1. Producing Informality in a post- apartheid Township Theodore Powers Africanist Doctoral Fellow Woodrow Wilson International Center for Scholars ------- Doctoral Candidate CUNY Graduate Center An investigation into the relationship between HIV/AIDS, social development, and informal urban settlements in South Africa

2. The Challenge of HIV/AIDS Locally It seems that politics here is somehow distant from getting involved with the HIV/AIDS issues. And that is the challenge that you are sitting with. They receive funding and we’ve approached them to say that we don’t receive adequate funding. And it’s just like…there’s really a deafness. They are supposed to be part of our meetings. That is one of the challenges that we sit with. Some structures are supposed to be part of the MSAT strategy. They don’t attend meetings at the sub-district level. This is happening all over. Member of MSAT leadership, unspecified sub-district Source: Powers, unpublished dissertation material

3. Structure of the Presentation  Contextualizing the HIV epidemic in South Africa  Informal Settlements in South Africa  The Public Health Crisis and Service Delivery  HIV/AIDS and Contemporary Politics in Khayelitsha  Policy Implications for the Donor Community

4. Global HIV Infection Source: UNAIDS 2007

5. The HIV Epidemic in South Africa  5.5 million infections out of 44.7 million citizens  Adults aged 15 to 49 HIV prevalence rate 18.8%  Percentage of HIV-infected women and men receiving antiretroviral therapy 21.0%  Source: UNAIDS 2006

6. The HIV Epidemic in South Africa Source: Nations Online Project

7. The HIV Epidemic in South Africa Source: SANDoH 2007

8. HIV Prevalence in Cape Town Source: PAWC DoH 2007

9. HIV Prevalence in Cape Town  A strong correlation between the areas where informal settlement is concentrated (Khayelitsha, Gugulethu/Nyanga) and HIV prevalence  This corresponds to national-level studies that point to a strong relationship between HIV prevalence and Informal Settlements

10. HIV Prevalence in Informal Settlements Source: Thomas 2006

11. Informal Settlements in South Africa Photo: Theodore Powers

12. Informal Settlements in South Africa  Peri-urban informal settlements defined by Davis (2006) as key geopolitical spaces as they will be the primary source of the world’s population growth in the 21 st century  Informal settlements were first established during colonial period in South Africa  Expansion of informal settlement with the construction of townships under apartheid in the 1950s

13. Informal Settlements in South Africa  Khayelitsha established in 1983  Originally planned to house 250,000 residents  Current population estimates range from 600,000 to 1 million  Unemployment rates for informal settlements are estimated at 58% - 72% (Richards et al. 2007)  Shift in patterns of migration / movement  Correlation between movement and HIV status

14. The Public Health Crisis They wait months to be put to treatment. And I have been asked what is going on, and I have been told that we don’t have enough staff members, or enough doctors, or nurses to increase the number for the patients to be on treatment. It compromises everything. It paralyzes almost everything. You can go out and mobilize people on testing. When people go to the clinic, they don’t get tested. They take hours to be tested, just tested, for HIV. People who are sick. There is a problem. Community Activist, Site B, Khayelitsha Source: Powers, unpublished dissertation material

15. The Public Health Crisis  “Brain drain” of doctors and nurses to developed countries  Inadequate funding  Lack of institutional capacity  These issues are undermining the fight against HIV/AIDS in South Africa

16. Service Delivery  An average of 105 people per toilet in Sites B & C in Khayelitsha  In Cape Town, there is an estimated housing backlog of 265,000 homes that continues to grow by 16,000 annually  It is estimated that 1/3 of Cape Town’s population lives in informal settlements  Source: Isandla 2007

17. Service Delivery  Cost recovery model utilized by South Africa pushes the cost of infrastructural development onto the community  Policy input primarily technical, has the effect of reducing community participation in policy (Khan 1998)  Heller (2003) argues that the closure of the local policy process has pushed the civics movement into local representative structures

18. Service Delivery and Local Government  My research asks what effect, if any, has the shift described by Heller had on the implementation of HIV/AIDS policies?  Has the shift towards highly technical policies and loss of local political autonomy pushed the civics to “capture” local representative structures in order to maintain influence on, and control over, their communities?  And if so, what are the implications of this process for HIV/AIDS policy in South Africa and for the donor community?

19. Western Cape HIV/AIDS Coordinating Structures Source: Isandla 2007

20. Western Cape HIV/AIDS Coordinating Structures  MSATs, much like the City Coordinating Committee, have had difficulty securing commitment from sector departments, have experienced a lack of participation from health officials, and generally lack capacity to fulfill their mandate  Members of the Khayelitsha MSAT described a lack of cooperation from the Khayelitsha health forum

21. Western Cape HIV/AIDS Coordinating Structures  The inability of the Khayelitsha MSAT and the Khayelitsha Health Forum to work together means that the city and the community cannot effectively coordinate HIV/AIDS policy  The question that remains unresolved in this formulation is why the community structure, the Khayelitsha Health Forum, is not working with the formal coordinating structure, the MSAT

22. South African National Civic Organization (SANCO)  Founded in 1992 out of township-based civic structures  6.3 million members in 43 branches in South Africa  New structure characterized as ‘hierarchical’ and ‘corporatist’ (Zuern 2001, Heller 2003)  Privatization of service delivery and consequent closure of participatory policy development has pushed SANCO to “capture” local representative structures (Heller 2003)  Post-apartheid role of intermediary between communities and the ANC (Zuern 2006)

23. The Treatment Action Campaign  Founded on December 10, 1998  Successful campaigns to lower prices for key pharmaceuticals and expand access to ART  Focus on access to HIV/AIDS treatment as a human right  Vocal critic of the HIV ‘dissident’ position of President Thabo Mbeki  Key driver of the re-structured SANAC and the implementation of the NSP Photo: Theodore Powers

24. Contemporary Politics in Khayelitsha Photo: Jacqueline Greene

25. Contemporary Politics in Khayelitsha  The Treatment Action Campaign has been labeled by members of the ANC as a tool of pharmaceutical companies  Members of the Treatment Action Campaign have called for the ANC leadership to be tried for genocide due to their position on HIV/AIDS

26. Contemporary Politics in Khayelitsha  The fact that SANCO’s political survival is intertwined with that of the ANC has meant that the attacks on the ANC by the Treatment Action Campaign have caused a rift between the two key actors for community organization for HIV/AIDS in Khayelitsha.  There is therefore, a split in civil society that is creating a huge challenge to effective coordination and implementation of HIV/AIDS policies in Khayelitsha and throughout South Africa.

27. Contemporary Politics in Khayelitsha  TP: So what effect does SANCO have on the community? I mean, do they have a big influence on what people think and the way that they act?  KHAYE-001: They have a big influence on the people in the community.  TP: How do they have an influence?  KHAYE-001: They are the one that is bringing development. If there is anything that is going to take place or be built in that area, it should start through their meetings. Source: Powers, unpublished dissertation material

28. Contemporary Politics in Khayelitsha  TP: So it’s through SANCO?  KHAYE-001: Ja, and they should agree as SANCO members before they go, there’s an exco meeting, and they should agree at that exco meeting before they call a general meeting for the whole area to understand what is going on to tell the community. […]  TP: But it’s within SANCO structures that they decide that?  KHAYE-001: Ja. They don’t decide that with everyone in the community. They will decide that. You can’t just go there and be a speaker. You have to consult uSANCO, and if uSANCO is happy with what you are going to do, they are going to say it’s fine, build it, or do it. And if they are not happy, they will point you to that direction and point you to that direction and point you to that direction and you end up losing… Source: Powers, unpublished dissertation material

29. Contemporary Politics in Khayelitsha  SANCO serves as the primary community feedback mechanism from the community to the local political leadership in Harare  Community members who are not accepted by members of SANCO are essentially excluded from local representative structures  SANCO controls local structures in Harare and it is able to stifle critical input from community members at the most local of levels: the street or ward committee

30. Contemporary Politics in Khayelitsha Zones of political constituency in Harare, Khayelitsha Source: Powers, unpublished dissertation material

31. Contemporary Politics in Khayelitsha   The larger green-outlined area to the left represents the ANC constituency area   The orange-outlined section to the left represents the constituency zone for the Independent Democrats (ID)   The unmarked area in the middle is a contested and mixed political zone

32. Uneven spatial development in Harare All the projects that came for Harare it’s only for that area. There is a Score, there is a sports center, there’s a community hospital in that area. Community Activist, Harare, Khayelitsha Source: Powers, unpublished dissertation material

33. Uneven spatial development in Harare Zones of political constituency and social development projects in Harare, Khayelitsha Source: Powers, unpublished dissertation material

34. Uneven spatial development in Harare   The yellow dots represent churches or crèches   The orange dots are income-generating projects and are clustered at Lingilethu West Shopping Center   The blue square is a police station   The cross represents a community clinic   The large S represents an elementary school   Focus on post-apartheid projects

35. Uneven spatial development in Harare Source: VPUU Current distribution of businesses within the Harare and Kuyasa Safe Node Areas

36. Uneven spatial development in Harare  Harare Draft Urban Design (VPUU)  Connects Khayelitsha Business District (iLitha Park) to Lingilethu West Shopping Center (Harare)  Includes craft markets, sporting grounds, schools, small enterprise centers, housing

37. Uneven spatial development in Harare Location of VPUU “Harare Draft Urban Design” superimposed on Harare Political Constituency Areas with location of social development projects Source: Powers, unpublished dissertation material

38. Uneven spatial development in Harare   The correlation here between the location of the Harare draft urban design and the ANC constituency area is quite strong

39. Uneven spatial development in Harare Source: VPUU Ideal business locations for “would be” business owners in the two Safe Node Areas.

40. Uneven spatial development in Harare  The survey work conducted by VPUU indicates that the social development projects initiated in ANC constituency areas will be key drivers of future businesses and employment in Harare  If current trends continue, there will be uneven development in Harare with negative effects for opposition political areas that will be driven by entrepreneurs and market forces rather than overt political support for constituent areas

41. Uneven spatial development in Harare There is more jobs on those projects and if you try to understand, which area people are working in, they are from. You will find they are from in the same area where there is a shopping mall, there’s a shopping center, there’s a craft market. You won’t find people that are from this area that are working there. -Community Activist, Harare, Khayelitsha Source: Powers, unpublished dissertation material

42. Policy Implications for the Donor Community Photo: Theodore Powers

43. Policy Implications for the Donor Community   1) Capacitate the existing institutional framework by expanding the role of community in the MSAT and create a Local Aids Council that serves the interest of civil society, community-based organizations and international donors   Pros: Demand from the community for this approach; financial support for civics could create greater organizational autonomy   Cons: Given the political dynamics described above, maintaining institutional autonomy may prove to be difficult

44. Policy Implications for the Donor Community   2) Create an autonomous feedback mechanism involving civil society organizations so that the impact of these political processes and an objective needs assessment can be incorporated into the planning process for donors   Pros: Donors will receive more detailed data concerning the political realities as they exist in particular areas   Cons: Selecting specific non-governmental or community-based organizations to serve as feedback mechanisms could exacerbate existing political tensions

45. Policy Implications for the Donor Community   3) Utilization of Geographic Information Systems (GIS) as a consultative policy tool with communities could be an effective and efficient way to measure the extent to which uneven socio-spatial development is occurring with social development projects as well as the response to HIV/AIDS  Pros: This would give donors the ability to track geographic development and counteract uneven development  Cons: GIS could serve to disempower communities from contributing substantive input on local policy as it favors technical expertise over “local” forms of knowledge

46. A final word from Khayelitsha In South Africa, it is easy for us to challenge the government, to criticize the government, to do many things without fearing that the government is going to intimidate us, arrest us…you know? There is change, compared to before 1994. But the change, it is supposed to be felt by people on the ground. Economically speaking, it is not being felt by people on the ground. What’s the point of becoming free, or being free, when you are homeless, when you are jobless, when you are dying from AIDS? Community Activist, Site B, Khayelitsha Source: Powers, unpublished dissertation material

47. For further information please contact: Theodore Powers powers.theodore@gmail.com