The Impact of HIV and AIDS Research: A Case Study from Swaziland

From a special Supplement, Strengthening the Research to Policy and Practice Interface: Exploring Strategies Used by Research Organisations Working on Sexual and Reproductive Health and HIV/AIDS, of the journal Health Research Policy and Systems (HARPS), produced by the Sexual Health and HIV Evidence into Policy (SHHEP) initiative, this research document analyses the impact of research results reported in the October 2007 document, ‘Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era’, (hereafter called ‘Reviewing Emergencies’), which was published, distributed, and disseminated. In June 2008, the impact of the work was evaluated and is the subject of this article.

"The report spoke to two audiences. For Swazi’s it confirmed that AIDS was indeed having a devastating effect on their nation. The same message was aimed at the international community. However it also urged the latter to re-examine the HIV and AIDS epidemic. It sought to broaden the traditional consensus on what constitutes an emergency to include ‘long-wave emergencies’."

The assessment objectives were:

• Document the creation and dissemination of the report;

• Identify and explain its impact;

• Identify any barriers and/or limitations to its impact;

• Draw lessons for maximising the impact of future research.

In the section entitled “The significance of communication", respondents cited the significant impact of use of graphs and charts and the use of demographic implications of the HIV and AIDS epidemic on the Swazi population. "The application of Swaziland’s HIV prevalence rate to western countries, in Table 2 (page 8) of the report ‘stuck’ with some This table shows if the UK [United Kingdom] had the equivalent burden there would be nearly 11.5 million British citizens infected. When presenting these data, it would be tailored to the audience -  for example talking in Sweden the presenter said ‘Swaziland’s prevalence would be equivalent to 1.75 million Swedes being infected’."

Impact was enhanced by planned methods of dissemination: "The communication and advocacy efforts surrounding a message help facilitate impact and are important to understanding where, how and why impact was achieved. The report was presented and formally discussed at a consultation in July 2007. It was available in print from October 2007, and a core set of power point slides was developed and presented to a range of organisations inside and beyond Swaziland. The audiences included civil servants, politicians, the donor community, NGOs [non-governmental organisations], academics and businesses."

The authors of "Reviewing Emergencies" had long-term involvement in research in Swaziland as head of organisations working on the HIV epidemic; hence, "...the report was disseminated into a receptive network of researchers, policymakers and associates with whom HEARD [Health Economics and HIV/AIDS Research Division] and NERCHA [National Emergency Response Council on HIV/AIDS in Swaziland] had established links."

Among conclusions about the importance of context, timing, and credibility of evidence and investigators, the authors draw from the assessment the following lessons: "Communication is critical. The original work - collecting existing data to tell one clear story - is a striking way to demonstrate the reach and scale of disease impact; the demographic implications of AIDS powerfully communicated the severity of the epidemic; a targeted, tailored and cohesive dissemination effort helped facilitate the impact of research; sustained advocacy which is vital in keeping momentum for a message, should be reflected in planning and resources; further publications validating and extending a message are a good way to do this; and terminology can help or hinder the impact of a message....An assessment should ideally be planned in advance, facilitating the process of ‘tracking’ and information gathering; careful attention should be paid to the measurement and analysis process - if basing the study on qualitative data, how will this be analysed and how will the effects of bias be mitigated; the ‘net should be cast wide’ when considering areas of potential impact, recognising both the multiplicity of policy players and the potential for unintended impacts; understand that impacts may also change over time; and ultimately, to understand why an impact took place, the socio-cultural, political and economic context must be considered. "