I. 1 The HIV Epidemic in Sub-Saharan Africa

Jeffery Gow, Acting Director of the Health Economics and HIV/AIDS Research Unit of the University of Natal in Durban, gave an overview of the epidemic in Sub-Saharan Africa. He pointed out that the sub-continent counted 70% of the people living with HIV worldwide, 83% of the deaths due to AIDS, and 95% of the orphans due to AIDS, while it only represents 10% of the world population.

The impact of the epidemic on society is enormous: life expectancy has decreased in most affected countries, such as Zimbabwe, from 64.9 years without HIV/AIDS to 39.2 years with HIV/AIDS, a loss of 25.7 years by the year 2010. Child mortality has increased, and in some cases tripled: for example in Namibia, Botswana, and Zimbabwe from around 40 per 1000 without HIV/AIDS to over 120 per 1000 with HIV/AIDS.

Economies of the sub-region are also being adversely affected: firms see their productivity decrease and their costs increase, while households must face reduced incomes, and increased expenditures on health care. As a result, the economic performance of the whole continent is hindered. In many countries, such as Zimbabwe, Namibia, and Botswana, growth rates are being reduced. The epidemic is reversing thirty years of development gains.

Local governments are heavily affected as the demand for social services, such as health facilities, foster care, and burial space, increases, and the tax base as well as citizens' ability to pay dwindle.

According to Mr. Gow, effective and sustained action on HIV/AIDS require that local government show leadership. It is important to evaluate local government services and determine the impact of the epidemic on them, identify resources and prioritise development projects. The Alliance represents a unique opportunity to mobilise partnerships among local authorities and civil society organisations at the community level.

I. 2 The International Partnership Against AIDS in Africa

Mr Elhadj As Sy and Mayor Mavunde

The next presentation focused on the response of the international community through the International Partnership Against AIDS in Africa. Elhadj As Sy, the UNAIDS Inter-Country Team Leader based in Pretoria, outlined the principles on which the International Partnership is based, i.e.: African political leadership, action centered at country level and based on community-identified priorities, respect for human rights and full involvement of people living with HIV/AIDS, and building on existing global, regional and national structures.

At the international and regional level the Partnership works together to create a policy and social environment conducive to successful action with national and regional leadership, and to mobilise the additional human and financial resources necessary for impact on a bigger scale and in a more strategic and focused manner. The Partnership provides relevant, accessible and high quality technical and logistical support to national level responses. It also supports networking, joint advocacy and sharing of lessons learned.

The presentations elicited a lively discussion among the participants and the presenters.

Poverty was recognised as an important factor in facilitating the spread of the epidemic, along with other structural causes such as gender inequalities, violence (including gender violence) and dangerous workplaces. In particular, the difference between Southern Africa and West Africa can be better understood in light of the history of apartheid and the institution of migrant labour.

Comments were also made on the necessity to address the role of men in the epidemic. Until recently, programmes targeted mostly women, because they appeared more vulnerable to the epidemic, singling them out and unwillingly stigmatising them. One of the participants emphasised the need to bring men into the process, because empowering women without including men does not work. Indeed, the role of men needs to be better understood, in particular relationships between older men with young girls, and addressed for a more effective response.

The issue of promoting abstinence in prevention activities was also addressed, and Mr. Sy noted that sex education was necessary to help young people have the right understanding and a supportive environment that would allow them to make the right decisions. There is no place for morality, when the goal is to stop an epidemic that is killing African youth, and threatening the future of the continent.

Funding for prevention and care was discussed, and it was stressed that there should be no dichotomy between prevention and care. Care is often the best way to prevent the spread of HIV, especially when 95% of those infected are not aware that they are infected, and reluctant to find out because of the stigma and discrimination associated with HIV/AIDS.

From left to righ: Mr. Terry Parker of Manzini City Council, Mayor Mthembu, Mr. Jeffery Gow, and Mayor Mobio.

Finally, Mr. Mobio reiterated the crucial role of mayors working in partnership with communities and civil society organisations, to ensure that the activities undertaken with support from national and international partners meet the needs of their communities. Mayors and municipal leaders can facilitate communication between the communities and international NGOs and other organisations.

I. 3 Municipal Responses

Mayors and municipal leaders from Manzini, Dodoma and Abidjan shared with the participants the experience of their municipalities in responding to the HIV epidemic. These responses share common characteristics, in particular, they are inscribed within a larger national response and are explicitly linked to it. In Swaziland, for example, the HIV epidemic was declared a national emergency by His Majesty King Mswati III. Responses are also based on strong partnerships between government agencies, NGOs, CBOs and include people living with HIV/AIDS. Abidjan has established a partnership with an umbrella NGO to undertake prevention activities and provide care to affected people. These three municipalities have joined the Alliance of Mayors, and have prepared local plans of action based on the AMICAALL strategy. A video, narrated by Danny Glover, UNDP Goodwill Ambassador, outlining the basic principles of AMICAALL, and highlighting Swaziland, was presented by Lady Mthembu, Mayor of Manzini.

Municipal Responses

Manzini Action Plan

Establish a social responsibility policy
Establish a centre for counselling, education, legal aid, advocacy, testing and referral
Encourage status identification
Focus on affected and infected persons
Cooperate with other service providers and NGOs

Dodoma Action Plan

Poverty alleviation through community-based initiatives
Inclusion of people living with HIV (PLWHA) to reduce denial and stigma (in collaboration with the national body of PLWHA (SHDPHA+)
NGO/CBO capacity-building
Training for peer educators and counsellors
Provision of care and counselling services
Reducing vulnerability of women, girls and youths
Establish a youth information centre on HIV
Prevention activities

Abidjan Action Plan

Municipal budget allocation to HIV response
Support for the Alliance of Mayors (Coordination and Executive Secretariat with support from UNDP)
Establish a Committee on HIV/AIDS
Establish a partnership with COS-CI, an umbrella NGO that works at community level
Training for NGO facilitators
Prevention activities