HIV and AIDS and Municipalities

What is in this guide

Introduction:
Why should municipalities address HIV and AIDS?

  1. Important facts about HIV and AIDS
  2. HIV and AIDS Strategic Plan for South Africa, 2007-11
  3. Overview of action that should be taken at local level
  4. Developing a multi-sectoral local strategy on HIV and AIDS
  5. How to set up coordinating structures
  6. Motivating people to get involved
  7. Municipal mainstreaming and workplace policies

This manual was produced by the Education and Training Unit (ETU)
2007

ETU is a non-profit organisation committed to development and democracy in South Africa. We offer support for municipalities and Local AIDS Councils to develop HIV and AIDS strategies and local coordinating structures.

ETU can be contacted on 011 6489430/1 or edutrain@iafrica.com. Our training materials are available on www.etu.org.za

This manual was funded by The Olof Palme International Centre, SIDA and the JS Mott Foundation.

  1. Important facts about HIV and AIDS
  2. In stage one the person is HIV positive but has no symptoms, except for some short-term flu-like symptoms which may occur within a few weeks of infection.  This stage may last several years during which the person might have no HIV-related illnesses.
  3. In stage two the person begins to develop minor illnesses. Ear infections, frequent flu and skin problems are common at this stage.
  4. In stage three the person may lose a lot of weight and have longer term illnesses.  These may include thrush in the mouth, pneumonia, a fever which lasts more than a month and tuberculosis of the lungs.
  5. In stage four, the person has illnesses due to a very weak immune system.  These may include PCP, pneumonia, chronic diarrhoea, toxoplasmosis and meningitis.  It is at this stage that a person is said to “have AIDS.”  A person is also said to “have AIDS” if their CD4 count (white blood cells) goes under 200.
  6. Unprotected sex.
  7. Contact with infected blood.
  8. Mother to child transmission.
  9. Young women between 15 and 30 years old - many of the women in this age group are in unequal relationships where they cannot refuse unsafe sex, or are exposed to sexual violence.
  10. Sexually active men and women who have more than one partner. Although polygamy (having more than one wife) is a custom followed only by some men, many others have a wife and a girlfriend or casual sexual partners. They may get the virus from a casual partner and pass it on to their wife.
  11. Migrant and mine workers – they are separated from their families for most of the year and many of them have sex with sex workers.
  12. Transport workers – they travel a lot and many of them use the services of sex workers.
  13. Sex workers – they are exposed to many partners and are sometimes powerless to insist on safe sex.
  14. Drug users who share needles – one person who is HIV positive can infect a group of people who share the same needle unless it is sterilised in between usage. Many drug addicts also become sex workers to pay for their drugs.
  15. People who practice anal sex – the anus can easily be injured during sex because it has no natural lubrication (wetness) and the virus can be passed on unless a condom is used. Women who have anal sex, gay men and other men who have sex with men (for example prisoners), are vulnerable to this form of transmission.
  16. People with HIV and AIDS in South Africa have the same rights to housing, food, social security, medical assistance and welfare as all other members of our society. People with HIV and AIDS in South Africa are also protected by our Bill Of Rights and have the same rights that protect all citizens. 
  17. There can be no discrimination against anyone who has HIV and AIDS.
  18. They have the right to medical treatment and care from our health and welfare services. 
  19. Children with HIV and AIDS are allowed to attend any school. 
  20. No one can be fired from a job just because they are HIV positive
  21. No one can be forced to have an HIV test at work or before getting a job.
  22. Test results cannot be shown to anyone else without the person’s permission.
  23. Pregnant women with HIV and AIDS have the right to make a choice about their pregnancy.
  24. Private medical aid schemes cannot refuse to cover people with HIV and AIDS (but they don’t have to pay for antiretrovirals or the costs of treating any AIDS-related illness until a year after the person joins the scheme).
  25. Informed consent is compulsory before HIV testing can be done.  Informed consent means that the person has been made aware of, and understands, the implications of the test.
  26. The person should be free to make his or her own decision about whether to be tested or not, and cannot be forced into being tested. (But you should always try to address any  fears that a person may have about the test and give them support)
  27. Anonymous and confidential HIV testing with pre- and post-HIV test counselling should be available to everyone.
  28. Proxy consent for an HIV test may be given where a person is unable to give consent. Proxy consent is consent by a person legally entitled to give consent on the behalf of another person. For example, a parent or guardian of a child under 16 years to medical treatment may give proxy consent to HIV testing of the child.
  29. People with HIV and AIDS have the right to make their own decisions about any matter that affects marriage, family and child-bearing. (But counselling about the consequences of their decisions should be provided).
  30. No restrictions can be placed on the free movement of people with HIV and AIDS. They may not be segregated, isolated or quarantined in prisons, schools, hospitals or elsewhere merely because of their HIV positive status.
  31. There will be fewer people living in the area in 10 years than earlier projections.
  32. People will not live for as long as projected (around 43 years instead of 60 years)
  33. Infant mortality will increase because of mother to child transmission as well as a higher death rate among orphans who lack parental care.
  34. There will be an increase in the need for health care.
  35. There will be an increase in the need for poverty alleviation.
  36. Existing inequalities between rich and poor areas will become worse.
  37. The number of orphans will grow dramatically.
  38. The make-up of your population in terms of age distribution will change.
  39. The number of old people who need care will increase since many of them will lose the adult children who may have been helping to support them.
  40. Economic growth will shrink since less disposable income is available for spending.
  41. Poor households will be less able to pay for services, rents and rates.
  42. Productivity in the economy will be affected by increased absenteeism.
  43. It will cost more to recruit, train and provide benefits for employees because of loss of skilled staff.
  44. It is likely that there will be an increase in bad debts.
  45. Municipal employees could be affected on a large scale and this could affect their ability to deliver key services.
  46. Expenditure meant for development may have to be spent on health and welfare.
  47. HIV and AIDS Strategic Plan for South Africa, 2007-11
  48. Reduce vulnerability through poverty reduction, the empowerment of women and  promoting testing,
  49. Reduce sexual transmission through promoting behaviour change among young, HIV positive and high risk people. Develop programmes for workplaces,  male sexual health and  against gender violence and alcohol and substance abuse
  50. Improve programmes to deal with TB, STIs and prevention of infection in sexual assault cases.
  51. Reduce mother to child transmission to less than 5% by expanding services
  52. Minimise transmission through blood through workplace safety, safe blood transfusion supplies and programmes to deal with risk in traditional practices and drug use.
  53. Reduce the number of people who are ill with AIDS or who die from AIDS by providing the appropriate package of treatment, care and support to 80% of people who need it by 2011.
  54. Increase access to voluntary counselling and testing
  55. Enable people with HIV to lead healthy and productive lives by increasing treatment, care and support and managing TB and HIV co-infection.
  56. Improve care for people who are dying.
  57. Strengthen the health system and improve access to it.
  58. Target mothers and children who are ill and provide proper treatment, ART and nutrition to them.
  59. Strengthen community care programmes, home-based care and support groups.
  60. Ensure that programmes are developed to target older people and disabled people affected by HIV and AIDS.
  61. Develop and implement a monitoring and evaluation system.
  62. Support research into microbicides and vaccines and male circumcision.
  63. Conduct research on cost-effective forms of treatment and prophylaxis (prevention) as well as on the effectiveness of traditional medicines
  64. Ensure everyone knows and understands the laws and policies relating to HIV and AIDS.
  65. Ensure non-discrimination and adherence to laws and monitor human rights violations.
  66. Mobilise society to organise it self and build leadership of HIV positive people to protect and promote human rights.
  67. Identify and remove legal, policy and cultural barriers to effective prevention, treatment and support.
  68. Focus on the human rights of women and girls, including those with disabilities and mobilise society to stop gender violence and advance equality in sexual relations.
  69. Overview of action that should be taken at local level
  70. Prevention
  71. Care for people with HIV and AIDS and
  72. Care for children affected by HIV and AIDS
  73. Working together
  74. The response of African municipalities
  75. Educate every person in our community to understand how HIV and AIDS is spread and what we can do to protect ourselves.
  76. Encourage people to change their sexual behaviour and to practice safe sex at all times.
  77. Make condoms freely available and distribute them in places where people can have easy access to them - after hours, and close to where they live. Places like spaza shops, public toilets, taxis and other public transport, hostels, truck stops and garage shops, discos and clubs, bars, education institutions and so on.
  78. Make everyone aware of the plight of those of us living with HIV and AIDS and the burden on our families, and work hard to promote openness and compassion to break down the stigma and silence surrounding HIV and AIDS.
  79. Encourage testing for all people who have active sex lives so that we can be sure that we are not spreading the disease. Only an estimated 15% -20% of people who are HIV positive have been tested and many people are spreading the disease without knowing it. Testing must be accompanied with counselling and treatment.
  80. Ensure that every farm, factory, shop, mine, office and other places of employment has a workplace plan that targets employees.
  81. Ensure that all schools are implementing the Department of Education’s Life skills curriculum on HIV and AIDS.
  82. Encourage people ill with AIDS to be assessed for antiretroviral treatment (ART).
  83. Ensure that rape survivors get access to treatment that can prevent the transmission of HIV through close co-operation between the police service and health facilities.
  84. Encourage people, especially men, to seek treatment for sexually transmitted infections (STIs) at clinics and hospitals.
  85. Encourage pregnant woman and new mothers to seek help to prevent infecting their child (called mother to child transmission or MTCT).
  86. Make sure testing is accompanied by counselling to help the person cope, to refer them to support projects and to advise them how to change their sexual behaviour so they do not spread the disease.
  87. Set up support groups for people with HIV and AIDS where people meet others with the illness and discuss common problems, feelings and ways of coping.
  88. Build and support organisations for people with HIV and AIDS that take up issues and co-ordinate support.
  89. Offer treatment for all opportunistic infections
  90. Ensure that people living with AIDS get antiretroviral treatment (ART) once they need it, and the support to stay on their medication.
  91. Support nutrition, vegetable-growing and wellness projects to help people stay healthy for longer.
  92. Set up home-based care projects in communities to make sure that people who are ill at home receive proper care. Volunteers should be used to carry out home visits to give support to families and basic care for people with AIDS. Volunteers should work with and under the supervision of local clinic staff.
  93. Target people with HIV and AIDS and their families for poverty alleviation projects.
  94. Make sure people with HIV and AIDS have easy access to the available grants and government support.
  95. Set up step-down facilities linked to hospitals for people who are discharged and cannot be cared for at home.
  96. Organise effective support for families and children.
  97. Involve the municipality, welfare organisations and the religious sector in providing food, clothing and other forms of relief for families in need.
  98. Set up community childcare committees to identify and help provide emotional and material support to children in need.
  99. Introduce foster care programs where possible, for children who have lost parents.
  100. Make information and assistance to get child support grants available to children and their caregivers.
  101. Introduce school programmes to ensure that children who are affected by HIV and AIDS get the necessary support to stay at school.
  102. Make sure food and nutritional support programs target children in need.
  103. Include special school lessons on HIV and AIDS related to different subjects. For example, biology should include lessons on healthy eating for people with HIV, language teachers should have speak-out lessons and encourage children to write about how the disease is affecting them. Life skills should deal with responsible sexual behaviour, and so on.
  104. It is essential that all organisations that provide services or can recruit and mobilise volunteers, work together. 
  105.  
  106. Here are some of the things that should be done:
  107. Coordinating mechanisms like Local AIDS Councils should be used to make sure that there is a coherent and coordinated response from everyone involved.
  108. People from health, welfare and municipal services should be drawn in to work together with community, religious, business and service organisations. People living with HIV and AIDS should be part of any coordinating structure.
  109. AIDS Councils should be broken into working groups or task teams that concentrate on one area of work – for example: prevention, care for people with HIV and AIDS and care for children.
  110. A cross-referral system should be set up between services (click here for cross-referral systems).
  111. The AIDS Council should monitor projects and make sure there is a coherent plan that is implemented.
  112. AIDS Councils should also develop links to government structures, resources and funds at district, provincial or national level.
  113. provide strong political leadership on the issue
  114. create an openness to address issues such as stigma and discrimination
  115. co-ordinate and bring together community centred multi-sectoral actions
  116. create effective partnerships between government and civil society
  117. bring together the key stakeholders in civil society and local government
  118. ensure that there is a coherent HIV strategy in place for the area
  119. provide cohesive structure to help co-ordinate the delivery of services to those most affected
  120. avoid duplication
  121. mobilise volunteers to provide care
  122. Developing a multi-sectoral local strategy on HIV and AIDS
  123. Understanding the terrain
  124. Drawing in stakeholders
  125. Analysing incidence, impact, available resources and key interventions
  126. Deciding priorities and activities
  127. Setting up coordination mechanisms
  128. Getting support of leaders and the community
  129. What is the incidence of infection and which wards are most affected?
  130. Estimates for number of orphans.
  131. Number of families that have lost a breadwinner.
  132. Number of people receiving care from hospitals and clinics.
  133. Number of people receiving support form welfare services and organisations
  134. Educational and preventative services and projects available
  135. Counselling, testing and support services available in area.
  136. Health care services and facilities available
  137. Home based or other care services and projects
  138. Orphan care projects and services available in area.
  139. Municipal resources and services currently used
  140. Organisations for people living with AIDS
  141. Initiatives taken by schools and employers
  142. Local health and welfare services
  143. The local economy and availability of labour
  144. Education
  145. Social problems and crime
  146. Housing and service delivery
  147. Prevention and education
  148. Promoting openness
  149. Provision of care for people living with AIDS or ill from AIDS
  150. Provision of care and support for orphans
  151. Key local individuals from government departments like health and social development. 
  152. Organisations from the community that already offer a service or have some expertise about AIDS.
  153. Major employers, church leaders and community leaders.
  154. Members of district or provincial AIDS Councils can act as resource people.
  155. How to set up coordinating structures
  156. Introduction
  157. The role of the municipality
  158. Local AIDS Councils
    • Coordination and Task teams
    • Strategy and action plan
  159. Provincial AIDS Councils
  160. District AIDS Councils
  161. Introduction
  162. Education and prevention
  163. Care, support and treatment for people with HIV and AIDS
  164. Care for children affected by HIV and AIDS
  165. The role of councillors
  166. wearing the red ribbon
  167. using all opportunities to show support for the campaign against AIDS
  168. acting as a role model of how to treat people living with AIDS
  169. encouraging testing and openness
  170. setting up a ward-based  AIDS committees or child care forums
  171. visiting clinics and organisations that assist people with AIDS
  172. mobilising and recruiting volunteers for care projects  for ill people and  families
  173. Running a broad public education campaign about prevention of AIDS, non-discrimination and care for people living with AIDS, that aims to reach as many people as possible
  174. Organising local awareness-raising events and campaigns to change sexual behaviour and attitudes to people with AIDS and creating openness about the disease by speaking about it, publicly supporting people who are open and encouraging voluntary testing and actively and publicly encouraging the destigmatisation of AIDS
  175. Organising support for people who are ill with AIDS by mobilising volunteers into community and home-based care projects
  176. Organising community support and care for AIDS orphans - through foster care, support for the basic needs of orphans, education, counselling and food programmes
  177. Local AIDS Councils
  178. Prevention and education
    All education projects, health workers, school life skills project, councillors, community organisations, youth leaders and trade unions. 
  179. Care, support and treatment for people with HIV and AIDS
    Health workers, social workers, people living with HIV and AIDS, religious organisations, welfare organisations, and community projects working on care.
  180. Care for children affected by HIV and AIDS
    Social workers, Child Welfare Society, school principals, religious organisations, community projects providing care for children.
  181. Provincial AIDS Councils
  182. District AIDS Councils
  183. Bring together the most important organisations and government departments that are involved in the fight against AIDS in the district
  184. Make sure that there is a strategy for tackling AIDS in the district
  185. Monitor implementation of the strategy and initiate work where there are no local projects
  186. Help to mobilise resources and build capacity for AIDS projects and for Local AIDS Councils
  187. Motivating people to get involved
  188. Municipal mainstreaming and workplace policies
  189. What are the impacts of HIV and AIDS on staff (in terms of absenteeism, mortality, morale, loss of skills etc) currently, and what are the projections for future impacts?
  190. What can be done to reduce the susceptibility of staff to HIV infection and to support staff and their families living with HIV and AIDS? (e.g. prevention, care and support interventions)
  191. How can the impacts of HIV and AIDS on the functioning of the organisation be minimised?  (i.e. what policies or systems might be needed to ensure that the organisation can continue to function effectively in the face of the epidemic?)
  192. How do HIV and AIDS affect the people the department works with (i.e. its ‘clients’)?
  193. What are the changing needs of clients as a result of HIV and AIDS?
  194. What can the department do, as part of its core business, to respond to these changing needs?
  195. How might the work of the department increase susceptibility and vulnerability of households/communities to HIV and AIDS?
  196. What are the comparative advantages of the department in respect of responding to HIV and AIDS?
  197. Have we made provision for the voices of HIV and AIDS to be raised throughout the IDP planning and implementation process?
  198. Have we ensured that the voices of HIV and AIDS have adequate access to consultation activities that do not only relate to HIV and AIDS but also to the other development issues in our municipality?
  199. People living openly with HIV and AIDS;
  200. Households
  201. Local AIDS Councils
  202. CBOs, FBOs, NGOs and resource persons who specialise in HIV, AIDS and development;
  203. HIV and AIDS “champions” among officials, politicians and traditional leaders.
  204. Individual and focus-group interviews;
  205. Focus-group planning meetings;
  206. The setting up of a dedicated consultation panel comprising vulnerable and marginalised members of the community; and
  207. Involving “champions” or voices of HIV and AIDS in the IDP structures and processes occurring within existing IDP participation and decision-making mechanisms. 
  208. Obtain information on HIV prevalence and incidence (ii). Prevalence studies have shown that HIV prevalence is highest in urban settings (especially urban informal settlements) and lowest in rural and farm settlements, but it is important to bear in mind that HIV prevalence differs from place to place in the municipal area of jurisdiction;
  209. Engage with HIV and AIDS role-players within the municipality to investigate what factors are driving HIV infection. The drivers of HIV may be related to economic activities (e.g. mining, tourism, truck stops as drivers of mobility) or social practices (e.g. alcohol and drug abuse). High transmission areas should be identified;
  210. Identify what activities the municipality undertakes in its routine operations that affect the spread of HIV (e.g. an LED strategy for developing the municipal area as a freight port could increase use of sex workers);
  211. Consider the rate at which the epidemic is growing in the municipal area. This will help you decide whether to emphasise prevention interventions in future. If in your municipal area HIV prevalence is fairly low but growing rapidly, then prevention efforts must be actively pursued to ensure that those who are currently HIV negative remain so; 
  212. Identify which socio-economic groups are at particular risk of contracting HIV. The purpose of the exercise is not to single out particular socio-economic or demographic groups but to be better equipped to develop and implement prevention strategies that respond to the specific susceptibilities facing each group;
  213. Identify where the communities most affected by HIV and AIDS and with least access to basic life sustaining goods and services live. A healthy environment can substantially decrease the risk of opportunistic infections. An unhealthy environment will compromise the health and wellbeing of those who are infected with HIV and those who are not infected alike. The provision of services such as water, sanitation, clean energy, solid waste removal and housing play a critical role in lessening the impacts of HIV and AIDS;
  214. Identify which services HIV-positive and AIDS affected persons receive and from which service providers in order to identify opportunities for:
    • Partnerships for implementing a service-orientated strategy through Local Aids Councils and other cooperative efforts;
    • Municipal support to organisations providing services; and
    • Leveraging support for organisations from other role-players (such as provincial and national government departments, parastatals, NGOs, donors and the private sector).
  215. Consider, proactively, if any new IDP strategies, projects and activities will increase or minimise the drivers of HIV infection (susceptibility);
  216. Consider how the local economy is likely to be affected by HIV and AIDS. For example, are high rates of absenteeism and mortality likely to affect local rates of economic growth and job creation?
  217. Consider how municipal finances are likely to be affected by HIV and AIDS. This question must consider the likely impacts of the epidemic on the sources of municipal revenue, including rates and services levies.
  218. Commitment to addressing HIV and AIDS, at the highest political and administrative levels; and
  219. A basic level of technical knowledge about HIV and AIDS as a workplace issue (which may involve bio-medical knowledge and institutional development knowledge).
  220. Identify what is the likely HIV prevalence in the municipal workplace for both staff and councillors.
  221. Consider how HIV and AIDS might impact on the critical roles of the municipality as an institution of governance, administration and service delivery
  222. Understand the cost implications and proactively strategise on how to manage the direct costs of HIV and AIDS within the municipality;
  223. Ensure that steps are taken to minimise and manage the impacts of HIV and AIDS in the workplace, including:
  224. A prevention programme among municipal role-players, which includes their household members;
  225. A treatment and care programme among municipal role-players, which includes their household members;
  226. An institutional efficiency element so that institutional systems and procedure are robust in the face of disruption; and
  227. A cost management intervention that proactively manages the workplace cost of HIV and AIDS.
  228. Are consultation and participation mechanisms for planning and implementation accessible to affected and infected individuals?
  229. Are the water, sanitation, energy, solid waste, transport and environmental management services provided within the municipality appropriate in terms of quantity, reliability, accessibility, quality and affordability?
  230. What are the implications of widespread municipal service gaps for affected households and communities?
  231. How affordable are municipal levies, property taxes and service charges for employers and users in the context of HIV and AIDS?
  232. What are implications for the core developmental mandate of the municipality of long-term socio-demographic transformation, increasing informal settlements, new patterns of migration and the emergence of chronically vulnerable households and communities within the municipal area?
  233. What is the broader implication of HIV and AIDS in service delivery and planning?
  234. Are the systems and procedures for routine management as well as strategic decision-making within the municipality able to accommodate disruption as well as the sporadic and/or chronic absence of decision-makers in the administrative and political arms of the municipality?
  235. To what extent do HIV and AIDS further weaken institutional memory and technical know-how in a context of existing capacity constraints?
  236. How will the fiscal viability and sustainability of the municipality be affected by the internal costs of HIV and AIDS in terms of staff absenteeism, increased costs of medical and other benefits, rehiring, retraining and decreased productivity levels, especially in the face of existing problems of personnel retention?
  237. How will the impact of HIV in the workplace affect the municipality’s ability to deliver services in communities affected by HIV and AIDS?
  238. How should the municipality be structured institutionally to respond to local development priorities affected by HIV and AIDS on the ground?
  239. What resources (financial, institutional and assets) are available to implement the response to HIV and AIDS and how does the municipality leverage the involvement of other stakeholders and role-players to participate in the local-level response?
  240. Provides a framework within which a workplace programme can be implemented
  241. Represents management’s position and approach to HIV and AIDS, defining responsibilities as well as limitations
  242. Communicates to employees the company’s concern and commitment of the management to addressing HIV and AIDS in the workplace
  243. Defines the responsibilities of HIV positive employees within their job situation
  244. Defines the responsibilities of employees towards HIV positive colleagues
  245. Defines how specific HIV-related situations should be managed
  246. Allows institutions to pro-actively, in consultation with employees, define how anticipated HIV-related situations should be managed
  247. Provides security and protection to both management and employees
  248. It should be the result of a consultative process that involves employees and their representatives
  249. Its development and implementation should be seen as a dynamic process, with regular monitoring and review
  250. It should be supported by procedures that allow employees recourse to justice
  251. It should apply equally to core and peripheral staff
  252. It should deal with HIV as a blood-borne infection and appropriate safety measures should be instituted
  253. It should deal with the institution’s position around issues like sick leave, medical aid and treatment support.
  254. It should seek to change behaviour and attitudes of employees and their families
  255. It should be popularised through education and awareness programmes
  256. Job access for HIV positive employees
  257. Job security for HIV positive employees
  258. The municipality’s approach to HIV testing of employees
  259. Guidelines on the management of confidentiality and disclosure
  260. Steps to protect employees against discrimination
  261. Employee benefits
  262. Access to training, promotion and other benefits
  263. Performance management in the context of HIV and AIDS
  264. Grievance procedures
  265. Elect or establish a fully representative HIV and AIDS working group. (It may be the HIV and AIDS management committee, the HIV and AIDS champion team or a group put together specifically for the development of the policy).
  266. Conduct a needs analysis within the company
  267. Formulate a draft policy
  268. Circulate the draft policy for comment
  269. Revise policy if necessary and circulate final draft
  270. Adopt the policy
  271. Ensure effective communication of the policy
  272. Review the policy regularly as new information becomes available
  273. Top management and mayoral committee members, representing the municipality
  274. Shop stewards, representing the employees
  275. Supervisors
  276. Occupational health staff/health workers
  277. Human resources managers
  278. Other skilled personnel
  279. Run workshops on AIDS and the policy for all employees
  280. Include a session on the policy in the induction training programme
  281. Include sessions on the policy in other education and training programmes
  282. Display the policy throughout the workplace
  283. Publish the policy on the intranet, ideally on this HIV and AIDS portal