The impact of and responses to HIV/AIDS in the private security and legal services industry in South Africa potx

Free download from www.hsrcpress.ac.za Compiled by the Social Aspects of HIV/AIDS and Health Research Programme of the HSRC Funded by and prepared for the Safety and Security Sector Education and Training Authority The impact of and responses to HIV/AIDS in the private security and legal services industry in South Africa S A F E T Y S E C U R I T Y & Free download from www.hsrcpress.ac.za Funded by and prepared for the Safety and Security Sector Education and Training Authority (SASSETA). Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za First published 2007 ISBN 978-0-7969-2205-2 © 2007 Human Sciences Research Council Copy-edited by Laurie Rose-Innes Typeset by Simon van Gend Print management by comPress Distributed in Africa by Blue Weaver Tel: +27 (0) 21 701 4477; Fax: +27 (0) 21 701 7302 www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) Tel: +44 (0) 20 7240 0856; Fax: +44 (0) 20 7379 0609 www.eurospangroup.com/bookstore Distributed in North America by Independent Publishers Group (IPG) Call toll-free: (800) 888 4741; Fax: +1 (312) 337 5985 www.ipgbook.com Suggested citation: Simbayi LC, Rehle T, Vass J, Skinner D, Zuma K, Mbelle MN, Jooste S, Pillay V, Dwadwa- Henda N, Toefy Y, Dana P, Ketye T & Matevha A (2007) The impact of and responses to HIV/AIDS in the private security and legal services industries in South Africa. Cape Town: HSRC Press. Free download from www.hsrcpress.ac.za  List of tables and figures v Foreword ix Contributors x Acknowledgements xii Abbreviations and acronyms xiv Executive summary xv  1.1 Background 1 1.2 Literature review 1 1.3 Epidemiological model 6 1.4 Objectives 6 1.5 Conceptual framework of the project 7 1.6 Scope 8 1.7 Overview of the report 10  2.1 Introduction 11 2.2 Overall research approaches 11 2.3 Study 1 (HIV prevalence, HIV incidence and KABP survey): the formative research phase 11 2.4 Study 1 (HIV prevalence, HIV incidence and KABP survey): the main study 12 2.5 Study 2 (Business impact and response): the formative research phase 20 2.6 Study 2A (Employer survey of business impact and response): the main study 20 2.7 Study 2B (Employee survey of business impact and response): the main study 21 2.8 Study 2C (Review of HIV/AIDS policies) 21 2.9 Ethical considerations 23  3.1 Introduction 25 3.2 Response analysis 25 3.3 HIV prevalence 29 3.4 HIV incidence 31 3.5 Behavioural and social determinants of HIV/AIDS 33 3.6 Voluntary counselling and testing 43 3.7 Substance use 46 3.8 Self-reported behaviour change 47 3.9 Male circumcision 48 3.10 Communication about HIV/AIDS and related issues 48 3.11 Associations between HIV prevalence and sexual behaviour indicators 50  4.1 Introduction 55 4.2 Response analysis 55 4.3 HIV prevalence and HIV incidence 60 4.4 Knowledge, attitudes, perceptions and behaviour 62 4.5 Awareness and use of VCT services 67 4.6 Self-reported behaviour change 68 Free download from www.hsrcpress.ac.za 4.7 Substance use 69 4.8 Communication about HIV/AIDS and related issues 70 4.9 Associations between HIV prevalence and sexual behaviour indicators 72   5.1 Introduction 73 5.2 Response analysis 73 5.3 Perceptions of general HIV/AIDS impact 78 5.4 Impact on employee profile 78 5.5 Impact on employee costs 80 5.6 Impact on demand and supply of skills 81 5.7 Business response 83 5.8 Employee perceptions of HIV/AIDS impact 85 5.9 Discussion 87   6.1 Introduction 91 6.2 Response analysis 91 6.3 Perceptions of general HIV/AIDS impact 96 6.4 Impact on employee profile 97 6.5 Impact on employee costs 98 6.6 Impact on demand and supply of skills 100 6.7 Business response 101 6.8 Employee perceptions of HIV/AIDS impact 103 6.9 Discussion 105   7.1 Introduction 107 7.2 Background 107 7.3 Commentary on policies 108 7.4 Gaps and general problems with the policies 110 7.5 Key issues not included in the policies 114 7.6 Areas requiring improvement 120  8.1 Introduction 133 8.2 Summary of main findings for Study 1: HIV prevalence, HIV incidence and KABP survey 133 8.3 Perceptions of business impact and responses 138 8.4 Recommendations 144  Appendix 1 Nurses who were trained as fieldworkers 153 Appendix 2 Terms of reference for policy experts 154  Free download from www.hsrcpress.ac.za v  Tables Table 1.1 Crude and adjusted company-level HIV prevalence in 22 South African workplaces 3 Table 2.1 Overview of employees and companies in the sub-sectors from various sources 12 Table 2.2 Policy reviewers 22 Table 3.1 Individual response rates for interviews and testing by background characteristics 25 Table 3.2 Characteristics among respondents interviewed and tested for HIV 26 Table 3.3 Profile of respondents compared to the national profile of employees in the private security sector 28 Table 3.4 Profile of study participants from the private security firms vs. national profile of employees in the private security sector 28 Table 3.5 HIV prevalence among respondents by demographic characteristics 30 Table 3.6 HIV prevalence among respondents by occupational category 30 Table 3.7 HIV incidence among respondents by demographic characteristics 32 Table 3.8 Responses to individual HIV/AIDS knowledge items by sex 33 Table 3.9 Attitudes towards HIV/AIDS (N = 2 787) 35 Table 3.10 Perceived seriousness of HIV/AIDS by sex and race 36 Table 3.11 Perceptions of personal risk of HIV infection by sex 37 Table 3.12 Reasons for believing that one did not have a high risk of HIV infection 38 Table 3.13 Sexual activity of respondents in the past 12 months by sex and race 39 Table 3.14 Number of sexual partners in the past 12 months by sex and race 39 Table 3.15 Age mixing among sexually active respondents by sex and race 40 Table 3.16 Condom use during last sexual intercourse by demographic characteristics 41 Table 3.17 Condom use during last sexual intercourse in different age groups by marital status and number of partners 42 Table 3.18 Awareness of where to access VCT services 44 Table 3.19 Alcohol use as measured using AUDIT scores by demographic characteristics 46 Table 3.20 Self-reported behaviour change by sex 47 Table 3.21 Communication messages/slogans about HIV/AIDS recalled by respondents by sex 49 Table 3.22 Comfort in communication with others about sex and HIV/AIDS-related issues by sex 49 Table 3.23 HIV prevalence and key sexual behaviour practices 51 Table 3.24 HIV prevalence and age mixing by sex 52 Table 3.25 HIV prevalence and perceived personal risk of HIV infection 52 Free download from www.hsrcpress.ac.za vi Table 3.26 HIV prevalence and awareness of HIV status 53 Table 3.27 HIV prevalence and recency of HIV test 53 Table 4.1 Individual response rates for interviews and testing by background characteristics 55 Table 4.2 Profile of respondents by demographic characteristics (N = 421) 56 Table 4.3 Profile of respondents by employment category and situation, and household economic situation (N = 421) 57 Table 4.4 Characteristics among respondents interviewed and tested for HIV 58 Table 4.5 HIV prevalence among respondents by demographic characteristics 60 Table 4.6 HIV prevalence among respondents by occupational category 61 Table 4.7 Responses to individual HIV/AIDS knowledge items by sex 62 Table 4.8 Responses to individual attitudinal statements about HIV/AIDS 64 Table 4.9 Perceptions of personal risk of HIV infection by sex 64 Table 4.10 Reasons for believing that one did not have a risk of HIV infection 65 Table 4.11 Age mixing among sexually active respondents by sex 66 Table 4.12 Awareness of where to access VCT services 67 Table 4.13 Self-reported change of behaviour by sex 69 Table 4.14 Alcohol use as measured using AUDIT scores by demographic characteristics 70 Table 4.15 Communication messages/slogans about HIV/AIDS recalled by respondents by sex 71 Table 4.16 Comfort in communication with others about sex and HIV/AIDS-related issues by sex 71 Table 4.17 HIV prevalence and perceived personal risk of HIV infection 72 Table 5.1 Profile of employer respondents 73 Table 5.2 Profile of employees by occupational category, population group and sex (N = 14 105) 75 Table 5.3 Profile of employees by age group, population group and sex (N = 972) 76 Table 5.4 Employment status of employees 77 Table 5.5 Perceptions of past and future impact of HIV/AIDS on operations and profits (N = 13) 78 Table 5.6 Perceptions of the HIV/AIDS impact on employee profile 79 Table 5.7 Reported number of employees (n) who may have died due to AIDS or AIDS-related causes, 2003–2006 79 Table 5.8 Reported number of employees (n) who may have left due to health-related causes, 2003–2006 80 Table 5.9 HIV/AIDS impact on increasing employee benefit costs (N = 12) 81 Table 5.10 Impact on expenditure on HIV/AIDS services (N = 12) 81 Free download from www.hsrcpress.ac.za vii Table 5.11 Perceived impact of HIV/AIDS on the demand and supply of skills (N = 12) 82 Table 5.12 HIV/AIDS impact on investment in training by occupation (N = 12) 82 Table 5.13 HIV/AIDS impact on output, service delivery and consumer demand 83 Table 5.14 Awareness and implementation of HIV/AIDS policies 83 Table 5.15 Implementation of HIV/AIDS programmes (N = 12) 84 Table 5.16 Employee perceptions of HIV/AIDS impact on employees and the company 85 Table 5.17 Awareness of HIV/AIDS policies and their implementation 85 Table 5.18 Employee knowledge about content of and gaps in company HIV/AIDS policies 86 Table 5.19 Reported employee access to HIV/AIDS interventions in company 86 Table 5.20 Perceived gaps in company HIV/AIDS interventions (N = 732) 87 Table 6.1 Profile of employer respondents 92 Table 6.2 Profile of employees by occupational category, population group and sex (N = 417) 93 Table 6.3 Profile of employees by age group, population group and sex (N = 417) 94 Table 6.4 Employment status of employees (N = 416) 95 Table 6.5 Perceptions of HIV/AIDS as a business concern and the measurement thereof 96 Table 6.6 Perceptions of past and future impact of HIV/AIDS on operations and profits (N = 20) 97 Table 6.7 Perceptions of the HIV/AIDS impact on employees by occupational category (N = 19) 97 Table 6.8 Reported number of employees who may have died due to AIDS or AIDS-related causes, 2003–2006 (N = 15) 98 Table 6.9 Reported number of employees who may have left due to health-related causes, 2003–2006 (N = 15) 98 Table 6.10 HIV/AIDS impact on increasing employee benefit costs (N = 19) 99 Table 6.11 Impact on expenditure on HIV/AIDS services (N = 18) 99 Table 6.12 Perceived HIV/AIDS impact on the demand and supply of skills (N = 19) 100 Table 6.13 HIV/AIDS impact on investment in training by occupation (N = 18) 100 Table 6.14 Potential HIV/AIDS impact on supply of critical skills and strategies for skills turnover (N = 20) 101 Table 6.15 HIV/AIDS impact on output, service delivery and consumer demand (N = 20) 101 Table 6.16 Awareness and implementation of HIV/AIDS policies 102 Table 6.17 Implementation of HIV/AIDS programmes (N = 20) 102 Free download from www.hsrcpress.ac.za viii Table 6.18 Employee perceptions of HIV/AIDS impact on employees and the company 103 Table 6.19 Awareness of HIV/AIDS policies and their implementation 104 Table 6.20 Employee knowledge of contents and gaps in company HIV/AIDS policies (N = 101) 104 Table 6.21 Reported employee access to HIV/AIDS interventions in company 105 Table 6.22 Perceived gaps in company HIV/AIDS interventions (N=134) 105 Table 7.1 Coverage of key issues in the HIV/AIDS policies of SASSETA and private security companies 109 Table 7.2 Coverage of key issues in the HIV/AIDS policies of the legal firms 109 Figures Figure 1.1 Epidemiological model of the impact of HIV/AIDS in a workplace 7 Figure 2.1 HIV testing strategy 17 Figure 3.1 Profile of respondents by employment benefits (N = 2 787) 29 Figure 3.2 HIV test history, participation in VCT and awareness of HIV status 45 Figure 4.1 Profile of respondents by employment benefits (N = 421) 58 Figure 4.2 Sexual activity and number of partners in the past 12 months by sex 66 Figure 4.3 HIV test history, participation in VCT and awareness of HIV status 68 Figure 5.1 Profile of employees by occupational category (N = 14 105) 75 Figure 5.2 Employees by age group (N = 972) 76 Figure 5.3 Number of companies with health-related benefits (N = 11, 8, 8, 11 & 9) 80 Figure 6.1 Profile of employees by occupational category (N = 417) 93 Figure 6.2 Employees by age group (N = 417) 94 Figure 6.3 Number of companies with health-related benefits (N = 16, 10, 12 & 11) 99 Free download from www.hsrcpress.ac.za ix  When sector education and training authorities (SETAs) were established in 2000 and we drafted the first sector skills plan, the consultation process with stakeholders contained one constant input: HIV and AIDS may have an impact on our sector and we should be doing something about it. At the time, the Police, Private Security, Legal, Correctional Services and Justice (Poslec) SETA realised that it had an important contribution to make towards the fight against AIDS with a distinct training perspective. However, nobody could give direction in respect of what the SETA should focus on. While the majority of interventions generally seemed to focus on prevention awareness, some employers were raising questions around succession planning and maintaining a healthy workforce. Others were raising questions about the cost to their companies. It was very clear that the scope and impact of the HIV and AIDS problem in the then Poslec sector was not understood, and that interventions from a SETA perspective would be short-sighted if they were not designed and specifically targeted to meet the sector’s needs. Thus, the idea of this research project was born. Now, seven years later, SASSETA is proud to present the results of the first survey into the state of HIV and AIDS in two of its constituencies – the private security industry and the legal profession. This project, sponsored by SASSETA, was a collaborative effort between the HSRC, SASSETA and stakeholder representatives over one and a half years. While the process was not without stumbling blocks, we believe this to be a major step in the direction of informed and targeted interventions for our sector. Having covered four very important aspects, namely a policy provision analysis, a business impact study, a knowledge, attitudes and practices (KAP) survey, and a prevalence and incidence survey, the findings and recommendations in this report can now be constructively be put to use in the development and implementation of HIV and AIDS management strategies for the private security industry and the legal profession. As is evident from the report, both groups are affected by HIV and AIDS; however, the hesitancy to participate in this survey on the part of so many employers is a clear indicator that the subject-matter has not crossed into the general awareness of businesses in our constituency. We hope that this report will be useful, beyond its original purpose of informing the SETA, in contributing to the general body of knowledge that is being generated on the subject. This publication is presented to the reader with the challenge to take HIV and AIDS seriously as an individual and as a businessperson. Perhaps, if we manage to repeat a similar study in the future, we may be fortunate enough to witness the difference we have made. Temba Mabuya Acting CEO, SASSETA Free download from www.hsrcpress.ac.za x  Authors are listed in order of contribution to the conceptualisation and preparation of the proposal, the development of the questionnaire, preliminary planning, management of the project, data collection, data analysis and report writing. Leickness Chisamu Simbayi, DPhil Research Director Behavioural and Social Aspects of HIV/AIDS Section Social Aspects of HIV/AIDS and Health Research Programme Thomas M Rehle, MD, PhD Research Director Epidemiology, Strategic Research and Health Policy Section Social Aspects of HIV/AIDS and Health Research Programme Jocelyn Vass, MA Senior Research Specialist World of Work Section Education, Science and Skills Development Research Programme Donald Skinner, PhD Chief Research Specialist Behavioural and Social Aspects of HIV/AIDS Section Social Aspects of HIV/AIDS and Health Research Programme Khangelani Zuma, PhD Chief Research Specialist Epidemiology, Strategic Research and Health Policy Section Social Aspects of HIV/AIDS and Health Research Programme Ntombizodwa M Mbelle, MA(ELT), MPH Senior Research Manager (Doctoral Research Trainee) Behavioural and Social Aspects of HIV/AIDS Section Social Aspects of HIV/AIDS and Health Research Programme Sean Jooste, MA Research Specialist (Doctoral Research Trainee) Behavioural and Social Aspects of HIV/AIDS Section Social Aspects of HIV/AIDS and Health Research Programme Victoria Pillay, PhD Research Specialist Epidemiology, Strategic Research and Health Policy Section Social Aspects of HIV/AIDS and Health Research Programme Nomvo Dwadwa-Henda, MA Chief Researcher (Doctoral Research Trainee) Behavioural and Social Aspects of HIV/AIDS Section Social Aspects of HIV/AIDS and Health Research Programme [...]... www.hsrcpress.ac.za In October 2005, the Safety and Security Sector Education and Training Authority (SASSETA) awarded a tender to the Human Sciences Research Council (HSRC) to undertake a critical assessment of HIV/AIDS in the private security and legal services industries, in terms of the prevalence rate of HIV, its impact on business and the responses of businesses to the epidemic thus far Furthermore, the study... security and legal services industries, in terms of the prevalence rate of HIV, its impact on business and the responses of businesses to the epidemic thus far Furthermore, the study sought to establish both sufficient and reliable empirical data about the status quo, which would then be the basis for forecasting the possible impact of HIV/AIDS on selected indicators within the sub-sectors Due to the availability... critical in mitigating the impact of HIV/AIDS on productivity, economic costs, labour, and demand and supply of skills Prior to the present project, no such study had been conducted in the private security and legal services industries In October 2005, the Safety and Security Sector Education and Training Authority (SASSETA) put out a tender to undertake a critical assessment of HIV/AIDS in the private security. .. epidemic to their core business Thus, there is a need to conduct assessments of the impacts of HIV/AIDS and responses thereto by companies Obtaining such information would inform the concerned organisations about, among other things, the appropriateness of their current responses in terms of prevention and treatment interventions as well as the suitability of their HIV/AIDS policies This information... still required There are significant gaps in the policies regarding, in particular, the impact of HIV/ AIDS on women and the social pressures that increase the risk of HIV The information on HIV included in the policies needs to be accurate In many of the policies, technical details were incorrect, such as in the use of terminology like ‘HIV virus’ and around the legality of testing There were differences... sought to establish both sufficient and reliable empirical data about the status quo, which would then be the basis for forecasting the possible impact of HIV/AIDS on selected indicators within the sub-sectors Due to the availability of new laboratory-based HIV-incidence methods, the HSRC and SASSETA agreed on the use of the BED technology to measure incidence testing, instead of basing it on modelling The. .. been instrumental in informing possible prevention and treatment interventions as well as policy imperatives that are being followed up by various stakeholders in the education sector It is clear that a thorough understanding of the economic sectors, and their skills and demographic profiles, is fundamental to an understanding of the impact of HIV/AIDS on various sectors and the demand and supply of. .. sub-sectors of SASSETA (namely, the private security and legal services industries) investigated in the present study With regard to the private security industry, there are many parallels between it and the public security services, such as the military, police and intelligence services Although the two types of services are not identical, they share many attributes, one of which is a predominant employee... of HIV/AIDS impact xxvi As was the case in the private security sector, employees were asked, as part of Study 1, for their perceptions of the impact of HIV/AIDS on the company and its employees The following findings emerged: The overwhelming majority of the 421 respondents displayed very little knowledge about colleagues living with HIV/AIDS or having died of HIV/AIDS- related illnesses However, the. .. decreased and that the study would take place in only three provinces (namely, KwaZuluNatal, Gauteng and the Western Cape), instead of in four provinces for each sector, as had been planned In the original plan, the private security industry study was meant to include Mpumalanga as the fourth province, while the Eastern Cape had been earmarked as the fourth province in the legal services industry study . Education and Training Authority The impact of and responses to HIV/AIDS in the private security and legal services industry in South Africa S A F E. been conducted in the private security and legal services industries. In October 2005, the Safety and Security Sector Education and Training Authority