Andrew Gibbs

Combined structural interventions for gender equality and livelihood security: a critical review of the evidence from southern and eastern Africa and the implications for young people

Young people in southern and eastern Africa remain disproportionately vulnerable to HIV with gender inequalities and livelihood insecurities being key drivers of this. Behavioural HIV prevention interventions have had weak outcomes and a new generation of structural interventions have emerged seeking to challenge the wider drivers of the HIV epidemic, including gender inequalities and livelihood insecurities.

Heeding the push from below: how do social movements persuade the rich to listen to the poor?

This article discusses three successful pro-poor social movements: the Brazilian Landless Workers’ Movement, the Indian wing of the People’s Health Movement and the South African Treatment Action Campaign. These have mobilized poor people to demand access to land, health services and life-saving medical treatment respectively. We show how each group has succeeded not only through building the ‘voice’ of the poor to make forceful demands, but also through facilitating the development of ‘receptive social environments’ in which the rich are willing to take these voices seriously. Community psychologists need to pay more attention to the latter challenge.

Youth Participation in the Fight against AIDS in South Africa: From Policy to Practice.

Effective youth participation in social development and civic life can enhance young peoples’ health and well-being. Yet many obstacles stand in the way of such involvement. Drawing on 105 interviews, 52 focus groups and fieldworker diaries, this paper reports on a study of a rural South African project which sought to promote effective youth participation in HIV/AIDS management. The paper highlights three major obstacles which might be tackled more explicitly in future projects: (i) reluctance by community adults to recognise the potential value of youth inputs, and an unwillingness to regard youth as equals in project structures; (ii) lack of support for meaningful youth participation by external health and welfare agencies involved in the project; and (iii) the failure of the project to provide meaningful incentives to encourage youth involvement. The paper highlights five psycho-social preconditions for participation in AIDS projects (knowledge, social spaces for critical thinking, a sense of ownership, confidence and appropriate bridging relationships). We believe this framework provides a useful and generalisable way of conceptualising the preconditions for effective ‘participatory competence’ in youth projects beyond the specialist HIV/AIDS arena.

'Men value their dignity': securing respect and identity construction in urban informal settlements in South Africa.

Background Urban informal settlements remain sites of high HIV incidence and prevalence, as well as violence. Increasing attention is paid on how configurations of young mens masculinities shape these practices through exploring how men build respect and identity. In this paper, we explore how young Black South Africans in two urban informal settlements construct respect and a masculine identity. Methods Data are drawn from three focus groups and 19 in-depth interviews. Results We suggest that while young men aspire to a ‘traditional’ masculinity, prioritising economic power and control over the household, we suggest that a youth masculinity emerges which, in lieu of alternative ways to display power, prioritises violence and control over mens sexual partners, men seeking multiple sexual partners and mens violence to other men. This functions as a way of demonstrating masculinity and their position within a public gender order. Discussion We suggest there are three implications of the findings for working with men on violence and HIV-risk reduction. First, there exist a number of contradictions in mens discourses about masculinity that may provide spaces and opportunities for change. Second, it is important to work on multiple issues at once given the way violence, alcohol use, and sexual risk are interlinked in youth masculinity. Finally, engaging with mens exclusion from the capitalist system may provide an important way to reduce violence.

Extended family childcare arrangements in a context of AIDS: collapse or adaptation?

Abstract Families are subjected to a number of social, economic, political and demographic challenges. In recent years, the AIDS epidemic has constituted a major challenge for already poor families due to its wide reaching social, economic and health consequences. The devastating consequence of HIV and AIDS is being seen through the prolonged illness and death of family members of prime working age which impacts on family livelihoods and the ability to provide for and protect its members. This paper forms part of a review – commissioned by the Joint Learning Initiative on Children and HIV/AIDS – of qualitative studies of how families in southern Africa have changed, and are changing, as a result of the impact of HIV and AIDS. This paper presents results of how extended family childcare arrangements are changing as a result of the AIDS epidemic. In a southern African context, family denotes a wider array of relations than biological parents and their children – with children growing up amongst a multitude of relations sharing responsibility for their care and upbringing (Chirwa, 2002; Verhoef, 2005). Recently, there has been growing interest in the capacity of the extended family to care for the increasing number of children whose parents have died. However, literature on the role of the extended family in caring for orphaned children remains contradictory. One approach – the social rupture thesis (Chirwa, 2002) – suggests that the extended family network is collapsing under the strain of AIDS. On the other hand, families are portrayed as resilient and dynamic entities which are adapting their systems of childcare in response to the epidemic (Kuo,2007). In line with Abebe and Aase (2007) and Adams, Cekan, and Sauerborn (1998), this paper proposes a continuum of survival rather than a polarisation of extended family childcare arrangements.

Hearing community voices: grassroots perceptions of an intervention to support health volunteers in South Africa

With the scarcity of African health professionals, volunteers are earmarked for an increased role in HIV/AIDS management, with a growing number of projects relying on grassroots community members to provide home nursing care to those with AIDS – as part of the wider task-shifting agenda. Yet little is known about how best to facilitate such involvement. This paper reports on community perceptions of a 3-year project which sought to train and support volunteer health workers in a rural community in South Africa. Given the growing emphasis on involving community voices in project research, we conducted 17 discussions with 34 community members, including those involved and uninvolved in project activities – at the end of this 3-year period. These discussions aimed to elicit local peoples perceptions of the project, its strengths and its weaknesses. Community members perceived the project to have made various forms of positive progress in empowering volunteers to run a more effective home nursing service. However, discussions suggested that it was unlikely that these efforts would be sustainable in the long term, due to lack of support for volunteers both within and outside of the community. We conclude that those seeking to increase the role and capacity of community volunteers in AIDS care need to make substantial efforts to ensure that appropriate support structures are in place. Chief among these are: sustainable stipends for volunteers; commitment from community leaders and volunteer team leaders to democratic ideals of project management; and substantial support from external agencies in the health, welfare and NGO sectors.

Reconstructing masculinity? A qualitative evaluation of the Stepping Stones and Creating Futures interventions in urban informal settlements in South Africa

Evidence shows the importance of working with men to reduce intimate partner violence and HIV-risk. Two claims dominate this work. The first is that interventions ‘reconstruct’ masculinities – these new formations of masculinity exist in opposition to existing ones and are healthier for men and less harmful for women. The second is that to be successful, such interventions need to address mens exclusion from the economy. Using a qualitative longitudinal cohort study of young men who participated in a gender transformative and livelihood strengthening intervention, as well as dyadic interviews with mens main female partners, we explore these claims. Data suggests men saw some improvements in livelihoods and relationships. However, challenging social contexts, including high rates of unemployment, peer networks and a dominant youth masculinity, limited change. Rather than reconstructing masculinity, a more subtle shift was seen with men moving away from ‘harmful’ aspects of a dominant youth masculinity towards a form of masculinity whereby male power is buttressed by economic provision and attempting to form and support ‘households’. Working with men on their livelihoods at an instrumental level encouraged participation in the intervention. Beyond encouragement, mens improving livelihoods afforded men the opportunity to materially demonstrate the social changes – in the form of shifts in masculinity – they were seeking to enact.

Creating Social Spaces to Tackle AIDS-Related Stigma: Reviewing the Role of Church Groups in Sub-Saharan Africa

An expanding body of literature explores the role of African church groups in facilitating or hindering the support of people living with AIDS and challenging or contributing to HIV/AIDS-related stigma. Treating church groups as social spaces in which HIV/AIDS-related stigma may potentially be challenged, we systematically review this literature, identifying five themes that highlight the complex and contradictory role of the church as a potential agent of health-enhancing social change. In many ways the church perpetuates HIV/AIDS-related stigma through (i) moralistic attitudes and (ii) its reinforcement of conservative gender ideologies. However some churches have managed move towards action that makes a more positive contribution to HIV/AIDS management through (iii) promoting various forms of social control for HIV prevention, (iv) contributing to the care and support of the AIDS-affected and (v) providing social spaces for challenging stigmatising ideas and practices. We conclude that church groups, including church leadership, can play a key role in facilitating or hindering the creation of supportive social spaces to challenge stigma. Much work remains to be done in developing deeper understandings of the multi-layered factors that enable some churches, but not others, to respond effectively to HIV/AIDS.

Strengthening Community Responses to AIDS: Possibilities and Challenges

Many AIDS programmes in sub-Saharan Africa have had disappointing results (Gregson et al., 2007), with HIV rates continuing to rise, stigma remaining stubbornly resistant to change, and access and adherence to treatment and support remaining inconsistent. Other interventions have worked well in carefully controlled research conditions, but these have been difficult to scale up in less highly monitored ‘real-world’ settings (Binswanger, 2000; Chopra and Ford, 2005; Greig et al., 2008). One key reason for the less-than-optimal outcome of many programmes is that they fail to resonate with the worldviews and perceived needs and interests of their target groupings, or to take adequate account of the complex social relations into which programmes are inserted (Gruber and Caffrey, 2005; Pfeiffer, 2003). Too many programmes are imposed on communities in ‘top-down’ ways by outside experts. In such settings, target communities are seen as passive recipients of prevention, care and treatment services rather than active participants working in partnership with health professionals to improve their health (Campbell, 2003).

Frustrated potential, false promise or complicated possibilities? Empowerment and participation amongst female health volunteers in South Africa.

We present a longitudinal case study of lay womens participation in a project seeking to facilitate home-based care of people dying of AIDS in a rural community in South Africa, drawing on four sets of interviews conducted with volunteers over a five-year period. We link participation in the project to three dimensions of womens agency: their knowledge and skills, their confidence; and their personal experiences of efficacy. We show that whilst the experience of participation enhanced each of these dimensions of volunteers’ agency at various stages of the project, the empowerment that did take place appeared to be limited to womens project-related roles, rather than generalising to other areas of their lives beyond the project. The project had limited impact on womens ability to negotiate condom use with husbands, to assert themselves in relation to male project leaders and to become more involved in wider community decision-making and leadership. We discuss three possible interpretations of our findings: (i) that greater empowerment might have occurred had the project run for a longer time period; (ii) that whilst such projects play a vital role in providing services, the more general ‘empowerment via participation’ agenda is a false promise in highly marginalised communities; or (iii) that whilst generalised positive impacts of such projects on volunteers are hard to track, such projects do open up glimpses of increased agency for many women. These might have positive but unpredictable results in ways that defy formulation in linear conceptualisations of social transformation and development, understood in terms of clearly observable and measurable inputs and outputs.