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What are the key issues linking social capital, health and AIDS?

Mobilising social capital in a world with AIDS

AIDS2031, Salzburg, 30 March to 1 April 2009

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AIDS, power and social inequalities

• women

• young people

• poor people

• people in rural areas

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International health and development industry has trivialised concept of ‘community involvement’

Involvement of poor women in provision of unpaid service provision

Absence of wider empowerment or capacity building – to increase poor peoples’ access to political and economic power

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‘Power is never conceded without a demand’ (Frederick Douglass)

• Elite groups seldom hand over power without vociferous demands from the excluded

• Social capital projects need to facilitate:– the VOICE of the poor and the

marginalised– the development of RECEPTIVE

SOCIAL ENVIRONMENTS

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History of HIV/AIDS management in SSA

• Disappointing

• Fail to resonate with worldviews and perceived needs of target communities; to accommodate complex social contexts

• Top down – imposed by active outside ‘experts’ on passive communities

• Community involvement increasingly cited as vital precondition for success

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Reasons for focus on community involvement

Interesting evidence for possible links between group memberships and likelihood of HIV-transmission – suggests it may be useful for AIDS programmes to promote membership of particular groups

1. Campbell, C., Williams, B. and Gilgen, D. (2002) Is social capital a useful conceptual tool for exploring community level influences on HIV infection? An exploratory case study from South Africa. AIDS-Care. 14(1), 41-55 (February)

2. Gregson, S, Terceira, N, Mushati, P, Nyamukapa, C and Campbell, C (2004) Community group participation: can it help young women to avoid HIV? An exploratory study of social capital and school education in rural Zimbabawe. Social Science and Medicine, 58 (11): 2119-2132.

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HIV/AIDS interventions are useless, even harmful, unless they focus on strengthening or building local resources

e.g. Pfeiffer (2004) Mocambique study

e.g. Gruber and Caffrey (2004) Nigerian study

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‘Facilitation of local responses’ vs ‘intervention’

Promotion of community participation – via bonding and bridging social capital – is a key strategy for the development of ‘AIDS competent communities’

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What is an ‘AIDS-competent community’?

People work collaboratively to support each other in achieving :

• behaviour change• stigma reduction• support for PLWAs & their carers• support for volunteers and

health workers responding to HIV/AIDS

• accessing of health services and welfare grants, where these exist.

Campbell et al., (2007)

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Five features of an AIDS competent community.

i) AIDS-related knowledge and skills.

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ii) Social spaces for

dialogue and critical thinking

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Critical thinking: people most likely to change their behaviour as individuals ….

- through engaging in collective dialogue about obstacles to behaviour change and how best to tackle these

- through working collaboratively with others to create health-supporting social environments

Paulo Freire

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Public sphere

-participants in debate meet as peers

-engage in dialogue in conditions of equality

-where ideas evaluated in terms of inherent good sense vs status of speaker, extent to which they support the status quo

Habermas

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Social identity: people are most likely to

change attitudes and behaviours when they see liked and trusted peers changing theirs

•

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Third feature of an AIDS Competent Community

iii) Sense of agency, ownership, responsibility

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iv) Sense of solidarity and common purpose

Where members of a geographical community can form ‘strategic alliances’ across competing interests (e.g. adults/youth, men/women)

Form context in which people can brainstorm strategies for how to tackle the problem – individually, and through existing social networks.

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v) Bridging social capital

Community’s ability to forge links with outside organisations capable of supporting their fight against HIV/AIDS

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Conclusion: role of social capital in HIV/AIDS management

In facilitating:

i) welfare responses (condoms, home nursing)

ii) voice of AIDS-affected people

iii) receptive social environments

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• International health and

development community complicit in depoliticising AIDS

• Defining it as a technical challenge

• Neglecting the economic and political roots of peoples’ inabilities to take control over their health

• Danger of parallel depoliticisation of ‘social capital’

• Need for the development of a critical conceptualisation of ‘social capital’ – as a powerful tool for analysis and action

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