Heterogeneity of the HIV epidemic in Lesotho Formative Assessment: MOHSW SECTORAL RESPONSE -MOHSW ACTIONS TAKEN AND TOOLS AVAILABLE - TO DATE DISSEMINATION- tools ADVOCACY FOR BUY IN- - PPP WELLNESS CHAMPIONS AND STRUCTURES ADVOCACY-WELLNESS ACTIVITIES M/E Tools Cost benefit analysis Learning and sharing Action Research : Sejojo Phaaroe 3D MEDIA

1. HIV and AIDS in the Workplace for
Health Workforce –
Formative Assessment:
Lesotho
Sejojo Phaaroe

2. Know where you are and where
you are going

3. Lesotho Mountain terrains

4. About Lesotho

5. OUT LINE
 Heterogeneity of the HIV epidemic in Lesotho
 Formative Assessment: MOHSW
 SECTORAL RESPONSE -MOHSW
 ACTIONS TAKEN AND TOOLS AVAILABLE - TO
DATE
 DISSEMINATION- tools
 ADVOCACY FOR BUY IN- - PPP
 WELLNESS CHAMPIONS AND STRUCTURES
 ADVOCACY-WELLNESS ACTIVITIES
 M/E Tools
 Cost benefit analysis
 Learning and sharing

6. Goal
HIV and AIDS in the Workplace Policy for Health Workforce
our programme must be designed to enable
behaviour change by providing employees
with tools that encourage and support HIV
negative employees to stay negative, and those
living with
HIV and AIDS to lead a
functional and productive life

7. There is no need to catch a ball if you
do not know where the goal is

8. Goal
 Sustainable
- process cycle / driven
- build capacity
- monitoring and evaluation
- record keeping
-cost benefit analysis
- efficacy
- Make alterations

9. HOW BIG IS THE
PROBLEM?
HIV AND AIDS
AMONGST HEALTH
CARE GIVERS AND
THEIR FAMILIES

10. Response?

11. Response?
I see how big it is but there is
nothing I can do!

12. Response!!!!
HIV and AIDS is a
workplace issue
Lets take immediate
strategic measurable
action!!!

13. A Major Pillar for any HIV program

14. Total: 33.2 (30.6 – 36.1) million
Western &
Central Europe
760 000
[600 000 – 1.1 million]
Middle East & North
Africa
380 000
[270 000 – 500 000]
Sub-Saharan Africa
22.5 million
[20.9 – 24.3 million]
Eastern Europe
& Central Asia
1.6 million
[1.2 – 2.1 million]
South & South-East
Asia
4.0 million
[3.3 – 5.1 million]
Oceania
75 000
[53 000 – 120 000]
North America
1.3 million
[480 000 – 1.9 million]
Latin America
1.6 million
[1.4 – 1.9 million]
East Asia
800 000
[620 000 – 960 000]
Caribbean
230 000
[210 000 – 270 000]
Adults and children estimated to be living with HIV
2007

15. Estimated number of adults and children
newly infected with HIV, 2007
Western &
Central Europe
31 000
[19 000 – 86 000]
Middle East & North
Africa
35 000
[16 000 – 65 000]
Sub-Saharan Africa
1.7 million
[1.4 – 2.4 million]
Eastern Europe
& Central Asia
150 000
[70 000 – 290 000]
South & South-East
Asia
340 000
[180 000 – 740 000]
Oceania
14 000
[11 000 – 26 000]
North America
46 000
[38 000 – 68 000]
Latin America
100 000
[47 000 – 220 000]
East Asia
92 000
[21 000 – 220 000]
Caribbean
17 000
[15 000 – 23 000]
Total: 2.5 (1.8 – 4.1) million

16. Western &
Central Europe
<1000
[630 – 3100]
Middle East & North
Africa
5500
[3800 – 8200]
Sub-Saharan Africa
370 000
[320 000 – 470 000]
Eastern Europe
& Central Asia
3500
[2200 – 6400]
South & South-East
Asia
24 000
[14 000 – 31 000]
Oceania
<1000
[<1000 – 1400]
North America
1600
[<1000]
Latin America
6700
[5500 – 12 000]
East Asia
2100
[<1000 – 2100]
Caribbean
2000
[1800 – 3400]
Estimated number of children (<15 years)
newly infected with HIV, 2007
Total: 420 000 (350 000 – 540 000)

17. Estimated adult and child deaths from AIDS, 2007
Western &
Central Europe
12 000
[<15 000]
Middle East & North
Africa
25 000
[20 000 – 34 000]
Sub-Saharan Africa
1.6 million
[1.5 – 2.0 million]
Eastern Europe
& Central Asia
55 000
[42 000 – 88 000]
South & South-East
Asia
270 000
[230 000 – 380 000]
Oceania
1200
[<500 – 2700]
North America
21 000
[18 000 – 31 000]
Latin America
58 000
[49 000 – 91 000]
East Asia
32 000
[28 000 – 49 000]
Caribbean
11 000
[9800 – 18 000]
Total: 2.1 (1.9 – 2.4) million

18. Amongst them are health workers

19. Amongst them are health workers

21. Amongst them are health workers

23. Amongst them are health workers

24. Amongst them are health workers

25. Amongst them are health workers

26. Amongst them are health workers

28. Amongst them are health workers

33. Heterogeneity of the HIV epidemic in Lesotho
Lower HIV prevalence Higher HIV prevalence
Males aged 15-30 years (10.1%) Females aged 15-30 years (21.4%)
Females aged 40-50 years (23.3%) Males aged 40-50 years (30.9%)
Men and women living in rural areas
(21.9%)
Men and women living in urban areas
(29.1%)
Poorer women (19.6% in lowest quintile) Wealthier women (28.9% in highest
quintile)
Men and women who are not working
(19.9%)*
Working men and women (30.3%)*
Men and women with education (23.2%) Men and women without education (27.4%)
Never-married men who have had sex
(11.4%)
Never-married women who have had sex
(24.2%)
Married women (26.9%) Married men (32.9%)
Men and women without sex partner in
last 12 months (23.1%)
Men and women with 1 or more sex partners
in last 12 months (28.3%)
Women reporting sex only with spouse or
cohabiting partner in last 12 months
(27.4%)
Women who had higher-risk sex in last 12
months (37.2%)

34. Statistics
 120 000 AIDS orphans in Lesotho
 HEALTH CARE WORKERS‟ OPHANS ARE
THEY INCLUDED IN THE OVC
PROGRAMMS?

35. THE TRANSMISSION
OF HIV
How do you become infected with
HIV?

36. UNDERSTANDING HIV / AIDS
H :
I :
V :
HUMAN
IMMUNE DEFICIENCY
VIRUS
HIV is therefore a virus that
breaks down the immune
system within human beings
A :
I :
D :
S :
ACQUIRED
IMMUNE
DEFICIENCY
SYNDROME
AIDS is therefore a collection of
many infections in the body as
a result of a weakened immune
system caused by the HIV Virus

37.  Virus does not survive outside the body
 Cannot enter through intact skin
 Quantity of virus
 Enough time
 Point of entry
 Enough Quantity
THREE CONDITIONS FOR TRANSMISSION:
NO TRANSMISSION BECAUSE:

38. You will NOT transmit HIV through:
SOCIAL CONTACT
Shaking hands, swimming, kissing,
hugging, sharing toilet, cutlery
BEING WITH AN HIV+ PERSON
TRAVELLING
FOOD AND EATING
WORK ENVIRONMENT

39. HIV can only be transmitted through:
Unprotected sexual intercourse
Infected blood
Intra-venous drugging
Mother-to-child
X




40. Unprotected sexual intercourse

41. Structure of a killer disease-HIV

42. HIV Lifecycle
1. Attachment -
Fusion
Reverse
Transcriptions Act
Here
2. Entry
3. Transcription
4. Integration
5. Polyprotein
Production
6. Release – Assembly
& Budding
7. Maturation
7 Protease
inhibitors Act
Here
 Phases: binding and entry, reverse transcription, replication, budding, and maturation

43. Cytology micrograph of HIV
BUDDING

45. HIV Clinical stages at different CD + counts
(1993 CDC)CD 4+ COUNT INFECTIONS NEOPLASIA/
CANCERS
>500 cells/ ml CANDIDIASIS
CERVICITIES
CIN
Invasive Cancer of
cervix
Idiopathic
Thrombocytopenia
purpura
Hodkins Lymphoma
Non Hogkins
Lymphoma
K.S
200-500 TB ,
Bacterial pneumonia
Herpes Zoster
Oral candidiasis
Oesophagial candidiasis
CIN
Invasive Cancer of
cervix
Idiopathic
Thrombocytopenia
purpura
Hodkins Lymphoma
Non Hogkins
Lymphoma
K.S
50- 200 Extra pulmonary TB
PCP
Cryptococoosis
Toxoplasmosis
Blastomycetes
Septicaemia
Herpes
Wasting-
Anaemia
Peripheral Neuropathy
Non Hodgkins
Lymphoma
Cardiomyopathy
<50 CMV

46. Natural History of HIV
Infection

47.  Viral
 Herpes simplex
virus
 Varicella Zoster
virus
 Cytomegalovirus
 Molluscum
contagiosum
 EBV
 JCV
 HPV
 Bacterial
 Pneumococcus
 H. Influenza
 Staphylococcus
 TB
 nocardia
 Salmonella
 Klebsiella
 Pseudomonus
 Rhodococcus equi

48. Where are OIs come from in the
health work place ?
 Food
Raw vegetables, fruits
Raw meat, eggs, poultry
Stored food, unwashed food
 Water
Cryptsporidiosis, microsporidiosis
 Air
TB, Cryptocococcus

49. Summary of General
Side Effects of Drugs- especially ART
The lab plays a major role in the diagnosis and monitoring
 NeuromuscularNeuromuscular
–– MyopathyMyopathy
–– PeripheralPeripheral
neuropathyneuropathy
 AbdominalAbdominal
–– PancreatitisPancreatitis
–– HepaticHepatic
 BoneBone
–– OsteonecrosisOsteonecrosis
–– OsteoporosisOsteoporosis
 MetabolicMetabolic
–– LacticLactic AcidemiaAcidemia
–– LipodystrophyLipodystrophy
–– DyslipidemiaDyslipidemia
–– DiabetesDiabetes
 HypersensitivityHypersensitivity
 HematologicHematologic
–– AnemiaAnemia

50. Palliative care is a continuum of
care from diagnosis to death
Island Hospice Service
Palliative
care
death
Disease modifying therapy (curative, life
prolonging or palliative in intent)
illness
Presentation-
diagnosis
bereavement
careCurative
Adapted from: American Medical Association. Institute for Medical Ethics (1999)
EPEC: education for physicians on end-of-life care.

51. Palliative care in the
developing world
Death
Disease-oriented
care
Supportive & Palliative
Care
Impacts on
Individual,
Family,
Community
Care of
orphans
Bereavement
Care
Diagnosis
Hospice Care
Primary Health Care & Specialist Care
Adapted from WHO: Defilippi, Gwyther 2002

52. WHAT IS THE
IMPACT OF HIV
IN THE WORK
PLACE FOR THE
HEALTH
WORKFORCE IN
LESOTHO?
BIG QUESTION!!!!!!!

53. Formative Assessment:
Attitudes and needs of employees
of the MOHSW for development of
HIV and AIDS Policy and
Intervention Programmes
What has been done so far for health
workforce

54. Presentation Outline
1. Study methodology included Key research Questions,
selection criteria
2. Limitations of the study
3. Study Findings
 Study Participants
 Perceptions of Health Care Workers regarding existing
HIV vulnerabilities in the workplace.
 Current status on programming, services and activities for
employees
4. Implications for MOHSW & Partners
5. Conclusions & Recommendations

55. 1. Study Methodology
Formative assessment using both qualitative &
quantitative measures in order to triangulate
results & findings:
• Desk reviews, stakeholder consultations
• Data analysis – , Thematic analysis (manual)
• Documentation

56. Key Research Questions
i) What are the existing perceptions, attitudes and
vulnerabilities of HCWs in relation to HIV and AIDS
in the workplace?
ii) What is the current status of HIV and AIDS
programming, services and activities for employees
of the MOHSW and CHAL
iii) What programmes, services and activities need to
be put in place? What priorities should the policy
address regarding protection and rights of HCWs
including HIV and AIDS stigma and discrimination in
the workplace?

57. Limitations to the study
 More junior staff participated in the study
due to availability, small numbers of staff,
workshops, work shifts etc.
 Some staff felt not particularly part of the
study – Lab staff at HQs levels
 There are very small numbers of doctors
due to their small number (and
unavailability due to workload)

58. Participating Facilities
 Quthing (Quthing Hospital & Villa Maria
Health Centre)
 Maseru (Scott Hospital & St. Barnabas
Health Centre)
 Berea (Maloti Adventist Hospital &
Mapheleng Health Centre)
 Leribe ( Motebang Hospital & Maputsoe
Filter Clinic)

59. Study Participants
Name of district
Quthi ngLeri beBereaMaseru
Count
60
50
40
30
20
10
0
Office Assi stant
Nurse Assi stant
Messenger
HIV/AIDS Focal Poi nt
Cleaner
Pharmacy Techni ci an
Admi ni strator
Registered Nurs
Pri nci pal Pharm acy T
echni ci an
Dri ver
Matron

60. Study Participants
 Administrators 32.6%
 Nursing staff 21.3%
 Doctors 0.6%
 Pharmacy staff 8%
 CHWs 7.3%
 Other personnel/support staff
44.7%

61. Study Participants
Current Post Districts Total
Msu Ber Lrb Qtg
Administrator 25 9 7 8 49
Doctor - 1 - - 1
Nursing staff 4 14 8 6 32

62. Study Participants
Current Post Districts Total
Ms
u
Ber Lr
b
Qtg
Pharmacy 10 - 2 - 12
HIV Focal Points 1 1 1 - 3
CHWs 2 2 3 4 11
Information Officers - - 1 - 1

63. Study Participants
Current Position Districts Total
Msu Ber Lrb Qt
g
Lab Services 1 - - - 1
Environmental
Officer
- - 2 1 3
Social Workers 1 1 1 - 3
Chief Health
Educator
1 - - - 1

64. Study Participants
Current Post Districts Total
Msu Ber Lrb Qtg
Social Workers 1 1 1 - 3
Human Resources 2 - 1 - 3
DGHS 1 - - - 1
PHC Director 1 - - - 1
CNO 1 - - - 1

65. Study Participants
Current Post Districts Total
Msu Ber Lrb
Qut
Orthopaedic
Technician
1 - 1 - 2
Statistician 1 - - - 1
Radiography
Asst
- 1 - - 1

66. 1. HIV Risk Factors
What are the job related tasks that expose employees to
risk of infection at the workplace?
HSA
H/Q
Quthi ng
Motebang
Mal uti
Scott
Count
40
30
20
10
0
Contact wi th patient
s
Taki ng blood samples
to l ab
All of the above
Handling contami nate
d needles
Sti chi ng/wound dress
ing
Admi ni stering inject
ions
Mi ssing

67. 1.1 Workplace Related
vulnerability
1. Needle stick related injuries (88.4%)
2. No: of immediate risk in work
environment (5.4%)
3. Other (includes contact with patients,
working with bare hands, taking blood
samples to lab etc) (6.2%)

68. 1.2 Reasons for Vulnerability
HCWs believe they are at risk of contracting HIV infection
at workplace due to Needle stick injuries, Blood splashes,
cleaning & disposal tasks etc.
This they see as inevitable given the nature of their work.
(Occupational hazard)

69. 1.3 Other Reasons for
Vulnerability
1. Inadequate supply & less reliable protective clothing
2. Shortage of staff which requires other non-nursing
professionals to assist & give care (cleaners,
pharmacists, laboratory etc)
3. Inadequate knowledge & skills on how to properly
handle potentially harmful materials due to lack of
materials, training, induction and supervision
4. Limited availability & access to PEP (knowledge,
stocks & info on correct use)

70. 1.3 Other Reasons for
Vulnerability (Cont…)
5. Sharps and medical waste disposal is not supervised.
- Containers not available/misused
- No disposal facilities at health centre level.
6. Supervision – Rarely done. Staff expected “to know”.
Cleaners only responsible to Administrator (GoL).
7. Hand-washing – Not mentioned anywhere as one of the
precautionary measures.

71. 1.4 Workers’ Response to risk
As a consequence, HCWs feel;
• Worried (they will get/are infected)
• Neglected - not important to employer; no
support systems in place; remuneration low
• Stressed – how families will cope

72. 1.5 Sectoral Response
Despite the mentioned risks no specific
Prevention and occupational health and
Safety programmes are in place to reduce
risk of infection

73. 1.6 Implications to MOHSW and
Partners
 High levels of infection among HCWs
resulting in ill health & death
 Resignations as people seek better
opportunities elsewhere
 Retraining costs to replace lost staff
 Reduced levels in quality of care as sector
loses trained & experienced workers

74. 4. Conclusions of the survey
There is;
 High HIV infection vulnerability at work place
 Negative and unsupportive attitudes from
workers (Stigma/discrimination)
 Lack of care & support services
 Inadequate info/knowledge on HIV and AIDS
latest trends and developments in terms of
service & equipment

75. Recommendations (short term)
1. Workplace HIV and AIDS prevention programme should
be initiated to address the high levels of risk identified.
It should include –
 Strict adherence to safety precautions
 Availability & access to PEP and its use
 Prevention interventions for all workers (all ages)
 Counselling (psychosocial) support to manage stress
2. Support systems – Policy to facilitate access to
confidential HIV and AIDS services
 testing
 Counselling
 staff clinics

76. Recommendations (Long term)
1. Development of HIV & AIDS workplace policy,
strategy- which we are disseminating today
2. Integrate HIV & AIDS information in all training
programmes- including L&S FORUMS
3. Improve HR systems – Task shifting-SAHCD,MHS
4. Improve incentive/remuneration packages to
take into account new responsibilities
5. Strengthen partnerships –, international
organizations etc- we have presented to them for buy-in
purposes
6. Develop wellness centers for health workforce

77. PRINCIPAL SECRETARY
National Wellness Committee
Director Human Resource
TECHNICAL WORKING COMMITTEE
South (Kkotso, Itumeleng,
Mabokang), Nthateng
Central (Nthabiseng, Sejojo, Mpho,
Mosala )
North (Mokebisa, Nkemele,
Petlane)
FACILITIES WELLNESS COMMITTEES
WORK PLACE WELLNESS STRUCTURE

78. ACTION PLAN FOR LESOTHO WORK PLACE WELLNESS PROGRAMME
SERVICES TO BE PROVIDED AT FACILITY LEVEL
Services Activities Responsibility Required
resources
Available
resources
Partners/dept M&E
Initiate the
wellness
programme
-Sensitize Management and staff
about the programme
-Nominate the Wellness committee
-Identify and lobby for space and
equipment for the Wellness Clinic
-Adopt the action plan for the
programme
Wellness
Champions
Work Place Policy
Strategic plan
Draft Work plan
A room
Equipment
HR
Work Place
Policy
Strategic plan
Draft work plan
A room
Equipment
HR
Heads of
Departments
Partners
Existence of
a Wellness
programme
Provide
Preventive
services
Provide the following services:
-Health Education
-HIV Testing and Counseling
-PMTCT
-PEP
-Vaccines
-Screening; Blood pressure, Blood
sugar levels, TB, STI, Diabetes,
Oral health, weight and height
Wellness
Committee
-Testing kits
-IEC materials
-Drugs
-PEP Kits
-Vaccines
-BP Machine
Glucometer
Stationary
-Stethoscope
-Scale
Lancets
Cotton swabs
-Testing kits
-Drugs
-Heads of Dept
-Clinical staff
-partners
No of
services
provided
% of people
accessing
services
Curative
services
-Undertake consultation and provide
prescription
-Provide health education
-Initiate ARV drugs
-monitor treatment- Lab tests
-Wellness
Committee
-Clinical staff
-Medical equipment
ARV drugs
Lab Monitoring
(CD4,LFTS,FBC,U
A, Pap test, lactate,
-Clinical staff -Clinical staff
Heads of Dept
No of
consultatio
ns
Today's –buy in

79. Stress
management
Initiate and coordinate recreational
activities
- Aerobics
- Ball games
- Gymnasium
Wellness
committee
-Hall
-Ball
-skipping ropes
-Grounds
Stress balls,
balloons,
equipment
Hall
-Ball
-skipping ropes
-Grounds
Stress balls,
balloons,
equipment
-Heads of Dept
No of staff
members
accessing
the services
Care &
support
-Provide psychological Counseling
-Establishing support groups
-Palliative care services
-Christian health fellowships
-home based care visits
Wellness
committee
- Wellness
centre
- HR
- Wellnes
s centre
- HR
Partners &
HODs
- Nurse
Counselors
-Support groups
-Peer educators
-No of
active
support
groups
-No of HW
counseled
Referral
services
-Establish referral procedures among
well clinics in different hospitals.
-
Wellness
Committee
Referral
forms
HR
Referral
forms
HR
HODs
Medical Officer
Number of
referral
cases made

80. How will these help?-
Measure and respond The impact
 On the individual
 On the family
 On the workplace
 On the community
 On the government / country

81. Economic impact of HIV/AIDS
ECONOMY WORKPLACE
INDIVIDUAL ILLNESSES & DEATHS
IMPACT WILL DEPEND ON
NUMBER OF PEOPLE THEIR EMPLOYMENT STATUS
INFECTED
UNEMPLOYED / SKILLED /
HIGHLY
UNSKILLED PRODUCTIVE
27% (HIV+) 12% (HIV+)

82. Current Economy?
 Global financial – economic crisis
 Ripples into social crisis
 Southern Africa HIV pandemic added fuel
 Reduction / abolishment of employee
support programmes

83. Effect
 Increased pressure on employee
 Increased pressure on Champion
 Increased pressure on PEERS
 Retrenched people

84. Effect
 Increased risk of HIV / Diseases
- Alcohol abuse
- Drug abuse
- High risk sexual behavior
- Financial problems
- Stress
- Depression
-BURNOUT

85. REVIEWS
EXISTING AND NEW NATIONAL POLICIES, LEGAL
FRAMEWORKS AND EMPLOYMENT AND LABOUR
LAWS
WFP
OVC

86. The impact of HIV/AIDS
An individual
HEALTH CAREGIVER
FAMILY
MEMBER:
Income earner
Caregiver
Educator
Lack of family
structures and
finances
Lack of support
COMMUNITY
MEMBER:
Leadership
Service
Support
CONSUMER
Economic
Slow down –
Individual +
Community
Suffering
PRODUCER:
Productivity losses
Increased costs – staff
replacement
High medical cost -
Illness
Labour loss - Death
Reduced market for
products

87. The impact on labour force
BIGGEST IMPACT ON:
Availability: Skills shortage
Recruiting from limited pool
Performance:
Cost of labour: Increase in Remuneration,
Recruitment, Training
and Retraining
IMPACT MAY CAUSE CHANGES RE:
 Age/experience of workforce
 Wage costs of top skilled employees
 Size of work force
 Keep retired employees longer

88. The most important effects on
organisations
Decreased productivity
Increased absenteeism
Increased ill health retirement
Early disability
Loss of skill – increased recruitment &
training
cost
Risk - financial
- morale
- quality

89. Impact on absenteeism
Absenteeism due to:
 Illness of HIV (+) employees
 HIV (-) employees to care & support
family
 Attending funerals
 Mental absenteeism

90. Impact on employee benefits
Impact will Primarily depend on:
 Business type
 Conditions of employment
 Skills level of staff
 Benefits provided by a company
 Ability to replace employees
Secondary impact:
 The management of HIV(-) employees
 Provision of ART/ General treatment
 Point of incapacity / ill health retirement
Benefits may rise
from 12% to 18%
HIV 30% of all
medical costs
Loss of cross
subsidy

91. Cost of HIV and AIDS
DIRECT / INDICRECT / SYSTEMIC COST
PROGRESSION OF HIV
AND THE COST TO
THE ORGANISATION

92. Why HIV and AIDS
Workplace programme?
 National prevalence
 Value of human capital
 Risks - financial
- morale
- quality
 Moral obligation:
It is the right thing to do

93. Make
HIV and AIDS
a boardroom issue
and not
a bedroom issue

94. What are the
ethical & legal
implications?

95. Stigma
HIV/AIDS-Related Stigma:
“a „process of devaluation‟ of people either living
with or associated with HIV/AIDS”. (UNAIDS)
HIV/AIDS-related Discrimination:
“Discrimination follows stigma and is the unfair
and unjust treatment of an individual based on
his or her real or perceived HIV status”.
(UNAIDS)

96. Race
Pregnancy
Disability
Gender
Culture
Sexual
Orientation
HIV
status
Language Belief /
Religion Colour
Marital
Status
Ethnic /
social
origin
 Does the action affect any of the under mentioned?
 Does it impose a burden (s), obligation (s) or disadvantage?
 Does it withhold benefit (s) , opportunities or advantages?
Are you one of the puzzle?
Were you discriminated against?
The following questions will determine whether it was fair of unfair discrimination

97. Key HIV related legal issues
 Eliminating unfair discrimination and
promoting a non-discriminatory workplace
 No direct or indirect discrimination
 Confidentiality and disclosure
 Informed consent
 Promoting a safe working environment

98. Legislation within the
workplaceLAW RIGHT
Constitution
Labour Relations
Act (LRA)
EQUALITY / FREEDOM / PRIVACY /
ACCESS TO HEALTH CARE
a) Right to fair Labour practices
b) Right not to be unfairly dismissed
because of HIV + status

99. Legislation within the workplace
LAW RIGHT
Employment Equity
Act (EEA)
a) Right not to be unfairly
discriminated against on the
basis of your HIV status
b) Right not to be tested for HIV
unless your employer ahs applied
to the Labour Court for
authorisation
c) Do not have to disclose HIV
status
Occupational
Health and Safety
Act
Right to a safe working environment

100. Legislation within the workplace
LAW RIGHT
Compensation for
Occupational
Injuries and
Disease Act
(COIDA)
Right to certain basic standards of
employment, including 6 weeks of paid sick
leave year a 3 year period
Basic Conditions of
Employment Act
Right to certain basic standards of
employment, including 6 weeks of paid sick
leave over a 3-year period
Medical Schemes
Act
Right to no unfair discrimination in giving
employee benefits
Common Law Right Right to privacy about your HIV status at
work

101. MONITORING
and
EVALUATION?

102. Reporting
 Detailed
 Applicable
 Appropriate
 Per intervention / monthly / annual
 Integrate with other statistics:
- Absenteeism
- Disability
- Deaths

103. Reports
 1st / 2nd / 3rd time testing
 Date tested +
 Registration CD4+ count, FBC, LFTS,UA,
 Increased adherence
 Therapy type
 Pathology markers
 Trends
 Outcomes (PEP & PMTCT)

104. Monitor and Evaluate
Measurement of objective outcomes is
essential to plan future strategies,
optimal resource utilisation and
identify possible areas of improved
interventions
A MAJOR TOOL FOR THE CHAMPIONS

105. Recommendations
 Flexible and customised
 Outcomes driven
 Holistic approach
 Wellness approach
 Integrated approach
 Health Seeking behaviour
 Partnerships
 Community resources
 Medical insurance

106. Recommendations
 In line with Department of Health
objectives
 Trends
 Monitoring and Evaluation
 Increased accuracy of statistics
 Accurate and appropriate rapports and
feedback
 Protect human capital

107. HIV life cycle
PREVENTION
PROGRAMME
BEHAVOIUR
CHANGE
HEALTH RISK MANAGEMENT
PROGRAMME

108. YES WE CAN!!!!!
CONVERT HIV & AIDS CRISIS INTO AN OPPORTUNITY??

109. THE ROAD AHEAD NOW?

110. Thank you