Occupational A Practical Guide for Managers_3

84 Occupational health In only two areas is HIV antibody testing currently carried out on employees or potential employees: • Airline crews—this has been justified on the basis that their lifestyle is irregular and this is known to potentiate the development of AIDS in an HIV antibody positive individual; and because they are required to have frequent vaccinations and immunisations which may be impacting on an already damaged immune system. • Staff on overseas postings—some countries require a clearance certificate for entry. Health care workers are in a different category from other employees. Such workers may themselves be at risk from HIV-infected patients, although up to the end of 1992 only 148 cases of occupationally acquired HIV infection had been reported worldwide. Health care workers are required by their professional bodies to report the fact if they know themselves to be HIV antibody positive or if they have reason to suspect that they may be. There are three clear reasons for this: • An injury to them while performing invasive procedures may result in their blood contaminating the patient’s blood. • AIDS may be associated with the development of various infectious conditions which can be passed on to patients made vulnerable by their own disease. • A significant percentage of individuals with AIDS experience intellectual deterioration. Incapacity and sickness absence In general, individuals who are HIV antibody positive need counselling and support. This is hardly surprising when they have to cope with a potentially fatal disease for which there is no known cure. Added to this they have to deal with prejudice and feelings of stigmatisation. Although there are exceptions, most employees who are HIV antibody positive or have AIDS do not want to share this information with work colleagues. They may confide in their manager, or the personnel or occupational health department, and they should be able to do so with a guarantee of confidentiality. There may be reasons why a limited number of other people need to know: • when there is disciplinary action under way concerning frequent sickness absence; • where they may be putting, or have put, other people at risk, e.g. health care workers; AIDS and employment 85 • when deteriorating health requires redeployment; • when deteriorating health leads to retirement on the grounds of ill health. The existence of an AIDS policy which guarantees confidentiality within these limits will help to ease the situation. The individual who first receives the confidence should obtain written consent from the sufferer to inform those who ‘need to know’. Deteriorating health and performance should be dealt with as in the case of any other chronic disease. Clearly, a point may be reached where the level of attendance or performance is unacceptable, and consideration must be given to redeployment to less onerous duties or hours, or ill health retirement. The employer does not have right of access to medical information as is clearly demonstrated in the Access to Medical Reports Act 1988. In the absence of any information as to the cause of unacceptable absence or performance, the employer is entitled to follow the normal disciplinary procedures. Training and education It is essential that the policy covers the training and education of staff. This should include reinforcement of the principles stated in the policy, the facts about AIDS including epidemiology and mode of infection, and advice on reducing the risk of contracting the disease both in the social arena and at work. The education should also reassure employees that there is no risk of contracting AIDS from using crockery, glasses, towels etc. which have been used by an HIV antibody positive colleague. First aid Trained first aiders should be reassured about the risk of infection and informed clearly how the disease can be contracted. They should already know how to avoid direct contact with blood and body fluids because of the risk of hepatitis B virus infection. Precautions include: • covering their own abrasions with waterproof dressings; • using disposable plastic gloves and apron when clearing up blood and body fluids; • using a mouthpiece for mouth-to-mouth resuscitation. They should also be reassured that the risk from mouth-to-mouth resuscitation is negligible and that this should not be withheld if a mouthpiece is unavailable. 86 Occupational health Staff who travel overseas Avoiding the risk The greatest risk to overseas travellers is sexual transmission. In eastern and central Africa and in much of the Caribbean and South America, the main route of transmission is heterosexual intercourse. In some of these areas the chances of a partner being infected is one in five. Travellers should be advised to abstain or use safer sex techniques and condoms. Injecting drug users will also be at risk from contaminated syringes and needles. In some European and American cities up to 80 per cent of drug users are probably infected. It cannot be assumed that all blood used for transfusion has been tested for HIV. In a country where there is a high incidence of HIV infection, travellers should avoid blood transfusion unless it is essential to preserve life or unless there is convincing evidence that the blood has been screened. Medical treatment is potentially hazardous if syringes need to be used. Frequent travellers should be provided with a small pack of syringes and needles. Travellers should be advised to avoid any procedures which puncture the skin, such as tattooing. HIV antibody testing Some countries insist on a certificate of clearance; anyone intending to live or work in that country must have a certificate stating that he or she is HIV antibody free. Admission will not be allowed without this. Insurance Some insurance companies may refuse life insurance to those who will be working in countries with a high incidence of HIV infection. Where insurers do provide cover they may require a higher premium. Legal considerations Recruitment of individuals with HIV/AIDS Employers have the right to decide whom they wish to employ but they must not discriminate directly or indirectly on the grounds of race or sex: for example, requiring information on HIV infection either by questionnaire or blood testing only from men. AIDS and employment 87 Dismissal of employees with HIV/AIDS Any full-time employee with two years’ service is protected by the Trade Union Reform and Employment Rights Act 1993. Testing for HIV antibodies Implicit in every contract of employment is that employees will obey reasonable instructions, but only in exceptional cases would HIV testing be justified as relevant to the employee’s capability to do the job. If the employee is pressured to undergo the test, he or she may have a claim for constructive dismissal. If male, he may be able to claim unlawful indirect discrimination. An example of an unreasonable instruction was seen in the catering industry where homosexual male chefs were required to undergo a blood test and then moved to non-food handling work. There is no medical reason why those who are HIV antibody positive should be removed from food handling. Hostility from colleagues Problems arising from the fear or hostility of colleagues were common in the early days of public recognition of the disease. The level of education about AIDS now makes such an occurrence unlikely. If a colleague asks to be moved away from the infected employee and refuses to work near him or her, every effort should be made to reassure by providing the facts about AIDS and infection. If the individual persists in the request or refuses to work, the employer has every right to dismiss the protester (UCATT v. Brain 1981). More commonly, colleagues will put pressure on the employer to dismiss or move the person with AIDS. If dismissal results this will normally be deemed to have been unfair. If the employer has been faced with industrial action the dismissal will still be perceived as unfair. The development of a policy on AIDS, as previously described, should prevent these problems arising among the workforce. Customer pressure If there is customer pressure to dismiss an employee, as in the case of pressure from colleagues, the employer must endeavour to allay the customer’s fears. If this fails and the economic threat is significant, the dismissal may be seen as fair. 88 Occupational health Conclusion Much of the public concern about HIV antibody positive and AIDS patients has been reduced by successful government and other educational programmes. When an infected individual presents in the workplace, the situation is likely to be handled unemotionally and fairly if an AIDS policy is in place. There should be an assurance of confidentiality, no discrimination and a guarantee that procedures to deal with redeployment and retirement will be the same for all employees. It should also be clear that victimisation and harassment will not be tolerated. ... - tailieumienphi.vn