FIGHTING HIV/AIDS IN THE WORKPLACE

Transcription

1 WORKPLACE HIV/AIDS PROGRAM GUIDE WHAT S INSIDE FIGHTING HIV/AIDS IN THE WORKPLACE A COMPANY MANAGEMENT GUIDE Business Case Practical Guidance Case Studies & Best Practice Examples Sample Workplace Policies 1

2 Cover Page: Mine community women, sex workers amongst them, do a Friday awareness drive at the roadside in South Africa. Photo by Brent Stirton/Getty Images for GBC TABLE OF CONTENTS Why this Guide was Developed 1 Introduction 3 Managing HIV/AIDS in the Workplace and Community 8 Foundations of a Program 8 Implementation & Partnership 20 Appendix: Workplace Policies 37 About the Partners 42 Acknowledgements 44 2

3 Why this Guide was Developed This guide is aimed at companies operating in developing countries and emerging markets. It is based on the premise that even though much progress has been made globally to slow the pace of new HIV infections and to increase the proportion of those needing AIDS medicines who receive them, HIV/AIDS still poses huge challenges challenges that many countries aren t equipped to overcome. In those contexts, companies fill critical gaps in prevention, care and treatment that governments do not have the resources to contend with. According to the United Nations, nearly 65 million people have been infected with HIV since the start of the epidemic in the 1980s, and an estimated 25 million have died of AIDS-related illnesses. 1 In recent years the global epidemic has begun to stabilize: The annual number of new HIV infections declined from 3.0 million in 2001 to 2.7 million in AIDS deaths are expected to begin to decline by about Despite these positive developments in prevention and treatment, AIDS still imposes a huge economic burden. Untreated, AIDS kills primarily young and middle-aged adults during their peak productive and reproductive years. At the macro level, AIDS reduces disposable incomes, savings rates, investment and consumer spending. With treatment, HIV-positive individuals can continue to feel well and work productively in their jobs, but AIDS medicines are expensive. 1 UNAIDS/WHO, AIDS epidemic update (2002). 2 UNAIDS/WHO, Report on the Global AIDS epidemic (2008). 3 WHO, The global burden of disease: 2004 update (2008). FIGHTING HIV/AIDS IN THE WORKPLACE 1

4 At the micro level, companies feel the greatest impact of HIV/AIDS through their workforce, with direct consequences for their bottom line. These include increased expenditures on medical and health insurance, funeral costs and death benefits, and the time and cost of recruiting and training new employees to replace lost personnel. In high prevalence areas, companies that take no action see their revenues, and ultimately profits, decrease as a result of higher absenteeism and staff turnover, reduced productivity, declining morale, and a shrinking consumer base. Even companies that do take action may find that their cost of doing business increases because suppliers and distributors are affected, leading to similar disruptions in the supply chain. The global HIV/AIDS epidemic has reached into every corner of society, affecting parents, children and youth, teachers and health workers, rich and poor. The good news is that highly effective AIDS medicines known as antiretrovirals (or ARVs) now reach 42% of those around the world who need them in low- and middle-income countries. 4 Between 2003 and 2008, access to antiretroviral drugs in such countries increased 10-fold, thanks in large part to donor-funded programs. 5 Yet, governments in low and middle-income countries cannot afford to meet the remaining need, which means that companies committed to protecting the health of their workers must spend their own resources to do so. Co-authored by the International Finance Corporation (IFC) and the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC), Fighting HIV/AIDS in the Workplace: A Company Management Guide is the product of the IFC s ongoing commitment to sustainable development and GBC s mandate to catalyze business action to fight HIV/ AIDS. Targeting the private sector operating in developing countries, the document provides practical guidance and a range of options to companies based on corporate experiences and the efforts and expertise of IFC s program, IFC Against AIDS, and GBC, for designing and implementing prevention and care programs to support company employees and the communities in which they work and live. Though the past ten years have witnessed a huge growth in the establishment and diversity of workplace HIV/AIDS programs, good practice approaches are still evolving and reflect an ongoing learning process. The examples in this document come from publicly available sources such as agency publications and company Web sites, and include the experiences of IFC, its clients, and GBC and its members. 6 4 WHO, Towards universal access: scaling up priority HIV/AIDS interventions in the health sector (2009). 5 UNAIDS/WHO, Report on the Global AIDS epidemic (2008). 6 The authors have not verified the accuracy of the information or the companies practices; all information included herein is provided in good faith 2 FIGHTING HIV/AIDS IN THE WORKPLACE

5 Photo by Brent Stirton/Getty Images INTRODUCTION Employees of Daimler Chrysler work on the production line in East London, South Africa. Daimler Chrysler provides free and confidential HIV testing and care at their East London facility. The global HIV/AIDS epidemic has reached into every corner of society, affecting parents, children and youth, teachers and health workers, rich and poor. The good news is that highly effective AIDS medicines known as antiretrovirals (or ARVs) now reach 42% of those around the world who need them in low- and middle-income countries.7 Between 2003 and 2008, access to antiretroviral drugs in such countries increased 10-fold, thanks in large part to donor-funded programs.8 Yet governments in lowand middle-income countries cannot afford to meet the remaining need, which means that companies committed to protecting the health of their workers must spend their own resources to do so. The Joint United Nations Programme on HIV/AIDS (UNAIDS) in its yearly Global Summary provides updated data on the total number of people living with HIV/AIDS, people who are newly infected with HIV, AIDS deaths, and comparative global HIV/AIDS statistics. For more information on UNAIDS, visit WHO. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector (2009). UNAIDS/WHO, Report on the Global AIDS epidemic (2008). FIGHTING HIV/AIDS IN THE WORKPLACE 3

6 Box 1: What Is HIV/AIDS? HIV stands for Human Immunodeficiency Virus (HIV), the virus causing the Acquired Immunodeficiency Syndrome (AIDS). HIV attacks and slowly destroys the body s immune system. After a long period of infection, usually 3 7 years (sometimes much longer), enough cells of the immune system have been destroyed to lead to immunodeficiency, and a person begins to experience the symptoms associated with AIDS. Until that time, someone with HIV can be physically well. Under conditions of suboptimal nutrition and poor health, and without treatment access, the onset of AIDS can occur sooner than would otherwise be the case. When a person becomes immunodeficient and has AIDS, his or her body has difficulty defending against opportunistic infections as well as certain cancers. Without treatment, the body ultimately succumbs to one or more of these infections. Tuberculosis, for example, is a frequent cause of death among AIDS patients in many developing countries. While the impact of the disease can be mitigated with proper treatment and people can live many years due to effective medications, there is, in fact, no cure for AIDS. There are three main ways in which HIV is transmitted: By sexual contact through exchange of bodily fluids Through infected blood that is passed into the body, such as by blood transfusion or use of contaminated material (for example, syringes) From an infected mother to her child during pregnancy, childbirth or breastfeeding HIV is not transmitted through casual contact with HIV-infected people, or by contact with their saliva, sweat and tears. 1. Prevalence of HIV/AIDS in Developing Countries and Emerging Markets Sub-Saharan Africa has only one-tenth of the world s population but is home to more than two -thirds of the people living with HIV/AIDS. A 2008 UNAIDS report documented that West Africa has the lowest rates in the region, followed by East and Central Africa. Southern Africa, particularly South Africa, has the highest prevalence of HIV/ AIDS. 9 With seroprevalence rates above five percent of the general population, many African countries have what are known as generalized HIV epidemics (see Box 2) Yet, across the region, effective mobilization against the epidemic at the country level has caused declines in the epidemic. Overall, HIV/AIDS prevalence in Sub- Saharan Africa seems to be leveling off, albeit at high levels in southern Africa. 10 In East and Central Europe, Russia has the largest HIV/AIDS epidemic. The annual numbers of newly reported HIV diagnoses are rising in Azer- baijan, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Tajikistan, and Uzbekistan, which now has the largest epidemic in Central Asia. The overlap of sex work and injecting drug use features prominently in this region s epidemics. Nowhere in this region have HIV/AIDS epidemics reached a stage where they are likely to evolve independently of HIV transmission among injecting drug users and sex workers, and into a generalized epidemic. 11 In South and Southeast Asia, the HIV/AIDS epidemic remains largely concentrated in injecting drug users, men who have sex with men, sex workers, and clients of sex workers and their immediate sexual partners. India carries the highest country caseload of people living with HIV/ 9 Ibid. 10 UNAIDS/WHO, Report on the Global AIDS epidemic (2006). 11 UNAIDS/WHO, Report on the Global AIDS epidemic (2008). 4 FIGHTING HIV/AIDS IN THE WORKPLACE

7 INTRODUCTION Box 2: Commonly Used Terms Incidence: The number of newly diagnosed cases during a specific time period. Prevalence: The number of cases alive on a certain date. Classification of Epidemic States (recommended by UNAIDS and WHO) Low Level: HIV prevalence has not consistently exceeded five percent in any defined sub-population Concentrated: HIV prevalence consistently over five percent in at least one defined subpopulation but below one percent in pregnant women in urban areas. Generalized: HIV prevalence consistently over one percent in pregnant women nationwide. AIDS. 12 India s overall HIV/AIDS prevalence rate is estimated to be between 0.5 and 1.5 percent among people aged years; high-prevalence areas include the southern states as well as the easternmost states where the epidemic is largely associated with drug use. Although national prevalence in China remains low, there are clusters of high prevalence geographically and among population sub-groups. Slightly fewer than half the people living with HIV/AIDS in China, estimated at 700,000 in total in , are believed to have been infected through use of contaminated injecting equipment and blood. These numbers, however, should be considered in the context of China's extremely large population, about 1.3 billion. The overall levels of HIV infections in Latin America have remained fairly constant and well below 1% in the past decade. HIV transmission in this region is occurring primarily among men who have sex with men, sex workers, and (to a lesser extent) among injecting drug users. In several Caribbean countries, the epidemic in the region appears to have stabilized. In a few urban areas, including the Dominican Republic and Haiti, which has the largest epidemic in the Caribbean, the epidemic is declining. Heterosexual sex, paid or otherwise, is the main mode of transmission in this region; unprotected sex between men is also a significant factor in several national epidemics. 14 The limited HIV/AIDS information available for the Middle East and North Africa indicates that the epidemics in the region are comparatively small. Chief risk factors are unprotected paid sex and the use of contaminated drug injecting equipment. The Islamic Republic of Iran is home to a serious drug-related epidemic, where HIV prevalence has been documented among about one-fifth of male injecting drug users in Tehran. Unprotected sexual intercourse is the main factor in Sudan s epidemic which, with about 1.4% seroprevalence, has approximately 320,000 people who are HIV-positive. 15 Although there has been substantial progress in containing HIV/AIDS in certain geographic areas, prevention and treatment efforts cost billions of dollars yearly. The pace of new infections far outstrips available treatment. 12 UNAIDS/WHO, Report on the Global AIDS epidemic (2006). 13 UNAIDS/WHO, Report on the Global AIDS epidemic (2008). 14 Ibid. 15 Ibid. Box 3: HIV and TB: A Deadly Synergy Tuberculosis is the most common cause of death amongst those living with HIV. The two diseases create a deadly synergy, each fueling the progress of the other. Persons co-infected with HIV and TB are 30 times more likely to progress to active TB disease. Tuberculosis accounts for one-third of AIDS deaths worldwide and is one of the most common causes of morbidity in people living with HIV/AIDS (PLWHA). Joint management of the two epidemics in all settings, including the workplace, is critical to addressing each individual disease. FIGHTING HIV/AIDS IN THE WORKPLACE 5

8 Photo by Brent Stirton/Exclusive by Getty Images 2. The Business Case for Mobilization against HIV/AIDS The HIV/AIDS epidemic presents very tangible challenges to businesses especially those operating in countries where the HIV prevalence rate is high, countries where the government has limited capability to provide health care, and most acutely in countries facing both challenges. Most companies will be concerned about three types of business risks associated with the spread of HIV/AIDS: financial, reputational and in the case of small and medium-size businesses-- company viability. Second, companies are motivated to act because they want to do the right thing and be seen as responsible citizens. Companies in industries with many migrant workers or other characteristics associated with vulnerability to HIV infection are motivated both by cost concerns and by a desire to protect their people. Finally, small- and medium-size enterprises (SMEs) are particularly vulnerable to the HIV/ First, the HIV/AIDS epidemic creates direct and indirect costs for the private sector in developing countries. Although ARV treatment access has greatly increased, exerting a transformative effect, there are huge costs and challenges associated with keeping more people on treatment for the rest of their lives. In the shortto medium- term, HIV/ AIDS increases the cost of doing business and reduces productivity. Many companies recognize the impact of HIV/AIDS on their operations but may not know how to mitigate that impact. Other companies are unaware that a problem exists among their workforce, even when it may already be having a negative effect on their bottom line. The ienergizer call center complex in New Delhi, India. There are often thousands of young people who work in these centers working odd hours to deal with time differences and often living together in massive hotel style complexes. The young people have money, are independent and are not under the usual scrutiny and are thus at more likely to engage in risky sexual behavior. AIDS threat due to their limited financial, clinical, and human resource capacity to undertake HIV/ AIDS prevention and care interventions. Vulnerability of small and medium enterprises is compounded by increased risk to viability due to the loss of key employees and skills. The loss of a key employee may prove catastrophic for a small company in a situation where a larger firm might have access to multiple employees who are capable of performing comparable work. 6 FIGHTING HIV/AIDS IN THE WORKPLACE

9 INTRODUCTION 3. Costs and Benefits of Mobilizing Against AIDS in the Workplace It is difficult to generalize about the costs and benefits to companies of implementing workplace programs to address HIV/AIDS because there are many variables to consider. For example, a business operating in a high-prevalence region, i.e. above 5% of the adult population, or locality where the epidemic is well advanced may have a very different cost-benefit scenario than a business located in an area where HIV/AIDS ment costs were predicted to vary considerably among companies depending on which segment of the workforce was targeted and the type of care offered. The researchers concluded that even for companies with low-cost structures, for example, offering limited employment benefits and on-the-job training provided savings that appeared to outweigh costs. Companies that extend prevention and treatment programs to the community are seeing benefits tangible as well as intangible from these programs. These include increased performance and motivation among employees, better management, and improved reputation among stakeholders. prevalence is relatively low but increasing. The former may see care and treatment programs for its workforce as a priority; whereas, for the latter, a focus on education and prevention would bring cost-effective benefits. Other variables affecting costs may include size of the company, setting, industry sector, cost margin, ratio of skilled to unskilled workers, risk factors, HIV/ AIDS prevalence in the workforce, and availability of government or NGO-supported healthcare programs and facilities. The key is to find an affordable solution to fit a company's particular needs. With this in mind, various studies have been undertaken to explore the costs and benefits associated with business action on HIV/AIDS. In the early 2000 s, research produced costing models to estimate the cost of new HIV infections in the formal business sector. Costs of new infections were estimated in relation to annual salaries; results varied depending on skill level, associated benefits, and prevalence in the area. This research showed that HIV/AIDS was adding between 0.4 and 5.9% to the annual wage bill of large companies in South Africa and Botswana, under a conservative set of assumptions. 16 Treat- Businesses need to make an evaluation based on their own particular circumstances, areas of operation, level of risk, and available resources and partners. It is also important to note that beyond the motivations of financial incentive and risk management, an increasing number of companies are motivated by a sense of corporate social responsibility to sponsor programs and interventions that benefit the wider community, target particularly vulnerable segments of society, or help safeguard the health of future generations. Companies that extend prevention and treatment programs to the community are seeing benefits tangible as well as intangible from these programs. These include increased performance and motivation among employees, better management, and improved reputation among stakeholders. 16 Rosen S, Vincent, MacLeod, Vox, Thea and Simon, The cost of HIV/AIDS to businesses in southern Africa FIGHTING HIV/AIDS IN THE WORKPLACE 7

10 Photo by Brent Stirton/Exclusive by Getty Images MANAGING HIV/AIDS IN THE WORK- PLACE AND COMMUNITY Bajaj management and union representatives attend a lecture on HIV issues conducted by Dr Akolkar, resident physician at the Bajaj factory in India. 1. Foundations of a Program There are three initial steps a company can take as it embarks on a workplace and/or community HIV/ AIDS program: A. Identify and engage key stakeholders in order to devise an HIV/AIDS strategy based on partnerships and collaboration B. Put in place the key components and management structures needed for an effective response C. Implement a program that fits the needs of the targeted population through risk assessment exercises 8 FIGHTING HIV/AIDS IN THE WORKPLACE

11 MANAGING HIV/AIDS IN THE WORKPLACE FOUNDATIONS OF A PROGRAM Through experience, IFC and GBC have found that involving key stakeholders from the outset and putting in place proven structures of engagement greatly improves understanding of the problem and enables a more successful response. Internal stakeholders may include management, various functions within the company (e.g. medical staff, operational staff, and human resources), and employee associations or labor unions. Other pertinent stakeholders include employee families, neighboring communities, some NGOs, and some governmental organizations or services. Box 4: IFC and Serena Hotels: Implementing a Wellness Program The Serena Hotels Group, East Africa s largest hotel chain, employs more than 2,300 people at 19 hotels and lodges at beaches, parks, and game reserves in Kenya, Rwanda, Uganda, and the United Republic of Tanzania and Zanzibar. Between 1998 and 2002, Serena lost 35 employees to AIDS in Kenya alone. The company s insurance provider cancelled its coverage, and HIV rates continued to climb. When Kenya s National AIDS Control Council launched a campaign to engage private sector response to the disease, Serena s management took up the challenge. The company developed a comprehensive HIV/AIDS workplace and community program to reduce the vulnerability of employees and their families to HIV infection; lessen the adverse impact of HIV/AIDS on those affected; and eliminate stigma and discrimination against employees infected and affected by HIV/AIDS. Through a partnership with the IFC Against AIDS program, Serena Hotels received training in program monitoring and evaluation, and seed funding to support the implementation, and monitoring and evaluation of Serena s HIV/AIDS activities. In 2007, with IFC s continuing support, the company transformed its efforts in the area of HIV/AIDS into a comprehensive wellness program, covering a wide range of health and wellness issues. Through a collaborative effort with the NGO NOPE, Serena received technical support for its Wellness Champions in Kenya. The program promotes awareness of the prevention of sexually transmitted infections, as well as of communicable diseases (malaria, tuberculosis, and typhoid), and HIV prevention remains a central focus of the effort. Additionally, the program encourages active and healthy lifestyles, including the prevention of illnesses and conditions such as diabetes, hypertension, and heart diseases. Finally, the program promotes prevention of sexual harassment, alcohol and drug use, accidents, and violence. AIDS-related deaths among Serena employees declined from more than 35 in the five years before the program, to eight over the next five years. The cost of the company s employee life insurance premium fell by $90,000 due to reduced death claims. HIV infections among staff have fallen, absenteeism has dropped, and the company is operating more efficiently. Serena s experience demonstrates that programs to improve employee wellness can also save a company money. Source: IFC Operations FIGHTING HIV/AIDS IN THE WORKPLACE 9

12 Photo by Brent Stirton/Exclusive by Getty Images 1A. Stakeholder Engagement Rather than develop programs and activities in isolation, companies should aim to work in partnership with key stakeholders from within their operations and their surrounding communities. Companies can save time and money by identifying and leveraging existing resources and ongoing initiatives already in place. This is particularly important for small and medium enterprises that often lack both resources and capacity. Companies can also join forces and pool their resources to hire an external party to assist in program design and implementation. Industry associations and business coalitions against AIDS are also a valuable source of support and expertise. Create an Internal Focal Point Appointing a staff person to serve as a focal point for handling all company HIV/AIDS-related activities brings accountability and focus to the process. Large companies may be able to deploy a full-time HIV/AIDS program lead but in smaller companies, these functions are generally added to existing job responsibilities. The focal point is a facilitator responsible for coordinating activities undertaken within the company and the community. The person may be chosen from existing staff or recruited from outside. In either case, it is important that he or she be vested with authority over activities and given a direct line of communication with senior management. The person can play an important role in representing the company in multi-stakeholder forums and coordinating company representation among various functions (see Box 5 HIV/AIDS Is Everybody s Business ). Create an HIV/AIDS Response Committee Through experiences with its clients, IFC has found it effective to encourage a company to consider its HIV/AIDS response in terms of potential interventions in four key areas: operations medical interventions senior management support community involvement. Within each of these spheres lie particular skills and resources that need to be identified and leveraged if the fight against HIV/AIDS is to be won in the company's area of operations. This approach also brings together company and community stakeholders to establish a coordinated action plan with clear roles and responsibilities. The four areas of responsibility might then be Bajaj management and union representatives attend a lecture on HIV issues conducted by Dr Akolkar, resident physician at the Bajaj factory in India. 10 FIGHTING HIV/AIDS IN THE WORKPLACE

13 MANAGING HIV/AIDS IN THE WORKPLACE FOUNDATIONS OF A PROGRAM formalized within Four Spheres of Action. A committee made up of representatives from each sphere is established to identify needs, key issues, and capabilities, and to progressively develop the details of an HIV/AIDS Action Plan. Neither all committee members nor all actions need to be decided at once. Members can be added over time as progress is reviewed and valuable actions or individuals are identified. propose for their area. For example, if tuberculosis has had a dramatic HIV-linked resurgence, the committee would likely undertake more systematic TB screening and prevention. Such a move would lead to cooperation with the company management on budget allocation for TB prophylaxis, with the operations representatives for flexible working schedules to accommodate treatment regimens, and with the community arm for grassroots mobilization and awareness. Companies that want to address the issue of HIV/AIDS in their workplace do not need to start from scratch. There are often resources in the wider community that companies can leverage. The objective of this structure is to help design a program that ensures ownership over diverse projects and sites; across the main functional areas in the company such as senior management, human resources, operational management, and clinical services; and in the community. This should be a functional workgroup that has decision-making authority. The workgroup should be small enough to reach consensus on action. Coordination in choices and actions in the Four Spheres of Action will shape the response of the company to HIV/AIDS in its workplace and in relation to the community. Members of the committee play on one another's strengths to maximize the chances of success and cooperate in the four spheres or functional areas of the company. For examples, committee members from operations may identify entry points that exist at the level of company operations for HIV/AIDS education and prevention. In mining operations, for instance, occupational health and safety briefings for employees are performed on a regular basis and could be extended to include HIV/AIDS education and prevention. Similarly, clinical or medical members of the medical committee will focus on the health problems they confront and solutions that they Find Service Providers and Partners As mentioned earlier, companies that want to address the issue of HIV/AIDS in their workplace do not need to start from scratch. There are often resources in the wider community that companies can leverage, including public programs undertaken by Ministries of Health or National AIDS Committees, NGO activities and initiatives launched by other businesses, employer associations, or medical organizations. Strategic partners can help businesses analyze their risk factors, design and implement focused programs, leverage their resources, learn from the experience of others, and ensure the confidentiality of employees' conditions and care. Smaller companies with limited capacity may find it also practical to partner with other local businesses or participate through industry associations or local chambers of commerce. FIGHTING HIV/AIDS IN THE WORKPLACE 11

14 Box 5: HIV/AIDS Is Everybody s Business: Maximizing the Chances of Success through Four Spheres of Action IFC s experience in working with companies through its dedicated program has shown that the most successful interventions involve coordinated action among four separate but interrelated areas: operations, medical interventions, senior management support, and community involvement. A committee can be formed of members from all four areas. Operations: Representatives from this sphere include individuals from the operational level of a company. In addition to these employees, the committee may also include employee peer educators, staff from human resources, contractors, and union representatives. Committee members from operations can identify risks at the working level; opportunities for promoting on-the-job education and prevention; and specific needs of employees in terms of health programs and services. This committee can also evaluate and report back on employee satisfaction with the program. Medical interventions: The medical sphere comprises clinical staff from the company as well as from public hospitals, NGOs or local health offices. These representatives can identify the general health trends in the area, prioritize concerns, and coordinate medical programs and services. Senior management support: Committed leadership is essential for companies to address HIV/ AIDS effectively. The senior management representatives and board members can champion the program, allocate budgetary and staff resources, and undertake a periodic review of the various activities. Community involvement: Representatives drawn from the local community may include prominent citizens such as village chiefs, religious leaders, or school representatives, as well as members of community organizations, women's groups, and NGOs. Committee members can serve as liaisons between the company and the community, strengthening communication and cooperation in efforts to combat HIV/AIDS. Source: IFC Operations 1B. Core Principles of an Effective Response Once stakeholder groups and partners have been identified, companies can then begin to focus internally on establishing the key components of an effective response. This involves setting company-specific goals and objectives, developing a policy on HIV/AIDS to guide company action, ensuring strong and visible support from senior management, and allocating a budget for the HIV/AIDS program. These building blocks are essential for the credibility of the program and for building trust among key stakeholder groups. Be Clear about Goals and Objectives Typically, companies have two objectives in undertaking a workplace HIV/AIDS program: to limit the incidence of new infections among staff and the surrounding community; and to manage the impact of existing infections on the company, staff, and community. To achieve these objectives, a company's program might set goals for changing behavior and increasing the use of preventive measures, as well as for improving medi- 12 FIGHTING HIV/AIDS IN THE WORKPLACE

15 MANAGING HIV/AIDS IN THE WORKPLACE FOUNDATIONS OF A PROGRAM Box 6: ILO Code of Practice on HIV/AIDS: Key Principles [Excerpt] The following principles are part of the International Labour Organization's Code of Practice on HIV/AIDS and the World of Work. The code is voluntary and meant for use by the private sector in the development of workplace policies and guidelines. Recognition of HIV/AIDS as a workplace issue HIV/AIDS is a workplace issue, not only because it affects the workforce, but also because the workplace can play a vital role in limiting the spread and effects of the epidemic. Non-discrimination There should be no discrimination or stigmatization against workers on the basis of real or perceived HIV status. Discrimination and stigmatization of people living with HIV/AIDS inhibits efforts aimed at promoting HIV/AIDS prevention. Gender equality The gender dimensions of HIV/AIDS should be recognized. Women are more likely to become infected and are more often adversely affected by the HIV/AIDS epidemic than men due to biological, socio-cultural and economic reasons. More equal gender relations and the economic and social empowerment of women are vital to preventing the spread of HIV infection and enabling women to cope with HIV/AIDS. Healthy work environment The work environment should be healthy and safe, and adapted to the state of health and capabilities of workers. Social dialogue A successful HIV/AIDS policy and program requires cooperation, trust, and dialogue between employers, workers, and governments. Screening for purposes of employment HIV/AIDS screening should not be required of job applicants or persons in employment, and testing for HIV should not be carried out at the workplace except as specified in the ILO code. Confidentiality There is no justification for asking job applicants or workers to disclose HIV-related personal information. Nor should co-workers be obliged to reveal such personal information about fellow workers. Access to personal data relating to a worker's HIV status should be bound by the rules of confidentiality consistent with existing ILO codes of practice. Continuing the employment relationship HIV infection is not a cause for termination of employment. Persons with HIV-related illnesses should be able to work for as long as medically fit in appropriate conditions. Prevention HIV infection is preventable. Prevention of all means of transmission can be achieved through a FIGHTING HIV/AIDS IN THE WORKPLACE 13

16 variety of strategies which are appropriately targeted to national conditions and which are culturally sensitive. Employers, workers and their representatives, and government are in a unique position to promote prevention efforts through information and education; and to support changes in attitudes and behavior. Care and Support Solidarity, care, and support should guide the response to AIDS in the workplace. All workers, including workers with HIV, are entitled to affordable health services and to benefits from statutory and occupational schemes. Source: cal care and providing support to persons affected by HIV/AIDS and other infectious diseases. Develop an HIV/AIDS Policy to Guide Program Development As with any serious chronic medical condition, it is important to clearly delineate the principles that a company will follow towards employees who are infected with HIV/AIDS. An official company policy serves to inform employees of their rights and responsibilities; articulates the commitment of management; clarifies company obligations and, in certain cases, protects a company from liabilities. In addition to being readily accessible and visible in many locations, the company HIV/AIDS policy should be actively communicated to employees in a manner that explains why the policy matters. Staff should feel confident that the company is dedicated to maintaining employee privacy and to taking reasonable strides to safeguard the health of the workforce. The HIV/AIDS policy is the first piece of the HIV/ AIDS program to be used for internal briefing and also as a provision for third parties. There is now a large body of work including voluntary codes and guiding principles to assist businesses in developing workplace policies on HIV/AIDS. Such a policy generally includes a statement endorsing the company's commitment to addressing HIV/AIDS, a respect for the confidentiality of HIV status, and the establishment of nondiscriminatory practices in relation to people living with HIV/AIDS (PLWHA). For further guidance on workplace policies, please see the Key Principles of the ILO Code of Practice on HIV/AIDS (Box 6) and sample policies provided in the section Workplace Policies. Ensure Senior Management Commitment Senior management commitment is vital to an effective HIV/AIDS program. Senior management Box 7: Engaging Senior Management: GBCs CEO HIV/AIDS Nondiscrimination Pledge n December 2008, over 100 CEOs from GBC member companies signed a pledge to end HIV stigma and discrimination. This unprecedented public commitment sent a powerful signal to company employees, families, communities and stakeholders that their CEOs care and are doing their part to end stigma around the disease. CEO leadership through the pledge has also sent a message to the public health community that business is committed to ending the epidemic, at all levels of the company. Source: GBC 14 FIGHTING HIV/AIDS IN THE WORKPLACE

17 MANAGING HIV/AIDS IN THE WORKPLACE FOUNDATIONS OF A PROGRAM support includes recognizing HIV/AIDS as a corporate priority and demonstrating active support for program activities. At some stage, management may set performance targets for the HIV/ AIDS program and provide incentives for achieving these targets in employees and/or managers performance goals, performance reviews and bonus plans. Allocate a Budget for the HIV/AIDS Program Dedicating a budget for implementation of the program will be a good investment in the long run. The budget could come from a centralized cost center or constitute a percentage of each operational department s own budget, creating a greater incentive for departmental participation. This budget should also take into consideration any staff time and in-kind contributions. Address Gender Dimensions of HIV/AIDS Gender inequality especially women's lack of economic empowerment in many developing countries is an important factor driving the increase in HIV infection among women. Women are disproportionately vulnerable to HIV for social, economic and even physiological reasons (transmission occurs more readily from a male to female partner than the reverse). In Sub-Saharan Africa, for every 10 adult men living with HIV, there are about 14 adult women infected. In that region in 2007, almost 61 percent of adults living with HIV were women. 17 Therefore, as companies operate in an increasingly diverse workplace and draw their workforce from various subsets of the population, they need to consider the differing needs of men and women in their workplace HIV/AIDS strategies. An understanding of how gender issues affect people in their daily lives, particularly in the workplace, is essential in designing an appropriate and effective action plan to manage HIV/ AIDS. A starting point for a gender-sensitive HIV/ AIDS strategy is an awareness and appreciation of gender-differentiated vulnerabilities and risks. These include traditional norms of femininity and masculinity; greater physiological vulnerabilities Box 8: Standard Bank s HIV/AIDS Program and Gender Standard Bank addresses gender issues to reduce HIV risk for women. The Bank provides employees and their families access to family planning services and information about sexually transmitted infections and mother-to-child transmission of HIV as part of its comprehensive HIV/AIDS program, which also includes education and awareness-raising, voluntary counseling and testing, and specialized care. Additionally, the program addresses domestic violence, a pressing social problem in South Africa, through education and awareness raising. Source: GBC and Standard Bank (2008) of women and young girls; societal notions and tacit condoning of certain risk behaviors, such as multiple partners, violence against women, and sugar daddies ; and the culture of silence around sex and sexual matters. In all societies and business environments, gender norms influence people's attitudes to sex, sexuality, fidelity, cultural practices, and access to services and information. Introducing activities that tackle gender disparities and bias can help to mitigate the increasing burden of HIV on women, both as people living with HIV/AIDS and as caretakers. Companies can target efforts to ensure nondiscriminatory practices and equitable access to legal, medical, and social benefits and services. Tackle Stigma and Discrimination Sociologists describe stigmatization as a societal labeling of an individual or group as different or deviant in an undesirable way. 18 Discrimination in the workplace reinforces stigmatization of people living with AIDS. At the same time, the workplace offers a unique opportunity to confront societal discrimination and stigma by dis- 17 UNAIDS, AIDS Epidemic Update, Lisanne Brown, Lea Trujillo and Kate Macintyre, Interventions to Reduce HIV/AIDS Stigma: What Have We Learned? Population Council (2001). FIGHTING HIV/AIDS IN THE WORKPLACE 15

18 Photo by Brent Stirton/Getty Images Exclusive A young girl holds a baby outside of a Ranbaxy Pharmaceutical in New Delhi, India. Ranbaxy Pharmaceuticals was one of the first companies in the world to put forward the notion of generic medicine for AIDS patients at greatly reduced prices. pelling myths and communicating that people living with HIV are entitled to the same rights and compassion as any other group and that they need not fear that the company will discriminate against them, nor is there any reason for HIV-negative employees to fear people living with HIV. These messages can be reinforced further by workplace-based, anti-discrimination policies and programs, which demonstrate that people can live and work with HIV for many years. Encouraging an HIV/AIDS support group for employees, or involving people living with HIV/AIDS in company awareness activities can also be a powerful means of breaking down misconceptions and fostering understanding and acceptance. Box 9: Action steps: How can my company go about developing an HIV/AIDS program? 1. Create an HIV/AIDS Response Committee and appoint a staff person to handle all company HIV/AIDS related activities. 2. Develop a workplace policy on HIV/AIDS. 3. Engage senior management in program activities. 4. Assess the rate of infection in the workforce, any risk factors and impact on business. 5. Conduct a survey (preferably administered by an outside party) to identify the Knowledge, Attitude, Practice and Behavior of the employees. 6. Determine which program, an Awareness/Education or a Care/Treatment, would be relevant for your company and implement the appropriate program. 7. Partner with the Ministry of Health or National AIDS Committees, NGOs, medical organizations and other local businesses and leverage their resources. 8. Integrate TB into the HIV/AIDS workplace program and ensure that the HIV/AIDS strategy is gender sensitive. 16 FIGHTING HIV/AIDS IN THE WORKPLACE

19 MANAGING HIV/AIDS IN THE WORKPLACE FOUNDATIONS OF A PROGRAM Monitoring and Evaluation Monitoring is an important part of any corporate HIV/AIDS program because it enables a company to measure its progress against stated goals and make informed decisions about how well interventions are succeeding. To be most effective, a monitoring system should involve reporting throughout the chain of command with accountability to senior management. Effectiveness of a company s program can be measured in both quantitative and qualitative terms, assuming that good baseline data exist or have been collected at the start of the program to enable comparison. Tracking HR statistics and clinical data can provide a low-cost monitoring alternative, although some firms find it useful to tailor indicators specifically to their HIV/AIDS, TB, malaria and wellness efforts. Quantitative indicators may include productivity measures, such as absentee rates and additional weeks or months gained on the job for employees receiving care. They can also include behavioral indicators such as condom use, number of requests for VCT services, number of volunteer peer educators, and disease indicators, such incidence rates of STIs reported in the company clinic. Qualitative indicators such as staff morale, general attitudes toward HIV/AIDS and satisfaction with company programs can be evaluated through questionnaires, focus groups, and key informant interviews. These results can then be reviewed in light of expenditures to determine the overall cost-effectiveness of a company's activities. 1C. Risk Assessment In reality, many companies can neither gauge the magnitude of the threat posed by HIV/AIDS to their business, nor determine how serious a risk it poses to their workforce. This can be determined at the occasion of an HIV risk assessment, which also creates an opportunity for a company to assess other health issues that may impact their workforce; in fact, companies can decide to do a more comprehensive health assessment for this very reason. Identify Risk Factors In defining the extent of the problem, a company should examine its operations in light of the risks to its workforce. There are a number of risk factors to be considered regarding HIV transmission. Some industries are riskier than others because their operations rely on workers separated from their families for long periods of time. Such conditions, which systematically contribute to a local sex industry and high-risk behavior are often associated with sectors such as mining, oil and gas, infrastructure construction, longdistance transportation and trucking, and agribusiness. Employees in locations such as southern Africa where the HIV epidemic is generalized and affects over five percent of the population are at risk merely by virtue of being sexually active. Other groups with increased levels of risk include company healthcare workers, as they may be accidentally exposed to HIV in their job; and mobile or migrant labor populations, who often have significantly higher salaries than the general population and can support a local sex industry. Workers in rural settings are also at risk because rural areas generally have poor access to government health services and fewer HIV educationprograms. Determine the Rate of Infection To assess the extent of the problem, the first step is to determine the approximate rate of infection in the workforce. Although workforce infection rates can in most cases be assumed to be similar to the rate for the local population, testing yields a more accurate picture and provides other benefits. The most accurate assessment will be from voluntary, anonymous, and unlinked testing of the entire workforce (participation must be at least 90 percent of employees to ensure accuracy of results), and provided by a third party. However, initially a company may rely on interpolation from associated FIGHTING HIV/AIDS IN THE WORKPLACE 17

20 data (for example, cause of death from medical records), or extrapolation from public data (national prevalence rate in the adult population as well as regional data, if available). This approach is in fact advisable for smaller enterprises, for cost effectiveness and confidentiality reasons. HIV prevalence studies should be carefully conducted to ensure anonymity and to preserve the trust of employees, which is why testing by a third party is suggested. Collecting this baseline information is important not only to focus company efforts, but also for monitoring and measurement of the effect of any interventions undertaken, and estimating the cost for implementation of an antiretroviral (ARV) treatment program. Data on the rate of infection can be gathered through other means a good starting point is usually the national Ministry of Health or a specialist AIDS-control agency. A review of recent mortality data among the general population may also provide insight into the situation. UNAIDS collects and maintains national level data for most countries. A company may establish a baseline by reviewing absenteeism and staff turnover rates, insurance claims and statistics from the company clinic, such as rates of sexually transmitted infections (STIs) among employees. As the program is implemented, it will be important to keep track of the data to assess how well the interventions are succeeding over time. Identify the Knowledge, Attitude, Practice, and Behavior of the Staff Knowledge, Attitude, Practice, and Behavior (KAPB) studies are important in assessing employee knowledge of HIV/AIDS, planning effective programs, and measuring the subsequent success of interventions. The company can gather anecdotal, qualitative evidence of behaviors, attitudes, risk factors, knowledge gaps, as well as their evolution through commissioned or internally provided KAPB studies. Surveys of managers, foremen, and employees help determine general attitudes and perceptions about the impact of the disease on operations and whether people feel they are at risk. This information will be critical for developing appropriate training programs. A KAPB survey administered by an outside party is more likely to be objective and yield candid responses. If the survey is performed internally, i.e. by other employees such as peer educators, it should focus on questions related to knowledge of HIV/AIDS rather than issues of behavior and practices. Assess the Impact on the Business The evaluation of the impact of HIV/AIDS on the business (productivity loss, absenteeism increase, health services demand and costs, and recruitment and training needs) can be undertaken. This assessment can be made through survey, qualitative analysis, and quantitative analysis. The information yielded is crucial in implementing human resource mitigation plans, including needs for increasing the scope of certain workers job responsibilities (multi-tasking), additional training, and hiring. Box 10: What We Have Learned Over 10 years of practice, the IFC Against AIDS program and GBC have documented the following experiences in working with clients and members to develop and implement HIV/AIDS workplace and community programs. Coordinating action is essential: The most successful programs involve coordinated action among four separate but interrelated spheres (see Box 5 HIV/AIDS Is Everybody s Business: Maximizing the Chances of Success through Four Spheres of Action ) 18 FIGHTING HIV/AIDS IN THE WORKPLACE