Tackling the Social Complexities of HIV and AIDS: Understanding the Social Roots of the Epidemic and Learning from Developments in HIV Communication

• Author: Robin Vincent
• Pages: 153-176

153

TACKLING THE SOCIAL COMPLEXITIES

INTRODUCTION

There is an urgent need to tackle the social drivers of HIV and AIDS

if global HIV infection rates are to be reduced, and the current targets

–– for universal access to prevention, treatment, care and support by

2010, and the Millennium Development Goal of halting or starting to

reverse the spread of HIV by 2015 –– are to be realized. It is particularly

urgent that effective HIV communication approaches are developed to

tackle key social challenges underpinning vulnerability to HIV –– such

as stigma and discrimination, gender inequity, and socio-economic

inequality –– given the challenges of preventing emerging epidemics in

Eastern Europe, South Asia, and the Caribbean, and the increasing

‘feminization’ of the pandemic identified in recent epidemiological trends.

The need to address social, political and economic factors that structure

differential vulnerability to HIV is increasingly recognized, yet, policy

relevant research that renders these complex social factors amenable to

intervention is lacking. This chapter reviews a range of recent international

developments in HIV and AIDS communication theory and practice,

which attempt to address its social dimensions more effectively: to look

beyond narrow, short-term interventions focused on individual

behaviours, and understand some of the social and structural underpinnings

of an effective public health response to HIV and AIDS. The chapter

draws on developments in participatory communication for social change

thinking and practice, lessons from the dynamics of HIV social

movements, and recent attempts to apply the theory of complex systems

Robin Vincent

Chapter 8

Tackling the social

complexities of HIV and AIDS

Understanding the social roots of the epidemic and learning from

developments in HIV communication

154

SEXUALITY, SOCIAL EXCLUSION AND HUMAN RIGHTS

to understand social change. Together, these suggest the need to work to

support and facilitate a range of broader social capacities and capabilities

that underpin health and well-being, rather than the predominant narrow

focus on changing the sexual and ‘risky’ behaviour of individuals in HIV

and AIDS programmes. Such approaches connect with the present concern

to move from a focus on individual risk to the way vulnerability to HIV

is structured by a range of social factors, and the need to address these

factors for effective HIV programming.

Recent initiatives aimed at addressing stigma and discrimination and

gender inequity –– identified as key social drivers of HIV by UNAIDS in

126 country consultations during 2005/6 (UNAIDS 2006) –– confirm

the need for multileveled and integrated approaches which go beyond the

more discrete project interventions common in HIV and AIDS responses.

By reflecting on a range of such examples from around the world, and

from Africa in particular, the paper offers a range of lessons learned and

productive questions, which may inform the ongoing development of

responses to HIV and AIDS in the countries of the Caribbean.

ADDRESSING THE SOCIAL DIMENSIONS OF

HIVAND AIDS

The need to address the social dimensions of HIV and AIDS has been

driven partly by lessons learned from previous experiences in HIV and

AIDS responses, and also by developments in the fields of HIV and

development communication. A number of factors, present to varying

degrees in different countries, have been prominent in successful responses

to HIV and AIDS, and have been reviewed elsewhere in detail (Panos

2006a).1 Factors which contribute to a successful response include: political

leadership; civil society mobilization; open dialogue and discussion and

knowledge-sharing in personal communication networks (Panos 2003,

11); media promoting dialogue and debate; country-driven responses

(Green 2003); multisectoral responses to prevention and care (Sittitrai

2001, 5); matching the response to the stage and character of the epidemic;