Report on Hiv/Aids Workshop

Meeting report

PUBLIC WORKS PORTFOLIO COMMITTEE
19 February 2003
REPORT ON HIV/AIDS WORKSHOP

Chairperson: Mr S Hlengwa

Document handed out:
HIV/AIDS Report (Appendix)

SUMMARY
The Independent Development Trust presented the workshop on HIV/AIDS held in Durban, on 26 November 2002. The objective was to assess the impact of HIV/AIDS within construction industry, challenges facing the construction industry with regards to HIV/AIDS, and the industry's response to the pandemic, both internally and externally.

MINUTES
Rev Musa Zondi (ANC), Deputy Minister of Public Works, stepped in to introduce the new Director General, Mr James Maseko to the gathered committee.

Ms Sangweni of the Independent Development Trust in her report emphasised the importance of coming to grips with the social, cultural and economic issues which rendered people vulnerable to the HIV/AIDS virus. The Construction Industry was especially vulnerable, as its labour force was constituted of those in the most productive years of their lives. Furthermore the Construction Industry made use of migrant labour, which rendered both their working environment and home environment vulnerable to infection.

The objective of the workshop was to get a broad overview from the different stakeholders. These included the Institute for Security Studies, Medical Research Council, National Youth Commission and the Construction Industry Development Board. The Department of Public Works, The Department of Social Development, The Traditional Leaders, Traditional Healers, Parliamentarians from the Portfolio Committee for Public Works, The Mining Industry, Stakeholders and The Independent Development Trust), were key partnerships in the fight against HIV/AIDS. The overview was based on the understanding of the contextual factors which increased the industry's vulnerability to the pandemic, the challenges facing the construction industry, and the industry's responses to the challenges posed.

The National Department of Public Works has developed a strategy that ensured the implementation of a HIV/AIDS program, as well as awareness campaign and service providers who would be responsible for education.

The National Youth Commission responded with peer education programmes and youth friendly services.

Traditional Healers advocated for integration into the conventional health care system, whilst the Traditional Leaders urged for the breaking of taboos and the formation of a national network.

The Medical Research Council recommended the promotion of the use of local labour, improved housing, and an outreach programme to sex workers.

As the Construction Industry was fragmented its board was urging for coordination and the integration of the issues concerned.

Social Development recommended the need for partnerships, destigmatization and the disclosure of the HIV/AIDS virus, and further recommended that childcare givers (for those orphaned) come from the community to limit estrangement.

The Mining Industry recommended that the work force be recruited from the local population and provide its employees with training regarding HIV/AIDS.

The Institute for Security Studies warned of the direct impact that may undermine the institutions of democracy, as well as the economic impact within the Sub Saharan countries, and the ensuing strain on other members of the household.

Ms Sangweni stated that the response to the HIV/AIDS virus should expand beyond the parameters of the Department of Health. The plans from the different role players should be integrated and a platform for these partnerships should be created.

Discussion
Mr Schippers (NNP) commented on the comprehensiveness of the report, however he felt that broader Church had not been approached for its opinion and that this was a serious oversight as it formed an integral part of any community.

Mr Blanche (FA) felt that the committee should revisit its recommendations to ensure that implementation had taken place, and that this should appear somewhere in the relevant report. He felt that the migrant labour system had not been investigated.

Ms Sekgobela (ANC) said that she was concerned about the reports' overview. She suggested that this be amended as soon as possible. The report needed to elaborate on the economic effects as far as infrastructure and human resources were concerned.

A member inquired why the department had not been approached to review the document before the sitting of the committee.

Mr Schippers (NNP) wanted clarification from the South African Medical Council as to whether HIV/AIDS was a terminal illness as mentioned in the report.

Mr Radebe (ANC) replied that AIDS was a syndrome whilst HIV was a virus.

Mr Chikane (ANC) felt that the report needed to be amended before it was presented to parliament.

Mr Opperman (NNP) suggested that the stakeholders should be approached for their input. This suggestion was amenable to all.

Ms Sangweni agreed that the necessary alterations would be made within the next month.

Meeting was adjourned.

Appendix
HIV/AIDS WORKSHOP
CONTENTS
Executive summary

Introduction
Workshop Objectives
Expected Outputs
Overview of Proceedings
Contextual Factors Increasing the vulnerability of the construction Industry to HIV/AIDS
The effects of HIV / AIDS on the sector
Current responses
2.3.1 The Department of Public Works
2.3.2 The Construction Industry Development Board (CIDB)
2.3.3 The Mining Houses
2.3.4 Traditional Leaders
2.3.5 Traditional Healers
The Institute of Security Studies
Social Development
The National Youth Commission
The Medical Research Council
3.0 Lessons learnt and outstanding challenges
4.0 Conclusion and Way Forward
5.0 Recommendations
Annexures / Presentation
Annex 1: Medical Research Council
Annex 2: Jo-Block Construction & Mining
Annex 3: Construction Industry Development Board
Annex 4: Department of Public Works
Annex 5: Department of Social Development

EXECUTIVE SUMMARY

The Workshop on HIV/AIDS in the Construction industry was held on the 25^th and 26^th of November 2002 in Durban. The workshop was held in recognition of the devastating impact of HIV/AIDS on this sector and the communities from which the sector draws its human resources. The construction industry is the largest employer in South Africa. It is also the industry that separates families for a long time. Recent studies show that the industry is under siege from HIV and AIDS and the impact on the sector can no longer be ignored.
The workshop was honoured by the presence of the Minister of Public Works, Ms Stella Sigcau and the Chairperson of the Portfolio Committee on Public Works, Inkosi Hlengwa. The Minister's as well as the Members of Parliament's presence underlined the Government's commitment to respond to the challenge of HIV and AIDS. The deliberations of the workshop were further enriched by the participation of members of the portfolio Committee on Public Works (representing decision makers), representatives of the Department of Public Works (government officials), the Construction Industry Development Board representatives, stakeholders in the Industry, traditional leaders, traditional healers and experts in the field of HIV / AIDS.
Although the workshop was on the impact of HIV/AIDS in the construction industry, the various papers presented led to a discussion of many other areas of concern. The Industry committed itself to implementation of a national strategy dealing with HIV/AIDS within the industry developed by the Department of Public works. It undertook to formulate a plan of action that will improve the Sector's response to the epidemic.
Towards the end of the workshop, participants committed themselves to strengthening partnerships between communities and the construction industry; and to raising awareness of the epidemic in their immediate environments. A declaration to this effect was consequently adopted by the workshop participants Workshop participants consequently adopted a declaration to this effect.

INTRODUCTION

In its effort to bring to the forefront the fight against the HIV/AIDS pandemic, the Portfolio Committee on Public Works, in collaboration with the Department of Public Works (DPW), the Independent Development Trust (IDT) and the Construction Industry Development Board (CIDB) organized a workshop that brought together decision makers, government officials, traditional leaders, traditional healers, experts in the field of HIV/AIDS and the South African Construction Industry Stakeholders.
The purpose of the workshop was to assess the impact of HIV/AIDS in the construction industry. The construction industry is the largest employer in South Africa. It is also an industry that separates families for a long time. While there are obvious economic spin offs derived from the industry, there are negative impacts on the communities from which the industry sources its human resources which typically, are the rural and poverty stricken areas. A negative impact is also experienced by the receiving communities where construction projects are undertaken.
It is the Amakhosi, in their traditional areas, who are confronted by the faces of people living with HIV/AIDS, orphans, as well as the elderly becoming surrogate mothers with little or no support except the old age pensions. It is in this context that this workshop came into being.

1.1 Workshop Objectives

The objectives of the workshop are to determine the following:
How do we support the rural areas in the fight against the HIV/AIDS pandemic
The challenges facing the construction industry with regards to HIV/AIDS
How to ensure government programs have a response strategy to the pandemic, both internal and external
Share experiences from the various districts - give experiences of what is happening in our communities

Expected Outcomes

Getting a broad overview from different stakeholders on what strides have been achieved in addressing the pandemic
Identifying key partnerships in the fight against HIV/AIDS
Developing approaches for mainstreaming HIV/AIDS into governance programs
 
2.0 OVERVIEW OF PROCEEDINGS

Presentations and discussions at the workshop focussed on a number of areas including:
An outline and understanding of the contextual factors which increase vulnerability of the construction industry to HIV/AIDS
Challenges facing the construction industry viz HIV/AIDS
Current responses to the challenges posed by the epidemic : by government through the initiatives of the Department of Public works, the partnership programme between the departments of health welfare and education, the mining houses, the youth sector, traditional leaders, traditional healers and the research organisation
Key strategic questions
Contextual factors increasing the vulnerability of the construction industry to HIV/AIDS

Presentations provided an understanding of how the demographic and socio-economic profile of human resources within the industry has become one of the key drivers of the epidemic within this sector. Typically, the industry attracts individuals with diverse socio-economic profiles ranging from the highly skilled civil engineer for instance, to the unskilled casual or contracted labourer. Like all the other economic sectors the industry employs people who are at the prime reproductive age, who therefore are generally at a higher risk for HIV infection. Furthermore, the nature of jobs in this industry tends to be short term, thus rendering the workforce in this industry a highly mobile group.
The effects of HIV/AIDS on the sector

Research commissioned by the Department of Public Works indicates that the construction industry has the third highest incidence rate of HIV/AIDS per economic sector in South Africa. The impact of HIV/AIDS within the industry manifests in the form of high rates of absenteeism, depletion of skills adding to a high cost of training of new staff and perpetuation of the poverty cycle particularly at household level.

Current responses

Presentations on current responses included sector specific responses as well as responses of other players regarded as key in the construction industry like the National Youth Commission, and the Traditional Leaders. Most of the able bodied young man and women drawn to the construction industry come from the rural areas under the traditional leaders. Sector specific responses are expanded below

2.3.1 The Department of Public Works
 
In response to the pandemic, the Department of Public Works (DPW) has developed a strategy that will ensure that the industry develops and implements comprehensive programmes for HIV/AIDS within the industry. The strategic objective of the programme includes:
creating awareness about the HIV/AIDS pandemic in the Construction Industry in general,
ensuring that service providers within the industry provide HIV/AIDS education within their projects,
briefing project managers within the DPW on strategies for mitigating the impact of HIV/AIDS within the industry.
 
Pilot projects for implementation of the strategy are currently underway and are described in Annexure I. Lessons learnt from these pilots will inform the implementation of the strategy across the industry.
Construction Industry Development Board (CIDB)

The Construction Industry Construction Board (CIDB) is a statutory body appointed in 2001 to promote the contribution of the industry to the country's social and economic objectives while improving performance, efficiency & competitiveness within the industry. As such, one of their key responsibilities is to drive the implementation of strategies for development within the industry. In this regard the CIDB is the implementing arm of the Department of Public Work's strategy for HIV/AIDS prevention. The CIDB is currently driving the implementation of the strategy in the four pilot sites which would be rolled out throughout the industry in due course. (See Annexure I)
The CIDB acknowledged that the industry is fragmented, it's all over and there are different players. However the CIDB is in the process of developing an effective and broad based strategy for the Construction Industry. One of the main challenges is the coordination and integration of issues.

The mining houses

An overview of the impact of the HIV/AIDS within the mining houses was highlighted by presentations from this sector and included the following:
70 percent of the workers in the mining industry come from the Eastern Cape and Kwa Zulu Natal
There is a high infection rate in the surrounding communities that these migrant workers are housed
Increased cost of recruitment and training
Additional sick and compassionate leave
Negative impact on staff morale
Cost of occupational health standards
Dealing with prejudice
Loss of turnover and profits
The concern for the mining houses was an observation that when an employee dies of AIDS, quite often, the death is not reported to the employer ( who at the same time is often not able to contact the family members). Consequently the deceased employee is regarded as having taken leave without permission and subsequently loses out on all death related benefits.
One of the responses of the mining houses has been to establish workplace programmes designed to address factors which increase the vulnerability of the mine workers to HIV/AIDS.
Programmes are designed to maintain traditional values and family structure increased self-worth of their employees, provide access to medical care are particularly found to be appropriate.
Some specific strategies suggested in the approach described above include:
Recruitment of workforce from the local population rather than using migrant labour. The merit of going local is that employees stay with their families and within their communities where traditional and local values are maintained. In addition the families of employees have access to medical benefits that they may be entitled to through the employed member. This type of arrangement also makes it easier for the employee's spouse or family members to access the employee's benefits in the event of death. Housing for the employee is also of benefit to both the family and the company and there is a stabilizing effect on children as the family unit is intact.
Provision of occupational and ABET training and HIV awareness program geared to empower employees by improving their self worth.
Provision of on site services for occupational and primary health care including free HIV testing services. In addition the family of the infected employee is provided with counseling and support systems.
The Traditional Leaders

The traditional leaders feel they are in an advantageous position to make a significant contribution in the fight against the scourge of AIDS. In his opening remarks Inkosi Hlengwa highlighted the fact that a significant group of migrant labourers come from traditional areas and when they get sick they go back to the traditional areas. The onus therefore falls on the community to take care of their sick and dying.
The National House of Traditional leader's response to the virus was the formation of the twenty member HIV/AIDS forum in association with the National Department of Health. The task teams emanating from this forum, are to be trained in order to lead community initiatives on prevention of HIV/AIDS. Traditional leaders are mindful of challenges around issues of HIV/AIDS facing this sector including:
breaking of taboos such as free discussion of sexual matters between parents and children,
forming a National Framework that is aimed at guarding traditional initiation schools and the difficulty of getting rural people to practice safer sex.
The Traditional leaders urged for a multi sectoral approach to the disease
The Traditional healers

The discussions emanating from the traditional healers presentation dymistified the role of traditional healers around the HIV/AIDS virus. The presenter noted that real traditional healers or IziNyanga do not claim to cure AIDS. Instead they dispense medicines made from herbs and ingredients to keep their patient strong and healthy and help them regain their strength after illness. He also acknowledged however that there were unscrupulous elements who advertised themselves as having the ability to cure the virus.
The key challenge facing this sector was being integrated into the conventional health care system, which, in their view, would only be possible once the government acknowledges the overall role of traditional healers in health care provision. In their view, the logical starting point for working with the government would be for the government to offer training programmes to traditional healers at local levels on HIV/AIDS.
The Institute of Security Studies (ISS)

The highlights of this presentation showed that there is:
more direct impact of the epidemic may undermine democracy and institutions
epidemic has a 'ripple effect" as it affects the various government departments like the army, the police services
economic impact as 70 percent of those affected by the HIV virus live within the Sub Saharan region
Terminal illness is demoralizing
Households have to fund the sick with limited resources and end up getting loans
Strain to other members of the households
Estimated that there would be more than 1 million orphans by 2005
The psychological impact too intense
Loss of familiar surroundings and trauma
Social Development

The presenter gave an overview of the HIV/Seroprevalence Survey which showed an increase from 1991 to 2000. She noted that HIV is:
the fastest growing epidemic
has an impact on life expectancy
those born with the virus die within 2.5 years
life expectancy is likely to drop to 40 years by 2010
has an impact on the age sex structure
HIV+ children are likely to drop out of school because of psychological distress
The response from this sector focused on:
Workplace programmes to manage the impact as the service demands on social services increase
The need for partnerships to address child headed households to ensure the basic needs for children are met
Distigmatization and disclosure of the HIV virus as a disease like any other
Developing programmes and partnerships as DSC has done with DPW
Ensuring that caregivers come from the community
The presenter noted however that the main challenge is integration and coordination
The National Youth Commission

The presenter noted that the construction industry is one sector of the economy that is very much reliant on transient labor, which basically means that its labor force is very much mobile, interacting with different settled communities at different intervals while still very much attached to their families.
Some of the National Youth Commission's response strategies include:
Provision and more roll out of youth friendly health services
More promotion of confidential VCT
More peer education programmes in the school curriculum as well as for tertiary institutions not only in the context of formal schooling. Peer education facilitates open dialogue amongst peers even in a work environment.
Strengthening of the government partnership against HIV/AIDS, mobilising broad based support and resources with particular attention on prevention and education, as well as community support in home based care
The role of the private sector has to be emphasized, current efforts by some companies in the fight are appreciated but more still needs to be done. The sector has acknowledged the impact that HIV is having in terms of the human, financial and social costs to its operations and communities. HIV/AIDS affects people within their most productive years and in the long-term this leads to declining productivity and economic growth as a result of absenteeism, organisational disruption, and drainage of pension as well as medical insurance schemes. It has been established that for poor bereaved families, it may take up five months or more to recover financially from a single funeral.

The Medical Research Council

The specialist epidemiologist from the Medical Research Council in his presentation said the UN characterized HIV/AIDS as "greatest single threat to Africa's social and economic development". The HIV/AIDS epidemic is rapidly reversing the social and economic achievements of the past half a century and now poses a threat to development in Sub Saharan Africa, a growing threat in Asia and the Caribbean a probable threat in some Eastern European Countries. He argued that development projects may actually promote the transmission of HIV and so undermine key developmental objectives. He gave the example of the Akhosombe River Dam in Ghana where construction necessitated the displacement of an approximately 80 thousand farmers who then obtained jobs on the construction site. Women found work in hotels and bars while others resorted to commercial sex. The upshot of it all was that surveillance surveys in 1985 showed that in the town of Agomaya the administrative center of the district that abuts the Akhosome Dam, the HIV infection rates were 5 to 10 times above the level of average HIV prevalence in Ghana.
For the specific management and mitigation of HIV/AIDS he advocates voluntary counseling and testing, prophylactic therapies, administration of anti retroviral, home based care programs and medical aid policies for the workforce. For addressing the "vulnerability of the workforce, the following sector suggestions were made:
Promotion of the use of local labour
Adjust labour recruitment to address gender issues
Improve labour housing to accommodate families and provide integration into the community as well as recreational facilities
In addressing the vulnerability of the impacted communities, he put forth the following:
Outreach to sexworkers
Resettlement policies
Access to STD in the community
Capacity building in the community
Social marketing of condoms

LESSONS LEARNT AND OUTSTANDING CHALLENGES

The workshop identified the following as key challenged facing the industry:
1) At a conceptual level i.e Bringing the HIV and AIDS to the center of the governance agenda
 
2) At an operational level i.e. responding to two basic questions which are
What is the impact of AIDS on development
What are the negative impacts on the spread of HIV in the community? What policies, strategies and actions should be put in place to enhance the positive impacts
The discussions brought to the fore the importance of:
Mainstreaming of HIV/AIDS by going beyond "business as usual" thus ensuring that the impact of HIV/AIDS is addressed and reduced within the industry and the communities from which the industry's human resources is drawn.
Changing the way people work i.e improvement of the situation of people already affected by HIV/AIDS using lessons learnt from the presentations eg (As highlighted in Jo Block's presentation)
Partnerships (see expected outcomes)

CONCLUSION / WAY FORWARD

The workshop brought HIV/AIDS to the center of development and helped expand the response away from the Department of Health and forced everybody to focus on the virus as our business because it impacts on all of us. It also brought home the fact that as government, development agents, traditional healers, traditional leaders, the industry as well as the community, there is a need to look at the impact of the policies, laws, and procedures that are influencing the spread of HIV/AIDS. By the end of the proceedings it became clear that individuals were beiginning to talk about moving the goal posts to an emergency response through the integration of plans from the different players.
Therefore mainstreaming the HIV/AIDS epidemic will mean developing plans that take care of the epidemic. It has to be a core mandate. The following is what development agencies can do:
Creating guiding coalitions for dealing with the HIV/AIDS virus
Creating an awareness of an emergency which will accelerate and ensure that it reaches more people (intensification)
Expand to other key stakeholders across all governance institutions in partnership. Use of stakeholder mapping will be helpful
Providing platforms for these partnerships to flourish

RECOMMENDATIONS

The workshop participants ended in agreement that many people are dying of the HIV/AIDS pandemic, our government institutions need to position themselves to lead the efforts. Partnerships were raised as one of the important strategies to fight the scourge. The Portfolio Committee will therefore have to create a forum for a dialogue with other stakeholders to ensure that their efforts are not lost.