HIV and AIDS AND THE LAW

INTRODUCTION

Everybody has heard about HIV and AIDS. It is one of the most widely talked about illnesses in history and has become a pandemic of massive proportions particularly in Southern Africa. There are many untrue stories about AIDS and this causes people who are living with the disease to live with fear, prejudice and discrimination. It is important that people understand what HIV and AIDS are and how to prevent the disease from spreading but it is also important that we look at ways of undoing the prejudice that has built up around the disease.

South Africa is experiencing the largest HIV and AIDS epidemic in the world. An estimated 5.6 million South Africans were living with HIV at the end of 2009, including 300 000 children under 15 years old. This is the largest number of any country in the world. Different provinces in South Africa however experience different levels of HIV infections and AIDS related deaths. This shows that the epidemic is in different stages of development in each province and that a different approach to addressing the epidemic is necessary to change the course of new infections and deaths.

A computer model made by the Actuarial Society of South Africa, called ASSA2008 calculated that the number of people who died of AIDS dropped from an estimated 257,000 in 2005 to 194,000 in 2010. The figure for 2010 was far less than the figure estimated by the ASSA2003 model (388,000 AIDS deaths). This decline in estimated AIDS mortality is believed to be due to antiretroviral treatment being more widely available.

(Source:www.actuarialsociety.org.za; www.avert.org/aidssouthafrica)

What are HIV and AIDS?

HIV stands for the Human Immune Deficiency Virus. This virus attacks the immune system which is the body's defence against disease. HIV can live in our bodies for years without us looking or feeling sick in any way. Most people with HIV feel healthy and are able to work and live healthy lives for many years. It is only when a person develops an AIDS-related illness that he or she becomes very ill.

AIDS is caused by HIV. AIDS stands for Acquired Immune Deficiency Syndrome. It is the name given to a group of serious illnesses that are caused by your body being unable to fight infections. People with HIV or AIDS are more likely to get some diseases and infections because their immune system cannot fight them off.

The different stages of HIV

There are four stages of the HIV disease:

Stage 1: Primary HIV infection

After an early feeling of sore throat, swollen glands, headache, muscle aches or similar flu-like symptoms, you will return to feeling completely well. This stage may last several years during which the person might have no HIV-related illnesses

Stage 2: The asymptomatic or "silent" stage

If you have the primary HIV illness you can feel very well for many years without showing any major symptoms. A person with HIV who lives a healthy lifestyle by eating healthy foods, taking exercise, food supplements and antiretroviral treatment (ART) when necessary, can remain in stage 1 or 2 of the illness for many years living a normal life.
Where the person does not live healthily and/or fails to take ART treatment, he or she will begin to develop minor illnesses in stage 2. Ear infections, frequent flu and skin problems are common at this stage.

Stage 3: Early HIV symptomatic disease

Gradually, after many years, the person’s immune system starts to break down and the CD4+ cell count drops lower and lower. (The strength of a person’s immune system is calculated by their CD4+cell count). Some people will begin to show mild symptoms of HIV disease, for example, shingles, swollen lymph glands, occasional fevers, mild skin irritations and rashes, fungal skin and nail infections, mouth ulcers, chest infections and weight loss.

Stage 4: Medium-stage HIV symptomatic disease

This is the stage when the CD 4+ cell count gets very low and people use ART treatment to boost their immune systems. In stage four, the person has illnesses due to a very weak immune system. These may include PCP, pneumonia, chronic diarrhoea, toxoplasmosis and meningitis. It is at this stage that a person is said to “have AIDS.” A person is also said to “have AIDS” if their CD4 count (white blood cells) goes under 200.

How do you get HIV?

There are only three ways to get HIV/AIDS:

1. Unprotected sex (sex without a condom),
2. Contact between your blood and infected blood or body fluids, and
3. Mother-to-child transmission.

1. Unprotected sex.

This is the most common way that people get HIV/AIDS. If you have sex with an HIV positive person and there is direct contact between the penis and vagina or anus, you can easily get infected. The virus lives in the fluids inside the penis and vagina and can easily enter your bloodstream. Using condoms properly is the only protection against this kind of infection.

You cannot get AIDS from kissing someone on the lips, hugging, sharing food and drink or using the same bath or toilet as someone who is HIV positive. (Deep kissing or French kissing can pass on HIV if you have sores in your mouth).

2. Contact with infected blood.

If you have an open wound and it is exposed to the blood of an HIV positive person, you can be infected. This contact could be through using the same needles for drugs or unsafe instruments used for circumcision. It is possible to get HIV if you use the same razor blade or tooth brush as an HIV-positive person if there are any traces of blood on the implement. While you could easily contract HIV from a blood transfusion if the blood is contaminated, all blood in SA is tested for safety. Medical workers can get it from accidentally pricking themselves with needles they have used to inject HIV positive people.

3. Mother to child transmission.

HIV positive mothers can pass the infection to their babies. An estimated 15-30 % of mothers with HIV will transmit the infection during either pregnancy or during childbirth. This happens because of the contact with blood. Another 10-20 % will pass the HIV to the baby through breast milk. A medicine called Nevirapine (antiretroviral treatment) can make it half as likely that a mother will transmit the virus to her child in the womb or during childbirth. If the mother has been taking the full cocktail of antiretrovirals the risk is reduced even more. Using formula instead of breast-feeding can ensure that the baby is not infected through breast milk.

Who is most at risk of contracting HIV?

Anyone can get HIV, but some people are more vulnerable because they do not have the power to say no to unprotected sex or because of their risky lifestyles. The groups who are most vulnerable and have the highest infection rates are:

• Young women between 15 and 30 years old - many of the women in this age group are in unequal relationships where they cannot refuse unsafe sex or are exposed to sexual violence.
• Sexually active men and women who have more than one partner. Although polygamy (having more than one wife) is a custom followed only by some men, many others have a wife and a girlfriend or casual sexual partners. They may get the virus from a casual partner and pass it on to their wife.
• Migrant and mine workers who are separated from their families for most of the year and many of them have sex with sex workers.
• Transport workers who travel a lot and many of them use the services of sex workers.
• Sex workers who are exposed to many partners and are sometimes powerless to insist on safe sex.
• Drug users who share needles – one person who is HIV positive can infect a group of people who share the same needle unless it is sterilised in between usage. Many drug addicts also become sex workers to pay for their drugs.
• People who practice anal sex – the anus can easily be injured during sex because it has no natural lubrication (wetness) and the virus can be passed on unless a condom is used. Women who have anal sex, gay men and other men who have sex with men (for example prisoners), are vulnerable to this form of transmission.

Young women are the most vulnerable because they are often powerless to say no to unprotected sex with an HIV positive partner. They have the highest infection rate of all in South Africa. They are also the most common victims of rape and sexual abuse. Young girls who are virgins are also at risk because of the myth that a person can be cured of HIV or AIDS by having sex with a virgin. This is completely untrue and is just an excuse for child abuse.

It is easier for women to get infected by HIV than men. The virus can easily enter the bloodstream through the vagina. When the vagina is not lubricated (wet), it can be injured during sex and infection happens more easily. Rape and practices like dry sex (where herbs and other materials are used to keep the vagina dry) contribute to the rapid spread of HIV and AIDS among women.

Men and women who have other sexually transmitted diseases (such as syphilis or gonorrhoea) are also more vulnerable because they often have open sores on their private parts.

How do you treat HIV and AIDS?

You can find out whether you are HIV positive by having a free blood test at any clinic or hospital. The results will only be given to you. If you are positive, you should tell your sexual partner so that he or she can also be tested and you should only practice safe sex by using a condom.

There is no cure for HIV, but there are many ways to help people living with HIV to strengthen their immune systems for example:

• by treating the opportunistic infections that are caused by HIV so that people can live longer, for example, by giving people antibiotics to fight diseases;
• by following a healthy diet, exercising and living in a clean and healthy environment;
• by providing counselling and emotional support to the person and his or her family;
• treating people with anti-retroviral drugs.

There are medications that can help to fight the illnesses like pneumonia and stomach infections that easily kill people with AIDS. These infections are called opportunistic infections. Many of the medicines used to fight opportunistic infections are available at clinics and the government is working to get more affordable medicines to people who need them.

Anti-retroviral treatment (ART), when taken properly, can greatly reduce the level of HIV in the body, reduce susceptibility to HIV/AIDS illness and extend the person’s life, sometimes for many years. ART prevents the virus from reproducing and helps prevent further damage to the body. Many people find that, after taking ART for a few months, the level of the virus in their blood is so low that it cannot be detected.

ART cannot, however, repair damage to organs and systems to the body that the virus has already made. Once a person goes on ART, they must accept that they will have to keep taking the medication for many years to come and quite probably for the rest of their lives.

Prophylactic Anti-retroviral Treatment

If a person has been exposed to HIV infected body fluids (for example, through being raped) then he or she should start with ART within 6 hours or as soon as possible after exposre (but no longer than 24 hours). This is called prophylactic ART. The person should be tested immediately after being exposed to the virus which will indicate whether he or she was HIV negative at the time, but will not show whether the person was infected through rape. The person should be testede again at 6 weeks, 3 months and 6 months after the exposure.

See Sexual violence and HIV testing

How do HIV and AIDS impact on individuals and society?

The impact on people living with HIV/AIDS

Finding out that you are HIV-positive can be a big shock in itself and can lead to further emotional and physical suffering. There is still a lot of ignorance and prejudice about HIV and AIDS and it is often seen as a “death sentence”. Most people are scared when they are first diagnosed. Some respond by feeling that their lives are over and become very depressed. Many people cannot accept the diagnosis and deny that they are positive to their families and to themselves. Others react with anger and refuse to be responsible and practice safe sex. Many people feel ashamed of their HIV status and think that they will be rejected by their partners and family, or that their communities will isolate them if they are open about being HIV positive.

It takes courage to face this disease and a lot of support is needed to fight it. People with HIV/AIDS can live long and productive lives if they get emotional support, strengthen their immune systems, get proper medical treatment and take good care of their health.

The vast majority of people who are HIV positive do not know it although people are becoming more aware of the importance of voluntary testing and counselling (VTC). Many people only realise they are HIV positive when they develop AIDS and get seriously ill.

The impact on families and children

The burden of care falls mostly on the families and children of those who are ill. Often they have already lost a breadwinner and the few resources they have left are not enough to provide care for the ill person and food for the family. Families also suffer the daily stress of looking after someone who is ill and, in many cases, facing death. Many children, especially older female children, have to leave school to look after ill parents.

Children who are orphaned are often deprived of parental care and financial support. More and more orphans are living in child-headed families where no-one is earning an income. Many of them leave school and have no hope of ever getting a decent education or job. These children who grow up without any support or guidance from adults may become our biggest problem in the future. They are more likely to become street children or turn to sex work or crime as a way of surviving.

Older female relatives, mostly grandmothers, are the most likely to take in orphans. Many of them survive on pensions and already live in dire poverty. When their children die and they become responsible for grandchildren, they get a huge extra financial burden and at the same time they lose the financial support they may have received from their children.

Poverty, the economy and HIV/AIDS

People who carry the heaviest burden as a result of HIV and AIDS are the poor. AIDS increases poverty and families are the first to feel the economic effects of having members of the family who have HIV and/or AIDS. Families lose income if an earner is sick. Often another family member stays at home to look after the sick person and further income is lost. Families have also increased costs as they have to spend money on caring for the sick or paying for funerals.

Government spending will also be affected since more and more of the taxes will have to be spent on health care and welfare. Our social welfare system may not be able to cope with the number of orphans who need grants. Our health system is already strained to provide basic health care for all diseases.

In addition, very poor people usually cannot afford the basic requirements for a healthy lifestyle - such as healthy food, a clean environment and clean water. They also cannot afford the costs of basic health care such as transport to clinics or hospitals and vitamin supplements.

So, it is clear that poverty cannot cause HIV or AIDS, but poor people are more at risk of HIV infection and of developing the disease more quickly.

Most of the people who are dying are between the ages of 20 and 45 – an age when most people are workers and parents. This has serious consequences for our economy and the development of the country.

Breaking the silence around HIV/AIDS

Although HIV and AIDS have become very common it is still surrounded by silence. People are ashamed to speak about being infected and many see it as a scandal when it happens in their families. People living with HIV or AIDS are exposed to daily prejudice born out of ignorance and fear. Fear leads to discrimination and victimisation against those living with HIV or AIDS. People have been taught to believe that only gays, prostitutes, people who sleep around and drug users get infected with HIV. They think if you are not one of 'these', you are safe. This makes it easy for some people to discriminate against others and blame them for the disease, while not protecting themselves. And because people fear the discrimination they will face if others know that they are HIV positive, they are afraid to go for an HIV test or to be open about their HIV status.

There are myths around HIV/AIDS and they lead to people seeing it as something that should be kept secret. Many people see those with HIV/AIDS as people who are somehow to blame because they were promiscuous or homosexual. AIDS is seen by some people as a plague that you can catch just from being with someone who is HIV positive. In some communities people with HIV or AIDS have been chased out or attacked. This underlines the great importance of widespread community education efforts because the ignorance and prejudice around HIV/AIDS can be almost as destructive as the disease itself. In some countries AIDS activists have adopted the slogan “Fight AIDS NOT People with AIDS.”

See Running an HIV/AIDS awareness campaign

The challenge for us is to make people fear getting the disease without them turning against those who are already HIV positive. This means that we have to make it easier for people to be open, to go for tests and to seek care. We have to treat it as an illness and not a shameful secret. We must work to ensure respect for and observance of rights and freedoms for people with HIV/AIDS, as well as the avoidance of HIV/AIDS-related discrimination and stigma.

We have to create an environment where communities become more caring towards people living with HIV/AIDS and orphans and we all take responsibility for education around prevention. Although AIDS is a terrible disease that can destroy families and communities, we should never forget that it is also a preventable disease. We can also protect ourselves against becoming infected by the virus.

HIV/AIDS and Rights

The Constitution includes many rights but most important for people living with HIV and Aids are the socio-economic rights, such as the right to basic health care, education, social services, shelter, and so on. The government has a duty over time to make it possible for people to use their socio-economic rights.

WHAT THE RIGHTS MEAN FOR PEOPLE LIVING WITH HIV OR AIDS

Acknowledgements, HIV/AIDS & The LAW: A Resource Manual, 2nd edition.
The Aids Law Project & The Aids Legal Network

Health and Medical Rights

Many people living with HIV or AIDS complain that they are treated badly at hospitals and clinics. Sometimes medical staff even refuse to treat patients who have HIV or AIDS. People also complain that information about their illness is not kept confidential.

Health care workers also have rights, including the right to a safe working environment, while patients have rights to:

• confidentiality
• testing for HIV and informed consent
• medical treatment.

Confidentiality

Confidentiality means that doctors, nurses, psychologists, dentists and other health care workers have a moral and legal duty to keep all information about patients confidential. Any information about the patient's illness or treatment cannot be given to another person unless:

• the patient consents (agrees) to this
• the information is about the illness or treatment of a child - then health workers can tell others but only with the permission of the child's parent or guardian
• the patient is dead - then the doctor must get permission from the next-of-kin (the person's closest family)

Some rules about confidentiality

Telling other health care workers - A health care worker must get a patient's permission before giving any of that patient's medical information to another health care worker or to another health care centre.

Telling a patient's sexual partner - A health care worker may not tell the patient's sexual partner that the patient has HIV, unless the partner appears to be at risk because the patient refuses to practise safer sex. The health care worker must counsel the patient on the need to tell their sexual partner and to practise safer sex. The health care worker must then warn the patient that if he or she does not tell their sexual partner or practise safer sex, then the health care worker will have to tell the partner about the person's HIV status.

Telling a court - A court can order a health care worker to give them confidential information.

Confidentiality and openness

HIV/AIDS is not an open issue mainly because people living with the disease fear the prejudice and discrimination they will suffer if they are tell people about it. Communities need to be educated about HIV and Aids and the supportive role they can play in the lives of people living with the disease. In this way people may be encouraged to be open about their HIV status. Some people choose to be open about their status to certain people but this does not mean they lose their right to confidentiality with a doctor, nurse, health care worker, employer or friend. A person’s personal right to privacy and confidentiality must always be respected.

What can you do if a health care worker abuses your right to confidentiality?

You can complain to the Health Professions Council of South Africa (HPCSA). You can also make a civil claim for damages (compensation) against the health care worker, hospital or clinic, or any member of the public who has abused your rights.

See Resources

HIV testing and informed consent

• Everyone has the right to make their own decisions about their body so no patient can be given medical treatment without their consent. Consenting to medical treatment has two parts to it: information (understanding) and permission (agreeing).

With an HIV test, you must know what the test is, why it is being done and what the result will mean for you before you agree to the blood sample being taken. This is called pre-test counselling. After the HIV test results have been received you must be counselled again to help you understand and accept the effect that a negative or a positive result will have on your life. This is called post-test counselling.

Some rules about HIV testing and consent

Here are some rules to remember :

• You can give verbal or written consent to have an HIV test
• If you go to hospital, you cannot be tested for HIV without your consent

Exceptions to the rule of informed consent

These are the only exceptions to the rule that a person must give their consent to treatment or an operation:

• if a patient needs emergency treatment
• testing done on blood donations
• mentally ill patients - in this case the mental hospital must get permission from one of the following people: the patient's husband or wife, parent, child (if the child is 21 or older), brother or sister.
• HIV tests are routinely done on the blood of all pregnant women for health research, but the name of the woman is not attached to the blood sample, so no-one knows whose blood it is.

Who can give consent?

Adults who are of sound and sober mind can give consent to medical treatment. Children over 14 years can also give their own consent to medical treatment.

Children and youth and HIV/AIDS

What can you do if an HIV test was done without your consent?

If an HIV test was done without consent, your rights have been abused. You can complain to the Health Professions Council of South Africa (HPSCSA). You can also bring a civil claim for invasion of privacy, and a criminal charge of assault against the health care worker or the person they were acting on behalf of.

The right to health care and medical treatment

Everyone has the right of access to health care services and medical treatment, including access to affordable medicines and proper medical care. The right to access to health care services includes the right to proper care from a health care worker which means it is against the law for a health care worker to :

• refuse to treat a person because they have HIV
• treat people with HIV differently to other patients.

If a hospital or clinic refuses to treat someone living with HIV/ AIDS, they can be reported to the Department of Health, the Public Protector or the South African Human Rights Commission.. The case can also be taken to the High Court, which can review and cancel the hospital's decision to refuse to provide treatment.

Protecting human rights.

The right to health care includes the provision of medical treatment to people in need. The government has committed itself as part of its strategic plan, to making antiretroviral treatment available to all people who have reached a certain stage of the illness. Roll-out of the treatment has begun in most provinces. A person who wants to receive antiretroviral treatment must be medically certified by a state doctor.

HIV/AIDS in the workplace

Laws that give employees with HIV and/or Aids rights at work

Employees living with HIV/AIDS are often discriminated against by their employers, supervisors or colleagues (other employees). The following laws give people rights at work:

The Constitution

The Constitution gives all employees the right to be treated fairly at work including the right to fair labour practices and the right to equal treatment and non-discrimination.

The Labour Relations Act (LRA)

The LRA gives employees the right to be treated equally. It is an unfair labour practice to discriminate against an employee on any grounds, including, race, gender, sex, colour, sexual orientation, age, disability and so on. Discrimination is 'automatically unfair' if it breaks any of the basic rights of employees such as discrimination on grounds of a person’s disability.

See Automatically unfair dismissals.

The Employment Equity Act (EEA)

The EEA is more specific about the rights of people living with HIV or AIDS. The EEA explicitly prohibits unfair discrimination against people at work on grounds of their HIV status. The EEA also prohibits testing for HIV in the workplace unless this is authorised by the Labour Court.

See Employment Equity Act.

An employer cannot :

• force a person who is applying for a job to have an HIV test
• automatically make an HIV test part of a medical examination
• force someone who is already working for them to have an HIV test

The EEA doesn't cover members of the South African National Defence Force, the Secret Service or the National Intelligence Agency. But members of these organisations can still take their cases to the Constitutional Court

The Occupational Health and Safety Act and Mine Health and Safety Act

Sometimes an accident at work can cause a bleeding injury. If the injured person is HIV-positive and someone who tries to help the person also has an open wound, there is a small chance of the helper becoming infected if the wound comes into contact with the injured person's blood. The employer has a responsibility to make sure that the workplace is safe and that employees are not at risk of HIV infection at work.

See Occupational Health and Safety Act.

There are new regulations issued by the Department of Labour which say:

• employers must keep rubber gloves in the first aid box
• all staff must be trained so that they know what safety measures to take if an accident happens

Compensation for Occupational Injuries and Diseases Act (No 130 of 1993) (COIDA)

COIDA gives employees the right to compensation if they are injured or become ill at work. If you get infected with HIV because of a workplace accident, you can claim for compensation.

See Compensation Fund.

The Medical Schemes Act No 131 of 1998 and Regulations: Government Gazette 20556, 20 October 1999

Medical aid as a form of insurance is an important employee benefit in the workplace. In the past, the majority of medical schemes refused to cover illnesses that were linked to HIV infection.

The Medical Schemes Amendment Act of 1998 prohibits discrimination on the grounds of 'state of health'. This covers a person living with HIV or AIDS. It means that the medical scheme cannot refuse to cover reasonable care that could prolong the health and lives of people living with HIV or AIDS

The Medical Schemes Act stops medical schemes from discriminating against people living with HIV or AIDs. It states that all schemes must offer a minimum level of benefits, decided by the government, to employees with HIV or AIDS. The minimum levels of benefits include:

• treating all opportunistic infections for HIV or AIDS
• hospital admissions with treatment
• they do not have to provide anti-retroviral drugs

General rules about HIV and Aids that apply in the workplace

• A person who is HIV positive does not have a duty to give this information to his or her employer because of their right to privacy.
• If you tell your employer about your HIV status, the employer cannot tell anyone else without your consent. If the employer tells anyone else, this is breaking your privacy and right to confidentiality, and it is possibly an unfair labour practice.
• A doctor or health care worker who tells an employer about an employee's HIV status without their consent is acting against the law. This is breaking the employee's right to confidentiality.
• An employer cannot demand to know if the cause of an illness is HIV infection.
• An employer cannot refuse to employ you because you have HIV.
• An employer cannot dismiss you because you have HIV.
• An employer cannot dismiss you because you have HIV, even if other employees refuse to work with you.
• The Promotion of Equality and Prevention of Unfair Discrimination Act also protects an HIV-positive person from unfair discrimination in the workplace.

Code of Good Practice on HIV and AIDS and employment

The Department of Labour has published a Code of Good Practice on Key aspects of HIV and Employment. This Code gives employers and trade unions guidelines to ensure that people who are HIV-positive are not unfairly discriminated against in the workplace. This includes provisions dealing with:

• creating a non-discriminatory work environment
• HIV testing, confidentiality and disclosure
• providing equitable employee benefits
• dismissals
• managing grievance procedures

The Code also provides guidelines for employers, employees and trade unions on how to manage HIV/AIDS in the workplace.

For a copy of the Code, see the website: www.labour.gov.za and search under ‘Legislation’.

What happens if you become too ill to work?

All employees have a right to sick leave and an employer has no right to discriminate against or dismiss an employee who uses these rights. The Basic Conditions of Employment Act says an employee can have 6 weeks paid sick leave over any 3-year cycle. However, people with HIV will eventually start to become ill and this will affect their capacity to perform their work. An employer is allowed to dismiss an employee on grounds of incapacity and poor work performance, even if the employee has not used all their sick leave. This means, if an employee is unable to do their job properly because of their illness then the employer will eventually be able to dismiss them.
There are very clear guidelines for employers to follow when they want to dismiss an employee for incapacity. For example, the employer must see whether the incapacity is going to be permanent and must also investigate alternative employment. for the employee.

See Dismissal for incapacity.

What can you do to protect your rights at work?

Employees can take disputes about dismissals or discrimination to a Bargaining Council or the Commission for Conciliation, Mediation and Arbitration (CCMA). The Bargaining Council or CCMA will try to settle the dispute by conciliation, mediation or arbitration.

See Solving disputes under the Labour Relations Act.

Cases about unfair discrimination and automatically unfair dismissal will be referred to the Labour Court. Employees can appeal against decisions of the Labour Court by going to the Labour Appeal Court.

See Case study: ‘A’ vs South African Airways.

Women and HIV/AIDS

The impact of the HIV pandemic has been far greater on women than men. Women are at greater risk of being infected by HIV because of the power relationships between women and men. For example:

• Women are often dependent on men for money and shelter so they do what their partners say, including sexual behaviour.
• Women are not able to demand that their sexual partners practice safer sex by wearing a condom.
• Traditional views allow men to believe that women don't have a right to say no to sex with their partners.
• Most victims of domestic violence are women and children who are usually unable to take control of their relationships and unable to demand safer sex. This puts them at greater risk of getting HIV.

Rape and HIV infection

If a woman has been raped she should ask for an HIV test. Even if the result is negative, she should go for another test after 3 or 4 months. If she is HIV positive this will be proof that she was infected by the rapist. She should report this to the prosecutor in her case who will be able to raise it in court. If a rapist is found by the court to be HIV positive, and he knew of his HIV status before the rape, this could be used to give him a harsher sentence.

A rape survivor can also make a civil claim against a rapist. If she has been infected with HIV during the rape, and she can prove this, she can make a claim against the rapist for her medical expenses and for pain and suffering because of the rape.

See Problem 6: Reporting rape or assault and going to court.

See Sexual violence and HIV testing

Abortion

If a woman falls pregnant and does not want to continue the pregnancy, she can choose to have an abortion without the consent of her partner. This becomes very important for a woman who is HIV positive and doesn’t want to risk passing on the virus to the foetus.

Sterilisation

A woman with HIV cannot be sterilised unless she agrees to this. All women, including women with HIV, have the right to have children. However, women who are HIV should think carefully about having children as it is possible that the children will also get HIV.

Domestic violence

Women who suffer abuse are usually unable to take control of their relationships and unable to demand safer sex. This puts them at a greater risk of getting HIV. The Domestic Violence Act protects women by giving them a quick way to apply for a Protection Order to stop their partner from abusing them again.

See Getting a Protection Order.
See Problem 7: Using the law against domestic violence.
See Problem 8: Getting a Protection Order.

Sexual harassment

Sexual harassment is unwanted attention given to a peron in the workplace. Women are often the targets of sexual harassment. The person being harassed will be at greater risk of getting HIV. Sexual harassment is an unfair labour practice and should be reported to a supervisor. The Code of Good Practice on the handling of Sexual Harassment Cases in the Workplace says how people must deal with allegations of sexual harassment in the workplace.

See Code of Practice on the handling of Sexual Harassment Cases

Commercial sex work

Commercial sex workers are vulnerable to HIV because:

• their customers often don't want to use condoms
• sex is often violent and without a condom which makes it easier to pass on HIV
• many sex workers are raped or abused but they are unable to report this to the police because sex work is a crime

Customary practices

Some customary practices affect the rights of women by giving them less power than men in the community. Practices that make women unequal to men put them at greater risk of contracting HIV. Virginity testing for example, is a custom sometimes practiced on girls. Some people believe that this practice prevents the spread of HIV and AIDS as it encourages young girls not to have sex (in other words, if a young girl knows she is going to have her virginity tested she will be less likely to have sex.). Other people say this isn't true and it may have the effect of putting young girls at greater risk because -

• they will have anal sex to avoid vaginal penetration and this has a higher risk of transmitting HIV
• there is a myth that a person can be cured of AIDS by having sex with a virgin so men are encouraged to have sex with virgins which leads to rape and other forms of abuse.

Mother-to-child transmission of HIV

Research has shown that giving anti-retroviral drugs to HIV-positive pregnant mothers before they give birth decreases the risk of passing HIV on to the baby.

The Constitutional Court has said that the national government must make it possible for all pregnant mothers to have access to drugs that will prevent mother-to-child transmission of HIV.

Lesbians & gay men and HIV/AIDS

In the early days when HIV and Aids were first identified, gay communities were blamed for spreading the disease. This stigma continues today and adds to the discrimination and prejudice against gay people.

A gay person with HIV or AIDS will therefore suffer a double burden of discrimination and negative attitudes towards them: because of having the disease and because of being gay. Because of the general prejudice and discrimination against gay and lesbian people, important ways of educating people about HIV and AIDS are lost. For example, sexuality education in schools ignores or avoids discussion about lesbian or gay relationships.

See What rights mean for people living with HIV and AIDS.

Children & youth and HIV/AIDS

HIV and Aids can affect children in the following ways:

• where they are infected from birth or from sexual abuse from a very young age
• where their parents have HIV or AIDS and they have to live with the illness and loss
• where they have to live with the illness and loss of friends, teachers, and other family members.

Children who have HIV or whose parents are ill because of HIV or AIDS are often shunned and discriminated against by people in the community. Many suffer from neglect or are abandoned as babies. There are many examples of children being refused access to crèches, schools and bursaries. Orphans of parents who have died from AIDS are particularly vulnerable and many survive in child-headed households. Many of them turn to crime, drugs, or to the streets in order to survive.

How are children protected by the law?

Children are protected by various international, regional and local human rights documents and these are some of their major rights.

See Section 28: Children’s Rights.

Dealing with HIV/AIDS in schools

All children have the right to basic education. If a child is stopped from going to school because of his or her HIV status, this is unlawful and can be challenged in court. Learners with HIV should also not be denied the opportunity to reach their full potential so they should not be treated differently to other learners. It is important to remember that HIV is never passed on through casual contact. It is very difficult for children of any age to get HIV from contact at school. Therefore the risks of infection of other children cannot be used as a reason to exclude children with HIV from a school.

Parents do not have to tell the school authorities if their child has HIV, even if the school asks them to fill this in on the application form. Schools are also not allowed to test learners for HIV before they are admitted to the school or while they are at school. A learner cannot be tested for HIV without his or her consent (if over 14 years and/or parents or guardians consent if younger than 14 years.)

With the increasing numbers of learners and teachers becoming infected with HIV and Aids, it is important for all schools to have an HIV/AIDS policy so that:

• the rights of all learners and teachers are respected
• learners and teachers with HIV are managed in an appropriate way
• further HIV infection is prevented
• a non-discriminatory and caring learning environment is created

The Department of Education has drafted a national policy on the management of HIV/AIDS in schools. School governing bodies should develop and adopt their own policies but these must be in line with the principles in the national policy. They should do this in consultation with the wider school community. A schools AIDS policy should include guidelines to the following:

• Non-discrimination on grounds of a person’s HIV status
• Admission policy
• HIV testing
• Prevention of HIV transmission
• Management of HIV/AIDS
• HIV/AIDS education programme which should be integrated into the Life Orientation programme of the school
• Refusal to study, teach or work with a person with HIV

Children's health and medical rights & HIV and AIDS

Rules regarding testing and confidentiality for children include:

• Children who are 14 or older can consent to medical treatment on their own, including having an HIV test, but until they are 18 they need the consent of their parents or guardian for an operation (except for an abortion).
• If the child is younger than 14, the child cannot consent to an HIV test without the consent of the parent or guardian. The test results must be given to the parents or guardian.
• If a child consents to an HIV test, they have the right for the information to be kept confidential, even from the child’s parents.
• A school does not have to be told about a child's HIV status.
• A children's home or place of safety can be told of a child's HIV status if the child is under 14 and it is in the child's best interests for this information to be passed on. The information must be kept confidential by the staff of the home, and the child must not suffer any kind of discrimination because of it.

See Confidentiality.

Adoption and fostering and HIV/AIDS

The Child Welfare will not allow someone to adopt a child before they have gone through a medical examination which includes an HIV test. The following people must have an HIV test before adoption can happen:

• the parents who want to adopt
• the child
• the natural parents, if it is possible to find them

See Adoption of children.
See Problem 3: Adopting a child.

Fostering is usually for a short period so children are not tested for HIV before they are fostered.

See Foster care.

Remember the following points when dealing with cases of adoption or fostering :

• Child Welfare will not allow a person who has HIV to adopt a child. But, this is not something that the law demands and it can be considered an invasion of a person's privacy.
• Child Welfare will tell parents who want to adopt whether the child they are adopting has got HIV. But, this is not what the law demands so not all adoption agencies do this.
• If a child is under 14 and his or her HIV status is known, this can be told to the foster parents.

Prisoners and HIV/AIDS

In many cases, prisoners with HIV or AIDS continue to be strongly discriminated against.

Some rights and rules about prisoners and HIV/AIDS

• It is against the law for a prisoner to be tested for HIV against his or her wishes or knowledge. A prisoner does not have to have an HIV test even if the prison authorities demand this. Informed consent must always be given for an HIV test.

See HIV testing and informed consent

• It is against the law to force a person to make a confession or admission, for example about his or her HIV status, so that this can be used against him or her.
• The courts cannot use evidence that was forced out of a prisoner in a way that goes against the person's rights.
• Prisoners have the right to adequate medical treatment. This means prisoners with HIV should have access to the same kinds of treatment and care that are available to non-prisoners. In the case of EN v Government of South Africa (2007), the Durban High Court held that affected prisoners had a right to be provided with ARV treatment
• Prisoners have the right to confidentiality about their HIV status.

See Confidentiality

• It is against the law to segregate (separate) a prisoner with HIV or AIDS from other prisoners.
• HIV education and condoms should be available to all prisoners, as they are available to people in the community.

The rights of accused people

Accused people are people who have been charged with crimes but who have not yet been found guilty or not guilty. However because of the potential prejudice to a victim of sexual violence if he or she does not know the HIV status of the perpetrator, the victim can apply to court for an order to have the perpetrator have an HIV test and for the results of the test to be given to him or her. This application can also be brought by any person that has an interest in the victim’s well-being or the investigating officer investigating the case. The application must be brought within 90 days after the act of sexual violence was committed.

If the person is successful with the application, the investigating officer must take the person who committed the act of sexual violence for an HIV test. The HIV test results must then be given to the victim in writing. The HIV test results are private and confidential and should not be disclosed to others.

See Sexual violence and HIV testing

Bail and sentencing for rape accused with HIV/AIDS

All accused people have a right to apply for bail. However, where the crime is very serious, for example, rape, the law makes it more difficult to get bail particularly where the accused knew that he was HIV positive or had AIDS at the time of the rape. The minimum sentence for a person accused of rape who is HIV positive, is much higher than the minimum sentence for a person accused of rape who is NOT HIV positive.

See The Criminal Procedures Second Amendment Act (Bail law).

Social support and medical care for people living with HIV/AIDS

If people are unable to support themselves and their dependants they have the right to social assistance. People living with HIV are able to work and support themselves during the first phases of their illness. However, eventually many people with HIV become sick and unable to look after themselves and will require palliative care.  Social support includes the right to health care and medical treatment.

There are different types of social grants available to people living with HIV and Aids or people caring for someone with HIV or Aids:

• disability grants
• grants-in-aid
• foster care grants
• care dependency grants

The government has said that people living with HIV or AIDS will qualify for social security and assistance such as nutrition, transport, rent, burial costs and school books, where necessary.

See Social grants for adults.

See Social grants for children.

Disability grants

A person who has HIV or an AIDS-related illness will only get a disability grant if they become too sick to work. If that person is unemployed but still fit for work, they will not get a grant. The Department of Social Development will look at the medical report to make sure that the disability will stop the person from working for more than 6 months. Usually, a person will lose their grant if they become healthy enough to work.

See Applying for a grant.

Fast-tracking grants

The government has created a facility for ‘fast-tracking’ grants for people who are urgently in need of social support. The provincial district office is responsible for processing disability grants and for deciding on the policy on ‘fast-tracking’. These policies might differ from province to province. However, these are some of the standard rules about fast-tracking.

Both disability grants and care-dependency grants in respect of children, can be ‘fast-tracked’ for a person who is sick with AIDS. However, only if a person is in stage 4 of Aids will they qualify to have the grant fast-tracked. (See The different stages of HIV) If a grant is to be fast-tracked it means it should take no more than five (5) working days to be processed. The procedure for applying to have a grant fast-tracked is as follows:

• A prescribed medical form is issued AND stamped by the District Office of the provincial social services department. The person must take this form to a state doctor and not their own private doctor to have it completed. The person either has to take the medical form back to the social services department or the doctor sends it. The grant should then be available within 5 days.

A care-dependency grant will only be paid if a child’s physical condition stops him or her from going to school. The child must be in the full-time care of a care-giver at home.

See Care-dependency grants.

Grants-in-aid

A grant-in-aid is help in the form of nursing care. This grant is given to people who are too sick to take care of themselves at home. When a person applies for a grant-in-aid, they must bring the same forms to the SASSA office as they would for a disability grant.

See Grant-in-Aid.

Other forms of relief

Palliative care

What is palliative care?

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering. This is achieved by identifying, asssessing and treating pain and other problems that could be physical, psychosocial and spiritual.  Palliative care therefore provides relief from pain and other distressing symptoms, offers a support system to help patients live as actively as possible until death and to help families cope during the patient’s illness, will enhance quality of life.

Right to palliative care

Section 27 of the Constitution gives every person the right of access to health care services. The Health Act aims to promote the health of all people and the South African Patients’ Rights Charter states that ‘Everyone has the right of access to health care services that include: “provision for special needs in the case of … patients in pain… palliative care that is affordable and effective in cases of incurable or terminal illness’. In order to realise these rights government needs to put in place a policy on palliative care so that this can form part of the comprehensive health care system, in the formal and informal health care sectors.

Access to helath care depends on access to doctors, nurses, dentists and pharmacists. In South Africa as well as internationally, there are several different problems confronting human resources within health care services, including:

• Shortage of professional staff in rural areas and poor urban areas
• Many health care workers leaving the public health system and going to rich countries where payment and conditions are much better
• The impact that HIV is havingo n the capacity of the health system by greatly increasing the numbers of people in need of care.

Organisations such as the Hospice Palliative Care Association of South Africa provide palliative care provide palliative care and support. In 2007 South African hospices falling under the HPCA cared for 14% of patients requiring palliative care and the organisation has experienced increasing numbers of patients requring support. It is however difficult for these organisations to find adequate resources to meet the growing needs.

See www.hospicepalliativecaresa.co.za, click on ‘Find a Hospice” to find Hospices in your province.

Obstacles to access to palliative care

While organisations such as HPCA continue to provide palliative care and support there are a number of obstacles that standing in the way of people accessing their right to palliative care. These include:  

• Lack of access to an appropriate place of care, for example, a hospice, or a home-based care service.
• Lack of integration of palliative care into govenrment health programmes.
• Lack of palliative care education and training for doctors and nurses resulting in professionals who are not able to deal with the clinical and emotional issues in caring for patients for whom cure is no longer an option.
• A shortage of trained palliative care staff.
• Legislation that only allows doctors to prescribe specific medication that can provide pain relief; this limits access to pain medication for many patients in need as it is home-carers not doctors who are attending to patients in their homes. The South African Nursing Council and civil society are working on regulations that will allow professional nurses to prescribe and administer medication in cases requiring pain management.
• Geographic challenges in rural areas where the infrastructure is bad, for example, poor road conditions and no public transport make it difficult to reach people in need and to provide the appropriate medication.
• Fear of the stigma attached to terminal illnesses means families often delay contacting an organisation such as HPCA to treat the sick person at the home, or they prefer to treat the person on their own without support.
• Language barriers between care-givers and patients.
• Cultural barriers where some cultures believe that talking about death invites death in, or not acknowledging the illness leads to a delay in accessing palliative care.
• Religious beliefs where some people believe in the power of prayer and not medical care.
• Women generally play the nurturing role and men often distance themselves from caring for the very ill as they see this as a women’s task. This puts a burden on female members of the family and limits the responsibility of the male in the home in caring for ill members of family.
• Child-headed households -  where the child replaces the parent, it places a big responsibility on the child if a member of the household is very ill and this often leads to poor compliance with the medication, and other logistical problems. 

Information for this section was taken from the following publication: ‘ Legal aspects of Palliative Care” developed by the Hospice Palliative Care Association of South Africa (www.hospicepalliativecaresa.co.za, click on ‘Legal Resources’ to download a copy of the manual.

Medical costs - Most public hospitals give medical care for people living with HIV on a sliding scale. This means each person pays according to what they can afford. Pregnant women and children below the age of 6 years can get free medical services. The government is also committed to making ART treatment available to people who are at a certain stage of the illness. This roll-out is happening in most provinces.

Child support - Under the Social Assistance Act the following grants are available for the support of children, including children living with HIV, or whose parents are living with HIV or AIDS :

• Foster Care Grant (See Foster Care Grants.)
• Child Support Grant (See Child Support Grants.)
• Care Dependency (special care) Grant (See Care Dependency Grants.)

Anti-retroviral treatment - The government has approved a comprehensive treatment and care plan for HIV and AIDS in all provinces in South Africa. The plan includes providing people with anti-retroviral treatment in government hospitals, clinics and identified service points (one service point per health district throughout South Africa). Ongoing monitoring of patients is required for people on ART treatment. Contact your nearest state health clinic for information on how to access ARV treatment.

HIV/AIDS Strategic Plan for South Africa, 2007 - 2011

In 2003 the South African government approved a Comprehensive National Plan on HIV/AIDS Care, Management and Treatment. This plan was evaluated and revised in 2006 and a new strategy was published for 2007 to 2011. A new strategy for 2012 to 2016 is currently being developed.

SANAC

The South African National AIDS Council (SANAC), is the main official body coordinating the government’s HIV/AIDS programme.

It is chaired by the South African Deputy President and has members from government, civil society (NGOs), the private sector and unions. People living with HIV/AIDS and women’s groups are also represented. SANAC is engaged in shaping, influencing and implementing policies and programme interventions.

Acknowledgement

The contents of certain sections of this chapter were originally based on relevant chapters in the publication HIV/AIDS and the Law, published by the AIDS Law Project and Lawyers for Human Rights. For more information see www.alp.org.za.

PROBLEM 1: Keeping medical information confidential

Dr Vincent is a doctor at Langa day hospital. He has a patient called Themba who is HIV positive. Dr Vincent tells two other doctors about Themba's HIV status. Themba, is very angry about this. He believes Dr Vincent should have kept his HIV status confidential. Themba wants to take action against the doctor.

What does the law say?

Doctors, nurses, health-care workers, and other medical professionals have a legal and moral duty to keep information about a patient absolutely confidential.

See Confidentiality

What can you do?

• You can refer Themba to a lawyer who will make a civil claim on his behalf against the doctor.

See Steps in a civil claim

• You can also help Themba draw up an affidavit complaining about the doctor's conduct. Send the affidavit to the Health Professions Council of South Africa (HPCSA) (www.hpcsa.co.za) .

See Affidavits.
See Resources: Health Professions Council of South Africa (HPCSA).

PROBLEM 2: Entry to school refused

The principal of the local high school, Mrs Shabangu, refuses to admit a student, Melanie, to the school because Melanie is HIV positive.

What does the law say?

It is an act of discrimination to keep a child out of a school because of their HIV status and every child has a right to education.

What can you do?

You can help Melanie and her parents by first setting up a meeting with the chairperson of the School Governing Board. If this doesn’t help you can write a letter of complaint to the South African Human Rights Commission about the school's actions. The SAHRC must investigate the complaint.

See Problem 1: Taking a case to the South African Human Rights Commission.
See Dealing with HIV/AIDS in schools.

PROBLEM 3: Dismissing a worker who is HIV-positive

Susan is a machine-operator in a factory. She tells her employer that she is HIV-positive. The employer tells Susan that she will have to leave her job, because the other workers will complain if they find out and he doesn't want any trouble in his factory.

What does the law say?

Everyone has the right to be treated equally and fairly at work. There can be no discrimination against a person because they are HIV-positive. The Labour Relations Act and the Equality Act (Promotion of Equality and Prevention of Unfair Discrimination Act, 2000) protect people living with HIV or AIDS from being discriminated against in the workplace.

An employer cannot dismiss a person because he or she is HIV-positive, even if other employees refuse to work with this person.

See Laws that give employees with HIV and/or Aids rights at work.

What can you do?

You can help Susan fill in the correct form for her to refer her case to the Commission for Conciliation, Mediation and Arbitration (CCMA).

See Solving disputes under the LRA.

PROBLEM 4: Refusing to employ an HIV positive person

Brian applies for a job with the South African Police Services (SAPS). On the application form he fills in that he is HIV positive. The SAPS refuses to employ him and give him no reasons explaining their refusal.

What does the law say?

The SAPS must give Brian reasons why he didn't get the job. The Labour Relations Act and the Equality Act say an employer cannot refuse to employ a person because they have HIV. This is discriminating against the person.

See Laws that give employees with HIV and/or Aids rights at work.

See Section 33: Just Administrative Action.

What can you do?

You can help Brian find out the reasons why he didn't get the job. If the SAPS refuses to give the reasons, Brian can complain to the Department of Safety and Security.

If the reasons do not seem valid, and Brian suspects that the real reason he didn't get the job is because he is HIV-positive, he can take up a case of an unfair labour practice involving arbitrary discrimination against the SAPS. You can help Brian fill in the correct form to refer his case to the Commission for Conciliation, Mediation and Arbitration (CCMA). The CCMA will investigate the allegation of discrimination.

See Solving disputes under the LRA.

PROBLEM 5: Making a complaint about being refused medical care

Tina was in an accident and is a patient at the Lagunya Hospital. Tina agrees to an HIV test. The test is positive.

Tina's wounds need to be treated every day, but the nurse treating her finds out the results of the test and refuses to treat her again. She also tells all the other nurses. They too refuse to touch Tina, and she is left in pain, with blood-soaked bandages for many hours. When she recovers she wants to take action against the hospital for the degrading way in which they treated her.

What does the law say?

Everyone has the right of access to health care services. It is against the law for a health care worker to refuse to treat a person because they have HIV, or to treat people with HIV differently to other patients.

See The right to health care and medical treatment.

What can you do?

There are a number of ways to respond to this problem:

1. You can refer Tina to a lawyer to make a civil claim against the health workers or the hospital on behalf of the patient. A High Court can review and set aside the decision of a hospitcal to refuse to treat a patient.

See Civil claims.

2. You can help Tina draw up an affidavit explaining her complaint. Include the names the health workers involved. Send the affidavit to the relevant medical council which can discipline their members. This includes the South African Nursing Council (SANC) if the cmoplaint is against a nurse, or the Health Professions Council of South Africa (HPCSA), if the complaint is against a doctor..

See Affidavits.

See Resources for information on SANC and HPCSA.

3. You can also help Tina send a letter of complaint to the South African Human Rights Commission (SAHRC).

See Problem 1: Taking a case to the South African Human Rights Commission.

4. A letter of complaint can also be sent to the Public Protector

See Making a complaint to the Public Protector

PROBLEM 6: Applying for a disability grant

Nobantu and Sipho are married with three young children below the ages of 10. Both partners are HIV-positive.

Sipho has lost his job because he became too ill to work. The doctor says that he could die within 6 months. Nobantu earns R400 per month doing part-time domestic work but she has also become increasingly ill and her employer has warned her on a number of occasions that she will have to find someone else to do the work.

What does the law say?

Both Sipho and Nobantu are able to apply for a disability grant. The Minister of Social Development has also notified the department that applications from HIV-positive people for disability grants should be 'fast-tracked'. This means that these applications should be given priority and processed faster than any other grant applications. The parents can also apply for Child Support Grants for the 3 children.

See Social grants for adults.

See Social grants for children.

What can you do?

You should find out from the provincial office that processes disability grants what the policy is on ‘fast-tracking’. Then you should write a letter, setting out the particular circumstances of Nobantu and Sipho and ask the provincial office to ‘fast-track’ their applications. You should also help them apply for Child Support Grants for their three children (who all qualify for the grant because of their ages.)

COMMUNITY ACTION

Running an HIV and AIDS Campaign

These guidelines will help you to run an HIV/AIDS campaign in your community - when you are planning your campaign you must keep them in mind.

What is the aim of the Campaign?

The aim of the campaign says what you want to achieve at the end of the campaign. To think about your aim ask yourself this question:

What do I want to achieve with this campaign?

So, for example, your aim(s) for an HIV/AIDS campaign could be:

I want to:

• reduce the rate of HIV infection in my community and
• ensure that people with HIV or AIDS and their families in my community are given care and support"

How are you going to achieve your aims?

Setting objectives for the campaign

Objectives are more specific than aims; they help you to achieve your aims. You can ask yourself the question:

What must we do to achieve our aims?

Your objectives could be as follows:

To build openness and awareness around HIV/AIDS

We will do this in the following ways -

• wear a red ribbon
• act as role models to show support for the campaign
• organise AIDS awareness-raising events for example, marches, cultural events, protests, prayer meetings, loudhailers, information tables in public places
• openly support people who are open about their HIV status and encourage people be tested for HIV
• print posters, pamphlets or use graffiti
• encourage and support people living with AIDS to go public about their illness
• encourage voluntary counseling and testing by organising testing drives and ask community leaders who are willing, to go public about their results
• encourage leaders and other influential people who are HIV-positive to become role models for other people by being open about their status

To educate people about prevention, care and treatment

We will try to get people to change their sexual behaviour in the following ways -

• public meetings - invite people to speak on HIV/AIDS, particularly people who are HIV-positive and willing to speak in public about their illness
• speeches - ask institutions like schools, churches, workplaces, etc if we can send a speaker to talk about HIV/AIDS
• workshops - present community education workshops
• chat shows - ask to be invited to speak on chat shows of local radio stations
• newspapers - write articles for newspapers on prevention of AIDS, non-discrimination and care for people living with AIDS or ask journalists to write them
• plays and songs
• Distribution of pamphlets booklets etc

To develop community care projects

We will try to help community members living with HIV/AIDS, their families and orphans in the following ways -

• openly organise support and care for people living with HIV or AIDs
• start vegetable garden projects to help provide the right food to people who cannot afford it
• make sure the local health services keep supplies of the cheap medicines that can be used to fight common infections that harm people with AIDS
• organise support groups where people living with HIV or AIDs can meet and talk to each other
• train volunteers in basic home care and counselling so that they can help with house visits and also provide training to home care-givers
• work with the Department of social services or the Child Welfare Society to encourage people in the community to take care of orphan children, for example, to provide foster care

Who are we going to target?

The campaign should reach everyone in the community but we can also target specific sectors which are more vulnerable -

The education and prevention part of the campaign

• sexually active youth, particularly young girls
• migrant and transport workers
• sex workers
• women, particularly those in relationships with HIV positive men
• men who are HIV positive
• drug users

The awareness and openness part of the campaign

These groups are most likely able to influence people's attitudes -

• The local mayor
• Ward councillors
• Members of national and provincial parliaments
• Local leadership
• Religious leaders
• Traditional leaders
• Sport and cultural stars
• Popular business people
• Community organisation leaders
• Union leaders
• Teachers
• Community radio DJ's and newspaper reporters

The support and community care part of the campaign

People who need information, care and/or support:

• People who are HIV positive
• People who are sick with AIDS and need home care
• Children whose parents are dying or have died of AIDS

People who can help provide information, care and/or support -

• community structures and leaders
• community welfare organisations
• religious leaders
• women's groups
• local business
• schools
• individual volunteers for home care or foster care projects

What will our message be?

You need to give the campaign an identity and decide what the main messages will be. For example, the Treatment Action Campaign encourages people to wear T-shirts with the slogan 'HIV-positive' to help bring AIDS awareness to the public.

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