Campbell Catherine, Scott Kerry, Nhamo Mercy, Nyamukapa Constance, Madanhire Claudius, Skovdal Morten, Sherr Lorraine, Gregson Simon
London School of Economics and Political Science, Institute of Social Psychology, Houghton Street, London, UK.
AIDS Care. 2013;25 Suppl 1(Suppl 1):S114-22. doi: 10.1080/09540121.2012.748170.
Community involvement is increasingly identified as a "critical enabler" of an effective HIV/AIDS response. We explore pathways between community participation and HIV prevention, treatment and impact mitigation in Zimbabwe, reviewing six qualitative studies in Manicaland. These find that community group membership is often (not always) associated with decreased HIV incidence, reduced stigma and improved access to some services, particularly amongst women. Participation in formal community groups (e.g., church or women's groups) and informal local networks (e.g., neighbours, families) provides opportunities for critical dialogue about HIV/AIDS, often facilitating renegotiation of harmful social norms, sharing of previously hidden personal experiences of HIV/AIDS, formulation of positive action plans and solidarity to action them. However, implementation of new plans and insights is constrained by poverty, social uncertainty and poor service delivery. Furthermore, dialogue may have negative effects, spreading false information and entrenching negative norms. The extent that formal groups and informal networks facilitate externally imposed HIV/AIDS interventions varies. They potentially provide vital practical and emotional support, facilitating service access, treatment adherence and AIDS care. However, they may sometimes play a negative role in prevention activities, challenging stereotypes about sexuality or gender. There is an urgent need for greater recognition of the role of indigenous community groups and networks, and the inclusion of "strengthening local responses" as a key element of interventions and policy. Such efforts require great sensitivity. Heavy-handed external interference in complex indigenous relationships risks undermining the localism and bottom-up initiative and activism that might be central to their effectiveness. Cautious efforts might seek to enhance the potentially beneficial effects of groups, especially for women, and limit potentially damaging ones, especially for men. Efforts should be made to facilitate contexts that enable groups to have beneficial effects, through nesting them within wider comprehensive responses, and supporting them through strong partnerships with service providers.
社区参与日益被视为有效应对艾滋病毒/艾滋病的“关键推动因素”。我们探讨了津巴布韦社区参与与艾滋病毒预防、治疗及减轻影响之间的途径，回顾了马尼卡兰省的六项定性研究。这些研究发现，社区团体成员身份通常（并非总是）与艾滋病毒感染率下降、耻辱感减轻以及获得某些服务的机会增加相关，尤其是在女性中。参与正式社区团体（如教会或妇女团体）和非正式地方网络（如邻居、家庭）为就艾滋病毒/艾滋病展开关键对话提供了机会，这往往有助于重新协商有害的社会规范，分享以前隐藏的艾滋病毒/艾滋病个人经历，制定积极行动计划并团结起来付诸行动。然而，新计划和见解的实施受到贫困、社会不确定性和服务提供不佳的制约。此外，对话可能产生负面影响，传播虚假信息并强化负面规范。正式团体和非正式网络促进外部强加的艾滋病毒/艾滋病干预措施的程度各不相同。它们有可能提供至关重要的实际和情感支持，促进服务获取、治疗依从性和艾滋病护理。然而，它们有时可能在预防活动中发挥负面作用，挑战有关性取向或性别的刻板印象。迫切需要更多地认识到本土社区团体和网络的作用，并将“加强地方应对措施”纳入干预措施和政策的关键要素。此类努力需要高度敏感性。对复杂的本土关系进行高压式外部干预，有可能破坏地方主义以及自下而上的主动性和行动主义，而这些对于其有效性可能至关重要。谨慎的努力可能会寻求增强团体的潜在有益影响，特别是对女性而言，并限制潜在的有害影响，特别是对男性而言。应努力营造有利环境，使团体能够产生有益影响，方法是将它们纳入更广泛的综合应对措施之中，并通过与服务提供者建立强有力的伙伴关系来支持它们。
