Inner-city informal settlements and HIV:  reflections and experiences 17 th  July 2007 Jo Vearey  [email_address]   Univer...
Overview <ul><li>Reflect on experiences of an innovative programme; </li></ul><ul><li>Mpilonhle – Mpilonde: </li></ul><ul>...
Johannesburg inner-city
Internal migrants residing in  Hidden Spaces <ul><li>Single-sex migrant labour  hostels ; </li></ul><ul><li>Informal settl...
Community prioritisation of needs Men Women
© Thuli Zwane ‘… .  They stay in the shacks and they are trying to cope with the situation.’
© Ntombifuthi Ngwenya ‘ This is (a) Squatter Camp and the people are using the public toilets.  They are feeling very bad ...
© Busisiwe Zondo
© Nathi Makhanya
© Nathi Makhanya ‘ This woman was pictured fetching some water down the hole.  This is the only source where water is foun...
Internal migrants in the inner-city RHRU, 2005 High HIV prevalence Dependents Unemployed Cultural ties Rural Young Who? 24...
Key question <ul><li>How to develop an appropriate, effective </li></ul><ul><li>social and structural intervention  for th...
HIV, public health and development <ul><li>Quality Life Clubs </li></ul>i d asa   An urban public health programme in Jobu...
Quality Life Clubs (1) <ul><li>Fusion of:  </li></ul><ul><ul><li>‘ Community Health Clubs ’ in Zimbabwe and Sierra Leone (...
Quality Life Clubs (2) <ul><li>Community driven structures that aim to: </li></ul><ul><ul><li>Build a demand  for health, ...
Simple, sustainable Reflecting Time Changing Learning
Quality Life Clubs (3) <ul><li>Behaviour change </li></ul><ul><ul><li>Begins with issues faced on a daily basis, problems ...
Partnerships i d asa   Partnerships are key
Process Evaluation Membership <ul><li>Clubs launched in February 2005; </li></ul><ul><li>400 members; </li></ul><ul><li>3 ...
Process Evaluation Individual & Collective action <ul><ul><li>Club member initiated  community clean-up campaigns  . . . ....
Process Evaluation   Positive outcomes <ul><ul><li>Positive outcomes among members: </li></ul></ul><ul><ul><li>Increased k...
Process Evaluation  Key challenges <ul><li>Structural & social interventions </li></ul><ul><ul><li>Context specific ; </li...
Conclusions:  QLCs <ul><li>Positive impacts on  quality of life  at the local level; </li></ul><ul><li>Quality of life is ...
Acknowledgements <ul><li>Partner organisations </li></ul><ul><li>Idasa </li></ul><ul><li>GreenHouse Project </li></ul><ul>...
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Inner-city informal settlements and HIV: reflections and experiences

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  • Hostels have been home to migrant workers in Johannesburg for decades. Labour practices supported the large-scale movement of men to urban areas. Apartheid polices that restricted the urbanisation of black South Africans resulted in migrant, predominantly rural, workers being housed in isolated single-sex hostels. A mine company, or other industrial business, would own a hostel providing each of it’s employees with a bed ticket. Numbers of hostel residents were therefore controlled. In the build up to democracy, however, political clashes between the predominantly Zulu nationalist hostel residents, and the ANC aligned groups of the townships, led to destabilisation of the areas where hostels are found. Today, young men continue to travel to Johannesburg in search of work and come to reside in hostels. They come to the hostels as they have family members or home-boys living there. Today, however, there are no jobs, no management structures and no control on numbers. As a result, severe overcrowding and consequent public health issues have arisen. Indunas and traditional leaders control the hostel environments and political affiliations persist. This has resulted in a lack of services being provided to hostel residents and no health related programmes have previously been run in this environment.
  • The survey showed us that HIV is a pressing issue within this community. Participatory needs assessments - using pairwise ranking – were also carried out in order to establish community prioritisation of needs. As illustrated on this graph, for both men and women, the biggest need was employment with unemployment being consistently ranked as the highest priority. This is more so for men. These men and women moved to Joburg in order to find work, yet the reality is that the city has very few jobs. So already, upon arriving, the dream of finding employment is not met. HIV was ranked low on the list of community identified priorities. For the women especially, issues such as adequate housing, access to water and overall health were identified as more pressing. When considering the daily struggles for survival encountered in this population, it is no surprise that HIV is not a priority – it is a challenge to consider tomorrow when today is a struggle for survival.
  • The Mpilonhle – Mpilonde programme is working with a population of approximately 24,000 migrant men and women, residing within single-sex hostels and informal settlements in an industrial area of the inner-city. A community-based behavioural and prevalence survey of 2,500 residents was undertaken and I will share some of these results with you. The focus of this presentation is on the intervention design and I am not going to go into the research methodology here. CLICK 1 So who makes up this migrant population? They are young, rural, with strong cultural ties. The majority remain unemployed, although travelling to Joburg for the purpose of finding work. They have dependents. And HIV prevalence was found to be disturbingly high. Click 2 71% of the men residing in single-sex hostels are under 35 years of age and nearly 70% originate from rural areas, predominantly KZN. 68% of the men are unemployed And over 60% have children back home – that are dependent on their income. HIV prevalence was found to be 24%. Click 3 Just over 80% of the women residing in the informal settlements neighbouring the hostels were under 35 years of age. 60% originate from rural areas and again, the majority are from KZN. The women, however, make up a more mixed population and few (only 1%) are from outside of South Africa. With 76% unemployed, the women struggle more than the men, especially considering that over 80% have children – these children live with their mothers in the informal settlements. And with HIV prevalence at a very high level – 56% - it is apparent that this is a community very much in need.
  • In an era of HIV interventions where vertical targeted efforts like the ARVs rollout , social and structural interventions are rare but in this context of poverty and extremely high rates of infection – very necessary. We propose 3 critical ingredients to run such an intervention. First – a strong theoretical framework – drawing on various disciplines and previously tested models, appropriately adapted to the context, Second – simple, sustainable and community run activities Finally - a strong research base that effectively generates baseline data and evaluates intervention through a sound process evaluation .
  • Bringing together various experiences from the continent and wider, as well as the frameworks developed, the concept of Quality Life Clubs was established.
  • Quality Life Clubs are Community driven structures that: build a demand for health, wellbeing, rights awareness and civic engagement increase self efficacy and ultimately causing patterns of behaviour to shift and to change. Behaviour change takes time. The Clubs, that are open to all residents – any age – free of charge, assist members with behaviour change by Beginning with issues faced on a daily basis, problems that are not highly sensitive, food and nutrition, environment and sanitation, for example; Over the course of six-months members begin to witness both their capacity to change and the benefits of the change in their lives; Become better prepared and confident to addressed more stigmatised and threatening problems relating to:
  • Quality Life Clubs are based on simple, and sustainable community based activities. The Clubs facilitate a continuous cycle where Club members obtain new information , reflect on it , try it out , learn more , discuss more and keep on the cycle. Initially small, individual change and ultimately larger, community change is put into place. Weekly ‘ Learning Sessions ’ begin with issues faced on a daily basis – identified by community and the survey. These are problems that are not highly sensitive, food and nutrition , environment and sanitation Members then meet in smaller groups – Reflect circles – later in the week to ‘reflect’ upon what they have learnt and the impact that it has upon their own lives: Action planning is a key output of this process as Club members – through their reflect circles, begin to make, experience, and witness change.
  • Finally, thank you to our partners – JOburg, GHP, actionaid, Idasa and Soul City and their continued support and enthusiasm.
  • The process evaluation has enabled us to track the Clubs since their launch in February this year. 150 members since February 2005 1 st Graduation of 85 members – July 2005 The graduation consisted of Club performances about Quality of Life and HIV, involving music, song, dance, poetry. The performances clearly demonstrated the strong club identities that had developed, as well as their and cohesiveness.
  • The process evaluation has also tracked the changes that club members have begun to make in their lives. This includes both individual, and collective actions as members become more aware of their rights and responsibilities, and as they begin to gain more control over their lives. As their capacity to aspire increases, members feel more able to instigate change. The actions observed have all been directed by Club members and include: community clean-up campaigns . . . . holding local Councillors accountable, demonstrating civic awareness and participation contact with local authorities – PikitUp, Rand Water – in relation to service provision problems, this has resulted in members obtaining water tanks and toilets for their communities Gardens set up to grow vegetables and herbs and the use of containers where space is limited. Visits to Greenhouse Project showing that members are beginning to utilise services available to all Joburg residents.
  • The Process Evaluation has also entails in-depth interviews with members. The overall p ositive outcomes among members - so far include: Increased knowledge &amp; awareness Established sustainable structures – in the form of reflect circles Built a demand for a better quality life – that is cleaner, safer, greener, healthier Generated ‘staying power’ to a process that has NO financial gain – a really positive result considering the demand for money and employment. Built self confidence to express own ideas – a willingness to challenge leadership And, importantly the clubs have i nstilled a capacity to plan – to think into the future, to aspire, and to try and realise dreams.
  • The process evaluation also enabled us to track the challenges encountered when implementing the Quality Life CLubs,. Importantly, a structural &amp; social intervention such as this is a challenge in itself. The programme is subject and sensitive to the ever-changing context – politics, weather – with communtiy meeting spaces limited, sessions run outside or in run-down hostel buildings. Due to this, the programme is staff and time intensive. Secondly, this is a complex urban population that has not yet been effectively reached by any public health programmes. Traditional, political, elected and non-elected leadership are strong gatekeepers. Perpetual crises (shocks) – shack fires, ethnic violence. There are a wide range of shocks and stresses encountered on a daily basis, with residents at a survival stage. Their asset bases and therefore control over their own lives is limited. High unemployment – high levels of despair &amp; depression, resulting in high levels of apathy Dependency &amp; entitlement syndrome - expectations of financial reimbursement &amp; dish-outs Allegiances to other communities – minimal commitment to Johannesburg These men and women travelled to Joburg to find work – upon arriving, the reality of their dream of a job is not realised and so self-esteem is low. Residents do not perceive Joburg as their home and their allegiances are with their home communities – the concept of community development and building assets is referred to their home communities, even though they spend their daily lives in JOburg.
  • Although the Mpilonhle – Mpilonde programme has faced a range of challenges since 2003 when the programme began working with this community, the clubs have helped to create a sense of community. Young hostel residents have moved out from the hostel environment to Clubs that bring hostel and settlement residents together, helping establish the kind of balanced community that they crave. This Club has assisted individuals in collectively coping and recovering from shocks and stresses. And, importantly, this could have far reaching benefits for other, similar migrant groups where a true sense of a balanced community that is able to support all members, is currently absent. And in the context of HIV, within a closed community such as these inner-city hostels, without such a collective coping and recovery strategy, any prevention, encouragement of testing, or treatment effort will struggle as the residents within it are not currently accessible.
  • Transcript of "Inner-city informal settlements and HIV: reflections and experiences"

    1. 1. Inner-city informal settlements and HIV: reflections and experiences 17 th July 2007 Jo Vearey [email_address] University of the Witwatersrand Forced Migration Studies Programme http://migration.org.za
    2. 2. Overview <ul><li>Reflect on experiences of an innovative programme; </li></ul><ul><li>Mpilonhle – Mpilonde: </li></ul><ul><ul><li>STI/HIV Research Directorate of the RHRU www.rhru.co.za </li></ul></ul><ul><ul><li>2003 – 2006 </li></ul></ul><ul><ul><li>Research informed intervention </li></ul></ul><ul><ul><ul><li>Formative work including cross-sectional survey and participatory research ; </li></ul></ul></ul><ul><ul><ul><li>Intervention design ; </li></ul></ul></ul><ul><ul><ul><li>Implementation ; </li></ul></ul></ul><ul><ul><ul><li>Process evaluation . </li></ul></ul></ul>
    3. 3. Johannesburg inner-city
    4. 4. Internal migrants residing in Hidden Spaces <ul><li>Single-sex migrant labour hostels ; </li></ul><ul><li>Informal settlements ; </li></ul><ul><li>‘ Shack Farms ’: shacks inside abandoned factory buildings; and </li></ul><ul><li>Subdivided flats under the control of slum landlords. </li></ul><ul><ul><li>Informal housing as Hidden Spaces </li></ul></ul><ul><ul><li>- presents a range of public health and development challenges </li></ul></ul>
    5. 5. Community prioritisation of needs Men Women
    6. 6. © Thuli Zwane ‘… . They stay in the shacks and they are trying to cope with the situation.’
    7. 7. © Ntombifuthi Ngwenya ‘ This is (a) Squatter Camp and the people are using the public toilets. They are feeling very bad about that situation.’
    8. 8. © Busisiwe Zondo
    9. 9. © Nathi Makhanya
    10. 10. © Nathi Makhanya ‘ This woman was pictured fetching some water down the hole. This is the only source where water is found for the whole settlement…’
    11. 11. Internal migrants in the inner-city RHRU, 2005 High HIV prevalence Dependents Unemployed Cultural ties Rural Young Who? 24% 63% with children 56% unemployed 94% from KZN; 6% rest of SA 69% from rural areas 85% under 35 years Men (n = 1458) Single-sex hostels 56% 86% with children 76% unemployed 75% from KZN; 23% from SA; 1% outside SA 61% from rural areas 82% under 35 years Women (n = 1002) Informal Settlements
    12. 12. Key question <ul><li>How to develop an appropriate, effective </li></ul><ul><li>social and structural intervention for this highly </li></ul><ul><li>affected and infected urban population? </li></ul><ul><ul><li>Facilitate local responses to local needs; </li></ul></ul><ul><ul><li>Strong theoretical frameworks adapted to the context; </li></ul></ul><ul><ul><li>Simple , sustainable , community run ingredients; and </li></ul></ul><ul><ul><li>Strong research base , including formative work, survey and process evaluation. </li></ul></ul>
    13. 13. HIV, public health and development <ul><li>Quality Life Clubs </li></ul>i d asa An urban public health programme in Joburg inner-city Mpilonhle – Mpilonde
    14. 14. Quality Life Clubs (1) <ul><li>Fusion of: </li></ul><ul><ul><li>‘ Community Health Clubs ’ in Zimbabwe and Sierra Leone (Waterkyn and Cairncross, 2002) </li></ul></ul><ul><ul><li>‘ Reflect methodology ’ in South Africa and Nigeria (Newman, 2004) </li></ul></ul><ul><ul><li>‘ Study Circles ’ – a Swedish innovation (Idasa, 2004) </li></ul></ul><ul><ul><li>‘ Inter-generational dialogue ’ in Guinea (Van Roenne, 2004) </li></ul></ul><ul><ul><li>Sustainable Livelihoods (Chambers & Conway, 1992) </li></ul></ul>
    15. 15. Quality Life Clubs (2) <ul><li>Community driven structures that aim to: </li></ul><ul><ul><li>Build a demand for health, wellbeing, rights awareness and civic engagement; </li></ul></ul><ul><ul><li>Increase self efficacy ; and </li></ul></ul><ul><ul><li>Ultimately cause patterns of behaviour to shift and to change . </li></ul></ul>
    16. 16. Simple, sustainable Reflecting Time Changing Learning
    17. 17. Quality Life Clubs (3) <ul><li>Behaviour change </li></ul><ul><ul><li>Begins with issues faced on a daily basis, problems that are not highly sensitive, such as food and nutrition, environment and sanitation; </li></ul></ul><ul><ul><li>Over the course of six-months members begin to witness both their capacity to change and the benefits of the change in their lives; and </li></ul></ul><ul><ul><li>Members become better prepared and confident to addressed more stigmatised and threatening problems such as gender and HIV. </li></ul></ul>
    18. 18. Partnerships i d asa Partnerships are key
    19. 19. Process Evaluation Membership <ul><li>Clubs launched in February 2005; </li></ul><ul><li>400 members; </li></ul><ul><li>3 Graduation events held: </li></ul><ul><ul><li>Club performances about Quality of Life and HIV: music, song, dance, poetry; </li></ul></ul><ul><ul><li>Community photography exhibition; </li></ul></ul><ul><ul><li>Strong club identity and cohesiveness. </li></ul></ul>
    20. 20. Process Evaluation Individual & Collective action <ul><ul><li>Club member initiated community clean-up campaigns . . . . </li></ul></ul><ul><ul><li>Club members beginning to hold local Councillors accountable – civic awareness and participation </li></ul></ul><ul><ul><li>Member initiated contact with local authorities – PikitUp, Rand Water – in relation to service provision problems, obtaining water tanks, toilets . . . . </li></ul></ul><ul><ul><li>Gardens set up to grow vegetables and herbs – containers where limited space . . . . </li></ul></ul><ul><ul><li>Visits to Greenhouse Project – beginning to utilise services available to all Joburg residents - citizenship </li></ul></ul>
    21. 21. Process Evaluation Positive outcomes <ul><ul><li>Positive outcomes among members: </li></ul></ul><ul><ul><li>Increased knowledge & awareness; </li></ul></ul><ul><ul><li>Established sustainable structures – reflect circles; </li></ul></ul><ul><ul><li>Built a demand for a better quality life - cleaner, safer, greener, healthier; </li></ul></ul><ul><ul><li>Generated ‘staying power’ to a process that has NO financial gain; </li></ul></ul><ul><ul><li>Built self confidence to express own ideas - willing to challenge leadership; </li></ul></ul><ul><ul><li>Instilled a capacity to plan – to think into the future; and </li></ul></ul><ul><ul><li>Registration of a community based organisation (CBO): Sipho eSihle. </li></ul></ul>
    22. 22. Process Evaluation Key challenges <ul><li>Structural & social interventions </li></ul><ul><ul><li>Context specific ; </li></ul></ul><ul><ul><li>Context is dynamic . </li></ul></ul><ul><li>Complex urban population </li></ul><ul><ul><li>Leadership structures – traditional vs political; </li></ul></ul><ul><ul><li>Perpetual crises (shocks) – shack fires, evictions; </li></ul></ul><ul><ul><li>High unemployment – high levels of despair & depression, resulting in high levels of apathy; </li></ul></ul><ul><ul><li>Dependency & entitlement syndrome - expectations of financial reimbursement & dish-outs; </li></ul></ul><ul><ul><li>Allegiances to other communities – minimal commitment to Johannesburg. </li></ul></ul>
    23. 23. Conclusions: QLCs <ul><li>Positive impacts on quality of life at the local level; </li></ul><ul><li>Quality of life is a long term-investment ; </li></ul><ul><li>Many challenges ; </li></ul><ul><li>The Clubs have helped to create a sense of community : </li></ul><ul><ul><li>Assists individuals in coping and recovering from shocks and stresses; </li></ul></ul><ul><li>This could have far reaching benefits for other, similar migrant groups where a sense of community is currently absent ; </li></ul><ul><li>A way of tackling the health and social problems encountered by this marginalised, highly infected and affected urban population ; and </li></ul><ul><li>HIV prevention and treatment efforts require coping and recovery support structures to be present within a community . </li></ul>
    24. 24. Acknowledgements <ul><li>Partner organisations </li></ul><ul><li>Idasa </li></ul><ul><li>GreenHouse Project </li></ul><ul><li>Soul City </li></ul><ul><li>Market Photo Workshop </li></ul><ul><li>Community facilitators </li></ul><ul><li>Fieldworkers </li></ul><ul><li>Sarun Charumilind </li></ul><ul><li>Malourene Cordier </li></ul><ul><li>Sinead Delany </li></ul><ul><li>Mary Edwards </li></ul><ul><li>Oarabile Monakwane </li></ul><ul><li>Witness Moyo </li></ul><ul><li>Sibusiso Mweli </li></ul><ul><li>Pearl Ndlovu </li></ul><ul><li>Monique Oliff </li></ul><ul><li>Themba Sibeko </li></ul><ul><li>Kara Telesmanick </li></ul><ul><li>Muzi Zuma </li></ul><ul><li>QLC members and graduates </li></ul><ul><li>Sipho eSihle </li></ul><ul><li>RHRU </li></ul><ul><li>EC </li></ul><ul><li>City of Johannesburg </li></ul>

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