2012 alafa kap report

7/29/2019 2012 ALAFA KAP Report

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INTERVENTIONS IN THE

LESOTHO APPAREL INDUSTRY

KNOWLEDGE, ATTITUDE & PRACTICES

PROGRESS & OUTCOMES REPORT IN 2012


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Workplace HIV and AIDS programmes are a cornerstone ofglobal response to the epidemic

The ALAFA programme is well established and addressesHIV prevention, support and treatment in a very high

prevalence context

Two previous HIV prevalence and knowledge, attitude andpractices (KAP) studies have been conducted (2007,2009)in factories where ALAFA programmes are run

Previous findings have shown high knowledge and lowstigma with high HIV prevalence among the predominantly

female work force

Positive changes and outcomes in relation to HIVprevention and stigma have been linked to ALAFAprogramme activities

PRESENTATION BACKGROUND

2BRINGING HEALTHCARE TO THE WORK PLACE


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The 2012 study included an HIV seroprevalence survey,KAP questionnaire and qualitative focus groups in 15factories that were also sampled in 2007 and 2009

Managers, supervisors, skilled and unskilled factory flooremployees, as well as administrative and other staff

15 focus groups were conducted with managers/supervisors, male and female factory floor staff and peereducators

Data was collected in Sesotho and English The HIV data was anonymous and unlinked and was

collected via bloodspots from finger pricks, and analyzed atan external laboratory

Ethical approval received from MoHSW in Lesotho

RESEARCH DESIGN & METHODOLOGY



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The study uses globally proven approaches for KAP, HIVand qualitative surveys and draws on extensive southernAfrican experience of the research team

Survey findings are representative of employees in apparelfactories in Lesotho (n=2,800)

Although comparison is made to previous surveys, this isnot a cohort study so we cannot measure the extent of newinfections directly

Uptake of antiretroviral treatment programmes markedlyreduce death rates, so increases in HIV prevalence do not

necessarily indicate increases in new infection

The qualitative study aids and strengthens interpretation ofthe quantitative findings

STUDY STRENGTHS & LIMITATIONS



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KEY FINDINGS

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


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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+

6

HIV

Status

2012

Sample

2012

%

2009

%

2007

%

Positive 1,195 42.7% 41.0% 43.2%

Total 2,800

42.7%POSITIVE

HIV POSITIVEHIV NEGATIVE

BRINGING HEALTHCARE TO THE WORK PLACE


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HIV PREVALENCE RATES ARE STABILISING

7

HIV

positive

2012

%

2009

%

2007

%

Female 44.7% 42.7% 44.2%

Male 29.7% 28.8% 35.6%

Between 2007 and 2012, HIV prevalenceamongst women stabilized between 42.7% 44.7%

Variations in the male population are difficultto interpret as the male sample is small (12%of total sample).

0

10

20

30

40

50

60

2007 2009 2012

Women Men


%


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8

8.70%

27.30%

37.50%

43.90%

29.10%

41.80%

52.60%50.70%

18 - 24 25 - 29 30 - 34 35 - 39

FEMALE

MALE

Amongst womenHIV prevalence peaks (52.6%) between 30 -

34. Over half the women between the ages of 35 39

surveyed were HIV+


PREVELANCE RATES AND DEMOGRAPHICS


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9

8.70%

27.30%

37.50%

43.90%

29.10%

41.80%

52.60%50.70%

18 - 24 25 - 29 30 - 34 35 - 39

FEMALE

MALE

For those who are younger; prevalence is significantly less thanaverage at 29.1%




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10

8.70%

27.30%

37.50%

43.90%

29.10%

41.80%

52.60%50.70%

18 - 24 25 - 29 30 - 34 35 - 39

FEMALE

MALE

AmongmenHIV prevalence peaks (43.9%) between the

ages of 35-39. The sample size for men was small.




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INTERPERSONAL EXPOSURE TO HIV AIDS

11

In the last year, just under half (48%) of the workers had attended the

funeral of someone who had died of an AIDS related illness.33% had cared for a person sick with an AIDS related illness.1 in 6 workers had cared for a child orphaned by AIDS related illness.

69%

48%

33%

17%

Told by someone theyare HIV+

Attended funeral ofsomeone who has died

of an ARI

Cared for a person sickwith an ARI

Cared for a childorphaned AIDS related

illness



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SEXUAL HEALTH

12

Nearly a half (47%) of respondentsreported an unusual sore or discharge on

their genitals in the past month. This is a

subjective measure of STI.


All Respondents

47%


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BRINGING HEALTHCARE TO THE WORKPLACE 13

PEER EDUCATION

- Awareness & Participation- Satisfaction & Effectiveness- Qualitative analysis


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AWARENESS OF PEER EDUCATION

14

87%81%

87%79%

74% 72%

62% 61%

45%

30%

Posters infactory

AIDSevents infactory

Leafletsand

booklets

Peereducationand club

sessions

Drama infactory

Songs ormusic

PSIactivity in

factory

Video

72% of employees mentioned peer education and clubsessions when asked for sources of HIV information in the

workplace.

BRINGING HEALTHCARE TO THE WORKPLACE


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ALAFA RUNS PEER EDUCATION SESSIONS

15

88%

All Respondents

95% 90% 89%

77%

Management Skilled employee Unskilled employee Admin / Other


It was widely known and recognised that ALAFA runs these

peer education sessions in the workplace.


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ALAFA TRAINS PEER EDUCATORS

16

87%

All Respondents

93%

89%

87%

78%

Management Skilled employee Unskilled employee Admin / Other


As is the fact that ALAFA trains the peer educators.


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THE PEER EDUCATION EFFECT

17

33% of workers have

attended peer

education sessions

33%

95%95% learned something

new at the session

95% changed their

behavior after95%

85% prompted to go

for testing85%



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ATTENDEE SATISFACTION & FEEDBACK

18

98% of attendees

enjoyed attending the

sessions

98%

94% 94% felt free to askquestions at the sessions

86% thought there were

too many attendees86%

33% thought the

sessions were too long33%



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IMPACT OF ALAFA PARTICIPATION

19

76%

15% 4%

56%50%

84%

50%

5%

61% 61%

Confidence inrevealing HIV Status

Tested previously,most recent test at

this factory

Two or morepartners in past

month

Use a condomeverytime / almost

everytime

Made changes tobehavior in past year

There were significant differences between those who

accessed ALAFA services (clinic / peer education) andthose that didnt. In particular around testing and changes

to behavior in the past year.



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Peer education sessions werevalued and sessions were said to

be creative and interesting and thatthe topics were sufficiently varied

Peer educators were said to beknowledgeable and capable of

conducting and controlling thediscussion groups

Peer educators need to besupported so they can continue

with their work. They guide us alot

QUALITATIVE STUDY: PEER EDUCATION

20

[Before] I was not a caringperson. But now I take

things seriously and takeinterest. I even share the

information with others



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Peer educators felt that theyworked hard and did a good job

and that PLHIV in ALAFA factorieswere much better off than in other

factories

Some peer educators mentionedthat it was difficult to deal withtraumatic stories that employees

shared with them and debriefing

would be useful


21

Before I had an active

social life. My cellphone

always ringing with callsfrom men. Now that has

gone down. I have cutdown on my male partners



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It was felt that there should besome form of support for PEs forexample, by receiving some form ofrecognition monthly e.g.cellphone airtime.

It was suggested by one group ofpeer educators that there be moreopportunities for creating dramasand poems as a means ofcommunicating.

Peer educators were satisfied withthe training they received and werealso motivated to make changesthemselves including, for example,testing for HIV (including partnertesting), being faithful to onespartner and changing lifestyles:


22

Maybe have a projector,

people watch a movie,

instead of listening to us allthe time. Pictures can

explain better to otherpeople



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COMMUNICATION AND CONTEXT

HEALTH & WELLNESS IN THE WORKPLACE 25

- /Users/Simon/Documents/Clients Folder/Alafa/Alafa forAustin/Other photos from 2012/factory HTC.jpg

COMMUNICATIONSAWARENESS & EDUCATION


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Media access remains a great challenge

26

Most workers (84%) have regular access (two days per week or more) toa 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%

InternetRadio

84%



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MOBILE / CELL PHONES ARE UBIQUITOUS.

27

CellPhone

97% of all workers have regular access to a mobile or cell

phone. This potentially provides an important out of workplace

communications channel for ALAFA.

Two or more times per week (97%)

One time or less (1%)

Never (3%)



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WHERE DO WORKERS GET THEIR INFORMATION?

28

87%81%

81%

69% 67%64% 62%

58%

43%

Factory / AIDSEducation

Friends Factory / Clinic AIDSOrganisation

Hospital Parent / Family Private Doctor

The workplace is a critical and leading source of HIV / AIDS

information, over80% of employees cited factory and AIDSeducation as sources of information in the past year; with over

two-thirds citing the factory clinic.



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WHAT COMMUNICATIONS HAVE IMPACT?

29

87%81%

87%79%

74% 72%

62% 61%

45%

30%

Posters infactory

AIDS eventsin factory

Leaflets andbooklets

Peereducationand club

sessions

Drama infactory

Songs ormusic

PSI activityin factory

Video

Within the workplace itself, the activities with the highest levelsof recall were posters, AIDS events, leaflets & booklets and

peer education and club sessions.



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OUT OF WORKPLACE COMMUNICATIONS

ACTIVITIES WITH CUT THROUGH.

30

87%81%

88%

67%61%

40%

5%

Radio adverts orprogrammes

Posters / Leafletsor Stickers

TV adverts orprogrammes

Magazineinformation or

magazines

Internet

Radio (88%) was by far the most mentioned source of

information; followed by posters, TV and magazines. Internet is

negligible (in line with earlier usage data).



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KNOWLEDGE OF HOW TO PREVENT INFECTION

31

87%81%

95.00%

12.00% 11.00% 11.00% 0.03%

Always usecondoms

Abstaining Limit or reducepartners

Have only onepartner

Don't share utensilswith PLHIV

When asked the main ways to avoid HIV infection, use of

condoms was almost universal (95%); changing other sexualbehaviors was lower.



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UNDRSTANDING HIV / AIDS

32

87%81%

94% 90%

48%

75%

A person who lookshealthy can be HIV+

HIV can be passed frommother to baby

Circumcised men areless likely to get infected

HIV / AIDS can be cured

There are now high levels of knowledge around some of the

fundamental facts of HIV / AIDS, but further education aroundcircumcision as a means of risk mitigation is still required.



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Communication about HIV through posters and other materials was said tobe valuable and materials were noted to be appropriate in design andlanguage: The language is clear and the format is perfect. Someparticipants felt materials could be updated more regularly

Although knowledge was generally good, it was felt that educationremained necessary and that interactive forums including support groups

were useful approaches, and it was felt that there was potential to haveadditional education sessions on weekends. It was also noted that peer

educators were able to address questions: Where we dont understand,

PEs are there to assist

Previously people who said they were HIV positive were laughed at, butthat this no longer occurred. Disclosure was seen as beneficial

QUALITATIVE INSIGHT: COMMUNICATIONS



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Good overall understanding ofHIV with main concerns being about

transactional sex, with femaleemployees relating their low income as arisk factor

Alcohol consumption was recognised asa risk factor for exposure to casual sex

Training in budgeting was mentioned asa way to reduce vulnerability

There were some concerns aboutexposure to HIV infected blood, and

concerns that universal precautionswere not always followed e.g. alwaysusing gloves or keeping first aid itemssterile

QUALITATIVE INSIGHT: UNDERSTANDING HIV



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DE-STIMATISING HIV AND THOSE INFECTED

35

87%81%

97%

90%

81%

I would work next to someonewho is HIV positive

People living with HIV in thisfactory are accepted by their

fellow workers

If I was HIV+ I would feelcomfortable disclosing at this

factory

There are very low levels of stigma directed towards PLHIV

and four out of five people would be happy to disclose theirstatus at their workplace.



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36

Awareness of ALAFA and its

work to bring healthcare tothe workplace.



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AWARENESS OF ALAFA SERVICES

37

ServicesAll

(n=2,800)

Manager/

Supervisor

(n=153)

Skilled

employee

(n=1,141)

Unskilled

employee

(n=1,134)

Admin/

other

(n=372)

Know of Clinic or Nurse at factory 96% 95% 95% 95% 98%

Of yes, personally received treatment or advice 66% 77% 66% 64% 67%

Yes, one can get free male condoms in factory 98% 100% 98% 99% 98%

Of yes, personally obtained male condoms 90% 91% 90% 91% 92%

Of yes, male condoms are available most or all the time 84% 90% 83% 84% 84%

Yes, one can get free female condoms in factory 84% 93% 81% 82% 92%

Of yes, personally obtained female condoms 68% 65% 70% 69% 64%

Of yes, female condoms are available most or all the time 72% 80% 69% 69% 68%

Yes, I know of AIDS peer educators in this factory 76% 91% 76% 72% 78%

Of yes, attended sessions in past year 45% 52% 45% 46% 37%

Of those attending in past year, attended once a week

or more42% 47% 41% 46% 33%



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HAVE YOU HEARD OF ALAFA?

38

86%

All Respondents

There are very high levels of awareness ofALAFA, 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 followingservices.



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AWARENESS OF ALAFA : EDUCATION

39

86%

All Respondents

87% 88% 85%

0%

20%

40%

60%

80%

100%

Trains Peer Educators Runs Peer Sessions Provides HIV / AIDSmaterials



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AWARENESS OF ALAFA : PREVENTION

40

90% 88% 91%

0%

20%

40%

60%

80%

100%

Distributes free malecondoms

Distributes Free femalecondoms

HIV testing for employees

86%

All Respondents



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AWARENESS OF ALAFA : TREATMENT

41

90% 88%

0%0%

20%

40%

60%

80%

100%

Supports clinic in factory Supports HIV treatment

86%

All Respondents



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AWARENESS OF ALAFA : FACTORY POLICY

42

86%

All Respondents

82%

0% 0%0%

20%

40%

60%

80%

100%

Helps develop factorypolicy



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COMMUNICATION AND CONTEXT

43

- /Users/Simon/Documents/Clients Folder/Alafa/Alafa forAustin/Other photos from 2012/factory HTC.jpg

Building profile.

Awareness of ALAFA and

its work to bring healthcare

to the workplace.



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ALAFA PARTICIPANTS OUTCOMES

44

76%

15%

4%

56%50%

84%

50%

5%

61% 61%

0%

20%

40%

60%

80%

100%

Confidence inrevealing HIV

Status


this factory


month


everytime

Made changes tobehavior in past

year

There were significant differences between those who accessed

ALAFA services (clinic / peer education) and those that didnt. Morelikely to be tested, more likely to use a condom and more likely to

have changed behavior in the past year.



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PEER EDUCATOR OUTCOMES

45

81%

40%

4%

59% 57%

87%

54%

6%

68% 71%

0%

20%

40%

60%

80%

100%

Confidence inrevealing HIV

Status


this factory


month


everytime

Made changes tobehavior in past

year

There were significant differences between those who are

peer educators and those who arent. In particular interms of testing and behavioral changes.



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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.

46BRINGING HEALTHCARE TO THE WORKPLACE

7%

72%

16% 6%0%

20%

40%

60%

80%

100%

None One Two Three or more


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The clinical services provided to support PLHIV were valued by employees,although there were concerns that general medication was not available tothose who were HIV negative

Attending the clinic might create an association with being HIV positive:There is not confidentiality protected, as people know that when a persongoes to the clinic they are positive

Some concerns with ART - side effects such as changes in body shape.Need for adequate food was highlighted

Support groups were noted to be useful, especially when it was highlightedthat one did not necessarily have to be HIV positive to attend. However, itwas not always well known that support groups included positive and

negative participants, and this reduced interest

QUALITATIVE INSIGHT: CLINIC SERVICES



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KEY CONCLUSIONS


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HIV prevalence is stable, and has reached saturation levels among femaleemployees in their 30s, with higher rates of new infections more likely to beoccurring in the younger age range where HIV prevalence is lower

The main risk for HIV infection among employees is sexual partner turnover andfor females, exposure to higher risk men.

There is a good general knowledge and a good proportion of employeesacknowledge they take prevention measures and have changed their behaviourto prevent HIV

There are strong and significant impacts on employees who have participated inthe 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



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Overall, there are good levels of knowledge and low levels of stigma with agood openness towards disclosure. The survey data shows that ALAFAprogrammes 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 andvalued. There is a good uptake of VCT

Peer education sessions are well valued and the approach and format is wellappreciated. The main concern is that the groups could be smaller

There are strong and significant impacts on employees who have participated inthe peer education sessions or accessed clinic services especially in relation

to HIV testing, condom use and saying they had changed behavior. Risk relatedto partner reduction remains a key gap

KEY CONCLUSIONS