What is in this guide
Why should municipalities address HIV and AIDS?
- Important facts about HIV and AIDS
- HIV and AIDS Strategic Plan for South Africa, 2007-11
- Overview of action that should be taken at local level
- Developing a multi-sectoral local strategy on HIV and AIDS
- How to set up coordinating structures
- Motivating people to get involved
- Municipal mainstreaming and workplace policies
This manual was produced by the Education and Training Unit (ETU)
ETU is a non-profit organisation committed to development and democracy in South Africa. We offer support for municipalities and Local AIDS Councils to develop HIV and AIDS strategies and local coordinating structures.
ETU can be contacted on 011 6489430/1 or email@example.com. Our training materials are available on www.etu.org.za
This manual was funded by The Olof Palme International Centre, SIDA and the JS Mott Foundation.
Introduction: Why should municipalities address HIV and AIDS?
HIV and 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 HIV or 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 developed a response 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 should ensure that all planning and projects take account of AIDS and its consequences. Our Integrated Development Plans must deal with the issues around poverty and development that assist in the rapid spread of HIV and AIDS. As employers we should also make sure that our own employees are adequately protected and that we have workplace policies and programmes that spread awareness, provide care and educate around prevention and non-discrimination.
But our role goes far beyond adapting our own programmes and looking after our own personnel. 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 HIV and to provide care for people living with HIV and 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 HIV or 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 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 HIV and 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 HIV and AIDS.
To deal with the results of the disease and the social problems it creates, we have to make sure that people living with HIV and AIDS get care, antiretrovirals, nutrition and emotional 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 affect 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 HIV and 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 HIV and 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.
The incidence of people who have the HIV infection is rising rapidly and over 5.4 million people are already HIV positive (2006 Department of Health figures). Thousands of people are becoming ill and dying every week and more and more children are being orphaned. As more people have become ill, the impact of AIDS has been be felt in virtually every community.
The research to measure how common HIV infection is in South Africa is done among pregnant women who visit state health clinics. The infection rates quoted below for each province are for those women. The national HIV infection rate among pregnant women attending antenatal services in 2006 was 28.3%. These statistics apply mostly to young women who are sexually active. Many of the men who are partners to these women will also be HIV positive. Estimates are that these figures mean that about 19.2% of all South African adults are infected.
The infection rate amongst pregnant women is as follows:
KwaZulu-Natal 40.2% Free State 33.7% Mpumalanga 32.5% Gauteng 35.8% North West 29.2% Eastern Cape 27.7% Limpopo 19.6% Northern Cape 19.9% Western Cape 15.5%
(The above figures are for 2006 and were released by the Department of Health)
By the end of 2006, an estimated 5.4 million South Africans were infected with HIV, the largest number of individuals living with the virus in a single country.
South Africa HIV estimates, end 2006
Source: The Demographic Impact of HIV/AIDS on SA, Centre for Actuarial Research, 2006
By the end of 2006 an estimated 1.8 million people had died of AIDS in South Africa and more than 1 million children had become orphans as a result of AIDS. Almost one thousand people die every day.
Life expectancy, which was 60 years in 1990, had decreased and around 50% of people will not live to 60. 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 working age and men in their working years. This will badly affect our society as a whole.
Understanding 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 body’s defence against disease – your white blood cells attack and destroy many diseases. AIDS is caused by the Human Immunodeficiency Virus, usually called HIV.
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).
AIDS moves through four different stages:
- In stage one the person is HIV positive but has no symptoms, except for some short-term flu-like symptoms which may occur within a few weeks of infection. This stage may last several years during which the person might have no HIV-related illnesses.
- In stage two the person begins to develop minor illnesses. Ear infections, frequent flu and skin problems are common at this stage.
- In stage three the person may lose a lot of weight and have longer term illnesses. These may include thrush in the mouth, pneumonia, a fever which lasts more than a month and tuberculosis of the lungs.
- In stage four, the person has illnesses due to a very weak immune system. These may include PCP, pneumonia, chronic diarrhoea, toxoplasmosis and meningitis. It is at this stage that a person is said to “have AIDS.” A person is also said to “have AIDS” if their CD4 count (white blood cells) goes under 200.
AIDS itself does not kill people – they usually die from other infections like the ones listed in stage four. 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.
How do you get HIV?
There are only three ways to get infected with HIV:
1. unprotected sex (sex without a condom),
2. contact between your blood and infected blood or body fluids, and
3. mother to child transmission.
- Unprotected sex.
This is the most common way that people become HIV positive. 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.
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)
- Contact with infected blood.
If you have an open wound and it is exposed to the blood of an HIV positive person, you can be infected. This contact could be through using the same needles for drugs or unsafe instruments used for circumcision. It is possible to get HIV if you use the same razor blade or tooth brush as an HIV-positive person if there are any traces of blood on the implement. While you could easily contract HIV from a blood transfusion if the blood is contaminated, all blood in SA is tested for safety. Medical workers can get it from accidentally pricking themselves with needles they have used to inject HIV positive people.
- Mother to child transmission.
HIV positive mothers can pass the infection to their babies. An estimated 15-30 % of mothers with HIV will transmit the infection during either pregnancy or during childbirth. This happens because of the contact with blood. Another 10-20 % will pass the HIV to the baby through breast milk. A medicine called Nevirapine (ART) can make it half as likely that a mother will transmit the virus to her child in the womb or during childbirth. If the mother has been taking the full cocktail of antiretrovirals the risk is reduced even more. Using formula instead of breast-feeding can ensure that the baby is not infected through breast milk.
People most at risk
Anyone can get HIV, 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 between 15 and 30 years old - many of the women in this age group are in unequal relationships where they cannot refuse unsafe sex, or are exposed to sexual violence.
- Sexually active men and women who have more than one partner. Although polygamy (having more than one wife) is a custom followed only by some men, many others have a wife and a girlfriend or casual sexual partners. They may get the virus from a casual partner and pass it on to their wife.
- Migrant and mine workers – they are separated from their families for most of the year and many of them have sex with sex workers.
- Transport workers – they travel a lot and many of them use the services of sex workers.
- Sex workers – they are exposed to many partners and are sometimes powerless to insist on safe sex.
- Drug users who share needles – one person who is HIV positive can infect a group of people who share the same needle unless it is sterilised in between usage. Many drug addicts also become sex workers to pay for their drugs.
- People who practice anal sex – the anus can easily be injured during sex because it has no natural lubrication (wetness) and the virus can be passed on unless a condom is used. Women who have anal sex, gay men and other men who have sex with men (for example prisoners), are vulnerable to this form of transmission.
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 HIV and 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 and other materials are used to keep the vagina dry) contribute to the rapid spread of HIV among women.
Men and women who have other sexually transmitted diseases (such as syphilis or gonorrhoea) are also more vulnerable because they often have open sores on their private parts.
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. But people can live with AIDS for many years if they get proper medical treatment and care. Free antiretrovirals (ART) are available at more than 200 state treatment centres for people who are ill with AIDS. For those who are not yet very ill, healthy eating, exercise, a clean environment and a positive mental attitude can make a big difference and help to keep the immune system strong.
There are medications that can help to fight the illnesses like pneumonia and stomach infections that easily kill people with AIDS. These 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.
Antiretroviral medications (ART), when taken properly, can greatly reduce the level of HIV in the body, reduce susceptibility to illness and extend the person’s life, sometimes for many years. ART prevent the virus from reproducing and help prevent further damage to the body. Many people find that, after taking ART for a few months, the level of the virus in their blood is so low that it cannot be detected.
ART cannot, however, repair damage to organs and systems to the body that the virus has already made. Once a person goes on ART, they must accept that they will have to keep taking the medication for many years to come and quite probably for the rest of their lives. Some people struggle with side-effects and it is important to get proper medical monitoring and support to help overcome it.
The rights of people living with HIV and AIDS
- People with HIV and AIDS in South Africa have the same rights to housing, food, social security, medical assistance and welfare as all other members of our society. People with HIV and AIDS in South Africa are also protected by our Bill Of Rights and have the same rights that protect all citizens.
- There can be no discrimination against anyone who has HIV and AIDS.
- They have the right to medical treatment and care from our health and welfare services.
- Children with HIV and AIDS are allowed to attend any school.
- No one can be fired from a job just because they are HIV positive
- No one can be forced to have an HIV test at work or before getting a job.
- Test results cannot be shown to anyone else without the person’s permission.
- Pregnant women with HIV and AIDS have the right to make a choice about their pregnancy.
- Private medical aid schemes cannot refuse to cover people with HIV and AIDS (but they don’t have to pay for antiretrovirals or the costs of treating any AIDS-related illness until a year after the person joins the scheme).
Insurance companies can insist on people being tested for HIV and may refuse life insurance. However, many insurance companies do have special policies for people who are HIV positive.
Below are some other important points on rights that are important for people with HIV and AIDS:
How does AIDS affect all of us?
- Informed consent is compulsory before HIV testing can be done. Informed consent means that the person has been made aware of, and understands, the implications of the test.
- The person should be free to make his or her own decision about whether to be tested or not, and cannot be forced into being tested. (But you should always try to address any fears that a person may have about the test and give them support)
- Anonymous and confidential HIV testing with pre- and post-HIV test counselling should be available to everyone.
- Proxy consent for an HIV test may be given where a person is unable to give consent. Proxy consent is consent by a person legally entitled to give consent on the behalf of another person. For example, a parent or guardian of a child under 16 years to medical treatment may give proxy consent to HIV testing of the child.
- People with HIV and AIDS have the right to make their own decisions about any matter that affects marriage, family and child-bearing. (But counselling about the consequences of their decisions should be provided).
- No restrictions can be placed on the free movement of people with HIV and AIDS. They may not be segregated, isolated or quarantined in prisons, schools, hospitals or elsewhere merely because of their HIV positive status.
People living with HIV and AIDS
Finding out that you are HIV positive can be a big shock in itself and can lead to further emotional and physical suffering. There is a lot of ignorance and prejudice about HIV and AIDS and it is often seen as a “death sentence”. Most people are terrified when they are first diagnosed. Some respond by feeling that their lives are over and become very depressed. Many people cannot accept the diagnosis and deny that they are positive to their families and to themselves. Others react with anger and refuse to be responsible and practice safe sex. Many people feel ashamed of their HIV status and think that they will be rejected by their partners and family, or that their communities will isolate them if they are open about being HIV positive.
It takes courage to face this disease and a lot of support is needed to fight it. People with HIV and AIDS can live long and productive lives if they get emotional support, strengthen their immune systems, get proper medical treatment and take good care of their health.
The vast majority of people who are HIV positive do not know it. In South Africa only 15% - 20% of people who are positive have been tested. The people who do not know may be spreading the disease by having unprotected sex. Many of them only realise they are HIV positive when they develop AIDS and get seriously ill.
Families and children
The burden of care falls mostly 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. Families also suffer the daily stress of looking after someone who is ill and, in many cases, facing death. Many children, especially older female children, have to leave school to look after ill parents.
Children who are orphaned are often deprived of parental care and financial support. More and more orphans are living in child headed families where no-one is earning an income. 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. They are more likely to become street children or turn to sex work or crime as a way of surviving.
Older female relatives, mostly grandmothers, are the most likely to take in orphans. Many of them survive on pensions and already live in dire poverty. When their children die and they become responsible for grandchildren, they get a huge extra financial burden and at the same time they lose the financial support they may have received from their children.
Poverty and the economy
People who carry the heaviest burden as a result of HIV and AIDS are the poor. AIDS increases poverty and families are the first to feel the economic effects of HIV and AIDS. Families lose income if an earner is sick. Often another one of the family members stays at home to look after the sick person and further income is lost. Families also have increased costs as they have to spend money on caring for the sick or paying for funerals.
Government spending will also be affected since more and more of the taxes will have to be spent on health care and welfare. 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. If government spends more on health and welfare, less money will be available for providing basic services or for spending on development.
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.
It is very likely that AIDS will have the following direct impact on your municipality:
- There will be fewer people living in the area in 10 years than earlier projections.
- People will not live for as long as projected (around 43 years instead of 60 years)
- Infant mortality will increase because of mother to child transmission as well as a higher death rate among orphans who lack parental care.
- There will be an increase in the need for health care.
- There will be an increase in the need for poverty alleviation.
- Existing inequalities between rich and poor areas will become worse.
- The number of orphans will grow dramatically.
- The make-up of your population in terms of age distribution will change.
- 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.
- Economic growth will shrink since less disposable income is available for spending.
- Poor households will be less able to pay for services, rents and rates.
- Productivity in the economy will be affected by increased absenteeism.
- It will cost more to recruit, train and provide benefits for employees because of loss of skilled staff.
- It is likely that there will be an increase in bad debts.
- Municipal employees could be affected on a large scale and this could affect their ability to deliver key services.
- Expenditure meant for development may have to be spent on health and welfare.
Breaking the silence around HIV and AIDS
Although HIV and 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 HIV and AIDS are exposed to daily prejudice born out of ignorance and fear.
There are myths around HIV and AIDS and they lead to people seeing it as a scandal that should be kept secret. Many people see those with HIV and AIDS as people who are somehow to blame because they were promiscuous or homosexual. AIDS is seen by some people as a plague that you can catch just from being with someone who is HIV positive. In some communities people with HIV and AIDS have been chased out or attacked. This underlines the great importance of widespread community education efforts because the ignorance and prejudice around HIV and AIDS can be almost as destructive as the disease itself. In some countries AIDS activists have adopted the slogan “Fight AIDS - not people with AIDS.”
In countries where the infection rate has gone down, this only happened after so many people became ill that no-one could pretend it was not happening. Everyone started fearing that they would be next. We cannot afford to wait that long and must find ways of bringing HIV and AIDS into the open.
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 must work to ensure respect for and observance of rights and freedoms for people with HIV and AIDS, as well as the avoidance of HIV and AIDS-related discrimination and stigma.
We have to create an environment where communities become more caring towards people living with HIV and AIDS and orphans and we all take responsibility for education around prevention. Although HIV and 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.
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 guide.]
In 2003 the South African government approved a Comprehensive National Plan on HIV and AIDS Care, Management and Treatment. This plan was evaluated and revised in 2006 and a new strategy was published.
The strategy has clear targets and aims to reduce the number of new infections by 50% and get appropriate treatments, care and support to 80% of people who need it by 2011. It also has a strong focus on reducing the number of infections among young people.
The government, however, faces a big challenge in meeting these goals and will need a great deal of cooperation from civil society and local communities. The strategy is based on the principles of partnership, effective leadership and good communication. It seeks to promote social change and to make sure that funding is available for key programmes.
The strategy is holistic and also addresses issues like poverty reduction and social safety nets, the empowerment of women, the promotion of testing, etc. It also focuses on human and legal rights, medical research and monitoring and evaluation of programmes and projects.
Here are some of the key targets and programmes:
- Reduce vulnerability through poverty reduction, the empowerment of women and promoting testing,
- Reduce sexual transmission through promoting behaviour change among young, HIV positive and high risk people. Develop programmes for workplaces, male sexual health and against gender violence and alcohol and substance abuse
- Improve programmes to deal with TB, STIs and prevention of infection in sexual assault cases.
- Reduce mother to child transmission to less than 5% by expanding services
- Minimise transmission through blood through workplace safety, safe blood transfusion supplies and programmes to deal with risk in traditional practices and drug use.
Treatment, Care and Support
- Reduce the number of people who are ill with AIDS or who die from AIDS by providing the appropriate package of treatment, care and support to 80% of people who need it by 2011.
- Increase access to voluntary counselling and testing
- Enable people with HIV to lead healthy and productive lives by increasing treatment, care and support and managing TB and HIV co-infection.
- Improve care for people who are dying.
- Strengthen the health system and improve access to it.
- Target mothers and children who are ill and provide proper treatment, ART and nutrition to them.
- Strengthen community care programmes, home-based care and support groups.
- Ensure that programmes are developed to target older people and disabled people affected by HIV and AIDS.
Research and monitoring
- Develop and implement a monitoring and evaluation system.
- Support research into microbicides and vaccines and male circumcision.
- Conduct research on cost-effective forms of treatment and prophylaxis (prevention) as well as on the effectiveness of traditional medicines
Human and Legal Rights
- Ensure everyone knows and understands the laws and policies relating to HIV and AIDS.
- Ensure non-discrimination and adherence to laws and monitor human rights violations.
- Mobilise society to organise it self and build leadership of HIV positive people to protect and promote human rights.
- Identify and remove legal, policy and cultural barriers to effective prevention, treatment and support.
- Focus on the human rights of women and girls, including those with disabilities and mobilise society to stop gender violence and advance equality in sexual relations.
The strategy is a living document and will be reviewed and updated regularly.
The South African National AIDS Council (SANAC or NAC), is the main official body coordinating the government’s HIV AND AIDS programme.
It is chaired by the South African Deputy President and has members from government, civil society (NGOs), the private sector and unions. People living with HIV AND AIDS and women’s groups are also represented. SANAC is engaged in shaping, influencing and implementing policies and programme interventions.
This chapter contains a summary of the four main areas of action that should be taken at a local level to ensure a coherent multi-sectoral response to AIDS. It deals with:
- Care for people with HIV and AIDS and
- Care for children affected by HIV and AIDS
- Working together
- The response of African municipalities
The website guides on HIV and AIDS gives much more information on each of these topics.
A very important area to focus on is preventing the further spread of HIV. The vast majority of people (around 80% of adults) do not have HIV and AIDS and we can still do much to ensure that they stay safe.
There are many different things we can do to prevent the spread of HIV and AIDS:
- Educate every person in our community to understand how HIV and AIDS is spread and what we can do to protect ourselves.
- Encourage people to change their sexual behaviour and to practice safe sex at all times.
- Make condoms freely available and distribute them in places where people can have easy access to them - after hours, and close to where they live. Places like spaza shops, public toilets, taxis and other public transport, hostels, truck stops and garage shops, discos and clubs, bars, education institutions and so on.
- Make everyone aware of the plight of those of us living with HIV and AIDS and the burden on our families, and work hard to promote openness and compassion to break down the stigma and silence surrounding HIV and AIDS.
- Encourage testing for all people who have active sex lives so that we can be sure that we are not spreading the disease. Only an estimated 15% -20% of people who are HIV positive have been tested and many people are spreading the disease without knowing it. Testing must be accompanied with counselling and treatment.
- Ensure that every farm, factory, shop, mine, office and other places of employment has a workplace plan that targets employees.
- Ensure that all schools are implementing the Department of Education’s Life skills curriculum on HIV and AIDS.
- Encourage people ill with AIDS to be assessed for antiretroviral treatment (ART).
- Ensure that rape survivors get access to treatment that can prevent the transmission of HIV through close co-operation between the police service and health facilities.
- Encourage people, especially men, to seek treatment for sexually transmitted infections (STIs) at clinics and hospitals.
- Encourage pregnant woman and new mothers to seek help to prevent infecting their child (called mother to child transmission or MTCT).
2. Care for people with HIV and AIDS
The millions of people who already have HIV or AIDS need support, treatment and care.
We should do the following kinds of things in every community:
- Make sure testing is accompanied by counselling to help the person cope, to refer them to support projects and to advise them how to change their sexual behaviour so they do not spread the disease.
- Set up support groups for people with HIV and AIDS where people meet others with the illness and discuss common problems, feelings and ways of coping.
- Build and support organisations for people with HIV and AIDS that take up issues and co-ordinate support.
- Offer treatment for all opportunistic infections
- Ensure that people living with AIDS get antiretroviral treatment (ART) once they need it, and the support to stay on their medication.
- Support nutrition, vegetable-growing and wellness projects to help people stay healthy for longer.
- Set up home-based care projects in communities to make sure that people who are ill at home receive proper care. Volunteers should be used to carry out home visits to give support to families and basic care for people with AIDS. Volunteers should work with and under the supervision of local clinic staff.
- Target people with HIV and AIDS and their families for poverty alleviation projects.
- Make sure people with HIV and AIDS have easy access to the available grants and government support.
- Set up step-down facilities linked to hospitals for people who are discharged and cannot be cared for at home.
- Organise effective support for families and children.
- Involve the municipality, welfare organisations and the religious sector in providing food, clothing and other forms of relief for families in need.
3. Care for children affected by HIV and AIDS
Every community needs a program that can identify children affected by HIV and AIDS – those who are living with parents who are ill, those whose parents have already died, and children who have HIV and AIDS themselves.
These are some of the things that can be done:
- Set up community childcare committees to identify and help provide emotional and material support to children in need.
- Introduce foster care programs where possible, for children who have lost parents.
- Make information and assistance to get child support grants available to children and their caregivers.
- Introduce school programmes to ensure that children who are affected by HIV and AIDS get the necessary support to stay at school.
- Make sure food and nutritional support programs target children in need.
- Include special school lessons on HIV and AIDS related to different subjects. For example, biology should include lessons on healthy eating for people with HIV, language teachers should have speak-out lessons and encourage children to write about how the disease is affecting them. Life skills should deal with responsible sexual behaviour, and so on.
4. Working together
It is clear that national, provincial and local government alone cannot tackle or take responsibility for all these projects. Our hospital and welfare services cannot cope with the demand for support. It is essential that local communities get involved and set up projects that draw in and rely on volunteers.
The roles played by local leaders and opinion-makers, local organisations and local municipalities are crucial. It is only when communities are effectively mobilised by those they respect that HIV and AIDS projects will succeed.
It is also vital that everyone who works on HIV and AIDS cooperate to ensure that those in need are properly identified and catered for. This is especially important for health, welfare and other service organisations or NGOs. Referral systems have to be set up so that families in need can access support.
For example, if a child drops out of school and teachers find out that parents are ill, the child should be referred to projects for support and the parents should also be referred to the support and treatment programs that exist.
5. 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 and 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:
SALGA will provide support to implement AMICAALL 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 many areas. Each municipality selects the option that best suits them and aims to achieve the following:
This guide was written to be used together with a strategic planning process that helps a municipality, government and community stakeholders to develop a clear strategy for dealing with AIDS. The process used to develop a strategy should have the following components:
- Understanding the terrain
- Drawing in stakeholders
- Analysing incidence, impact, available resources and key interventions
- Deciding priorities and activities
- Setting up coordination mechanisms
- Getting support of leaders and the community
This guide does not deal with the issues of mainstreaming AIDS in municipal programmes or municipal workplace policies. It focuses on strategy development to build partnerships to deal with AIDS in the community and the work of multi-sectoral forums or AIDS councils, driven and coordinated by the municipality.
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 sections of this guide 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 and AIDS are, who are the most affected and what interventions are effective and realistic. Here are some examples of the information needed:
- 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 and AIDS on the following
- Local health and welfare services
- The local economy and availability of labour
- 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
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 a working partnership 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, health committee chair and health and IDP officials are 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.
3. 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 gate-keeping 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.
The next section deals in more detail with the setting up of structures.
6. Getting support of leaders and the community
Changing attitudes about AIDS and mobilising community action depend on the support of local leaders and community organisations. It is important to popularise the strategy and win broad support for it. It should be presented to, and adopted by the municipal council and presented to key opinion-makers in the area. A launch or a series of public activities can be used to increase community awareness, publicise services and mobilise volunteers.
Good coordination is the key to dealing with HIV and AIDS. In this section, we look at ways of organising Local AIDS Councils. This section contains the following:
- The role of the municipality
- Local AIDS Councils
- Coordination and Task teams
- Strategy and action plan
- Provincial AIDS Councils
- District AIDS Councils
No organisation or project can tackle HIV and AIDS alone. At national, provincial and district level the government has set up AIDS councils to bring together government services, NGOs and community organisations. At a local level, we need good coordination so that we can work together and properly use scarce resources.
Local projects on HIV and AIDS can be divided into the three main areas of work we have dealt with in this manual:
- Education and prevention
- Care, support and treatment for people with HIV and AIDS
- Care for children affected by HIV and AIDS
Many organisations, services and projects can play a role to do work in each of these areas. It is very important that they should all work together to make sure we prevent the further spreading of the disease and that people and families affected by HIV and AIDS get the support they need.
There are different ways of coordinating local efforts. You can set up an AIDS Forum or coordinating committee and involve all the different stakeholders. If the local municipality is committed to dealing with HIV and AIDS, a Local AIDS Council is a good way of coordinating work between government and civil society.
The role of the municipality in a multi-sectoral response
Coordination: Bring together stakeholders to develop strategy and coordinate implementation of projects.
Facilitation: Assist projects from civil society to get access to resources and to other government services and funding processes. Make council facilities available and use municipal communications facilities like newsletters and notice boards. Use clinics and public toilets for condom, distribution.
Planning: Ensure that the impact and consequences of AIDS are taken into account in the long term planning around the municipal IDP [Integrated Development Plan]. Develop clear poverty alleviation and indigent policies and target child-headed families and families that have lost breadwinners.
Leadership: Mayors and ward councillors should be role models for the community and provide moral leadership on dealing with AIDS and people who are affected by AIDS.
The municipality should also mainstream HIV and AIDS in all appropriate municipal programmes and should develop a workplace policy for its own employees (click here for more details on this)
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:
- wearing the red ribbon
- using all opportunities to show support for the campaign against AIDS
- acting as a role model of how to treat people living with AIDS
- encouraging testing and openness
- setting up a ward-based AIDS committees or child care forums
- visiting clinics and organisations that assist people with AIDS
- mobilising and recruiting volunteers for care projects for ill people and families
Broad ideas for action
At a local level action can include the following 4 key things:
- 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
- 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
- Organising support for people who are ill with AIDS by mobilising volunteers into community and home-based care projects
- Organising community support and care for AIDS orphans - through foster care, support for the basic needs of orphans, education, counselling and food programmes
In many parts of South Africa, municipalities are trying to set up Local AIDS Councils. The aim of the LAC is to develop a coherent strategy and action plan to deal with HIV and AIDS in the area. It should coordinate local efforts to ensure that services are properly delivered and to monitor effectiveness.
The LAC should have a clear link to government so that all government services and departments can be easily accessed. As the form of government closest to people, municipalities are well placed to initiate setting up of a LAC. All relevant government departments should also be drawn in – for example Welfare (Social Development) Health, Education and Home Affairs. Any welfare organisations and community projects that work on prevention, education or care projects should be involved. A Local AIDS Council should link with all local organisations, religious organisations, schools and businesses.
Coordination and task teams
We suggest that the LAC works as a coordinating structure and that the work happens in task teams around specific areas of work. The LAC can include everyone and be a broad forum that does not need to meet often. A smaller coordinating committee should be set up to do day to day coordination. This committee should consist of the task team heads, key government or welfare workers and one or two senior staff and politicians from the municipality.
It is important to first bring together those organisations and services that are already doing something and involve them in task teams that focus on the three areas of work. Municipalities should try to bring together every organisation and service that can help in any way. The municipality should play a facilitating role and not try to take over the good work that others are already doing.
Structures should not be too bureaucratic and should be designed to coordinate specific areas of work, 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. The LAC must ensure 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 influence and status. It is vital that any coordinating structure does not become a gate keeping structure that stops organisations from getting involved. AIDS affects everyone. It 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 care for people with HIV and AIDS or public education. People who are directly involved in these areas should play a leading role in these teams.
You should have at least the following three task teams with these members:
- Prevention and education
All education projects, health workers, school life skills project, councillors, community organisations, youth leaders and trade unions.
- Care, support and treatment for people with HIV and AIDS
Health workers, social workers, people living with HIV and AIDS, religious organisations, welfare organisations, and community projects working on care.
- Care for children affected by HIV and AIDS
Social workers, Child Welfare Society, school principals, religious organisations, community projects providing care for children.
All provinces have set up Provincial AIDS Councils to coordinate the fight against AIDS. The Provincial AIDS Councils are meant to coordinate the work of different government departments as well as the work of civil society organisations.
The Provincial AIDS Councils should develop a coherent strategy for the province and make sure all stakeholders are working together to implement it. The provincial strategy should reflect the priorities in the National Strategic Plan. The Provincial AIDS Councils should link with government departments like Health and Social Development, as well as with District and Local AIDS Councils and support the work they do. It should also work closely with welfare, faith-based and community-based organisations.
The Provincial AIDS Council should also help to mobilise resources that can be used in the fight against AIDS. It can play an important role to make sure that government and donor funding gets to the places where they are most needed.
It is important to find out what the Provincial AIDS Council in your province is doing and how to get support and advice from it.
All provinces are setting up District AIDS Councils to help coordinate work on AIDS in each municipal district. Most of these DACs have not been set up for long and many of them are still finding their feet. In different provinces, they sometimes work in different ways. The Department of Health is a key player in setting up the DACs. Health is organised according to districts and the district health officials coordinate all the government programmes like testing, treatment, clinics, support for home-care and treatment for sexually transmitted infections and TB.
The most important roles of DACs are to:
Most of the work on AIDS has to happen at a local level to have any effect. It is very important that DACs work closely with LACs and support their work on the ground. It is not practical to bring everyone to district meetings all the time and to try and coordinate work over a huge area. The LACs are in a better position to work with projects and organisations on the ground.
Once LACs are set up in all municipalities in a district, they should send representatives to the DAC so that there can be better coordination. DACs should help LACs to develop strategies, set up projects and access funding and resources.
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.
Public education/ awareness raising/ openness
Community care for people living with AIDS or orphans
Hold discussion and education meetings around AIDS, and what we can do.
Recruit volunteers for community care programmes.
Local welfare organisation or NGO
Give talks and workshops at schools, churches and organisational or community meetings.
.Organise care projects for people living with AIDS and orphans.
Educate members and encourage openness and testing.
Protect rights of workers living with AIDS.
Get own house in order with good education programmes, policies and services.
Support community programmes.
Run education programmes in community and clinics, on prevention, treatment, testing and care
Counselling for HIV positive people and accessing best available treatment for people who are ill.
Community education programmes.
Help set up community care projects
Promote openness and hold workshops
Set up counselling and care projects for people with AIDS and orphans.
Life skills training in classes.
Identify families in need.
Education and awareness programmes.
Set up counselling services.
Cultural and sport clubs
Cultural events like plays and songs against AIDS.
Raise funds and recruit volunteers.
This section is a summary of the chapter on Mainstreaming from the Municipal HIV and AIDS Framework published by the Department of Provincial and Local Government in April 2007.
As we have seen from previous section, municipalities and councillors should play a major role in building partnerships and local coordinating structures to drive a multi-sectoral local response to HIV and AIDS. Municipalities also have to ensure that they adapt their own programmes and policies to effectively deal with AIDS. In this section we look at mainstreaming HIV and AIDS as part of municipal planning and programmes and at developing a workplace policy for municipal employees.
What is mainstreaming?
Mainstreaming means bringing something into the main areas of work, rather than treating it only as a special side-issue with its own dedicated programmes. It is often used to describe what we have to do to achieve integration of gender issues in all policies and programmes.
HIV and AIDS mainstreaming, is an approach whereby HIV and AIDS is seen through a development and governance lens. Mainstreaming as an approach to HIV and AIDS requires municipalities, to analyse how HIV and AIDS impacts on themselves as organisations and on their core work, and to determine how they should respond
The concept of mainstreaming is based on the understanding that HIV and AIDS is not merely a health issue and that education and awareness around prevention is not enough to stop the rapid spread of the disease and deal with its consequences. To deal with the negative impacts of the epidemic, we need sustained, equitable and inclusive socio-economic development. This means that all sectors, including those that traditionally are not considered to have a bearing on health issues, have a role to play in responding to HIV and AIDS. Mainstreaming requires all municipal departments to look at their core work through the lens of HIV and AIDS and to take HIV and AIDS causes and effects into account during all stages of the municipal planning, implementation, budgeting, monitoring and evaluation process.
Mainstreaming should be taking place in both the internal functioning of a municipality, and the externally focussed service delivery work.
Internal mainstreaming deals with measures to reduce the susceptibility of municipal staff to HIV infection, and to reduce the vulnerability of the organisation to the impacts of the epidemic. It includes working with staff to educate them about HIV and AIDS, conducting VCT, and providing, or facilitating access to, ART. It also means re-examining and adapting internal systems and procedures to reduce the negative impacts of HIV and AIDS on the organisation, for example, reviewing HR policies and succession planning. The aim of internal mainstreaming is to try to ensure that the organisation can continue to operate effectively in the face of HIV and AIDS and continue to fulfil its functions.
External mainstreaming deals with the work of the municipality in the community. It means that every line department within municipalities should adapt their core work to take into account susceptibility to HIV infection and vulnerability to the impacts of AIDS amongst the communities within the municipal area. Adapting core work does not mean fundamentally changing what municipalities do, but rather identifying the possibilities that exist within their core work for reducing susceptibility and vulnerability in communities.
Mainstreaming is meant to complement HIV and AIDS programming, as it is about planning and implementing development and governance interventions that support educational, preventative, and care and treatment programmes. For example, mainstreaming interventions that aim to promote the safety of women and children assist in reducing the risk of women and children’s exposure to sexual violence and hence the potential transmission of HIV. To use another example, lack of access to clean water and sanitation can severely compromise the health and comfort of those living with HIV and AIDS. At the most basic level, mainstreaming means ensuring that developmental local governance proactively tackles conditions of marginalisation and vulnerability in the municipal area.
Key questions for mainstreaming HIV and AIDS
The following are useful questions for municipalities and departments within municipalities to ask when considering how to mainstream HIV and AIDS internally and externally:
- What are the impacts of HIV and AIDS on staff (in terms of absenteeism, mortality, morale, loss of skills etc) currently, and what are the projections for future impacts?
- What can be done to reduce the susceptibility of staff to HIV infection and to support staff and their families living with HIV and AIDS? (e.g. prevention, care and support interventions)
- How can the impacts of HIV and AIDS on the functioning of the organisation be minimised? (i.e. what policies or systems might be needed to ensure that the organisation can continue to function effectively in the face of the epidemic?)
- How do HIV and AIDS affect the people the department works with (i.e. its ‘clients’)?
- What are the changing needs of clients as a result of HIV and AIDS?
- What can the department do, as part of its core business, to respond to these changing needs?
- How might the work of the department increase susceptibility and vulnerability of households/communities to HIV and AIDS?
- What are the comparative advantages of the department in respect of responding to HIV and AIDS?
Since the municipal IDP is the overarching plan that is meant to guide all development activities within the municipal area, HIV and AIDS mainstreaming needs to be reflected in the IDP. The IDP should include an analysis of the susceptibility to infection and vulnerability to the impact of AIDS of different communities. The overall IDP should include clear responses that could improve the situation. Programmes, projects and budgets should be adjusted. This requires that the priorities and strategic thrust of the municipal IDP be reviewed to ensure that they respond to the range of place-specific drivers of HIV susceptibility and of vulnerability to impact proactively. Alongside the review of the IDP, the municipal budget, organogram and municipal systems also need to be adjusted where necessary to respond to the internal and external HIV and AIDS challenges.
Mainstreaming HIV and AIDS in the IDP review
To support municipalities to mainstream HIV and AIDS as part of the IDP review process, a set of key principles and questions has been developed(i). These principles and questions are meant to support structured discussions within the IDP structures (such as the IDP Steering Committee and the IDP Representative Forum).
Depending on the capacity of the municipality, the manner in which these questions are addressed would vary. For example, while well-resourced municipalities may be able to undertake detailed technology-backed demographic and economic impact modelling activities, others might only be able to consider such questions through discussions with resource persons and those affected.
Mainstreaming HIV and AIDS through participation
Preparation for the IDP review process must ensure that participation mechanisms enable marginalised and vulnerable people to participate. Without effective participation for target groups, municipal planning will not meet their development needs.
Participation should also include the major role-players in the municipal economy (such as employers and unions), and provide a platform for identifying how these role-players are affected by HIV and AIDS, what they are doing about it and what opportunities exist for establishing partnerships.
The following questions can help municipalities to consider whether their IDP Process Plan allows sufficient participation in a context of HIV and AIDS:
The voices of HIV and AIDS can include, but are not limited to:
- People living openly with HIV and AIDS;
- Local AIDS Councils
- CBOs, FBOs, NGOs and resource persons who specialise in HIV, AIDS and development;
- HIV and AIDS “champions” among officials, politicians and traditional leaders.
Superficial forms of consultation limit participation to needs identification and cannot serve as an effective basis for partnership-driven planning and implementation. Alternative and more meaningful mechanisms for participation could include:
HIV and AIDS within the municipal area (external mainstreaming)
- Obtain information on HIV prevalence and incidence (ii). Prevalence studies have shown that HIV prevalence is highest in urban settings (especially urban informal settlements) and lowest in rural and farm settlements, but it is important to bear in mind that HIV prevalence differs from place to place in the municipal area of jurisdiction;
- Engage with HIV and AIDS role-players within the municipality to investigate what factors are driving HIV infection. The drivers of HIV may be related to economic activities (e.g. mining, tourism, truck stops as drivers of mobility) or social practices (e.g. alcohol and drug abuse). High transmission areas should be identified;
- Identify what activities the municipality undertakes in its routine operations that affect the spread of HIV (e.g. an LED strategy for developing the municipal area as a freight port could increase use of sex workers);
- Consider the rate at which the epidemic is growing in the municipal area. This will help you decide whether to emphasise prevention interventions in future. If in your municipal area HIV prevalence is fairly low but growing rapidly, then prevention efforts must be actively pursued to ensure that those who are currently HIV negative remain so;
- Identify which socio-economic groups are at particular risk of contracting HIV. The purpose of the exercise is not to single out particular socio-economic or demographic groups but to be better equipped to develop and implement prevention strategies that respond to the specific susceptibilities facing each group;
- Identify where the communities most affected by HIV and AIDS and with least access to basic life sustaining goods and services live. A healthy environment can substantially decrease the risk of opportunistic infections. An unhealthy environment will compromise the health and wellbeing of those who are infected with HIV and those who are not infected alike. The provision of services such as water, sanitation, clean energy, solid waste removal and housing play a critical role in lessening the impacts of HIV and AIDS;
- Identify which services HIV-positive and AIDS affected persons receive and from which service providers in order to identify opportunities for:
- Partnerships for implementing a service-orientated strategy through Local Aids Councils and other cooperative efforts;
- Municipal support to organisations providing services; and
- Leveraging support for organisations from other role-players (such as provincial and national government departments, parastatals, NGOs, donors and the private sector).
- Consider, proactively, if any new IDP strategies, projects and activities will increase or minimise the drivers of HIV infection (susceptibility);
- Consider how the local economy is likely to be affected by HIV and AIDS. For example, are high rates of absenteeism and mortality likely to affect local rates of economic growth and job creation?
- Consider how municipal finances are likely to be affected by HIV and AIDS. This question must consider the likely impacts of the epidemic on the sources of municipal revenue, including rates and services levies.
Mainstreaming HIV and AIDS within the municipality (internal)
The IDP process is not only concerned with identifying community development needs and priorities. It is also concerned with assessing and addressing the capacity of the municipality as an institution to deliver on these needs and priorities.
Considering the institutional impacts of HIV and AIDS requires:
- Commitment to addressing HIV and AIDS, at the highest political and administrative levels; and
- A basic level of technical knowledge about HIV and AIDS as a workplace issue (which may involve bio-medical knowledge and institutional development knowledge).
The following issues should be addressed:
- A prevention programme among municipal role-players, which includes their household members;
- A treatment and care programme among municipal role-players, which includes their household members;
- An institutional efficiency element so that institutional systems and procedure are robust in the face of disruption; and
- A cost management intervention that proactively manages the workplace cost of HIV and AIDS.
To support municipalities to respond to the internal impacts of HIV and AIDS, SALGA has produced a guide, entitled HIV/AIDS in the Municipal Workplace, which is available on the SALGA website (www.salga.net).
Checklist for assessing HIV and AIDS mainstreaming in the IDP
The following questions need to be answered when considering external mainstreaming and impact on the IDP:
- Are consultation and participation mechanisms for planning and implementation accessible to affected and infected individuals?
- Are the water, sanitation, energy, solid waste, transport and environmental management services provided within the municipality appropriate in terms of quantity, reliability, accessibility, quality and affordability?
- What are the implications of widespread municipal service gaps for affected households and communities?
- How affordable are municipal levies, property taxes and service charges for employers and users in the context of HIV and AIDS?
- What are implications for the core developmental mandate of the municipality of long-term socio-demographic transformation, increasing informal settlements, new patterns of migration and the emergence of chronically vulnerable households and communities within the municipal area?
- What is the broader implication of HIV and AIDS in service delivery and planning?
The internal mainstreaming of HIV and AIDS includes questioning as a minimum:
Understanding the internal capacity to respond to the external mainstreaming of HIV and AIDS includes questioning as a minimum:
- How will the impact of HIV in the workplace affect the municipality’s ability to deliver services in communities affected by HIV and AIDS?
- How should the municipality be structured institutionally to respond to local development priorities affected by HIV and AIDS on the ground?
- What resources (financial, institutional and assets) are available to implement the response to HIV and AIDS and how does the municipality leverage the involvement of other stakeholders and role-players to participate in the local-level response?
Developing a workplace policy
Most institutions in our country are experiencing a drop in productivity due to the high rate of absenteeism caused by poor health or people who take time off to care for people who are ill. This also results in loss of skilled and trained workers. Some institutions have to spend money to employ and train replacements for people who are sick or who have died.
South African laws ensure fair treatment of all employees whether they are infected by the HI virus or not. These laws make it the responsibility of the employers to create an environment for a fair treatment of all employees irrespective of their status.
Employers should, in consultation with all stakeholders within the institution, develop a workplace AIDS policy that provides support to the employees.
A policy is a statement that defines what an organisation, and its associated employees, will do within a particular set of circumstances. It provides a framework within which various responsibilities, as well as expected behaviours and practices of both employers and employees, are clearly defined.
People with HIV and AIDS are protected by law against any arbitrary and unfair discrimination and stigmatisation in the workplace.
A good HIV and AIDS policy seeks to:
- Provides a framework within which a workplace programme can be implemented
- Represents management’s position and approach to HIV and AIDS, defining responsibilities as well as limitations
- Communicates to employees the company’s concern and commitment of the management to addressing HIV and AIDS in the workplace
- Defines the responsibilities of HIV positive employees within their job situation
- Defines the responsibilities of employees towards HIV positive colleagues
- Defines how specific HIV-related situations should be managed
- Allows institutions to pro-actively, in consultation with employees, define how anticipated HIV-related situations should be managed
- Provides security and protection to both management and employees
Requirements of an effective workplace policy
An effective workplace policy should meet the following requirements:
- It should be the result of a consultative process that involves employees and their representatives
- Its development and implementation should be seen as a dynamic process, with regular monitoring and review
- It should be supported by procedures that allow employees recourse to justice
- It should apply equally to core and peripheral staff
- It should deal with HIV as a blood-borne infection and appropriate safety measures should be instituted
- It should deal with the institution’s position around issues like sick leave, medical aid and treatment support.
- It should seek to change behaviour and attitudes of employees and their families
- It should be popularised through education and awareness programmes
A number of key personnel issues should also be addressed. Among them:
- Job access for HIV positive employees
- Job security for HIV positive employees
- The municipality’s approach to HIV testing of employees
- Guidelines on the management of confidentiality and disclosure
- Steps to protect employees against discrimination
- Employee benefits
- Access to training, promotion and other benefits
- Performance management in the context of HIV and AIDS
- Grievance procedures
Steps for developing a policy
- Elect or establish a fully representative HIV and AIDS working group. (It may be the HIV and AIDS management committee, the HIV and AIDS champion team or a group put together specifically for the development of the policy).
- Conduct a needs analysis within the company
- Formulate a draft policy
- Circulate the draft policy for comment
- Revise policy if necessary and circulate final draft
- Adopt the policy
- Ensure effective communication of the policy
- Review the policy regularly as new information becomes available
We suggest that at least the following people be involved in the development of an HIV and AIDS policy:
- Top management and mayoral committee members, representing the municipality
- Shop stewards, representing the employees
- Occupational health staff/health workers
- Human resources managers
- Other skilled personnel
Communication is key to the policy’s success. Here are some useful methods:
- Run workshops on AIDS and the policy for all employees
- Include a session on the policy in the induction training programme
- Include sessions on the policy in other education and training programmes
- Display the policy throughout the workplace
- Publish the policy on the intranet, ideally on this HIV and AIDS portal
Supervisors should be familiar with the content of the policy and able to discuss its implementation with employees
2. Prevalence refers to the number of people within a population infected with HIV, while incidence is the number of new HIV infections that occur over a particular time period (e.g. a year).
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