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      Evidence for a contribution of the community response to HIV decline in eastern Zimbabwe?

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          Abstract

          Membership of indigenous local community groups was protective against HIV for women, but not for men, in eastern Zimbabwe during the period of greatest risk reduction (1999–2004). We use four rounds of data from a population cohort to investigate: (1) the effects of membership of multiple community groups during this period; (2) the effects of group membership in the following five years; and (3) the effects of characteristics of groups hypothesised to determine their effect on HIV risk. HIV incidence from 1998 to 2003 was 1.18% (95% CI: 0.78–1.79%), 0.48% (0.20–1.16%) and 1.13% (0.57–2.27%), in women participating in one, two and three or more community groups at baseline versus 2.19% (1.75–2.75%) in other women. In 2003–2005, 36.5% (versus 43% in 1998–2000) of women were members of community groups, 50% and 56% of which discussed HIV prevention and met with other groups, respectively; the corresponding figures for men were 24% (versus 28% in 1998–2000), 51% and 58%. From 2003 to 2008, prior membership of community groups was no longer protective against HIV for women (1.13% versus 1.29%, aIRR = 1.25; p = 0.23). However, membership of groups that provided social spaces for dialogue about HIV prevention (0.62% versus 1.01%, aIRR = 0.54; p = 0.28) and groups that interacted with other groups (0.65% versus 1.01%, aIRR = 0.51; p = 0.19) showed non-significant protective effects. For women, membership of a group with external sponsorship showed a non-significant increase in HIV risk compared to membership of unsponsored groups (adjusted odds ratio = 1.63, p = 0.48). Between 2003 and 2008, membership of community groups showed a non-significant tendency towards higher HIV risk for men (1.47% versus 0.94%, p = 0.23). Community responses contributed to HIV decline in eastern Zimbabwe. Sensitive engagement and support for local groups (including non-AIDS groups) to encourage dialogue on positive local responses to HIV and to challenge harmful social norms and incorrect information could enhance HIV prevention.

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          Bowling alone

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            Bowling Alone : The Collapse and Revival of American Community

            Once we bowled in leagues, usually after work; but no longer. This seemingly small phenomenon symbolizes a significant social change that Robert Putnam has identified and describes in this brilliant volume, "Bowling Alone." <p> Drawing on vast new data from the Roper Social and Political Trends and the DDB Needham Life Style -- surveys that report in detail on Americans' changing behavior over the past twenty-five years -- Putnam shows how we have become increasingly disconnected from family, friends, neighbors, and social structures, whether the PTA, church, recreation clubs, political parties, or bowling leagues. Our shrinking access to the "social capital" that is the reward of communal activity and community sharing is a serious threat to our civic and personal health. <p> Putnam's groundbreaking work shows how social bonds are the most powerful predictor of life satisfaction. For example, he reports that getting married is the equivalent of quadrupling your income and attending a club meeting regularly is the equivalent of doubling your income. The loss of social capital is felt in critical ways: Communities with less social capital have lower educational performance and more teen pregnancy, child suicide, low birth weight, and prenatal mortality. Social capital is also a strong predictor of crime rates and other measures of neighborhood quality of life, as it is of our health: In quantitative terms, if you both smoke and belong to no groups, it's a close call as to which is the riskier behavior. <p> A hundred years ago, at the turn of the last century, America's stock of social capital was at an ebb, reduced by urbanization, industrialization, and vast immigration thatuprooted Americans from their friends, social institutions, and families, a situation similar to today's. Faced with this challenge, the country righted itself. Within a few decades, a range of organizations was created, from the Red Cross, Boy Scouts, and YWCA to Hadassah and the Knights of Columbus and the Urban League. With these and many more cooperative societies we rebuilt our social capital. <p> We can learn from the experience of those decades, Putnam writes, as we work to rebuild our eroded social capital. It won't happen without the concerted creativity and energy of Americans nationwide. <p> Like defining works from the past that have endured -- such as "The Lonely Crowd" and "The Affluent Society" -- and like C. Wright Mills, Richard Hofstadter, Betty Friedan, David Riesman, Jane Jacobs, Rachel Carson, and Theodore Roszak, Putnam has identified a central crisis at the heart of our society and suggests what we can do.
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              Health by association? Social capital, social theory, and the political economy of public health.

              S Szreter (2004)
              Three perspectives on the efficacy of social capital have been explored in the public health literature. A "social support" perspective argues that informal networks are central to objective and subjective welfare; an "inequality" thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a "political economy" approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state-society relations to public health outcomes.
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                Author and article information

                Journal
                AIDS Care
                AIDS Care
                caic
                AIDS Care
                Taylor & Francis
                0954-0121
                1360-0451
                9 June 2013
                June 2013
                : 25
                : Suppl 1
                : S88-S96
                Affiliations
                [a ] Department of Infectious Disease Epidemiology, Imperial College London, London, UK
                [b ] Biomedical Research and Training Institute, Harare, Zimbabwe
                [c ] Department of Health Promotion and Development, University of Bergen, Bergen, Norway
                [d ] London School of Economics and Political Science, London, UK
                [e ] Zimbabwe National AIDS Council, Harare, Zimbabwe
                [f ] Research Department of Infection & Population Health, University College London, London, UK
                Author notes
                [] Corresponding author. Email: Sajgregson@ 123456aol.com
                Article
                10.1080/09540121.2012.748171
                3687248
                23745635
                6a8e6d5f-c27e-45fc-be8f-d790c8739b1e
                © 2013 The World Bank

                This is an open access article distributed under the Supplemental Terms and Conditions for iOpenAccess articles published in Taylor & Francis journals , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 June 2012
                : 5 November 2012
                Categories
                Research Article

                Sexual medicine
                community response,social capital,community groups,hiv decline,zimbabwe
                Sexual medicine
                community response, social capital, community groups, hiv decline, zimbabwe

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