Community Responses to HIV/AIDS in South Africa: Findings from a Multi-Community Survey

"What contributions are community initiatives actually making to the larger struggle against HIV/AIDS? What motivates individuals or groups to begin engaging with HIV/AIDS-related issues in a public or collective way? Are there certain conditions under which community responses emerge and/or flourish? Are there are ways that government or donor policies could better support and encourage such activity? Should they? Few, if any, systematic studies have been undertaken on community responses to HIV/AIDS."

In an attempt to shed light on these and other questions about the extent, shape and impact of community responses to HIV/AIDS, the South Africa-based Centre for AIDS Development, Research and Evaluation (CADRE) notes in this 80-page resource that, although widespread, community-level responses to AIDS "have often been overlooked and marginalised in favour of emphasis on large-scale centralised approaches to HIV/AIDS prevention, care and treatment." While acknowledging that "community initiatives cannot and should not be seen as an alternative to the state in issues of development and service delivery", they urge that there are compelling reasons to take a closer look at these types of responses, "not least because these activities are, and will almost certainly continue to be, a fundamental part of the way HIV/AIDS is lived and experienced at the local level."

This report presents findings from an audit of local-level responses to HIV/AIDS in 3 South African communities: Vosloorus (a large urban township), Obanjeni (a rural area), and Grahamstown (a medium-sized town). This research was carried out by CADRE, with support from the Department for International Development (UK) and the Health Communication Partnership based at the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, under the auspices of the Communicating AIDS Needs (CAN) project. The audit, which involved 179 South African organisations and groups, sought to gain information about the nature of local-level responses, the major actors involved, the types of services being provided (and by whom), and the challenges that local groups involved in AIDS response face. It was also motivated by an interest in the applicability of notions of social capital - "the capacity for heterogeneous groups within communities to act collectively to address shared challenges" - to the HIV/AIDS epidemic.

The focus of this report is on the activities of government institutions, civil society organisations (CSOs), and faith-based organisations (FBOs) identified in the survey (n=88). Key findings are presented, in the categories of:

• Community Actors
• Prevention
• Care and Support
• Treatment
• Communication and Education - e.g., "More than 80% of organisations use educational materials and communication activities as part of their work. However only 63% of organisations using [information, education, and communication, or] IEC report being able to obtain the materials they need easily, and only 47% can obtain them in appropriate languages."
• Rights and Legal Assistance
• Training, Human Resources & Capacity Building
• Financial Management and Funding
• Monitoring, Evaluation and Research
• Coordination and Networking - e.g., "A majority of government institutions (83%) and CSOs (88%) report linkages with other organisations involved with AIDS response, although these linkages tend to be informal associations rather than official partnerships. The survey found a slightly lower level of networking among FBOs (50%)."

A discussion section culls out the implications of these findings. To cite a central one: "Community organisations have emerged as active players in AIDS response, but their activities are not necessarily well integrated with those of other local actors and the organisations themselves face a range of institutional and developmental challenges." Based on that observation, the authors stress that, if the role of community-based responses is to be encouraged and strengthened:

• "Linked-up" networks of organisations with expertise in particular sectors of the HIV/AIDS response should be cultivated - "in other words, a shift from 'unfocused mobilisation' to more specialised, co-ordinated activity at community level."
• Training in practical and easily implemented monitoring and evaluation (M&E) techniques, rather than donor-driven M&E requirements, should be increasingly offered to community-based organisations.
• Partnership building at the local level should be emphasised in order to "enhance coordination between various actors, to strengthen referral networks and information sharing, and to emphasise the integration of various AIDS-related services. Strengthening ties between a diversity of groups and organisations locally may be one of best ways to facilitate collective action in relation to this enormous shared challenge."
• The gap between the availability of funding at the macro level and the more modest resource needs of community groups at grassroots should be bridged, a strategy that requires attention from donors and government structures - "both in terms of their own policies and procedures and in providing training for community groups in areas such as project design, proposal writing, record keeping and financial management."