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Balancing community mobilisation and measurement needs in the evaluation of targeted interventions for HIV prevention
  1. Helen Lambert
  1. Correspondence to Dr Helen Lambert, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK; h.lambert{at}bristol.ac.uk

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The case that engaging communities at a high risk of HIV to act in reducing their own vulnerability is essential to prevention programmes has gained widespread acceptance as a public health principle. Producing unequivocal evidence of its effectiveness in reducing HIV transmission is problematic however and the means and mechanisms through which such effects may operate remain a matter of debate. The papers in this special issue contribute to our understanding of both these issues, while indicating that it is feasible to mobilise high risk, marginalised communities for HIV prevention on a large scale. Overall, the papers document remarkable successes across diverse regional contexts and local populations in establishing community groups and building collective solidarity among group members. Yet, some findings are less robust and the papers also show how systematic measurement of community mobilisation and the production of reliable evidence concerning its effects on HIV risk remain fraught with difficulties. In part, these arise from a tension between the research design requirements for producing consistent and reliable evidence acceptable to the public health community and the nature of the very activities that may contribute to effective HIV prevention.

The mechanisms through which community mobilisation exerts effects are addressed in a model1 which conceptualises community mobilisation (glossed as ‘identification, collectivization and ownership’) as an outcome of increasing community participation that will, in turn, lead to better programme outcomes (ie, a reduction in HIV transmission). Arguably however, a reverse pathway in which community participation rests on mobilisation activities is equally plausible and, …

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