title: Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa.
abstract: OBJECTIVE
  Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa.
  
  
  METHODS
  The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews.
  
  
  RESULTS
  We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV.
  
  
  CONCLUSIONS
  Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation.
authors.affiliation: University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America.
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Lippman
authors.affiliation: University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: Treves-Kagan
authors.affiliation: University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Gilvydis
authors.affiliation: University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
authors.forename: Evasen
authors.initials: E
authors.lastname: Naidoo
authors.affiliation: University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Khumalo-Sakutukwa
authors.affiliation: University of California San Francisco, Center for AIDS Prevention Studies, San Francisco, California, United States of America.
authors.forename: Lynae
authors.initials: L
authors.lastname: Darbes
authors.affiliation: University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
authors.forename: Elsie
authors.initials: E
authors.lastname: Raphela
authors.affiliation: University of Washington, International Training and Education Center for Health (ITECH) - South Africa, Pretoria, South Africa.
authors.forename: Lebogang
authors.initials: L
authors.lastname: Ntswane
authors.affiliation: University of Washington, International Training and Education Center for Health, Seattle, Washington, United States of America.
authors.forename: Scott
authors.initials: S
authors.lastname: Barnhart
mesh_terms: D015658:HIV Infections / Q000517:prevention & control*; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care; D011314:Preventive Health Services / Q000379:methods* / Q000592:standards; D015397:Program Evaluation / Q000592:standards / Q000706:statistics & numerical data*; D013019:South Africa