Bridging the gap between VCT and HIV/AIDS treatment uptake: perspectives from a mining-sector workplace in South Africa.

This qualitative study sought to understand users' perceptions of the voluntary counselling and testing (VCT) and HIV-treatment services offered by a mining company in South Africa, with the intention of making recommendations to improve the rates of uptake. A purposive sample of 75 employees was interviewed and three focus groups were conducted with VCT users as well as with HIV-positive employees currently enrolled in the company's treatment programme. The relatively high uptake of VCT at the workplace appeared to be a function of the convenience afforded by rapid testing and the on-site nature of the company's annual campaign, the group nature of the campaign, and increased HIV awareness facilitated by pre-test counselling. Notwithstanding this, the study revealed barriers to uptake of VCT in the workplace, including: perceived violations of confidentiality by healthcare staff and doubts about the voluntary basis of HIV testing; organisational factors, including the visible group nature of the VCT campaign; and fear of a HIV-positive result and discrimination in that event. In contrast to VCT uptake, there was a relatively low rate of enrolment in the treatment programme: a significant proportion of HIV-positive employees identified in the VCT campaign did not present to the company's clinic for treatment. Impediments to treatment uptake included fears of being identified in the workplace as HIV-positive, which arose from perceived confidentiality violations on the part of the healthcare staff as well as organisational factors they believed allowed easy identification of the programme's users; limited time to attend the clinic; poor quality of post-test counselling and follow-up; difficulties in coping with the diagnosis; and traditional explanatory models of illness, which precluded medical care. A combination of the current annual, opt-in VCT campaign and a provider-initiated opt-out approach to VCT should be carefully considered in order to bridge the gap between the current levels of VCT and HIV-treatment uptake by employees at the company.