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Acronyms 
EMA      Environment Management Act
SHE       Safety and Health Environment
ARVs     Antiretroviral
OSHE      Occupation Safety and Health Environment

DAY ONE: 7 APRIL 2004

1.0   SESSION ONE

1.1 Introduction:
In her welcome remarks The Project Officer and Director of Ceremonies welcome the participants to the workshop. She explained that the workshop was part of a project whose objective is to respond to the state of HIVAIDS in Swaziland. This it seeks to do by raising the awareness that the environment that people are placed in should be safe and healthy; this it does with a focus to the workplace environment. The critical question that arises for consideration is what each sector can do to contribute to mitigating HIV/aids.  For Yonge Nawe purpose the relevant question was how the environment affected people with HIV/AIDS.  How can the conditions of the environment at the workplace be made conducive to safety and health. With these questions in mind the project was conceived to explore interventions to ensure that safety health and environmental standards at the workplace are adequate to address challenges of HIV/AIDS.

1.3 Director’s Opening Remarks: 

The Director thanked the unions for attending. She explained that the workshop’s objectives were two fold, on the one hand Yonge Nawe seeks to equip the workers with some technical knowledge of she matter, and on the other Yonge Nawe wishes to learn from the participants because the knowledge that the organization has is no match with whatever happens practically at workshop- which can be shared by the forum. She observed that the workshop addresses an area of concern to the organization as the human as part of the environment has been marginalized.  Considering that people spend most of the time at the workplace it is fitting that equilibrium is sought between workers and the work place environment.  The HIV Epidemic and poor working conditions have compromised the workforce. Through this project and other SHEq programmes the workplace can be restored to its role of enhancing the quality of the life. 

1.3 Participants Expectations of the Workshop:

•  To be equipped with skills to train co-workers about Occupation Safety and Health.
• Hope to obtain remedies for the environmental and OSH problems experienced at the workplace.
• Acquire knowledge of OSH and HIV/AIDS; especially on how to support those already ill. 
• Issues of HIV/AIDS not dealt with at the workplace, this forum will provide the opportunity to explore these issues. 
• To be informed about how to respond to the indifference of the employer in enacting policies despite the prevailing unsafe hazardous conditions
• To know why there is secrecy about the HIV virus not normally experienced with other conditions such as like TB.
• Acquire knowledge on the relationship between the environment and HIV.
•  Share experience with other participants

•  To establish how HIV/AIDS, environment and OHS link.
•  To draw an intervention that promotes the positive link between the tripartite.
•  To produce a publication showing the link between HIV/AIDS, Environment and OHS.

2.0   SESSION TWO
2.1 The Science of HIV/AIDS and Immunity
by Richard Phungwayo

In his preliminary remarks the presenter urged the participants to think about HIV/AIDS broadly to encompass, amongst others, their working environment and shift from the notion that HIV/AIDS is a health issue. He emphasized the importance of using correct language in explaining about the HIV condition and that one of the purposes of the discussion was to relate to AIDS as a condition not a disease.

He defined AIDS in terms of the sequence of alphabets ABC.
A: Condition
B: Diseases resulting from weakened immunity, such as TB, diarrhea, skin disease.
C: Conditions leading to a low immune system. These may be caused by the different factors including abuse of alcohol; poor diet; pregnancy; stress (of certain levels) and HIV; which is particularly destructive to the immunity. The understanding of the above is important because the lack of it leads to preconception and prejudice. There is a tendency that when there is an outward manifestation of any of these conditions people jump to the conclusion that the person in question is HIV positive. 
AIDS was said to be synonymous with a journey with significant phases, one that once set upon cannot be terminated. One can however significantly slow the process.
To illustrate the effect of the HIV virus on the body immunity he depicted a scenario in which two people, A and B, are exposed to an illness, there are given treatment A responds the other not. The question becomes why the latter does not respond to treatment? The causes may be HIV related and it would be advisable to persuade B to go for HIV testing.

A further definition of AIDS was given as:

A: Acquire- meaning to get, and in this context the HIV virus. The human fluids containing HIV are blood; saliva, when mixed with blood; sex fluids, breast milk.  I: Two conditions are necessary for transmission to occur; the presence of body fluids and a cut or a bruise. Infection then occurs, and that denotes a process during which the body immune system is under attack. The lymphnodes in the body contain T4 cells; these cells identify foreign elements as they enter the body and inform the B cells, which are antibodies that prepare the body to fight against invasion such as HIV. HIV weakens the body defense by enters through the cut or bruise; the body produces the T 4 cells; the HIV infects the T4 cells, replicating and enters the blood stream. 
D: at this stage an infected person develops AIDS related conditions
S: (syndrome) is a collection of more than two unrelated illnesses.

Mechanism of the immune system and the effects of HIV
The body has its defense mechanism, which the presenter analogised with barracks situated at various strategic points. These are lymphnodes, lymphocytes and other protective glands. The lymphocytes contain T4 cells; these cells identify foreign elements as they enter the body and inform the B cells, which are antibodies that prepare the body to fight against invasion such as HIV.  The B cells do not fight but prepare for the fight by producing T cells, which are killer cells. In this line of defense there areT8 cells which are suppressor cells, these are the cells continue to suppress the immunity post the infection stage.

In the case of HIV the body immune system is weakened when the following occurs. The HIV enters through a cut or bruise; the T 4 cells detect the HIV and leave the ‘barracks’ to alert the B-lymphocytes. The HIV ingests the protein and infects the T4 cells, replicates the infected T4 cells, burst and enters the blood stream. Because the HIV is carried within the replicated T cells, it cannot be distinguished from normal T4 cell and therefore has clothed itself with protection against T killer cells produced to attack it.  The HIV virus released into the blood stream causes more T4 cells to emerge, only to be infected as in the first cycle. The process goes on and on until the body immune system is destroyed. 
Upon testing a person whose T4 cells will reflect the presence of HIV in their body; as the immune system is eroded there may be a time when the test does not show the presence of the virus because the virus will have killed all the T4 cells. 

Testing for HIV
T4 cells are also known as CD4, and a CD4 count is used in a HIV test to determine how any of the cells remain in the body.  In the ordinary course of events a person’s CD 4 count is 1000; with 700 still considered to be found in a person with a physical well being.  WHO sets a low CD4 count at 300.  Once the CD count has been reduced to 150 the person is very ill.  Other methods of HIV testing the liver function tests and the viral load respectively. The viral load measures the amount of virus in the body and the liver function test determines the condition of the liver’s capacity to metabolise antiretroviral drugs (ARVs). 

The presenter emphasized importance of testing and of voluntary counseling and testing in the light of the above. He highlighted that testing is the only means through which it can properly be determined whether a person was in the first instance HIV positive and secondly whether their condition was at a point where ARVs could be administered. In addition to the test it is imperative to identify those things that obtain at the workplace that contribute to ill-health; he gave examples of alcohol intake, sexual activity, stale food and stress. These conditions can lead to wasting of the body, which has sometimes been mistaken for the HIV condition. Individuals should undergo a test before believing themselves to be HIV positive.

Antiretroviral Drugs
Antiretroviral drugs were originally manufactured to treat cancer and are very toxic. The test for effectiveness is 80% for cancer- this percentage is regarded as acceptable. The test has not been done in respect to their effectiveness in HIV, but the underlying issue is that they have to be administered with care; and due regard taken to the requisite time to start the treatment.

Advantages of Antiretroviral Treatment 

• Lowers the risk of mother to child transmission
• Stops/inhibits replication of HIV. The question of their success will be determined by how much damage would have occurred when they are first taken and what other damage controls measures are taken.
•  Health status is improved.

•  HIV test
•  Liver function test 
•  CD4 count test; if there are below 400 may start taking the ARVs 
•  Viral load. 
•  Avoid re- infection
•  Sensitization to facilitate compliance at the workplace 

•  Resistance as a result of under dosage. 
•  Compliance should be ensured, if the drugs are not taken continuously their effectiveness is compromised, for example if one goes without the them the tablets are rendered 20% less effective, absence of two weeks diminishes the effectiveness by 80%. 
•  Re- infection

 It was noted that there was fear of assisting injured persons at the workplace. What can be done to ensure that they are safety measures like the First Aid kit are utilised? 
It was explained that the response to assist an injured person was critical necessitating the availability of First Aid kits. It seemed that the different industries were at varying levels of compliance, in some instances kits were not available at all, in others they were available to the use of only the managers, and in others in place but adequately equipped. 

 Some participants wanted to know the techniques of counselling and how one approaches an ill person when there is clearly a need for counselling services. 
They were advised to use correct language for example refer to low immunity and avoid the use of HIV/AIDS.  The issue of HIV should arise in the course of discussion if is essential to eventually get there. It was pointed out that the spirit of nursing is important. For effective mitigation workers were advised to be proactive and not to wait until the condition has set before starting on self help programmes.

3.0 Session Three

3.1 Occupational Safety and Health: by Sr. Dorothy Dlamini 
The discussion covered common occupation safety health issues and was not confined to any particular industry.
Common workplace hazards are normally classifies as: 
 Chemical 
 Physical
 Ergonomic
 Biological
 Psychological
 Shift Work

Chemical Hazards: commonly found in community, factories, mines, farms. They manifest in gases and dust other substance. Health effects on those exposed include susceptibility to lung disease, skin disease, blood disorder and cancer especially when a person is exposed especially in large doses.

Physical Hazards: commonly occurring in factories, farms, mines and many types of industry and manifest in radiation, low or high temperatures, vibration.  Adverse temperatures can course ill health e.g. thermal, frost bite; and vibration can affect joints. Radiation affects body cells and can cause cancer in high exposure. Excessive hazards may diminish level of awareness, irritability and poor performance which may lead to accidents. It is important that occupational exposure levels limits should be respected.

Ergonomic: these occur where there is incorrectly designed workplace and equipment, for example the type of equipment used in mines in the past. The importance of well designed jobs, work methods cannot be overemphasised if work performance is to be improved and worker discomfort reduced. 

An ergonomic hazard is more of the result of the absence of ergonomic considerations. These include awkward posture; exertion of grip, which will affect the arm eventually; discomfort that cause worker to work slower; repetitive work continued without breaks; environmental effects such as heat, contact stress such as slippery floors, uneven surfaces. They affect the tendons, cause muscular disorders, nerve compression and vascular disorders. 

Biological Hazards: found where viruses and bacteria from sewage, hospitals, and abattoirs can be passed from animal to human; and from human to animal. 
Some workers may be exposed to HIV and hepatitis B, rabies and anthrax. 

Psychological Hazards: found in all work places. There are direct and indirect causes to them mainly resulting from poor organisation, undefined roles and long shifts.

Shift Work: in circumstances of protracted shift work the body forced to alter patterns that the body is accustomed to, or designed to cope with; and eating times may be affected. The resultant behaviour will be fatigue and sleepiness during working hours; and finally eating disorder, sleeping disorder, poor alertness and inclination towards high intake of alcohol and drugs. 

Issues arising for discussion
 How can make shift work be made safer and long hours be avoided?
           Shift work should follow a plan wherein the worker is gradually eased into night work by first assigning a day to evening, evening to night and finally a night shift. Each night shift should not exceed eight hours.
It was noted that in some industry the machinery was a perpetual hazard and the question is what to do in these circumstances. An example was given of problems experienced at the textile industry where there was consistent vibration of machines and workers get swollen feet after standing for long hours.
The response was that hazards should be minimized or controlled. Each industry should do a risk assessment and put in place the necessary safeguards. 

 Shop Stewards are fearful of employers and consequently will not protest when exposed to danger, yet they should set an example. Shop Stewards often embark on the hazardous work and then workers feel obligated to follow. It was suggested that shop stewards ought to take their leadership role seriously and sensitise other workers even informally at weekends.

 How do we approach employers when introducing this matter?  How can space be made for interrogating this matter and forge a way forward?
A suggestion was that Government agents should be engaged, so as to make the necessary intervention. Increasingly certain deaths and illnesses are attributed to HIV whereas there are in fact occupational.
 Some laws are archaic and ought to be reformed.   On the question of inspection a concern was raised that Labour Inspectors should, during inspection also interview workers and so in private, currently the employer accompanies them. In addition to that measure, inspection should be impromptu and unannounced.
 Worker representatives are not truly representative of the workers; they do not feed back to workers when they acquire knowledge.  Representative should sensitise and mobilise workers, to agitate for compliance of SHE standards.
 In some industries employer do not make an effort to comply with the required practices and standards and workers who draw their attention to this are told that the conditions complained of will prevail; an example of cold conditions was given. 

Adverse Effects of Health Hazards as they relate to the workplace.

The following were identified:

         Immediate Effects: 

• dust leads to cough.
• chemical spill leads to skin irritation.

 

 
 
 
 
 
 
 
 
 

Long Term Effects:

• noise induces hearing loss 

 

 
 
 
 
 
 
 
 
 

 Visible/invisible:

• cancer from radiation
• skin lesions due to contact with chemical
• digestive disorder due to shift work
• some are mistaken for HIV because they weaken the immune system.

 

 
 
 
 
 
 
 
 
 

Reversible/irreversible

• Tuberculosis
• Asbestosis

Identify hazards related to the specific workplace (this is especially so for SHE reps.)
• Do a health risk assessment.
• Notify and educate workers and employers; they should know about hazard identified.
• Legal Compliance-– know occupational exposure limits. 

 

 
 
 
 
 
 
 
 
 

Control At Source.  (where does it come from?)

• Eliminate it possible, e.g. replace with new one, close 
• Enclose
• Isolate
• Substitute

• Ventilation    divert extractor fan.
• General Housekeeping.

Issues arising for discussion

• A concern was raised about the inadequacy of protective clothing provided for example, when confronted with dust masks are offered, but there are obviously inadequate because dusk is always found on the nose.
• Employers cause employees to enter into a contract, normally for a year. The renewal of the contract is dependant, amongst other things, a doctor’s clean bill of health, thus exposing the worker to the likelihood of non-renewal of the contract, whereas the condition suffered from may be one caused by the workplace environment.
• Employers employ workers without a contract, after a certain period they insist that a contract be drawn; the danger inherent in this arrangement is that at that point a medical report is required and any illness detected will cause the worker to lose employment whereas as indicated above the illness could have been occupational. It is best that any contract be drawn at the initial employment time.
• Health representatives have decision making capacity over safety issues; if there is a problem they are expected to take direction from the supervisors, should they insist they are considered to be usurping the position of supervisor.  What to do? The meeting agreed that Health Representatives should be supported at the work place, if their function is to be appreciated.
• Employers and Managers need a workshop on the same subject matter.

SHEQ HISTORY

• Tambankulu Estates started with the NOSA MBO safety system in 1986 
•  We were the first company in Swaziland to be graded in 1987
• At our first grading we had a accident rate index of 10.5 and achieved 3 stars. 
• We have a incentive scheme in place for all employees if we achieve our SHE targets, 
• In 1997 we achieved ISO 9002 certification on our citrus section and a year later we had the sugar operation certified 
• In 2003 Tambankulu was given the ISO 9001/2000 certification - Quality Management System
• In 2004 Tambankulu was ISO 14001:1996 certified – Environmental Management System

• 1st Place for Good Housekeeping
• 1st Place for the Most Improved Company in SHE Safety, Health and Environmental Management
• 1st Place SEE”A”
•  1st Place in the Agricultural Competition
• Runner up Health Personality of the year
• 1st Place SHE Practitioner of the year
• Winner International SHE Competition Agriculture

• 1st Place Agricultural Competition
• 3rdPlace Social and Health Work
• Best Safety Program
• Best Environmental Management Program
• Best Company in World Class Performance
• Best SHE Representative in the Advanced Category
• Executive Responsible for SHE Award
•  Winner- HIV/AIDS coordinator of the year
• Winner SHE Officer of the year

• Quality Policy
• Audit Results
• Corrective and Preventive Action
• Quality Objectives
•  Analysis of Data
• Management Review

3.3  AIDS Programme at Tambankulu
Tambankulu has a HIV/Policy is in place and this has been integrated in the SHE programme. The policy is often analysed for its relevance and reviewed as necessary. It does not conflict with other company policies and Is in line with the country legislation.

Reference is made to the policy to determine standards to be applied in designing programmes. The policy also assists in avoiding haphazard and uncoordinated implemention of programmes. It covers these three major areas:

• Structure of Responsibility.
•  Awareness Raising (Education) for Prevention
•  Treatment care and support

4.O    Session Four 
4.1 The Environment: by Joseph Mutsigwa
The session was introduced through an activity wherein the participants were asked to fill in VP cards and state, ‘what comes to mind when you hear the word environment?’ 
The following responses emerged; My workplace; life; trees; surroundings; things of nature; creation; animals; place; water; humans.

There are four categories of the environment namely, Biophysical, Political, Social and Economic. The responses of the participants were classified under the categories as follows:
Biophysical: life; trees; nature; water; animals; creation; 
Political: impacts on the environment, decisions, policies and laws, who makes the laws, who takes the decisions.
Social: surroundings; humans
Economic: workplace

The above elements consist of the environment and need each other to exist. In interrogating these elements further it was shown that the political encompasses all rules/laws required to protect the environment. The Social includes the interactions of people and raises the question of, who is benefiting? Who is carrying the costs? Who is suffering? How are people / humans relating to each other? In the Economic the tools of production are the issue for consideration. Are technologies appropriate? Are relevant policies, for example on investment, in place? What about AGOA and its potential for job creation?

The Legal framework
The presenter introduced The Environment Management Act 2002, which is framework for the protection of the environment in Swaziland. He noted that sections 50-59 were very significant as they provide, amongst other things, for public civil participation and civil action against violation of the environment. They further provide for access to environment information; enabling informed decision making about the quality of the environment especially at the work place.

The Swaziland Environment Authority is a statutory body, whose mandate is, inter alia,
 Compile a report on the state the environment 
 Compilation of Register 

Access to Information at the Workplace: participants were asked to discuss how they access environmental and OHS information at the workplace. These were the varying responses

• Some indicated that no information was given to them; they were hearing of these matters for the first time. 
• Information given when taken for health examination
• Some indicated that they were taken for a test every six months.
• They were told not to touch machines unless instructed to do so, not to talk when using machine.
• Usually have a session on safety and there is a safety induction when a person resumes work after leave.
• There used to be medical tests in done in 2000, but now those tests were no longer done.

Issues arising for discussion

• How were participants to introduce Act to Act to employers, and how would it work
• It was explained that the EMA is used in conjunction with other regulations, and that each industry is enjoined to have a compliance certificate under the Act. .
• Yonge Nawe requested to do follow up visits. Participants expressed that they viewed the workshop as the beginning of a long term relationship between themselves and Yonge Nawe.

5.0   SESSION FIVE
5.1   Drawing the links between HIV/AIDS, Occupation Safety and Health and the Environment; by Richard Phungwayo

The presenter raised a preliminary question of whether HIV/AIDS was affecting development or was development causing HIV/AIDS?
He ventured to suggest the two were occurring in tandem. He illustrated that with industriaIisation the incidence of HIV increased, for instance during road, dam, construction.  Incidence seems to be aggravated by migration. Furthermore research has shown that where there is work there is likely to be more money, this and dense populations increase incidence.

What hazards in the work environment promote/aggravate transmission and progression?

Chemical Hazards: workers are exposed to contact with chemicals because of the work processes. Spillage may occur, or the chemical may be exhaled because of emission of certain types of chemicals, 
Where the person is already infected the exposure can perpetuate progression to the AIDS condition due to respiratory problems. Once lungs are damaged, not enough oxygen is taken to them; hence problems in walking and performing duties are experienced.  Progress to Tuberculoses and AIDS will be faster. Chemical are hazardous in these ways:

•  Washing Spillage sometimes occurs and there is skin contact; these skin problems experienced at the work place are always attributable to HIV and there is little investigation of the corrosive chemical causes.
• Mixing Breathing – Affects lungs and cause Respiratory Problems.
•  Type of chemical. 

Issues arising for discussion

• Does milk help in blocking harmful elements from entering lungs? Milk used to be administered before work to those workers who worked with thinners but the doctor stopped the practice.
• Protein in milk binds with thinners so that it is excreted. If the milk was found not to be helpful; an alternative should have been sought. Advocacy for healthy environment must start with proposes technique and then Personal Performance Equipment as back up/last resort. 
• Can hazardous material be transmitted to others at home, through binding on clothing?
• Yes. Consequently Personal Performance Equipment should be left in cloak room at work.

Biological Hazards: Transmission and Progression from pools of water, soil are a proper medium for growth of micro organism [facilitate progression to full blown aids].  What causes the multiplication of microorganism?
Bacteria: weakness in the immune system, which doubles up every 20 minutes.
Fungi: there is a relationship between fungi and HIV; excessive use of antibiotics aggravates fungi, which facilitates the multiplication of HIV.
What need to be addressed in the above cases are the insufficient ventilation, overcrowding, and communal use of amenities, like toilets and equipment. 
Low pay may cause stress, which may result in alcohol abuse.

Ergonomic Hazards: may be experienced at work places not designed in a friendly way, bearing in mind the different type of people that may be employed. This can cover a wide range of situations including uneven floors, high levels, and heavy machinery which may cause militate against performance of the worker, and may lead to stress, inattention and accidents.

Progression may occur because stress releases hormones that will compromise the immune system, stress should not be continuous. It may also be caused alcohol abused to mitigate stress; and where there has not been counselling following a traumatic situation confronted at the workplace.

Psychological Hazards:  At 60%, psychological hazards are highest. They result in accidents caused by people in an improper frame of mind, because of stress and other difficult conditions. 

Shift Work: Shift Work can be linked to transmission of HIV because it gives opportunities for sexual activity including sexual harassment. Progression can be facilitated by stress aggravating an already lowered immunity. To mitigate this, there should be alternate placing between day and night. The HIV condition can rapidly progress to AIDS because of eating and sleeping disorders associated with shift work.

It can be shown that knock off time makes people vulnerable and they may be exposed to conditions that lend them to HIV transmission. Staggered employment also leads to vulnerability that may result in sexual activity to sustain livehood.
Confinement in disciplined forces may lead to activity resulting in transmission and tensions aggravating progression.

Issues arising for discussion

• It was suggested that visual inspection should be done to mitigate accidents caused by irresponsible workers. The other view was that supervisors cause stress by their administrative attitude.
• How can factors such as light/ heat exposure affect health?

They cause cancer.
• Does close proximity to a person with tuberculosis expose co-workers to danger?
•  Ventilation needs to be ensured to protect the workers generally; however a person is not infectious after 14 days of taking tablets.
• There is inadequate Personal Performance Equipment in most industries, for example no masks are provided in the textile industry.

 
• What remedy is available to workers when employers assert that there are correct OSHE practices whereas there is evidence of lack of safety practices and violation of the environment? Examples were given of dying fish; chemical Spillage killing snakes, grasshoppers and rats.
• Does spraying of chicken adversely affect the humans? The workers have noticed that after spraying the birds, the catchers present with rash.

6.0   WAY FORWARD
6.1   The following was proposed as a way forward:

• Integrate Civil Society, Union and Governments’ mandate and initiative and ensure collaboration, especially in the area of compliance and enforcement.
• Sensitisation and training of workers on the relevant OSHE issues, especially to empower them to make the necessary linkages.
• Workers and workers representatives to identify hazards and when necessary to institute protest action ”and refuse to embark or hazardous work.” 
• Monitor and evaluate safety measures taken at the workplace. 
• Training on Occupational Safety Health Act and other relevant legislation, especially on roles and responsibilities of Employers and Employees.
• Advocacy Strategies; commitment to follow up for implementation and sensitisation of others.

Mobilise Workers.