Use What You Have: Resolving the HIV/AIDS Pandemic

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Not all workplaces with a policy will have a program as shown in a South African study that found only The content of HIV prevention programs can also range from simply providing condoms to a whole range of continuum including treatment to employees. An inclusiveness process of policy formulation, development, and dissemination allows for wide consultation and negotiation on policy content as well as what is feasible for the employer. Leadership for policy gives it governance, representation, responsibility, and accountability as well as advocacy for its implementation [ 16 ].

It ensures championing and planning for resources in the overall organizational plans. Participation in programs by both management and employees affects successful implementation. This ensures that issues affecting different groups are addressed as key stakeholders. In a study that evaluated HIV and AIDS programs in the ministry of education in Zambia it was found that low management involvement in programs [ 17 ] affected employee morale to get involved in programs.

Another case study in Zambia [ 18 ] found that in spite of the widespread awareness External stakeholder involvement also necessary in ensuring linkages to key partners for services, support and resources mobilization.

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It also ensures that the workplace is kept abreast with new trends. Policy decisions are usually reflected in the resources allocated for program implementation [ 19 ]. Dedicating human, time, financial, infrastructure, and material resources affect implementation based on the quantities and quality allocated. Small workplaces may have limited capacity to fund programs compared to larger workplaces [ 15 ]. An assessment of the national HIV policy implementation in Guatemala and El Salvador [ 11 ] pointed out the lack of tools for monitoring and evaluating processes for workplace programs.

There was a lack of feedback which affected collaboration and the sharing of best practices, [ 21 ] making it difficult to understand what was working in policy implementation. Emerging issues from workplaces with policies show a lack of leadership roles, a lack of involvement in policy formulation and dissemination process [ 16 , 18 ], a low policy translation into programs [ 12 ] and a lack of participation in programs [ 18 , 22 ] and over dependency on donor support [ 20 , 23 ] for programs.

Workplaces have a notable difficulty with respect to monitoring and evaluation of programs [ 18 , 21 ]. There was limited current scholarly literature on private sector response to HIV in the workplace in Zambia with reports mainly focusing on public sector evaluations and partner reports. This was adapted from the health policy initiative.

It describes seven dimensions [ 11 ] that interact together in a complex policy environment that either facilitates or hinders successful implementation. An illustration of the conceptual framework for successful implementation of HIV and AIDS workplace policy as adapted from the health policy initiative [ 11 ].

The 7 dimensions of; 1. Context, 3. Leadership 4. Stakeholders, 5. Reasources, 6.

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Programs and 7. This definition was applied for this study. The study used this definition. We used this definition for this study.


The size of a workplace was defined by the number of employees [ 12 ]. The large workplaces had between and employees and the very large workplaces had more than employees. Implementation was defined as the process of putting a decision on HIV and AIDS workplace plans into effect by systematically executing them in order to achieve desired goals and targets [ 25 ]. Therefore the presence of a program, when a workplace had a policy, was defined as implementation, irrespective of the number of programs provided.

Key implementers were defined as individuals tasked by the workplace with the responsibility of organising and coordinating the HIV and AIDS workplace programs [ 13 ]. Stakeholders are people or groups of people, affected by the outcomes, negatively or positively, or those who can affect the outcomes of a proposed intervention [ 26 ]. These include employees, employers, management, financiers implementing partners, and donors [ 19 , 26 , 27 ].

The study was a mixed method study design that used quantitative and qualitative methods concurrently. With a population of 1. All these factors made Lusaka an ideal setup for the study. Study population were member companies of the Zambia Federation of Employers ZFE , the majority of whom are private sector organisations.

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We used a sampling frame from the Zambia Federation of Employers ZFE and simple random sampling, without replacement, was used to select workplaces to be contacted. Appointments for interviews were set with key implementers with permission from the workplace. Where: n 0 is the calculated sample size without considering the finite population in the above proportion calculation. This was adjusted to workplaces at a response rate of Purposive sampling was done for respondents that wanted to give in-depth explanation to quantitative responses already given.

As a result a total of 28 in depth interviews were conducted. This tool has been used to evaluate policy implementation in Guatemala [ 11 ] and El Salvador [ 21 ] among others. We also assessed how these were provided; onsite, through government clinics or subcontracted.

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The statistical software Stata version Measures of association using Chi-Square Test - Fishers exact were employed because the contingency table outputs had cell counts less than 5 on cross tabulations as a result of the scaled breakdown responses that used in assessing the extent to which a particular variable was addressed by the programs. Logistic regression was applied to categorical variables on policy and program.

Qualitative data was put into similar topics and coded based on related topics. This was then grouped according to whether the data was coming from a workplace with a policy, a program only, both, or none. The codes allowed for a systematic identification of themes into major and sub-themes [ 26 ]. A written transcript was then generated and integrated into the quantitative data report. Consent forms and data collection tools were kept separate and accessed only by the researcher and key stakeholders for research purposes only. Data was kept strictly confidential by the use of codes for both the company and key informants interviewed.

The majority of respondents were Human resources A breakdown on the availability of policy and programs in the overall sample and the private sector workplaces is shown in Fig. The distribution of HIV workplace policy and programs in workplaces surveyed including the private sector workplaces. The distributions shows the overall proportion of workplaces with a policy, the proportion of workplaces in the process of developing their policy, the overall proportion of workplaces with programs, the number workplaces with both programs and a policy and the overall proportion of the private sector workplaces, with a policy and with programs.

Logistic regression: on predictors of policy implementation found odds ratio at 2. Suggesting that the odds of having a policy for workplaces in this study were increased with increased size of a workplace by 2. Univariate analysis of top management support, funding mechanisms and having a specific budget for HIV were all statically significant when all other variables are held constant.

Human resources numbers were statistically not significant with odds ratio 1. Table 3. Illustrates the frequency distribution on a scaled response from key implementers on the extent to which workplace policy goals and objectives addressed 1. Gender and HIV, 2. A scale of responses from 1. Most are addressed a few missing , 3.

Some are addressed many missing and 4. Not addressed at all.

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Shows the distribution of responses from key workplace implementers in 47 workplaces with a policy on the extent of participation of employees and management in the policy formulation process of their HIV and AIDS workplace Policy. Policy Dissemination: We found that the majority of workplaces had wide dissemination that allowed for forums of discussion, Fig. Through interviews we found that workplaces used internal channels of communication such as emails, bulletins, meetings and workshops to disseminate their policy.

However we also found that ongoing dissemination had reduced overtime. Qualitatively, we found that a lack of action in approving drafted policies and rebuffing negative comments from some managers on the relevance of programs was seen as a lack of support. We found that effectiveness of committees was based on their active involvement in workplace programs. We found government level stakeholders whose roles were mainly to guide and mentor workplaces on implementation, these included;.

Afya Mzuri 2. We found that implementing partners were well coordination and transparent in implementation under Zambia workplace partnership. Mutual respect among the partners was reported to exist because these organizations are not in competition but work together to address the HIV and AIDS epidemic in Zambia. Some workplaces provided free HIV treatment to employees through their own clinic, a government clinics, an external provider or through a medical insurance schemes Table 5.

The extent to which selected epidemic drivers were addressed is illustrated in Fig. Sex workers and HIV as an epidemic driver were a concern in the agricultural sector and in workplaces that reported frequent traveling of their employees.

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Most respondents reported that they had difficulty in addressing this because it is a personal choice, as explained by one implementer,. However, workplaces providing medical health insurance for their employees felt that PMTCT was adequately covered in the health insurance scheme and there was no need to address it as a workplace. It was integrated in sexual harassment policies and some activities that correspond with national and international statutes on GBV. Some workplaces were also partnering with the victim support unit of the police and with gender experts in on GBV.

Many workplaces addressed it alongside GBV and condom utilisation as a cause of condom failure. We found that faith-based organisations, the drug enforcement unit of the police were among the partnerships that workplaces used to educate employees on alcohol and drug abuse. Through interviews we found that alcohol abuse affected productivity and safety in a number of workplaces, as explained by one implementer,. E specially during those days when tujilijili local name for packaged alcoholic spirits were common….

We also found that the use of champions on Male Circumcision was a key strategy in promoting voluntary male medical circumcision. Key implementers explained that this is because it is illegal in Zambia and not openly practiced. Some key implementers said it was also an uncomfortable subject because culturally it is perceived as a taboo and immoral, one implementer said,. The extent of participation in programs by managers, union leaders, and employees is illustrated in Fig.

Employees had wider participation compared to Top management. However we found that there were fewer females with moderate and wide participation compared to males. We also noted that moderate participation of males was more compared to that of females. Suggeting that workplaces with a policy were more likely to have more female participation in workplaces programs. Through interviews, we found that low participation of female employees in workplaces programs was attributed to cultural factors as female employees were generally reported to be shy when it came to talking openly about issues relating to sex and HIV and AIDS.

Extent of participation in programs for I. As is noted by a Lancet article , inaccessibility to healthcare is a substantial challenge individual health security, which collectively form global health security. The high number of individuals without adequate means to treatment poses a significant threat to global health security.

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One population which may continue to be of concern over long term are the children who have been affected by HIV. While the use of combination antiretroviral therapy has had tremendous success in preventing the transmission of HIV from expectant mothers to their children, infants who have been exposed to antiretroviral therapy during pregnancy have been found to have higher chances of adverse birth outcomes. The study found increased infant mortality, by as much as twofold, in children exposed to HIV and antiretroviral therapy during pregnancy.

In addition, prenatally exposed infants were more susceptible to infections. Antiretroviral treatment ART aims to suppress viral load to very low, or undetectable, levels, delaying HIV disease progression [ 2 , 3 ] and reducing the risk of onward transmission [ 4 ].


We commend Richard Hayes and colleagues for their success in navigating the complex logistic challenges in implementing a large-scale universal testing and treatment UTT intervention in sub-Saharan Africa, as described in their accompanying research article in PLOS Medicine [ 6 ]. They report how close they were able to come to reaching the first two stages of the 90—90—90 target in four communities in Zambia after one year of implementing their PopART intervention comprising home-based HIV testing by Community HIV care Providers [CHiPs] with support for linkage to care, adherence, and retention.

We note that many process indicators in the study were based on self-report and, apparently, data from the CHiPs electronic capture system were not verified with clinic data. The different approaches to the estimation of percentages in the HIV care cascade in these trials hinder direct comparison of results; hence, we agree with Hayes and colleagues that approaches for estimating proportions of people at different stages in the HIV cascade need to be harmonised. Hayes and colleagues report that it was challenging to find young men at home, again in line with experience elsewhere [ 10 ].

Slow linkage to care suggests that people will only attend facilities once they prioritise doing so, and this is especially pertinent before they are driven to do so by the development of HIV symptoms and signs. An earlier study in rural KwaZulu-Natal highlighted that linkage to care was significantly less likely in those who had never been in HIV care, students in education, and those further away from the clinic, while those who had positive experience of ART in friends or family were more likely to access the trial clinic [ 11 ].

Hayes and colleagues, although suggesting success of UTT in the first round of trial implementation, do not provide information about sustainability of either HIV test offer uptake or ART adherence, issues which may be especially important in settings with high migration movements.