Abstract
The article describes a design journey that culminated in an HIV-Conversant Community Framework that is now being piloted in the Limpopo Province of South Africa. The objective of the initiative is to reduce the aggregate community viral load by building capacity at multiple scales that strengthens peoples' HIV-related navigational skill sets—while simultaneously opening a ‘chronic situation’ schema. The framework design is based upon a transdisciplinary methodological combination that synthesises ideas and constructs from complexity science and the management sciences as a vehicle through which to re-conceptualise HIV prevention. This resulted in a prototype that included the following constructs: managing HIV-prevention in a complex, adaptive epidemiological landscape; problematising and increasing the scope of the HIV knowledge armamentarium through education that focuses on the viral load and Langerhans cells; disruptive innovation and safe-fail probes followed by the facilitation of path creations and pattern management implementation techniques. These constructs are underpinned by a ‘middle-ground’ prevention approach which is designed to bridge the prevention ‘fault line’, enabling a multi-ontology conceptualisation of the challenge to be developed. The article concludes that stepping outside of the ‘ordered’ epistemological parameters of the existing prevention ‘messaging’ mind-set towards a more systemic approach that emphasises agency, structure and social practices as a contribution to ‘ending AIDS by 2030’ is worthy of further attention if communities are to engage more adaptively with the dynamic HIV landscape in South Africa.
Highlights
This article describes a conceptual, prototype framework that has been developed in the Limpopo Province of South Africa which was named ‘promoting HIV-Conversant Communities’
Construct one: managing HIV-prevention in a complex, adaptive epidemiological landscape. We introduce this notion based upon a concern that there is an ‘epistemic fault line’ in the realm of HIV— at the metatheoretical level (Adam 2011)—and at the level of implementation
In turn this has the potential to contribute to altering existing social practices and becomes a useful educational heuristic to critically examine the collective influence of communities in shaping the current and future trajectory of the epidemic; (3) In order to open the chronic schema space, the issues cited above are applied as discussion points so that ‘anticipatory chronic literacy’ is conceptually linked to both structural and proximal forms of risk
Summary
This article describes a conceptual, prototype framework that has been developed in the Limpopo Province of South Africa which was named ‘promoting HIV-Conversant Communities’. The prototype framework, comprising three principle components—education, experiential application of the learning and implementation—was designed with the ambition of opening innovative ‘middle-ground’ intervention spaces that better equip rural communities to construct novel and contextually relevant skill sets to assist them to navigate the complex, adaptive epidemiological HIV landscape. Navigation of this landscape is both a prevention and treatment challenge and—increasingly—a chronic disease management challenge (Chu & Selwyn 2011). Re-framing the HIV challenge into a complex adaptive epidemiological landscape
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