Nhamo Mercy, Campbell Catherine, Gregson Simon
Institute of Social Psychology, London School of Economics and Political Science, London, UK.
AIDS Care. 2010;22 Suppl 2(2):1662-9. doi: 10.1080/09540121.2010.521544.
We explore the wider social context of an HIV-prevention programme in rural Zimbabwe. We make no comment on the programme itself, rather seeking to examine the wider community dynamics into which it was inserted, to highlight how pre-existing social dynamics may have influenced community "readiness" to derive optimal benefit from the intervention. Using the concept of "the AIDS competent community", we analysed 44 interviews and 11 focus groups with local people. Despite high levels of HIV/AIDS-related knowledge, there were several ways gender, poverty and low literacy may have undermined its perceived relevance to peoples' lives. Lack of opportunities for dialogue in the social milieu beyond the intervention may have limited opportunities for translating factual AIDS knowledge into action plans, or sharing hidden individual experiences of HIV/AIDS-affected family members or friends, given stigma and denial. The initiative of women and young people to respond effectively to AIDS was limited in a context dominated by adult males. People spoke of HIV/AIDS in a passive and fatalistic way, expecting outsiders to solve the problem. This tendency was exacerbated given the community's previous experiences of HIV/AIDS-related NGOs, which had often regarded local people as unpaid volunteer labour rather than building their capacity to make significant decisions and play leadership roles in health programmes. Despite obstacles, however, there were many potential community strengths and resources. There were high levels of HIV/AIDS-related knowledge. Public denial of HIV/AIDS masked huge reservoirs of private support and kindness to AIDS-affected family and friends. There were many strong community organisations and clubs, potentially forming the springboard for more empowered community responses to HIV/AIDS. HIV/AIDS programmers should pay greater attention to community readiness for interventions, especially around: (1) identifying and anticipating pre-existing obstacles to programme success and (2) mobilising the social assets that exist, even in contexts of poverty and gender inequality.
我们探究了津巴布韦农村地区一项艾滋病预防项目所处的更广泛社会背景。我们不对该项目本身进行评价，而是试图审视其所处的更广泛社区动态，以突出既有的社会动态可能如何影响社区从该干预措施中获取最大益处的“准备程度”。运用“艾滋病防治能力社区”这一概念，我们分析了对当地居民进行的44次访谈和11个焦点小组的情况。尽管人们对艾滋病相关知识的知晓程度较高，但性别、贫困和低识字率等因素可能在若干方面削弱了该项目在人们眼中与自身生活的相关性。在干预措施之外的社会环境中，缺乏对话机会可能限制了将实际的艾滋病知识转化为行动计划的机会，也限制了分享受艾滋病影响的家庭成员或朋友不为人知的个人经历的机会，因为存在耻辱感和否认态度。在成年男性主导的环境中，妇女和年轻人有效应对艾滋病的主动性受到限制。人们以消极和宿命论的方式谈论艾滋病，期望外部人员解决问题。鉴于该社区此前与艾滋病相关的非政府组织的经历，这种倾向更加严重，那些组织常常将当地居民视为无偿志愿劳动力，而不是培养他们在卫生项目中做出重大决策和发挥领导作用的能力。然而，尽管存在障碍，但仍有许多潜在的社区优势和资源。人们对艾滋病相关知识的知晓程度较高。公众对艾滋病的否认掩盖了对受艾滋病影响的家人和朋友的大量私下支持与善意。有许多强大的社区组织和俱乐部，有可能成为社区更有力应对艾滋病的跳板。艾滋病防治项目人员应更加关注社区对干预措施的准备情况，尤其是在以下方面：（1）识别和预见影响项目成功的既有障碍；（2）调动即使在贫困和性别不平等背景下也存在的社会资产。
