A new phase of the struggle in South Africa

Gerard Payne, affiliate coordinator for the AIDS Consortium at the Sandfontein clinic in the North West province of South Africa.

All over South Africa, thousands of small community organizations are responding to the HIV/AIDS crisis gripping the country. Many are run by volunteers who look after orphans, deliver food to people too ill to work, and care for the sick. In many cases, the volunteer staff has no formal training, but they care deeply about their neighbors.

These community organizations are the leaders in an epic struggle against HIV and AIDS in South Africa. They are doing what the government cannot seem to do: deliver essential services that directly benefit the millions of people in the country infected and affected by HIV/AIDS.

"If the government of South Africa wants to address HIV issues, then it needs to strengthen community-based organizations," says Gerard Payne, who works for the AIDS Consortium, a national organization that supports thousands of community groups. He says that the HIV/AIDS crisis is the most significant challenge facing South Africa since the transition from apartheid.

The scale of the problem requires a local, grassroots response, and community organizations are doing their best to deliver it. Many are overcommitted and underfunded. "Whether it is through financial resources, whether it is through training, we need to strengthen them, so we can reduce the rate of HIV in this country," Payne says.

Payne has just been to visit one such community organization, where he stood in the dusty courtyard outside a two-room cinderblock house in South Africa's North West province as a dozen high-energy toddlers played and ran around him. Four of the organization's home-based care givers prepared to make their rounds, visiting patients in their homes to help cook, clean, and remind them to take their medication.

Payne's job at the AIDS Consortium is affiliate coordinator, so he visits the community-based organizations, assesses their needs and capabilities, and recommends a course of action to train the staff. Many must learn and implement procedures for raising and managing money, and develop a strategic vision for what the organization can be and where it can go. This helps the community organizations get past simply reacting to the HIV/AIDS crisis and working towards measures that will help improve the situation.

One example is in the care of orphans and vulnerable children in the community. The government of South Africa estimated last year that there are 1.5 million children under 17 directly affected by HIV: one or both parents are dead, or they are living with the virus themselves. With so many children now in need of a place to live, or at least hang out after school, get a meal, and stay out of trouble, it is the community organizations that are struggling to meet this need, many of them without specialized training or adequate funds. "They may be running a program, but have no idea how to really do it properly," Payne says. "So we will help them get training so they can provide counseling and other services that will help the children. We help them get to a level where they have good infrastructure and are rendering quality services." This can include a curriculum to teach "life skills" to young people so they can learn how to prevent HIV.

Treatment literacy

Another essential area where community groups can make a big difference is in helping people living with HIV and AIDS to understand what treatment is available and how to get it—a basic level of knowledge known as "treatment literacy." This is particularly helpful for women, who for reasons related to poverty and discrimination may be unable to get to a clinic or hospital—their families may not give them time, they may not have money to pay for transportation, or they may just simply not know that they are HIV positive and need medication.

Gerard Payne says that even if a patient can get to a hospital, he or she still may not understand what they need to do to stay alive. "Patients go there, the staff does a CD-4 count and gives them some medication, but they do not explain anything," Payne says. "Our objective is to educate organizations how to help patients understand the different treatments needed, and their rights to access treatment."

He adds that educating people about their right to treatment is a big step for many groups that are accustomed to delivering food and other care. "Community-based organizations respond to needs: if someone is sick, they go to them once or twice a week and take care of them," he explains. "We are saying they need to take it a step further. That patient is eventually going to get really ill, so they need to understand what care is available, where to access it, and that they must adhere to the treatment."

Progress in the new struggle

Seeing organizations grow and become more effective is one of the things that keeps Payne engaged in his work. "Last year I had one affiliate with no money, so I helped them get financial management systems in place," Payne says. "The first 1,000 rand [US $125] they raised was due to the fact that we showed them how to open up a bank account and write some letters to raise money."

"The joy and satisfaction I get comes when someone tells me that the work we do is making a difference," Payne says.

Payne says that South Africa is at a crucial stage in its history. "We have come a long was as a country, and struggled through many hardships," he says. "We are now in a different kind of struggle, and I want to be able to feel that I am contributing in the struggle against HIV."

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