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. The terminal stage of the human immuno-deficiency virus (HIV), AIDS is transmitted by contamination of the bloodstream 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 mothers to fetuses during pregnancy. 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, biting insects, or airborne means, and transmission through body fluids such as saliva and tears has never occurred. Once a person becomes infected with HIV, the incubation period averages eight years before AIDS symptoms appear.
Given a supportive work environment and early detection, people with HIV and AIDS can continue to be productive members of the workforce. Studies have shown that for half of the people who contract HIV, it takes more than a decade to develop AIDS. With medical treatment, many of them can 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 means there will be more employees on the job with HIV in the future. This, in turn, means that most, if not all, businesses will eventually have to deal directly with HIV-infected and AIDS-afflicted employees.
The Business Responds to AIDS (BRTA) program was formed in 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 training for management and labor leaders and education for employees and their families.
Corporate HIV and AIDS policies and practices should comply with federal, state, and local legislation and Occupational Safety and Health Administration (OSHA) guidelines. Federal laws regarding AIDS in the workplace include: the Occupational Safety and Health Act of 1970; the Vocational Rehabilitation Act of 1973 (VRA); the Employee Retirement Income Security Act of 1974 (ERISA); the U.S. Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA); and the Americans with Disabilities Act (ADA) of 1990.
The ADA, which applies to any company with 15 or more employees, forbids discrimination against any employee affected by a disability or chronic disease, including AIDS. It defends people who are infected, people perceived to be at high risk, and relatives and caregivers of people with AIDS in matters ranging from hiring and promotion to resignation and retirement. Basically, employers cannot treat employees who are affected by AIDS any differently than other employees, and they are required to provide appropriate accommodations whenever possible. The ADA does make a slight exception for restaurants, however, in that they are permitted to reassign employees with HIV or AIDS to positions in which they are not required to handle food.
In 1998 the U.S. Supreme Court also stipulated that asymptomatic HIV patients (those without visible signs of illness) should be included under the Americans with Disabilities Act. The Court ruled in a 5-4 decision (in Bragdon v. Abbott ) that asymptomatic patients should still be covered by the ADA because HIV infection interferes with "major life activities"—in this case, the major life activity of reproduction.
Despite the growing impact of AIDS and AIDS-related illnesses on American businesses, very few companies are aware of their legal obligations to affected employees or have enacted policies to ensure compliance with the law. In their book Employee Benefits for Small Business, Jane White and Bruce Pyenson emphasize that small business owners need to take proactive steps to be prepared to deal with AIDS in the workplace. The owners should educate themselves about AIDS, establish policies to prevent discrimination, and also educate their employees—ideally, before the virus affects an employee, customer, or vendor of the company.
A preemptive AIDS education program can minimize the potential for turnover or loss of productivity when AIDS impacts the small business. White and Pyenson note that educational information should be presented to employees in a number of formats and repeated several times to be effective. AIDS education should stress that HIV cannot be transmitted through the type of contact that ordinarily takes place at work, including handshakes, sharing bathrooms and water fountains, eating in the same cafeteria, or being exposed to coughs and sneezes. HIV-positive individuals may be more susceptible to respiratory diseases that could be contagious, however, so the employer should advise appropriate precautions in that instance. AIDS education should also emphasize actions that can help prevent the spread of HIV. In occupational settings where transmission of the virus is possible, like a hospital, the employer must provide appropriate safety measures. Above all, an education program should promote an atmosphere of compassion and understanding.
White and Pyenson also note that companies should adopt and communicate formal policies and guidelines regarding AIDS in the workplace. First and foremost, the policies should comply with all applicable laws. For example, since HIV-positive people are included within the ADA definition of disabled, they can sue successfully for wrongful termination or discrimination. A small business's hiring and employment policies cannot discriminate against a person with HIV or AIDS as long as he or she is able to perform the job. Mandatory pre-employment screening for HIV is illegal in most states. Once a person with HIV or AIDS becomes an employee, the company is required by law to make reasonable accommodations for their disability, including modifying their duties, giving them time off for medical treatments, allowing them to work at home via computer, or reducing their workload or hours. In addition, the employer is required to maintain the confidentiality of the employee's medical condition. Mere speculation in the workplace that a person has HIV or AIDS can be grounds for libel or slander suits.
Employers and coworkers should strive to approach HIV and AIDS as illnesses, not moral issues. Unfortunately, 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. The National Leadership Coalition on AIDS, a consortium of more than 200 businesses, found that two out of three adults still mistakenly believed they could contract the virus by working near, or being touched by, a person with AIDS.
Despite repeated and ongoing prodding from government and private agencies, most companies appear to have adopted a reactive, rather than proactive, stance on HIV and AIDS in the late 1990s. In fact, evidence suggests that fewer companies are offering HIV/AIDS education to their employees than in the early 1990s. A report released by the National AIDS Fund and the National Association of Manufacturers, for instance, revealed that only 18 percent of employers who responded to a 1997 survey offered HIV/AIDS information in the workplace, down 10 percent from 1992. Moreover, the results of the survey made it clear that many employees held erroneous beliefs about the legal rights of workers suffering from HIV or AIDS. For example, 29 percent of the employees polled in the survey thought that HIV-infected employees could be fired or placed on disability by their employers when their illness became apparent, while another 13 percent believed that employers could restrict the benefits of an employee with HIV or AIDS. (In reality, the Americans with Disabilities Act prevents employers from pursuing any of these courses of action.)
Companies that did provide HIV/AIDS education programs for their employees in the late 1990s reported that attendance rates typically hovered around the 50 percent range. But experts believe that companies can produce dramatic improvements in participation rates if they take make the programs mandatory, schedule sessions during regular work hours, and emphasize that the information can be used as a tool to educate children at home.
"AIDS Presents New Challenges for Employers." Employee Benefit Plan Review. March 1998.
Knotts, Rose, and J. Lynn Johnson. "AIDS in the Workplace: The Pandemic Firms Want to Ignore." Business Horizons. July/August 1993.
Roberts, Sally. "AIDS Training at Work Becoming Less Common: But Time to Educate is Now, Observers Say." Crain's Chicago Business. November 10, 1997.
Romano, Catherine. "Experience Drives Corporate AIDS Policies." Management Review . December 1993.
White, Jane, and Bruce Pyenson. Employee Benefits for Small Business. Prentice-Hall, 1991.
Zachary, Mary-Kathryn. "Supreme Court Resolves Questions, Raises Others, with HIV Ruling." Supervision. November 1998.