Problem: What problem is this project trying to address?
The rate of HIV/AIDS prevalence among farm workers in rural areas of South Africa is very high. Estimates indicate that an average 40% of people from rural areas (statistics for Limpopo and Mpumalanga provinces) employed as farm workers were HIV positive as of 2010 as compared to the national average prevalence rate of 18.1%, which includes rural and urban (International Organization for Migration, 2010). This is because people in rural areas in general lack proper knowledge and education on the prevention of HIV resulting in risky behaviors that accelerate the spread of HIV infections. This is more so for farm workers who have problems accessing HIV/AIDS care services provided in their communities consistently and conveniently because of their migrant nature. The farm workers are ferried on buses from their communities (as far as a 3-hour drive) as early as 4:30 am and only get back home around 7 pm. This means they do not have time to visit clinics for services like VCT, counseling, general check-ups and ARV refills.
Another problem faced by farm workers that are HIV positive relates to stigmatization and discrimination both from their fellow workers and farm owners and managers. Lack of proper knowledge and information on HIV/AIDS and also the inherent perceptions about sexually transmitted diseases, especially in rural areas, leads to segregation and emotional suffering for people that are infected and this deteriorates their health even more. This becomes more evident if the infected people are immigrants (mostly from Zimbabwe, Malawi and Mozambique) as there is already a history of xenophobia towards foreigners. On the other hand, people that look like they are suffering from AIDS would be refused employment (or even fired if already employed) by farmers as they are associated with low productivity.
Further, South Africa has a history of poor working relationships between farm workers and farmers which stems from the Apartheid era. Farmers are known to ill-treat their workers not caring for their wellness and working conditions and usually pushing for production through cheap labor. On the other hand, farm workers tend to have a defiant spirit and look at the farmers as oppressors which also leads to stressful working environment on the farms. Based on this sour relationship most farmers would refuse their workers sick leave to visit the clinics (even for ART refills or required check-ups) and they would be marked absent without pay or even get fired if it is repeated. Most workers would then choose to abscond on clinic visits and default on ART than lose their precious jobs which would further deteriorate their health. A survey by Médecins Sans Frontières (MSF) in 2012 reports that migrant farm workers are three times more likely to default on ART within 3-6 months of the treatment than other populations within the same area. Therefore, the stressful working conditions lead to rapid deterioration of their health and some of them end up dying prematurely or losing their jobs because they can no longer cope and this negatively impacts on the living standards of their families.
The government, through the Department of Health has failed to effectively reach out to migrant farm workers with convenient and accessible HIV/AIDS services because of lack of capacity to create a holistic model that targets the underlying problems above. On the other hand, other development organizations that work with farm workers on HIV/AIDS have created models that fail to penetrate the farms and reach out to the individuals influencing behavior change and creating cohesion between the workers and the employers. Although access to HIV/AIDS is the underlying problem, most organizations ignore the need to transform the farm into conducive working environment linked to the communities where workers feel accepted and at home both by their peers and also the management. HIV positive farm workers therefore lack an all-round support system stemming from the workplace to their families and communities to ensure that they live stress free health lives and are able to keep their jobs and sustain their livelihoods.
Solution: What is the proposed solution? Please be specific!
Agriculture is considered one of the main industries providing employment to the majority of the labor force in rural areas of South Africa. Many people in rural areas are employed on farms either as permanent or seasonal workers providing unskilled labor to the farmers. Almost 85% of people employed on the farms migrate on a daily basis from rural communities as far as more than 100 km away from the farms. This makes it difficult for those that are HIV positive to access decent health and support services on a regular basis from health centers in their communities since they spend the whole day on the farms, leaving home around 4:30 am and coming back around 7 pm. Christine has developed a practical solution for reaching out to the farm workers on site with effective, reliable and regular healthcare solutions on HIV/AIDS and other related diseases. Through her organization, Hlokomela Training Trust (HTT), Christine makes sure that HIV positive farm workers are able to access medication and support services on-site and during working hours consistently and conveniently to ensure their wellness and positive living.
Hlokomela’s entry point is the establishment of HIV/AIDS clinics that are conveniently accessible to farm workers. The clinics are staffed with professional healthcare workers and provide all basic HIV/AIDS services including Voluntary Counselling and Testing (VCT), administering Anti-Retroviral Treatment (ART), counseling, nutrition and all round wellness services. HTT also has an outreach program through mobile clinics to ensure that workers even from distant farms and game reserves are accessing the services conveniently. One of Christine’s strongest innovations is in the way she has incorporated into her idea a peer caregiving strategy that influences behavior change on the farms and ensures integral wellness of farm workers that are HIV positive. Each farm has a caregiver called Nompilo (meaning “one who brings life”) who is a farm worker selected by the farm workers themselves and acts as a pivotal figure responsible for the health and wellness of their colleagues. These Nompilos are trained in relevant courses to equip them with the knowledge and leadership skills to effectively assume their roles. The Nompilos initiate behavior change in their fellow workers to reduce the spread of HIV and eliminate stigmatization both from other workers on the farm, community members and the farm managers. They are responsible to ensure that workers regularly go for VCT and practice safe sex and also reduce the rate of defaulting on ART.
Nompilos are at the core of Christine’s model in linking the farm workers, the farm owners/manager and HTT and together provide a holistic inside-out caregiving structure for migrant farm workers. They also represent their colleagues to the farm managers on labor issues relating to HIV/AIDS care (like negotiating for sick leave to go for check-up). Therefore, Christine is also working to improve the working conditions of farm workers by brokering relationships between farm workers and the farm owners. Christine realizes that the strained and poor working conditions for farm workers on most farms contribute to the deterioration of the farm workers’ health especially those that are HIV positive and this has a direct negative impact on overall productivity on the farms. This is based on the concept that a satisfied worker in good health is the most valuable asset to increase productivity.
Christine is currently reaching out to about 12,000 farm workers on more than 69 farms and game reserves, through a network of about 70 Nompilos. HTT has negotiated for a revised work place policy with assistance from the International Organisation for Migration which has now been adopted on 65 farms around Hoedspruit. Further, low HIV prevalence have been reported on the farms where Christine works: currently at 29% as compared to the average prevalence rate of 40% for farm workers in South Africa. She is now ready for national spread and is negotiating a partnership with the government’s department of health which wants to adopt her model and scale out to other farms beyond the Limpopo province. She is also seeing early adoption of her model in neighboring Lesotho.