"Letting Them Die": Why HIV/Aids Intervention Programmes Fail

Article excerpt

"Letting Them Die": Why HIV/Aids Intervention Programmes Fail By Catherine Campbell. African Issues. Bloomington, Ind.: Indiana University Press, and Oxford: James Currey, 2003. Pp. vii, 214. $49.95.

"Letting Them Die" is Catherine Campbell's timely analysis of why HIV intervention programs fail, even when they are highly resourced and well conceived. The title borrows a quote from South African satirist Pieter-Dirk Uys: "In the old South Africa we killed people, now we are just letting them die." By equating HIV intervention projects to processes of "letting [South Africans] die," Campbell demands researchers and public health practitioners to critically analyze contemporary methods for dealing with HIV/AIDS. Campbell draws on observations and data from an HIV intervention in a mining town in South Africa, that she calls the Summertown Project, to contextual ize two participatory approaches to HIV control: peer education and stakeholder management. "Letting Them Die" offers a much-awaited theorization of commonly used, but rarely theorized, concepts in public health practice.

As Campbell points out, there has been a "paradigm drift" in public health practice away from individual level behavior change programs to interventions that actively involve community members in the design, research, and implementation of health promotion projects. The Summertown Project had the makings of what would be considered good community-based programming. The impetus for the project came from the community and the participatory strategies were grounded in the social science concepts of social capital, social identity, power, and critical consciousness. What actually happened in the Summertown Project, however, is a lesson in how the practical application of concepts, such as social capital, play out (or fail to play out as anticipated by program directors) in contexts of extreme deprivation and distrust.

Campbell divides the book into four parts. She first describes the project, the context in which it was implemented, and her theoretical framework. The following three parts deal with the groups involved in the project: sex workers, youth, and the project "stakeholders." The sex workers who lived in shack settlements on the periphery of the gold mines were the initial focus of the Summertown Project. Campbell presents a rich and heart-wrenching collection of quotes from interviews with sex workers. In a thoughtful analysis of the sex workers' lives and the implementation of the peer education program among sex workers, she resists the common depiction of African women as victims of HIV/AIDS while remaining clear about the violence and poverty that shape HIV transmission among sex workers. …