Reaching men through HIV self-testing in the informal economy, small and medium enterprises in Mozambique

Background

Mozambique is one of the countries most affected by the HIV epidemic worldwide. Out of its total population of 35 million, 2.4 million are people living with HIV. An estimated 89 per cent of people living with HIV know their status as against the global target of 95 per cent. Men are being left behind. Only 85 per cent of men living with HIV know their status, whereas 92 per cent women living with HIV know their status1. Delayed diagnosis of HIV amongst men hampers their chances of having treatment on time.

Men have less access to HIV services for various reasons. Some of which may have to do with the nature of their work (mobility like in the case of long-distance drivers), migration, opportunity costs in accessing HIV testing services at health facilities, and gender-related stereotypes.

Building over years of ILO’s work in the area of HIV and AIDS in the world of work, the ILO has focused on reducing the HIV testing and treatment gap, particularly amongst men. The ILO’s voluntary counselling and HIV testing programme for workers (VCT@WORK) included HIV self-testing at workplaces in the last three years to provide another option to workers to know their HIV status.

Salient features of the strategy

Since 2021, the ILO has collaborated with government, employers' and workers' associations, civil society, and PSI (Population Services International) to promote HIV self-testing at workplaces.

As 85 per cent of the workforce in Mozambique is employed in the informal economy, the programme focused on young people and men working in the informal economy and in small and medium enterprises. Several interventions aiming to improve access to HIV self-testing, treatment, and care, were supported by the ILO in partnership with the Employers' Business Coalition Against AIDS, workers' organizations and the Association of Informal Workers.

HIV self-testing is a way to take care of the health of the worker, the most precious resource in the production of wealth in a company. I encourage all workers to make use of it. Know your status and live positively.
Helena Ferro, President, Business Coalition Against AIDS (ECOSIDA), Mozambique

HIV self-testing under the VCT@WORK initiative is a great opportunity for our members and their clients to get tested; and also to receive HIV related services in the informal workplace.
Ramos Marrengula, President, Informal Sector Association Mozambique

The interventions in the workplaces consist of three components:

Capacity building of HIV workplace peer educators and service providers to engage with workers and communities at the workplace and related locations were undertaken. The capacity building package included HIV prevention, condom use, HIV testing and follow up, stigma and discrimination, promotion of rights and fighting gender-based violence.
In the informal sector and at community level, partners designed intervention strategies to mobilize men and women to take part in the events. Mobile brigades travelled to companies and informal settings (including markets, transport terminals, hot spots) and carried out awareness-raising activities on HIV prevention, and created demand for voluntary HIV testing. The brigades included service providers, peer educators, associations of people living with HIV and

persons with disabilities, community-based organizations, as well as theatre groups, wherever possible. During these social mobilization campaigns, people living with HIV gave testimonies on their experiences of living with the virus and shared the benefits of testing early.
Holistic services were offered at work sites through mobile clinics and health fairs at company level and worksites, Including markets, transport terminals and surrounding communities. Wide-ranging health were offered including for HIV prevention, condom distribution to prevent HIV, sexually transmitted infections and unplanned pregnancies, voluntary HIV self-testing, linkage to treatment and screening for non-communicable diseases such as cancer, hypertension, and diabetes. Medical doctors from surrounding health facilities participated and offered services. Attention was given to monitoring and providing follow up to workers to after HIV testing to ensure that those who test positive were linked to treatment and care.

An inclusive approach: HIV testing covered persons with disabilities

The ILO and the Business Coalition against AIDS (ECOSIDA) expanded the HIV testing in the workplace programme to include persons with disabilities with the engagement and capacity strengthening of the Association of Persons with Disabilities of Mozambique.

Key activities included:

Training of 80 peer educators on disability inclusion, HIV, and human rights.
Organizing health fairs at Maputo’s Xiquelene informal market.
Training of 75 champions to promote disability inclusion in workplaces.
Contributing to revising disability rights laws to address HIV and AIDS.

This approach resulted in providing HIV testing to 15,506 people, among people with disabilities, informal workers and workplace surrounding community members. This included 4,373 persons with disabilities (2,748 men and 1,625 women); 7,239 community members (2,854 men and 4,385 women); and 3,894 informal economy workers (2175 men and 1,719 women). A total of 1,394 (689 men and 705 women) tested positive. All people who tested positive were linked to treatment and care.

Results

Between 2021 and mid-2024, close to 73,000 workers accessed HIV self-testing services in their workplaces, 73 per cent were men. This shows the advantage of taking HIV services to work sites for reducing HIV testing gaps amongst men.
4.3 per cent of those tested were HIV positive (3.5% of men and 5.5% of women). An estimated 15 per cent were first time testers. All those who tested positive were linked to treatment.
HIV self-testing in workplaces offers greater confidentiality and men can be reached who would otherwise not have accessed health services.
Offering different health services in workplaces beyond HIV ensures workers have access to additional health benefits, such as screening for non-communicable diseases. It also reduces stigma and discrimination around HIV testing.

Lessons learnt

Implementing VCT@WORK and HIV self-testing reduces HIV testing gaps amongst hard-to-reach men.
Partnerships (of government, employers’ and workers’ organizations, civil society and the ILO), and capacity building are crucial to delivering a successful HIV testing programme.
Male engagement strategies in the implementation of the social mobilization campaigns and adoption of multi-disease testing results in early diagnosis and timely treatment, not just for HIV but also for other health conditions. This approach also reduces stigma associated with HIV testing.
HIV self-testing is well received by workers; and support provided by workplace peer educators was key.
Workplace HIV interventions have the potential to reach not only workers but their families and communities around workplaces.
HIV interventions need to be inclusive of persons with disabilities, who need HIV services.

Next steps

Encouraged by the results and capacities developed, ILO and partners intend to scale up HIV testing at workplaces, including HIV self-testing, adopting an inclusive and multi-disease testing approach.