A CUT ABOVE THE REST:
HOW AN NPO, FOUNDED BY SOUTH AFRICA’S UNION MOVEMENT,
BECAME AN UNLIKELY CHAMPION FOR MEDICAL MALE CIRCUMCISION
On the occasion of the 21st International AIDS Conference (AIDS 2016) to be hosted in July in Durban, it is an opportune time to reflect on a little known champion of the fight against HIV, AIDS and TB – the SACTWU Worker Health Programme (SWHP).
South Africa’s organised labour movement mobilised relatively early on to attend to the scourge of HIV, AIDS as well as TB in the workplace. One such programme launched was the SACTWU Worker Health Programme. Founded in 1998, the programme initially focused on helping the Union to manage the effects of the disease on its membership. In 2003, SWHP registered as an NPO and broadened its reach, delivering services on a national basis to other communities affected by the HIV, AIDS and TB pandemics. For the past 18 years, the SACTWU Worker Health Programme 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 to over 1.2 million people directly, and many more indirectly.
Unions have a rich history of promoting the human rights, dignity and wellbeing of workers. In South Africa, they’ve played a leading role in the anti-apartheid liberation movement – a contribution which has earned them a powerful voice in civil society. Unions have also assumed a key position in the fight against HIV, AIDS and TB, ensuring that the interests of workers from under-privileged communities are represented. These communities often tend to lack the best access to health, social services and information, with the result that the resource deficit is a major factor affecting the rate of spread and impact of these diseases.
SWHP exists to put the power of wellbeing within the reach of previously disadvantaged communities. SWHP has aligned its work with South Africa’s National Strategic Plan for HIV, STIs and TB (NSP), along with the UNAIDS ’90 90 90’ strategy aimed at bringing about an HIV-free generation. The UNAID strategy entails that, by 2020, 90% of all people living with HIV will know their status, 90% of those eligible for anti-retroviral treatment (ART) will be on sustained treatment, and 90% of people on ART will have suppressed viral loads. Together, these strategies represent our country’s response to the prevention and treatment of these diseases.
Unlike many organisations in its area of work, SWHP was able to bring the union movement’s significant influence to bear in the fight against these chronic diseases; mobilising their relationships with employers, employees, the government and communities to help negotiate workplace agreements and policies that set the standard for the workplace response to HIV, AIDS and TB. SWHP further initiated a series of workplace programmes focusing on education and training, counselling and testing, voluntary medical male circumcision as well as support and treatment for HIV, AIDS and TB. These programmes apply to both male and female employees across many industries, including clothing and textile factory workers, jail wardens, school teachers, their families, and their communities.
SWHP has grown into a programme that understands the need for holistic solutions to address the drivers of HIV, AIDS and TB infection. The programme incorporates meaningful interventions that prevent the spread of these pandemics by enabling different facets of individual and community wellbeing.
Colleen Khumalo, SWHP CEO: ‘We believe that the spread of HIV, AIDS and opportunistic diseases like TB, will only be halted through a comprehensive approach that focuses on the drivers of these illnesses in addition to implementing evidence-based biomedical prevention and treatment measures. Drivers to be addressed include negative stigma, poverty, inequality, violence against women as well as lack of accessible skills development."
A Holistic View: Men and Public Health
The SWHP’s holistic approach is also illustrated by the organisation’s contribution to South Africa’s Voluntary Medical Male Circumcision Programme (VMMC). 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) as well as funding and policy partners including The United States President's Emergency Plan for AIDS Relief (PEPFAR), The World Health Organisation (WHO), The United Nations AIDS Program (UNAIDS), The Bill & Melinda Gates Foundation, The United States’ Center of Disease Control (CDC) and the United States Agency for International Development (USAID). SACTWU is said to have been the first union to offer medical male circumcision services to its members when the programme launched in June 2011.
Colleen Khumalo, SWHP CEO: “Our own insights and experience showed that it would not be enough to simply give men access to circumcisions. 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 the 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 in particular. 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 the uptake of voluntary medical male circumcision. 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, in particular women, about the benefits of voluntary medical male circumcision. 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.”
Colleen Khumalo, SWHP CEO: “48 159 medical male circumcisions were performed in the first year, with the number climbing steadily year on year as the education process and funding efforts bore fruit. We built trust, and by 2016, SWHP had become the leading service provider of voluntary medical male circumcisions with a total of 344 621 procedures performed – close to a quarter of total procedures linked to the broader Government programme. In our experience youth are currently more likely to undergo the procedure.”
“South Africa has made a great deal of progress in the battle against HIV, AIDS and TB. Statistics show that new HIV, AIDS infections in a number of key demographics have fallen, more people are receiving the treatment they need, and life expectancy is rising. There is a great deal to be hopeful about.”
She adds: “But we cannot become complacent. To achieve our goals, we need to collaborate and pool resources on every front – medical, social and psychological to save our people. As SWHP, we hope to continue to secure the investment and support we need to expand our work across many more communities.
Fast Facts: SWHP
The total number of SWHP beneficiaries, across all initiatives, since the founding of SWHP:
• HIV counselling and testing = 164 081
• Workplace training = 559 508
• Shop stewards trained = 3 266
• VMMC conducted = 344 621
• Workers receiving social worker support care services = 3 589
• Home-based care visits = 44 905
• No. of condoms distributed = 2 194 420
• No. of clients on ART = 1 303
• Operates: Nationally, South Africa.
• No. of SWHP employees = 223