|Drivers of the HIV epidemic: A look at the South African Police Service (SAPS)|
|Written by Given Mutinta (1) Tuesday, 02 November 2010 07:52|
The South African Police Service (SAPS) is currently facing challenges related to HIV & AIDS. In this CAI discussion paper, I argue that the HIV epidemic is driven by interrelated risk factors, some of which suggest that SAPS personnel, under certain circumstances, stand a greater risk of contracting HIV & AIDS than many other sub-populations in South Africa. The main aim of this paper is to identify the key drivers of the HIV epidemic in the SAPS. In order to do this, I conducted a meta-analysis of literature on the key drivers of the HIV epidemic in the SAPS using data sourced from a SAPS human resource database over a six-year period (2003/04 - 2008/09).
Key drivers of the HIV epidemic
Evidence from a study on HIV & AIDS and the SAPS conducted in 2003 shows that the nature of their work renders police officers highly susceptible to HIV infection.(2) In this section, I outline some of the key drivers of the HIV epidemic in the SAPS in particular.
In South Africa, exploitation of sex workers by police officers is significant. A study conducted in 2006 by the Sex Workers’ Education and Advocacy Taskforce (SWEAT) reported that 30% of surveyed sex workers said that police officers abused them sexually.(3) In some instances, sex workers are forced to have sex with police officers to evade arrest.(4)
A broader literature review also reveals that when sex workers are being sexually exploited, they have little power to negotiate safe sex.(5) In 2004 the Centre for HIV and AIDS Networking (HIVAN) conducted a study which tested 247 sex workers for HIV and established that 45% of these women were HIV positive. Sex workers who had been in the trade for only three months exhibited similar levels of infection to those who had been working for a year.(6) Thus, sexual abuse of sex workers renders police officers highly susceptible to HIV infection.
Researchers argue that police officers working away from their families are especially susceptible to HIV.(7) They are removed from their social support structures, including families and regular sexual partners.(8) As a result, they often feel lonely and bored, particularly when off duty, and this increases the likelihood of their engaging in risky sexual behaviour. The findings also show that police officers’ wives are often left in difficult financial circumstances. Hence, they too are often driven by need and loneliness to find other supportive (sexual) partners, who also assume some of their financial obligations.(9)
Alcohol has been identified as a significant driver of the HIV epidemic in the SAPS. Police officers engage in alcohol abuse as a way of dealing with stress caused by the nature of their work.(10) A study on drug abuse found that alcohol abuse influences police officers to engage in unsafe sex.(11) It argued that 75% of people in a drunken state find it difficult to use condoms during sex. The findings show that male police officers are more vulnerable than female officers to this particular problem because they consume more alcohol.(12) Similarly, a study by the Centre for Aids Development, Research, and Evaluation (CADRE) found that alcohol intoxication impairs nearly every aspect of information processing, making it more likely that drinking police officers will engage in risky sexual activities. In addition, it correlated heavy alcohol use with a lifetime tendency toward high-risk sexual behaviour.(13) It is therefore possible to state that alcohol lowers inhibitions, diminishes the ability to assess risks, and may increase sexual aggression – a correlation which accounts for the measured relationship between alcohol and police officers’ risky sexual activity.
Police officers are further susceptible to HIV because they engage in spontaneous sexual relationships, otherwise known as one-night stands (even though these might include more than one sexual encounter). Findings from a study conducted in Kenya, Tanzania and Uganda on HIV & AIDS and uniformed services show that in these situations there are no premeditated arrangements regarding behaviour, and there is no pledge of any subsequent intimate relationship.(14) Thus, police officers engage in sexual encounters with partners they do not know well and with whom they have no immediate expectation of starting long-term sexual relationships. In addition, they have minimal time to get to know each other before indulging in sex. Evidence shows that one-night stands can take place repeatedly with the same partner but not but not regularly.(15) This practice makes police officers especially vulnerable to HIV infection.
Multiple and concurrent sexual partnerships
Data shows that police officers are also susceptible to HIV infection because they engage in sexual relationships with many partners at the same time or within the same period of time (16) – a practice known as having concurrent sexual partnerships. This practice is exacerbated by the fact that police officers are deployed to work in different local communities. Concurrent sexual relationships are highly risky because they link police officers to sexual networks with sex workers, men who have sex with men, and injection-drug users.(17) Data also shows that when engaging in sex with regular partners, police officers tend not to use condoms, argueing that they trust their partners – when in fact their partners have many partners as well.(18)
In addition to the above-mentioned hazards, my meta-analysis shows that police officers are prone to HIV because they come into contact with blood – mostly when dealing with victims of motor vehicle accidents and victims of violent crimes. This includes removing dead bodies from crime scenes.(19) Their work involves apprehending dangerous criminals and interacting with risk groups such as intravenous-drug users and sex workers.(20) They are also at risk when analysing forensic evidence at crime scenes and in laboratories.(21) A study in Europe analysed 112 exposures of police officers to blood and concluded that the risk of HIV infection amongst police officers was low. When 79% of these cases of exposure were tested, it was found that only 4% were HIV positive.(22) However, literature suggests that police officers are not aware of standing orders concerning the reporting of occupational exposure.(23) The SAPS Annual Report for 2004/05 indicates that close to two-thirds (63%) of police officers thought that they were at risk of contracting HIV while doing their work, while 45% considered that their work put them at high risk of infection and a small proportion, 15% considered their work to be low-risk.(24)
Evidence shows that the SAPS has only recently begun to educate its personnel about HIV & AIDS.(29) In addition, prevention activities in the SAPS are not prioritised by senior management and poorly implemented. As a result they have had little impact on police officers’ high-risk behaviour.(30) The SAPS Annual Report for 2004/05 shows that voluntary counselling and testing (VCT) was only introduced in 2003. There were a mere 167 counsellors, while 257 were estimated to be needed. The number of personnel per counsellor was 787. In 2008/09 there were 1,237 counsellors, with the vacancy rate of 14.1 causing counsellors to have huge workloads.(31) As a result, despite the high-risk environment in which police officers operate, findings show that many do not have adequate information on how their environment may put them at risk of contracting HIV.(32)
The findings show that police officers are additionally vulnerable to HIV because of stigma. Researchers have found that police officers concealed their status in order not to damage their chances of promotion or to avoid the possibility of being declared medically unfit, which is stigmatising.(33) Data also shows that poor pensions for police officers force HIV-positive officers to remain in the service as long as possible, which carries with it the risk that they will have more time to engage in high-risk sexual activities while on duty.
The overall meta-analysis presented in this discussion paper shows that the drivers of the HIV epidemic in the SAPS, as well as the impact of HIV & AIDS, are neglected areas of research. This lack of information extends even to the most basic and fundamental issues such as the vulnerability of police officers to HIV & AIDS and its impact on the SAPS. In order to close these gaps in knowledge, there needs to be more thorough research, including new data collections and revamped analyses of previous studies. These previous studies should be replaced with more nuanced and case-specific approaches.
(1) Contact Given Mutinta through Consultancy Africa Intelligence’s HIV & AIDS Unit (