Social determinants of HIV in the Eastern Cape

Abstract

This report was prepared for the Eastern Cape Socio Economic Consultative Council to review the Social Determinants of HIV/AIDS in the Eastern Cape with the aim of proposing programmes and research agenda for the scale up of effective HIV prevention. The report is based on a rapid review of available and accessible literature, both published and unpublished ('grey literature'), of HIV/AIDS studies conducted mainly in the Eastern Cape, and secondary analyses of HSRC's national HIV prevalence surveys (SABSSM) and the Department of Health's annual survey of HIV infection in antenatal clinic attendees.

The report addresses the following research questions: *What is the state of HIV/AIDS epidemic in the Eastern Cape Province? *What are the social, economic and political factors that influence HIV and AIDS incidence and prevalence in the Eastern Cape Province? *What are the social and structural factors shaping patterns of risk behaviour in the Eastern Cape, e.g. informal settlements, teenage pregnancy, etc? *How can the knowledge of these factors be used effectively to advise the government to design relevant HIV and AIDS policies and programmes in the Eastern Cape Province? *What are the research gaps and priorities? *What are the key recommendations on priority research areas?

The report shows that HIV prevention remains the most important priority. While there has been substantial media attention focused on the decline in HIV prevalence in some age groups, overall, the levels of infection and the human toll from the epidemic remain unacceptably high. The HIV epidemic continues to expand and there is an urgent need for more effective HIV preventions.

This report also highlights the major social, economic and behavioural factors that drive the epidemic in the Eastern Cape which include culture and social norms, stigma and denial, poverty, labour-related migration, gender-based violence including rape, concurrent multiple sex partners and age mixing patterns.

Further, the report identifies several gaps in information and advocates for more local studies to explore social determinants of HIV infection. The case is made for these studies to explore the general findings from national research but fine tune it for the circumstances found in the Eastern Cape.

This report makes several recommendations, namely: *There is a need to address inadequate HIV and AIDS surveillance systems; *Studies specifically on social determinants of HIV are needed; *Gaps in knowledge of effective prevention strategies should be addressed; and *The impacts of structural interventions (e.g. economic empowerment) should be explored in more detail.

This report has attempted to identify province-specific data on the social determinants of HIV for the Eastern Cape. It is by no means conclusive and has, as might have been predicted, found that the amount of local information is quite limited. However, it is intended as a working document which, with the 'Conference on the Political Economy of HIV and AIDS' to be held in East London from 7-9 March 2010, will be the starting point for more comprehensive analysis in the future.