Informal settlements and HIV in South Africa:


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  • If we’d like a map?
  • Not sure that we need this slide as the data/findings are presented over the next few slides….
  • There are several ways of viewing food security: dietary diversity is one. Also access to food…. But I’m trying to keep it simple. I can ‘talk to it’ if needed (i.e. about other ways we measured food security).
  • I can talk to this (I’ve not put numbers).
  • I’ve kept is simple… just thought easier to convey that there is a need rather than getting too caught up in the detail??
  • Informal settlements and HIV in South Africa:

    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 2 nd December 2009 Johannesburg, South Africa
    2. 2. Overview <ul><li>Why a focus on urban informal settlements and HIV ? </li></ul><ul><ul><li>The importance of urban when considering HIV. </li></ul></ul><ul><ul><li>Key findings from research studies. </li></ul></ul><ul><ul><li>Urban informal settlements as a “neglected space”. </li></ul></ul><ul><li>The role of “ developmental local government ” in responding to HIV and informal settlements: </li></ul><ul><ul><li>The urgent need for local level developmental responses. </li></ul></ul>
    3. 3. Structural and contextual factors Why a focus on HIV and urban informal settlements? Housing ? Urban ? SADC, 2006
    4. 4. A focus on the urban: an increasing urban population
    5. 5. 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
    6. 6. Henk Van Renterghem, UNAIDS (2009)
    7. 7. 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?
    8. 8. Why a focus on HIV and urban informal settlements? three key points <ul><li>Urban informal settlements in South Africa are associated with some of the highest HIV prevalence globally. </li></ul><ul><ul><li>Effective responses to address both the vulnerability to – and impact of - HIV in informal settlements are currently lacking . </li></ul></ul><ul><ul><li>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” </li></ul></ul><ul><ul><ul><li>In South Africa, the MDG target has been (mis)interpreted as the ‘eradication of informal settlements’. </li></ul></ul></ul><ul><ul><ul><li>A lack of respectful in situ upgrading. </li></ul></ul></ul><ul><ul><li>Urbanisation in developing countries involves informal settlements (Bocquier, 2008) </li></ul></ul><ul><ul><ul><li>An urgent need to engage with the realities of urban growth , and increasing urban poor populations – including those residing in informal settlements. </li></ul></ul></ul><ul><ul><ul><li>Action from Regional, National, Provincial, Local levels. </li></ul></ul></ul>
    9. 10. Sol Plaatjies informal settlement n = 200
    10. 11. RENEWAL: urban informal settlement compared to urban formal <ul><li>Food security is poor; </li></ul><ul><li>Perception of risk of HIV is greater; </li></ul><ul><li>Residents are mostly internal South African migrants and female; </li></ul><ul><li>Access to basic services is limited. </li></ul>
    11. 12. 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.
    12. 13. 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
    13. 14. Inadequate access to basic services <ul><li>No electricity (despite upgrading) </li></ul><ul><ul><li>Paraffin and candles </li></ul></ul><ul><li>Water </li></ul><ul><ul><li>Communal taps </li></ul></ul><ul><li>Sanitation </li></ul><ul><ul><li>Communal toilets </li></ul></ul><ul><ul><li>Open bush </li></ul></ul><ul><li>Waste removal </li></ul><ul><ul><li>Irregular collection </li></ul></ul><ul><ul><li>Dumping </li></ul></ul><ul><li>Negative impact on health, especially for people living with HIV . </li></ul><ul><li>(Mporetji, 2008; Bezuidenhout, 2009; RENEWAL, 2009) </li></ul>
    14. 15. Housing
    15. 16. Schooling
    16. 17. Transit camps
    17. 18. Development…..
    18. 19. The role of local government in responding to HIV and informal settlements
    19. 20. 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. 21. National Strategic Plan (NSP) for HIV & AIDS and STIs, 2007 - 2011 <ul><li>Recognition of: </li></ul><ul><ul><li>Informal settlements; </li></ul></ul><ul><ul><li>The importance of local government in implementing an effective response. </li></ul></ul><ul><li>However: </li></ul><ul><ul><li>No framework or guideline for how to implement local level developmental responses to HIV in informal settlements . </li></ul></ul>
    21. 22. Key findings
    22. 23. Urban informal settlements <ul><li>Informal settlements present a range of development challenges to local government : </li></ul><ul><ul><li>High HIV prevalence; </li></ul></ul><ul><ul><li>High perceived risk of HIV; </li></ul></ul><ul><ul><li>Inadequate food security; </li></ul></ul><ul><ul><li>Poor access to basic services; </li></ul></ul><ul><ul><li>Inappropriate development process; </li></ul></ul><ul><ul><li>Mobility – the importance of “home”. </li></ul></ul><ul><li>Residents experience HIV in an integrated way : </li></ul><ul><ul><li>It is not possible to ‘divorce’ HIV from their other urban development needs. </li></ul></ul>
    23. 24. Establishing a local-level response to informal settlements and HIV <ul><li>HIV is not viewed as a developmental challenge. </li></ul><ul><li>Challenges: </li></ul><ul><ul><li>Enabling a developmental response; </li></ul></ul><ul><ul><li>Establishing partnerships with and between local government departments; </li></ul></ul><ul><ul><li>The amount of time required to establish a sustainable interventions; </li></ul></ul><ul><ul><li>The expectations of external funding agencies; </li></ul></ul><ul><ul><li>The frustrations of community participants. </li></ul></ul>
    24. 25. Responding to HIV in urban informal settlements <ul><li>There is currently a lack of guidance for cities on how to respond to HIV – particularly within urban informal settlements. </li></ul><ul><li>Local government must take action on the determinants that increase vulnerability to HIV, and on the impacts of HIV. </li></ul><ul><li>Viewing HIV as a central development challenge requires local government to “get the basics right”: </li></ul><ul><ul><li>Provision of basic services - HIV is more than a health issue. </li></ul></ul><ul><li>A broad, integrated, multisectoral response is required to address the challenges outlined: </li></ul><ul><ul><li>Commitment by all partners to work together. </li></ul></ul><ul><ul><li>Inter-sectoral understanding and action by all partners including local government. </li></ul></ul><ul><ul><li>Commitment to working with and being informed by community views and priorities. </li></ul></ul><ul><ul><li>Need to draw on community strengths. </li></ul></ul>
    25. 26. Future research <ul><li>Intervention research - piloting new interventions: </li></ul><ul><ul><li>A current lack of intervention studies; </li></ul></ul><ul><ul><li>Multisectoral responses are required; </li></ul></ul><ul><ul><li>Appropriate funding streams that understand the importance of time are required; </li></ul></ul><ul><ul><li>Linked to process evaluations. </li></ul></ul><ul><li>Smaller city and town research is needed. </li></ul><ul><li>Functionality of local AIDS councils. </li></ul><ul><li>Political buy-in to urban interventions. </li></ul>
    26. 27. Acknowledgements <ul><li>Sol Plaatjies community </li></ul><ul><li>Sol Plaatjies photo project participants </li></ul><ul><li>Simon Mporetji </li></ul><ul><li>Pinky Mahlangu </li></ul><ul><li>City of Joburg HIV Directorate </li></ul><ul><li>Jozi Ihlomile volunteers </li></ul><ul><li>Market Photo Workshop </li></ul><ul><li>Planact </li></ul><ul><li>RENEWAL & IDRC </li></ul><ul><li>Atlantic Philanthropies </li></ul>