HIV/AIDS PRODUCT SAMPLE
Introduction
The virus responsible for the condition known as AIDS (Acquired Immunodeficiency Syndrome), is named HIV (Human Immunodeficiency Virus). AIDS is the condition whereby the body's specific defense system against all infectious agents no longer functions properly. There is a focused loss over time of immune cell function which allows intrusion by several different infectious agents, the result of which is loss of the ability of the body to fight infection and the subsequent acquisition of diseases such as pneumonia. We will examine the virus itself, the immune system, the specific effect(s) of HIV on the immune system, the research efforts presently being made to investigate this disease, and finally, how one can try to prevent acquiring HIV.
The Virus
The Immune System
The immune system is a system within all vertebrates (animals with a backbone) which in general terms, is comprised of two important cell types: the B-cell and the T-cell. The B-cell is responsible for the production of antibodies (proteins which can bind to specific molecular shapes), and the T-cell (two types) is responsible either for helping the B-cell to make antibodies, or for the killing of damaged or "different" cells (all foreign cells except bacteria) within the body. The two main types of T-cells are the "helper"T-cell and the cytotoxic T-cell. The T-helper population is further divided into those which help B-cells (Th2) and those which help cytotoxic T-cells (Th1). Therefore, in order for a B-cell to do its job requires the biochemical help of Th2 helper T-cells; and, for a cytotoxic T-cell to be able to eliminate a damaged cell (say, a virally-infected cell), requires the biochemical help of a Th1 helper T-cell.
Whenever any foreign substance or agent enters our body, the immune system is activated. Both B- and T-cell members respond to the threat, which eventually results in the elimination of the substance or agent from our bodies. If the agent which gains entry is the kind which remains outside of our cells all of the time (extracellular pathogen), or much of the time (virus often released) the "best" response is the production by B-cells of antibodies which circulate all around the body in the bloodstream, and eventually bind to the agent. There are mechanisms available which are very good at destroying anything which has an antibody bound to it. On the other hand, if the agent is one which goes inside one of our cells and remains there most of the time (intracellular pathogens like viruses or certain bacteria which require the inside of one of our cells in order to live), the "best" response is the activation of cytotoxic T-cells (circulate in the bloodstream and lymph), which eliminate the agent through killing of the cell which contains the agent (agent is otherwise "hidden"). Both of these kinds of responses (B-cell or cytotoxic T-cell) of course require specific helper T-cell biochemical information as described above. Usually, both B-cell and cytotoxic T-cell responses occur against intracellular agents which provides a two-pronged attack. Normally, these actions are wonderfully protective of us. The effect of HIV on the immune system is the result of a gradual (usually) elimination of the Th1 and Th2 helper T-cell sub-populations.
How HIV Specifically Affects the Immune System
Remember about the proteins which are part of the envelope of HIV? Well, one of these proteins, named gp 120, (a sugar-containing protein called a glycoprotein, of approximately 120,000 molecular weight), "recognizes" a protein on helper T-cells named CD4, and physically associates with it. The CD4 [Cluster of Differentiation Antigen No. 4] protein is a normal part of a helper (both Th1 and Th2) T-cell's membrane. Thus, CD4 is a specific receptor for HIV. This virus however, can also infect other cells which include macrophages and certain other kinds of cells which can engulf substances through a process known as phagocytosis. As a consequence of the interaction with CD4 on helper T-cells, HIV specifically infects the very cells necessary to activate both B-cell and cytotoxic T-cell immune responses. Without helper T-cells, the body cannot make antibodies properly, nor can infected cells containing HIV (an intracellular pathogen) be properly eliminated. Consequently, the virus can: multiply, kill the helper T-cell in which it lives, infect adjacent helper T-cells, repeat the cycle, and on and on, until eventually there is a substantial loss of helper T-cells.
The fight between the virus and the immune system for supremacy is continuous. Our body responds to this onslaught through production of more T-cells, some of which mature to become helper T-cells. The virus eventually infects these targets and eliminates them, too. More T-cells are produced; these too become infected, and are killed by the virus. This fight may continue for up to ten years before the body eventually succumbs, apparently because of the inability to any-longer produce T-cells. This loss of helper T-cells finally results in the complete inability of our body to ward-off even the weakest of organisms (all kinds of bacteria and viruses other than HIV) which are normally not ever a problem to us. This acquired condition of immunodeficiency is called, AIDS.
Research
This virus has been under intense scrutiny for several years, now (since approximately 1985), and an astonishing amount of information has been gathered. One must wonder, "why isn't there a cure?" There isn't a cure primarily because there isn't a cure for most viruses. We do not yet know how to specifically kill a virus which spends most of the time hiding inside of our cells. The substances which we know can directly harm such a virus, unfortunately can also harm our own cells. Unlike our immune system, we do not yet know how to direct an attack on only those cells which are infected with the virus. Our knowledge so far allows us only to attack all of our cells (much like we do in chemotherapy for cancer treatments). We can't even sort-of focus an attack, as one can do with radiation treatment - if radiation treatment were used for HIV infections, this treatment would significantly hurt our immune system's ability to function, which is the opposite of what we want. To date, the most effective treatment against viruses is to develop a vaccine - which stimulates our own immune system to enable our immune system to better fight the virus. Thus, we have vaccines against poliovirus, smallpox virus, measles virus, influenza viruses, and others. The vaccine per se does not fight the virus, but instead causes an immune response specifically directed against the particular virus from which the vaccine is made - this response directly increases the number of specific B- and T-cells available to respond against a live virus infection encountered at some later time. Unfortunately, the fact that HIV is a retrovirus causes serious problems in vaccine development. The enzyme which generates RNA and DNA copies of the virus's RNA genetic material, makes errors. These errors are sometimes not lethal to the virus, but instead result in a different strain of a given virus - a different "looking" virus. Indeed, HIV is approximately 65-times more likely to undergo such changes as influenza virus
ELISA TEST AND WINDOW PERIOD
The window period is the time from infection until a test can detect any change. The average window period with HIV-1 antibody tests is 25 days for subtype B. Antigen testing cuts the window period to approximately 16 days and NAT (Nucleic Acid Testing) further reduces this period to 12 days. The enzyme-linked immunosorbent assay (ELISA), or enzyme immunoassay (EIA), was the first screening test commonly employed for HIV. It has a high sensitivity.In an ELISA test, a person's serum is diluted 400-fold and applied to a plate to which HIV antigens have been attached. If antibodies to HIV are present in the serum, they may bind to these HIV antigens. The plate is then washed to remove all other components of the serum. A specially prepared "secondary antibody" — an antibody that binds to human antibodies — is then applied to the plate, followed by another wash. This secondary antibody is chemically linked in advance to an enzyme. Thus the plate will contain enzyme in proportion to the amount of secondary antibody bound to the plate. A substrate for the enzyme is applied, and catalysis by the enzyme leads to a change in color or fluorescence. ELISA results are reported as a number; the most controversial aspect of this test is determining the "cut-off" point between a positive and negative result.
VCT
VCT stands for voluntary counselling and testing . VCT is when a person chooses to undergo HIV/AIDS counselling so that they can make an informed decision about whether to be tested for HIV. The government is encouraging all of us to come forward to be tested for HIV. it believes that if many of us get tested, even though we may not be sick, this will help to lessen the amount of stigma associated with the HIV test. Also, if we find out as an earlier stage, that we are infected with HIV, we can learn more about the virus and how it effects our body. Look after our health so that we stay as healthy as possible for as long as possible
Get information and counselling around how to live positively with the virus. This means learning to accept the fact hat we are HIV-infected, seeking emotional support, eating a health diet, learning how to control the amount of stress in our life, making sure we don't become re-infected, and planning for the future. Learn to recognize the signs of opportunistic infections so we can get them treated promptly.Find out what resources are available within our community to help us manage our HIV status
Find out about prophylatic drugs. These drugs do not cure HIV/AIDS, but can prevent us from getting some oportunistic infections that are common with people living with HIV/AIDS eg. T.B and some kinds of Pneumonia
Access Nevirapne. This is a drug available at a number of hospitals and clinics that lessens the chance of a pregnant mother passing the virus onto her baby.
Get emotional support by seeking counselling and joining support groups.
Make sure that we don't infect anyone else or get re-infected ourselves
Learn how to manage the stress in our lives
If we are not infected with HIV, VCT can motivate us to stay HIV antibody negative, and to accept those who are infected.
STAGES OF PROGRESSION
STAGE 1:
This stage of infection lasts for a few weeks and is often accompanied by a short flu-like illness. In up to about 20% of people the HIV symptoms are serious enough to consult a doctor, but the diagnosis of HIV infection is frequently missed.
During this stage there is a large amount of HIV in the peripheral blood and the immune system begins to respond to the virus by producing HIV antibodies and cytotoxic lymphocytes. This process is known as seroconversion. If an HIV antibody test is done before seroconversion is complete then it may not be positive.
STAGE 2:
This stage lasts for an average of ten years and, as its name suggests, is free from major symptoms, although there may be swollen glands. The level of HIV in the peripheral blood drops to very low levels but people remain infectious and HIV antibodies are detectable in the blood, so antibody tests will show a positive result.
Research has shown that HIV is not dormant during this stage, but is very active in the lymph nodes. A test is available to measure the small amount of HIV that escapes the lymph nodes. This test which measures HIV RNA (HIV genetic material) is referred to as the viral load test, and it has an important role in the treatment of HIV infection.
STAGE 3:
Over time the immune system becomes severely damaged by HIV. This is thought to happen for three main reasons:
The lymph nodes and tissues become damaged or 'burnt out' because of the years of activity;
HIV mutates and becomes more pathogenic, in other words stronger and more varied, leading to more T helper cell destruction;
The body fails to keep up with replacing the T helper cells that are lost.
Antiretroviral treatment is usually started once an individual’s CD4 count (the number of T helper cells) drops to a low level, an indication that the immune system is deteriorating. Treatment can stop HIV from damaging the immune system, therefore, HIV-infected individuals on treatment usually remain clinically asymptomatic.
However, in HIV-infected individuals not receiving treatment or on treatment that is not working, the immune system fails and symptoms develop. Initially many of the symptoms are mild, but as the immune system deteriorates the symptoms worsen.
Symptomatic HIV infection is mainly caused by the emergence of certain opportunistic infections that the immune system would normally prevent. This stage of HIV infection is often characterised by multi-system disease and infections can occur in almost all body systems.
Treatment for the specific infection is often carried out, but the underlying cause is the action of HIV as it erodes the immune system. Unless HIV itself can be slowed down the symptoms of immune suppression will continue to worsen.
STAGE 4:
As the immune system becomes more and more damaged the individual may develop increasingly severe opportunistic infections and cancers, leading eventually to an AIDS diagnosis.
A clinical criteria is used by WHO to diagnose the progression to AIDS, this differs slightly between adults and children under five. In adults and children (aged 5 or over) the progression to AIDS is diagnosed when any condition listed in clinical stage 4 is diagnosed and/or the CD4 count is less than 200 cells/mm3 or a CD4 percentage less than 15. In children younger than five, an AIDS diagnosis is based on having any stage 4 condition and/or a CD4 percentage less than 20 (children aged 12-35 months) and a CD4 percentage less than 25 (children less than 12 months). The criteria for diagnosing AIDS may differ depending on individual country guidelines.
PRE and POST test counselling
Counseling before and after an HIV test is important because it provides critical information about HIV itself and about the testing process. While counseling services may not be available in all health care settings, many testing sites do offer these services. If you would like access to pre-test and post-test counseling, be sure to inquire about the availability of these services at your chosen test site. If they do not have them readily available, the staff may be able to direct you to alternate service providers who do.
Pre-test counseling sessions generally include the following:
•Information about the HIV test—what it tests for, what it might NOT tell you, and how long it will take you to get your results
•Information about how HIV is transmitted and how you can protect yourself from infection
•Information about the confidentiality of your test results •A clear, easy-to-understand explanation of what your test results mean
HIV POSITIVE MOTHERS
Mother-to-child transmission (MTCT) is when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, around 15-30 percent of babies born to HIV-infected women will become infected with HIV during pregnancy and delivery. A further 5-20 percent will become infected through breastfeeding
Effective prevention of mother-to-child transmission (PMTCT) requires a three-fold strategy.5 6
Preventing HIV infection among prospective parents - making HIV testing and other prevention interventions available in services related to sexual health such as antenatal and postpartum care.
Avoiding unwanted pregnancies among HIV positive women - providing appropriate counseling and support to women living with HIV to enable them to make informed decisions about their reproductive lives.
Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding.
Integration of HIV care, treatment and support for women found to be positive and their families.
If a pregnant woman is infected with HIV, she can transmit the virus to her baby during pregnancy, labour and delivery, or breastfeeding. Without treatment, around 15-30 percent of babies born to HIV-infected women will become infected with HIV during pregnancy and delivery. A further 5-20 percent will become infected through breastfeeding.1
Modern drugs are highly effective at preventing mother-to-child transmission of HIV. When combined with other interventions, including formula feeding, a complete course of treatment can cut the risk of transmission to below 2 percent. Even where resources are limited, a single dose of medicine given to mother and baby can cut the risk in half.
A woman who knows that she or her partner is HIV positive before she becomes pregnant can find out about interventions that may be able to protect herself, her partner or her baby from becoming infected with HIV. Doctors will be able to advise which interventions are best suited to her situation, and whether she should adjust any treatment she is already receiving if she is HIV positive.
HIV in the workplace
Legal Framework
5.1. The Code should be read in conjunction with the Constitution of South Africa Act, No. 108 of 1996, and all relevant Legislation which includes the following:
(i) Employment Equity Act, No. 55 of 1998;
(ii) Labour Relations Act, No. 66 of 1995;
(iii) Occupational Health and Safety Act, No. 85 of 1993;
(iv) Mine Health and Safety Act, No. 29 of 1996;
(v) Compensation for Occupational Injuries and Diseases Act, No. 130 of 1993;
(vi) Basic Conditions of Employment Act, No. 75 of 1997; and
(vii) Medical Schemes Act, No. 131 of 1998.
(viii) Promotion of Equality and Prevention of Unfair Discrimination Act, No. 4 of 2000.
5.2. The contents of this code should be taken into account when developing, implementing or reviewing any workplace policies or programmes in terms of the statutes listed above.
5.3. The following are selected, relevant sections contained in certain of the above-mentioned legislation. These should be read in conjunction with other legislative provisions.
5.3.1. The Code is issued in terms of Section 54(1)(a) of the Employment Equity Act, No 55 of 1998 and is based on the principle that no person may be unfairly discriminated against on the basis of their HIV status. In order to assist employers and employees to apply this principle consistently in the workplace, the Code makes reference to other pieces of legislation.
>> top
5.3.2. Section 6(1) of the Employment Equity Act provides that no person may unfairly discriminate against an employee, or an applicant for employment, in any employment policy or practice, on the basis of his or her HIV status. In any legal proceedings in which it is alleged that any employer has discriminated unfairly, the employer must prove that any discrimination or differentiation was fair.
5.3.3. No employee, or applicant for employment, may be required by their employer to undergo an HIV test in order to ascertain their HIV status. HIV testing by or on behalf of an employer may only take place where the Labour Court has declared such testing to be justifiable in accordance with Section 7(2) of the Employment Equity Act.
5.3.4. In accordance with Section 187(1)(f) of the Labour Relations Act, No. 66 of 1995, an employee with HIV/AIDS may not be dismissed simply because he or she is HIV positive or has AIDS. However where there are valid reasons related to their capacity to continue working and fair procedures have been followed, their services may be terminated in accordance with Section 188(1)(a)(i).
5.3.5. In terms of Section 8(1) of the Occupational Health and Safety Act, No. 85 of 1993; an employer is obliged to provide, as far as is reasonably practicable, a safe workplace. This may include ensuring that the risk of occupational exposure to HIV is minimised.
5.3.6. Section 2(1) and Section 5(1) of the Mine Health and Safety Act, No. 29 of 1996 provides that an employer is required to create, as far as is reasonably practicable, a safe workplace. This may include ensuring that the risk of occupational exposure to HIV is minimised.
5.3.7. An employee who is infected with HIV as a result of an occupational exposure to infected blood or bodily fluids, may apply for benefits in terms of Section 22(1) of the Compensation for Occupational Injuries and Diseases Act, No. 130 of 1993.
5.3.8. In accordance with the Basic Conditions of Employment Act, No. 75 of 1997, every employer is obliged to ensure that all employees receive certain basic standards of employment, including a minimum number of days sick leave [Section 22(2)].
5.3.9. In accordance with Section 24(2)(e) of the Medical Schemes Act, No 131 of 1998, a registered medical aid scheme may not unfairly discriminate directly or indirectly against its members on the basis of their "state of health". Further in terms of s 67(1)(9) regulations may be drafted stipulating that all schemes must offer a minimum level of benefits to their members.
5.3.10. In accordance with both the common law and Section 14 of the Constitution of South Africa Act, No. 108 of 1996, all persons with HIV or AIDS have a right to privacy, including privacy concerning their HIV or AIDS status. Accordingly there is no general legal duty on an employee to disclose his or her HIV status to their employer or to other employees.
>> top
6. Promoting a non-discriminatory work environment
6.1. No person with HIV or AIDS shall be unfairly discriminated against within the employment relationship or within any employment policies or practices, including with regard to:
i. recruitment procedures, advertising and selection criteria;
ii. appointments, and the appointment process, including job placement;
iii. job classification or grading;
iv. remuneration, employment benefits and terms and conditions of employment;
v. employee assistance programmes;
vi. job assignments;
vii. the workplace and facilities;
viii. occupational health and safety;
ix. training and development;
x. performance evaluation systems;
xi. promotion, transfer and demotion;
xii. disciplinary measures short of dismissal; and
xiii. termination of services.
>> top
6.2. To promote a non-discriminatory work environment based on the principle of equality, employers and trade unions should adopt appropriate measures to ensure that employees with HIV and AIDS are not unfairly discriminated against and are protected from victimisation through positive measures such as:
(i) preventing unfair discrimination and stigmatisation of people living with HIV or AIDS through the development of HIV/AIDS policies and programmes for the workplace;
(ii) awareness, education and training on the rights of all persons with regard to HIV and AIDS;
(iii) mechanisms to promote acceptance and openness around HIV/AIDS in the workplace;
(iv) providing support for all employees infected or affected by HIV and AIDS; and
(v) grievance procedures and disciplinary measures to deal with HIV-related complaints in the workplace.
7. HIV testing, confidentialify and disclosure
7.1. HIV Testing
7.1.1.No employer may require an employee, or an applicant for employment, to undertake an HIV test in order to ascertain that employee’s HIV status. As provided for in the Employment Equity Act, employers may approach the Labour Court to obtain authorisation for testing.
7.1.2. Whether s 7(2) of the Employment Equity Act prevents an employer-provided health service supplying a test to an employee who requests a test, depends on whether the Labour Courts would accept that an employee can knowingly agree to waive the protection in the section. This issue has not yet been decided by the courts.
7.1.3. In implementing the sections below, it is recommended that parties take note of the position set out in item 7.1.2.
7.1.4. Authorised testing
Employers must approach the Labour Court for authorisation in, amongst others, the following circumstances:
(i) during an application for employment;
(ii) as a condition of employment;
(iii) during procedures related to termination of employment;
(iv) as an eligibility requirement for training or staff development programmes; and
(v) as an access requirement to obtain employee benefits.
7.1.5. Permissable testing
(a) An employer may provide testing to an employee who has requested a test in the following circumstances:
(i) As part of a health care service provided in the workplace;
(ii) In the event of an occupational accident carrying a risk of exposure to blood or other body fluids;
(iii) For the purposes of applying for compensation following an occupational accident involving a risk of exposure to blood or other body fluids.
>> top
(b) Furthermore, such testing may only take place within the following defined conditions:
(i) At the initiative of an employee;
(ii) Within a health care worker and employee-patient relationship;
(iii) With informed consent and pre- and post-test counselling, as defined by the Department of Health’s National Policy on Testing for HIV; and
(iv) With strict procedures relating to confidentiality of an employee’s HIV status as described in clause 7.2 of this Code.
7.1.6 All testing, including both authorised and permissible testing, should be conducted in accordance with the Department of Health’s National Policy on Testing for HIV issued in terms of the National Policy for Health Act, No. 116 of 1990.
7.1.7. Informed consent means that the individual has been provided with information, understands it and based on this has agreed to undertake the HIV test. It implies that the individual understands what the test is, why it is necessary, the benefits, risks, alternatives and any possible social implications of the outcome.
7.1.8. Anonymous, unlinked surveillance or epidemiological HIV testing in the workplace may occur provided it is undertaken in accordance with ethical and legal principles regarding such research. Where such research is done, the information obtained may not be used to unfairly discriminate against individuals or groups of persons. Testing will not be considered anonymous if there is a reasonable possibility that a person’s HIV status can be deduced from the results.
7.2. Confidentiality and Disclosure
7.2.1. All persons with HIV or AIDS have the legal right to privacy. An employee is therefore not legally required to disclose his or her HIV status to their employer or to other employees.
7.2.2. Where an employee chooses to voluntarily disclose his or her HIV status to the employer or to other employees, this information may not be disclosed to others without the employee’s express written consent. Where written consent is not possible, steps must be taken to confirm that the employee wishes to disclose his or her status.
7.2.3. Mechanisms should be created to encourage openness, acceptance and support for those employers and employees who voluntarily disclose their HIV status within the workplace, including:
(i) encouraging persons openly living with HIV or AIDS to conduct or participate in education, prevention and awareness programmes;
(ii) encouraging the development of support groups for employees living with HIV or AIDS; and
(iii) ensuring that persons who are open about their HIV or AIDS status are not unfairly discriminated against or stigmatised.
>> top
8. Promoting a safe workplace
1. An employer is obliged to provide and maintain, as far as is reasonably practicable, a workplace that is safe and without risk to the health of its employees.
2. The risk of HIV transmission in the workplace is minimal. However occupational accidents involving bodily fluids may occur, particularly in the health care professions. Every workplace should ensure that it complies with the provisions of the Occupational Health and Safety Act, including the Regulations on Hazardous Biological Agents, and the Mine Health and Safety Act, and that its policy deals with, amongst others :
i. the risk, if any, of occupational transmission within the particular workplace;
ii. appropriate training, awareness, education on the use of universal infection control measures so as to identify, deal with and reduce the risk of HIV transmission in the workplace;
iii. providing appropriate equipment and materials to protect employees from the risk of exposure to HIV;
iv. the steps that must be taken following an occupational accident including the appropriate management of occupational exposure to HIV and other blood borne pathogens, including access to post-exposure prophylaxis;
v. the procedures to be followed in applying for compensation for occupational infection;
vi. the reporting of all occupational accidents; and
vii. adequate monitoring of occupational exposure to HIV to ensure that the requirements of possible compensation claims are being met.
>> top
9. Compensation for occupationally acquired HIV
9.1. An employee may be compensated if he or she becomes infected with HIV as a result of an occupational accident, in terms of the Compensation for Occupational Injuries and Diseases Act.
9.2. Employers should take reasonable steps to assist employees with the application for benefits including:
(i) providing information to affected employees on the procedures that will need to be followed in order to qualify for a compensation claim; and
(ii) assisting with the collection of information which will assist with proving that the employees were occupationally exposed to HIV infected blood.
9.3. Occupational exposure should be dealt with in terms of the Compensation for Occupational Injuries and Diseases Act. Employers should ensure that they comply with the provisions of this Act and any procedure or guideline issued in terms thereof.
>> top
10. Employee benefits
10.1. Employees with HIV or AIDS may not be unfairly discriminated against in the allocation of employee benefits.
10.2. Employees who become ill with AIDS should be treated like any other employee with a comparable life threatening illness with regard to access to employee benefits.
10.3. Information from benefit schemes on the medical status of an employee should be kept confidential and should not be used to unfairly discriminate.
10.4. Where an employer offers a medical scheme as part of the employee benefit package it must ensure that this scheme does not unfairly discriminate, directly or indirectly, against any person on the basis of his or her HIV status.
>> top
11. Dismissal
11.1. Employees with HIV/AIDS may not be dismissed solely on the basis of their HIV/AIDS status.
11.2. Where an employee has become too ill to perform their current work, an employer is obliged to follow accepted guidelines regarding dismissal for incapacity before terminating an employee’s services, as set out in the Code of Good Practice on Dismissal contained in Schedule 8 of the Labour Relations Act.
11.3. The employer should ensure that as far as possible, the employee’s right to confidentiality regarding his or her HIV status is maintained during any incapacity proceedings. An employee cannot be compelled to undergo an HIV test or to disclose his or her HIV status as part of such proceedings unless the Labour Court authorised such a test.
12. Grievance procedures
12.1. Employers should ensure that the rights of employees with regard to HIV/AIDS, and the remedies available to them in the event of a breach of such rights, become integrated into existing grievance procedures.
12.2. Employers should create an awareness and understanding of the grievance procedures and how employees can utilise them.
12.3. Employers should develop special measures to ensure the confidentiality of the complainant during such proceedings, including ensuring that such proceedings are held in private.
>> top
13. Management of HIV in the workplace
13.1. The effective management of HIV/AIDS in the workplace requires an integrated strategy that includes, amongst others, the following elements:
13.1.1. An understanding and assessment of the impact of HIV/AIDS on the workplace; and
13.1.2. Long and short term measures to deal with and reduce this impact, including:
i. An HIV/AIDS Policy for the workplace
ii. HIV/AIDS Programmes, which would incorporate:
iii. Ongoing sustained prevention of the spread of HIV among employees and their communities;
iv. Management of employees with HIV so that they are able to work productively for as long as possible; and
v. Strategies to deal with the direct and indirect costs of HIV/AIDS in the workplace.
14. Assessing the impact of HIV/Aids on the workplace
14.1. Employers and trade unions should develop appropriate strategies to understand, assess and respond to the impact of HIV/AIDS in their particular workplace and sector. This should be done in cooperation with sectoral, local, provincial and national initiatives by government, civil society and non-governmental organisations.
14.2. Broadly, impact assessments should include:
(i) Risk profiles; and
(ii) Assessment of the direct and indirect costs of HIV/AIDS;
14.3. Risk profiles may include an assessment of the following:
i. The vulnerability of individual employees or categories of employees to HIV infection;
ii. The nature and operations of the organisation and how these may increase susceptibility to HIV infection (eg migrancy or hostel dwellings);
iii. A profile of the communities from which the organisation draws its employees;
iv. A profile of the communities surrounding the organisation’s place of operation; and
v. An assessment of the impact of HIV/AIDS upon their target markets and client base.
14.4. The assessments should also consider the impact that the HIV/AIDS epidemic may have on:
(i) Direct costs such as costs to employee benefits, medical costs and increased costs related to staff turnover such as training and recruitment costs and the costs of implementing an HIV/AIDS programme;
(ii) Indirect costs such as costs incurred as a result of increased absenteeism, employee morbidity, loss of productivity, a general decline in workplace morale and possible workplace disruption;
14.5. The cost effectiveness of any HIV/AIDS interventions should also be measured as part of an impact assessment
>> top
15. Measure to deal with HIV/Aids within the workplace
15.1. A Workplace HIV/AIDS Policy
15.1.1. Every workplace should develop an HIV/AIDS policy, in order to ensure that employees affected by HIV/AIDS are not unfairly discriminated against in employment policies and practices. This policy should cover:
(i) the organisation’s position on HIV/AIDS;
(ii) an outline of the HIV/AIDS programme;
(iii) details on employment policies (e.g. position regarding HIV testing, employee benefits, performance management and procedures to be followed to determine medical incapacity and dismissal);
(iv) express standards of behaviour expected of employers and employees and appropriate measures to deal with deviations from these standards;
(v) grievance procedures in line with item 12 of this Code;
(vi) set out the means of communication within the organisation on HIV/AIDS issues;
(vii) details of employee assistance available to persons affected by HIV/AIDS;
(viii) details of implementation and coordination responsibilities; and
(ix) monitoring and evaluation mechanisms.
15.1.2. All policies should be developed in consultation with key stakeholders within the workplace including trade unions, employee representatives, occupational health staff and the human resources department.
15.1.3. The policy should reflect the nature and needs of the particular workplace.
15.1.4. Policy development and implementation is a dynamic process, so the workplace policy should be:
(i) communicated to all concerned;
(ii) routinely reviewed in light of epidemiological and scientific information; and
(iii) monitored for its successful implementation and evaluated for its effectiveness.
15.2. Developing Workplace HIV/AIDS Programmes
15.2.1. It is recommended that every workplace works towards developing and implementing a workplace HIV/AIDS programme aimed at preventing new infections, providing care and support for employees who are infected or affected, and managing the impact of the epidemic in the organisation.
15.2.2. The nature and extent of a workplace programme should be guided by the needs and capacity of each individual workplace. However, it is recommended that every workplace programme should attempt to address the following in cooperation with the sectoral, local, provincial and national initiatives:
(i) hold regular HIV/AIDS awareness programmes;
(ii) encourage voluntary testing;
(iii) conduct education and training on HIV/AIDS;
(iv) promote condom distribution and use;
(v) encourage health seeking behaviour for STD’s;
(vi) enforce the use of universal infection control measures;
(vii) create an environment that is conducive to openness, disclosure and acceptance amongst all staff;
(viii) endeavour to establish a wellness programme for employees affected by HIV/AIDS;
(ix) provide access to counselling and other forms of social support for people affected by HIV/AIDS;
(x) maximise the performance of affected employees through reasonable accommodation, such as investigations into alternative sick leave allocation;
(xi) develop strategies to address direct and indirect costs associated with HIV/AIDS in the workplace, as outlined under item 14.4
(xii) regularly monitor, evaluate and review the programme.
15.2.3. Employers should take all reasonable steps to assist employees with referrals to appropriate health, welfare and psycho-social facilities within the community, if such services are not provided at the workplace
No comments:
Post a Comment