The Higher Education AIDs Programme in South Africa: A Real Force for Transformation

Development projects and programmes aim to change lives around the world using various methods from technical assistance to capacity development. But what actually happens when a project ends and the money is withdrawn from one day to the next? What legacy does the EU leave behind? Dr Ramneek Ahluwalia, Country Director and Head of the Higher Education and Training HIV/AIDS (HEAIDS) Programme in South Africa shares his experiences, including how he overcame financial cutbacks and near collapse, to oversee one of South Africa’s best success stories. 

In Ladysmith, a town in the north east province of KwaZulu-Natal, 10 young female students from a technical vocational education and training college were given a task. They had to speak to other young girls and women in their community and explain the use of subdermal implants as a contraceptive measure.

“When a young woman from Ladysmith speaks Zulu, it’s a different Zulu than is spoken in Durban [a coastal city in the same province].  When she speaks to her community about rape or sexual violence, she brings much more of a ripple effect than an outsider or a peer educator that you’re sending from Durban to train this community,” explained Ahluwalia. Within a month of the 10 students’ campaign he received requests from 196 girls in the community to have an implant inserted. 

The HEAIDS programme uses students as its own ‘foot soldiers’ to spread the word on HIV, safe sex, and other health issues including non-communicable diseases. Higher education students can volunteer to become part of this awareness raising programme that provides a range of services from condom demonstrations to health checks.

South Africa is well known for having the largest HIV affected population in the world, and young women aged 15-25 are the most vulnerable as they often become infected during their first sexual encounters. Embedded into the post-school education system in the country, HEAIDS focuses on educating this age group. 

 “Universities usually take students from 18, 19 [years old] onwards. But in TVET colleges, which is where the plumbers, the miners, the electricians, the artisans, the real South African workers are coming from, we have students joining from the age of 15, grade 8, onwards. So you also see a population which is quite young, coming into the post-school education system,” explained Ahluwalia.

In 2015, UNAIDS estimated that there were 4 million women aged 15 and over living with HIV in South Africa. This number is larger than the total number of men and women in any other country living with HIV. Programmes like HEAIDS play a key part in the battle to fight the spread of this disease. 

HEAIDS was launched in 2000 by South Africa’s Department of Education (DoE) in collaboration with universities. The first phase was funded by the British and Irish official development programmes, as well as the American Centre for Disease Control. Some of the key focus areas included curriculum integration as well as peer education. 

In 2005 the second phase of the programme began. Lasting four years, it received €18.9 million from the European Union, with the DoE as the implementing authority. Yet at the end of phase 2 the European Union did not sign on again to fund phase 3.

So how did Ahluwalia build on the legacy that the EU left behind?

“The European Union was one of the biggest donors to HEAIDs between 2006 and 2009,” said Ahluwalia. “And then it was me and one peer who took over. And when I took over it went from €20 million to just 5 million [South African] Rand [equivalent to approximately €500 000 in those days]. But we started a new journey of growth and what needed to be done. It’s an important sector and you can’t leave your economy vulnerable to such an epidemic of HIV/AIDS. We worked hard with the government, worked hard with other development partners, private sector and I’m very proud to see where we are today.”

During the EU funding period HEAIDS worked with 22 universities comprising around 90 campuses. Almost seven years later the programme has expanded to cover all 427 campuses in South Africa, the entirety of the higher education system: both universities and TVET colleges. This distinction is extremely important as Ahluwalia explained that a university doesn’t define a campus. “I’m dealing with human lives and human lives doesn’t mean confined to just a main campus and you count a university as a tick. I did this, and I thought oh I’ve covered all the universities, but then I remembered I only covered the main campuses, I need to cover all the campuses of all the universities.”

For example in the North West province of South Africa, the main university has three campuses. There is a ‘posh’ main campus, but there is also one in Mafikeng (Mafeking), housing 30-40,000 students from very poor households.  This peripheral campus must not be forgotten, as Ahluwalia considers the most disadvantaged students in these peripheral campuses his real target audience.

Another change is the focus of the programme. Under EU funding, work was very research orientated: finding baselines, understanding how the HIV epidemic affected the education sector, what were its causes. Whereas phase three was very much an implementation phase, running seven subsidiary programmes as part of HEAIDS.

“I think this [research phase] was very useful because it gave me the energy to know what the programme needed to deliver,” noted Ahluwalia. But he feels that the EU left too soon, just as the programme was starting to come into its own and understand its goals. This left Ahluwalia with a funding gap to translate research into action.

Today the programme is sustainable and receives significant funding from the South African government. However, Ahluwalia believes that a transition period to wind down EU funding would have been more effective:

“I’m sorry I’m being blunt, but I’m being honest. [The EU’s sudden departure] caused a lot of retrenchments, everything collapsed, at one moment. When I took over I had to rebuild from scratch from the ground immediately. But what I had was a wealth of European Union research and evidences that gave me enough power to go and talk and negotiate.”

The first partner to come on board was the American government, followed by the South African Department of Health. Since then the German government, the Global Fund, private sector and pharmaceutical companies have all supported HEAIDS. Funding from these partners not only maintains the existence of the programme, but it also translates directly into free services and products for students. “We don’t need to buy anything [condoms, testing kits etc.]. It’s all provided for free [by the National Department of Health and other partners],” said Ahluwalia.

For example the South African Department of Health funded free coloured and scented condoms. These cost them around 1-2 South African Rand [equivalent to 7-14 euro cents] to produce. In 2015 HEAIDS distributed 27 million of them, which equates to 27-54 million South African Rand [€1.76-3.5 million] from one government department just for one product. HEAIDs also receives HIV testing kits, blood pressure and body mass index recording tools, treatments, mobile clinics, and much more. 

“It was a painful experience begging for a population that will be the next economy of South Africa,” said Ahluwalia, but he does not harbour any hard feelings and readily acknowledges the EU’s strong contribution to kick-start the programme, labelling the programme their ‘baby’.

“I still beg the European Union to come back. It’s your legacy. We’ve achieved a lot, we are number one in Africa, but this cannot be isolated from the good start that you gave. I still think it’s a best practice, European Union should be very proud of it that a small thing that started has become one of the biggest drivers of change in South Africa.”

Flora Bertizzolo, is the Health Project Officer in the EU Delegation to South Africa. Although she joined the Delegation after funding to HEAIDS had already stopped, Bertizzolo is very familiar with the programme and the impact that it has had on the country. She believes that the key to success was the government’s willingness to continue the project as well as Ahluwalia’s dynamic personality, “but you don’t have that latitude or that possibility in all countries,” she explained. “Without that kind of strength and need to continue a project that proved effective, then maybe many of the good things the project achieved could have been lost.”

Today Ahluwalia has received requests from four other African nations, including Zimbabwe, to develop HEAIDS programmes in their countries. He is also in talks with the South African government to see if a similar programme could be rolled out in high schools: “My mandate is post-school but yes I’d love to see this rolled out. I think history will be made if a similar charisma can be replicated there. Obviously it will require a lot of funding and a lot of energy to build this infrastructure.”

Perhaps the real legacy of the programme lies in these educated young South African students who are the real transformation force for South Africa. Ahluwalia shared the story of two young female students who discovered that they had HIV through the HEAIDS programme’s screening tests; one had contracted the disease through sexual violence. Both got treatment, and have since learned to live with the disease. Although they have now graduated and entered the workplace they still volunteer to educate students on safe behaviours in their old campuses.

“I don’t pay them, I don’t know them. They know us and that’s more important,” says Ahluwalia. Rather than him begging for money and providing statistics that the programme has helped so many thousand young people, he believes the best example to share is these two women “who came back and have taken more than 80 HIV infected students under their wing, [acting as] their parent to look after them, to teach them, and for them too to go back and give back to the society. I think that’s where the real win of the programme is,” concluded Ahluwalia.