1. 1 BUILDING FROM WITHIN The scope for a culturally contextualised response to HIV-AIDS in KwaZulu-Natal South Africa UNESCO WORKSHOP Learning and Empowerment Key issues for HIV-AIDS Prevention Chiangmai – Thailand March 1-5 2004

2. 2 Contents of presentation  KwaZulu-Natal as the epicentre of the South African AIDS epidemic  The Political Economy and cultural Context of AIDS in KwaZulu-Natal  The response of the public sector and assessment of impact of current awareness and prevention strategies  Contextualising opportunities for empowerment and learning in local communities  Developing programmes of action

3. 3 KwaZulu-Natal: Epicentre of the South African AIDS epidemic  Demographic features Population 9.4 million (21% of total population) Population 9.4 million (21% of total population) 45.7% women: 54.3% men 45.7% women: 54.3% men 56% of the population live in non urban areas 56% of the population live in non urban areas 32% of the population lives in the greater Durban area 32% of the population lives in the greater Durban area 55% of the population lives below the poverty line 55% of the population lives below the poverty line 82.5% of the population are African 82.5% of the population are African  Spatial challenges for service delivery Dispersed settlement pattern unique in South Africa Dispersed settlement pattern unique in South Africa Extreme difficulties in providing services to dispersed dwellings especially home based care Extreme difficulties in providing services to dispersed dwellings especially home based care

4. 4 KwaZulu-Natal: Epicentre of the South African AIDS epidemic (continued)  Economy and Development Unemployment has risen from 38.8% to 39.7% in 2000 Unemployment has risen from 38.8% to 39.7% in 2000 94% of the unemployed are African 94% of the unemployed are African  Per Capita income Ranges from monthly income of R727.13 in some municipalities to R141.16 in others Ranges from monthly income of R727.13 in some municipalities to R141.16 in others  Poverty Rate has increased 45.9% in 1996 to 53% in 2000 Rate has increased 45.9% in 1996 to 53% in 2000 Human Development Index estimated at 0.66 against national figure of 0.69 Human Development Index estimated at 0.66 against national figure of 0.69

5. 5 KwaZulu-Natal: Epicentre of the South African AIDS epidemic (continued)  Prevalence of HIV-AIDS KZN infection rate in 2001 33.5.% increased to 36.5% in 2002 KZN infection rate in 2001 33.5.% increased to 36.5% in 2002 National infection rate in 2002 24.8% increased to 26.5% National infection rate in 2002 24.8% increased to 26.5% Rates of infection decreasing in age group < 20years but increasing in all age categories Rates of infection decreasing in age group < 20years but increasing in all age categories Age group 25-29 years has highest rate of infection 34.5% Age group 25-29 years has highest rate of infection 34.5%

6. 6 3) The Political Economy and Cultural Context of HIV-AIDS in KwaZulu-Natal  Political Economy of HIV- AIDS in KwaZulu-Natal Rural poverty and urban migration Rural poverty and urban migration Resettlement of people in terms of separate development policy Resettlement of people in terms of separate development policy Disintegration of family Disintegration of family Factional and political conflicts Factional and political conflicts  Cultural Context Traditional life still very significant Traditional life still very significant Dynamics of sexual behaviour Dynamics of sexual behaviour Hegemonic masculinity Hegemonic masculinity Multiple sexual relationships Multiple sexual relationships Disintegration of culture, globalisation and merging youth culture Disintegration of culture, globalisation and merging youth culture

7. 7 4) The Response of the Public Sector and Assessment of Impact of Current Strategies  Positioning of HIV-AIDS in the public sector  Programmatic responses to HIV-AIDS Media and marketing Media and marketing Life Skills Training Life Skills Training Training and capacitation within specific sectors Training and capacitation within specific sectors Home based care Home based care Management of sexually transmitted infections Management of sexually transmitted infections Voluntary Counselling and Testing Voluntary Counselling and Testing Post Exposure Prophylaxis for victims of sexual assault Post Exposure Prophylaxis for victims of sexual assault Prevention of Mother to Child Transmission Prevention of Mother to Child Transmission Roll out of anti retroviral treatment Roll out of anti retroviral treatment Social security assistance to vulnerable children and people with full blown AIDS Social security assistance to vulnerable children and people with full blown AIDS

8. 8 The Response of the Public Sector and Assessment of Impact of Current Strategies  Assessing impact of the awareness and prevention programmes Respondents seem to have a sound knowledge and understanding of HIV-AIDS from the point of view of transmission of the disease Respondents seem to have a sound knowledge and understanding of HIV-AIDS from the point of view of transmission of the disease Relationship between multiple partners and spread of HIV- AIDS is not readily made. (50% participated in multiple partnerships) Relationship between multiple partners and spread of HIV- AIDS is not readily made. (50% participated in multiple partnerships) Approximately 33% took no measures against infection Approximately 33% took no measures against infection Majority of respondents did not know their status and seemed unwilling to be tested. Majority of respondents did not know their status and seemed unwilling to be tested. Position of women is still one of extreme vulnerability as a result of continued disempowered status in society Position of women is still one of extreme vulnerability as a result of continued disempowered status in society

9. 9 5) Contextualising opportunities for empowerment and learning in local communities  Dominance of the biomedical model has made it difficult to develop culturally sensitive responses to the epidemic  Notions of empowerment are not embedded in public sector programmes  Participatory processes are not well developed within tertiary training institutions.  South Africa’s decades of isolation have stunted the growth of experience and best practice in developing community based approaches. (institutional memory contributes little)  Preventive education seems to be “prepackaged” and does not take into account diverse world views and cultural reference points

10. 10 5) Contextualising opportunities for empowerment and learning in local communities Building from within (In the context of rural communities)  Traditional youth cohorts are still in place  Working for the well being of the community  The concept of ubuntu and building social capital  Traditional authorities as custodians of the wellbeing of all people within their boundaries.  Empowering women within a traditional context  The challenge of participatory learning strategies

11. 11 6) Developing programmes of action  There is evidence that rural people want to be engaged in poverty and HIV-AIDS issues  Participatory research methodologies must be introduced whereby communities can work collaboratively to identify key cultural resources that can be integrated into awareness and prevention programmes  AIDS prevention programmes must be integrated into broader based substantive programmes  Tertiary institutions must adopt progressive learning strategies that can be integrated into AIDS prevention and community related work.  A substantive programme of action to support the participation and empowerment of women in all aspects of community life needs to be put in place. Appropriate learning materials to support such a programme must be devised.

12. 12 Thank you!