Resumen
Los conceptos de "asociación de grupos de interés" y "participación comunitaria" son artículos de fe en salud pública. Sin embargo, existen pocos trabajos que investigan los factores que dan forma a los resultados potenciales de la participación y las asociaciones sobre la salud. Este trabajo examina estas cuestiones a través de un estudio de tres años sobre un programa de prevención del HIV en una comunidad minera de Sudáfrica. Este programa no tuvo resultado a pesar del abundante aporte de capitales, del uso de estrategias conductuales y biomédicas modernas y de la participación de una amplia esfera de grupos de interés de los sectores públicos, privados y de la sociedad civil. La autora examina: 1) la desigualdad entre la vida social y la vida sexual de los grupos analizados (mineros, trabajadoras sexuales y población joven) y la forma en la que el programa de prevención del HIV se diseñó e implementó, y 2) las posibilidades y las limitaciones de las diversas asociaciones de grupos de interés para la prevención del HIV. La dinámica entre los grupos de interés socavó la posibilidad de una colaboración efectiva. Esta relación incluyó diversos niveles de compromiso de los grupos interesados, la representación excesiva de la habilidad biomédica, la falta de voluntad o resistencia para el desarrollo de vías innovadoras de trabajo en conjunto, la carencia de sistemas de salud para la integración de los esfuerzos de los grupos de interés y la falta de incentivos para asegurar que los grupos de interés más poderosos trabajaran para mejorar las posibilidades de vida de los grupos marginales.
Palabras clave
HIV/SIDA, asociación, participación, grupos de interés
Clasificación en siicsalud
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página www.siicsalud.com/des/des039/04910000.htm
Especialidades
Principal: Infectología
Relacionadas: Atención Primaria, Medicina Interna
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PARTICIPATION, PARTNERSHIPS AND PUBLIC HEALTH A CASE STUDY OF HIV PREVENTION IN SOUTH AFRICA
Abstract
The concepts of "stakeholder partnerships" and "community participation" are articles of faith in public health. However little work examines the factors shaping the potential impacts of participation and partnerships on health. This paper examines these issues through a three-year study of an HIV prevention programme in a South Africa gold mining community. This programme had no impact despite generous funding, the use of state-of-the-art biomedical and behavioural strategies and the participation of a wide range of community stakeholders from the public and private sectors and civil society. The author examines (i) the mismatch between the social and sexual lives of target groups (miners, sex workers and youth) and the way in which the HIV prevention programme was designed and implemented; and (ii) the possibilities and limitations of multi-stakeholder partnerships for HIV prevention. Dynamics amongst stakeholder partners undermined the possibility of effective collaboration. These included varying levels of stakeholder commitment, over-representation of biomedical expertise, unwillingness to develop innovative ways of working together, the lack of health systems to integrate stakeholder efforts and the lack of incentives to ensure that more powerful stakeholders would work to improve the life chances of marginalized groupings.
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Bibliografía del artículo
- These concepts are re-emphasised in the most recent WHO World Health Report. World Health Organisation (2003) The World Health Report 2003: Shaping the future. Geneva: WHO.
- Williams, B, Taljaard, D, Campbell, C, Gouws, E, Ndhlovu, L, van Dam, J, Carael, M, Auvert. B (2003) Changing patterns of knowledge, reported behaviour and sexually transmitted infections in a South African gold mining community. AIDS. 17, 2099-2017.
- Williams et al. (2003) cited above.
- Campbell, C (2003) Letting them die: why HIV prevention programmes fail. Bloomington: Indiana University Press. Oxford: James Currey.
- Campbell, C. (1997) Migrancy, masculine identities and AIDS. Social Science and Medicine. Vol. 45 (2), 273-281, May.
- Campbell, C. (2000) Selling sex in the time of AIDS: the psycho-social context of condom use by southern African sex workers. Social Science and Medicine, 50, 479-494.
- MacPhail, C. and C. Campbell (2001) "I think condoms are good but, aai, I hate those things": Condom use among adolescents and young people in a southern African township. Social Science and Medicine, 52, 1613-1627.
- Campbell, C and Mzaidume, Y (2002) How can HIV be prevented in South Africa A social perspective. British Medical Journal, 324, 229-232 (26 January).
- See Campbell (2003) for a detailed account of these factors.
- Campbell, C and Mzaidume, Y (2001) Grassroots participation in health promotional projects: HIV prevention by sex workers in South Africa. American Journal of Public Health, 91(12), 1978-1987.
- Campbell, C, Foulis, CA, Maimane, S and Sibiya, Z (2004) "I have an evil child in my house": stigma and the struggle against youth HIV in South Africa. Submitted for publication.
- Campbell, C and MacPhail, C (2002) Peer education, gender and critical consciousness: Participatory HIV prevention by S. African youth. Social Science and Medicine. 55 (2), 331-345.
- Here it must be emphasised that the author uses Pierre Bourdieu\'s concept of social capital, with its explicit emphasis on the relationship between social capital and health inequalities. See Campbell (2003) cited above, for further discussion of this point.
- Susan Saegert, J. Phillip Thompson and Mark R. Warren (2001) Social capital in poor communities. New York Russell Sage Foundation.
- Campbell, C. (2000) Social capital and health: Contextualising health promotion within local community networks. Chapter in Baron, S., Field, J. and Schuller, T., (Eds) Social capital: critical perspectives. Oxford University Press. 182-196.
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