According to the UNAIDS/WHO AIDS epidemic update (December, 2005), there are over 40 million people infected with the virus worldwide, and more than 60% of people living with HIV/AIDS (PLWHA) live in sub-Saharan Africa. There was a recorded total of 3.1 AIDS deaths in 2005 alone, and approximately eight times more deaths since 1981 (UNAIDS, July 2004). With adult (15-49 years old) prevalence rates of almost 40% in Swaziland, Africa, as a continent is more affected than any other part of the world (UNAIDS, July 2004). Women make up more than half of this HIV-infected population and the rate of mother-to-child-transmission (MTCT) is on the increase.

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South Africa at a Glance

Situated in sub-Saharan Africa, South Africa is one of the richest countries in the continent. With a population of approximately 45 million people (World Bank, 2005) over a total area of 1.2 million sq km, it is an evenly populated country. The current gross domestic product (GDP) is US$240.2 billion, and the nation had shown an annual GDP growth rate of 4.9% in 2005. The economy is based primarily on earnings from industries and services, with agriculture only making a modest contribution.

An estimated 5 million South Africans are presently living with HIV/AIDS with more than 20% of adults being infected. Almost 3 million of the HIV-positive population are women. Rates in teenage girls are five times those of boys the same age; and among young adults (early 20s), prevalence rates are three times higher in women (UNAIDS, 2004).

Risky cultural practices and illiteracy are probably the most influencing factors behind the alarming HIV/AIDS prevalence rates in South Africa. Widow inheritance, sexual hospitality and “dry sex” are only a few of the common practices which help foster HIV transmission. In most African communities, sex is a taboo subject, and as HIV/AIDS is largely seen as a sexual disease, it is often shrouded in secrecy and disgust. Stigmatisation and ostracization are the usual social consequences of a HIV-positive diagnosis (Kalichman et al, 2004).

Females are generally disadvantaged, and especially in the African society (Lau and Muula, 2004). Apart from the “receptive” nature of the female genitalia, there are numerous factors behind higher HIV prevalence rates in African women. Women have little or no access to education, employment and healthcare facilities. In addition , in keeping with tradition and cultural norms, women are commonly coerced into marriages and other sexual relationships over which they have little or no control.

The aforementioned factors coupled with her established role as a care provider within the family make it imperative to adequately educate the African woman regarding HIV/AIDS. Educating women is the first all-important step to educating the family and the society as a whole, and would be invaluable in creating public awareness regarding HIV/AIDS.

The Public Awareness Programme

The proposed programme is a public awareness programme aimed directly at South African women. The objectives of the programme include:

To improve public awareness of the HIV/AIDS pandemic among the women of the rural villages of Kwazulu-Natal.
To provide basic educational resources for these women regarding causes, effects, modes of transmission, prevention and treatment of HIV/AIDS.
To empower these women to enable them make more informed choices regarding their sexual health, and life in general.

Target Population

This programme is targeted at all women in the region, regardless of age, tribe, religion or social status. However, considering the general demographics of the geographical area, the target market can be typically described as shown in table 1 below. The large population and the high HIV prevalence rates especially in women is an indicator of the number of potential benefactors of the proposed proramme.

Table 1: General demographics of the target population

Demographics	Description
Gender	Female
Age	15-49 years old
Location	Kwazulu-Natal
Lifestyle	Mainly heterosexual. Sex workers.
Marital Status	Both

The total Kwazulu-Natal population is approximately 9.9 million, with women making up more than half of the population (South Africa Statistics, 2006). Women aged 15-49 account for more than half of the total female population at 2.6 million. This forms the overall target population of the programme. However, this is a very optimistic target, and realistically, the outreach of the programme will be start on a lower scale, and spread gradually.

Existing Public Awareness Programmes

A similar public awareness campaign aimed at 13-25 year olds in Madagascar has been implemented (Azafady, 2006). The organisation promoted key and relevant information regarding HIV/AIDS to their target audience through a number of participatory events such as youth advisory groups, interactive workshops and leaflet production. Although the target markets are different, some of these measures could be adapted to educating South African women.

In addition, the Red Cross Societies of numerous African countries participate on a small-scale in various activties to support the fight against HIV/AIDS. These include HIV/AIDS education, home-based care training, condom distribution, blood donor recruitment and public awareness programmes. The success of these and other education and public awareness programmes in Africa is proof of the feasibility and effectiveness of such campaigns.

Planned Activities

The activities that will make up the public awareness campaign/programme are briefly highlighted below. These are activities that have been carefully chosen to effectively reach the target population. Most of these have strong evidence-base supporting their cost-effectiveness.

Radio programmes: Simple campaigns will be broadcast on the local radio stations. This is an effective medium as villages in the Kwazulu-Natal province are largely radio-listening populations. Television and internet campaigns may not be as far-reaching as the radio. According to the World Bank statistics, as of 2004 less than 10% of the people were internet users. In addition, in many rural areas, only few families own televsion sets compared to transmitter radios. The campaigns will be broadcast in English as well as the local language to ensure that the message is conveyed to the people towards which it is aimed.

Leaflet and poster production: Educational leaflets will be distributed to the women. As with the radio campaigns, the message will be simple, clear and catchy, and will be printed in English and the native language. These leaflets will be distributed at strategic places where the women of the community are likely to be e.g. the market place, farmland areas, town halls e.t.c. Posters could be displayed in health centres, on the roads and other public places.

Workshops: Interactive workshops that feature presentations on sexual health will be arranged. These will be prepared in collaboration with the local school authorities in order to avoid offensive contents. Working with the locals gives an in-depth knowledge of taboos and religious beliefs. For instance, it would not be politically correct to promote condoms in Catholic schools.

Message boards: Message boards have been used succesfully in the past in African communties. They provide an anonymous medium of asking and answering “embarrassing” questions. Women will be urged to write down any questions they may have pertaining to HIV/AIDSand tack them up on a designated board. These notes will be routinely (weekly) collected and addressed appropriately. The answers will then be displayed on the message boards for all to see.

Arts and Crafts Seminars: In a bid to encourage independence, and provide them with alternative means of livelihood, South African women will be engaged in hands-on arts and crafts seminars. This is an attempt to help develop useful skills, which in the long-run could empower them to take control of their lives and make more informed choices.

Condom distribution: Free condoms will be distributed in appropriate venues. This will be complemented by demonstrations on proper use as well as brief and simple sex education.

Human Resources

In order to ensure effective organisation of all activities of the programme, certain manpower is required. Two key members of staff will be in charge of organisation. They will also be responsible for any ad-hoc training of local volunteers. Volunteers will be recruited for physical labour, leaflet distribution, interpretation, printing tasks and other administrative duties. If there is a shortage o volunteers, local labour will be hired.

A local expert will also be essential to act as a go-between and ease any misunderstandings that could arise due to cultural or language barriers. An artist and a craftsman will be employed to teach these handy skills at the workshops.

Strengths, Weaknesses, Opportunitues and Threats (S.W.O.T.) Analysis

To ensure the viability and feasibility of the proposed programme, an extensive analysis of the internal and external environment must be conducted. It is of utmost importance to identify the strengths and weaknesses, the opportunities available and the potential threats that are associated with the programme. This is summarised in figure 1 below.

Strengths	Weaknesses
Small investment Provide accurate information regarding HIV/AIDS Anonymously answers personal questions Help develop life-skills Well-organised	Training
Opportunities	Threats
Change public beliefs and opinions Educate the general directly and indirectly through the women Quantitative and qualitatve research Prevent further spread of the virus Reduce HIV-associated morality and morbidity	Cultural and religious beliefs Stigma associated with HIV/AIDS Political will

Potentially, the major threats to the awareness programmes are the cultural and religious beliefs of the people. However, these will be appropriately addressed by these educational interventions. The strengths and opportunities outweigh the potential threats and weaknesses. Considering the huge benefits to be gained by the people, this would be a worthwhile cause to embark upon.

2. Financial Plan

To prepare a financial plan, it is necessary to estimate the costs associated with the various activities of the proposed programme. For the purpose of this proposal, these are presented as start-up costs and operating costs. All costs are reported in US dollars. ($1=7.532ZAR). It is necessary to understand that these costs are merely estimates and there may be variations between the costs in this proposal and in reality.

2.1 Start-up Costs

Table 2 shows the costs of getting the programme started, i.e. the start-up costs.

Expenditures	Costs
Rent deposit	$520
Equipment and office furniture	$750
Utility set-up fees	$250
Personnel training	$540
Starting inventory of arts and crafts materials	$950
Printing	$150
Radio corporation fees	$200
Total	$3,360

2.2 Operating Costs

The continuous or ongoing costs associated with the programme are briefly described in table 3 -for example the annual costs of sustaining the proposed public awareness programme. This includes annual bills and allowances and will be both fixed and variable costs.

Expenditures	Costs
Rent	$520
Utility bills	$520
Maintenance	$250
Direct labour	$3500
Administrative salaries	$2000
Printing	$150
Broadcasting fees	$200
Office supplies	$360
Telecommunications	$250
Transport costs	$400
Total	$8,150

2.3 Funding Mechanism

Financial support will be sought in form of government grants, using this proposal to demonstrate the feasibility and potential benefits of the proposed campaign. Increased international funding for HIV/AIDS has been received in the form of bilateral donations from other national governments. President Bush’s Emergency Plan for AIDS Relief (PEPFAR) targets South Africa as one of 12 sub-Saharan African countries to help (Global AIDS Alliance, 2003).

In addition, local funds-raising activities can be carried out to gain support from well-meaning members of the South African public. Free condom donations will be sought from manufacturers.

2.4 Cost-benefit Analysis

The cost of the activities and resources highlighted above coupled with the intensity of the programmes make this programme a very cost-effective intervention. There is vast evidence investigating the cost-effectiveness of various HIV/AIDS interventions in Africa. Those relevant to this programme would include peer education for prostitutes, condom distribution and voluntary counselling and testing (VCT) programmes. The World Bank has recommended an upper limit cost per disability-adjusted life year (DALY) of US$62 (Creese et al, 2002). Peer education of prostitutes in Cameroon was found to be very cost-effective at US$4-7 per DALY gained (Kumaranayake et al, 1998). Voluntary counselling programmes in Kenya and Tanzania also met the World Bank’s criteria at US$18-22 per DALY gained (Sweat at al, 2000).

Considering the relatively low costs of implementing the programme and the potential hundreds of thousands of people that could be effectively educated and informed, the public awareness programme is economically viable, and should be included in local health policy making.

3. Quality Assessment and Assurance

In order to guarantee that the campaign is beneficial and consistently effective, annual audits will be carried out to assess the outcome of the programme. A pilot HIV awareness survey will be administered to the determine baseline knowledge of the South African women. This will serve as a point of reference with which to compare future annual findings.

3.1 Expected Outcomes

The expected outcomes of the programme are highlighted below:

Increased understanding among women of what HIV/AIDS is, how it affects the body and how to prevent contracting it.
Eliminate the stigma that surrounds HIV/AIDS.
Reduced infection rates.
Increased number of people being tested.
Increased number of infected people receiving treatment.

If well-organised, the programme has the potential to reach and change behaviours and uneducated beliefs regarding the HIV/AIDS pandemic. At very modest costs, the programme will have impressive cost-benefit ratios and should be implemented as soon as possible.

Bibliography

Azafady (2006) A proposal for Project Mampisaina -an HIV/AIDS and STI education and awareness programme for 13-25 year olds in Fort Dauphin, Madagascar. [WWW] http://www.madagascar.co.uk/pdfs/Reports/Mampisaina_HIV-AIDS_STIs_project_june06.pdf (October21st 2006)

Creese, A., Floyd, K., Alban, A., and Guinness, L. (2002) "Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence". The Lancet, vol. 359, pp. 1635-1642.

Global AIDS Alliance (2003) President George W. Bush’s Emergency Plan for AIDS Relief in sub-Saharan Africa and the Caribbeans. [WWW] http://www.globalaidsalliance.org/docs/updated_analysis.pdf#search=’president%20bush%20emergency%20fund’ (October21st 2006)

Kalichman, S.C. and Simbayi, L. (2004) "Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa". AIDS CARE 16, 572-580.

Kumaranayake, L., Mangtani, P., Boupda-Kuate, A. (1998) personal communication in Creese, A., Floyd, K., Alban, A., and Guinness, L. (2002) "Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence". The Lancet 359, 1635-1642.

Lau, C. and Muula, A.S. (2004) "HIV/AIDS in sub-Saharan Africa". Croatian Medical Journal, vol. 45, no. 4, pp. 402-414.

Statistics South Africa (2006) Mid-year population estimates, South Africa. [WWW] http://www.statssa.gov.za/publications/P0302/P03022006.pdf (October21st 2006)

Sweat, M., Gregorich, S., Sangiwa, G., Furlonge, C., Balmer, D., Kamenga, C., Grinstead, O., and Coates, T. (2000) "Cost-effectiveness of voluntary HIV-1 counseling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania". The Lancet, vol. 356, pp. 113-121.

UNAIDS, Report on the Global HIV/AIDS epidemic, July, 2004

UNAIDS/WHO AIDS epidemic update, December 2005.

World Bank Group (2005) South Africa Data Profile [WWW]

http://devdata.worldbank.org/external/CPProfile.asp?SelectedCountry=ZAF&CCODE=ZAF&CNAME=South%2BAfrica&PTYPE=CP (October 21^st 2006)