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

1.5 Conceptual framework of the project 71.6 Scope 81.7 Overview of the report 102฀Methodology฀฀฀฀฀฀11 2.1 Introduction 112.2 Overall research approaches 112.3 Study 1 HIV prevalence, HI

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and responses

to HIV/AIDS in the private security

and legal services industry in

South Africa

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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:

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1.5 Conceptual framework of the project 71.6 Scope 8

1.7 Overview of the report 102฀Methodology฀฀฀฀฀฀11

2.1 Introduction 112.2 Overall research approaches 112.3 Study 1 (HIV prevalence, HIV incidence and KABP survey):

the formative research phase 112.4 Study 1 (HIV prevalence, HIV incidence and KABP survey):

the main study 122.5 Study 2 (Business impact and response):

the formative research phase 202.6 Study 2A (Employer survey of business impact and response):

the main study 202.7 Study 2B (Employee survey of business impact and response):

the main study 212.8 Study 2C (Review of HIV/AIDS policies) 212.9 Ethical considerations 23

3฀Results฀from฀study฀1:฀private฀security฀sector฀฀253.1 Introduction 25

3.2 Response analysis 253.3 HIV prevalence 293.4 HIV incidence 313.5 Behavioural and social determinants of HIV/AIDS 333.6 Voluntary counselling and testing 43

3.7 Substance use 463.8 Self-reported behaviour change 473.9 Male circumcision 48

3.10 Communication about HIV/AIDS and related issues 483.11 Associations between HIV prevalence and sexual behaviour indicators 504฀Results฀from฀study฀1:฀legal฀services฀sector฀฀฀฀฀554.1 Introduction 55

4.2 Response analysis 554.3 HIV prevalence and HIV incidence 604.4 Knowledge, attitudes, perceptions and behaviour 624.5 Awareness and use of VCT services 67

4.6 Self-reported behaviour change 68

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5.5 Impact on employee costs 805.6 Impact on demand and supply of skills 815.7 Business response 83

5.8 Employee perceptions of HIV/AIDS impact 855.9 Discussion 87

6฀Results฀from฀studies฀2a฀and฀2b:฀฀

legal฀services฀sector฀฀฀฀฀฀91

6.1 Introduction 916.2 Response analysis 916.3 Perceptions of general HIV/AIDS impact 966.4 Impact on employee profile 97

6.5 Impact on employee costs 986.6 Impact on demand and supply of skills 1006.7 Business response 101

6.8 Employee perceptions of HIV/AIDS impact 1036.9 Discussion 105

7฀Results฀from฀study฀2c:฀a฀review฀of฀HIV/AIDs฀ policies฀in฀both฀sectors฀฀฀฀฀฀107

7.1 Introduction 1077.2 Background 1077.3 Commentary on policies 1087.4 Gaps and general problems with the policies 1107.5 Key issues not included in the policies 1147.6 Areas requiring improvement 120

8฀Conclusions฀and฀recommendations฀฀฀฀฀฀133

8.1 Introduction 1338.2 Summary of main findings for Study 1: HIV prevalence, HIV incidence and KABP survey 133

8.3 Perceptions of business impact and responses 1388.4 Recommendations 144

Appendices฀฀฀฀฀฀฀153

Appendix 1 Nurses who were trained as fieldworkers 153Appendix 2 Terms of reference for policy experts 154References฀฀฀฀฀฀155

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Table 3.1 Individual response rates for interviews and testing by background

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

Table 3.4 Profile of study participants from the private security firms vs national

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 3.10 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

Table 3.19 Alcohol use as measured using AUDIT scores by demographic

Table 3.21 Communication messages/slogans about HIV/AIDS recalled by

Table 3.22 Comfort in communication with others about sex and HIV/AIDS-related

Table 3.23 HIV prevalence and key sexual behaviour practices 51

Table 3.25 HIV prevalence and perceived personal risk of HIV infection 52

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Table 4.4 Characteristics among respondents interviewed and tested for HIV 58Table 4.5 HIV prevalence among respondents by demographic characteristics 60Table 4.6 HIV prevalence among respondents by occupational category 61Table 4.7 Responses to individual HIV/AIDS knowledge items by sex 62Table 4.8 Responses to individual attitudinal statements about HIV/AIDS 64Table 4.9 Perceptions of personal risk of HIV infection by sex 64Table 4.10 Reasons for believing that one did not have a risk of HIV infection 65Table 4.11 Age mixing among sexually active respondents by sex 66

Table 4.14 Alcohol use as measured using AUDIT scores by demographic

Table 4.17 HIV prevalence and perceived personal risk of HIV infection 72

Table 5.2 Profile of employees by occupational category, population group and

Table 5.3 Profile of employees by age group, population group and sex (N = 972) 76

Table 5.5 Perceptions of past and future impact of HIV/AIDS on operations and

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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 5.16 Employee perceptions of HIV/AIDS impact on employees and

Table 5.17 Awareness of HIV/AIDS policies and their implementation 85

Table 5.18 Employee knowledge about content of and gaps in company

Table 5.19Reported employee access to HIV/AIDS interventions in company 86

Table 5.20 Perceived gaps in company HIV/AIDS interventions (N = 732) 87

Table 6.2 Profile of employees by occupational category, population group

Table 6.3 Profile of employees by age group, population group and sex (N = 417) 94

Table 6.5 Perceptions of HIV/AIDS as a business concern and the measurement

Table 6.8 Reported number of employees who may have died due to

Table 6.9 Reported number of employees who may have left due to health-related

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

Table 6.15 HIV/AIDS impact on output, service delivery and consumer

Table 6.16 Awareness and implementation of HIV/AIDS policies 102

Table 6.17 Implementation of HIV/AIDS programmes (N = 20) 102

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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 3.1 Profile of respondents by employment benefits (N = 2 787) 29Figure 3.2 HIV test history, participation in VCT and awareness of HIV status 45Figure 4.1 Profile of respondents by employment benefits (N = 421) 58Figure 4.2 Sexual activity and number of partners in the past 12 months by sex 66Figure 4.3 HIV test history, participation in VCT and awareness of HIV status 68Figure 5.1 Profile of employees by occupational category (N = 14 105) 75

Figure 5.3 Number of companies with health-related benefits (N = 11, 8, 8, 11 & 9) 80Figure 6.1 Profile of employees by occupational category (N = 417) 93

Figure 6.3 Number of companies with health-related benefits (N = 16, 10, 12 & 11) 99

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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

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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

Jocelyn Vass, MA

Senior Research Specialist

World of Work Section

Education, Science and Skills Development Research Programme

Donald Skinner, PhD

Chief Research Specialist

Khangelani Zuma, PhD

Chief Research Specialist

Ntombizodwa M Mbelle, MA(ELT), MPH

Senior Research Manager (Doctoral Research Trainee)

Sean Jooste, MA

Research Specialist (Doctoral Research Trainee)

Victoria Pillay, PhD

Research Specialist

Nomvo Dwadwa-Henda, MA

Chief Researcher (Doctoral Research Trainee)

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Thabile Ketye, MA

Senior Researcher

Azwihangwisi Matevha, MA

Senior Researcher (Doctoral Research Trainee)

Nkululeko Nkomo, MA

Senior Researcher (Doctoral Research Trainee)

Yolande Shean

Project Administrator

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The South African Safety and Security Sector Education and Training Authority

•฀

(SASSETA) for awarding the tender to the HSRC to conduct this study We especially wish to acknowledge Ms Yvette Raphael and Mr Jens Gunther from SASSETA for their continuous support throughout the study Without their passion and strong commitment, this study would not have been successfully completed

The Steering Committee members consisting of senior staff from SASSETA, the HSRC

stakeholders from SASSETA who tirelessly and regularly met to discuss the progress

of the study and to smooth out potential risks to the project whenever there was a need

We would like to thank Mr T Proudfoot and Mr E Boshoff for facilitating

who co-ordinated fieldwork in Gauteng

Mr Sizwe Phakathi of Oxford University and Mrs Pavathy Anthony of the

•฀

University of KwaZulu-Natal who co-ordinated the fieldwork in KwaZulu-Natal

Dr Victoria Pillay and Mr Sean Jooste who co-ordinated fieldwork in the

Ms Sinelisiwe Ngwenya who assisted with project administration in the project

•฀

management office

Mrs Linda Ngcwembe who diligently assisted with the project expenditure

•฀

updates, report and guidance

Ms Alicia Davids for helping with putting together the report

•฀

We wish to thank the following people for reviewing the preliminary report

•฀

(especially the areas indicated) as part of the Experts’ Panel:

Dr Mark Colvin, Epidemiologist, Centre for AIDS Development Research and

Cape Town – Behavioural and social factors driving HIV/AIDS

Professor Carel van Aardt, Economist, Bureau of Market Research, University of

•฀

South Africa (UNISA) – Impact of HIV/AIDS and response by business

Professor Geoffrey Setswe, Public Health Specialist, Human Sciences Research

•฀

Council (HSRC) – HIV/AIDS policies in workplaces

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We also thank all the private security and legal services companies and their

•฀

employees that participated in the study We would like to thank the companies for their generosity in allowing the HSRC senior managers to hold meetings and conduct presentations, and for opening doors to fieldworkers to conduct interviews on their premises and among their employees

We wish to thank the staff from the National Institute of Communicable Diseases

•฀

(NCID) National Health Laboratory Services in Johannesburg and the Global Clinical and Viral Laboratory for undertaking HIV testing during the main study and pilot studies, respectively, and the staff from Maphume for capturing data We would also like to thank NICD for undertaking, without charge, HIV incidence testing using the BED technique

Finally, we thank our individual families for their support and encouragement during

•฀

the time when we undertook this study

Prof Leickness Simbayi Prof Thomas Rehle Ms Ntombizodwa Mbelle

Principal Investigator Principal Investigator Project Manager

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AIDS Acquired Immunodeficiency Syndrome

ART antiretroviral therapy

CDC Centers for Disease Control and Prevention

CEO chief executive officer

GRI Global Reporting Initiative

ILO International Labour Organisation

KABP knowledge, attitudes, beliefs and practices

LSSA Law Society of South Africa

M&E monitoring and evaluation

PLWA people living with AIDS

PLWHA people living with HIV/AIDS

SABCOHA South African Business Coalition on HIV/AIDS

SARS South African Revenue Services

SAS Statistical Analysis Systems

SASSETA Safety and Security Sector Education and Training AuthoritySIRA Security Industry Regulatory Authority

SMMEs small, medium and micro enterprises

SPSS Statistical Package for Social Scientists

STD sexually transmitted disease

STI sexually transmitted infection

UNAIDS Joint United Nations Programme on HIV/AIDS

VCT voluntary counselling and testing

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The generalised nature of the HIV/AIDS epidemic in South Africa is believed to have

uneven impacts on various business organisations operating in the country Indeed, many

companies have responded, in different ways and means, to the challenge posed by the

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 is 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 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 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 tender was won by the HSRC, and the contract with SASSETA was signed on 7 March

2006 The intended duration of the project was 12 months Due to the limited funding

that was made available by SASSETA, it was agreed that the sample sizes would be

decreased and that the study would take place in only three provinces (namely,

KwaZulu-Natal, 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 Although work started

immediately, delays were experienced as a result of a strike in the private security

industry In addition, problems were experienced in accessing most companies in the two

sectors of SASSETA, which necessitated some changes to the sampling design, prolonging

the duration of the project by six months The project was concluded at the end of

August 2007

Objectives

The central objective of the present study was to conduct a critical assessment of HIV/

AIDS in the private security and legal services industries, in terms of the prevalence and

incidence rates of HIV, business impact, and the responses of businesses to the epidemic

thus far

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Two research approaches were followed Firstly, the study employed a highly

participatory approach, which our team had used successfully in similar prior research This entailed a significant involvement of key stakeholders in the conceptualisation and design of the study as well as its execution This was effected through a steering

committee and a technical task team, consisting of members of our research team and representatives from SASSETA, as well as its stakeholder organisations, the private security companies, legal firms and the unions, which oversaw the implementation of the project from beginning to the end

Secondly, we used a triangulation of several research methods, due to the complexity of the issues that were under investigation simultaneously This, we believe, allowed for a deeper understanding of the issues than would have been the case if only one method had been used

The original overall project structure is shown in the figure opposite In order to fulfil the objectives of the study, two parallel sets of studies where conducted within each sector Study 1, which sought to address Project Outcomes 1 and 2, focused on HIV prevalence and HIV incidence, and knowledge, attitudes, practices and beliefs, while Study 2, which addressed Project Outcomes 3 and 4, investigated the business impact of HIV/AIDS and responses thereto

Both Studies 1 and 2 in each sector were preceded by a formative study involving

interviews with managers or key people involved in HIV/AIDS in a few companies and focus groups of employees in all employment categories The main part of Study 1 consisted of two cross-sectional surveys using the second-generation surveillance

approach, which simultaneously collects both biological specimens for HIV testing and behavioural measures that are linked via bar codes HIV testing was done on dry blood spot (DBS) specimens from a finger prick with a special surgical lancet In the private security services sector, 2 787 respondents from 15 mainly large firms were interviewed by trained nurses, and 2 224 of them agreed to be tested for HIV In the legal services sector,

421 respondents from 23 legal services firms agreed to be interviewed, 341 of whom agreed to be tested for HIV

Study 2 consisted of three parts The first involved surveys of employers or their

representatives from the private security and legal services sectors, who completed a questionnaire about the impact of and response to HIV/AIDS on behalf of each company that participated in the project The second part included modules in the survey

conducted as part of Study 1, which asked employees in the private security and legal services sectors about their perspectives regarding the impact of and response to HIV/AIDS The third and final part of Study 2 involved the use of a panel consisting of experts who critically reviewed three HIV/AIDS policies from the private security sector, three from the legal services sector, and the SASSETA HIV/AIDS policy

All DBS specimens were first tested on the Genscreen ELISA, and all reactive specimens were subjected to confirmatory tests with a second enzyme immunoassay (Vironostika Uniform 11 + 0) For quality control, a second test was conducted for 10% of cases where the first test was negative Samples testing positive in enzyme immunoassay 1 and

negative in enzyme immunoassay 2 (producing discordant results) were tested further on

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Study 2

Business impact (Project outcome 3) Business response (Project outcome 4)

SASSETA Project

Process followed in both sectors Phase 1

Formative or elicitation research: focus groups &

key informants (Project outcome 2)

Phase 2a

Pilot study

Phase 2b

Main survey (2 cross- sectional surveys)

Phase 1

Formative or elicitation research: focus groups &

key informants (Project outcome 2)

Phase 2a

Pilot study (in conjunction with Study 1)

Phase 2b

Main survey (2 cross- sectional surveys, in conjunction with Study 1)

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Data from each study was captured and analysed using appropriate methods as described

in full in the main report

Finally, ethical approval was obtained from the HSRC’s Research Ethics Committee

Main findings from Study 1: The HIV prevalence, HIV incidence and KABP survey

Private security sector

The following results were obtained:

HIV prevalence among the respondents in the private security sector is 15.9% Other

•฀

analysis showed that:

males had a slightly (although not significantly) higher HIV prevalence (17.3%)

people had the lowest HIV prevalence (6.8%);

KwaZulu-Natal (22.8%) had the highest HIV prevalence, followed by Gauteng

•฀

(17.8%) and the Western Cape (3.4%);

respondents who were labourers, cleaners, porters and messengers had the

•฀

highest HIV prevalence (24.5%), followed by service workers, clerks and protective service workers (21.8%), while senior officials, professionals, managers and directors had the lowest HIV prevalence (5.1%);

HIV incidence was higher among Africans (2.5%) than other race groups;

•฀

HIV incidence among respondents younger than 25 years of age (3.6%) was

•฀

higher than among those aged 25–49 years (1.2%);

no new infections found among respondents aged 50 years and older; and

•฀

respondents from KwaZulu-Natal had a higher HIV incidence (3.4%) than those

•฀

from the Western Cape (1.1%) and Gauteng (2.0%)

The respondents in this study were generally very knowledgeable about HIV/AIDS,

•฀

except for the following few misconceptions or myths:

patients with TB also have HIV;

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More males than females believed that they were are risk of HIV infection

•฀

Conversely, more females than males believed that they were not at risk Most believed they were not at risk because they were faithful to one partner/trusted their partner, either always used condoms or were abstaining from sex, did not share used needles or body-piercing instruments, did not have sex with prostitutes, and knew that both they and their partner had tested HIV negative, in that order

Of the four race groups, both males and females of African origin (95.3% and 89.7%

•฀

respectively) were found to be the most sexually active in the last 12 months, compared with their counterparts from the other race groups, especially white males (90.8%) and coloured females (76.3%)

The large majority of respondents (86.7%) reported that they had regular sexual

•฀

partners, 10.4% had non-regular sexual partners and 0.6% had had sex with commercial sex partners The breakdown of those who had non-regular partners was as follows:

more African and coloured males reported having had two or more sexual

•฀

partners than did their male white and Indian/Asian counterparts;

more coloured females reported having had two sexual partners than did their

•฀

counterparts from the other race groups; and more importantly, not a single Indian/Asian female reported having had two or

•฀

more concurrent sexual partners

The large majority of respondents (89%) of both sexes had partners who were

•฀

within 10 years of their own ages The breakdown was as follows:

more males (10%) than females (3.3%) reported that they had sexual partners

•฀

who were 10 years younger than themselves;

more females (8%) than males (0.5%) reported having had sexual partners who

ever used condoms;

among those sexually active, 41.9% reported having used condoms with regular

condom use (62.4% and 53.6% respectively), compared to their counterparts of

50 years and above (16.4% of males and 9.1% of females respectively);

both single males and females reported higher use of condoms (57.1% and

•฀

53.0% respectively) than did those of other marital statuses;

widowed males reported the highest condom use, after single males, while

•฀

none of the widows reported having used condoms in the last 12 months;

African males and females reported significantly higher use of condoms (46.0%

•฀

and 49.8% respectively) than did white and coloured males (23.8% and 23.3%

respectively) and white and coloured females (22.8% and 22.6% respectively);

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respondents younger than 50 years old who had more than two partners

•฀

reported the highest condom use in their last sexual encounters

The large majority of respondents (88%) knew where to obtain VCT services

had been told of their test results;

the majority of those tested (70.2%) had pre-test counselling before undergoing

being aware of their HIV status

Half of the respondents (48.2%) who knew about their HIV status had regular

A very low level of drug use was found in this study, with dagga (cannabis) being

•฀

the most commonly used drug (and then amongst only 1.3% of respondents)

Two-thirds of the respondents (67%) reported having changed their behaviour in the

•฀

face of widespread HIV infection, using mainly ABC strategies such as having one partner only or being faithful, always using condoms, abstaining from sex, or reducing their number of sexual partners

Of the 1 582 males who participated in this part of the study, 40.5% reported having

•฀

been circumcised No reliable difference was found between the HIV prevalence rates of men who had been circumcised (17.2%, 95% CI = 12.55–23.09) and those who had not (17.4%, 95% CI = 13.05–22.84)

The most common message/slogan recalled was on condom use, followed by

•฀

abstinence tied with ‘fear’, and the need for faithfulness

The majority of respondents were generally comfortable communicating about sex,

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HIV prevalence was found to be higher among respondents who reported that they

•฀

had used condoms during their last sex act than it was among those who reported not having done so More HIV-positive respondents reported that they had been using condoms with regular sexual partners consistently over the past year, compared to those who had not

Respondents who perceived themselves to be at high risk of HIV had a higher HIV

•฀

prevalence (19.9%) than those who considered themselves to be at low risk (9.8%)

However, the difference was not significant

Males who had partners 10 years younger than themselves had a higher HIV

•฀

prevalence (20.2%) than males who had partners 10 years older than themselves (10%) However, females who had partners 10 years older than themselves had an HIV prevalence of 16.3%, compared to a prevalence of 9.3% among those that had partners 10 years younger than themselves

Legal services sector

The main findings that emerged from this study were as follows:

HIV prevalence among the respondents was 13.8%, with the following breakdown:

of the other race groups combined (1.7%);

respondents who were 25–49 years old had a higher HIV prevalence (16.0%)

(18.7%) than married respondents (10.1%);

KwaZulu-Natal had the highest HIV prevalence (23.7%), followed by Gauteng

previous six months, it was not possible to calculate a valid HIV incidence estimate

Respondents were generally very knowledgeable about HIV/AIDS, but had many of

•฀

the same myths or misconceptions as respondents in the private security industry

The overwhelming majority of respondents generally had very positive attitudes

•฀

towards HIV/AIDS-related issues including PLWHA, except for 61% of the respondents who were either unsure or said that they would want to keep the HIV-positive status of a family member a secret, and 50% of the respondents who were either unsure or said that they would not have a problem having protected sex with

a partner who has HIV/AIDS

The overwhelming majority of respondents, irrespective of gender and race group,

•฀

indicated that they had started to take the problem of AIDS seriously This perception varied by race group, with Africans being the most concerned (98.9%) and coloured respondents the least (83.3%)

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A large majority (86.2%) of the respondents (94.7% of the females and 67.3% of the

•฀

males) reported that they had one sexual partner Nearly one-fifth of males reported that they had two partners (18.3%) or more than two partners (3.9%), compared to their female counterparts (4.0% and 1.2% respectively)

About a tenth of males (8%) had a partner who was 10 years younger than

The large majority of respondents (84%) knew where to obtain VCT services, with

Overall, nearly two-thirds of the respondents (64%) reported having changed their

while a tenth (9.9%) were high risk-drinkers (AUDIT score 8+);

males (23%) were more likely than females (4%) to be high-risk drinkers;

drinkers, while no Indian/Asian respondents were high-risk drinkers

Overall, very low substance use was found in this study Dagga (cannabis) was used

•฀

more commonly (0.7%) than other substances

The most frequently recalled messages were about the use of condoms (C), fear,

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Respondents who perceived themselves as being at high personal risk of HIV

•฀

infection had a higher HIV prevalence (18.4%) than those who perceived themselves

to be at low risk of being infected with HIV (8.7%)

Main findings from Studies 2A and 2B in the private security sector

Employer perceptions of the impact of HIV/AIDS on business

The following main findings were obtained from the two studies:

Just over half of the employer respondents (53.8%) regarded HIV/AIDS as a business

Most employer respondents reported that HIV/AIDS had no impact on their

•฀

employee profile However, a few indicated otherwise, and the impact varied by occupational category, especially among service workers, security guards and labourers

Many AIDS or AIDS-related deaths were reported to have occurred in 2003 and

•฀

2004

Turnover was mainly among service workers and security workers, and a fair

•฀

number was reported among labourers

Most companies provided a company retirement benefit, whereas only half provided

increasing employee benefit costs On average, 66.7% reported that there would be

no impact on benefit costs

Companies spent very little on HIV/AIDS services in the period prior to the survey

While some companies reported that there had been no HIV/AIDS impact on output

•฀

and service delivery, some indicated that there had been increases in related absenteeism and funeral attendance (38.5%) and health-related turnover

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Employer perceptions of business response

The following four main findings were obtained:

Most companies had very little knowledge or awareness of industry-wide or

union-•฀

based HIV/AIDS policies

Nearly a third of the companies, in particular the larger ones, had a written HIV/

implementing HIV/AIDS programmes or elements thereof, such as the replacement

of staff that became ill (50%), condom provision (41.7%), job security for positive staff (41.7%), prevention and awareness education (38.5%) and provision of protective equipment (33.3%)

HIV-Most companies were not aware of the reasons for poor implementation, while

•฀

some cited the nature of the ‘unskilled’ workforce and ‘long distances’ or multiple worksites as obstacles in conducting education and awareness programmes in the sector

Employee perceptions of HIV/AIDS impact

The following findings about employees emerged from data collected as part of Study 1:Very few employee respondents displayed knowledge about colleagues living with

•฀

HIV/AIDS (4.1%) or having died of HIV/AIDS-related illnesses (9.6%)

In spite of this lack of knowledge about colleagues living with HIV/AIDS or having

•฀

died of HIV/AIDS-related illnesses, more than half of all respondents reported that employees had been affected in terms of taking over the tasks of colleagues who were ill (64.9%), a shortage of employees (58.4%) and decreases in effective functioning (58.7%)

Most employees displayed very low levels of awareness of HIV/AIDS policies, with

•฀

only 8.5% aware of an industry-wide policy, which was considerably higher than the 2.5% awareness of a trade union policy Interestingly, two-thirds of those who were aware of an industry-wide policy indicated that it had been implemented in their companies

The most commonly cited contents of company HIV/AIDS policy (among those few

Amongst the key programmatic gaps identified were lack of education and training

•฀

about HIV/AIDS (42.1%), followed by the absence of VCT programmes (28.7%) and

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Main findings of Studies 2A and 2B in the legal services sector

Employer perceptions of impact of HIV/AIDS on business

The following main findings emerged:

HIV/AIDS was not regarded as a business concern by most of the respondents

•฀

(70%) Consequently, most employers had not made any attempt to measure the potential impact of HIV/AIDS, while a few companies had conducted a quantitative assessment of HIV/AIDS impact, focusing mostly on cost analysis

Most of the participating companies reported no HIV/AIDS impact on operations

impact on profits over the following three years thought so because of the small size

of the company, low risk among employees or no illnesses thus far, and a degree of awareness among staff about HIV risk factors

Most respondents reported that HIV/AIDS had no impact on their employee profiles,

•฀

irrespective of occupational category However, where a small impact was perceived,

it was indicated that this would have occurred mainly among labourers, followed by support and clerical staff, then among professionals and associate professionals, and learners/candidate attorneys, in that order

Very few employees were reported to have died due to AIDS or AIDS-related causes

AIDS-related skills turnover

Nearly all companies reported that there had been no change in output and service

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Employer perceptions of business response

The following four main findings emerged:

Most respondents displayed low levels of knowledge and awareness of HIV/AIDS

•฀

policies in the business environment

Only a few of the firms reported having a written HIV/AIDS policy, and only 40% of

•฀

these had implemented the policy

Despite the lack of HIV/AIDS policies, a few of the companies were implementing

•฀

HIV/AIDS programmes or elements thereof, such as the replacement of staff who became ill, provision of equipment to prevent infection, prevention and awareness programmes, treatment of opportunistic infections and campaigns to limit stigma.The four main explanations provided for the limited implementation of HIV/AIDS

Employee perceptions of HIV/AIDS impact

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 them were very high

When asked about the contents of company HIV/AIDS policies, the most common

•฀

provisions cited by respondents were those in regard to discrimination, confidentiality, workplace safety, and counselling and support of those with HIV/AIDS Workplace prevention programmes and HIV testing were very low on the list

•฀

measures were the supply of equipment to protect staff from infections, condom provision, HIV prevention programmes, and other programmes such as VCT and ARV, in that order

Among the gaps that were perceived by respondents in the company’s HIV/AIDS

•฀

interventions were the lack of education and training programmes, VCT services and programmes to address stigma, in that order

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Main findings of Study 2C on HIV/AIDS policies in both sectors

The following are the main findings:

The bigger security firms (and SASSETA) and the larger legal firms have developed

•฀

policies However, in the smaller security firms and smaller legal firms, these policies have not been developed The central bodies in the legal industry have also not developed policies, although groups like the AIDS Law Project have made recommendations The major trade unions representing staff in these sectors have also not developed policies This lack of policy is of concern, and shows either that inadequate priority has been given to HIV or a sense that the sectors’ members are not vulnerable, which is even more worrying SASSETA has developed a policy outline for security companies, which, together with this report, should facilitate the development of HIV/AIDS policies in private security companies A similar broad policy framework has not been developed for legal firms

The policies that have been developed go some way towards addressing the

•฀

immediate concerns of companies in the wake of the pandemic As they stand, however, they are neither creative nor far-reaching in their orientation The progressive nature of the disease calls for flexibility and a much more multi-focused approach Much of the policy is tied to legislation, especially the Code of Good Practice (DOL 2000), which is important as it provides clarity on the core of what must be done in any business However, this is not sufficient, and policies need to

be flexible and responsive to changes in context as a result of the epidemic

A key criticism from all of the reviewers across most of the policies was that they

a length and style of language that allows for them to be easily distributed, read and understood The policies varied in this requirement, but broad distribution did not appear to have been a focus anywhere

The process of establishing a policy also has to be understood and respected A

be incorporated into training materials instead Policies that include information need

to be updated regularly to ensure that the information is correct It is easier to keep track of training materials, which could be outsourced or shared on an industry-wide basis While both sectors are extremely competitive, there are real opportunities to save and reduce costs by working together in the development of policy and training materials

The anti-discrimination clauses are good and important These set the framework for

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treatment, especially ARVs, and resources for protection such as condoms, STD treatment and counselling While all of these increase costs (and ARVs, in particular, are expensive), the companies need to consider the long-term costs of not providing such resources

Also of concern is that not all staff are incorporated into the policy, which appears

•฀

to apply mainly to permanent staff This is particularly significant in the private security industry, where many staff are employed on a short-term or contract basis The issue of people who are affected but not infected by HIV/AIDS requires greater

•฀

consideration People can be affected by the death and illness of family and friends,

by having to take additional people into their households and by community stress These impacts require different responses from companies, but it is important to address them by way of recognition of family compassionate leave and supportive counselling

Key to many of the above points is the conflict between care for staff and profits,

•฀

balancing the needs of company versus staff Both sectors have very high profit margins and are known to be high growth areas in the economy Ultimately, this becomes a moral choice for the companies and the sectors concerned

The policies often lack a clear implementation strategy For some issues, such as

•฀

response to discrimination, no immediate implementation is required as it depends

on such a situation arising However, implementation strategies are required for prevention programmes, treatment and developing responses to cases of discrimination The implementation of the policy must be designated as the responsibility of a specific person, and resources need to be committed to the policy

Monitoring and evaluation need to be incorporated into all policies This must go

•฀

beyond saying that it will happen Someone must be designated the responsibility, and be provided with the necessary resources and strategic plan to carry it out

General recommendations

Several lessons were learnt in this study These include the following:

Firstly, there is a need for a reliable database to use as a sampling frame for a study

•฀

like the present one Major problems were experienced at the beginning of this study, as the SASSETA database of private security companies was not as reliable as required This was partly because of the 3-month strike in the private security sector that coincided with the start of the project It is possible that several of the smaller security firms closed as a result of the impact of this long and divisive strike

Secondly, the research team experienced immense difficulty in accessing companies

•฀

in both sectors, because the study had been commissioned by a third party, SASSETA, rather than by an employer or a union or both, as was the case in some successful previous studies Many organisations that were approached attested to their ignorance about SASSETA and why the study was being carried out in their industry This situation caused enormous hardship for the fieldwork team during both the pilot study and the first half of the fieldwork period during the main

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by stakeholders, especially the employer groups and unions is recommended

Preferably, all advance advocacy work and buying into the project by companies should be finalised before tendering is done

Thirdly, due to all the limitations mentioned in the report (especially the above),

•฀

although highly illustrative of the impact of HIV/AIDS on the two sectors and the response by companies to the epidemic, the research team strongly recommends that another larger study be undertaken in a few years time in order to monitor and evaluate the impact of the responses that will emanate from programmes that are recommended below for development, adoption or adaptation and timeous implementation

Specific recommendations

Study 1: HIV prevalence, HIV incidence and KABP survey in both sectors

The following recommendations are made:

More basic HIV/AIDS health education is required, in order to:

improves in the near future

There is a need to develop interventions that promote disclosure and address stigma

•฀

among families with members who are living with HIV/AIDS

It is important to continue highlighting the fact that everyone is at risk in a

•฀

generalised epidemic In this way, no one (including members of race groups that are least affected) will be fooled into complacency and a false sense of security and, thus, not respond appropriately to prevent themselves from being infected by HIV

There is a need to promote further health education among women to enable them

Although a majority of respondents had been tested and knew their HIV status,

There is a need for interventions that will lead to societal disapproval and censure of

•฀

being a sugar daddy, which is common amongst older men who usually also have multiple partners due to their higher economic status This will help prevent the further spread of HIV infection among young women

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Studies 2A and 2B: Private security sector

In order to remain competitive in the long run, the private security sector needs to

•฀

take a long-term developmental attitude and approach to maintaining and extending the productive lives of its skills base, which is comprised mainly of security guards and other protective service workers

The pre-existing awareness of HIV/AIDS as a business concern must be maintained

•฀

and up-scaled A major networking approach should prioritise working with sectors that have highly mobile workforces, in order to transmit the HIV/AIDS message effectively across multiple worksites Also, co-ordination with clients on health and safety measures and VCT provision for subcontracted guards is necessary

The low spending on HIV/AIDS services and non-responsiveness among SMMEs

Studies 2A and 2B: Legal services sector

Awareness and advocacy about the importance of HIV/AIDS as a business concern

•฀

is necessarily based on an evidence-led approach in a network of credible professional legal organisations Given the ‘time-is-money’ approach in the sector, discretionary grant funding may be used to implement low-cost prevention and awareness programmes

A specially packaged policy framework to mediate basic policy formulation and

Study 2C: HIV/AIDS policies in both sectors

Gaps where policies do not exist are a problem, particularly in the trade unions and

•฀

general lawyer bodies Tedium and stress can lead a person into risky sexual behaviour This may be heightened for those who operate in situations of danger

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managerial top-down approach to an inclusive approach

Policies have to be of a length and in style of language that allows for them to be

•฀

easily distributed, read and understood

The problems in the policy documents relating to adapting the policies to a specific

•฀

workplace must be addressed

Many of the policies are limited to permanent staff, excluding temporary and

Policies need to be kept up to date on HIV information (if such information is

•฀

incorporated in the policy documents) and on changes in legal issues surrounding HIV Treatment changes and the availability of new medications or means of protection may also impact on policy and need to be monitored

There is no reason why a legal firm would consider testing its employees for HIV,

•฀

except possibly for anonymous prevalence testing Accordingly, there would be no need to include this aspect in the workplace HIV/AIDS policy, unless it is to clarify that testing will not be done for company purposes

The policies generally acknowledge the right to confidentiality and to choose when

•฀

to disclose HIV status, but there is no specific provision on how this would be done practically in the workplace It should be clearly spelled out how any information, whether in a personnel file or minutes from an incapacity hearing, which reveals an employee’s HIV status, should be secured to ensure that confidentiality is

Generally, stigma and discrimination were dealt with well in the policies, and reflect

•฀

the requirements of the Code of Good Practice (DOL 2005), but these clauses need teeth to make them effective A clear link to disciplinary action, and a description of the nature of the disciplinary action, is required Likewise, the clauses on

confidentiality need to be secured

Policies should facilitate protection for staff outside of the workplace as well as at

Access to services, particularly medical treatment for AIDS and counselling around

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for the workplace Considerations in this regard include:

human rights aspects of HIV/AIDS;

•฀

an understanding of the specific impact of HIV/AIDS on clients’ lives, and the

•฀

services that are available for people living with HIV/AIDS;

key information about the disease, the implications of contracting the virus and

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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 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 contract with SASSETA was signed on 7 March 2006 The intended duration of the

project was 12 months Due to the funding available, it was agreed that the sample sizes

would be decreased and that the study would take place in three provinces (namely,

KwaZulu-Natal, Gauteng and the Western Cape), instead of in four provinces for each

sector, as had been planned Although work started immediately, delays were

experienced as a result of a strike in the private security industry In addition, problems

were experienced in accessing companies, which necessitated some changes to the

sampling design, prolonging the duration of the project by six months The project was

concluded at the end of August 2007

1.2 Literature review

1.2.1 HIV prevalence and incidence in South Africa

South Africa has one the highest numbers of people living with HIV/AIDS in the world

(UNAIDS 2006) Two surveys conducted during 2002 and 2005 by a consortium led by

the HSRC found a consistent and relatively high national HIV prevalence rate of about

16% among adults aged 15–49 years (Shisana & Simbayi 2002; Shisana et al 2005a) The

2005 survey, which also measured national HIV incidence, found this to be 1.4% per year,

meaning that an estimated 571 000 new infections occurred during 2005 (see also Rehle

et al 2007a) More importantly, an HIV incidence rate of 2.4% was recorded for the age

group 15–49 years Of particular concern was the finding that the incidence of HIV

among females peaked in the 20–29-year age group at 5.6%, which was more than six

times the incidence found in 20–29-year-old males (0.9%) Even more disconcerting was

the finding that for youth aged 15–24 years, females accounted for 90% of the recent HIV

infections Although some research has suggested the possible role of HIV transmission

through nosocomial infection, as a result of poor infection control in healthcare settings

(see, for example, Gisselquist et al 2002), there is a degree of consensus that the main

route of HIV transmission is via heterosexual sex, which accounts for more than 90% of

infections (UANIDS 2006; Schmid et al 2004) The 15–49-year age group accounts for

most of the infections and deaths from HIV and AIDS (UNAIDS 2006) What is significant

about this age group is that it represents the largest proportion of the economically active

and productive section of the population; and, with increasing deaths, human resources

attrition is a likely outcome for many sectors of the economy

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1.2.2 The impact of HIV/AIDS on various sectors of the economy in South Africa

During the past decade, several studies have been published that have examined the impact of HIV/AIDS on various sectors of the economy in South Africa, including mining and manufacturing (Evian et al 2004; Stevens et al 2006), health (Shisana et al 2004) and education (Badcock–Walters et al 2003) While two recent HSRC studies show that HIV prevalence levels among health-sector workers and educators are similar to those found

in the general population (see Shisana et al 2004, 2005b), the groundbreaking study by Evian et al (2004), which was conducted among 44 000 employees in 34 workplaces involved mainly in mining and manufacturing in Botswana, South Africa and Zambia during 2000–2001, found a national prevalence rate of 14.5% in South Africa and showed that the epidemic is affecting economic sectors differently In particular, HIV/AIDS

appeared to affect the mining and metal processing sectors (with prevalence rates of 15.5% and 17.8%, respectively) more than it does other industrial sectors (with rates between 11.6% and 13.0%), mainly because of the migratory labour system that forces men to live away from their families Evian et al.’s findings in the mining sector were recently replicated by Stevens et al (2006), who found the relatively high prevalence rate

of HIV infection of 24.6% among 11 339 employees in Anglo Platimum, representing about 18.4% of the entire workforce in this large, multinational mining organisation operating in the Gauteng, Limpopo and North West provinces of South Africa Further, there is growing evidence that the epidemic is slowly transforming from an HIV to an AIDS epidemic, as increased morbidity and mortality trends become apparent (Bradshaw

et al 2004)

Apart from the published studies mentioned above, many organisations in South Africa have undertaken HIV prevalence studies on their workforces in order to determine the extent of the impacts of HIV/AIDS and to plan their responses accordingly However, most research in this field is not published because of concerns around confidentiality of company information and potentially negative publicity Colvin, Connolly and Madurai (2007) recently reported on the findings of a study they did after combining datasets of such studies that have been conducted at 22 South African companies involving a total of

32 015 respondents A summary of the results is shown in Table 1.1 Prevalence rates were found to vary from 7.1% in an Eastern Cape Municipality to 24.3% in a national transport parastatal, without any clear industry-related patterns It is interesting to note that the mean prevalence rate was 10.9%, which is the same as that found in the South African general population (see Shisana et al 2005a) Similarly, HIV prevalence was higher among Africans (16.6%) than among other race groups (2.7%), which also is consistent with Shisana et al.’s (2005a) findings However, HIV prevalence was higher among men (11.3%) than among women (9.8%) This finding is similar to that of Evian et al.’s (2004) study, but differs from the finding among educators (Shisana et al 2005b) where no sex differences were apparent More importantly, this difference is in the opposite direction to that found in the general population survey (see Shisana et al 2005a), leading Colvin et al (2007) to hypothesise that being employed may be protective for women, a conclusion which appears to be supported by findings from the educators’ study (Shisana et al 2005b)

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Standardised (%) a

Adjustment factor b

Final prevalence (%) c

Public Eastern Cape

Gauteng Local

Limpopo Municipality 10.1 6.2 2.30 14.3Utility/parastatal National parastatal 6.6 5.6 1.32 7.4

National parastatal 10.9 11.0 1.43 15.7National transport

1.2.3 The second-generation surveillance approach to

link HIV infection and behaviour

Unlike most of the published HIV workplace studies reported above, the study

undertaken by the HSRC among educators (Shisana et al 2005b) yielded not only

information about HIV prevalence but also about factors underlying it This was made

possible through the use of the second-generation surveillance approach designed by

UNAIDS and the World Health Organisation (2000) and Family Health International

(2000), which allows for both biological and behavioural surveillance to be conducted

simultaneously and for the two sets of measures to be directly linked to each other (see

Chapter 2 for further discussion of this approach) While the study provided useful

information on HIV prevalence, including the fact that this was higher in rural areas than

in urban areas, and identifying districts with very high prevalence rates known as

‘hotspots’, the study also identified various risk behaviours underlying the HIV epidemic,

Trang 36

such as having concurrent sexual partnerships, intergenerational sex, poor use of

condoms, and mobility, as well as the common perception of not being at risk of HIV infection (Shisana et al 2005b)

This information has 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 labour and skills The economic effects of the disease will be felt unevenly across sectors, with some more impacted on than others Individuals exposed to particular situations and who enjoy a particular socio-economic status may have a higher or lower than average risk of infection Most of the studies have shown that the sections of the workforce most vulnerable to the impact of HIV/AIDS tend to be those in lower-skills occupations and the previously disadvantaged, exactly the target categories for SETA training and skills development (Colvin et al 2007; Evian et al 2004)

1.2.4 HIV/AIDS in the public security services

There is a paucity of accurate information on infection and mortality rates in, as well as general data on the impact of AIDS on, the two 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 complement of single men, most of whom are under the age of

40, previously disadvantaged and not very highly educated Therefore, a brief review of literature available on the HIV/AIDS situation among the military might be illustrative of what to expect

According to Okee-Obeng (2002), there is a strong historical association between soldiers, prostitute contact and the spread of sexually transmitted infections (STIs) including HIV/AIDS This is because soldiers tend to be young, sexually active, away from home and surrounded by opportunities for sex (Beresford 2001) Consequently, soldiers are believed

to have between twice to five times the civilian rates of STI infections, which facilitates the spread of HIV in most sub-Saharan African countries According to Beresford, as a rule of thumb, it is generally believed by the USA’s Department of Defense that HIV infection rates among soldiers in most sub-Saharan African countries with advanced HIV/AIDS epidemics are at least twice those found among the general population A few years ago, the prevalence of HIV infection among soldiers was estimated to be as high as 60% (Kirk 2000) Last year, the South African National Defence Force revealed that the

prevalence rate among soldiers who had volunteered to be tested as part of their HIV/AIDS programme was only about 2–3% higher than the national prevalence rate

determined by UNAIDS based on antenatal survey data obtained from pregnant women Clearly, this finding is not based on a representative sample As no empirical studies had been conducted to validate any of the HIV prevalence rates cited above, there was a need to conduct an empirical HIV/AIDS survey among private security industry

employees

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1.2.5 HIV/AIDS in the legal services industry

With regard to legal services professionals and employees, again there is no published

empirical evidence on HIV prevalence for this sector or similar professions However,

unlike among private security employees, there is no reason to believe that the HIV

prevalence rate among professionals and employees in this sector is any different from

that found among adults aged 15 years and older in the general population This is

because legal services professionals and employees are drawn from all age groups, work

normal hours and live with their families in all communities

1.2.6 Behavioural determinants of HIV infection

Apart from basic demographic characteristics such as age, gender, race and occupational

classification, identified in the tender specification as being important determinants of HIV

infection, there are also several socio-cultural and behavioural factors that are believed to

be driving the HIV/AIDS epidemic in South Africa The present study, therefore, offered a

golden opportunity to understand the role that these risk or protective factors play in the

HIV/AIDS epidemic The information obtained will be crucial for informing both SASSETA

and, especially, the stakeholders (employers and labour) of the two sub-sectors, about

appropriate policies and programmes to control and prevent the further spread of HIV

infection

Among the socio-cultural and behavioural factors that need to be investigated are the

following: various individual and societal sex-related behaviours such as unsafe sexual

practices (e.g unprotected vaginal, anal and dry sex, and the number of partners), male

circumcision, condom use, pattern of sexual mixing (e.g age differences between

partners), gender inequality and the high levels of violence against women in society, and

various cultural practices relating to rites of passage, marriage and death In addition to

the above, other social and economic factors that are crucial in driving the HIV/AIDS

epidemic in South Africa are stigma and denial associated with HIV/AIDS infection, the

migration of people, and poverty (see Simbayi 2002)

All the above-mentioned factors were investigated in the two HIV/AIDS surveys of both

management and employees in the two sub-sectors, through the use of interview-based

questionnaires and by obtaining dry blood spot specimens for HIV antibody testing An

advantage of doing this was that we did not know what proportion of the employees in

the two sub-sectors already knew about their HIV status and how this information might

have been impacting on their behaviour

1.2.7 The impact on and response of business to HIV/AIDS in South Africa

In terms of an appreciation among employers of the business impact of HIV/AIDS, there

is still a perception among most employers that HIV/AIDS is not yet a high-priority

business issue (Deloitte & Touche 2002) This is changing, though, as the impact of

AIDS-related illnesses and deaths become apparent Thus, a recent study in the manufacturing

and retail sectors by the South African Business Coalition on HIV/AIDS indicates that HIV/

AIDS has become a ‘bottom-line’ issue, as 34% of the surveyed companies indicated a

negative impact on profits (SABCOHA 2004).A similar change in perception may be

anticipated in the two sub-sectors under investigation

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Further, the study showed that the business response to HIV/AIDS has remained

extremely weak Efforts to mitigate the impact of the disease through company-based prevention, awareness and intervention programmes have been very uneven Only 26%

of the surveyed companies had an HIV/AIDS policy in place Large companies tended to respond the best, less so the medium-sized companies, and little or no intervention was apparent in the majority of small and micro-sized companies (SABCOHA 2004) This trend

is particularly pertinent to SASSETA, given the predominance of small and medium-sized businesses in the two sub-sectors

No significant empirical data are available on the impact of HIV/AIDS on skills

distribution However, forecasting data, and a number of company surveys, suggest that there is a negative relationship between skills levels and HIV/AIDS prevalence This implies that the predominance of semi-skilled service employees in the private security sector points towards potentially high HIV prevalence, whereas the skilled and highly skilled profile in the legal services sub-sector may imply low levels of prevalence

However, intervening demographic and other factors may result in differing profiles Also,

as pointed out earlier, in the absence of empirical data, these trends remain speculative Therefore, in order to facilitate a future skills and training development strategy, it is fundamental for SASSETA to have an understanding of the size and specific nature of the impact of HIV/AIDS on its constituent sub-sectors, the broader risk environment and business In turn, this will facilitate HIV/AIDS impact mitigation and will determine the growth path for current and future skills replacement and the need for investment

in training

1.3 Epidemiological model

The model that was developed for the educator study by Shisana et al (2005b) was adapted for the present study and, therefore, it is only briefly summarised here As illustrated in Figure 1.1, the epidemiology of HIV/AIDS in the workplace can be

understood as the result of an interplay among various factors The independent variables

at work include both behavioural and social risk factors (classified as distal, proximal and person factors) and HIV/AIDS itself; other influences, which impact on the demand and supply of employees, the recruitment and training of new employees, retention and attrition, and productivity (including workload), are mediated by work- and HIV/AIDS-related factors

The model acknowledges the significance of biological factors such as STIs, male

circumcision and HIV viral load For additional detail, the reader is referred to the report

by Shisana et al (2005b)

1.4 Objectives

The central objective of the present study was to conduct a critical assessment of HIV/AIDS in the private security and legal services industries, in terms of the prevalence and incidence rates of HIV, business impact, and the responses of businesses to the epidemic thus far

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1.5 Conceptual framework of the project

1.5.1 Study 1 (project outcomes 1 & 2): HIV prevalence, HIV incidence and

knowledge, attitudes, practices and beliefs (KABP) survey

As was alluded to earlier, the conceptual framework that informs this study is known as

the second-generation surveillance system (Family Health International 2000; UNAIDS/

WHO 2000) This framework is based on surveys of ‘knowledge, attitudes, beliefs and

practices’ (KABP) in relation to sexual behaviour and HIV infection that have been carried

out worldwide during the past 20 years The study uses this conceptual framework to:

determine estimates of HIV prevalence rates;

Distal factors

Sexual cultural norms

Migration & mobility

Condom availability

Moderating factors

Training Support HIV policy ARV treatment

Intention to leave Decrease in supply of employees (turnover)

Job stress & job satisfaction

Absenteeism

of employees

Decrease in quality of work

HIV status Illness severity

Independent variables Dependent variables

Figure 1.1 Epidemiological model of the impact of HIV/AIDS in a workplace

Source: Adapted from an original model developed by Shisana et al (2005b)

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practices related to HIV/AIDS among employees in the two sub-sectors.

1.5.2 Study 2 (project outcomes 3 & 4): Business impact and response

The conceptual bases for defining indicators in project outcomes 3 and 4 were

international standards of practice as generated by the International Labour Organisation (ILO), the Global Reporting Initiative (GRI) Framework, the AIDS Management Standard (AMS) and the South African Code of Good Practice on Key Aspects of HIV/AIDS and Employment These ensured conformity with both local and international best practice, and established reliable baseline information Further, special cognisance was taken of small, medium and micro-sized businesses

1.6 Scope

The scope of the assessment of the impact of HIV/AIDS across the private security and legal services sub-sectors is outlined below

1.6.1 Study 1 (project outcomes 1 & 2): HIV prevalence, HIV incidence

and KABP survey

The determination of HIV prevalence was based directly on HIV antibody testing of specimens collected from a representative sample taken for the population of employees from each of the two sub-sectors of SASSETA Often, this approach was accompanied by

a behavioural risks survey, in order to understand more about the risk or protective factors in terms of HIV infection It also enables one to determine the proportion of people who know about their status and how this impacts on their behaviour This is the best practice approach recommended by UNAIDS/WHO (2000)

To accomplish the goal of improving HIV-prevention programmes, it is critical to

understand the context within which HIV-related risk behaviours occur The context influences whether or not knowledge and information about HIV lead to behaviour change Where leaders or managers show commitment to HIV prevention and care, they allocate resources that make it possible for people to obtain, for example, condoms, treatment for STIs and voluntary counselling and testing (VCT) services Knowledge, information and practical skills gained do not necessarily translate into behaviour change

if such concrete prevention commodities and/or services are not within the reach of those who intend to change their behaviour Contexts do not always provide protective

environments or resources; they may be harmful For example, some of the messages may lead to detrimental behaviour One needs systematically to identify those contexts that are positive as well as those that are negative, with a view to informing programme development

To identify appropriate measures and indicators, the process that was followed

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