meant to be 'fully gendered* to score '2'. This is still subject to ratification by the Advisory Panel as at 2 March 2005.
51 Para 8.3
Note that international standards require that SA reduce HIV infection by 25% by 2005, and halt by 2015 and begun to reverse the spread of HIV/AIDS. By 2005 young women and men aged 15-24 should have access to the information and skills required to reduce their vulnerability to HIV infection.
Each performance area sets more detailed targets and identifies the basic strategies for meeting these, as well as the lead agencies responsible. At this level the targets are not gendered.
The Health Goals, Objectives and Indicators 2001-5 appear to operate at a more detailed level, but are not necessarily more gendered.
In addition, the Department of Social Development Strategic Plan sets out a number of outputs and performance indicators for its work on mitigating the socio-economic impacts of HIV and AIDS. At this level, the targets do not appear to be gendered.
Again the score depends on the approach taken to scoring by UNECA in respect of the gender component of plans.
UNECA requires a fully gendered approach for a score of '2'.53 Although targets appear to be in place, and flow from the National AIDS Plan, there is insufficient evidence that they are fully gendered. Given the importance of gendered targets to planning and delivery, this scores a'l\
INSTITUTIONAL MECHANISMS 1
A national directorate on HIV and AIDS is in place in the National Department of Health. All provincial departments have directorates on HIV/AIDS that report to the national department.
In the 2000-2005 Strategic Plan, it was suggested that Interdepartmental Provincial Committees be set up, as well as District level HIV/AIDS Committees (para 7.1(b)). These would also address non-health issues such as transport and poverty alleviation.
As part of the primary health-care system, effective delivery of HTV and AIDS health services depends upon the ability to increase resources and build capacity at provincial and district levels. It is here that many of the difficulties have been experienced (2000-2005 Strategic Plan, 9-10). In 1997, the SA National HTV7AIDS/STD Review noted that major restructuring had affected provincial departments and that some district structures had not been established.
In addition, there are still ongoing processes to integrate gender issues, such as gender-based violence and HIV and AIDS, into primary health care institutions.
Within the Department of Social Development, programmes to mitigate the socio-economic impact of HIV and AIDS are carried out by a directorate 'HIV/AIDS' within the chief directorate 'Development Implementation Support'.
The National Integrated Plan is located in the Departments of Health, Education and Social Development and structures exist down to district level.
The fact that not all structures exist at provincial and local/district level, or that they are inadequately equipped, scores a '1'.
BUDGET 2
Overall the budget for HIV and AIDS has increased over past years, and is set to increase further. Much of this money will go directly to provinces where and when they need it. The Medium Term Expenditure Framework anticipates increases over the medium term for
Confirmed at meeting of researchers in Addis Ababa in November 2004.
Centre for Applied Legal Studies Health 125
University of the Witwatersrand
The African Women's Progress Report Social Power South Africa
preventing mother-to-child transmission and community/home-based care, which should directly benefit women.
Addressing provincial equity in allocation should improve health-care for women in poorer provinces, government has begun to do this (Director-General, Review, 2002).
In addition:
> 98 million has been given to prevention programmes that include a gender component (although it is not clear how this gets allocated)
> the government has committed to making further funds available for the roll-out of Prevention of Mother to Child Transmission (GCIS Update, 9 October 2002).
> the government is providing funding for training, drugs and HIV testing of survivors of sexual assault (GCIS Update, 9 October 2002).
> The Department of Social Development's budget for Home- and community based care is also set to increase from 5 million in 2001 to 138 million in 2004/5
Problems of underspending, where they occur, relate to issues of capacity, rather than budget.
Substantial underspending was reported in some provinces during 2003 (Simelela, The Star 1 June 2004)
The continuing increase in budgetary allocation, especially in areas that affect women, scores a '2'. It should be noted, however, that, given problems such as human resources and institutional mechanisms expressed elsewhere in this section, these increased allocations will not necessarily reach their target of women.
HUMAN RESOURCES 1
The 2000-2005 Strategic Plan states that 'it is vital to the success of this Strategic Plan that adequate human resources are available to ensure delivery', with the constraint being capacity rather than funding (para 7.1(b)). This continues to be a core problem in the ability of government to address HIV and AIDS and its gendered implications.
HIV and AIDS services have not yet been fully integrated into reproductive health services.
For example, '[r]isk assessment for exposure to STIs/HIV infection and reproductive health screening of contraceptive clients are not carried out routinely' (National Contraceptive Guidelines, 14). Reasons for this include a lack of information, skills and management/supervision (National Contraceptive Guidelines, 14).
In general, health care workers are not fully equipped to deal with gender and HTV and AIDS and staff turnover, bumout and negative attitudes remain a huge problem in providing an effective service.
The Strategic Plan of the Department of Social Development notes the severe capacity constraints of the Department in implementing its HTV and AIDS programmes (at 19).
Enhancing departmental capacity is a priority of the Medium Term Expenditure Framework.
The Department is also training community health care workers to try and meet capacity problems.
Problems of capacity mean that this scores a '1'.
RESEARCH 1
The 2000-2005 Strategic Plan supports policy research, as well as research into vaccines, MTCT, PEP and traditional medicines (Priority Area 3, Goals 10-12). Extensive research has been carried out in the area of HIV and AIDS, including clinical trials on microbicides,
research on the use of the female condom, research into sigma and discrimination based on HIV and AIDS (including gender).The Strategic Plan of the Department of Social Development makes provision for research on the social impacts of HIV and AIDS and targets one major report per year (Department of Social Development Strategic Plan 2002/3 - 2004/5,24).
However, there remains room for government to plan and conduct further research into
understanding the gendered dimensions of the epidemic and ways of addressing the gendered
challenges of prevention, treatment and care. This scores a ' 1 \INVOLVEMENT OF CIVIL SOCIETY 2
There has been some involvement of women and women's organisations on issues relating to women's health and home-based care. However, there has not been extensive involvement of women's organisations in HIV and AIDS issues. Part of the reason for this stems from the fact that women's organisations themselves have not taken up HIV/AIDS as a core issue. On the other hand, the human rights approach of AIDS organisations has also excluded women.
This has begun to change. For example, in the field of gender based violence, women's organisations are taking up the issue of AIDS in relation survivors of sexual assault. This has largely resulted in engagement with the Department of Justice rather than Health. However, women's rights and health organisations have worked with government on a range of issues relating to policy and implementation.
The government funded about 120 Non Government Organisations during 2001/2 to the extent of R30 million (Annual Report 2002), but we have been unable to determine how much ofthis went to funding for gender issues/women's organisations.
Government has mobilised community women in 'Women in Partnership Against Aids', especially around their interests and needs as care-givers.
In general, the relationship between government and civil society in the AIDS sector has been contradictory. It has been good in very many instances, but very conflictual in others (such as
treatment). In relation to gender and HIV/AIDS, there are many examples of positive
relationships at national level and in most provinces. There have also been rare examples of conflictual relationships, such as the controversy over the provision of post exposure prophylaxis in Mpumalanga.However, even where there have been conflictual relationships, South Africa's democracy