Accessing Voluntary HIV Testing in the Construction Industry: A Qualitative Analysis of Employee Interviews from the Test@Work Study

Abstract

HIV, globally, remains a significant public health issue and community HIV testing can help to identify those with HIV at an early stage of disease. The workplace offers a prime location for provision of opt-in HIV testing as part of wider health promotion initiatives. The construction industry offers a key opportunity for HIV testing provision in a generally male-dominated group exhibiting some risky behaviors related to HIV. The intervention was an optional one-off individual health check with tailored health advice and signposting, offered to the construction workforce in health check events delivered as part of a large-scale multi-site research program called Test@Work. The events were undertaken at 10 participating organizations (21 events across 16 different sites), none had previously offered sexual health awareness or HIV testing to their workforce. Participants were invited to participate in a semi-structured interview following general health checks which included HIV testing. Out of 426 employees attending the health check events, 338 (79.3%) consented to interview on exit. Accessing HIV testing at work was valued because it was convenient, quick, and compatible with work demands. Interviewees identified HIV risks for construction including drug use, high numbers of sexual partners and job-related exposures, e.g., to used needles. Health seeking in construction was limited by stigma and low support, with particular barriers for non-permanent workers. The organization of the construction industry is complex with multiple organizations of different sizes having responsibility for varying numbers of employees. A disparity between organizational policies and employment circumstances is evident, and this generates significant health inequalities. To combat this, we recommend that organizations in the construction sector offer their employees awareness-raising around health behaviors and health protection in packages, such as toolbox talks. We recommend these be accompanied by annual health checks, including sexual health awareness and opt-in workplace HIV testing. This approach is highly acceptable to the workforce in the industry and removes barriers to access to healthcare.

Opt-in HIV testing in construction workplaces: an exploration of its suitability, using the socioecological framework

“…This research used rapid diagnostic testing, which gave employees their results within 15–20 minutes of testing, and this was highly acceptable to employees [ 28 ]. Rapid testing has previously been reported as being acceptable to clients and as increasing the probability of individuals receiving their results compared to other testing strategies [ 3 ].…”

“…Test@Work found a high uptake of HIV testing in this context; 97% of health check participants opted to have a consultation about sexual health and 82% had an optional HIV test, of whom 78% had not previously been tested [ 27 , 31 ]. There was good acceptability with the workforce [ 28 ]. The current study examines the perspectives of the managers who had arranged for testing to take place and the health professionals who provided the general health checks and HIV testing.…”

Enablers and barriers to mental health initiatives in construction SMEs

“…The predominance of a largely young, male workforce, with relatively low educational attainment and poor job security are known risk factors for mental illness, self-harm and suicide [ 6 ]. Health-seeking behaviour is limited in this industry by stigma and low levels of support [ 7 ]. Small- to medium-sized enterprises (SMEs: ≤250 employees) account for 99.9% of the total business population in the UK [ 8 ] with the largest number of SMEs (914 175 or 17%) operating in construction [ 8 , 9 ].…”