Abstract
Community involvement is increasingly identified as a “critical enabler” of an effective HIV/AIDS response. We explore pathways between community participation and HIV prevention, treatment and impact mitigation in Zimbabwe, reviewing six qualitative studies in Manicaland. These find that community group membership is often (not always) associated with decreased HIV incidence, reduced stigma and improved access to some services, particularly amongst women. Participation in formal community groups (e.g., church or women's groups) and informal local networks (e.g., neighbours, families) provides opportunities for critical dialogue about HIV/AIDS, often facilitating renegotiation of harmful social norms, sharing of previously hidden personal experiences of HIV/AIDS, formulation of positive action plans and solidarity to action them. However, implementation of new plans and insights is constrained by poverty, social uncertainty and poor service delivery. Furthermore, dialogue may have negative effects, spreading false information and entrenching negative norms. The extent that formal groups and informal networks facilitate externally imposed HIV/AIDS interventions varies. They potentially provide vital practical and emotional support, facilitating service access, treatment adherence and AIDS care. However, they may sometimes play a negative role in prevention activities, challenging stereotypes about sexuality or gender. There is an urgent need for greater recognition of the role of indigenous community groups and networks, and the inclusion of “strengthening local responses” as a key element of interventions and policy. Such efforts require great sensitivity. Heavy-handed external interference in complex indigenous relationships risks undermining the localism and bottom–up initiative and activism that might be central to their effectiveness. Cautious efforts might seek to enhance the potentially beneficial effects of groups, especially for women, and limit potentially damaging ones, especially for men. Efforts should be made to facilitate contexts that enable groups to have beneficial effects, through nesting them within wider comprehensive responses, and supporting them through strong partnerships with service providers.
Highlights
Community involvement is increasingly identified as a ‘‘critical enabler’’ of effective AIDS responses (Rodriguez-Garcıa et al, 2011; Schwartlander et al, 2011)
What role do community responses play in managing HIV/AIDS in Sub-Saharan Africa? Formal interventions carry a small proportion of the burden, the bulk carried by the communities in which the HIV-affected live their daily lives
We have reported on longitudinal surveys involving 10,000 residents of Manicaland, highlighting the role of membership of indigenous community group memberships (Table 1) in this decline
Summary
Community involvement is increasingly identified as a ‘‘critical enabler’’ of effective AIDS responses (Rodriguez-Garcıa et al, 2011; Schwartlander et al, 2011). What role do community responses play in managing HIV/AIDS in Sub-Saharan Africa? Formal interventions (by governments, NGOs or donors) carry a small proportion of the burden, the bulk carried by the communities in which the HIV-affected live their daily lives. Discussions of the ‘‘AIDS response’’ have been dominated by formal responses, with less attention to the role of indigenous social relations in promoting health-enhancing behaviour change, and supporting externally driven prevention, treatment and impact mitigation efforts. Zimbabwe experienced a significant decline in HIV prevalence from the late 1990s, accelerated by a decline in risk behaviours, partner We do so to explore the form taken by this ‘‘behind the scenes’’ support in one particular setting, focussing on local efforts which are often regarded as secondary to the ‘‘main action’’ by health and development professionals.
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