According to this report, Community Conversation (CC) is an interactive process which brings people together and engages communities to discuss and explore underlying causes fuelling the HIV and AIDS epidemic. CC was initiated in Ethiopia in 2002 by the National HIV/AIDS Prevention and Control Office (NHAPCO). CARE International's Health Improvement and Women Owned Transformation (HIWOT) programme adopted the approach, initiating 105 CC groups in 14 districts on issues related to HIV and sexual and reproductive health (SRH) between 2006 and 2007. CC recognises that people have capacities, knowledge, and resources to transform individually and collectively once they perceive ownership of a problem. The authors propose that the CC approach creates a participatory space for listening, speaking, being, inclusion, and agreement, in order to deepen a community's understanding of the pandemic and facilitate decision making and action in the local context.

In the Community Conversation approach, community facilitators with leadership competencies are identified and approached to lead CC discussion groups of 50-60 volunteers from diverse backgrounds. According to the authors, after 12 months, the following changes were noted in communities:

• Some CC groups condemned early marriages in their communities, committing themselves to protecting school girls from discontinuing their education due to forced marriage.
• Other CC participants decided to stop Female Genital Cutting (FGC) in their areas or penalise traditional circumcisers (frequently traditional birth attendants) who do not use new razor blades for each girl they circumcise. In some places, participants discussed harmful traditional practices apart from HIV/AIDS (i.e. milk teeth extraction), and passed by-laws to stop FGC in their locality.
• Some CC participants reached a consensus to avoid practicing risky behaviours that predispose to HIV infection, such as going to night clubs and drinking alcohol, which is very common in the community, as well as practices like widow inheritance.
• Researchers found the sessions have helped reduce stigma and discrimination towards people living with HIV (PLWH), with some CCs providing care to people living with HIV and AIDS or forming HIV/AIDS clubs.

According to the authors, an intrinsic outcome of CC is empowerment of communities and individuals to identify and address issues that are important to them. However, in one instance CC groups identified HIV transmission occurring more frequently in newly married couples and decided to make HIV testing mandatory for both partners before marriage. This led to a discussion among HIWOT staff on human rights approaches regarding pressure for voluntary counseling and testing. The authors state that there is a dilemma here in terms of globally accepted human rights approaches to voluntary counselling and testing (VCT).

The authors identified monitoring and evaluation, ensuring representation of diverse marginalised communities, and the need to further support facilitators as key challenges. The report also identifies the following lessons learned:

• Community Conversation is a powerful tool to reduce risk behaviour towards HIV embedded in a community's local context and to promote HIV prevention and stigma reduction. It is highly flexible but dependent on the facilitators' skills to foster instead of dominate a group.
• Identifying, training, and monitoring of skilled facilitators are critical for successful implementation of CC. The facilitators must be guided by a value system that includes sensitivity to local community experiences, gender sensitivity, respect, commitment to reduction of vulnerabilities, improvement of sexual and reproductive health, and upholding human rights.
• When communities are fostered to express and understand their own problems and concerns, and can explore their values and issues in their own language, they may come up with decisions driven by values that they appreciate, but may contradict globally accepted values and ethics promoted by human rights activists and donors.

Email received from Tula Michaelides on October 13 2008.