1 What are the key issues linking social capital, health and AIDS? Mobilising social capital in a world with AIDS AIDS2031, Salzburg, 30 March to 1 April 2009

2 AIDS, power and social inequalities women young people poor people people in rural areas

3 International health and development industry has trivialised concept of ‘community involvement’ Involvement of poor women in provision of unpaid service provision Absence of wider empowerment or capacity building – to increase poor peoples’ access to political and economic power

4 ‘Power is never conceded without a demand’ (Frederick Douglass) Elite groups seldom hand over power without vociferous demands from the excluded Social capital projects need to facilitate: –the VOICE of the poor and the marginalised –the development of RECEPTIVE SOCIAL ENVIRONMENTS

5 History of HIV/AIDS management in SSA Disappointing Fail to resonate with worldviews and perceived needs of target communities; to accommodate complex social contexts Top down – imposed by active outside ‘experts’ on passive communities Community involvement increasingly cited as vital precondition for success

6 Reasons for focus on community involvement Interesting evidence for possible links between group memberships and likelihood of HIV-transmission – suggests it may be useful for AIDS programmes to promote membership of particular groups 1.Campbell, C., Williams, B. and Gilgen, D. (2002) Is social capital a useful conceptual tool for exploring community level influences on HIV infection? An exploratory case study from South Africa. AIDS-Care. 14(1), (February) 2.Gregson, S, Terceira, N, Mushati, P, Nyamukapa, C and Campbell, C (2004) Community group participation: can it help young women to avoid HIV? An exploratory study of social capital and school education in rural Zimbabawe. Social Science and Medicine, 58 (11):

7 HIV/AIDS interventions are useless, even harmful, unless they focus on strengthening or building local resources e.g. Pfeiffer (2004) Mocambique study e.g. Gruber and Caffrey (2004) Nigerian study

8 ‘Facilitation of local responses’ vs ‘intervention’ Promotion of community participation – via bonding and bridging social capital – is a key strategy for the development of ‘AIDS competent communities’

9 What is an ‘AIDS-competent community’? People work collaboratively to support each other in achieving : behaviour change stigma reduction support for PLWAs & their carers support for volunteers and health workers responding to HIV/AIDS accessing of health services and welfare grants, where these exist. Campbell et al., (2007)

10 Five features of an AIDS competent community. i) AIDS-related knowledge and skills.

11 ii) Social spaces for dialogue and critical thinking

12 Critical thinking: people most likely to change their behaviour as individuals …. -through engaging in collective dialogue about obstacles to behaviour change and how best to tackle these -through working collaboratively with others to create health- supporting social environments Paulo Freire

13 Public sphere -participants in debate meet as peers -engage in dialogue in conditions of equality -where ideas evaluated in terms of inherent good sense vs status of speaker, extent to which they support the status quo Habermas

14 Social identity: people are most likely to change attitudes and behaviours when they see liked and trusted peers changing theirs

15 Third feature of an AIDS Competent Community iii) Sense of agency, ownership, responsibility

16 iv) Sense of solidarity and common purpose Where members of a geographical community can form ‘strategic alliances’ across competing interests (e.g. adults/youth, men/women) Form context in which people can brainstorm strategies for how to tackle the problem – individually, and through existing social networks.

17 v) Bridging social capital Community’s ability to forge links with outside organisations capable of supporting their fight against HIV/AIDS

18 Conclusion: role of social capital in HIV/AIDS management In facilitating: i)welfare responses (condoms, home nursing) ii)voice of AIDS- affected people iii)receptive social environments

19 International health and development community complicit in depoliticising AIDS Defining it as a technical challenge Neglecting the economic and political roots of peoples’ inabilities to take control over their health Danger of parallel depoliticisation of ‘social capital’ Need for the development of a critical conceptualisation of ‘social capital’ – as a powerful tool for analysis and action

20