The role of HIV/AIDS committees in effective workplace governance of HIV/AIDS in South African small and medium-sized enterprises (SMEs)

The primary purpose of this study was to assess the role, status and scope of workplace HIV/AIDS committees as a means of effective workplace governance of the HIV/AIDS impact, and their role in extending social protective HIV/AIDS-related rights to employees. In-depth qualitative case studies were conducted in five South African small and medium-sized enterprises (SMEs) that were actively implementing HIV/AIDS policies and programmes. Companies commonly implemented HIV/AIDS policies and programmes through a workplace committee dedicated to HIV/AIDS or a generic committee dealing with issues other than HIV/ AIDS. Management, through the human resources department and the occupational health practitioner often drove initial policy formulation, and had virtually sole control of the HIV/AIDS budget. Employee members of committees were mostly volunteers, and were often production or blue collar employees, while there was a notable lack of participation by white-collar employees, line management and trade unions. While the powers of workplace committees were largely consultative, employee committee members often managed in an indirect manner to secure and extend social protective rights on HIV/AIDS to employees, and monitor their effective implementation in practice. In the interim, workplace committees represented one of the best means to facilitate more effective workplace HIV/AIDS governance. However, the increased demands on collective bargaining as a result of an anticipated rises in AIDS-related morbidity and mortality might prove to be beyond the scope of such voluntary committees in the longer term.


Introduction
A key factor in the effective governance of HIV/AIDS in the workplace is the collaboration of employers and employees.
Thus, guidelines on best practices for effective HIV/AIDS management in the world of work promote the establishment of collaborative mechanisms, including committees at national, regional, company and workplace level (Department of Labour, 2000; International Labour Organisation [ILO], 2004). However, there is very little research available that explores the role, dynamics and challenges of such committees, especially in the workplace. The key research objective of this study was to assess the role, status and scope of workplace committees as a means of effective workplace governance of the HIV/AIDS impact in the participating companies. A secondary objective was to assess the extent to which such committees created new opportunities to extend social protective rights to South African employees to mitigate the scourge of HIV/AIDS more effectively.
In-depth qualitative case studies were conducted in five SMEs in Gauteng province in South Africa, which documented the implementation of HIV/AIDS policies and programmes. Four companies were medium-sized employing 50-500 employees, while the fifth company was small and employed fewer than 50 employees. Most of the companies were in the manufacturing sector, while one was in the services sector. Results for Company D were reported separately as D 1 and D 2 , as these were two different sites belonging to one company.

Background
HIV/AIDS interventions in the South African private sector are largely led by corporates with extensive access to financial resources, and information and knowledge networks. Thus, local studies show consistently that small companies tended to lag behind in the management of the epidemic and access to HIV/AIDS services, while medium-sized companies performed relatively better in this regard (Connelly & Rosen, 2003;Ellis & Terwin, 2004) support. However, the successful attainment of these objectives requires appropriate institutional and governance capacity within workplaces. This is especially relevant to SMEs, who often suffer resource and capacity constraints in HIV/AIDS management (Connelly & Rosen, 2003). Thus, lessons may be learnt from SMEs that have allocated resources and capacity.

Results
The development and implementation of HIV/AIDS policies and programmes in most of the participating SMEs was driven by a workplace committee, either dedicated to HIV/AIDS, or a "generic" committee dealing with broader employee issues. attributed to the fact that, as a small company, it did not have sufficient resources to sustain an independent structure. The key rationale forwarded by management for a dedicated HIV/AIDS committee was that employee representation would facilitate "… buy-in from the floor", facilitating a "bottom-up" approach and workforce involvement in the HIV/AIDS programme. It was also recognised that it was a business "best practice" advocated by private sector role models.

Control of HIV/AIDS budget and expenditure
The case studies suggested that management had virtually sole

Role of HIV/AIDS committees in policy development
All of the committees operated on a consultative basis, and did Employee committee members argued that the apparent absence of a meaningful response to the initial policy was related to a lack of independent institutional support, information and resources.
Thus, a lack of access to information sources and technology, such as the Internet and computers, was cited as contributory reasons. In most cases they acknowledged their reliance on, for instance, the occupational health practitioner for information.
Over time however, external sources of information in the communities, such as nongovernmental organisations (NGOs) working on HIV/AIDS, played a role in improving the capacity of some employee committee members.
Secondly, influence was also indirectly derived by the committees. Thus, even though employee committee members were not party to the initial policy development process, they  and Company E. Table 3 provides an overview of the provision of HIV/AIDS-related treatment and care interventions among the participating companies.
As shown in Table 3, medical aid coverage was poor among many production employees, as the premiums were often deemed unaffordable. Further, in the absence of formal collective bargaining to negotiate access to paid ART provision, the alternative arrangements outlined here provided interim yet viable solutions. It is possible that the latter had been facilitated by the fact that at the time of the research, most companies had not had major negative impacts on the labour force and costs through extensive AIDS morbidity and mortality rates. As such, the cost of care and treatment had not been prohibitive, facilitating a form of company subsidisation. Further, management cited the declining market price of ART as a contributory factor. At the time of the study, the rollout of the government care and treatment programme had just commenced, and had not been a primary consideration, as most adopted a "wait and see" attitude or felt that for now they would "…go it alone". However, there might be a limit to which companies would be prepared to carry the costs, given a significant increase in the AIDS burden. This was likely to test the capacity of the HIV/AIDS committees in deriving further rights and benefits related to care and treatment in the absence of collective bargaining.   As far as the HIV/AIDS committees were concerned, the study suggested that the merits of the voluntary system of participation needed to be considered carefully. Thus, the volunteer system seemed to be acceptable in these companies, especially given the sensitivity of HIV/AIDS among the workforce, as well as the high level of personal commitment and sensitivity that appeared to be required from committee members. However, uneven coverage of sections of the workforce on the committees seemed to have had unintended consequences. This related particularly to the dominance of production employees relative to the poor representation of white-collar, administrative employees and line management. Furthermore, in most cases the latter sections of the workforce often also displayed low levels of participation in prevention activities. This might perpetuate the stereotype that HIV/AIDS was a predominantly "black" disease and did not affect other (white or skilled) employees. Finally, the case studies in this research study were not meant to represent trends within the larger population of SMEs.

Discussion
However, the research did provide more in-depth knowledge on underlying dynamics as well as greater insight into available means for developing and improving governance capacity in the management of HIV/AIDS among SMEs in particular.

Recommendations
The

Conclusions
This research study suggests that workplace HIV/AIDS committees could play a key role in improving HIV/AIDS governance capacity in the South African workplace.
Furthermore, such committees represent an opportunity for monitoring the implementation of mandatory rights, empowering employees in advocating and communicating such rights, and securing additional rights and benefits related to HIV/AIDS prevention, treatment and care. The study also suggests that in these SMEs the demands on the collective bargaining process had been relatively muted thus far. However, given the anticipated rise in the negative impact of AIDS morbidity and mortality, this might change. In the interim however, an effective and representative stakeholder committee offered one of the best means for effective mitigation of the HIV/AIDS impact, and the extension of employee rights and protection in the workplace.