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Some multinational employers offer services to support workers with the disease. Start by reducing stigma, they advise.
A senior manager at an African facility of SABMiller was HIV-positive. He passed on the virus to his wife, who went on antiretroviral therapy covered under the company's health care insurance. Unlike the national health care program in Africa, SABMiller's insurer provides treatment with two drugs, thereby reducing the patient's chance of passing on the virus. It paid off: The woman bore an HIV-negative baby.
"That's a real win," says Jenni Gillies, SABMiller's group HIV consultant, because HIV-positive Africans tend to be in their childbearing years.
The example is a stark illustration of the efficacy of employee assistance services for workers with HIV or AIDS, in an era when powerful drugs make it possible for people with this disease to live longer and work longer.
"There has been an uptick with those employed that have HIV/AIDS," says Randy Vogenberg, principal of the Institute for Integrated Healthcare in Sharon, Mass. "Because the disease has turned into more of a chronic disease, you tend to see it more in the commercial workplace."
SABMiller, parent of MillerCoors, is joined by Levi Strauss & Co. and Chevron as some of the multinational companies whose corporate leaders grasp the global implications of the disease and dedicate human and financial resources to handling it. Often operating in countries with a high prevalence of HIV, they:
Clear Up Misinformation
HR professionals face a very different situation now than they did in the early days of the disease. Today, everyone knows something about HIV and AIDS. But that can be a problem: Employees may think they're informed when they're actually misinformed.
AIDS was first reported in the United States in 1981; at that point, a diagnosis was effectively a death sentence. Now, with protease inhibitors, a one-pill-a-day regimen makes it possible for more people with HIV and AIDS to continue in their jobs.
Who has HIV, the virus that causes AIDS? As of 2009, the latest year for which data are available, an estimated 1.18 million adults and adolescents in the United States live with HIV, according to the Centers for Disease Control and Prevention. Globally, an estimated 34 million were living with HIV in 2010, according to the World Health Organization and the United Nations. Two-thirds are in sub-Saharan Africa, though that area has only slightly more than 10 percent of the world's population. In the United States, gay and bisexual men, black individuals and to a lesser extent Latinos are disproportionately affected. Gay and bisexual men, though they make up only an estimated 2 percent of the U.S. population, accounted for 57 percent of HIV diagnoses in the U.S. in 2009. Black individuals accounted for 44 percent of new diagnoses; Latinos, 20 percent.
The number of AIDS cases is much smaller–479,868 in the United States at the end of 2008. There are no comparable global figures.
Does it make sense to have a workplace policy on HIV and AIDS? "It's not a question of whether a business is going to be confronted with this," says Peter Petesch, a labor law attorney and shareholder at Littler Mendelson in Washington, D.C. "It's a question of how soon."
When The Conference Board surveyed 134 health benefits officers and HR professionals worldwide in 2006, more than two-thirds said their operations had already been affected. Numbers were higher for those operating in sub-Saharan Africa.
Executives at Levi Strauss & Co. experienced the need to respond to HIV early on, partly because of the company's San Francisco location. "We were at the epicenter of the global pandemic," says Paurvi Bhatt, senior director for the employee HIV/AIDS program in Levi Strauss' global human resources department. "We saw our employees in need." Then, employees worried that if they were seen getting information about HIV and AIDS, they would be stigmatized for being perceived as gay.
Levi Strauss started offering employee education in 1982 and coverage for drug therapy for HIV-positive employees in the United States in 1987. In 2006, company leaders realized that Levi Strauss had become global and decided they should improve access to HIV services and refresh employee education.
The company made a commitment through the Clinton Global Initiative, a project founded by U.S. President Bill Clinton in 2005 that convenes global leaders from public and private sectors to solve worldwide problems. The pledge: to establish a policy that all employees and their families worldwide should have access to HIV and AIDS treatment and education. The policy has now been rolled out in 44 locations.
Build a Policy
Not many U.S. companies, and even fewer small ones, have HIV and AIDS policies. But the Business Responds to AIDS/Labor Responds to AIDS program, a public-private partnership affiliated with the Centers for Disease Control and Prevention, recommends that all employers create such a policy. Its website has a Workplace Policy Builder that offers guidance. For instance, such a policy should cover:
The specific elements would depend on a company's area of business and location. In the United States, reasonable accommodation and confidentiality are required by federal law.
Provide Health Care, Drugs and Counseling
Employee health benefits vary. Most U.S. companies treat HIV and AIDS like any other life-threatening illness. In Europe, HIV and AIDS treatment is included in national health care plans. In Africa, larger companies may have clinics to supplement care in countries where national health care or insurance plans don't offer complete HIV coverage, or didn't when the employer decided to offer coverage.
HIV-positive employees in the United States are less likely to need reasonable accommodations now than they would have several years ago because antiretroviral therapy often allows them to work a normal schedule.
In the United States, "people are very aware of the pressures of the global pandemic. Where there's a disconnect is that it's also an issue here, with yourself, your team, your family," says Paurvi Bhatt, the senior director for the employee HIV/AIDS program at Levi Strauss. "People think they understand the stigma. But they are worried if they are positive, will they get promoted?"
Levi Strauss trains employees worldwide on the subject of HIV and AIDS. Bhatt and her colleagues were surprised by the prevalence of misinformation. And, they were surprised to discover how many employees have been affected by HIV, saying they had a friend or family member who was HIV-positive. After seeing a video about a hypothetical employee who must reveal her positive status to get a work visa to travel for a project requested by her boss, employees have "team-building conversations," Bhatt says. "At the end of the training, they're incredibly engaged. It's a problem they didn't think they could resonate with."
Different face-to-face, one-hour training sessions are offered for managers. The trainers, who work for a local nonprofit, "go through scenarios," Bhatt says. "You're in a conference room. Somebody just cut their finger. What do you do?"
The training is conducted in Levi Strauss' factories and stores. Store managers receive a retail kit that contains a copy of the HIV/AIDS policy and a comic book that has facts about HIV and answers questions such as what could happen in a store and how rumors get started. "At the beginning of every shift, the manager walks through a question," Bhatt says. "You don't have much time in a store environment."
Workplace education on HIV and AIDS is not as common as it once was, says Peter Petesch, a labor law attorney and shareholder at Littler Mendelson. Several years ago, it was strongly advocated by the Centers for Disease Control and Prevention. It should be part of diversity training, Petesch says.
Chevron has mandatory 90-minute training for managers worldwide on the basics of HIV and AIDS and on its policy. The education is offered to new employees and embedded in other training, such as that on sexual harassment, says David McMurry, manager of global HIV/AIDS policy. In high-prevalence countries, extra time may be devoted to topics such as condom use, access to treatment and care services, other sexually transmitted infections, and efforts to reduce the stigma.
Even in the United States, where HIV prevalence is lower, "there are always going to be pockets where people are going to have some fears," McMurry says. "All we can do is try to educate."
Workplace education often takes a different focus in an organization that offers health care services or works with HIV-positive clients. Amida Care is a small New York City-based nonprofit health plan specifically designed for individuals with HIV and AIDS. Every employee goes through annual training that includes information on how HIV is contracted, the importance of keeping patients' information confidential, the mandatory reporting requirement for sexually transmitted diseases and the need for early intervention in domestic violence, says HR coordinator Joel Lester.
And even if accommodations are needed, employees may not need to tell their supervisors about their HIV status, says David McMurry, Chevron's manager of global HIV/AIDS policy. "They can say, 'I'm having some health issues. I'm going to need to reduce my work hours.' "
At Chevron, based in San Ramon, Calif., if employees want to talk more about their health issue, they can use the employee assistance program or go to the company's global health office.
Around the world, free counseling services have become important benefits for people with HIV and AIDS. The services can come from a regular employee assistance program or from a program exclusively for HIV and AIDS questions. "If an employee is having a hard time dealing with a diagnosis, or if HIV becomes full-blown AIDS, an employee assistance program could be very beneficial," explains Lynn Franzoi, chief executive officer of LLF Consulting in Long Beach, Calif.
Last year, Levi Strauss added HIV Connect, a free, worldwide counseling and referral service exclusively for HIV questions from employees. Provided by Ceridian, callers can get referrals to providers that offer subsidized or free health care or counseling. Question topics range from health care and finances to housing issues. Managers can ask about accommodations.
HIV Connect's startup costs were just a few thousand dollars, says Levi Strauss' Bhatt. Counseling and referral costs about $300 per case. The program is too new to judge return on investment, she says.
With pharmaceuticals keeping many people with HIV and AIDS working, a good portion of the cost of their medical coverage is attributable to the cost of this medication. HIV and AIDS drugs cost from $200 to $700 per month per person, with the average being $300 to $400 a month, says consultant Vogenberg. The price has risen: Protease inhibitors with three drugs in one pill have "pretty much become the standard," Vogenberg says. "That's why it's become more expensive." The cost of diagnostics, testing and monitoring blood-level counts add up, too.
But, he says, "you can't discriminate. If you have a medical or drug benefit, you have to cover it." He puts the costs in perspective: "Even though AIDS is relatively expensive, it's not as expensive as arthritis or cancer."
Urge Employees to Get Tested
SABMiller has 70,000 employees in 75 countries, including 11 African countries where workplace education takes on a more urgent tone. "One of our main aims is to help employees remain [HIV-]negative," Gillies say. To that end, peer educators distribute free condoms and train employees to encourage their peers to practice safe sex.
In most of these African countries, corporate leaders "put all their managers through peer education," she says. The peer educators also work with managers and supervisors to reduce prejudice against HIV-positive employees. Managers are trained in how to manage an employee who has disclosed that he is HIV-positive and how to maintain strict confidentiality. SABMiller has one peer educator for every 13 employees in countries where HIV and AIDS prevalence is higher than 5 percent.
SABMiller started offering prevention and treatment programs at South African Breweries in March 2003 and expanded the initiative to operations in 10 other African countries by year-end. The company offered a wellness program and drug therapy for those whose immune systems were already compromised. It was an important move: At that time, antiretroviral therapy was not available through the national health care system.
Lives have been saved in these African facilities, Gillies says, although it was too late for some. "Nobody needs to die of this disease anymore," she says. "They're not getting treatment because of the fear of stigma from peers and the community."
Because of the stigma, persuading employees to get tested can be tricky. So, the company sponsors couples testing at Family Days sponsored by the facilities. These events include a health fair, and awards are given in a drawing for couples who get tested together. "It's a way to overcome the fear of disclosing [their HIV status] to spouses," Gillies says. It's a supportive environment, and counseling and information about treatment are offered at the test site.
How do you measure return on investment for an HIV/AIDS policy? The answer may not be straightforward.
Chevron, with 57,000 employees worldwide, has nearly 700 medical staff globally, and all receive HIV training.
The company's health officials hired a financial consultant to study the impact of HIV in the countries where it operates. Looking purely at dollar costs, the researcher found, not surprisingly, that it's more cost-effective to spend money on prevention than on care and treatment.
In sub-Saharan Africa, SABMiller's analysts looked at how much the company's HIV/AIDS program had saved the company by saving employees' lives. The study measured the cost of absenteeism and the recruitment and training of new workers who would have been needed to replace those who could have died.
Company representatives didn't give specifics, except to say that after deducting the cost of treatment, the program saved money and lives.
At Levi Strauss, "we're capturing what didn't happen," says Paurvi Bhatt, senior director for the employee HIV/AIDS program. Yet because Levi-Strauss doesn't operate in countries with a high prevalence of infection, the cost of care has not been high, she says.
The company's health officials are encouraging couples counseling as the best way to reach employees' spouses. "People didn't like to come into the company to be tested as a couple," Gillies says. "We had our medical staff get consent from the employee to go into their homes. But that has its own stigma." To overcome such resistance, the medical staff would talk to the couple at their home about a range of health issues–malaria, reproduction, hypertension–and then encourage them to be tested for HIV.
SABMiller now provides free voluntary HIV testing and counseling for employees in Africa, Latin America and India. It treats HIV-positive employees and their dependents for life. For those who catch the virus early, the program includes monitoring of physical health, nutrition education and provision of vitamins. Last year, 74 percent of employees were tested in countries where HIV and AIDS prevalence is higher than 5 percent. In Uganda, 84 percent of employees were tested. Of those found HIV-positive, 98 percent of employees and 86 percent of spouses are in the wellness program or receiving antiretroviral therapy.
Ensure Access to Health Care
Chevron offered health coverage for HIV and AIDS in Africa before expanding it globally. In 2005, the company released a global policy that covers all employees.
To get there, health specialists went through every benefit plan Chevron had around the world to eliminate exclusionary clauses. It was a two-year process, recalls Ernesto De La Torre, global public health coordinator.
At the time, Chevron operated in 29 countries where there was no coverage for HIV or AIDS treatment. Reasons varied: In some cases, HIV and AIDS coverage was excluded under the national health care system or by benefits plans provided by Chevron's local vendors. While the exclusions were being worked out, Chevron reimbursed vendors for providing treatment based on coverage rates for other life-threatening diseases.
At Levi Strauss, employees in India and China still cannot get HIV coverage because insurers there don't cover it. The company offers a 100 percent reimbursement plan just for HIV. To retain confidentiality, Levi's uses a French third-party insurer.
Around the world, HIV and AIDS are not the killers they once were–and corporate leaders may not think the virus represents an important workplace issue. But, Bhatt says, "It's a concern that you don't see because it's very hard to talk about." Employees are not likely to speak up unless they feel there's a safe place for them to discuss the issue. It's up to the employer to create that space.
The author is a freelance writer in Washington, D.C.
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