Where working men prefer to get HIV tests and treatment
In recent decades, Tanzania has made great strides in HIV prevention, treatment, and control. However, working men are more than twice as likely to be HIV positive (4.2%) than unemployed men (1.9%) (TACAIDS, et al., 2013). In collaboration with TACAIDS (Tanzania Commission for AIDS) and USAID/Tanzania, the SHOPS Plus project in Tanzania conducted a qualitative formative study to inform workplace interventions that will target this population segment.
The study conducted 22 focus group discussions with men from three workplaces—a mining company, a manufacturing company, and an association of transport motorcycle (“boda-boda”) operators—to understand their perceptions of HIV testing, treatment, and workplace program design. SHOPS Plus learned how the employees and association members conceptualize HIV, where they would prefer to get HIV tests and treatment, and their priorities for a workplace program.
“This study provided key insights into the thinking of the working male demographic and can inform future workplace programs to ensure that they meet the needs of the end users—the male employees themselves.” - Maureen Ogada-Ndekena, SHOPS Plus Chief of Party, Tanzania
Many of the focus group participants were extremely fearful of HIV testing. While most understood that HIV can now be treated as a chronic disease, participants explained that an HIV diagnosis continues to be equated with death. This was paired with beliefs and behaviors that could be perceived as contradictory. Participants explained that although extra-marital affairs—which increase the risk of exposure to HIV—are common, men proactively avoid HIV testing explicitly because they know that they are at higher risk. These attitudes have implications for effective communication with employed men on the benefits of HIV testing and how to prevent HIV.
The study found that the participants prefer to receive HIV testing and treatment in a facility external to the workplace, primarily due to perceived increased confidentiality. The research uncovered a fair degree of distrust among employees for their employers, particularly around disclosing a positive status.
Employed men were eager to learn more about HIV, especially related to stigma reduction, prevention, linking to care, and living with HIV. Importantly, they were also interested in other health topics, such as non-communicable diseases and workplace hazards, which could be included in comprehensive workplace wellness program.
The research points to the need for a multi-pronged approach to effectively reach male employees with HIV information and improve testing and linkages to care. Employees are interested in learning directly from their peers through interactive peer-education sessions. They also find digital messaging and community field days with games, family-friendly activities, and HIV information appealing.
“When our fellow [boda boda] drivers say something, we tend to believe him. We believe that is safe and right. So [a peer education group] might contribute a great deal [to HIV] prevention.” – boda boda driver
Finally, there is also an opportunity for employers to take steps to improve employee trust and buy-in to new or existing workplace health programs by making it clear to their employees that they have supportive policies and procedures when an employee has a chronic illness, including HIV. Company support from the leadership level could help employees feel more comfortable both testing for HIV and, if necessary, accessing HIV treatment, even if external to the workplace.
This research was disseminated in Tanzania with nearly 20 key stakeholder groups through a half-day workshop.
Reference: Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF International 2013. Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS, OCGS, and ICF International.