Fear of job loss and anticipated stigma are deterrents for disclosure of HIV serostatus in the workplace; narratives of domestic workers in affluent suburbs of South Africa

Introduction: Domestic work is a large sector of employment for women who are rendered vulnerable to HIV by their disadvantaged backgrounds. The domestic work sector has been identified as one of the areas where disclosure of HIV status remains a challenge. Although South Africa is one of the southern African countries with a sizable number of domestic workers, there is lack of data on issues related to HIV and disclosure in the domestic work sector. This study explored the context within which domestic workers would disclose or conceal their HIV status in the workplace setting and examined the outcome of disclosure to their employers. Methods: We conducted a qualitative explorative study with domestic workers in an affluent suburb of Gauteng Province of South Africa. We used purposive sampling to recruit 32 domestic workers living with HIV to participate in six focus group discussions. Data analysis was inductive and followed the thematic approach. Results: All 32 domestic workers were female aged between 20-60 years, 19 were living on the employers’ premises, and nine were migrants from outside the borders of South Africa. The reported positive working relationship with their employers did not translate to disclosure and intentions to disclose in the future. Fear of job loss and stigma and discrimination were the major deterrents to disclose to the employer. Living-in increased the risk of unintended disclosure due to the lack of privacy. The post HIV diagnosis relationship with the employer was characterised by silence, lies, and deceptions in an attempt to protect their serostatus. Conclusion: The threat of dismissal was distressing for most of the domestic workers, whereas for some the threat of actual dismissal was real. The acts of stigma experienced by the domestic workers call for specific HIV prevention interventions that focus on the domestic work sector.