HIV and Social Complexity

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HIV and Social Complexity Insights from complex
systems theory for more effective responses

• Dr Robin Vincent, Senior AdvisorHIV and AIDS,
  Panos London
• XVII International AIDS Conference, Mexico 6
  August

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Outline

• HIV communication that addresses social aspects
  of HIV and AIDS
• Research on stigma and discrimination, and gender
• Developments in participatory communication for
  social change
• Complex systems theory to understand health and
  social change

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Why the social aspects of AIDS?

• Previous successful responses (Panos 2003,
  2006) role of public communication and social
  factors
• methodological individualism of behaviour
  change (Airhihenbuwa and Obregon 2000)
• Need to tackle structural violence in HIV and
  public health (Farmer, 2004)
• Promising communication for social change
  approaches need more investment, research and
  evaluation
• - Ethiopia youth dialogues
• - 3rd generation Entertainment-education
• - community conversations (UNDP, UNAIDS)

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Key Barriers to Universal Access

• Stigma and discrimination against people living
  with HIV and AIDS and vulnerable groups
• Inequality faced by women and girls
• UNAIDS country consultations 2005/6 and wide body
  of research
• Complex social issues power and communication

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Tackling stigma and discrimination

• Still everyday experience for people living
  with HIV and AIDS obstacle to prevention
• Misunderstood and neglected now recognised as
  sustaining social inequalities
• Need for multi-levelled response
• Combined action at community and interpersonal,
  institutional, legal and policy levels (Panos
  2006)

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Tackling stigma and discrimination

• Promising examples common at core (ICRW/DFID
  2007)
• Role of participatory education
• Legal and structural aspects neglected in
  practice - power
• Lessons from social movements and civil society
  initiatives positive identity (Vincent and
  Stackpool-Moore, forthcoming)

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Tackling gender inequity

• Parallel need for multi-levelled action
• Gender embedded in social norms and practices
• Success of participatory communication approaches
• But broader structural constraints, and practical
  how-to lacking (UNAIDS 2007)
• Limits to addressing entrenched power with
  programmes?

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Participatory development limits

• Rise of participatory approaches
• Critiques of participatory development -
  dangers of co-optation (Cooke and Kothari, 2001)
• Tokenistic involvement of people living with HIV
  and AIDS GIPA principle (ICASO, 2004)
• Analyse spaces of participation in each case
  invited and claimed (Cornwall 2004).
• Power relations reproduced or challenged?

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Social life as a complex system

• Emergent character of social life, with
  different qualitative states linked to variation
  key parameters (degree of inequality)
• Different conception of development not
  amenable to command and control linear planning
  (Rihani,2002)
• Away from focus on directing behaviour in HIV
  communication

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Complexity of health

• TB epidemic where wealth inequality reaches a
  threshold (Byrne 1998)
• Wider determinants of health and susceptibility
  to HIV (Stillwaggon 2006)
• Away from focus on risk behaviour just in
  time intervention
• Empirical but not narrowly predictive
• Need for basic health and social infrastructure
  and capabilities (Sen 2004)
• Echoes of Primary Health Care (recent aim of
  integration of HIV response with TB, sexual and
  reproductive health, nutrition)

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Complexity of politics of AIDS responses
control or support?

• Moralistic and ideologically driven prevention
  abstinence only, criminalising of people who
  inject drugs, conflation of sex work and
  trafficking
• AIDS transforming African governance (De Waal
  2006)
• Participation and rights of PLWHA OR coercion
  around treatment compliance
• Record of food aid, ARVs used for patrimonial
  networks of government
• Focus on treatment infrastructure or broader
  health systems, rights and access

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Complex systems implications?

• Diversity of initiatives, local freedom of action
• Linking initiatives and feedback association
  model of scale (Chetley, 2004)
• Enhancing learning and strengthening overall
  response
• Strengthen basic social support systems and
  capabilities not only targeted approach
• Change may be emergent (ODI, 2008)
• Puntos de Encuentro, Nicaragua - popular soap,
  network of social movements, youth training
  (Lacayo 2006)

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Conclusions addressing complexity

• Social challenges need multi-levelled approaches
  stigma, gender
• Support and facilitate local action without
  co-optation or state avoiding responsibility
• Ethnographies of participation
• Insights of complex systems - beyond linear
  planning to supporting broader capabilities and
  social infrastructure and allow emergent change
• Further strengthen communication for social
  change

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Thanks
robin.vincent_at_panos.org.uk www.panos.org.uk