Rhetoric to action August 2003 Sector: Health and disability Sub-sector: AIDS (South Africa) Executive summary “The challenge is to move from rhetoric to action, and action at an unprecedented intensity and scale. There is a need for us to focus on what we know works.” - Nelson Mandela · This report provides a guide to grant-makers and donors seeking to understand and address the problem of HIV/AIDS in South Africa. Its research shows how well-placed philanthropy can literally make a life-saving difference. The scale of the problem should not deter private funds: current and promised future funding from international governments, though apparently large, will take some years to be disbursed and is actually inadequate to meet the crisis. · The statistics on the AIDS pandemic are horrifying. South Africa has more people with HIV or full-blown AIDS than any other country in the world. Almost five million people, over 11% of the population, are HIV positive. There are already more than half a million orphans and projections show the number rising to one million by 2005. Prevalence is concentrated among certain groups and there is evidence of South African society being “hollowed out” by the disease, affecting the education system, health services, communities, families and children. The effects on individuals, infected and affected, are appalling. · The South African government is considering action through a national antiretroviral treatment programme, but the details of this remain unclear and it will not solve the enormous problems over any reasonable timescale. Meanwhile, people are dying and grass roots organisations have received little benefit. · The social and clinical life cycle of the virus can be intercepted at various points. Initiatives to prevent HIV spreading further, treatment and care for those infected, care for families bereaved and children orphaned all make an invaluable contribution to the war on HIV/AIDS. Often interventions tackling one aspect can assist with other issues at the same time: those caring for infected people can help to educate communities as well as assisting those left behind. · Funders have a range of options. There are antiretroviral drug treatments; there are simple, inexpensive and community based techniques to help people with AIDS in rural areas as well as townships; there are organisations concerned with the welfare of children affected by the pandemic; other projects focus on prevention and education. · NPC assesses the outcomes of each intervention for the immediate individual and for those connected with that individual. This has implications for our cost analysis: avoided infections save the lives of future partners; antiretroviral drug therapy arrests orphanhood; registration of orphans leverages government funding. · The research in this report is based on a survey of the subject together with examination of organisations working on the ground. A separate series of detailed reports on some of the individual organisations is available to grant-makers and donors. · NPC seeks to encourage higher levels of funding for outstanding projects; we help donors to develop their grant-making strategies and propose specific grant-making recommendations through presentations to donors. New Philanthropy Capital Rhetoric to action August 2003 New Philanthropy Capital Rhetoric to action August 2003 2 Contents Introduction.................................................................................................................................4 Section I: The need....................................................................................................................5 Prevalence of HIV...................................................................................................................5 Effect of AIDS.........................................................................................................................8 Section II: Governmental responses........................................................................................10 The South African government.............................................................................................10 Foreign governments............................................................................................................13 Section III: Non-governmental responses.................................................................................15 South African voluntary sector..............................................................................................15 Foreign NGOs and grant-making trusts................................................................................16 Section IV: Ways to combat AIDS............................................................................................18 Introduction...........................................................................................................................18 Prevention and education.....................................................................................................19 People with HIV/AIDS...........................................................................................................22 People affected by HIV/AIDS................................................................................................28 Section V: Outcomes from interventions..................................................................................33 Introduction...........................................................................................................................33 Outcomes of prevention........................................................................................................34 Outcomes of treatment and care..........................................................................................35 Outcomes of support of children and families affected by AIDS...........................................37 Cost analysis........................................................................................................................38 Options.................................................................................................................................39 Section VI: Examples of delivery..............................................................................................40 Section VII: Conclusion............................................................................................................43 Appendix: Antiretrovirals Q&A..................................................................................................44 Glossary...................................................................................................................................49 Acknowledgements..................................................................................................................50 References...............................................................................................................................52 Map of South Africa..................................................................................................................57 New Philanthropy Capital Rhetoric to action August 2003 3 Introduction The purpose of this report This report aims to provide a guide for donors who wish to fund projects to help those affected by HIV/AIDS in South Africa. Its purpose is to provide the detailed contextual information and analysis required to understand the extent of the pandemic, resulting social needs, types of response in operation, and the outcomes generated by such interventions. The donors to whom this report is addressed will range from private individuals to grant- makers with extensive experience in this area. While the report aims to help all in this spectrum, it should be recognised that parts of the report have been written for the benefit of newcomers to the subject. When we refer to “donors” we include grant-makers, private individuals, companies or anyone else wishing to donate funds or provide grants. Funding this complex and rapidly changing issue, at considerable geographical distance from the donor, can be far from straightforward. Few foundations or private individuals are in a position to dedicate in-country resources to support their grant-making. This guide puts the case for combating the effects of the pandemic, analyses the delivery mechanisms, and advises on how donors can target their resources most effectively. A supplementary report takes this process a step further, by making specific project recommendations. NPC is in a position to help with grant-making to these recommended projects. The content of this report The report is based on research carried out through extensive meetings with organisations, researchers, policy makers, analyses of charity accounts and activities and reading of research materials. Two visits to South Africa formed an integral part of the research. In South Africa many projects were visited in the field and meetings were held with experts, project workers and beneficiaries. There is an enormous need for organisations and individuals to tackle HIV/AIDS in South Africa, as the crisis far exceeds the reach of organisations active on the ground. However, it would be impossible to cover all the organisations operating in the field in a research project such as this. Rather, the research for this report has analysed a range of organisations, covering different areas in South Africa and tackling HIV/AIDS through different means. This we hope will provide a