HIV /AIDS in Southern Africa pdf

Introduction 1 An outline of the Kellogg projects 2 Day one: HIV/AIDS policy in six southern African countries 4 Opening address: Dr Phetsile Dlamini 4 Background to the involvement of W

Projects funded by the WK Kellogg Foundation on

HIV/AIDS in southern Africa Report of the Colloquium

Projects funded by the WK Kellogg Foundation on

HIV/AIDS in southern Africa

Report of the Colloquium

Compiled by the Social Aspects of HIV/AIDS and Health Research Programme of the Human Sciences Research Council (HSRC)

Funded by the WK Kellogg Foundation

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Introduction 1

An outline of the Kellogg projects 2

Day one: HIV/AIDS policy in six southern African countries 4

Opening address: Dr Phetsile Dlamini 4

Background to the involvement of WKKF: Bishop Malusi Mpumlwana 4

Overview of the HIV/AIDS policy project: Dr Olive Shisana 5

HIV/AIDS policy: Dr Lucky Odirile 6

A comparative analysis of prevention and care projects:

Ms Mpumi Zungu-Dirwayi 7

Legal issues: Ms Marlize Richter 7

Financing of HIV/AIDS in the six southern African Countries:

Dr Olive Shisana 8

Drug policies: Dr Henry Fomundam 9

The health strategy of the New Partnership For Africa’s Development

(NEPAD): Prof Eric Buch 10

Day two: The development, implementation and evaluation of

interventions for the care of OVC in Botswana, South Africa

and Zimbabwe 12

An Overview of the WKKF-funded OVC research programme:

Prof Leickness Simbayi 12

The WKKF OVC programme: Dr Phetsile Dlamini 12

Implementing interventions to improve the social conditions,

health, development and quality of life of OVC: Mr Jephias Mudondo 14

Interventions to support families and housefolds:

Ms Ntjantja Ned

Strengthening community-based support systems as a way of

supporting vulnerable children: Pastor Adrian Mpofu 15

Lessons learned from OVC projects so far: Dr Donald Skinner 15

Summing up: Ms Ntjantja Ned 16

In November of 2003, the Human Sciences Research Council (HSRC) and the

WK Kellogg Foundation (WKKF) hosted a colloquium to present and reviewthe research that the HSRC has conducted with the support of the Foundation

in projects across six southern African countries namely, Botswana, Lesotho,Mozambique, South Africa, Swaziland, and Zimbabwe The two-day event wasdesigned to cover the two focal areas of the work; thus the first day focused onthe policy research that has been done across the six countries in southernAfrica, and the second day looked at the work that has been done withorphaned and vulnerable children (OVC) in Botswana, South Africa andZimbabwe

The colloquium was seen as an opportunity to report back to the WKKF and

to local stakeholders, including representatives from government, serviceproviders in health and social development, state policy and regulatorybodies, academics and researchers, intervention workers from both NGOs andstate services, policy makers and interested advocates around policy andchildren Work at the colloquium was directed at using the forum to facilitate

as much discussion and debate as possible The event was also designed toserve as a space for networking and social connection between all theorganisations involved

In that light the following themes were used as starting points for discussionand to structure the programme at the colloquium:

• Financing of HIV/AIDS programmes in southern Africa;

• Legislation affecting people living with HIV/AIDS in the six countries;

• HIV/AIDS policies and strategic plans in the six countries;

• Access to HIV/AIDS prevention and care services;

• Pharmaceutical policies and infrastructure for the provision ofantiretroviral drugs in the six southern African countries;

• Interventions aiming to improve social conditions, health, developmentand quality of life of vulnerable children and orphans;

• Interventions aiming to provide support to families and householdscoping with an increased burden of care for affected and vulnerablechildren;

an indirect means to support vulnerable children

An outline of the Kellogg projects

As the principle aim of the colloquium was to examine the work of two country projects, it is important that the basic aims and philosophies of thesetwo projects be understood These are outlined briefly below

multi-HIV/AIDS policy in six southern African countries

As part of its commitment to assist economic and social development insouthern Africa, the WKKF has established an Integrated Rural DevelopmentProgram (IRDP) to contain the spread of HIV and mitigate the impact ofHIV/AIDS in rural communities With this goal in mind WKKF, through theCentre for Applied Social Sciences at the University of Zimbabwecommissioned the Social Aspects of HIV/AIDS and Health ResearchProgramme of the HSRC in South Africa, to undertake a review of thesituation on HIV/AIDS in six southern African countries (Botswana, Lesotho,Mozambique, South Africa, Swaziland, and Zimbabwe); to put forwardrecommendations to WKKF to strengthen its policy in this area and to guideits future work in the area of HIV/AIDS and rural development The studyalso meant to analyse HIV/AIDS policy, legislation, financing and implemen-tation of programmes in the six countries By the time of the colloquium, thefollowing research processes had been undertaken:

policy and strategy;

reviewed and the progress countries have made in implementing the UNinternational agreements and guidelines was assessed;

documented case studies, were subjected to a detailed review;

• Access to HIV/AIDS prevention and care services was investigated in allsix countries, based on surveys of the population in the nine sites whereWKKF is implementing the IRDP;

interventions suitable for implementation in the six countries

The development, implementation and evaluation of interventions for the care of OVC in Botswana, South Africa and Zimbabwe

The HSRC has been granted funds by WKKF to implement research-driven,evidence-based, intervention programmes to assist children, families andcommunities affected by HIV/AIDS in Botswana, South Africa and Zimbabweover five years This programme is contributing towards the development of astrategy for the care of OVC in Botswana, South Africa and Zimbabwe; withthe potential of deploying these strategies in other parts of Africa as well Thestrategy will be informed by research that supports innovative and sustainablemodels that target OVC, as well as families and households coping with anincreased burden of care for affected children

The programme aims at a holistic response so efforts are directed at all levelswhich are needed to ensure adequate support for OVC, namely the vulnerablechildren and orphans themselves; households with vulnerable children; andcommunities where vulnerable children and orphans are concentrated

The goals of the programme are to:

vulnerable children and orphans

for affected and vulnerable children

support vulnerable children

support to vulnerable children and households over the long term

Day one: HIV/AIDS policy in six

southern African countries

Opening address: Dr Phetsile Dlamini

The official opening address was given by Dr Phetsile Dlamini, in which sheemphasised the gravity of the HIV/AIDS epidemic in Africa with southernAfrica being the epicentre Two key problems in responding were a lack oflocal research, leading to a dependence on information from Europe and theUSA where context is often different; and the gap between researchers, policymakers and implementers She expressed the hope that meetings of thisnature, and the support that WKKF had provided, would continue to developlocal, evidence-based research and close partnerships between all thestakeholders in all six countries

Background to the involvement of WKKF:

Bishop Malusi Mpumlwana

Bishop Malusi Mpumlwana, Regional Director of the WKKF, gave thebackground of WKKF involvement with HIV/AIDS and OVC As part of its75th anniversary celebrations, the WKKF developed a vision of working withchildren and families to empower people in affected communities This visionled to the creation of a programme, ‘Socio-economic transformation of thesouthern African region towards healthy, viable and sustainable ruralcommunities’ which has put special emphasis on women, youth and families

A systems-change approach is being applied based on four pillars of action

1 Economic opportunities through support for:

2 Leadership and skills development to enhance:

3 Health and well-being to encourage development that focuses on:

4 Civic responsibility to promote:

He wished the meeting well and encouraged the researchers to produce good,evidence-based research and to share those experiences effectively for thedevelopment of Africa as a whole

Overview of the HIV/AIDS policy project:

Dr Olive Shisana

This project drew on the research results across Botswana, Lesotho,Mozambique, South Africa, Swaziland and Zimbabwe Dr Shisana emphasisedthe importance of looking at the themes across the six countries but, moreimportantly, of using this research to establish a dialogue between researchersand government in each country

The high prevalence of HIV/AIDS in the region (65 per cent of all peopleliving with the HIV/AIDS worldwide live in the SADC countries) makes thisresearch critical Amongst the countries involved in the study, Botswana hasthe highest prevalence at 38.9 per cent of the population Zimbabwe andSwaziland have similar levels of infection, while South Africa has the largestnumber of people living with HIV/AIDS, namely 4.5 million people aged twoyears and older

One of the key focuses for the study was to examine progress made by African

leaders who were party to the Declaration on the Commitment to HIV/AIDS at

the UN General Assembly Special Session on HIV/AIDS held in June 2001.Heads of state and governments made an undertaking that, by 2003, theywould have developed multi-sectoral, national and strategic plans whichdirectly address the epidemic Great concern was expressed around the fact thatleaders of many countries made commitments in international forums, butundertook little active work to honour these commitments at a national level.The paper introduced some of the key debates of the day, and Dr Shisanacalled on each of the speakers to answer the critical question of whether thepolicies in the countries were appropriate for the challenges posed by thepandemic, and would ensure that the human rights of people with HIV/AIDSwere protected

Discussion focused on the prevalence rates in countries, comparing theantenatal sentinel-surveillance approach with other methods like the baselinesurvey done in South Africa It was proposed that incidence rates wouldenable researchers to more accurately gauge the impact of education onpreventing new HIV infections

HIV/AIDS policy: Dr Lucky Odirile

Dr Lucky Odirile presented a comparison of the current status of policies inthe six countries South Africa was shown to be the only country withcomprehensive laws and policies that respond to the challenge of HIV/AIDS.Policy development in the other countries had lagged with research showingthat some countries had only partially addressed this issue while others had

A comparative analysis of prevention and care projects:

Ms Mpumi Zungu-Dirwayi

Ms Mpumi Zungu-Dirwayi noted that all the countries studied had nationalHIV/AIDS policies and strategic plans that dealt with prevention of HIV Themajor prevention programmes centred around the distribution of condomsand HIV/AIDS awareness campaigns Prevention of mother to childtransmission (PMTCT) had also been incorporated into strategic plans withcoverage increasing every year in all the countries studied Many countrieshad also already set up voluntary counselling and testing (VCT) sites and wereattempting to increase these sites within the countries Countries leading inprovision of PMTCT and VCT were South Africa, Botswana and Zimbabwe.The smaller countries lagged behind but were in the process of increasingtheir delivery

It was proposed that a greater focus on the prevention of new infections wasrequired The greatest challenge is to develop intervention programmes thatimpact on behaviour change and encourage risk-free sexual behaviour inyoung people Stigma was also an area of concern, as it had affected a number

of interventions, particularly around mother-to-child transmission where itimpacted on the use of formula feeding The importance of the socio culturalsetting was emphasised again

Legal issues: Ms Marlize Richter

Ms Marlize Richter presented a study of the legal provisions in the sixcountries, looking particularly at issues of human rights, discrimination andgender sensitivity Awareness of these issues, particularly of gender sensitivity,was found to be lacking in the legislation in most countries One particularlyimportant challenge raised was the integration of customary/traditional lawswhich tend to be unwritten

This study showed that, while South Africa has comprehensive laws that touch

on the different areas of HIV/AIDS, many of the other countries had not set

up specific legislation around many of the key areas There was also adisturbing pattern of using legislation and traditional law in ways thatdiscriminated against women, thus making them more vulnerable to

infection Even international conventions were found to not give people livingwith HIV sufficient recourse against stigma and discrimination It wasproposed that areas that require clear legislation include:

Financing of HIV/AIDS in the six southern African

countries: Dr Olive Shisana

This study assessed the financing provided for HIV/AIDS programmes in twoways This was assessed, firstly, as a percentage of the amount actually required

to deal with the problem of HIV/AIDS Secondly, it was assessed againstcommitments African leaders had made in Abuja in 2001 to use 15 per cent oftheir national budgets on health

HIV/AIDS expenditure was defined as either core, that is dedicated to specific programmes such as VCT or home-based care; or expanded, which includes

other expenditure incurred by health care facilities, such as the treatment ofopportunistic infections Some of the salient observations were:

large differences Botswana and South Africa have the highest figures andZimbabwe has the lowest;

countries except for Mozambique, which was lowest and is now showingsome growth following the end of the war;

Treasury Some information also came from surveys such asincome/employment studies and household surveys as well as reportsfrom multilateral agencies

The percentage of national budget spending on health in the six countries iscurrently: