south africa: lessons learned from private sector initiatives regional videoconference: addressing...
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South Africa: Lessons Learned from Private Sector Initiatives
Regional Videoconference: Addressing Stigma and Discrimination of HIV/AIDS in
AfricaPretoria, South Africa
April 2, 2009
Country Context and Status
Source: www.unaids.org
Country Context and StatusHIV prevalence amongst public antenatal clinic attendees
(DOH)2000 2001 2002 2003 2004 2005 2006
2007
Eastern Cape 20.2 21.7 23.6 27.1 28.0 29.5 28.6
26.0
Free State 27.9 30.1 28.8 30.1 29.5 30.3 31.1
33.5
Gauteng 29.4 29.8 31.6 29.6 33.1 32.4 30.8
30.3
KwaZulu Natal 36.2 33.5 36.5 37.5 40.7 39.1 39.1
37.4
Limpopo 13.2 14.5 15.6 17.5 19.3 21.5 20.6
18.5
Mpumalanga 29.7 29.2 28.6 32.6 30.8 34.8 32.1
32.0
Northern Cape 11.2 15.9 15.1 16.7 17.6 18.5 15.6
16.1
North West 22.9 25.2 26.2 29.9 26.7 31.8 29.0
29.0
Western Cape 8.7 8.6 12.4 13.1 15.4 15.7 15.1
12.6
RSA 24.5 24.8 26.5 27.9 29.5 30.2 29.1 28.0
Current national prevalence: 18.8%
Source: NATIONAL HIV AND SYPHILIS PREVALENCE SURVEY SOUTH AFRICA 2007 © National Department of Health 2008
Country Context and Status April 1994
1st democratic elections held in South Africa. October 1998
Deputy President Thabo Mbeki makes the Declaration of Partnership Against AIDS, in which he calls for an end to discrimination against people living with HIV.
Less than 2 months later Gugu Dlamini, an AIDS activist in Durban, is beaten
to death by her neighbors after declaring that she is HIV-positive on World AIDS Day.
From: http://www.avert.org/aidssouthafrica.htm
Country Context and Status
2002 A study reveals that only one third of
respondents who had revealed their HIV-positive status were met with a positive response in their communities. One in ten say that they had been met with outright hostility and rejection.
2005 "Let us give publicity to HIV/AIDS and not hide it,
because [that is] the only way to make it appear like a normal illness.“ Nelson Mandela after the death of his son due to AIDS.
Policy Framework for Responding to Stigma and Discrimination
Legislation Labour Relations Act (No.66 of 1995)
The Labour Relations Act protects employees against unfair dismissal.
Employment Equity Act (No.55 of 1998) This Act ensures that all employees are treated
equally and that there is no discrimination in the workplace.
Basic Conditions of Employment Act (No.75 of 1997) This Act sets standards for employers on how many
hours an employee may work in a week and how much leave they are allowed to have.
Policy Framework for Responding to Stigma and Discrimination
Promotion of Equality and Prevention of Unfair Discrimination (No.4 of 2000)
The Promotion of Equality and Prevention of Unfair Discrimination Act also sees to it that there is no unfair discrimination in the workplace.
Occupational Health and Safety Act (No. 85 of 1993)
An employer is obliged to ensure that the risk of occupational exposure to HIV is minimized as far as is possible.
Compensation for Occupational Injuries and Disease Act (No.130 of 1993)
Policy Framework for Responding to Stigma and Discrimination
Department of Health: Comprehensive HIV and AIDS Care,
Management and TreatmentPlan for South Africa
Training manual - Operational plan for comprehensive HIV and AIDS care, management and treatment for South Africa
HIV and AIDS and STI Strategic Plan for South Africa, 2007-2011
Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa
National Antiretroviral Treatment Guidelines Monitoring and Evaluation Framework
Policy Framework for Responding to Stigma and Discrimination
Department of Labour: Code of Good Practice on Aspects of
HIV/AIDS Employment HIV/AIDS Technical Assistance
Guidelines Private Sector:
Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria
South African Business Coalition on HIV/AIDS
Sector initiatives
Intro to CareWorks
The CareWorks Group: HIV Management
Workplace programs (private sector) Focus predominantly on mobile males (construction, transport, mining)
Treatment programs PEPFAR partner Focus
CareWorks Training Change management specialists Diversity
CareWorks Africa 15 countries’ industrialization funds (EFP) as partners Objective: Deliver all CareWorks solutions into Africa
Enrol HIV +
ARV adherence“Keep the positives healthy and productive”
“Keep the negatives negative”
Objectives Of HIV Management in the Private Sector
Reduce Stigma & Discrimination
Prevent Transmission (Prevention strategy)
Prolong Productivity (Treatment strategy)
What makes our approach work? Passion Plan Objectives driven and aligned Measured (good data) Involvement of HIV Positive People Multi-disciplinary approach Business experience … BUT… CARE WORKS!
Can it be achieved in the Private Sector?
% HIV Prevalence 15.5% 8.5%
% Staff trained in HIV 100% 100%
% staff tested 91% 88%
% of HIV+ on Treatment Program
99% 90%
% of those on ARVs that are adherent
90% 80%
% disclosed to company 100% +80%
Change in prevalence over 4 years
.08% Data NA
Programs and Interventions to address Stigma and Discrimination
Key approaches/strategies used to implement program/intervention?
Broad strategy (long term)
Create reasonable, deliverable expectations – align objectives
Leadership active commitment (CEO, Unions, managers) Policy (formulation, promotion and implementation /
adherence management) KAPB surveys (baseline and focus) Good knowledge and understanding for all (combat
myths and ignorance) Process vs. events Ongoing focus… (WPEs / steer com / reporting /
communications / support and involvement of HIV+ (PLWHAs) etc.)
Programs and Interventions to address Stigma and Discrimination
Episodes (short term) Focus groups Organizational culture Counseling Diversity (racism / gender…) Disciplinary action
Programs and Interventions to address Stigma and Discrimination
Who are the target groups? All employees Communities
Who are the key partners? Senior management Unions Line management WPEs PLWHAs
Programs and Interventions to address Stigma and Discrimination
Response from a client?“We embarked on an intensive HIV/AIDS program
nine years ago with the assistance of CareWorks. It definitely was not an easy task, but today we are very thankful that we went that route. Our employees share our dream: stopping new infections, encouraging all staff members to know their status and to encourage infected employees to receive the treatment offered.”
Marlene Cronje, Human Resources Director, Power Construction
Challenges and Gaps
Challenges and gaps Syndromic – finding the problem through
WPEs KAP Results!
Understanding Change Management process
Lessons learnt in the private sector
Remain focused on program objectives Management’s active commitment is imperative Always include Trade Unions (where represented) HIV/AIDS should be a strategic priority Education and focus must be ongoing. This provides the
platform to address stigma and discrimination within the content of the intervention
Involve a PLWHA (not at the beginning of the program, rather towards the Testing phase)
Aim for disclosure in a secure environment
Lessons learnt in the private sector
Establish an effective Steering Committee to manage and oversee the program
Ensure senior management and union representation Train the Steering Committee members in policy
matters and how to deal with stigma and discrimination issues
Address any form of stigma and discrimination immediately and seriously. If not, it could lead to failure of program and even labor unrest
The Way Forward Develop standard measurement
criteria and tools Continue learning, recording and
sharingThank you!
+27 21 673-5300