The influence of lotteries on employees' workplace HIV testing behaviour.

The aim of the study was to understand how lottery incentives influenced the HIV counselling and testing (HCT) behaviour and behaviour intention of shop-floor workers who participated in a workplace HCT campaign initiative in two companies in the Nelson Mandela Bay municipality, South Africa. A post-test only quasi-experimental approach was used. The data were first collected, using a self-administered cross-sectional survey instrument, among the control group (n = 88) followed by the experimental group (n = 110) after the advent of HIV testing and lotteries was announced. HIV testing behaviour data were collected on the days of the HIV testing events. The theory of planned behaviour (TPB) was used as guiding theory. Principal component analysis (PCA), t- and chi-square tests, and logistic regression were conducted to analyse the data. A significant increase in the mean scores of the experimental as compared to the control condition for the subjective norm's construct (t = -3.55, p < 0.001) and HIV testing behaviour intention (χ2 = 12.35, p < 0.001) was measured following the announcement of lottery incentives. The constructs of TPB explained 40% of the variance in HCT behaviour intention (R2 = 0.40). The strongest predictor of behaviour intention was the subjective norm (B = 0.435 and p < 0.001), followed by the attitudinal component (B = 0.323 and p = 0.040). The announcement of lotteries made shop-floor workers develop a stronger intention to participate in workplace HIV testing through anticipation of stronger social support and encouragement. It was not possible to link behaviour intention to behaviour due to missing data. The findings point to the importance of providing workers with an opportunity to openly discuss HIV testing thus allowing mitigation of HIV stigma and discrimination and permitting HIV testing to become socially sanctioned and seen as part of a collective effort.

Barriers to workplace HIV testing in South Africa: a systematic review of the literature.

Low workplace HIV testing uptake makes effective management of HIV and AIDS difficult for South African organisations. Identifying barriers to workplace HIV testing is therefore crucial to inform urgently needed interventions aimed at increasing workplace HIV testing. This study reviewed literature on workplace HIV testing barriers in South Africa. Pubmed, ScienceDirect, PsycInfo and SA Publications were systematically researched. Studies needed to include measures to assess perceived or real barriers to participate in HIV Counselling and Testing (HCT) at the workplace or discuss perceived or real barriers of HIV testing at the workplace based on collected data, provide qualitative or quantitative evidence related to the research topic and needed to refer to workplaces in South Africa. Barriers were defined as any factor on economic, social, personal, environmental or organisational level preventing employees from participating in workplace HIV testing. Four peer-reviewed studies were included, two with quantitative and two with qualitative study designs. The overarching barriers across the studies were fear of compromised confidentiality, being stigmatised or discriminated in the event of testing HIV positive or being observed participating in HIV testing, and a low personal risk perception. Furthermore, it appeared that an awareness of an HIV-positive status hindered HIV testing at the workplace. Further research evidence of South African workplace barriers to HIV testing will enhance related interventions. This systematic review only found very little and contextualised evidence about workplace HCT barriers in South Africa, making it difficult to generalise, and not really sufficient to inform new interventions aimed at increasing workplace HCT uptake.

A lottery incentive system to facilitate dialogue and social support for workplace HIV counselling and testing: a qualitative inquiry.

Despite South African mid-sized companies' efforts to offer HIV counselling and testing (HCT) in the workplace, companies report relatively poor uptake rates. An urgent need for a range of different interventions aimed at increasing participation in workplace HCT has been identified. The aim of this study was to explore qualitatively the influence of a lottery incentive system (LIS) as an intervention to influence shop-floor workers' workplace HIV testing behaviour. A qualitative study was conducted among 17 shop-floor workers via convenience sampling in two mid-sized South African automotive manufacturing companies in which an LIS for HCT was implemented. The in-depth interviews employed a semi-structured interview schedule and thematic analysis was used to analyse the data. The interviews revealed that the LIS created excitement in the companies and renewed employees' personal interest in HCT. The excitement facilitated social interactions that resulted in a strong group cohesion pertaining to HCT that mitigated the burden of HIV stigma in the workplace. Open discussions allowed for the development of supportive social group pressure to seek HCT as a collective in anticipation of a reward. Lotteries were perceived as a supportive and innovative company approach to workplace HCT. The study identified important aspects for consideration by companies when using an LIS to enhance workplace HIV testing. The significance of inter- and intra-player dialogue in activating supportive social norms for HIV testing in collectivist African contexts was highlighted.