A situational assessment of a workplace voluntary counselling and testing (VCT) and HIV/AIDS treatment programme in the mining sector : a case study
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Introduction: Globally, over forty million adults are infected with the Human Immunodeficiency Virus (HIV), with twenty-five million people having already died of Acquired Immunodeficiency Syndrome (AIDS) worldwide by 2007. To date, approximately twenty-eight million members of the labour force have been lost to AIDS. In terms of the settings approach to Health Promotion, the workplace presents as one of the most effective and significant settings in which to respond to the epidemic. This study formed part of The Workplace VCT/Treatment Uptake Project (WVUP), which is a longitudinal study located in a company in the South African mining sector. The broad aim of the WVUP was to provide new knowledge on the reasons for low and slow uptake of VCT and treatment services in workplace settings and to implement and evaluate interventions to improve uptake of these services. The specific aim of this phase of the study (a Situational Assessment) was to unravel the contextual influences on VCT and treatment participation rates at the selected site, as a precursor to succeeding phases of the WVUP. Method: This Situational Assessment comprised of an archival documentary analysis (aimed at developing a historical perspective of the company’s HIV/AIDS program) and interviews and focus groups with key organisational stakeholders (aimed at a contextual assessment of the program). A qualitative approach was used for this study, as it provided an in-depth and detailed understanding of the organizational and personal experiences, incidences and occurrences that make up the contextual milieu for the VCT and HIV/AIDS treatment services at the study site. Fourteen individual interviews were conducted with key stakeholders, followed by eight focus group interviews with these constituencies. Data was collected using audiotapes and were transcribed verbatim. A quality assurance check was conducted with random sections of the tape compared against the transcripts. A list of themes across all interviews and data was developed and then reduced and coded using Nvivo7, a qualitative datamanagement software programme. This tool enabled the researcher to store and code the data and search the data thematically. The results of the study were interpreted through the lens of two theoretical frameworks, viz., the Precede-Proceed model and the Elaboration Likelihood Model. Results and Conclusions: The discussion of results incorporated the findings from the archival audit and documentary analysis as well as the various factors that emerged from the key stakeholder and focus group interviews. Even though the mine had high VCT uptake rates, significant concerns were apparent with regard to the VCT and treatment programmes. Some of these concerns centered around the levels of support from mine management and Head Office, support of employees for the HIV/AIDS programme, relational challenges with the union, confidentiality issues, treatment and treatment adherence issues, environmental influences, spousal VCT uptake, race, culture and sexism, and fear. Salient findings have been discussed using the selected theoretical frameworks and several theoretically and empirically derived recommendations were offered to inform the next phase of the WVUP study.