Independent researchers recognize trade union contribution to HIV prevention in Nigeria.

Dr Pricilla Ibekwe, independent consultant, and Mr Chidozie Ezechukwu from the National Agency for the Control of AIDS (NACA) in Nigeria who conducted an independent evaluation of the three-year HIV/AIDS project point out that 'the workplace provides a fertile ground for reaching individuals with HIV, using proven strategies such as peer education and HCT' and conclude that 'the Project made an appreciable contribution to national achievements for HIV Counseling and Testing(HCT) and Prevention of Mother to Child Transmission (PMTCT), thereby contributing to the national progress towards MDG No. 6 targets and universal access targets which are in line with the project goal.'

Background

In 2009, the TUC secured funding from the UK Department for International Development (DFID) under the Programme Partnership Arrangement (PPA) for the implementation of a workplace initiative to combat HIV/AIDS in Nigeria. The three-year Building Workplace Capacity to Combat HIV/AIDS Project launched in partnership with the Nigeria Labour Congress (NLC) in July 2009 was successfully completed in June 2012 and a project completion report was compiled in December 2012. Six NLC affiliates in the health and education sectors took part in the Project designed to reduce HIV prevalence, protect employment and human rights of affected workers and lobby the authorities on the enactment and enforcement of anti-discrimination legislation. A total of 22,977workers attended the two Voluntary Counselling and Testing (VCT) facilities in Abuja in 2010-12, far in excess of the initial target of 9,000. 5.8 per cent of the attendees - a higher prevalence among workers than the national average based on sentinel surveillance - were diagnosed with HIV and referred to appropriate hospitals for treatment, care and support. 431 trade union officials trained under the project took part in counselling colleagues on HIV prevention and in collective bargaining on the protection and promotion of the rights of people living with HIV/AIDS. The information and education campaign and other awareness-raising activities organised at workplaces by the participating unions were attended by trade union members and reached some 600,000 members of the six participating unions, their family members and workplace participants. Workplace policies on HIV/AIDS were developed by participating unions with the technical expertise provided through the TUC while training and educational material produced under the Project contributed significantly to the awareness-raising of the need for HIV/AIDS prevention and enforcement of the rights of the affected workers.

The NLC, in consultation with TUC Aid, engaged the services of two researchers to conduct an independent evaluation of the Project. The assessment was carried out through a multi-faceted cross-sectional survey among participants from the six unions affiliated to the NLC in the Federal Capital Territory (FCT) and Nassarawa State. Three sets of questionnaires were used to elicit relevant information from the participants. 88.2% of the participants were aged between 15 and 49, representing the age-group most affected by the pandemic. In addition, focus group discussions were held at affiliates' headquarters in the FCT with a view to collecting qualitative information. Following is a summary of key findings and conclusions.

Findings

The researchers found that the knowledge about the disease was high among union members, although significant gaps still remained. 95.7% of the respondents to survey questions identified sexual relations with an infected person as the main source of infection, while blood transfusion (81.8%), use of unsterilized instruments (66%) and mother-to-child transmission (57%) were correctly noted as possible sources of infection. These findings reflect an improvement and compare favourably with national averages (2008) and data collected through the baseline survey immediately after the launch of the Project. 91% of the respondents claimed to have changed their sexual behaviour as a result of attending information and education activities organised under the Project. However, only 38.9% of male respondents who had high risk sex in the twelve months preceding the survey reported to have used condoms, which is well below the national average (56%) reported in 2008.

According to the survey, there have been changes in attitude in favour of people living with HIV/AIDS. 78% of those surveyed said that they would share eating utensils with a person living with HIV/AIDS while 83% would buy fresh vegetables from a shop keeper with HIV/AIDS. In 2009, 72% of those surveyed were prepared to make purchases from a shop keeper living with HIV/AIDS.

The survey also found that there is a low perception of risk of infection among the respondents with 25% saying that that there was no chance of their getting infected. Only 4.7% considered the risk to be high. Nevertheless, 78% had used condoms, with 44.3% of them claiming to have used them to avoid infections. Only 9.3% said that they had unprotected sex with a non-regular partner, representing a significant drop from 17% in 2009 in the baseline survey.

Voluntary Counselling and Testing

VCT has been by far the most successful of all project activities, resulting in outcomes exceeding project targets by 139%, according to the evaluators. 82.2% of respondents to the survey had gone for an HIV test by 2012. The highest uptake was recorded among the members of the Senior Staff Association of Nigerian Universities. The attendance at information and education events organized under the project has been instrumental in boosting the uptake, with 87.8% of the attendees having gone for VCT, which confirms the effectiveness of union involvement in encouraging workers to know their HIV status. The researchers point to a statistically significant difference between those who attended information and education sessions and those who did not, the former being far more likely to go for VCT. 81% of those who went for VCT did so to know their status while only 2.2% said that they were required to do so by the employer.

The evaluators highlight the success of VCT and confirm that all those diagnosed with HIV/AIDS had been referred to appropriate medical institutions for confirmatory testing, treatment and counseling, which suggests a 100% referral rate. Peer follow-up of those in need of treatment has indicated that the percentage of those undergoing treatment is well above the expected target of 30%.

Universal precautions

209 respondents to the survey were members of a union in the health sector. 75.6% of them reported that they had adopted the universal precautions in the discharge of their duties, with 93% of nurses and midwives confirming it.

Capacity building

The evaluators found that five of the six participating unions had developed HIV/AIDS policies in line with the recommendations of the ILO and communicated them to their members, that they had a focal person responsible for policy implementation with a budget and that the unions concerned had been successful in securing the enforcement of employment rights of workers affected by or infected with HIV/AIDS. They also found that all respondents were aware of, and had read, the National HIV/AIDS Policy published by the Federal Ministry of Labour and Productivity. In addition, the researchers confirmed that the NLC had reviewed and updated its own policies adopted in 2004 in the light of the ILO Recommendation (R200).

Stigma and discrimination

The evaluators found little evidence of discrimination against workers living with HIV/AIDS. In fact, only 8 cases involving union members had been reported during the course of the Project. All the cases concerned termination of employment on the basis of HIV status. Three of the affected workers have been reinstated by the employers.

Information and Education Activities

72.2% of respondents had attended 1-3 information and education activities held under the Project and nearly 89% of them had found them useful. Only 1.2% said that they did not find them useful. 82% of the attendees were satisfied with the information received at the briefing sessions.

Conclusions and recommendations

The evaluators point out that 'The 'building workplace capacity to combat HIV/AIDS in Nigeria' implemented by the Nigerian Labour Congress (NLC) in collaboration with six of its affiliate unions have demonstrated that the workplace provides a fertile ground for reaching individuals with HIV prevention using proven strategies such as peer education and HCT. This is evidenced by the improvements observed in the evaluation findings over that of the baseline results. The project recorded remarkable achievement in tackling stigma and discrimination against PLHIV through the development of HIV/AIDS workplace policy by five of the six affiliate unions reached under this project. NLC also supported the on-going advocacy by civil society for passage of the anti-discrimination bill by the National Assembly.'

On union capacity building, they note that 'The project contributed significantly towards capacity development of the affiliated unions for effective HIV/AIDS programming at policy, strategic and implementation levels to carry on the work beyond this project. This project was successful in that awareness and knowledge of HIV among union members has increased. In addition, the institutional and technical capacity of affiliated unions has also increased: written HIV workplace policy, union leaders trained in counseling, and bargaining skills, focal persons and budget for HIV work in place.'

'The uptake for HIV testing was high (82%), with clear indication that the peer-education partly accounts for the high uptake rate for HIV testing. The two pilot sites for HIV testing exceeded their targets by 139% and conducted 840 tests for pregnant women, contributing to the national targets for PMTCT. This is highly commendable when viewed against the background that increased HCT and PMTCT coverage remain national priorities.', comment the researchers on VCT provided under the Project.

They conclude that 'In summary, the project was well conceived and implemented resulting in appreciable success in achieving its goal and objectives. The use of existing structures of the NLC promoted efficiency thereby ensuring value-for-money. Future HIV workplace programmes should retain the fundamental infrastructure of a good HIV programme. However, further efforts to widely disseminate and effectively communicate the HIV policy to all union members should be undertaken.'