An important message to the person finding out that they are infected is that a healthy, continued life is possible (don’t give up!) Studies point to the enormous difference made by nutrition, basic food safety, adequate sleep and a positive attitude. And ARV medication holds out a lifeline.

With only 0.7% of the world’s population, South Africa carries almost one-fifth of the global HIV carriers. The situation in neighbouring states is not much better. HIV/AIDS is a national and also a regional issue.

Farm workers are the most under-serviced labourers in South Africa. Poor access to health care and health-related information is partly due to their remote location of work. The high incidence of poverty and low level of education makes the farm worker even more vulnerable to the impact of HIV and AIDS. And lack of awareness is compounded by high levels of stigma around the issue, a problem because the stigma severely tests and often severs the safety net of support from village and extended family. Workers are scared to test and fear that they might be HIV positive. Unfortunately not knowing your status and not testing will not remedy this situation.

Farmers often don’t know where to turn to in order to help their workers. Losing skilled workers has a significant impact on productivity, but there are also social challenges. How do you deal with a household that is now without an income? And what if there are orphans that are left behind?

The cost of HIV/AIDS is largely borne by rural communities. Infected urban dwellers often return to their villages of origin where rural households (particularly women) provide most of the care. The rural families pick up the bill for food, medical costs and funeral expenses.

 

The burden of the socio-economic impact disproportionately affects rural women. Widows become poorer as they lose access to land, property, inputs, credit and support services.

 

The impact on children is severe as the increasing number of orphans bring the coping mechanisms of many extended families to breaking point. Withdrawal from school, a decrease in food intake, a decline in inherited assets and less attention from caretakers are among the adverse effects of the epidemic on children.

 

Adapted from Topouzis, Addressing the Impact of HIV/AIDS on Ministries of Agriculture: Focus on Eastern and Southern Africa.

International business environment

The third of the global goals agreed to by governments in 2015, the Sustainable Development Goals (SDGs), has to do with health.

The UNAIDS 90-90-90 targets stipulate that by 2020 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART), and 90% of all people receiving ART will have viral load suppression.

 

Some role players

  • Africa Centres for Disease Control and Prevention (Africa CDC)www.africacdc.org
  • The African Comprehensive HIV/AIDS Partnerships (ACHAP) at www.achap.org
  • www.africaid-zvandiri.orgAfricaaid works with HIV positive children and adolescents in Zimbabwe.
  • AIDS Healthcare Foundationwww.aidshealth.org
  • Read “The impact of HIV/AIDS on agriculture and food security” on the FAO website at www.fao.org/docrep/005/y8331e/y8331e05.htm
  • The Global Fund to fight HIV/AIDSwww.theglobalfund.org
  • For a global database on how HIV/AIDS is viewed (there are restrictions in some countries), see www.hivtravel.org.
  • International AIDS Society (IAS) is “the world’s largest association of HIV professionals” with members from more than 180 countries. See www.iasociety.org.
  • Read about the International Labour Organisation’s Programme on HIV/AIDS at www.ilo.org/aids.
  • Men Star Coalition www.menstarcoalition.org The aim of this organisation founded in 2018 is “to expand the diagnoses and treatment of HIV infections in men – keys to breaking the cycle of HIV transmission and ultimately ending the AIDS epidemic as a public health threat by 2030”.
  • Population Councilwww.popcouncil.org
  • Population Services International (PSI)www.psi.org
  • Society for AIDS in Africahttp://saafrica.org
  • Southern Africa HIV and AIDS information Dissemination Service (SAfAIDS) is based in Zimbabwe with country offices in South Africa, Swaziland and Zambia – www.safaids.net
  • The Joint United Nations Programme on HIV and AIDS (UNAIDS)www.unaids.org. Find the latest statistics here and news on the progress against HIV and AIDS.
  • USAID through PEPFAR has subsidised the NPOs who do HIV testing, and many of these offer Voluntary Counselling and Testing (VCT) free-of-charge in the rural areas. Visit www.usaid.gov.
  • The World Health Organisation (WHO)www.who.int

Local business environment

For 2018, the estimated HIV prevalence rate is approximately 13.1% of the total population — up from 12.9% in 2017 (Stats SA Mid-year Population estimates 2018). The total number of persons living with HIV increased from an estimated 4.25 million in 2002 to 7.52 million by 2018. For adults aged 15 – 49 years, an estimated 19.0% of the population is HIV positive, while HIV prevalence among the youth aged 15 – 24 has declined over time from 6.7% in 2002 to 5.5% in 2018.

The subsistence farmer

HIV/AIDS accelerates rural impoverishment and the breakdown of extended family relations that have over many years been the foundation of traditional safety-net mechanisms.

Subsistence agriculture makes for a hard life, particularly in areas that are badly hit by HIV. Put farming and AIDS together, add drought or disease, and you have a diabolical mixture of circumstances. Subsistence farmers typically work in remote areas with poor access to markets and agricultural services. Poverty is widespread. The burden of tending to family members with AIDS-related diseases – and the frequent death of these persons – leads to a decline in production among subsistence households, as human and financial resources are invested in taking care of people rather than crops and animals. Lower production, in turn, causes food insecurity that exacerbates the effects of AIDS – and heightens the likelihood of HIV exposure and infection. A vicious cycle is set in motion.

Because HIV largely affects the population group aged between 15 and 49 years, it is often parents that are lost to the pandemic. As a result, farming skills that would normally be passed from mothers and fathers to their children tend to be lost, with the new generation left ill-equipped to continue with agriculture. In some cases, when AIDS claimed all the adults, children are left to manage households, raise siblings and attempt to produce food. This creates another cycle of lack of formal education, leading to unemployment and children growing up without any parental guidance and love, leading to marginalisation.

Advice to subsistence or small-scale farmers would include:

  1. Grow millet and sorghum. These crops can grow without irrigation – no small matter in an aids-affected household – with little labour or money to spare.
  2. Invest more in the farming of indigenous livestock e.g. Nguni cattle, a local breed that copes better with dry African weather than other breeds and which has greater resistance to ticks and diseases. European breeds need expensive medication and vaccinations, and that they are sometimes unable to survive the South African climate.
  3. Chicken farming, which requires less expertise than cattle breeding, could also prove useful for families struggling to cope with AIDS. In addition, poultry is a cheap source of the protein that is vital in maintaining the immune system of HIV-positive persons for as long as possible.
Adapted from an article in the Mail & Guardian, 7 June 2005

The stigma, different misconceptions and the fear to die alone if diagnosed with HIV, especially in rural settings, necessitate that a HIV/AIDS policy needs to be built upon trust and confidence amongst all the players/stakeholders. Involvement of all stakeholders in an early stage helps building the necessary team approach. Before starting awareness sessions for the farm workers, the farmer / farm management need to speak to the farm workers, indicating commitment and stipulating assurance that people will not be fired (one of the fears is that they will be fired if tested positive). By implementing an HIV programme the hope is that the workers are more knowledgeable about the importance of a healthy life style.

 

Source: AgriAid. Contact them at 012 320 8455 or visit www.agriaids.org.za.

Nutrition and food safety

No specific food or nutrient can destroy the virus, but a healthy eating pattern and life style will strengthen the immune system. Good nutrition will help you to fight infections and delay the development of full-blown AIDS. This will improve well being and prolong life.

It seems prudent for all HIV infected individuals to consume an adequate vitamin intake from food, but in those with a poor dietary intake, a multivitamin and mineral supplement should be used.

Food hygiene is important in HIV-positive individuals with poor immune function as they are at an increased risk of food poisoning. Special care should be taken with uncooked products such as eggs, fish, meat and milk products.

Food Safety Precautions

  1. Wash hands thoroughly before handling or eating food. Avoid raw/ unpasteurised milk.
  2. Meat, fish or chicken should always be well cooked.
  3. Avoid raw eggs in uncooked foods e.g. drinks, mayonnaise, etc. Discard cracked eggs.
  4. Do not buy prepared salads with chicken, fish, meat, egg or mayonnaise from the supermarket.
  5. Leftover food should be refrigerated as soon as it has cooled. It should be reheated once and should be hot all the way through.
  6. Wash all fruit and vegetables well.
  7. Store food in a cool, dry place.
  8. Moderate exercise should be encouraged and will assist in the toning or development of muscle.
Source: Dr Marianne E.Visser

National strategy and government contact

Since the World Health Organisation (WHO) recommendation (2015) that ARV treatment should begin as soon as possible after diagnosis, test and treat has been implemented at all South African health facilities. South Africa treats 3.7 million with ARV treatment, more people than any other country with anti-retrovirals, consuming one-quarter of global generics. South Africa treats more people than any other country with anti-retrovirals, consuming one-quarter of global generics.

The National Development Plan (NDP) sets out a target of no new HIV infections by the year 2030. Even once this goal has been reached, “there will still be a sizeable number of HIV-positive people requiring treatment, presenting a continuous challenge for the tuberculosis infection rate and the risk of drug-resistant HIV strains developing” [Cyril Ramaphosa, Deputy President and South African National Aids Council (SANAC) chairperson, 2017]. By all indications, the epidemic and its implications for public policy are likely to persist for at least another generation, possibly two.

The National Strategic Plan (NSP), a guide for the country’s response to these infections, seeks to reduce new HIV infections by 63% – from 270 000 in 2016 to less than 100 000 by 2022. See http://nsp.sanac.org.za.

Find the “HIV/AIDS”option at www.health.gov.za, website of the Department of Health.

  • Department of Higher Education & Training – see http://heaids.org.za
  • Department of Social Development www.dsd.gov.za
  • Department of Science and Technology (DST) www.dst.gov.za
  • South African Health Products Regulatory Authority (SAHPRA) was established in February 2018 to replace the Medicines Control Council (MCC). See www.sahpra.org.za.
  • South African National Aids Council (SANAC) officially brings together the government and civil society in the fight against HIV/AIDS. Visit www.sanac.org.za. Find statistics and details of each of the province’s own councils on the website.

Role players

National Aids Helpline – 0800-012-322 www.lifelinesa.co.za

  • ACAT KZN Tel: 033 234 4118 www.acatkzn.co.za
  • AgriAids acts as a conduit between farm owners/management, farm workers and the Department of Health. Call 012 320 8455 or visit www.agriaids.org.za.
  • AIDS Foundation of South Africa (AFSA) Tel: 031 277 2701 www.aids.org.za
  • AIDS Law Project Tel: 011 356 4100
  • CareCross is involved in programmes at several farms in the Eastern Cape. Visit www.carecross.co.za.
  • Desmond Tutu HIV Foundation Tel: 021 406 6966 http://desmondtutuhivfoundation.org.za
  • Find the Eastern Cape Aids Council pages at www.ecsecc.org.
  • Good nutrition is of enormous importance to HIV-positive people. e’Pap is more than 29 times more nutritionally dense than refined maize and is packed with 28 micro and macro nutrients. Visit www.epap.co.za.
  • The GreaterGood South Africa Trust connects givers with good causes, including social work and care around HIV/AIDS. Take a look at www.greatergoodsa.co.za.
  • Health Professions Council of South Africa (HPCSA) Tel: 012 338 9300 www.hpcsa.co.za
  • Health Systems Trust Tel: 031 266 9090 www.hst.org.za
  • Healthi Choices Tel: 011 991 8520 www.healthichoices.com
  • Hope Cape Town www.hopecapetown.com
  • Info4africa (formerly HIVAN) Tel: 031 260 3335 www.info4africa.org.za
  • International Organisation for Migration South Africa works with sectors that traditionally employ a relatively large number of migrant workers including the commercial agriculture sector. Call 012 342 2789 or visit https://southafrica.iom.int.
  • Kaelo has offices in Johannesburg, Cape Town and Durban. Visit www.kaelo.co.za.
  • Khululeka Grief Support provides training, materials and support for pre-schools and care-givers across a wide region. Visit www.khululeka.org.
  • Employees dismissed on the grounds of HIV who have no resort to legal assistance can seek free legal advice at the HIV and TB helpline operated by Legal Aid SA on 0800 110 110
  • Details of Lifeline offices and crisis lines across the country are available at www.lifelinesa.co.za.
  • LoveLifewww.lovelife.org.za
  • Medical Research Council – see South African AIDS Vaccine Initiative (SAAVI)
  • National Institute for Communicable Diseases is a division of the National Health Laboratory Service. Call 011 386 6000 or visit www.nicd.ac.za.
  • Right to Care builds public- and private-sector capacity for the clinical care and treatment of individuals countrywide living with HIV and associated diseases. Visit www.righttocare.org.
  • South African Business Coalition on HIV/AIDS (SABCOHA) is “empowering business in the fight against HIV”. Visit www.sabcoha.org.
  • South African Chamber of Commerce and Industry (SACCI) runs workshops and guidance on implementing HIV/AIDS policies. Call 011 446 3800 or visit www.sacci.org.za.
  • South African AIDS Vaccine Initiative (SAAVI) Tel: 080 VACCINE www.saavi.org.za
  • South African Medical Association (Sama) Tel: 012 481 2000 www.samedical.org
  • Southern Africa AIDS Trust www.satregional.org
  • Southern African HIV Clinicians Society Tel: 011 728 7365 www.sahivsoc.org
  • Southern Africa Trust www.southernafricatrust.org
  • TB/HIV Care Association Tel: 021 425 0050 www.tbhivcare.org
  • The Valley Trust Tel: 031 716 6800 www.thevalleytrust.org.za
  • Treatment Action Campaign (TAC) Tel: 011 276 1200 www.tac.org.za
  • Ubuntu Institute Tel: 011 566 6813 www.ubuntuinstitute.com

 

Voluntary Counselling and Testing (VCT)

Numerous clinics and hospitals around the nine provinces do VCT. Lists of these are available on www.lifelinesa.co.za. You can also call the National AIDS Helpline and ask for the nearest voluntary counseling and testing (VCT) centre. The number is 0800-012-322.

 

Helping to support the “ordinary” lives of AIDS orphans

 

Training

The Higher Education & Training HIV/AIDS programme (HEAIDS) runs programmes at tertiary institutions. Read about it at http://heaids.org.za.

  • AgriSETA accredited training providers cover HIV/AIDS Awareness. Find their details at www.agriseta.co.za.
  • Agri-IQ Tel: 032 586 1010 www.agri-iq.com
  • AIDS Consortium has offices in Johannesburg, Polokwane and Rustenburg. It is the South African linking organisation to the International HIV/AIDS Alliance. Visit www.aidsconsortium.org.za.
  • Centre for HIV and AIDS Prevention Studies (CHAPS) Tel: 011 484 8068 www.chaps.org.za
  • Education, Training and Counselling Tel: 011 614 0872 www.edutc.co.za
  • Educational Support Services Trust (ESST) Tel: 021 913 7710 www.esst.org.za
  • The Foundation for Professional Development‘s HIV/AIDS Clinical Management Course supports the professional growth of physicians, nurses and health care workers. The FPD has also worked with AgriAids to provide VCT (Voluntary Counselling and Testing) on farms with mobile units. Call 012 816 9000 or visit www.foundation.co.za.
  • Megro Learning Tel: 013 752 5525 http://megrolowveld.com
  • PMI SA Tel:  031 201 1260 http://pmi-sa.co.za
  • Project Literacy operates countrywide. Find contact details at www.projectliteracy.org.za.
  • Tutor Tel: 011 475 4777 www.learnsupport.co.za

 

Research (and training)

  • Africa Centre for HIV/AIDS Management at Stellenbosch University. See www.aidscentre.sun.ac.za
  • Centre for AIDS Development, Research and Evaluation (CADRE) has offices in Johannesburg, Grahamstown and Cape Town. Visit www.cadre.org.za.
  • Find out about the Centre for the Aids Programme of Research in South Africa (CAPRISA) at the University of KwaZulu-Natal at www.caprisa.org.
  • Centre for Sexualities, AIDS and Gender Tel: 012 420 4391 www.csa.za.org
  • Contact Dr Makobetsa Khati at Tel: 012 841 4770 or mkhati [at] csir.co.za to find out about the involvement of the Council for Scientific and Industrial Research (CSIR).
  • Durban University of Technology HIV/AIDS Centre Tel: 031 373 2287/60 www.dut.ac.za
  • Health Economics and HIV/AIDS Research Division (HEARD) Tel: 031 260 2592 www.heard.org.za.
  • Human Science Research Council (HSRC) – Find the HAST (HIV/AIDS, STIs and TB) pages at www.hsrc.ac.za.
  • There is a HIV Prevention Research Unit at the Medical Research Council. Contact Prof Gita Ramjee at gita.ramjee [at] mrc.ac.za, call the Durban branch at 031 242 3600, or visit www.mrc.ac.za.
  • Contact the HIV/AIDS Unit at the Nelson Mandela University at 041 504 2344 or visit http://hivaids.mandela.ac.za/.
  • Sub-programme 5 of the North-West University’s Unit for Environmental Sciences and Management is “spatial planning, development and implementation”. HIV and AIDS features as a “cause for enormous concern”. (See block below). Contact Selna Cornelius at 018 299 2544 or with an email to selna.cornelius [at] nwu.ac.za.
  • Stellenbosch University’s Bureau for Economic Research has done research on the economic impact of HIV/Aids. Visit www.ber.ac.za. A post-graduate diploma in HIV/AIDS Management is offered. Call 021 808 3002. See also the earlier listing of the Africa Centre for HIV/AIDS Management.
  • Contact the Department of Agricultural Economics at the University of the Free State. Call 051 401 2824 / 3864 or visit www.ufs.ac.za/agri-econ In the university’s Cluster Approach, Health, Wellness and Community Resilience is Focus Area 1. 
  • Wits Reproductive Health and HIV Institute Tel: 011 358 5300 www.wrhi.ac.za

Spatial implications of the prevalence of HIV/AIDS

 

HIV & AIDS has a vast impact on the country’s demographic profile and this consequently leads to spatial as well as psycho-social impacts, especially with regards to the communities living within South Africa’s Informal Settlements. The growing number of maternal orphans as well as the high mortality rate amongst the adult (and economically active) population, raises cause for enormous concern regarding the impacts of these demographic changes on the socio-economic environment as well as spatial development within these areas.

 

Central questions that arise include:

  • Does the HIV & AIDS pandemic impact (spatially as well as psycho-socially) on the lives of the people living in the informal settlements?
  • Which of the current spatial structures functions well within these communities?
  • How can these spatial structures be improved or changed in order to accommodate HIV & AIDS affected households?
  • How can we change our current planning approach to settlement development in order to accommodate the demographic changes caused by the HIV & AIDS pandemic?

 

In order to achieve this, extensive research is needed within the spatial and psycho-social environment within which these informal settlements function. Current approaches to informal settlement development within South Africa do not take the needs of HIV & AIDS affected households into consideration. Housing and other forms of aid are provided on an ad hoc basis. This research therefore takes a look at the existing approaches to informal settlement development in South Africa and other selected case study areas within Africa.

 

Source: Selna Cornelius, North-West University (Potchefstroom). Contact her at Tel: 018 299 2544 or selna.cornelius [at] nwu.ac.za.

Websites and publications

Visit the websites listed earlier in the chapter.

The following Info Paks are available at www.daff.gov.za, website of the Department of Agriculture, Forestry and Fisheries (DAFF).

Find publications like South African National HIV Prevalence, Incidence, Behaviour and Communication Survey by the Human Sciences Research Council (HSRC) at www.hsrcpress.ac.za.

Find details of the Southern African Journal of HIV Medicine at www.sahivsoc.org.

Impact of HIV & AIDS on agriculture and food security: The case of Limpopo Province in South Africa can be found among the historical documents on www.fanrpan.org.

The HIV/AIDS Emergency – A Guideline for Educators available in four languages (English, Afrikaans, Sesotho, Xhosa). This is available from the Department of Basic Education.

Moyle, D. Speaking Truth to Power. 2015. Johannesburg: Jacana.

Find information on the African Journal of AIDS Research at www.nisc.co.za.

www.aidsmap.com – “HIV and AIDS – sharing knowledge, changing lives”

“Global information and advice on HIV & AIDS” , www.avert.org

“The Complete HIV/AIDS Resource” – www.thebody.com

The medical journal The Lancet periodically runs articles about HIV/AIDS. See www.thelancet.com. 

POZ is a magazine for HIV positive people. See www.poz.com.

Epstein, H. 2007. The Invisible Cure: Africa, the West and the Fight against AIDS. New York: Farrar, Straus, and Giroux.

Find the HIV option at www.verywell.com for comprehensive information on the HIV condition.

The World Development Reports reveal that most people affected by the HIV/AIDS pandemic in sub-Saharan Africa depend on agriculture. Find the “Infectious Diseases and Vaccines” option at www.worldbank.org.

 

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