01 Vearey J Et Al Sahara Infs And Hiv 2 Dec 2009

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01 Vearey J Et Al Sahara Infs And Hiv 2 Dec 2009

  1. 1. 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 2nd December 2009 Johannesburg, South Africa
  2. 2. 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.
  3. 3. Why a focus on HIV and urban Structural and contextual factors informal settlements? Housing ? Urban ? SADC, 2006
  4. 4. A focus on the urban: an increasing urban population
  5. 5. By 2030, 50% or more of the African population will be living in a city World Urbanization Prospects (2005 Revision), United Nations, Department of Economic and Social Affairs
  6. 6. Ranking of urban HIV epidemics (ESA) among national epidemics Est. number Adult Est. number Adult PLHA (2007) PLHA (2007) 1 South Africa 5,400,000 21 Ghana 250,000 2 Nigeria 2,400,000 22 Myanmar 240,000 3 India 2,300,000 Maputo 220,000 Gauteng 1,550,000 23 Carribean 220,000 4 Mozambique 1,400,000 24 Mexico 200,000 5 Kenya 1,400,000 Lusaka 185,000 6 Tanzania 1,300,000 25 Angola 180,000 7 Zimbabwe 1,200,000 26 Chad 180,000 8 USA 1,100,000 Nairobi 180,000 9 Zambia 980,000 Dar Es Salaam 180,000 10 Russian Fed 940,000 27 Swaziland 170,000 11 Ethiopia 890,000 28 Colombia 160,000 12 Malawi 840,000 Port Elisabeth 155,000 13 Uganda 810,000 29 Italy 150,000 Durban 730,000 Addis Abeba 150,000 14 Brazil 710,000 30 France 140,000 15 China 690,000 31 Spain 140,000 16 Thailand 600,000 32 Central African Republic 140,000 17 Cameroon 500,000 33 Rwanda 130,000 18 Ukraine 430,000 34 Argentinia 120,000 19 Cote d'Ivoire 400,000 35 Burkina Faso 120,000 Cape Town 315,000 36 Togo 120,000 21 Vietnam 290,000 Kampala 110,000 22 Botswana 280,000 East London 105,000 23 Indonesie 270,000 … 20 Lesotho 260,000 Pakistan 94,000 Harare 260,000 Bulawayo 90,000 UK 77,000 Luanda 70,000 Henk Van Renterghem, UNAIDS (2009)
  7. 7. HIV prevalence in adults aged and49 years by Why a focus on HIV 15 – urban locality type, South Africa, 2005 informal settlements? 30 25.8 25 HIV prevalence (%) 20 17.3 13.9 13.9 15 10 5 0 Urban informal Urban formal Rural informal Rural formal settlements settlement Locality type (HSRC, 2005)
  8. 8. 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. 1. Effective responses to address both the vulnerability to – and impact of - HIV in informal settlements are currently lacking. 2. 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. 3. 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.
  9. 9. Sol Plaatjies informal settlement n = 200
  10. 10. 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.
  11. 11. 24 hours Dietary Diversity Score: respondents residing informally are more likely to have a deficient dietary score 70 60 50 Relative frequency 40 In a context of high HIV Informal prevalence, urban informal Formal 30 settlements have poor food 20 security. 10 0 Deficient Sufficient Diverse Score 0 - 3 Score 4 - 6 Score 7 - 9 Chi-square 89.880; 24 hour Dietary Diversity Score p = <0.0001
  12. 12. Perception of risk of HIV Relative frequency (%) 70 60 50 40 In a context of high HIV Informal prevalence, urban informal 30 Formal settlement residents 20 perceive themselves at risk 10 of HIV 0 No Risk Risk Perception of risk of HIV Chi-square = 14.221; p = 0.0002
  13. 13. 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)
  14. 14. Housing
  15. 15. Schooling
  16. 16. Transit camps
  17. 17. Development…..
  18. 18. The role of local government in responding to HIV and informal settlements
  19. 19. 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)
  20. 20. 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.
  21. 21. Key findings
  22. 22. 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.
  23. 23. 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.
  24. 24. 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.
  25. 25. 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.
  26. 26. 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

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