South Africa’s unequal prospect/RESEARCH PROGRAMME Social Aspects of HIV/AIDS and Health

South Africa’s unequal prospect
Tom Burgis, 5 - 08 - 2009
The gap between South Africans’ incomes and life-chances undermines their dream of an inclusive future, says Tom Burgis.
5 - 08 - 2009



The vista from among the shacks, hubbub and agonies of Alexandra says it all. Towering beyond the crumbling hostels built for the township's migrant mineworkers are two skyscrapers - the pinnacles of Sandton, the financial district that marks the wealthiest apex of the wealthiest city in Africa: Johannesburg.
Tom Burgis is West Africa correspondent at the Financial Times, based in Lagos, having previously been the Johannesburg correspondent. Before joining the FT, he was freelance and spent a year in South America, most of it with the Santiago Times as Chile attempted to bring Augusto Pinochet to justice.

He has written for openDemocracy's debates on protest and globalisation, and for a year presided over the monthly Bad Democracy Awards.

Among Tom Burgis's articles in openDemocracy:

"Arresting development in Chile" (14 June 2005)

"Michelle Bachelet's hard lesson" (26 June 2006)

"The siege of Hong Kong" (12 December 2005)

"A guide to the post-9/11 world" (8 September 2006)

"Addicted: William Burroughs and a world in heat" (3 November 2006)Few countries have such an unequal distribution of wealth as South Africa. Since the end of apartheid fifteen years ago, the prevailing economic orthodoxy has held that a rising tide would eventually lift all boats. Yet inequality lies at the root of many of the nation's ills.
The rallying-cry of the latest township riots is a demand for basic services - without which poor South Africans' hopes of escape from destitution are throttled. The income-gap serves as a place where crime, violence and Aids ferment.
It was not supposed to be like this. When Nelson Mandela led the African National Congress to victory in the 1994 elections that deposed white rule, many South Africans believed - despite the long-jailed freedom-fighter's warnings to the contrary - that democracy would automatically engender prosperity.
Instead, the new order inherited modern history's most successful attempt to concentrate wealth in the hands of the few. Johannesburg's juxtaposition of dirt-poor townships and plush suburbs is the geographical legacy: a black labour-force near enough to work but far enough away for wealthy whites to sleep easily.
Today the economic pyramid largely retains the shape of the apartheid years, even if a few black notables have reached the peak.
The Organisation for Economic Cooperation and Development (OECD) concluded in a 2008 report: "The most disappointing aspect of post-apartheid economic performance is the emergence and persistence of extreme levels of unemployment, particularly for less-skilled younger blacks, together with the continuation of widespread poverty and the widening of inequalities."
Olive Shisana, head of the Human Sciences Research Council, says income inequality lies behind a potentially alarming rise in the number of young women whose sexual partners are much older.
The girls who slink into corrugated-iron knocking-shops are hardly in a position to insist that their older lover put on a condom. Experts call this "transactional sex", where the wealthy partner supplies mobile-phones and other tokens that serve as a sticking-plaster over the lack of meaningful economic advances.
"If you had a society that was different in terms of access to resources, I think things would be very, very different", says Dr Shisana. "For people to try to equalise, they go to sugar daddies."
It was horror at inequality in its own right, rather than a hatred of the whites who benefited from it, that motivated some of the country's most valuable ideas. Mandela's renowned non-racialism is the most prominent; among the others is the proposal of the white South African Aubrey Meyer - fed originally by an abhorrence of "separate development" - that climate change should be countered by allocating the right to pollute equally among every human being on the planet.
Yet the skewed distribution of resources continues to define life in South Africa.
The wall within
Such disparities - combined with rampant car-theft - have given rise to an entire informal industry: the guards who earn a few rand keeping watch over parked vehicles.
The overwhelmingly black attendants depend for their living on the very lawlessness from which they, rather than those who can afford electric fences, are much more likely to suffer. The gratuitous violence that accompanies many crimes appears to be motivated as much by economic structures that have kept most blacks poor than by a lasting racial animosity.
The other end of the spectrum was recently evident at one of Johannesburg's most chic nightspots, where a multi-coloured elite was plied with champagne as models enacted James Bond scenarios to showcase designer bulletproof attire. What better way to avoid becoming one of the 19,000 South Africans who are murdered annually while still flaunting the wealth that makes you a target, was the barely concealed sales pitch.
Politicians argue, with some merit, that righting the distortions of apartheid was never going to be straightforward. Supporters of Thabo Mbeki, president until September 2008, point to the achievements of "black economic empowerment" (BEE), the policy that obliges leading companies to transfer equity and other benefits to the black majority.
Others, though, say the income-gap is a direct result of such policies, whose main beneficiaries have been a crop of politically-connected black magnates.
Moeletsi Mbeki, the former leader's brother and a critic of BEE, writes in a new book that the policy "strikes a fatal blow against the emergence of black entrepreneurship by creating a small class of unproductive but wealthy black crony capitalists made up of ANC politicians, some retired and others not, who have become strong allies of the economic oligarchy".
The new government, led by Jacob Zuma, promises more "broad-based" black empowerment. Yet it seems unlikely that much will change while there persists among those with the credentials to work the system a mindset that was best expressed by Smuts Ngonyama, a former spokesman for the Mbeki government. He said simply: "I did not join the struggle to remain poor."

Also in openDemocracy on South African politics and society:
Gillian Slovo, "Making history: South Africa's Truth and Reconciliation Commission" (5 December 2002)
John Matshikiza, "Johannesburg: shanty city, instant city" (13 December 2002)
Paul Kingsnorth, "Apartheid: the sequel" (20 May 2003)
Nahla Valji, "South Africa: no justice without reparation" (2 July 2003)
Achille Mbembe, "South Africa's second coming: the Nongqawuse syndrome" (15 June 2006)
Achille Mbembe, "Whiteness without apartheid: the limits of racial freedom" (4 July 2007)
Roger Southall, "South African lessons for Kenya" (8 January 2008)
Roger Southall, "South Africa and Zimbabwe: the end of ‘quiet diplomacy'?" (29 April 2008)
Faten Aggad & Elizabeth Sidiropoulos, "South Africa's tipping-point" (2 June 2008)
Tom Lodge, "Nelson Mandela: assessing the icon" (18 July 2008)
Roger Southall, "Thabo Mbeki's fall: the ANC and South Africa's democracy" (13 October 2008)
Elleke Boehmer, "Beyond the icon: Nelson Mandela in his 90th year" (12 November 2008)
Roger Southall, "South Africa's election: a tainted victory" (7 April 2009)



XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

ANNOUNCE AS COMPLEMENTARY FROM THE MUKTIDOOTH BANGLADESH

The Guardian International Development Journalism
Competition 2009 Finalists Announced

10 August 2009

London: The Guardian International Development Journalism Competition 2009 has now reached its final stages with the announcement of the 16 finalists.

The competition is a collaboration between the Guardian, Marie Stopes International and seven other non-government organisations (NGOs) and was launched in April with the financial support of the Department for International Development and Glaxo Smith Kline. Both amateur and freelance professional journalists were encouraged to submit articles on key development issues before the June deadline.

"We continue to be very impressed by the ability of many journalists – professional and amateur - to grasp and convey such complex issues relating to global poverty and international development," said Michael Holscher, Director of Strategy and External Affairs for Marie Stopes International. "We urge you to visit the site and read not only the excellent articles by the 16 finalists, but those by all the 40 longlisted entrants. It is unfortunately all too rare for the media light to shine on these powerful and emotive issues.”

One of the finalists from the professional category, Rebecca Stewart, wrote on one of Marie Stopes International’s themes, focusing on the appalling toll unsafe abortion has on young women’s lives in Zambia: Legal but they don’t know it. Another, Candida Beverage, wrote a disturbing piece on women’s rights in Sumatra: No money, no baby.

The 16 finalists (eight professional and eight amateur journalists) will be given final assignments relating to international development issues and taken on trips to various countries in Africa, Asia, Eastern Europe and the Caribbean so that they can experience and investigate these issues first hand. The winners – one from each strand – will be announced at an award ceremony in November, after which all the final assignments will be published by the Guardian newspaper in special supplements.

The other NGO partners in the project are Amref, British Red Cross, Farm Africa, Find Your Feet, International Childcare Trust, One World Action and Panos London.

To view the articles, visit www.guardian.co.uk/developmentcompetition.

For more information, please contact Nicole Brown at
Marie Stopes International on +44 (0)20 7034 2343 nicole.brown@mariestopes.org

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

RESEARCH PROGRAMME



Social Aspects of HIV/AIDS and Health
Research to inform HIV/AIDS prevention, care and impact mitigation

Prof Leickness Simbayi
Executive director
What we do
The Social Aspects of HIV/AIDS and Health (SAHA) research programme specialises in research on the social determinants of health - not only with regard to HIV/AIDS, but also for public health in general. This research goes beyond medical interventions and strives to address health problems at their source, namely, at the social and population levels.
The programme is a national and regional resource for research on the following issues:
• Large-scale surveys at national, community and economic sector levels
• Applied, epidemiological, social and behavioural research
• Health services and health systems research
• Operations research (descriptive and intervention)
• Programme evaluation
• Qualitative research (ethnographic, focus-groups)
• Surveillance and analysis of epidemiological trends
SAHA incorporates the Social Aspects of HIV/AIDS Research Alliance (SAHARA), an alliance of partners established to conduct, support and use social sciences research to prevent the further spread of HIV and mitigate the impact of its devastation in sub-Saharan Africa.
South African National HIV Prevalence, Incidence, Behaviour and Communication Survey report released
Scope of work
SAHA conducts research in three main areas:
Behavioural and social aspects of HIV/AIDS
This research aims to understand social (interpersonal) and behavioural (personal) factors driving the HIV/AIDS epidemic. We use this knowledge to develop and test behavioural HIV interventions that are theory-based and directed at prevention of HIV infections in both the general public and people living with HIV/AIDS (PLWHA).
Other research focuses on reducing stigma and discrimination against PLWHA; risk behaviour among men who have sex with men; and efforts to mitigate the impact of the disease among orphaned and vulnerable children (OVC).
Epidemiology, strategic research and health policy
This area provides epidemiological support and expertise, undertakes applied policy-relevant epidemiological research, and conducts strategic research that addresses the needs of South Africa and other African partner countries. It covers four research areas:
• Infectious disease epidemiology, with a focus on HIV/AIDS survey methodology and epidemiological modelling;
• Biostatistics, data management and analysis;
• HIV/AIDS intervention research aimed at the development of synergistic prevention and care programmes; and
• Monitoring and evaluation, including assessing the impact of national programmes.
Health systems and social determinants of health
This area focuses on research on developing and evaluating interventions which promote evidence-based health-care provision. The issues dealt with include: disparities in health services; health promotion; the transformation of health systems; and operations research.
The research places a specific emphasis on strengthening equitable provision of health services and investigates how the social conditions under which people grow, live, work and age, affect health.
Regional and international collaboration
Within South Africa, SAHA works with national, provincial and local government departments, other statutory research councils, universities, parastatal and non-governmental organisations, as well as virology laboratories. Most importantly, SAHA has contributed both directly and indirectly, to the development and implementation of the HIV & AIDS and STI Strategic Plan for South Africa 2007-2011.
In the rest of Africa, SAHA has worked mainly with partners based at the Université Cheikh Anta Diop in Dakar, Senegal, and the Tropical Institute of Community Health at the Great Lakes University of Kisumu in Kenya. Collaborative work includes government departments, university researchers and research organisations, NGOs and local and international donors. This network has allowed us to undertake several large multi-country and multi-site research studies. Through the SAHARA network, SAHA enjoys a special relationship with the Southern Africa Development Community's (SADC's) HIV/AIDS Unit in Gaborone, Botswana, and the Joint United Nation's Programme on AIDS' (UNAIDS) Regional Support Team for East and Southern Africa, based in Johannesburg.
SAHA also collaborates with many international research institutions and universities outside Africa and with several multilateral international organisations. Longstanding relationships exist with, among others, the National Institute of Mental Health, Centers for Disease Control and Prevention (CDC), National Development and Research Institutes (NDRI), ORC Macro International, Pennsylvania State University, and the University of Connecticut, all from the USA. There are moves to establish partnerships with international research institutions and universities in other parts of the world.
Funding
Although SAHA receives some government funding, being part of a statutory research council (HSRC), the majority of its funding comes from national and international donors.
Within South Africa, funders include: national and provincial government departments; other parastatals and non-governmental organisations. These include: the national Departments of Health, Science and Technology, and Social Development; the AIDS Foundation of South Africa; the Anglican Church of Southern Africa; Education Labour Relations Council; the Nelson Mandela Foundation; the Presidency; and the Safety and Security Sector Education and Training Authority (SASSETA).
Internationally, recent funding has been accessed mainly from the USA's President's Emergency Plan for AIDS Relief - PEPFAR (via a collaborative agreement with the Centers for Disease Control and Prevention).
Other funders over recent years include the following:
• Bill and Melinda Gates Foundation
• British Commonwealth Fund
• CDC Atlanta
• Ford Foundation
• National Institutes of Health (USA), mainly via the University of Connecticut
• SAHARA (drawing on funding from the Canadian International Development Agency, Department for International Development (DFID), UK, and the Netherlands International Aid Agency, DGIS)
• Swiss Agency for Development and Cooperation (SDC)
• Tibotec REACH Initiative
• WK Kellogg Foundation
• World AIDS Foundation
• World Health Organization (WHO).
Implementation networks
In keeping with the HSRC motto, Social Science that Makes a Difference, SAHA uses implementation networks to ensure that our research is relevant, properly understood and then implemented. As SAHA works at regional, national and local community levels, it involves key stakeholders at each of these levels. Multi-country and multi-site studies, and most large national studies, have Steering Committees and Boards drawn from relevant stakeholders to provide advice, while local studies have Community Advisory Boards which do the same. In conjunction with the Policy Analysis Unit of the HSRC, we endeavour to convert all research findings into policy briefs for dissemination to key stakeholders.
Themes

Theme 1: Population-based HIV surveys
SAHA undertakes population-based HIV/AIDS surveys, employing the second-generation surveillance approach at national, provincial, and local community levels. These surveys provide essential information for informing policy and programmes in response to the HIV/AIDS epidemic in South Africa and neighbouring SADC countries. The surveys are the primary data source for the government's HIV & AIDS and STI Strategic Plan for South Africa 2007-2011.
Theme 2: National Monitoring & Evaluation and programme impact assessment
The HIV and AIDS and STI Strategic Plan recognises monitoring and evaluation (M&E) as an important policy and management tool. As a lead research programme in the design and implementation of national M&E frameworks, the government has requested SAHA to assist in the outcome and impact assessment of national policies and programmes.
Theme 3: Prevention of mother-to-child transmission (PMTCT)
An ambitious aim of the Strategic Plan is to reduce mother-to-child transmission rate of HIV to less than 5%. SAHA conducts research to improve the effectiveness and coverage of PMTCT services, especially in poor, rural areas.
Theme 4: Nosocomial transmission of HIV and TB
Previous studies have shown deficiencies in infection prevention and control (IPC) in health facilities throughout South Africa. In addition, nosocomial transmission of HIV is suspected in several unexplained cases of HIV infection. Since 2005, there have also been multiple cases of extensively drug-resistant tuberculosis (XDR-TB) where evidence clearly pointed to a nosocomial transmission mode. SAHA has undertaken studies in collaboration with Stellenbosch University to improve infection control practices in public sector health-care facilities to reduce the potential for HIV and TB transmission both to patients and health-care workers.
Theme 5: Orphans and vulnerable children (OVC)
One of the main consequences of the hyperendemic nature of HIV/AIDS in the Southern African region has been the premature death of parents of young children which has produced large numbers of orphans. This has exacerbated an already hazardous situation in which the many children are vulnerable because of pervasive levels of poverty also found in the region. Consequently, SAHA has prioritised research into the mitigation of the impact of HIV/AIDS among OVC with a view to identify best practices which help improve both their own conditions as well as those of their caregivers, in line with imperatives of the South African National Strategic Plan on HIV & AIDS and STI for 2007-2011.
Theme 6: Theory-based social and behavioural risk reduction interventions
A set of theory-based behavioural risk reduction intervention programmes under the name Phaphama (meaning "wise up" or "be wise") have been developed and tested over the past few years in collaboration with the University of Connecticut in the USA. These are mainly aimed at providing evidence-based behaviour change interventions, which are being evaluated as a means to reduce new HIV infections. Apart from targeting individuals, some interventions are now beginning to target whole communities in order to try to change social norms. This is also in line with the imperatives of the HIV & AIDS and STI Strategic Plan for 2007-2011.
Theme 7: Positive prevention among people living with HIV/AIDS
As more people test for HIV and become aware of their status, one of the major challenges is to promote behavioural risk reduction among them, in order to promote both primary and secondary prevention. A new approach, known as positive prevention, aims to achieve both goals. SAHA is collaborating with the original developers of the interventions and is thus able to benefit directly from their expertise and experience while adapting the interventions for local conditions in line with the National Strategic Plan on HIV & AIDS and STI for 2007-2011.
Theme 8: Research on HIV/AIDS-related stigma and discrimination
HIV/AIDS is one of the most stigmatised medical conditions in the world. Stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalised by people living with HIV and AIDS. SAHA is undertaking research to understand HIV/AIDS-related stigma and how to reduce it in line with the imperatives of the HIV & AIDS and STI Strategic Plan for 2007-2011.
Theme 9: Health systems
The complexity and modalities of antiretroviral therapy (ART) have not been sufficiently explained in the South African context. SAHA is therefore carrying out operations research on traditional and complementary medicine in relation to ART in order to identify the most effective ART delivery models in line with imperatives of the National Strategic Plan on HIV & AIDS and STI for 2007-2011.
Theme 10: Social determinants of health
The social determinants of health include, among others, poverty, social exclusion and food insecurity. These factors interact with one another to structure lifestyle choices that become powerful predictors of individual and population health. SAHA is undertaking work to identify and address such factors as a critical step in diminishing inequalities in health.

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX