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7. Conclusion: Key lessons, questions and recommendations
   Last updated: 29.06.02
 
The first year of the “Community Lessons, Global Learning” collaboration between the Alliance and Positive Action has enabled a rich sharing of practical experiences among communities, countries and continents. In addition to improving the quality of individual efforts in HIV/AIDS prevention and care, the initiative has highlighted vital lessons, questions and recommendations of relevance to key stakeholders involved in the global response to HIV/AIDS.

Lessons and questions:

As highlighted at the end of each chapter of this report, “Community Lessons, Global Learning” has identified many essential lessons in community responses to HIV/AIDS. The following presents a synthesis of these lessons, and also suggests key questions which will require future attention by the Alliance, Positive Action and others:

Lesson 1: NGOs can move beyond awareness raising into more effective responses to HIV.

Key questions for the future include:

  • How can the experiences of NGOs which have successfully moved beyond awareness raising most effectively be multiplied and replicated in other settings?

  • Which lessons from NGO successes in moving beyond awareness raising are applicable in the public sector, and how can they be transferred?


Lesson 2: It is possible - and valuable - to “put into practice” the principle of involving people living with HIV and AIDS.

Key questions for the future include:

  • How can the Alliance and others locate its work to counter the social exclusion of people living with HIV and AIDS within a broader human rights agenda and movements for social justice?

  • The meaningful involvement of people living with HIV and AIDS and a recognition of their expertise may challenge existing notions of expertise and power dynamics between providers and users of services. How can the Alliance and others address these shifts in relation to programme design and delivery?


Lesson 3: To focus their programmes, NGOs often require support in developing a more complex understanding of the concept of vulnerability and a richer picture of the vulnerabilities of specific communities.

Key questions for the future include:

  • Can the structural concept of vulnerability produce useful insights into ways of working with those who are advantaged by their gender, class, age and sexuality and who may be held responsible for the vulnerability of others?

  • How can HIV prevention strategies reflect both the micro-level understanding of vulnerability generated by a participatory community assessment and an appreciation of macro-level factors?

  • How can community assessments be used to inform national and international advocacy and policy-making?

  • How can assessment tools and techniques be best adapted for use in participatory community evaluations - in order to stimulate continued and improved HIV prevention strategies?


Lesson 4: Development work which addresses problems of socio-economic marginalisation appears to be an important strategy toward the goal of HIV prevention and care.

Key questions for the future include:

  • In what ways can operations research generate a better understanding of how specific types of development work in specific situations contribute to HIV prevention?

  • To what extent does a “development” focus of prevention work call for the Alliance and others to develop more political advocacy around development decisions and resource allocation, at both national and international levels?

  • What is the role of organisations focused on health or HIV/AIDS, as opposed to large-scale development institutions, in responding to these challenges?


Lesson 5: Gender, sexuality and sexual health are all significant determinants of vulnerability to HIV, and pathways for “moving beyond awareness raising”.

Key questions for the future include:

  • What strategies can be developed to address the links between social constructions of masculinity and safety within male sexuality?

  • In what ways can clearer conceptual and operational connections be made between movements and strategies for women’s empowerment and HIV prevention?

  • To what extent does the resource-intensity of groupwork strategies to address gender and sexuality limit their wider application?

  • How can the Alliance use its understanding of gender, sexuality and sexual health as part of a wider advocacy for expansion and enhancement of relevant service provision?


Lesson 6: Greater community involvement in HIV/AIDS programming is a key to more relevant, accountable and sustainable prevention and care responses.

Key questions for the future include:

  • What kinds of community involvement produce what kinds of benefits for in HIV prevention and care work?

  • More particularly, do participatory approaches which facilitate the emergence of community leadership and social action actually have an impact on sexual, drug taking and care-giving behaviour?

  • What approaches to participation last over time, and foster sustainable community responses to HIV/AIDS?


Recommendations
The lessons and questions highlighted by the first year of “Community Lessons, Global Learning” lead to the following key recommendations:

For Donors:

  • We already know a great deal about how to respond to HIV/AIDS, but there is still a need to promote and fund appropriately focused research - to generate a more strategic understanding of, and dialogue about, the links between HIV prevention and development, gender, sexuality and community participation;

  • There is a need for a wider dialogue within the development “community” about HIV prevention and its implications for development policy and the roles of donors, governments and civil society; and

  • Linked to this dialogue is the need to consciously locate HIV prevention within a wider vision of social justice and donors’ broad mission and mandates.


For the Alliance:

  • To build on the lessons being learned about moving beyond awareness raising, the technical support provided by the Alliance should focus not only on participatory techniques and related skills but also on improving an understanding of the key concepts (such as development, gender and participation), as well as promoting a reflection on attitudes and values as they relate to these issues;

  • The Alliance should prioritise the strengthening of institutional capacity to continue to learn and share lessons, both nationally and internationally. This will require an increased emphasis on participatory processes and outcome evaluations, as well as strategic operational research initiatives and the nurturing of information exchange and peer technical support; and

  • The Alliance secretariat has an international presence and voice with which it can articulate, and advocate for, the needs and aspirations of the marginalised communities with whom it works.


For NGOs and NGO support programmes:

  • Consideration should be given to the potential that exists for NGO support programmes to expand their national advocacy role vis-a-vis HIV/AIDS prevention and care and related issues of vulnerability, in particular acting as a channel by which the findings of participatory community assessments can serve to influence policy;

  • Given the lessons being learned about structural vulnerability and the links between marginalisation, inequalities and the epidemic, NGO support programmes and NGOs should collaborate with strategic partners who are addressing key issues, such as human rights, gender and development, sexuality and sexual violence;

  • Priority should be given to developing practical strategies which counter the social exclusion of people living with HIV/AIDS. These must include strategies which promote their active and meaningful involvement in programme planning, delivery and evaluation; and

  • It is vital to continue to nurture local capacity to provide technical support and to emphasise the role that external support plays in transferring skills and in building institutional capacity. Given this role, strategic planning should explicitly focus on the timing and pace of the decrease of external support in parallel with its replacement by local expertise.


Source: Beyond Awareness Raising
This is an extract from Beyond Awareness Raising: Community lessons about improving responses to HIV/AIDS, published by the International HIV/AIDS
Alliance in 1998.

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