Evaluation of the community response to HIV and AIDS: Learning from a portfolio approach

Abstract

While communities have played a large role in the HIV/AIDS response, their contributions and innovative approaches to HIV prevention, treatment, care and support have not always been the focus of systematic and rigorous evaluations. To address this gap, the World Bank led an evaluation of the impact of the community response to HIV, including country studies in Burkina Faso, India, Kenya, Lesotho, Nigeria, Senegal, South Africa and Zimbabwe over a three-year period. Due to the complexity and varied nature of community responses, the evaluation attempted to determine the results that investments have produced at the community level by applying a mixed method approach: Randomized Controlled Trials, quasi-experimental studies, qualitative studies and analytical studies including financial data. Specifically, the studies examined a typology of community response and the flow of funds to community-based organizations, while investigating the impact of the community responses on (1) knowledge and behavior, (2) use of services, (3) social transformation, and (4) HIV incidence. This editorial summarizes the results of this evaluation portfolio, finding that investments in communities have produced significant results, including, improved knowledge and behavior, and increased use of health services, and even decreased HIV incidence. Evidence on social transformation was more mixed, with community groups found to be effective only in some settings. Each study in the evaluation provides a partial view of how communities shape the local response; however, taken together they corroborate the common wisdom that communities can be a vital part of the global HIV/AIDS response.

Fighting against HIV and AIDS within a resource constrained rural setting: a case study of the Ruvheneko Programme in Chirumhanzu, Zimbabwe

“…An interesting finding regarding all the initiatives towards the establishment of Ruvheneko is that the severity of HIV and AIDS in Chirumhanzu created some kind of fear of the unknown to the extent that members felt obliged to be part of the programme. This resonates with Rodriguez-Garcia’s (2013) model of social change that looks at how social challenges foster social cohesion and collectively problem solving approaches. This also reveals grassroots response to the impact of HIV and AIDS since the community improvised some self-help mechanisms in order to respond to such social challenges like AIDS (Rodriguez-Garcia, 2013).…”

“…This resonates with Rodriguez-Garcia’s (2013) model of social change that looks at how social challenges foster social cohesion and collectively problem solving approaches. This also reveals grassroots response to the impact of HIV and AIDS since the community improvised some self-help mechanisms in order to respond to such social challenges like AIDS (Rodriguez-Garcia, 2013). As noted by Schwobel (2006), it is precisely when human dignity is compromised that it becomes imperative for the church to engage in critical and affirmative public theology.…”

Time for full inclusion of community actions in the response to AIDS

“…A growing body of literature demonstrates that communitybased services have measurable impact, serve populations that are not accessing public health services [7] and can reach people at scale [8,9]. A 2012 World Bank study identified community-based efforts as a ''cornerstone'' of the response to AIDS [10].…”

COVID-19 - Enacting a ‘new normal’ for people who use drugs

“…From the annals of lived experience, we have always known the solutions that are needed for people who use drugs. The essential role of communities in the HIV movement reshaped the global health agenda in critical ways, including drawing the world's attention to the social-structural determinants of health, biopower and biopolitics and embedding the principle of meaningful community involvement within the rigid and depersonalised corridors of public health (Foucault, 1976;Rodriguez-García et al, 2013). Today, these past lessons are being brought into sharper focus.…”