IMPLEMENTATION OF WORKPLACE HIV/AIDS POLICIES IN PRIVATE INSTITUTIONS IN UGANDA

1

IMPLEMENTATION OF WORKPLACE HIV/AIDS POLICIES IN PRIVATE

INSTITUTIONS IN UGANDA

CASE STUDY OF REPRODUCTIVE HEALTH UGANDA AND UGANDA

TELECOM LIMITED

A DISSERTATION SUBMITTED TO UGANDA MARTYRS UNIVERSITY, NKOZI

IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF

THE DEGREE OF MASTER OF ARTS IN DEVELOPMENT STUDIES.

OLOYA PAUL

MAY, 2013

i

Declaration

I Oloya Paul hereby declare that this dissertation is my own work and that all sources that

have been referred to and quoted have been indicated and acknowledged with complete

references. This work has not been submitted to any other institution for the award of any

academic qualification.

Signed ……………………………. Date……………………………….

Oloya Paul

Signed………………………………Date………………………….

(Supervisor)

ii

Approval

This is to certify that this report has been prepared under my supervision and now is ready for

submission with my approval as a university supervisor for a requirement for the award of a

Master of Arts in Development Studies of Uganda Martyrs University, Nkozi.

Signature:......................................................... Date:..................................................

iii

Dedication

I dedicate this work to my family and friends and my colleagues at work who contributed

immensely through their moral and financial support to make my course manageable.

iv

Acknowledgements

I wish to extend my sincere appreciation and gratitude to the people who supported me and

provided the necessary encouragement to see the research to the end. I would also like to

thank the staff of Reproductive Health Uganda and Uganda Telecom, who so willingly

participated in the study, and provided the necessary data, without which the study would not

have been possible.

I would like to thank, my family and friends who encouraged and believed in me. To my

supervisor, Mr. Mubangizi Denis for guidance and his willingness to share his experience and

knowledge – Thank you very much and God bless you.

Lastly to my creator, for bestowing unto me the necessary courage, good health and mental

ability to complete the study.

v

Table of Contents

Declaration ............................................................................................................................................. i

Approval .................................................................................................................................... ii

Dedication ............................................................................................................................................ iii

Acknowledgements ............................................................................................................................. iv

Table of Contents ................................................................................................................................. v

List of Figures ...................................................................................................................................... ix

List of Tables ........................................................................................................................................ x

CHAPTER ONE: GENERAL INRODUCTION ........................................................................ 1

1.0 Introduction ..................................................................................................................................... 1

1.1 Background to the study ............................................................................................................... 1

1.2 Statement of the problem .............................................................................................................. 3

1.3 Purpose of the study ...................................................................................................................... 3

1.4 Objectives........................................................................................................................................ 3

1.5 Specific objectives ......................................................................................................................... 4

1.6 Research Questions ........................................................................................................................ 4

1.7 Significance of the study ............................................................................................................... 4

1.8 Scope of the study .......................................................................................................................... 5

1.9 Conceptual Framework ................................................................................................................. 5

CHAPTER TWO: LITERATURE REVIEW ............................................................................. 7

2.0 Introduction ..................................................................................................................................... 7

2.1 Global Situation of the HIV/AIDS Pandemic ............................................................................ 7

vi

2.2 Situation of HIV/AIDS in Sub-Saharan Africa .......................................................................... 9

2.3 HIV/AIDS Situation in Uganda ................................................................................................. 11

2.3.1 Factors Fuelling HIV Transmission in Uganda .................................................................... 13

2.4 Effects of HIV/AIDS in the workplace ..................................................................................... 16

2.5 Efforts by International Organizations and Employers in Combating HIV/AIDS in the

Workplace ........................................................................................................................................... 21

2.6 Salient Issues addressed by Workplace HIV/AIDS Policies ................................................. 23

2.7 Challenges facing implementation of workplace HIV/AIDS Policies.................................. 25

CHAPTER THREE: RESEARCH METHODOLOGY ......................................................... 27

3.0 Introduction ................................................................................................................................... 27

3.1 Research Design ........................................................................................................................... 27

3.2 Study area ...................................................................................................................................... 27

3.3 Population of the study ................................................................................................................ 27

3.4 Sample size ................................................................................................................................... 27

3.5 Sampling Techniques .................................................................................................................. 28

3.6 Data collection techniques and instruments ............................................................................. 29

3.7 Research Procedure ..................................................................................................................... 29

3.8 Quality control .............................................................................................................................. 30

3.9 Data analysis ................................................................................................................................. 30

3.9.1 Statistical Data Analysis using Statistical Packages for Social Scientists (SPSS)........... 30

CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND INTERPRETATION ............ 31

4.0 Introduction ................................................................................................................................... 31

vii

4.1 The Biographical Characteristics of the Respondents ............................................................ 31

4.1.1 Age bracket of respondents ..................................................................................................... 31

4.1.2 Sex of respondents .................................................................................................................... 32

4.1.3 Education level of respondents ............................................................................................... 33

4.1.4 Length of employment of respondents .................................................................................. 33

4.1.5 Job position of respondents ..................................................................................................... 34

4.2 Level of exposure of the employees to the HIV/AIDS workplace policy ............................ 34

4.2.1 Familiarity with the work place HIV/AIDS policy .............................................................. 35

4.2.2 Familiarity of HIV/AIDS Policy by Sex ............................................................................... 36

4.2.3 Familiarity of HIV/AIDS Policy by age ................................................................................ 37

4.3 The functionality of the workplace HIV/AIDS policies ......................................................... 37

4.3.1 Recognition of HIV/AIDS policy as a workplace issue ...................................................... 38

4.3.2 HIV/AIDs policy and the principle of non discrimination .................................................. 39

4.3.3 HIV/AIDS policy and the issue of a healthy work environment ........................................ 40

4.3.4 HIV/AIDS policy and encouragement of social dialogue on HIV/AIDS issues .............. 41

4.3.5 HIV/AIDS policy and strengthening confidentiality ........................................................... 42

4.3.6 HIV/AIDS policy and supporting prevention initiatives on HIV/AIDS ........................... 43

4.3.7 HIV/AIDS policy and staff care and support with regard to HIV/AIDS .......................... 44

4.3.8 HIV/AIDS policy and continuation of employment relationship ...................................... 45

4.4 Challenges faced in implementation of HIV/AIDS policy ..................................................... 46

CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS ......... 48

5.0 Introduction ................................................................................................................................... 48

viii

5.1 Summary ....................................................................................................................................... 48

5.1.1 Level of exposure of the employees to the HIV/AIDS workplace policy ........................ 48

5.1.2 The functionality of the workplace HIV/AIDS policies ...................................................... 49

5.1.3 Challenges faced in implementation of HIV/AIDS policy ................................................. 50

5.2 Conclusion .................................................................................................................................... 50

5.3 Recommendations ........................................................................................................................ 51

References ........................................................................................................................................... 51

Appendix : Questionnaire.................................................................................................................. 58

ix

List of Figures

Figure 4.1: Age of respondents ................................................................................................ 31

Figure 4.2: Respondents‟ sex ................................................................................................... 32

Figure 4.3: Respondents‟ Education level ............................................................................... 33

Figure 4.4: Respondents‟ length of employment ..................................................................... 33

Figure 4.5: Job Position of respondents ................................................................................... 34

x

List of Tables

Table 4.1:Familiarity to HIV/AIDS policy..............................................................................35

Table 4.2 Sex and Familiarity to HIV/AIDS programme Cross tabulation ............................. 36

Table 4.3: Age Bracket and Familiarity to HIV/AIDS policy Cross tabulation ...................... 37

Table 4.4: Perceptions of respondents on Recognition of HIV/AIDS policy as a workplace

issue.......................................................................................................................................... 38

Table 4.5: Responses on organization‟s HIV/AIDS policy and the principle of non

discrimination .......................................................................................................................... 39

Table 4.6: Responses on HIV/AIDS policy and the issue of a healthy work environment ..... 40

Table 4.7: Responses on HIV/AIDS policy and encouragement of social dialogue on

HIV/AIDS ................................................................................................................................ 41

Table 4.8: Responses on HIV/AIDS policy and strengthening confidentiality ....................... 42

Table 4.9: Responses on HIV/AIDS policy and supporting prevention initiatives on

HIV/AIDS ................................................................................................................................ 43

Table 4.10: Responses on HIV/AIDS policy and staff care and support................................. 44

Table 4.11: Responses on HIV/AIDS policy and continuation of employment relationship .. 45

Table 4.12: Pair wise matrix ranking of challenges faced in implementation of HIV/AIDS

policy........................................................................................................................................ 46

1

CHAPTER ONE

GENERAL INRODUCTION

1.0 Introduction

The grapple of this research is set to analyze the Implementation of workplace HIV/AIDS

policies in private institutions in Uganda using Reproductive Health Uganda and Uganda

Telecom Limited as case studies. This chapter sets the base for the study. It contains the

background to the research, statement of the problem, purpose of the study, objectives of the

study, research questions which guided the study, the scope and the significance of the study.

It also gives the definitions of the key concepts used in this study, as well as the conceptual

framework.

1.1 Background to the study

HIV/AIDS is a major workplace issue often regarded as similar to other serious illnesses, but

due to its means of transmission it has created great social stigma. More than 42 million

people around the world are infected with HIV, including some 26 million workers aged

between 15 and 49 years who are in the prime of their productive lives. Sub-Saharan Africa

remains the region most heavily affected by HIV (Garcia – Calleja, Gouws, Ghys, 2006). In

2008, sub-Saharan Africa accounted for 67% of HIV infections worldwide, 68% of new HIV

infections among adults and 91% of total new HIV infections (UNAIDS 2008). While the

rate of new HIV infections in Sub-Saharan Africa has slowly declined – with the number of

new infections in 2008 approximately 25% lower than at the epidemic‟s peak in the region in

1995 – the number of people living with HIV in sub-Saharan Africa slightly increased in

2008, in part due to increased longevity stemming from improved access to HIV treatment

(UNDP, 2009). Adult HIV prevalence declined from 5.8% in 2001 to 5.2% in 2008. While,

an estimated 1.4 million AIDS – related deaths occurred in Sub-Saharan Africa, representing

and 18% decline in annual HIV-related mortality in the region since 2004 (UNDP, 2008;

Whiteside et al, 2006).

In Uganda, employers are facing a major threat from HIV/AIDS and that is eroding the

development of the economy; consequently, a number of organizations have developed

workplace HIV/AIDS policies, partnered to fight HIV/AIDS and supported their employees

who are infected with HIV (Asingwire & Birungi, 2006). The dramatic and widespread effect

2

of HIV/AIDS on communities across the country is having a major impact on employers in

Uganda where 70% of reported cases fall in the 15 and 49 year age group (Collins and Rau,

2000; Uganda HIV/AIDS Manual for Work Places, 2004).

According to the Uganda HIV/AIDS Manual for work places (2004), workplace HIV/AIDS

policies and programs that are in place such as the „Stop AIDS Now‟ Project: Managing HIV

and AIDS in the workplace in Uganda, (2008); Kasese Town Council‟s Workplace

HIV/AIDS Policy; and Agro Eco/EPOPA Uganda HIV/AIDS Workplace Policy (2006) have

attempted to deal with how to protect employees and their families from infection; the kind of

assistance to give employees suffering from HIV/AIDS, as well as the communities in which

they live. The manual states that private sector institutions are particularly well placed to deal

with HIV/AIDS because they have structures that can take quick and effective action; they

know their employees and are in close contact with their families; they have systems for

handling personnel matters including health issues; and are part of wider networks which

work closely (The Uganda HIV/AIDS Manual for Work places, 2004).

Uganda Telecom Limited (UTL) is the most experienced telecommunications organization in

Uganda. It was previously a government parastatal and the only telecommunications provider

until the liberalization policy took effect and saw in new market entrants that led to its

privatization in June 2000. At Uganda Telecom, although HIV/AIDS testing and screening of

employees for purposes of access to employment is not compulsory, employees are

encouraged to take the test privately and know their status; and the company is ready to assist

in cases of positive results. Confidentiality of HIV/AIDS information is upheld and within its

financial capability, UTL provides medication, including ARVs to staff and eligible family

members infected with HIV/AIDS; awareness and counselling sessions are also held for staff.

Reproductive Health Uganda (RHU) is a national, voluntary, non-discriminatory and not-for-

profit, Non-Governmental Organization promoting and providing Sexual and Reproductive

Health and Rights. Formerly known as Family Planning Association of Uganda, RHU is the

pioneer of family planning services in Uganda and has remained the lead NGO in the

provision of family planning services. At Reproductive Health Uganda, disclosure of HIV

status is voluntary. The principle of equal opportunity is adhered to in hiring and promoting

staff, without discriminating on the grounds of race, tribe, colour, creed, gender, sexual

3

orientation, physical handicap, HIV status or age, provided the prospective employee can

fulfil the requirements of the job (The RHU Policy Handbook, 2009).

The effects of HIV/AIDS are felt by employees, their families, their employers and ultimately

national economies. The population most affected are the youths and people within the

productive age bracket most of who constitute a nation‟s workforce. Having a written policy

in itself is not sufficient unless it is operationalized. Response to the HIV/AIDS pandemic

within the workplace is crucial if progress is to be made in the prevention, impact mitigation

and provision of care and support for People Living with HIV/AIDS (PLWHA) and People

affected by HIV/AIDS. However, such responses are not without obstacles, that is why this

study sought to unearth the challenges faced in implementing HIV/AIDS Workplace policies.

1.2 Statement of the problem

Despite the existence in many workplaces of the HIV/AIDS policy and formal commitment

to its values and objectives, practices that work against the spirit of the policy still abound.

Stigma and discrimination are obvious examples. Despite decades of awareness raising and

education, stigma and discrimination against infected and affected people continues to be a

concern in many societies. Job security is not assured and many people can be fired or let go

due to their HIV positive status. As a social contract in the workplace, policies are

fundamental to protect people‟s rights. Care must be taken when implementing workplace

policies that they adhere to the principles in the policy declarations as well as acknowledge

and address stigma and discrimination when they arise.

1.3 Purpose of the study

This study sought to assess the implementation of HIV/AIDS policies in the workplace by

private organisations. The institutions chosen as case studies were Reproductive Health

Uganda, and Uganda Telecom Limited.

1.4 Objectives

The major objective of this study was to assess the implementation of workplace HIV/AIDS

policies in private institutions in Uganda and establish the challenges faced.

4

1.5 Specific objectives

The specific objectives of this study were:

1. To determine the level of exposure of the employees to the HIV/AIDS workplace

policy.

2. To assess the functionality of the workplace HIV/AIDS policies in private institutions

in Uganda.

3. To investigate the major challenges facing implementation of workplace HIV/AIDS

policies by private institutions.

4. To suggest recommendations towards the improvement of workplace HIV/AIDS

policy implementation.

1.6 Research Questions

1. To what extent are the employees of the two organisations exposed to the HIV/AIDS

workplace policy?

2. To what extent are the HIV/AIDS policies functional in the two study private

institutions?

3. What are the major challenges facing implementation of workplace HIV/AIDS

policies by private institutions?

1.7 Significance of the study

To academicians, it is hoped that the results of this study will help fill in some gaps that

previous similar studies could have left, and contribute to relevant body of information;

To policy makers and implementers, the researcher hopes that the results of the study will

inform the design and formulation of future workplace HIV/AIDS policies and refine existing

national policies.

To other organizations, it is hoped that the findings of the study can create a ripple effect for

other agencies to copy in the implementation of their related policies on HIV/AIDS.

5

1.8 Scope of the study

The study was limited to assessing the implementation of workplace HIV/AIDS policies in

two purposively selected private sector institutions in Kampala. It covered the period between

2005 and 2010 within which the researcher through his review of related literature feels

workplace HIV/AIDS policies took root especially in Uganda.

1.9 Conceptual Framework

Dependent Variable

Functionality of workplace HIV/AIDS

policies

- Reduction in stigmatization

- Increased disclosure of HIV/AIDS

status

- Availing HIV/AIDS health care

services

- Positive living

- Quality of working relationships

Intervening Variables

- Stigmatization

- Resistance to routine HIV

counselling and testing

- Low productivity of the HIV+

employees

Independent Variable

Workplace HIV/AIDS policies

- Non-discrimination on basis of

sero-status.

- Equal involvement of HIV+

employees.

- Confidentiality about

employees‟ sero-status.

- Routine workplace HIV

counseling and testing.

6

The conceptual framework above is based on the specific objectives of this study. It clearly

illustrates the inter-play between the independent and dependent variables which are further

influenced by the intervening variables attempting to provide alternative explanations for the

results of the study.

The framework illustrates that in designing workplace HIV/AIDS policies several factors are

taken into consideration and they include; non-discrimination on basis of sero-status, equal

involvement of HIV+ employees, confidentiality about employees‟ sero-status and routine

workplace HIV counseling and testing. Therefore, when these factors are considered they are

likely influence the functionality of the HIV/AIDS policies and outcomes may vary in terms

of level of stigmatization, disclosure of HIV/AIDS status, HIV/AIDS health care services,

positive living and quality of working relationships.

However, intervening variables may also interfere with the relationship between the

independent and dependent variables. These are mainly challenges which may affect the

implementation of the workplace HIV/AIDS policies and these include; stigmatization, low

productivity of employees with HIV/AIDS, and resistance by employees to undergo HIV

counselling and testing. The confounding factors shall be controlled by the researcher for

purpose of validity of the results of the interplay between the independent and dependent

variables.

7

CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This study aimed at assessing the implementation of workplace HIV/AIDS policies in private

institutions in Uganda. The key concepts in the study were therefore the level of exposure of

the employees to HIV/AIDS workplace policy, the functionality of the workplace HIV/AIDS

policies in private institutions and the major challenges facing implementation of workplace

HIV/AIDS policies by private institutions. It was necessary to make reference to other studies

conducted in areas related to the concepts specifically and the study problem in general.

In this chapter, a discussion is made of such related literature under the themes: Global

situation of the HIV/AIDS pandemic, situation of HIV/AIDS in Sub-Saharan Africa,

HIV/AIDS situation in Uganda, factors fuelling HIV transmission in Uganda, effects of

HIV/AIDS in the workplace, efforts by International organizations and employers in

combating HIV/AIDS in the workplace, salient issues addressed by workplace HIV/AIDS

policies, and challenges facing implementation of workplace HIV/AIDS Policies.

2.1 Global Situation of the HIV/AIDS Pandemic

HIV stands for Human Immunodeficiency Virus. Viruses such as HIV cannot grow or

reproduce on their own, they need to infect the cells of a living organism in order to replicate

– make new copies of themselves. The human immune system usually finds and kills viruses

fairly quickly, but HIV causes AIDS by damaging the immune system cells until the immune

system can no longer fight off other infections that it would usually be able to prevent. It

takes around ten years on average for someone with HIV to develop AIDS (UNAIDS, 2002).

However, this average is based on the person with HIV having a reasonable diet; therefore,

someone who is malnourished may well progress from HIV to AIDS more rapidly.

With around 2.7 million people becoming infected with HIV in 2008, there are now an

estimated 3.3 million people around the world who are living with HIV, including millions

8

who have developed AIDS (WHO 2009, Unicef, 2009). The number of people living with

HIV worldwide continued to grow in 2008, reaching an estimated 33.4 million (31.1 million

– 35.8 million). The total number of people living with the virus in 2008 was more than 20%

higher than the number in 2000, and the prevalence was roughly threefold higher than in

1999. The continuing rise in the population of people living with HIV reflects the combined

effects of continued high rates of new HIV infections and the beneficial impact of

antiretroviral therapy. As of December 2008, approximately 4 million people in low-and

middle-income countries were receiving antiretroviral therapy – a 10 -fold increase over five

years (WHO 2009, Unicef, 2009). In 2008, an estimated 2.7 million new HIV infections and

two million deaths occurred due to AIDS–related illnesses worldwide. The latest

epidemiological data indicate that globally the spread of HIV appears to have peaked in 1996,

when 3.5 million new HIV infections occurred. In 2008, the estimated number of new HIV

infections was approximately 30% lower than at the epidemic‟s peak 12 years earlier (WHO

2009, Unicef, 2009).

Unknown before 1981, HIV/AIDS is now a worldwide pandemic that has claimed more than

28 million lives. An estimated 40 million others are living with HIV, including 19.2 million

women and 2.5 million children under 15 years old. In the U.S, more than 501,669

individuals had died of HIV/AID by the end of 2002, and 384,906 others were believed to be

living with AIDS (UNAIDS, 2002; U.S. Centres for Disease Control and Prevention (CDC)

2003). The Centres for Disease Control and Prevention (CDC) estimates that up to 600,000

additional U.S. residents are living with asymptomatic HIV infection and that one half are

unaware of their condition. The CDC also estimates that at least 40,000 U.S residents become

infected with HIV annually. Additionally, CDC information indicates that in 2002, the

number of diagnosed HIV/AIDS cases in the United States rose to more than 42,000, an

increase of about 1,000 cases from 2001 (UNAIDS, 2002).

In other parts of the world, however, HIV/AIDS can be likened only to the very worst disease

scourges in human history. Four nations in sub-Saharan Africa have general HIV infection

rates today higher than 30 percent. Botswana has 38.8%, Zimbabwe 33.7%, Swaziland 33.4%

and Lesotho 31%). Several others have infection rates above 20 percent, including South

Africa and Zambia. More than 13 million children have been orphaned and broad areas of

regions have been depopulated, with grave implications for entire economies and cultures.

These statistics, and the treatment and prevention challenges behind them, show the desperate

9

need for greater collaborative multi-sectoral strategies and extensive public and private

resources to limit the expansion of HIV/AIDS and address the critical needs of those infected

and directly affected by HIV/AIDS. This is especially true in light of interventions – both

therapeutic and preventive which have proven successful in the U.S. and increasingly in the

developing world (UNDP, 2008; Whiteside et al, 2006).

Notwithstanding its comparatively low HIV prevalence, Asia has not escaped the epidemic‟s

harmful consequences. The economic consequences of AIDS will force an additional 6

million households in Asia into poverty by 2015 unless national responses are significantly

strengthened (Commission on AIDS in Asia, 2008). The epidemic continues to have an

enormous impact on households, communities, businesses, public services and national

economies in the Sub-Sahara. In Swaziland, average life expectancy fell by half between

1990 and 2007 to 37 years largely due to the pandemic (UNDP, 2008; Whiteside et al, 2006).

2.2 Situation of HIV/AIDS in Sub-Saharan Africa

Developing countries have been severely affected by HIV and AIDS. Sub-Saharan Africa has

been declared as the region most severely hit by HIV and AIDS. It is home to just six percent

(6%) of the world population but, statistics indicate that two thirds of all the people living

with HIV worldwide are found in Sub-Saharan Africa (Desmond, Karam & Steinberg 2003).

Research has shown that HIV/AIDS and other infectious diseases thrive in the communities

where there is much poverty (Bendell, 2003). People from environments that are poverty-

stricken cannot afford basic needs, such as healthy food and clean water. The observations of

Kauffman and Lindauer (2004) concur that poverty exacerbates HIV and AIDS. Moreover,

HIV/AIDS affects all spheres of life including the workplace.

Africa‟s share of the horror of the estimated 40 million people worldwide infected with

HIV/AIDS at the end of 2001, at least 70 percent or 28.1 million were residing in Sub-

Saharan Africa (Development Management Associates; 2002). About 3.4 million new

infections occurred in 2001 and 2.3 million Africans died of AIDS in that year alone. The

epidemic caused the death of both parents of 1.7 million African children by the end of 1999.

Africa‟s share of total estimated deaths due to HIV\AIDS since the beginning of the epidemic

is above 85 percent. By comparison with other regions, this is a crisis.

10

Dr. EM Samba (2000), the director of the World Health Organisation‟s Regional Office in

Africa said the following regarding the impact of HIV/AIDS on the African continent:

“…the sad and gloomy scenario is becoming even more painfully

familiar: everyday, cemeteries and funeral service outfits in rural and

urban Africa brim with business – welcoming and handling new

arrivals…in some of our countries, at least 2000 people are buried

every week, victims, we now know of the HIV/AIDS pandemic”.

South Africa has been declared as the country worst affected by HIV/AIDS and Kauffman

and Lindauer (2004:17) go as far as referring to South Africa as “the HIV capital of the

world”. A number of factors have fuelled the spread of HIV in sub Saharan Africa as

summarised below:

Although individual worker‟s behaviour and decision do play major roles in reducing or

increasing the risk of infection, certain types of work situations are more susceptible to the

risk of infection than others. Work involving the mobility of a youthful workforce in

industrial enterprises such as mines, oilfields, and road and dam-building projects are for

example high on the list. Workers posted in geographically isolated environments with

limited social interaction and limited health facilities and those engaged in highway

transportation are also vulnerable. Work involving occupational risks such as contact with

human blood using inadequate equipment is equally susceptible to the risk. So is work that is

dominated by men, where women are in a small minority. Various studies have looked at the

role of truck drivers, both in Africa and in Asia, in the spread of HIV.

Behavioural practices continue to drive the probability curve that a worker and/or employer

may acquire the infection upwards. These include unprotected sexual relationships with

partners, whose HIV status is not known, lack of adherence to infection-control warnings and

cultural norms and values. Finally, a climate of discrimination and lack of respect for human

rights leaves workers more vulnerable to infection and less able to cope with AIDS because it

makes it difficult for them to seek voluntary testing, counselling, treatment or support; they

will also not be in position to take part in advocacy and prevention campaigns. Moreover,

individuals who suffer discrimination and lack of respect for their human rights are both more

vulnerable to becoming infected and less able to cope with the burdens of HIV/AIDS.

11

This spread comes with a number of consequences that include but are not limited to:

Along with the reduction in population size, the distribution of the working population profile

will change in terms of age, skills and work experience as a result of the epidemic. Three

interrelated factors could lead to rising number of widows and orphans, which will alter the

labour market structure as more and more widows and orphans enter to seek a livelihood.

Also as people living with AIDS (generally in the age group of 20-49 years) exit the labour

market, the tendency for early entry of poorly prepared and unskilled children into the active

labour force becomes greater. It is further envisaged that early withdrawal of people with

AIDS from the workplace will increase the need to retain older persons in the labour force

who may not have the necessary stamina to meet the corresponding rigorous labour market

demands.

Cohen sees the end result as the evolvement of a smaller and smaller active labour force and

a greater dependency ratio (Karen A. Stanecki & Peter O. Way; 1996). The US Bureau of

Census has predicted 8 to 31 years of life will have been lost in those countries most affected

by HIV\AIDS in sub-Saharan Africa by the year 2010 (ILO; June 2000) . Using population

data from Botswana, Cameroon, Ethiopia, Cote d‟Ivoire, Kenya, Malawi, Mozambique,

Namibia, Nigeria, South Africa, Tanzania, Uganda and Zimbabwe, the ILO made some

observations as well including the following two: (i) there would be about 24 million fewer

workers in hard hit countries alone in the year 2020 as a result of the AIDS epidemic; and (ii)

the labour force should be 10% to 22 % smaller in those countries with rates greater than

10% than it would have been if there had been no HIV/AIDS by the year 2020 (ILO;

December 2000).

Emanating from the guidelines set by United Nations and the World Health Organisation,

different continents and regions have crafted their own strategies applicable to their

respective regions to address the spread of HIV and the eventual severe impact of the AIDS

pandemic.

2.3 HIV/AIDS Situation in Uganda

Uganda is one of the countries in Sub-Saharan Africa that has demonstrably slowed down the

AIDS epidemic. According to the Ministry of Health HIV/AIDS surveillance report of June

2001, the number of adults with HIV in 2000 was 1,107,644 adults (543,753 women, 453,127

12

men and 110,880 children below 15 years). The decline in HIV prevalence has been

attributed to among others: - extensive national STD/HIV education and treatment

programmes, counselling of PHAs, treatment of opportunistic infections, voluntary HIV

counselling and testing, prevention programmes and a good political will as well as consistent

funding and technical assistance from international donors.

Almost three decades after the first reported cases in Uganda in 1982 (Serwadda, 1985),

AIDS has continued to pose a significant public health and development challenge. Uganda

has a generalized HIV epidemic with a prevalence of 6.4% in adults and 0.7% in children

(UAC, June 2009). Approximately 1.1 million people in Uganda are HIV-infected

(MoH/ORC Macro 2004-5). The incidence rate by far outstrips AIDS related mortality and

the numbers of clients enrolling into chronic AIDS care. The wave of new as well as old

infection has shifted to older age groups (Kirungi et al., 2008) with both HIV incidence and

prevalence in Uganda‟s mature HIV epidemic having stopped declining around 2000 and

hence remaining more or less stable (Kirungi et al., 2006).

The number of people with AIDS, is however on the rise as more people already infected

with HIV are falling sick. The results of the 2011 Uganda AIDS Indicator Survey (UAIS)

indicate that 7.3% of adults age 15-49 in Uganda are living with HIV. Among children under

age five, HIV prevalence is 0.6%. These results are based on a nationwide survey that was

conducted to provide estimates of HIV prevalence and other important HIV/AIDS

programme indicators.

“These results demonstrate indisputably that HIV/AIDS remains a significant health problem

for Uganda and should serve as a call to action for us all,” said Minister of Health Dr

Christine Ondoa. “The Ministry of Health along with our dedicated international partners

takes this as an opportunity to recommit ourselves to continued scale-up of proven HIV

interventions, to the goal of universal access to ARV treatment, and to our shared vision of a

future free of HIV.”

The survey shows that there has been a tremendous increase in voluntary HIV testing in

Uganda over the past 6 to 7 years. The proportion of women age 15-49 who have ever been

tested for HIV and received their results increased fivefold, from 13 percent in 2004-05 to 66

percent in 2011. The increase among men has been somewhat more modest, from 11 percent

in 2004-05 to 45 percent in 2011. The main reason for the gender difference is likely to be the

13

high level of testing of pregnant women. Survey results indicate that almost three in four

pregnant women (72 percent) were tested for HIV and received results as part of their

antenatal care.

Whereas male circumcision has been shown to have a protective effect on HIV transmission,

the proportion of Ugandan men age 15-49 that are circumcised has remained almost

unchanged at 26%. The proportion of men circumcised ranges from 2 percent in Mid

Northern region to 53 percent in Mid-Eastern region. Furthermore, the data indicates that

multiple sexual partnerships (proportion of respondents having two or more partners in the

previous 12 months), which is a key driver of Uganda‟s HIV epidemic, remains unacceptably

high at 25% among men and 4% among women.

The UAIS results demonstrate both the strengths and challenges of Uganda‟s HIV response.

The survey identifies a continued need for individual behaviour change, and scale-up of

evidence-based prevention interventions such as prevention of mother-to-child transmission

services and safe male circumcision, as well as increased treatment coverage for people living

with HIV. Interventions should be targeted to those most-at-risk populations and must pay

particular attention to those regions and districts most heavily impacted by the epidemic.

This tailored and enhanced approach should significantly impact future rates of HIV infection

in Uganda. Women, urban dwellers and residences of the post conflict northern Uganda

region are more disproportionately affected.

In Uganda, sexual transmission continues to contribute 76% of new HIV infections while

mother to child transmission contributes 22%. Currently, estimates indicate that over 100,000

new infections occur annually. During 2008, an estimated 110,694 new HIV infections

occurred countrywide and approximately 61,306 people died from AIDS related illnesses in

2008 (MoH, 2009).

2.3.1 Factors Fuelling HIV Transmission in Uganda

A review of assessments of the epidemiology of HIV infection in Uganda reveals evidence of

the factors associated with increased risk of HIV transmission (UAC, 2006). Sex with

multiple partners, HIV discordance among married and co-habiting couples, intact foreskin

and infection with genital herpes (HSV-2) and other STIs appear to be some of the current

14

key risk factors fuelling the HIV epidemic in Uganda. The perception that HIV&AIDS is

normal by some sections of the community has also contributed to some form of

disengagement from preventive behaviour, (UAC 2006; 2007).

There is increasing evidence according to the Uganda AIDS Commission (2007) to show that

the number of multiple sexual relationships increased between 2001 and 2005 from 25% to

29% in men and from 2% to 4% in women. Among married couples, the proportion reporting

extra-marital sex during the same period increased from 14% to 29% among men but

remained stable at 3% among women.

Historically, the zero grazing campaigns of the late 1980s had a great impact on HIV

transmission contributing to the decline in prevalence from 18% to 6.4%. Married and co-

habiting couples are thus a key population group that needs to be targeted with an HIV

prevention package specifically designed to suite the uniqueness of marital relationships.

Serwadda et.al, (1995) in a study conducted as part of the Rakai Health Sciences Program

showed that the risk of HIV transmission among discordant couples is as high as 10 times the

risk of transmission among the general population. A secondary analysis of the 2004-05

Uganda HIV Sero- Behavioural Survey (UHSBS) showed that among couples where one is

HIV positive, 40% have an HIV negative spouse and only 9% are aware of the HIV status of

their spouse (Bunnell et al. 2007). In addition, of their last unprotected sexual encounters,

84% were with their spouses and 13% with steady partners.

Available evidence suggests that overall, consistent condom use is very low. Between 2001

and 2005, condom use during the most recent sexual intercourse with casual sex partners

increased from 39% to 48% among women, but decreased from 61% to 53% among men.

This low use of condoms irrespective of type of partner increases vulnerability to HIV

transmission.

The evidence linking lack of circumcision with increased risk of HIV transmission is

overwhelming. Three randomized controlled trials including one in Uganda showed efficacy

of medical male circumcision as a prevention intervention against HIV transmission, a

vaccine with 50% - 60% efficacy (Gray et. al., 2007).

Thus, the most-at-risk behaviours that put people at greater risk of HIV infection include:

high rates of multiple sexual partnerships, low rates of condom use, high rates of concomitant

15

STIs, unprotected anal sex with multiple partners and injecting drug use with shared

equipment.

Whereas HIV&AIDs is now a generalized epidemic in Uganda, there are still population

groups in which most-at-risk behaviours are concentrated. These include commercial sex

workers and their partners, long distance truck drivers (see Morris and Ferguson 2006), fisher

folk, uniformed services, men who have sex with men (MSMs) and injecting drug users

(IDUs).

Whereas information on men who have sex with men (MSMs) and injecting drug users

(IDUs) is either scanty or unavailable in Uganda, one study on MSM (Kajubi et al. 2008) in

Uganda shows that 39% of the MSMs reported being bisexual, 37% had unprotected

receptive anal sex in the last six months and 11 % reported a history of urethral discharge.

The Modes of Transmission (MOT) study predicts that 43% of all new HIV infections

expected to occur in the next year will be among persons in mutually monogamous

relationships among the sexually active adult population aged 15 – 49 years (Odiit, 2008).

This proportion is only second to those in casual sexual relationships. Married and co-

habiting couples are thus a key population group that needs to be targeted with an HIV

prevention package specifically designed to suite the uniqueness of marital relationships. It is

not enough to assume that they will benefit from interventions targeting the general

population (Odiit, 2008).

Trends in prevalence among the adolescents and young people especially those aged 15 – 19

year olds reflect recent trends in HIV incidence since this age group has recently initiated sex,

duration of infection is short and mortality is low. Abstinence programs have been quite

successful in this age group. Life-skills training, for both in-school and out of school

children, have also been successful leading to a decline in HIV prevalence and an increase in

age of sexual debut (UHSBS, 2005).

In terms of sexual behaviour, the UHSBS showed that youth who are orphans or vulnerable

children were slightly more likely to have sex by age 15 than other youth. Young women

classified as orphans and vulnerable children (OVC) were 1.5 times more likely to initiate sex

before age 15 than other young women, while young men who were OVC are 1.1 times as

16

likely. These findings emphasize the need to protect OVCs from the risk of acquisition of

HIV.

Various factors associated with social and cultural values, beliefs, perceptions and practices

are known to influence dominant sexual behaviours that have a bearing on HIV prevention.

For instance, the value for children, even when people know they have HIV amid limited

social services such as PMTCT and ART, and the pressure exerted by society has tended to

influence adults to have diminished control over their sexuality (Oundo and Siu 2006).

Despite some progress in human rights protection, many women often have little say in all

matters concerning their lives including sex, and young girls are socialized likewise (Whyte

1997); thus the social impact of HIV infection has increased women's vulnerability (Porter,

2004).

In the event of a more urbanized mobile family, in relation to guidance against HIV&AIDS,

the role of peers has increased in importance as the role of parents has diminished (Neema et

al. 2000). These too are struggling with a plethora of new cultures and practices which have a

negative influence on young people‟s ability to prevent HIV infection.

Many studies (e.g. UNAIDS 2004; UNESCO 1999; PSI 2006) have long shown the linkages

between economic aspects especially poverty with transactional sex. Cases of sexual

exploitation, mostly unprotected cross-generational sex (Neema et al. 2004), in some cases

involving male adolescents with old women (Bohmer and Kirumira 2000), and unwanted

pregnancies for female youths (Kyaddondo et al. 2005) have been reported.

2.4 Effects of HIV/AIDS in the workplace

The epidemic‟s impact on the education system could affect the quality of future labour

inputs in the workplace mainly resulting from poor outflow of new entrants into the labour

market. Few studies have made the case forcefully. One school suggests that the epidemic‟s

effect on the school system is manifested in its impact on students‟ learning curves and

classroom performance. The hypothesis is that children who have to live daily carrying

within them the grief, trauma and/or experiences of seeing close relatives, friends and

teachers fall sick, suffer and die of AIDS, would be in a more vulnerable state of mind in

responding to learning. Furthermore, there are a number of students who would have lost

their parents or guardian to AIDS subjecting them to a lower living standard in the absence of

17

alternative source of income (Loewenson, R. & Kerkhoven, R.; May 1996). For these

children, balancing the demands of school and the demands of life could present a practical

problem. The problem could become even more disturbing for students who know that they

are infected with the virus, and will die of it someday. In addition to the fright of dying and

the loss of hope for living, the tendency is high for such students to shy away from active

participation in class work and therefore retard in learning and performance.

Teachers are not exempted from these trauma or loss of life either. Deaths among teachers are

occurring in large numbers in highly affected countries. For example, the number increased

by 60 % between 1994 and 1999 in Botswana including 84 primary school teachers who died

in 1999 as compared to only 8 in 1994. In Zambia, 40 % of teachers are infected with HIV

and are dying at a faster rate than the number of teacher graduations. Filling in the gap is

indeed a very difficult task. On the other hand, the quality of instruction diminishes as more

and more teachers fall sick. Frequent bouts of sickness of either teachers or family members

take away many person hours from classroom teaching. Worse still, the stress of sickness and

the knowledge of impending death reduces the quality of lecture preparation and delivery.

The end result is the poor quality of people flowing from the education system in relation to

the demands of the workplace and society (Loewenson, R. & Kerkhoven, R.; May 1996).

Many African governments have called upon the business community in their respective

countries to join in the fight against HIV/AIDS. Public sector institutions, NGOs and CBOs

are also involved in promoting a viable and supportive response to the epidemic. There are

direct and opportunity costs associated with each intervention taken in response to this call.

As the rate of infection increases, so are the costs associated with the epidemic. These

increasing costs may ultimately affect the level of benefits that a business is able to provide

for its workforce.

Cost increases come about through a variety of ways, three of which are worth mentioning.

Demand for recruitment and training rises as a result of increased staff turnover and loss of

skills. For example, 36 out of 1600 employees of Barclays Bank in Zambia died of AIDS-

related sicknesses. Situations like these, call for the employment of extra labour, multi-

skilling, succession strategies and extensive human resource monitoring only to cope with

staff fluctuations and losses. These are done mainly through training, re-training and

recruitment costs, which would mean falling rates of return on human capital formation. The

18

higher income and more skilled employee categories of staff involved, the greater the cost

(Sehgal, Jag M.; November 1999).

Secondly, the costs to enterprises, public or private, are those incurred in the provision of

health care for infected employees. A study (Rugalema, 1999) of a commercial agro-estate in

Kenya estimated that “medical expenditure rose to over 400 % above that of projected

expenditure without AIDS” (Sehgal, Jag M.; November 1999). However, the provision of

health care in countries where public health care provision is limited and private health care

expensive, the cost could be considered an investment, preventing or limiting

sickness\absenteeism and controlling workforce health risks.

Finally, company life insurance premiums and pension fund commitments will rise as a result

of early retirement or death. This is particularly problematic in those economies where such

benefits are more comprehensive. For example, in Zimbabwe, over a two-year period, life

insurance premiums quadrupled as a result of HIV\AIDS. Where businesses provide for the

funeral costs of employees, the operating cost component could get bigger as mortality rate of

HIV\AIDS gets bigger. Additional costs are incurred from frequent absenteeism due to illness

or attendance at funerals, as well as time spent on training. Whiteside (1999) calculated that

absenteeism accounted for anywhere between 25-54 percent of costs on average for a group

of businesses in East Africa (Karen A. Stanecki & Peter O. Way; 1996).

HIV/AIDS is a threat to enterprise delivery capacity and performance. The impact of the

epidemic has therefore raised a number of concerns for the employer and self-employed who

demand labour inputs to sustain their enterprises. A major area of concern is the high labour

turnover due to HIV/AIDS related deaths. The case is serious as the rapid turnover leads to a

less experienced workforce relative to the skills demanded (UNDP; “June 2001, p 10).

Another area of concern is the effect of the pandemic on the competitiveness of enterprises in

the production of quality goods and services. Losses in labour time and skills will reduce the

quantity and quality of outputs produced. This can directly affect the quality of products and

services, leading to reputation losses and ultimately a reduction in customers. Quality of

goods and services produced by small firms in the formal and informal sectors also suffer

from the effects of the epidemic. Loss of one or more key employees may be even more

catastrophic. It has been observed that food production reduced and food security declined in

rural sectors as labour and time are reallocated from agricultural work to non-agricultural

care activities. Maize outputs for small farmers in Zambia fell by 45 % due to all deaths.

19

When AIDS was factored out as the cause of death, maize production figures went down by

61%, cotton 47 %, vegetables 49 % and groundnuts 37 % respectively (UNDP; “June 2001, p

10).

Disruption in the production process due to the loss of skills from the workforce is another

area of concern for the renters of labour. Such disruption is severed if it is a loss of

“intellectual capital”, which has become increasingly important relative to “financial capital”

and with the progressive changes in the way companies are now valued. In other words, skills

losses could lead to lower value or lower quality products and decrease the value of goods

produced. Finally, what happens in one sector could impact events in another sector. For

example, skills losses and interruption of production in say the telecommunications and

electricity sectors may lead to production losses in all other sectors that use these services. In

the public sector, skills losses in an already skills deficit situation, will compound problems

of public administration and policy management (UNDP; “June 2001, p 10).

A direct link exists between HIV\AIDS and declining productivity and profits. The bottom

line is that declining levels of productivity could lead to declining profits especially when

production costs are not declining at an equal or higher rate, as is usually the case when the

prevalence rate of HIV/AIDS is high among the productive segment of the population. We

had reviewed earlier the increasing costs associated with the need for employers and

individual workers to redress the rising scourge of the epidemic. For example a transport

company in Zimbabwe incurred a total cost equal to 20 percent of profits to deal with

HIV/AIDS related issues in the company (Stover, J. & Bollinger, L. ; 2000).

One principal area in which HIV\AIDS impacts on productivity in addition to costs escalation

is increased organisational disruption within the workforce due to high rates of morbidity and

mortality. Usually making prompt and adequate adjustments to the erratic rate of staff

turnover coupled with the loss of skills and tacit knowledge can be very difficult. The main

problem is the passing on of acquired skills and knowledge, which has been such a major

factor in the growth of labour productivity, diminishes. Besides, staff morale can be severely

affected by the loss of colleagues; discrimination against people living with HIV\AIDS; and

the disruption of work activities to attend infected and affected workmates. These less visible

organisational factors are built up over longer time frames and are critical for a more

efficient, effective and ultimately productive workforce. While these factors may be

20

essentially invisible in nature and difficult to calculate, their impact on productivity levels is

nonetheless enormous (Stover, J. & Bollinger, L.; 2000).

As discussed earlier, HIV/AIDS could lead to less productive employment and lower earning

power. These would in turn depress domestic private savings. It should be noted that national

savings are the outcome of what happens to domestic savings and the balance of capital

inflow and outflow. Consequently, depressed domestic savings would lead to depressed

investments and eventually to depressed growth. Attempts to quantify this expected decline

in growth indicators as a result of HIV/AIDS have been made. One study using data from

Tanzania, Cameroon, Zambia, Swaziland, Kenya, KwaZulu-Natal and a few other Sub-

Saharan African countries found that the “rate of economic growth may be reduced by as

much as 25 percent over a 20-year period as a result of the HIV/AIDS pandemic” (ILO; June

2000, p. 12.] . Way and Over, (1992) also concluded that “AIDS could suppress gross

domestic product (GDP) by as much as 10 percent over a 15-year period” (Loewenson, R. &

Kerkhoven, R.; 1996).

HIV/AIDS has multiple implications for the smooth functioning of public services. Besides

causing prolonged absenteeism and the loss of key staff, the disease drains the organisations

of institutional memory, of tacit knowledge of the workings of institutions, and of new ideas

and energy that younger staff members could bring to the work environment (Rau, 2003).

HIV/AIDS affects the economically active age groups; therefore the implications for the

world of work are unlike those associated with any other disease. In addition, the fact that the

disease, in an infected employee, remains “invisible” for years and then follows an often

unpredictable pattern from symptomatic HIV disease to death means that it is very difficult to

plan for an organisation‟s human resource needs (Smart, 2004).

For the private sector, HIV/AIDS affects both productivity and profitability; the effects on

productivity include increased absenteeism, staff turnover and lower staff morale. The

impacts of HIV/AIDS on profitability include increased costs, declining investment and

threat to consumer base (Maphosa, 2003). It is argued that these effects will negatively

impact on tax revenues and domestic and foreign investment, levels of human capital and,

ultimately, the macro-economy as a whole (Pharoah, 2005).

Page et al., (2006) say that HIV/AIDS affect people in their economically active years which

are mostly the ages of 25 to 49 years. The HIV-infected person - depending on the

21

individual‟s lifestyle, access to treatment and the progression of the viral load - can become

less productive as fatigue and opportunistic infections set in. Should the HIV-infected person

die, his or her knowledge, training and experience will also be lost by the workplace.

In view of the foregoing points, the International Labour Organisation (ILO) declared

HIV/AIDS as a workplace issue (ILO, 2001). The effects of HIV/AIDS on the work

environment prompted the ILO to outline guidelines to be followed by its member states in

the mitigation of the impact of HIV/AIDS in the workplace.

Page et al., (2006) further observe that HIV/AIDS is a concern for the workplace because of

the consequences of HIV and AIDS, such as an inability to work due to poor health and

eventually death, the financial constraints placed on companies due to medical aid claims

absenteeism and loss of employees, the stress and trauma experienced by employees due to

the illness and deaths of colleagues, morale degeneration due to the loss of colleagues,

burnout experienced by the remaining employees due to ever growing amounts of work, a

potential decrease in productivity, the loss of skills and finally stigmatisation and

discrimination against people suspected to be infected or affected by HIV and AIDS.

2.5 Efforts by International Organizations and Employers in Combating HIV/AIDS

in the Workplace

According to the Joint United Nations Programme on HIV/AIDS and the International

Organisation of Employers (2002), the majority of employers are concerned with how to

protect their workforce from HIV infection and how to deal with those who are already

infected.

Actual initiatives taken by an employer to respond to HIV/AIDS in his or her company,

however, will depend on the following two key factors:

i. The HIV prevalence rate within the company and the surrounding community; and

ii. The level of knowledge and awareness by the management of the real and potential

impacts of the pandemic.

Understanding the potential impact on needs and capacity is essential in mobilizing

HIV/AIDS responses and enabling effective planning, action and efficient use of available

resources. This should clearly identify key areas of susceptibility and vulnerability of

employees and overall system function.

22

Informed planning in many severely affected countries requires projection of the scale of

various impacts (Lamptey & Gayle, 2001).

The Joint United Nations Programme on HIV/AIDS and the International Organisation of

Employers (2002) further mention five main initiatives that an organisation can take to

respond to HIV/AIDS in the workplace which are: developing a HIV/AIDS policy for the

company, providing HIV prevention education in the workplace, providing care and support

in the workplace, Implementing fair employment practices and community involvement.

Many countries now have HIV/AIDS policies and, increasingly, countries are also adopting

HIV/AIDS policies for the workplace; in some countries, specific ministries have designed

AIDS policies for their workforces. The rationale for a ministry developing an AIDS

workplace policy is to provide its employees with clear statements on expectations and

responsibilities (Rau, 2003).

These policies are based on the International Labour Organisation (ILO) Code of Practice on

“HIV/AIDS and the World of Work”, the code of practice contains fundamental principles

for policy development and practical guidelines from which concrete responses can be

developed at the enterprise, community and national levels (International Labour

Organization, 2001). The code is adaptable to a variety of situations and different levels of

resources (Joint United Nations Programme on HIV/AIDS (UNAIDS) and the International

Organisation of Employers (IOE), 2002).

A workplace policy provides a framework for action to reduce the spread of HIV/AIDS and

manage its impact. It defines an institution‟s position on HIV/AIDS, and outlines activities

for preventing the transmission of the virus and providing care and treatment for staff who

are infected. It also ensures that the response is balanced, activities complement each other,

and resources are used most effectively (Pharoah, 2005).

A good HIV and AIDS workplace policy always contains an outline or a description of how

the particular organisation, institution or business is going to manage HIV and AIDS on a

day-to-day basis. Establishing an HIV/AIDS programme and policy in the workplace is a

cost-effective solution and will help reduce the future spread and impact of the disease

(UNAIDS, 1998).

An HIV and AIDS workplace programme is an action-oriented plan that an organisation will

23

implement in order to prevent new HIV infections, provide care and support for employees

who are infected or affected by HIV or AIDS, and manage the impact of the epidemic on the

organisation. It outlines how all the different principles within the policy will be translated

into practice at the workplace (Stellenbosch University and the USAID Health Policy

Initiative, 2008).

Workplace HIV/AIDS programmes are most effective when they include a comprehensive

and coordinated set of prevention, care, and support components. Whether they are provided

directly by employer or by employer sponsored referrals to service providers in the

community, such programs are more likely to be strong, cost-effective, and sustainable

(Academy for Educational Development, 2004).

2.6 Salient Issues addressed by Workplace HIV/AIDS Policies

The International Labor Organization (ILO) provides a comprehensive framework which

addresses how Persons Living with HIV/AIDS should be handled at the workplace. It also

has a policy document which guides the design and development of workplace HIV/AIDS

issues and spells out the salient issues how they are to be observed by employers.

ILO‟s policy regarding personnel issues emphasises that employers should not engage in nor

permit any personnel policy or practice that discriminates against workers infected with or

affected by HIV/AIDS. In particular, it clearly spells out that employers should not require

HIV/AIDS screening or testing unless otherwise specified in section 8 of this code; ensure

that work is performed free of discrimination or stigmatization based on perceived or real

HIV status; encourage persons with HIV and AIDS-related illnesses to work as long as

medically fit for appropriate work; and provide that, where a worker with an AIDS-related

condition is too ill to continue to work and where alternative working arrangements including

extended sick leave have been exhausted, the employment relationship may cease in

accordance with anti-discrimination and labour laws and respect for general procedures and

full benefits.

To address issues pertaining to grievances and disciplinary procedures, the ILO Code of

Practice on HIV/AIDS and the World of Work (2001) provides that employers should have

procedures that can be used by workers and their representatives for work-related grievances.

These procedures should specify under what circumstances disciplinary proceedings can be

24

commenced against any employee who discriminates on the grounds of real or perceived HIV

status or who violates the workplace policy on HIV/AIDS. Regarding confidentiality,

HIV/AIDS-related information of workers should be kept strictly confidential and kept only

on medical files, whereby access to information complies with the Occupational Health

Services Recommendation, 1985 (No. 171), and national laws and practices. Access to such

information should be strictly limited to medical personnel and such information may only be

disclosed if legally required or with the consent of the person concerned. Organizations are

required by the code to adhere to the set standards of risk reduction and management, which

calls on employers to ensure a safe and healthy working environment, including the

application of Universal Precautions and measures such as the provision and maintenance of

protective equipment and first aid. To support behavioural change by individuals, employers

should also make available, where appropriate, male and female condoms, and counselling,

care, support and referral services. Where size and cost considerations make these difficult,

employers and/or their organizations should seek support from government and other relevant

institutions.

In the design and development of Workplace HIV Policies by organizations, workers and

their representatives are required to consult with their employers on the implementation of an

appropriate policy for their workplace, designed to prevent the spread of the infection and

protect all workers from discrimination related to HIV/AIDS. Workers and their

organizations should adhere to national law and practice when negotiating terms and

conditions of employment relating to HIV/AIDS issues, and endeavour to include provisions

on HIV/AIDS protection and prevention in national, sectoral and workplace/enterprise

agreements. Workers and their organizations should use existing union structures and other

structures and facilities to provide information on HIV/AIDS in the workplace, and develop

educational materials and activities appropriate for workers and their families, including

regularly updated information on workers‟ rights and benefits.

The effects of HIV/AIDS on the socio-economic status of individuals as well as on the

economy of nations cannot be underscored. And in cognizance of this fact, workers and their

organizations have the obligation to work together with employers to develop appropriate

strategies to assess and appropriately respond to the economic impact of HIV/AIDS in their

particular workplace and sector. They have also championed initiatives to work with

employers, their organizations and governments to raise awareness of HIV/AIDS prevention

25

and management. The ILO Code of Practice on HIV/Aids and the World of Work (2001)

provides that workers and their representatives should support and encourage employers in

creating and implementing personnel policy and practices that do not discriminate against

workers with HIV/AIDS. It also asserts that workers‟ representatives have the right to take up

issues at their workplaces through grievance and disciplinary procedures and/or should report

all discrimination on the basis of HIV/AIDS to the appropriate legal authorities.

Similarly, Stellenbosch University and the USAID Health Policy Initiative, (2008) have

identified that the key elements of an HIV and AIDS workplace programme include:

An impact assessment of HIV and AIDS on your organisation, HIV and AIDS awareness

programmes, voluntary counselling and HIV-testing programmes, HIV and AIDS education

and training, condom distribution, encouraging health treatment for STIs and TB, universal

infection-control Procedures, creating an open and accepting environment, wellness

programmes for employees affected by HIV and AIDS, the provision of antiretroviral or

referral to relevant service providers, education and awareness about antiretroviral and

treatment literacy programmes, counselling and other forms of social support for HIV-

positive employees, reasonable accommodation for HIV-positive employees, strategies to

address direct and indirect costs and other practical implications of HIV and AIDS

monitoring, evaluation and review of the programme.

2.7 Challenges facing implementation of workplace HIV/AIDS Policies

UNAIDS, (1998) says that organisations face enormous challenges in responding to

HIV/AIDS such as setting up comprehensive, sustained programmes, adopting relevant

policies, obtaining management commitment, ensuring confidentiality and non-

discrimination, supporting staff who are infected with HIV/AIDS, dealing with attitudes of

co-workers and sustaining involvement (UNAIDS, 1998).

Other challenges include strengthening existing structures as well as capacity to develop and

implement workplace programmes and having specific issues related to HIV/AIDS

incorporated into planning and implementation of departmental core functions (GTZ, 2003).

Among the greatest challenges in addressing HIV/AIDS are stigma and discrimination. They

often result from fear caused by myths, misinformation, and a lack of knowledge about how

HIV is and is not transmitted. The negative effects of workplace stigma and discrimination

26

can be substantial, both to the business and to workers themselves (Academy for Educational

Development, 2004).

In a study conducted by Chetty in 2006, despite the existence of the policy and formal

commitment to its values and objectives, practices that work against the spirit of the policy

often continue. Stigma and discrimination are an obvious example. Despite decades of

awareness raising and education, stigma and discrimination against infected and affected

people continues to be a concern in many societies. Job security is not assured and many

people can be fired or let go due to their HIV positive status.

As a social contract in the workplace, policies are fundamental to protect people‟s rights.

Care must be taken when implementing workplace policies that they adhere to the principles

in the policy declarations as well as acknowledge and address stigma and discrimination

when they arise. The segments of the population affected most are the youths and people

within the productive age bracket most of who constitute the nation‟s workforce. Response to

the HIV/AIDS pandemic within the workplace is crucial if progress is to be made in the

prevention, impact mitigation and the provision of care and support for People Living with

HIV/AIDS (PLWHA) and People affected by HIV/AIDS (Chetty, 2006).

The Interagency Coalition on AIDS and Development (2004), outlines some of the

challenges facing the development and implementation of Workplace HIV/AIDS policies as;

the level of staff participation required in terms of research and policy development,

implementation, communication, monitoring and adjustments; perceived costs involved in

training; the duty to accommodate altered work schedules; legal input and associated costs;

possible costs for consultant to research and develop policy; regular review necessary - who

will do this, when and who is responsible for tracking legislative or human rights up-dates?;

different codes and standards between organizations, union and non-union requirements;

considerations for parity; stigma and/or discrimination; and lack of human and financial

resources as well as attitude issues around willingness to develop such a policy.

The National Tripartite Committee of Ghana, 2004, complements that the fundamental rights

to workers infected by the AIDS virus or affected by HIV/AIDS is compromised with respect

to the pervasive discrimination and stigmatization that such workers face especially in the

case that fellow workers are not sensitized about the implications of stigma.

27

CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

Chapter three presents a detailed description of the selected research design. It details what

was done and how it was done. It comprises several sub-sections which include the research

design, study population, sampling, data collection/instrumentation, data quality management

including validity and reliability, and data analysis, research procedure and data quality

control.

3.1 Research Design

The study employed a case study design to investigate the challenges of implementing the

Workplace HIV/AIDS policies at Uganda Telecom Limited and Reproductive Health

Uganda. Data collection strategy was both qualitative and quantitative, using structured and

semi-structured interviews, document analysis and FGDs. Probability and non-probability

sampling techniques were used for the study.

3.2 Study area

The study was carried out at the head offices of Reproductive Health Uganda and Uganda

Telecom Limited, both located in Kampala city.

3.3 Population of the study

This study was conducted at Reproductive Health Uganda and Uganda Telecom Limited

from where a population of seventy (70) respondents were targeted in both organisations. The

targeted respondents were those in the positions of managers, officers and assistants.

3.4 Sample size

The sample consisted of ninety sixty (60) respondents in total; selected from Reproductive

Health Uganda and Uganda Telecom Limited. The following formula was used to determine

the sample size;

28

Formula is: n = N

1+N (e) 2

Whereby “n” is unknown sample you want to arrive at

“N” is the total number of beneficiaries

1 is a constant

“e” is the acceptable error in research always expressed as 0.05 or 0.01

3.5 Sampling Techniques

This study employed both probability and non probability sampling techniques namely

purposive sampling and systematic random sampling to select the respondents for the study.

Sampling techniques refer to a description of the strategies which the researcher will use to

select representative respondents from the target population (Onen and Oso, 2005).

Purposive sampling was used to select the two private institutions from where the sixty (60)

respondents were drawn. This is because large institutions are more likely to have

comprehensive human resource management policies including HIV/AIDS workplace policy.

Purposive sampling is a non-probability type of sampling in which the researcher decides

who to include in the sample for the purpose of collecting focused information for the study

(Onen and Oso, 2005).

Systematic random sampling was used to select the sixty employees from the two institutions.

Every third (3rd

) employee from the list of each of the two institutions was a respondent. The

list was generated by randomly assigning a number of each of the other employees from each

organization. This was done in order for the researcher to obtain a representative sample. In

systematic random sampling, the researcher selects the „nth

‟ number of the population from a

randomized list of the population. It employs a probability sampling strategy (Onen and Oso,

2005). Purposive sampling was then used again to select ten (10) key informant respondents

from each of the two private institutions, after the systematic random sampling which

generated the sixty respondents.

29

3.6 Data collection techniques and instruments

Collection of the data involved the use of a number of methods including questionnaire

surveys, focused group discussions, and document analysis.

A Questionnaire survey was carried out to collect data about the level of exposure of the

employees to their workplace HIV/AIDS policy and to assess the functionality of the

workplace HIV/AIDS policies in the study organisations. The technique involved the use of

questionnaires developed by the researcher and administered to the respondents who

responded to the items in writing. The technique was appropriate because the respondents had

varying yet busy schedules; and it is cost effective and less time consuming.

Focussed group discussions (FGDs) were also used to explore group perceptions especially

with regard to the major challenges faced in the HV/AIDS policy implementation in the work

place. FGDs were used because they it allowed the researcher o obtain in-depth information

to supplement the responses yielded by questionnaires. A pair wise ranking matrix was used

for this purpose.

3.7 Research Procedure

This describes how the data was collected by using the instruments described above.

A letter of introduction was sought by the researcher from the school of postgraduate studies

to enable the researcher approach respondents. Both qualitative and quantitative data was

collected by the researcher using semi-structured and structured questionnaires. Qualitative

data was collected from the ten key informants using semi-structured and unstructured

questionnaires, while quantitative data from the forty other respondents was collected using

structured questionnaires. The data was collected by the researcher alone because of financial

constraints limiting the use of research assistants and in order for him to be able to capture

first hand other non verbal but observable communication cues given the sensitive nature of

the issue of HIV/AIDS. The raw data was checked for completeness, sorted coded and

analysed using Statistical Packages for Social Scientists (SPSS) in order for interpretation to

be made. Then the researcher concluded and accordingly made relevant recommendations.

30

3.8 Quality control

Validity and Reliability

The validity and reliability of the data collection tools was ensured by pre-testing them to

make sure they are easy to understand, have ability to capture the actual information and

generate the responses for which they have been designed and can replicate similar responses

whenever used under similar circumstances.

Eliminating extraneous variables was also done by the researcher as a quality control measure

against externalities such as noise, interruptions of other nature, interference from non

respondents and time. The researcher did this by carrying out the focus group discussions and

interviews in the conducive environment of a board room which was free from noise and

interference from non-respondents; and he allocated equal amount of time for each focus

group and key informant.

3.9 Data analysis

This section dealt with the organization, interpretation and presentation of collected data and

it postulates how the data was analyzed.

Being a predominantly qualitative study, thematic analysis was used to interpret and discuss

the findings and responses from the data gathered from respondents including the key

informants through focus group discussion and interview guides. A narrative was provided as

the basis for sound conclusion and recommendations by the researcher.

3.9.1 Statistical Data Analysis using Statistical Packages for Social Scientists (SPSS)

Data analysis and interpretation was done by the researcher using Statistical Packages for

Social Scientists (SPSS) in order to yield data that is accurate and simple to understand when

presented in percentile, graphical and chart forms.

31

CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.0 Introduction

Chapter four explored the analyses and interpretation of the data collected through self-

administered questionnaires. The findings presented and discussed in this chapter are based

on the analysis of data derived from sixty research participants who are employees of

Reproductive Health Uganda and Uganda Telecom Limited who were randomly selected.

The objectives of the study were: to determine the level of exposure of the employees to their

workplace HIV/AIDS policy, to assess the functionality of the workplace HIV/AIDS policies

in private institutions in Uganda, to investigate the major challenges facing implementation

of workplace HIV/AIDS policies by private institutions and to suggest recommendations for

improving workplace HIV/AIDS policy implementation.

4.1 The Biographical Characteristics of the Respondents

4.1.1 Age bracket of respondents

Source: Questionnaire survey

Figure 4.1 shows the distribution of respondents according to age; where it is observed that

majority of the respondents are in the age group of 21-30 years accounting for 26 (43%), 14

(23%) were in the age group 31-40 years, 16 (27%) were in the age group 41-50 years

whereas the least number of respondents were above 50 years of age accounting for 4 (7%)

respondents. The results indicate that the respondents were relatively young people and are

Figure 4.1: Age of respondents

32

Figure 4.2: Respondents’ sex

therefore suitable for the study. According to Whiteside & Sunter, (2000) young people in the

age groups (mid-twenties to mid- thirties) are the worst affected by HIV/AIDS. The fact that

HIV/AIDS affects young people has also had the consequence of young people living with

AIDS exit the labour market and the tendency for early entry of poorly prepared and

unskilled children into the active labour force becomes greater. It is further envisaged that

early withdrawal of people with AIDS from the workplace will increase the need to retain

older persons in the labour force who may not have the necessary stamina to meet the

corresponding rigorous labour market demands. The end result as the evolvement of a smaller

and smaller active labour force and a greater dependency ratio (Karen A. Stanecki & Peter O.

Way; 1996). Similarly The US Bureau of Census has predicted 8 to 31 years of life will have

been lost in those countries most affected by HIV\AIDS in sub-Saharan Africa by the year

2010 (ILO; june 2000) .

4.1.2 Sex of respondents

Source: Questionnaire survey

Figure 4.2 shows that a majority of the respondents 37(62%) were males whereas females

were 23(38%).

33

Figure 4.3: Respondents’ Education level

4.1.3 Education level of respondents

Source: Questionnaire survey

Figure 4.3 shows a distribution of respondents according to education level; whereby a

majority of the respondents were bachelors degree holders accounting for 32(54%), diploma

and Advanced level qualifications had 11(18%) respondents each, whereas Respondents with

postgraduate training and Ordinary level both accounted for 3(5%) of the respondents. The

respondents of the study were therefore well educated and gave informed views about the

issues being investigated in the study.

4.1.4 Length of employment of respondents

Source: Questionnaire survey

Figure 4.4: Respondents’ length of employment

34

Figure 4.4 shows a distribution of respondents according to length of employment from

where it was observed that a majority of the respondents 28(46%) were employed for 1-3

years, 16 (27%) were employed for less than one year, 10 (17%) were employed for 3-5 years

whereas the least number of respondents 6 (10%) were employed for less than a year. The

results show that there is a variation in the length of employment amongst the respondents

with some respondents having worked in the organisations for a short period of time whereas

others worked for a long period. These results are an indicator that the views that they

presented were representative of the situation as it was at the time of the study and also how it

was in the past. The findings were therefore representative of a long period of time.

4.1.5 Job rank of respondents

Source: Questionnaire survey

Figure 4.5 shows a distribution of respondents according to job rank, where it was observed

that a majority of the respondents 42(70%) were officers/ facilitators, 11(18%) were

assistants whereas 7(12%) were managers. These results show that representative views were

got from all employee ranks right from management to junior staff. This was vital to the

study in that HIV/AIDS affects everyone in the work place irrespective of rank and therefore

the views from all categories of people in the workplace were needed for the study.

4.2 Level of exposure of the employees to the HIV/AIDS workplace policy

The first objective of this study was to establish the level of exposure of the employees to the

HIV/AIDS workplace policy in their respective organisations. The analysis for this objective

was presented under the themes of: familiarity with the work place HIV/AIDS policy,

familiarity of HIV/AIDS policy by sex and familiarity of HIV/AIDS policy by age.

Figure 4.5: Job rank of respondents

35

With reference to a 5 point likert scale, descriptive statistics were generated to examine the

level of exposure of employees to their workplace policy. The parameters in the likert scale

included very high extent, high extent, moderate extent, low extent and very low extent.

These parameters served to show the degree to which respondents were familiar with the item

in question.

4.2.1 Familiarity with the work place HIV/AIDS policy

Table 4.1: Familiarity to HIV/AIDS policy

Response Frequency Percent

Very High Extent 8 13.3

High Extent 14 23.3

Moderate Extent 14 23.3

Low Extent 15 25

Very Low Extent 9 15

Total 60 100.0

Mean 3.05

Std. Deviation 1.281

Source: Questionnaire survey

Respondents were asked to state the extent to which they are familiar with their workplace

HIV/AIDS policy. Table 4.1 shows that a majority of the respondents 15(25%) reported that

they are familiar with their workplace HIV/AIDS policy to a low extent whereas the least

number 8(13.3%) mentioned that they were aware of the HIV/AIDS policy to a very low

extent. A mean score of 3.05 implies that the respondents were moderately familiar with their

work place HIV/AIDS policy.

However, a standard deviation of 1.281 implies a wide variation in familiarity of HIV/AIDS

policy by the respondents. The implication of this is that whereas there were many

respondents whose awareness of the work place HIV/AIDS policy was high, there were also

many respondents whose awareness of the HIV/AIDS policy was low. These results are not

encouraging because the respondents have been in employment with their organizations for

quite a long time and should have been exposed to the policy in some way or another given

the fact that HIV/AIDS are of great concern in the workplace. This can be a consequence of

36

poor implementation of the HIV/AIDS work place policy. Furthermore, even those who may

be familiar with the policy may not take it very seriously as shown by a study conducted by

Chetty in 2006 which showed that despite the existence of a policy and formal commitment

to its values and objectives, practices that work against the spirit of the policy often continue

especially Stigma and discrimination.

Esu-Williams et al., (2005) recommends that it is necessary for any company to; once it has

implemented an HIV/AIDS workplace programme, embark on an evaluation process of that

intervention. The reason for this is to determine if the programme is addressing the issues that

it was intended to deal with.

4.2.2 Familiarity with the workplace HIV/AIDS Policy by Sex

Table 4.2 Sex and Familiarity with the workplace HIV/AIDS policy Cross tabulation

Familiarity with the workplace HIV/AIDS Policy Total

Very High

Extent

High

Extent

Moderate

Extent

Low

Extent

Very Low

Extent

Sex Male 5 9 5 11 7 37

Female 3 5 9 4 2 23

Total 8 14 14 15 9 60

Source: Questionnaire survey

A cross-tabulation was carried out to find out familiarity levels of employees with their

workplace HIV/AIDS policy among males and females. Table 4.2 shows that males mostly

reported to be familiar with the organization‟s HIV/AIDS policy to a low extent whereas

females mostly mentioned that they are familiar to a moderate extent. The results are an

indication that more work is needed to make both sexes familiar with the policy and with

more attention given to the males.

37

4.2.3 Familiarity with the workplace HIV/AIDS Policy by Age

Table 4.3: Age Bracket and Familiarity with workplace HIV/AIDS policy Cross

tabulation

Familiarity to HIV/AIDS policy Total

Very

High

Extent

High

Extent

Moderate

Extent

Low

Extent

Very Low

Extent

Age

Bracket

21-30years 5 3 7 6 5 26

31-40years 2 4 1 4 3 14

41-50years 1 6 6 3 0 16

50years+ 0 1 0 2 1 4

Total 8 14 14 15 9 60

Source: Questionnaire survey

A cross tabulation was carried out to find out familiarity levels of respondents with their

workplace HIV/AIDS policy among the age groups. Table 4.3 shows that the respondents in

the age group of 21 to 30 years mainly reported that they were familiar to their workplace

HIV/AIDS policy to a moderate extent, those in the age group of 31 to 40 years mentioned

that they were aware of the policy to a high extent and low extent accounting for 4

respondents each, the respondents in the age group between 41-50 years were familiar with

the policy to a higher extent whereas those in the age group 50 and above were familiar with

the policy to a lower extent. The results are an indication the awareness of the HIV/AIDS

policy is lower among the younger people and yet HIV/AIDS problem affects them the more.

4.3 The functionality of the workplace HIV/AIDS policies

The second objective of the study was to investigate the functionality of the work place

HIV/AIDS policies. The analysis for this objective was presented under the following

themes: Recognition of HIV/AIDS policy as a workplace issue, HIV/AIDs policy and the

principle of non discrimination, HIV/AIDS policy and the issue of a healthy work

environment, HIV/AIDS policy and encouragement of social dialogue on HIV/AIDS issues,

HIV/AIDS policy and supporting prevention initiatives on HIV/AIDS, HIV/AIDS policy and

38

staff care and support with regard to HIV/AIDS and HIV/AIDS policy and continuation of

employment relationship.

With reference to a 5 point Likert scale, descriptive statistics were generated to examine the

functionality of the workplace HIV/AIDS policies according to the perceptions of the

employees. The parameters in the Likert scale included strongly agree, agree, don‟t know,

disagree, and strongly disagree. These parameters served to show the degree to which

respondents agreed or disagreed with the item in question.

4.3.1 Recognition of HIV/AIDS as a workplace issue

Table 4.4: Perceptions of respondents on Recognition of HIV/AIDS as a workplace issue

Response Frequency Percent

Strongly Agree 18 30

Agree 27 45

Don‟t know 5 8.3

Disagree 6 10

Strongly Disagree 4 6.7

Total 60 100

Mean 2.18

Std. Deviation 1.172

Source: Questionnaire survey

Respondents were asked whether their companies recognize HIV/AIDS as a workplace issue.

Table 4.4 shows that majority of the respondents agreed that their organization recognizes

HIV/AIDS as a work place issue, whereas the least 4 (6.7%) strongly disagreed. A mean on

2.18 shows that a majority of the respondents agreed that their organization recognizes

HIV/AIDS as a work place issue. A standard deviation of 1.172 shows a small variation

among the perceptions of the respondents. This implies the respondents generally felt that

their workplace recognizes HIV/AIDS as a work place issue. The fact that HIV/AIDS is

recognised as a work place issue is in line with The International Labor Organization (ILO)

which provides a comprehensive framework which addresses how Persons Living with

HIV/AIDS should be handled at the workplace. It also has a policy document which guides

the design and development of workplace HIV/AIDS issues and spells out the salient issues

and how they are to be observed by employers.

39

Similarly, Stellenbosch University and the USAID Health Policy Initiative, (2008) suggests

that recognition of HIV/AIDS should be carried out in an organization through awareness

programmes as one of the key elements of a workplace HIV/AIDS program.

However, the creation of awareness programmes is a big challenge to orgainsations as

indicated by UNAIDS, (1998) which says that organisations face enormous challenges in

responding to HIV/AIDS through processes such as setting up comprehensive, sustainable

programmes, adopting relevant policies, obtaining management commitment, ensuring

confidentiality and non-discrimination, supporting staff who are living with HIV/AIDS,

dealing with attitudes of co-workers and sustaining involvement.

4.3.2 HIV/AIDs policy and the principle of non-discrimination

Table 4.5: Responses on organizations’ HIV/AIDS policy and the principle of non-

discrimination

Response Frequency Percent

Strongly Agree 29 48.3

Agree 17 28.3

Don‟t Know 4 6.7

Disagree 4 6.7

Strongly disagree 6 10

Total 60 100

Mean 2.02

Std. Deviation 1.321

Source: Questionnaire survey

Respondents were asked whether their organization‟s HIV/AIDS policy promotes the

principle of non-discrimination. Table 4.5 shows that majority of the respondents 29 (48.3)

strongly agreed that their organization‟s HIV/AIDS policy promotes the principle of non-

discrimination. A mean of 2.02 is indicative that a majority of the respondents agreed that

their organizations HIV/AIDS policy promotes the principle of non-discrimination. A

standard deviation of 1.321 shows a relatively large variation among the perceptions of the

respondents, implying that whereas respondents generally felt that their workplace

HIV/AIDS policy promotes the principle of non-discrimination, a number of them disagreed.

40

Kauffman and Lindauer (2004), mention that the issue of discrimination is an important

aspect in workplace HIV/AIDs policy because a climate of discrimination and lack of respect

for human rights leaves workers more vulnerable to infection and less able to cope with

AIDS because it makes it difficult for them to seek voluntary testing, counselling, treatment

or support; they will also not be in a position to take part in advocacy and prevention

campaigns. Moreover, individuals who suffer discrimination and lack of respect for their

human rights are both more vulnerable to becoming infected and less able to cope with the

burdens of HIV/AIDS (Kauffman and Lindauer 2004).

ILO‟s policy regarding personnel issues emphasises that employers should not engage in nor

permit any personnel policy or practice that discriminates against workers infected with or

affected by HIV/AIDS.

4.3.3 HIV/AIDS policy and the issue of a healthy work environment

Table 4.6: Responses on HIV/AIDS policy and the issue of a healthy work environment

Response Frequency Percent

Strongly agree 18 30

Agree 23 38.3

Don‟t know 6 10

Disagree 10 16.7

Strongly disagree 3 5

Total 60 100

Mean 2.28

Std. Deviation 1.209

Source: Questionnaire survey

Respondents were asked whether their organization‟s HIV/AIDS policy addresses the issue

of a healthy work environment. Table 4.6 shows that Majority of the respondents 23 (38.3)

agreed, whereas the least number of respondents 3 (5%) strongly disagreed. A mean of 2.28

shows that a majority of the respondents agreed that their organization‟s HIV/AIDS policy

addresses the issue of a healthy work environment. A standard deviation of 1.209 shows a

relatively large variation among the perceptions of the respondents, implying that whereas

41

respondents generally felt that their workplace HIV/AIDS policy addresses the issue of a

healthy work environment, a number of them actually disagreed.

These findings show that the organisations‟ policies are in line with ILO‟s code of practice on

HIV/AIDS and the World of Work (2001) which provides that employers should ensure a

safe and healthy working environment, including the application of Universal Precautions

and measures such as the provision and maintenance of protective equipment and first aid.

The policy further provides that to support behavioural change by individuals, employers

should also make available, where appropriate, male and female condoms, and counselling,

care, support and referral services. Where size and cost considerations make these difficult,

employers and/or their organizations should seek support from government and other relevant

institutions

4.3.4 HIV/AIDS policy and encouragement of social dialogue on HIV/AIDS issues

Table 4.7: Responses on HIV/AIDS policy and encouragement of social dialogue on HIV/AIDS

Responses Frequency Percent

Strongly agree 9 15

Agree 21 35

Dont know 6 10

Disagree 14 23.3

Strongly disagree 10 16.7

Total 60 100

Mean 2.92

Std. Deviation 1.369

Source: Questionnaire survey

Respondents were asked whether their organization‟s HIV/AIDS policy encourages social

dialogue on HIV/AIDS issues among employees. Table 4.7 shows that Majority of the

respondents 21 (35%) agreed, while few respondents 6 (10%) did not know. A mean of 2.92

shows that a majority of the respondents were not sure if their organizations HIV/AIDS

policy encourages social dialogue on HIV/AIDS issues among employees. A standard

deviation of 1.369 shows a relatively large variation among the perceptions of the

respondents. The responses were evenly distributed across all perceptions.

42

The National Plan of Action for Implementing the National Policy on HIV/AIDS and the

World of Work, (2010) provides that private organizations have the responsibility of

promoting social dialogue and advocacy for inclusion of workplace HIV/AIDS programmes,

ensuring employers‟ involvement and participation in the HIV/AIDS campaign.

Apart from Social dialogue, other activities should be promoted and carried out such as

impact assessment of HIV/AIDS on an organisation, HIV and AIDS awareness programmes,

voluntary counselling and testing for HIV, HIV and AIDS education and training, condom

distribution, encouraging health treatment for STIs and TB, universal infection and control

procedures, creating an open and accepting environment, wellness programmes for

employees affected by HIV and AIDS, provision of anti-retroviral treatment or referral to

relevant service providers, education and awareness about anti-retroviral treatment and other

treatment literacy programmes, counselling and other forms of social support for HIV-

positive employees, reasonable accommodation for HIV-positive employees, strategies to

address direct and indirect costs and other practical implications of HIV and AIDS

monitoring, evaluation and review of the programme.

4.3.5 HIV/AIDS policy and strengthening confidentiality

Table 4.8: Responses on HIV/AIDS policy and strengthening confidentiality

Response Frequency Percent

Strongly Agree 18 30

Agree 24 40

Don‟t know 7 11.7

Disagree 8 13.3

Strongly disagree 3 5

Total 60 100

Mean 2.32

Std. Deviation 1.546

Source: Questionnaire survey

Respondents were asked whether they felt that their organization‟s HIV/AIDS policy

emphasizes the need to strengthen confidentiality. Table 4.8 shows that Majority of the

respondents 24 (40%) agreed whereas the lowest number of respondents 3 (5%) strongly

disagreed. A mean of 2.32 shows that a majority of the respondents agreed that their

43

organization‟s HIV policy emphasizes the need to strengthen confidentiality. A standard

deviation of 1.546 shows a relatively large variation among the perceptions of the

respondents. This implies that whereas some respondents agreed that their organization‟s

HIV policy emphasizes the need to strengthen confidentiality others felt the contrary. These

findings are in line with the World of Work (2001),which recommends that HIV/AIDS-

related information of workers should be kept strictly confidential and kept only on medical

files, whereby access to information complies with the Occupational Health Services

Recommendation, 1985 (No. 171), and national laws and practices. Access to such

information should be strictly limited to medical personnel and such information may only be

disclosed if legally required or with the consent of the person concerned.

4.3.6 HIV/AIDS policy and supporting prevention initiatives on HIV/AIDS

Table 4.9: Responses on HIV/AIDS policy and supporting prevention initiatives on HIV/AIDS

Response Frequency Percent

Strongly agree 22 36.7

Agree 15 25

Don‟t know 7 11.7

Disagree 11 18.3

Strongly disagree 5 8.3

Total 60 100

Mean 2.37

Std. Deviation 1.365

Source: Questionnaire survey

Respondents were asked whether they felt that their organizations‟ HIV/AIDS policy

supports prevention initiatives on HIV/AIDS at their work place. Table 4.9 shows that

Majority of the respondents 22 (36.7%) strongly agreed whereas the least number of

respondents 5(8.3%) strongly disagreed. A mean of 2.37 shows that a majority of the

respondents agreed that their organisation's HIV policy supports prevention initiatives on

HIV/AIDS at the work Place. A standard deviation of 1.365 shows a relatively large variation

among the perceptions of the respondents. This implies that whereas some respondents

agreed that their organisation's HIV policy supports prevention initiatives on HIV/AIDS at

the work Place a reasonable number of others felt the contrary. The 2011 Uganda AIDS

44

Indicator Survey (UAIS) identifies a continued need for individual behaviour change, and

scale-up of evidence-based prevention interventions such as prevention of mother-to-child

transmission services and safe male circumcision, as well as increased treatment coverage for

people living with HIV. Interventions should be targeted to those most-at-risk populations

and must pay particular attention to those regions and districts most heavily impacted by the

epidemic. Similarly prevention interventions should be carried out in workplaces as

recommended by the ILO Code of Practice on HIV/AIDS and the World of Work (2001)

provides that Workers and their organizations should endeavour to include provisions on

HIV/AIDS protection and prevention in national, sectoral and workplace/enterprise

agreements.

4.3.7 HIV/AIDS policy and staff care and support with regard to HIV/AIDS

Table 4.10: Responses on HIV/AIDS policy and staff care and support

Response Frequency Percent

Strongly agree 6 10

Agree 20 33.3

Don‟t know 9 15

Disagree 10 16.7

Strongly Disagree 15 25

Total 60 100

Mean 3.13

Std. Deviation 1.384

Source: Questionnaire survey

Respondents were asked whether they felt that their organization‟s HIV/AIDS policy deals

with staff care and support with regard to HIV/AIDS. Table 4.10 shows that Majority of the

respondents 20 (33.3%) agreed whereas the least number of respondents 6(10%) strongly

agreed. However, a mean of 3.13 shows that there was general uncertainty amongst the

respondents as regards to their perceptions on whether HIV/AIDS policy deals with staff care

and support with regard to HIV/AIDS. A standard deviation of 1.365 shows a relatively large

variation among the perceptions of the respondents. One of the five main initiatives

mentioned by the International Organisation of Employers (2002) that an organisation can

45

take to respond to HIV/AIDS in the workplace is providing care and support in the

workplace.

A good HIV and AIDS workplace programme is one that is action-oriented and one that an

organisation will implement in order to prevent new HIV infections, provide care and support

for employees who are infected or affected by HIV or AIDS, manage the impact of the

epidemic on the organisation and also outlines how all the different principles within the

policy will be translated into practice at the workplace.

4.3.8 HIV/AIDS policy and continuation of employment relationship

Table 4.11: Responses on HIV/AIDS policy and continuation of employment relationship

Responses Frequency Percent

Strongly agree 27 45.0

Agree 9 15.0

Don‟t know 5 8.3

Disagree 8 13.3

Strongly disagree 11 18.3

Total 60 100.0

Mean 2.45

Std. Deviation 1.599

Source: Questionnaire survey

Respondents were asked whether they felt that their organization‟s HIV/AIDS addresses the

continuation of employment relationship. Table 4.11 shows that Majority of the respondents

27(45%) strongly agreed whereas the least number of respondents 5(8.3%) did not know. A

mean of 2.45 shows that there was general agreement amongst the respondents as regards to

their perceptions on whether organization‟s HIV/AIDS addresses the continuation of

employment relationship. A standard deviation of 1.599 shows a relatively large variation

among the perceptions of the respondents.

According to the Kenya public sector workplace policy on HIV and AIDS, (2005) HIV

infection is not a cause for termination of employment. Persons with HIV related illnesses

should be allowed to work for as long as medically fit in available appropriate work.

46

4.4 Challenges faced in implementation of HIV/AIDS policy

The third objective of the study was to establish the most pressing problem faced in the

implementation of the work place policies by private organizations. A focused group

discussion was carried out with the respondents and a pair wise ranking matrix was used to

establish the challenges faced most in the implementation of the HIV/AIDS polices in the two

organizations. Pair wise ranking is a method in which each item on a list is compared in a

systematic way with each other. To construct this table, each problem was compared in turn

with each of the other problems.

Table 4.12: Pair wise matrix ranking of challenges faced in implementation of HIV/AIDS policy

Problem Problem number Score Rank

1 2 3 4 5 6 7 8 9 10

1. Lack of management commitment 2 3 4 5 6 7 8 9 10 0 10

2. Weak emphasis on confidentiality and non-

discrimination

2 4 2 2 2 8 2 2 7 3

3 Lack of support for staff with HIV/AIDS 4 3 3 3 8 3 3 6 4

4 Negative attitudes of co-workers and lack

of involvement in HIV/AIDS programs

4 4 4 8 4 4 8 2

5 Gender inequality in our organisation 5 5 8 9 10 3 7

6 The work environment is not socially well

maintained

6 8 9 10 2 8

7 Little money allocated for HIV/AIDS work 8 9 10 1 9

8 Stigma and discrimination against

employees who are HIV positive.

8 8 9 1

9 Social dialogue on HIV/AIDS issues is hard

to foster at work.

10 4 6

10 Prevention initiatives are quite costly for the

organisation in terms of time and money

5 5

Source: Focus group discussion

Table 4.12 shows a pair wise ranking of the most pressing challenges faced in the

implementation of the HIV/AIDS policies in the organizations. It can be seen that the highest

ranked problem is Stigma and discrimination of employees who are HIV/AIDS positive had a

score of 9 and was thus ranked number 1 by the respondents. These findings are in line with

the Academy for Educational Development, (2004) that found that among the greatest

47

challenges in addressing HIV/AIDS are stigma and discrimination which often result from

fear caused by myths, misinformation, and a lack of knowledge about how HIV is and is not

transmitted. The negative effects of workplace stigma and discrimination can be substantial,

both to the business and to workers themselves.

The second ranked challenge was negative attitudes of workers and lack of involvement in

the implementation of the HIV/AIDS policies with a score of 8. These findings are consistent

with UNAIDS, (1998) that says that organisations face enormous challenges in responding to

HIV/AIDS such as dealing with attitudes of co-workers and sustaining involvement.

Lack of confidentiality and non discrimination also ranked highly at number 3 with a score of

7. UNAIDS, (1998) further adds that organisations face enormous challenges ensuring

confidentiality and non-discrimination in the workplace.

Other problems included lack of support for HIV/AIDs workers ranked at number 4 with a

score of 6, Prevention initiatives being quite costly for the organisation in terms of time and

money rank 5 with a score of 5, Social dialogue on HIV/AIDS being hard to foster at work

,rank 6 with a score of 4, Gender inequality in the organization rank 7 with a score of 3, the

work environment not socially well maintained rank 8 with a score of 2, Little money

allocated for HIV/AIDS work was at rank 9 with a score of 1 whereas lack of commitment to

tackle the HIV/AIDS issue ranking last with no score.

These results are consistent with The Interagency Coalition on AIDS and Development

(2004), which gives a general outline of some of the challenges facing the development and

implementation of Workplace HIV/AIDS policies as; the level of staff participation required

in terms of research and policy development, implementation, communication, monitoring

and adjustments; perceived costs involved in training; the duty to accommodate altered work

schedules; legal input and associated costs; possible costs for consultant to research and

develop policy; regular review necessary; different codes and standards between

organizations, union and non-union requirements; considerations for parity; stigma and/or

discrimination; and lack of human and financial resources as well as attitude issues around

willingness to develop such a policy.

48

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

The purpose of the study was to assess the implementation of HIV/AIDS policies in private

institutions in Uganda with Reproductive Health Uganda, and Uganda Telecom Limited as

case studies. This final chapter comprises a summary, conclusions and recommendations

basing on the findings of the study.

5.1 Summary

The main findings are summarised in terms of the stated objectives and sub-sections of the

questionnaire.

5.1.1 Level of exposure of employees to their HIV/AIDS workplace policy

The first objective of this study was to establish the level of exposure of employees to the

workplace HIV/AIDS policy in their respective organizations.

The majority of respondents reported a low extent of familiarity with their workplace

HIV/AIDS policy, whereas the least reported that they were fully familiar with the policy. A

mean score of 3.05 showed that the respondents were moderately familiar with their work

place HIV/AIDS policy. However, a standard deviation of 1.281 showed a wide variation in

familiarity with the workplace HIV/AIDS policy by the respondents implying that whereas

the respondents were aware about their work place HIV/AIDS policy, the level of awareness

in a number of them was low.

Males mostly reported a low extent of familiarity with their organizations HIV/AIDS policy,

whereas females reported familiarity to a moderate extent.

In terms of awareness and age brackets, the younger people appeared to be less aware of the

existence of their workplace HIV/AIDS policy as compared to the older people.

49

5.1.2 The functionality of the workplace HIV/AIDS policies

The second objective of the study was to investigate the functionality of the work place

HIV/AIDS policies.

A mean of 2.18 and a standard deviation of 1.172 showed that majority of the respondents

agreed that their organization‟s policy recognizes HIV/AIDS as a work place issue.

With a mean of 2.02, the study also found that majority of the respondents agreed that their

organization‟s HIV/AIDS policy promotes the principle of non-discrimination. However with

a standard deviation of 1.321, there was a relatively large variation among the perceptions of

the respondents indicating that a good number of respondents disagreed.

The majority of the respondents agreed that their organization‟s HIV/AIDS policy addresses

the issue of a healthy work environment. This was represented by the mean score of 2.28.

But, whereas respondents generally felt that their workplace HIV/AIDS policy addresses the

issue of a healthy work environment, a relatively large variation in their perception

represented by a standard deviation of 1.209 was also reported.

A mean on 2.92 showed that majority of the respondents were not sure if their organization‟s

HIV/AIDS policy encourages social dialogue on HIV/AIDS issues among employees. With a

standard deviation of 1.369, a relatively large variation among the perceptions of the

respondents is seen; implying that the responses were evenly distributed on all perceptions.

A mean of 2.32 showed that majority of the respondents agreed that their organization‟s HIV

policy emphasizes the need to strengthen confidentiality. However, a standard deviation of

1.546 shows a relatively large variation among the perceptions of the respondents. This

implies that whereas some respondents agreed that their organization‟s HIV policy

emphasizes the need to strengthen confidentiality others felt the contrary.

A mean of 2.37 showed that a majority of the respondents agreed that their organisation's

HIV/AIDS policy supports prevention initiatives on HIV/AIDS at the workplace. However, a

standard deviation of 1.365 shows a relatively large variation among the perceptions of the

respondents. This implies that whereas some respondents agreed that their organisation's

HIV/AIDS policy supports prevention initiatives on HIV/AIDS at the workplace, a

reasonable number of others felt otherwise.

50

A mean of 3.13 showed that there was general uncertainty amongst the respondents on how

they felt their workplace HIV/AIDS policy addresses staff care and support with regard to

HIV/AIDS. However, a standard deviation of 1.365 shows a relatively large variation among

the perceptions of the respondents implying an even distribution of those who agreed and

disagreed that it is well addressed.

A mean of 2.45 shows that there was general agreement amongst the respondents as regards

their perceptions on whether their organization‟s HIV/AIDS policy addresses the

continuation of employment relationship. The standard deviation of 1.599 shows a relatively

large variation among the perceptions of the respondents implying that a good number of

respondents actually disagreed.

5.1.3 Challenges faced in implementation of HIV/AIDS policy

The third objective of the study was to establish the most pressing problem faced in the

implementation of the workplace policies by private organizations.

A pair wise ranking of the most pressing problems being faced in the implementation of the

HIV/AIDS policies of the organizations showed that the highest ranked problems were

stigma and discrimination of people with HIV/AIDS, negative attitudes of workers towards

employees living with HIV/AIDS; lack of involvement by employees in the implementation

of their workplace HIV/AIDS policies and Lack of confidentiality and non-discrimination in

addressing HIV/AIDS among employees.

Other problems included lack of support for HIV/AIDs positive employees, prevention

initiatives being quite costly for the organisation in terms of time and money, social dialogue

on HIV/AIDS being hard to foster at the workplace, gender inequality in the organization, the

work environment not socially well maintained, little money allocated for HIV/AIDS issues

and lack of commitment by management to tackle the issue of HIV/AIDS at work.

5.2 Conclusion

The purpose of the study was to assess the implementation of HIV/AIDS policies in private

institutions in Uganda. This was done by establishing the level of exposure of employees to

their workplace HIV/AIDS policies, the functionality of workplace HIV/AIDS policies and

the challenges faced in implementation of the workplace HIV/AIDS policies.

51

The study revealed that though majority of the respondents were familiar with their

organisation‟s HIV/AIDS policies, there was a disparity in familiarity in terms of gender and

age with women and the older people more familiar.

The study also revealed that most private organizations‟ workplace HIV/AIDS policies are

functional to a small extent; but some issues in the policies are not well addressed.

Finally, the study reveals that the effective implementation of workplace HIV/AIDS policies

in private organisations is hampered by a range of challenges.

It can therefore be concluded that despite the fact that private organisations strive to

implement their workplace HIV/AIDS policies, the capacity to meet their objectives is

influenced by gender, age, management of the implementation of those policies and the

unique challenges that arise from the implementation of such a unique policy.

5.3 Recommendations

It is recommended that the employees especially the males and the young should be

encouraged to orient themselves with their workplace HIV/AIDS policy and that they should

be encouraged to become familiar with its contents.

It is also recommended that private organisations should design well formulated programmes

and include the various HIV/AIDS policy instruments so as to ensure that the HIV/AIDS

policies are well implemented.

All the challenges that inhibit the success of the implementation of these policies should be

identified and addressed.

Private organisations should allocate adequate funding for their workplace HIV/AIDS policy

implementation.

References

ACADEMY FOR EDUCATIONAL DEVELOPMENT. (2004). A Workplace Guide for Managers

and Labor Leaders: HIV/AIDS Policies and Programs. Publisher, place of publication

do this for all references

ALAGARI, P., SUMMERS T, KATES J. Trends in U.S. Spending on HIV/AIDS. Henry J. Kaiser

Family Foundation. July 2002. www.kff.org.

52

ALAGARI, P., SUMMERS T, KATES, J. Federal HIV/AIDS Spending: A Budget Chartbook – Fiscal

Year 2002.

ATTIA, S. et al., (2009). Sexual Transmission of HIV according to viral load and antiretroviral

therapy: systematic review and meta – analysis. AIDS, 23:1397-1404.

BENDELL, J. 2003. Waking up to risk: corporate responses to HIV/AIDS in the workplace. Geneva:

UNRISD and UNAIDS.

BOLTON-MOORE, C, et al. (2007). Clinical outcomes and CD4 cell response in children receiving

antiretroviral therapy at primary health care facilities in Zambia. Journal of the

American Medical Association, 298(16):1888-1899.

BONG, C. et al. (2007). Risk factors for early mortality in children on adult fixed-dose combination

antiretroviral therapy in a central hospital in Malawi. AIDS, 2:1905-1810.

BOULLE, A, et al. (2008). Antiretroviral therapy and early mortality in South Africa. Bulletin of the

World Health Organization, 86:678-687.

BUSSMANN H et al. (2008). Five-year outcomes of initial patients treated in Botswana’s national

antiretroviral treatment program. AIDS, 22(17):2303-2311.

CENTERS FOR DISEASE CONTROL AND PREVENTION (2008). HIV prevalence estimates –

United States, 2006. Morbidity and Mortality Weekly Report, 57(39): 1073-1076.

COUNCIL ON FOUNDATIONS. “Trends in Grandmaking”. Corporate Update, Winter 2003, page

6.

DESMOND, C., KARAM, L. & STEINBERG, M. (2003). Still everybody’s business: the

enlightening truth about AIDS. Bellville: Metropolitan Group.

53

DEVELOPMENT MANAGEMENT ASSOCIATES (2002). “Situation Analysis of HIV/AIDS in

Botswana”; a report prepared for the Government of Botswana, July 2002.

ESU-WILLIAMS.2005. Strengthening workplace HIV/AIDS programs: The Eskom experience in

South Africa. Johannesburg: Population Council/Horizons.

GRAY, D. E. (2004). Doing Research in the Real World. SAGE.

GRAY, R.H, LI, X., KIGOZI, G., SERWADDA, D., NALUGODA, F., WATYA, S., REYNOLDS,

S.J, WAWER. M. (2007). The impact of male circumcision on HIV incidence and cost

per infection prevented: a stochastic simulation model from Rakai, Uganda. AIDS. Apr

23;21(7):845-50.

HALL, HI. et al. (2008). Estimation of HIV incidence in the United States. Journal of the American

Medical Association, 300(5):520-529.

HALLETT, T., et al. (2008). Estimating incidence from prevalence in generalized HIV epidemics:

methods and validation. PLoS Medicine, 5(4):e80.

HALLETT, T.B. et al, (in press). Estimates of HIV incidence from household-based prevalence

surveys in sub-Saharan Africa. AIDS.

HENRY, J. KAISER FAMILY FOUNDATION. September 2003.

www.kff.org/content/2003/6076/6076v2.pdf.

HERBS, A.J. et al. (2009). Adult mortality and antiretroviral treatment roll-out in rural KwaZulu-

Natal, South Africa. Bulletin of the World Health Organization, 87:754-762.

ILO (2000). “HIV/AIDS: A Threat to Decent Work, Productivity and Development” Mimeo, (A

discussion paper for high-level meeting on HIV/AIDS and the World of Work), Geneva,

June 2000.

ILO (2000). HIV/AIDS in Africa: The Impact on the World of Work, Addis Ababa, December 2000.

INTERNATIONAL LABOUR ORGANIZATION, 2001. An ILO code of practice on HIV / AIDS and

the world of work. Geneva: ILO.

JAHN, A. et al., (2008). Population – level effect of HIV on adult mortality and early evidence of

reversal after introduction of antiretroviral therapy in Malawi. Lancet, 371:1603-1611.

54

JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS) AND THE

INTERNATIONAL ORGANISATION OF EMPLOYERS (IOE). (2002). Employers’

Handbook on HIV/AIDS – A Guide for Action.

JOINT UNITED NATIONS PROGRAMME ON HIV/AIDS (UNAIDS). Press release:

Implementing the Declaration of Commitment on HIV/AIDS. 22 September 2003.

www.unaids.org/html/pub/Media/Pressreleases01/UNGASS_Pressrelease_2003_en_doc.

htm.

KAJUBI, P., KAMYA, M.R., RAYMOND, H.F., et al. (2008), Gay and Bisexual Men in Kampala,

Uganda, AIDS Behaviour 12:492-504.

KAREN A. STANECKI & PETER O.(1996). The Demographic Impacts of HIV/AIDS Reprinted from

World Population Profile: 1996, U.S. Bureau of the Census, Washington, D.C. June

1996.

KAUFFMAN, K.D. & LINDAUER, D.L. (2004). AIDS and South Africa: the social expression of a

pandemic. New York: Palgrave Macmillan.

KIRUNGI, W.L., MUSINGUZI, J., MADRAA, E., MULUMBA, N., CALLEJJA, T., GHYS, P.,

BESSINGER, R. (2006). Trends in antenatal HIV prevalence in urban Uganda

associated with uptake of preventive sexual behaviour. Sex Transm Infect. 2006 Apr; 82

Suppl 1:i36-41.

KYADDONDO, D., NAKKAZI, P. AND SIU, G. (2005). Causes and perceptions about child

marriages in Maddu sub county Mpigi District, Kampala: Child Health and

Development Center Makerere University.

LIMA, V.C. et al. (2008). Expanded access to highly active antiretroviral therapy: a potentially

powerful strategy to curb the growth of the HIV epidemic. Journal of Infectious

Diseases, 198:59-67.

LOEWENSON, R. & KERKHOVEN, R. (1996); The Socio-Economic Impact of AIDS: Issues and

Options in Zimbabwe, SafAIDS, Colon Press, May 1996.

MAPHOSA, F. (2003). HIV/AIDS at the workplace: A study of corporate responses to the HIV/AIDS

pandemic. CODESRIA Bulletin, 2, 56-58.

MERMIN, J. et al. (2008). Mortality in HIV-infected Ugandan adults receiving antiretroviral

treatment and survival of their HIV-uninfected children: a prospective cohort study.

Lancet, 371:752-759.

55

MoH. (2009). HIV/AIDS Epidemiological Surveillance Report, GoU/MoH/ACP, Kampala, Uganda.

MUSICCO, M. et al. (1994). Antiretroviral treatment of men infected with Human Immunodeficiency

Virus type 1 reduces the incidence of heterosexual transmission. Archives of Internal

Medicine, 154(17):1971-1976.

NATIONAL COMMITTEE FOR RESPONSIVE PHILANTHROPY. The NCRP Quarterly, Summer

2003. p7.

NATIONAL ORGANIZATIONS RESPONDING to AIDS (NORA). Fiscal Year 2003 HIV/AIDS

Appropriations Recommendations. May 2003.

NEEMA, S., SSEKIWANUKA, J. and SSEDYABULE D. (2000), Children living in difficult

circumstances: vulnerability and coping mechanisms of child-headed households in

Rakai, Uganda. Kampala, Straight Talk Foundation.

ODIIT, M. (2008). A Review of the sources of Incident HIV Infections in Uganda, Modes of

Transmission Study: Uganda, GoU/UNAIDS/UAC Oct.2008.

ONEN, D. and OSO, Y. W. (2005). A concise approach to research methodology: (1st ed.), Options

printers and publishers: Kisumu.

OU, C et al., (2007). Identification of HIV-1 infected infants and young children using real-time RT

PCR and dried blood sports from Uganda and Cameroon. Journal of Virological

Methods, 144:109-144.

OUNDO G. and SIU, G. (2006). Sexual and Reproductive Behavior Among People Living With

HIV/AIDS (PHA) In Busia District, A research report, funded by Child Health and

Development Centre.

PAGE, J, LOUW, S, PAKKIRI, D & JACOBS, M. (2006). Working with HIV/AIDS. Cape Town:

Juta And Company LTD.

PHARAOH, R. & SCHONTEICH, M. (2006). AIDS, Security and governance in Southern Africa:

exploring impact. Johannesburg: Institute for Security Studies.

PSI (2006), Uganda: Understanding Current Attitudes to Condoms and Pre- Testing Messages in

Uganda, A study commissioned by PSI/Uganda Research Division for MoH, conducted

by Asingwire, N., S. Kyomuhendo, J. Kiwanuka.

56

RAU, B, ROBERTS, M & EMERY, A. 2002. Workplace HIV/AIDS programs. Arlington: Family

Health International.

SEHGAL, JAG M. (1999). The Labour Implications of HIV/AIDS and the World of Work, published

by ILO, Geneva, November 1999.

SERWADDA D, MUGERWA, R.D., SEWANKAMBO, N.K., LWEGABA, A., CARSWELL, J.W.,

KIRYA, G.B. (1985), Slim disease: a new disease in Uganda and its association with

HTLV-III infection, Lancet; 2:849-852.

SHISANA, O. et al. (2009). South African National HIV prevalence, incidence, behavior and

communications survey 2008: a turning tide among teenagers? Cape Town, South

Africa, HSRC Press.

Smart, R. (2004). HIV/AIDS Guide for the Mining Sector - A Resource for Developing Stakeholder

Competency and Compliance in Mining Communities in Southern Africa.

STELLENBOSCH UNIVERSITY and the USAID HEALTH POLICY INITIATIVE. (2008).

Developing an HIV and AIDS Policy: Content, Process, Challenges and Implementation.

STOVER, J. & BOLLINGER, L. (2000). “The Economic Impact of AIDS”, the Policy Project.

Quoted in UNAIDS/ Global Business Council on HIV and AIDS; The Business Response

to HIV/AIDS: Impact and Lessons Learned, Geneva and London, 2000.

THE NATIONAL ALLIANCE OF STATE AND TERRITORIAL AIDS DIRECTORS (NASTAD),

NASTAD 2003 Policy Priorities, June 2003.

www.nastad.org/documents/public/Public/Policy/200364NASTAD2003PolicyPriorities.

pdf.

UNAIDS (2007). Practical guidelines for intensifying HIV prevention. Geneva, UNAIDS.

UNAIDS (2008). Report on the global AIDS epidemic. Geneva, UNAIDS.

UNAIDS (2009). Joint action for results: UNAIDS outcome framework 2009-2011. Geneva.

UNAIDS.

UNAIDS. (1998). HIV/AIDS and the workplace: forging innovative business responses. Geneva.

UNAIDS.

UNAIDS. 2004. Sub-Saharan Africa fact sheet. Geneva: UNAIDS.

UNAIDS. Fact Sheet 2002: The Impact of HIV/AIDS. Geneva. UNAIDS.

57

UNAIDS. Fact sheet: Meeting the need: June 2003. At www.unaids.org/fact_sheets . Geneva.

UNAIDS.

UNAIDS. Report on the State of HIV/AIDS Financing: Programme Coordinating Board, 14th

Meeting UNAIDS/PCB (14)/03. Conference Paper 2a 25 June 2003. www.unaids.org,

www.businessfightsaids.org. and www.hivatwork.org. Geneva. UNAIDS.

UNDP (2001). “HIV/AIDS: Implications for Poverty Reduction”, (Policy Paper), June 2001, p 10;

and ILO; “HIV/AIDS: A Threat to Decent Work, Productivity and Development”

Mimeo, (A discussion paper for high-level meeting on HIV/AIDS and the World of

Work), Geneva, June 2000, p 21.

VIOLARI, A. et al. (2008). Early antiretroviral therapy and mortality among HIV-infected infants.

New England Journal of Medicine, 359:2233-2244.

WHITESIDE, A. & SUNTER, C. (2000). AIDS: the challenge for South Africa. Cape Town: Human

& Tafelberg.

WILLIAMS, B. et al. (2001). Estimating HIV incidence rates from age prevalence data in epidemic

situations. Statistics in Medicine, 20(13):2003-2016.

WORLD HEALTH ORGANIZATION (2008). World health statistics 2008. Geneva, World Health

Organization.

WORLD HEALTH ORGANIZATION, UNITED NATIONS CHILDREN‟S FUND, UNAIDS

(2009). Universal access: scaling up.

58

Appendix : Questionnaire

Serial No:

Introduction:

My name is Paul OLOYA, a student of M.A Development Studies at Uganda Martyrs

University, Nkozi. As a course requirement, I am undertaking a study titled “The Challenges

Facing Organizations in Implementing Workplace HIV/AIDS Policies: A Case Study of

Uganda Telecom Limited and Reproductive Health Uganda”. You have been selected as a

respondent to participate in this study. This study is voluntary and purely for academic

purposes. Respondents‟ identities and responses shall be kept confidential. I therefore request

you to spare a few minutes and respond to these questions. Please respond according to the

instructions given, and kindly respond to all questions.

Section A: BIO-DATA (INSTRUCTION: For 1-5, Tick against the response that best

applies to you)

1. Age Bracket:

(a) 21-30yrs:……… (b) 31-40yrs:……..

(c) 41-50yrs:……… (d) 51yrs ++:……..

2. Sex: (a) Male: ……….. (b) Female: ………..

3. Job Rank:

a) Assistant Officer: ……………………..

b) Officer/Supervisor: ……………………

c) Manager/Head of Department: ……….

4. Length of employment in this Organization:

(a) Less than 1 yr ……… (b) 1-3yrs………

59

(c) 3-5yrs ……… (d) More than 5yrs:………

5. Highest level of Education: (a) O‟ Level:…………

(b) A‟ Level:…………. (c) Diploma:…………..

(d) Bachelors:………… (e) Postgraduate:.……..

Section B: level of exposure of the employees to the HIV/AIDS workplace policy.

How strongly do you agree or disagree with the following statements about the HIV/AIDS

policy of your organization? (Tick in the box below the number which best represents your

view using the following key: (Strongly Agree [1], Agree [2], Don’t Know [3], Disagree

[4], Strongly Disagree[5])

Statement

1

2

3

4

5

a) My organization‟s HIV Policy recognizes HIV/AIDS as a

workplace issue

b) Promotes the principle of non-discrimination

c) Takes into account gender equality at the workplace

d) Addresses the issue of a healthy work environment

e) Encourages social dialogue on HIV/AIDS issues among

employees

f) Discourages screening for purposes of exclusion from work or

work processes

g) Emphasizes the need to strengthen confidentiality

h) Handles the issue of continuation of employment relationship

i) Supports prevention initiatives on HIV/AIDS at the workplace

j) Deals with care and support with regard to HIV/AIDS

Section C: Functionality of the HIV/AIDS Policy of the Organization

60

How strongly do you agree or disagree with the following statements about the functionality

of the HIV/AIDS policy of your organization? (Tick in the box below the number which best

represents your view using the following key: (Strongly Agree [1], Agree [2], Don’t Know

[3], Disagree [4], Strongly Disagree[5])

Statement 1

2

3

4

5

a) HIV/AIDS is recognized as a workplace issue

b) HIV positive people are not discriminated against at my workplace

c) Gender equality is encouraged in our organization

d) The issue of a healthy work environment is addressed in our

organization

e) Social dialogue on HIV/AIDS issues takes place in our

organization

f) Workers are not screened for purposes of exclusion from work or

work processes

g) Workers HIV status is kept secret and not disclosed openly without

their permission

h) Handles the issue of continuation of employment relationship

i) Our organization is actively involved in prevention of HIV/AIDS

at the workplace

j) Care and support is offered by our organization with regard to

HIV/AIDS

Section D: Challenges Facing Implementation of Workplace HIV/AIDS Policies

How strongly do you agree or disagree with the following statements about the challenges

faced by your organization in the implementation the HIV/AIDS policy? (Tick in the box

below the number which best represents your view using the following key: (Strongly Agree

[1], Agree [2], Don’t Know [3], Disagree [4], Strongly Disagree [5]).

Statement

1

2

3

4

5

a) HIV/AIDS is not recognized as a workplace issue

61

Statement

1

2

3

4

5

b) Preventing discrimination against HIV positive people is hard

c) There is gender inequality in our organization

d) The work environment is not socially well maintained

e) Social dialogue on HIV/AIDS issues is hard to foster at work

f) Screening of employees is difficult since HIV testing is

voluntary

g) Keeping the records of employees secret especially regarding

their HIV status is difficult

h) Managing employment relationship with HIV positive workers

is difficult

i) Prevention initiatives are quite costly for the organization in

terms of time and money

j) High cost of providing care and support to HIV positive

workers

Thank you very much for your time!