HIV and Aids workplace initiatives should be integrated into national Aids programmes and a wide range of health approaches, including occupational safety and health, says a new report launched by the International Labour Organization (ILO) in South Africa. The study provides a comprehensive assessment of HIV and AIDS workplace initiatives across 10 African countries: Côte d’Ivoire, Ghana, Kenya, Madagascar, Morocco, Mozambique, Namibia, Senegal, South Africa and Zambia.
“The ILO study captures the impact that HIV workplace programmes make in reducing risky behaviours and in promoting the uptake of services, particularly voluntary counselling and testing. The study also highlights factors that lead to such an impact – the foremost being management commitment,” said Alice Ouedraogo, chief, HIV/Aids and World of Work Branch (ILOAIDS), ILO Geneva. “With Aids still unfinished business, we look forward to the study being implemented to expand the HIV response in workplaces,” she added.
The study, commissioned by the ILO and undertaken by the Human Sciences Research Council (HSRC) of South Africa, is based on research conducted between January 2013 and October 2014 in a total of 66 workplaces – public, private, formal and informal. It highlights the progress of workplace initiatives as well as, challenges and opportunities in making their HIV response more efficient, contributing to sustainability, increased scale-up and country ownership.
Leadership makes the most significant contribution: Management commitment was a key element in increasing knowledge about HIV and Aids in 96% of the workplaces surveyed. Approximately 65% of the workplaces investigated provided solid evidence of actions that led to changing or reducing risky behaviours, such as reducing the number of sexual partners, having safer sex by using condoms, maintaining fidelity in relationships and accessing HIV testing and counselling services.
Approximately 79% of the workplaces studied provided evidence that they had increased uptake of voluntary counselling and testing (VCT) services. The use of peer educators in 81% of the workplaces to promote VCT was a cost-effective strategy.
Economic benefits of workplace programmes: the costs of not having a workplace programme far exceed the cost of having one. Six workplaces in three countries (Namibia, Kenya and Zambia) undertook positive cost-benefit analyses.
Public-private partnerships are essential. The introduction of low-cost insurance plans in Namibia, Zambia and Kenya helped companies save costs they were facing due to absenteeism. In 96% of the workplaces surveyed, the establishment of a sound monitoring and evaluation system proved essential in assessing and tracking changes in the levels of knowledge, identifying gaps and redefining strategies.
Reducing stigma and discrimination: Only 14% of workplaces investigated were able to provide conclusive evidence that their programmes had reduced HIV-related discrimination. The factors contributing to reducing stigma and discrimination were: management commitment; creating an enabling legal and workplace policy environment, engaging with people living with HIV, and strengthening monitoring and evaluation systems.
The study highlights the importance of meaningful engagement of people living with HIV (PLHIV) in all activities. PLHIV contributed significantly to increasing the uptake of voluntary counselling and testing by normalizing perceptions of HIV and increasing acceptability among employees. Employment has a reinforcing role on HIV treatment adherence. People are more likely to stay on treatment if they have a job. Partnership with national AIDS programmes is the key as most of the countries provide free antiretroviral treatment.
The study recommends that workplaces should establish linkages with on-going HIV programmes to ensure that the continuum of care is not broken. Workplaces should also cover the cost of treatment of opportunistic infections and reduce the financial burden on employees living with HIV. Gender-specific strategies were identified such as ensuring access to male and female condoms; having training sessions on addressing sexual harassment; and empowering women as change agents.
The final purpose of the study is to accelerate workplace initiatives to make them an efficient and sustainable instrument in the reality of the HIV response in Africa. Successful workplace responses to HIV and Aids are significant for an Aids-free future in Africa.
The study follows the recent launch of the UNAIDS report, which is aimed at speeding up interventions towards reducing new HIV infections and increasing the number of people accessing treatment. “The ILO study is timely to ensure that workplaces are aware of their contribution and they continue to provide access in scaling-up HIV and TB programmes towards ending the AIDS epidemic in Africa,” says Simphiwe Mahbele, ILO HIV/Aids specialist based in Pretoria, South Africa.