IT IS THE time of year when organisations are winding down and we all look forward to a break from busy schedules and pressing responsibilities at work. While many of us are fortunate enough to enjoy spending time with loved ones and can do so in the comfort of our homes or holiday destinations, for others this time of year is particularly difficult. Not only is this a period when those who are no longer with us are often most acutely missed, it is also the time when poverty and disparities are most obviously felt. As window displays and adverts entice us to spend, spend, spend, let's remember those who hardly have enough to make this season special in any way.
Isandla Institute wishes all of you a good holiday season and we look forward to engaging with you in 2006.
In this month when we focus more than usual on HIV/AIDS, Stacey-Leigh Joseph, Isandla Institute's Policy Researcher on HIV/AIDS in the City, has made a fitting contribution to the public debate in Thought Matters.
Local government and HIV/AIDS: Making a case for a developmental perspective
By Stacey-Leigh Joseph
SOUTH AFRICA HAS one of the fastest growing HIV/AIDS epidemics in the world and yet, strategies for prevention and treatment in this country remain highly contested. It is alarming that in South Africa where at least 5.5 million or 11.7 % of a population of 47 million are infected with the virus, the message from the national government continues to focus on ABC (abstain, be faithful and condomise). South Africa's Deputy President, in her speech on World AIDS day repeatedly emphasised that it is the responsibility of people, particularly young people, to delay sexual activity as this played a large role in the high infection rate amongst young South Africans. During her speech, she also rightly acknowledged the important link between gender violence and HIV infection and the role played by social factors like unequal gender and sexual relations that make women and children vulnerable to the disease. Finally, she acknowledged that poverty increased vulnerability and susceptibility to contracting the virus. However, despite acceding to the fact that poverty and lack of service delivery is a major problem, the Deputy President failed to provide an adequate plan for how government would attempt to address these issues of vulnerability and susceptibility experienced by particularly poor South Africans.
The HIV/AIDS infection rate in South Africa has grown at alarming rates during the past 10 years and it is clear that there is an urgent need for more to be done and for current policies regarding HIV/AIDS to be re-evaluated. While there has been recognition of the extended role to be played by all government departments, nationally, provincially and locally, this is not always carried out in practice. For example, the National Department of Health's Strategic Plan for 2000-2005 recognizes that certain socio-economic indicators predispose people to HIV transmission and that the responsibility for HIV/AIDS prevention should be extended to all government departments and their partners. However, South Africa's current HIV/AIDS strategy continues to have a specifically health and prevention oriented focus at the expense of an effective multi-sectoral strategy that involves all sectors of government.
Local government in particular has an important role to play in terms of addressing development backlogs which have been instrumental in increasing vulnerability and susceptibility to the disease among the poor and those living on the margins of society. For example, lack of access to basic services like housing, water and sanitation, and electricity not only means that the poor and marginalised are at increased risk of contracting HIV, but also that they do not possess the necessary resources to deal with the impact of full blown AIDS. In a country where a large proportion of citizens continue to lack basic services and where high levels of poverty, inequality and unemployment persist, an effective HIV/AIDS strategy requires a nuanced approach. In order for such an approach to succeed, the epidemic can no longer merely be seen as a health issue or as the responsibility of the individual. Instead, factors such as the rate of poverty, which affects people's ability to maintain healthy lifestyles, poor living conditions and lack of adequate shelter as well as the unequal status of women in society, all point to the fact that HIV/AIDS is a development issue. While it is important to keep in mind that this epidemic is not exclusive to the vulnerable and marginalised in society, it is clear that they continue to be most adversely affected.
However, current responses from local government have been ineffective and its inability to implement a holistic approach, which sees underdevelopment and inequality as major contributors to HIV infections, could be perceived as a principal reason why South Africa continues to have such a high rate of new HIV infections and why thousands continue to die of the disease. This lack of adequate engagement at the local level can largely be explained by ineffective leadership from national government on this issue.
In order to develop effective mechanisms to address HIV/AIDS, all spheres of government should consider HIV/AIDS when carrying out their everyday work. This process is known as mainstreaming which essentially means that government departments need to implement a comprehensive and expanded response to the epidemic, both internally and externally, even when their core business does not seem directly related to HIV/AIDS. For example, when municipalities produce their Integrated Development Plans (IDPs), it is essential that consideration is taken of how the provision of services like water and sanitation or transport affects the day to day lives of citizens. This means that they have to assess whether or not susceptibility increases because people have to make use of standpipes that are in areas where there is no effective lighting and where they are at risk of being attacked. It is particularly relevant in terms of addressing the risk for women and children as they are most likely to carry the responsibility for household chores like water collection. At the same time, municipalities should also ensure that employees, through their day to day work, are not placed in a vulnerable position for contracting the disease.
It is crucial to note that the above example addresses susceptibility to HIV infection but that departments should also have strategies to deal with the disease at the different levels of progression from HIV to AIDS. For example, where someone has developed full blown AIDS, the availability of adequate water and sanitation is essential and in this instance municipalities should ensure that people have a reliable source of clean and safe water.
In terms of local government responses to the epidemic, only a small number of municipalities have begun to move toward the approach outlined above. As one of these municipalities, the City of Cape Town has introduced its HIV/AIDS/TB Multi-Sectoral Strategy. While this is a promising initiative on the part of the City, a recent study by Isandla Institute has shown that there continues to be a number of challenges faced by the City in its attempts to mainstream HIV/AIDS. A crucial finding has been the inability of staff across all departments to understand that HIV/AIDS impacts their day to day running and that an effective response means more than targeted awareness raising interventions. These issues are not unique to the City of Cape Town and it is imperative that all departments in municipalities begin to develop responses that incorporate HIV/AIDS into their planning. In addition, national government should recognise the need to move away from a prevention strategy that places too much emphasis on the role of the individual to protect him/herself and a treatment strategy that is primarily informed by a health perspective. While treatment and prevention strategies are very important, it has become increasingly clear that unless government and society see HIV/AIDS as an issue of underdevelopment, inequality and poverty, many people will continue to be infected and affected by the disease.