Workplace HIV/AIDS Peer Educators in South African Companies

1. Workplace HIV/AIDS Peer Educators in South African Companies Dr David DickinsonWits Business School

2. Presentation Outline • Background • The Research • The Profile of Workplace Peer Educators • Becoming a Peer Educator • Training • Motivations • Activity • Appropriate Number of Peer Educators • National Potential • Support for Peer Educators • Emotional Labour Conducted by Peer Educators • The Community Dimension • Where to from Here?

3. Acknowledgements • The five participating companies • Those who completed the questionnaires and who were interviewed • Wits’ Faculty of Commerce Law and Management Faculty Research Committee & Wits AIDS Research Institute • The WBS Marketing & Communication Department • Academics and Support Staff at WBS • Karen Birdsall, Gila Carter, Steven Ramotsei, and Marion Stevens • The South African Business Coalition on HIV/AIDS

4. HIV/AIDS and Companies • Level of adult (15-49) HIV infection rate estimated at 16.2 percent. Prevalence peaks between 25 and 29 years for women (33.3 percent) and 30 – 40 years for men (23.3 percent) (HSRC 2005). • Limited evidence for effective behavioural change to date and prevalence continues to rise. • Companies face lower productivity, absenteeism, loss of human capital, increased costs of employee benefits, and impact on markets. • Company HIV/AIDS programmes are still developing within an uneven national response.

5. Peer Education and the Workplace • ‘Involves training and supporting members of a given group to effect change among member of the same group.’ (Horizons/Population Council, ND:i) • ‘Similarity between message source and recipient is vital to the ultimate impact of the message.’ (Wolf and Bond 2002:362) • Able to accesspeople infected with HIV or vulnerable to infection. This access is both physicaland sociocultural. (UNAIDS 1999) • Department of Labour (2003) recommends a ratio of peer educators to employees of 1:50. • If taken up across the formal economic this would mean 150,000 workplace peer educators in South Africa.

6. The Research Objectives • Establish a baseline for South African workplace HIV/AIDS peer educators: • Profile • Entry routes into peer education & motivation • Training • Activity (inside and outside the workplace) • Enablers & Barriers to activity • Strengthen workplace-based responses to HIV/AIDS

7. Research Limitations • Provides a ‘snap shot’ – not a longitudinal study • Reports on what peer educators say they do, rather that what they do • Doesn’t measure effectiveness of their activity (e.g. impact on infection rates) • Doesn’t calculate the cost-effectiveness of what they do

8. Methodology • Five participating companies • Four research components • In-depth interviews with ‘key’ players (what should be happening and what is already known) • Questionnaire to all peer educators (demographics, activity, structures etc) 614 respondents (mid 2005) • Overall response rate 34.5% • Range 22.2 to 84.7% • In-depth interviews with peer educators • Participatory observation

9. The Profile of Peer Educators (I) • Data on age, marital status, education, income, time in company • Data on race and gender shows over-representation of African women in particular

10. The Profile of Peer Educators (II) • Symbolic lack of peer educators in senior positions

11. The Profile of Peer Educators (III) • High religious involvement: 79.1% attend services twice a month or more (n=593) • Close to the epidemic: 82.7% knows somebody well who is HIV-positive or who has died of AIDS (n=607) • Involved in communities: 46.9% involved in community-based HIV/AIDS projects (n=591)

12. Becoming a Peer Educator (I)

13. Becoming a Peer Educator (II) • Percentages into peer education are stable by date of becoming a peer educator (and, probably, over time)

14. Training (I) • Most peer educators receive initial training: 96.5%, excluding 2005 entry peer educators (n=591) • Training is generally evaluated as good in dimensions of; • information, • communication and presentation skills, • and giving confidence. • Nevertheless improvements can be made in training content and style • Variation in length of initial training (between and within companies)

15. Training (II) • 27.6% of peer educators (excluding 2004 and 2005 entry) report having no follow up or refresher training • Problems in attending training include • Being too busy • Training not offered • Not been told • Managers/supervisors not releasing

16. Peer Educators’ Contributions

17. Views on Appropriate Rewards • Range of views over appropriate rewards. Distribution influenced by gender, but not union membership or elected vs. volunteer peer educators. • Interviews indicate that payment may emerge as a collective demand, motivated on grounds of fairness and dignity rather than money per se.

18. Activity: Formal Presentations • Most peer educators give formal talks: 89.7% (n=602) • Most give talks on a regular basis: 36.8% weekly, 29.8% monthly (n=500) • Giving formal talks to co-workers raised peer educators profile and is linked to a higher level of informal work

19. The Appropriate Ratio ofPeer Educators to Employees • Number of co-workers addressed can be used to establish the appropriate ratio of peer educators to employees – taking into account suitable size of groups

20. Activity: Informal Discussions • 86.3 percent conduct informal discussions with other employees at work • 62.9 percent conduct informal discussions with people who are not company employees at work • 88.9 percent conduct informal discussions with people outside of work

21. Informal Discussion - National Scenario

22. Activity: Roles • We need to understand activity of peer educators not only in terms of measurable outputs but roles they play within social structures at work • Identified roles (additionally to supporting company HIV/AIDS programmes) • The Influencers • The Advisers • The Stigma Busters • The Normalisers • The Sex Talkers • The Family Builders • The Condom Kings

23. Influencers & Advisers • Influence peoples’ understanding of the epidemic and provide them with alternative behavioural options • At lunch, on transport, at mine ‘stations,’ supermarket checkouts (during quiet periods) etc. • Advise people around HIV/AIDS and (often) other issues of concern • With AIDS it’s ‘talk, then tears, then more talk’ • Flexibility in dealing with people of different beliefs

24. Stigma Busters & Normalisers • Challenge stigma in the workplace • Confront gossipers • Befriend and support the stigmitised • Often below management’s ‘radar’ • Normalise the epidemic • Encourage open talk about HIV/AIDS • Bring HIV/AIDS into a correct perspective at work and in the community

25. The Sex Talkers • Open taboo areas of sex as a topic for discussion to enable safer sex practices • Complex area: for example realistic promotion of abstinence requires talking about masturbation • Overcome own inhibitions within peer educator training/meetings and take this to the workplace • Often meets resistance (linked to gender and age differences between peer educators and employees) • I would make it a joke. Like I’ll say, ‘You know, guys that are married, I don’t think girls should be going around looking for excitement from [other] men. They have excitement [their husbands] at home and you know you can get some for [your wife] in adult [sex] shops to show how you can make your sex life exciting after fifteen, twenty years.’ I’ll make it up so that they’ll accept it. If I tell them not to go to the shebeen, they’ll ask me ‘Who the hell do you think you are?’ (Young coloured women peer educator in auto company)

26. Family Builders & Condom Kings • An understanding of the importance of family and the need to address relationship difficulties between men and women • Attempt to address underlying frustrations in relationships, recognising the economic necessity of many relationships • Attempt to proactive educate youth to make good decisions on choosing sexual/marriage partners • Widespread understanding of the need for condoms (even if not compatible with their personal beliefs). • A few, generally male, peer educators put condoms at the centre of their work • A focus on condom distribution and challenging myths around condoms

27. Organisation of Peer Educators • Wide range of ways that companies organise peer educators. • HR management • Health & Safety structures • Occupational health practitioners • Corporate social responsibility officers • Multi-stakeholder HIV/AIDS committees • Dedicated HIV/AIDS management • Line management • Self organisation • These vary within as well as between companies. • Often these are based on circumstances rather than strategic planning. • ‘If X was in building maintenance, we’d be organising the peer educators from there.’ • HIV/AIDS managers are attempting to run HIV/AIDS programmes with too few dedicated staff and need more resources for this purpose if peer education is to be properly supported and evaluated.

28. Support: Resources • N = 536, 523, 541, 539, 528, 514, 520, 466

29. Support: Resources • Time for peer education activity correlates to increased: • percentages of peer educators conducting formal education sessions, and • frequency with which these sessions are conducted. • A place to meet and formal opportunities to address co-workers correlates to increased: • percentage of peer educator conducting formal education sessions. • The provision of time, a place to meet, and formal opportunity does not affect: • informal activity being conducted by peer educators.

30. Support: Peer Educators’ Perceptions

31. Peer Educators and Trade Unions • Peer educators, who are union members, perceive that union officials and office bearers give similar levels of support as supervisors • Data supported by interviews • Not that union officials oppose peer education – many individual unionists give support, but unions as institutions are not seen to be doing so • The importance of unions is not being challenged, the concern is the identified ‘gap’ between unions and peer educators: workplace HIV/AIDS responses are weakened • Root of the problem may well lie in different ways of operating • Unions: collective demands leveled against social injustice • Peer Educators: promote individual behavioural change • Need to identify areas of common concern between the two groups on which they can work jointly

32. Mutual Support Between Peer Educators • 82.5 percent of peer educators meet with other peer educators (n=588) • 63.5 percent do so every month or more (n=477). 41.3% find these meetings ‘extremely useful’ and 39.6 % ‘very useful’ (n=480) • Limited mutual support by peer educators across companies, non between companies – an area that should be considered. • Peer educators who attend meetings with other peer educators conduct more: • formal sessions, • have more informal discussions, and • are more likely to have co-workers disclose that they are HIV+ (43.1% vs. 23.0%, n=544)

33. Mutual Support: Levels of Activity

34. Mutual Support: Sustainability

35. Peer Education as Emotional Labour • ‘Being a peer educator is stressful. When you come face to face with somebody opening up to you [that they are HIV positive] you have to keep it to yourself. You have to be a rubbish bin for whatever they cough out.’ • 50.6% (n=516) of peer educators report informal discussions have been emotionally stressful • 39.7% (n=559) of peer educators have had co-workers disclose that they are HIV+ • Correlation between the two, but other stressful topics (HIV+ relatives, rape, abuse, bereavement etc) are often dealt with by peer educators • The line between referral and counselling is not always clear or maintained

36. The Community Dimension • Activity by workplace HIV/AIDS peer educators in the community is extensive and goes beyond formal company programmes. • Workplace peer educators are often community HIV/AIDS activists who extend their work into the company (when given the opportunity), rather than being the creation of companies. • Activity radiates out from family and friends to the wider community. • Working in churches, youth groups, sports clubs, etc • ‘Evangelising’ in public places • Bringing community into the workplace • ‘Official’ visiting of community-based HIV/AIDS projects • This is an area that we need to understand better. • Companies could place more emphasis on the work their peer educators are doing in the community.

37. Where to From Here? • There are areas where more research is needed, but this should not delay action • Existing workplace peer educator programmes should be strengthened and peer education should be extended across the formal economy • We need to understand the strengths of workplace peer education and build on this potential at work and in the community

38. Workplace Peer Educators in South African Companies • Thank you • Questions?