|Community Mobilization and AIDS (UNAIDS, 1997, 8 p.)|
Ensuring that community members "take ownership'' of the initiative
It is generally accepted that a true community-based initiative is one in which local people will say, "We did it ourselves." This basic principle of community mobilization is frequently forgotten in the haste of many community health initiatives. Facilitators and sponsors may rush the mobilization process in order to meet planned goals, and in doing so jeopardize its long-term success.
The assessment and planning phases of an initiative must take into account the need for community feelings of ownership to be created. This may require more resources or simply more time than is necessary to meet the technical requirements of the initiative; it may also require better communications with community opinion-makers or informal leaders.
One of the most effective ways of encouraging ownership is to work on some short-term and easily achievable objectives that involve as many people as possible. Small-scale but visible achievements are valuable ways to keep people's interest, spark more participation, and show people that their collective action can actually lead to success. For example the Ugandan group TASO (see box) worked hard in their early days to get a physician to join their group; once this was accomplished, TASO's HIV-infected members were finally able to get treatment in hospital for opportunistic infections.
Creating strong links to outside resources
Communities are not closed, self-sustaining systems. The ability of communities - no matter how well organized and motivated - to meet all of their needs is limited. These limits must be recognized and then planned for. For example, a community may successfully distribute information about the use of condoms for HIV prevention to most of its families, but that is not helpful if there is no consistent source of condoms. Similarly, an awareness campaign can quickly lose the confidence of community members if there is no place to refer people who want to test for HIV or who need counselling or care for AIDS-related problems.
Mobilizing a professional community: The Lawyers' Collective, Bombay, India
Bombay-based lawyer Anand Grover was hesitant when the Indian Health Organization asked him to take the case of Dominic D'Souza in February, 1989. D'Souza was found to be HIV-positive after he donated blood in a local hospital. Under the Goa Public Health Act he had been arrested as a "public threat'' and put in solitary confinement.
Grover knew almost nothing about HIV at the time, but as a member of the Lawyers' Collective (a small group of lawyers doing public interest litigation) he knew a great deal about human rights. He fought the case all the way to the High Court, was able to get D'Souza released, and also caused amendments to be made to the Public Health Act.
The Lawyers' Collective soon began to devote a great deal of energy to the legal needs of people with HIV/AIDS. Largely self-financed, it fought many individual cases in court, lobbied politicians, and worked hard to change laws that discriminate against people with HIV/AIDS. And, by recruiting and training a nation-wide network of lawyers, it has set an example of how a professional community can mobilize against the pandemic. (See Broadening the Front: NGO Responses to HIV and AIDS in India in the Key Materials.)
Community-level initiatives should identify and create linkages to other sources of information or support. This may include negotiating formal agreements or simply cultivating contacts with a range of other organizations, including any government agencies that can aid (or block) the community's efforts. For example, the Bangkok-based support group "Wednesday Friends' Club'' has for many years worked with a monk from a local Buddhist temple, enabling the club to offer much-appreciated spiritual and emotional support to members.
Securing long-term support
Maintaining the momentum of a community response needs regular replenishment of energy, skills and resources. Some communities are able to do much of this from within through such methods as local fund raising (for more financial resources) or rotating leadership posts (to avoid "burning out'' existing leaders or entrenching a clique). Other communities with fewer internal options must make arrangements with outside sources.
Non-financial support, such as skill-building workshops and advice from experienced leaders in another community, can be very helpful in maintaining momentum.
Optimal leadership and optimal representation
Energy must be invested not only in supporting good leadership but in ensuring optimal representation. The participation of marginalized groups such as refugees, or people in stigmatized professions, is an important part of this, particularly when they are among the most affected by the problem.
Whenever possible, widening the established discussion or decision-making mechanisms of the community (e.g. the village council or community hall meeting) to accommodate these groups should be tried first. In some cases, reserving seats for them at these meetings or on the governing bodies of community organizations may be all they need to participate fully.
In other cases, special efforts such as focus groups (small, facilitated discussion groups) may be necessary to help people to voice their concerns in a setting that feels safe and supportive. The opinions and information brought out by these discussions can then be communicated to the larger community. (For more on focus groups in HIV initiatives, see Manual of Group Interview Techniques to Assess the Needs of People with AIDS in the Key Materials.)
Taking action: Duang Prateep Foundation, Thailand
The Duang Prateep Foundation has provided a wide range of educational and social services in the poor Bangkok neighborhood of Klong Toey since 1979. All decision-makers and fieldworkers of the foundation are community members themselves. Gradually, the foundation became aware of the rapid spread of HIV among people such as injecting drug users, sex workers, and Bangkok's ubiquitous motorcycle taxi drivers.
At first, Duang Prateep viewed HIV/AIDS as too complex an issue for a community-based organization to deal with. But as they recognized the growing impact on their community, the foundation took action. By 1992, five full-time staff and over 200 volunteers were working directly with vulnerable groups, and promoting general public awareness. One of their most notable successes, they feel, has been the increased acceptance of people with HIV/AIDS by relatives, friends and neighbours. (See Community Responses to HIV and AIDS: Experiences from India and Thailand in the Key Materials.)