Under new rules announced by the Department of Health in August, healthcare workers with HIV will be allowed to undertake all procedures if they are on an effective combination of anti-retroviral drug therapy.
Professor Dame Sally Davies, England’s chief medical officer, celebrated the news. For her, many of the UK’s HIV policies were designed in the 1980s and had been left behind by scientific advances and effective treatments. According to her, “the risk to patients is ‘negligible’ now and HIV positive people will be able to partake in a number of tasks, including dentistry and surgery”.
The recent announcement is just one positive development in the many battles against discrimination that people living with HIV and organisations and individuals supporting them have fought over the years. For many, working in a fair, non-discriminatory environment, or even finding a job, has not been easy.
Nearly a decade ago, Malcolm Bryant, who now works as a lawyer in the Ministry of Justice, was applying for new jobs. He had been diagnosed HIV positive a few months earlier and felt somewhat uncomfortable coming out in the open about his condition. When one of his applications required him to be specific about any medical conditions he might have, he decided to reveal he was HIV positive.
The recruiters asked him for a face to face meeting and then to bring a doctor’s letter providing more information about his condition. Three weeks later they offered him the job. “There seemed to be a delay in my start date compared to other new recruits with whom I had the interview; that always made me feel a bit behind. That was the first time I felt I was treated slightly differently,” he remembers.
Malcolm’s anecdote is just one among many. Although HIV stories are not as frequent in the media as they were decades ago and awareness campaigns do not seem to be as visible as they used to be, it does not mean that people living with HIV do not face day-to-day challenges when it comes to discrimination in their workplaces. Lack of knowledge, prejudices and uneasiness with the stigma that was associated with HIV in the 80s are some of the factors that can still lead to discriminatory practices.
In 2009, the National Aids Trust (NAT) carried out research in partnership with City University, which included a survey of over 18,000 HIV positive gay men in employment. Over half of the respondents, employed across a diverse range of sectors, testified that HIV had no impact on their working life.
The most recent development in UK national legislation regarding disabled people and people with AIDS is the Equality Act 2010, which replaced the Disability Discrimination Act 1995 and 2005. Under the Equality Act, it is now illegal for employers to ask people to disclose their health status before they have been offered a job.
Furthermore, the act protects anyone who has, or has had, a disability, along with anyone being treated less favourably because they are linked or associated with a disabled person. The act defines a disabled person as “someone who has a physical or mental impairment, which has substantial and long-term adverse effect on their ability to carry out normal day-to-day activities”.
An additional development concerns the ban on direct discrimination; the previous law protected disabled people when the discrimination was taking place in the workplace. Now, the ban on discrimination applies to other areas such as access to goods and services.
Discrimination comes in many forms
Jackie Redding, spokesperson for the Terrence Higgins Trust (THT), a charity providing HIV and sexual health services in the UK since the 80s, explained to Safety Management the various types of discrimination that may occur in working life. “Direct discrimination is when someone treats a person less favourably than others on the grounds of their medical status. Indirect discrimination occurs when someone, for example an employer, has a generic policy in place, which is applied to everyone, but in fact restricts a disabled person from undertaking a particular task.” She clarifies: “If there was a rule banning people from wearing something on their head, then this would be indirect discrimination against Muslim women.”
Jackie defines associate discrimination as “a situation where an employer treats someone unfavourably because they are associated with someone who is protected under the Equality Act 2010. For example, if his or her son is homosexual or if people think he is. ”The act protects people from every form of discrimination by rendering unfavourable treatment of any sort as unlawful.”
Suzi Price, communications manager at NAT, refers to two other forms of discrimination, less known but equally significant. “It is illegal if a management practice or workplace policy results in unfavourable treatment of an individual member of staff living with someone with HIV for a reason connected to their HIV status; this is discrimination arising from disability.” As she clarifies, “this type of discrimination is similar to indirect discrimination but legally distinct from it; discrimination arising from disability only applies if the employer knows about the employee’s HIV status, and the policy deliberately aims at their unfavourable treatment”.
Suzi describes perceptive discrimination as a situation where “the employer treats someone differently assuming it is HIV positive, because, for instance, he or she is homosexual or coming from a country with a high HIV prevalence”.
The 11ft tall ‘Tay’, the UK’s first AIDS memorial in Brighton. Photograph: Dominic Alves
There are some actions that employers need to implement in order to create a discrimination-free working environment, when there are HIV positive people among the staff. The employer needs to ensure that the workplace provides a supportive environment for people living with disability, and especially with AIDS.
Therefore, the first step for the employer is to familiarise themselves, if they have not done so, with the Equality Act 2010. Furthermore, an employer has to make some ‘reasonable adjustments’ to accommodate HIV positive people. NAT describes reasonable adjustments as “those changes to the workplaces or the work practices, which remove a substantial disadvantage that a disabled person might experience because of their disability”.
Malcolm explains that people with HIV need to take some time off work for hospital visits and medication treatments, so employers need to give allowances and make adjustments, such as flexible hours or some leave for a clinic appointment. “Surely that is a better way of managing staff, rather than having people taking time off sick due to stress or due to their face blotches after a medication treatment,” he says. Malcolm would urge all employers to check their procedures and also make sure that during the recruitment process they do not put off applicants by being too intrusive with questions about their health.
But he also thinks it is convenient for colleagues and members of staff to be aware of HIV positive employees’ health condition. “People are not as obsessive now and they understand the implications of one’s condition,” he says. “If your colleagues are not aware then you keep wondering ‘What if I cut myself and someone comes to help me?’ It is very relieving to know that people know.”
Side effects of medication is another aspect that employers need to take into account when they manage HIV-positive people. Side effects can include fatigue, nausea, sleep disturbance and diarrhoea, which sometime require additional reasonable adjustments at work.
Actual risk of transmission
According to the NHS, the body fluids that contain enough HIV to infect someone are semen, vaginal fluids, breast milk, blood and lining inside the anus. HIV cannot be transmitted through spitting, contact with unbroken, healthy skin, being sneezed on, sharing towels or crockery or mouth-to-mouth resuscitation.
THT explains that the actual risk of transmitting HIV in the workplace is minimal. This is because HIV is very fragile outside of the body and dies very quickly in the air. The infected bodily fluid would need to get into an open and bleeding wound in order to infect a person. If the wound is not bleeding, it is sealed; nothing can get into it. Also, if the wound is bleeding out then it’s very hard for any fluid to get in.
HIV cannot be transmitted via anything other than bodily fluid, so there is no risk around food preparation or sharing cups or crockery.
Employers working on awareness and prevention
In 2001, L’Oréal Group, in partnership with UNESCO, initiated a preventive education programme, called ‘Hairdressers against AIDS’. The programme has spread over 36 countries and reached out to more than 1.5m hairdressers so far. The programme was born in South Africa, where AIDS is a prevalent issue and a safety risk for the industry. The official launch of the campaign was in 2005, when UNESCO put together a questionnaire and a film to be incorporated into all education and training of potential hairdressers. The Group paid for part of the course.
L’Oréal has also created an activity-based day on 1 December and has developed a fund, the profits of which go to charities such as the NAT and Children with AIDS. The group also uses the red ribbon (universal symbol of AIDS awareness) as its badge and distributes it to all staff, in all events.
Naomi Scroggins, communications director, L’Oréal Professional Products (UK), feels proud of the work done by the group worldwide: “If we could just touch people and remind them that HIV is still around, that would be good for us, it is our way of helping to create awareness and accordingly help those who live with AIDS.”
Employers’ duties (guidelines from Terrence Higgins Trust)
- Ensure there is a robust policy for supporting people who have chronic conditions, including HIV
- Ensure that all staff have information and training around HIV
- Support staff who have HIV if they choose to disclose it, and deal with inappropriate behaviour and comments robustly
- Respect people’s right not to disclose
- Help end stigma and discrimination by supporting World AIDS Day (1 December).
HSE guidance on managing incidences of blood-borne viruses at work can be found at the HSE Website.
With thanks to The British Safety Council