AIDS stigma as epidemiological problem

AIDS stigma as epidemiological problem and municipal governance priority: 

AIDS stigma as epidemiological problem and municipal governance priority Kevin Kelly - CADRE, Rhodes University CONFERENCE ON LAUNCHING OF COALITION OF AFRICAN CITIES AGAINST RACISM AND DISCRIMINATION (Nairobi, Africities, September 18-24, 2006)

Outline: 

Outline Urbanisation trends in Africa Urbanisation and HIV Stigma as epidemiological problem The necessity of combating stigma Overcoming stigma through municipal practice Milestones of good practice

Rural and urban population: Africa: 

Rural and urban population: Africa Millions 2017 2007 Data source: Cohen, 2006

Key facts: 

Key facts Rapid urbanisation without economic growth = increase in slums 72% of the urban population of Africa was living in slums in 2003 The bulk of the increase in urban population over the next 15 years will be in towns and cities with fewer than half a million inhabitants Rapid urban growth is seriously outpacing the attempts of most cities to provide adequate basic services for their citizens One of every 2-3 African city dwellers lives on less than one dollar a day

HIV and urbanisation: 

HIV and urbanisation 1.7 times greater HIV prevalence in urban areas Greater differences in countries with larger geographic area Greater differences in countries with large groups of vulnerable people (e.g., sex workers, unemployed youth, drug users) Some evidence that urban prevalence is greatly higher in urban informal settlements

Rural vs. Urban HIV prevalence antenatal clinic clinics (last year before 2004): 

Rural vs. Urban HIV prevalence antenatal clinic clinics (last year before 2004) Data Source: Asamoah-Odei, et al, Lancet, 2004 Southern Africa Eastern Africa Western Africa Central Africa

HIV prevalence by geotype: South Africans older than 2 years: 2005: 

HIV prevalence by geotype: South Africans older than 2 years: 2005

Why more rapid spread of HIV in urban informal areas?: 

Why more rapid spread of HIV in urban informal areas? Higher levels of sexual age-mixing Break down of social regulatory processes relating to sexual behaviour and partnering Less peer monitoring and minding (rural communities tend to safeguard partnering norms) Economic necessity leading to transactional sex Higher STI levels because of poor access to health services Higher levels of sexual concurrency often with partners living apart Poor social capital and coherence: affecting ability of communities to organise around their circumstances

The consequences for towns and cities: 

The consequences for towns and cities From high transmission areas to generalised epidemics Threat to the sustainability of cities Major drain on existing services Crisis management rather than developmental planning

Vicious circles: 

Vicious circles The most important areas to target are the most difficult areas to incorporate The hopeless plight of the AIDS sufferer (in terms of treatment and support) makes stigma and denial more likely This prevents people from testing, receiving care and protecting others from being infection STIGMA IS NOT ONLY A RIGHTS ISSUE, BUT A MAJOR MANAGEMENT ISSUE IT IS THE BIGGEST STUMBLING BLOCK IN FIGHTING AIDS IT IS AN EPIDEMIOLOGICAL PROBLEM AND MUST BE MANAGED AS SUCH

SACN City Strategic Framework Building blocks for integrated development: 

SACN City Strategic Framework Building blocks for integrated development Productive City Inclusive City Sustainable City Well- governed City City Development Strategy

What has worked: 

What has worked Local government leadership – no progress without a vocal and visible AIDS champion Municipal workplace policies supportive of HIV positive people Municipality leading through example Incorporation of marginalised areas into municipal service planning Promoting (not necessarily conducting) local coordination and networking Ensuring involvement of organisations representing people with HIV/AIDS Promoting integration of services – linkages Creating a forum for partnerships – leveraging funding for civil society through support of local government Local, national & international resource mobilization

What has worked: 

What has worked Promoting sustainable mainstreaming in local government departments (% of budget and within KPA of managers), and avoidance of once-off mobilisation campaigns Involvement of civil society and business in local government initiatives. Recognition of the huge role of civil society. A specific action plan to which the municipality can be held accountable Inclusion of AIDS funding in poverty reduction strategies Tireless promotion of prevention oriented VCT Adoption of a human rights framework to justify a framework for accountability and action access to procedural, institutional and other monitoring mechanisms for enforcing rights

Resources: 

Resources www.worldbank.org/urban.hivaids/index.htm (urban development)