In-depth: The Treatment Era: ART in Africa

SOUTH AFRICA: The two sides of workplace HIV/AIDS treatment programmes

Photo: IRIN

Derrick Khathi - battling with his employer for HIV/AIDS treatment

JOHANNESBURG, 6 December 2004 (IRIN In-Depth) - The fear of stigma and discrimination is preventing many HIV-positive employees from accessing workplace care and treatment programmes.

Vodacom, one of South Africa's most lucrative mobile phone companies, has put in place care programmes, but few workers are willing to access the freely available treatment.

According to Mark de Clark, an administrative coordinator at Vodacom, the company has some of the most comprehensive AIDS treatment programmes in the country, second only to that of mining giant Anglo-American.

"Employees seeking to determine their HIV status need only present positive identification and a letter of employment at any laboratory, or make use of the mobile voluntary counselling and testing (VCT) facilities, available at the company's premises at least once a week," De Clark told PlusNews.

Should an employee test HIV positive, the workplace programme covers basic lifestyle and health management, antiretroviral (ARV) therapy, and treatment for any opportunistic infection accompanying the virus, such as tuberculosis (TB), pneumonia and diarhorrea.

Delivery of medication has been contracted to a chronic drugs courier, Direct Medicines, as part of maintaining the programme's confidentiality clause.

'ARROGANCE OF MANAGEMENT'

HIV-positive workers are entitled to fortnightly visits to any private physician to check their viral load and CD4 counts (a gauge of the strength of the immune system), to determine how well they are doing on prescribed medication.

"Over and above these benefits, staff and family members have access to an HIV/AIDS helpline, where trained staff offer counselling and practical advice on all aspects of disease management, from identifying drug side effects and opportunistic infection symptoms, to coping with stigma, discrimination and disclosure. Family members are also provided with post-exposure prophylactic treatment in the event of accidental exposure," said De Clark.

Despite this costly intervention, De Clark is one of only three known HIV-positive Vodacom employees making use of the life-prolonging treatment benefits.

Having counselled many of his colleagues, he blames their reluctance to get tested on the "arrogance of management".

"While enough has been done, by the book, to encourage VCT and the promotion of the AIDS management programme, top-level executives still believe they are not susceptible to HIV infection. This is a mild form of discrimination that encourages the stigma, which leads to employees at all levels unnecessarily succumbing to HIV and, ultimately, AIDS-related illnesses," De Clark said.

He warned that unless senior staff became more involved by acknowledging that the virus affects all aspects of the corporate sector, even elaborate programmes, such as Vodacom's, would have no effect.

Coupled with the financial losses due to AID-related staff sick leave, and an eventually diminished workforce, HIV/AIDS could have a devastating impact not only on business, but also on South Africa's economy.

De Clark's sentiments are not uniquely South African; they are shared by the World Economic Forum (WEF) in their 2003-04 report, 'Business and HIV/AIDS: Who me?', which covers 103 economies and provides the first global survey of business leaders' perceptions of the impact of HIV/AIDS and their responses to the pandemic.

Jointly undertaken by UNAIDS and the Harvard School of Public Health, the WEF study found that few companies had an HIV policy, most discriminated against those who were HIV positive, and believed their policies and responses were satisfactory.

According to the research, less than 6 percent of companies provided ARV drugs to their employees, and only 15 percent had a policy that did not compel employees to disclose their HIV status.

While some HIV-positive professionals may be hesitant to take advantage of free treatment programmes, their semi-skilled labour counterparts remain locked in battle with employers over the provision of basic workplace care.

DERRICK'S BATTLE

Derrick Khathi, a 26-year-old HIV-positive textile machine operator at Cotton King, a factory in the coastal province of KwaZulu-Natal, says he is "appalled" at the lack of basic healthcare and AIDS education available to the estimated 300 labourers at the factory.

"When I was diagnosed towards the end of 2003, all I had was the tiny company surgery where I spent a great deal of time, as I was constantly ill. It was obvious to many, including management, what was wrong with me, but it was left up to me and the factory nurse, who referred me to one of the public hospitals for testing," Khathi told PlusNews.

He says the high level of discrimination in the factory prevents other workers from getting tested, "even when the symptoms are visible".

"There is very little action from the management to educate workers about the disease," he explains. "There is one poster in this huge factory that doesn't do much to encourage staff to find out about their HIV status. But I sometimes am approached by sickly workers for advice, because most of them know about me being HIV-positive, and my active role in the clothing and textiles worker's union HIV/AIDS programme."

Khathi comments that if factory owners made treatment programmes available, workers would be more willing to get tested, and attitudes and misconceptions about HIV and AIDS would change.

Doctor Feroza Munsoor, who heads the HIV/AIDS Project of the South African Clothing and Textiles Workers Union (SACTWU), says business and all organisations can do a lot more in education and treatment by developing partnerships with government.

"Synergies need to be formed between government and organisations like SACTWU that compliment the health department's HIV/AIDS treatment plan, so that our workers don't become a burden to the government," Munsoor said.

Noting the lack of readily available treatment at factories, she suggests that government provide SACTWU with antiretrovirals for its members, as the union already has a comprehensive education programme and is willing to help roll out drugs to members.

"If government can do that, SACTWU can provide quality care to our members, and not be rushed by huge target figures [for providing treatment]."

For now, Munsoor hopes that SACTWU's education campaign, which also uses live theatre performances to encourage testing, will be sufficient until the union is able to provide the necessary HIV/AIDS treatment.

She says if her campaign can assist in educating just one worker per day about HIV and AIDS, then it will have been successful.

[Resource: "ILO Report with Estimates on HIV/AIDS and Global Trends in the World of Work", International Labour Organization, 2004 - www.ilo.org]

The Treatment Era
ART in Africa

December 2004
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Links & References

The WHO 3 by 5 Initiative
www.who.int
The Global Fund to Fight HIV/AIDS Tuberculosis and Malaria
www.theglobalfund.org
The President's Emergency Plan for AIDS Relief
www.usaid.gov
World Bank AIDS site
www1.worldbank.org
Pan-African Treatment Access Movement
www.patam.org
WHO Prequalification Project
http://mednet3.who.int/
Eldis Resource on ARVs
www.eldis.org

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