A TALE OF 2 (LOW-PREVALENCE) CITIES - SOCIAL-MOVEMENT ORGANIZATIONS AND THE LOCAL-POLICY RESPONSE TO HIV AIDS/

In the field of HIV/AIDS, social movement organisations (SMOs) have be en identified as powerful potential catalysts for change through their impact on formal organisational structures and the policy process. In addition, they have the capacity to be important providers of service s in their own right, through the community resources they are capable of mobilising. In the United Kingdom, however, their role in policy f ormation is disputed. Previous studies have concluded that they have b een most influential at national policy and ward level. At the level o f local policy making, their influence has been found to be patchy and confined largely to securing recognition of HIV as an issue. Most pre vious research has, however, been conducted in high prevalence, metrop olitan settings with functional SMOs. This paper presents the results of a comparative case study of two neighbouring provincial low prevale nce district health authorities (HAs) in England. We describe the chan ging national policy context from 1986 to 1995 and use a strategic cha nge model to analyse the local development of care and treatment servi ces for people with HIV/AIDS, in particular the relationship between S MOs and HAs. Despite being demographically, socioeconomically and epid emiologically similar, and sharing an identical national policy framew ork, the two districts demonstrate completely divergent organisational responses to the HIV/AIDS epidemic. We conclude that the level of pri or social movement mobilisation and the degree of receptivity for chan ge within the HA are the key variables for explaining variations in th e scale of strategic change observed in the two districts. Crown copyr ight (C) 1998 Published by Elsevier Science Ltd. All rights reserved.