Reflection and Action within Most at Risk Populations (RAMP) is the foundational model of GHC behavioral intervention programming. RAMP starts from the assumption that information is rarely enough to change behavior, and that most people need to address personal, social and environmental barriers that prevent them from behaving in ways they already know are risky.

RAMP interventions begin with small groups of the target population reflecting on specific examples of risk behavior in a fictional story that illustrates barriers and facilitators to change. Based on this reflection, participants identify their own priority issues and propose solutions. Groups then create a workplan for concrete action. Participants also receive one-to-one counseling and attend a one-day change fair where a wide range of health and social services are available.

Most at-risk populations (MARPs) such as sex workers, drug users, and men who have sex with men (MSM) have unique experiences that can be very difficult for people outside these groups to understand. As public health experts, we may believe we know what people need to do to reduce their risk for HIV, but until we understand how people see their own lives, how they prioritize their own concerns, and why they do what they do, we will have little impact on risk reduction. RAMP offers a unique opportunity to engage with MARPs in ways that encourage them to reflect on specific elements of their lives and their particular structural environment, and for them to offer solutions. In this way, RAMP allows us to learn about peoples’ lives while they literally tell us what they need and how we can help. 

RAMP incorporates three key elements:

  • The Story
  • Three structured action phases
  • The change fair

The Story
Each RAMP story is carefully crafted for a specific target population using behavioral theory and qualitative research that incorporates the local context and nuanced aspects of peoples’ lives. Fictional characters confront a range of authentic behavioral barriers and facilitators in realistic settings. These stories are then used as a tool in the action phase component to initiate discussion of issues surrounding risk behavior. The drama serves as a kind of inkblot test that allows group members to project their own issues and needs onto the characters in the story and permits discussion of highly personal and subjective issues in an externalized, objective manner.

The RAMP Process