HIV still taboo in the South African workplace

South Africa’s long struggle with HIV and the plethora of organisations, initiatives and campaigns that the epidemic has spawned would lead one to expect that the country had squared up to the challenge of HIV and, after a fatally slow start, was now effectively combating the epidemic.

This is unfortunately still not the case, “especially in the South African work place where many companies remain unsure of how to treat the epidemic and are still too afraid to broach the subject more generally” says Dr Lerato Motshudi, Medical Advisor at Health Management Solutions, Alexander Forbes Health.

The result is that over two decades into the struggle against HIV many South African companies still do not have a clear, well articulated and generally understood HIV policy. Where policies do exist they often remain merely that, policy, with companies battling, or in many cases, not even attempting to turn their policies in to practice.

“The whole issue does however need to be tackled with research and numbers” says Dr. Motshudi. For example, if 2% of a company has HIV while 40% suffer from heart disease it does not make sense to have a large, elaborate and expensive HIV programme regardless of what other organisations may be doing.

Organisations need to develop a numbers-driven idea of their major health problems. Then if indeed HIV is shown to be an important factor, organisations need to be very clear about what the function of the policy will be, how it will work, how it will be communicated and how employees will use it.

In other words “HIV policies need to be tailored to the specific infection set of each business, taking into account how infection will impact the business and how HIV treatment will be most effective in meeting legislative, people and business goals” explains Dr. Motshudi.

In short, organisational HIV policies should:

· Outline precisely how every employee will be treated despite their HIV status. “This gives managers the courage and support to broach the subject with employees” adds Dr. Motshudi.

· Specify areas of potential abuse and acknowledge areas where individuals may need support while guiding employees to access this support.

· Be aligned with all other company policies and guided by professionals able to offer advice on the drafting as well as the reviewing of policies. Companies “may also benefit from viewing other policies in order to benchmark against similar companies with the same infrastructure and challenges” adds Dr. Motshudi.

Developing an HIV policy document also helps organisations:

· Acknowledge that HIV is a nationwide problem and that it is receiving appropriate attention from senior management.

· Guide senior staff to deal with challenges and correctly engage with their staff.

· Assure their employees that their rights are protected.

Off-the-shelf HIV policies are unlikely to deliver an effective outcome. Instead, getting the Management of HIV right in organisations means tailoring a unique policy for each set of circumstances.

Dr. Motshudi cites the example of a company employing several hundred truck drivers with high HIV infection rates. While the company’s HIV policy provided antiretrovirals to infected employees, the truck drivers often shared these with partners and children, rendering them ineffective in treating the drivers themselves. To ensure that the truck drivers, and ultimately the organisation, benefitted from the HIV policies’ provision of antiretrovirals it was necessary to appoint a disease administrator. The administrator appointed doctors country-wide to deal personally with each driver, test their levels of infection and calculate the correct antiretroviral regime while educating each driver in the necessity of sticking to the regime and closely monitoring intake and results.

“While this cost more up front, in the long run, it was more than offset by the savings derived from a healthier workforce, especially amongst the drivers” says Dr. Motshudi.

In another example a company that employed hundreds of short term contract workers had a standard HIV policy which didn’t appear to be working as short term employees were failing to embrace the policy. In this situation Dr. Motshudi found it made more sense for the company to focus its HIV policy on the community that most of the short term contract workers came from. Most communities already have HIV programmes. Though largely underfunded and inadequate compared to the demand they offer a network that companies can augment with funds, proper administration and up to date medication. “Working with existing community structures helps companies get to workers who would otherwise slip thorough the net of more formal in-house HIV programmes” advises Dr. Motshudi.