Towards a "fourth generation" of approaches to HIV/AIDS management: creating contexts for effective community mobilisation
Towards a "fourth generation" of approaches to HIV/AIDS management: creating contexts for effective community mobilisation
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DOI：
10.1080/09540121.2010.525812
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发表时间：
2010-01-01
影响因子：
1.7
通讯作者：
Cornish, Flora
中科院分区：
文献类型：
--
作者：
Campbell, Catherine;Cornish, Flora
由于缺乏有效的社区动员，许多旨在预防、护理和治疗的艾滋病毒/艾滋病生物医学和行为方案的结果令人失望。但众所周知，社区动员是很难实现的。我们提出了一个概念框架，映射出这些方面的社会背景，可能会支持或破坏社区动员的努力，建议应注意三个方面的社会背景：物质，象征性和关系。本文共分四个部分。我们开始概述了为什么社区动员被视为有效的艾滋病毒/艾滋病管理的核心方面：它增加了“达到”和可持续性的方案，这是一个更广泛的“任务转移”的议程鉴于在许多艾滋病毒/艾滋病脆弱的环境卫生专业人员的稀缺性的重要组成部分。最重要的是，它促进了我们认为是有效预防、护理和治疗的重要先决条件的社会心理过程。其次，我们绘制了三代艾滋病毒/艾滋病领域内的行为改变的方法：艾滋病毒的认识，同伴教育和社区动员。我们批判性地评估每种方法对行为变化驱动因素的基本假设，以构建我们对动员和健康之间途径的理解，借鉴社会资本，对话和赋权的概念。第三，我们指的是两个有据可查的案例研究，在印度和南非的社区动员，以说明我们的主张，社区动员是不可能成功的支持性材料，象征性和关系的情况下。第四，我们提供了一个简短的概述，如何在这个特殊的问题，帮助我们充实我们的概念化的“健康有利的社会环境”。最后，我们认为迫切需要在艾滋病毒/艾滋病管理的理论和实践中采用“第四代”方法，这种方法更加关注对方案成功的更广泛的背景影响。
Many biomedical and behavioural HIV/AIDS programmes aimed at prevention, care and treatment have disappointing outcomes because of a lack of effective community mobilisation. But community mobilisation is notoriously difficult to bring about. We present a conceptual framework that maps out those dimensions of social context that are likely to support or undermine community mobilisation efforts, proposing that attention should be given to three dimensions of social context: the material, symbolic and relational. This paper has four parts. We begin by outlining why community mobilisation is regarded as a core dimension of effective HIV/AIDS management: it increases the "reach'' and sustainability of programmes; it is a vital component of the wider "task shifting'' agenda given the scarcity of health professionals in many HIV/AIDS-vulnerable contexts. Most importantly it facilitates those social psychological processes that we argue are vital preconditions for effective prevention, care and treatment. Secondly we map out three generations of approaches to behaviour change within the HIV/AIDS field: HIV-awareness, peer education and community mobilisation. We critically evaluate each approach's underlying assumptions about the drivers of behaviour change, to frame our understandings of the pathways between mobilisation and health, drawing on the concepts of social capital, dialogue and empowerment. Thirdly we refer to two well-documented case studies of community mobilisation in India and South Africa to illustrate our claim that community mobilisation is unlikely to succeed in the absence of supportive material, symbolic and relational contexts. Fourthly we provide a brief overview of how the papers in this special issue help us flesh out our conceptualisation of the "health enabling social environment''. We conclude by arguing for the urgent need for a "fourth generation'' of approaches in the theory and practice of HIV/AIDS management, one which pays far greater attention to the wider contextual influences on programme success.