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However, the relationship between these two factors can at times be paradoxical, with disease often thriving in the wake of economic progress.
Transport sector services and infrastructure are experiencing a boom throughout the Southern African Development Community (SADC) region. Characteristic patterns of social relationships and economic activities determined by the history of population migration in sub-Saharan Africa translate into ever-increasing movement of people across borders at all times: demand for transport facilities has never been higher. However, this good news is tempered by the fact that some of the economic activities facilitated by this expansion are also key elements in the causation and spread of HIV/Aids.
Since most of the countries in question are landlocked, road, rail and air transportation are vital to trade and tourism. As globalisation proceeds apace, too, inter-country migration is on the rise, and populations are integrating at international level. South Africa is no stranger to this process.
People have been travelling to South Africa in search of work for over a century, some settling to establish families, others establishing short-term contacts with local people before returning to their original countries. Over the last 50 years, transport networks have become increasingly streamlined, with a corresponding surge in human movements, especially men attracted by the possibility of employment within the mining and transport sectors. Of course, the downside to the massive increase in the ease and efficiency with which people move around is that diseases such as HIV/Aids are getting a free ride.
Mobility gives rise to opportunity, not least for making new sexual contacts. Many employed with the transport sector are periodically absent from their partners; long-distance truck drivers, maritime personnel, long-distance taxi drivers, and rail and air workers spend most of their time away from home. By way of illustration, research indicates that 71% of long-distance truck drivers in South Africa spend 15 or fewer days at home over a period of six months.
Recently, the South Africa Business Coalition Against Aids (SABCOHA) commissioned the Bureau for Economic Research (BER) to carry out a study on the impact of HIV/Aids on business. The transport sector has been particularly affected: 46% of transport companies surveyed said that HIV/Aids has already dented profitability; 40% reported a loss of experience and vital skills directly attributable to the virus.
In the light of these sobering statistics, firm resolve and action are required. Radebe spoke of the government’s commitment and determination not to stand idly and watch the virus outstrip efforts to contain it, reiterating that government, business, civil society, NGOs, churches and private sector can defeat HIV/Aids together.
Radebe went on to list a number of milestones in the ongoing struggle against the disease: the launch of the National Aids Co-ordinating Committee of South Africa (NACOSA) in 1992, the South African government’s endorsement of NACOSA’s strategy in 1994, and the review of 1997 that brought to light weaknesses in the health sector’s approach, focusing as it did on the disease itself. Recommendations were made to move beyond this narrow focus and build the capacity of implementing agencies, increase political commitment, improve involvement and strengthen integration.
Considerable effort was expended to carry out the recommendations stemming from the NACOSA review. Provincial Aids co-ordinators were appointed, the Inter-Ministerial Committee on Aids was established, Partnerships against Aids was launched in 1998, and the Department of Education’s HIV/Aids learners and educators policy was developed. Subsequently, further national policies such as syndromic STD management were developed, the South African Aids Vaccine Initiative (SAAVI) was established in 1998, and SANAC and the national interdepartmental committee on HIV/Aids.
As a result of the HIV/Aids and STI Strategic Plan for South Africa 2000 - 2005, key programmes such as health education, voluntary HIV counselling and testing (VCT), prevention of mother-to-child transmission (PMTCT) and antiretroviral therapy (ART) were established and expanded. Cabinet approved the National Operational Plan for Comprehensive HIV & Aids Management, Treatment, Care and Support in November 2003, providing some 250 000 people with access to ARV treatment; 204 health facilities received ARV treatment accreditation from February 2006. Most recently, and flowing from the HIV Aids and STI Strategic Plan 2000 - 2005, the New National Strategic Plan on HIV & Aids for 2007 - 2011 became operational in April 2005.
Radebe stated that the aim of the plan is to reduce infection levels by 50% by 2011. There is also a commitment to reduce morbidity, mortality and other HIV/Aids impacts by providing 80% of HIV-positive people and their families with appropriate treatment, care and support services by 2011.
SABCOHA has enabled the private sector as a whole to gain ground in HIV/Aids workplace policy and programme development, taking broad responsibility for employees, facilitating prevention, organising treatment, care and support and upholding human rights. For HIV/Aids programmes and policies to be implemented effectively and practically, however, much remains to be done.
The transport sector offers a positive example of a proactive approach to tackling HIV/Aids in the workplace with the Road Freight Industry’s ‘Trucking Against Aids/Focus on Aids’. This is a joint venture between the Road Freight Association, trade unions, the National Bargaining Council for Road Freight Industry and the Department of Health. Trucking Against Aids deploys four mobile wellness centres and 12 roadside wellness centres at truck stops throughout South Africa. Among the primary health services available are HIV/Aids services.
As part of the the strategic framework’s main objectives, the transport sector has undertaken to strengthen the application of HIV/Aids workplace policies, programmes and outreach programmes in order to dampen the onslaught of HIV/Aids throughout South Africa. Primary objectives are improving transport workers’ knowledge, attitudes, beliefs and practices. The impact of HIV/Aids in workplaces can be softened by means of HIV/Aids outreach initiatives. Increasing the number of transport companies with HIV/Aids programmes and policies and capacitating employers’ and employees’ associations in HIV/Aids programme development and management is also an essential element of the framework.
The framework is intended to ensure that relevant policies, guidelines and legislation are implemented to protect transport workers from unfair labour practices and that the Code of Good Practice on workplace HIV/Aids is complied with. Resources will be mobilised and co-ordinated to improve sectoral response to HIV/Aids.
Elements adapted by the transport sector from the National Strategic Plan on HIV/Aids for 2007 – 2011 and prioritised include prevention and halving the new infection rate by 2011. The majority of South Africans are HIV negative; that must not change. This will reduce transport workers’ vulnerability to infection as well as the impacts of HIV/Aids. Programmes empowering women and educating men on human rights, especially women’s, must be accelerated and intensified. Sexual transmission of HIV can be minimised through behaviour change communication strategies adapted to the various transport sectors. Guidance on rolling out the increasing number of prevention programmes for high-risk populations as well as workplace prevention programmes must also be provided.
This strategy includes as a principle to minimise HIV transmission risk through blood, blood products and occupational exposure among transport workers.
Since every growing economy requires a healthy workforce, the strategy’s second priority covers treatment, care and support, with the intention of reducing HIV/Aids morbidity and mortality. The socio-economic aspect will be dealt with through appropriate treatment, care and support packages to be delivered to 80% of HIV-positive transports workers and their kin by 2011. Coverage to voluntary counselling will be increased, regular HIV testing will be promoted, and people living with HIV will be empowered to adopt a proactive stance in leading healthy productive lives.
A monitoring and evaluation framework and behaviour change research policy will be developed to facilitate the implementation of research, monitoring and surveillance, considered essential management tools.
Another priority area covers stigma and discrimination. In this regard, human and legal rights challenges will take centre stage so that workplace programmes around these issues will be implemented consciously. The government has committed to ask organisations in the transport sector to allocate more resources and encourage effective programme and intervention co-ordination. Part of this initiative would entail organisations becoming more involved with people who live with HIV/Aids. As such, organisations ought to be helped to play a meaningful role in every aspect of the national response to the pandemic as well as providing youth with the tools to change their own behaviour.
Minister Radebe concluded by summarising the key principles of the transport sector: creating a non-discriminatory work environment, developing gender-sensitive programmes, and putting mainstream HIV/Aids activities at the core of organisational activities. In this regard, the response to workplace HIV/Aids should be guided by treatment, care and support in order to create safe, healthy work environment. Further conditions that are key to the success of the strategic plan are the demographic, socio-economic, psychological, political, institutional and capacity building realities of South Africa.
Greg Penfold
