This thesis reports on a process of developing a new approach called the "Local Responses to HIV/Aids" undertaken in Gaoua District, Burkina Faso, between 1997 and 2000. It focuses on how communities, and organisations from the public and other sectors (voluntary, non and for profit, Churches) can develop more effective responses to HIV/Aids in their settings.

The study described in this thesis aims: first, to improve the knowledge and gaps of how to plan and implement HIV/Aids strategies in rural settings in Africa by testing an approach called the Local Responses; second, to document critically a three years process, including some early results.

The research objectives were:

- first, to develop a rapid appraisal method which can be a resource for district and communities to circumscribe their needs in relation to HIV/Aids,

- second, to carry out situation analyses at the community and district levels,

- third, to apply the findings to improve responses, and

- finally, to assess the results, including the lessons learnt from using this approach for national and international implications.

The method used is based on health systems research with a pre-experimental before and after prospective intervention study.

The study gives evidence of the importance of carrying out situation analyses for HIV/Aids (baseline, 1997) both at the community and district levels. Based on the findings of the analyses a consensus-building was reached on a common vision to address the epidemic with all key partners from the District, including community representatives. In complement to the existing prevention strategies, the much needed care and counselling and psycho-social support components were identified as neglected up to now, and future priority areas. I document the development of a new organisational tool called the Rapid Organisational Review (ROR). Finally, despite the strengths of this approach, the applications and limitations are presented using the case of migrants as a specific vulnerable group.

Six months of implementation of the Local Responses (2nd semester 1999) are sufficient to document already substantial results:

- The partnerships of non-health public sectors (i.e. Education, Agriculture etc.) and non-governmental partners (i.e. Churches, traditional authorities), and local Associations (Community-Based Organisations of different nature) have increased tremendously.

- Some vulnerable groups (e.g. youth, prisoners) are now addressed specifically.

- Geographic coverage has increased in the District, both in towns and rural areas.

- A massive number of agents of change have been trained for some in HIV prevention from the different local Associations, and others in care and counselling.

- The District of Gaoua and Poni Province have now a locally owned Technical Committee and Provincial Committee who co-ordinate the process locally.

The study reports on some of the national and international positive direct benefits of the "Local Responses" as well.

The study concludes that despite its positive overall outcomes, and its potential in the decades ahead, many issues related to methods used for Local Responses, to the policies, and to the research still need to be addressed in order for this approach to become more broadly known, credible, and sustainable.