HEALTH ECONOMICS AND HIV AND AIDS RESEARCH DIVISION
Evidence for Impact in Health and HIV
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HEARD's Increasing Focus on HIV in Urban Areas


Recently, the USAID funded Sexual HIV Prevention Programme (SHIPP) co-ordinated, in conjunction with HEARD, a workshop in which leading researchers, service providers and policy makers participated to review, assess and make recommendations on the current scale of provision of HIV prevention and treatment services in informal settlements in South Africa.

The workshop was a request from the national Department of Health and the outcomes of the workshop will assist in informing responses to the National Strategic Plan (NSP) for HIV & AIDS, Tuberculosis and STIs 2012-2017. Such stakeholder engagements at all levels are critical to HEARD's agenda of getting research into policy and practice. They ensure that HEARD's research work is applicable at multiple scales so that, ultimately, the impact of projects such as this go beyond 'the sum of their parts', making a tangible difference to mitigating the incidence and impact of HIV and AIDS in southern Africa.

Regionally, an estimated 28% of people living with HIV and AIDS live in 14 cities in southern and eastern Africa; approximately 15% of the global epidemic. In South Africa, 29.1% of the total estimated number of new HIV infections are found in urban informal settlements, even though only 8.7% of South Africans older than two years live in these areas. Urban informal settlements are spaces in which HIV, livelihood insecurity and gender inequalities intersect to drive acute vulnerabilities. To tackle these concurrent drivers of HIV and AIDS it is clear that interventions need to move beyond focusing on HIV risk behaviour alone.

This year, HEARD partnered with the Medical Research Council and Project Empower to develop 'The Stepping Stones and Livelihoods Strengthening Pilot Study'. Stepping Stones is a gender transformative intervention developed for Uganda in the 1990s, and since then it has been used in over 40 countries. A livelihoods intervention is currently being developed by the study team which aims to encourage young people to critically think about the barriers they face to constructing their livelihood and how they may overcome these to better build and draw on financial, human, social, physical and natural resources.

'The Stepping Stones and Livelihoods Strengthening Pilot Study' will combine the Stepping Stones and Livelihoods curricula in an integrated participatory intervention to be implemented with about 120 young people in selected eThekwini informal settlements. Its impact on participants' lives will be evaluated through both quantitative and qualitative methods. As with all HEARD projects, the project team is working towards building strong partnerships with a number of key stakeholders in order to ensure the study design and findings are relevant to them. Since our long-term goal is to upscale this intervention and ensure it can be adapted for national - and ultimately regional - application, we are working with municipal level stakeholders, but also with stakeholders at other levels.

For more information about 'The Stepping Stones and Livelihoods Strengthening Pilot Study', contact Dr Alison Misselhorn on 

Upcoming Events

New workshop dates will be released soon. Please email enquiries to

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