A decent income is the first step towards real freedom

In his speech in December 2009 during World AIDS Day in December 2009 President Zuma demonstrated a renewed quest to deal with HIV and AIDS challenges in the country.

Article | 20 July 2010
In his speech in December 2009 during World AIDS Day in December 2009 President Zuma demonstrated a renewed quest to deal with HIV and AIDS challenges in the country.

In demonstrating its commitment the South African Government announced the following interventions:
  • All HIV positive pregnant women and adults with TB/HIV will be eligible for ART if theirD4 count is less than or equal to 350. This will significantly increase the number of people accessing ARV considering that 70 percent of people who are HIV positive have TB.
  • A target to test 15 million people by 2011
  • A commitment to provide ARV access by 2011 to 80% of people in need thereof.
While the initiatives will greatly enhance the fight against HIV and AIDS, there will be costs involved.

The Global Fund reported that out 1.7 million people needing ART only 41% (701000) are accessing it, this leaves the country with a short fall of 663 000 to reach the 80% target by 2011.

Government issued new treatment guidelines outlining a new 1st line treatment regime which includes TDF + 3TC+ EFV; with the current tender prices, this treatment will cost R4000/person per year. However, the Clinton Health Initiative which is involved in helping the government to procure drugs through a new tender indicated that the costs can be brought down to R2200/person per year.

According to the government treatment guidelines, one of the requirements is to conduct CD4 count tests on patients before putting them on ARVs or in the first 6 months of their treatment. A CD4 count test costs R203 at the National Health Laboratory Services. Therefore to conduct 663 000 CD4 count test will require R134 million.

Putting a single patient on 1st line ART (TDF,+ 3TC + EFV ) for 1.3 million people in one year will cost the government R3.74 billion a year, assuming government will obtain the drugs at R2200, excluding monitoring cost.

To have 15 million people tested will costs government R115 million, using the average costs of a rapid test of R7.50, at the National Health Laboratory, excluding other costs.

The total costs of these new interventions will amount to an estimated R3.98 billion, including other costs such as monitoring and logistics costs. Henceforth the Actuarial Society of South Africa estimated new HIV infections to be 1.1% of the total population until 2015, which equals 480 000 new infections every year until 2015. Looking at the costs above it is clear that this is not sustainable. Comprehensive HIV programmes which include care and support will eventually eat up the health budget and make other equally important health programmes suffer.

It is therefore important that in complementing government efforts to address HIV, relevant and appropriate strategies aimed at preventing and or delaying people falling ill are scaled up to mitigate the impact that this may have on the fiscus.

The fact that HIV prevalence is disproportionally high in Sub-Saharan Africa, which happens to be a region with high levels of poverty, clearly demonstrates that poverty is a fertile ground for HIV transmission. Some define poverty simply as lack of income which makes the poor susceptible and vulnerable to all kinds of diseases and illnesses. Lack of decent income limits the choices that people make, including sexual choices. A decent income is the first step towards more freedom and life choices: the choice to have healthcare, to offer education to your children and to eat sufficient healthy food.

HIV interventions which seek to make an impact on reducing the impact and incidences of HIV should take into consideration daily choices that the poor in informal settlements and poor communities are confronted with. Most of HIV prevention strategies do not consider the plight of the poor or daily choices poor people have to make, therefore rendering themselves inappropriate and irrelevant to the environmental existence of the poor. The UNDP has indicated that even if the poor understood what they are being told or urged to do, they hardly have the incentive or resources to adopt recommended behaviour promoted by prevention campaigns. Hence, it becomes complex to convince a young woman working as commercial sex workers in a Zeerust truck stop, Ventersburg truck stop, Skilpadhek border post or Lebombo border post to use a condom while her client will offer R300 for having sex without a condom, R200 more than normal going rate of R50-R100 with a condom. Faced with this reality of foregoing R200 which may determine whether a family can go for a day/s without food or children unable to attend school, these are some of the tough choices that our prevention strategies do not address. These are some of the hard choices not only confronting some sex workers but even women in poor communities who do not have control over financial decisions. As UNDP puts it for the poor it is “here and now” that matters, and policies and programmes that recommend delayed gratification will and do fall on deaf ears.

The International Labour Organisation have realised that in addition to prevention and behaviour change interventions , people need resources and incentives to adopt less risky behaviours hence it is important to design strategies that will give the poor incentives that will make it easy to adopt such practices. Hence the inception of the Project on HIV prevention and economic empowerment along transport corridors in Southern Africa.

The programme identified areas along transport corridors and cross borders characterised by high HIV prevalence rate, low labour absorption rate, high poverty levels and interaction between the local communities and mobile populations. The project will conduct a study to try to understand the economic and structural motives that induce women to choose commercial sex as an escape route from poverty.

The programme will adopt a two pronged strategy: (1) Prevention; focusing on providing information on HIV&AIDS and encourage people and transport workers to go for VCT
thus complementing government’s effort of having 15 million people tested by 2011 and (2) focus on vulnerable groups and provide them with skills and resources that will enable them to make independent sexual choices by improving their income. It will do so by building capacity of cooperatives apex organisations, informal economy associations and other social economy organisations that operate in transport corridors to improve both business and social services to their members in order to mitigate the impact HIV/AIDS and TB.

Reducing economic vulnerability alone will not address the HIV epidemic but using pragmatic, context relevant strategies and interventions that understand the local epidemic and through social dialogue with all partners in the targeted areas will be able to make impact. As Lerato Tladi, Senior Researcher at the HRSC puts it “any efforts to reduce HIV infection rates successfully should take poverty into consideration, just as poverty reduction programmes aiming at success should take HIV/AIDS into consideration”

Letsholo Mojanaga
National Project Coordinator: International Labour Organisation
Economic Empowerment and Vulnerability Reduction Project
Email: Mojanaga@ilo.org