Bridging the gap between VCT and HIV/AIDS treatment uptake: perspectives from a mining-sector workplace in South Africa

Abstract

This qualitative study sought to understand users' perceptions of the voluntary counselling and testing (VCT) and HIV-treatment services offered by a mining company in South Africa, with the intention of making recommendations to improve the rates of uptake. A purposive sample of 75 employees was interviewed and three focus groups were conducted with VCT users as well as with HIV-positive employees currently enrolled in the company's treatment programme. The relatively high uptake of VCT at the workplace appeared to be a function of the convenience afforded by rapid testing and the on-site nature of the company's annual campaign, the group nature of the campaign, and increased HIV awareness facilitated by pre-test counselling. Notwithstanding this, the study revealed barriers to uptake of VCT in the workplace, including: perceived violations of confidentiality by healthcare staff and doubts about the voluntary basis of HIV testing; organisational factors, including the visible group nature of the VCT campaign; and fear of a HIV-positive result and discrimination in that event. In contrast to VCT uptake, there was a relatively low rate of enrolment in the treatment programme: a significant proportion of HIV-positive employees identified in the VCT campaign did not present to the company's clinic for treatment. Impediments to treatment uptake included fears of being identified in the workplace as HIV-positive, which arose from perceived confidentiality violations on the part of the healthcare staff as well as organisational factors they believed allowed easy identification of the programme's users; limited time to attend the clinic; poor quality of post-test counselling and follow-up; difficulties in coping with the diagnosis; and traditional explanatory models of illness, which precluded medical care. A combination of the current annual, opt-in VCT campaign and a provider-initiated opt-out approach to VCT should be carefully considered in order to bridge the gap between the current levels of VCT and HIV-treatment uptake by employees at the company.

What can companies do to support HIV-positive workers? Recommendations for medium- and large-sized African workplaces

“…However the literature reviewed and our interviews suggest that assessing whether a workplace will have better results by testing on-or off-site is a complex issue. A corporate decision about on-site testing will depend on the capacity to uphold confidentiality surrounding test results and ensure that presenting for testing will not result in stigmatization (Bhagwanjee, et al, 2008).…”

“…Conversely, workplaces must ensure that workers are not coerced or pressured into being tested-an issue illuminated in Bhagwanjee et al's (2008) study of VCT in a South African mine.…”

“…Options include offering vouchers or providing detailed information about how to access local services. Emphasizing that management cannot access the results instills worker trust in the programme's confidentiality and leads to higher uptake; having an independent organization conduct the testing is one way to increase worker trust (Stevens, et al, 2006;Bhagwanjee, et al, 2008).…”

“…Low uptake of workplace DMPs and high attrition have been problems across many sectors (George, 2006;Connelly and Rosen, 2006;ILO, 2003;Bhagwanjee, et al, 2008). Anglo…”

Psychosocial and behavioural correlates of attitudes towards antiretroviral therapy (ART) in a sample of South African mineworkers

“…According to Connelly and Rosen (2006), in terms of the number of employees in DMPs only 12.2% of mineworkers were enrolled in workplace ART programmes, despite 90% of these mineworkers having had access to ART. At the site of the study that is being reported on, Bhagwanjee, Petersen, Akintola and George (2008) found a relatively low uptake rate into the mine's ART programme, despite an uptake rate of 86% achieved in the 2007 VCT campaign. Significant obstacles emerged in interviews with employees that hindered them from enrolling in the mine's ART programme.…”