Many workers go to work everyday concerned that they might become infected with HIV or AIDS. Others fear discrimination in the workplace if they become infected. It is important to provide HIV/AIDS information and have workplace policies and control programs in place to allay these misconceptions and fears and to put the question of catching HIV/AIDS in a more realistic perspective.

What is AIDS?

AIDS stands for Acquired Immunodeficiency Syndrome. It is the most serious disease resulting from HIV (Human Immunodeficiency Virus). HIV, also known as the AIDS virus, impairs the body's defense or immune system and leaves it vulnerable to life-threatening illnesses.

People with HIV infection are usually healthy for several years before the virus becomes very active. The time period for the stages of HIV infection as well as the types of diseases differ from one individual to another. We do know that many people with HIV infection, including people with AIDS, are able to take part fully in their community and in their workplace. People with AIDS are living with AIDS.

The scope of the problem

Worldwide
1,000,000 cases of AIDS
5 to 6 million men with HIV infection
3 to 4 million women with HIV infection
(World Health Organization Jan. 17, 1992)

Canada
6116 cases of AIDS
3746 deaths from AIDS
(Health Protection Branch, Health and Welfare Canada, April 1992)

Manitoba
75 cases of AIDS
335 cases of HIV antibody positive, Jan. 1985 to June 30,1992
(Manitoba Health, Communicable Disease Control, June 1992)

How is HIV/AIDS Spread?

HIV/AIDS is spread by three major routes:

• through unprotected sexual contact with an infected female or male
• by infected blood entering the skin either through sharing of needles or through needle pricks
• through an infected pregnant woman to her unborn baby

Since the screening of the Canadian blood supply for HIV antibodies began in 1985, the risk of contracting AIDS from blood transfusions and blood products is almost non-existent.

HIV/AIDS cannot be spread by casual contact such as

• touching or bumping into someone
• using public washrooms, fountains or showers
• close contact in the office or on the assembly line
• sharing equipment such as pens, computers, tools or telephones
• coughing or sneezing

Addressing AIDS in the Workplace

Joint workplace health and safety committees can address AIDS related issues in their workplace by promoting

1. a non-discriminatory workplace policy to accommodate workers with HIV/AIDS
2. a thorough, straightforward education program on HIV/AIDS, geared to their particular workforce (i.e. the particular risks in their work)
3. a control program, only applicable where there is risk of exposure to blood or body fluids during the course of work duties (i.e. health care and service workers)

1. Defining Your Organization's Policy on HIV and AIDS

A workplace policy for HIV/AIDS should protect the human rights and dignity of HIV infected people and people with AIDS and not allow discriminatory action in the provision of services and employment.

Most federal and provincial jurisdictions in Canada have human rights legislation which prohibits discrimination against employees with HIV/AIDS. Organizations (and individuals) under Provincial jurisdiction can consult with the Manitoba Human Rights Commission to discuss their HIV/AIDS workplace policy and/or employment issues.
Whatever the size of the organization, policies and procedures need to be developed through a team approach that includes workers. Senior management support and commitment is critical if the HIV/AIDS program is going to be successful. The HIV/AIDS workplace policy should be

• communicated to all concerned;
• monitored for its successful implementation;
• evaluated for its effectiveness;
• continually reviewed in the light of new scientific information.

There is no need to completely reinvent the wheel when developing an HIV/AIDS workplace policy. There are many resources that can provide information and "sample" workplace policies which can assist an organization to develop their own in-house policy. (For examples, see Resources and References listed at the end of fact sheet.)

HIV/AIDS workplace policy components include the employer's commitment that

• workers with HIV/AIDS or other life-threatening diseases be treated with dignity and respect
• employees with HIV/AIDS be permitted to work and if needed, accommodations be made related to work schedules or duties
• employees will be assured of confidentiality when seeking counselling or other assistance from the employer
• the employer does not discriminate against HIV-infected workers, and does not test prospective employees for AIDS
• all employees will receive a comprehensive HIV/AIDS education program.

2. Education Program

As part of the workplace policy, an HIV/AIDS education program needs to be provided for all workers. Key elements of the program

• provide an overview of the company's position/policies on HIV/AIDS
• address the fears about how the disease is and is not transmitted
• provide workers with information on their rights regarding testing, employment security and discrimination
• must be geared to the particular workforce (i.e. their particular work tasks and risks)
• offer guidance in planning specific workplace procedures and infection control practices (if applicable) that eliminate exposure to blood and body fluids
• offer a supportive approach on how to work with people who have HIV/AIDS, either patients or coworkers
• evaluate the effectiveness of the program and make changes, as required
• provide ongoing and updated programs to keep employees informed of any new developments regarding HIV/AIDS.

3. Evaluation of Risk of Transmission of HIV to Workers

Job tasks, procedures and working conditions should be reviewed and evaluated to identify activities and conditions that may put workers at risk of exposure to blood or body fluids.

In the vast majority of workplaces, there is no risk of transmission of the HIV/AIDS virus to a worker. The risk of coming into contact with the HIV/AIDS virus is present in workers whose work brings them in direct contact with blood and body fluids, needles or various other medical instruments. Health care workers such as doctors, nurses, dentists, dental workers, laboratory workers, and ambulance workers may come into close contact with infected blood or other body fluids. Other groups of workers such as correction workers, police and firefighters may face a risk of incidental exposure to blood or other body fluids in the course of their work.

4. Infection Control Program

The adoption and ongoing monitoring of an infection control program is essential for the protection of workers from on-the-job exposure to HIV and other blood borne diseases. This program is only applicable where there is a risk of transmission of HIV to workers while performing normal job duties.

In the workplace, the prevention of the transmission of HIV is based on the avoidance of skin and mucous membrane contact with blood and body fluids of all patients. This approach is recommended by the Centres for Disease Control (CDC) in Atlanta, and is referred to as universal precautions. Although the universal precautions guidelines were targeted for health care and public service workers, the recommendations are suggested for any other setting in which workers may be exposed to blood or other body fluids. As per the CDC guidelines, body fluids include amniotic, pericardial, peritoneal, pleural, synovial, or cerebrospinal fluid, semen, and vaginal secretions or any body fluids visibly contaminated with blood. Copies of universal precautions guidelines are available from a number of sources.

Workers should be provided with appropriate personal protective equipment (PPE) such as gloves, gowns, fluid-proof aprons, laboratory coats, head and foot covering; face shields or masks and eye protection; and mouthpieces, resuscitation bags or other ventilation devices. PPE and supplies must be accessible and in sufficient quantity and quality to protect workers. Workers need to have training in the proper use, maintenance and limitations of PPE.
Housekeeping duties need to include procedures for infectious waste disposal, sharps disposal and treatment of contaminated laundry.

As part of communicating hazards to employees, there should be hazard warning signs posted at entrances to work areas where potentially infectious materials are present. Warning labels need to be affixed to containers of infectious waste and other potentially infectious materials. All employees with potential occupational exposures need to participate in a training program designed to explain all aspects of the Infection Control Program.
The joint workplace health and safety committee needs to be consulted on the infection control program including selection of PPE.

What is a Worker's Approach to HIV/AIDS Prevention?

The approach to prevention of HIV/AIDS in the workplace is the same as other workplace hazards whether they are chemical or biological. The following WORKERS' RIGHTS must be observed:

Right to Participate

Workers must be involved in developing their HIV/AIDS workplace policies and procedures. They must be assured that there is sufficient training, equipment and supplies to meet the standards of their workplace's Universal Precautions - Infection Control Program.

Right to Refuse

Some workers have exercised the right to refuse dangerous work, citing the fear of contracting HIV/AIDS. There are no grounds for sustaining a work refusal solely based on a worker having casual contact with an infected patient, client, or coworker as HIV is not transmitted by casual contact. However, a refusal may be upheld if adequate protective equipment such as gloves or clothing are not provided, or if there are inadequate work guidelines, training, infection control and safety procedures.

Right to Know

Hazard warning signs must be posted in work areas where potentially infectious materials are present and warning labels must appear on all infectious materials with which workers may come in contact.

Resources

A wide variety of education and up-to-date sources of information on HIV/AIDS are available. In addition to the MFL Occupational Health Centre, you may obtain information/materials from the following:

• AIDS Information Line (Manitoba)
  Telephone (204) 945-2437
  1-800-782-2437 (Toll Free Manitoba Only)
• Nine Circles Community Health Centre
  Telephone (204) 940-6000

References

Canadian AIDS Society. (1990). Managing HIV and AIDS in the Canadian Workplace: Part A Guide for Managers, Part B Manual for Employee Education.

Puckett, S.B. & Emery A.R. (1988). Managing AIDS in the Workplace, Addison-Wesley Publishing Company.

October 1992