Understanding the Impact of a Community-led HIV Prevention Program in South Africa: Context, Conceptual Framework and Methodology

Abstract

In this paper we provide an account of our multi-dimensional evaluation of a community led HIV-prevention program in the southern African mining community of Carletonville. The Mothusimpilo Project has three pillars: peer education and condom distribution, syndromic management of sexually transmitted diseases (STDs), and stakeholder mobilisation. Substantial efforts are being made to evaluate the impact of the intervention and in this paper we outline the theoretical rationale, research design and some preliminary results of the evaluation. The first section provides the setting for the evaluation work, viz an intervention which seeks to contextualise traditional biomedical and behavioural approaches to HIV-transmission within their broader community and social contexts. In the second section we outline the theoretical assumptions underlying the evaluation (which has both 'outcome evaluation' and 'process evaluation' components). In particular, we discuss the way in which the concepts of identity, empowerment and social capital are used to understand the processes involved in health-enhancing behaviour change. In the third section we describe our multi-disciplinary evaluation methodology and present some preliminary findings from our on-going evaluation study. One important goal of our evaluation research is to demonstrate the extent to which community level factors serve to assist or hinder the project in achieving its goals. In this way we hope to contribute to understandings of the role of community participation in influencing the outcomes of community-based health promotional projects.