Tanzania Union of Journalists held a course on HIV/AIDS for its members at Njuweni Hotel, at Kibaha in Tanzania from 27th-31st January 2003 and was attended 22 participants from branches, regional based press clubs, coming from different regions of the country. The participation was therefore 91 percent.
Introduction to HIV/AIDS Definitions, Mode of Infections, and Preventions.
INTRODUCTION ON HIV/AIDSIn his introductory notes the facilitator said in 1978 in the US unexplained chest diseases were common among Haitians homosexual and haemophiliacs. Doctor scientists could not identify the problem until 1981 when the isolated the virus which was responsible HIV.
HIV attack immune system of the human body. They attack lymphocytes, which produce the white cells, the constituents of the immunity system. HIV viruses are taken by blood to all parts of the body including the bone marrow where lymphocytes are produced. The effect of infection produces polymorphs otherwise knows as scavengers which carry the infected lymphocytes into all nodes.
HIV/AIDSAs the intensity of HIV increases one human immune system drops reaching a point where the body cannot resist the attack of opportunistic diseases. This is a point where one suffers viral infections otherwise known as bizarre symptoms they come and go.
In developing countries infected persons develop AIDS much faster than in developed countries largely contributed by patterns of eating and living being diverse.
HOW HIV SPREADS:
He explained how HIV spreads as:
- Through vaginal, anal oral sex with someone infected by HIV.
- Through sharing of needles , syringes with persons infected
- Through pregnancy, at child birth or through breast feeding
- One could easily get infected when the vagina had ulcers or bruises Similarly anal intercourse was extremely dangerous because of its nature of having mucous lining making it fragile.
- Blood to blood contact, also through tattoes, tribal marks, circumcision, female genital mutilations etc.
- The issue of blood donation to patients during window period raised concern among the participants as the rapid test method for screening HIV was inadequate blood recipients were subjected to receive blood infected wit HIV
- One could not get HIV through handshake, hugging, coughs sneezes or mosquito bites eating or living around with a person infected with HIV.
Exercise to answer the following question done in four groups to assess the level of understanding on the part of the participants:
1. Differentiate between the HIV infection AIDS
2. What is the window period in HIV infection
3. What are the possible ways of HIV transmission
4. How can you prevent HIV at the workplace
After the exercise participants could now understood that window period depends on the individual immunity strength
HIV infection from the time the body starts to react to the virus
Window period is the period when the laboratory tests can pick the virus symptoms
AIDS is a syndrome, a complex situation where all the opportunistic diseases attack the body because of the low immunity.
The importance of the CD4 was very well covered. The situation where CD4 is 350 of lymphocytes cell per ml that’s where the opportunistic disease take the charge. That is when somebody has to observe good living and eating conditions to live longer. However, in developed countries the situation is better than in developing countries.
Mode of infection
- Heterosexual mode of transmission is dominant and counts about 80 percent
- Homosexual is not very common in Africa, but nowadays young girls fearing of being pregnant prefer sodomy to normal way of sexual intercourse
Other modes of infections:
- Blood to blood contact including tribal mark tattoos female genital mutilations
- Infected mothers to unborn child
- In the womb
- During delivery
- Methods of preventions were detailed as follows:
- Comprehensive education campaign
- Safer blood free of HIV virus
- Safer sex abstinence masturbate, be faithful to one partner who is free of HIV
- Infected partners should avoid pregnancies
- Have clear policies at work places e.g. health workers
- Should have post exposure propylaxis.
- Clear policies on workers behaviours to protect the vulnerables
- Use of condoms
The importance on the use of condoms in East Africa and HIV/AIDS degree of prevalence was emphasised because it was related to degree of infections in three countries. Tanzania has high rate of HIV/AIDS because only 6,000.0000 condoms for 34.4m people were used last year. While 40.000.000 for 25m Kenyans and 70m condoms for 14 m in Ugandans.
Condom distribution at proper places at workplaces is very important to encourage the use of condom.
If properly used is 84 percent safe this depends on quality and how it is stored before use.
To conclude the topic there was a demonstration on how to use a male condom.
Discussions on whether to use condom or not
Experience show that Catholics are becoming flexible in using condom though not officially approved. There is a debate in developed conservative countries such as Italy and Portugal, however scenario whether to or not use condoms will change over time.
HIV virus is like someone ready to kill you, can not just stay without defending yourself, the only way is use of condoms.
A short film was screened on STI diseases followed by few remarks on STI
- Not all diseases bring pains It does only when diseases have reached an advanced stage
- It was unethical for doctors to divulge information on diseases to a third party
- Proper treatment sexually transmitted diseases reduce HIV/AIDS by 17 times.
HIV is pandemic as it a global issue as it can not be compared to epidemic or a disaster
There were four types of medication so far:
- Those which inhibit HIV with interfering with proper functioning of genetic materials the cells known as Nucleotide Analogue.
- Others being Non-nucleotide Reverse transcriptax preventing further multi plication of HIV.
- Highly Active Antiretrivial Therapy (HAART) which raise the human immune system and vaccines
An overview of HIV/ AIDs – Situation World/Tanzania
An overview of situation was to enable participants to realise the immense of HIV/AIDS prevalence in Tanzania and be in position to explain to their fellow workers at the workplaces.
The facilitator introduced a short exercise of one question as follows:
Explain in three ways you know about sexual act:
- Fresh to fresh contact for bearing children
- Love making
- Anal contact
- Sucking the female organ
- Insertion of penis in the vagina
- Supine position
- Side by side
- On top
- Oral sex
- Group sex
Written above are the ways suggested by participants.
What should peer educators do in fighting HIV/AIDS?
- Frankness is a key factor
- In fighting this war the peer educators should be open as possible using the most appropriate words so that the message sinks the moment they feel shy then the whole message will not have a great impact.
- Sometimes you will have to educate workers and families.
- As ILO Director General Juan Somavia puts it ‘‘HIV/AIDS pandemic is both workplace and developmental issue affecting workers and heir families’’
Recent HIV/AIDS Data:
- There are over 42 million by the end of 2002 living with HIV/AIDS world wide 30 million in Africa in Su-Saharan Africa 28millon.
- 3.4 million new infection more than 70 percent are women
- It is out this realisation that gender issue integrated in combating HIV/AIDS
- Every minute 60000 are infected worldwide. Source: World Summit on Sustainable Development (WSSD) reports in Johannesburg
- More than 2.3 million deaths as result of AIDS
- More than 2.5m workers infected by HIV are of age group 15-49 year. Source: ILO
- There are 14 million orphans as a result of HIV/AIDS
- Tanzania belong to a group of 25 countries most hit by HIV/AIDS in the world and among these Tanzania is number 15.
- More than 12% of the adult population is infected
- This adult population of age group 15-49
- More than 3.5 million people were living with HIV/AIDS in 2002.
- 13 % of pregnant mother attending Ante Natal Clinics are HIV positive.
- In hospitals more than 50% patients with AIDS occupy hospital beds.
- Mode of transmission accounts for 77% o all the cases.
- 48.2% of HIV positive are married people.
Recommendation: Use of condoms but should be available and of good quality
HIV/AIDS as a trade union issue:- Threatens the basic fundamental objective of the labour movement.
- The HIV does not discriminate however the workers infected are discrimination at the workplaces.
- The fellow trade unionists should fight against their discrimination.
- Union must try to make access to medical treatment and make sure the victim remains at work as far as is physically able.
- AIDS problems involve the same union principles and skills that are used to solve other union problems.
- Union at the workplace can either promote greater better understanding, create greater fear, or jeopardise safety hence create greater risk at workplace if HIV/AIDS issue is not taken as a trade union issue.
National overview of the National Policy:
- Inaugurated in October 2001.
- It embodies all ILO and WHO codes on HIV/AIDS and on top of that it has taken all the precautions on how to attend the infected and the remaining orphans after death of all parents.
- It takes in consideration of the 88% of the people who are not infected by HIV by encouraging voluntary counselling and testing (CVT).
- However only 10 % have volunteered in testing for while 90% have not tested for HIV.
The main objectives of the policy is to protect the workers by:
- Reducing infections at workplaces.
- Campaigns and sensitisation to prevent infections at workplaces and home.
- Union representatives should take fully responsible to find how HIV is transmitted at workplaces, looking specifically for environment that promotes infections.
- Revisit their lifestyles both at workplace and home to deduce enabling environments that promotes sex at workplaces.
- Find why workers embark on casual sex. It may be because of pleasure, arrangement working conditions (shifts), poor remunerations, sex due to threats from bosses, or as way for promotion.
- Unions at the work places should encourage counselling and voluntary testing.
- Frank and open discussions on HIV/AIDS. Dialogues among husbands, wives and children should be organised by unions.
HOW TO CONTAIN HIV/AIDS AT WORKPLACE- Full participation of the workers of all the issues at place of work on all issues.
- Participation in all working conditions affecting the workers.
- Every worker should know that he has fully responsible for his health at place of work.
- The importance protecting the interests of the companies.
- Prepare policies on HIV/AIDS at the workplaces.
ILO/WHO Codes of Conduct:
- Pre employment screening for HIV/AIDS is prohibited and unnecessary.
- Persons employed no direct or indirect testing is required.
- Confidentiality, otherwise if the management breaks the confidentiality it violates law
- No obligation is required by the employee to give the employer her/his HIV/AIDS status.
- Protection from stigmatisation and discrimination of the employees by unions workers and the employers
- Information and education on HIV/AIDS to employees and their families
- Social benefits should be available to HIV infected employees.
- HIV infection is not a limitation to work if a victim is impaired the management should look for the alternatives.
- HIV infection is not a ground for termination.
- First Aid kits at workplaces reduces risks of HIV infection
Impact on HIV/AIDS at workplace:
HIV is in economically active population, therefore affecting the following:
- Labour productivity decreases
- It is more expensive
- Reduced productivity
- Increase costs loss of customers
- Increased absenteeism
- Sagging motivation
- Sick unable to work
- Fatigue leads to accidents
- Skill diminished
- Costs on health care
- Company loans to be written off
- Market shrinkage
- Budget packages for disability death
- Recruitment and training costs
- Indirect costs
- Compassionate leave
- Management cost on issue related to HIV social and legal
- Morbidity reduced work performance
- Loss of cohesion
- Disruption of teams
- Breakdown of discipline
- Low morale
- Reduction of social performance through institutional memory and experience.
Distribution of increased labour costs due to HIV/AIDS a case study from South Africa
- Recruitment 9%
- Health care 5%
- Burial 16%
- HIV absenteeism 37%
- AIDS absenteeism 15%
- Funeral attendance 6%
- Labour turnover 5%
- Training 7%
Opportunities to save costs and to prevent new infections:
Avoid or reduce future infections.
Provide and support of HIV worker and treatment.
How HIV/AIDS have affected workforce in the following countries:
Zambia 1500 percent of the workforce died 1995 were related to HIV
Uganda 10th of workforce dead was related to HIV/AIDS in 1998
Kenya 43 out 50 deaths of the employees are related to HIV/AIDS
Zimbabwe 20% of profits from companies were ploughed back to cover HIV/AIDS related costs
Tanzania 50 % of beds in hospitals are occupied by patients with related HIV/AIDS complications
Frame work of intervention
- Policy formulation at the work places
- Impact analysis
- Voluntary counselling and testing
- Wellness management
- Care of HIV positive and worker HIV negative
- Monitoring surveillance
Hurdles to interventions:
- Workers fear regarding confidentiality, victimization, ostracisation
- Non-participation due to fear or suspicion
- Stigmatisation by employers and workers
- Costs of interventions
Prevention of new infections:
- Education programmes
- Training educator
- STI control
Care of HIV/AIDS:
- Prophylaxis against opportunistic diseases
- Nutritional support
- Use of therapy
- Support psychological diet and legal
The work place can offer an excellent opportunity for intervention of HIV/AIDS and care of HIV infected workers.
Employment Assistance Programme:
Companies recognises that personal problems can interfere with employees job performance.
Factors which affect job performance can interfere with employees’ productivity. Eg marital or family problems associated with financial, legal alcohol /drugs etc.
Sacking, pay cuts, employment of other workers has proved futile.
Employment Assistance Programme funded either from outside or inside is vital for it addresses the following:
- Social psychological medical economic and legal
- Employees with such problems advised to see EAP advisor or co-ordinator
- Referral system disciplinary action advisory services
- No employee with personal problems will have his job jeopardised
- The role of a supervisor
- Raising awareness 1/2hour twice a week, provisions of condoms and referral to STD
- VCT 1/2hr counselling 1/2hr testing and leisure and day care support programmes for workers and their families
- Wellness promotions
- Individualised for smokers and alcoholics
- Groups in heavy manual work
- HIV positive diet, health living safe sex
- Improvement of working conditions and environment chemical and physical agents, management costs and PPE
- Use of ARVT for HIV/AIDS patients in conjunction of time frame and costs
- Monitoring and evaluation
HIV/AIDS and the Rights at work:Facts opinions and rumours
- You cannot get HIV the first time you have sex.
- Healthy looking people do not have aids.
- Good people do not use condoms except prostitute.
- Condoms may get lost inside the vagina.
- You can use one male condom many times if you wash after use.
- Mosquito can transmit HIV.
- Some people get AIDS by being bewitched
- Workers with HIV should be isolated, It is uncomfortable working close with some one with AIDS.
- AIDS is a punishment for immoral behaviour.
- Only with AIDS are the ones to blame.
- Only promiscuous people have AIDS.
- Life is not worth living if you have AIDS.
- AIDS epidemic only some tribes.
- Mosquitoes do not spread the HIV.
- Condoms are laced with HIV virus.
- Men and women can contract HIV by not using sex
- Men always like to have sex
- Only homosexual get infected by HIV
What is a Right?
- Is derived through behaviour, action morally good, justified or required by law or duty.
- Instruments confer rights at work are:
- Instruments at the international level: UN Charter 1945 on Basic Human Rights- Universal respect and observance of human rights and fundamental freedom without discrimination
- Bill of Rights
- Non- interference of privacy
- African Charter is a replica of the Universal Declaration of Human rights.
- ILO convention no. 155 of 1981
- Health and safe conditions at the work place.
- Recommendation 171of 1985 occupational health services.
- Keeping medical records confidential.
- ILO code of Practice on HIV/AIDS.
- An offspring United Nations General Assembly Special Session (UNGASS) 2000
- ILO 1998 declaration on fundamental principles and rights at work place
- URT National Constitution 1977 part 111 Article 12 to 32 provides the Bill of Rights.
- Art. 13 (4) No discrimination….
- Art.16 entitled to respect….
- Art 22 Right to work………
- Art. 22 entitled to remuneration
- TACAIDS 2001 s. 5 (K) protect human
- (l) promotes positive living people with HIV/AIDS
- Bad law infectious Disease Ordinance Cap 96 amended by GN No 340 1986 declared HIV/AIDS as an International notified disease
- Amounts to breach of confidentiality
- CBA can confer rights where law is inadequate.
Rights of WLWHA at workplace:
- For employed HIV/AIDS screening should not be required whether direct or indirect.
- Medical records must be kept confidential.
- Employees not required to tell their employer.
- WLWHA should be protected from stigmazation and discrimination from co-workers, employers and clients.
- WLWHA whose fitness are impaired should be reasonable accommodated
Eg Change type of work.
Reduced number of hr and change of schedules
- WLWHA should be entitled to all social benefit.
Education and training:
- Workers and families should have access to HIV/AIDS information.
First Aid boxes:
- Situation requiring first aid box in the work place precaution should be taken to reduce risk of transmitting blood borne infections (post exposure prophylaxis).
- HIV/AIDS is not a cause for termination of the employment. Just like any other disease; they should be allowed to as long as they are able.
Care and support:
- Affordable medical care including Antiretroviral drugs
- Counselling home care and preventive programmes on mother to child transmission.
Behavioural change interventions:
Participants were made to understand that HIV/AIDS is essentially behavioural problem.
The way we do sex should change, however without that changing the way to do sex, HIV/AIDS prevention cannot be effective.
Heterosexual contact begins in early teen and goes at peak at 30 of age.
90% of the population do not know that they carrying HIV.
Mother to child HIV infection is on increase, more women continue to be infected and become pregnant.
Illiterates and unemployed are at higher risk less than 60% cannot read written message
Patients with STD are 2 to 9 times more likely to be infected with HIV.
STD management within the existing PHC system can reduce the incidence of HIV infection by about 40%
Herpes, syphilis chancroid lesions may serve as ways for HIV infections
Stigmatisation and Discrimination:
- Harming a character of person in the eyes of others it occurs when you label another person and set him apart as unwanted, inappropriate attitude make fighting HIV/ADS difficulty loose of self esteem, denial, apathy, fears doubts and worries results stigma.
- Wrong perception on transmission.
- Lack of understanding the disease.
- Myths about how HIV is transmitted
- Lack of treatment the fact that AIDS is incurable makes even stigma even more serious.
- Social fears about sexuality for sacred relation only.
- Self stigma is a shame felt by an individual after receiving negative responses and reaction of the others or believing they are to blame for getting AIDS.
- Social stigma fear of HIV related stigmatization by care providers including doctors counsellors nurses etc.
- HIV/AIDS related stigma makes people not likely adopt preventive strategies, this worsen their immune system.
- Do not seek early care for TB and other opportunistic diseases.
- Do not seek treatment for sexually transmitted infections.
- Do not seek counselling/testing or return for results.
- Because of stigma no access to good quality treatment
- Do not reveal HIV status.
Solution to overcome stigma:
- PLWHA must start living positive.
- PWHIV should except that they are physically fit and can lead normal life.
- HIV/AIDS should be accepted as everyone problem.
- It also requires correct information on HIV to educate others.
- Promotion of greater involvements of PLWHA in community programmes
- Encourage companies to develop non-discriminatory policies WLWHA.
Some behavioural change interventions:
Good counselling assists making:
- Informed decision.
- Lead more positive.
- And prevents further transmission.
Some few data on CVT:
- Counselling and HIV testing are provide by government and NGO’s
- Records show that 6539 new clients who were counselled 3338, 51% were tested.
- Among those tested over 50% were HIV sero-positive
Factors include competence, freedom, full information, understanding
HIV/AIDS behaviour change in group settings.
Material support self-help groups.
Cycle of behavioural changes
Pre-contemplation, contemplation, decision, action, maintenance and relapse
Basic skills in counselling:
Counseling is a helping relationship, however, it is guided by principles as one comes for counseling when he/she cannot handle the situation. Therefore he/she needs:
- To be listened to and to be heard
- To be supported while he/she gathers strength to bear social stigma and actual situation living with HIV/AIDS and at approaching death.
- Get a fresh look on alternatives and some new insights and learning some needed skills
- To face fears, worries about HIV.
- To come to a decision and courage to act.
Purpose of counseling:
- Emotional support.
- Information giving.
- Education provision.
- Encouragement showing faith that one can live positively.
- Problem solving, decision reduced number of sexual partners, use of condoms.
Types of counseling:
- Individual counseling
- Group counseling
Principles of Counseling:
- Individualizes, recognizes and respect HIV/AIDS client’s uniqueness.
- Emotional involvement must be controlled.
- Sensitivity, listening to feelings verbal cues and non-verbal cues
- Understand what these feelings mean to the client.
Responding a response may be internal or external empty phrases should be avoided.
- I know how you feel
- This is hard for you
- Counselors should express empathy not sympathy
- Self determination
- Counselor help clients to make balanced decision
- The principle of self determination is not a license it is influence the rights of others.
Pillars of counseling:
- Do not reveal secrets
- Interviews confidential
Confidentiality in HIV/AIDS
- Do not inform any body about the client’s results without his consent
- If the client does not want you to inform any body (even his partner or her partner) you should not do so.
- Respect your client’s wish otherwise you break the positive relationship
HIV/AIDS at workplace is increasing
Who is eligible for counselling for HIV/AIDS
- A knowledge
- Helping the client to understand to live positively.
- Helping the client to die in peace.
Types of HIV/AIDS Counselling:
- Pre-testing counselling
- People worried of being infected
- Partners of HIV infected people
- People who donate blood
- People who have symptoms of infection
- People who want to get married
Important questions to be asked
· Giving Basic Information on HIV and AIDS and testing
· Elisa and western blot
· Post testing counselling
· Clear, short answers
· Crisis Counselling
Gender issues and HIV/AIDS:
Definition: Relationship of men and women boys and girls influenced economically socially and culturally.
- Power to decide is male dominated families have paterlineal lineage
- Violence and partner beating in South Africa and rapes
- Outside People are the contributing factors in the families, they should not be influenced by what people will say.
- Present or payment for the sexual services
HIV/AIDS Policy Development and Implementation:
- ILO Code Practice suggests that workplace HIV policy is between the management and the workers.
- There should be an agreement.
- Agreement means commitment.
- Agreed policy will be implemented.
There should be an opportunity to iron out differences of the policy before being put in practice.
Tips on HIV/AIDS Policy:
Policy development and implementation is dynamic so the HIV/AIDS policies should be communication on changes taking place, continuous review, monitoring and evaluation.
Policy component what should be included in?
- Recognition of HIV as an issue
- Non discrimination in relation to recruitment promotion training
- Gender equality
- Health and safety issues accommodation WLWHA
- Information and education to workers and families
- No screening required for job applicants or persons in employment
- Continuation of the employment relationship
- First Aid boxes for health workers.
Activity of the union policies:
Participants carried an exercise to understand union policy
By assessing the current situation, Where are we now?
Behavioural position, awareness and rate of infections.
Forecast future position, Where we want to promotion and use of condoms.
It was emphasized that in preparing the proposals and action plan for the activities the achievements should be measurable
HIV/AIDS Policy Lay Out:
Background and justification, statement of the problem, justification, mission, policy specific objectives, monitoring and valuation Action plan.
Collective Bargaining on HIV/AIDS at workplaces:
Participants were taken through the concepts of collective bargaining as all negotiations which take place between the employer or group of employers on one hand and on the other hand one or more workers’ organizations determining conditions and terms of employment regulating relations between employers or their organizations and workers or their organizations These agreements have time factor.
Principles governing Collective Bargaining:
Bargains should be carried in good faith as employers were interested in profits while workers were interested in good salaries.
Bargains should be voluntary
Freedom and non-interference should prevail in all Collective Bargaining.
Good faith will bring compromise and interference will make implementation problematic.
International instruments which provides for Collective Bargaining are the ILO Conventions 87(19480, 98(1949),151(1978), and 154(1981)
Local instruments include Security of Employment Act Cap 574 of 1964 and the Industrial Court Act no 41 of 1967
- Formation of committees
- Preparation of the agenda
In preparing the agenda issues covered by law should not be taken into account. All the workers should be involved to prepare the agenda Collect and check all the necessary data for bargaining
Characteristics of bargaining
Employer interested in profit and productivity while workers interested wage increase and improved working conditions.
Strategies at the bargaining table:
The union should be strong, timing, strong arguments, be firm, flexible and reasonable, consult members, be cool do not panic, prepare enough reliable data be confident.
Issues that can be concluded in CBA’s
Include terms of better working wages HIV/AIDS, child labour, families women etc.
Role play on collective bargaining on HIV/AIDS with following specifis tabled:
- No HIV testing at the time of employment
- Children education support for infected workers
- Employer to provide jobs for widows
- To provide social security to a worker with AIDS
- Employers to provide education to community
- Provide extra comfort to WLWHA
The outcome of the role play weak because the issues raised from the workers side to an extent being irrelevant and from what done in the workshop on HIV/AIDS
Recommendation by participants to the guest of honour Retired Maj. Gen. Herman Lupogo during the closure of HIV/AIDS course at Njuweni hotel 31 January 2003
(a) The participants recommend that confidentiality on the status of HIV should be maintained in order to prevent stigmatisation and Discrimination, which is still a big problem in Tanzania.
(b) Trade Unions have a major role to play in fighting HIV/AIDS hence we request that TACAIDS should assist the Trade Union Congress of Tanzania (TUCTA) in mobilising resources for effective HIV/AIDS interventions at the workplaces.
(c) Use of condoms is one the effective ways of preventing HIV infections but there has been laxity on part of the government to provide free condoms. We recommend that TACAIDS should mobilize for procurement and distribution of free condoms.
(d) VCT centres should be increased, operate 24 hours and services be free of charge.
(e) Frequent campaigns, rallies and educational programmes should be conducted regularly not be limited the World’s International AIDS day.
(f) Workers living with HIV/AIDS should be protected by the government by enacting a specific law on HIV/AIDS to protect them from stigmatization and discrimination.
(g) The Infectious Disease Ordinance which was amended in 1986 to classify HIV/AIDS as a notifiable disease should be stroke out because it amounts to discrimination.
Participants’ evaluation was based on awareness raising, ability to educate others, development of workplace policies, ability to engage employers and personal comments.