We examined the social roots of stigma by means of a case study of HIV/AIDS management among young people in a South African community (drawing from interviews, focus groups, and fieldworker diaries). We highlight the web of representations that sustain stigma, the economic and political contexts within which these representations are constructed, and the way in which they flourish in the institutional contexts of HIV/AIDS interventions. Stigma serves as an effective form of "social psychological policing" by punishing those who have breached unequal power relations of gender, generation, and ethnicity. We outline an agenda for participatory programs that promote critical thinking about stigma's social roots to stand alongside education and, where possible, legislation as an integral part of antistigma efforts.

In this paper we discuss our conceptualisation of a 'health-enabling social environment', and some of the strategies we are currently using to build social contexts most likely to support effective HIV/AIDS management in southern Africa. In developing these ideas, we draw on our on-going collaboration with residents of Entabeni, a remote rural community in South Africa where 43% of pregnant women are HIV positive. The aim of this collaboration is to facilitate contextual changes that will enable more effective community-led HIV/AIDS management in an isolated area where people have little or no access to formal health or welfare support, and where HIV/AIDS is heavily stigmatised. We give an account of the three phases of collaboration to date. These include research; the dissemination of findings and community consultation about the way forward; preliminary project activities (skills training for volunteer health workers; partnership building and a youth rally) as a way of illustrating what we believe are six key strategies for facilitating the development of 'HIV-competent' communities: building knowledge and basic skills; creating social spaces for dialogue and critical thinking; promoting a sense of local ownership of the problem and incentives for action; emphasising community strengths and resources; mobilising existing formal and informal local networks; and building partnerships between marginalized communities and more powerful outside actors and agencies, locally, nationally and internationally. We discuss some of the triumphs and trials of this work, concluding with a discussion of the need to set realistic goals when working at the community level in highly conservative patriarchal communities to tackle problems which may be shaped by economic and political processes over which local people have little control.

We highlight the complex interplay of psychological and social factors driving AIDS stigma, drawing on a study of community responses to HIV/AIDS in two communities in KwaZulu-Natal, South Africa. We draw on 120 semi-structured interviews and focus groups, in which open-ended topic guides were used to explore community responses to HIV/AIDS. Drivers of stigma included fear; the availability and relevance of AIDS-related information; the lack of social spaces to engage in dialogue about HIV/AIDS; the link between HIV/AIDS, sexual moralities and the control of women and young people; the lack of adequate HIV/AIDS management services; and the way in which poverty shaped people's reactions to HIV/AIDS. We discuss the implications of our findings for stigma-reduction programmes.

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Effective youth participation in social development and civic life can enhance young peoples' health and well-being. Yet many obstacles stand in the way of such involvement. Drawing on 105 interviews, 52 focus groups and fieldworker diaries, this paper reports on a study of a rural South African project which sought to promote effective youth participation in HIV/AIDS management. The paper highlights three major obstacles which might be tackled more explicitly in future projects: (i) reluctance by community adults to recognise the potential value of youth inputs, and an unwillingness to regard youth as equals in project structures; (ii) lack of support for meaningful youth participation by external health and welfare agencies involved in the project; and (iii) the failure of the project to provide meaningful incentives to encourage youth involvement. The paper highlights five psycho-social preconditions for participation in AIDS projects (knowledge, social spaces for critical thinking, a sense of ownership, confidence and appropriate bridging relationships).We believe this framework provides a useful and generalisable way of conceptualising the preconditions for effective 'participatory competence' in youth projects beyond the specialist HIV/AIDS arena.

With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS -as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research, we conducted 17 discussions with 34 community members, including those involved and uninvolved in project activities -at the end of this 3-year period. These discussions aimed to elicit local people's perceptions of the project, its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However, discussions suggested that it was unlikely that these efforts would be sustainable in the long term, due to lack of support for volunteers both within and outside of the community. We conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief among these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health, welfare and NGO sectors. Keywords: Evaluation, home-based care, volunteers, task shifting, participation, stipends, leadership. RésuméEtant donnée la rareté des professionnels africains de la santé, les volontaires sont destinés à des rôles de plus en plus importants dans la gestion du VIH/SIDA, avec un nombre croissant de projets reposant sur les membres des communautés de base pour qu'ils fournissent des soins à domicile à ceux vivant avec le SIDA -dans le cadre d'un agenda plus large de transfert des taches. Pourtant, on sait très peu comment faciliter au mieux cette implication. Cet article rend compte des perceptions de la communauté d'un projet de 3 ans qui visait à former et à appuyer les travailleurs volontaires de la santé dans une communauté rurale en Afrique du Sud. Etant donnée l'attention croissante accordée à l'implication de la parole des communautés dans l' étude du projet, nous avons organisé 17 discussions avec 34 membres de la communauté, y compris ceux qui sont impliqués dans des activités du projet et ceux qui ne le sont pas -à la fin de la période de 3 ans. Ces discussions visaient à obtenir les perceptions des personnes locales sur le projet, ses forces et ses faiblesses. Les membres de la communauté ont perçu le projet comme un projet ayant permis diverses formes de progrès positifs dans l'habilitation des volontaires à gérer un service de soin à domicile plus efficace. Cependant, les...

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Although youth participation is a pillar of international HIV/AIDS policy, it is notoriouslydifficult to facilitate. We explore this challenge through a case study of a community-