Definition of the Prevention Area
Although the effects of HIV in the workplace differ by the size of the company/organization and the type of labor employed, for many companies and government employers HIV prevention efforts are essential to protecting an organization's productivity, profitability, economic growth, and efficiency. HIV in the workplace can lead to disruptions in production or internal processes as workers become ill, require time off for medical or care-giving purposes, or retire for medical reasons. Health care and insurance costs are also likely to rise if employees contract HIV. Existing evidence suggests that small and medium-sized companies experience a small average benefit as a result of their workplace programs.
Epidemiological Justification for the Prevention Area
From a public health perspective, the workplace provides a ready audience of both males and females for prevention messages and increasingly for counseling, testing, and referrals for further services. Strengthening prevention efforts in the workplace targets groups who may be mobile as a result of work; these populations have been found to be at higher risk for HIV infection because they are away from their communities and families and have incomes that can be used to establish sexual relationships. Implementing workplace HIV interventions can help to influence norms, combat stigma, and foster a broader sense of community investment in public health. By prioritizing the health of their workers, large employers in particular can set a tone of community responsibility.
Core Programmatic Components
Workplace interventions vary according to the size of the workforce, and employment terms, but several core components can be identified.
- Prevention interventions are often incorporated into broader service delivery efforts that include voluntary testing and counseling, treatment and support.
- Programs often extend beyond the employee to include family members, and beyond the workplace to reach out to the local community.
- Workplace HIV interventions can include elements to influence norms, combat stigma, and foster a broader sense of community investment in public health.
- Using peers rather than outside experts to lead interventions is a common approach.
- As well as taking the scale of the employer and the size of the workforce into account, workplace interventions may have to cater to the needs of mobile populations.
Current Status of Implementation Experience
Many large and multinational companies have adopted workplace policies related to HIV and AIDS and have implemented complementary prevention awareness programs. Likewise, numerous government ministries, departments, and universities have adopted HIV and AIDS workplace policies to guide managers and to outline rights and responsibilities of employees. National, regional, and global business coalitions have been formed by the private sector and in collaboration with governments. They provide member companies with information on HIV and AIDS and advocate for expanded responses. Opportunities to engage small and medium-sized enterprises have been underexplored, due in part to the lack of organizations such as chambers of commerce that would bring the scale required.
The impact of the epidemic on private and public sector workforces has been documented in countries with high-level epidemics. Public sector institutions, such as schools and health facilities, have experienced significant labor losses, adding to the burden of service delivery in those areas. In countries or areas with low-level or concentrated epidemics the impact is far less intense. In those areas, few companies report significant losses in skilled labor or increased health care or insurance costs.
It is often expected that private sector firms will supplement public sector funding for HIV and AIDS programs, and this has occurred among some larger firms. However, more often, especially with the increase in contract labor arrangements, workers found to be or suspected to be HIV-infected are dismissed.
Unions and workers' representatives have helped organize workplace HIV and AIDS prevention programs and have added their influence to programs initiated by company managers. Although there are notable exceptions, unions have not made HIV and AIDS benefits a part of their contract negotiations.