Strengthening community responses to AIDS: Possibilities and challenges

Abstract

Many AIDS programmes in sub-Saharan Africa have had disappointing results (Gregson et al., 2007), with HIV rates continuing to rise, stigma remaining stubbornly resistant to change, and access and adherence to treatment and support remaining inconsistent. Other interventions have worked well in carefully controlled research conditions, but these have been difficult to scale up in less highly monitored 'real-world' settings (Binswanger, 2000; Chopra and Ford, 2005; Greig et al., 2008). One key reason for the less-than-optimal outcome of many programmes is that they fail to resonate with the worldviews and perceived needs and interests of their target groupings, or to take adequate account of the complex social relations into which programmes are inserted (Gruber and Caffrey, 2005; Pfeiffer, 2003). Too many programmes are imposed on communities in 'top-down' ways by outside experts. In such settings, target communities are seen as passive recipients of prevention, care and treatment services rather than active participants working in partnership with health professionals to improve their health (Campbell, 2003). © 2009 Springer Science+Business Media, LLC.