1. Community Dialogues in South Africa Malega Connie Kganakga PhD, MPH, MA (Psychology) Department of Social Development South Africa OWN, SCALE-UP & SUSTAIN The 16 th International Conference on AIDS & STIs in Africa 4 to 8 December 2011, Addis Ababa www.icasa2011addis.org

2. HIV/AIDS Epidemic in South Africa  Population of SA – 50.6 million  5,86 million infected by HIV and AIDS – 10,6 % of the population  Incidence rate – 1.49 per annum (UNAIDS Report 2009)  SA incidence the fourth highest in Sub-Saharan Africa  KwaZulu-Natal & Gauteng Province accounting for 54% of epidemic  Concentrated in urban informal settlements – people with low economic status  Young women between 20 - 24 show an infection rate that is four times that of infected male counterparts indicating gender disparities between young women and men (KYE – KYR 2010)  Poverty and early sexual debut with older men (KYE – KYR 2010)

3. Instruments Guiding SA’s Response  SA National Strategic Plan 2007 - 2011 – flagged the need for HIV and AIDS competent communities. No evident progress made  UNAIDS 2031 – recommends long–term view in addressing epidemic  UNAIDS 3 ZEROS VISION 2020  SA National Strategic Plan 2012-2016 launched on 1 December 2011  Department of Social Development (DSD) strategy on social behaviour change focusing on prevention.  The DSD Socio-Ecological Model – Community Capacity Enhancement through Community Dialogues

4. Department of Social Development: A Socio- ecological Model socio-economic environment national enabling environment national institutions services leaders associations institutions norms traditions social cohesion and social capital services leaders associations institutions norms traditions social cohesion and social capital partners families friends peers support partners families friends peers support Individual Interpersonal Community Society

5. Creating An Enabling Environment and taking a long term view eg. supportive community attitudes, enforcement of supportive policies More Equitable Gender Norms e.g. knowledge of HIV prevention, Awareness of risks of Multiple concurrent partners, supportive professional and workplace policies Results in 1-2 years Results in 3-5 years Results in 5+ years

6. Promoting Social Cohesion Promoting Social Cohesion Community Based Dialogic Approach Creates safe spaces for listening, inclusion and agreement Replicable: transferable to any social issue Meaningful and participatory within cultural contexts Facilitation rather than intervention by experts Influence policy and legislation Builds on local family and community experiences Adopts a human rights approach 6 Community Dialogues -Value Proposition

7. The Nelson Mandela Foundation, Community Dialogues and DSD  Piloted from 2008-2010 in 9 Provinces and 11 Communities  Over 300 conversations / dialogues held over 3 years  Over 60 facilitators trained on the Community Capacity Enhancement methodology  “Burning issues” raised by communities across the full development spectra  Handover to DSD in 2011  Undertaken community dialogues in all provinces

8. Tools used during the dialogues – A group of women during the dialogues interrogating the Tree Diagram

9. Analysis from Community dialogues  Issues emerging from dialogues are similar and require multi pronged approach  High levels of poverty, HIV and AIDS, teenage pregnancy, alcohol and substance abuse, gender based violence  patriarchal communities  ‘fetched you from your home to come and bear children’  ‘women have to do as men are telling them – if witch-craft is being practiced you need to practice it,  ‘working women are easily bought and will bring illegitimate child in the family’  ‘talking about sexual issues in front of women is a disgrace’  ‘women are bought law does not allow her to do as they like’  Crime, unemployment, access to basic services  Women bearing the brunt of poor service delivery - e.g. girls walking long distance to school when they fall pregnant it is the woman’s fault, women have to fetch fire wood from the forest and sell it

11. An illustrative Case Study: An illustrative Case Study: Numbers of people presenting for HCT in Khakhala clinic per week. Statistics provided by Khakhala village, Sister Mthombeni Testing periodNumber of people presenting for HCT 9-16 April 2010115 (20 men; 81 women and 14 children) 7-14 May 2010163 (4 not ready to be tested) 18-25 June 201096 2-9 July55 5-12 August116 (5 not ready to be tested) 13-19 August179 (62 not ready to be tested) 20-26 August124

12. Future developments  DSD has adopted the community dialogues methodology  Stakeholder co-ordination  Provincial champions appointed from the department to drive, monitor community facilitation and liaison with other stakeholders beyond government “In the face of a phenomenon so intricately linked into the fabric of a society and as personally and professionally threatening as the HIV epidemic, it may be that the only programs which penetrate the soul of a community, organization or nation will be effective”. (Ian Campbell, 1997)

13. Thank You