Conceptualizing Community Mobilization for HIV Prevention: Implications for HIV Prevention Programming in the African Context

Abstract

IntroductionCommunity mobilizing strategies are essential to health promotion and uptake of HIV prevention. However, there has been little conceptual work conducted to establish the core components of community mobilization, which are needed to guide HIV prevention programming and evaluation.ObjectivesWe aimed to identify the key domains of community mobilization (CM) essential to change health outcomes or behaviors, and to determine whether these hypothesized CM domains were relevant to a rural South African setting.MethodWe studied social movements and community capacity, empowerment and development literatures, assessing common elements needed to operationalize HIV programs at a community level. After synthesizing these elements into six essential CM domains, we explored the salience of these CM domains qualitatively, through analysis of 10 key informant in-depth-interviews and seven focus groups in three villages in Bushbuckridge.ResultsCM domains include: 1) shared concerns, 2) critical consciousness, 3) organizational structures/networks, 4) leadership (individual and/or institutional), 5) collective activities/actions, and 6) social cohesion. Qualitative data indicated that the proposed domains tapped into theoretically consistent constructs comprising aspects of CM processes. Some domains, extracted from largely Western theory, required little adaptation for the South African context; others translated less effortlessly. For example, critical consciousness to collectively question and resolve community challenges functioned as expected. However, organizations/networks, while essential, operated differently than originally hypothesized - not through formal organizations, but through diffuse family networks.ConclusionsTo date, few community mobilizing efforts in HIV prevention have clearly defined the meaning and domains of CM prior to intervention design. We distilled six CM domains from the literature; all were pertinent to mobilization in rural South Africa. While some adaptation of specific domains is required, they provide an extremely valuable organizational tool to guide CM programming and evaluation of critically needed mobilizing initiatives in Southern Africa.

Development, validation, and performance of a scale to measure community mobilization

“…Because in this rural area community activity centers mostly around family-based informal networks, we revised the initially piloted scale and developed items to assess the presence and significance of specific formal and informal affinity groups. (13) While performance was much improved, we believe that the measure could benefit from additional work not only to elicit responses that confirm the presence, visibility, and perceived salience of organized groups in the community, but also to assess whether these groups actually play a role as a mobilizing resource. This domain may also be intrinsically difficult to measure where networks are diffuse.…”

“…(13) For example, our measure of shared concerns focused on the theme of the mobilization intervention in which the CMM was being utilized: HIV prevention. Thus, items assess the degree to which the community perceives HIV as a salient concern that they can work together to prevent.…”

“…A detailed review of the literature is published elsewhere. (13) Six domains of mobilization were identified: 1) A shared concern or community issue that may address power imbalances, improve access to resources and services, or promote social inclusion. (14-17) 2) Critical consciousness addresses the requirement that the shared concern be built from collective sensitization processes, or Paulo Freire’s ‘consentização,’ (18) which lies at the heart of the community empowerment literature (15, 19) and the concept of the learning culture (20) from community capacity.…”

Mitigating intimate partner violence to promote safe linkage to care for South African women who test HIV positive during mobile counseling and testing.

“…Theory provides a framework for how and why communities begin to mobilize 28 around an issue (Lippman et al, 2013). For example, community-based HCT appeared when traditional HIV testing services failed to appeal to certain highrisk populations, and community members subsequently championed efforts to increase testing uptake among those groups.…”

“…Africans have branded HIV as a private matter of individual pathology, but the ensuing need for community responsibility and response has been documented (Lippman et al, 2013). Following the 2010 South African government campaign to increase HIV testing in nonmedical and mobile forums (Bassett, Govindasamy, et al, 2014), mobile HCT has increased in popularity and facilitated a needed shift in HIV testing norms (Khumalo-Sakutukwa et al, 2008).…”