Building contexts that support effective community responses to HIV/AIDS: a South African case study

Abstract

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.

Orphan competent communities: A framework for community analysis and action

“…Campbell's concept of the 'AIDS competent community' is one starting point (Campbell, Nair, & Maimane, 2007;Campbell, Nair, Maimane, & Gibbs, 2009, in press). She defines this as a community where people are most likely to work collaboratively to tackle the challenges of HIV/AIDS (including avoiding infection, caring for the sick, and accessing support and treatment).…”

Hearing community voices: grassroots perceptions of an intervention to support health volunteers in South Africa

“…The research in this paper is underpinned by our conceptualisation of an ' AIDS-competent community' -a social environment that provides an enabling and supportive context for HIV/AIDS prevention, care and treatment (Campbell, Nair, Maimane & Sibiya, 2005;Campbell et al, 2007a …”

“…Les points les plus importants étant: des bourses pérennes pour les volontaires, un engagement des dirigeants de la communauté et des directeurs d' équipes de volontaires envers des idéaux démocratiques de la gestion du projet, et un soutien substantiel de la part d'agences externes dans les secteurs de la santé, de la protection sociale et des ONG. (Campbell, Nair & Maimane, 2007a;Campbell, Gibbs, Maimane & Nair, 2008c;Nair & Campbell, 2008). Our 'community insiders' data consist of interviews and focus groups with local Entabeni residents, including those who have implemented the project and those who have been targeted by it.…”

Inviting Backchat: How schools and communities in Ghana, Swaziland and Kenya support children to contextualise knowledge and create agency through sexuality education

“…So in the contexts of the six countries in which research was done, particular attention was paid to issues of 'presumed innocence' (Faulkner, 2011), taboos around talking about sex (Oshi et al, 2005), strong moral messages about sex not grounded in everyday realities (Bhana, 2007a;Pattman and Chege, 2003;Pattman, 2006) and the myriad of ways poverty affected sexual relationships, through for example transactional sex and the influence of substance abuse on sexual behaviour (Campbell, 2003).…”

“…In the first stage of our research, we encountered frequent reference to community censure from teachers and schools heads . It is this that drew us to the Campbell's notion of 'AIDS competent communities' (Campbell et al, 2007).…”