Open House International

Wamsler, Christine

2008 Open House International

doi: 10.1108/OHI-04-2008-B0001

HIV/AIDS has now become part of everyday life in urban settlements in the developing world, and presents the world with one of the most serious and disastrous urban challenges it has ever had to face. Since HIV first emerged in the early 1980s, more than 25 million people (adults and children) have lost their lives to AIDS worldwide. The UNAIDS 2007 figures estimate that 33.2 million people are currently living with the virus. Over 95 percent of these people live in developing countries, with Sub-Saharan Africa - particularly Eastern and Southern Africa - most affected. Slum conditions, in which up to 72% of the urban poor in Sub-Saharan African live, are marked by inadequate housing and settlements, which place their inhabitants in a position of heightened vulnerability to HIV infection.

Gopalen, Priya; Pinsky, Barry

2008 Open House International

doi: 10.1108/OHI-04-2008-B0002

HIV and AIDS is an urgent housing and human settlements issue, especially among women and children living in poverty and suffering from poor housing conditions in urban slums in the South. The link between poverty and HIV prevalence is well established, and the fact that inadequate shelter increases the vulnerability of the urban poor to HIV and AIDS is increasingly recognised. Since 2003, Rooftops Canada and their partners in Kenya, Tanzania, Cameroon, Zimbabwe, South Africa, and more recently Uganda, have been working on strategies and developing programmes to respond to the AIDS crisis in these countries. Related programmes link shelter to poverty reduction through sustainable economic and social development, environmental protection, respect for human rights, democratisation and gender equality.This paper compiles the experiences of the partner housing organisations and resource groups in Sub-Saharan Africa responding to HIV and AIDS among their constituent stakeholders. The community-based responses focus on promoting social sustainability, enhancing operational capacity and improving financial sustainability. Community-based responses relate to issues of stigma and discrimination, reducing the impact of housing rights violations and responding to the specific vulnerability of children, women and youth. Social sustainability deals with the impact of HIV and AIDS on the social viability of communities. Operational capacity analyses housing groups' responses to the organ-isational impact of HIV and AIDS - including loss of staff, leadership and institutional memory, decreased productivity and capacity - and the experience of including HIV and AIDS within the core organisational mandate. Financial sustainability explores the challenges of reconciling related financial and social goals.

Kinuthia-Njenga, Cecilia; Ndungu, Charles

2008 Open House International

doi: 10.1108/OHI-04-2008-B0003

UN-HABITAT's experiences in the Lake Victoria region and Sub-Saharan Africa show that the underlying causes of the HIV/AIDS epidemic and its consequences on urban development must be urgently and comprehensively addressed. The epidemic affects all sectors of urban development, including housing, transportation, water, and access to health services. Development agencies, whose mission is urban development, have thus started to recognise that achieving their objectives is difficult without addressing and mitigating the impact of the epidemic. A comprehensive policy and programming is required to mitigate both the spread and the effects of the epidemic. Consequently, UN-HABITAT, working with partners and city authorities around Lake Victoria, has embarked on an HIV/AIDS mainstreaming strategy in its Slum Upgrading and Poverty Reduction programme. Related activities and lessons are presented.

Joseph, Stacey-Leigh; Donk, Mirjam van

2008 Open House International

doi: 10.1108/OHI-04-2008-B0004

A key development in South Africa's response to the HIV/AIDS epidemic has been the recognition that there are a number of external factors in the socio-economic and physical environment in which people live that are central to the spread of the epidemic. A growing body of evidence suggests that poverty, inequality, inadequate shelter, overcrowding and other symptoms of underdevelopment are fundamental drivers in undermining people's ability to practice and negotiate safe sex, thereby enhancing vulnerability to HIV infection. Similarly, these factors affect the ability of individuals, households and communities to cope with the subsequent health and socio-economic effects of infection. In a context where large numbers of South Africans live in poverty, without adequate shelter and access to basic resources and services, HIV/AIDS will thus have far reaching and serious impacts, not only on citizens and communities but also for and on the state.The South African government has shifted its approach to housing development from the provision of housing to a sustainable human settlements approach, as encapsulated in its 2004 development plan ‘Breaking New Ground’. This paper explores the conceptual and theoretical links between this sustainable human settlements agenda and HIV/AIDS. It argues that the creation of sustainable and integrated human settlements is potentially a crucial component in the response to HIV/AIDS. However, this can only be achieved if HIV/AIDS becomes an explicit component of sustainable human settlements planning, development and management. In light of this, the paper discusses key characteristics of integrated, sustainable human settlements and reviews the current instruments for the implementation of a sustainable settlement agenda in South Africa in relation to the dynamics and implications of HIV/AIDS both for the South African state and its people. The paper concludes with a set of policy recommendations to make HIV/AIDS an integral component of the sustainable human settlements agenda.

Ndlela, William N.

2008 Open House International

doi: 10.1108/OHI-04-2008-B0005

Swaziland is one of the countries with the highest Human Immune-deficiency Virus (HIV) rates in the world. Consequently, the increased need for care and support for people living with Acquired Immune-deficiency Syndrome (AIDS), as well as orphaned and vulnerable children, is unprecedented. The response to combat the HIV epidemic has been evident in many areas as the country continues its fight against the HIV epidemic. However, efforts to provide care and support - including Anti-Retroviral Therapy (ART), management of opportunistic infections, and community home-based care - have, so far, largely stemmed from the health sector. Housing care and other non-medical support is continuing to lag behind. Lack of proper housing is one of the deprivations suffered by orphaned children and people living with AIDS, which predisposes them to attacks by opportunistic infections and other vulnerabilities and disrupts the continuum of care, whilst at times denying occupants the required privacy.This paper focuses on creating an understanding of why housing care and support for HIV and AIDS affected is lagging behind in Swaziland. It suggests cultural, economic, political and policy issues as the underlying reasons for this, and, therefore, concludes that there is need for bold policy reforms in these areas. In order to create a proper framework for such reforms, the paper reviews the following:The national housing policy's implications on the care and support for people living with HIV and AIDS and the orphaned and vulnerable children; andThe current human settlements related responses to HIV and AIDS in Swaziland's rural, peri-urban and urban areas.In this context, urban development planning paradigms and the extent to which HIV and AIDS is being integrated into the development plans are discussed.

Tomlinson, Richard

2008 Open House International

doi: 10.1108/OHI-04-2008-B0006

The background to this paper is the increasing interest in the relationship between housing and municipal services and HIV/AIDS. The purpose of this paper is to clarify what, precisely, one has in mind when thinking that housing and municipal services might prevent HIV infection and associated opportunistic infections. The focus is not on the socioeconomic dimensions but on the modes of transmission associated with specific opportunistic infections. That is, the paper first disputes the relevance of housing and services to HIV prevention, but then demonstrates that housing and municipal services are important for (a) the prevention of certain opportunistic infections to which people affected by HIV/AIDS are particularly vulnerable, and (b) for the provision of home-based care.In addition to the medical focus of the paper, there is attention to the empirical backdrop on the relation between housing, municipal services and HIV/AIDS, analysing survey findings regarding among whom and where HIV prevalence is highest, and projections regarding the extent of HIV infections and AIDS based on the World Health Organization clinical staging system. Using Johannesburg as a case study, it is demonstrated that the number of persons having AIDS is smaller than one might expect and also that the number is already declining, which has implications for the provision of home-based care. However, it is also shown that the number of households that lost one or several members is increasing rapidly. In this context, labour force surveys are employed to identify the impacts on specific categories of households. At this stage, a defining unknown is the scale, nature and location of these reconstituted households and what this means for housing policy.Finally, a feature of the research was the extent to which medical practitioners viewed housing as a quixotic sideline within the broader struggle for HIV prevention and the provision of treatment. In sum, the paper provides an argument for incorporating housing and municipal services into both HIV and AIDS prevention and treatment programmes.

Nord, Catharina

2008 Open House International

doi: 10.1108/OHI-04-2008-B0007

This article analyses and discusses spatial conditions contributing to confidentiality in HIV healthcare facilities carried out by two non-governmental organisations in Uganda, the AIDS Information Centre (AIC) and The AIDS Support Organisation (TASO). The provision of confidential space was found to be the most important architectural quality promoting client wellbeing, where Voluntary Counselling and Testing (VCT) as well as ongoing services to people living with HIV are provided. The study shows that confidential space is a requirement in a number of situations: when the client approaches the health centre; during the visit; and in the meeting between client, counsellor and medical staff. An unobtrusive location of the centre and separate, private counselling rooms are thus the most favourable spatial conditions.This article is based on a qualitative, explorative case study carried out in Jinja, Uganda during four months in 2004. Direct observation, interviews, primarily with clients and staff, spatial analyses and a qualitative content analysis were carried out.

Olufemi, Olusola

2008 Open House International

doi: 10.1108/OHI-04-2008-B0008

This paper contends that the peculiar, chronic, itinerant lifestyles and precarious spaces occupied by the homeless enhance their risk and vulnerability to HIV/AIDS. These spaces, including the streets, shacks and cardboard boxes, mine dumps and unorganised shelters, expose them to indecent lifestyles, poor choices and greater risk of HIV, as well as Tuberculosis (TB) and Sexually Transmitted Infections (STIs).This study was conducted amongst street homeless people, shack and hostel dwellers in informal settlements in various locations in Johannesburg. Inferences were drawn from the personal experiences of homeless people, and inputs from individuals and organisations that are engaged and work in the field of homelessness. Types of dwellings, overcrowding, livelihoods, knowledge of HIV/AIDS and survival sex are among the issues examined.Preliminary findings indicate that, firstly, poverty is a leading cause of precarious housing among the homeless. Secondly, behavioural practices, especially survival sex, make homeless people vulnerable to HIV. As a result, there is an increase in mortality rates from both HIV and AIDS amongst this group of people. Thirdly, the difficulties homeless people experience in gaining access to water, sanitation and health care services also compromises the care of those who are infected or affected by HIV/AIDS. Finally, other barriers to care and determinants of vulnerability to HIV/AIDS are the lack of knowledge, judgemental attitudes of the care providers overcrowding and lack of adequate nutrition amongst the homeless.