June 2003

HIV/AIDS Workplace Programs
Mobilizing managers, crafting policies, educating workers

Workers at Eskom, South Africa's largest power company. Eskom has implemented HIV/AIDS prevention programs throughout its many work sites. Photo credit: Eskom

HIV/AIDS is affecting workplaces around the world. In sub-Saharan Africa, the epidemic has been devastating to businesses and industries, threatening every economic sector in many nations, targeting workers in both blue- and white-collar positions, as well as health workers, government employees, farmers, and teachers. Within the private sector, high levels of illness-related absenteeism and the loss of skilled workers have led to lower profits, greater difficulty delivering products and services, and higher costs for production, training, and insurance.

Even in regions with lower HIV prevalence, business organizations, unions, and governments increasingly recognize the need to address the issue now, before the threat becomes overwhelming. Such is the case in Vietnam, where the construction industry, the Ho Chi Minh City AIDS Committee, and the Ho Chi Minh City Labor Union are working together to implement peer education on AIDS prevention for the highly mobile workers who move among building sites around the city (Vietnam article). In Thailand, the Thailand Business Coalition on AIDS is exploring the value of incentives to urge business managers to institute nondiscriminatory workplace policies on HIV/AIDS and educate their workers about the disease (Thailand article). These examples illustrate an important key to success: getting management to respond proactively by supporting programs for their workers and “signing on” to stronger workplace policies that end discrimination against those who are infected.

Some companies, including South Africa’s giant Eskom power company, have implemented nondiscriminatory policies and broad-scale HIV/AIDS prevention, care, and treatment programs for their workers. Yet they sometimes find these efforts are blunted by fear of HIV/AIDS-related stigma among workers. These concerns discourage many workers from getting tested for HIV and may also prevent them and their families from getting care, support, counseling, and treatment.

Despite the clear need, there have been few workplace interventions designed to reduce stigma or create support for workers who are HIV-positive. One significant barrier is the difficulty of designing and evaluating interventions aimed at reducing the problem, due to uncertainty about how to define and measure the complex process of stigmatization.

To address these issues, Horizons is collaborating with Eskom and Development Research Africa, a South African research institute, to conduct an intervention study exploring how to improve Eskom’s HIV/AIDS program, including addressing stigma and discrimination in the workplace. Findings from this research may well prove to have wider application to workplace settings in other regions.

Identifying Needs

Eskom is one of the largest electric companies in the world. It has won awards for its HIV/AIDS workplace programs and policies. Yet there was concern that the workplace services it provided were underutilized because employees feared stigma and discrimination.

Eskom manager Kurt Dedekind speaks to staff on World AIDS Day 2002. Photo credit: Eskom

In February 2000, Eskom and Horizons held a two-day workshop in KwaZulu Natal Province, South Africa, to identify weaknesses in current Eskom HIV/AIDS programs and policies, examine potential solutions, and develop a study protocol to test their effectiveness. Using findings from an earlier assessment study and additional input from field-based Eskom staff, participants discussed a number of topics, including the effects of stigma within South African society; how to improve care and support, voluntary counseling and testing, and sexually transmitted disease prevention and treatment services; ways to reach the families and communities of the Eskom work force with HIV/AIDS-related activities; and the limitations of Eskom’s current peer education program in addressing issues beyond prevention. Participants felt strongly about the importance of creating a favorable workplace environment for promoting acceptance of people living with HIV/AIDS (PLHA).

Before the intervention component of the study began, a qualitative exploratory study was conducted in 2001 to examine the issue of HIV/AIDS-related stigma and discrimination. Researchers conducted in-depth interviews and focus groups with male Eskom workers and their sexual partners and other female family members, workplace supervisors, HIV/AIDS program staff, and community leaders.

For the intervention baseline, investigators conducted structured interviews with 379 male employees from 22 work sites in KwaZulu Natal. (Eskom’s work force at field-based sites is overwhelmingly male.) One female family member per worker, preferably a sexual partner, was asked to also answer the questionnaire, and 351 agreed. The interviews addressed perceptions of HIV/AIDS-related stigma and discrimination, HIV risk factors, and preferences regarding HIV-related services and activities. Both the exploratory and baseline findings were used to develop activities for the interventions.

Concerns About Stigma

Baseline data revealed that Eskom workers worry more about stigma from co-workers than discrimination within the workplace. Only 23 percent of the workers interviewed said they would be concerned about being fired if they were HIV-positive and their serostatus were revealed. In contrast, 55 percent of the female partners or family members—many of whom work as domestic laborers—said they would be afraid of losing their jobs if their employers learned they had HIV.

“This difference is likely due to Eskom’s emphasis on non-discrimination and its efforts to inform employees of their rights, in contrast to the unregulated environment in which many of the female partners work,” said Robert Stewart of Development Research Africa.

But the gap between Eskom workers and female partners or family members closes when it comes to concerns about stigma. Almost 90 percent of workers and family members surveyed either agreed or strongly agreed with the statement, “If I had AIDS, people would call me names and gossip about me.”

“People make jokes about HIV-positive people and point fingers at them,” said one female respondent. “There are so many with AIDS and so much gossip, too.”

The respondents themselves expressed similarly negative attitudes about PLHA. Overall, male respondents were somewhat more likely to express stigmatizing attitudes and express support for discriminatory behaviors. Almost half of the men (46 percent) and 37 percent of the women strongly agreed or agreed that HIV/AIDS is a punishment for bad behavior. About a third of male and more than a fourth of female respondents (31 percent and 27 percent, respectively) said that people with HIV/AIDS should not be allowed to work. Fifty-six percent of male and 48 percent of female respondents agreed that people with HIV/AIDS should not sell food.

Of special note is that concern about casual contact with a person who has HIV/AIDS was of relatively little concern to male or female respondents. Eighty percent of the men and 88 percent of the women surveyed said they would be at ease shaking hands with someone who is HIV-positive. Over three-quarters of the respondents said that they would be comfortable sharing their work tools or using the same toilet as a person living with HIV/AIDS.

Another important finding is that more women than men in the study believe that women are more likely to be blamed for HIV infection. Over half of female respondents (58 percent) compared to 37 percent of male respondents feel that women living with HIV/AIDS are more stigmatized than men living with HIV/AIDS. A greater proportion of female respondents (56 percent) than male respondents (36 percent) believe that their regular partners would leave them if told they were HIV-positive.

“This disease is associated with misbehavior,” said one male worker. “People would think the woman was sleeping around. They never blame a man.”

Stigmatization based on association with people living with HIV/AIDS is also a concern. About one-third of male (32 percent) and female (35 percent) respondents agreed that if they were to be seen sitting next to someone with AIDS, then others would think that he or she has AIDS, too. HIV/AIDS program staff also told researchers that they experience stigma because they offer AIDS-related services.

Other findings highlight the role stigma may play in underutilization of Eskom’s workplace HIV/AIDS services, especially voluntary counseling and testing. Health care providers told researchers that although counselors who visit the work sites are trained to discuss a wide range of topics, workers perceive them as dealing exclusively with HIV/AIDS and therefore do not want to be openly associated with them for fear that they will be stigmatized as having the disease. From the baseline survey findings, researchers found that workers who fear stigma were significantly more likely to avoid using voluntary HIV counseling and testing services.

The Effect on the Workplace

These interim results show the significant impact that HIV/AIDS-related stigma can have on the workplace environment and on utilization of workplace HIV/AIDS programs. Although Eskom’s implementation of non-discriminatory policies may help employees feel secure in their jobs, fear of social isolation and ridicule from co-workers and community members discourages them not only from disclosing their HIV status but also from making full use of all the services available to them.

In response, a number of intervention activities are under way as the study continues. In the third research arm, researchers assessed local NGOs to determine which HIV/AIDS services are currently offered within the community and what their capacity and staff training needs are. With fear of stigma so strong within the workplace, NGO services—such as support groups and counseling—that are community-based yet linked to the workplace could prove to be valuable additions to programs based at the work site. Four NGOs were selected, and plans for collaboration and mechanisms for service delivery are currently being coordinated.

In November 2002, Eskom and Horizons sponsored a workshop for trainers who will train a total of 125 peer educators for the study, including workers and interested female spouses and girlfriends, as well as NGO staff. A peer education training manual was developed, pretested, and revised to address issues that were raised during formative research, such as care and support, stigma and discrimination, cultural issues, gender and violence, and community outreach.

After many months of planning, a support group for people living with HIV/AIDS—Asikhulume (“Let’s Talk”)—has begun to meet, drawing membership from two Eskom work sites. Its mission is to address stigma, educate employees using trained co-workers who are HIV-positive, and provide care and support to members.

“The support group will help increase workplace acceptance of HIV-positive employees, encourage employees who are positive to be open about their infection, and help all employees take prevention issues more seriously,” said Mazwi Mngadi, founder of Asikhulume and Horizons coordinator for the Eskom study.

Researchers will collect the final round of data in 2004. After the data have been analyzed, Eskom plans to use the findings to strengthen HIV/AIDS activities at other sites. Researchers will disseminate findings to various groups, including Eskom supervisors and workers, NGOs, community and business leaders, and policymakers. Other companies in the region have also expressed interest in learning from Eskom’s experiences and possibly applying study findings to their own workplaces.

To receive e-mail notice when future reports and summaries about this study are published, sign up at www.popcouncil.org/horizons/signup.html.

This article was written by Sherry Hutchinson in conjunction with the study team, which includes Julie Pulerwitz, Horizons/Program for Appropriate Technology in Health; Eka Esu-Williams, Horizons/Population Council; and Robert Stewart, Development Research Africa.

© 2003 The Population Council, Inc.

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03 January 2009