Treatment for HIV/AIDS at South Africa's largest employers: Myth and reality

Center for International Health and Development, Boston University School of Public Health, USA.
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (Impact Factor: 1.63). 03/2006; 96(2):128-33.
Source: PubMed


To determine what proportion of employees at the largest private-sector companies in South Africa have access to HIV/AIDS care and treatment, including antiretroviral therapy (ART); how many employees are enrolled in disease management programmes; how many are receiving ART; and which approach to the financing and delivery of care is proving most successful at reaching eligible employees.
All 64 private-sector and parastatal companies with more than 6000 employees in South Africa were identified and contacted. Those that agreed to participate were interviewed by telephone using a structured questionnaire.
Fifty-two companies agreed to participate. Among these companies, 63% of employees had access to employer-sponsored care and treatment for HIV/AIDS. However, access varied widely by sector. Approximately 27% of suspected HIV-positive employees were enrolled in disease management programmes, or 4.4% of the workforce overall. Fewer than 4000 employees in the entire sample were receiving ART. In-house (employer) disease management programmes and independent disease management programmes achieved higher uptake of services than did medical aid schemes.
Publicity by large employers about their treatment programmes should be interpreted cautiously. While there is a high level of access to treatment, uptake of services is low and only a small fraction of employees medically eligible for ART are receiving it.

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    • "Low uptake of workplace DMPs and high attrition have been problems across many sectors (George, 2006; Connelly and Rosen, 2006; ILO, 2003; Bhagwanjee et al., 2008). Anglo American in South Africa, widely considered to exhibit one of the strongest employer responses to HIV, has found that over 30 per cent of those who started on ART were no longer being treated (Connelly and Rosen, 2006). Operational costs of DMPs increase when workers do not access services or default (George and Quinlan, 2008). "
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    • "However, it also has been observed that many health workers prefer to seek care far away from where they live or work, which means incurring considerable extra financial costs [14]. Outside the health worker context, in-house (employer) and independent disease management have achieved higher uptake of services than medical aid schemes, but overall usage has remained low [19]. "
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