HIV/AIDS Workplace Policy Implementation in Selected Private Sector Workplaces in Lusaka District: Implementer's Perspective

Abstract

Introduction: Adult HIV prevalence in Zambia has declined from 16 % (2001-2002) to 13% (2013-2014) but still remains high. The UNAIDS call on eradicating HIV/AIDS by 2030 challenges strengthening multi–sectral response to HIV/AIDS. To understand factors affecting implementation of HIV/AIDS workplace policies, especially in the private sector, it is important to know the extent to which policies exist and experiences on implementation. Methods: A mixed method analysis of availability and implementation of policy using the health policy initiative implementer’s tool was conducted. Data from 128 member companies of the Zambia Federation of Employers was randomly collected through purposively sampled policy implementers. Categorized variables on implementation were analysed using Stata version 12.0: Fishers’ exact test and logistics regression were applied to implementation factors. Concurrently, 28 in-depth interviews on purposively sampled implementers were done. Thematic analysis was used and qualitative results integrated with quantitative findings. Results: Policies were available in 47/128 (36.72%) workplaces. The private sector accounted for 34/47 (72.34%) of all workplaces with policy. Programs were available in 56/128 (43.75%) workplaces. Both policy and programs were found in 46/47 (97.87 %) workplaces. Availability of policy was 2.7 times more likely with the increase in the size of a workplace, P Value=0.0001, (P<0.05). Top management support and having a specific budget for HIV programs were strongly associated with implementation. Management support was 0.253 times more likely in workplaces with policy, P value=0.013, (P<0.05).A specific budget for programs was 0.23 times more likely with policy (P<0.05). Implementation was hindered by reduced funding, lack of time, lack of sensitisation, ill-defined indicators and lack of Monitoring/Evaluation systems. Experiences with implementation, found HIV/AIDS/Stigma and awareness were the most addressed HIV epidemic drivers in workplace programs. Commercial sex workers, GBV, Mother to Child Transmission and Males having sex with males were the least addressed. Onsite VCT and provision of MC, ART were provided through health insurance, government clinics, and subcontracted providers. Conclusion: HIV/AIDS Workplace policies exist in the private sector at a very low proportion but policy translation into programs among workplaces with policies was very high suggesting that workplaces with policies are more likely to translate their policy into a program. Recommendation: Structures for addressing health and safety of employees exist and should be strengthened through sensitisation to include response to HIV/AIDS towards eradicating HIV/AIDS by 2030. The extent to which workplace programs address HIV/AIDS epidemic drivers in Zambia should focus on marginalised populations, gender integration and a wellness approach. Key Words: HIV/AIDS, workplace, policy, programs, implementation.