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Letting Them Die—Why HIV/AIDs prevention programmes fail
  1. N O’Farrell
  1. Pasteur Suite, Ealing Hospital, London UB1 3HW, UK; ofarrellpostmaster.co.uk

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    Edited by Catherine Campbell. Pp 214; £40.00 (cloth) £12.95 (paper). Oxford: James Currey, September 2003. ISBN 0-85255-867-8 and 0-85255-868-6.

    What is going on with HIV in South Africa? The epidemic escalates with no sign of slowing down, making the country the worst affected in the world. The government continues to try and find excuses not to deliver either treatment or prevention programmes. The sense of stigma is so palpable that ignorance of serostatus carried to the grave seems to be the usual way of living with the virus.

    This book tells the story of an HIV intervention project in Carletonville, a mining area near Johannesburg, where mineworkers and female sex workers eke out a day to day existence in which overindulgence in alcohol and unprotected sex appear to be the norm. It tells a salutary tale of a project conceived optimistically that gets dragged down through petty arguments, jealousy, and mistrust but still emerges to provide fresh insights into how to tackle the epidemic.

    Working in HIV in South Africa has always been full of challenges and, based on the story told here, those challenges would appear to be increasing. The author (a social scientist and member of the project research team) reports not only the successes, but also, more bravely, the failures of the project. She sets out her stall to tackle HIV through a project focusing at the community level. The plan was to have a project directed by stakeholders who would work together as a group and develop guiding principles that local HIV affected communities could use to support both individuals and promote HIV prevention programmes among female sex workers, miners, and youth. Unfortunately, the mine groups didn’t cooperate and other individuals saw themselves as just that, individuals rather than members of a cohesive, homogeneous community. Peer education, a major component of the project, faced many difficulties. With the benefit of hindsight, it seems as though many of the important stakeholders did not perceive adequate ownership of the project and became disillusioned early on leaving most of the day to day running to those employed by the project directly.

    The book is well written and clear and is recommended reading for anyone contemplating a large scale HIV prevention project, whether as a planner, implementer, or evaluator. The book explains social science terminology succinctly for those with limited knowledge of the discipline. It also demonstrates and describes very well that what works in one part of Africa will not necessarily work elsewhere, and that initial local assessment at the design stage of a large scale project is paramount.

    As HIV continues to spread outside the high risk groups, the need to educate at the community level also increases but the former group should not be forgotten. A combination of both strategies is probably the best approach. The reality is that, although the HIV epidemic in South and southern Africa has come a long way, there is still some distance to go. Hopefully, those involved in HIV project management will pick up the lessons set out in this excellent little book.

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