Many biomedical and behavioural HIV/AIDS programmes aimed at prevention, care and treatment have disappointing outcomes because of a lack of effective community mobilization. Reviews of programmes with successful outcomes increasingly point to the presence of some kind of community involvement as a key aspect of their work. Growing resources have been focused on community based organisations and it is clear that a more detailed understanding is now needed to deconstruct the elements of community provision that are helpful and to understand the nature and mechanism of optimum community mobilisation, reaction and facilitation to enhance the AIDS response.

Our understandings of precisely which forms of community mobilisation are most likely to facilitate programme success, and how best to implement them, are still in their infancy. It is against this background that we are exploring:

1. Links between community mobilization and HIV avoidance and between community mobilization and access to AIDS care and treatment
2. Long-term evidence for the pathways between community mobilization and health;
3. Community-level determinants of intervention outcomes
4. Implications for policy and practice to create ‘AIDS competent communities’

The evaluation is to be conducted through a collaborative study between the LSE and Imperial College London. The Imperial College component will provide quantitative data from Manicaland on the first three of these questions. The LSE component will draw from an extensive qualitative data set collected in the same study areas to provide context and guidance for the analysis and interpretation of the quantitative data on each of these questions. The rich and extensive qualitative data will provide new insights into the complex social processes mediating statistical associations.

The qualitative data comprise of 100s of hours of verbal, observational and visual material including 197 in-depth interviews, 35 focus group discussions with a total of 280 participants, 8 community conversations with 64 participants, and 135 drawings and essays by children. The data all focus in some way on how HIV/AIDS has impacted on the lives of ordinary Manicaland residents, how people have responded to the epidemic as individuals, families and local groups, and peoples’ understandings and experiences of prevention, care and treatment efforts. They contain a wealth of, as yet, undocumented material on indigenous community responses to HIV/AIDS; AIDS stigma; the role of formal and informal local group memberships in supporting or undermining indigenous responses, with particular reference to church responses – particularly important given that the church is the most well-established local network in many settings; community experiences of peer education and condom distribution programmes; community engagement with care and treatment services; and children’s experiences of AIDS.

We are currently exploring this data to provide a detailed description of how AIDS has impacted on peoples’ opportunities for positive social participation. This study will develop and illustrate that opportunities for positive social participation lie at the heart of efforts to build ‘AIDS competent communities’ where people are most likely to work collaboratively to develop effective responses to the challenges of prevention, care and treatment.

- Simon Gregson
- Catherine Campbell
- Kerry Scott
- Mercy Nhamo
- Morten Skovdal
- Constance Nyamakupa
- Lorraine Sherr

Funding agency
The World Bank