Ebook HIV, Aids and urban development issues in sub-Saharan Africa
In sub-Saharan Africa, HIV prevalence in the urban population is on average 1.7 times higher than among those who live in rural areas. Oft repeated reasons for higher HIV prevalence in urban areas systematically refer to the characteristics of the populations who live in them (young and sexually active) and the cultural norms that shape their interactions, especially in respect of sexual behaviour and gender dynamics. These factors are significant, yet they over-emphasise the behavioural dimensions of HIV transmission.
The manner in which any ‘problem’ is defined, affects the type of response that is crafted to address it. Hence, if the HIV and Aids ‘problem’ is defined primarily as one of ‘risky’ sexual behaviour on one hand, and poor access to medical treatment on the other, the responses crafted are primarily about behaviour change, ART (antiretroviral therapy) and PMTCT (Prevention of Mother to Child Transmission) roll-out.
Most analyses of the concentration of HIV in urban (especially informal) settlements refer to the mobility of their residents, supposedly leading to more opportunities for sexual networking and elevated partner-change rates. An alternative perspective posits that the higher HIV prevalence has more to do with the high concentration of poor people with serious health problems and immune systems already compromised by malnutrition.
HIV and Aids are not gender neutral. Women are the worst affected and any intervention must pay special attention to the different susceptibilities and vulnerabilities of women and men. Dedicated HIV programmes acknowledge this situation. Yet, achieving sustained and meaningful gender transformation is a complex goal that continues to elude both the grasp of HIV and urban development practitioners alike.
Understanding the systemic linkages between HIV, Aids and urban development can assist urban development and HIV programming actors to frame their respective responses to HIV and Aids. Defining the HIV problem solely from the notion that people’s behaviour puts them at risk limits the realm of possible interventions. It also fails to engage appropriately with the range of co- and contextual factors that put people living in informal settlements at risk, both before and beyond sexual behaviour. Just as responses that focus on behaviour-change interventions as the only means to reverse the spread of HIV, a narrow medicalised response to HIV and Aids is unlikely to succeed unilaterally.
Contents
1 Aim of the report
1.1 Structure of the report
1.2 Methodology
2 HIV, Aids and urban development in sub-Saharan Africa
2.1 Key characteristics of HIV prevalence in sub-Saharan Africa
2.2 Behavioural understanding of the higher HIV prevalence in urban slums
2.3 Behaviour change and biomedical responses and their limits
- 2.3.1 The ABC and implications of mainstream HIV and Aids information
2.3.2 Will access to medicine reduce HIV and Aids in the population unilaterally?
2.4 Environmental co-factors of HIV susceptibility and vulnerability in urban areas
- 2.4.1 High densities and overcrowding
2.4.2 Inequitable spatial access and city form
2.4.3 Access to safe water, sanitation, solid waste management and energy
2.4.4 Competition over affordable land and access to urban development resources
2.4.5 Pressure on urban capacity and resources
3 Programming and mainstreaming – different types of responses
3.1 Conceptual framework
3.2 Findings
- 3.2.1 Community-based, faith-based, non-governmental organisations
3.2.2 National and sub-national government structures
3.2.3 Local governments
3.2.4 Multilateral and bilateral organisations
3.3 Issues arising
4 Lessons and recommendations
4.1 Programming responses to HIV and Aids in urban areas
4.2 Mainstreaming HIV and Aids in urban development
- 4.2.1 Integrating the voices of HIV and Aids in planning, implementation and monitoring
4.2.2 Outcomes of urban development processes that mainstream HIV and Aids
4.3 Recommendations
4.4 Research and information on co-factors such as malaria, worms and TB
Annex 1 - Worms, Bilharzia and Malaria
References & Bibliography
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