A TUC Aid project report urges trade unionists to engage with the gay community in Uganda.

Workers' AIDS Project (WAP)

Implemented in partnership with National Organisation of Trade Unions (NOTU), Uganda

2009-2010

Bandula Kothalawala

TUC International Officer

ACKNOWLEDGEMENTS

TUC Aid takes this opportunity to express its appreciation of the contribution made by Peter Christopher Werikhe, Secretary-General, National Organisation of Trade Unions (NOTU) in Uganda, Baligasima Yazidi, Project Coordinator, and all other NOTU staff members and those of its affiliates to the successful implementation of the Workers' AIDS Project. It also wishes to thank Roofings Limited Uganda and other employers for their co-operation and support for workplace activities held on their premises.

Bill Morris Testimonial Fund for HIV-AIDS in Africa

The Workers' AIDS Project (WAP) in Uganda was funded by the Bill Morris Testimonial Fund for HIV/AIDS in Africa through TUC Aid. Bill Morris was General Secretary of the Transport and General Workers' Union between 1992 and 2003. On retirement he set up the Bill Morris Testimonial Fund to support education work with trade unions in Africa in their response to the challenges posed by the HIV/AIDS pandemic. In April 2006 Bill Morris was awarded a life peerage and took the title: Lord Morris of Handsworth

Introduction

The Republic of Uganda with a population of 32.7m is a land-locked country in East Africa. In 2009, per capita GDP was USD 490 while the annual growth rate for 2010 (1) was 5.8%. Agriculture accounted for 12% of Uganda's GDP in 2009. The share of industry was estimated at 54% for the same year. The annual inflation rate (2) for the twelve months to June 2010 dropped to 4.4% from 12.3% in the corresponding period in 2009. Infant mortality rate remains high at 79.4 per thousand births. Life expectancy at birth was 52.7 years in 2009.

HIV/AIDS in Uganda

HIV/AIDS had become a serious public health problem by 1992 with a prevalence rate of 18% among the adult population. The Government of Uganda in partnership with all stakeholders and the international community put in place an effective prevention strategy, reducing the prevalence rate (3) to about 6% in the 15-49 age-groups by 2008. 'After a quarter of a century of a generalized HIV epidemic, Uganda continues to experience a severe and mature epidemic', says the Uganda (4) AIDS Commission (5). HIV prevalence is said to be highest in the Kampala, Central and North Central regions (8%). According to the UAC, more women than men (7.5% compared to 5%) are infected with HIV. The role of workplace in combating HIV/AIDS has long been recognized with the development and publication of a national policy on HIV/AIDS in 2007(6). The current National HIV & AIDS Strategic Plan aims at promoting the implementation of the HIV & AIDS Workplace Policy (7) and encourages the private sector to invest in the workplace response. By 2006, 25 of 30 of Uganda's largest employers are said to have had workplace policies and programmes on HIV/AIDS in place. The UAC expects (8) 96% coverage by 2011/12. Some 1.2m Ugandans are estimated to be living with HIV/AIDS, including about 150,000 children aged 0-14. About 64,000 deaths were attributed to HIV/AIDS in 2009 (9).

Partner - NOTU

The National Organisation of Trade Unions (NOTU) is the largest and most representative national trade union centre in Uganda. The total membership of its 20 affiliated unions was estimated at 192,373 (10) in March 2011. The NOTU was one of the first national trade union centres in Africa to initiate action to combat HIV/AIDS as a workplace issue. Since the publication of a trade union manual on HIV/AIDS with financial support from the then Commonwealth Trade Union Council (CTUC) in 2000, the NOTU and its affiliates have continued awareness-raising programmes for union members and their engagement with employers, the Government of Uganda and its agencies on the need for the protection and promotion of employment and human rights of workers affected by the disease. Despite the progress made in this regard in the last decade, there is a persistent need for continuity of workplace action on the disease and its impact on workers and their families.

Project

TUC Aid agreed to fund the implementation of the Workers' AIDS Project (WAP) submitted to it by NOTU in response to the invitation for applications from the Bill Morris Testimonial Fund for HIV/AIDS in Africa. The Project was designed to build the capacity of the National Organisation of Trade Unions (NOTU) and its affiliates to respond to the challenges posed by the pandemic at workplace and address the protection of rights and entitlements of workers living with HIV/AIDS through the union bargaining agenda with employers. It also sought to raise awareness of the impact of HIV/AIDS on the workplace among trade union leaders, shop stewards and rank and file members through a programme of training and education activities. The outreach component of the programme was designed to contribute to the prevention of the spread of the disease through the dissemination of information and advice on risks of infection, Voluntary Counselling and Testing (VCT) and access to treatment, care and support for those living with the disease.

The implementation of the Project had been delayed due to the departure of the NOTU project officer who developed it initially in partnership with TUC Aid in 2008. All activities under the two-year initiative launched in partnership with the NOTU in July 2009 were successfully completed by the end of 2010. This Report on the WAP sets out project aims and objectives, looks briefly at outcomes and achievements and challenges, and seeks to assess its contribution to the prevention of the spread of the disease in Uganda before making a few recommendations. The bulk of the information was gathered during a visit to Kampala from 14 to 16 March 2011 through a series of informal conversations with beneficiaries and participants. It also draws on the discussions with the NOTU leadership and some union officials from affiliated unions and Baligasima Yazidi, Project Coordinator, with environment, health and safety officials at Roofings Limited Uganda, and also on progress reports.

Aims and Objectives

The overall aim of the Project is to contribute to the prevention of the spread of the disease, facilitate access to VCT, care and support for workers living with it and to the protection and promotion of rights and entitlements of workers affected by it through a comprehensive programme of training and education activities. The expected outcomes were as follows;

Trade union leaders are aware of impact of HIV/AIDS on workplace and integrate workplace action on pandemic into trade union agenda as a priority;

Shop stewards are well informed about the pandemic and its impact on workers' rights and entitlements;

Rank and file members are made aware of risks of infection and informed of access to VCT and encouraged to go for testing;

Those who test positive seek treatment and receive counseling, care and support;

Trade union leaders agree on strategies to raise HIV/AIDS-related workplace issues at collective bargaining arrangements; and,

NOTU and affiliates secure agreement with employers on the incorporation of workplace policies on HIV/AIDS in CBAs.

Achievements

• Workers have a better understanding of HIV prevention and related issues and show more willingness to go for VCT following interventions by 60 Peer Educators from the NOTU-affiliated unions trained under the Project;
• NOTU affiliated unions are in a position to deploy 25 trained Focal Persons in lobbying and advocacy campaign;
• Workers are better informed of risks of HIV infection and prevention following distribution of Information and Education material - 20,000 brochures and leaflets-and condoms in outreach activities;
• Swahili and Luganda speakers, too, have received information and education material in their own languages;
• Senior leaders of NOTU and its affiliates remain committed to project objectives and engage the Government and employers on the protection of employment and human rights of people living with HIV/AIDS;
• Support from employers for project objectives has been secured through the representatives of the Federation of Ugandan Employers (FUE) who took part in some project activities and pledged support for it.

There is a high degree of awareness of the impact of the pandemic on the workplace among NOTU leaders and those of its affiliates and among union officials directly involved in the Project. Union leaders from transport (11) and building sectors (12) are knowledgeable about, and conversant with, the basic facts and figures of the epidemic in Uganda. They are conscious of the role of the workplace in combating it and remain convinced of its effectiveness. On the whole, union leaders have shown commitment to, and leadership in, organising awareness-raising activities and advocacy campaigns on the protection of the rights and entitlements of people living with HIV/AIDS in Uganda.

There is on-going collaboration with the Federation of Ugandan Employers (FUE) on the implementation of the current National Workplace Policy (13), dating back to the early 2000s when the FUE and NOTU jointly produced a handbook on HIV/AIDS for use at workplaces (14) and the participation of a number of FUE representatives (15) in the events organised under the Project has strengthened the relationship and brought the unions and employers closer in the fight against HIV/AIDS. The visit to the Health Centre at Roofings Ltd provided a useful insight into the collaboration between the Company and the unions in workplace action on HIV/AIDS. There is evidence of meaningful joint initiatives by the Uganda Building, Construction, Civil Engineering, Cement and Allied Workers' Union (16) and the Company in awareness-raising, VCT and treatment, care and support. The Environment, Health and Safety Officer and the Nurse in charge of the Health Centre provided detailed information on the role of the Health Centre as well as on VCT facilities, treatment and care in combating HIV/AIDS at workplace. Roofings Ltd Uganda considers the provision of VCT (17) and follow-up to be an essential part of their corporate social responsibility (18) and appreciates union support and involvement. The Company has a workplace policy on HIV/AIDS which, inter alia, says that there is absolutely no justification for mandatory HIV testing (19). Employers have in general been supportive of workplace HIV/AIDS prevention programmes (20).

The training of shop stewards in the protection of employment rights and in preventative measures has led to increased understanding of the disease and of its implications for the workplace among them and should facilitate the dissemination of basic information on HIV/AIDS on the shop floor. According to union leaders and officials, in general, workers are no longer reluctant to go for VCT in fear of testing positive and of losing their jobs as a consequence. However, it is hard to generalise this for all sectors. Neither NOTU nor its affiliates seem to have reliable data on the proportion of their members or workers in general who have already gone for testing (21).

The Amalgamated Transport and General Workers' Union (22) (ATGWU) has long been involved in HIV/AIDS prevention primarily with support from the international trade union movement, notably, the International Transport Federation (ITF). Union officials expressed gratitude for the support given by TUC Aid and spoke in detail of problems specific to the transport sector - long absence from families, limited access to services in neighbouring countries, presence of commercial sex workers at truck-stops, insecurity and vulnerability to harassment, prejudice against transport workers (23) (truck drivers) as 'transmitters of HIV/AIDS'. The inclusion of clauses on HIV/AIDS-related issues in collective bargaining arrangements has been a significant achievement in Uganda. The Management of the Entebbe Ground Handlers (ENHAS) has agreed to a set of terms and conditions with ATGWU including education grants for children and an HIV/AIDS Prevention Programme (24).

It is important to note that many union leaders and officials are of the view that the mobilisation around HIV/AIDS has enabled them to organise workers in some sectors more effectively and that membership has increased as a result and that their members very much appreciate the role of trade unions in fighting the pandemic (25).

Challenges

Trade unions in Uganda have made a significant contribution to the reduction in HIV/AIDS prevalence and the protection of employment and human rights through workplace action. The NOTU and its affiliates are keen to continue the campaign and seek support from the international trade union movement and solidarity support organisations.

The NOTU has not been able to take part in the Country Coordinating Mechanism (CCM) processes despite its willingness to get involved in it on behalf of organised labour. The CCMs are deemed to involve all stakeholders including workplace representatives and encourage their participation and partnership at all levels. However, the current arrangements for the CCM in Uganda appear complex and weighted in favour of the involvement of the government and its agencies, notably, the Ministry of Health. There appears to be little room in the current arrangements for organised labour to be meaningfully involved in the CCM process in the near future. This severely limits access of one important component of civil society to the Global Fund for AIDS, Tuberculosis and Malaria and other relevant international agencies and its contribution to the fight against HIV/AIDS through workplace action.

There is a persistent need for the training of peer educators and focal persons in unions in HIV/AIDS prevention and related issues, which appears to be, at least partly due to the high turnover of labour in some sectors like construction, plantations and agriculture where casual labour is a common feature. This, of course, is a problem which concerns not just Uganda, but also other countries with high HIV prevalence. Many union officials point to the inadequacy of training arrangements for peer educators and to the lack of resources to carry out their work.

Representatives from unions representing workers in the hospitality and entertainment industry emphasized the need for urgent action, for, according to them, the prevalence rate is as high as 80% in some subsectors. While it is difficult to confirm or deny this on available information, there is no mention of such exceptionally high prevalence rates in the Progress Report from the Government of Uganda submitted to the UN in March 2010 (26).

According to the Focal Person in the union representing members in the fisheries sector, the fight against HIV/AIDS in the sector has been an uphill task due to a variety of reasons. Most fishermen live in remote areas where access to basic services is difficult, unreliable and often unaffordable. Only rudimentary primary healthcare services are available in some rural areas. Moreover, many fishermen are functionally illiterate and unable to make use of written information and education material. It is also said that superstition plays a significant part in their daily life, that the belief in promiscuous sex life as a way of improving their catch stands in the way of HIV/AIDS prevention and that their extravagant spending habits following a good catch often results in casual sex and sexually transmitted infections. The 'Jaboya system' in which fishermen receive sexual favours from local women in exchange for fish is also considered to be a significant factor contributing to the high prevalence of HIV/AIDS in the fishing community around Lake Victoria. In addition, the limited availability of condoms seems to add to the problem. Although condoms (27) are usually available free of charge at some workplaces and also from union sources, fishermen do not seem to have easy access to them. According to union sources, a packet of 3 condoms is retailed at UGX 1000 (28) in the open market. Initial concerns about the quality of free condoms have been addressed and seem to have been overcome, to a great extent.

The lower echelons of the workforce in most sectors, notably, in the building, fisheries and agriculture sectors are not familiar with English and do not read or write or even understand it. Moreover, a substantial number of them are said to be functionally illiterate in local languages, too, and need to be reached through other media of communications. Radio programmes can be effectively used when printed information material is unlikely to produce desired results. Luganda is the most widely spoken local language in Uganda with some 6m speakers who use it as their first language while a further 4m people are supposed to have a working knowledge of it. Swahili is also understood in many parts of Uganda. Some of the information and education material produced under the Project has been translated into Luganda and Swahili and disseminated among the relevant speakers. While it is important that workers and their families in the most vulnerable sectors are provided with the required information in a medium accessible to them, trade unions cannot be expected to undertake the production and dissemination of information on a scale commensurate with the needs for the whole country (29).

Neither NOTU nor its affiliates have an explicit policy stance on the gay community in relation to HIV/AIDS or on the protection and promotion of their human rights. They point out that there is no discrimination against the gay community, as far as their employment rights are concerned and that people with different sexual orientations are found in all walks of life in Uganda. Nevertheless, union leaders admit that homosexuality remains taboo in many ethnic groups and cultures and that there is resentment when members of the gay community want to assert their rights. Contrary to the perception in some quarters, 'Men who have sex with men (MSM) and intravenous drug users (IDUs) contribute less than 1%' to HIV/AIDS prevalence in Uganda (30). In fact, 43% of new infections are among monogamous relationships (31). There is, therefore, hardly any justification for stigmatising the gay community as transmitters of HIV.

The representatives from the Uganda Nurses and Midwives Union(32) drew particular attention to the stigma, discrimination and marginalization of those diagnosed with HIV/AIDS, noting that attitudinal changes were urgently required if progress was to be made in combating the disease and that prejudice against people living with HIV/AIDS was not uncommon among the members of their profession.

The Government of Uganda supported the ILO Recommendation on HIV/AIDS and the World of Work adopted by the ILO Conference in June 2010 and has appointed a technical committee to make recommendations on its implementation. However, there is concern over some aspects of the proposed legislation on HIV/AIDS (33), notably, on the mandatory nature of proposed testing, notification and disclosure obligations and criminalisation of HIV transmission and other conduct related to HIV/AIDS.

Conclusions and Recommendations

It is evident that the fight against HIV/AIDS in Uganda has been successful in many respects and that it has long been supported by a number of key stakeholders including employers, government agencies, civil society organisations and the international community. Workplace action, too, has received substantial support from the international trade union movement, ILO, relevant government agencies and local and international NGOs. The WAP has certainly achieved its objectives in terms of expected outcomes and related achievements. However, they need to be put into perspective, for the Project has built on the progress already made on HIV/AIDS prevention and on the protection and promotion of employment and human rights of workers through workplace action.

It is not easy to pinpoint the 'unique contribution' made by the WAP to the collective effort by all actors working on HIV/AIDS in Uganda. The impact of the WAP cannot be isolated and assessed as a clearly identifiable, distinct and discrete contribution which stands out among manifold outcomes of various workplace interventions by many other actors.

The NOTU and its affiliates should continue its workplace programmes in collaboration with employers and relevant government agencies, local and international NGOs with a view to further consolidating the achievements of the WAP and other workplace interventions supported by the international trade union movement.

The lobbying and advocacy campaign for the implementation of the ILO Recommendation (R200) on HIV/AIDS and the World of Work needs to be given priority in view of its obvious implications for workplace. The NOTU and its affiliates may give consideration to initiatives to bring the National Workplace Policy and company policies into line with R200 with appropriate amendments to both NWP and various company policies currently in force.

The NOTU and its affiliates should study in detail the controversial provisions in the proposed legislation on the prevention and control of HIV and AIDS in Uganda and develop a common position on it and reach consensus among all stakeholders. They may approach the ILO, ITUC and key players in the international trade union movement for support and advice in addressing their concerns and in engaging the Government of Uganda, employers and other interested parties in this regard.

The production and/or reproduction of information and education material in a form easily accessible to intended users deserve urgent attention, as most vulnerable sections in the workforce, especially, those in sectors and subsectors where HIV/AIDS prevalence is high, are unable to make use of the available material. The use of radio programmes and audio-visual material where appropriate and possible, in addition to printed material, should be given serious consideration. This could be undertaken in partnership with other interested parties who are already relying on media other than printed material for the dissemination of information on HIV/AIDS and other sexually transmissible infections.

The NOTU and affiliates need to engage with organizations representing the interests of the gay community regarding their employment and human rights as well as their role in HIV prevention strategies. There is a wealth of experience, expertise and knowledge in the international trade union movement on building mutually beneficial relations with vulnerable and marginalized communities. The NOTU and affiliates should have no difficulty in tapping into trade union expertise and goodwill in order to develop appropriate responses in line with policies and practices agreed within the international trade union movement.

There is an obvious need for the continuation of training of Peer Educators and Focal Persons, especially, in some sectors where there is high labour turnover for a variety of reasons. Part of the solution consists in the incorporation of workplace action on HIV/AIDS prevention, VCT and related issues in general health and safety systems and structures at workplace level. The protection and promotion of employment rights and related issues of people living with HIV/AIDS need to be integrated into collective bargaining arrangements in a more formal and systematic way than at present. This ties in with the current holistic and integrated approach advocated by the authorities and the donor community in national HIV/AIDS prevention strategies.

Uganda has been the recipient of substantial financial assistance (34) from bilateral partners and a variety of international donors and institutions for its HIV and AIDS prevention and control programmes at all levels. In fact, only a fraction of the costs (about 7%) involved have been borne by the Government of Uganda in recent years. The trade union movement needs to build alliances with employers, government agencies, civil society and other interested parties in order to have access to more resources so that it can play its unique and distinctive role effectively in combating the pandemic from workplace.

Workers in the formal and informal sectors are appreciative of trade union involvement in the fight against the disease and its consequences for the workforce and, in many instances, have joined unions following their contact with union officials campaigning on employment and human rights of people living with HIV/AIDS. The trade union movement in Uganda should make good use of the opportunity to improve on service delivery to members, defend their rights and entitlements and strengthen its position vis-à-vis the Government of Uganda and employers.

Endnotes

1 Financial Stability Report, June 2010, Bank of Uganda

2 Op cit

3 Prevalence is determined by the number of new infections including babies born with HIV infection, deaths attributable to the disease and the difference between emigrants and immigrants living with HIV/AIDS. It is, therefore, necessary to interpret data with due care and caution.

4 Uganda AIDS Commission (UAC) was established in 1992 by Statute No. 2 of Parliament under the Office of the President.

5 Executive Summary, National HIV& AIDS Strategic Plan 2007/08 -2011/12, Uganda AIDS Commission

6 National Policy on HIV/AIDS and the World of Work, Ministry of Gender, Labour and Social Development, July 2007

7 See objective 16, op cit

8 Annexe I, Results Framework, op cit

9 UNAIDS, Uganda, information on website

10 NOTU, Affiliated trade union membership statistics and No of CBAs, Annex II

11 Amalgamated Transport and General Workers' Union (ATGWU) and Uganda Railway Workers' Union (URWU) have produced a useful booklet on HIV/AIDS and other sexually transmitted infections.

12 Uganda Building, Construction, Cement and Allied Workers' Union has its own policy document on HV/AIDS at the workplace.

13 NWP in Uganda was substantially based on the ILO Code of Practice on HIV/AIDS. See Foreword by Minister of Gender, Labour and Social Development, P3

14 Uganda HIV/AIDS Manual for Workplace, Private Alliance on HIV/AIDS 2004

15 Six FUE representatives took part in the seminar held in Nov 2009.

16 The Union has 5047 members. It has 17 CBAs.

17 The Company's initiatives on HIV/AIDS predate their involvement in WAP, see the Monitor, UN Plus, 17/01/2008

18 Mr Lalani Sikander, Chairman, Roofings Ltd Uganda, ibid

19 Company Clinic, WI/11/HR/CLINIC -01, 17 Feb 2011

20 50% of 'large employers' are providing ART services to their employees, according to the UNGASS Progress Report, March 2010, P48

21 Available information seems imprecise and patchy at best.

22 ATGWU has 3193 member as at March2011. The union is credited with 9 CBAa.

23 See Using the ILO Code of Practice on HIV/AIDS and World of Work, Guidelines for the transport sector, P4,

24 ILO Press Release, 6 June 2008, ILO website.

25 A view reaffirmed in a workshop held in Jan 2011 in Tanzania, ITF Fortnightly Update 101, Feb 2011, P2.

26 Most At Risk Populations, UNGASS Progress Report - Uganda, March 2010, P31

27 The Government of Uganda receives large consignments of condoms from international aid agencies such as USAID, UNEPA, GFATM etc and makes them available to relevant local agencies or distributes them through social marketing networks.

28 Approximately, 25p, 24 March 2011

29 There are at least 11 languages used by various ethnic groups in Uganda.

30 UNGASS Country Progress Report Uganda, March 2010, P15

31 Op cit, P16

32 The UNMU has 204 members.

33 HIV and AIDS Prevention and Control Bill, 2009

34 Some £260m in FY2007/8 and FY 2009/10, according to the UNGASS Country Progress Report, March 2010, (estimated at the GBP/UGX exchange rate on 25 March 2011)