Looking for strengths in response to AIDS: individual,group and public authority roles in strategy

The HIV/AIDS pandemic is a challenge not only to medical understanding but also to understanding about how society works or can be made to work. New treatment regimes have to be matched with new social organisation. Caring and coping present society‐wide challenges and to the need to reinvent key social institutions in order to respond effectively. Existing studies demonstrate the vulnerability of modern, large‐scale state institutions to loss of knowledge, skill and competence in the face of high attrition rates in their pay role staff. Equally, family and kinship as well as other civil society institutions or ‘traditional’ social structures may be so disrupted by the loss of carers and providers that they cease to generate adequate levels of well‐being and security. The role of key individuals in providing public leadership is recognised but the significance of personal networks in communicating effective messages and mores is more difficult to pin down. Associations and mass movements have emerged that play a vital role in changing social attitudes and behaviour, and social institutions are adapting to the challenge. It appears that diverse social responses are essential, but, I argue, public policy thinking has a ‘centralist’, hierarchical, bias that discourages' sensible thinking about plural, diverse, strategies. This article seeks to develop a way of thinking about strategy, around the idea of institutional competence, to take account of, and be responsive to, diverse social forms and initiatives. Copyright © 2004 John Wiley & Sons, Ltd.