Expanding the prevention armamentarium portfolio: A framework for promoting HIV-Conversant Communities within a complex, adaptive epidemiological landscape

Abstract

The article describes a design journey that culminated in an HIV-Conversant Community Framework that is now being piloted in the Limpopo Province of South Africa. The objective of the initiative is to reduce the aggregate community viral load by building capacity at multiple scales that strengthens peoples’ HIV-related navigational skill sets—while simultaneously opening a ‘chronic situation’ schema. The framework design is based upon a transdisciplinary methodological combination that synthesises ideas and constructs from complexity science and the management sciences as a vehicle through which to re-conceptualise HIV prevention. This resulted in a prototype that included the following constructs: managing HIV-prevention in a complex, adaptive epidemiological landscape; problematising and increasing the scope of the HIV knowledge armamentarium through education that focuses on the viral load and Langerhans cells; disruptive innovation and safe-fail probes followed by the facilitation of path creations and pattern management implementation techniques. These constructs are underpinned by a ‘middle-ground’ prevention approach which is designed to bridge the prevention ‘fault line’, enabling a multi-ontology conceptualisation of the challenge to be developed. The article concludes that stepping outside of the ‘ordered’ epistemological parameters of the existing prevention ‘messaging’ mind-set towards a more systemic approach that emphasises agency, structure and social practices as a contribution to ‘ending AIDS by 2030’ is worthy of further attention if communities are to engage more adaptively with the dynamic HIV landscape in South Africa.

Keywords: chronic schemas, complex adaptive epidemiological landscape, disruptive innovation, pattern management, safe-fail probes