HIV AND AIDS IMPACTS AND CHALLENGES

Critical issues that municipalities must address

The HIV and AIDS epidemic in South Africa is severe, currently affecting more than five million people living with the virus. It is especially men and women in their reproductive and economically productive years that are vulnerable to infection. It is therefore of critical importance for municipalities, and particularly those including cities which are engines of economic growth, to deal proactively with the epidemic.

With around one out of five adults infected, the epidemic increasingly affects government, social and economic sectors nationwide, and causes an unstable situation for both families and society as a whole.

Apart from the health impacts and the individual and family suffering often related to HIV and AIDS, the epidemic also affects the employment rates as it claims the lives of skilled and unskilled workers across all sectors.

In terms of service delivery at the local level, municipalities are affected both as employers and service providers. The demand for services is constantly increasing, while staff capacity and the ability of residents to pay rates is decreasing due to the epidemic. The productivity of workers with AIDS decreases as they become weaker and are more often absent from work. New household configurations emerge due to the epidemic – households with invalids needing care, child-headed households resulting when both parents die, grandparents caring for grandchildren, and relatives and neighbours having to care for extra children. This places extra demands on families, housing, the health care system and cemeteries.

A lack of understanding of how HIV is spread leads to unsafe sexual practices, particularly in poor communities. The spread of HIV through sexual abuse and rape are exacerbated by over-crowded housing, unemployment, alcohol abuse, social insecurity and unsafe public spaces.

In those areas where people lack adequate access to water, sanitation and waste management, health risks are particularly severe for those with HIV/AIDS, who normally die from other diseases such as TB. Poverty also results in poor nutrition which further weakens the immune system, and inability to afford expensive antiretroviral drugs.

These realities need to be increasingly reflected in municipal development plans, policies, prevention programmes and information campaigns, in order to provide and promote healthy and safe living environments for communities.

Challenges for an integrated local - government response to HIV and AIDS
Below is a summary of key issues to be addressed by an integrated local government response to HIV and AIDS:
• Lack of dedicated HIV and AIDS human and financial resources at municipalities – where there are staff, they are usually of junior rank and lack decision making powers
• Lack of uniformity regarding the location of HIV/AIDS Units within municipalities
• Lack of a clear common understanding of the meaning of ‘mainstreaming’ of HIV and AIDS
• Little or no knowledge management process/system with regard to HIV and AIDS in municipalities, and weak Management Information functionality
• Perceived lack of commitment to HIV and AIDS related matters at the local level by politicians and senior officials

Recommendations to address the above challenges:
The Department of Provincial and Local Government needs to develop a plan to implement the policy framework on HIV/AIDS. Examples of what the plan would cover include:
• Support for municipalities in addressing the epidemic
• A process for developing and managing HIV and AIDS integration projects in provinces/municipalities
• Define a generic approach for mainstreaming of HIV and AIDS that can be rolled out to all municipalities
• Formulate a resource plan and training plan for provinces/municipalities • Approve resources for the above.

Towards new initiatives
Municipal programmes to combat HIV and AIDS in South Africa have for a long time and to a large extent been managed by HIV and AIDS coordinators who have lacked the power to influence decision making. Many municipalities still only have external policies and where there is an internal workplace policy in place, the staff is not always aware of its existence. Moreover, HIV and AIDS policies have often been unclear, academic and difficult to implement. Many municipalities have, due to the amalgamation and transformation process, been challenged by structural barriers such as the need for capacity. Another challenge has been, and still is, lack of strategic planning around the impact of HIV and AIDS and its long-term consequences, both for communities and local authorities.

However, progress has been made and several municipalities have now embarked on new programmes to establish an effective HIV and AIDS response at the local level.

Buffalo City and Nelson Mandela Bay municipalities both have progressed significantly in adopting proactive approaches to the epidemic in order to support communities. Both municipalities have received support through the Urban Programme for projects to combat the spread of HIV and mitigate the impact of AIDS.

HIV and AIDS have an impact on all spheres of society, and a range of measures are necessary to counter the epidemic. The impact of HIV and AIDS is so serious that it has been addressed as a cross-cutting issue in all projects of the Urban Programme.