Abstract
Introduction: this article reflects on data that emanated from a programme evaluation and focuses on a concept we label ‘distributed-efficacy’. We argue that the process of developing and sustaining ‘distributed-efficacy’ is complex and indeterminate, thus difficult to manage or predict. We situate the discussion within the context of UNAIDS’ recent strategy — Vision 95:95:95 — to ‘end AIDS’ by 2030 which the South African National Department of Health is currently rolling out across the country.Method: A qualitative method was applied. It included a Value Network Analysis, the Most Significant Change technique and a thematic content analysis of factors associated with a ‘competent community’ model. During the analysis it was noticed that there were unexpected references to a shift in social relations. This prompted a re-analysis of the narrative findings using a second thematic content analysis that focused on factors associated with complexity science, the environmental sciences and shifts is social relations.Findings: the efficacy associated with new social practices relating to HIV risk-reduction was distributed amongst networks that included mother—son networks and participant—facilitator networks and included a shift in social relations within these networks.Discussion: it is suggested that for new social practices to emerge requires the establishment of ‘distributed-efficacy’ which facilitates localised social sanctioning, sometimes including shifts in social relations, and this process is a ‘complex’, dialectical interplay between ‘agency’ and ‘structure’.Conclusion: the ambition of ‘ending AIDS’ by 2030 represents a compressed timeframe that will require the uptake of multiple new bio-social practises. This will involve many nonlinear, complex challenges and the process of developing ‘distributed-efficacy’ could play a role in this process. Further research into the factors we identified as being associated with ‘distributed-efficacy’ — relationships, modes of agency and shifts in social relations — could add value to achieving Vision 95:95:95.
Highlights
This article reports on the findings of, and reflections from, a programme evaluation undertaken in 2013
The Value Mapping technique indicates that the network members included The Development Facilitation and Training Institute (DevFTI) of the University of Limpopo; The Waterberg Welfare Society (WWS); the Boys 2 Men programme (WWS–Boys 2 men (B2M)); schools, sports teams, community groups and a community outreach programme attached to WWS called Stepping Forward
We have reported on a programme evaluation and taken the opportunity to reflect on the unexpected second order findings and argued that both first and second order dynamics may coalesce into nonlinear forms of ‘distributed-efficacy’
Summary
This article reports on the findings of, and reflections from, a programme evaluation undertaken in 2013. We report briefly on those findings and reflect in more detail on a theme we have labelled ‘distributed-efficacy’ because it could contribute to an increased understanding about one of the discrete dynamics of behaviour change in the context of HIV. This reflection was prompted by the release of UNAIDS’ Fast Track and Gap Report, 2014, which outlines the current ambition of ‘ending AIDS by 2030’. Within this argument UNAIDS emphasise that “[we] have a fragile five-year window to build on the rapid [biomedical] results that have been made. Many reflections about the consolidation of new social practices in the context of HIV demonstrate that this is a major challenge that remains contested and is worthy of further critical reflection (Ellman, 2015)
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