Factors influencing HIV risk-taking behaviours amongst textile factory workers living with HIV in Lesotho

With its number of employees ranging from 45,310 to 46,000, the textile and apparel industry is the main private sector employer of labour in Lesotho. It has been reported that a third (an estimated 34%) of these workers are living with HIV. There is perception that textile factory workers living with HIV (TFWLWH) in Lesotho indulge in HIV risk-taking behaviours. However, no study has yet investigated or documented factors that influence risk-taking behaviours amongst these workers. Transmitting the disease to others, treatment complications and death consequent to HIV reinfection are complications associated with HIV risk-taking behaviours by seropositive individuals. Using an in-depth, face-to-face, semi-structured interview, this study obtained the perspectives of ten factory workers from three randomly selected textile factories in Maseru, Lesotho on factors that influence HIV-risk taking behaviour amongst TFWLWH in Lesotho. Analysis of the comments given by workers revealed four core themes, namely, peer pressure, communication, cultural norms and societal norms. Determining the predictors of HIV risk-taking behaviours amongst these workers will inform both present and future interventions aimed at supporting textile factory workers living with HIV in Lesotho. This supports the need for continued research to identify HIV risk-taking behaviours by people living with HIV countrywide, to decrease the incidence of new infections and complications arising from reinfection.


Introduction
Since recording its first case of AIDS in 1986, the number of HIV infections in Lesotho has increased exponentially [1]. With an adult prevalence rate of 25% [2], Lesotho has one of the highest HIV burdens in the world [3]. The worst affected groups include sex workers (79.1% prevalence), textile factory workers (42.7% prevalence), men who have sex with men (32.9% prevalence), prison inmates (31% prevalence), and pregnant women (25.9% prevalence) [4]. With an estimated 45,310 to 46,000 employees [5,6], of whom the majority are young women and a third (an estimated 34%) are HIV positive [7], the textile and apparel industry is the main private sector employer of labour in Lesotho [5].
In order to lessen the HIV/AIDS burden amongst workers in the textile industry, the ComMark Trust-funded by the UK Department for International Development (DFID) in 2005-invented the Apparel Lesotho Alliance to Fight AIDS (ALAFA) project, to provide support for HIV-positive workers in the textile and apparel industry [8]. There is perception that TFWLWH in Lesotho indulge in HIV risk-taking behaviours. However, no study has yet investigated factors that influence indulging in HIV risk-taking behaviours by these workers.
Using an in-depth, face-to-face, semi-structured interview, this study obtained the perspectives of ten factory workers on factors that influence the indulgence in HIV-risk taking behaviour by TFWLWH in Lesotho. Indulging in HIV risk-taking can lead to HIV reinfection [9], increased viral load and disease progression [10], and increased chance of acquiring resistant strains [11]. Determining the predictors of HIV risk-taking behaviours by these workers will inform both present and future interventions aimed at supporting TFWLWH in Lesotho.

Methods
This research was designed as a qualitative study that made use of an in-depth, face-to-face, semi-structured interview to obtain qualitative data.
In-depth, face-to-face, semi-structured interviews: participants were interviewed using a pretested schedule. Nine volunteers (three in each factory) participated in the study.
Exploratory interview: an exploratory interview was conducted to test the suitability of the questions in the interview guide. This interview was conducted with one eligible participant, and no changes to the interview schedule were indicated after administration.
Findings from the exploratory interview was included in the dataset.

Results
Demographic information of participants: ten interviews were conducted (7 women and 3 men). Participants were between the ages of 18 and 31 years.   [12]. "I am also aware that culture has a role to play especially among women to make decisions, women cannot negotiate safe sex, the culture of paying lobola (pride price), proofs women's sexual obligation, gives men the power over women that they own them and therefore women cannot negotiates or decide when and how to have sex" "We don't talk to our husband about sex, it's our culture". infected persons [14]. In a renewed effort to achieve the former, there are calls to use a positive approach that stimulates behaviour change among HIV seropositive individuals, so that they make decisions to take care of their health and prevent possible harm to others [15]. Factors this study found to influence HIV risk-taking behaviour amongst the workers are consistent with findings in literature [12,[16][17][18][19][20][21] Furthermore, these factors could be interdependent on one another as presented in the puzzle schematic in Figure 1.  influence an individual to indulge in multi-partner and/or transactional sex that can also be precipitated by poverty