According to Brazil's National AIDS Programme, the highest HIV infection rates are found among the socially and economically productive age group of 20-49 years, constituting 87% of the cases in Brazil. In Rio de Janeiro, 84% of the more than 31,000 cases of AIDS belong to that age group. In view of that reality, in 1998 Grupo Pela Vidda started a new HIV-prevention workplace initiative in partnership with private companies. These programmes provide information to the workforce on HIV/STI prevention and the correct use of male and female condoms.

According to the National AIDS Programme, 215,810 cases of AIDS had been diagnosed in Brazil since the beginning of the epidemic through June 2001. The number of people living with HIV/AIDS (PLWHAs) is now estimated at 597,000. In spite of these large numbers it is generally accepted that the growth rate of the epidemic in Brazil is decreasing. This is attributed to prevention measures such as harm-reduction strategies among drug users, media campaigns and continuous education efforts in community centres and schools, which have led to more and more people using male or female condoms. Adequate monitoring of the epidemic, however, is hampered by the relatively low percentage (20%) of sexually active people actually tested for HIV.

Grupo Pela Vidda

Grupo Pela Vidda (GPV: Group for the Recognition, Integration and Dignity of People Living with HIV/AIDS) is a non-profit community-based organisation formed by PLWHAs, their friends and families in 1989. GPV has developed a wide range of activities, involving and empowering PLWHAs through self-help and support meetings, educational programmes about care and prevention, home-based "buddy" care for PLWHAs and a national legal AIDS support service. It also maintains ongoing networking activities with other organisations, such as the International HIV/AIDS Alliance, Schorer Foundation, Project Inform, Treatment Action Campaign.

In the world of work, GPV aims to sensitise employees on AIDS-related issues and educate them so they do not discriminate against HIV-positive colleagues or those thought to be infected. HIVpositive volunteers give talks to help workers understand what living with AIDS means. Interactive group techniques are used and participants are invited to engage in open discussion. In addition, educational materials giving accurate, up-to-date information on HIV/AIDS and condoms, are distributed. GPV also assists companies in establishing HIV-prevention programmes and conducts peer-education training for employees. To date, 198 interventions have reached more than 9000 workers. Unfortunately, interest in maintaining a continuous HIV-prevention programme in the company is usually restricted to the human resources staff and not shared by the employers. For this reason, educational programmes have often been single-session courses with poor and unsustained results, even though some enterprises officially included HIV-prevention activities as part of their "Quality of Life" programmes for employees.

Partnerships

Establishing partnerships with state governments and groups of companies to promote workplace HIV prevention activities is another line of action. In 1999, the Rio de Janeiro State Government invited GPV to become a member of the State Consulting Committee for HIV/STI Prevention at the Workplace. The Committee's main objective is to sensitise and mobilise business people and trade unions to develop educational and prevention activities for employees. In addition, it intends to conduct training programmes to prepare managers and workers for developing prevention policies in their companies and promote social marketing of condoms.

The Committee is providing technical support to the recently created Rio de Janeiro Business Council for HIV/STI Prevention, which comprises 15 major enterprises - the first such Council in Brazil. The Council's main goals include development of internal AIDS policies among member companies, facilitating the exchange of experiences on HIV-policy implementation and sponsoring mass-media campaigns. As part of the technical support offered by the Consulting Committee to the Council, GPV has participated in eight courses, sponsored by the State Government, training 126 employees in setting up workplace policies and programmes. GPV is convinced that working together with the companies of the State Business Council will enhance the possibilities of guaranteeing an effective response for the workforce and making prevention available to all employees.

Lessons learned

Experience in implementing workplace prevention programmes has allowed GPV to formulate some concepts concerning the difficulties and perspectives of prevention:

• The company's commitment is the most important factor for a successful workplace intervention and this requires the support of the highest level of staff.
• Medium-sized and small companies, in particular, are reluctant to set up workplace HIV/AIDS programmes because they lack human and financial resources; also, persuading companies to allow employees to take part in AIDS activities during work hours can be contentious. The large and multinational companies are more sensitive about developing these programmes. Although they have policies for implementing them, management often does not make sufficient effort to find alternative work for those with HIV/AIDS.
• Although companies may have relevant policies, management often does not make sufficient efforts to find alternative work for those with HIV/AIDS, if necessary.
• Even today, some employers consider HIV/AIDS too sensitive an issue or feel uneasy about associating their business or brand name with AIDS.
• As a result of the government's free distribution of antiretroviral drugs, which helps keep HIV-positive employees at work, companies have not experienced severe absenteeism or loss of experienced personnel due to AIDS-related health problems. This, in turn, makes employers less motivated to promote AIDS workplace activities.
• Most companies of the State Business Council have recognised the need for developing workplace initiatives and policies in response to HIV/AIDS, but have not yet started to implement them. They seem to be too involved in developing general corporate policies and programmes.

Despite these constraints, GPV has been able to disseminate helpful information about AIDS and contribute to the formulation of better prevention policies. Increasing attention has been given to the process of contacting the companies and GPV has learned that the best strategy to break resistances regarding HIV/AIDS is to investigate the company's culture and employees' level of knowledge. This way, customised approaches can result in relevant and effective programmes. Enhancing the formulation of these approaches is a priority for GPV's workplace activities in the near future.