WELLBEING: HIV AND AIDS: PREVENTION AND CARE:
Introduction

Tips and Tools

The impact of HIV and AIDS across geographic regions Sample policy statement on HIV and AIDS (CIFOR) Sample information brochure HIV and AIDS (World Agroforestry Center) Resources on the Internet for HIV and AIDS management in the workplace CGIAR information resources on HIV and AIDS

This introductory section deals with the following issues:

• why prevention and care of HIV and AIDS is important for inclusion
• good practice
• understanding HIV and AIDS
• the global incidence of HIV and AIDS – 2006
• the impact of HIV and AIDS on women and children
• medical treatment
• best practice in HIV and AIDS workplace policies and programs
• what these guidelines provide (including sections on model policy, sample practices, and tips and tools for implementation.)
  

The Gender & Diversity Program (G&D) recognizes that HIV and AIDS will present a major challenge to the success of the Consultative Group on International Agricultural Research (CGIAR) for the foreseeable future. The HIV and AIDS pandemic continues to grow despite improved medication, with its prevalence affecting:

• the health of staff members as well as their families, friends and colleagues;
• the quality of research, because participants from CGIAR Centers and partner organizations living with HIV and AIDS may be unable to contribute to their full extent; and
• the adoption of CGIAR research by end-users, because those living with HIV and AIDS may not be sufficiently healthy to implement new technologies, nor to pass their enhanced knowledge and experience on to others.

Thus HIV and AIDS ultimately impact on prosperity and development throughout the world.

In addition, HIV and AIDS have profound implications for a Center’s ability to sustain an inclusive workplace. Managers and staff will often feel at a loss about how to handle the situation if a colleague has HIV or AIDS if they lack factual information. Unless a Center can educate its staff properly about both the risks and myths associated with HIV and AIDS, it faces the prospect for prejudice, stigma, fear and discrimination to fester across its workforce which has the potential to undermine inclusion. In this respect, HIV and AIDS are completely different from other life-threatening diseases, such as cancer or malaria.

Consequently, the CGIAR must take a proactive stand and build strategies for meeting the challenges of HIV and AIDS, not only in its organizational management practices but also in its research programs.

G&D has worked with the CGIAR Centers since 2002, spearheading initiatives for both preventing HIV and AIDS and caring for staff members who are living with these illnesses. As a continuation of this involvement, G&D has now developed these guidelines to assist CGIAR Centers in refining their existing practices. The guidelines reflect developments in general knowledge and practices for HIV and AIDS management, coupled with the experiences of Centers that have established very effective HIV and AIDS policies, practices and initiatives.

These guidelines include a model policy ready to be adapted or adopted by the Centers as well as related sample practices, and tips and tools. All are linked to make it easy for you to tap into our best recommendations for preventing HIV and also for caring for those already suffering from HIV and AIDS.

Many Centers have shared their best practices to help G&D develop these guidelines, and some external organizations have served as models of good practice. This Inclusive Workplace e-Resource Center is designed to serve as a platform for ongoing exchange and improvement.

WHY IS PREVENTION AND CARE OF HIV AND AIDS IMPORTANT FOR INCLUSION?
1 Community attitudes about HIV and AIDS vary widely across the world. In some communities, people with HIV and AIDS are treated with compassion. In other communities, those with HIV and Aids are stigmatized and feared, even threatened which, in turn, leads to poor social dynamics both in the broader community and in the immediate workplace.

Diversity Alert
Need for accurate information is crucial
An inclusive workplace cannot be achieved if inadequate or inaccurate information about HIV and AIDS leads to fearing of staff members who are living with these illnesses and, thus, causes prejudice, stigma and discrimination.

GOOD PRACTICE
2 Adopting good practice for preventing HIV infection and, in turn, AIDS, and for caring for those already living with these illnesses is a strategic issue for CGIAR Centers. This is not only because of the direct influence of HIV and AIDS on staff, but also because of how these illnesses impact the Centers’ work.

3 In this context, “good practice” is not limited to adopting current ideas. It requires actively seeking new information about the prevalence and treatment of HIV and AIDS on an ongoing basis and being innovative in developing new initiatives for HIV and AIDS prevention and care.

4 Knowledge is developing rapidly about HIV and AIDS. Information about the scope and rate of infection around the world is updated periodically by bodies such as UNAIDS, which is the joint United Nations Programme on HIV and AIDS. Knowledge about the prevention of HIV infection is now well established and, although there is no cure, there has been progress in retarding the progression of AIDS. Compared to just five years ago, far more effective medicines are now available, and access to those medicines has improved significantly – often accompanied by considerable cost reductions.

Good practice
HIV and AIDS prevention and care requires ongoing commitment
Centers must:
• actively seek new information about the prevalence and management of people living with HIV and AIDS, and
• be innovative in developing new initiatives for HIV and AIDS prevention and care.

5 Through their policies and practices for preventing and managing HIV and AIDS and extending compassion to all those affected, CGIAR Centers have the potential to function as role models for their research partners and in the broader community.

UNDERSTANDING HIV AND AIDS
What are HIV and AIDS?
6 Human Immunodeficiency Virus (HIV) is the virus that causes AIDS. HIV is a life-long infection that weakens the body’s natural ability to fight off diseases.

7 Acquired Immunodeficiency Syndrome (AIDS) is a medical condition in which the body’s immune system breaks down, leaving the sufferer vulnerable to developing a variety of life-threatening illnesses.

How is HIV spread?
8 HIV is transmitted via body fluids, specifically blood, semen, vaginal secretions, and an infected mother’s breast milk. A person may become infected with the HIV virus by engaging in unprotected sexual intercourse, sharing needles or syringes with HIV-infected persons, or from infected blood transfusions. HIV-infected mothers can transmit the disease to their children during pregnancy or childbirth, or through breastfeeding.

9 HIV is not

• transmitted through casual contact in the workplace;
• transmitted through air, food, water, utensils, toilet seats or anything else that does not involve blood, semen, vaginal fluids or breast milk.

Understanding the development of AIDS
10 There are three phases of HIV infection. During the first phase, the virus exerts no serious effects and people who have contracted the virus can lead a normal and productive life.

11 In the second phase, AIDS starts to develop. In this phase, the immune system begins to weaken and sufferers succumb to illness more frequently. Depending on a sufferer’s constitution, nutrition, hygiene and general wellness, the first and second phases can last up to 15 years. However, with improved treatment, the latency period of infection is increasing. Anti-retroviral (ARV) drug therapies have greatly improved the health and longevity of those who are HIV-positive.

12 In the third phase, colloquially termed “full-blown AIDS”, the immune system completely breaks down and sufferers become incapacitated. Having full-blown AIDS means their natural immune system can no longer fight infections, making them highly susceptible to opportunistic, and often fatal, diseases.

THE GLOBAL INCIDENCE OF HIV AND AIDS - 2006
13 UNAIDS, the UN organization that deals with HIV and AIDS, tracks the global data dealing with the pandemic. The latest report, the UNAIDS/WHO AIDS Epidemic Update: December 2006 (www.unaids.org/en/HIV_data/epi2006/default.asp) estimates:

• 39.5 million people living with HIV – adult women, 45%; adult men, 49%; children under 15 years, 6%;
• 4.3 million people newly infected with HIV in 2006 – adults, 88%; children under 15 years, 12%;
• 2.9 million people died of AIDS in 2006 – adults, 90%; children under 15 years, 10%.

14 In each of the ten geographic regions covered by the 2006 UNAIDS data, the number of people living with HIV or AIDS had increased since a similar survey conducted in 2004. Deaths from AIDS had increased in seven of the ten regions, remained stable in two and reduced in one.

15 Perhaps the clearest message about HIV and AIDS from these regional perspectives is that there is no scope for complacency in any region.

Good Practice
Monitor what’s happening in your region
Stay as current as possible by accessing data on the incidence of HIV and AIDS in your location and taking note of any changes that are taking place in incidence of the disease according sectors, gender and age groups. Reliable data can be found on Web sites such as www.unaids.org or www.who.org.

HIV AND AIDS at CGIAR Centers
16 There is no clear data on the incidence of HIV and AIDS at CGIAR Centers. Precise numbers are always difficult to establish, as confidentiality and cultural barriers often preclude disclosure of HIV and AIDS status.

Initiatives by CGIAR Centers
17 CGIAR Centers have responded very well to the challenge of AIDS. They have taken many initiatives worldwide to limit the impact of HIV and AIDS within their workplaces by establishing good policies, practices and action plans. Some of those initiatives are presented in the Tips and Tools section.

IMPACT OF HIV AND AIDS ON WOMEN AND CHILDREN
18 In many parts of the world, women are disproportionately affected by HIV and AIDS. In sub-Saharan Africa, for example, UNAIDS reports that for every 10 adult men living with HIV and AIDS, there are about 14 adult women infected, and about 59 percent of all age groups living with AIDS are women (2006). Not only are women more likely than men to be infected with HIV, they are also more likely to be the care-givers for people infected with HIV.

Diversity Alert
How much do women know about HIV and AIDS?
In many communities, women typically know less than men about how HIV is transmitted and how to prevent infection. In other communities, women may well know how HIV is transmitted, but are disadvantaged when taking precautions due to male dominance in such decisions. Their knowledge often is rendered useless by the discrimination and violence they face.

19 UNAIDS also reports that HIV and AIDS can have devastating effects on households, through the loss of primary income earners, the loss of income when family members stay home to care for the sick, and through the sheer cost of ARV drugs in their locations.

20 Children can be profoundly affected by HIV and AIDS. They may lose their childhoods if they are orphaned by HIV and AIDS and have to become the breadwinners and caregivers for sick relatives and extended family members. This extra burden puts a strain on their meager resources which, in turn, exposes them to increased health risks of their own due to inadequate nutrition, housing, clothing and basic care. They are also less able than other children to attend school regularly.

MEDICAL MANAGEMENT OF HIV AND AIDS
21 Anti-retroviral drugs (ARVs) offer the best hope available for managing AIDS. These drugs are now available and affordable in almost every country in which the CGIAR operates. In addition, their cost has dropped significantly making HIV and AIDS treatment an affordable option for CGIAR Centers.

Diversity Alert
What are the implications for people infected with HIV and AIDS?
Individuals living with HIV and AIDS can have productive lives for 15 years or more. With the increased availability and improvement in anti-retroviral drug treatment, longevity continues to improve.

22 It is now common practice to use a variety of ARVs in combination to maximize their impact. This treatment is called Highly Active Anti Retroviral Therapy (HAART).

23 The significant reduction in cost of ARVs has not only enhanced access to the drugs, it has made health insurance more feasible. Most insurance companies now offer HIV and AIDS packages. Centers are encouraged to include these in their staff medical plans or explore other local options. If they are not successful in that regard, they could opt for:

• supplemental self-insurance, or
• international insurance coverage secured on the basis of regional or inter-regional pooling.

These latter options are considerably more expensive than many medical plans now in place, but they offer coverage for HIV and AIDS that is not available in some Centers’ current plans.

24 Many countries face the challenge of establishing adequate medical support for administration of ARVs, as well as insurance coverage for the care of people living with HIV and AIDS. However, even in those countries, HAART services and insurance coverage are improving daily.

Diversity Alert
Does your organization’s insurance cover HIV and AIDS?
If a Center’s current insurer does not cover HIV and AIDS testing, counseling and treatment, it should switch (if possible) to an insurer that does.

25 In conjunction with reduced drug prices, significant improvements in availability and cost of diagnostics are also sharply reducing the overall cost of HAART.

26 Evidence is building from international studies that investment in HIV and AIDS education and prevention, and in ARV therapy offers clear financial benefits to organizations.

Best practice in HIV AND AIDS workplace policies and programs
27 The best workplace policies clearly define the management of HIV and AIDS infection and prevention. This means they include the following:

• fundamental policy commitments
• compassionate message and assurance of non-discrimination
• education and prevention programs
• participatory process
• compliance with local law.

These issues are explained in the following paragraphs.

Fundamental policy commitments
28 Best practice among most international organizations in addressing the problems of HIV and AIDS in the workplace typically incorporates the following principles:

• no pre-employment screening for HIV and AIDS;
• voluntary HIV and AIDS testing available, counseling encouraged and confidentiality assured;
• no termination of staff members who disclose positive HIV or AIDS status, provided they are physically capable of continuing to work;
• provision of health insurance benefits for all staff with HIV and AIDS, irrespective of location or employment status;
• access to HAART for all staff with HIV and AIDS, irrespective of location and employment status; and
• peer counseling provided within the organization.

Compassionate message and assurance of non-discrimination
29 In one form or another, effective programs emphasize an organization’s understanding and commitment to ensuring a supportive environment for individuals affected by HIV and AIDS. In terms of ongoing employment, this includes treating people with HIV and AIDS on the same basis as those with other significant illnesses. That is, their ongoing employment is subject to their fitness to continue working, rather than the medical condition that affects their fitness.

Education and prevention programs
30 Education and prevention programs, essential to reduce the impact of HIV and AIDS in the workplace, are the wisest investments for Centers and, ideally, strive to induce behavior change. Educational programs take many forms, and resources are growing to develop appropriate programs worldwide. Many organizations find it necessary to begin with awareness programs designed to remove fears and prejudices associated with HIV and AIDS.

Support for the bereaved
31 The death of family and friends from AIDS-related causes has a significant impact on staff. Depending on local cultural practices, this may require increased time off for funerals and may cause financial stress for the bereaved staff member and family.

Participatory process
32 Successful HIV and AIDS programs integrate representatives from all levels of the organization in policy planning and implementation.

Compliance with local law
33 Employment policies always must consider national, regional and local laws and regulations. However, compliance with local law often requires setting only minimal standards and does not necessarily assure an appropriately compassionate, inclusive and non-discriminatory policy. As international organizations, Centers have to hold themselves to the highest standards.

WHAT DO THESE GUIDELINES PROVIDE?
Model Policy
34 The Model Policy suggests a broad policy statement focusing on policy issues for governing prevention and care of HIV and AIDS

Sample Practices
35 The sample practices provided in this section include:

• sample HIV and AIDS organizational action plan;
• the role of senior management;
• the role of HR;
• the role of line managers;
• model practice for education and prevention;
• voluntary confidential counseling and testing (VCCT) for HIV and AIDS;
• avoidance and control of workplace infection;
• travel and post-exposure prophylactic (PEP) kits.

Tips and Tools
36 The tips and tools provided in this section include:

• the impact of HIV and AIDS across geographic regions;
• sample policy statement on HIV and AIDS;
• sample information brochure on HIV and AIDS;
• Internet resources for HIV and AIDS management in the workplace;
• CGIAR resources for information on HIV and AIDS.

Acknowledgements
In preparing these guidelines we drew extensively on material published by UNAIDS as well as the existing policies and practices currently used by several CGIAR Centers for the prevention and care of HIV and AIDS. We particularly thank World Agroforestry Center (ICRAF) and the Centre for International Forestry Research (CIFOR) for the material they provided for inclusion in the Tips and Tools.

Significant input also came from:

• G&D Working Paper No. 28 “HIV/AIDS in the CGIAR: Model policies and practices”, Nancy J Allen, May 2001
• G&D Working Paper No. 38 “HIV/AIDS policy in the CGIAR Workplace: the challenge of implementation”, Nancy J Allen, October 2002
• Family Health International (FHI)
• The European Union’s Guidelines for developing a workplace policy and programme on HIV/AIDS and STDs. (March 1997)
• Charles Flexner, MD., (1998) Post Exposure Prophylaxis Revisited: New CDC Guidelines. Johns Hopkins University AIDS Service, Division of Infectious Diseases.

This project could never have been realized without G&D’s creative teamwork, bringing together the talents of Bob Moore, Emily Nwankwo, Hulda Mogaka, and Unni Vennemoe along with myself for content, and Nancy Hart, Joanne Morgante and Roberto Magini for editing, design and programming. I sincerely thank each for their artistry and sincere dedication to inclusion.

Vicki Wilde
Leader
CGIAR Gender & Diversity Program

© CGIAR Gender & Diversity Program 2006