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Building HIV/AIDS Capacity in a deep rural community
in KwaZulu Natal
Yugi Nair, Catherine Campbell, Sbongile Maimane
“Now that I am involved in home based
care and HIVAN has come into my life, things are beginning to have meaning
for me again. I am not like a person who is sitting at home doing nothing.
I am now able to give advice to people. I am also a role model to some
people. People who have been looking down upon home-based care are now
starting to think otherwise. They have seen us graduating. They see
many things happening in the community.” (Home based carer)
Summary
HIV/AIDS continues to ravage many parts of sub-Saharan Africa, bringing
untold suffering to millions and threatening many fragile development
gains (Barnett and Whiteside, 2002). To date, little hard scientific evidence
exists for sustained positive impacts of interventions (Gregson, Adamson,
Papaya et al., 2005). Despite much rhetoric about mobilising communities,
most South African HIV/AIDS management strategies are biomedical and behavioural
in nature, spearheaded by outside experts with little reference to the
realities of their target communities. With this in mind, our project
is community-initiated and community-owned. Our role is that of external
change agent, seeking to work with our project community to develop the
capacities, resources and partnerships that are most likely to enable
them to respond more effectively to HIV/AIDS in ways that are appropriate
to their own experience of the problem, rather than to some kind of externally
imposed understanding of it. In so doing, we also aim to use HIV/AIDS
as a springboard to social development around leadership and poverty.
In this paper we discuss some of the strategies
we are currently using to build social environments that are most likely
to support effective HIV/AIDS management in southern Africa. In developing
these ideas, we draw on our on-going collaboration with residents of Entabeni,
a remote rural community in South Africa where 43% of pregnant women are
HIV positive. The aim of this collaboration is to facilitate contextual
changes that will enable more effective community-led HIV/AIDS management
in an isolated area where people have little or no access to formal health
or welfare support, and where HIV/AIDS is heavily stigmatised.
We give an account of three phases of collaboration to date. These include
research; the dissemination of findings and community consultation about
the way forward; preliminary project activities (skills training for volunteer
health workers; partnership building and a youth rally) as a way of illustrating
what we believe are six key strategies for facilitating the development
of ‘HIV-competent’ communities: building knowledge and basic
skills; creating social spaces for dialogue and critical thinking; promoting
a sense of local ownership of the problem and incentives for action; emphasising
community strengths and resources; mobilising existing formal and informal
local networks; and building partnerships between marginalized communities
and more powerful outside actors and agencies, locally, nationally and
internationally. We discuss some of the triumphs and trials of this work,
concluding with discussion of the need to set realistic goals when working
at the community level in highly conservative patriarchal communities
to tackle problems which may be shaped by economic and political processes
over which local people have little control.
Yugi Nair - nairy3@ukzn.ac.za
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