Developing HIV / AIDS and STD workplace policies

Employers and/or community leaders carry the primary responsibility for setting up workplace HIV/AIDS and STD (sexually transmitted disease) policies. They should include workers from the beginning to help identify policy objectives and content. Major objectives of a workplace policy include ensuring the health and rights of workers, reducing the effects of poor health on workplace productivity, and contributing to the general welfare of the community. Clearly stated principles of workplace policy may encompass freedom from mandatory HIV testing for job applicants and workers, ensuring a safe working environment, supporting treatment of HIV/STD-related illnesses, assuring confidentiality of HIV status, establishing a climate in which HIV-positive workers feel they can tell their employers about their status, and ensuring freedom from discrimination. HIV/AIDS and STD workplace policies are likely to include management and employee training, education and support services, and observance of employee rights. Examples of heeding employee rights are application and promotion procedures that do not require HIV testing, opportunities for HIV-positive workers to do work other than their usual work when their physical condition deteriorates, establishment of and adherence to disciplinary and grievance procedures if confidentiality of HIV status is violated, and treatment for STDs and other illnesses. A few persons should be responsible for monitoring implementation of HIV/AIDS and STD workplace policy. Monitoring may consist of regular meetings to reassess and, if needed, adapt the policy; a system of feedback from employees; assessment of use of support services; and conversations with HIV-positive workers to learn of the success of the workplace program in tending to their concerns and needs.     

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.     

HIV / AIDS control programme: lessons from the VHAI-EC joint initiative

The Voluntary Health Association of India (VHAI), with financial support and technical advice from the European Commission, developed the HIV/AIDS Control Programme. The program began in January 1995. Its overall goal was to strengthen the capacities of nongovernmental organizations (NGOs) in initiating and developing HIV/AIDS interventions at the grass-roots level. Program strategies include capacity building within NGOs for effective HIV/AIDS efforts, primary prevention of HIV/sexually transmitted disease (STD) transmission through information and education and promotion of safer sex, promotion of condom use, improvement of STD control in primary health care, and advocacy and social mobilization in support of persons affected by HIV/AIDS. VHAI first invited project proposals from NGOS in Manipur, Assam, West Bengal, Bihar, Kerala, and Andhra Pradesh. Then it held a workshop for interested NGOs on policy and funding criteria. 24 NGOs were selected in the first round from all the above states, except Andhra Pradesh. The intended audiences included youth, women, migrant workers, intravenous drug users, commercial sex workers, tribals, and students. The selected projects consisted of awareness generation, needle exchange, blood safety, condom promotion, and counseling. Training programs addressed project management, counseling, and training of health personnel (medical practitioners, health workers, peer educators, and paramedical workers). State-specific communication strategies involved traditional and folk media, a condom key chain, workshops for journalists, and meetings with members of the Legislative Assembly. VHAI is developing a comprehensive communication package for lobbying and advocacy activities. The May-June 1996 mid-term evaluation found that the program helped state VHAs to work more closely with member NGOS and non-member groups and that NGOs did become familiar with HIV/STD prevention and control. NGOS had inadequate experience in project management. NGOs were able to mobilize communities, to take on innovative interventions, and to network effectively.     

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.     

Knowledge, attitudes, beliefs, and behaviors of the business community relative to HIV-AIDS

One of the goals of the Centers for Disease Control's (CDC) policy on the prevention of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is to support business organizations in implementing HIV and AIDS information, education, and prevention activities. However, the response of the American business community to HIV infection and AIDS has been varied. Although company executives consider AIDS to be one of the leading problems in the country, surveys typically indicate that less than one-third of businesses have or are developing some type of AIDS policy. The workplace appears to be a valid site for AIDS information and education programs, given the weight employees attach to information received there. However, workplace education and information programs are undertaken primarily by large companies. Many small companies do not devote much time and effort to these activities, even though extensive, indepth educational programs are likely to have positive impacts on worker attitudes and behavior, whereas short programs or literature distribution may only increase workers' fears. The question of what is an effective workplace program still needs additional research. Very little is known about the magnitude of the costs of HIV infection and AIDS to business. These costs, which are affected by the changing roles of employer-based health insurance, cost shifting, and public programs, will influence how employers react to the epidemic and how they respond to CDC's prevention initiatives.     

建水县HIV阳性暗娼综合干预管理模式探索

目的探索建立HIV阳性暗娼综合干预管理模式。方法对建水县辖区的HIV阳性暗娼开展建档管理、规范行为告诫谈话、抗病毒治疗转介、性病检查、随访督导、生活救助及转行指导等综合干预管理。结果通过项目实施,建水县建立了由防艾办协调领导,以县疾控中心为核心,以县卫健局、卫计综合执法局和社区等相关部门为组织保证,集艾滋病防治健康教育、行为干预、心理疏导、随访、抗病毒治疗转介、生活救助及转行指导为一体的HIV阳性暗娼综合干预管理模式。结论建水县HIV阳性暗娼综合干预管理模式的建立,有效加强了阳性暗娼的管理,遏制了以该人群为桥梁的艾滋病二代传播和家庭传播。     

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: India

Linking more than 3000 health and development organizations, the Voluntary Health Association of India (VHAI) is one of the largest networks in the country. In 1990 VHAI began incorporating HIV/STD-related activities into its broader programs. An existing infrastructure for intersectoral collaboration in the areas of community health promotion, public policy, information and documentation, and communications facilitated inclusion of the new activities. Several VHAI departments collaborate in offering training courses, workshops, and seminars at the state and community levels to involve nongovernmental organizations and professional groups in HIV/STD prevention and counseling. More than 950 persons have been trained so far, including trainers of primary health care workers, family physicians, medical practitioners, social scientists, teachers, community volunteer workers, and youth leaders. Local experts act as training resource persons; materials produced locally, abroad, and by VHAI itself are used. Training facilities are offered free of charge to member organizations; VHAI also awards fellowships for field training and financial support for approved projects. VHAI suggests intervention measures to governmental and nongovernmental organizations related to drug users, youth, truck drivers, blood donors, and people living with HIV/AIDS. The information, documentation, and communications departments provide members with a wide variety of information, education, and communication (IEC) materials that can be translated into local languages: posters, folders, flip charts, stickers, and folk songs. VHAI advocacy issues that have been highlighted through the press include: confidentiality, protection against discrimination, the right of all persons to health care, and the need to make properly-equipped STD clinics available. VHAI has established sub-networks in Tamil Nadu (155 organizations) and Manipur (55 organizations) states. VHAI has found that incorporating HIV/STD activities into its general health education programs is more cost-effective than having a vertical program.     

Reorienting health and social services

The global HIV/AIDS epidemic poses the particular challenge of how to concentrate resources and bring about results without provoking stigmatization against those groups who are highly vulnerable. AIDS-based discrimination is increasing around the world and is manifested in the unwillingness to fund programs claiming that the victims are at fault. This means that sexually transmitted diseases (STDs) and AIDS programs are responsible for promoting nondiscriminatory approaches. STD treatment programs generally provide pre- and post-test counseling, but broader antistigmatization efforts have been carried out by AIDS service organizations and nongovernmental organizations. A well-developed response to HIV/AIDS and STDs involves service and program providers, community health workers, traditional health practitioners, general and private practitioners, pharmacists, traditional birth attendants, and social workers. Outreach staff need to link with community workers and volunteers close to the client groups. HIV/STD diagnosis and treatment programs need to be coupled also with intensive community-led prevention and support activities in order to influence sexual behaviors. Programs conducted in this spirit share information more easily, provide authoritative roles for nonbiomedical workers, and have clear goals that are supported by the clients. These programs forge alliances between clients, service providers, and community leaders. The underlying concept of human rights embraces a broader perspective looking for the determinants and remedies for vulnerability to HIV/STD. HIV/AIDS/STDs must be fought to defeat both the virus and social backlash. This two-pronged struggle requires the reorientation of health and social services centering on partnerships and a conducive management style. Health and social services can be constrained by a trend toward reduced funding, but HIV-affected communities induce them to change whereby new partnerships could be forged.     

江川县舞厅暗娼性病/艾滋病健康促进干预效果评价

评价江川县性病/艾滋病健康促进与干预措施实施效果及可行性。方法：通过对县内32个舞厅的卖淫妇女实施3次性病/艾滋病健康促进与干预措施，以问卷调查进行评价。结果：性病/艾滋病知识的知晓率及高危行为改善均有显著效果。结论：实施的效果良好，并具可行性。     

Country watch: Zimbabwe

In 1991, the Matabeleland AIDS Council (MAC) in Bulawayo, Zimbabwe, established a peer education program for industry workers. To date, workers from 45 companies, particularly manufacturing companies, have participated in the program. Program goals include prevention of the spread of HIV and promotion of a supportive response to co-workers known or suspected to have HIV infection or AIDS. MAC first contacts senior management to get company support. It then helps personnel and training management staff develop each company's program. MAC negotiates free time for the 5-day initial training course of peer educators and for the quarterly follow-up meetings. Workers complete questionnaires so MAC can determine training content and materials required. Management and workers choose workers to be trained as informal resource persons. The criteria for the non-paid peer educators are that they be permanent employees, good communicators, literate in English, highly motivated, and persons trusted and respected by their co-workers. The peer educator/worker ratio is 1-2/100. The task of peer educators is dispelling misconceptions and myths and creating on-going discussions about HIV/AIDS both in and outside the workplace. MAC also trains nurses in 16 companies in AIDS counseling and methods of training peer educators. MAC conducted an evaluation of the peer educator program in 1994 in 15 companies. 13 companies either did not have an AIDS policy or did not address AIDS in its general health policy. 91% of workers had received written materials. 74% attended drama or video sessions, 66% received condoms. 30% asked a peer educator personal questions. Between 1992 and 1993, distribution of condoms increased from 25,776 to 49,392. Workers have adopted a positive attitude towards persons with AIDS. Many peer educators have taken up AIDS related-community work. Business leaders acknowledge the benefits of the peer educator program.     

Integrating HIV / AIDS care in family welfare services: the PSS experience

In India, participants of a consultative meeting in early February 1994 in Haryana State on STD (sexually transmitted disease) and AIDS prevention in family welfare programs and those at a December 1994 workshop in Jaipur State on integration of RTI (reproductive tract infections)/STD/HIV prevention activities into family welfare programs agreed on the need to broaden the scope of family welfare programs to include RTI/STD/HIV prevention and control. The meeting participants examined 4 case studies on the issue of RTI and STDs in the context of family welfare programs. One case study reviewed activities of the New Delhi-based Parivar Seva Sanstha (PSS), which provides comprehensive reproductive health services. All PSS staff have received training in HIV prevention. In Madras, PSS initiated a pilot project to integrate RTI/STD services into its mainstream family planning services. It tailored experiences of the Colombian Family Welfare Association (PROFAMILIA) to fit PSS project objectives. Formative research revealed that both men and women seek STD diagnosis and treatment services from the private sector despite the high costs and poor quality of care. Based on these findings and the PROFAMILIA experiences, PSS developed a model for integrated services for implementation, evaluation, and eventual replication. PSS has increased its focus on the use of condoms for contraception and HIV/STD prevention. All female clients now have access to standard screening, diagnosis, and treatment. PSS will create a new clinic offering reproductive health services for males. It will also develop systems for partner referral and community-based programs to provide education and motivation for family planning and RTI/STD/HIV prevention. Operational research will provide insight into the needs and perceptions of the population, process evaluation of the project, and RTI/STD/HIV control. Based on the case studies, certain ideas for future actions emerged (e.g., a major advocacy drive) as well as ideas for training, education, counseling, and social marketing and research and evaluation.     

Mobile health units and STD control

Sexually transmitted diseases (STDs), especially genital ulcers, facilitate HIV transmission. Prevention and control of STDs could reduce HIV transmission in sub-Saharan Africa where the STD prevalence is still high. The principles of primary health care (PHC) should guide coordinated or integrated AIDS and STD programs in sub-Saharan Africa. WHO recommends implementing the following AIDS prevention and control activities: district-based epidemiological surveillance, education and communication efforts, blood safety, nursing care, counseling, and activities targeting youth, women, and workers at risk. PHC funding is still low in sub-Saharan Africa, even though health professionals have been involved in intensive efforts to mobilize and coordinate national and international financial support for AIDS control programs. Expenditures on infrastructure and training beyond current practical levels are needed to achieve WHO recommendations. The POD from the Shanning Group can address sub-Saharan Africa's problems with using mobile clinic/laboratory facilities. The major problems are cost and difficult terrain. The POD is a modular demountable unit that can be removed from the vehicle for use as a self-supporting facility. The vehicle is then free for other uses. The POD's uses span from a simple examination and STD treatment facility to a sophisticated laboratory conducting basic STD testing as well as HIV and hepatitis ELISA testing. In fact, the POD can serve both roles simultaneously. The Shanning Group also has an audio-visual POD which can present STD educational material to a wide audience.     

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.     

广东省3个综合示范区五类人群艾滋病相关KABP情况调查

目的了解广东省3个示范区各类人群艾滋病相关知识、态度及高危行为情况,为采取针对性的艾滋病健康教育及干预措施提供依据。方法在广东省3个艾滋病综合防治示范区,采用方便抽样的方法,对一般人群及高危人群进行调查,调查内容包括社会人口学、艾滋病的基本知识、态度及高危性行为情况。结果共调查一般人群1 826人,高危人群838人。居民、学生、吸毒人群、暗娼、性病患者的艾滋病知识知晓率分别为60.3%7、2.6%、66.1%、56.0%、45.0%;吸毒人群注射吸毒率为76.3%,近6个月共用针具率为30.5%,艾滋病病毒(HIV)感染率为15.1%;暗娼人群近3个月持续使用安全套率为21.4%,近6个月性病患病率为31.8%,近12个月注射过毒品率为8.5%;性病患者中最近3个月内有非婚性伴率为42.9%,近3个月内与非婚性伴每次都用安全套率为3.3%。结论3个示范区人群艾滋病知识知晓率较低,高危人群高危行为的发生率及HIV感染率较高,应加强艾滋病健康教育及行为干预措施。     

Housing issues of persons with AIDS

The housing status of persons with HIV/AIDS is a central issue in their care and prognosis. We conducted eight focus groups to explore the housing needs of special populations of persons with HIV/AIDS in New York State; these populations included substance users, ex-offenders, persons with documented histories of homelessness, and rural dwellers/migrant workers. For the focus groups, 52 participants were recruited from the clientele of health and social service agencies. A major theme was the potent effect that housing situations had on participants’ health. Participants frequently attributed lowered T-cell counts and increased lethargy to the stress associated with governmental rules and paperwork. Lack of money, inadequacy of entitlements, and high costs of housing were the major barriers to securing stable and appropriate housing. Furthermore, participants experienced housing discrimination based on HIV status and experience with the criminal justice system or drugs.     

公共娱乐场所性服务小姐艾滋病行为干预效果评价

目的 探讨对公共娱乐场所性服务小姐性传播疾病成滋病（STD／AIDS）行为干预的健康促进模式，为在该特殊人群中实施有效的STD／AIDS预防干预措施提供理论基础和新思路。方法 运用流行病学定量研究和社会学定性研究相结合的研究方法，出台相关支持性政策，以外展服务方式到公共娱乐场所开展多种形式的干预活动、实施有效的STD／A1DS预防措施，采用横断面调查法收集干预前后性服务小姐有关STD／AIDS行为危险因素变化情况。结果 性服务小姐的预防STD／AIDS知识、态度和行为发生了显著变化，认为使用安全套可以预防艾滋病的从83．1％提高到90．9％（P〈0．01）；最近一次商业性服务中安全套使用率从64．4％上升到75．4％（P〈0．01）；最近三次都使用的率从38．1％上升到61.0％（P〈0．01）；淋病的感染率从8．6％下降到2．2％（P〈0．01）。结论 在公共娱乐场所针对性服务小姐开展100％推广使用安全套预防STD／AIDS健康促进活动切实可行且卓有成效。     

路边店艾滋病/性病预防知识宣教和行为干预

[目的]提高路边店女性服务人员性病艾滋病知识知晓率和安全套的使用率,促进行为改变,增加其预防艾滋病性病的能力,遏制艾滋病/性病在该类人群中的传播蔓延。[方法]采用对领导层倡导,建立多部门合作的艾滋病防治管理体系。在对目标人群需求评估的基础上,采取形式多样的方法进行宣传和干预。[结果]目标人群艾滋病防治知识知晓率和安全套使用率有所提高,自我保护意识增强;项目工作人员能力提高,基本形成多部门合作的防治体系。[结论]项目工作的成功为探索在路边店性服务人员中开展性病艾滋病防治干预活动积累经验。     

Pharmaceutical patents and public health: challenges for the Brazilian antiretroviral treatment policy

The high prices of patented drugs have fueled the debate regarding the impact of the intellectual property system on access to treatment, with a special focus on HIV/AIDS. The Brazilian policy for antiretroviral treatment, part of a comprehensive program that includes both disease prevention and health promotion activities, has allowed the country to meet goals for coverage and quality and has been considered a model for other countries. However, as the Brazilian STD/AIDS Program reaches maturity, the increasing incorporation of patented drugs into the AIDS treatment regimen imposes an increasing burden on the country's health budget. This article discusses the public health challenges raised by pharmaceutical patents and discusses possible ways to sustain the national policy for free, universal access to HIV/AIDS treatment.     

STD/STI患者艾滋病防治健康教育效果比较

目的了解极高危人群STD/STI患者对艾滋病相关知识的掌握情况,评价艾滋病宣传教育的效果,探讨艾滋病宣传教育工作所能发挥的作用,为艾滋病防控提供理论依据。方法采用横断面调查、追踪调查相结合的方式,分析STD/STI患者干预前后艾滋病相关知识知晓率及其行为和态度的改变情况。结果干预后调查对象对艾滋病的含义、传播途径及预防措施有了更加正确的认识(P均<0.01),78.9%的人对安全套的使用形成正确认识(P<0.01),62.7%的人认为对艾滋病患者或艾滋病毒感染者应持关心的态度(P<0.01)。结论正确的干预活动可提高极高危人群STD/STI患者对艾滋病防治措施的认识及自我保护意识,从而降低艾滋病的发病率。