A multi-sectorial committee in directing HIV/AIDS-specific interventions in the occupational setting: an example from South Africa.

We present a descriptive analysis of a mechanism to coordinate and implement human immunodeficiency virus (HIV) prevention and care in the occupational setting. The mechanism we describe is a multidisciplinary committee composed of stakeholders in the occupational health environment including unions, management, medical researchers, and medical personnel. The site chosen for the analysis was a South African sugar mill in rural KwaZulu-Natal. The factory is situated in an area of high HIV seroprevalence and has a workforce of 400 employees. The committee was initiated to coordinate a combined prevention-care initiative. The issues that were important in the formation of the committee included confidentiality, trust, and the traditional roles of the stakeholder relationships. When these points were addressed through the focus on a common goal, the committee was able to function in its role as a coordinating body. Central to this success was the inclusion of all stakeholders in the process, including those with traditionally opposing interests and legitimacy conferred by the stakeholders. This committee was functionally effective and demonstrated the benefit of a freestanding committee dedicated to addressing HIV/acquired immune deficiency syndrome (AIDS) issues. We describe the implementation and feasibility of a multisectoral committee in directing HIV/AIDS initiatives in the occupational setting in rural South Africa.

A package of care for HIV in the occupational setting in Africa: results of a pilot intervention.

We describe a package of care including prevention, education, and therapeutics for human immunodeficiency virus (HIV) infection in the occupational setting in sub-Saharan Africa and evaluate the outcomes of this package over 1 year. A prospective cohort study was done between 1999 and 2000 in a sugar mill employing 386 men in Kwa-Zulu Natal in South Africa. A package of care for HIV in the occupational setting was developed and implemented in 1999. This response included prevention, education, and therapeutic components. Outcomes measured included condoms distributed, sexually transmitted infections treated, numbers of HIV-infected individuals entering into the therapeutic pathway developed, and numbers of individuals counselled and tested for HIV. HIV prevalence in this population was 27.15% in January 1999. Between 1999-2000 in this workforce of 386, 58 of 102 (54%) individuals with HIV were identified through voluntary counselling and testing. Of these, 48 (82.8%) voluntarily entered the HIV treatment pathway. Condom distribution in the sugar mill increased 400% and the number of sexually transmitted infections treated at the mill decreased by 88% during this time period. Using AVERT software to model HIV infection over time a decrease in incidence of 91.67% from that expected in this population was calculated. 11 HIV infections were averted in a single year of this program. HIV/acquired immune deficiency syndrome (AIDS) is prevalent in the occupational setting in South Africa. This setting can provide a venue for HIV care and prevention. A package of care for HIV including prevention, education, and therapeutics can be effective in both providing care for HIV-infected individuals and preventing new infections.

The direct costs of HIV / AIDS in a South African sugar mill.

PIP: This article assesses the impact of HIV on a retrospective cohort of HIV-infected sugar mill employees and the cost incurred by their employers in the province of KwaZulu-Natal, South Africa. In a single occupational health clinic that provides the primary care needs of a sugar mill workforce with approximately 400 employees (96% males), records of 23 workers who took ill-health retirement due to HIV during 1991-98 were inspected. Direct cost estimation associated with HIV infections were obtained from the occupational health clinic, hospital and insurance sources. In the preliminary study, the cost of HIV treatment increased in the last 2 years of the employee's tenure. Using the human resource data and employee job description, the cost of lost productivity was approximately R100 for each day lost, while the total cost per worker annually for the period of the analysis is R9543.73. These costs could be divided equally into replacement worker costs, productivity losses and absenteeism. Similar findings were also obtained in separate studies conducted in Zimbabwe and Kenya. This article confirms the significant amount of lost economic activity due HIV infection and the increasing burden on the economic industry as the epidemic matures.^ieng

Relationship between energy expenditure and productivity of sugar cane cutters and stackers.

The main aim of this study was to measure the energy expenditure of sugar cane cutters and stackers during a normal working day and to relate this to their productivity (tonnes of cane cut or stacked per day). A secondary aim of the study was to relate the food and fluid ingestion of the workers during the day to energy expenditure, productivity and changes in body mass. Cutters (n = 12) and stackers (n = 12), who were randomly selected from all the workers (n = 50) on a Natal sugar estate in South Africa, wore heart rate monitors for the entire working day (7 h +/- 30 min). On a separate occasion, all subjects underwent treadmill exercise tests in which oxygen consumption (VO2) and heart rate (HR) were measured simultaneously. A VO2-HR regression equation was calculated for each subject. Based on this regression equation, energy expenditure (kJ) for the working day was calculated for each subject. There was no difference in the mean productivity of the cutters (9.0 +/- 0.7 tonnes) compared to the stackers (9.0 +/- 0.5 tonnes). Both groups expended a large and similar amount of energy during the working day (cutters = 11,695 +/- 1288 kJ; stackers 14,127 +/- 1710 kJ). They ingested similar amounts of energy while working (cutters = 5179 +/- 161 kJ; stackers = 5281 +/- 324 kJ). The best predictor of productivity was the length of the working day (r = 0.63), followed by the energy expended (r = 0.60). Despite the large amount of fluid ingested (up to 6.0 litres/day), some workers lost more than 3% of their body weight.(ABSTRACT TRUNCATED AT 250 WORDS)