thinking about your (say the
risk behaviour) and related risks,
how ready are you to change your
behaviour? Are you…..?
NOT at all ready* Somewhat
ready
Ready
Actively
working on it
If you were to decide now to change your behaviour, how
CONFIDENT are you that you could succeed? Are you….?
What would help you to have more confidence?
NOT at all
important
EXTREMELY
important
Important
IMPORTANCE
CONFIDENCE
READINESS
If no, state: “I encourage you to keep in mind how your behaviour may be aecting you and others. I have provided you with some
information, and feel free to seek support from us (state name of org, physical location, give phone number if available), at the clinic,
local NGO or support group, when you are willing to change your behaviour.
If yes state: “I am glad you are willing to change some of your behaviours. Changing a behaviour is a process. To be realistic we should
start with one behaviour you would like to work on rst. Which of the behaviours we just listed would you like to work on changing?”
Multiple Concurrent Partnerships
Im
p
ortant
Section 3: Review
32
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 4: Planning & Support
33
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 4
Planning & Support
Section 4: Planning & Support
34
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 4: Planning & Support
35
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
STEP 7: RISK REDUCTION PLANNING FOR
PRIORITISED RISK BEHAVIOUR
(Refer to page 15 of Risk Reduction Tool)
1. Steps towards behaviour change are dierent for everyone.
2. A supportive environment and internal factors such as risk perception, belief in ability and
perceived rewards are important.
VI. RISK REDUCTION PLANNING
RISK REDUCTION: PLAN 1
Now that you have decided which behaviour you would like to change, I will assist you to make a plan. The basic components of a
plan are a goal ‘the dream of what you would like to see change’ , steps to the goal ‘how you will reach the goal’, support you may
need , and challenges you may face . Please note that changing behaviour takes time. Therefore, after we have developed this plan
together, I will make appointments to follow up with you to see how your plan is going and continue to support you and refer you to
any relevant service providers.
Visit 1
Visit 2
Visit 3
Visit 4
Visit 5
1.
2.
3.
Referral 1
Type
Place
Date
Scheduled Visit 1:
Date
Scheduled Visit 4:
Date
Current Risky
Behaviour:
Goal:
Steps to Change
Behaviour:
(including date)
Challenges to
Behaviour Change:
Support Systems
Needed:
Referral Made:
(tick after
completed)
Scheduled Visits:
if completed
if not completed
Notes on progress:
Scheduled Visit 5:
Date
Scheduled Visit 2:
Date
Referral 2
Type
Place
Date
Referral 3
Type
Place
Date
Scheduled Visit 3:
Date
Note for Facilitator:
Complete one plan for each prioritised behaviour. Remember to set a goal, develop steps to reach this goal, and potential challenges
to reaching this goal. Brainstorm support needed to overcome these challenges so the client is prepared. If the client needs support
from other service providers to reach his/her goal do not forget to complete the referrals sections below. Refer to pages 19-23 for
sample goals and steps to assist with development of a risk reduction plan.
Purpose
To help the client develop tangible goals and steps that he/she will make to address their current
risk behaviours.
Part J - Risk Reduction Plan 1
Section 4: Planning & Support
36
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Example of a goal:
To use a condom correctly and consistently during every single sex act by January 30, 2012.
1. Develop a goal that addresses the identied risk behaviour.
2. Goals should be Specic, Measureable, Attainable, Relevant and Time-bound (remember SMART).
3. Too many or too high standards will only set the client up for failure and discourage them from
trying to change their behaviour.
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Reduction Tool to assist with completion of goals and steps (sample below).
MCP Reduce the number of partners I currently have from to by
so that I can make healthy decisions for myself and reduce my risk of contracting
HIV.
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DVUEPXOBUMFBTUPOFQBSUOFS
Use a condom with my partner during every single sex act.
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DPOEPNT
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RISK GOALS AND STEPS
BEHAVIOUR
Try to create a small, rst step that can be reviewed in your rst follow-up visit.
i. Example of a step for the above goal: Equip myself with information about how to use a condom and
where I can get them.
ii. Example of Step 2 for the above goal: Learn how to use a condom and demonstrate to a facilitator to
ensure I am doing it correctly.
iii. Example of Step 3 for the above goal: Educate my partner about condoms and its benets, and
communicate my desire to use condoms.
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Tips for Setting Goals and Steps for a Risk Reduction Plan
Section 4: Planning & Support
37
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Tip!
KEY COMPONENTS FOR STEPS TOWARDS BEHAVIOUR CHANGE
Challenges to behaviour change
There are certain factors that may limit, impede or decrease the likelihood of sustained behaviour change.
Being aware of these factors is helpful, so you can discuss and nd ways to overcome these barriers with
the client.
Identify any potential challenges, for example, peer pressure to drink alcohol, partner reluctance to
use a condom, or lack of skills to communicate about issues related to sex, and discuss strategies to
overcome these challenges.
ECONOMIC: LOW WAGES
FORCING INDIVIDUALS INTO
TRANSACTIONAL SEX
CHALLENGES
TO BEHAVIOUR
CHANGE
LACK OF SUPPORT
TO SUSTAIN NEW
BEHAVIOUR
LACK OF
RELEVANT
INFORMATION
STIGMA AND
DISCRIMINATION: CONSTRAINS
COVERAGE AND ACCESS
TO SERVICES
UNSUPPORTIVE SOCIO-CULTURAL
BELIEFS AND PRACTICES EG: BELIEFS
THAT SEX WITH VIRGINS WILL CURE
HIV, ACCEPTANCE OF MULTIPLE
PARTNERS AMONGST MALES,
AND PEER PRESSURE
RELIGIOUS BELIEFS WHICH
PREVENT INDIVIDUALS FROM
SEEKING TREATMENT FOR
ST I s OR USING CONDOMS
LOW SELF-
EFFICACY
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behaviour.
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BCPVUTBGFSTFYUISPVHISPMFQMBZTUPQSBDUJDFVTFPGUIFTFTLJMMT
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Support Systems
For a client to be successful in his/her risk reduction plan, they may need to seek support from other
channels, given that you will not be providing guidance on a daily basis, so:
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with them to strengthen their skills to eectively implement strategies.
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BTTJTUUIFNJOJNQMFNFOUJOHUIFTUSBUFHZGPSFYBNQMFGSJFOETQBSUOFSTGBNJMZDIVSDIDMJOJDTUBò
etc. Support systems such as these can increase a client’s ability to stay healthy and practice safer
TFYVBMCFIBWJPVS
Section 4: Planning & Support
38
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Referral Form
Details of Referring Organization
Date of Referral: Name of referrer:
Contact Details:
Referring Organization: Position:
Details of Client
Client ID No:
Date of Birth:
Gender:
Details of Receiving Organization
Organization:
Physical Address:
Contact Person
Telephone:
Nature of referral
Tick the appropriate referral made
Social Support Services Male Circumcision Spiritual Support
Family Planning Support Group HIV Counseling and
Testing
Civil Society Organizations Clinical Services Legal Services
OTHER(Name type of referral):__________________________________________________________________________
Referrals
It is important to:
1. Develop up-to-date lists of service providers in your area, including types of services, eligibility
DSJUFSJBJGBOZBOEMPDBUJPO
 &TUBCMJTISFMBUJPOTIJQTXJUITFSWJDFQSPWJEFSTPOUIFSFGFSSBMTMJTUTPUIFZBSFDMFBSBCPVUZPVS
services and the role you play in your community, as well as to know their services and eligi-
bility criteria.
 /PUFBOZSFGFSSBMTNBEFGPSUIFDMJFOUVTJOHUIF3FGFSSBM'PSNCFMPX
4. Give this form to the client to take to the referred service provider.
5. Note down the details of the referral in the risk reduction plan and remember to follow-up
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Section 4: Planning & Support
39
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
STEP 8: GOAL CARD
(Refer to page 27 of Risk Reduction Tool)
Instructions for facilitators:
Remember to ll this out after developing a risk reduction plan and leave it with the client.
Purpose
Provides a reminder to client of developed goals and steps to change behaviour.
GOAL CARD
My Goal
To reach my goals I commit to the following steps:
1.
........................................................................................................................
............................................................................................................................
2.
........................................................................................................................
............................................................................................................................
3.
........................................................................................................................
............................................................................................................................
4.
........................................................................................................................
............................................................................................................................
If I have challenges I commit to actively look for information and support to get
me to my goals.
Signature: ________________ Date: ___________
Carry this goal card with you and look at it throughout each day.
Think about what you can do today to get closer to reaching your goal.
Part K - Goal Card
Write the goal
that the client has
committed to in
the risk reduction
plan.
To be signed
by the client as
conrmation of
their commitment
to work towards
their goal and
steps.
Section 4: Planning & Support
40
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
STEP 9: FOLLOW-UP
(Refer to page 16 of Risk Reduction Tool)
There are no recommended number of follow-up visits as this depends on the need, but plan for
at least two for each client.
Purpose
To monitor the client’s progress on their developed risk reduction plan and ensure they have the
support, encouragement and information to achieve their goals.
Instructions for facilitators:
After handing out the Goal Card, plan a follow-up visit with the individual 2 weeks after the initial
assessment. Write the date in the box under Scheduled Visit 1: Date (circled in green below).
After completion of the rst follow-up visit, place a tick in the box next to the date (circled in red below).
RISK REDUCTION: PLAN 2
Visit 1
Visit 2
Visit 3
Visit 4
Visit 5
1.
2.
3.
Referral 1
Type
Place
Date
Scheduled Visit 1:
Date
Scheduled Visit 4:
Date
Current Risky
Behaviour:
Goal:
Steps to Change
Behaviour:
(including date)
Challenges to
Behaviour Change:
Support Systems
Needed:
Referral Made:
(tick after
completed)
Scheduled Visits:
if completed
if not completed
Notes on progress:
Scheduled Visit 5:
Date
Scheduled Visit 2:
Date
Referral 2
Type
Place
Date
Referral 3
Type
Place
Date
Scheduled Visit 3:
Date
Part L - Risk Reduction Plan 2
Section 4: Planning & Support
41
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Checklist for follow-up visits
Ask the client if they
want to work on other
identied behaviours
YES
Repeat the planning process to address the
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Reduction Plan 2. You can begin working on
this plan at the same session you end Risk
Reduction Plan 1. Alternatively, schedule a
follow-up meeting within two weeks to ensure
rapid follow-up and continuation, taking
advantage of the momentum gained.
NO
Congratulate the individual on his/her
behaviour change and encourage them
to continue to make healthy decisions
that will protect them.
Let them know they can seek continued
support from clinics, your organisation
or other NGOs if they require assistance
in the future.
Completion of Risk Reduction Plan 1
Review the identied behaviour, goal and steps with the client again. Note how far he/
she has come in addressing their rst step.
Provide further information to ll any knowledge gaps concerning the prioritised risk
behaviour if needed.
Clients who have successfully implemented or have tried to implement strategies should
be congratulated for their eort.
Challenges should be addressed as much as possible and new/revised strategies devel-
oped for those who were unable to implement strategies.
If new strategies need to be developed, they should be written under the already cre-
ated steps to behaviour change. If current steps need to be revised, they should be up-
dated on your copy of the client’s plan and a new goal card developed.
Clients should not be judged, or their lack of success viewed as a failure; this will discour-
age them from trying to implement the strategies.
When the client has been able to implement all or most of the strategies, or decides they
no longer need your support, termination of the sessions/relationship should be clearly
communicated.
Section 4: Planning & Support
42
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 4: Monitoring & Evaluation
43
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 5
Monitoring & Evaluation
Section 4: Monitoring & Evaluation
44
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Section 4: Monitoring & Evaluation
45
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
STEP 10: MONITORING AND EVALUATION (M&E)
Overview of M&E forms
DAILY SESSION FEEDBACK FORM
Purpose: Summary of all comments from audience feedback, further needs/information
User: Facilitator
Frequency: Daily
Due Date: 2nd-3rd day of following month
DAILY ACTIVITY ATTENDANCE REGISTER
RRAPS DAILY ACTIVITY SHEET
Purpose: Source of data verication for each activity implemented
User: Facilitator
Frequency: Daily
Due Date: 2nd-3rd day of following month with HIV Prevention Daily Activity Sheet
Purpose: Summary of each risk reduction session
User: Facilitator
Frequency: Daily
Due Date: 2nd-3rd day of following month with all complete registers
HIV PREVENTION DAILY ACTIVITY SHEET
Purpose: Summary of each activity, number of individuals reached, etc (group and risk reduction)
User: Facilitator
Frequency: Daily
Due Date: 2nd-3rd day of following month with all complete registers
HIV PREVENTION MONTHLY SUMMARY FORM
Purpose: Summary of all activities implemented per facilitator, per village, per month
User: Project Ocer / Programme Manager
Frequency: Monthly
Due Date: 8th day of following month
Co
m
m
m
m
u
u
ni
t
O
u
u
tre
a
a
a
ch
R
R
i
s
s
k
k
R
R
e
e
e
d
d
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c
t
t
i
o
o
o
n
n
All
Ac
t
t
t
ivi
t
ies
Purpose
To document and report all risk reduction sessions.
Monitoring and evaluation is a routine process that allows facilitators to keep track of progress made in
delivery of risk reduction support. Several tools have been developed to document implementation of HIV
prevention activities, both community outreach group sessions and one-on-one risk reduction sessions.
All interventions ultimately are then documented into one organisational monthly reporting tool. Refer to
the M&E owchart below.
Section 4: Monitoring & Evaluation
46
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Reporting Month and Year: _____________________________ Village/Ward: ____________________________________
Facilitator Name: _______________________________________
_
Organisation: _____________________________________
No Client ID
New Repeat M F
10-14
15-25
26-35
36-50
None
Alcohol and Drugs
MCP
Cross Generational Sex
Transactional Sex
Gender Based Violence
No, incorrect, incons Condom
Unknown HIVStatus
Unknown Partner HIV Status
Tuberculosis
Family Planning
Male Circumcision
Assessment
√
Visit1
√
Visit2
√
Visit3
√
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
S
IGNATURE OF FACILITATOR______________________ DATE OF SUBMISSION: _________ SUPERVISOR: _________________________ DATE OF REVIEW: _________
1st Contact Gender Age Category Follow-Up Visits (Dates, Completed)
TOTAL
Identified Risk Behaviours
Page _____ of ________
RRAPS Daily Activity Sheet
Section 4: Monitoring & Evaluation
47
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
RISK REDUCTION ASSESSMENT PLANNING AND SUPPORT M&E TOOLS
Risk Reduction Assessment, Planning and Support (RRAPS) Daily Activity Sheet
Assessments and follow-up visits for all individuals should be recorded on the HIV Prevention
Daily Activity Sheet.
Section
Reporting Month and Year
Village/Ward
Facilitator Name
Organisation
Client ID
First contact
Gender
Age Category
Identied Risk Behaviours
Follow-up Visits
Totals
Instructions
Month and Year for which you are submitting your report, for
example, March 2011
Your area of coverage
Your name
Organisation for which you are working
Write the Client ID from the risk reduction assessment, planning
and support tool for each individual that you have seen during the
month.
Indicate if the client is new (never seen during this year (starting
October 2010 to you or any other facilitator from your organisation)
or repeat (has been seen since October 2010 from group session or
home visit for example).
Tick male (M) or female (F) for client.
Tick age category of client, refer to the background information table
on page 1 of the RRT for this information.
Tick all identied risk behaviours from the risk reduction tool. If client
is not at risk, tick none column.
a. Assessment: Write the date of the initial assessment and tick after
it has been completed
b. Visit 1: Write the date of the rst follow-up visit and tick after
it has been completed
c. Visit 2-3: Same as above
Write the totals for each category in the tool on the line, that is the
total # of new, repeat clients, age category, etc.
RiMhdY
MhdYf hih bii f
ll d
Yf
F ilit t N
Your name
Oiti
Organisation
f
f
or w
h
hi
h
ch
you are working
h
d
f
h
l
d
k
f
Ti k ll id
i
dikbh i
f
hikd i lI
f
li
Id i d Ri k B h i
Ti k f li f h b k d i f i bl
C
k
l
(
)
f
l
(
)
f
l
I
di
t
i
f
th
l
i
t
i
(
i
t
hi
(
t
ti
Fi
W i h Cli ID f h i k d i l i
Cli I
D
Purpose
To document all one-on-one risk reduction sessions implemented.
Section 4: Monitoring & Evaluation
48
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
HIV PREVENTION DAILY ACTIVITY SHEET –A/AB and OP
1. Reporting Period: Month ___________ 2.Year __________________
3. District: _______________ 4. Village/Ward: _______________ 5. Facilitator Name: __________________________
Parents
MFMFMFMFMFMFMFMFMFMFMFMFMFMFMFMF
Note that Community Outreach has to adhere to minimum standard before recording here
1
6. SIGNATURE OF FACILITATOR________________________________ 17. DATE OF SUBMISSION: _________ 18. SUPERVISOR: _________________________________ 19. DATE OF REVIEW: _______
__
15.TOTALS
7. Reg
#
9. Communication
Guide/Risk Reduction
36-50
New Repeat
6.Date
(dd/mm)
15-24
11. # Reached with AB Messages
Other
One-One
Group 2-25
MCP
Put X for target group, session type Enter actual number of people reached, materials distributed & referrals. Separate row for each session
Delayed Sexual Deb
u
Alcohol
Cross Gen Sex
GBV
Risk Reduction
CCC
Repeat
36-50
Condoms
IEC
MTCT/ART
25-35
New Repeat New
13.
# Given
10-14
Repeat
CT
TB
FP
New Repeat New Repeat
12. # Reached with OP Messages
New Repeat New
15-2410-1425-35
New Repeat
STI
14. # Referrals
In school
Out school
Workplace
Shebeen/Bar
PLWHA
Church
8. Target Group 10.Session
20. Page _____ of ________
HIV Prevention Daily Activity Sheet
Section 4: Monitoring & Evaluation
49
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
HIV Prevention Daily Activity Sheet
Target Group
Communication Guide
Session Type
Number of people
reached through AB
messages and OP
messages
Indicate with an X who the main people are for the session, i.e. in
school youth, out of school youth, etc.
Indicate with an X which Communication Guide was used for the
intervention or if it was a risk reduction session.
Indicate with an X which type of session was facilitated on that
day:
a. One-on-one session: Report here when you conduct a risk
reduction session, for which you have talked to only one person
at a time.
b. Group Session (2-25): Report here when you talk to 2-25 people
at a time, i.e. shebeen intervention.
Numerical value of number of people reached through sessions
should be reported under these categories as per age, gender and
new or repeat.
Note: All the risk reduction sessions should be reported under OP
messages. Indicate with a ‘1’ under OP for the relevant age, gender
and contact type (new or repeat).
f
Nillfbf l hdhhi
Nb f l
1. All risk reduction sessions should be integrated into the HIV Daily Activity Sheet and be
reported as a one-on-one session.
2. Information that is required should be taken from the Risk Reduction Assessment, Planning
and Support Daily Activity Sheet, i.e. - new, repeat, age, date of contact, etc.
Purpose
To document all HIV prevention activities implemented.
Section 4: Monitoring & Evaluation
50
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Sample Community Map by Facilitator
Sample for Samuel Kagisong: this map shows that Samuel Kagisong assessed 12
clients in the community in these locations.
SHEBEEN
SHEBEEN
MORAMA
CJSS
KGOMO
PS
SPAR
W.U.C.
R.A.C.
CAMP
HEALTH
POST
KGARA
CLINIC
GHANZI
PRIMARY
HOSPITAL
TLW
YOHO
SK-04
SK-05, 06, 07, 08
SK-01
SK-02
SK-03
SK-09, 10, 11, 12
KEY
WORKPLACE
CSO
SHEBEEN
HEALTH
FACILITY
SCHOOL
SHEBEEN
Data storage and management
1. Completed RRAPS tools should be stored securely at your organisation’s oce.
2. When submitting monthly M&E reports, completed RRAPS tools should be submitted and led
as well.
3. Each client who has been assessed should be allocated a le that is kept in a locked ling cabi-
net.
4. Each RRAPS tool has two copies of the risk reduction plan. One copy of the plan should be
kept in a le at the oce and the other copy should be kept with the facilitator for follow-up
purposes.
5. To assist with data management, individual maps should be developed (sample below) to doc-
ument the location of clients who are being supported with RRAPS. This will help with follow-
up as well as ensure continued support to clients in case a facilitator is no longer employed by
the organisation. Each facilitator for the RRAPS process should document where either their
client lives or where they have arranged to meet i.e. at the clinic. On the map the facilitator
should indicate the client ID # to reference where to follow-up with that client. This process
assists with condentiality of individuals supported through the RRAPS process. Again, two
copies should be made, one for the organisational records, the other to be kept with the facili-
tator.
6. Once a client has been asssessed and a plan developed, the completed RRAPS tool should be
led immediately. After a new client has been assessed, the community map should be up-
dated both in the organisational ling system and on the facilitator’s map.
All information collected during the RRAPS process is condential.
Section 4: Monitoring & Evaluation
51
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)
Recommended organisational filing of RRAPS tools
Files for each implementer should be organised accordingly:
Client File #: LP-02
Completed RRAPS Tool (including copy of Risk Reduction Plan)
Client File #: LP-01
Completed RRAPS Tool (including copy of Risk Reduction Plan)
Map for LP to document client location
(updated every month)
Implementer 2: Lillian Pule (LP)
Client File #: SK-03
Completed RRAPS Tool (including copy of Risk Reduction Plan)
Client File #: SK-02
Completed RRAPS Tool (including copy of Risk Reduction Plan)
Client File #: SK-01
Completed RRAPS Tool (including copy of Risk Reduction Plan)
Map for SK to document client location
(updated every month)
Implementer 1: Samuel Kagisong (SK)
Section 4: Monitoring & Evaluation
52
STANDARD OPERATING PROCEDURES (SOP) MANUAL for RISK REDUCTION ASSESSMENT, PLANNING and SUPPORT (RRAPS)