HIV/AIDS In The Workplace From The Perspective Of An Occupational Medicine Practitioner - Lecture

OBJECTIVES OF THIS LECTURE:

This lecture will present you with the following aspects of the problem of HIV-AIDS in the workplace:

1. Epidemiology.
2. Legal considerations.
3. Organisational response.
4. Primary prevention: prevent infection.
5. Secondary prevention: early diagnosis and appropriate treatment.
6. Tertiary prevention: accomodation, disability management.

EPIDEMIOLOGY:

This may be approached in two ways:

• By direct measurement, as is the case in the Gold Mining industry and the Public Health Services:
• Indirectly: Regional prevalence is adjusted for differences of workforce from surveillance populations, or from modelled prevalence

LEGAL CONSIDERATIONS:

1. Employment Equity Act, 1998:

• Unfair discrimination on HIV status prohibited.
• Employer initiated HIV testing restricted.

2. Promotion Of Equality And Prevention Of Unfair Discrimination Act, 2000:

• Prohibits unfair discrimination.
• Applies to workplaces not covered by EEA.

3. Labour Relations Act, 1996:

• Procedures for dismissal due to incapacity.
• No exclusion from benefits.

4. COIDA, 1993:

• Exposure vs. infection.

5. OHSA, 1993; MHSA, 1996:

• Obligation to provide safe, healthy workplace, (for example, by providing health care workers, emergency workers).

6. Medical Schemes Act, 1998:

• Non discrimination on benefits.
• Minimum benefits.

7. Basic Conditions of Employment Act, 1997

• Caters, inter alia, for sick leave

8. Constitution (1996) and Common Law:

• Addresses issues with respect to the Right to Privacy

ORGANISATIONAL RESPONSE:

The management's response can be manifested in four ways:

1. Conducting impact assessment.
2. Securing worker participation.
3. Writing a policy.
4. Implementing a prevention programme.

Impact assessment:

• Absenteeism, decreased productivity.
• Turnover, training costs.
• Direct health care (for example, the mining health services).
• Medical scheme contributions.
• Disability/medical retirement/life assurance.
• Management/industrial relations: effort and cost.
• Market perceptions/investment.

Securing employee participation:

Writing a policy (see separate note):

• Paper exercise vs. implementation?
• What are the elements?

Implement a prevention (and treatment) programme:

• Primary prevention.
• Secondary prevention.
• Tertiary prevention.

PRIMARY PREVENTION:

1. Information , awareness, group education:

   • Understand what works.
   • Need gender sensitivity.



2. Peer education.

3. Condom provision.

4. Universal precautions in first aid.

5. Supporting voluntary counselling and testing.

6. Treatment of sexually transmitted illness.

7. Supporting community prevention programmes.

SECONDARY PREVENTION:

1. Confidentiality.

2. Counselling and support.

3. Referral to, liaison with other health services.

4. Control of occupational hazards (for example, TB).

5. Treatment:
             Medical scheme benefits.
             On site?

   • Periodic checks for infections (thrush, RTI, other fungal, herpes, GI/diarrhoea, TB, etc.).
   • Supervised TB treatment.
   • Antiviral herpes treatment.
   • Prophylaxis: cotrimoxazole, INH.
   • Nutritional support - ?.
   • Highly active antiretroviral therapy (HAART).

TERTIARY PREVENTION:

1. Confidentiality.

2. Accomodation.

3. Disability process.