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Improvements in treatments for AIDS and HIV disease are making it possible for employees to return to work in greater numbers than before, and that, in turn, poses a challenge to occupational health professionals who previously had little interaction with these workers. The good news, according to some health providers, is that these employees can be accommodated with little trouble as long as you familiarize yourself with their special medical needs and the challenges they face in returning to work.
The federal Centers for Disease Control and Prevention (CDC) in Atlanta reports there are between 650,000 and 900,000 people in the United States with HIV, with the majority of AIDS cases occurring in the 25 to 44 age range. AIDS is the second leading cause of death in that age group, and that group accounts for more than half of the country’s 126 million workers. (Editor’s note: Some argue that the federal statistics don’t reflect all the HIV cases since many go unreported to the CDC.)
Recent years have seen dramatic improvements in the way HIV disease is treated, with the result that HIV infection no longer necessarily means a steady decline and then a rapid fall once AIDS is diagnosed. With careful treatment, many people with HIV infection can manage the symptoms and remain reasonably active and healthy. One effect of that change is that more HIV-positive workers remain in the workplace or return to their jobs when at one time, when treatment was not as effective, the same person may have been too sick to work.
For occupational health professionals, the possibility of accommodating HIV-infected employees can be intimidating. Even when well-managed, HIV disease is an affliction that is complex and not a situation that is usually dealt with in the workplace. Some providers have developed ways to respond, and their advice centers on the need to understand the disease, its current treatment strategies, and what the worker is experiencing.
At the IBM facility in Somers, NY, area medical director Glenn Haughie, MD, MPH, says occupational health professionals must realize that HIV disease is now a part of their responsibility.
"It used to be that it was almost uniformly fatal, and you just never saw these workers after they reached a certain point in their disease," he says. "Now it’s becoming more and more of a chronic disease like arthritis or kidney problems. There’s no need to single these workers out for special attention. But at the same time, you do need to make sure you put this disease on that whole list of chronic illnesses that may need attention in the workplace."
Similar advice comes from Richard Williams, PhD, worldwide manager of the AIDS Awareness Program for the Polaroid Corp. in Cambridge, MA. He notes about one out of every 100 workers in the United States is infected with HIV, so it is almost inevitable employers will encounter the illness in the workplace.
"It used to be that workers were fairly ill before the illness was identified, so they were kind of at the end of the cycle, and there wasn’t much opportunity for accommodation," he says. "If you did try to accommodate them, it was usually less than a year before the worker was out on disability or died. The pattern is now very different, and the company’s response will have to be longer and perhaps more complex."
IBM and Polaroid both have been recognized for their efforts to incorporate AIDS education into the training of their employees, along with a pledge to treat employees with HIV disease just like any other employee with a chronic illness. They are afforded privacy, permitted to work if able, and eligible for all company benefits including medical disability. In addition, management provides various accommodations to help them continue working. Haughie explains that the occupational health provider’s role is important in all of those issues.
"We all have the responsibility to try to assist the employee and management in working out a mutually beneficial arrangement for the people involved," he says. "Occupational health providers can play an important liaison role, helping to translate information into actions. That usually means helping the employer be flexible enough to help the worker deal with whatever are his or her current needs in the workplace."
Much of that will involve making physical alterations and policy changes that assist the worker in coping with the demands of an elaborate and very strict drug regimen, plus the myriad side effects. Even though the occupational health provider will not provide any actual treatment for the HIV disease, the treatment provided elsewhere can result in problems that must be dealt with in the workplace.
For instance, a worker with HIV disease may be ostensibly healthy and capable of working as long as he or she follows a carefully prescribed drug regimen. But that drug regimen may involve taking 20 different medications a day, notes Sherryl Zemo, an information specialist with the CDC’s Business and Labor Responds to AIDS program, which helps employers accommodate workers with HIV.
"That’s an example of the kind of thing you might see with HIV/AIDS that you wouldn’t see with most other illnesses that a worker might have," she says. "The employee may be struggling to take all these medications properly, and he or she wants to know whether the employer is going to be sensitive to how hard that can be. The occupational medicine physician could be instrumental in showing the employer what that’s all about and how to give the employee a little assistance."
(For more ideas on how to make accommodations for workers with HIV disease, see related story, p. 4.)
Zemo also notes the legal questions involving HIV disease in the workplace can be complex. The illness is covered by the Americans with Disabilities Act (ADA), so it is necessary to make reasonable accommodations. It also is important to maintain the worker’s privacy by not disclosing the HIV status unnecessarily.
"We hear a lot from company RNs about legal issues," she says. "They often say that a worker just informed them of an HIV status, and they want to know if they should tell the co-workers, supervisors, and first responders at the work site. The answers are: No, no, and no. You don’t tell anyone unless you have express written permission to do so."
First responders are supposed to be trained in the proper use of universal precautions, so a co-worker’s HIV status is immaterial, Zemo says. It also is unnecessary and illegal to inform supervisors and co-workers, though she notes that the worker may choose to inform his or her supervisor about why certain accommodations are necessary.
But ensuring one employee’s privacy does not mean to never discuss HIV in the workplace. Quite to the contrary, occupational health providers should be heavily involved in educating workers about the facts of HIV disease. If the entire work force is properly educated about HIV disease, afflicted individuals will be more likely to step forward when they need accommodation or need to report symptoms that could be dangerous in the workplace. The CDC estimates that only 30% of American employers with more than 750 workers provide HIV education, but some provide extensive education programs. IBM even offers on-site HIV testing through its occupational medicine department.
[Special educational materials are available from the U.S. Department of Health and Human Services program called Business and Labor Responds to AIDS. Free education kits are available from the federal AIDS Information Clearinghouse at (800) 458-5231. See examples of educational materials used in the workplace, inserted in this issue.]
Safety issues also can be affected by the presence of workers with any serious illness requiring medication. With HIV disease in particular, the drug regimen can result in a long list of side effects that could be hazardous in the workplace if not monitored carefully perhaps more side effects and more serious than the occupational health provider is used to encountering in a person who is still able to work. Familiarity with the most commonly prescribed drugs can help the occupational health provider watch for effects that may be dangerous on the job.
While there may not be any need to single out workers with HIV disease or to go looking for them, it is crucial for employees to feel that they can come to the occupational health provider with any concerns or report symptoms that may be dangerous. That atmosphere is possible only when the employer, with the occupational health provider’s guidance, has made it clear that there are no repercussions for reporting HIV disease or its symptoms, Zemo says. (For more on commonly prescribed drugs and their side effects, see related story, p. 5.)
"The biggest thing I hear employees complaining about is that they just want a comfortable dialogue with the manager or the clinical person in the workplace once they have disclosed that they have HIV disease," she explains. "If there are questions that health care workers need to ask, they should feel comfortable about asking. If workers need to tell you that they feel dizzy sometimes and shouldn’t be driving a forklift, they should be able to say that.
"But with HIV and AIDS, everyone is afraid to speak. The employees are afraid they will lose their jobs if they report symptoms, and the employers are sometimes afraid of asking necessary questions because they might offend the worker. You’ve got to create good communication, and then you’ve beaten most of the problem."
[Editor’s note: American Health Consultants, the publishers of Occupational Health Management, has a complete HIV/AIDS resource available in its Common Sense About AIDS sourcebook. This book is a comprehensive source of education materials, overviews of OSHA regulations, forms, and other materials that provide you with a better understanding of HIV/AIDS. For more information, call customer service at (800) 688-2421.]