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This article questions the recommendations to 'revive ABC (abstain, be faithful, condomise)' as a mechanism to 'educate' people in South Africa about HIV prevention as the South African National HIV Prevalence, Incidence and Behaviour Survey, 2012, suggests. We argue that ABC was designed as a response to a particular context which has now radically changed. In South Africa the contemporary context reflects the mass roll-out of antiretroviral treatment; significant bio-medical knowledge gains; a generalised population affected by HIV that has made sense of and embodied those diverse experiences; and a government committed to confronting the epidemic. We suggest that the situation can now be plausibly conceptualised as a complex, adaptive epidemiological landscape that could benefit from an expansion of the existing, 'descriptive' prevention paradigm towards strategies that focus on the dynamics of transmission. We argue for this shift by proposing a theoretical framework based on complexity theory and pattern management. We interrogate one educational prevention heuristic that emphasises the importance of risk-reduction through the lens of transmission, called A-3B-4C-T. We argue that this type of approach provides expansive opportunities for people to engage with the epidemic in contextualised, innovative ways that supersede the opportunities afforded by ABC. We then suggest that framing the prevention imperative through the lens of 'dynamic prevention' at scale opens more immediate opportunities, as well as developing a future-oriented mind-set, than the 'descriptive prevention' parameters can facilitate. The parameters of the 'descriptive prevention' paradigm, that maintain - and partially reinforce - the presence of ABC, do not have the flexibility required to develop the armamentarium of tools required to contribute to the management of a complex epidemiological landscape. Uncritically adhering to both the 'descriptive paradigm', and ABC, represents an historically dislocated form of prevention - with restrictive options for reducing the overall burden of HIV-related challenges in South Africa.

The article describes a design journey that culminated in an HIV-Conversant Community Framework that is now being piloted in the Limpopo Province of South Africa. The objective of the initiative is to reduce the aggregate community viral load by building capacity at multiple scales that strengthens peoples' HIV-related navigational skill sets-while simultaneously opening a 'chronic situation' schema. The framework design is based upon a transdisciplinary methodological combination that synthesises ideas and constructs from complexity science and the management sciences as a vehicle through which to re-conceptualise HIV prevention. This resulted in a prototype that included the following constructs: managing HIV-prevention in a complex, adaptive epidemiological landscape; problematising and increasing the scope of the HIV knowledge armamentarium through education that focuses on the viral load and Langerhans cells; disruptive innovation and safe-fail probes followed by th...

This article argues that decision making is a discrete social driver that can be associated with the HIV/AIDS epidemic in the Limpopo province in South Africa. The authors argue that complexity science can inform future research and interventions by presenting two decision making frameworks arising out of complexity science that have the potential to enable young people to better negotiate decision-making contexts whilst simultaneously opening spaces of dialogue that can mitigate the impact of HIV-risk in specific, punctuated contexts. The methodological design was prompted by findings from youth-oriented community engagement projects that include Communication Conversations and Sex & Relationships Education. The proposed methods have the potential to exploit the phenomenon of leadership emergence as a product of decision making at critical moments. This has the potential to promote the growth of home-grown leadership skill sets that make sense to young people and to enable them better manage their own health, thus reducing risk and vulnerability to HIV infection and sexual violence.

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.

The article describes a design journey that culminated in an HIV-Conversant Community Framework that is now being piloted in the Limpopo Province of South Africa. The objective of the initiative is to reduce the aggregate community viral load by building capacity at multiple scales that strengthens peoples' HIV-related navigational skill sets-while simultaneously opening a 'chronic situation' schema. The framework design is based upon a transdisciplinary methodological combination that synthesises ideas and constructs from complexity science and the management sciences as a vehicle through which to re-conceptualise HIV prevention. This resulted in a prototype that included the following constructs: managing HIV-prevention in a complex, adaptive epidemiological landscape; problematising and increasing the scope of the HIV knowledge armamentarium through education that focuses on the viral load and Langerhans cells; disruptive innovation and safe-fail probes followed by the facilitation of path creations and pattern management implementation techniques. These constructs are underpinned by a 'middle-ground' prevention approach which is designed to bridge the prevention 'fault line', enabling a multi-ontology conceptualisation of the challenge to be developed. The article concludes that stepping outside of the 'ordered' epistemological parameters of the existing prevention 'messaging' mind-set towards a more systemic approach that emphasises agency, structure and social practices as a contribution to 'ending AIDS by 2030' is worthy of further attention if communities are to engage more adaptively with the dynamic HIV landscape in South Africa.

This article questions the recommendations to 'revive ABC (abstain, be faithful, condomise)' as a mechanism to educate people in South Africa about HIV prevention as the South African National HIV Prevalence, Incidence and Behaviour Survey, 2012, suggests. We argue that ABC was designed as a response to a particular context which has now radically changed. In South Africa the contemporary context reflects the mass roll-out of antiretroviral treatment; significant bio-medical knowledge gains; a generalised population affected by HIV that has made sense of and embodied those diverse experiences; and a government committed to confronting the epidemic. We suggest that the situation can now be plausibly conceptualised as a complex, adaptive epidemiological landscape that could benefit from an expansion of the existing, descriptive prevention paradigm towards strategies that focus on the dynamics of transmission. We argue for this shift by proposing a theoretical framework based on complexity theory and pattern management. We interrogate one educational prevention heuristic that emphasises the importance of risk-reduction through the lens of transmission, called A-3B-4C-T. We argue that this type of approach provides expansive opportunities for people to engage with the epidemic in contextualised, innovative ways that supersede the opportunities afforded by ABC. We then suggest that framing the prevention imperative through the lens of dynamic prevention at scale opens more immediate opportunities, as well as developing a future-oriented mind-set, than the descriptive prevention parameters can facilitate. The parameters of the descriptive prevention paradigm, that maintain and partially reinforce the presence of ABC, do not have the flexibility required to develop the armamentarium of tools required to contribute to the management of a complex epidemiological landscape. Uncritically adhering to both the descriptive paradigm, and ABC, represents an historically dislocated form of prevention with restrictive options for reducing the overall burden of HIV-related challenges in South Africa.

This article argues that decision making is a discrete social driver that can be associated with the HIV/AIDS epidemic in the Limpopo province in South Africa. The authors argue that complexity science can inform future research and interventions by presenting two decision making frameworks arising out of complexity science that have the potential to enable young people to better negotiate decision-making contexts whilst simultaneously opening spaces of dialogue that can mitigate the impact of HIV-risk in specific, punctuated contexts. The methodological design was prompted by findings from youth-oriented community engagement projects that include Communication Conversations and Sex & Relationships Education. The proposed methods have the potential to exploit the phenomenon of leadership emergence as a product of decision making at critical moments. This has the potential to promote the growth of home-grown leadership skill sets that make sense to young people and to enable them better manage their own health, thus reducing risk and vulnerability to HIV infection and sexual violence.

Introduction: UNAIDS' Vision 90:90:90 is a call to 'end AIDS'. Developing predictive foresight of the unpredictable changes that this journey will entail could contribute to the ambition of 'ending AIDS'. There are few opportunities for managing unpredictable changes. We introduce 'weak signal detection' as a potential opportunity to fill this void. Method: Combining futures and complexity theory, we reflect on two pilot case studies that involved the Archetype Extraction technique and the SenseMaker w Collector TM tool. Results: Both the piloted techniques have the potentials to surface weak signals, but there is room for improvement. Discussion: A management response to a complex weak signal requires pattern management, rather than an exclusive focus on behaviour management. Conclusion: Weak signal detection is a window of opportunity to improve resilience to unpredictable changes in the HIV/AIDS landscape that can both reduce the risk that emerges from the changes and increase the visibility of opportunities to exploit the unpredictable changes that could contribute to 'ending AIDS'.

The purpose of this article is to describe the different dimensions of the community-university interactions that emanated from a Community Engagement Audit which was undertaken at the University of Limpopo (UL) in 2014. The Audit methodology followed a quantitative survey research approach. A sample of 278, out of a population of 559 academic staff at UL that included 196 with PhDs and 363 without PhDs, participated in the study. SPSS was used to compute factor analysis. The results indicated the dominant partners that faculties interact with across the spheres of engaged scholarship were multinational companies, small, medium and micro-enterprises, national regulatory and advisory and sectorial organisations. The types of relationship with external social actors were contract research, continuing education and collaborative research and development projects. Channels of information were popular publications, public conferences, seminars or workshops, oral or written testimony or advice prominent. The outputs were new or improved products/processes, scientific discoveries and community infrastructure and facilities. The outcomes and benefits were regional development, improved quality of life for individuals and communities and research focus and research projects, theoretical and methodological development in an academic field, academic and institutional reputation. The main constrains experienced during engagement are lack of academic resources and institutional support and relationships with external social partners. The results provide guiding parameters to improve the scale and reach of CE at the UL and a snapshot of the architecture and terrain of engaged scholarship at a rural-based HEI in South Africa.

UNAIDS' Vision 90:90:90 is a call to 'end AIDS'. Developing predictive foresight of the unpredictable changes that this journey will entail could contribute to the ambition of 'ending AIDS'. There are few opportunities for managing unpredictable changes. We introduce 'weak signal detection' as a potential opportunity to fill this void. Combining futures and complexity theory, we reflect on two pilot case studies that involved the Archetype Extraction technique and the SenseMaker(®) Collector(™) tool. Both the piloted techniques have the potentials to surface weak signals - but there is room for improvement. A management response to a complex weak signal requires pattern management, rather than an exclusive focus on behaviour management. Weak signal detection is a window of opportunity to improve resilience to unpredictable changes in the HIV/AIDS landscape that can both reduce the risk that emerges from the changes and increase the visibility of opportunities to exploit the unpredictable changes that could contribute to 'ending AIDS'.

This article reports on the first twelve months of a pilot study that was designed to improve community responses to HIV/AIDS in rural South Africa. The framework was designed to enable the modification of emergent attractor landscapes. Specifically, we report on the introduction of a primary probe; the secondary, community initiated probes and the attractors that emerged through the process. Probes were designed to stimulate frame changes amongst participants that would influence social practices. Attractors represent the empirically visible culmination of discrete patterns that influence the dynamic landscape. Managing or modifying these patterns, thus changing the landscape, including social practices, is the principle that underpins the framework. The findings were analysed using a qualitative methodology called causal layered analysis. Six attractors emerged that contribute to reducing the aggregate community viral load, and three attractors emerged that detract from that ambit...

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.

This article emphasises that when working with complex adaptive systems it is possible to stimulate new social practices and/or cognitive perspectives that contribute to risk reduction, associated with reducing aggregate community viral loads. The process of achieving this is highly participatory and is methodologically possible because evidence of 'attractors' that influence the social practices can be identified using qualitative research techniques. Using findings from Limpopo Province, South Africa, we argue that working with 'wellness attractors' and increasing their presence within the HIV/AIDS landscape could influence aggregate community viral loads. While the analysis that is presented is unconventional, it is plausible that this perspective may hold potential to develop a biosocial response - which the Joint United Nations Programme on HIV and AIDS (UNAIDS) has called for - that reinforces the biomedical opportunities that are now available to achieve the ambition of ending AIDS by 2030.

This article focuses on the utility of a knowledge management heuristic called the Cynefin framework, which was applied during an ongoing pilot intervention in the Limpopo province, South Africa. The intervention aimed to identify and then consolidate low-cost, innovative bio-social responses to reinforce the biomedical opportunities that now have the potential to "end AIDS by 2030″. The Cynefin framework is designed to enable leaders to identify specific decision-making domain typologies as a mechanism to maximise the effectiveness of leadership responses to both opportunities and challenges that emerge during interventions. In this instance the Cynefin framework was used to: (1) provide an indication to the project managers whether the early stages of the intervention had been effective; (2) provide the participants an opportunity to identify emergent knowledge action spaces (opportunities and challenges); and (3) categorise them into appropriate decision-making domains in preparation for the next phases of the intervention. A qualitative methodology was applied to collect and analyse the findings. The findings indicate that applying the Cynefin framework enabled the participants to situate knowledge action spaces into appropriate decision-making domains. From this participatory evaluation a targeted management strategy was developed for the next phases of the initiative. The article concludes by arguing that the Cynefin framework was an effective mechanism for situating emergent knowledge action spaces into appropriate decision-making domains, which enabled them to prepare for the next phases of the intervention. This process of responsive decision making could have utility in other development related interventions.