Acquired immune deficiency syndrome (AIDS) is a disease that impairs the human immune system and renders it susceptible to infections that would be repelled by a functioning immune system. AIDS, the terminal stage of the human immunodeficiency virus (HIV), is transmitted by contamination of the blood-stream with HIV-infected body fluids, specifically blood, semen, breast milk, and vaginal fluid. The virus is principally spread through vaginal or anal intercourse, by the transfusion of virus-contaminated blood, by the sharing of HIV-infected intravenous needles, or by breast feeding. U.S. Centers for Disease Control (CDC) literature emphasizes that "no additional routes of transmission have been recorded, despite a national sentinel system designed to detect just such an occurrence." AIDS is not spread by casual physical contact, insect bites, or airborne means, and transmission through body fluids such as saliva and tears has never occurred. Following infection, the incubation period averages eight years before symptoms appear.
As of June 1997, the World Health Organization estimated that 30.6 million people worldwide were infected with HIV. Through December 31, 1997, the CDC had received 641,086 reports of AIDS cases in the United States, including 633,000 cases in adults and adolescents and 8,086 cases in children (persons under the age of 13 when diagnosed). Of adult cases, 534,532 occurred in males and 96,468 cases in females. By 1998 more than 390,692 Americans died of AIDS. The virus carries many legal and ethical implications for businesses. The CDC estimated that between 650,000 and 900,000 Americans were living with HIV as of 1998, and that at least 40,000 more would be infected each year.
First conclusively identified in 1981, the disease was known as "gay cancer" or GRID (gay related immuno-deficiency) in the United States because it appeared to be limited to male homosexuals. Its subsequent spread to intravenous drug users, hemophiliac recipients of contaminated transfusions (the U.S. blood supply was not screened for HIV until 1985), heterosexual females whose sexual partners had contracted AIDS, and their children contradicted that theory. Although homosexual males still comprise the majority of AIDS cases, it is clearly no longer limited to that segment of the population.
Estimates compiled by the CDC predicted that at least 40 million people worldwide would be infected with HIV by the turn of the 21st century. An economic analysis by DRI/McGraw-Hill, Inc. projected that "the potential worldwide economic impact of the worst-case scenario" could equal 1.4 percent of the global gross domestic product annually, "roughly equivalent to the entire economy of Australia or India today."
The majority of infected Americans in the late 1990s were between 25 and 44 years old, and members of that age group were most likely to be infected in the future. For the nation's businesses, this meant that 50 percent of the workforce was at risk. By the late 1990s, HIV/AIDS had become the third-leading cause of death among 25 to 44-year-olds.
Given a supportive work environment and early detection, however, people with HIV and AIDS could continue to be productive members of the workforce. Studies showed that for half of the people who had HIV, it would take more than a decade to develop AIDS. With medical treatment, many of them could manage the infection as a chronic, long-term condition, similar to many other medical disorders. The numbers of people with HIV, and their extended life expectancy, presaged more employees with HIV in the future. This foreshadowed the fact that most if not all businesses would eventually have to deal directly with HIV-infected and AIDS-afflicted employees. Businesses would also begin dealing with related issues such as medical benefits, psychological affects of the illness, performance issues, and the legal rights of both AIDS victims and their colleagues.
Businesses were also affected by the rising costs of health care associated with the AIDS virus. According to a Review of Business article by Robert J. Paul and James B. Townsend, the typical AIDS patient would amass $140,000 in medical bills over the life of the illness. Businesses whose insurance covered AIDS-related claims would see rising health care costs and insurance premiums. They would also see productivity losses as infected workers grew ill.
The Business Responds to AIDS (BRTA) program was formed on December 1, 1992, as a public-private partnership among the CDC, the public health sector, other organizations and agencies, and business and labor to provide workplace education and community services in order to prevent the spread of HIV. The BRTA program assists businesses of all sizes in the creation and implementation of workplace-based HIV and AIDS policies. In addition to education, service, and prevention of the spread of HIV, the program's goals are to prevent discrimination and foster community service and volunteerism both in the workplace and in the community. In order to achieve these goals, the BRTA has developed materials and technical assistance to help businesses form comprehensive HIV and AIDS programs, including: policy development, training for management and labor leaders, education for employees and their families, community involvement, and volunteerism.
Many authorities, including the BRTA, advise that employers formulate a well thought out AIDS policy to preempt problems. Such a policy would incorporate a position statement and outline such issues as education, employee safety, and employee rights. Additional accommodations might include flexible working hours, extended leaves of absence, and shorter working hours when necessary.
Corporate HIV and AIDS policies and practices should comply with federal, state, and local legislation and Occupational Safety and Health Administration guidelines. Federal laws regarding AIDS in the workplace include: the Occupational Safety and Health Act of 1970,29 U.S.C. Section 651, et seq.; the Vocational Rehabilitation Act of 1973 (VRA), 29 U.S.C. Section 701, et seq.; Section 510 of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. Section 10001 et seq.; the U.S. Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), Pub. L. No. 99-272, Section 10001, et seq.; Section 5 (a) of the Americans with Disabilities Act of 1990, Pub. L. No. 101-336, Section 101, et seq.; and the National Labor Relations Act (which covers the rights of an infected person's colleagues to organize activities such as protesting working conditions and circulating petitions).
The July 1992 passage of the Americans with Disabilities Act (ADA), which applied to any company with 25 or more employees, was a watershed of federal legislation. This landmark law forbids discrimination against any employee affected by a disability or chronic disease, specifically AIDS. It defends people who are infected, people perceived to be at high risk, relatives and caregivers of people with AIDS, and employees, from hiring to promotion to resignation or retirement. Over and above the legal stipulations of the ADA, authorities recommend that corporate HIV/AIDS policies preserve employee confidentiality, discourage discrimination, evaluate benefits programs, promote prevention, and foster an environment of understanding through the dissemination of the most up-to-date, accurate information.
Among the corporations that have composed HIV/AIDS policies are: Kodak, Levi Strauss, Pacific Bell, Bank of America, Honeywell, Kimberly-Clark, Westinghouse Electric Corp., Goodyear Tire and Rubber Company, Chrysler Corp. (now Daimler Chrysler), Lotus Development Corp., Apple Computer, Inc., Nike, RJR Nabisco, Time Warner, General Motors Corp., and Pacific Gas & Electric. Digital Equipment Corp. went so far as to create an HIV/AIDS Program Office, the first full-time corporate department devoted to AIDS awareness.
In more specific terms, employers and coworkers should strive to approach HIV and AIDS as illnesses, not moral issues. One of the most important concepts employers can convey is that there is no known risk of HIV transmission to coworkers, clients, or consumers from contact in most industries. Even in the riskiest occupational category, involving health care workers, the CDC had documented only around 40 cases of HIV contraction following on-the-job exposures as of 1997. Conversely, there has been only one confirmed instance of patients being infected by a health care worker; this involved HIV transmission from an infected dentist to six patients. Investigations by the CDC of more than 22,000 patients of 63 HIV-infected doctors and dentists identified no other cases of this type of transmission.
Unfortunately, and in spite of the massive public service campaigns of the BRTA and hundreds of agencies across the nation, misinformation has continued to disrupt productivity and cause unnecessary anxiety as the AIDS epidemic progresses through its second decade. In the early 1990s, the Center for Work Performance Problems at the Georgia Institute of Technology reported the results of a survey of 2,000 full-time workers that illustrated the scope of workers' fear of AIDS infection from casual contact. Two-thirds of the workers surveyed had reservations about using the same bathroom as coworkers with AIDS; 40 percent were concerned about using the same cafeteria; and more than one-third of those surveyed were reluctant to use the same equipment as a coworker with AIDS. In the late 1990s these fears were no less real, and AIDS victims were still struggling to find acceptance in the workplace.
Despite repeated and ongoing prodding from government and private agencies, most companies continued to assume a reactive, rather than proactive, stance on HIV and AIDS. Many large companies had instituted an HIV/AIDS policy by the late 1990s—79 percent of businesses employing more than 750 people had done so. Smaller businesses lagged behind, however. Only 18 percent of businesses employing fewer than 50 people had such a policy in place. A substantial portion of small businesses included HIV/AIDS under broad policies that addressed life-threatening illness or disabilities. On average, HIV/AIDS education policies offered by the private business sector were down from 28 percent to 18 percent of all businesses in the late 1990s.
[ April Dougal Gasbarre ,
updated by Wendy H. Mason ]
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