The Role of Community Conversations in Facilitating Local HIV Competence: Case Study from Rural Zimbabwe

This journal article examines the potential of using community conversations to strengthen positive responses to HIV in resource-poor environments. Guided by a facilitator, community members collectively identify local strengths and challenges and brainstorm potential strategies for solving local problems. Researchers conducted a series of such community conversations in Zimbabwe to promote critical thinking and action planning in response to HIV/AIDS and to test the strategy using the concept of community-level HIV/AIDS competence as a lens for analysis. The study found that community conversations hold great potential to help communities recognise their potential strengths and capacities for responding more effectively to HIV, but contextual factors, such as availability of treatment, poverty, poor harvests, and political instability, can help or hinder communities' response plans.

The theoretical framework of community competence is described as follows. "An HIV competent community is one in which people are able to work together to support appropriate accessing of HIV testing and treatment, the provision of compassionate care for people living with HIV/AIDS (PLWHA), open and non-stigmatizing discussions of HIV, and concrete strategies to prevent new infections." Community involvement and the ability to engage in critical thinking about local challenges and strengths is at the core of the concept of HIV competence as it helps to support behaviour changes and collective action. During community conversations, members engage in dialogue but also generate action plans. The conversations "have an explicit 'problem solving' agenda, aiming to spur critical thought that enables people to formulate local solutions to local issues."

Researchers conducted 18 community conversations (CCs) in two locations, with 6 groups participating in 3 conversations each. During the sessions, participants were asked to "reflect on how they were responding to the challenges of HIV, both as individuals and in community groups, and to think of ways to better support openness about HIV, kindness towards people living with HIV and greater community uptake of HIV prevention and treatment."

The first section of the article outlines how community conversations helped contribute to HIV competence.

• Conversations enabled participants to develop concrete, practical action plans to better cope with HIV: The "findings suggest that the CCs were effective in supporting participants to jointly come up with possible new strategies to cope with HIV: participants brainstormed how better to care for PLWHA, how to reduce HIV stigma and how to encourage prevention, testing and treatment." The article notes that: participants reported that some of these plans were put into action; people felt more empowered to be able to do something about HIV and AIDS; and people who were already caring for PLWHA benefited from being able to speak to others about their experience.
• Participants were encouraged and challenged by involvement of outside facilitators: The article explains that while many "community conversations" engage local facilitators from the community, this intervention used facilitators considered to be from outside. "Community members appeared to trust and relate to them but also expressed respect for them and gratitude that they had come to the region and cared to help. Their presence seemed to appeal to participants and strengthen the effectiveness of the conversations..."
• CCs constituted a forum in which people could develop sense of community, common purpose : Overall, it was found that community conversations allowed people to discuss strengths and challenges, boosting a sense of common purpose. While it is noted that these conversations take place among people who already consider themselves as community, "the process helps to deepen a sense of purpose and working together."
• CCs encouraged participants to move from passive recipients of HIV-related information to active problem solvers: Participants expressed that there was already significant local knowledge about HIV within their community; however, the CCs helped people to develop a sense of their own capacity to do something: "[T]hey expressed a lack of collective agency to move from information to action."
• Community conversations reduced the silence and stigma surrounding HIV: As people discussed their own experiences, it became apparent that everyone was in some way affected by HIV. The conversations helped encourage discussion and break the silence that left people feeling like they were alone in what they were experiencing. It also helped to bring living with HIV and caring for PLWHA out of the private sphere and into the public.

The second half of the article discusses how HIV competence is influenced by many factors which can facilitate or hinder the outcome of community conversations. For example, the availability of anti-retrovirals enabled people to be able to implement their actions plans to help support PLWHA. Unfortunately, on the other hand, poverty, poor harvests, and political upheaval made it difficult for people to implement their action plans. While the community had the good intentions of helping to support PLWHA, their own lack of resources, especially scarce food from poor harvests, made this difficult.

The article concludes that "findings suggest that conversations may create social space for people to reflect on the possibility of more effective responses to HIV, but a host of other factors will intervene in shaping whether such reflection leads to concrete behaviour change." However, despite these challenges, the researchers "remain confident that our conversations were successful in the modest aims which we set them - to create spaces in which people might 'break the silence', think critically about obstacles to effective responses and brainstorm action plans. Such dialogue is a vital, if not a sufficient, precondition for health-enhancing behaviour change."