This page presents an introduction to and analysis of the dilemma. It does so through the integration of real-world scenarios and case studies, examination of emerging economy contexts and exploration of the specific business risks posed by the dilemma. It also suggests a range of actions that responsible companies can take in order to manage and mitigate those risks.
"When operating in countries with a high prevalence of HIV/AIDS and poor health care systems, how does business implement an effective and responsible disease management programme that respects the right to privacy and ensures non-discrimination against employees?"
Many of the countries with a high prevalence of HIV/AIDS are also characterised by relatively weak socio-economic conditions, as well as poor public services. Within such contexts, and faced with the alternative of losing valuable employees and working time to the disease, multi-national companies will often choose to take their own steps to protect and treat their employees through their own in-house HIV/AIDS management programmes.
How are such programmes best governed so that the privacy of employees is respected in the context of duty of care in the work place and so discrimination is prevented?
A key to the success of such programmes is confidential HIV/AIDS testing supported by counselling. This lets those living with HIV/AIDS know their status, giving them the opportunity to change behaviours and to seek counselling and treatment from their employer.
It is in the interest of companies to identify all such persons in order to enhance the effectiveness of their HIV/AIDS management programmes and to optimise the protection of their workforce. Nonetheless, this must be balanced against some key human rights considerations, which also have serious implications for the effectiveness of any HIV/AIDS management programme:
As a result, a sensitive and nuanced approach is advised when pursuing company HIV/AIDS management programmes. This is not only to protect the human rights of employees, but also in order to ensure long term success in helping curb the spread and impact of HIV/AIDS.
An anonymous case study cited by the South African Business Coalition on HIV/AIDS (SABCOHA) found that at one company, not one of 330 employees participated in an anonymous HIV/AIDS surveillance testing programme. Upon investigation, the company found employees did not understand why the results would be of benefit to them. They were also suspicious about managers' motives for the testing - including rumours that it could be in order to replace African workers by those from other ethnic groups.
All employees were subsequently offered an education programme framed within the health and safety context. Prevalence testing was then re-launched, with more than 95% of all employees providing saliva samples and survey responses.1
A number of South Africa-based companies including South African Breweries, BMW South Africa and Standard Bank include strict confidentiality measures in their HIV/AIDS policies. These include measures to allow the disclosure of HIV/AIDS-related information with the written and informed consent of employees only, strong disciplinary measures for breaches of confidentiality by medical staff and the use of third party service providers to ensure testing is carried out 'at arm's length'.
A December 2008 report from the World Gold Council, Safeguarding workplace and community health, cites a peer education programme initiated in Ghana in August 2004 by Gold Fields to de-stigmatise HIV/AIDS - including campaigns in which people living with the disease share their experiences. Senior managers supported the programme by openly undergoing voluntary counselling and testing (VCT). All employees are given the Gold Fields Ghana HIV policy, which outlines the company's commitment to ensuring those with HIV are cared for and are not discriminated against.
Since the start of the programme the number of employees getting tested rose from 13% in 2005 to 60% in 2007.2
Over the last 25 years, HIV has spread from a few locations to become a truly global challenge. According to UNAIDS, in 2007 (latest figures) there were an estimated 33 million people living with HIV globally. In the same year, the number of new infections stood at an estimated 2.7 million (a moderate reduction from three million in 2001).
Despite the global nature of the epidemic, sub-Saharan Africa stands out as the worst affected region. In 2007, it accounted for an estimated 67% of all people living with HIV and for 72% of global AIDS deaths in 2007. The worst-hit countries are all located in southern Africa, including:
Other emerging market countries (i.e. BRICs and N11 countries) with relatively high prevalence rates (i.e. 0.5% or above) include:
Whilst companies operating in such countries will not face the same magnitude of challenge as in southern Africa, circumstances will mean that a degree of HIV/AIDS management will be required. Sub-national rates of HIV/AIDS vary considerably and prevalence is generally higher around truck routes, border crossings and ports for example.
The global nature of the challenge means it is likely that most multi-national companies will be impacted by HIV/AIDS in some shape or form. Aside from the impact HIV/AIDS is having on local consumer bases and the communities in which companies operate, the most direct impact is upon the workforce - from junior employees to senior managers. According to the International Labour Organization (ILO), as many as 36 million of the 39 million people living with HIV are in some form of productive activity.4
HIV/AIDS is already having significant negative effects on certain industries in high-prevalence countries. These industries are particularly vulnerable where they have highly mobile workers that interact with local populations, are heavily reliant on the accumulated skills of their employees, and where workers live and work away from their families.
Examples include the following:
For example, research in South Africa cited by the South African Business Coalition on HIV & AIDS (SABCOHA) shows that the mining, metals processing, agribusiness and transport sectors are most affected, with more than 23% of employees infected with HIV/AIDS. These sectors show prevalence rates two to three times higher among skilled and unskilled workers than among supervisors and managers.5
In such scenarios, the state may already provide high levels of care, education and support to its citizens. This is not always the case, however, and there can be stigma associated with participating in public programmes. Nonetheless, in many cases companies will choose to provide their own HIV/AIDS management programmes in order to protect their workforce - particularly where public providers lack the capacity or resources to do so effectively themselves or where public providers are located at a distance.
Different elements of a company HIV/AIDS management programme may include:
As noted above, VCT forms a key part of almost all HIV/AIDS management programmes - whether public or private. The identification of those who are living with HIV/AIDS is essential for the effective provision of ART and care. This is particularly the case given that many people will not be aware that they are infected in the first place.
Given the stigma surrounding HIV/AIDS, the willingness of people to submit themselves for VCT will be highly dependent upon their faith in:
As a result, the creation of a non-discriminatory and stigma-free work environment, in which the privacy of the individual is fully protected, is essential for a successful HIV/AIDS programme. In addition, it will help ensure that companies do not violate the right of employees to be free of discrimination whilst implementing effective HIV/AIDS management programmes.
The ILO Code of Practice on HIV/AIDS and the World of Work7 contains 10 key principles to help guide companies approaches to HIV/AIDS in the workplace.
Relevant principles relating to this dilemma include the following:
HIV/AIDS has a significant stigma attached to it. This is often due to entrenched cultural values, human psychology and a lack of education about the realities of HIV/AIDS.
Stigma can be particularly strong in relation to those living with the disease due to its perceived association with:
Stigma interacts with peoples' fear of infection, as well as high mortality rates, to give rise to discrimination - both within society generally, and within the workplace. For example, teams of employees may reject individuals who they know or suspect to be living with HIV/AIDS on the grounds of personal prejudice or (often unfounded) fears about the potential health and safety implications of working closely with one another.
Reflective of such attitudes, a July 2009 survey by the Chinese Centre of Disease Control and Prevention noted that 46% of the general population and 25% of health workers surveyed discriminate against people with HIV/AIDS. Nonetheless, a 2008 report from the ILO, Saving lives, protecting jobs, has identified a significant increase in supportive attitudes within the workplace .
The report, which surveys six countries including Belize, Benin, Cambodia, Ghana, Guyana and Togo found that the proportion of workers who reported supportive behaviour towards colleagues living with HIV rose from 49% to 63% over the course of four years. In Ghana, for example, the proportion of workers who reported having a supportive attitude towards co-workers living with HIV increased from 33% to 63%.
Workplace discrimination can also take place at an institutional level. The infection of an employee with HIV/AIDS has potentially significant financial and organisational implications for their employer (see below). This being the case, companies may in some cases be tempted to avoid employing those with HIV/AIDS, manipulating their exit or denying them benefits or promotions otherwise available to their colleagues.
Typical forms of workplace discrimination include:
Examples of scenarios companies might face when operating in emerging economies include:
China: In February 2009, China's Ministry of Health announced that, for what is thought to be the first time, HIV/AIDS was the leading cause of death in 2008 compared with other infectious diseases.9 The state media reported 7,000 deaths as a result of HIV/AIDS in the first nine months of 2008. China's Ministry of Health says that until three years ago, fewer than 8,000 people altogether had died from HIV/AIDS. By 2008 the number had risen to around 40,000. However, data on HIV/AIDS remains unreliable in China, although official reporting appears to have improved.
Egypt: Homosexuals and persons with HIV/AIDS (around 9,200 adults and children live with HIV/AIDS) face significant social stigma in society and the workplace. In a May 2007 report, Concluding observations of the Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families, the UN Committee on Migrant Workers reports that foreign migrant workers seeking permission to work in Egypt must provide a certificate proving that they do not carry HIV/AIDS. This contravenes the ILO Code of practice on HIV/AIDS and the world of work. Although the law does not explicitly criminalise homosexual acts, police arrest homosexuals and persons with HIV/AIDS on charges of "debauchery."
India: UNAIDS' 2008 Report on the Global AIDS Epidemic reports there are up to 3.2 million people living with HIV in India, although the government places this figure at 2.3 million. The ILO reports that 70% of persons living with HIV face discrimination in India. According to Human Rights Watch (HRW), many doctors refuse to treat HIV-positive children. HRW also claims that some orphanages refuse HIV-positive children and that some children are expelled from school on the grounds that their parents are infected with HIV.
Indonesia: Indonesia has one of Asia's fastest growing HIV rates, with an adult prevalence rate of 0.2% (some 270,000 people), up from 0.1% (93,000 people) in 2001. In January 2008, it was reported that the Asian Development Bank (ADB) claimed that Indonesia's construction boom is driving an "exponential" rise in HIV/AIDS infections as migrant workers are more likely to engage in high-risk sex.
In 2004, the Ministry of Manpower and Transmigration issued a decree on HIV/AIDS prevention and control in the workplace, which requires companies to protect workers with HIV/AIDS from discriminatory action and treatment. Under the decree, employers are prohibited from conducting HIV tests as part of recruitment requirements or as compulsory regular medical check-ups. However, enforcement of these provisions has been weak.
Mexico: UNAIDS' 2008 Report on the Global AIDS Epidemic reports that around 200,000 people live with HIV, a prevalence of 0.3% among 15 to 49 year olds. A 2005 government survey on discrimination found that 44% of those surveyed said they would not share a house with an HIV-positive person. In 2005 the National Human Rights Commission reported that nine of every 10 complaints it received from people diagnosed with HIV were related to discrimination that they experienced in the public health sector.
Nigeria: Persons living with HIV/AIDS, which is considered by society as a disease resulting from 'immoral' behaviour, face widespread discrimination. They often lose their jobs or are denied health care services. UNAIDS estimates that only 13% of persons with advanced HIV receive anti-retroviral treatment in Nigeria.
Physicians for Human Rights reports that a considerable minority of health care professionals engage in "discriminatory and/or unethical behaviour, including denial of care, refusal of admission to a hospital, testing for HIV without consent and disclosing confidential medical information without permission." They note that discrimination undermines efforts to provide effective prevention education, diagnosis, and treatment.
Russia: UNAIDS' 2008 Report on the Global AIDS Epidemic estimates a high adult prevalence rate of 1.1%. Reports suggest that 80% of those infected are between 15 and 30 years old, representing a risk to the current and future workforce, particularly as almost half of newly diagnosed cases are women of a childbearing age.
South Africa: With 5.7 million people living with HIV, South Africa has the largest epidemic in the world. Approximately 500,000 new HIV infections are reported each year, with almost 1,000 people dying of related causes every day. UNAIDS' 2008 Report on the Global AIDS Epidemic reported that 18.1% of the South African population were living with HIV in 2007, the fourth highest prevalence rate in the world, behind Swaziland, Botswana and Lesotho.
South Africa also has the largest antiretroviral treatment programme in the world. Despite a past denial that AIDS is caused by HIV, the South African government, which only began making free AIDS drugs available to sufferers in 2004, has developed a National Strategic Plan (NSP) for tackling HIV/AIDS and sexually transmitted infections, which runs from 2007 to 2011. The NSP emphasises the need for partnership between government, civil society and business to halt the spread of the disease.
Viet Nam: Persons with HIV/AIDS experience societal discrimination. The US Department of State reports in its 2009 Country Report on Human Rights Practices that some persons with HIV/AIDS lose their job or suffer from discrimination in the workplace. However the government, assisted by foreign donors, has attempted to decrease the social stigma and discrimination associated with HIV/AIDS by taking steps to treat and assist infected persons.
Because stigma and discrimination have such a direct impact on the effectiveness of companies' HIV/AIDS management programmes, the risks posed by failing to address these issues are essentially the same as for HIV/AIDS itself. These include:
According to the World Economic Forum Global Health Initiative Global Review of the Business Response to HIV/AIDS 2005-2006, 22% of respondent firms reported experiencing impacts from the virus. In sub-Saharan Africa this figure was 65%, with 21% of firms reporting a serious impact. Respondents were pessimistic about the future, with 46% expecting some impact from HIV/AIDS on their business in the next five years.10
SABCOHA notes that the provision of care and treatment for HIV-positive employees can reduce the financial burden of HIV/AIDS by as much as 40%. It cites findings from DaimlerChrysler, which found savings from preventing a new infection in its South African workforce ranged from US$25 000 to US$280 000, depending on the job level.11
Similarly, IBM South Africa estimates the successful implementation of a treatment programme could avert 42% of US$10.6 million in HIV/AIDS related expenses over 10 years. The company estimates the costs associated with the death of an employee in South Africa from AIDS as being:
Aside from undermining effective HIV/AIDS management programmes, discrimination on the basis of HIV status can entail many of the risks associated with any form of serious discrimination. These include, for example, reputational damage, which has the potential to be particularly compelling given the well-publicised and very serious human challenge posed by HIV/AIDS. This has the potential to affect:
According to the ILO, the ILO Discrimination (Employment and Occupation) Convention, 1958 (No.111) may be used in cases of discrimination related to HIV status.13 As a result, relevant legislation is likely to be in place in many jurisdictions that provide for legal sanctions against companies unfairly discriminating against their employees - whether on the grounds of their actual or perceived HIV status, or otherwise.
For example, in January 2009 a former soldier sued US private security company Triple Canopy after he was ejected from its training programme in November 2005 and told that the company's government contract required that employees have no contagious diseases.14
For a company to address responsibly HIV/AIDS within its workforce, it should first look to comply with relevant national laws. Where national laws are set lower than international standards on HIV/AIDS, privacy, confidentiality and discrimination, then companies should strive to meet these higher standards.
A company would also be well advised to engage in human rights due diligence to a level commensurate with the risks posed by its HIV/AIDS management programmes, as well as its ability to impact positively on reduction of stigma and discrimination in order to discharge its responsibility to respect human rights. This might include conducting impact assessments and audits to gauge the likelihood and nature of human rights abuses in the context of their HIV/AIDS management programmes.
The ILO has developed a document providing comprehensive guidance on managing HIV/AIDS within the workplace. The ILO Code of Practice on HIV/AIDS and the World of Work15 addresses a wide range of issues, including non-discrimination and confidentiality.
Related actions recommended for employers and their organisations relate to:
The ILO has developed Implementing the ILO Code of Practice on HIV/AIDS and the world of work: an education and training manual to accompany the Code and guide its application. This is complemented by a step-by-step online guide to taking action on HIV/AIDS in the workplace.16 This takes users through 10 different steps from basic information on HIV/AIDS to human rights. In addition, SABCOHA has developed a Workplace HIV/AIDS Toolkit, which is particularly targeted at small and medium sized companies of 30-500 employees, including suppliers of larger companies.
Key components include the following:
In addition to this guidance, additional suggestions for responsible businesses include the following:17
Companies should consider committing themselves to:
For example, the IFC has an extensive Good Practice Note on HIV/AIDS in the Workplace, which includes a boilerplate policy. Amongst other things, this states that the company will:
The IFC notes that a balance must be struck, however, with the company's obligation to provide a safe work environment for all employees. It likewise commits the company to be sensitive to co-worker's concerns and to put emphasis on educating employees about HIV/AIDS.18
According to the ILO Code of Practice on HIV/AIDS and the World of Work, employers should: "consult with workers and their representatives to develop and implement an appropriate policy for their workplace, designed to prevent the spread of the infection and protect all workers from discrimination related to HIV/AIDS." In addition, the Code recommends that: "Employers should not engage in nor permit any personnel policy or practice that discriminates against workers infected with or affected by HIV/AIDS."
More specifically, this means employers should:
The ILO's step-by-step online guide notes that such policies are not a substitute for action and should be supported by actual workplace programmes that are ideally gender sensitive, include prevention, care and the protection of rights and are based on consultation and collaboration between the management and workforce representatives including unions. In addition, the guide recommends relevant policies should actually set out the rights of workers who are infected and/or affected by HIV/AIDS.
Total South Africa provides an example of the kinds of measures that a company could consider in the development of their HIV/AIDS policy.
For example, their policy includes provisions to ensure:
One less obvious area in which policy can focus is on employee benefits. For example, a number of companies in South Africa have policies in place relating to non-discrimination with respect to retirement and life coverage. This includes Standard Bank, which states that the group retirement fund will not discriminate on the grounds of HIV status to the extent that all new employees join the fund regardless of their HIV status and enjoy retirement benefits. Benefits include life coverage, which is included under the group retirement fund - although not necessarily where an employee has a pre-existing condition when they join the fund (which may include HIV, if it is disclosed by the employee).21
In a survey published in November 2008, ethical investment company EIRIS noted that of the top 40 largest South African companies listed on the Johannesburg Stock Exchange, 85% have a global HIV/AIDS policy covering confidentiality, non-discrimination and commitment to development programmes for treatment and prevention.22
Although VCT forms an essential part of any HIV/AIDS management programme, companies should put in place certain restrictions in order to ensure testing does not undermine the human rights of employees.
For example, the ILO recommends that:
Volkswagen do Brasil instituted an AIDS Care programme in 1996. In addition to treatment and care, the programme focuses on education and counselling, using a range of media including videos, radio, internal newspapers and the intranet. As part of the company's non-discrimination policy, assistance is given to those living with HIV to help them reintegrate into the workplace. Anti-discrimination measures prohibit mandatory testing, protect HIV-positive employees from dismissal and commit to the protection of confidentiality.24
In December 2009, Brewer SABMiller extended HIV testing to the spouses of farmers in Uganda who provide the company with sorghum for their beer. This is in a context in which the company not only provides VCT, ART and condoms to its employees, but also to its supply chain, including truck drivers, farmers and bar staff. At the point of writing, a total of 4,800 people had been through HIV awareness training, and 29% of these had been tested.25
Education and training can do much to tackle stigma and discrimination, and thus to encourage uptake of VCT.
The ILO Code of Practice on HIV/AIDS and the World of Work recommends that training should, amongst other things:
In addition to formal training, many companies rely on peer education in order to tackle HIV/AIDS, as well as associated issues of stigma and discrimination. This is not only effective from a costs point of view, but many employees are more likely to engage in open dialogue about some of the sensitive issues surrounding HIV/AIDS when talking to peers rather than qualified specialists.
In Ghana, for example, Newmont Mining worked with its health service provider International SOS to implement a programme at its Ahafo gold mine in July 2005 to train employees and community members to act as peer educators. As the programme progressed, it switched to a peer-nomination process as this appeared to increase the willingness of workers to discuss HIV/AIDS related issues. New HIV infections fell from an average of four per month during the construction of the mine between 2005 and 2006 to two per month between January and September 2008. During the latter period, the programme educated 10,100 workers, distributed 30,250 condoms and encouraged 230 people to participate in VCT.26
Also in Ghana, Gold Fields instigated a peer education programme to de-stigmatise HIV/AIDS - including campaigns in which people living with the disease share their experiences. Senior managers supported the programme by openly undergoing VCT. All employees are given the Gold Fields Ghana HIV Policy, which outlines the company's commitment to ensuring those with HIV are cared for and are not discriminated against. Since the start of the programme the number of employees getting tested rose from 13% in 2005 to 60% in 2007.27
An anonymous case study cited by SABCOHA found that not one of 330 employees turned up to an anonymous surveillance testing event prepared by a company's HIV/AIDS committee. Upon investigation, it was found that employees could not understand why the results would be of benefit to them, and were suspicious about managers' motives for the testing - including possible replacement of African workers by those from other ethnic groups. Employees were subsequently subject to an education programme framed within the health and safety context. Prevalence testing was then re-launched, with more than 95% of all employees provided saliva samples and survey responses.28
The ILO recommends that managers, supervisors and personnel officers receive specific training (in addition to general education efforts to reduce stigma).
In particular, this includes training to:
At Old Mutual, training on HIV/AIDS includes specific components on employee rights. In addition, training provided to managers includes a focus on 'managing HIV-positive employees'.30 Where relevant, the training of managers should be supported by clear non-discrimination policies.
For example, under South African financial services company Nedcor's HIV/AIDS policy:
According to the ILO Code of Practice on HIV/AIDS and the World of Work, employers should adhere to the following principle: "HIV/AIDS-related information of workers should be kept strictly confidential and kept only on medical files, whereby access to information complies with the Occupational Health Services Recommendation, 1985 (No. 171), and national laws and practices. Access to such information should be strictly limited to medical personnel and such information may only be disclosed if legally required or with the consent of the person concerned."
Recommendation No.171 says that:
Similar restrictions should be put in place with respect to all related information, including that relating to counselling, care, treatment and receipt of associated benefits - including that held by third parties. UNAIDS' Interim Guidelines on Protecting the Confidentiality and Security of HIV Information offer information on data transfer, guiding principles, and the disposal of information to help maintain patient confidentiality.
Key recommendations aimed at public authorities, but which can also be applied to private health providers include:
South African Breweries has taken a number of measures to maintain a supportive environment within which employees who are HIV positive are able to divulge their HIV status and receive support. These include strict confidentiality of information concerning the medical condition of all employees, and disclosure with the written and informed consent of the employee only.32
BMW South Africa's HIV/AIDS policy notes that employees are not required to disclose their status, and if it is disclosed, it cannot be revealed to others without written consent. Importantly if medical staff with access to confidential medical information breach the company's confidentiality policy, it is grounds for immediate dismissal.33
Standard Bank in South Africa uses an external service provider, Independent Counselling and Advisory Service, to ensure confidentiality and uptake of VCT. Meanwhile, employee benefits, including medically appropriate access to anti-AIDS drugs, are made available separately through the bank's medical aid, Bankmed.34
The ILO recommends that HIV/AIDS should be managed within the workplace no less favourably than any other serious illness or condition. Infected employees should receive the same benefits, workers' compensation and reasonable workplace accommodation as provided to any other employee with a serious illness or condition. Employees living with HIV should be afforded the same job security and opportunities for advancement as other employees.
Companies should implement clear and strong disciplinary procedures for those who breach confidentiality or who discriminate in relation to HIV/AIDS. Given the serious implications of the disease, as well as the heavy psycho-emotional burden it often brings with it, sanctions should be proportionately serious.
According to the ILO Code of Practice on HIV/AIDS and the World of Work, employers should implement grievance procedures that: "specify under what circumstances disciplinary proceedings can be commenced against any employee who discriminates on the grounds of real or perceived HIV status or who violates the workplace policy on HIV/AIDS."35
Where possible, companies should accommodate employees living with HIV/AIDS within the workplace, in order to ensure they are able to continue working and earning a wage whilst at the same time taking a responsible approach both to their health, and the health of their colleagues.
For example, the ILO Code of Practice on HIV/AIDS and the World of Work recommends that employers: "in consultation with the worker(s) and their representatives, should take measures to reasonably accommodate the worker(s) with AIDS-related illnesses. These could include rearrangement of working time, special equipment, opportunities for rest breaks, time off for medical appointments, flexible sick leave, part-time work and return-to-work arrangements."
In addition to accommodating the practical medical needs of HIV-positive employees, companies can also consider approaches to extending the productive work life of HIV-positive employees. These might include, for example a change of role to one that represents a lower health risk both to themselves and their colleagues, (e.g. moving people from less physically demanding tasks or ones that represent higher safety risks, to more administrative or clerical roles).
Work in partnership with health services, expert NGOs and other organisations to address the sophisticated and sensitive challenges that companies may not have the skills to manage.
In its 2008 Report on the Global AIDS Epidemic36 UNAIDS notes, for example, that business coalitions on HIV/AIDS have emerged as an effective platform for the private sector response to the epidemic. The report notes that some companies do not know how to mitigate the risk of HIV/AIDS, despite being fully aware if the impact that HIV/AIDS can have on operations. UNAIDS outlines how business coalitions can fill this gap and act as a voice for the private sector - for example through representation on national HIV/AIDS committees and by interacting with other key stakeholders. They can also support the business response to HIV/AIDS through the design, development and implementation of workplace programmes.
An example cited by UNAIDS is the Ethiopian Business Coalition against HIV/AIDS (EBCA),37 which has implemented a pilot programme with the GTZ Engineering Capacity Building Program, the World Bank Institute and the Rapid Results Institute. In 2008 the programme brought together 180 members of staff from 12 companies who attended workshops aimed at enabling participants to identify HIV/AIDS focus areas, set ambitious targets and develop work plans.
The Asia Pacific Business Coalition on AIDS (APBCA) was launched by former US President Bill Clinton in 2006 in order to lead the region's private sector response to HIV/AIDS. Participants include ANZ, Pfizer, IBM, L'Oreal, Rio Tinto, Westpac, Qantas and BHP Billiton. APBCA is supported by a dedicated website, which includes case studies on company HIV/AIDS programmes. These include efforts by Ok Tedi Mine Limited to boost VCT participation through a "Know Your HIV Status" campaign, including the use of local radio and mobile VCT. In addition all team leaders, supervisors and managers underwent mandatory HIV training in order to pass on knowledge to the broader workforce.38 BHP Billiton's HIV/AIDS management programme in South Africa includes extensive awareness raising, education and training at all operation sites, as well as extensive VCT. In 2006, for example, 60% of its South African workforce of 5,927 employees volunteered for VCT.
Companies should monitor a range of indicators to ensure that all other measures taken to minimise stigma and discrimination are having effect.
According to UNAIDS, indicators of successful programmes to reduce stigma and discrimination in the context of workplace HIV/AIDS programmes include:
Although there is currently no cure for HIV/AIDS, global efforts are focused on prevention and treatment - both of which have a vital role to play in fighting the epidemic. For example, Voluntary Counselling and Testing (VCT) prevents the spread of the disease by allowing people to know their status and adapt their behaviour accordingly. It also allows people to access treatment, care and support before the symptoms of infection manifest themselves, potentially prolonging their lives.
In addition, Anti-Retroviral Treatment (ART) is used to stop or interfere with the reproduction of the virus in the body. If used correctly, ART can slow the spread of HIV within the body almost to a stop. This can, along with appropriate care and support, maintain an infected person's quality of life and productivity for a long period of time.
According to the World Health Organisation the high cost of these drugs meant that by the end of 2007 only 3 million people in low- and middle-income countries were receiving ART.40 In recent years, however, there has been a significant increase in access to ART as a result of lower prices, stronger international political will and improved levels of financing.
Some population groups tend to be more vulnerable to HIV/AIDS - both in terms of risk of infection and the impact of infection. Groups considered vulnerable by UNAIDS include women, children, minorities, indigenous people, people living in poverty, migrant workers, refugees, sex workers, people who use drugs, men who have sex with men, and prisoners.
Women, for example, accounted for almost 60% of all HIV infections in sub-Saharan Africa in 2007. This compares to a global figure of about 50%.41 At a biological level, women and girls are twice as likely than men to acquire HIV from an infected partner during unprotected sex.42 Many women have less access to education and economic opportunities, resulting in greater financial dependence on men. This can limit women's power to refuse sex or to negotiate condom-use. In many societies women and girls also often lack full human rights protection and may face high levels of sexual violence.
In the business context, vulnerable workers tend to include those who are highly mobile, away from their families and who have a high degree of interaction with local communities. These include, for example, transport workers, miners and maritime workers.
People who are HIV positive are at risk of social, cultural and economic exclusion. The socio-economic consequences for women are also often more severe than for men. Women are more likely to assume care responsibilities when male partners, children and parents fall ill as a result of HIV/AIDS. Women and girls who are widowed or orphaned as a result of HIV/AIDS can face discrimination or even abandonment. This can have serious financial consequences for them and their families that are likely to push them into activities that put them at higher risk of HIV infection, or compromise their ability to seek treatment and care.
Associated human rights violations, including discrimination, violence and degrading treatment, particularly against vulnerable groups such as women, children and men who have sex with other men, compound the stigma attached to infection. Violations can lead to further marginalisation and restricted access to preventative resources and treatments.
In 2006, Executive Director of UNAIDS Peter Piot cited a number of drivers behind the HIV/AIDS epidemic, including:
Other human rights that are typically associated with the management of HIV/AIDS in the workplace include:
Right to life (ICCPR, Article 6):43 Restricted access to medicine and healthcare services impact the right to life. Where access is limited, proactive businesses may act to disseminate information about HIV/AIDS and implement disease management programmes for employees and stakeholders.
Right to freedom from cruel, inhuman or degrading treatment (ICCPR Article 7): This right is likely to be violated if people are subject to mandatory HIV/AIDS testing - particularly if associated with the use of force, or if a refusal to be tested results in non-employment or dismissal.
Right to liberty and security of person (ICCPR Article 9): Demographic groups that are particularly vulnerable to HIV infection (including women, children and men who have sex with men) should be free from violence, including sexual violence.
Right to privacy (ICCPR, Article 17): There is a danger that poor management of VCT could result in the leak of high sensitive and personal information about participants. Any disclosure of a person's HIV-status may result in discrimination in hiring and firing patterns, pay and training, as well as stigma in the workplace.
Right to protection of the family and right to marry (ICCPR, Article 23): HIV/AIDS can affect workers' families in two key ways. The first is direct infection through sex and/or other forms of close contact. The second is through the economic, psycho-emotional and practical consequences of a member of the family being infected or dying as a result of infection. This is particularly the case if they are the main bread-winner or care-giver in the family. Women may also be ostracised when widowed as a result of HIV.
Right to equality before the law, non-discrimination (ICCPR, Article 26): Persons with HIV/AIDS are vulnerable to discrimination and stigma, both in society and the workplace. This includes discrimination in access to basic services such as healthcare and education.
Right to work (ISESCR, Article 6): Those infected with HIV/AIDS are at risk of not be hired, fired or discriminated against in career advancement on the basis of their HIV/AIDS status. The right to work is closely linked to the rights of just and favourable working conditions and the right to non-discrimination.
Right to enjoy just, favourable conditions of work (ICESCR, Article 7): In working locations with a high prevalence of HIV, there is a heightened risk of infection within the workplace. This may be through interaction between employees or with local communities, or in a health and safety context (e.g. workplace accidents and injuries). The right to enjoy just, favourable conditions of work is closely linked to the right to non-discrimination.
Right to health (ICESCR, Article 12): When operating in a context where HIV/AIDS prevalence is high, companies may face an expectation to provide access to HIV prevention, education and information as well as health care services, for employees and even the wider community.
Right to education (ISESCR, Article 13): People may find that their access to education and training - including HIV education and information - is compromised as a result of HIV/AIDS. This may be as a result of discrimination, poverty or the need to care and support for infected family members. Within a workplace context, this may result in negative professional development impacts, compromising the equality of opportunities for those with HIV/AIDS or effected by HIV/AIDS.
Right to benefit from scientific progress (ICESCR, Article 15): Many people with HIV/AIDS will find that their ability to access advanced medications, equipment and/or other medical/scientific assistance is severely restricted due to inadequate financial resources and/or logistical challenges. This may have direct consequences for their survival and/or quality of life. This is a particularly severe issue in those low income countries where so many infections take place.
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Maplecroft in partnership with the United Nations Global Compact
