INTERVENTIONS IN THE LESOTHO APPAREL INDUSTRY ALAFA KNOWLEDGE, ATTITUDE & PRACTICES PROGRESS & OUTCOMES REPORT IN 2012

– Workplace HIV and AIDS programmes are a cornerstone of global response to the epidemic – The ALAFA programme is well established and addresses HIV prevention, support and treatment in a very high prevalence context – Two KAP studies have been conducted (2007,2009) – Previous findings have shown high knowledge and low stigma with high HIV prevalence among the predominantly female work force – Positive changes and outcomes in relation to HIV prevention and stigma have been linked to ALAFA programme activities PRESENTATION BACKGROUND BRINGING HEALTHCARE TO THE WORK PLACE

– The 2012 study included an HIV seroprevalence survey, KAP questionnaire and qualitative focus groups in 15 factories that were also sampled in 2007 and 2009 – Managers, supervisors, skilled and unskilled factory floor employees, as well as administrative and other staff – 15 focus groups were conducted with managers/supervisors, male and female factory floor staff and peer educators – Data was collected in Sesotho and English – The HIV data was anonymous and unlinked and was collected via bloodspots from finger pricks, and analyzed at an external laboratory – Ethical approval received from MoHSW in Lesotho RESEARCH DESIGN & METHODOLOGY BRINGING HEALTHCARE TO THE WORK PLACE

– The study uses globally proven approaches for KAP, HIV and qualitative surveys and draws on extensive southern African experience of the research team – Survey findings are representative of employees in apparel factories in Lesotho (n=2,800) – Although comparison is made to previous surveys, this is not a cohort study so we cannot measure the extent of new infections directly – Uptake of antiretroviral treatment programmes markedly reduce death rates, so increases in HIV prevalence do not necessarily indicate increases in new infection – The qualitative study aids and strengthens interpretation of the quantitative findings STUDY STRENGTHS & LIMITATIONS 4 BRINGING HEALTHCARE TO THE WORK PLACE

KEY FINDINGS -Topline data on HIV AIDS prevalence -Peak demographics & trends -Societal and personal impacts of HIV AIDS

At 42.7%, HIV prevalence amongst apparel industry workers in Lesotho is very high. Prevalence rates are similar amongst all employee categories. Migrant workers are at a slightly higher risk than those who live and work in the same area. MORE THAN 2 IN 5 OF THE WORKFORCE IS HIV % POSITIVE HIV POSITIVEHIV NEGATIVE BRINGING HEALTHCARE TO THE WORK PLACE

HIV PREVALENCE RATES ARE STABILISING 7 HIV positive 2012 % 2009 % 2007 % Female44.7%42.7%44.2% Male29.7%28.8%35.6% Between 2007 and 2012, HIV prevalence amongst women stabilized between 42.7% – 44.7% Variations in the male population are difficult to interpret as the male sample is small (12% of total sample). BRINGING HEALTHCARE TO THE WORK PLACE %

8 FEMALE MALE Amongst women HIV prevalence peaks (52.6%) between Over half the women between the ages of 35 – 39 surveyed were HIV+ BRINGING HEALTHCARE TO THE WORK PLACE PREVELANCE RATES AND DEMOGRAPHICS

SEXUAL HEALTH 9 Nearly a half (47%) of respondents reported an unusual sore or discharge on their genitals in the past month. This is a subjective measure of STI. BRINGING HEALTHCARE TO THE WORK PLACE All Respondents 47%

Most of those who had ever had sex, only had one partner in the past year (72%), and one in 15 (7%) had no partner. Around one fifth (22%) had two or more partners in the past year, and a minority of this group had two or more partners in the past month (5% or 1% of the total population) SEXUAL PARTNERS IN THE PAST YEAR. 10 BRINGING HEALTHCARE TO THE WORKPLACE

11 PEER EDUCATION -Awareness & Participation -Satisfaction & Effectiveness -Qualitative analysis

ALAFA RUNS PEER EDUCATION SESSIONS 12 88% All Respondents BRINGING HEALTHCARE TO THE WORKPLACE It was widely known and recognised that ALAFA runs these peer education sessions in the workplace.

THE PEER EDUCATION EFFECT 13 33% of workers have attended ALAFA peer education sessions 33% 95% 95% learned something new at the session 95% changed their behavior after 95% 85% prompted to go for testing 85% BRINGING HEALTHCARE TO THE WORKPLACE

IMPACT OF ALAFA PARTICIPATION There were significant differences between those who accessed ALAFA services (clinic / peer education) and those that didn’t. In particular around testing and changes to behavior in the past year. BRINGING HEALTHCARE TO THE WORKPLACE

COMMUNICATION AND CONTEXT HEALTH & WELLNESS IN THE WORKPLACE 15 - /Users/Simon/Documents/Clients Folder/Alafa/Alafa for Austin/Other photos from 2012/factory HTC.jpg COMMUNICATIONS AWARENESS & EDUCATION

Media access remains a great challenge 16 Most workers (84%) have regular access (two days per week or more) to a radio; just under a half watched TV more than once per week. Internet access is rare – 96% of workers have never used it. Print & Magazines 9% Television 43 % 3% Internet Radio 84 % BRINGING HEALTHCARE TO THE WORKPLACE

WHERE DO WORKERS GET THEIR INFORMATION? 17 87% 81% The workplace is a critical and leading source of HIV / AIDS information, over 80% of employees cited factory and AIDS education as sources of information in the past year; with over two-thirds citing the factory clinic. BRINGING HEALTHCARE TO THE WORKPLACE

KNOWLEDGE OF HOW TO PREVENT INFECTION 18 87% 81% When asked the main ways to avoid HIV infection, use of condoms was almost universal (95%); changing other sexual behaviors was lower. BRINGING HEALTHCARE TO THE WORKPLACE

DE-STIMATISING HIV AND THOSE INFECTED 19 87% 81% There are very low levels of stigma directed towards PLHIV and four out of five people would be happy to disclose their status at their workplace. BRINGING HEALTHCARE TO THE WORKPLACE

20 Awareness of ALAFA and its work to bring healthcare to the workplace. BRINGING HEALTHCARE TO THE WORKPLACE

HAVE YOU HEARD OF ALAFA? 21 86% All Respondents There are very high levels of awareness of ALAFA, given the migratory nature of the workforce this is a strong result. We then asked those who were aware of ALAFA if they were aware of the following services. BRINGING HEALTHCARE TO THE WORKPLACE

AWARENESS OF ALAFA : PREVENTION 22 86% All Respondents BRINGING HEALTHCARE TO THE WORKPLACE

AWARENESS OF ALAFA : TREATMENT 23 86% All Respondents BRINGING HEALTHCARE TO THE WORKPLACE

COMMUNICATION AND CONTEXT 24 - /Users/Simon/Documents/Clients Folder/Alafa/Alafa for Austin/Other photos from 2012/factory HTC.jpg Building profile. Awareness of ALAFA and its work to bring healthcare to the workplace. BRINGING HEALTHCARE TO THE WORKPLACE

KEY CONCLUSIONS

– HIV prevalence is stable, and has reached saturation levels among female employees in their 30s, with higher rates of new infections more likely to be occurring in the younger age range where HIV prevalence is lower – The main risk for HIV infection among employees is sexual partner turnover and for females, exposure to higher risk men. – There is a good general knowledge and a good proportion of employees acknowledge they take prevention measures and have changed their behaviour to prevent HIV – There are strong and significant impacts on employees who have participated in the peer education sessions or accessed clinic services – especially in relation to HIV testing, condom use and saying they had changed behavior. Risk related to partner reduction remains a key gap KEY CONCLUSIONS 26 BRINGING HEALTHCARE TO THE WORKPLACE

– Overall, there are good levels of knowledge and low levels of stigma with a good openness towards disclosure. The survey data shows that ALAFA programmes were also the main source of HIV and AIDS information, and there was good awareness of various elements of the programme. These findings, along with the qualitative data, provide strong evidence that the ALAFA programme is achieving its broad objectives – The clinical services and resources such as condoms are well understood and valued. There is a good uptake of VCT – Peer education sessions are well valued and the approach and format is well appreciated. The main concern is that the groups could be smaller – There are strong and significant impacts on employees who have participated in the peer education sessions or accessed clinic services – especially in relation to HIV testing, condom use and saying they had changed behavior. Risk related to partner reduction remains a key gap KEY CONCLUSIONS 27 BRINGING HEALTHCARE TO THE WORKPLACE