title: The impact of aid chains: relations of dependence or supportive partnerships for community-led responses to HIV/AIDS?
abstract: In the context of increasing global emphasis on partnerships between international, governmental and civil society organisations in the distribution of international aid, this paper examines the ways in which the resulting aid chains promote and undermine community-led responses to HIV/AIDS. The impact of the aid-granting system is examined using an ethnographic case study of an HIV/AIDS prevention programme with Cambodian military families. The case study draws on observations of stakeholder meetings and programme activities, interviews with stakeholders (the donor, NGOs and military community) and textual materials (programme guidelines, policies and reports). Campbell et al.'s interrelated concepts of relational, symbolic and material context are used to frame the analysis. The establishment of a relationship with a more powerful international NGO is shown to be beneficial to the military community and civil society groups. The international NGO uses its significant material and economic leverage to improve the community's relational context (by ensuring the support of the military high command), symbolic context (by strengthening the position of community and civil society partners in relation to government bodies) and material context (through increasing access to health services). However, material and symbolic asymmetries between partners in the aid chain persist, curtailing the community's involvement and leadership. At the material and relational levels, the hierarchical flow of aid encourages accountability to the demands of the donor while excluding grassroots groups from directly accessing funding. At the symbolic level, problem-focused representations of the military further reinforce the community's position as recipients of intervention, which undermines recognition for the community's knowledge, strengths and right to fully participate. Thus while aid chains can be supportive of community-led responses, this analysis highlights how the structures and dynamics of international aid continue to position marginalised communities as recipients, not leaders, of HIV/AIDS programmes, raising particular dilemmas for intermediary international NGOs.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK. emmilie_may@yahoo.co.uk
authors.forename: E L
authors.initials: EL
authors.lastname: Aveling
mesh_terms: D002160:Cambodia; D019058:Community Networks / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007373:Interinstitutional Relations; D007391:International Cooperation; D014837:Voluntary Health Agencies / Q000458:organization & administration