Introduction Nelleke Bak

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T. Barnes

My presentation was a summary of a research project which was completed in November 2000, for the Education Policy Unit at UWC and the Association for the Development of Education in Africa (ADEA). It is encouraging that since the end of my project, there have been several developments at UWC, such as the appointment of Ms. Tania Vergnani to the newly-created office of HIV/AIDS programmes, and the sponsorship of programmes such as this one-day conference.

We interviewed 195 members of the UWC community – mainly students, but also lecturing staff and managers, and consulted a range of documents from UWC, the South African government, and national and international NGOs.
The first research on HIV/AIDS at UWC dates from 1988. However, because there has not been any random blood testing regimen at UWC, there are no hard data on HIV infection rates, or on the number of people living with AIDS. Our study therefore focused on perceptions of the disease. Our major finding was that the fear of speaking out prevailed across the campus. We only heard of one member of the UWC community who had openly declared his HIV status. The silence remained deafening, and all participants noted that the fear of being stigmatized was a determining factor.
We found that there were major differentials by gender in perceptions along a range of issues. We tried to focus on issues of unsafe sex, and therefore of pregnancy, abortion, rape and the link between unsafe sex and the availability of alcohol. Significantly higher percentages of female students thought that these were important problems at UWC.
The effort to write an inclusive, comprehensive HIV/AIDS policy for UWC began in 1998 and is nearing completion.
There is a varied academic response to the pandemic in UWC’s seven faculties. Two, Education and Dentistry, have been leading the way in terms of the integration of information into courses, faculty discussions and outreach programmes. A second tier might include Law and Community and Health Sciences. In a third tier are the faculties of Economic and Management Sciences, Science and Arts, where individual academics may have extensive involvement in teaching but the faculty as a whole has not taken up issues of integrating perspectives on the pandemic into their core activities. There are institutes and units across campus involved in a range of research and outreach activities. In short, there is a great deal of expertise at UWC, but it is scattered and largely unco-ordinated (although in 2001, some progress has been made in this regard).
I pointed to three challenges in current HIV/AIDS research:

  1. Issues of power and research – there is a long history of engagement with race and gender issues in social research in South Africa. It would be a shame if those debates and resulting insights were not shared with the new ‘growth industry’ of HIV/AIDS research.

  2. How can this new industry be managed so that it does not simply funnel money to professional consultants, and therefore away from more community-based approaches?

  3. How can new research be quickly and successfully integrated into educational practice in terms of curricula, management and the development of more open and caring atmospheres of teaching and learning?

Dealing with HIV/AIDS
The fight against HIV/AIDS in the Western Cape:

An evaluation of the mother-to-child transmissionnd programme in Khayelitsha (work-in-progress report)

S.J. Mngomezulu

(School of Government, University of the Western Cape)

Never again shall an African child die of curable/avoidable diseases’2

Cries about the spread of HIV/AIDS have become ubiquitous to the extent that their impact on society has been drastically reduced. Unfortunately, HIV/AIDS is a reality one cannot shy away from because it continuously devours the population like an insane soldier shooting at innocent civilians. The changing structure of the population will have untold effects on the way societies organize and reproduce themselves. Undoubtedly, the impact of this killer disease will be devastating if it remains untreated.
Current reports (Strategic AIDS Plan 2000-2005 and the Western Cape AIDS Plan 2001) indicate that the Western Cape has the lowest HIV prevalence in South Africa. This can be attributed to the good and sound health system that has been put in place. The province is largely urban (70% of the area is urban) unlike other rural provinces such as the Eastern Cape or Northern Province. Furthermore, poverty levels are less severe than in the other provinces mentioned above. Nevertheless, there has been a remarkable increase in HIV seroprevalence in the Western Cape from 7.1 (1999) to 8.7 (2000), and these figures keep changing all the time. Failure to intervene while the pandemic is still in its relatively early stages may result in the collapse of the health system. For instance, a critically ill patient in the Intensive Care Unit (ICU) may be displaced by an even more critically ill person. None of the provinces would like to get to that kind of situation.

Historical background of HIV/AIDS

Two decades ago the terms HIV and AIDS would not have been found in any medical dictionary, and would undoubtedly have caused empty looks on the faces of health authorities. Today the epidemic is one of the most serious problems facing many countries in the world. Although the disease has to be seen in context, given that there are many health and other problems facing many countries, there are a number of characteristics that makes it unique (Loewenson and Whiteside, 1997). In particular, it is far more than a health problem.

The HIV/AIDS epidemic is a new epidemic and its origin has not been positively identified. This disease, or more correctly syndrome, has been portrayed as having taken on a character of malicious intent, with its own destructive technology, becoming, in the minds of some observers, a ‘killer disease’, a slow plague, and a misery-seeking missile. The HIV/AIDS epidemic was first detected in 1979 and 1980 in the United States of America. Doctors began to observe clusters of diseases that previously had been extremely rare. These included a type of pneumonia spread by birds (pneumocysis carinii) and a cancer called karposi’s sarcoma (Whiteside and Sunter, 2000: 1). Not long after this, health workers began to notice a new disease characterised by diarrhoea and severe weight loss.
The first public documentation of the phenomenon was contained in the Morbidity and Mortality Weekly Report (MMWR), a widely-circulated report on infectious diseases and deaths in the USA. The report recorded a small number of cases of pneumocystics carinii. Later, the MMWR reported a clustering of cases of both diseases that were mainly centred on New York, which rose rapidly, and scientists realised that they were dealing with a new phenomenon. Today HIV/AIDS is one of the leading causes of death among humans.
Khayelitsha is the most affected area in the Western Cape, and this paper looks at the pros and cons of the MTCT3 programme started in Khayelitsha.
HIV/AIDS transmission and prevention in general
HIV/AIDS transmission is causing sleepless nights to all sections of society. Whilst measures are being taken to address this problem, it appears that all parties involved in finding a solution have to grease all the nuts and bolts since the disease is continuously demonstrating its resilience. The problem of finding a quick solution to HIV/AIDS transmission is compounded by the fact that there are more than one way in which this deadly disease is transmitted from one person to another. These include the following:

  1. By having unprotected sex with an infected person

  2. Through contact with infected blood

  3. From an infected mother to her unborn or newborn child

The five strategic prevention programmes of the Western Cape Province are:

  1. Delay sexual debut through lifeskills programmes in schools

  2. Treatment of STDs

  3. Prevention of MTCT

  4. Voluntary counselling and testing

  5. Promotion of condom use

Mother-to-child transmission
HIV infection is currently a very serious public health problem globally (Ndiaye, 2000: 59). In the Western Cape, despite the government’s attempts to stop the spread of HIV/AIDS, the infection has increased significantly over the past six years. HIV prevention efforts are central to slowing the rapid spread of HIV/AIDS and reducing the rate of new infections. Prevention efforts should not only be about raising awareness and distributing condoms. Kumaranayake and Watts (2001) argue that key prevention measures should include the provision of education and condoms (both male and female), strengthening treatment services for sexually transmitted diseases, prevention of mother-to-child transmission (PMTCT) and ensuring the safety of blood transfusion systems. In a nutshell, the fight against HIV/AIDS should take a multi-faceted approach.

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