Social obstacles, community participation and HIV prevention in a South African mining community

Community participation and peer education are essential parts of HIV prevention programmes - which face social barriers to their effective implementation. In a South African mining community obstacles, such as the way in which the project was set up and managed, hindered success. For success to be achieved, local people must feel ownership of the project through full participation.

Researchers from theLondon School of Economics and the MothusimpiloProject in South Africa examined the role of social factors in determining thesuccess of a community-led HIV prevention programme in the Carletonvillemining community in South Africa. The project, initiated in 1997 by agrass-roots organisation and a number of academics, had three key features: thecontrol of sexually transmitted infections, community-led peer education andcondom distribution and multi-stakeholder project management.

The researchersinvestigated the peer education component from mid-1997 to mid-2000 through astudy of sexuality and community-led HIV prevention among miners, commercialsex workers and young people.  At thesame time they examined the effectiveness of the local stakeholder managementprocess.  They discovered socialobstacles to the programmes success. 

Despite high levels ofknowledge about HIV and AIDS, adoption of safe sexual behaviours was hinderedby social attitudes towards sexuality, and in particular by the adoption of amacho masculine identity among the miners and a lack of confidence among sexworkers in an environment where they were accorded little respect.  The effectiveness of project management wasaffected by variations in the commitment level and motivation of the differentstakeholder groups. The researchers also found that:

• there was a lack of trust and respectbetween stakeholder groups: women-led peer education programmes wereresented by the men, who were unfamiliar with the concept of female leadership;whilst some sex worker peer educators advocated violence or ostracismagainst those who did not use condoms
• among school students peer group meetings wereoften dominated by young men; girls were reluctant to assertthemselves.  Schools proved unsuitablevenues for young people to debate their sexuality openly
• over representation of biomedical experts onthe stakeholder committee combined with lack of commitment by the miners’trade union, with the result that peer education was under-valued and conductedin a patchy way. 

The creation of‘bridging’ social capital between diverse stakeholder groups is crucial for thesuccess of multi-stakeholder projects, but it is problematic and lessstraightforward than that of ‘bonding’ social capital within a homogeneousgroup.   Further implications for policyarising from this study are:

• The lack of government leadership incombating HIV and AIDS in South Africa has resulted in numerous programmesdesigned by international agencies. Such projects may suffer from lack of local ownership and localpeople may lack the conceptual understanding and technical skills toimplement them properly.
• HIV prevention and transmission must betreated as social issues, and should not be regarded purely as biomedicalor behavioural problems.
• There is a need for further research onthe role of community and social factors in a programme’s success.