Aveling E L
Department of Health Sciences, University of Leicester, Leicester, UK.
AIDS Care. 2010;22 Suppl 2:1588-97. doi: 10.1080/09540121.2010.507954.
In the context of increasing global emphasis on partnerships between international, governmental and civil society organisations in the distribution of international aid, this paper examines the ways in which the resulting aid chains promote and undermine community-led responses to HIV/AIDS. The impact of the aid-granting system is examined using an ethnographic case study of an HIV/AIDS prevention programme with Cambodian military families. The case study draws on observations of stakeholder meetings and programme activities, interviews with stakeholders (the donor, NGOs and military community) and textual materials (programme guidelines, policies and reports). Campbell et al.'s interrelated concepts of relational, symbolic and material context are used to frame the analysis. The establishment of a relationship with a more powerful international NGO is shown to be beneficial to the military community and civil society groups. The international NGO uses its significant material and economic leverage to improve the community's relational context (by ensuring the support of the military high command), symbolic context (by strengthening the position of community and civil society partners in relation to government bodies) and material context (through increasing access to health services). However, material and symbolic asymmetries between partners in the aid chain persist, curtailing the community's involvement and leadership. At the material and relational levels, the hierarchical flow of aid encourages accountability to the demands of the donor while excluding grassroots groups from directly accessing funding. At the symbolic level, problem-focused representations of the military further reinforce the community's position as recipients of intervention, which undermines recognition for the community's knowledge, strengths and right to fully participate. Thus while aid chains can be supportive of community-led responses, this analysis highlights how the structures and dynamics of international aid continue to position marginalised communities as recipients, not leaders, of HIV/AIDS programmes, raising particular dilemmas for intermediary international NGOs.
在全球日益强调国际、政府和民间社会组织在国际援助分配中建立伙伴关系的背景下，本文探讨了由此产生的援助链促进和破坏社区主导的艾滋病毒/艾滋病应对措施的方式。通过对柬埔寨军人家庭艾滋病毒/艾滋病预防项目的人种志案例研究，考察了援助授予系统的影响。该案例研究借鉴了对利益相关者会议和项目活动的观察、对利益相关者（捐助方、非政府组织和军事社区）的访谈以及文本材料（项目指南、政策和报告）。运用坎贝尔等人提出的关系、象征和物质背景相互关联的概念来构建分析框架。研究表明，与一个更有影响力的国际非政府组织建立关系对军事社区和民间社会团体有益。该国际非政府组织利用其巨大的物质和经济影响力来改善社区的关系背景（通过确保军事高层的支持）、象征背景（通过加强社区和民间社会伙伴相对于政府机构的地位）和物质背景（通过增加获得卫生服务的机会）。然而，援助链中伙伴之间的物质和象征不对称仍然存在，限制了社区的参与和领导作用。在物质和关系层面，援助的层级流动鼓励对捐助方要求的问责，同时将基层团体排除在直接获取资金之外。在象征层面，以问题为导向的对军队的表述进一步强化了社区作为干预接受者的地位，这削弱了对社区知识、优势和充分参与权利的认可。因此，虽然援助链可以支持社区主导的应对措施，但该分析凸显了国际援助的结构和动态如何继续将边缘化社区定位为艾滋病毒/艾滋病项目的接受者而非领导者，给国际中介非政府组织带来了特殊困境。
