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HIV/AIDS and Municipalities

What is in this guide

  1. Why should municipalities address HIV/AIDS
  2. Important facts to know about HIV/AIDS
  3. The impact of HIV/AIDS on local communities and municipalities
  4. How to respond to HIV/AIDS
  5. The government’s five-year strategy on HIV/AIDS
  6. How to develop a local strategy on HIV/AIDS
  7. How to run AIDS campaigns and projects
  8. Motivating other people to get involved

  1. Why should municipalities address HIV/AIDS?

HIV/AIDS is one of the biggest challenges we face as a country. The rate of infection is rapidly increasing and more and more people are getting ill and dying from AIDS. Of all the people living with AIDS in the world, seven out of every ten live in Sub-Saharan Africa. South Africa has one of the fastest growing rates of infection in the world.

Government together with welfare and other organisations has started to respond to the AIDS crisis, but without a coherent and collective approach at local level their efforts will not achieve as much as it could. Municipalities are ideally placed to play the coordinating and facilitating role that is needed to make sure that partnerships are built to bring prevention and care programmes to every community affected by AIDS. A local municipality is the sphere of government closest to the people and local councillors are the politicians directly elected to serve local communities. The impact of AIDS is increasing and will continue to do so over the next few years. Municipalities need a coherent strategy that brings together leaders of all sectors of the community, service providers and welfare organisations to halt the spread of AIDS and to provide care for people living with AIDS and their families.

Individuals, families and communities are badly affected by the epidemic. The burden of care falls on the families and children of those who are ill. Often they have already lost a breadwinner and the meagre resources they have left are not enough to provide care for the ill person and food for the family.

Children who are orphaned are often deprived not only of parental care, but also of financial support. Many of them leave school and have no hope of ever getting a decent education or job. These children who grow up without any support or guidance from adults may become our biggest problem in the future.

Most of the people who are dying are between the ages of 20 and 45 – an age when most people are workers and parents. This has serious consequences for our economy and the development of the country.

Our welfare system may not be able to cope with the number of orphans who need grants. Our health system is already strained to provide basic health care for all diseases and in parts of KwaZulu Natal and Gauteng almost half of hospital beds are taken by people who are ill from AIDS.

AIDS can affect anyone. But it is clear that it is spreading faster to people who live in poverty and lack access to education, basic health services, nutrition and clean water. Young people and women are the most vulnerable. Women are often powerless to insist on safe sex and easily become infected by HIV positive partners. When people have other diseases like sexually transmitted diseases, TB or malaria they are also more likely to contract and die from AIDS.

Although AIDS has become very common it is still surrounded by silence. People are ashamed to speak about being infected and many see it as a scandal when it happens in their families. People living with AIDS are exposed to daily prejudice born out of ignorance and fear.

We cannot tackle this epidemic unless we can break the silence and remove the stigma [shame] that surrounds it. As elected representatives in communities, councillors have to provide leadership on how to deal with AIDS.

The fight against AIDS has to happen on two main fronts - prevention and care. To prevent the spread of AIDS we have to educate people on how to prevent infection. We also have to change the social attitudes that make women vulnerable because they cannot refuse unsafe sex from a partner and the attitudes among men that lead to woman abuse and rape. Poverty alleviation and development are also important programmes that will limit the spread of AIDS.

To deal with the results of the disease and the social problems it creates, we have to make sure that people living with AIDS get care and support to help them live longer and healthier lives. We also have to make sure that those who are dying are properly looked after. For the children who are left orphaned, we have to find ways of looking after them so that they do not become hopeless and turn to crime or live on the streets because of poverty.

AIDS can reverse all the progress that has been made in our young democracy towards building a better life for our people. National and provincial government cannot fight this battle alone. They can provide health and welfare services, development programmes and information. But municipalities, together with organisations on the ground, have to provide the type of leadership and direction that will lead to real change in people’s attitudes and behaviour. Municipalities are also ideally placed to identify the needs of people in their area and to co-ordinate a coherent response to those needs. Local municipalities can engage with civil society, other government departments, as well as schools, churches and so on to make sure that everyone works together to combat the spread of AIDS and to care for those affected by the disease.

Mayors and councillors should act as role models for communities and be an example to people. We should take the lead in promoting openness and ending the silence that surrounds AIDS. We should also work closely with people living with AIDS and through our actions show that we accept and care for those affected. As political leaders we should use our influence and popularity to mobilise the community and involve volunteers in projects that provide care for people who are ill and orphans.

  1. Important facts to know about HIV/AIDS

AIDS affects millions of South Africans. It is estimated that more than 4 million South Africans are HIV positive and about 5 000 people die every week. Infection rates differ from region to region and in rural KwaZulu-Natal it may be over 25% in some areas – one in every four adults.

The research to measure how common HIV/AIDS infection is in South Africa is done among pregnant women who visit state health clinics. The infection rates quoted below are for those women. One can assume that many of the men who are partners to these women are also HIV positive but, if a province has a 10% infection rate amongst pregnant women, it probably has around a 5% infection rate among the population as a whole. The infection rate amongst pregnant women is as follows: (these figures were released in 2000)

KwaZulu-Natal 32.5%Free State 27.9%
Mpumalanga 27.3%Gauteng 23.9%
North West 23%Eastern Cape 18%
Northern Province 11.4%Northern Cape 10.1%
Western Cape 7.1%

Clear statistics for the number of AIDS orphans are not available since AIDS is not recorded as a cause of death on the death certificates of many people who die as a result of AIDS. Estimates are that in the middle of 2001 around 250 000 children had been orphaned as a result of AIDS. This will increase to around 2 million by 2010. Life expectancy in South Africa (the number of years the average person will live) is expected to go down from a high of around 60 years in 1994 to just over 40 years in 2005. Most of the people who are dying from AIDS are women between the ages of 18 and 40 and men between the ages of 30 and 50. This means that the most vulnerable groups are women of child rearing and economically active age and men in their economically productive years. This has severe implications for our economy and our society as a whole.

Statistics on this page are from UNAIDS – the United Nations agency set up to respond to the global crisis around AIDS.

AIDS and HIV

AIDS means Acquired Immune Deficiency Syndrome. It is a disease that destroys your ability to fight other infections through your immune system. The immune system is your boy’s defence against disease – white blood cells attack and destroy many diseases. You get AIDS from a virus called HIV – Human Immunodeficiency Virus.

AIDS moves through different stages. People who get HIV can stay healthy for many years and most infected people do not even know that they are HIV positive. There are no visible signs to show that a person is infected. They can pass the disease on to other people by having unprotected sex with them [sex without a condom].

The second phase of the disease is when you get AIDS and start becoming ill more easily. The immune system is weak and cannot fight viruses and infections effectively. In the final phase of the disease, the immune system collapses and people become ill and bedridden.

AIDS itself does not kill people – they usually die from other infections like flu, diarrhoea, pneumonia or TB. Poor people tend to become ill and die much sooner than wealthier people. This is because of poor nourishment, bad living conditions and poorer health care.

Some of the symptoms of a person living with AIDS could be losing weight very quickly and getting ill often with things like flu or pneumonia or stomach problems.

How do you get AIDS?

There are only three ways to get AIDS: unprotected sex, contact between your blood and infected blood or body fluids and mother to baby transmission.

  1. Unprotected sex:

This is the most common way that people get AIDS. If you have sex with an HIV positive person and there is direct contact between the penis and vagina or anus, you can easily get infected. The virus lives in the fluids inside the penis and vagina and can easily enter your bloodstream. Using condoms properly is the only protection against this kind of infection.

  1. Contact with infected blood.

If you have an open wound and it comes into contact with the blood of an HIV positive person, you can get infected. This contact could be through using the same needles for drugs or unsafe instruments used for circumcision. You can also get it from blood transfusions if the blood is contaminated [in SA all blood is screened]. Medical workers can get it from accidentally pricking themselves with needles they have used to inject HIV positive people.

  1. Mother to baby transmission.

HIV positive mothers can pass the infection to their babies, this happens in about 30% of cases. Transmission can happen during pregnancy, or childbirth because of the contact with blood, or during breast-feeding.

You cannot get AIDS from kissing someone on the lips, hugging, sharing food and drink or using the same bath or toilet as someone who is HIV positive. [Deep kissing or French kissing can pass on HIV if you have sores in your mouth]

People most at risk

Anyone can get AIDS, but some people are more vulnerable because they do not have the power to say no to unprotected sex or because of their risky lifestyles. The groups who are most vulnerable and have the highest infection rates are:

Young women are the most vulnerable because they are often powerless to say no to unprotected sex with an HIV positive partner. They have the highest infection rate of all in South Africa. They are also the most common victims of rape and sexual abuse. Young girls who are virgins are also at risk because of the myth that a person can be cured of AIDS by having sex with a virgin. This is total rubbish and is just an excuse for child abuse.

It is easier for women to get infected by HIV than men. The virus can easily enter the bloodstream through the vagina. When the vagina is not lubricated [wet] it can be injured during sex and infection happens more easily. Rape and practices like dry sex [where herbs are used to keep the vagina dry] contribute to the rapid spread of AIDS among women.

Men and women who have other sexually transmitted diseases are also more vulnerable because they often have open sores on their private parts.

Areas most at risk

Different municipalities have very different rates of infection. UNAIDS has identified the following as factors that can contribute to areas having a high rate of infection

Social attitudes

The biggest problem in fighting AIDS is breaking the silence that surrounds the epidemic. Although thousands of people are ill or dying, it is not spoken about and families often hide the fact that their relatives had AIDS.

People still feel that it is something that happens to others and not to their families. People who are infected fear rejection and discrimination from those around them and try to hide their illness. Although testing is available, only about one in ten people who are HIV positive know it. This means that they can carry on infecting others without knowing it.

There are myths around AIDS and they lead to people seeing it as a scandal that should be kept secret. Many people see those with AIDS as people who are somehow to blame because they were promiscuous or homosexual. AIDS is almost seen as a plague that you can catch just from being with someone who is HIV positive. In some communities people with AIDS have been chased out or attacked.

In countries where the infection rate has gone down, this only happened after so many people became ill that people could no longer pretend it was not happening and everyone started fearing that they will be next. We cannot afford to wait that long and must find ways of bringing AIDS into the open now.

The challenge for us is to make people fear getting the disease without them turning against those who are already HIV positive.

This means that we have to make it easier for people to be open, to go for tests and to seek care. We have to treat it as an illness and not a scandal that has to be kept secret. We have to create an environment where communities become more caring towards people living with AIDS and orphans and we all take responsibility for education around prevention.

Although AIDS is a terrible disease that can destroy families and communities, we should never forget that it is also a preventable disease. We can protect ourselves against it.

How do you treat AIDS?

You can find out whether you are HIV positive by having a free blood test at any clinic or hospital. The results will only be given to you. If you are positive you should tell your sexual partners so that they can also be tested and you should only practice safe sex.

There is no cure for AIDS. People can live with AIDS for many years if they get proper care. Healthy eating, exercise, a clean environment and a positive mental attitude can make a big difference. [See a healthy diet for people living with AIDS on page 26].

There are also many medicines that can help to fight the infections like pneumonia and stomach infections that easily kill people with AIDS. The infections are called opportunistic infections. Many of the medicines used to fight opportunistic infections are available at clinics and the government is working to get more affordable medicines to people who need them.

In first world countries people living with AIDS are often treated with antiretroviral drugs – medicines that that strengthen their immune system and slow down the virus. These drugs cannot cure AIDS, but help many people to live healthy lives for longer. These drugs can be very dangerous if they are not properly taken and they also cost thousands of Rands per month for each patient. If you can afford to take drugs like AZT you also need to go for regular tests to check your white blood cell count so that you can get the correct dosage of the drugs. These tests can only be done in laboratories and also cost a lot of money. Our health system cannot presently afford to give these drugs to all people and also does not have the infrastructure to monitor their use and limit the harm they can do when taken in the wrong dosage.

Mother to child infection can be limited in some cases by giving the mother anti-retroviral drugs. The Department of Health is doing research programmes in all provinces with these drugs, but they have not yet been approved as safe for general use.

The rights of people living with AIDS

People with HIV/AIDS in South Africa are protected by our Bill Of Rights and have the same rights which protects all citizens.

Insurance companies can insist on people being tested for HIV and may refuse life insurance. But many insurance companies do have special policies for people who are HIV positive.

  1. The impact of HIV/AIDS on local communities and municipalities

Municipal planners and politicians have to analyse threats to their areas and changes that can impact on communities and their service delivery needs. HIV/AIDS will affect every municipality in South Africa. This chapter covers some consequences the HIV/AIDS epidemic may have for your municipality and its people.

Family life and children

Family members of people living with or dying from HIV/AIDS are directly affected by the disease. People who are ill or dying are usually breadwinners and parents. This means that children are often put in the role of caregivers of those who are ill and at the same time have to find ways for the family to survive financially.

If both parents die many children are left heading households and looking after younger siblings. Children not only lose financial security but also very often lose their mothers who are their primary emotional caregivers. In most families affected by AIDS teenage girls are the first to step into the mother’s shoes and to take over providing and caring for the family. This means that girls have to leave school and lose a chance of getting an education that could lead to better employment in the future.

Families are also affected by very high costs associated with the disease - both for caring for the ill and for burying them. Many families spend a large part of their annual income paying for a single funeral (up to half in some cases). Families also suffer because of the loss in income because of the loss of productive time that members who are caring for the ill can spend outside the home.

The additional stress of looking after someone who is ill and dealing with the emotional trauma of a parent dying can put a great burden on the psychological well being of family members. At the best of times losing a parent is a difficult thing for a child to deal with. When it happens in an atmosphere of insecurity, financial problems and surrounded by the stigma, secrecy and suspicion created by AIDS, it becomes even more difficult.

Community

The poorest communities in our areas are often the ones that are expected to carry the heaviest burden as a result of HIV/AIDS. It is in poor communities where more people die and where relatives, neighbours and grandmothers are expected to provide the extra care, money and food needed by AIDS orphans.

The burden of looking after the ill who cannot afford medical care also falls on the poor. While so many people are dying from AIDS poor families are getting bigger - those families that are intact often take in children who are related to them who have lost their own parents. It is in the poorest communities where orphans also pose a potential threat in terms of social stability. Children living in child-headed households or on the streets lack adult parental guidance, support and discipline. Out of desperation they may turn to crime. There are already areas in our country where orphans and old people outnumber the economically active adults. This also has serious implications for the elderly who rely on their own children for support in their old age.

Health and welfare

South Africa’s health system is not in a position to provide adequate care for everyone who is ill with AIDS. The health system barely copes with diseases in normal times and the AIDS epidemic has put enormous pressure on the availability of services. Many hospital beds are taken up by people who are ill with AIDS. Additional medicines have to be made available for people who may get opportunistic infections because of AIDS and the testing, counselling and prevention services that clinics and hospitals have to implement put an extra burden on both budgets and staff.

The welfare system run by the Department of Social Development is only beginning to cope with the consequences of AIDS. Child support grants and foster grants for orphans are available but the take-up rate is not very high. Once everyone affected starts accessing these grants the state will have to find a large amount of extra funds to support orphans. This will put pressure on other welfare grants such as pensions. Welfare organisations at local level are also over-stretched as a result of dealing with so many more people in need.

Education

In most countries in Southern Africa where research has been done, teachers were found to be among the sectors most affected by HIV/AIDS. In Zambia almost twice the number of teachers are dying from AIDS as the rest of the population. This decrease in the availability of teachers can have a serious impact on education. At the same time the demand for schooling will change in areas where child-headed households cause young girls and boys to drop out of school. This decrease in a demand for education does not mean that fewer teachers are needed. In most areas it simply means that children have dropped out of school and other methods will have to be found to ensure that they get back into the mainstream of schooling.

A number of studies have shown that there is a very high infection rate in young adults at tertiary institutions. This means that many of the people who are already receiving a higher level of education and who will have a vital role to play in our economy, may die before they fulfil their potential.

Economy

The economic effects of AIDS are first felt by the families. Almost all families with relatives dying of AIDS have a decreased income because the affected person may have been employed or because another person may have to leave employment to become a caregiver. At the same time there is an increase in expenses for the family because of the need for medication and care and the high cost of funerals. This also affects the economy on a bigger scale. The fact that so many families have a decreased income and increased spending on funerals and healthcare means that there is less money available for spending in the economy.

The economy is also affected by the high rate of absenteeism of people who are ill or people who are caring for those who are ill. Many workplaces become less productive.

In the long term the economy is affected by the fact that trained and skilled workers will die and that it will cost a lot of money to replace people in terms of training. There will also be a reduction in the number of workers available in our economy. Ultimately when less money is available in the economy there is a decrease in savings and investments. Banks have less money available to lend and this drives up the cost of borrowing money. This will have a direct effect on government’s ability to invest in infrastructure like roads, sewage and piped water. Local government will also find borrowing money more costly.

Government will also be affected by the high expenses of providing health care and welfare for people with HIV/AIDS in their families. Less money will be available in government coffers for providing basic services. In poor areas fewer people will be able to pay for basic services and this will also affect the local economy of the municipality.

Municipal impact

It is very likely that AIDS will have the following direct impact on your municipality:

  1. There will be fewer people living in the area in 10 years than earlier projections.
  2. People will not live for as long as projected (around 43 years instead of 60 years)
  3. Infant mortality will increase because of mother to child transmission as well as a higher death rate among orphans who lack parental care.
  4. There will be an increase in the need for health care.
  5. There will be an increase in the need for poverty alleviation.
  6. Existing inequalities between rich and poor areas will become worse.
  7. The number of orphans will grow as a result of HIV/AIDS.
  8. The make up of your population in terms of age distribution will change.
  9. The number of old people who need care will increase since many of them will lose the adult children who may have been helping to support them.
  10. Economic growth will shrink since less disposable income is available for spending.
  11. Poor households will be less able to pay for services, rents and rates.
  12. Productivity in the economy will be affected by increased absenteeism.
  13. It will cost more to recruit, train and provide benefits for employees because of loss of skilled staff.
  14. It is likely that there will be an increase in bad debts.
  15. Municipal employees could be affected on a large scale and this could affect their ability to deliver key services.
  16. Expenditure meant for development may have to be spent on health and welfare.

[A Department of Social Development publication: Primary HIV/AIDS Capacity Development Course for Government Planners, and a USAID publication: HIV/AIDS in Southern Africa, provided useful information for this chapter.]

  1. How to respond to HIV/AIDS

There are a number of priority actions that need to be taken to reduce the impact of HIV/AIDS.

Prevention

First and foremost are effective prevention programmes that lead to a lower infection rate. AIDS is preventable and we can protect the people who are not yet infected. Unfortunately there is no vaccine yet for AIDS and people can only be protected if they are prepared to change their sexual behaviour. This demands an energetic and effective education campaign. Behaviour is very difficult to change and sexual behaviour is seen as personal and most people are embarrassed to discuss it. Prevention has to go beyond changing the behaviour of those who are already HIV positive. Everyone has a role to play in the campaign for ABC (Abstain, Be faithful or Condomise). The availability of condoms is also an important part of effective prevention.

Destigmatisation and openness

A very important issue to deal with in order to develop an effective response to AIDS is destigmatisation. While AIDS is treated as a scandal, is kept secret and people living with AIDS are discriminated against, it is very difficult to address the disease. Public education, awareness, prevention and care programmes need an atmosphere of openness to flourish. Destigmatisation is one of the biggest challenges we face in tackling HIV/AIDS. As the political leadership of municipalities, councillors have an important role to play in this. Destigmatisation can only succeed where openness is promoted and non-discrimination becomes the norm.

Testing and counselling

Another important response is the provision of testing and counselling facilities so that those who are already infected can find out about their status and play an active part in preventing the further spread of the disease. Testing is only effective when confidentiality is guaranteed and when people who come for voluntary testing are assured that no one will find out. Counselling is very important to help deal with the emotional effect of finding out that you are HIV positive as well as the choices you have to make to change your lifestyle so that you do not further spread the disease.

Treatment and care

Treatment of sexually transmitted diseases [STDs] and TB has to be an integral part of any response to AIDS since people with those diseases are more vulnerable.

People who are already HIV positive need treatment for opportunistic infections and to prevent mother to child transmission. They need a supply of condoms as well as guidance and support to lead healthy lifestyles and follow healthy diets [see page 26].

Specific projects have to be developed to provide for the health care needs of people who are ill with AIDS. Home care is an important aspect of this and there are many examples of home-care volunteers playing a major role in supporting people who are ill. Support also has to be organised for people’s basic needs and for feeding their families.

Care and support for orphans

Orphans need some adult supervision and care either through foster or community care programmes. They also need support to enable them to continue with their education. Most child-headed families or orphans need direct food support and some grants to survive as well as access to counselling and advice. Orphanages are the most expensive options and are neither economically viable nor the best places for children to grow up in. New community care options have to be developed where children remain part of the communities they come from. .

The response of African municipalities

An alliance of mayors and municipal leaders in Africa together with the United Nations Development Programme has developed an African Mayors’ Initiative for Community Action on AIDS at the Local Level. (AMICAALL) South Africa is one of 17 countries that have adopted a declaration in Abidjan in 1997 to develop a response by municipal leaders to HIV/AIDS. The declaration recognises that municipalities and councillors are closest to the people and are responsible for addressing local problems. It states that local government, mayors and councillors have a vital role to play to do the following:

  • provide strong political leadership on the issue
  • create an openness to address issues such as stigma and discrimination
  • co-ordinate and bring together community centred multi-sectoral actions
  • create effective partnerships between government and civil society
  • SALGA will provide support to implement AMILCAALL resolutions in South Africa.

South Africa has also established a National AIDS Council and each province has a Provincial AIDS Council to help provide support and co-ordination of AIDS initiatives. In many provinces District AIDS Councils are now being set up. At a local municipal level AIDS Forums or Councils do exist in some areas. Each municipality what option best suits them and aim to achieve the following:

  • bring together the key stakeholders in civil society and local government
  • ensure that there is a coherent HIV strategy in place for the area
  • provide cohesive structure to help co-ordinate the delivery of services to those most affected
  • avoid duplication
  • mobilise volunteers to provide care

  1. The government five-year strategy on AIDS

We included this summary of the government’s strategy on HIV/AIDS to help you understand how government plans to fight this epidemic. It is important that your municipal AIDS strategy fits into the same broad framework since the National and Provincial AIDS Council work as well as the work done by the Health and Social Development Departments in your area would be in terms of this strategy.

Introduction

The government has drawn up a strategy to fight AIDS that seeks to unite all sectors in a common programme. It is important to understand this strategy and to see where our campaign can support and deepen the government plan.

The national health department is the main driver of a strategic plan to co-ordinate the fight against AIDS by the whole country. Various government departments and sectors were consulted in the drawing up of this plan. These include traditional healers, business and religious organisations. The priority areas in this plan are:

What factors lead to the spread of AIDS

Unprotected sex and having many sexual partners are the main reasons for the spread of the disease.

In South Africa, the underlying causes of the rapid spread of AIDS include social and economic factors such as poverty, lack of access to health and social services, migrant labour, sex workers, the low status of women, illiteracy, lack of formal education, stigma and discrimination. The high rate of rape also exposes women to HIV. The national plan addresses all these issues.

Other health conditions which are linked to the HIV/AIDS epidemic are:

What has been achieved

Since 1994, government has initiated plans to combat the AIDS epidemic. These include:

There are also a number of weaknesses related to capacity, resources and lack of co-ordination in what was done so far and the plan tries to address these.

Goals of the plan

  1. Reduce the number of new HIV infections (especially among youth) and
  2. Reduce the impact of HIV/AIDS on individuals, families and communities

Key strategies to implement the plan

The main strategies that will be used are:

  1. A public awareness drive to influence behaviour change and encourage openness;
  2. Increasing access to voluntary HIV testing and counselling;
  3. Promoting increased condom use to reduce the spread of STD and HIV infections;
  4. Improving the treatment of people living with AIDS

Guiding principles

The strategy is guided be a set of principles:

Strategies for four priority areas

  1. Prevention

  1. Treatment, care and support

  1. Human rights

Conclusion

This plan can only succeed if all sectors of society join in the partnership to win the fight against HIV/AIDS. The underlying causes like poverty also need to be addressed. This plan will be assessed and updated.

  1. How to develop a local strategy on HIV/AIDS

This guide was written to be used together with a strategic planning process that helps a municipality to develop a clear strategy for dealing with AIDS. The process used to develop a strategy should have the following components:

  1. Understanding the terrain
  2. Drawing in stakeholders
  3. Analysing incidence, impact, available resources and key interventions
  4. Deciding priorities and activities
  5. Setting up coordination mechanisms

  1. Understanding the terrain

Successful strategies are built on understanding a problem properly and finding the most appropriate way of addressing it. As a first step the people involved in developing the strategy should be educated to understand AIDS. The first four chapters of this manual can be used to assist with an education workshop. Good research should be done in each municipal area to find out how serious the problems associated with HIV/AIDS are, who are the most affected and what interventions are effective and realistic. Here are some examples of the information needed:

Statistics:

  • What is the incidence of infection and which wards are most affected?
  • Estimates for number of orphans.
  • Number of families that have lost a breadwinner.
  • Number of people receiving care from hospitals and clinics.
  • Number of people receiving support form welfare services and organisations

Availability of services and resources:

  • Educational and preventative services and projects available
  • Counselling, testing and support services available in area.
  • Health care services and facilities available
  • Home based or other care services and projects
  • Orphan care projects and services available in area.
  • Municipal resources and services currently used
  • Organisations for people living with AIDS
  • Initiatives taken by schools and employers

Projected impact of HIV/AIDS on the following

  • Local health and welfare services
  • The local economy and availability of labour
  • Education
  • Social problems and crime
  • Housing and service delivery

Identify the key gaps that exist in terms of services and projects in the following areas:

  • Prevention and education
  • Promoting openness
  • Provision of care for people living with AIDS or ill from AIDS
  • Provision of care and support for orphans

  1. Drawing in stakeholders

Municipalities cannot deal with AIDS without the cooperation and support of other government services, religious, community and welfare organisations and volunteers.

In every municipality there are a number of key actors that should be drawn in to help develop a strategy to tackle AIDS. It is important to recognise the different roles that different people can play. Municipal officials will play a different role from municipal councillors who will play a different role from government services or civil society organisations.

It is important to make a difference between the stakeholders and key people who can contribute to developing a strategy and the stakeholders that you would want to involve in the long term. For example an effective AIDS strategy will try to involve all school principals to make sure that orphans are identified and supported. But an AIDS strategy workshop will only involve perhaps one school principal who has already done something that will help you to develop a better strategy.

The following are examples of who should be asked to help develop a strategy:

  • Municipalities should play a coordinating role and bring stakeholders together to jointly develop a strategy and action plan. Within the municipality key officials and politicians should be drawn in. The mayor, speaker and municipal manager are three key individuals who should be involved.
  • Key local individuals from government departments like health and social development.
  • Organisations from the community that already offer a service or have some expertise about AIDS.
  • Major employers, church leaders and community leaders.
  • Members of district or provincial AIDS Councils can act as resource people.

  1. Analysing incidence, impact, available resources and key interventions

A strategy workshop of all stakeholders should be held where the research and information gathered should be presented for discussion. Stakeholders should analyse the information, develop problem statements and discuss the key interventions that are needed in the area to lower the infection rate and to care for people affected by AIDS. They should set broad goals for what they want to achieve in the long term.

Deciding priorities and activities

The strategy workshop should decide on short term objectives and priorities and discuss the kind of approaches that are needed. They should identify possible partnerships and existing and potential resources that can be used to implement the strategy.

Setting up coordination mechanisms and task teams

A strategy is only a plan and implementation depends on having the best organisational structures to ensure effective coordination and mobilisation of resources. Structures should not be overly bureaucratic and should be designed to coordinate specific parts of the plan, bring resources together, promote communication and information sharing and mobilise broader involvement.

It should not be seen as a structure that will "control" AIDS work in the area. It should aim to make sure that the most affected areas and individuals in the municipality are effectively serviced and that available resources are used as efficiently as possible. Ongoing monitoring and assessment should be part of its work.

The municipality should play a leading role in coordination and using its resources to facilitate meetings and administration of the structure. It may be good to put the coordinating structure under the authority of the mayor to give it political clout and status. It is vital that any coordinating structure does not become a gatekeeping structure that stops organisations from getting involved. AIDS is an issue that affects everyone and should not be dealt with in a way that excludes anyone.

It is important to set up task teams that work together on specific projects – for example home care or public education. People who are directly involved in these areas should play a leading role in these teams.

  1. How to run AIDS campaigns and projects

This section shares some practical ideas for what can be done on the ground to tackle AIDS. It deals with education and awareness campaigns and care projects. Municipalities may choose not to get directly involved in all the things dealt with in this section, but in every community leaders and organisations should be encouraged to run campaigns and projects such as these.

The role of the municipality

The role of councillors

Councillors, as the locally elected political leadership, should give moral leadership to the campaign and should provide a public face for the campaign. This can involve things like:

Broad ideas for action

At a local level action can include the following 4 key things:

  1. Running a broad public education campaign about prevention of AIDS, non-discrimination and care for people living with AIDS, that aims to reach as many people as possible
  2. Organising local awareness-raising events and campaigns to change sexual behaviour and attitudes to people with AIDS and creating openness about the disease by speaking about it, publicly supporting people who are open and encouraging voluntary testing and actively and publicly encouraging the destigmatisation of Aids
  3. Organising support for people who are ill with AIDS by mobilising volunteers into community and home-care projects
  4. Organising community support and care for AIDS orphans - through foster care, support for the basic needs of orphans, education, counselling and food programmes

Targeting the right people

The AIDS campaign should reach every person in our community in some way, but we should also target specific sectors to make sure different parts of the campaign are effective.

For the education and prevention part of the campaign we must ask: who is most likely to get AIDS and/or to spread the virus? Our actions should target the following vulnerable groups:

For the parts of our campaign that creates awareness and openness we should ask: who can most influence people’s attitudes? We should try and involve people like:

For the support and community care part of our campaign we should ask: who will benefit most from care and support and who can we draw in to help? Those that will benefit most are:

Those whom we can draw in to help could be:

We would also have to work closely with government health and welfare services, as their staff will work with and support community care initiatives.

Message and slogan

Any strategy that seeks to change public attitudes and behaviour needs a clear message and slogan. It is important not to contradict the messages that are coming from other big educational communication campaigns. "Message themes" are the ideas we try to get across in everything we say and do. A campaign message is usually only a few sentences long, but it is used as the basis for all speeches, pamphlets, radio interviews, etc. A campaign will have much more impact if the message is clear and if everyone involved keeps saying the same things. The slogan is a short sentence that sums up the message. It can be used on posters, T-shirts, etc

Here are some examples:

The Treatment Action Campaign encourages people to wear T-shirts with the slogan "HIV positive". This helps to bring AIDS awareness out to the public.

ABC – Abstain, Be faithful or Condomise – is a slogan used by many youth organisations.

The Love Life campaign has many different slogans that appeal to young people.

Here are some examples of messages being used:

Message on the importance of the struggle against AIDS:

All of us are affected when half the children in this country may never grow up, when a quarter of our workforce may die in the next decade, when millions of children without parents, basic care or education have to look after themselves. AIDS is our problem.

Messages for prevention:

ABC – Abstain, Be faithful or Condomise

It is your responsibility to get tested, and if you are HIV positive, not to pass on the disease to your partners.

Respect your partner enough to only have safe sex

Real men can make the difference – Stop abuse and respect your partner enough to only have safe sex

There is no cure yet for AIDS but it can be prevented

You can only get AIDS from unsafe sex or from mixing your blood with the blood of someone who is HIV positive [ blood transfusion, using same needles for injections, mother to child during birth process]

Messages to promote openness, support and care and end discrimination:

While we are hiding this disease we will not be able to fight it. We must break the silence and shame that surround AIDS and deal with it openly and honestly

AIDS is not an individual problem – it is so widespread that it affects all of us. All of us have a duty to join the struggle against AIDS.

Let’s start talking and bring AIDS into the open so we can deal with it. Talk to your children. Speak out if you or your loved ones are affected. Let’s break the silence and stand by those who are suffering.

People living with AIDS need our support and care – they are no different from people with any other illness, why treat them differently?

No-one should be blamed if they get the disease. It can happen to any of us.

You cannot get AIDS from someone by sharing cups, plates, facilities or toilets with them. You can touch, hug or kiss someone with AIDS without fear.

Each municipal area could add their own message themes, but it is important that we all try to reinforce the ones above. We should avoid situations where the public gets confused because of totally conflicting messages.

Ideas for action

We will look at four main areas of action and give some tips for methods that can be used. The areas are:

  1. Public Education
  2. Awareness raising and openness about AIDS and people living with AIDS
  3. Care for people who are living with AIDS
  4. Care for orphans

  1. Public education

Public education should aim to get to as many people as possible to educate them about prevention and issues like non-discrimination and support for people living with AIDS. Always remember to select your target groups carefully and to stick to the message themes. Here are some ideas:

  • Speeches – ask schools, churches, organisations and workplaces in your area if you can send a speaker to come and talk about HIV/AIDS. Speeches/talks should be about 30 minutes long and you should leave lots of time for questions. Use the information on page 1,2 and 3 as the basis for a speech. Also tell people what their rights are and where they can go for help. Train all your speakers so that they understand the issues, the message themes and can answer difficult questions.
  • Workshops – a workshop can be a few hours long and is a good way to educate people and gives them a chance to discuss issues in more detail. [See workshop outline in box below]
  • Plays and songs – culture can be a very effective way of getting your message across to people who do not want to sit in meetings or workshops. Involve cultural groups in developing education programmes
  • Ward forums/community meetings – use ward forums or call meetings of interested people from your community or from a specific target group, where people can come together to discuss AIDS. Try to involve sympathetic community leaders like politicians, ward councillors, religious leaders and health workers. The leaders should be there to listen and to give leadership – a forum is meant to be a chance for people to come and talk about their problems. Speakers should make only a short speech that covers the main issues/problems and then ask for the participants to give their experiences and their views about what should be done. Leaders can sum up the way forward at the end.
  • Door-to-door – ward councillors can do house visits to talk to people about AIDS
  • Pamphlets – pamphlets are good for spreading information about HIV/AIDS as well as services offered by organisations. The Department of Health has many simple pamphlets you can use. If you write your own, keep it short and simple.
  • Radio/newspapers – talk to local community and regional radio as well as newspapers about doing stories that will educate people about prevention, non-discrimination and care. Ask for space to run a talk show or advice column on HIV/AIDS.

PUBLIC EDUCATION WORKSHOP OUTLINE – 2 hours

  1. Do you know anyone? Questions to audience 5 min.

[Ask the audience to put up their hands if they know anyone they think died of AIDS. Most people will put up their hands. Then ask them whether it was publicly admitted at the funeral, that the person had AIDS. Few will put up their hands. Use this to lead to next question]

  1. Why is there a silence around AIDS? Buzz groups 15 min.

[Ask people to discuss this question with two people next to them for five minutes. Then get each group to make one point only until all points are out. Add your own from the manual if they leave some out.]

  1. Facts about AIDS and local services Input 20 min. Questions 10 min.

[Use the introduction and Part 1 of the manual to do an input on AIDS. Add any local information on services that you can find. Allow for questions]

  1. What can we do? Group discussion 30 minutes, Report back + discussion 20 min

[Break people into groups of 5-10 and ask them to discuss these two questions:

  1. What can we do to protect ourselves against infection?
  2. What can we do to help people living with AIDS and orphans in our community?

After 30 minutes let each group make a brief report. Add in some of the things that are being done locally and ask people to join any projects that exist.]

  1. Personal pledges Individual task 15 minutes

[Ask people to each think of a pledge (promise) they can make about what they will change in their attitudes or behaviour after this workshop. Give them a few minutes and then go around the room and let each person speak. If you are recruiting volunteers – have forms for people to sign up]

  1. Close and thank people

  1. Awareness raising and openness

Awareness activities are used to make issues visible and to change public attitudes. They should aim to get publicity and to directly reach thousands of people. Be sensitive in the way you campaign. People are eas1ily turned away by campaigns that are too aggressive or negative. Here are some methods you could use:

  • Posters/pamphlets/graffiti – use posters and pamphlets to raise the issues or give people information. Get them from other organisations or make your own. Use council property to paint an educational mural in a public place.
  • Marches, events and culture – use marches, cultural events and parties to mobilise community support. Use "Breaking the silence" events where people living with AIDS come to talk about their experiences, or plays and songs that show the reality of HIV/AIDS.
  • Protests – support the campaign against drug companies that do not make medicines available cheaply to developing countries. Protest against any employer or body that discriminates against people living with AIDS.
  • Prayer meetings, funerals and other community events – Call special prayer meetings around AIDS. Get traditional leaders to call their subjects together to discuss AIDS. Use funerals of people who died of AIDS as an opportunity to raise awareness – be sensitive to the family’s wishes.
  • Loudhailers, information tables, etc. – use loudhailers to talk in taxi ranks or in train carriages, set up information tables at busy places.
  • Radio/newspapers – ask local media to raise awareness through phone-ins on radio, or interviewing people living with AIDS and your organisations. Get newspapers to publicise events and write letters to the letters page. Issue press statements and invite reporters to events.

We have to actively promote openness about AIDS and a more supportive environment for people living with AIDS. Unless we bring the disease into the open we cannot deal with it effectively. If we cannot break the silence in our own ranks we cannot expect society to do so. As councillors and members of organisations we can:

  • Encourage and support people living with AIDS to go public about their status.
  • Ask people living with AIDS to sit on platforms and speak at meetings with our leaders.
  • Encourage testing by organising testing drives and asking those leaders who are willing, to go public about their results.
  • Create role models for how to cope with AIDS, by encouraging our councillors and other influential people who are HIV positive to reveal their status and to help campaign and raise awareness.
  • Support and care for people living with AIDS.

  1. Support and care for people who are living with AIDS

An important focus should be to provide better support and care for people living with AIDS. Many people who are HIV positive can lead long and productive lives if they look after their health. The immune system is weakened by the virus and many people die from ordinary illnesses like flu because their bodies are too weak to fight the illness.

Emotional and mental health are also important. People living with AIDS need support from their communities and from each other. We can:

  • Openly organise support and care so that HIV/AIDS becomes a community issue and we help to destroy the secrecy and shame that many people live with.
  • Educate people with HIV/AIDS about healthy eating [see box below]
  • Start vegetable garden projects to help provide the right food types to people who cannot afford them.
  • Make sure our local health services have supplies of the cheap medicines that the government is making available to fight the common infections that easily kill people with AIDS
  • Help organise projects, support or discussion groups where people living with AIDS can meet and talk to each other
  • Educate people living with AIDS about their rights in terms of medicine, grants, employment, non-discrimination, etc.

Keeping a healthy body

People living with HIV or AIDS need different foods from healthy people. HIV/AIDS and the medicines people have to take can make you lose a lot of weight, feel cold all the time and get serious stomach problems. This will make you weaker and when you are weak you can more easily get serious infections. Because you easily get infections it is also very important to clean and cook food properly and to drink only clean water.

Good food

  • Drink two litres of water a day
  • Drink sour milk, milk or yoghurt
  • Eat beans, lentils, eggs or meat every day if you can – beans are just as good as meat if you put a tablespoon of uncooked sunflower oil with it before serving.
  • All vegetables and fruits are very good
  • For a healthy stomach eat raw garlic, raw carrots or dried pumpkin seeds.
  • Eat a lot of grains and starch – maize, rice, sorghum, brown bread

Bad foods

  • Sugar is very bad for the immune system and causes stomach problems
  • Fried foods and cooked oils stop the stomach from being able to digest food
  • Spicy food can also cause stomach upsets – do not eat too much

Do:

  • Keep yourself occupied and interested in things to avoid depression
  • Try to exercise without straining yourself
  • Get enough sleep and rest
  • Find people you can talk to about your feelings

Do not:

  • Smoke, drink or use addictive drugs
  • Go on diet or lose too much weight

People who are bedridden

For those people who are seriously ill we must try to mobilise volunteers to help with community care projects. Many people living with AIDS become weak and bedridden. There is not enough space for all of them to be looked after in hospitals and most people are cared for by their families. In many cases the sick person was a breadwinner and is a parent. Their children often become the main carers and they themselves need support.

Community care projects have been set up in many parts of Africa and South Africa. This is how they work:

  • Most people sick with AIDS are cared for by someone at home – often an old woman or a child. The patients as well as the care -givers are visited at home and given some training and support by volunteers. They also learn basic things to protect themselves - like not to touch blood or body fluids of the sick person without covering their hands in plastic bags.
  • Volunteers are trained to give basic advice, health care and support to a cluster of people who are sick at home and their care- givers. They assist people to link with health and welfare services and help them to get access to medicine and disability or child grants. Volunteers do some health care and counselling work through home visits to people who are no longer able to get to clinics. They educate and help families to cope and identify children who need support and care.
  • Volunteers are usually co-ordinated by welfare organisations that work with, and under the supervision of, the government health and welfare services in the area. This makes it easier to get help for people who need to go to hospital or to get a pension or grant.
  • Community care projects work best if they are joint projects co-ordinated between health and welfare services and community organisations. They must be well co-ordinated and managed since many people will depend on them for basic care.

Local municipalities can also play a big role in mobilising and supporting community care projects.

As councillors and members of organisations we can mobilise volunteers to work with the department of health, local welfare organisations and churches. Volunteers will have to be trained and could get some basic qualifications from training courses. In some areas unemployed school-leavers have been targeted as volunteers.

  1. Community-care for AIDS orphans

In many communities there are projects to help care for orphans. They are not reaching everyone and especially in poor rural areas little is being done. AIDS orphans can access government services and financial support, but many do not know how.

We cannot build enough orphanages to look after everyone and many experts believe that community care is a much better option for children. Community care can take a number of forms:

  • Care by relatives – this is the most common and often the best form of care since children stay with people they know. Relatives who look after orphans can access government support grants if they are poor.
  • Foster care – where individual children are placed worth families and looked after. The families can usually get the government support grants to help with costs. Many welfare societies can help with this.
  • Group foster parents – a group of orphans are housed in one place and looked after by a foster parent. Examples are farmers building a house for all the orphans on the farm and employing an adult to look after them, so they can stay in their community.
  • Child headed families – an older child looks after brothers and sisters and they stay in the family home.
  • Community childcare committees – volunteers help children who live alone by becoming part-time parents and providing some support.

None of these are easy to organise – you need help from the Department of Social Development or organisations like Child Welfare Society. Foster parents should get some training and should be monitored so that they do not just do it for the money.

Grants for orphans can only be accessed if the child has a birth certificate and if the parent/s deaths are registered. Municipalities and organisations could:

  • Do an audit of the number of AIDS orphans in the area – work with local organisations, schools, traditional leaders and health and welfare services.
  • Find out what projects or services are available in your area and make sure orphans are put in touch with them
  • Recruit volunteers to help with community care programmes
  • Run an awareness campaign to encourage people to register births and deaths
  • Visit orphans and make sure they are in school and being looked after by someone
  • Identify children in need and try to organise care for them

  1. Motivating other people to get involved

Use this table when you are talking to any of the sectors listed here. It will give you some ideas about what you can ask them to do.

Sector

Public education/ awareness raising/ openness

Community care for people living with AIDS or orphans

Community organisation

Hold discussion and education meetings around AIDS, and what we can do.

Organise local campaigns and events.

Create a culture of support for people living with AIDS.

Recruit volunteers for community care programmes.

Work with welfare and health services.

Local welfare organisation or NGO

Give talks and workshops at schools, churches and organisational or community meetings.

Monitor health, welfare and other services and lobby for improvements, e.g. For health services to work with volunteer caregivers

Organise care projects for people living with AIDS and orphans.

Train care volunteers and foster parents.

Support child headed households

Trade unions

Educate members and encourage openness and testing.

Engage employers in programmes.

Raise awareness and work to change men’s attitudes.

Create positive role models.

Protect rights of workers living with AIDS.

Pressurise workplaces to develop policies.

Push for treatment and support programmes in workplaces.

Business

Get own house in order with good education programmes, policies and services.

Support community programmes.

Practice non-discrimination in employment.

Support sick employees or orphans from deceased employees.

Health Workers

Run education programmes in community and clinics, on prevention, treatment, testing and care

Openly discuss AIDS with all patients and encourage testing.

Compassionate and good treatment for patients.

Counselling for HIV positive people and accessing best available treatment for people who are ill.

Training and co-ordination of home care volunteers

Social workers

Community education programmes.

Rights education about laws and grants.

Counsel clients who are positive.

Help set up community care projects

Train and monitor volunteers and foster parents.

Help clients access grants.

Religious leaders

Promote openness and hold workshops

Remove stigma of "sin" associated with AIDS.

Teach responsible behaviour.

Support role models and promote testing

Set up counselling and care projects for people with AIDS and orphans.

Involve congregation in volunteer projects.

Teachers

Life skills training in classes.

Encourage openness and try to change attitudes of boys towards girls.

Identify families in need.

Provide counselling and support.

Recruit volunteers to provide care for orphans.

Student organisation

Education and awareness programmes.

Create role models.

Encourage openness and testing.

Set up counselling services.

Recruit students to assist as volunteers in community care projects

Cultural and sport clubs

Cultural events like plays and songs against AIDS.

Sports events focus on AIDS awareness.

Hold workshops and invite speakers.

Support people who are positive.

Raise funds and recruit volunteers.

AIDS HELPLINE NUMBER 0800 012 322

For information, advice and contacts with services in your area

Index

HIV/AIDS Prevention |   Care for Children   |    Care for People with HIV    |   HIV/AIDS and Municipalities     |   Community Action  |   How to coordinate work around HIV/AIDS   |   How to set up Support Groups

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