Informal settlements and HIV in South Africa:

Informal settlements and HIV in South Africa: the need for a developmental local response Jo Vearey (Wits/HEARD) Liz Thomas (Wits/MRC) Lorena Nunez (Wits) Jacques Bezuidenhout (University of Nijmegen) Scott Drimie (IFPRI-RENEWAL/Wits) SAHARA Conference 2 nd December 2009 Johannesburg, South Africa

Overview
Why a focus on urban informal settlements and HIV ?
The importance of urban when considering HIV.
Key findings from research studies.
Urban informal settlements as a “neglected space”.
The role of “ developmental local government ” in responding to HIV and informal settlements:
The urgent need for local level developmental responses.

Structural and contextual factors Why a focus on HIV and urban informal settlements? Housing ? Urban ? SADC, 2006

A focus on the urban: an increasing urban population

World Urbanization Prospects (2005 Revision), United Nations, Department of Economic and Social Affairs By 2030, 50% or more of the African population will be living in a city

Henk Van Renterghem, UNAIDS (2009)

HIV prevalence in adults aged 15 – 49 years by locality type, South Africa, 2005 (HSRC, 2005) Why a focus on HIV and urban informal settlements?

Why a focus on HIV and urban informal settlements? three key points
Urban informal settlements in South Africa are associated with some of the highest HIV prevalence globally.
Effective responses to address both the vulnerability to – and impact of - HIV in informal settlements are currently lacking .
UN MDG 7, Target 11, “Cities without Slums”: “By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers”
In South Africa, the MDG target has been (mis)interpreted as the ‘eradication of informal settlements’.
A lack of respectful in situ upgrading.
Urbanisation in developing countries involves informal settlements (Bocquier, 2008)
An urgent need to engage with the realities of urban growth , and increasing urban poor populations – including those residing in informal settlements.
Action from Regional, National, Provincial, Local levels.

Sol Plaatjies informal settlement n = 200

RENEWAL: urban informal settlement compared to urban formal
Food security is poor;
Perception of risk of HIV is greater;
Residents are mostly internal South African migrants and female;
Access to basic services is limited.

24 hours Dietary Diversity Score: respondents residing informally are more likely to have a deficient dietary score Chi-square 89.880; p = <0.0001 Score 0 - 3 Score 4 - 6 Score 7 - 9 24 hour Dietary Diversity Score In a context of high HIV prevalence, urban informal settlements have poor food security.

Perception of risk of HIV Chi-square = 14.221; p = 0.0002 In a context of high HIV prevalence, urban informal settlement residents perceive themselves at risk of HIV

Inadequate access to basic services
No electricity (despite upgrading)
Paraffin and candles
Water
Communal taps
Sanitation
Communal toilets
Open bush
Waste removal
Irregular collection
Dumping
Negative impact on health, especially for people living with HIV .
(Mporetji, 2008; Bezuidenhout, 2009; RENEWAL, 2009)

Housing

Schooling

Transit camps

Development…..

The role of local government in responding to HIV and informal settlements

Developmental local government “ local government committed to working with citizens and groups within the community to find sustainable ways to meet their social, economic and material needs and improve the quality of their lives ” (RSA, 1998: 23)

National Strategic Plan (NSP) for HIV & AIDS and STIs, 2007 - 2011
Recognition of:
Informal settlements;
The importance of local government in implementing an effective response.
However:
No framework or guideline for how to implement local level developmental responses to HIV in informal settlements .

Key findings

Urban informal settlements
Informal settlements present a range of development challenges to local government :
High HIV prevalence;
High perceived risk of HIV;
Inadequate food security;
Poor access to basic services;
Inappropriate development process;
Mobility – the importance of “home”.
Residents experience HIV in an integrated way :
It is not possible to ‘divorce’ HIV from their other urban development needs.

Establishing a local-level response to informal settlements and HIV
HIV is not viewed as a developmental challenge.
Challenges:
Enabling a developmental response;
Establishing partnerships with and between local government departments;
The amount of time required to establish a sustainable interventions;
The expectations of external funding agencies;
The frustrations of community participants.

Responding to HIV in urban informal settlements
There is currently a lack of guidance for cities on how to respond to HIV – particularly within urban informal settlements.
Local government must take action on the determinants that increase vulnerability to HIV, and on the impacts of HIV.
Viewing HIV as a central development challenge requires local government to “get the basics right”:
Provision of basic services - HIV is more than a health issue.
A broad, integrated, multisectoral response is required to address the challenges outlined:
Commitment by all partners to work together.
Inter-sectoral understanding and action by all partners including local government.
Commitment to working with and being informed by community views and priorities.
Need to draw on community strengths.

Future research
Intervention research - piloting new interventions:
A current lack of intervention studies;
Multisectoral responses are required;
Appropriate funding streams that understand the importance of time are required;
Linked to process evaluations.
Smaller city and town research is needed.
Functionality of local AIDS councils.
Political buy-in to urban interventions.

Acknowledgements
Sol Plaatjies community
Sol Plaatjies photo project participants
Simon Mporetji
Pinky Mahlangu
City of Joburg HIV Directorate
Jozi Ihlomile volunteers
Market Photo Workshop
Planact
RENEWAL & IDRC
Atlantic Philanthropies

Informal settlements and HIV in South Africa:

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