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AIDS in the world of work:
When information is not enough
As AIDS - Acquired Immunodeficiency Syndrome - continues to decimate the workforce on most continents, and especially in Africa, governments, unions and employers are taking various steps to fight the disease. This year, the ILO organized a Special high-level session on HIV/AIDS in the world of work during the 88th International Labour Conference, to mobilize efforts against this disease. As part of a continuing series of reports from the field, World of Work examines how workers are faring, in this case in Uganda. (Further articles are planned on the roles of employers and governments.)
KAMPALA, Uganda - Francis Musolooze was a chauffeur in a private business in Kampala. Today, at the age of 39, he is too weak to even leave his bed. Infected with the human immunodeficiency virus (HIV), which causes AIDS, since 1998, he again visited the Nsambia hospital last December.
"But he was too weak to return home by himself", recalls Rosemary Massa Mamkolo, a nurse at the Catholic hospital, who since then visits him at home to administer pain killers and offer some comfort in prayer.
Mr. Musolooze is a prime example of a worker in the age group which statistics show to be the first victims of this epidemic. On average, 80 per cent of AIDS-related deaths in Africa attack the 20- to 49-year age group.
A problem of society
Uganda was, in fact, the first African country to openly acknowledge the gravity of the epidemic and develop a strategy to fight it. The latest figures show that there have been slightly fewer new cases in the cities, with a national average seropositive rate estimated at 10 per cent of the population. It was 30 per cent in 1992.
David Ogaram, the representative of the Ugandan Ministry of Labour who attended a regional conference on HIV/AIDS in the world of work held in Windhoek, Namibia by the ILO last October, said that since 1992, AIDS is no longer perceived in Uganda as a public health problem, but as a broader social issue.
"You do not see banners on AIDS in the streets as in other African countries because this type of campaign was undertaken a long time ago," continues Mr. Ogaram. Today Uganda boasts over one thousand organizations of all types working in the fight against the virus.
The central national trade union (which brings together 17 branches of trade unions under the name of NOTU) is one of them, and does what it can within its limited capacities.
"From 1994, we started to train permanent personnel with the help of foreign trade unions and specialists here," explains Lyelmo Otong Ongaba, NOTU's National Secretary. "Then we sent them to the workplace, in factories and work sites, to talk about AIDS during their short breaks. Currently, we have stopped due to a lack of means."
They had to explain not only how to protect oneself from the virus but also how to fight against the discrimination which was affecting the people already suffering from the disease. These actions were of limited scope simply because salaried employees are only a minority of the workers. All others, from shoeshine boys to peasants, sales-persons in the market place, to taxi drivers, are active in the informal sector. The central union, however, is going to try to organize certain professions. In consultation with the Ministry of Labour, the unions acted firmly when enterprises tried to impose HIV testing to detect the virus.
When poverty and AIDS go hand in hand
Due to a lack of resources, union action remains at the stage of providing information
"We cannot be of any help to our members who are sick", says Lyelomo Ongaba, "[because] we don't have the means. It is impossible to set up a solidarity fund, for example, when salaries often cover only 20 to 30 per cent of basic needs."
Even though the disease affects all levels of the population, poverty is, in fact, a close companion of the virus. To become aware of the situation, one only has to go to the "villages" constructed by the sugar cane plantation workers, near Lugazi for example, some 50 km east of Kampala.
The Sugar Cooperative of Uganda Ltd., employs between 6,000 and 10,000 workers, depending on the season. This means that together with the women and children, some 40,000 people live around the plantations and the factory, in "camps" such as that of Geregere, which shelters 600 workers and their families. Each house is a dual dwelling with a kitchen and a 10m2 room, whatever the size of the family. The base salary is 25,000 shillings, the equivalent of about 25 Swiss francs. Unions have managed to negotiate a 35 per cent "cost of living allocation".
This remains meagre, even if housing and medical services are provided (plus one meal a day for some categories of workers). In the neighbouring tea plantation, the salaries remain below 17,000 shillings, all inclusive. These salaries condemn the workers to abject poverty, and any method to supplement their income is good.
"The girls start to have sexual relations at 12 years," explains Joram Bruno Pajobo, the union official in charge of agricultural workers and plantations. He is called "Honourable Pajobo" here, since he is a Member of Parliament, where he represents the workers.
Since 1992, he has been organizing women's groups to perform plays to create awareness among the workers - and their wives - on AIDS, and encourage them to use condoms.
"Many workers come from far off places and are lonely", continues Pajobo. "They often visit the prostitutes at the bottom of the hill where there are some barrooms. For us, this aspect is the most difficult to tackle because it encroaches on morals."
Adds Saida Bidi, National Coordinator of women in the same union: "We give general information, but it is difficult to speak concretely of the use of condoms. Its their private affair."
Risky professions
This difference between the knowledge of the workers (and of the general population) of risks they are running and methods of protection, on the one hand, and its effective application on the other, is one of the main observations of a study financed by the International Transport Workers Federation in London.*
The research, the results of which will be published in June, focused on long-distance truck drivers and railway workers, and was undertaken as a result of a request for assistance by the African transport unions. It shows that almost all of the people questioned are aware of AIDS and know how to protect themselves. More than nine out of ten people have lost one family member or a co-worker to AIDS. But risky behaviour (many sexual partners, intercourse without condoms) has not decreased proportionately.
"There is a definite awareness," says Winnie Bikaako, the author of the report, "but one has the impression that it still has not reached the level where it would change behaviour significantly."
This is primarily because of the "cocktail" consisting of disastrous working conditions and a low salary. Among the professions most at risk are those where workers spend weeks and even months far away from home in very precarious conditions: truck drivers, construction workers, railway workers...
"In some cases the HIV virus should be considered as an occupational disease", notes Winnie Bikaako.
The situation seems to be getting worse with the restructuring taking place in Uganda, which furthers the workers' sense of insecurity.
"Railways are being privatized", explains Patrick Katabutingi, official in charge of the railway workers' union. "We were more than 4,000 workers, now we are 1,800. But we expect further layoffs."
In such conditions, even though those who are HIV positive are better accepted than in other countries, no one wants to admit to it for fear of being laid off at the first available opportunity. Thus, the sick people confront AIDS alone.
Repeated infections, typical of lowered immunity and defences, are not well-covered by sick leave. Moreover, because of overcrowding of hospitals, patients often remain at home. And if they are not hospitalized, their salaries will be stopped sooner. The burden is shifted to the spouse - if there is one - and in the case of women it is even more serious; often infected by their husbands, they become widowed without any rights to the household goods (land, house), plunge deeper into poverty - and the vicious cycle continues.
Limitations of the unions
The ITF study spells out concrete action for solidarity with African unions. This multi-faceted action will comprise education, collective agreements to improve the worker's lot, care for persons infected with HIV and an easing of the socioeconomic effects of AIDS.
Unions in Uganda today are not considered direct major players in the fight against AIDS. In the National Strategy Plan 2000-2005, which has just been the subject of a seminar, it is revealing to note that the central union has been named as a partner only in the framework of the fight against child abuse, and abuse against youth and women. Action in the workplce has not been mentioned specifically.
The most useful role (apart from information) which the unions can play is based on their primary calling: improving working conditions and the lives of workers. The plantation union, for example, has a programme to encourage women to participate more actively in unions, to take more responsibility - and thus control - over their lives.
Union representatives also attend training courses on reproductive health, organized by the Ministry of Labour. The three-week course leads to information exchange within the enterprise. It is a difficult task because the proportion of organized workers, and their mobilization, are weak (in some unions, workers are automatically members unless they resign in writing).
Privatization, for its part, encourages hiring by competitors. As to the legal framework, Bruno Pajobo, the parliamentarian, has no illusions: "The majority of the Members of Parliament are landowners or businessmen. It is very difficult to get the workers a fair deal."
Michel Bührer for World of Work
* The report will be presented in the new magazine of the International Transport Workers' Federation, "Transport International", in June 2000. The magazine will also be available in French. Contact: finke_sarah@itf.org.uk.