by Stacey-Leigh Joseph

A key development in South Africa’s response to HIV/AIDS has been the recognition of a number of external factors in the socio-economic and physical environment in which people live that are central to the spread of the pandemic.

It is now better understood that HIV/AIDS is, to a large extent, a disease of underdevelopment and that in order to develop an effective and comprehensive response we need to move towards a holistic approach that looks beyond traditional treatment and prevention methods. In a context where many South Africans live in poverty, without adequate shelter and access to basic resources and services, HIV/AIDS will have far-reaching and serious impacts, not only on citizens and communities, but also for and on the state.

Research has shown that people who reside in urban informal settlements are disproportionately vulnerable to infection due to their lack of access to basic services like water and sanitation, and the conditions created by unemployment, informality, overcrowding and poverty.

People in informal settlements are doubly burdened because these same factors also affect their ability to lead healthy, comfortable and dignified lives when infected with HIV.

The South African government, like many governments in the world, has for the past number of years treated HIV/AIDS as a medical concern. However, its recent National Strategic Plan on HIV/AIDS, 2007-2011, recognises the fact that the HIV/AIDS pandemic is being driven by a lack of development. Yet, despite this recognition, the strategic plan provides no suggestions or proposals to indicate how its plans will coincide with a developmental agenda.

Breaking New Ground (BNG), introduced by the national Department of Housing in 2004, provides a useful channel to respond to HIV/AIDS in the context of poverty and underdevelopment. This policy has been hailed as a comprehensive plan for the development of sustainable human settlements and recognises the need to “move away from a housing-only approach towards the more holistic development of human settlements and the provision of social and economic infrastructure”.

BNG suggests a number of approaches to bring about sustainable human settlements. This includes in situ upgrading, greenfields development (which is linked to the housing subsidy) and rental options, including social housing. While BNG does not make explicit mention of HIV/AIDS, given the link between HIV/AIDS and poverty and underdevelopment, it is clear that a response to the epidemic should be a crucial component of any sustainable settlements agenda.

In addition, in light of overwhelming evidence that people in urban informal settlements are disproportionately affected by HIV/AIDS, it is crucial that this policy take into consideration the implications of HIV/AIDS for shelter provision and the changing need for shelter. Thus cognisance should also be taken of the demands that HIV/AIDS places on the state as a service provider.

Certain elements of BNG do begin to respond to some of the needs of people in informal settlements. For example, in situ upgrading of informal settlements attempts to respond to immediate factors that affect people’s lives. This is done by prioritising the provision of basic services like water and sanitation as well as infrastructure upgrading like improving or increasing the number of roads in informal settlements to ensure better access to health care, educational, employment and recreational facilities. By ensuring that people have adequate access to water, sanitation, electricity, solid waste removal, basic health care and emergency services, some of the developmental factors associated with increased vulnerability to HIV infection would be addressed.

The social housing component of BNG also signifies some progress in developing alternative responses to the way shelter is currently being conceived of. Its focus on issues of racial, spatial and economic integration is crucial to the development of sustainable and integrated settlements that provide the enabling environment within which people are able to access the necessary resources that allow them to make decisions about their livelihoods and sexual health. However, much room for improvement remains in light of the fact that it excludes a number of vulnerable groups like the very poor and people affected by HIV/AIDS, despite the fact that its intention is to provide alternative options for particularly those groups.

From the perspective of HIV/AIDS, BNG’s main component, the development of greenfields housing projects, has a number of shortcomings. For example, when erecting new housing settlements, insufficient attention is paid to issues related to housing design and settlement design. Appropriate housing design can play an important part in reducing vulnerability to HIV, for example by addressing safety considerations (especially for women and girls) and through partitioning to allow consenting adults the necessary privacy, which in turn will shield young children from exposure to sexual activity.

Housing design is equally important for people living with HIV/AIDS, as issues such as unit size, internal partitioning, insulation, ventilation and damp-proofing all impact on their health, comfort and dignity.

Similar considerations apply to settlement design. For example, the location of housing units, street lighting and neighbourhood services can contribute to enhanced (or reduced) safety and a greater sense of security and “neighbourliness”, which can have positive implications for all three core dimensions of a holistic response to HIV/AIDS (ie HIV prevention and reducing vulnerability to HIV infection; treatment, care and support; impact mitigation).

While the housing subsidy remains an important component of greenfields developments, it similarly has a number of shortcomings that need to be addressed if it is to respond effectively to the shelter needs of vulnerable groups.

The responsibility for policy, planning and implementation of sustainable human settlements is located across and between various sectors and spheres of government. Yet municipalities are increasingly being recognised as the primary entities for addressing poverty and inequality and overcoming “the apartheid city”, although they clearly cannot do so without the support and assistance of provincial and national governments.

This is illustrated by the fact that the DPLG has identified a two-pronged and inter-linked strategic agenda for municipalities: the promotion of sustainable human settlements and of local economic development.

Local government is therefore particularly well placed to integrate a developmental perspective on HIV/AIDS into its strategic agenda and ensure that local responses are appropriate to the various needs of households and communities faced by HIV/AIDS.

Municipal responses should be based on a thorough understanding of the developmental needs required in different localities, by different social groups, at different points in time. This means that municipalities should implement an inclusive process (ie involving people living with HIV/AIDS and their representative organisations, care givers and affected households/social groups) where they will be able to identify the priorities in their specific localities, the dynamics and implications of HIV/AIDS in their constituencies and what this means for local policy and planning. This should then be tied into the overall policy and planning priorities identified by provincial and national government.

Recognising how developmental factors like poverty and gender inequality relate to and interact with HIV/AIDS signifies a major step forward in understanding the South African HIV/AIDS pandemic and its consequences at individual, household, community, societal and institutional levels.

It is therefore important for municipalities - and other spheres of government - to grasp the relationship between HIV/AIDS and development and their prospective (and very important) role in responding to this issue.

Clearly, guidance and support from provincial and national government is extremely important, as is an understanding of the capacity that is required for this response. At the same time, municipalities have a co-ordinating function to ensure provincial and national government also play a meaningful role in bringing about sustainable settlements that become bulwarks in the national response to HIV/AIDS. It is no longer sufficient for government, at all three spheres, to concentrate its interventions on traditional prevention, care and treatment and limited impact mitigation.

Instead, what is required is a holistic response that takes into consideration the developmental nature and implications of HIV/AIDS.

The Local Government Transformer Oct/Nov 2007
Printed with permission Isandla Institute