AIDS BRIEF for Professionals Architects

BriefAIDS

for professionals

BACKGROUND

The spread of HIV/AIDS is having a major impact on the economies of the world, in particular those of developing countries. This impactis realised across a wide range from individual households, to the macro-economy of a nation. While steps are being taken to halt the spreadof the virus and scientists are engaged in the development of vaccines, the true impact of the epidemic has not as yet been revealed.

The purpose of this Brief is not to explore the impact HIV/AIDS will have on infected workers within the architectural field, nor the effectthis will have on their productivity and output. However cognisance should be taken of such impacts within areas where these skills are inshort supply. The Brief does aim to show the probable consequences the epidemic will have on the provision of building types for thecommunity, and highlights the need for a reassessment of both government and provincial policies on building procurement and delivery.

Consequently, an awareness and understanding of the implications this epidemic has on the built environment is of prime importanceto Architects and associated Consultants. Finally, the Brief suggests a means of dealing with the resultant impact of AIDS on Architecture.

Architects

The professions of Architecture and its allied disciplines have the unique responsibility of creating and guiding the construction ofpractically all the buildings and housing activities performed by the various sectors of the community.

initial briefing and the handing over of thecompleted project to the Client. This may rangefrom a few weeks to a number of years. Ofdifficulty in the latter instance is that Architectsare required to plan for the future in an ever-changing and somewhat uncertain environment.The impact of HIV/AIDS will further complicatethis situation.

The changing role of the ArchitectThe traditional role of the Architect has

been one of Team Leader in the design team,controlling proceedings within a project andoverseeing and liaising with the otherConsultants in the team. Recent trends haveseen this role eroded by the birth of the ProjectManager, who, where employed, takes on the

Architecture, in pure terms, is centredaround the creation of a structure, shelter orspace. It is the Architects role to formulate abrief together with a Client, and encapsulatingthe latters intentions, conceive a design.Through documentation in drawn and writtenform, incorporating detailing and specification,the concept is developed into working drawingssuitable for tendering and constructionpurposes. Once the project proceeds onto thebuilding site, the Architect controls the Clientsinterests, through regular site inspections andmeetings with the project team, ensuring thatthe design is constructed accurately and thatstandards of workmanship are acceptable.

The nature of architectural projects is suchthat a degree of time lapse occurs between the

role of Project Coordinator. While this reducesthe Architects role as policeman, ensuringthat the deadlines of others in the team aremet, it in no way reduces the liaison that isneeded between the Architect and the otherConsultants.

Architectural workersThe exposure to HIV for the Architectural

worker under normal circumstances would beno greater than for any other professional person.However, the risk of contracting HIV may beincreased due to:n work performed away from the home/office

e.g. contract work and site supervision;n attendance at certain promotional launches

or functions of a marketing nature.

Architects AIDS BRIEF for Professionals

KEY ELEMENTSDepending on where they practise, most

Architects may not yet have been faced first-handwith the need to incorporate AIDS-relatedconsiderations into their designs. However, thisepidemic will sooner or later have a bearing ondetail design and the volumes of certain buildingtypes produced by Architects. Therefore, as amajor role-player in the creation of the builtenvironment, the Architect must come to termswith the factors HIV/AIDS will bring to bear onour environment, as they are essentialcomponents of all future planning and designdecisions.

While the past and present emphasis hasbeen to provide certain building types en masseto meet the needs of the ever multiplyingpopulation, statistics show that the prevalenceof AIDS in society will demand that we shift ouremphasis to other building types to conform withthe new accommodation requirements thisepidemic will incur.

Building types under threat fromthe AIDS epidemic due to anincrease in user numbers

Health facilitiesThe major burden of the HIV/AIDS epidemic

will fall upon the health sector. Hospitals arealready overcrowded and economic constraintsrestrict the extent of quality care and equipmentat the disposal of medical staff. Whereas in thepast, the age profile of patients within hospitalcare would decrease after birth and only increaseagain towards the more senior years, the HIV/AIDS impact will develop a new hump in theprofile around the nineteen to thirty-five year agegroup. The increase in numbers will have animpact on present resources including staffing,beds and pharmaceuticals. The effect on theeconomy due to the removal of these peoplefrom the workplace is self-evident.

The general belief that HIV/AIDS specificfacilities will not be frequented by affectedpeople, due to the attached stigma, is slowlylosing credibility, as with increased numbers andcommunity awareness through educationalmeans, there has been a broadening of theunderstanding and acceptance of the epidemic.While initial screening may be at a generalcommunity health facility or hospital, specialisedcare will be better dealt with by a centre withHIV/AIDS specific services.

Consideration of a) longer-term care, b)respite care and c) outpatient care are essential.The development of Hospice type facilitiesincluding day-care, to cater for the needs of

terminal patients, should be encouraged andappropriate state funding channelled into suchcentres. As the running costs of these centresare high, training of home care staff, using thesecentres as bases, and operating within thesurrounding communities, would effect somesavings.

There will also be an impact on the serviceelements associated with medical facilities.Increases in counselling, dispensing ofpharmaceuticals, hazardous waste disposal andphysiotherapy will need consideration, planningand accommodation.

Architectural input:n Conduct a study of the functioning of

organisations such as Hospice, Cancer, andTuberculosis Associations, as examplesfrom which to draw reference in determiningsuccessful models for the care of terminalpatients.

n Consider the development of Home Carecentres - local control/resource facilities -enabling the care of people within their ownhomes and communities.

Child-care facilities1) Childrens Homes (Orphanages)

As not all babies born to HIV-positivemothers are themselves HIV-positive (althoughsome may be infected thereafter via breast-feeding), it follows that a large percentage ofchildren will be orphaned within the first eightyears of their lives. Most of these children willrequire state-funded accommodation and care.The problem these orphans pose is multi-faceted. After the basic needs of housing,clothing and nourishment have been addressed,their upbringing, education and eventualplacement as contributing members of societywill need attention.

Few would disagree that institutionalised lifeis far from ideal, and that time spent within suchfacilities should be kept to an absolute minimum.Therefore, these child-care facilities should beviewed as temporary shelters for their wards.The governments of developing countries arehard pressed to maintain current rates of statefunding and the orphan crisis will crippleoverburdened coffers. There is no solution insight for the plight of these children, and urgentattention to this matter from all quarters isrequired.

Possible changes to building type:The existing model of the childrens home

will be brought into question as government-

aid cuts will require that they either seek fundingfrom alternative donors, which may proveinadequate, or, short of closing down, restructurethemselves to accommodate numbers withintheir means. With the increase in user numbers,either a greater number of facilities will need tobe provided or a faster turnover of residentswill need to occur. Child Welfare authorities maybe forced to relax their policies on the placementof children within foster care to relieve thissituation in some way.

Architectural input:n Research the functioning of existing

orphanage facilities.n Establish whether (area permitting) with an

increase in residential accommodation,existing service elements (e.g. kitchens andablutions) could cope with phased mealtimeand washing arrangements.

n Consider the reuse of other building typese.g. vacant schools, houses etc. forconversion to suit the needs of orphanages.

2) Street SheltersA variety of sociological causes may result

in the relocation of a child from its family unitto the streets, usually within a commercial centre.Whatever these causes may be, once on thestreets, these children become exposed to crime,drug abuse and prostitution, whether out ofnecessity, peer pressure or eventual addiction.As the effects of living on the street have far-reaching physical and psychologicalimplications, prompt rehabilitation is of primeimportance.

A number of church groups, in associationwith local authorities, have developed safehavens for street children. In most instances,disused buildings are modified to accommodatesuch persons in as comfortable a means aspossible. Most of these facilities offeraccommodation, meals and in some instancessome form of education, whether it be thelearning of a trade, or placement within localeducation systems. Essentially, it is desirable torelocate these children back into the communityfrom whence they came, and with research intothe cause of their initial departure, coupled withappropriate counselling, a reuniting of partieswill hopefully occur.

Architectural Input:n Support and facilitate the recycling of

existing buildings.

AIDS BRIEF for Professionals Architects

Funeral parlours, crematoria andgraveyards

In the light of available statistical predictionsas to projected fatalities from AIDS-relatedillnesses, one would draw the conclusion thatthis is impacting on existing funeral parlours,crematoria and graveyards. Evidence of this hasmanifested itself in a number of countries in sub-Saharan Africa. The major impact is the increasein the numbers of deaths over a shorter periodof time.

While the need for an increase in the numberof the initial two building types (funeral parloursand crematoria) could be seen as favourable byrole-players in that industry, the allocation ofprime land for graveyards, especially withindeveloped or rapidly developing urban precincts,could prove difficult. Many cultures andreligions are opposed to the cremation processand are thus reliant on the provision ofgraveyards for the burial of their people.

Graveyards usually fall under the control ofLocal Councils, and their Urban Planners willneed to take cognisance of this within theirrevised briefs.

Hazardous waste disposal unitsThe disposal of contaminated waste from

facilities caring for patients with HIV/AIDS needsparticular attention. Infected needles, swabs orother containers of body fluids must be isolatedand securely stored. Access to areas storing suchwaste must be carefully controlled and, onceretrieved by the designated waste vehicle,disposed of in a manner which will not causecontamination of waste handlers or members ofthe public.

As incineration is the usual means ofdisposing of this waste, planning for additionalfacilities should be considered, possibly on-site.

Building types under threat fromthe AIDS epidemic due to adecrease in user numbers

Educational buildingsStudies indicate that the majority of people

found to be HIV-positive fall into two main agegroups: children under the age of five and adultsaged between 20-40 years.

The age for children starting formaleducation may vary from country to country,however five or six years of age is the mostcommon. An increase in child mortality willreduce class numbers and could possibly leadto retrenchment of teaching staff. Conversely,

junior teachers fall into the high-risk category,and a shortage of teaching staff would impacton the entire education system. The same wouldapply to tertiary education. In this case, theeconomic impact that the disease will have onthe country should be considered, as the costsof educating people through years of schoolingand into tertiary education will be lost to thedisease.

Possible changes to building type:There are two scenarios within the educationspectrum.n At worst, as the epidemic takes hold, there

will be a drop-off in the numbers of childrenof school-going age. Classrooms could lievacant leading to the eventual coalescenceof schools in neighbouring areas.Retrenchment of staff would ensue andnumbers of student teachers would beproportionately reduced.In the interim, although numbers would beaffected as children born with HIV largelydie before reaching school-going age,provision would need to be made for infectedpupils who attend school irregularly. Theirneeds in terms of access (ramps,wheelchairs, seating arrangements etc.) andcomfort (provision of sick-bay, ablutionaccessibility etc.) require consideration,while the ongoing education of the otherpupils within the school should not beimpeded.

Architectural input:n Redesign existing facilities for access by

wheelchairs etc.n Remodel vacant school buildings for new

functions - possibly childrens homes.n Provide for a greater number of beds in sick-

bays.

n Should the numbers of staff succumbing toHIV-related diseases outweigh the drop-offin pupil numbers, and result in a shortageof teaching staff, the teaching duties ofavailable staff would need revision. Thiscould be in the form of:

a) the grouping of classes; divisions betweenclassrooms could be in the form of slidingscreens, so opening up into larger areas asrequired. The increase in the teacher:pupilratio would negatively impact upon theattention received by pupils and mostexisting classroom sizes could notaccommodate additional pupils.

b) staggered lessons; pupils could attendlessons in shifts, one teacher teaching thesame lesson to a number of classes. This

would increase the staff workload and couldnegatively affect the performance and healthof the teachers.

c) locum teachers; provision would need to bemade for such teaching staff. This impactmay be minor, and merely involve theprovision of additional lockers and seatingspace within staff and meeting rooms.

Architectural input:n Design remedial construction work to

existing school buildings.n Plan expansion in new classrooms e.g.

sliding screens.

HousingWhile on the one hand large sectors of the

population strive for some form of formal shelterin which to reside, and on the other, speculationof the numbers of predicted deaths due to theepidemic are widely variable, one mightconclude that with the imminent drop inpopulation, there will be a subsequent reductionin the need for new residential housing.

While this viewpoint is shortsighted, ithighlights the fact that long-term considerationfor the care of a population with a high HIVprevalence is needed. While we need to provideadequate shelter for our people, the questionmust be asked as to how this shelter can performas a multi-functional element in a culture ofchanging needs.

The housing and comfort of terminal AIDSpatients will arguably become the major fronton which Architects will face the reality of theepidemic. Current hospital, clinic and Hospicefacilities will not cope with the additional patientnumbers, and the associated costs of patientcare will cripple state and private funding. Homecare (the care of patients within their own homesby family members, with regular visits bysuitably qualified, medically trained persons)and day care facilities (centres where patientsmay be dropped off for certain hours a day orweek, for care, while family members are atwork), are the most viable solutions. Whereentire households become infected, thecommunity must rally to their assistance.Concerns over stigma do however prevail insome communities and this can only beovercome through education.

The explosion of the epidemic within somerural communities has necessitated that entiregroups of affected people and their willing familymembers group together to form a cooperativecoexistence in which care and support are given.It is this model that must gain support, asinstitutionalisation of people infected with HIV/AIDS arguably offers both a lesser quality of

Architects AIDS BRIEF for Professionals

SUMMARY

life and increases the burden on local andregional government.

Other concerns are (i) the inability of familiesaffected by AIDS to repay their home loans and,(ii) in cases where employers provide housingfor workers, the provision of housing for HIV/AIDS affected staff while needing to employ andhouse replacement staff.

Architectural input:n Ask the following questions of the design:n Will the unit provided be able to perform as

well if its function were altered?n What other functions might this building

type suit?n How easily can the building be modified to

suit an alternative usage and at what cost?n Can a number of these units be successfully

linked together to serve an area greater thaninitially conceived?

n Does the proposal engender the possibilityof co-responsibility amongst residents,allow easy external access to a number ofunits, make provision for home-basedincome generation and have suitablewashing facilities close at hand?

Provision of other building types

Recreational facilitiesOnce having taken the responsibility of

caring for infected persons within ourcommunities, we should see that they are keptmentally and physically stimulated. It isimportant that city planners attempt to introduceparks and recreational facilities within reasonablereach of city and sub-urban dwellers, as theoutdoor experience is therapeutic and animportant component of a comprehensivecontinuum of care.

In addition, income-generating activities(IGAs) are of central importance in any care andsupport initiative. Poverty tends to be pervasive,and job creation and IGAs are often the primeneeds expressed by people who are infected andtheir families. By combining AIDS facilities withyouth centres, accessibility to information andpreventative measures will be broadened.

Education and trainingThe prime method of reducing the numbers

of HIV infections should be through education.Concurrently, professionals who service thepopulation need to be trained suitably to providefor the needs of those infected by the virus. Theeducation of architectural undergraduates at

ACTION CHECKLIST

Universities and Technikons must, as a matterof urgency, introduce design problems relatedto the accommodation of infected people, toacclimatise graduates to the realities of theirprofessional obligations.

Architects in practice need to maintain anawareness of current trends with regard to theprovision for Architecture for AIDS, and this canbe facilitated by means of mid-career courses.

Architectural Input:n In view of the above situations which will

have a profound effect on the design anddelivery of buildings, place the HIV/AIDSepidemic high on the agenda for mid-careerand undergraduate architectural courses.

The construction industryA reduced volume of work, diverted funding

and a loss of trained skills, will affect the industryadversely. Indications of a reluctance to train newconstruction staff are emerging, as contractorsfear staff losses due to epidemic. Many majorconstruction projects have inadvertentlystimulated the spread of HIV, due to workersbeing relocated and housed in compounds forthe duration of the project.

Architects, together with their associatedmembers in the Design Team, are increasinglybeing faced with the realities and complexitiesof HIV/AIDS, and its impact on the builtenvironment. The needs of the past will notnecessarily be the needs of the future and AIDSwill make its mark on the profession.

Architects must endeavour to:n Attain sufficient training and education on

matters relating to the provision for thosewith HIV/AIDS;

n Creatively consider new methods ofimproving the accessibility to and comfortwithin their architecture, suited to the needs

of people living with HIV/AIDS;n Transform their Clients attitudes to make

allowance and provision for the adaptabilityof their buildings to suit the needs of peopleliving with HIV/AIDS. This should includeeasy adaptation for future redesign andreuse.

33333 Am I contributing to the spread of HIV/AIDSby designing vulnerable building types e.g.single sex hostels, casinos, barracks andworkers camps on remote sites?

33333 Can my design present opportunities for theprevention of HIV/AIDS, e.g. murals,counselling facilities, or user-friendly spacesfor affected persons?

33333 Does my housing design support the

potential for home-based nursing forinfected persons or mutual help forsupervising orphans?

33333 Is the design flexible enough toaccommodate evolving changes of use?

. . .

Useful contacts

HIVNET http://www.hiv.netHEARD http://www.und.ac.za/und/heardUNAIDS e-mail: unaids@unaids.org

Prepared by: Kevin Bingham and Rodney Harber,School of Architecture Planning & Housing,University of Natal, Durban, South Africabinghamk@gwise.mc.und.ac.za;harberr@gwise.mc.und.ac.za

Series Editor: Rose Smart

Funded by the USAIDBureau for Africa,

Office of SustainableDevelopment

Award No.AOT-G-00-97-00375-00

Commissioning Editor: Professor Alan Whiteside,Health Economics and HIV/AIDS ResearchDivision, University of Natal, Durban, South Africa

Layout : The Write Stuff, DurbanThe individual authors of the AIDS Briefs series are whollyresponsible in their private capacity for content andinterpretation.