Projects funded by the WK Kellogg Foundation on HIV/AIDS in southern Africa Report of the Colloquium 26–27 November 2003 Free download from www.hsrc p ress.ac.za HUMAN SCIENCES RESEARCH COUNCIL SOCIAL ASPECTS OF HIV/AIDS AND HEALTH RESEARCH PROGRAMME Projects funded by the WK Kellogg Foundation on HIV/AIDS in southern Africa Report of the Colloquium 26–27 November 2003 Phetsile K Dlamini, Donald Skinner & Nompumelelo Zungu-Dirwayi Free download from www.hsrc p ress.ac.za iv Compiled by the Social Aspects of HIV/AIDS and Health Research Programme of the Human Sciences Research Council (HSRC) Funded by the WK Kellogg Foundation Published by HSRC Publishers Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpublishers.ac.za © 2004 Human Sciences Research Council First published 2004 All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. ISBN 0 7969 2068 0 Cover by Jenny Young Production by comPress Distributed in Africa by Blue Weaver Marketing and Distribution, PO Box 30370, Tokai, Cape Town, 7966, South Africa. Te l: +27 +21-701-4477 Fax: +27 +21-701-7302 email: booksales@hsrc.ac.za Distributed worldwide, except Africa, by Independent Publishers Group, 814 North Franklin Street, Chicago, IL 60610, USA. www.ipgbook.com To order, call toll-free: 1-800-888-4741 All other inquiries, Tel: +1 +312-337-0747 Fax: +1 +312-337-5985 email: Frontdesk@ipgbook.com Free download from www.hsrc p ress.ac.za Contents Introduction 1 An outline of the Kellogg projects 2 Day one: HIV/AIDS policy in six southern African countries 4 Opening address: Dr Phetsile Dlamini 4 Background to the involvement of WKKF: Bishop Malusi Mpumlwana 4 Overview of the HIV/AIDS policy project: Dr Olive Shisana 5 HIV/AIDS policy: Dr Lucky Odirile 6 A comparative analysis of prevention and care projects: Ms Mpumi Zungu-Dirwayi 7 Legal issues: Ms Marlize Richter 7 Financing of HIV/AIDS in the six southern African Countries: Dr Olive Shisana 8 Drug policies: Dr Henry Fomundam 9 The health strategy of the New Partnership For Africa’s Development (NEPAD): Prof. Eric Buch 10 Day two: The development, implementation and evaluation of interventions for the care of OVC in Botswana, South Africa and Zimbabwe 12 An Overview of the WKKF-funded OVC research programme: Prof. Leickness Simbayi 12 The WKKF OVC programme: Dr Phetsile Dlamini 12 Implementing interventions to improve the social conditions, health, development and quality of life of OVC: Mr Jephias Mudondo 14 Interventions to support families and housefolds: Ms Ntjantja Ned Strengthening community-based support systems as a way of supporting vulnerable children: Pastor Adrian Mpofu 15 Lessons learned from OVC projects so far: Dr Donald Skinner 15 Summing up: Ms Ntjantja Ned 16 v Free download from www.hsrc p ress.ac.za 1 Introduction In November of 2003, the Human Sciences Research Council (HSRC) and the WK Kellogg Foundation (WKKF) hosted a colloquium to present and review the research that the HSRC has conducted with the support of the Foundation in projects across six southern African countries namely, Botswana, Lesotho, Mozambique, South Africa, Swaziland, and Zimbabwe. The two-day event was designed to cover the two focal areas of the work; thus the first day focused on the policy research that has been done across the six countries in southern Africa, and the second day looked at the work that has been done with orphaned and vulnerable children (OVC) in Botswana, South Africa and Zimbabwe. The colloquium was seen as an opportunity to report back to the WKKF and to local stakeholders, including representatives from government, service providers in health and social development, state policy and regulatory bodies, academics and researchers, intervention workers from both NGOs and state services, policy makers and interested advocates around policy and children. Work at the colloquium was directed at using the forum to facilitate as much discussion and debate as possible. The event was also designed to serve as a space for networking and social connection between all the organisations involved. In that light the following themes were used as starting points for discussion and to structure the programme at the colloquium: • Financing of HIV/AIDS programmes in southern Africa; •Legislation affecting people living with HIV/AIDS in the six countries; •HIV/AIDS policies and strategic plans in the six countries; •Access to HIV/AIDS prevention and care services; • Pharmaceutical policies and infrastructure for the provision of antiretroviral drugs in the six southern African countries; •Interventions aiming to improve social conditions, health, development and quality of life of vulnerable children and orphans; Free download from www.hsrc p ress.ac.za •Interventions aiming to provide support to families and households coping with an increased burden of care for affected and vulnerable children; •Interventions aiming to strengthen community-based support systems as an indirect means to support vulnerable children. An outline of the Kellogg projects As the principle aim of the colloquium was to examine the work of two multi- country projects, it is important that the basic aims and philosophies of these two projects be understood. These are outlined briefly below. HIV/AIDS policy in six southern African countries As part of its commitment to assist economic and social development in southern Africa, the WKKF has established an Integrated Rural Development Program (IRDP) to contain the spread of HIV and mitigate the impact of HIV/AIDS in rural communities. With this goal in mind WKKF, through the Centre for Applied Social Sciences at the University of Zimbabwe commissioned the Social Aspects of HIV/AIDS and Health Research Programme of the HSRC in South Africa, to undertake a review of the situation on HIV/AIDS in six southern African countries (Botswana, Lesotho, Mozambique, South Africa, Swaziland, and Zimbabwe); to put forward recommendations to WKKF to strengthen its policy in this area and to guide its future work in the area of HIV/AIDS and rural development. The study also meant to analyse HIV/AIDS policy, legislation, financing and implemen- tation of programmes in the six countries. By the time of the colloquium, the following research processes had been undertaken: •Key-informant interviews were conducted to obtain all primary data on policy and strategy; •Legislation affecting people living with HIV/AIDS in the six countries was reviewed and the progress countries have made in implementing the UN international agreements and guidelines was assessed; •HIV/AIDS policies and strategic plans in the six countries, as well as documented case studies, were subjected to a detailed review; REPORT OF THE COLLOQUIUM ON HIV/AIDS PROJECTS 2 Free download from www.hsrc p ress.ac.za •Access to HIV/AIDS prevention and care services was investigated in all six countries, based on surveys of the population in the nine sites where WKKF is implementing the IRDP; •Information was compiled on HIV/AIDS evidence-based behaviour interventions suitable for implementation in the six countries. The development, implementation and evaluation of interventions for the care of OVC in Botswana, South Africa and Zimbabwe The HSRC has been granted funds by WKKF to implement research-driven, evidence-based, intervention programmes to assist children, families and communities affected by HIV/AIDS in Botswana, South Africa and Zimbabwe over five years. This programme is contributing towards the development of a strategy for the care of OVC in Botswana, South Africa and Zimbabwe; with the potential of deploying these strategies in other parts of Africa as well. The strategy will be informed by research that supports innovative and sustainable models that target OVC, as well as families and households coping with an increased burden of care for affected children. The programme aims at a holistic response so efforts are directed at all levels which are needed to ensure adequate support for OVC, namely the vulnerable children and orphans themselves; households with vulnerable children; and communities where vulnerable children and orphans are concentrated. The goals of the programme are to: •Improve the social conditions, health, development and quality of life of vulnerable children and orphans. •Support families and households coping with an increased burden of care for affected and vulnerable children •Strengthen community-based support systems as an indirect means to support vulnerable children. •Build capacity in community-based systems for sustaining care and support to vulnerable children and households over the long term. INTRODUCTION 3 Free download from www.hsrc p ress.ac.za Day one: HIV/AIDS policy in six southern African countries Opening address: Dr Phetsile Dlamini The official opening address was given by Dr Phetsile Dlamini, in which she emphasised the gravity of the HIV/AIDS epidemic in Africa with southern Africa being the epicentre. Two key problems in responding were a lack of local research, leading to a dependence on information from Europe and the USA where context is often different; and the gap between researchers, policy makers and implementers. She expressed the hope that meetings of this nature, and the support that WKKF had provided, would continue to develop local, evidence-based research and close partnerships between all the stakeholders in all six countries. Background to the involvement of WKKF: Bishop Malusi Mpumlwana Bishop Malusi Mpumlwana, Regional Director of the WKKF, gave the background of WKKF involvement with HIV/AIDS and OVC. As part of its 75th anniversary celebrations, the WKKF developed a vision of working with children and families to empower people in affected communities. This vision led to the creation of a programme, ‘Socio-economic transformation of the southern African region towards healthy, viable and sustainable rural communities’ which has put special emphasis on women, youth and families. A systems-change approach is being applied based on four pillars of action. 1. Economic opportunities through support for: •Rural financing to empower rural communities; •Viable rural enterprises; •Market systems to support the rural enterprises; •Commodity associations; • Land tenure to ensure a resource base. 4 Free download from www.hsrc p ress.ac.za 2. Leadership and skills development to enhance: •Modern and indigenous African leadership systems; •Productive social, economic and life skills; •Policy engagement; •Culturally sensitive knowledge development systems. 3. Health and well-being to encourage development that focuses on: • HIV/AIDS and OVC programmes; •Nutrition and food security •Community-based health systems. 4. Civic responsibility to promote: •Social visioning for self-drive; •Further policy engagement and capacity building; •Social giving; •Human safety and security. He wished the meeting well and encouraged the researchers to produce good, evidence-based research and to share those experiences effectively for the development of Africa as a whole. Overview of the HIV/AIDS policy project: Dr Olive Shisana This project drew on the research results across Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe. Dr Shisana emphasised the importance of looking at the themes across the six countries but, more importantly, of using this research to establish a dialogue between researchers and government in each country. The high prevalence of HIV/AIDS in the region (65 per cent of all people living with the HIV/AIDS worldwide live in the SADC countries) makes this research critical. Amongst the countries involved in the study, Botswana has the highest prevalence at 38.9 per cent of the population. Zimbabwe and Swaziland have similar levels of infection, while South Africa has the largest number of people living with HIV/AIDS, namely 4.5 million people aged two years and older. DAY ONE: POLICY 5 Free download from www.hsrc p ress.ac.za One of the key focuses for the study was to examine progress made by African leaders who were party to the Declaration on the Commitment to HIV/AIDS at the UN General Assembly Special Session on HIV/AIDS held in June 2001. Heads of state and governments made an undertaking that, by 2003, they would have developed multi-sectoral, national and strategic plans which directly address the epidemic. Great concern was expressed around the fact that leaders of many countries made commitments in international forums, but undertook little active work to honour these commitments at a national level. The paper introduced some of the key debates of the day, and Dr Shisana called on each of the speakers to answer the critical question of whether the policies in the countries were appropriate for the challenges posed by the pandemic, and would ensure that the human rights of people with HIV/AIDS were protected. Discussion focused on the prevalence rates in countries, comparing the antenatal sentinel-surveillance approach with other methods like the baseline survey done in South Africa. It was proposed that incidence rates would enable researchers to more accurately gauge the impact of education on preventing new HIV infections. HIV/AIDS policy: Dr Lucky Odirile Dr Lucky Odirile presented a comparison of the current status of policies in the six countries. South Africa was shown to be the only country with comprehensive laws and policies that respond to the challenge of HIV/AIDS. Policy development in the other countries had lagged with research showing that some countries had only partially addressed this issue while others had no effective policies. The question of whether the policies are adequate could not be answered. It was noted that each country is different and has different challenges and goals in mind when designing its policies. It was also proposed that countries could learn from each other’s policies. For example, Botswana was the only country that had implemented their ARV policy and made ARV’s available through the public health system. Monitoring and implementation was identified as a challenge in many countries that do have good policies. REPORT OF THE COLLOQUIUM ON HIV/AIDS PROJECTS 6 Free download from www.hsrc p ress.ac.za [...]... require clear legislation include: Free download from www.hsrcpress.ac.za • • • • Children and HIV/ AIDS; Gender discrimination generally and in relation to HIV/ AIDS; Antiretroviral availability; Funding for activities related to HIV/ AIDS Financing of HIV/ AIDS in the six southern African countries: Dr Olive Shisana This study assessed the financing provided for HIV/ AIDS programmes in two ways This was assessed,... counselling and testing (VCT) sites and were attempting to increase these sites within the countries Countries leading in provision of PMTCT and VCT were South Africa, Botswana and Zimbabwe The smaller countries lagged behind but were in the process of increasing their delivery It was proposed that a greater focus on the prevention of new infections was required The greatest challenge is to develop intervention... a lot towards its health budget Per capita expenditure on HIV/ AIDS ranged from a high in South Africa of US$ 255, to a low of US$9 in Mozambique Many countries are currently increasing their spending on HIV In South Africa, it was projected that the ARV rollout will create general improvements in the health service, such as additional training for staff and access to additional resources It was noted... for one third of the world’s HIV/ AIDS burden but have access to considerably less than a third of the world’s spending on HIV The magnitude of the HIV/ AIDS burden in these six countries calls for the prioritisation, protection and targeting of HIV/ AIDS spending The Global Fund allocation to the six countries aims to complement what the countries themselves are spending on HIV/ AIDS It was noted that it... funding and risk programme collapse when that funding stops, especially if there are high recurrent costs Some countries in the group would be particularly vulnerable in this regard and need to maintain their own financial commitment to addressing HIV The ability of the country to absorb increased resources from the Global Fund for health care will determine whether the increased resources translate into... training in administering ARVs – adherence is crucial as drug resistance could have serious complications for the epidemic Issues of storage and checking of the quality of the drugs Given the newness of ARVs, and the size of interventions like a rollout of ARVs, there is a need for operational research The situation of HIV/ AIDS treatment is dynamic with new findings and changes in costs and purchasing... the WKKF programme sought to strengthen already existing initiatives and, in turn, the communities and households that these organisations serve Ultimately the project aims to identify the best practices in use in managing the issues of OVC in southern Africa Visits to individual projects in the three countries had already yielded some information on interventions that could be improved and shared Discussion... of HIV/ AIDS Secondly, it was assessed against commitments African leaders had made in Abuja in 2001 to use 15 per cent of their national budgets on health HIV/ AIDS expenditure was defined as either core, that is dedicated to specific programmes such as VCT or home-based care; or expanded, which includes other expenditure incurred by health care facilities, such as the treatment of opportunistic infections... maternal and infant mortality rates are still too high in Africa; Individuals and communities must be enabled to improve their own health; Resources must be effectively mobilised and utilised; There must be equity for the poor, displaced and marginalised The following priorities were identified in NEPAD’s initial programme of action around HIV/ AIDS: • • • • The prevention of new infections especially in youth;... situation as they only defined children as orphans up to the age of 15, and did not include children in affected communities that were rendered vulnerable by HIV or other factors in their environments It was noted that, in the countries working on this project, about 60 per cent of children live in poverty It was proposed, therefore, that African countries, including the countries working on this project, . related to HIV/ AIDS. Financing of HIV/ AIDS in the six southern African countries: Dr Olive Shisana This study assessed the financing provided for HIV/ AIDS programmes. colloquium: • Financing of HIV/ AIDS programmes in southern Africa; •Legislation affecting people living with HIV/ AIDS in the six countries; HIV/ AIDS policies and