Barriers to HIV counselling and testing uptake by health workers in three public hospitals in Free State Province, South Africa

Abstract

Recent WHO/ILO/UNAIDS guidelines recommend priority access to HIV services for health care workers (HCWs), in order to retain and support HCWs, especially those at risk of occupationally acquired tuberculosis (TB). The purpose of this study was to identify barriers to uptake of HIV counselling and testing (HCT) services for HCWs receiving HCT within occupational health units (OHUs). Questions were included within a larger occupational health survey of a 20% quota sample of HCWs from three public hospitals in Free State Province, South Africa. Of the 978 respondents, nearly 65% believed that their co-workers would not want to know their HIV status. Barriers to accessing HCT at the OHU included ambiguity over whether antiretroviral treatment was available at the OHU (only 51.1% knew), or whether TB treatment was available (55.5% knew). Nearly 40% of respondents perceived that stigma as a barrier. When controlling for age and race, the odds of perceiving HIV stigma in the workplace among patient-care health care workers (PCHWs) were 2.4 times that for non-PCHWs [95% confidence interval (CI): 1.80–3.15]. Of the 692 survey respondents who indicated a reason for not using HIV services at the OHU, 38.9% felt that confidentiality was the reason cited. Among PCHWs, the adjusted odds of expressing concern that confidentiality may not be maintained in the OHU were 2.4 times (95% CI: 1.8–3.2) that of non-PCHWs and were higher among Black [odds ratio (OR): 2.7, CI: 1.7–4.2] and Coloured HCWs (OR: 3.0, 95% CI: 1.6–5.6) as compared to White HCWs, suggesting that stigma and confidentiality concerns are still barriers to uptake of HCT. Campaigns to improve awareness of HCT and TB services offered in the OHUs, address stigma and ensure that the workforce is aware of the confidentiality provisions that are in place are warranted.

Keywords:

• confidentiality
• stigma
• occupational health
• HIV
• HCT
• health worker

Acknowledgements

We would like to thank our partners at Free State provincial Department of Health and the University of Free State. We would like to begin by thanking and acknowledging the participants of this study. Furthermore, we would like to extend our great appreciation and gratitude for the people without whom this study would not have been possible: the occupational health teams for their input, knowledge and championing of this work. We would like to thank Dr Asta Rau for context. We would also like to acknowledge Theresa Neuhoff, whose help with inputting survey data was appreciated; as was the invaluable support in statistical help provided by Faizal Haji and Yanling (Tara) Cai.

Funding

This work was supported by the Canadian Institutes of Health Research (CIHR) [grant number F09-04145].

Notes

1. Tolerance values were all well above 0.9 and no strong correlations were found among the independent variables included in the model, indicating multicollinearity was of no concern.

Additional information

Funding

Funding: This work was supported by the Canadian Institutes of Health Research (CIHR) [grant number F09-04145].