Many biomedical and behavioural HIV/AIDS programmes aimed at prevention, care and treatment have disappointing outcomes because of a lack of effective community mobilisation. But community mobilisation is notoriously difficult to bring about. We present a conceptual framework that maps out those dimensions of social context that are likely to support or undermine community mobilisation efforts, proposing that attention should be given to three dimensions of social context: the material, symbolic and relational. This paper has four parts. We begin by outlining why community mobilisation is regarded as a core dimension of effective HIV/AIDS management: it increases the "reach" and sustainability of programmes; it is a vital component of the wider "task shifting" agenda given the scarcity of health professionals in many HIV/AIDS-vulnerable contexts. Most importantly it facilitates those social psychological processes that we argue are vital preconditions for effective prevention, care and treatment. Secondly we map out three generations of approaches to behaviour change within the HIV/AIDS field: HIV-awareness, peer education and community mobilisation. We critically evaluate each approach's underlying assumptions about the drivers of behaviour change, to frame our understandings of the pathways between mobilisation and health, drawing on the concepts of social capital, dialogue and empowerment. Thirdly we refer to two well-documented case studies of community mobilisation in India and South Africa to illustrate our claim that community mobilisation is unlikely to succeed in the absence of supportive material, symbolic and relational contexts. Fourthly we provide a brief overview of how the papers in this special issue help us flesh out our conceptualisation of the "health enabling social environment". We conclude by arguing for the urgent need for a 'fourth generation' of approaches in the theory and practice of HIV/AIDS management, one which pays far greater attention to the wider contextual influences on programme success.

Acknowledgement: Alex Gillespie would like to acknowledge the support of an

Whilst much research has examined how to empower poor community members to identify the social roots of health problems and articulate demands for health-enabling living conditions, less is known about how to create receptive social environments where the powerful are likely to heed the voices of the poor. This paper seeks to characterise the social environments in which community-led health programmes are most likely to facilitate effective and sustainable health improvements, using three dimensions to characterise social contexts: women to deliver home-based nursing to people with AIDS. Whilst it performed a vital shortterm welfare function, it did not achieve its goals of leadership by local participants and longterm sustainability. By contrast, the Sonagachi Project in India, which started as an HIVprevention programme targeting female sex workers, has achieved both these outcomes. We examine the way in which pre-existing social contexts in West Bengal and rural KwaZuluNatal impacted on the possibility of effective mobilisation of excluded women in each case.We also highlight the strategies through which Sonagachi, but not Entabeni, was able to alter aspects of the material, symbolic and relational contexts of participants' communities in ways that opened up significant opportunities for project participants to articulate and assert their needs, and motivated powerful actors and groups to heed these demands.

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Original citation:Cornish, Flora and Campbell, Catherine (2009) The social conditions for successful peer education: a comparison of two HIV prevention programs run by sex workers in India and South Africa.