On the job, on treatment?

On paper, South Africa has some of the world's best HIV workplace programmes, but on the ground they just aren't adding up.

Diamond mining giant De Beers has long boasted that 86 percent of employees at its six mines have been tested by its voluntary counselling and testing (VCT) programme. The company estimates that 10 percent of its workforce is HIV-positive, but markedly less access the antiretroviral (ARV) treatment programme.

Workers' fears about confidentiality, a preference for traditional medicine and poor patient-doctor communication were all cited as challenges to raising treatment numbers, according to an ongoing study by De Beers.

The research was presented by the company and the University of KwaZulu-Natal (UKZN) on 6 November at the Private Sector Conference on HIV and AIDS, hosted by the South African Business Coalition on HIV and AIDS (SABCOHA).

Tim Quinlan, research director in the Health Economics and HIV/AIDS Research Division (HEARD) of UKZN, said although fears about confidentiality might be allayed by company campaigns reassuring workers of their privacy, other challenges could run deeper if local contexts were ignored when businesses tried to roll out programmes too quickly.

Large companies like De Beers would ideally like to roll out standardised programming across all sites, but tailoring programmes to local contexts could improve service uptake, Quinlan told the conference.  

Lost in translation

According to the World Health Organisation, about 80 percent of South Africans use traditional medicine. The De Beers study found that employees were often willing to forgo treatment rather than talk about their traditional medicines to clinic doctors, who they felt might not understand their beliefs. Language barriers between doctor and patient were another difficulty.

Spiwo Xaphile, director of the J.L. Zwane Community Centre in Cape Town, said language was not the only problem. "We speak English to you and you think youunderstand, but there is a cultural undercurrent that we will never talk about," he said, noting that there were cultural and racial divides as well as 11 official languages in South Africa.

'Remember the chicken' was the term used by peer educators to transactional sex in the workplace.

Rachel Tau, a peer educator at mining company Pamodzigold, said she often gave education sessions in Fanagalo, a mixture of local languages that serves as a lingua franca in the mines.

Tau recently took part in a peer educator workshop run by University of Witwatersrand Associate Professor David Dickinson, where participants were asked to map and name the sexual networks they found in the communities where they worked.

"Triple C" was the name given to sugar daddies who gave girls "cash, clothes and cell phones"; "Kiss and tell" described affairs between married neighbours in townships; and "Remember the chicken" described workplace relationships in which sex was traded for job advancement.

"Peer educators remain a good way of finding out what networks are around your company, and localising your response," said Dickinson, who has researched the role of peer educators in workplace programmes. "How often have I stood up [in a workshop] and said 'look to the community; sex doesn't happen in the workplace'."

If businesses wanted to localise programmes and break away from formulaic responses, Dickinson said, peer educators could provide a window, not only into workplace environments but also the surrounding communities.

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