"We now know that HIV is not spread easily and that it can be prevented through behavioural change. This has reduced the incidence of HIV in countries as diverse as Australia, Thailand and Uganda. There are also many opportunities to alleviate suffering and prolong the lives of people living with HIV/AIDS". Prevention of HIV infection, rather than dealing with impacts after people have contracted the virus, has the potential to be a cost effective use of resources.

The global problem of AIDS, with its social, economic, demographic, cultural and political impacts, requires a global response. The World Health Organisation Global Programme on AIDS (GPA) was established in 1987 as the active coordinator and director of the fight against AIDS. The GPA is supporting the development of strong national programmes in all countries as part of the global mobilisation to fight AIDS (WHO, 1990). An AIDS 2000 Conference, the 13^th international AIDS Conference, is to be held from June 9-15 at the International Convention Centre, and will be attended by over 10 000 delegates (Sowetan, 2000).

Global HIV prevention strategies consist primarily of three interrelated interventions, which have been shown to reduce HIV transmission:

• Encourage reduction in the number of sexual partners;
• Promote widespread use of condoms;
• Treat STD’s effectively and early to reduce infection rates (Steinberg et.al., 1999).

AIDS AWARENESS IN JOHANNESBURG

From the survey it appeared that the public wanted a message that was positive and optimistic and tended to avoid vague, abstract messages. These results could be useful in other awareness campaigns in the Greater Johannesburg area. Public awareness about AIDS, its transmission and prevention is vital, and buses are cost-effective ways of displaying the message. There also seems to be wide spread public approval for this type of health promotion (Evian et.al., 1991).

TEENAGERS, YOUNG ADULTS AND STREET CHILDREN

Various levels of health education and intervention programmes are needed for the youth on the streets. The alleviation of poverty, combined with family planning and counseling will also reduce the amount of homeless children on the streets, and reduce the spread of HIV/AIDS. Three rules apply to the educating and helping of adolescents in the AIDS pandemic. These include:

• "starting where the teenagers are at", meaning starting from their interests, visiting pop festivals or summer holiday spots and providing condoms, advice and counseling there.
• Secondly it must be remembered that young people like risky behaviour, and advice material should thus focus on alcohol, drugs and other visible places.
• Lastly multi-media and other channels of information with a personal sharing of experience can be very effective in education. Strip cartoons, booklets and teachers manuals are all necessary in todays schools and public places where young people gather (Kleinman, 1988).

The Department of Health launched a Beyond Awareness Campaign, using innovative murals to ensure maximum exposure to AIDS issues (Fox, 2000). The key goal of the campaign is to transform the public perception. By targeting tertiary schools and universities, one does not only encourage artistic and creative talents, but also teach the students how to handle tricky situations. The campaign also targets primary schools, through the use of puppets. ABANGANI (for the children) is an innovative township programme using puppets to spread the HIV-message. Primary schools in townships around Gauteng, including Soweto and Lenasia in the Greater Johannesburg area, has the show, followed by a question and answer session, to raise the children’s awareness. Many teachers and parents are also getting involved, teaching children about their rights, facts about the disease and helping with sex education (Bloch, 2000).

The education department has a big role to play in managing HIV/AIDS impacts, through prevention programmes that can influence youth that have not yet established high-risk sexual behaviour. Children from affected homes will have to be supported and their needs addressed (Steinberg et.al., 1999).

PRE-SCHOOL CHILDREN

Many South African children will have to face the harshness of HIV/AIDS before they even go to school, be it through the death of a friend, or being shut out due to a family member being infected. Sheila Drew, a trainer of teachers, has in association with the Woz’obona NGO, developed a pilot programme for the pre-school environment, which aims to encourage teachers, parents and children to know their rights and responsibilities and to apply it to others. "The best way to prevent the spread of the disease in the long term, is to talk about it now, to everyone and anyone. Often people are afraid to do so, because they do not have the correct information, they avoid the subject because of the stigma attached to it, or are to embarrassed. It is a nicety we can no longer afford" (Tulleken, 1999).

OCCUPATIONAL EXPOSURE

• Re-sheath or re-cover needles only with protective apparatus.
• Discard all needles into protective containers especially for this purpose.
• Always wear gloves when working with blood or sharp instruments.
• Always wash hands after examinations or doing a procedure.
• Always wear protective mouth and other gear, and clothing.
• Take immediate post-exposure treatment if exposure occurs (GlaxoWellcome, 1999).

BUILDING INDUSTRY

The slowdown in population growth will relieve the problem. Currently the population is growing at one million per annum, leading to an annual housing demand of 250 000 units, of which 80% (200 000) is low cost housing. A reduced population growth rate (from 2,5% to 1,5%) will reduce the annual low cost housing demand by 55% to 123 000 units in the next five years (Saturday Star, 2000).

HOUSEHOLD AND COMMUNITY LEVEL

Governments will need to identify feasible and efficient ways of supporting households and communities, especially to relieve poverty. Assistance on economic and psycho-social level will also be needed.

ECONOMIC RESPONSES

To reduce the impacts on business productivity and labour force, governments should:

• Work with the private sector and labour force to raise awareness on the implications of HIV/AIDS;
• Emphasize skills development and view the new shortages due to infection impacts;
• Efficiently manage the impacts on government employees and sectors such as electricity supply and telecommunications, to reduce impacts on a wider range of sectors (Steinberg et.al., 1999).

Many businesses will be able to manage impacts on productivity, competitiveness and profitability by proactive responses, which could include:

• more targeted and effective HIV preventative programmes;
• increased capital intensity of production processes;
• strategic use of multi-skilling;
• hiring more employees from lower HIV risk groups;
• limiting employee benefit liabilities by restructuring benefits and increasing outsourcing;
• active management and policy development to encourage employees to disclose status to allow for more effective workforce planning and management.

THE HEALTH SYSTEM

Health sectors will have to ensure that care is designed to maximise the effectiveness of the resource used. Help from other sectors will also be vital, to ensure that no health expenditures are wasted due to the inability to devolve care into more cost-effective community settings. Health care facilities will also have to be placed at strategic points to care for the priority needs of infected people (Steinberg et.al., 1999)..

• Show love, respect and support;
• Know the facts and talk openly about the disease;
• Help to reduce stress and stressful situations;
• Help provide balanced and nutritious meals;
• Encourage them to get treatment (Department of Health, 1998a).

CONSTITUTIONAL RIGHTS

The Bill of Rights in the South African Constitution, protects all people, and implies that people living with HIV/AIDS have the same right as any other person, including:

• the right to medical treatment and care;
• children have the right to attend any school;
• no employer can require that a job applicant have an HIV test before they are employed;
• any employee cannot be fired, retrenched or refused a job simply because they are HIV positive;
• women infected with HIV can not be forced to terminate their pregnancy; and
• any person with HIV/AIDS has the right to confidentiality about their status (Department of Health, 1998b).

A new law, The Promotion of Equality and Prevention of Unfair Discrimination Act 4 of 2000, was passed this year, and outlaws discrimination on the grounds of race, gender, marital status, ethnic or social origin, sexual orientation, age and disability. This also means no more discrimination against people with HIV-AIDS (Misbach, 2000).

CONCLUSION

The AIDS epidemic confronts us with a tragedy of unique dimensions. It demands that we seek answers to a range of questions:

• How to provide humane and high quality support for those who are infected now and in the future;
• How to change sexual behaviour and attitudes;
• Whether there are any particular health service interventions which can slow the spread of the disease;
• How the health service can improve the quality of care for the majority of South Africans while meeting this new challenge (The Centre for Health Policy, 1991).

If we are to meet this challenge, we need sober assessments of the situation, based on scientific research.

Preventing any new infections is the only winning strategy in the HIV/AIDS struggle, through:
- Mass Media Campaigns, to promote awareness and information amongst the whole population;
- Targeted Education, to have a specific focus on those groups at high risk to infections. The youth can be targeted through a Life skills programme in the school cirriculum, edutainment including drama and music, or Peer Educators on an outreach model.
- The provision of services to support behaviour change including access to condoms and effective treatment of STD's (Gauteng Provincial Government, 1998).

Preventing HIV/AIDS is easier than preventing the common cold: Abstain from sex, be faithful to one partner or use a condom.

Many of the impacts of AIDS can be anticipated and mitigated through effective and timeous management. Action will be required across all sectors of government, the labour force, infected people, NGO’s and community based organisations. Effective management will also require ongoing and improved data collection and monitoring to increase the understanding of impacts.

REFERENCES

Bloch, J. 2000: Puppets help school Aids education. Sowetan, 07/01, 9.

Department of Health 1998a: Caring for people with HIV/AIDS. DH: Pretoria.

Department of Health 1998b: HIV/AIDS and Rights. DH: Pretoria.

Evian, C.R.; M. de Beer; M. Crewe; G.N. Padayachee & H.S. Hurwitz 1991: Evaluation of an AIDS awareness campaign using city buses in Johannesburg. South African Medical Journal, 80: 10, 343-46.

Fox, S. 2000: Students enlisted in the battle against Aids. Sowetan, 07/01, 11.

Gauteng Provincial Government 1998: AIDS Strategy Pamphlet.

GlaxoWellcome 1999: Information for Health Care Workers – Brochure.

Kleinman, R.L. 1988: Adolescents and AIDS. IPPF Medical Bulletin, 22:4, 5.

Misbach, W. 2000: New Bill to protect people with HIV-Aids. Sowetan, 11/01, 2.

Saturday Star 12/02/2000: Building Industry hit by AIDS.

Sowetan 07/01/2000: Meeting to finalise details for AIDS event, 3.

Steinberg, M.; A. Kinghorn; J. Stein & L. Thomas 1999: The Impact of HIV/AIDS in Gauteng. University of the Witwatersrand (Centre for Health Policy ) & Gauteng Government (Health Section).

The Centre for Health Policy 1991: The Aids Epidemic – Beyond the Myths. University of the Witwatersrand: Johannesburg.

Tulleken, L. 1999: HIV/AIDS a harsh reality of pre-school life. The Star, 07/21, 18.