10/18/2010 06:54 pm ET Updated May 25, 2011

Pieces of the Behavior Change Puzzle

Molly Melching had accomplished something remarkable in Senegal. She took a stubbornly ingrained cultural norm, one with 2,000 years of history woven into the very fabric of family practices and tribal custom, with dangerous consequences, and provided the tools to reverse it. Skeptics, some reacting with hostility, said such a thing could not be done in 100 years, others argued 200 years, many more said that it was impossible, but her efforts proved otherwise.

In 1997, approximately 5,000 Senegalese villages practiced Female Genital Cutting (FGC). The practice was required for marriage and often performed on young girls between the ages of two and five. Molly recognized that social transformation, the kind needed to change these practices, had to come from the Senegalese themselves, not outsiders. To date, over half of the communities estimated to have practiced FGC in Senegal -- a total of 2,996 communities in all -- have abandoned the practice.

I met Molly at the Skoll World Forum last April. Almost immediately I began to see parallels between the work she has accomplished in Senegal, disease control efforts I had conducted in Uganda as part of the World Health Organization Global Program on AIDS, and a violence prevention initiative that CeaseFire staff had been strategizing for nearly two years. These seemingly disparate themes came together like pieces of a behavior change puzzle.

Uganda is the only country in Africa where the AIDS epidemic has been reversed. Our approach at the World Health Organization was to change the social norms on sexual behavior: reduce the number of partners having sex, increase condom use, and prolonging the time to first sexual experience. As with Molly's work, the approach recognized the importance to having credible messengers, individuals from within the community, to act as the driving force of change. Uganda held forums, led by community representatives selected for their credibility and trained in directing a conversation toward purposeful outcomes, not only to provide information that filled knowledge gaps on HIV/AIDS, but also offer behavioral skills that moved participants toward safer practices. These forums were not presentations - they were an orchestrated discourse. These community trainings and forums - all part of Uganda's unique plan - produced exceptional results, helping Uganda to be one of only two developing countries in the world that successfully reversed the course of its HIV epidemic in the early years - and an experience that has still not been fully reproduced.

I have been reflecting on these forums for the past couple years. While Molly's work was not a driving force behind this thinking, our meeting provided conviction that we were on the right track. How could CeaseFire, our public health strategy proven to stop shootings and killings, implement a similar behavior change strategy? CeaseFire recognizes violence as a learned behavior. The more people experience violence, the more likely they are to repeat it. These trainings and forums would further enhance our ability - not just to break the cycle as the CeaseFire Method has already been shown to do, but shift the ground so this "age-old practice," violence, also recedes into the past.

The nature of these sessions, as with those in Senegal or Uganda, is to establish a conversation that provides new information, insights, and views that can challenge prevailing assumptions and offer new behavioral skills. Here, the ability to resolve conflict without resorting to violence. Last week, my colleague Tio Hardiman, Director of CeaseFire Illinois, posted here on the first of these behavior change summits. This innovation is still new, but has already begun to shift the thinking, resulting in 20 peace treaties in a very short span of time. Skeptics may say that violence is too culturally ingrained, that it cannot be reversed in 100 years, or 200 years, if at all, but CeaseFire's methods are proving otherwise.