What is the role of employers in reducing the spread of HIV?

For many years people with HIV, and those presumed to be infected, have been subjected to discrimination, ostracisation and driven out of their place of employment on public health grounds or anxieties and demands of co-workers.

The law of probability suggests that HIV will enter the workplace soon, if it hasn’t already.

This begs the question: over and above the material benefits that employers bring, what is the role of employers in helping arrest the spread of the virus and disease, and in offering psychological support to employees?

For background purposes, a few years ago, the World Economic Forum’s Global Health Initiative survey revealed that businesses’ response to the epidemic has so far been limited.

Of nearly 8 000 businesses surveyed in 103 countries, fewer than six per cent had formally-approved written HIV policies, but over a third, nevertheless, believed their current policies and programmes were sufficient and effective.

The report indicated that while many firms are concerned about current or future impacts of Aids on their businesses and their communities, few have implemented measures to counter the threat.

The truth is, a lot has changed since the HIV epidemic was discovered 36 years ago.

So what is the role of employers in helping arrest the spread of the virus and disease?

Progressive companies with a vision for the future and, more importantly, concern for their employees, pride themselves on caring for their employees.

Aids programmes cost very little.

They certainly develop staff morale.

Strategically planned, they can even develop a good corporate image in the eyes of the public and the wider customers.

Companies can show their concern with HIV policies and programmes that consider all employees to be significant, respecting their rights, and showing compassion and understanding for victims of the world’s most misunderstood disease.

What companies need is a rational response strategy on HIV/Aids based on workplace guidelines and policies.

Every company needs to reframe HIV and Aids as a business issue.

Human resources, with its unique blend of strategic expertise and information about the human impact of policies, is the best partner to bring the new model into the conversation.

So what should be in the policy and programmes?

An effective Aids policy starts with a general statement of the company’s position on the disease by making a strong commitment to employee safety and understanding, and such a policy needs to back up that commitment.

The policy should include a guarantee of complete medical confidentiality.

That is even more important in the case of Aids, because of the irrational fears that surround the disease.

Employers must respect the privacy of employees and recognise the fear-inducing nature of the disease. There are also very real legal considerations.

If confidentiality is not observed, charges of unfair labour practices may result.

In addition, an employee-education programme is essential to any corporate HIV policy.

A programme for Aids education should address ways that the virus can be transmitted as well as signs and symptoms of HIV.

For counselling and referral needs, it is important that employees have access to an employee assistance programme.

That may include counselling an employee who has HIV calming and providing further education for co-workers of Aids patients, teaching stress management, or referring employees to outside counselling sources.

Combined with a thorough Aids-education programme, such assistance helps decrease the fear, rumours, and dissension that can arise when an employee is suspected of having Aids.

That is why 21 years ago Aid for Aids (AfA) became the first organisation to roll-out an HIV disease management programme to medical schemes in South Africa.

Today AfA remains the leading HIV manager as a result of close collaboration between funders, leading clinical experts, doctors in the field, pathology laboratories, pharmacies and patients themselves.

Since inception, AfA has touched the lives of more than 300 000 people living with HIV and 90% of all people on the AfA programme have an undetectable viral load.

What is really exciting about this is that where the virus is undetectable, not only does this mean less damage to the immune system and the reduced risk of infections (e.g. pneumonia) but it also means the chance of transmitting the virus to someone else is dramatically decreased.

A word of warning, however, safe sex practices should still be maintained!

Perhaps one of the things that AfA is most proud about is the fact that it has members who registered in 1998 and 20 years later are still doing well.

In fact, in 2018, 96% of people registered with AfA are on antiretroviral therapy with the viral load suppression rate at 90%.

These days, the concept of managed care is one that is familiar and widely accepted.

It is built on the premise that by providing a group of activities ranging from benefit and medicine management to behaviour change interventions, the cost of care is reduced while the quality is increased.

Despite tremendous advances in the medical treatment of HIV, stigma remains a significant impediment and has needlessly hindered progress.

While stigma has reduced over the years, too many people still do not know their HIV status, are not proactive about seeking treatment, and enrol on HIV management programmes too late.

Implementing a workplace HIV Programme must be based on a clearly defined value proposition for a company.

For employees registered on the programme this is evidenced through a suppressed viral load count leading to a decrease in the incidence of opportunistic infections and a significant improvement in overall health.

It is clear therefore that healthcare costs can be effectively controlled by managing the disease.

From the perspective of a business, it is important to not only consider the healthcare cost “savings” but also the impact on employees’ productivity which is affected by their state of health.

Healthy employees are more productive than unhealthy ones.

Poor health leads to absenteeism and presenteeism, that is being present at work but unproductive.

Therefore, against the evidence of discrimination there is also the need to recognise that some employing organisations have been in the forefront of countering prejudice and providing practical assistance to people affected by the virus, both through constructive policies, programmes and procedures and support for health education aimed at preventing further infection.

. Ahmed Banderker is CEO Afrocentric Group, South Africa’s largest health administration and medical risk management solutions provider, which owns health companies such Medscheme and Aid for Aids which received the highest PMR Award for disease management

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