The process of developing distributed-efficacy and social practice in the context of ‘ending AIDS’

Introduction: this article reflects on data that emanated from a programme evaluation and focuses on a concept we label ‘distributed-efficacy’. We argue that the process of developing and sustaining ‘distributed-efficacy’ is complex and indeterminate, thus difficult to manage or predict. We situate the discussion within the context of UNAIDS’ recent strategy — Vision 95:95:95 — to ‘end AIDS’ by 2030 which the South African National Department of Health is currently rolling out across the country. Method: A qualitative method was applied. It included a Value Network Analysis, the Most Significant Change technique and a thematic content analysis of factors associated with a ‘competent community’ model. During the analysis it was noticed that there were unexpected references to a shift in social relations. This prompted a re-analysis of the narrative findings using a second thematic content analysis that focused on factors associated with complexity science, the environmental sciences and shifts is social relations. Findings: the efficacy associated with new social practices relating to HIV risk-reduction was distributed amongst networks that included mother—son networks and participant—facilitator networks and included a shift in social relations within these networks. Discussion: it is suggested that for new social practices to emerge requires the establishment of ‘distributed-efficacy’ which facilitates localised social sanctioning, sometimes including shifts in social relations, and this process is a ‘complex’, dialectical interplay between ‘agency’ and ‘structure’. Conclusion: the ambition of ‘ending AIDS’ by 2030 represents a compressed timeframe that will require the uptake of multiple new bio-social practises. This will involve many nonlinear, complex challenges and the process of developing ‘distributed-efficacy’ could play a role in this process. Further research into the factors we identified as being associated with ‘distributed-efficacy’ — relationships, modes of agency and shifts in social relations — could add value to achieving Vision 95:95:95