THE RESPONSE TO HIV & AIDS AT UCT. Report to Council: March Prepared by HAICU for Professor Crain Soudien, Deputy Vice-Chancellor

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1 THE RESPONSE TO HIV & AIDS AT UCT Report to Council: March 2012 Prepared by HAICU for Professor Crain Soudien, Deputy Vice-Chancellor

2 Contents Executive Summary 3 Introduction 3 Conclusion 15 References 17 Appendix A: Leadership, Policy, Management and Service Provision 19 Appendix B: Curriculum Responsiveness 24 Appendix C: Research Development 34 Appendix D: Social Responsiveness, Consulting and Materials Development 88 Appendix E: UCT Policy on HIV Infection and AIDS 98 Appendix F: Revised Needlestick Injuries Policy 101 Appendix G: Addendum to Needlestick Injuries Policy 108 2

3 Report to Council Executive Summary Introduction The purpose of the 2011 survey of HIV and AIDS initiatives at the University of Cape Town (UCT) is to comprehensively record the response of the institution to the pandemic. Findings have been summarised from an annual mapping exercise conducted by the HIV/AIDS Institutional Coordination Unit (HAICU), which is part of the Transformation Services Office (TSO), based within the Office of the Vice-Chancellor (OVC). From 2012 onwards, as part of the 2013 presentation, this report will form part of the TSO report and will not include HIV & AIDS research (which will be available in the UCT research report) or social responsiveness (available in the social responsiveness report). It will only include HIV & AIDS management and teaching. Activities are included that were undertaken during the year Where 2010 articles are listed, this is because they were awaiting publication when the previous report was submitted to the UCT Council and were therefore excluded. UCT s HIV and AIDS-related initiatives have been benchmarked against international, regional and national criteria. The same documents mostly published by the Higher Education HIV/AIDS Programme (HEAIDS) in 2010 have been used to inform this content as those utilized when compiling the previous report. They are listed below: Hanson, S. (in press). Good practice HIV/AIDS prevention strategies for public higher education institutions in South Africa. A desktop review. Higher Education HIV/AIDS Programme HEAIDS strategic framework and beyond. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Policy framework on HIV and AIDS for higher education in South Africa. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Creating space for HIV and AIDS in the curriculum: a rapid assessment of curricular responses in South African higher education institutions. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Development and implementation support for HIV and AIDS workplace programmes at 23 public higher education institutions in South Africa. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Findings of the study on HIV prevalence and related factors at the University of Cape Town, Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Framework for HIV and AIDS workplace programmes for higher education in South Africa. Pretoria: Higher Education South Africa. 3

4 Higher Education HIV/AIDS Programme Full report the roles of educators in mitigating the impact of the HIV/AIDS pandemic on the education system in South Africa, December Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme HIV prevalence and related factors - higher education sector study, South Africa, Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme International and local good practice in workplace HIV and AIDS programmes - a desktop review. Pretoria: Higher Education South Africa. Joint United Nations Programme on HIV/AIDS (UNAIDS) Global report: UNAIDS report on the global AIDS epidemic Switzerland: UNAIDS. Kelly, M External observer s report: the response of the University of Cape Town to HIV and AIDS, UCT HIV/AIDS colloquium. Cape Town, South Africa, November Unpublished. Moodley, I. (in press). Development of sustainable funding models and mechanisms with respect to a comprehensive HIV and AIDS programme in the higher education sub-sector a draft institutional visit report on UCT. The intention of this Report to Council is to reflect on accomplishments in the HIV and AIDS field and to critically assess the challenges facing the University. Global, National and Institutional HIV Prevalence In 2009, according to UNAIDS, there were 33.3 million people living globally with HIV, 22.5 million of whom live in sub-saharan Africa. Globally in 2009, there were an estimated 2.6 million people who became newly infected with HIV, with 1.8 million of these new infections occurring in sub-saharan Africa. Additionally, there were 1.3 million deaths from HIV in sub-saharan Africa 1. An estimated 5.6 million people were living with HIV in South Africa in 2009 the highest proportion of a population of any country in the world. However, there are indications of a slowing of HIV incidence, as more young people are adopting safe sex practices: the annual HIV incidence among 18 year olds declined from 1.8% in 2005 to 0.8% in 2008, and among year old women from 5.5% in to 2.2% in In March 2010, HEAIDS released the findings of South Africa s first national HIV prevalence survey 3 of tertiary institutions. The 2008/2009 survey revealed a national HIV prevalence of 1.5% amongst academic staff, 4.4% amongst administrative staff and 12.2% amongst service staff. 1 and 2 Joint United Nations Programme on HIV/AIDS (UNAIDS) Global Report: UNAIDS Report on the Global AIDS Epidemic Switzerland: UNAIDS. 3 and 4 Higher Education HIV/AIDS Programme HIV Prevalence and Related Factors - Higher Education Sector Study, South Africa, Pretoria: Higher Education South Africa. 4

5 Of the 65% of students who reported ever having had sex, prevalence was given as 3.8%. Prevalence amongst female students was given as 4.7% and amongst males only 1.5%. Prevalence was higher amongst older students: 0.7% for year olds; 2.3% for year olds; and 8.3% for those over 25 years. These figures correlate with the sexual histories of students at UCT. HEAIDS reported that 48% of students aged 18 years had had sex before starting at UCT, rising to 65% among 20 year olds, and 74% among those older than 20 years i.e. many students have sex for the first time at university, when away from parental guidance. Of students, 6% of males and 3% of females had had more than one partner in the last month, while the rates for staff were 4% and 1% respectively. HEAIDS reported prevalence at UCT amongst students and staff to be 0.2%, with the highest prevalence amongst administrative staff at 1.3%. A total of 31 students and 25 admin/service staff at UCT were reported as living with HIV 4. Reassured by this low prevalence, UCT recommitted itself to initiatives that have served to prevent transmission, whilst supporting those already affected and infected by the virus. HEAIDS also reported that condom use was higher among students and staff who had had more than one sexual partner in the past year, in comparison to those with only one partner. Forty-eight percent of students and three quarters of staff had ever been tested for HIV. With more than 50% of student respondents reporting they had been drunk in the past month, it is important for the institution to recognise the link between alcohol use and sexual experimentation. There is also an ongoing need to create awareness of the high incidence of sexually transmitted infections (STIs) and unplanned pregnancies the prevalence of HIV was higher amongst persons reporting an STI 5. In response to this concern, HAICU again hosted (as in 2010) a public discussion in residence to create awareness of the Human Papilloma Virus (HPV) and the availability of vaccines. According to the HEAIDS survey, a perception of stigma continues to prevail at UCT. Only 50% of students, 58% of academic and service staff, and 41% of administrative staff feel that they would be supported by their friends at the institution if they were to disclose an HIV-positive status. Update on South African Higher Education initiatives HEAIDS 6 exists to develop and strengthen the capacity, systems and structures of all Higher Education Institutions (HEIs) to prevent, manage and mitigate the causes, challenges and consequences of HIV/AIDS. It stresses that Higher Education (HE) in South Africa has a vital role to play in mitigating and managing the effects of the HIV/AIDS epidemic through all aspects of its core operations of teaching, learning, research and community engagement 7. 4 Higher Education HIV/AIDS Programme Findings of the Study on HIV Prevalence and Related Factors at the University of Cape Town, Pretoria: Higher Education South Africa. 5 Ditto. 6 Available at: 7 Higher Education HIV/AIDS Programme Policy Framework on HIV and AIDS for Higher Education in South Africa. Pretoria: Higher Education South Africa. 5

6 With this in mind, it has identified the components of a comprehensive HIV response in relation to the teaching, training, research, community engagement and service functions of HEIs: a) Defined roles and responsibilities, and a developed policy; b) Support for human resource capacities and development of systems; c) Institutional-level development of norms and standards for sustainable funding models and mechanisms; d) Identifying and clarifying a role for educators and teacher education faculties; e) Identification and replication of best practice with respect to prevention, behavioural change, care and support, gender and curriculum integration; f) Support and strengthening of knowledge generation, assimilation and dissemination with respect to HIV and AIDS. UCT s Response This executive summary details four distinct components under review at UCT: A) Leadership, Policy, Management and Service Provision; B) Curriculum Responsiveness; C) Research Development; D) Social Responsiveness, Consulting and Materials Development. The summary report is augmented by appendices A to D (corresponding to the above), which provide a greater depth of analysis. Although every effort has been made to report comprehensively, there may be omissions. The UCT Policy on HIV Infection and AIDS: A Co-ordinated Response to HIV and AIDS 8, approved by UCT Council in November 2006, is provided in Appendix E. Appendices F and G detail the components of UCT s Needlestick Injuries Policy. A. Leadership, Policy, Management and Service Provision A i) Leadership and Policy The Office of the Vice-Chancellor (OVC) is responsible for UCT s HIV and AIDS policy. Accountability for policy implementation rests with Professor Crain Soudien, the Deputy Vice-Chancellor responsible for institutional transformation. The HIV and AIDS Institutional Coordination Unit (HAICU), situated within the Transformation Services Office (TSO), coordinates aspects of the institutional response, outlined in the UCT Policy on HIV Infection and AIDS. UCT s response is also informed by a policy on occupational post-exposure prophylaxis (PEP) entitled the UCT Needlestick Injuries Policy 9. 8 UCT The UCT Policy on HIV Infection and AIDS: A Co-ordinated Response to HIV/AIDS. Approved by Council, November Available at: 9 UCT Policy for the procedures to follow in the event of staff and students who have been exposed to blood and body fluids in the course of carrying out their duties. (UCT post-exposure prophylaxis policy). Available at: 6

7 The HIV/AIDS Policy Implementation (HAPI) Group meets quarterly to provide technical expertise and guidance from departments officially tasked with aspects of HIV/AIDS policy implementation and serves to enable an ongoing review and updating of policy. Policy implementation is the responsibility of HAICU, the Student Wellness Service SWS), Human Resources, Health and Safety, Communications and Marketing, Research and Innovation and the Faculties. The HEAIDS UCT prevalence report 10 indicates that most respondents felt that University management takes the problem of HIV and AIDS seriously. HEAIDS acknowledges that management at UCT is prioritising a response to the HIV pandemic. Benchmark HEAIDS calls for an established and functioning decision-making HIV and AIDS steering committee or task team, and this committee should have influence and representation on each campus with clear lines of responsibility. These should have annual workplans with clear targets and commitments, so that there can be greater accountability to performance. UCT s HAPI group responds to this need. Furthermore, HEAIDS stresses that strong institutional leadership is required for an effective response. It urges leadership to lead by example and that this ethos should be an integral component of a response 11. HEAIDS 12 asserts that HEIs must as employers recognise the potential impact of HIV and AIDS on both infected and affected employees and design policies and programmes to prevent/reduce infection rates and mitigate its impact on employees and the institution. Secondly, as institutions of teaching, learning, research and knowledge generation contributing to the next generation of future workers, managers and business leaders, HEIs need to develop proactive strategies focusing on prevention and on prolonging life through quality treatment, care and support to protect the investment capital that institutions are expending in preparing potential graduates for the open labour market. Service and contracted staff in particular, asserts HEAIDS, should be included in the response to HIV. It emphasises the need for companies that provide outsourced staff to take on board the institutional values and rights related to health and HIV and AIDS, through some form of HIV compliance policy. HEAIDS 13 states that there is a need for intensive and collaborative efforts to rationalise UCT s HIV programmes and services. UCT s response is to involve HAICU, SWS, Human Resources and staff and student associations and to include people living with HIV. 10 Higher Education HIV/AIDS Programme Findings of the study on HIV prevalence and related factors at the University of Cape Town, Pretoria: Higher Education HIV and AIDS Programme. 11 Higher Education HIV/AIDS Programme HIV Prevalence and Related Factors - Higher Education Sector Study, South Africa, Pretoria: Higher Education South Africa. 12 Higher Education HIV/AIDS Programme Framework for HIV and AIDS Workplace Programmes for Higher Education in South Africa. Pretoria: Higher Education South Africa. 13 Higher Education HIV/AIDS Programme HIV Prevalence and Related Factors - Higher Education Sector Study, South Africa, Pretoria: Higher Education South Africa. 7

8 A ii) Management and Service Provision Students HIV/AIDS Institutional Co-ordination Unit (HAICU) During 2011 HAICU conducted its core activities, which are aligned to the HEAIDS Good Practice recommendations 14. The Unit disseminated information about HIV to all students and staff through social marketing campaigns and events, as well as its peer education (PE) programme. HIV information was distributed to students during the Orientation period, and different aspects of HIV including stigma, concurrent sexual relationships and gender issues were explored during the year, through public events and a series of residence workshops. Further details of HAICU s activities and programmes appear in appendix A (Aii). Student Wellness Service (SWS) Student Wellness Service (SWS), the campus health service, provides students with HIV counseling and testing and clinical management of HIV, including treatment of opportunistic infections and referral for ARVs. SWS also prioritized the identification and treatment of STIs. 4,996 persons, mostly students, tested for HIV in 2011; 3,124 by HIV testing drives, 628 by mobile unit, 1,146 by drop-in and 98 at SWS. Twenty students tested HIVpositive and all students and staff received post-test counselling. Approximately 25 students were provided with support for OI therapy and were under the health management of SWS, receiving CD4 cell counts, RPR tests and other necessary investigations. A total of 274,100 male condoms and 3,500 female condoms were distributed by SWS in Staff Human Resources (HR) UCT s HIV/AIDS Workplace Programme Staff were provided with HIV testing as part of a holistic package of care at wellness screenings at the following Faculties in 2011: Humanities; SATVI; CHED; Science; Bremner; EBE; Libraries; Wellness Fair at FoHS; Commerce; and an additional Wellness Fair and Pensioner Wellness Fair. Three further faculty screenings were to be confirmed at the time of reporting. A total of 1,145 staff attended the screenings and 1,044 tested for HIV by opt-out, including 127 outsourced staff; in total, 91.18% staff were screened. Staff indicated that they wanted more fairs available during the course of the year. Additionally, staff were able to utilise the two HIV testing drives provided by SWS and its drop-in service at the UCT Sports Centre. A TB and STI risk assessment questionnaire was under review in 2011 and a new assessment questionnaire is to be piloted by nurses in Also, in the year under 14 Hanson, S. (in press). Good Practice HIV/AIDS Prevention Strategies for Public Higher Education Institutions in South Africa. A Desktop Review. 8

9 review, a TB awareness session was held in the Commerce Faculty and 20 staff members attended, consisting of 3 academics and 17 PASS staff. Thirty-nine staff and 6 dependents were utilising the HIV/AIDS Chronic Disease Management (CDM) Programme of Discovery Health in 2011, whilst one new case was referred for EAP counselling; HIV constituted 0.4% of these referrals. Additionally, there has been an increase in the number of staff referred for counselling. Health and Safety A statutory medical assessment protocol is applied for designated jobs as legally required. Risk management and placement procedures are followed for immunecompromised staff and those exposed to immune suppressants and/or infectious materials. Set protocols are followed, determined by person factors (immunecompromised state and job factors; exposure to risk; and exposure to hazardous biological agents that compromise immunity). Additionally, 99% of UCT s outside contractors comply with the institution s Safety, Health and Environmental (SHE) policies. Health and Safety continued in 2011 to train staff in first aid, and a section of the syllabus of Level 1 first aid training is devoted to universal precautions. Staff who sustained needlestick injuries were placed on ARVs, whilst students were referred to the Groote Schuur Hospital (GSH) Occupational Health Clinic (OHC). Both the Needlestick Injuries Policy and an Addendum are available on the UCT website at Benchmark HEAIDS notes that service staff, the most affected by HIV and AIDS at HEIs, have been largely overlooked in campus prevention, care and support programmes. With this in mind, HEAIDS advises university human resource departments to directly engage in HIV and AIDS response programmes: especially considering that on all campuses highest HIV prevalence is found in service staff 15. HEAIDS 16 emphasises the direct influence that HIV and AIDS have on human resource development: Students, representing a source of the future skills and knowledge base of the country, are hence a high priority as they are at risk themselves and the peers of those that are most susceptible and vulnerable to infection. HEAIDS adds that it is important not to lose the most valuable and productive members of the economy. Moodley 17 (in press) proposes an holistic response for staff, which includes the following: the co-ordination and implementation of programmes; education and training; HIV/AIDS and legal issues; testing; confidentiality; employment issues, such 15 Higher Education HIV/AIDS Programme HIV Prevalence and Related Factors - Higher Education Sector Study, South Africa, Pretoria: Higher Education South Africa. 16 Higher Education HIV/AIDS Programme Policy Framework on HIV and AIDS for Higher Education in South Africa. Pretoria: Higher Education South Africa. 17 Moodley, I. (in press). Development of Sustainable Funding Models and Mechanisms With Respect to a Comprehensive HIV and AIDS Programme in the Higher Education Sub-Sector a Draft Institutional Visit Report on UCT. 9

10 as incapacity, termination of services, etc; promotion of a safe working environment; compensation for occupational acquired HIV; employee benefits and provision of care; response to other employees; and a procedure for dispute resolution and grievances related to HIV and AIDS-related issues. B. Curriculum Responsiveness UCT faculties have adopted a number of different approaches to the integration of HIV and AIDS into the formal curriculum, including formal course components and modules. Kelly (2006) 18, a renowned educationalist, warns of the dangers of being satisfied with cosmetic responses that incorporate useful additions in the curriculum, but do not go far enough in developing the commitment, academic understanding and analytic ability that mastering HIV and AIDS requires. HEAIDS, in its strategic framework 19 ( ), indicates that students should be exposed to the following: Knowing how to keep themselves healthy; Understanding the gender dimension of HIV transmission and the role of women in sexual decision-making; Intellectual debate and inquiry about the medical, social, demographic and economic issues relating to HIV and AIDS; An informed understanding of how HIV and AIDS will affect their future professional careers; The implications of managing HIV and AIDS in universities and work places; The potential impact of HIV and AIDS on the economic and social development of South Africa and the world; Developing a caring, tolerant, and non-discriminatory approach to persons living with HIV and AIDS; and Engaging with the wider community. HEAIDS 20 notes that successful integration calls for innovative and participatory approaches to teaching and learning, as well as sufficient knowledge about HIV and AIDS. It states that staff development needs to be at the centre of HIV/AIDS curriculum integration initiatives and that there is a corresponding need to research a variety of teaching interventions, curriculum models and conceptualisations. HEAIDS 21 warns that without any clear mandate to address HIV/AIDS in teaching, and no clear set of anticipated outcomes, it is possible that initiatives in this area will simply become watered down or not accounted for (or evaluated) in teaching. The ongoing drive to develop and implement HIV and AIDS curricula and co-curricula activities across the institution is aligned to the University s strategic goal of making sure its graduates are AIDS-competent. With this in mind, there are compulsory and examinable HIV and AIDS-related courses for all first-year students in the Faculties of Commerce and Health Sciences and both these courses operate from the premise 18 Kelly, M External Observer s Report: the Response of the University of Cape Town to HIV and AIDS, UCT HIV/AIDS Colloquium. Cape Town, South Africa, November Unpublished. 19 Higher Education HIV/AIDS Programme HEAIDS Strategic Framework and Beyond. Pretoria: Higher Education South Africa. 20 Higher Education HIV/AIDS Programme Creating Space for HIV and AIDS in the Curriculum: A Rapid Assessment of Curricular Responses in South African Higher Education Institutions. Pretoria: Higher Education South Africa. 21 Ditto. 10

11 of developing critical thinking skills. External evaluations 22&23 of the two courses show they make a significant contribution to creating AIDS-competent UCT graduates. Health Sciences students also receive formal teaching on HIV and AIDS throughout the curricula, with MBChB students in particular receiving clinical exposure to HIV/AIDS through medicine lectures, tutorials and bedside teaching, which includes input from the Division of Clinical Pharmacology. Additionally, within the Commerce Faculty, a 3 lecture HIV component was taught in 2011 by HAICU as part of the Management Studies 4050 course. HIV and AIDS-related modules are also offered within the Humanities Faculty, in the African Gender Institute, Education, Historical Studies, Psychology, Social Anthropology, Sociology and Social Development. The Science Faculty explores biological, chemical, molecular, cellular and environmental aspects of HIV in certain courses. During 2011 the Law Faculty offered an elective regarding human rights law, which looked at the provision of ARVs to pregnant women living with HIV, and for the first time all first-year law students attended HAICU s O-Week HIV awareness workshops. There are still no compulsory, examinable HIV/AIDS-related courses that reach all first-year students in Law, Humanities, Science or Engineering & the Built Environment (EBE), despite pilot prgrammes being conducted in 2010 in the latter two faculties. With the objective of again reaching EBE Faculty students with important information on HIV and AIDS and the workplace, HAICU in 2011 arranged an additional pilot workshop for third year students. This took the form of an incentivized competition, in which students attended a half-day workshop before designing a PowerPoint about responding effectively to HIV in the EBE workplace. Students who attended the workshop were provided with knowledge and understanding of HIV-related issues pertaining to labour law, HR practice and the way other related issues impact on the broader engineering and construction industries in South Africa. The pilot was intended to provide for students at UCT in an important area of study beyond the restrictive confines of their core course of study, in an attempt to produce graduates who are reflective, empathic and AIDS-competent engineering professionals who understand the relevance of HIV to the workplace and who can make wise choices personally and professionally. There was no progress on implementation of a course component in the Science Faculty, despite a pilot initiated by HAICU in 2010 and an encouraging meeting of the CUES Faculty meeting in which HAICU presented the pilot report. Ad hoc curricula development and implementation by HAICU in response to departmental requests took place on an ongoing basis during These interventions included lectures about HIV-related issues in the workplace to 22 Lomofsky, D. Chames, C. Twaii, C. and Norushe, T Evaluation of the Implementation of the EBE Students Pilot HIV Course at the University of Cape Town. Southern Hemisphere Consultants. 23 Lomofsky, D. Chames, C. Twaii, C. and Norushe, T Evaluation of the Implementation of the Science Students Pilot HIV Course at the University of Cape Town. Southern Hemisphere Consultants. 11

12 construction engineering students and library studies students, as well as lectures about social marketing to postgraduate industrial psychology students. Hanson 24 (2009) suggests that faculties may be reluctant to incorporate HIV into their courses for a number of reasons, including the fact that they may not be totally comfortable with the subject: To catalyze students into deeply thinking about the problem of HIV/AIDS for themselves, their families, and society, faculty must be paramount role models who demonstrate excitement about the ideas being discussed. Benchmark HEAIDS has encouraged UCT to increase its integration of HIV and AIDS into academic programmes. It maintains that the HE sector is well positioned, through teaching and learning activities, to play a fundamental role in developing leaders who will shape future economies, communities and governments. It is an imperative for the HE sub-sector to produce high-calibre leaders and quality graduates competent to manage and control HIV/AIDS within their respective professions, hence calling for the mainstreaming of both professional and personal aspects of HIV/AIDS into each institutional learning programme 25. The imperative is expressed by HEAIDS for the development of various relevant professional and personal (HIV) skills (knowledge and values) regarding HIV/AIDS issues (to be) integrated widely, variedly and comprehensively in appropriate curricula 26. It also suggests that an in-service training programme would allow staff and students to demonstrate their professional and personal knowledge and skills regarding safe behaviour towards themselves and towards others. Additionally, HEAIDS recommends that AIDS-related engagement with and service to society should be incorporated into professional programme requirements. Staff should also, states HEAIDS, receive sufficient information and education to be able to effectively and fully integrate a relevant HIV and AIDS component into the curriculum, examining the issue of high-risk sexual behaviour. Moodley 27 maintains the minimum norms and standards for curriculum integration should comprise: a) an undergraduate course equivalent to four credits spread out over an entire degree; and b) a postgraduate course equivalent to four credits integrated into existing degree, including a research project. 24 Hanson, S. (in press). Good Practice HIV/AIDS Prevention Strategies for Public Higher Education Institutions in South Africa. A Desktop Review. 25 Higher Education HIV/AIDS Programme HEAIDS Strategic Framework and Beyond. Pretoria: Higher Education South Africa. 26 Higher Education HIV/AIDS Programme Policy Framework on HIV and AIDS for Higher Education in South Africa. Pretoria: Higher Education South Africa. 27 Moodley, I. (in press). Development of Sustainable Funding Models and Mechanisms With Respect to a Comprehensive HIV and AIDS Programme in the Higher Education Sub-Sector a Draft Institutional Visit Report on UCT. 12

13 C. Research Development A significant number of HIV and AIDS-related research projects were conducted during 2011, making important contributions to the way in which HIV is addressed in South Africa and the global community. The AIDS and Society Research Unit (ASRU), within the Centre for Social Science Research (CSSR), produced a diverse range of research and working papers and the Centre for Actuarial Research (CARe) modeled the impact of the epidemic. The Children s Institute, Paediatric Infectious Diseases, Red Cross Children s Hospital and the School of Child and Adolescent Health (SCAH) investigated childfocused interventions, mainly concerning the prevention of mother-to-child transmission (PMTCT), antiretroviral therapy (ART) and the association with TB. The Institute of Infectious Disease and Molecular Medicine (IIDMM) continued with its groundbreaking research into diagnostics, multi-drug resistance, vaccines, and the relationship between HIV infection and cervical human papilloma virus, as well as tuberculosis and other opportunistic infections. The Desmond Tutu HIV Centre (DTHC) within the IIDMM and the Division of Public Health investigated HIV testing, treatment, microbicides and vaccines. A number of other UCT departments and researchers were involved in various studies that are described in the appendices of this executive summary. Benchmark HEAIDS asserts that staff and research students should be encouraged to conduct policy and strategy-relevant research on HIV and AIDS issues 28. The HE sector is described by HEAIDS 29 as charged with the mandate of generating new technologies, practices, and understanding through research. HEAIDS 30 encourages both externally and internally oriented research, focusing equally on the knowledge, understanding and information needs of society, as well as on the needs of the sector itself. It identifies the importance of generating new knowledge about how to address HIV/AIDS in the higher education sector 31. UNESCO 32 describes promising examples of research programmes contributing to national policies and programmes at 12 reviewed HEIs. It describes an extensive dissemination of research internationally, but bemoans the lack of information sharing on HIV and AIDS research and related services and the lack of a mechanism to monitor and track the output of HIV-related research. Furthermore, UNESCO adds, research is mostly motivated by donor demands, personal interests of 28 Higher Education HIV/AIDS Programme International and Local Good Practice in Workplace HIV and AIDS Programmes - A Desktop Review. Pretoria: Higher Education South Africa. 29 Higher Education HIV/AIDS Programme Policy Framework on HIV and AIDS for Higher Education in South Africa. Pretoria: Higher Education South Africa. 30 Higher Education HIV/AIDS Programme HEAIDS Strategic Framework and Beyond. Pretoria: Higher Education South Africa. 31 Higher Education HIV/AIDS Programme Policy Framework on HIV and AIDS for Higher Education in South Africa. Pretoria: Higher Education South Africa. 32 UNESCO Expanding the Field of Inquiry: a Cross-Country Study of Higher Education Institutions Responses to HIV and AIDS. [Internet] UNESCO: Paris. Available at: [Accessed 25 November 2009]. 13

14 academic staff and demands from policy-makers. Institutions fail to collaborate internally, focusing rather on external partnerships and biomedical research in particular. D. Social Responsiveness, Consulting and Materials Development This section outlines the scope and diversity of many of UCT s HIV-related social responsiveness initiatives, and associated consulting and materials development undertaken by staff. Outreach initiatives relate to curriculum and research projects, as well as to co-curricula responses that deal directly with HIV. For example, the Desmond Tutu HIV Centre s mobile clinic, the Tutu Tester, provides HIV testing, as well as screening for other common chronic diseases, by travelling to many under-serviced communities in greater Cape Town. The GSH HIV Mental Health Group runs clinics that focus on psychosocial interventions related to PLWHA. Benchmark UNESCO 33 describes community outreach at institutions as a practical component of students academic programme, and part of their research, training and education. It adds that HIV and AIDS awareness-raising activities for nearby secondary schools are also common. Some institutions also target at-risk populations, such as the gay community and sex workers. However, outreach to persons affected and infected by HIV and AIDS was rare reflecting the preoccupation on prevention. HEAIDS 34 highlights the importance of engagement with the community by staff, students and civil society, in a two-way flow of expertise and support, which emphasizes partnerships and sponsorship programmes. It states that the sector has a vital responsibility to provide intellectual leadership and therewith produce informed and empowered individuals in communities, as well as in the country as a whole. HEAIDS suggests an institution could investigate ways in which the surrounding community may benefit from the HIV and AIDS curricula and applied and operational research-based learning. A number of academic programmes at UCT involve outreach activities, providing a symbiotic relationship between curriculum developers, researchers, students and surrounding communities. These programmes, which have a strong academic, research or consulting emphasis, are listed under departmental responses to HIV and AIDS. HEAIDS 35 stresses the importance of targeted prevention, care and support; a sustainable health and wellness approach that provides comprehensive support services to staff and students through a combination of in-house and referral systems, and the development of an effective workplace programme for employees. It indicates the following may be included: peer education; HIV counseling and testing (HCT); programmes to address gender based violence and 33 Ditto. 34 Higher Education HIV/AIDS Programme HEAIDS Strategic Framework and Beyond. Pretoria: Higher Education South Africa. 35 Higher Education HIV/AIDS Programme Policy Framework on HIV and AIDS for Higher Education in South Africa. Pretoria: Higher Education South Africa. 14

15 promote gender equity; alcohol and substance abuse prevention training; and education and behaviour change informed by research and good practice. UNESCO 36 emphasises that peer education (PE) programmes require the appropriate level of training, support and supervision. It indicates that the PE programmes of HEIs have succeeded in expanding HIV preventive education and health promotion, and developing life skills and psychosocial competencies among members. However, it warns that the PE approaches may lack depth and coverage of information, only focusing on prevention to the detriment of, for example, stigma and care for people living with HIV. At UCT, peer educators are utilized for prevention, gender, relationship, anti-stigma and treatment information workshops. Conclusion Whilst showcasing UCT s encouraging initiatives in response to HIV and AIDS, this report also reflects on a number of challenges. There is clearly no room for complacency in UCT s response to HIV and AIDS, despite findings released by HEAIDS in 2010 that suggest the institution has a low prevalence. The findings go on to stress the urgent need to resist treating all HEIs as an homogenous group, but rather to differentiate approaches between and within HEIs to segment the audience as far as education and communication campaigns go. This requires ongoing resources and efforts. The University continues to make important strides in terms of HIV and AIDS research output across a range of disciplines. However, regarding the incorporation of HIV and AIDS into the formal curriculum, there was scant progress, despite the piloting of two important HIV and AIDS curriculum components in 2010 in the EBE and the Science Faculties. Small developments in 2011 include a pilot course component in the Management Studies course of the Commerce Faculty and the establishment of a series of lectures within the formal curriculum of the Raymond Ackerman Academy (RAA) at the Graduate School of Business (GSB). Additionally, the Law Faculty has joined the rest of the institution in adopting Orientation Week workshops for its first year students, focusing on the basics of HIV and AIDS and service provision at UCT. A large part of our role as one of Africa s leading teaching and research universities remains to continually monitor whether UCT is leading the way in meeting the continent s and our country s need for producing graduates who will be AIDScompetent citizens 37 who become the generation that will turn the tide of the epidemic. The institution is presently far removed from providing this holistic education to all students in every faculty at UCT. Kelly (2006) 38 writes of the need for a curriculum response that strengthens academic understanding and analytical ability that mastering HIV and AIDS requires and articulates the need for UCT to continue to work towards its full 36 UNESCO Expanding the Field of Inquiry: a Cross-Country Study of Higher Education Institutions Responses to HIV and AIDS. [Internet] UNESCO: Paris. Available at: [Accessed 25 November 2009]. 37 Campbell, C., Nair, Y., Maimane, S. & Sibiya, Z Building AIDS-competent communities. AIDS Bulletin. 14(3), Kelly, M External Observer s Report: the Response of the University of Cape Town to HIV and AIDS, UCT HIV/AIDS Colloquium. Cape Town, South Africa, November Unpublished. 15

16 mandate, not only in terms of prevention and treatment, but in graduating HIV-literate students as part of an AIDS-competent community 39. There is still much work to be done at UCT in the pursuit of delivery of a comprehensive curriculum response to HIV across all faculties. 39 Campbell, C., Nair, Y., Maimane, S. & Sibiya, Z Building AIDS-competent communities. AIDS Bulletin. 14(3),

17 References Campbell, C., Nair, Y., Maimane, S. & Sibiya, Z Building AIDS-competent communities. AIDS Bulletin. 14(3), Coetzee, L., Lomofsky, D., Tawii, C. and Wessels, W ACES Risk Behaviour Survey and Evaluation. Southern Hemisphere Consultants. Hanson, S. (in press). Good Practice HIV/AIDS Prevention Strategies for Public Higher Education Institutions in South Africa. A Desktop Review. Higher Education HIV/AIDS Programme HEAIDS Strategic Framework and Beyond. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Policy Framework on HIV and AIDS for Higher Education in South Africa. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme HIV Prevalence and Related Factors - Higher Education Sector Study, South Africa, Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Findings of the Study on HIV Prevalence and Related Factors at the University of Cape Town, Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Creating Space for HIV and AIDS in the Curriculum: A Rapid Assessment of Curricular Responses in South African Higher Education Institutions. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Full Report The Roles of Educators in Mitigating the Impact of the HIV/AIDS Pandemic on the Education System in South Africa, December Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme International and Local Good Practice in Workplace HIV and AIDS Programmes - A Desktop Review. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Framework for HIV and AIDS Workplace Programmes for Higher Education in South Africa. Pretoria: Higher Education South Africa. Higher Education HIV/AIDS Programme Development and Implementation Support for HIV and AIDS Workplace Programmes at 23 Public Higher Education Institutions in South Africa. Pretoria: Higher Education South Africa. Joint United Nations Programme on HIV/AIDS (UNAIDS) Global Report: UNAIDS Report on the Global AIDS Epidemic Switzerland: UNAIDS. Kelly, M External Observer s Report: the Response of the University of Cape Town to HIV and AIDS, UCT HIV/AIDS Colloquium. Cape Town, South Africa, November Unpublished. Kramer, S The Projected Impact of HIV/AIDS on the University of Cape Town Student Community in ARV Treatment for UCT Students: Proposal for M. Hall Prepared by UCT HIV/AIDS Unit, 14 Aug

18 Lomofsky, D., Wessels, W., et al Evaluation of the Me and HIV/AIDS Programme in the Health Sciences Faculty. Southern Hemisphere Consultants. Moodley, I. (in press). Development of Sustainable Funding Models and Mechanisms With Respect to a Comprehensive HIV and AIDS Programme in the Higher Education Sub-Sector a Draft Institutional Visit Report on UCT. Shisana, O. et al South African National HIV Prevalence, Incidence, Behaviour and Communication Survey 2008: a Turning Tide Among Teenagers? Cape Town: HSRC Press. UCT The UCT Policy on HIV Infection and AIDS: A Co-ordinated Response to HIV/AIDS. Approved by Council, November UNESCO Expanding the Field of Inquiry: a Cross-Country Study of Higher Education Institutions Responses to HIV and AIDS. [Internet] UNESCO: Paris. Available at: [Accessed 25 November 2009]. 18

19 Appendix A: Leadership, Management and Policy A i) Leadership and Policy The Office of the Vice-Chancellor (OVC) is responsible for UCT s HIV and AIDS policy, while accountability for policy implementation resides with Deputy Vice- Chancellor (Transformation and Social Responsiveness) Professor Crain Soudien, along with a number of UCT department and units, including HAICU, the Student Wellness Service, Human Resources, Health and Safety, Communication and Marketing, Research and Innovation and the Faculties. Policy co-ordination and implementation is overseen by the HIV & AIDS Policy Implementation (HAPI) Group, which is comprised of representatives from HAICU, the Student Wellness Service, Human Resources and Health and Safety. It convenes at least four times a year to monitor HIV and AIDS policy implementation. UCT s HIV & AIDS strategic plan is aligned with the national policy framework and national strategic plan of HEAIDS. Benchmark HEAIDS calls for an established and functioning decision-making HIV and AIDS steering committee or task team, and this committee should have influence and representation on each campus with clear lines of responsibility. These should have annual workplans with clear targets and commitments, so that there can be greater accountability to performance. UCT s HAPI group responds to this need. Furthermore, HEAIDS stresses that strong institutional leadership is required for an effective response. It urges leadership to lead by example and that this ethos should be an integral component of a response 40. HEAIDS 41 asserts that HEIs must as employers recognise the potential impact of HIV and AIDS on both infected and affected employees and design policies and programmes to prevent/reduce infection rates and mitigate its impact on employees and the institution. Secondly, as institutions of teaching, learning, research and knowledge generation contributing to the next generation of future workers, managers and business leaders, HEIs need to develop proactive strategies focusing on prevention and on prolonging life through quality treatment, care and support to protect the investment capital that institutions are expending in preparing potential graduates for the open labour market. Service and contracted staff in particular, asserts HEAIDS, should be included in the response to HIV. It emphasises the need for companies that provide outsourced staff to take on board the institutional values and rights related to health and HIV and AIDS, through some form of HIV compliance policy. HEAIDS 42 states that there is a need for intensive and collaborative efforts to rationalise UCT s HIV programmes and services. UCT s response is to involve 40 Higher Education HIV/AIDS Programme HIV Prevalence and Related Factors - Higher Education Sector Study, South Africa, Pretoria: Higher Education South Africa. 41 Higher Education HIV/AIDS Programme Framework for HIV and AIDS Workplace Programmes for Higher Education in South Africa. Pretoria: Higher Education South Africa. 42 Higher Education HIV/AIDS Programme HIV Prevalence and Related Factors - Higher Education Sector Study, South Africa, Pretoria: Higher Education South Africa. 19

20 HAICU, SWS, Human Resources and staff and student associations and to include people living with HIV. A ii) Management and Service Provision Students: HAICU HAICU coordinated two HIV & AIDS-related courses for first year students; a component of Evidence-Based Management (EBM) in the Commerce Faculty and Becoming a Professional Me and HIV in the Health Sciences Faculty. Additionally, a series of HIV modules was added to the fourth year Management Studies 4050 course within the Commerce Faculty, and a lecture was given on social marketing of HIV to Organisational Psychology Masters students on social marketing and HIV/AIDS. Students of the Raymond Ackerman Academy (RAA) at the Graduate School of Business (GSB) received a series of workshops from HAICU on: basic HIV and AIDS information; context of HIV; HIV prevention and treatment; workplace law/policies/programmes; social marketing; and living positively with HIV. An HIV-focused design competition was held by HAICU for third and fourth year EBE students, in which participants were required to attend a compulsory briefing workshop that focused on how companies in the EBE sector could respond effectively and appropriately to HIV. The intention was to inform future managers about HIV in the (EBE sector) workplace, particularly regarding context, law, policies and programmes. HAICU trained 30 AIDS Community Educators (ACEs) student peer educators and equipped them with facilitation skills to transfer knowledge about: the transmission of HIV; safe sexual behavior; gender and sexuality issues related to HIV; the human papillomavirus (HPV) vaccine; and ways to access HIV testing and treatment at UCT. The ACEs then conducted 50 O-Week basic information workshops, which included learnings about correct condom use, risks associated with sexual activities, the window period, and where to get tested and receive counselling. HIV and AIDS-related resources were provided after each workshop to all first-year participants on a 4 GIG flash drive. ACEs facilitated further workshops with their peers in res throughout the year, in order to provide safe spaces in which to discuss important topics. These workshops covered stigma, gender and sexuality, TB, and concurrent sexual relationships. The emphasis was on reducing partner numbers and using a condom at every sexual encounter. A series of workshops was also conducted for school learners in the Cape Metropole. ACEs also conducted behaviour change conversations ( champion chats ) with their student peers, addressing issues related to HIV prevention, HIV-related stigma, sexual concurrency and multiple partners, and the role that gender plays in sexual relationships. These discussions were initiated with one or more students, friends or family members. Several campaigns were organised by HAICU during the year. A fashion design edutainment event was held in O-Week, with messaging focusing on prevention, and 20