Depressing challenges remain

South Africa is considered one of the global leaders in terms of international best practices for workplace programmes and policies of employees affected by HIV and Aids.

 The comprehensive testing campaign over the past 18 months has contributed to the testing of 13 million South Africans in total, said Denise Chendip, communications director of the South African Business Coalition on HIV/Aids (Sabcoha).

Saluting the work done by South Africa, Brad Mears, chief executive officer of Sabcoha, said: “Some of the most comprehensive and successful HIV workplace programmes are being developed in the South African private sector. These can be used as a blueprint by those countries that have yet to feel the impact of the disease.”

Yet, depressing challenges remain.

Deanne Goldberg noted on www.consultancyafrica.com that despite the touted importance of testing, the number of people actively aware of their status remains low.

Recent studies have indicated the median percentage of people who know their status in sub-Saharan Africa remains below 40%.

It further has been noted that even when structured testing programmes have been put in place, it is often the case that the number of employees who make use of these services is too low. (Source: www.consultancyafrica.com, 16 March 2011)

Ban Ki Moon, the United Nations Secretary-General, said: “Stigma remains the single most important barrier to public action. It is the main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so.

“It helps make Aids the silent killer because people fear the social disgrace of speaking about it, or taking easily available precautions. Stigma is a chief reason why the Aids epidemic continues to devastate societies around the world.”

Millennium Goals

Internationally, the drive to scale up HIV/Aids testing, and increase the number of people who know their status, has gained increasing impetus.

The UN Millennium Development Goals highlight as their sixth objective the drive to combat HIV/Aids, malaria and other diseases.

Specifically, they seek to “have halted by 2015 and begun to reverse the spread of HIV/Aids”, and “achieve, by 2010, universal access to treatment for HIV/Aids for all those who need it.”

In responding to this endeavour, the UN has called on communities worldwide, at both macro and micro levels, to respond to this challenge. HIV counselling and testing (HCT) represents a central mechanism in mobilising and capacitating the process of discovery and action in this regard.

The importance of HCT in the workplace

It is clear that society and industry alike are deeply and pervasively affected by HIV/Aids.

In addition to the numerous personal, relational and socio-cultural impacts of the virus, its far-reaching consequences pose a significant economic burden in the workplace.

Priya Bery, director of policy and research at the Global Business Coalition on HIV/Aids, has highlighted that corporations do not function in isolation.

Not unlike the nations they serve, they are deeply affected by the global HIV/Aids crisis, said Goldberg (Source: www.consultancyafrica.com, 16 March 2011)

Of particular relevance here is that HIV/Aids affects the labour force in a number of ways: the most productive segment of the working population is depleted; productivity and earnings decrease; labour costs increase; and skilled, experienced workers are often lost.

It is a combination of these factors that causes enterprises across the board to suffer.

With the majority of those affected by HIV being in the prime of their working lives, it is becoming increasingly clear that workplace interventions are a critical forum for prevention activities.

Thus, the call to action is an opportune one, and the efficacy of HCT in this context cannot be undervalued.

A call to arms

The International Labour Organization (ILO) has set forth a code of practice regarding HIV/Aids and the World of Work.

The first tenet of this code states: “HIV/Aids is a workplace issue... [It] should be treated like any other serious illness or condition in the workplace”. This is necessary not only because it affects the workforce, but also because the workplace – being part of the local community – “has a role to play in the wider struggle to limit the spread and effects of the epidemic”.

This statement highlights the integral role that businesses must play in catalysing action to prevent further spread of the virus.

Furthermore, Bery suggested that in sub-Saharan Africa, at the epicentre of the problem, corporations simply must become involved in prevention efforts.

For example, Sabcoha has begun to establish a community fund that aims to make HCT services available to vulnerable employees and industries, as well as their families and broader communities.

Consistent with this, a number of businesses have begun to incorporate HIV/Aids programmes into their organisational policies. HIV education campaigns and wellness days have become integral parts of employee well-being curriculums.

A smaller proportion of these enterprises have endeavoured to increase the number of employees aware of their status, and have developed supportive care and treatment services including HCT for employees and their family members, said Goldberg.

Stigma and discrimination

HCT is regarded widely as one of the central intervention and prevention strategies against the spread of the HIV/Aids epidemic.

Furthermore, HCT has come to be seen as one of the core aspects of national HIV/Aids plans in a number of developing countries.

This is due to its ability to act as a risk behaviour assessment and education forum, as well as being a relatively cost-effective intervention when compared with other strongly resource-dependent programmes.

Stigma (and the associated discrimination) continues to present one of the most influential and detrimental barriers to individuals’ decisions to test for HIV.

Stigma, in this context, refers to a particular discrediting attribute which, by its possession, reduces and casts the individual as tainted and deserving of denigration.

It has been shown that people infected with or affected by HIV/Aids continue to experience stigma, discrimination and social marginalisation on a daily basis.

Stigma is strongly linked to dominant social, political and economic power systems, and has the capacity to affect the global health of the individual significantly, as well as his/her specific functioning within each of these contexts.

In response to this facet of the lived HIV experience, the second tenet of the ILO’s code states that: “In the spirit of decent work and respect for the human rights and dignity of persons infected or affected by HIV/Aids, there should be no discrimination against workers on the basis of real or perceived HIV status.”

Discrimination and stigmatisation of people living with HIV/Aids inhibit efforts aimed at promoting HIV/Aids prevention.

Despite the ethical clarity and inclusivity inherent in this statement, as well as that found in most workplace policies with regard to HIV-positive employees, stigma remains an intimidating barrier to the success of testing and treatment interventions, said Goldberg.

Three manifestations of stigma and discrimination

Chendip said stigmatisation is still a major issue that sets the foundation in terms of why it is difficult to increase the uptake on voluntary testing in South Africa. It is still a major stumbling block in South Africa.

“Although, it must be pointed out that a significant amount of work has been done and is continuing to be done to educate and empower people in order to address this
issue,” she added.

Stigma and discrimination have been found to hamper the implementation and success of workplace HIV/Aids programmes.

In one example, drawn from a large South African company, stigma and discrimination and the impact thereof were assessed.
The findings of this study revealed three types of workplace interactions in which HIV/Aids-related stigma and discrimination may manifest:

Firstly, institutional-level stigma reactions include all facets of employees’ experiences with their organisation’s policies and practices.

The second category includes stigma related to the capabilities of the HIV-positive individuals to fulfil their job roles, as well as the risk of casual contact within the
work setting.

The nature of social interactions within the workplace was the third scenario that emerged. The respondents noted how HIV-positive persons would be the targets of gossip and social isolation and, in some cases, even verbal abuse. (Goldberg, www.consultancyafrica.com, 16 March 2011)

Problematically, and likely linked to the fear of such discrimination, more than 60% of workers indicated that they felt it inadvisable to disclose their HIV status, according to Goldberg.

The diagnosis of being HIV-positive is regarded as a traumatic and life-changing experience.

It is likely that the complicated emotional state in which one may find oneself before and after the testing experience may influence an individual’s decision to test.

The provision of workplace HCT is driven in part by the need to enhance accessibility of services, but the logistics – and, specifically, the location of testing facilities – can become a confounding variable.

Furthermore, employees may feel intimidated to walk into the testing centre for fear of discrimination by their colleagues.

The results of a study at a South African mining company note that structural factors, such as the on-site nature of an HCT campaign, caused some concern.

Workers feared that the results of the test would be available publicly as confirmed by the length of the post-test counselling session. Other workers feared that should others see a negative response or reaction, this would be interpreted as a non-verbal disclosure of a positive status.

Confidentiality was seen to be valued deeply by workers – both at a personal level and a company level – with concerns being expressed as to the true aim of the programme. In brief, they feared the company would discriminate against them as a result of their HIV status. (www.consultancyafrica.com, 16 March 2011)

Prevention better than cure

Mears says that for anyone doing business in South Africa, 10% to 40% of the workforce is likely to be infected with HIV.

But the impact and potential of HIV/Aids varies greatly from one company to the next. Labour- and capital-intensive industries, as well as those with high labour mobility, are most affected.

Research shows that if companies invest in prevention and treatment programmes, the savings outweigh the costs. Providing care and treatment for HIV-positive employees can reduce the financial burden of HIV/Aids by as much as 40%, says Mears.

In South Africa, the mining, metals processing, agribusiness and transport sectors are most affected by the pandemic, with more than 23% of employees infected with HIV/Aids.

Prevalence rates are higher among skilled and unskilled workers than among supervisors and managers.

Chendip told Leadership in HIV/Aids: “Turnover of staff is high in these industries. A key reason for this is that many employees do not present themselves for testing, and those who test do not get into treatment.

“Another reason, related directly to labour mobility, is that there is no consistency of treatment (employees stop treatment when they travel home) being practised.”

South Africa leading the way

Increasingly, companies in South Africa are becoming world leaders in workplace programmes.

Chendip told Leadership in HIV/Aids that in 2000, the Department of Labour introduced the code of good practice on key aspects of HIV/Aids and employment, which set the standard for the creation of all independent company policies thereafter.

The introduction of the national strategic plan, which is now approaching its second phase, includes an inclusive public and private sector blueprint that focuses on guiding the country to realising its goals in terms of HIV and Aids.

Sabcoha has been very successful in rolling out educational workshops that address key issues such as stigma and discrimination, medical male circumcision, and community dialogue.

Most successful of these have been the peer educator support workshops, BizAIDS programme, and the small and medium enterprise Supply Chain Development Project, said Chendip.

Thandi Mzizi from the Western Cape Provincial Government said it has targeted the big corporate employers in the province in ensuring HIV/Aids workplace policies are in place. Furthermore, it has researched the impact of HIV/Aids on the Western Cape economy.

The provincial government encourages companies to purchase the comprehensive Workplace HIV/AIDS Toolkit, produced by Sacoha. “In accordance with international best practice, the toolkit provides businesses, especially SMMEs [small, medium and micro enterprises], with a means of implementing cost-effective workplace programmes,”
said Mzizi.

Global awards

Businesses in South Africa repeatedly have received global awards for their sterling work in setting up workplace programmes to deal proactively with HIV/Aids.

Anglo Coal South Africa received the GBC Workplace Counselling and Testing Award in 2009, said Goldberg.

Its programme follows a five-pillar approach that includes a focus on “voluntary counselling and testing; awareness, education and prevention; care, support and treatment; partnerships; and commitment toAnglo’s six values.

A multilevel strategy in creating effective interventions clearly is valued in this instance.

Further, it notes a continuing commitment to creating awareness around its HIV non-discrimination policy, the aim of which is to reduce stigma and encourage testing concurrently.

The programme has shown measured success. In all, 94% of the workforce has been tested for HIV/Aids, including the CEO and executive staff members, who have tested publicly to show their commitment to, and investment in, their prevention endeavours.

The ILO and International Finance Corporation together have highlighted how an investment from senior management represents an important source of motivation for other employees.

One of the most unique and valuable aspects of Anglo Coal’s programme is its commitment to providing ART to all employees and their families, should they require it.

Implicit here is the knowledge that appropriate intervention has both socio-cultural and economic benefits, on macro and micro levels – beneficial to both the organisation and the individual employees, said Goldberg. (Source: www.consultancyafrica.com, 16 March 2011)

Fanie Heyns