As we enter the second-generation period of the HIV/AIDS epidemic, the principal approaches to  dealing with it in Canada are vastly different now from what they were at the onset. In the 20 or so years of Canadian involvement in HIV/AIDS issues, the epidemic has greatly evolved: treatments have improved, people are living longer, the virus has mutated and a wider variety of people are infected or affected. Despite this evolution, Canada's community-based response has not progressed at the same pace and is becoming increasingly obsolete. More and more, HIV/AIDS is considered a chronic illness and complacency has settled in. While we need to be thinking more about future responses to HIV/AIDS, activist approaches, which are reactive in nature, are still those used to effect change. A shift to a future-based approach is required and that shift is advocacy. Within the wider community, however, the concepts of activism and advocacy are often used interchangeably. In reality, activism and advocacy should be viewed as two distinct elements of an organisation's mobilisation and awareness strategies; resources, spokespeople and messages should be earmarked for both.

Activism vs. advocacy

Activism is defined as theory, doctrine, or practice of assertive, often militant action, such as mass demonstrations or strikes, used as a means of opposing or supporting a controversial issue, entity, or person. Activist methods are direct, noticeable, public and militant. They are used to call attention to an issue and often to shame, embarrass and create negative public opinion toward people with decision-making authority.
Advocacy, on the other hand, is the process of committing continuous, proactive support to an idea, person, or cause to bring about sustainable, long-term change. Advocacy seeks to bring about immediate changes to ensure a responsive strategy for emerging or potential challenges.

At the beginning of the AIDS crisis in North America,  AIDS was generally referred to as "the gay plague" and because the epidemic primarily affected gay men, initial official response was slow. The gay rights movement undertook an activist approach, drawing attention to the disease and organising a community-based response. Although the situation is not perfect, activism successfully corrected past wrongs. HIV awareness is high and Canadian PLWHAs benefited from sustained funding.

The role for advocacy

The next step in Canada's response strategy to HIV/AIDS is to aim for long-term, integrated, sustainable, institutional change. The community can be most effective in this area in the coming years. Achieving this, however, requires lobbying, negotiating, deal brokering, collaborating and co-ordinating by a variety of players. Sustainable change cannot be achieved by protest or scathing media commentary. To effect change, people must negotiate to  reach  consensus -- an entirely different approach from activism.

An effective transition to greater use of advocacy approaches could be the catalyst for:

• Establishing a 5- or 10-year vision of where Canada wants to be in the fight against HIV/AIDS
• Developing a national rehabilitation strategy for PLWHAs
• Involving a critical mass of people in  community-based response to HIV/AIDS to advocate for the integration of the disease into broader gay men's health issues
• Delivering AIDS Service Organisation (ASO) HIV/AIDS training to relevant organisations such as rape crisis centres, substance abuse recovery clinics and homeless shelters
• Collaborating and funding non-traditional partners such as reproductive health organisations or local charities who wish to deliver HIV/AIDS services to emerging client bases and
• Integrating complementary therapies into AIDS treatment regimens.

Activism and advocacy are two distinct beasts and both are required for the success of the community-based response. Nevertheless, a balance needs to be achieved. If an organisation adopts both approaches, it must recognise that activism is good in certain circumstances and advocacy is more appropriate at another time. Organisations should perceive activism and advocacy as two distinct elements of their mobilisation and awareness agendas.
The HIV/AIDS epidemic is in a constant state of flux and has no ethics, morals or conscience. It is not prepared to wait until the community is ready in order to shift to advocacy. The key to a successful community response to the epidemic is the community's ability to catch up to it and get (and remain) one step ahead of it. For this to happen, the structures and approaches currently favoured by community-based organisations (CBOs) have to change dramatically. Without change, two principal consequences are likely to occur: 1) current CBOs will become more and more irrelevant and new groups with more appropriate responses will threaten their survival; and 2) the transition period from the decline of the old to the emergence of the new will create an opportunity for the epidemic to proliferate, virtually unchallenged, resulting in waves of new infections in various population groups.