South Africa’s organised labour movement mobilised relatively early to attend to the scourge of HIV, AIDS as well as tuberculosis (TB) in the workplace. One such programme launched was the SACTWU Worker Health Programme (SWHP). For the past 18 years the SWHP has been part of the very fabric of many people’s lives in South Africa, delivering much-needed and in fact life-changing health services.
The 21st International AIDS Conference (AIDS 2016) to be hosted in July in Durban is an opportune time to reflect on the journey that SWHP has travelled in implementing evidence-based prevention and treatment interventions in the workplace and beyond.
The value of partnerships
In line with the National Strategic Plan as it pertains to AIDS, TB and STIs, as the SWHP we have, over the years, nurtured strategic partnerships with various stakeholders including national, provincial and district level government departments, health policy makers locally and abroad, agencies of the United Nations, national public health institutes like the United States Government’s Centers for Disease Control and Prevention (CDC), the US President's Emergency Plan for AIDS Relief (PEPFAR), academic institutions, as well as other NPOs and donors.
Effective community mobilisation has converted a call to action into uptake of services. By working with others SWHP has grown from humble beginnings into an organisation that can impact individual lives nationally on a massive scale; delivering much-needed health services to over 1.2 million people directly and many more indirectly. Our formal collaboration with key non-profits in South Africa and abroad has enabled improved care and more efficient monitoring of activities. Collaboration also ensures the avoidance of overlap and duplication of services; resources are maximised and efficiently utilised.
A holistic approach
We believe that the spread of HIV, AIDS and TB will only be halted through a comprehensive approach to the management of these illnesses. For this reason our approach has rested on a number of pillars. We have worked with employers to put in place human rights-based HIV, AIDS and TB policies to ensure that there is no discrimination against employees and that the stigma associated with the illness is eliminated. Further, we have initiated robust HIV, AIDS and TB prevention programmes focusing on sexual health education, increasing access to condoms, providing voluntary medical male circumcision (VMMC) services as well as voluntary counselling and testing.
We also firmly believe in the implementation of wellness programmes for employees, including the provision of life-saving treatment like antiretrovirals (ARVs), in partnership with the Department of Health. Finally, we have worked hard to address the drivers of the pandemics – including stigma, poverty, gender inequality, and violence against women, as well as lack of skills development.
We believe in the power of inspiring youth to have a positive outlook, to understand the value of learning a skill and working hard, to show respect for others and always to respect themselves. To achieve this is to have a direct impact on keeping them safe from gender-based violence and minimising their chances of risky behaviours which can lead to HIV transmission.and AIDS.
Innovating and tackling societal norms
Although the biomedical mechanics of HIV transmission are well understood, there is still a need for greater awareness about how behaviour that fuels infections is influenced by a complex set of variables, including individual knowledge and abilities, and personal and group attitudes, values and beliefs. An example of the complex nature of the fight against HIV is the national effort to increase the number of men voluntarily undergoing medical male circumcision. VMMC is seen as a vital HIV prevention measure, with studies by the World Health Organization (WHO) and other experts showing that it can reduce the chance of transmission from female to male by up to 60%. In response to this type of research, the South African Government developed and implemented the VMMC Programme with local partners like the SWHP and leading international experts including PEPFAR, the WHO, CDC, United Nations AIDS Program (UNAIDS), Bill & Melinda Gates Foundation and United States Agency for International Development (USAID). SACTWU is said to have been the first union to offer VMMC services to its members when the programme launched in June 2011.
Our insights and experience showed that it would not be enough to simply grant men access to circumcision. While HIV and AIDS affect both men and women, men are often not inclined to develop a health plan for themselves beyond vaccinations and hospitalisation for serious illnesses later in life. Moreover, research in Southern Africa has shown an increased rate of infection in cultures with entrenched notions of masculinity. These broad societal norms and resultant stigmas proved to discourage men from getting tested, acknowledging their HIV-positive status, adopting healthier lifestyles and even being receptive to taking advice from female medical professionals. It is also true that for many African tribes the decision to circumcise or not is sacred and linked to deep cultural beliefs.
To increase circumcision rates among African men we looked beyond just the medical intervention and accounted for the social and psychological issues that could hinder VMMC uptake. We sought out and worked closely with community and traditional leaders. Initial activities concentrated on educating employers, managers, shop stewards, workers, their families and communities, including women, about the benefits of VMMC. Our communication emphasised that procedures were safe and performed by well-trained health professionals in properly equipped settings. We also encourage men who have already undergone circumcision to encourage their peers to do the same.
In the first year 48 159 medical male circumcisions were performed, with the number climbing steadily year on year as the formal education process and funding efforts bore fruit. We built trust, and by 2016 SWHP has become a leading service provider of VMMC, with a total of 344 621 procedures performed – close to a quarter of total procedures linked to the broader Government programme.
Knowing the nature of the epidemic in a given context is crucial for creating effective prevention strategies.
In conclusion, while South Africa has made a great deal of progress in the fight against HIV, AIDS and TB, we cannot become complacent. The country has adopted the UNAIDS plan aimed at bringing about an HIV-free generation called the ’90-90-90’ strategy, which aims to ensure that by 2020, 90% of all people living with HIV will know their status, 90% of those eligible for treatment with ARVs will be on sustained treatment, and 90% of people on ARVs will have suppressed viral loads.
To get there we will continue to learn and work with others to implement biomedical interventions and tackle the broader development and socioeconomic factors that drive the epidemic, such as inequality, social exclusion and exposure to violence.
It is only through programmes that seek to ignite and protect each individual’s holistic wellbeing that we will truly change the life course of the disadvantaged and vulnerable. With these expanded goals, we continue to leverage our experience, credible track record, skills and capacity to keep converting our vision into a real impact.