CHAPTER ONE

INTRODUCTION

1.1 Backgroundof Study

According to UNAIDS Report (2004), almost five million people became newly infected with HIV in 2003, the greatest number in any one year since the beginning of the epidemic. At the global level, the number of people living with HIV continues to grow – from 35 million in 2001 to 38 million in 2003. In the same year, AIDS killed almost three million; over 20 million have died since the first cases of AIDS were identified in 1981 (UNAIDS Report, 2004).

The HIV/AIDS epidemic continues to spread, with the majority of infections occurring in sub-Saharan Africa. It is estimated that 25 million people are living with HIV in sub – Saharan Africa. There seems to be stabilization in HIV prevalence rates, but this is mainly due to a rise in AIDS deaths and a continued increase in new infections. UNAIDS Report (2004) states that prevalence is still rising in some countries such as Madagascar and Swaziland and is declining nationwide in Uganda. It is estimated that in 2003, three million people became newly infected and 2.2 million died (75% of the three million AIDS deaths globally that year).

HIV knows no social, gender, age or racial boundaries, but it is accepted that socio-economic circumstances do influence the disease patterns.  HIV thrives in an environment of poverty, rapid urbanisation, violence and destabilisation. Transmission is exacerbated by disparities in resources and patterns of migration from rural to urban areas.  Women particularly are more vulnerable to infection in cultures and economic circumstances where they have little control over their lives.

The prevention of HIV infection remains the most important approach to the control of the epidemic, care and support for the infected and affected is becoming crucial. Therefore, HIV and AIDS and interventions must address prevention, care and support issues. (Development Gateway: 2004)

In South Africa, a survey is conducted annually to establish the prevalence of

HIV infection amongst pregnant woman attending antenatal clinics.

Extrapolating from the 2001 antenatal survey, it is estimated that 4.7 million adults were infected with HIV – 2.65 million women between the ages of 15 and 49, and 2.09 million men in the same age group (Department of Public Service and Administration, 2002).

The impact of the HIV/AIDS epidemic is significant, affecting all spheres of life and all sectors.  It has the potential to reverse many development gains.  The Department of Social Development in the State of South Africa’s Population Report 2000, estimates that:

“Life expectancy has dropped from 63 years in 1990 to 56.5 years in 2000;

Child mortality has increased from 75 per 1 000 in 1990 to 91 per 1 000 in 2000; and

The probability of a 15 year old dying before the age of 60 was 27 per 1 000 in 1990 and has risen to 40 per 1 000 in 2000” (Department of Public Service and Administration, 2002:14).

1.2         Research Problem

HIV and AIDS are serious public health problems, which have socioeconomic, employment and human rights implications. It is recognised that the HIV/AIDS epidemic will affect every workplace, with prolonged staff illness, absenteeism, and death impacting on productivity, employee benefits, occupational health and safety, production costs and workplace morale (Code of Good Practice, 2000).

Furthermore HIV/AIDS is still a disease surrounded by ignorance, prejudice, discrimination and stigma.  In the workplace unfair discrimination against people living with HIV and AIDS has been perpetuated through practices such as pre-employment HIV testing, dismissals for being HIV positive and the denial of employee benefits.

The epidemic also affects business in many ways, including increasing costs because of absenteeism, sickness and recruitment, organizational disruption and loss of skills, and increasing health expenses and funeral costs. (UNAIDS Report, 2004). The disease ultimately reduces company profits as expenses increase, production or service delivery fails to adhere to planned schedules, and customers change their purchasing plans because of the HIV/AIDS expenses they themselves incur.

HIV/AIDS not only affects workers on the job, it also causes a major drain on family savings and resources. Just as a company experiences increased expenses due to HIV/AIDS, so does a household when members are all ill with HIV/AIDS. One outcome is loss of wages, as a person becomes too weak to work. Another outcome is an increase in medical expenses to treat conditions associated with infection. Caring for a sick family member disrupts the work schedules of others, further income. (Workplace HIV/AIDS Programs)

One of the most effective ways of reducing and managing the impact of HIV/AIDS in the workplace is through the implementation of a workplace HIV/AIDS policy and prevention programmes.

The HIV/AIDS remains the primary threat to South Africa’s economic, social and political development. According to Chetty & Michel (2005), the epidemic is maturing and infection rates still put South Africa squarely in the category of high prevalence countries. The Nelson Mandela/ HSRC study of HIV/AIDS (2002), revealed that South Africa, as a country, has the largest number of people living with HIV/AIDS in the world: 14, 4% of people living with HIV/AIDS live in South Africa. Dorrington et al. (2004) estimated that of the 5.6 million South Africans living with HIV/AIDS, the highest prevalence is among those aged 15 – 49 years with major differences for males and females. New AIDS cases during 2004 totalled 525 000. Total deaths were 701 000, of these non – AIDS deaths were 390 000 and AIDS deaths 311 000, and accumulated AIDS deaths mid – year were 1 212 000. The percentages of deaths due to HIV/AIDS were as follows: 70% for adults aged 15 – 49 years, 45% for adults aged 15 years and above, and 42% for children under 15 years of age (Department of Social Development, 2004).

While HIV is not transmitted in the majority of workplace settings, the supposed risk of transmission has been used by numerous employers to terminate or refuse employment. There is also evidence that if people living with HIV/AIDS are open about their status at work, they may well experience stigmatization and discrimination by others (www.avert.org/aidsstigma.htm)

Voluntary counselling and testing (VCT) is the entry point to know one’s HIV status. VCT is now acknowledged within the international arena as an efficacious and pivotal strategy for both HIV/AIDS prevention and care. The need for VCT is increasingly compelling as HIV infection rates continue to soar, and an organization, such as Department of Social Development (DSD), the case study for this research, has recognized the need for its employees to know their sero – status as an important prevention and intervention tool. Those employees who learn that they are sero – negative can be empowered to remain disease – free. For those HIV- infected, there will be the development of less costly interventions to reduce repeated infection and maintain productivity. In addition, other medical and supportive services can help those living with HIV to live longer, healthier lives and prevent transmission to others.

Despite the efforts being taken by DSD to remedy the situation, the department is confronted with challenges impeding its efforts because of HIV and AIDS related stigma. It therefore important to first understand stigma, the impact of stigma on the lives of employees living with and affected by HIV/AIDS, the causes of employees to react in this way to other employees living with HIV/AIDS, employees who are suffering enough either physically or mentally to endure another challenge of being judged by their colleagues, and who should be supporting and giving them a shoulder to cry on. If the cause of stigma could be understood and its impacts properly handled, then employees would react differently and DSD will be able to overcome the fight against stigma. Interventions to reduce stigma are therefore crucial for improving care, quality of life, and emotional health for people living with HIV and AIDS and eliminating stigma is a crucial element of global efforts.

The issue at hand, is that there are other chronic diseases like diabetes, hypertension, etc which can have similar adverse effects at workplaces like HIV and AIDS, but whose linkages with stigma and discrimination have been totally ignored. Flowing from the above, the key research question can thus be phrased as follows:

What can the Department of Social Development do to resolve the problem of stigma in order to reduce the negative impact associated with it?  The above key research question, has, thus be broken down into manageable units for easy manipulation as follows:

What is our understanding of HIV/AIDS stigma?

What is the impact of stigma on employees living with HIV/AIDS, and how do they respond to it?

What are the barriers to treatment and care?

What are the barriers to testing and disclosure?

How can our theoretical models of stigma be improved?

1.3 Research Objectives

To be able to answer the above research question, the following research objectives have been formulated:

To analyse the content of the local beliefs around HIV/ AIDS

To assess the impact of stigma on people living with HIV/AIDS and their response to the impact.

To determine the barriers to treatment and care and not just to reduce stigma itself.

To determine the barriers of testing and disclosure

To assess the extent of theoretical models of stigma in the workplace.

1.4 Scope of the Study

The study will be limited to the Head office of the Department of Social Development of the Eastern Cape Province, where the different categories of workers in the department are present. The study, thus, covered the top management, the middle management, supervisors / administrative staff and junior staff.

1.5          Significance of the Study

From a theoretical point of view, the research will fall into the current National focus area of ‘’Employee Wellness Programme” that addresses HIV/AIDS pandemic. It is envisage that the research will have the potential to make a significant contribution to the theoretical models of stigma in the workplace in South Africa.

On an empirical level, there is value in examining the notion of HIV/AIDS Programme and its application in South Africa, as it is a new approach to addressing the health conditions of the population.  It will also represent a documentation of interventions in the DSD, which are currently influencing policy planning at national, provincial and local authority levels.

The Governments Departments, especially DSD, can make use of the findings of the research in addressing the HIV/AIDS pandemic issues in the department.