HIV research impact: the quest for a helix

The ability to prove that research has impact is increasingly important, especially for donor-funded research. This growing emphasis is fuelled by the need for research to be relevant for the purposes of learning, accountability and to demonstrate the value of research investments (Sumner & Jones, 2008). HIV research impact refers to the tangible, beneficial societal changes stemming from changes in HIV prevention policy, programmes and practice as a result of HIV research (Morton, 2015). There is growing recognition in international development that research is never purely an academic exercise. Research should provide evidence that can be used to strengthen policy and programming for vulnerable populations, building policies and programmes that are informed by evidence because this will improve the lives of citizens. Publishing does not equate to research impact and more is needed to ensure that evidence is put into action (Waddell, 2001). Evidence into action (EiA) is a process that requires engagement with the right kind of influential stakeholders. This engagement should happen early in the research process, it should be done in a responsible manner, with good quality research processes, and it should happen continuously throughout the research continuum. The process of evidence making should be leveraged at key stages of the research continuum and engagement with carefully selected stakeholders should happen at each of these stages. By the time the results are published and disseminated, initial results from the engagement can be harvested as the ground has been prepared for evidence into action (EHPSA, forthcoming). Evidence use in HIV prevention policymaking is a fraught terrain, which draws out some of the most fundamental questions about the relationship between research and policy (EHPSA & INASP, forthcoming). Many health issues, particularly those connected to sexuality, represent the intersection of a wide range of disciplines, social norms, stereotypes and societal beliefs and values (Sumner & Jones, 2008). This makes HIV prevention policymaking a particularly complex area involving diverse stakeholders each pushing their own agenda and utilizing, often contradictory, evidence in the debates (Broadbent, 2012). Ensuring research impact in a politically sensitive environment, such as HIV prevention, requires an understanding of the policymaking dynamics. There is a well-developed body of knowledge on political decision making, which indicates that researchers and policy makers operate with different values, languages, time-frames, reward systems and professional ties (Caplan, 1979; Boshoff, 2013). Writers have identified four “competing rationalities”, which policy makers must balance to make decisions – technical, political, cultural and social (Lin, 2003; Larkin, 2006). technical rationality refers to research evidence; evidence that could be explicit knowledge, values and intentions which underlie the use of information. Political rationality is concerned with the distribution and management of power and the creation of legitimacy, which included accountability and transparency. Cultural rationality is about values, ethics and societal opinions and social rationality includes the way policy makers see and know the world, which may differ according to gender, class, age, ethnicity and place. Ultimately, decisions around HIV prevention policy are made by individuals, but individuals function in a complex organizational system. For evidence to find its way into action, there needs to be a thorough understanding of the rationalities and how they can be balanced to enable the correct decisions to be made. Context clearly matters for evidence into action approaches to be successful (Weyrauch, Echt, & Suliman, 2016). Efforts to ensure HIV prevention evidence is put into action have never been straightforward. Yet, HIV researchers have successfully navigated this landscape for decades through an HIV movement, which created a rather unique alliance between activism, evidence and delivering social justice (EHPSA, 2017). In literature (Kahn, 2016), this alliance is described as an innovation system and more recently, the term “quadruple helix” has been introduced (Fuzi, 2013; Arnkil, Järvensivu, Koski, & Tatu, 2010), allowing for a more complete understanding of the innovation process, emphasizing local context, in the larger world system. Combining the evidence base with real world experience indicates that effective Evidence into Action for HIV hinges on the successful creation of a “quadruple helix”, involving civil society actors, HIV researchers, business, and government. The onus should be placed on all actors to engage each other and ensure that populations outside the helix benefit from the innovations created within the helix.