Civil society based health programmes may use more rights-driven approaches, which can challenge health service roles and performance. Hence, for example, trade unions taking up issues of HIV/AIDS have not limited themselves to education programmes for their members using information provided by the health sector. They have also taken up the issues of employment rights and job security for people with HIV/AIDS, raising questions about how medical confidentiality is being managed by health services in employment settings (OATUU & Loewenson, 1997). These interactions are not without friction, and there is a role for mediation between bureaucratic administrations and medical professionals within health services and the wider spectrum of actors and styles of work found in the community.

As noted in this case study, civil society organizations as secondary stakeholders sometimes take on this very role of mediator.