'New era' of AIDS means new challenges for employers

The National Business and Labor Conference on HIV/AIDS was held September 29-30, 1997, in Washington, DC. The conference marked the first time that business and labor leaders met to address HIV/AIDS-related challenges in the workplace. One such challenge is the need for employers to provide reasonable accommodations to HIV patients experiencing medical symptoms associated with protease inhibitors. According to the Centers for Diseases Control and Prevention (CDC), one in six large companies reported having a worker living with HIV or AIDS. One in 15 smaller companies reported having an HIV-positive employee. Among other topics, the conference considered the need for employers to review workplace policies and benefits programs to insure that the programs conform with the Americans with Disabilities Act (ADA). A key topic is the development of a reasonable accommodation process for HIV-positive employees who wish to return to work. Companies must accommodate employees unless it presents undue hardship. Conference speakers provided suggestions for accommodating HIV-positive workers and those living with AIDS. These include not asking employees for unnecessary information, respecting employees' confidentiality, and maintaining open lines of communication with labor unions.     

HIV / AIDS,STDs and the workplace

Even though the workplace is ideal for promoting HIV/STD (sexually transmitted disease) prevention to benefit workers and employers, many workplaces are not convinced that they should be involved in HIV/AIDS and STD education, prevention, and support. They do not realize that time and money spent on health programs save them money. Perhaps they do not feel obligated to protect the health of their employees. The AIDS epidemic adversely affects society and the economy at both the macro and micro level. AIDS tends to strike the productive age group, thereby seriously affecting the workplace. In many Sub-Saharan African countries, at least 20% of the urban workforce may be infected with HIV. Persons living with HIV include top management, skilled professionals, general hands, and farm laborers. HIV/AIDS costs for formal employment are assumed through reduced productivity; increased costs of occupational benefits and social security measures; loss of skilled labor, professionals, and managerial expertise as well as the experience among workers; increased costs of training and recruitment; and low morale from stigmatization, discrimination, and subsequent industrial relation problems. Needed are comprehensive HIV/AIDS and STD workplace programs that ensure the rights of persons with HIV and compassionate treatment of these persons. Trade union or other labor representatives, management, and appropriate government departments should work together and build on existing health legislation and policy to bring about effective negotiation and policy development concerning AIDS and employment. Training of peer educators, support services (counseling, STD referral and/or treatment), community action, management commitment, monitoring and evaluation, and supportive workplace conditions make for effective comprehensive workplace programs. Successful programs operate in fishing villages in Tanzania, tea plantations in India, the University of Papua New Guinea, and Ugandan army camps.     

Country watch: Costa Rica

In 1998, Costa Rica passed a comprehensive law that safeguards the rights of people living with HIV/AIDS (PLWHA). It is noted that this law protects them against discrimination in the workplace, schools, and universities. It also penalizes medical personnel in both the private and the public sector who denies PLWHA needing medical attention. In addition, it promotes the advocacy of health care systems that HIV testing is always voluntary and test results are personal and confidential. However, despite evidence that the law has been a great boost in ensuring confidentiality for HIV/AIDS patients, many of the patients are still fearful that they will be seen by someone they know at the clinic. In addition, the problem of insensitive notification of a person about his/her testing HIV-positive is still present in the country.     

AIDS in the workplace: implementing an AIDS policy

Much needless anxiety and misinformation about AIDS exists today. Many people are concerned that they can "catch" AIDS in the workplace through casual contact with co-workers. AIDS is hard to get. It is not spread by nonsexual, person-to-person contact among workers, clients, and consumers in offices, schools, factories, or other workplaces. Managers of corporations should institute AIDS policies, addressing discrimination, confidentiality, infection control, and education, before the first cases of the disease emerge in the organization. It is predicted that about 90 percent of HIV-positive individuals are presently in the labor force; every American employer will have to come in contact with HIV/AIDS-infected employees in the near future. Any attempt to communicate positive messages--and reduce fear and confusion--leads to a more productive work environment, less discrimination, and more sensitivity regarding AIDS issues.     

HIV Stigma and Discrimination in Medical Settings: Stories From African Women in New Zealand

Recent changes in New Zealand's HIV and immigration situations have sparked a need to understand the experiences of HIV-positive African newcomers there. Here a narrative lens was brought to a previous qualitative study to harvest stories about discrimination in medical settings in New Zealand, told by four HIV-positive African women. Despite describing positive experiences with specialist HIV providers, their accounts shed light on weaknesses within the health care system regarding the rights and treatment of immigrants living with HIV. Participants reported inappropriate use of universal precautions, violations of confidentiality rights, discriminatory comments about Africans or persons with HIV, and misinformation about HIV transmission. Interventions must include enforcement of The Privacy Law and consistent training and monitoring of employee behavior in health care organizations.     

北京市丰台区114名女性性服务工作者艾滋病相关知识信念行为调查

目的了解女性性服务工作者的艾滋病（AIDS）相关知识信念行为情况，探索在该人群中开展AIDS宣传教育和行为干预的适合模式。方法对经确认的114名女性性服务工作者进行问卷调查。结果114名女性性服务工作者年龄最小的14岁，最大的39岁；51．8％的未婚；83．3％的文化程度为初高中生。调查对象具有一定艾滋病知识，性生活频率高而安全套使用率低，存在吸毒现象。109名女性性服务工作者接受性病艾滋病检测，查出梅毒阳性6人，HIV抗体均阴性。结论女性性服务工作者是艾滋病高危人群而自我防范意识差，应深入其中开展宣传教育和行为干预工作。     

社区女性性工作者性病艾滋病知识与性行为特征分析

了解社区女性性工作者性病艾滋病(STD／AIDS)知识知晓程度、艾滋病相关危险行为特征，为制定社区STD／AIDS的防治策略提供依据。方法对广东省中部某镇的女性性工作者进行面对面的问卷调查。结果共调查139名研究对象，艾滋病基本知识的知晓率为33.1％，对男、女性病症状的知晓率分别为18.0％和14.4％；安全套使用率为86.1％。结论社区女性性工作者对STD／AIDS知识了解甚少，艾滋病相关危险行为发生率高，应加强STD／AIDS的宣传教育和行为干预，减缓和阻止艾滋病病毒(HIV)通过性乱人群向一般人群传播。     

Assessing business responses to HIV / AIDS in Kenya

A consulting firm conducted interviews with managers of 16 businesses in 3 Kenyan cities, representatives of 2 trade unions, focus groups with workers at 13 companies, and an analysis of financial/labor data from 4 companies. It then did a needs assessment. The business types were light industry, manufacturing companies, tourism organizations, transport firms, agro-industrial and plantation businesses, and the service industry. Only one company followed all the workplace policy principles recommended by the World Health Organization and the International Labor Organization. Six businesses required all applicants and/or employees to undergo HIV testing. All their managers claimed that they would not discriminate against HIV-infected workers. Many workers thought that they would be fired if they were--or were suspected to be--HIV positive. Lack of a non-discrimination policy brings about worker mistrust of management. 11 companies had some type of HIV/AIDS education program. All the programs generated positive feedback. The main reasons for not providing HIV/AIDS education for the remaining 5 companies were: no employee requests, fears that it would be taboo, and assumptions that workers could receive adequate information elsewhere. More than 90% of all companies distributed condoms. 60% offered sexually transmitted disease diagnosis and treatment. About 33% offered counseling. Four companies provided volunteer HIV testing. Almost 50% of companies received financial or other external support for their programs. Most managers thought AIDS to be a problem mainly with manual staff and not with professional staff. Almost all businesses offered some medical benefits. The future impact of HIV/AIDS would be $90/employee/year (by 2005, $260) due to health care costs, absenteeism, retraining, and burial benefits. The annual costs of a comprehensive workplace HIV/AIDS prevention program varied from $18 to $54/worker at one company.     

株洲市艾滋病自愿咨询检测情况分析

目的 分析2008-2012年株洲市主动接受艾滋病自愿咨询检测（VCT）服务人群的社会人口学特征和艾滋病感染状况,为进一步制定株洲市艾滋病健康教育和高危干预措施提供依据. 方法 收集株洲市内所有艾滋病自愿咨询检测门诊2008-2012年的求询者资料进行分析. 结果 24 413名求询者中,23 745人进行了HIV检测,检测率97.26％.HIV阳性者141名,阳性率为0.59％.求询者集中在20～40岁之间的青壮年人群,占70.09％,初高中文化者多见.141名HIV阳性检出者中通过性传播途径感染,占81.56％,且检测人数和阳性患者在逐年增多（P=0.000）,进一步分析阳性检出率不断攀升的原因与株洲市商业性性行为日趋频现和男男性接触人群主动检测增多有关. 结论 应对青壮年人群进行广泛的艾滋病健康教育,加强针对男男性行为人群以及从事性服务工作者的行为干预措施.     

Women, reproductive rights, and HIV/AIDS: issues on which research and interventions are still needed

From 2002 to 2005, two literature reviews identified a number of reproductive health issues that appeared to be relatively neglected in relation to HIV/AIDS: contraceptive information tailored to the needs of HIV-positive people; voluntary HIV counselling and testing during antenatal care, labour, and delivery; parenting options for HIV-positive people besides pregnancy through unprotected intercourse (i.e. assisted conception and legal adoption or foster care); unwanted pregnancy; and abortion-related care. An additional finding was that stigma and discrimination were frequently cited as barriers to enjoyment of reproductive rights by HIV-positive women. Subsequently, a pilot project was initiated in which non-governmental organizations (NGOs) in developing countries used benchmarks to ascertain whether these neglected issues were addressed in local programmes and interventions serving women affected by HIV and AIDS. The benchmarks also assessed whether policies and programmes paid attention to the human and reproductive rights of HIV-positive women. This paper describes the main findings from the two exercises in relation to contraception for women living with HIV or AIDS, abortion-related care, legal adoption by HIV-positive parents, and reproductive rights. It concludes with a number of recommendations on topics to be incorporated into the international research agenda, policies, and programmes in the field of HIV/AIDS.     

Disclosure of HIV status in the workplace: considerations and strategies.

Maintaining a role in the workplace despite significant health concerns can be important in meeting an individual's emotional and economic needs. This qualitative research study reviewed the workplace experiences and disclosure decisions of 18 HIV-positive individuals. The most frequently cited reasonsfor disclosing HIV status were to explain choices they were making as they interviewed for a job and concerns about their job performance and the needfor accommodations. For individuals who disclosed their HIV status to selective members of the workplace or disclosed to no one, the primary reasons given were preference for privacy, nature of the work environment, andfear of possible consequences. The practice, policy, and research implications for social workers are also discussed.     

HIV / AIDS and STDs control: new policy perspectives

The prevention and control of HIV/AIDS is a social as well as a public health issue. This approach is reflected in new policy initiatives developed by the Government of India's National AIDS Control Organization in 1997. Future strategies will be based on a multisectoral, partnership-oriented approach. Bilateral agencies are encouraged to establish interventions in areas such as sexually transmitted disease (STD) control, condom distribution, counseling, health care, and hospice care. Special campaigns focused on youth and adolescents, including the inclusion of HIV/AIDS in the school curriculum, are planned. New strategies will be developed to address the HIV risk associated with drug abuse. The home- and community-based care of HIV/AIDS patients will be promoted, with emphasis on emotional and social support needs. Other areas to be addressed include the integration of STD control with primary health care, a blood transfusion policy, education for commercial sex workers, an end to discrimination against people with AIDS, and expansion of the national sentinel surveillance system.     

Red Cross offers tips for HIV education in government, business

The American Red Cross (ARC) has delivered workplace HIV/AIDS education to thousands of Federal and private-sector employees as a contractor since 1993. The ARC HIV/AIDS Workplace Program stresses the delivery of factual information about HIV/AIDS in a non-judgmental, culturally sensitive way. HIV transmission, prevention, and workplace legal rights and responsibilities are covered and tailored to the specific workplace by trained instructors. The ARC recommends that when establishing an HIV/AIDS workplace program, an agency or corporation should: set your own policies, know your audience, check trainers' qualifications, and get proof of results.     

Development of notification policy in Namibia

On 21 April, 1999, the Namibian press reported that the government was going to declare AIDS a notifiable disease. This announcement sparked much debate about the role of confidentiality in a sound public health approach to the prevention and control of HIV/AIDS. It also became apparent that in Namibia people's understanding of the principle of confidentiality varies widely. Many seem to confuse the concepts of secrecy and confidentiality. They see preserving confidentiality about HIV/AIDS information as strengthening the "veil of secrecy" that surrounds HIV, reinforcing stigma and undermining efforts to control the spread of HIV. A consultative process, initiated by Joint UN Program on HIV/AIDS, led to the formulation of a much needed policy framework for reporting and notification of HIV/AIDS. A task force was established to identify, discuss and report on national issues, policies and experiences that could inform the discussion on HIV reporting and confidentiality.     

娱乐场所服务小姐中性病、艾滋病危险因素调查

目的：了解娱乐场所服务小姐性病艾滋病（STD／AIDS）知识知晓程度，危险行为特征和性传播感染（STI）流行状况，为制定STD／AIDS）防治对策和干预策略提供依据。方法：运用问卷调查对娱乐场所服务小姐进行一对一深入访谈，同时采集标本进行STI感染状况检测，结果：娱乐场所服务小姐对STD／AIDS危险性认识不够，相关STD／AIDS预防知识缺乏；受多种因素影响，不能做到每次性活动中坚持使用安全套，没有养成良好的自我卫生保健习惯；STI感染率高，结论：应在服务小姐中进行STD／AIDS知识的健康教育和行为干预，预防STD／AIDS的传播和流行。     

Country watch: Sri Lanka

Though reporting on HIV/AIDS is supposed to be confidential, the social and cultural contexts in Sri Lanka are such that this type of information spreads very rapidly within the community. Reports of transgressions involving the medical staff illustrate how difficult it is to guarantee confidentiality in reporting HIV/AIDS in the country. As a consequence, individuals who can afford to travel prefer to be tested abroad to avoid stigmatization, and blood donors sometimes provide false information to avoid being identified. In view of such, the Community Front for the Prevention of AIDS (CFPA) decided to take action to guarantee strict confidentiality in reporting HIV in the country. The goal of CFPA was to protect human rights of people living with HIV and AIDS and their families and to facilitate voluntary counseling and testing. The analysis of existing legislation that might have impact on HIV/AIDS, conducted by CFPA, resulted to the formulation of legislation and policy recommendations to the Ministries of Health and Justice, confirming the principles of protecting public health and respect for human rights. Moreover, it raised the awareness of medical officers and lawyers on legal ethics and HIV/AIDS.     

'We are also dying like any other people, we are also people': perceptions of the impact of HIV/AIDS on health workers in two districts in Zambia

In countries with a high AIDS prevalence, the health workforce is affected by AIDS in several ways. In Zambia, which has a prevalence rate of 16.5%, a study was carried out in 2004 with the aim to: explore the impact of HIV/AIDS on health workers, describe their coping mechanisms and recommend supportive measures. The qualitative study was complemented by a survey using self-administered questionnaires in four selected health facilities in two rural districts in Zambia, Mpika and Mazabuka. It is one of the few studies to have explored the impact of HIV/AIDS from the perspective of health workers and managers in the region. Thirty-four in-depth interviews and five group discussions were conducted with health workers, managers and volunteers, and 82 self-administered questionnaires were filled out by health workers. In addition, burnout among 42 health workers was measured using the Maslach Burnout Inventory (MBI). The MBI measures three components that contribute to burnout: emotional exhaustion, depersonalization and personal accomplishment. The results show that in both districts, HIV/AIDS has had a negative impact on workload and has considerably changed or added tasks to already overburdened health workers. In Mpika, 76% of respondents (29/38), and in Mazabuka, 79% (34/44) of respondents, expressed fear of infection at the workplace. HIV-positive health workers remained 'in hiding', did not talk about their illness and suffered in silence. Despite the fact that health workers were still relatively motivated, emotional exhaustion occurred among 62% of the respondents (26/42). The interviews revealed that counsellors and nurses were especially at risk for emotional exhaustion. In each of the selected facilities, organizational support for health workers to deal with HIV/AIDS was either haphazardly in place or not in place at all. AIDS complicates the already difficult work environment. In addition to health workers, management also needs support in dealing with AIDS at the workplace.     

Professional risk, knowledge, attitudes and practice of health care personnel in Serbia with regard to HIV and AIDS

The aim of our investigation was to assess HIV/AIDS-related professional risk, knowledge, attitude and practice of health care workers in Nis. A cross-sectional study of health personnel from Primary Health Centre, Clinical Medical Centre and Dental Clinic in Nis was performed. The data were collected by an anonymous questionnaire. Mantel-Haenszel X2 testing and multiple logistic regression analysis were applied. Results show that 89% of health personnel perceived high professional risk of acquiring HIV infection. The risk perception of acquiring HIV infections was higher among those who were frequently exposed to patients' blood and other body fluids (OR = 10.1 95% CI = 3.1-32.5), and those who had treated HIV-positive patients (OR = 3.0 95% CI = 1.0-8.8). The majority of respondents had insufficient knowledge about the modes of HIV transmission. Nearly two thirds of health personnel agreed that every hospitalized patient should be tested for HIV, and more than four fifths of them agreed that their personal protection was more important than the confidentiality of patient's HIV/AIDS status. Twenty nine percent of health personnel use adequate protection during their daily work with patients. These findings indicated a need for urgent educational and training initiatives of HIV and AIDS for all categories of health care workers.     

AIDS Programmes at the Workplace: A Scoresheet for Assessing the Quality of Services

Little data is available on the extent or comprehensivenessof AIDS prevention activities at South African workplaces. Across-sectional postal survey was performed of all members ofthe local occupational health nursing association in the areaof greater Cape Town in 1994 to assess the quality of such programmes.Use was made of an index to score services based on their comprehensiveness,using criteria based on recommendations previously identifiedin the South Africa literature on AIDS control. The presenceof a workplace policy on AIDS was the strongest predictor ofhigh quality AIDS prevention activities. Substantial numbersof companies reported sending staff for HIV-related training,and the presence of training was non-significantly associatedwith higher quality services with regard to HIV prevention.Treatment of sexually-transmitted diseases (STDs) was reportedin slightly over half of the sample. Given the central importanceof STD treatment for the prevention and control of AIDS, improvementsin STD management at the workplace may significantly assistattempts at the public health control of the HIV epidemic. Inaddition, worker involvement in the planning, management andimplementation of AIDS prevention activities is also limitedat present and needs attention. Recommendations for the useof a scoring system to promote evaluation of AIDS programmesin the workplace are made.