A Best Practice Model for an HIVAIDS Policy

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					A best practice model for an HIV/AIDS policy- DRAFT

CAPACITY BUILDING, LEADERSHIP AND ACTION: Mitigating Greenhouse Gas Emissions in Southern African Industry

A Best Practice Model for an HIV/AIDS Policy
August 2004
Prepared by:

Peter Busse Independent HIV/AIDS Consultant Robyn Hamilton Independent Editor and Researcher

Johannesburg, South Africa

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A best practice model for an HIV/AIDS policy- DRAFT

Table of Contents
Key definitions Introduction 1. Framework for an HIV/AIDS policy 1.1 Vision statement 1.2 Guiding values 1.3 Principles 2. Components of an effective HIV/AIDS policy 2.1 General awareness policies 2.1.1 Increasing awareness and educating employees 2.1.2 Educating employees about transmission 2.1.3 Training in emergency procedures 2.1.4 Providing access to voluntary counselling and testing (VCT) 2.1.5 Guaranteeing confidentiality of status 2.1.6 Disseminating the organisation’s policy 2.2 Employment policies 2.2.1 Equality of opportunity and recruitment 2.2.2 Creating an HIV/AIDS-friendly work environment 2.2.3 Challenging stigma 2.2.4 Supporting HIV-positive employees 2.2.5 Providing compassionate and family responsibility leave 2.3 Health issues 2.3.1 Encouraging reporting of infectious diseases 2.3.2 Distributing free condoms and femidoms 2.3.3 Providing medical treatment 2.3.4 Ensuring access to ART 2.3.5 Providing post-exposure prophylaxis (PEP) 2.3.6 Preventing mother-to-child transmission (MTCT) 2.4 Social responsibility 2.5 Mainstreaming HIV/AIDS in organisational programmes 2.5.1 Assessing the impact of the pandemic 2.5.2 Mitigating the impact 2.5.3 Amending programmes 2.6 Reviewing and assessing the HIV/AIDS policy Appendix: An implementation plan for the HIV/AIDS policy

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Key definitions
Organisation The term ‘organisation’ refers to any non-governmental organisation (NGO), enterprise or body that seeks to implement an HIV/AIDS workplace policy.

Partner In this document, the term ‘partner’ is defined as: 1. the person to whom an employee is legally married, or 2. the person with whom the employee shares a long-term relationship, which resembles marriage. This definition includes same-sex partners. The long-term relationship is defined as a relationship of at least one year’s duration.

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Introduction
In many parts of the world HIV/AIDS has become one of the biggest challenges to effective development. The HIV/AIDS pandemic not only causes human suffering, but also jeopardises economic growth and social stability, especially in developing countries. Responses to the pandemic will vary from country to country, but the main priorities have been identified as promoting the prevention of transmission, while reducing the impact of HIV/AIDS as far as possible. Development and change are core features of Southern African societies and HIV/AIDS are major factors to be taken into account. Regardless of their areas of focus, it is crucial that all organisations, including enterprises, government structures and NGOs develop effective HIV/AIDS policies, for three important reasons: • • • to provide effective support to employees (and their partners) who are living with HIV/AIDS to provide a stigma-free work environment for employees, and to provide a model to other organisations and to the community of effective HIV/AIDS workplace policies.

This document provides an outline of a generic HIV/AIDS workplace policy that can be readily adapted to meet the specific needs of any organisation. The Appendix then provides a description of the full process of developing and implementing an HIV/AIDS policy for an organisation.

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Framework for the organisational HIV/AIDS policy 1.1 Vision statement
The aims of the HIV/AIDS policy for the organisation are: • • • to minimise the prevalence of HIV/AIDS among employees of the organisation to sustain the health and improve the welfare of employees living with HIV/AIDS to ensure that ignorance and stigma regarding HIV/AIDS in the workplace is replaced by understanding, knowledge and informed compassion.

1.2 Guiding values
The principle guiding values in establishing an HIV/AIDS policy are: • • • • to respect the human rights of employees who are infected with, or affected by, HIV/AIDS to respect the right of employees to non-disclosure of their HIV status to foster an ethos of living positively with HIV/AIDS to ‘mainstream’ HIV/AIDS in the organisation’s operations.

1.3 Principles
The organisation: • • • acknowledges that HIV/AIDS is a societal problem that requires the proactive intervention of all organisations perceives HIV/AIDS to be an environmental factor that is of equal significance to all other bio-physical and environmental factors commits itself to helping contain and manage the HIV/AIDS pandemic.

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2. Components of an effective HIV/AIDS policy 2.1 General awareness policies 2.1.1 Increasing awareness and educating employees
The organisation shall strive to develop an awareness amongst employees of the HIV/AIDS pandemic and its effects on the country or countries in which the organisation operates. The organisation may make use of media such as posters and pamphlets, and making information on HIV/AIDS available to employees on an intranet site. The organisation shall also educate employees about HIV/AIDS through training. Training should aim to equip employees with: • • • • • an understanding of the causes of HIV/AIDS an understanding of the consequences of the disease an awareness of how to prevent the spread of HIV understanding of how to live positively with HIV an awareness of latest developments in terms of research and treatment.

Training shall be interactive and shall utilise adult education principles. HIV/AIDS training is not a once-off process, but needs to be provided regularly to all employees, irrespective of position in the organisation, at least every six months.

2.1.2 Educating employees about transmission
The organisation shall provide employees with basic knowledge of the methods of transmission of HIV, as well as dispel unwarranted myths about transmission (such as fears of social contact or sharing of utensils and crockery). Employees shall be informed that in order to avoid HIV transmission, they should avoid unsafe sex, reduce the number of sexual partners, and avoid direct contact with blood. Wherever possible, AIDS educational materials in the home languages of employees shall be made freely available in the workplace to employees at all levels.

2.1.3 Training in emergency procedures
The organisation shall provide medical kits in the workplace for use in emergencies, which shall include sterile needles and latex gloves. These kits shall be checked at least six monthly to ensure that their components are still usable. Selected staff shall be given regular training in emergency procedures so that they know how to treat injury and bleeding in the workplace without the risk of HIV infection.

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2.1.4 Providing access to voluntary counselling and testing (VCT)
The organisation shall provide the opportunity for employees to test for HIV where they wish to do so, preferably through an outside provider of VCT services. Under no circumstances shall employees be forced or coerced into undergoing such testing. Testing shall be provided on a confidential basis, and shall include pre-test and posttest counselling conducted by professionally trained counsellors. Test procedures shall ensure that test results are confidential. Test results shall not be communicated to employees or employers in the organisation unless the tested employee specifically decides to disclose his or her status voluntarily.

2.1.5 Guaranteeing confidentiality of status
The organisation shall ensure that the HIV status of all employees is confidential. Under no circumstances shall an employee’s status be communicated to other employees without the employee’s expressed permission, preferably in writing.

2.1.6 Disseminating the organisation’s policy
The organisation shall distribute to all its employees and other relevant stakeholders copies of its HIV/AIDS policy. It shall also hold one or more meetings to brief all employees on the contents and implications of the HIV/AIDS policy. As part of the induction process, all new employees shall be briefed on the HIV/AIDS policy.

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2.2 Employment policies 2.2.1 Equal opportunity employment and recruitment
The organisation is an equal opportunities employer, which means that it shall not discriminate against HIV-positive people in terms of recruitment and employment. All employees – including those who are HIV positive – shall be treated as full and respected members of staff. HIV status shall not be taken into account when assessing suitability for promotion. There shall be no HIV screening prior to employment. However, applicants for positions may be asked to provide proof of fitness for work.

2.2.2 Creating an HIV/AIDS-friendly work environment
The organisation commits itself to creating a working environment which is HIV/AIDS friendly and where HIV-positive people shall feel accepted. The organisation expects all its employees to support the policy of non-discrimination and acceptance of HIV-positive staff members. Acts of discrimination or harassment of HIV-positive employees shall be considered a disciplinary offence. The organisation shall take appropriate steps to address any alleged incidents of discrimination or stigmatisation through internal organisational hearings.

2.2.3 Challenging stigma
The organisation is aware that the impact of the HIV/AIDS pandemic is exacerbated by stigma in the general community. Stigma can take two forms: internal stigma, where the HIV-positive person feels ashamed of their status and fears discrimination, and external stigma, where the person experiences discrimination, harassment, exclusion or even violence as a result of the actions of others. The organisation is committed to reducing stigma as far as possible in the workplace by: • • • • • encouraging sensitivity to the use of language which is positive and affirming (e.g. speaking of ‘people living with HIV/AIDS’ rather than ‘people suffering from AIDS’ or ‘AIDS victims’) educating employees about the HIV/AIDS pandemic on a regular basis acting quickly and openly against any employee who engages in acts of stigmatisation inviting people living with HIV/AIDS into the workplace to address employees providing support to any HIV-positive employees who wish to disclose their status to other employees as part of a counselling process that would ensure the employee’s readiness to disclose.

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Where practical, stigma reduction may be addressed as part of the diversity management programme of the organisation.

2.2.4 Supporting HIV-positive employees
HIV-positive employees may have special needs in the workplace. The organisation shall make every reasonable effort to accommodate these needs, within the limits of what is practical, including: • • • • • • agreeing to flexible working hours, to enable medical appointments to be met redefining the job description of an HIV-positive employee, in order to reduce physical demands on such an employee, where this is necessary considering reallocation of an HIV-positive employee to another job in the organisation, where the demands of the job are beyond the capacity of the employee sharing a job between an HIV-positive employee and another employee, where this could reduce the burden on the HIV-positive employee providing a rest room for the HIV-positive employee to take breaks, or where the HIV-positive employee is unable to work, considering early retirement on health grounds.

The organisation is committed to keeping the HIV-positive employee in the workplace for as long as is practical, provided that the employee is able to meet to a reasonable extent the demands of his or her position. The rights extended to HIV-positive employees shall not differ from the rights of any other employees who have chronic diseases.

2.2.5 Providing compassionate and family responsibility leave
Given the high rates of HIV infection in the general population, it is often necessary for employees to take leave in order to address family issues arising from HIV/AIDS, e.g. arranging and attending the funerals of family members who have died of AIDS, or taking care of children who have been orphaned by AIDS. The organisation shall endeavour to be accommodating as far as possible regarding employees who wish to take leave to address such family needs. Usually such leave falls under family responsibility and compassionate leave. The family in Southern Africa often denotes the extended family, which can extend beyond the nuclear family. For example, it is common for some employees to take responsibility for nieces and nephews, or for second cousins. South African law does not recognise these categories of relationship as falling within ‘family responsibility’. The organisation shall endeavour as far as possible to see family responsibility more inclusively.

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2.3 Health issues 2.3.1 Encouraging reporting of infectious diseases
Although employees have no obligation to disclose their HIV status to their employers, they do have a responsibility to disclose any infectious disease which they have – such as tuberculosis, typhoid, measles, etc. – to the organisation. The employee has a responsibility to seek treatment for such conditions and to apply for leave from work until the condition has been brought under control. This measure is important for the well being of all employees, and especially for HIV-positive employees, who may be at greater risk of contracting such infections.

2.3.2 Distributing free condoms and femidoms
The organisation shall make available to employees free condoms and femidoms (female condoms), so as to assist employees to protect themselves against the sexual transmission of HIV. Both condoms and femidoms shall be made available in a convenient private location, e.g. in staff toilets.

2.3.3 Providing medical treatment
Through the provision of adequate medical aid cover, the organisation shall help meet the costs of medical treatment for HIV/AIDS and related conditions for employees and their partners. Such treatment shall include the full cost of blood tests, viral load testing, treatment of opportunistic infections, treatment of sexually transmitted infections and all other HIV/AIDS-related conditions.

2.3.4 Ensuring access to anti-retroviral treatment
The organisation shall endeavour to make available anti-retroviral treatment (ART) to those HIV-positive employees who require it. Often such treatment can be made available through medical aid scheme membership. Where it is not possible for the organisation to provide ART to the employee at no cost, it shall facilitate obtaining treatment at reduced cost to the employee. ART, once started, needs to continue for life. The organisation shall endeavour to provide for ongoing treatment if an employee on treatment retires because of her or his age, is made redundant or retires for health reasons. The organisation shall also make available counselling to any employee on ART, given that strict adherence to ART is essential for the efficacy of the treatment and counselling has been shown to improve adherence to treatment. The organisation may at its discretion extend the same ART benefits to HIV-positive partners of employees.

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The governments of both Mozambique and South Africa have committed themselves to the provision of anti-retroviral treatment to those whose CD4 count is below 2000. Employers should assist in assessing staff eligibility criteria for such programmes and employees should be helped to participate in them through appropriate referral mechanisms and networks. Treatment literacy and compliance issues are both critical components of successful ARV treatment programmes. The assistance of local AIDS service organisations in these matters should be sought.

2.3.5 Providing post-exposure prophylaxis
If any employee is exposed to HIV through an accident in the workplace or while carrying out her or his official duties, the organisation shall provide post-exposure prophylaxis (PEP), and voluntary counselling and testing (VCT) to the employee at no cost to the employee. Access The organisation may decide to extend the same options of VCT and PEP to employees’ partners.

2.3.6 Preventing mother-to-child transmission (MTCT)
Mother-to-child transmission of HIV can be prevented easily and effectively at low cost. The organisation shall endeavour to provide treatment for the prevention of MTCT for employees and their partners where this is not already available through public health services. Where prevention of MTCT is available through public health services, the organisation shall facilitate the access of employees and their partners to such services.

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2.4 Social responsibility
The organisation shall recognise that its employees may come from disadvantaged communities which have been severely affected by the HIV/AIDS pandemic. As part of social responsibility, the organisation shall seek as far as possible to work in partnership with other organisations and initiatives in these communities to mitigate the effects of the HIV/AIDS pandemic on the communities. Social responsibility should have financial support and practical components. Appropriate practical activities could include partnering with local community based AIDS organisations, particularly those involved in care and support.

2.5 Mainstreaming HIV/AIDS in organisational programmes 2.5.1 Assessing the impact of the pandemic
The organisation shall endeavour to take into account the impact of the HIV/AIDS pandemic on its operations, both internal and external. It shall conduct an assessment of both the current impact and the potential future impact of the pandemic. Potential areas of assessment can include: • • • • • • staffing of the organisation availability of staff with appropriate skills availability of funding for the organisation impact on the output or services of the organisation impact on the community which the organisation serves impact on the needs of the community in relation to the organisation’s services.

The impact assessment shall then be utilised to plan for how best to mitigate the effects of the HIV/AIDS pandemic.

2.5.2 Mitigating the impact
Once the organisation has made an assessment of the impact of the pandemic, it is possible to plan for mitigation of impact. This shall involve asking questions such as: • • • • How can the organisation mitigate the possible loss of staff or loss of skilled staff due to HIV/AIDS? Does the organisation need to change its role or function in order to respond to changes in the demand for its services? How best can the organisation assist in reducing the effects of the pandemic on the community which it serves? Does the organisation’s work need to change in any way because of the impact of HIV/AIDS? How best can this be achieved?

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2.5.3 Amending programmes
The organisation shall undertake to amend all its programmes – as far as is feasible – in order to better mitigate the effects of the HIV/AIDS pandemic. This may involve: • • • incorporating HIV/AIDS messages into written materials or products distributed by the organisation using relevant opportunities for contact with the community to disseminate messages about HIV/AIDS changing the objectives of the programme to better meet changing community needs because of the pandemic.

2.6 Reviewing and assessing the HIV/AIDS policy
The organisation shall undertake to review and assess its HIV/AIDS policy and the implementation of the policy on an annual basis. The annual review shall include an assessment of the extent to which the policy addresses the needs of the organisation and its employees, and an assessment of whether changing circumstances require changes to the policy to improve its relevance and effectiveness. The process of the annual review shall include all relevant stakeholders.

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APPENDIX: An implementation plan for the HIV/AIDS policy
1. Circulate this document among all stakeholders in your organisation. Ensure that stakeholders have sufficient time to read the document. 2. Arrange a meeting to discuss the contents of the document. At this meeting provide input on the relevance of an HIV/AIDS policy to the organisation. Encourage full discussion of the contents of the document. 3. Obtain agreement from the stakeholders to proceeding further with the development of an HIV/AIDS policy. 4. Conduct an internal audit regarding the extent to which the organisation complies or does not comply with the recommendations of the generic HIV/AIDS policy. Report back to the stakeholder group regarding the findings of the audit. 5. Either request the stakeholder group to adapt the generic HIV/AIDS policy to meet the needs of the organisation OR Request the stakeholders to appoint a representative working group to adapt the generic policy to meet the needs of the organisation. 6. Once the HIV/AIDS policy has been developed, arrange a further stakeholder meeting to discuss the proposed new policy document. If the policy document is acceptable, it should be formally accepted. If not, any further necessary changes should be made to ensure its acceptance. 7. Finally, determine what steps need to be taken to ensure that the organisation complies with the policy. 8. 9. 10. 11. Draw up an action plan for implementation of these steps. Assign a timeline to the action plan. Monitor implementation of the action plan. Re-evaluate annually whether or not the HIV/AIDS policy needs to be adapted further to address changing needs.

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