Between the brick and the ballot : exploring community conversations, HIV prevention, and structural violence in the Ingquza Hill municipality of South Africa's Eastern Cape Province

Abstract

The prevailing prevention literature has increasingly expanded the scope of HIV/AIDS drivers beyond the behavioural and social to encompass an increasing focus on the structural drivers of AIDS. Throughout the structural drivers literature is an emphasis on the need for upstream interventions that shape policy and influence political processes (Gibbs et al 2012; Hunsman 2012; Parkhurst 2013. Some of the literature recommends an emphasis on promoting political processes that catalyse political change and address underlying forms of inequality (Heise and Watts 2013; Gibbs et al 2012). This literature dovetails with literature that advocates for an increasing emphasis on the political determinants of health in health promotions programming (Ottersen et al 2014). At the same time new directions in the HIV/AIDS preventative community mobilization literatures has emphasized the need to rethink and re-conceptualise community mobilization in the 21st century (Campbell 2014). More broadly systematic reviews of the literature suggest the need for an increasing focus on community mobilization efforts that respond to and influence the political context of health (Cornish et al 2014). This dissertations aims to influence and inform the space between these literatures through an empirical look into the convergence of the Nelson Mandela Foundations (NMF) Community Conversations political animus and a historical and present day reading of the ways in which structural forms of violence (Galtung 1969) continue to be inscribed into the life trajectories of residents/citizens living in Ingquza Hill, South Africa. The findings in this dissertation are based on narrative analyses of N = 63 life histories and semi-structured interviews conducted with residents, CC facilitators and participants, and local influential stakeholders that directly experienced, lived, and embodied this convergence throughout the dialogical and actioned oriented phases of the Community Conversations process. Findings suggest that the basis for re-conceptualising of community mobilization for the 21st century be predicated on a more politicized framing of HIV/AIDS along with a more explicit and intentional valuation of the intersection between the social and political determinants of health in programmes that employ community mobilization. Intersecting social and political power dynamics play a significant role in both opening up and the cultivation of civic spaces that promote responsive and inclusionary forms of local governance and decision-making. This in part entails an increased emphasis on the creation of accompaniment oriented socio-political technologies that intentionally support the cultivation of health enabling democracy.