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Compiled by the Social Aspects of HIV/AIDS
and Health Research Programme of the HSRC
Funded by and prepared for the Safety and
Security Sector Education and Training Authority
The impact of
and responses
to HIV/AIDS in the

private security
and legal services
industry in
South Africa
S A F E T Y S E C U R I T Y
&
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Funded by and prepared for the Safety and Security Sector Education and Training
Authority (SASSETA).
Published by HSRC Press
Private Bag X9182, Cape Town, 8000, South Africa
www.hsrcpress.ac.za
First published 2007
ISBN 978-0-7969-2205-2
© 2007 Human Sciences Research Council
Copy-edited by Laurie Rose-Innes
Typeset by Simon van Gend
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the formative research phase 11
2.4 Study 1 (HIV prevalence, HIV incidence and KABP survey):
the main study 12
2.5 Study 2 (Business impact and response):
the formative research phase 20
2.6 Study 2A (Employer survey of business impact and response):
the main study 20
2.7 Study 2B (Employee survey of business impact and response):
the main study 21
2.8 Study 2C (Review of HIV/AIDS policies) 21
2.9 Ethical considerations 23

3.1 Introduction 25
3.2 Response analysis 25
3.3 HIV prevalence 29
3.4 HIV incidence 31
3.5 Behavioural and social determinants of HIV/AIDS 33
3.6 Voluntary counselling and testing 43
3.7 Substance use 46
3.8 Self-reported behaviour change 47
3.9 Male circumcision 48
3.10 Communication about HIV/AIDS and related issues 48
3.11 Associations between HIV prevalence and sexual behaviour indicators 50

4.1 Introduction 55
4.2 Response analysis 55
4.3 HIV prevalence and HIV incidence 60
4.4 Knowledge, attitudes, perceptions and behaviour 62
4.5 Awareness and use of VCT services 67
4.6 Self-reported behaviour change 68

7.3 Commentary on policies 108
7.4 Gaps and general problems with the policies 110
7.5 Key issues not included in the policies 114
7.6 Areas requiring improvement 120

8.1 Introduction 133
8.2 Summary of main findings for Study 1: HIV prevalence,
HIV incidence and KABP survey 133
8.3 Perceptions of business impact and responses 138
8.4 Recommendations 144

Appendix 1 Nurses who were trained as fieldworkers 153
Appendix 2 Terms of reference for policy experts 154

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v

Tables
Table 1.1 Crude and adjusted company-level HIV prevalence in 22 South African
workplaces 3
Table 2.1 Overview of employees and companies in the sub-sectors from various
sources 12
Table 2.2 Policy reviewers 22
Table 3.1 Individual response rates for interviews and testing by background
characteristics 25
Table 3.2 Characteristics among respondents interviewed and tested for HIV 26
Table 3.3 Profile of respondents compared to the national profile of employees
in the private security sector 28
Table 3.4 Profile of study participants from the private security firms vs. national
profile of employees in the private security sector 28

characteristics 55
Table 4.2 Profile of respondents by demographic characteristics (N = 421) 56
Table 4.3 Profile of respondents by employment category and situation, and
household economic situation (N = 421) 57
Table 4.4 Characteristics among respondents interviewed and tested for HIV 58
Table 4.5 HIV prevalence among respondents by demographic characteristics 60
Table 4.6 HIV prevalence among respondents by occupational category 61
Table 4.7 Responses to individual HIV/AIDS knowledge items by sex 62
Table 4.8 Responses to individual attitudinal statements about HIV/AIDS 64
Table 4.9 Perceptions of personal risk of HIV infection by sex 64
Table 4.10 Reasons for believing that one did not have a risk of HIV infection 65
Table 4.11 Age mixing among sexually active respondents by sex 66
Table 4.12 Awareness of where to access VCT services 67
Table 4.13 Self-reported change of behaviour by sex 69
Table 4.14 Alcohol use as measured using AUDIT scores by demographic
characteristics 70
Table 4.15 Communication messages/slogans about HIV/AIDS recalled by
respondents by sex 71
Table 4.16 Comfort in communication with others about sex and HIV/AIDS-related
issues by sex 71
Table 4.17 HIV prevalence and perceived personal risk of HIV infection 72
Table 5.1 Profile of employer respondents 73
Table 5.2 Profile of employees by occupational category, population group and
sex (N = 14 105) 75
Table 5.3 Profile of employees by age group, population group and sex (N = 972) 76
Table 5.4 Employment status of employees 77
Table 5.5 Perceptions of past and future impact of HIV/AIDS on operations and
profits (N = 13) 78
Table 5.6 Perceptions of the HIV/AIDS impact on employee profile 79
Table 5.7 Reported number of employees (n) who may have died due to AIDS or

Table 6.7 Perceptions of the HIV/AIDS impact on employees by occupational
category (N = 19) 97
Table 6.8 Reported number of employees who may have died due to
AIDS or AIDS-related causes, 2003–2006 (N = 15) 98
Table 6.9 Reported number of employees who may have left due to health-related
causes, 2003–2006 (N = 15) 98
Table 6.10 HIV/AIDS impact on increasing employee benefit costs (N = 19) 99
Table 6.11 Impact on expenditure on HIV/AIDS services (N = 18) 99
Table 6.12 Perceived HIV/AIDS impact on the demand and supply of skills (N = 19) 100
Table 6.13 HIV/AIDS impact on investment in training by occupation (N = 18) 100
Table 6.14 Potential HIV/AIDS impact on supply of critical skills and strategies for
skills turnover (N = 20) 101
Table 6.15 HIV/AIDS impact on output, service delivery and consumer
demand (N = 20) 101
Table 6.16 Awareness and implementation of HIV/AIDS policies 102
Table 6.17 Implementation of HIV/AIDS programmes (N = 20) 102
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viii
Table 6.18 Employee perceptions of HIV/AIDS impact on employees and the
company 103
Table 6.19 Awareness of HIV/AIDS policies and their implementation 104
Table 6.20 Employee knowledge of contents and gaps in company HIV/AIDS
policies (N = 101) 104
Table 6.21 Reported employee access to HIV/AIDS interventions in company 105
Table 6.22 Perceived gaps in company HIV/AIDS interventions (N=134) 105
Table 7.1 Coverage of key issues in the HIV/AIDS policies of SASSETA and private
security companies 109
Table 7.2 Coverage of key issues in the HIV/AIDS policies of the legal firms 109
Figures
Figure 1.1 Epidemiological model of the impact of HIV/AIDS in a workplace 7

state of HIV and AIDS in two of its constituencies – the private security industry and the
legal profession. This project, sponsored by SASSETA, was a collaborative effort between
the HSRC, SASSETA and stakeholder representatives over one and a half years. While the
process was not without stumbling blocks, we believe this to be a major step in the
direction of informed and targeted interventions for our sector.
Having covered four very important aspects, namely a policy provision analysis, a
business impact study, a knowledge, attitudes and practices (KAP) survey, and a
prevalence and incidence survey, the findings and recommendations in this report can
now be constructively be put to use in the development and implementation of HIV and
AIDS management strategies for the private security industry and the legal profession. As
is evident from the report, both groups are affected by HIV and AIDS; however, the
hesitancy to participate in this survey on the part of so many employers is a clear
indicator that the subject-matter has not crossed into the general awareness of businesses
in our constituency. We hope that this report will be useful, beyond its original purpose
of informing the SETA, in contributing to the general body of knowledge that is being
generated on the subject.
This publication is presented to the reader with the challenge to take HIV and AIDS
seriously as an individual and as a businessperson. Perhaps, if we manage to repeat a
similar study in the future, we may be fortunate enough to witness the difference we
have made.
Temba Mabuya
Acting CEO, SASSETA
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
Authors are listed in order of contribution to the conceptualisation and preparation of the
proposal, the development of the questionnaire, preliminary planning, management of the
project, data collection, data analysis and report writing.
Leickness Chisamu Simbayi, DPhil
Research Director

Nomvo Dwadwa-Henda, MA
Chief Researcher (Doctoral Research Trainee)
Behavioural and Social Aspects of HIV/AIDS Section
Social Aspects of HIV/AIDS and Health Research Programme
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xi
Yoesrie Toefy, MA
Database Manager (Doctoral Research Trainee)
Social Aspects of HIV/AIDS Research Alliance (SAHARA)
Pelisa Dana, PhD
Research Specialist
Epidemiology, Strategic Research and Health Policy Section
Social Aspects of HIV/AIDS and Health Research Programme
Thabile Ketye, MA
Senior Researcher
Epidemiology, Strategic Research and Health Policy Section
Social Aspects of HIV/AIDS and Health Research Programme
Azwihangwisi Matevha, MA
Senior Researcher (Doctoral Research Trainee)
Behavioural and Social Aspects of HIV/AIDS Section
Social Aspects of HIV/AIDS and Health Research Programme
Nkululeko Nkomo, MA
Senior Researcher (Doctoral Research Trainee)
Behavioural and Social Aspects of HIV/AIDS Section
Social Aspects of HIV/AIDS and Health Research Programme
Yolande Shean
Project Administrator
Behavioural and Social Aspects of HIV/AIDS Section
Social Aspects of HIV/AIDS and Health Research Programme
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control of questionnaire data.
Mrs Yolande Shean who efficiently co-ordinated and administered project •฀
meetings, data collection material and communication in general. She also
helped put the final report together by collating the sections submitted by the
various collaborators who prepared the report.
Ms Sinelisiwe Ngwenya who assisted with project administration in the project •฀
management office.
Mrs Linda Ngcwembe who diligently assisted with the project expenditure •฀
updates, report and guidance.
Ms Alicia Davids for helping with putting together the report.•฀
We wish to thank the following people for reviewing the preliminary report •฀
(especially the areas indicated) as part of the Experts’ Panel:
Dr Mark Colvin, Epidemiologist, Centre for AIDS Development Research and •฀
Evaluation (CADRE), Durban – HIV/AIDS epidemiology, especially in
workplaces.
Ms Cathy Connolly, Biostatistician, South African Medical Research Council
•฀
(MRC), Durban – HIV/AIDS epidemiology, especially in workplaces, and
behavioural and social factors driving HIV/AIDS.
Professor Kelvin Mwaba, Psychologist, University of the Western Cape (UWC), •฀
Cape Town – Behavioural and social factors driving HIV/AIDS.
Professor Carel van Aardt, Economist, Bureau of Market Research, University of •฀
South Africa (UNISA) – Impact of HIV/AIDS and response by business.
Professor Geoffrey Setswe, Public Health Specialist, Human Sciences Research •฀
Council (HSRC) – HIV/AIDS policies in workplaces.
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xiii
We thank all the nurses who undertook the fieldwork. We have come to rely on •฀
these nurses, most of whom, although recently retired, are willing to further
contribute to the development of our country as fieldworkers and supervisors. We

GRI Global Reporting Initiative
HIV Human Immunodeficiency Virus
ILO International Labour Organisation
KABP knowledge, attitudes, beliefs and practices
LSSA Law Society of South Africa
M&E monitoring and evaluation
PEP post-exposure prophylaxis
PLWA people living with AIDS
PLWHA people living with HIV/AIDS
SABCOHA South African Business Coalition on HIV/AIDS
SARS South African Revenue Services
SAS Statistical Analysis Systems
SASSETA Safety and Security Sector Education and Training Authority
SIRA Security Industry Regulatory Authority
SMMEs small, medium and micro enterprises
SPSS Statistical Package for Social Scientists
STD sexually transmitted disease
STI sexually transmitted infection
TTT technical task team
UCT University of Cape Town
UNAIDS Joint United Nations Programme on HIV/AIDS
USA United States of America
VCT voluntary counselling and testing
WHO World Health Organisation
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
Background
The generalised nature of the HIV/AIDS epidemic in South Africa is believed to have
uneven impacts on various business organisations operating in the country. Indeed, many

August 2007.
Objectives
The central objective of the present study was to conduct a critical assessment of HIV/
AIDS in the private security and legal services industries, in terms of the prevalence and
incidence rates of HIV, business impact, and the responses of businesses to the epidemic
thus far.
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xvi
Methods
Two research approaches were followed. Firstly, the study employed a highly
participatory approach, which our team had used successfully in similar prior research.
This entailed a significant involvement of key stakeholders in the conceptualisation and
design of the study as well as its execution. This was effected through a steering
committee and a technical task team, consisting of members of our research team and
representatives from SASSETA, as well as its stakeholder organisations, the private security
companies, legal firms and the unions, which oversaw the implementation of the project
from beginning to the end.
Secondly, we used a triangulation of several research methods, due to the complexity of
the issues that were under investigation simultaneously. This, we believe, allowed for a
deeper understanding of the issues than would have been the case if only one method
had been used.
The original overall project structure is shown in the figure opposite. In order to fulfil the
objectives of the study, two parallel sets of studies where conducted within each sector.
Study 1, which sought to address Project Outcomes 1 and 2, focused on HIV prevalence
and HIV incidence, and knowledge, attitudes, practices and beliefs, while Study 2, which
addressed Project Outcomes 3 and 4, investigated the business impact of HIV/AIDS and
responses thereto.
Both Studies 1 and 2 in each sector were preceded by a formative study involving
interviews with managers or key people involved in HIV/AIDS in a few companies and

incidence
(Project outcome 1)
Knowledge, attitudes,
perceptions and behaviours
(Project outcome 2)
Study 2
Business impact
(Project outcome 3)
Business response
(Project outcome 4)
Legal services sector
Study 1
HIV prevalence and
incidence
(Project outcome 1)
Knowledge, attitudes,
perceptions and behaviours
(Project outcome 2)
Study 2
Business impact
(Project outcome 3)
Business response
(Project outcome 4)
SASSETA Project
Process followed in
both sectors
Phase 1
Formative or elicitation
research: focus groups &
key informants

conjunction
with Study 1)
Phase 2c
Managers’ survey
Phase 3
Expert panel review of HIV/
AIDS policies in 16
companies
Phase 4
Synthesis of expert reviews
and policy recommendations
Phase 5
Recommendations
(Project outcome 5)
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xviii
The detection of recent infections (incidence) was performed on confirmed HIV-positive
samples using the BED capture enzyme immunoassay (CEIA, Calypte® HIV-1 BED
Incidence EIA, Calypte Biomedical Corporation, Maryland, USA) optimised for DBS
specimens.
Data from each study was captured and analysed using appropriate methods as described
in full in the main report.
Finally, ethical approval was obtained from the HSRC’s Research Ethics Committee.
Main findings from Study 1: The HIV prevalence, HIV incidence
and KABP survey
Private security sector
The following results were obtained:
HIV prevalence among the respondents in the private security sector is 15.9%. Other •฀
analysis showed that:

the following two, about which many respondents were either negative or
ambivalent:
having protected sex with a partner who is living with HIV/AIDS; and •฀
disclosing the status of a family member, which most respondents indicated •฀
they would want to keep a secret or were unsure about disclosing.
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
The overwhelming majority of participants (95.6%) had started taking the AIDS •฀
problem more seriously, and this was equally true for both sexes and the different
race groups. Two-thirds of respondents (60%) indicated that it was because of the
increased number of deaths due to AIDS, while almost a third (30.1%) viewed the
reality of the disease as the second main reason.
More males than females believed that they were are risk of HIV infection. •฀
Conversely, more females than males believed that they were not at risk. Most
believed they were not at risk because they were faithful to one partner/trusted their
partner, either always used condoms or were abstaining from sex, did not share
used needles or body-piercing instruments, did not have sex with prostitutes, and
knew that both they and their partner had tested HIV negative, in that order.
Of the four race groups, both males and females of African origin (95.3% and 89.7% •฀
respectively) were found to be the most sexually active in the last 12 months,
compared with their counterparts from the other race groups, especially white males
(90.8%) and coloured females (76.3%).
The large majority of respondents (86.7%) reported that they had regular sexual •฀
partners, 10.4% had non-regular sexual partners and 0.6% had had sex with
commercial sex partners. The breakdown of those who had non-regular partners
was as follows:
more African and coloured males reported having had two or more sexual •฀
partners than did their male white and Indian/Asian counterparts;
more coloured females reported having had two sexual partners than did their •฀


xx
both male (63.9%) and female (44.8%) respondents with two partners reported •฀
higher condom use than their counterparts with single partners only (37.0%
and 31.9% respectively);
single respondents across all three age groups reported significantly higher use •฀
of condoms in their last sexual intercourse, compared to their married,
widowed or divorced counterparts; in particular, respondents below 25 years of
age (65.4%) reported higher use of condoms than did respondents in the other
two age groups (53.2% for those aged 25–49 years and 50.0% for those older
than 50 years); and
respondents younger than 50 years old who had more than two partners •฀
reported the highest condom use in their last sexual encounters.
The large majority of respondents (88%) knew where to obtain VCT services. •฀
However, white respondents and those aged 50 years and older were least aware of
VCT centres. With regard to VCT use:
a slight majority of respondents (53%) had ever had an HIV test, of whom 95% •฀
had been told of their test results;
the majority of those tested (70.2%) had pre-test counselling before undergoing •฀
the test, with more men (73%) than women (64%) having received counselling;
fewer, but still a majority of the respondents (60%), had post-test counselling •฀
after having had an HIV test; and
female respondents (64%) were more likely than males (46%) to report having •฀
being aware of their HIV status.
Half of the respondents (48.2%) who knew about their HIV status had regular •฀
partners, and the large majority (78.8%) of those with non-regular partners indicated
that they had used condoms consistently in the past 12 months.
One-fifth of the respondents (18.5%) who were found to be HIV-positive in this •฀
study had been tested for HIV within the previous two years, while 16.3% had
undergone HIV testing more than two years previously.

HIV prevalence was found to be higher among respondents who reported that they •฀
had used condoms during their last sex act than it was among those who reported
not having done so. More HIV-positive respondents reported that they had been
using condoms with regular sexual partners consistently over the past year,
compared to those who had not.
Respondents who perceived themselves to be at high risk of HIV had a higher HIV •฀
prevalence (19.9%) than those who considered themselves to be at low risk (9.8%).
However, the difference was not significant.
Males who had partners 10 years younger than themselves had a higher HIV •฀
prevalence (20.2%) than males who had partners 10 years older than themselves
(10%). However, females who had partners 10 years older than themselves had an
HIV prevalence of 16.3%, compared to a prevalence of 9.3% among those that had
partners 10 years younger than themselves.
Legal services sector
The main findings that emerged from this study were as follows:
HIV prevalence among the respondents was 13.8%, with the following breakdown: •฀
females had a slightly (but not significantly) higher HIV prevalence of 14.4%
•฀
than males (12.4%);
Africans had an HIV prevalence (20.2%) that was significantly higher than that •฀
of the other race groups combined (1.7%);
respondents who were 25–49 years old had a higher HIV prevalence (16.0%) •฀
than respondents in the other two age groups (5.7% for those aged 50 years
and above, and 5.3% for those aged 24 years and younger 5.3%);
respondents who had never married had a significantly higher HIV prevalence •฀
(18.7%) than married respondents (10.1%);
KwaZulu-Natal had the highest HIV prevalence (23.7%), followed by Gauteng •฀
(13.6%) and the Western Cape (2.1%); and
respondents classified as labourers, cleaners, porters and messengers had the •฀
highest HIV prevalence (21.1%), compared to respondents from other

their female counterparts (4.0% and 1.2% respectively).
About a tenth of males (8%) had a partner who was 10 years younger than •฀
themselves. The situation was the opposite among females, of whom 6% reported
that they had a partner who was 10 years older than themselves. No male
respondent had a sexual partner who was 10 years older than himself, while only
0.8% of the females had a partner 10 years younger than themselves.
Consistent condom use was higher in relationships involving either one non-regular •฀
sexual partner (55%) or more than one non-regular concurrent multiple sexual
partner (66%) than it was in regular relationships (16%).
Over the previous 12 months, the majority of respondents in casual (non-regular) •฀
relationships with one non-regular partner (55%) and two-thirds of those with two or
more non-regular partners (66%) reported consistent condom use, compared with
16% and 34% respectively for those in regular sexual relationships.
The large majority of respondents (84%) knew where to obtain VCT services, with •฀
African (92%) and coloured (80%) respondents having higher awareness of where to
access the services than white (71%) and Indian/Asian (63%) respondents.
Nearly three-quarters of the respondents (71.1%) had undergone testing, with more •฀
females than males having done so; of these, 64% had pre-test counselling and 51%
had post-test counselling, with two-thirds (66%) of them of both sexes having been
informed of the results of the tests and thus being aware of their status.
Overall, nearly two-thirds of the respondents (64%) reported having changed their •฀
behaviour in the face of widespread HIV infection. Most had done so mainly though
adopting ABC strategies.
Overall, 42.1% of the respondents reported that they had used alcohol in the •฀
previous 12 months:
nearly a third (32.2%) were classified as low-risk drinkers (AUDIT score 1–7), •฀
while a tenth (9.9%) were high risk-drinkers (AUDIT score 8+);
males (23%) were more likely than females (4%) to be high-risk drinkers; •฀
respondents aged 24 years and younger reported the highest levels of high-risk •฀
drinking (15%), compared to those older than 50 years (2%); and

23.1% a moderate impact and 30.8% a small impact.
Most employer respondents reported that HIV/AIDS had no impact on their •฀
employee profile. However, a few indicated otherwise, and the impact varied by
occupational category, especially among service workers, security guards and
labourers.
Many AIDS or AIDS-related deaths were reported to have occurred in 2003 and •฀
2004.
Turnover was mainly among service workers and security workers, and a fair •฀
number was reported among labourers.
Most companies provided a company retirement benefit, whereas only half provided •฀
either a medical aid or funeral benefit. Very few reported the provision of HIV/AIDS
coverage or an occupational health clinic, the latter in lieu of medical coverage.
Most companies did not anticipate that HIV/AIDS would have much of an impact on •฀
increasing employee benefit costs. On average, 66.7% reported that there would be
no impact on benefit costs.
Companies spent very little on HIV/AIDS services in the period prior to the survey. •฀
However, there does appear to have been some expenditure on HIV/AIDS education
and awareness services and VCT.
Most companies felt that HIV/AIDS had no impact on skills demand and supply •฀
across all occupational categories. Overall, it appears that there had been relative
stability in the companies in regard to the demand and supply of skills, irrespective
of occupation; consequently, very few companies had strategies in place to deal
with potential labour and skills turnover.
Most companies felt that HIV/AIDS had no major impact on investment in training. •฀
Among those that indicated otherwise, increases had been among labourers (33%),
followed by service workers and learners (20% each), the occupational categories
reported by companies as being severely impacted on by HIV/AIDS.
While some companies reported that there had been no HIV/AIDS impact on output •฀
and service delivery, some indicated that there had been increases in sickness-
related absenteeism and funeral attendance (38.5%) and health-related turnover

were ill (64.9%), a shortage of employees (58.4%) and decreases in effective
functioning (58.7%).
Most employees displayed very low levels of awareness of HIV/AIDS policies, with •฀
only 8.5% aware of an industry-wide policy, which was considerably higher than the
2.5% awareness of a trade union policy. Interestingly, two-thirds of those who were
aware of an industry-wide policy indicated that it had been implemented in their
companies.
The most commonly cited contents of company HIV/AIDS policy (among those few •฀
respondents who were aware of it) were non-discrimination, confidentiality, safety in
the workplace, counselling, support of employees living with HIV/AIDS, and
prevention programmes.
Very few of the respondents were able to identify gaps in the HIV/AIDS policies, •฀
which included counselling and support of PLWHA, workplace HIV/AIDS prevention
programmes, and HIV testing of employees.
With regard to reported employee access to HIV/AIDS interventions, the most •฀
commonly cited interventions were the provision of equipment to protect staff from
blood infections, condom provision, prevention programmes and replacement of
staff when ill.
Amongst the key programmatic gaps identified were lack of education and training •฀
about HIV/AIDS (42.1%), followed by the absence of VCT programmes (28.7%) and
programmes to address stigma (14.2%).
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Main findings of Studies 2A and 2B in the legal services sector
Employer perceptions of impact of HIV/AIDS on business
The following main findings emerged:
HIV/AIDS was not regarded as a business concern by most of the respondents •฀
(70%). Consequently, most employers had not made any attempt to measure the
potential impact of HIV/AIDS, while a few companies had conducted a quantitative

supply of skills as a result of HIV/AIDS; a few mentioned a shortage of associate
professionals.
Nearly all companies expressed the belief that their investment in training would not •฀
change as a result of HIV/AIDS, because they did not foresee a negative impact on
the supply of critical skills, nor did they have strategies in place to deal with HIV/
AIDS-related skills turnover.
Nearly all companies reported that there had been no change in output and service •฀
delivery, although a few reported that where there had been an impact, it reflected
sickness-related absenteeism, funeral attendance and health-related labour attrition.
Interestingly, the companies reported having experienced an increase in consumer
demand for services related to assistance with welfare grants, estate administration
and similar concerns.