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 ‘AIDS-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.
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Notes
A community is usually defined either as a group of people who share a common social identity, or as a group who live in a common geographical space. In practice—for reasons relating to place-based resource allocation and convenience—health interventions usually target their efforts at geographically defined communities. This is particularly the case in geographically remote areas such as the one discussed in this paper. As a result, we use this place-based notion of community in our work.
HIVAN is a university-based NGO, devoted to developing research and practice in the field of HIV/AIDS networking. http://www.hivan.org.za/gettoknowus/team.asp#dI
Entabeni is a pseudonym for our community of interest.
We use the term ‘social capital’ with some caution, given the critique that Putnam’s (2000) popular definition of this term directs attention too narrowly to the community level of analysis, ignoring the impact of wider political and economic determinants of social problems. In our work we use Bourdieu’s conceptualisation of this term, because of Bourdieu’s (1986) sensitivity to the way in which access to social capital is shaped by such economic and political factors (amongst which gender, poverty and stigma/symbolic exclusion would feature strongly in our community of interest).
A pseudonym to protect the anonymity of the community.
‘Xulu’ (a pseudonym) is the name of the area’s traditional chief. Local project participants emphasised the importance of acknowledging his stamp of approval if the project was to have any hope of success amongst grassroots people.
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Acknowledgements
Ethical clearance for this study was received from the University Ethics Committee, University of KwaZulu-Natal, South Africa, on 20 August 2002. Thanks to Caroline Howarth, Divya Naidoo, Yvonne Sliep, Cathy Vaughan and Anu Yacoob for comments and advice on this manuscript.
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Campbell, C., Nair, Y. & Maimane, S. Building contexts that support effective community responses to HIV/AIDS: a South African case study. Am J Community Psychol 39, 347–363 (2007). https://doi.org/10.1007/s10464-007-9116-1
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DOI: https://doi.org/10.1007/s10464-007-9116-1