You are the medical officer for a large paint manufacturer, providing occupational health and primary care services on thrice-weekly basis as well as overseeing the occupational health programme offered at the factory. The Programme employs one registered professional nurse and one staff nurse full-time in an on-site clinic, and serves a workforce of 950 full time employees, of whom the majority are blue collar workers. 85% of the staff are males, about 50% Xhosa-speaking and all live locally (no migrant labour).
The breakdown of the workforce is as follows:
The services provided at the clinic include first aid, primary care, pre-employment and periodic medicals as well as a limited amount of clinic-based health education. The clinic also oversees an environmental and biological monitoring programme in terms of the OSHA regulations. The biggest part of the staff time in the clinic is spent on accident and injury treatment and processing of Workmen's Compensation, although you have no accurate details on exact inputs. When you visit the clinic, about half of the cases you see are injuries, and most of the rest are primary care cases.
As far as you know, there are 3 workers who are HIV positive in the factory. Two workers were detected when they were investigated for TB at one of the township clinics, and they were referred to the workplace clinic for supervised treatment with the diagnosis already known. The third case was detected when the nurse picked up a worker with weight loss and lympadenopathy, who was investigated and found to have HIV. He is due for assessment for boarding.
There is a limited medical aid for workers at the plant. This medical scheme does not require workers to take any HIV testing but has put a cap on any benefits to be paid to workers found to have HIV related conditions (capped at R800 per month).
Medical costs when workers have exceeded their medical insurance cover are borne 30:70 by management and the employee.
Workers have a group life insurance which stipulates an entry HIV test but this has only been in place for the last 5 years, and turnover in the factory is low, so most workers will not have had any HIV testing for insurance purposes. HIV testing is available at the clinic on a voluntary basis with counseling from the nurse.