Letting Them Die: How HIV/AIDS Intervention Programmes Often Fail

This book examines the context and social construction of sexuality, HIV prevention and community development, based on a three-year study of a large-scale HIV/AIDS prevention programme in a South African gold mining community. The Summertown Project was a well-resourced intervention that sought to promote sexual health through the treatment of STIs,community-led peer education, and the promotion of local participation and 'stakeholder' partnerships.

The publication provides an account of sexuality and HIV prevention amongst three groupings: migrant mineworkers, commercial sex-workers and young people. These were the groupings the project identified as living and working in situations that placed their sexual health at particular risk.

Multiple levels of analysis are brought together in tracing the ways in which psychological factors such as desire and the need for intimacy are shaped and constrained by local community relations and macro-social contexts. These include aspects of both material contexts (such as poverty) and symbolic contexts (including access to political representation and the denial/stigmatisation of sexuality and AIDS). Gender is a central theme in these discussions.

The complex relationships between the diverse array of local stakeholders committed to implementing this complex and ambitious programme are explored. These included local residents and workers; the mining industry; trade unions; local and national government; nurses, social workers and traditional healers; overseas donors and researchers (STI specialists, epidemiologists and social scientists).

A framework is then proposed for theorising the construction of sexuality and the role of participation and partnerships in promoting health-enabling contexts. It examines the psychological and social processes underlying the negotiation of intimate sexual relationships, and highlights the mismatch between state-of-the art HIV prevention approaches and the realities of peoples' daily interactions. Drawing on the disciplines of social psychology, community health, sociology, developmentstudies and social medicine, it highlights both the seen and unseen the power dynamics inherent in, and beyond, impoverished communities struggling to address effects of the epidemic.