The key lesson of family planning programmes for HIV/AIDS control
The aim of this paper is to identify the lessons of the earlier international family planning movement, so as to apply them to AIDS control. Though the aims and technologies of these movements are different, the similarities, however, are more striking. Both address central human concerns - procreation and sex - and both attempt to de-link sex from its negative consequences: unintended pregnancy and infection. The authors conclude that the most important lesson is that adaptation to new threats through changes in ideas and behaviour takes time to emerge, particularly to threats that relate to core concerns of sex and procreation. The family planning evidence indicates that the local population must take ownership, \"domesticating\" the problem and the solutions. This process occurs through discussion in local social networks of relatives, friends and associates, in which stories of personal experience are of special importance. It is a necessary precursor to widespread changes in ideas and behaviour: even carefully designed and theoretically driven interventions have proved largely ineffective at accelerating the pace of change in the general population. The central importance of local ownership does not imply that well-funded actions of donors, governments and non-governmental organizations are irrelevant. Information campaigns provoke local conversational networks in which the issues are domesticated. Services should be in place when people come to want them. The implication is that AIDS prevention approaches that genuinely foster local ownership of the agenda are likely to be most successful, especially in the case of severe epidemics. Change would likely start in urban areas where infection levels are highest, and spread to rural areas. The prognosis with regard to less severe epidemics, that characterize many West and Central African countries, is less confident because fewer people will be exposed through social networks to AIDS-related illness and death.
AIDS (2006) 20(1) 1-3.