In 2002, the Horizons Programme, in conjunction with South Africa's state-owned power company ESKOM and Development Research Africa, initiated a research project at several of ESKOM's technical centres in KwaZulu-Natal Province to gain a more in-depth understanding of workers' perceptions and experiences.

ESKOM's HIV/AIDS programmes for employees stand out among South African businesses. The company has declared HIV/AIDS a strategic priority and created work groups to develop strategies to mitigate the impact of the epidemic on its workers and productivity. The company supports peer-educator training, VCT, counselling, and the GIPA principle (Greater Involvement of People Living with AIDS), and has implemented awareness campaigns, including road shows, presentations, theatre, and community choirs. Condoms are available free of charge.

Although ESKOM's HIV/AIDS policies and programmes are progressive, there is little documentation about its success in encouraging employees to use its HIV/AIDS services and their impact on employees. Within a larger research goal of improving ESKOM's prevention and support programmes, the Horizons study examined HIV/AIDS-related stigma and discrimination in the workplace to inform stigma-reduction activities.

Qualitative research was first done to explore the manifestations of stigma and discrimination, and to help develop appropriate quantitative measures for stigma. This consisted of 69 in-depth interviews and eight focus group discussions (FGDs) with male workers, their sexual partners and other female family members; workplace managers; HIV/AIDS programme staff; and community leaders. Nearly 400 staff from ESKOM's 22 technical service centres throughout KwaZulu-Natal, and one female family member per worker were then interviewed about their experiences and perceptions of stigma and discrimination, HIV risk factors, utilisation of, and preference for HIV/AIDS activities and services.

Where and how do stigma and discrimination appear?

Findings from the qualitative research revealed three categories of workplace interactions within which HIV/AIDS-related stigma and discrimination might occur.

The first category, institutional-level interactions, includes employee perceptions, understanding of, and experience with workplace HIV/AIDS policies and programmes. Almost a quarter of workers reported a fear of being fired if they had AIDS. Twice as many (55%) of the workers' female partners or relatives reported the same. When asked about the treatment of PLWHA at work during in-depth interviews and FGDs, almost nobody mentioned being fired as a possibility. And most workers who responded to the questionnaire (85%) knew that ESKOM allows HIV-positive employees to continue working.

The second category – employee interactions that relate to the physical job requirements – includes potential stigma from workers concerned about the ability of HIV-positive workers to continue working, and about the risks of casual on-the-job contact. Issues of physical strength and ability were foremost, probably because much of the work at ESKOM is physically demanding and potentially dangerous. Both FGDs and in-depth interviews revealed that workers said that as long as a person was able to work, they would have no problem working with PLWHA.

Fear of transmission through casual contact was found to be a potential source of stigma at the workplace, but only among a minority of workers. Nearly 80% indicated they would be comfortable sharing their work tools or shaking hands with an HIV-positive colleague or friend. Approximately 65% said they were comfortable allowing an HIV-positive colleague or friend to eat from their plate of food.

Fears of social isolation and ridicule

The greatest concern about stigma focused on the third category: social interactions that take place at the workplace. This includes those that occur during downtime at work, such as during meals or travel, and how employees' perceptions of stigma in the community permeate and influence their perceptions about stigma in the work environment.

Almost three-quarters of questionnaire respondents said that HIV-positive workers would experience social isolation, and nearly half said they would be subject to rumours and gossip. Almost one-fifth (18%) noted that workers with HIV/AIDS would experience verbal abuse. Furthermore, nearly 90% of workers surveyed agreed with the statement, "If I have AIDS, people will avoid me." Fear of social isolation and gossip at the workplace were also frequently discussed in the FGDs and in-depth interviews. These fears likely influenced workers' opinions about disclosure of HIV status – more than 60% said it was inadvisable to inform others.

Conclusions and recommendations

Institutional stigma and discrimination concerns are relatively low among ESKOM workers, most likely due to the existence and high awareness of ESKOM's anti-discrimination policies. However, a minority of the workforce did express various concerns, so policies should be disseminated even more widely and appropriately. Taking these issues into account, an intervention was developed and an evaluation is currently ongoing. Policies have been translated into the vernacular and posted throughout the workplace.

Stigma and discrimination related to physical labour are also low, possibly due to a relative lack of concern about casual contact with HIV-positive workers. However, concerns about sharing food with PLWHA remain, so information on HIV transmission has been incorporated into the peer education programme.

Stigma is most prevalent at ESKOM in everyday social interactions within the workplace. The fear of social isolation, rather than the fear of being fired, seems to inhibit workers' willingness to disclose HIV status. In response, new IEC materials have been developed on stigma, discrimination and disclosure, and a stigma-reduction component was integrated in the peer education programme. Family members and staff in community-based NGOs have been trained as peer educators to offer services and stigma-reduction activities in the community and in the workplace.

Workplace strategies to reduce HIV-related stigma and discrimination mainly focus on anti-discrimination policies and HIV prevention activities. But to successfully address stigma and discrimination, interpersonal aspects, such as social isolation, must also be directly addressed.

Julie Pulerwitz, Research Director Horizons/Population Council; 4301 Connecticut Avenue, NW Suite 280, Washington, DC 20008, USA; tel.: +1-202-237.94.11, e-mail: jpulerwitz@pcdc.org; Jessica L. Greene, formerly Population Council; Eka Esu-Williams, Horizons/Population Council; and Robert Stewart, formerly Development Research Africa