"When operating in countries with a high prevalence of HIV/AIDS and poor health care systems, how does business implement an effective and responsible disease management programme that respects the right to privacy and ensures non-discrimination against employees?"

HIV/AIDS management programmes and implementation dilemmas

Many of the countries with a high prevalence of HIV/AIDS are also characterised by relatively weak socio-economic conditions, as well as poor public services. Within such contexts, and faced with the alternative of losing valuable employees and working time to the disease, multi-national companies will often choose to take their own steps to protect and treat their employees through their own in-house HIV/AIDS management programmes.

How are such programmes best governed so that the privacy of employees is respected in the context of duty of care in the work place and so discrimination is prevented?

Balancing testing against individual rights

A key to the success of such programmes is confidential HIV/AIDS testing supported by counselling. This lets those living with HIV/AIDS know their status, giving them the opportunity to change behaviours and to seek counselling and treatment from their employer.

It is in the interest of companies to identify all such persons in order to enhance the effectiveness of their HIV/AIDS management programmes and to optimise the protection of their workforce. Nonetheless, this must be balanced against some key human rights considerations, which also have serious implications for the effectiveness of any HIV/AIDS management programme:

• Privacy: The serious and deeply personal nature of HIV/AIDS testing results means that due consideration should be given to an individual's ability to control the use of such information. In addition, respect for individual privacy will make it more likely employees will submit themselves for testing. It will then be up to them as to whether they inform their employer of their status.
• Confidentiality: If an employee elects to inform their employer of their status, due consideration should then be given to ensuring information is only used for the provision of appropriate counselling and treatment, and is otherwise kept confidential. Stigma and discrimination (see below) mean that many people will only inform their employer of their status if such protection is in place.
• Discrimination: The nature of HIV/AIDS means it is often surrounded by stigma and can frequently lead to discrimination within the workplace – whether by employers or colleagues. Aside from a company's usual duties to protect its employees from discrimination, this is also vital to encourage openness and transparency around HIV/AIDS, so that employees are forthcoming about their status and are not inhibited from pursuing counselling and treatment.

As a result, a sensitive and nuanced approach is advised when pursuing company HIV/AIDS management programmes. This is not only to protect the human rights of employees, but also in order to ensure long term success in helping curb the spread and impact of HIV/AIDS.

Real world examples

SABMiller, BMW South Africa, Standard Bank and others include confidentiality requirements in policies

A number of South Africa-based companies including SABMiller, BMW South Africa and Standard Bank include strict confidentiality measures in their HIV/AIDS policies. These include measures to allow the disclosure of HIV/AIDS-related information with the written and informed consent of employees only, strong disciplinary measures for breaches of confidentiality by medical staff and the use of third party service providers to ensure testing is carried out 'at arm's length'.

South African company boosts numbers of volunteers for testing by dispelling discrimination fears

An anonymous case study cited by the South African Business Coalition on HIV/AIDS (SABCOHA) found that at one company, not one of 330 employees participated in an anonymous HIV/AIDS surveillance testing programme. Upon investigation, the company found employees did not understand why the results would be of benefit to them. They were also suspicious about managers' motives for the testing - including rumours that it could be in order to replace African workers by those from other ethnic groups.

All employees were subsequently offered an education programme framed within the health and safety context. Prevalence testing was then re-launched, with more than 95% of all employees providing saliva samples and survey responses.1

SABMiller promotes prevention and tackles discrimination/stigmatisation through peer-education

South African brewer SABMiller has piloted Wellness Development Programmes in Botswana, South Africa, Swaziland and Tanzania – focused on HIV/AIDS, malaria, STDs, hepatitis and tuberculosis. Under the programme the company trains its employees to be peer educators – who then engage with their colleagues and the wider community to promote prevention, testing and treatment. According to the company, this has proven effective in reducing stigmatisation and increasing voluntary counselling and testing. By March 2013, the company had 1,733 HIV/AIDS peer educators – one for every 12 employees in high prevalence countries (i.e. >5% prevalence).2

• For examples of how multi-national companies such as De Beers, Coca-Cola, Standard Chartered and others have also addressed such dilemmas through measures including comprehensive HIV/AIDS policies and de-stigmatisation programmes, see:
• HIV/AIDS case studies
• Please contribute your commentary or suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

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HIV/AIDS prevalence

Over the last 25 years, HIV has spread from a few locations to become a truly global challenge. According to UNAIDS, at the end of 2012 (latest figures) there were an estimated 35.3 million people living with HIV globally. In the same year, the number of new infections stood at an estimated 2.3 million (33% lower than in 2001).3

Despite the global nature of the epidemic, sub-Saharan Africa stands out as the worst affected region. In 2012, it accounted for an estimated 70% of all new infections, although this does represent a decline of the annual number of new infections by 34% since 2001. The region had the highest estimated HIV prevalence rate of all regions - 4.7% for adults aged between 15 and 49 and an estimated 25 million people living with HIV. Approximately 1.2 million died from AIDS in 2012. The worst-hit countries are all located in southern Africa, including:

• Swaziland (26.5% adult prevalence rate)
• Botswana (23%)
• Lesotho (23.1%)
• South Africa (17.9%)
• Zimbabwe (14.7%)
• Namibia (13.3%)
• Zambia (12.7%)4

Other emerging market countries (i.e. BRICs and N11 countries) or key sourcing countries, with relatively high prevalence rates (i.e. 0.5% or above) include:

• Cambodia (0.8%)
• Myanmar (0.6%)
• Malaysia (0.4%)
• Nigeria (3.1%)
• Viet Nam (0.4%)5

Whilst companies operating in such countries will not face the same magnitude of challenge as in southern Africa, circumstances will mean that a degree of HIV/AIDS management will be required. Sub-national rates of HIV/AIDS vary considerably and prevalence is generally higher around truck routes, border crossings and ports for example.

HIV/AIDS and business

The global nature of the challenge means it is likely that most multi-national companies will be impacted by HIV/AIDS in some shape or form. Aside from the impact HIV/AIDS is having on local consumer bases and the communities in which companies operate, the most direct impact is upon the workforce - from junior employees to senior managers.

HIV/AIDS is already having significant negative effects on certain industries in high-prevalence countries. These industries are particularly vulnerable where they have highly mobile workers that interact with local populations, are heavily reliant on the accumulated skills of their employees, and where workers live and work away from their families.

Examples include the following:

• Logistics and transportation
• Mining
• Manufacturing
• Building and construction
• Agribusiness

For example, research in South Africa cited by the South African Business Coalition on HIV & AIDS (SABCOHA) shows that the mining, metals processing, agribusiness and transport sectors are most affected, with more than 23% of employees infected with HIV/AIDS. These sectors show prevalence rates two to three times higher among skilled and unskilled workers than among supervisors and managers.6

HIV/AIDS management programmes

In such scenarios, the state may already provide high levels of care, education and support to its citizens. This is not always the case, however, and there can be stigma associated with participating in public programmes. Nonetheless, in many cases companies will choose to provide their own HIV/AIDS management programmes in order to protect their workforce - particularly where public providers lack the capacity or resources to do so effectively themselves or where public providers are located at a distance.

Different elements of a company HIV/AIDS management programme may include:

• Care and support, including psychosocial support and treatment for 'opportunistic infections'
• HIV prevention, including education, behavioural change, stigma reduction and access to condoms
• HIV testing and counselling, including confidential voluntary counselling and testing (VCT) testing undertaken with the informed consent of the subject
• HIV treatment, including the provision of anti-retroviral treatment (ART)7

As noted above, VCT forms a key part of almost all HIV/AIDS management programmes - whether public or private. The identification of those who are living with HIV/AIDS is essential for the effective provision of ART and care. This is particularly the case given that many people will not be aware that they are infected in the first place.

Given the stigma surrounding HIV/AIDS, the willingness of people to submit themselves for VCT will be highly dependent upon their faith in:

• The confidentiality of their HIV status
• Not facing discrimination within the workplace

As a result, the creation of a non-discriminatory and stigma-free work environment, in which the privacy of the individual is fully protected, is essential for a successful HIV/AIDS programme. In addition, it will help ensure that companies do not violate the right of employees to be free of discrimination whilst implementing effective HIV/AIDS management programmes.

The ILO Code of Practice on HIV/AIDS and the World of Work contains 10 key principles to help guide companies approaches to HIV/AIDS in the workplace.

Relevant principles relating to this dilemma include the following:

• "HIV/AIDS is a workplace issue, and should be treated like any other serious illness/condition in the workplace
• In the spirit of decent work and respect for the human rights and dignity of persons infected or affected by HIV/AIDS, there should be no discrimination against workers on the basis of real or perceived HIV status
• HIV/AIDS screening should not be required of job applicants or persons in employment
• There is no justification for asking job applicants or workers to disclose HIV-related personal information. Nor should co-workers be obliged to reveal such personal information about fellow workers. Access to personal data relating to a worker's HIV status should be bound by the rules of confidentiality consistent with the ILO's code of practice on the protection of workers' personal data, 1997
• HIV infection is not a cause for termination of employment. As with many other conditions, persons with HIV-related illnesses should be able to work for as long as medically fit in available, appropriate work"

In addition, the ILO's Recommendation Concerning HIV and AIDS and the World of Work, 2010 (No. 200) builds on these principles, noting that (amongst other things):

• "There should be no discrimination against or stigmatization of workers, in particular jobseekers and job applicants, on the grounds of real or perceived HIV status or the fact that they belong to regions of the world or segments of the population perceived to be at greater risk of or more vulnerable to HIV infection"
• "Workers, their families and their dependants should have access to and benefit from prevention, treatment, care and support in relation to HIV and AIDS, and the workplace should play a role in facilitating access to these services"
• "Workers, their families and their dependants should enjoy protection of their privacy, including confidentiality related to HIV and AIDS, in particular with regard to their own HIV status"
• "No workers should be required to undertake an HIV test or disclose their HIV status"8

In addition, the recommendation provides more specific guidance with respect to discrimination and confidentiality, including the following principles:

• Real or perceived HIV status should not be a cause for termination of employment – and temporary absence from work due to illness or care-giving should be treated in the same way as any other health absence
• Those with HIV-related illness should "not be denied the possibility of continuing to carry out their work, with reasonable accommodation if necessary, for as long as they are medically fit to do so" and redeployment, training and facilitation of return should be encouraged to support this goal
• Testing should be entirely voluntary and testing programme must respect international guidelines on confidentiality, counselling and consent
• HIV testing (or related forms of screening) should not be required of current/potential workers
• Testing results should be confidential and should not affect access to employment, job security or career development9

Stigma and discrimination

HIV/AIDS has a significant stigma attached to it. This is often due to entrenched cultural values, human psychology and a lack of education about the realities of HIV/AIDS.

Stigma can be particularly strong in relation to those living with the disease due to its perceived association with:

• Drug use
• Sex work
• Homosexual practices
• Vulnerable social groups including women and migrants

Stigma interacts with peoples' fear of infection, as well as high mortality rates, to give rise to discrimination - both within society generally, and within the workplace. For example, teams of employees may reject individuals who they know or suspect to be living with HIV/AIDS on the grounds of personal prejudice or (often unfounded) fears about the potential health and safety implications of working closely with one another.

Workplace discrimination can also take place at an institutional level. The infection of an employee with HIV/AIDS has potentially significant financial and organisational implications for their employer (see below). This being the case, companies may in some cases be tempted to avoid employing those with HIV/AIDS, manipulating their exit or denying them benefits or promotions otherwise available to their colleagues.

Typical forms of workplace discrimination include:

• Denial of employment based on HIV-positive status
• Compulsory HIV testing
• Exclusion of HIV-positive individuals from pension schemes or medical benefits10
• Reduced opportunities for career development and promotion for HIV-positive individuals
• Targeted retrenchment of HIV-positive employees

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Examples of scenarios companies might face when operating in emerging economies include:

China: According to UNAIDS, China has an adult HIV prevalence rate of 0.1% - or 730,000 people (2014 latest figures).11 By the end of 2014, there were 501,000 reported cases of people living HIV/AIDS, with sexual transmission the primary means of infection. Although national prevalence is low, the government reports "higher-prevalence" in some areas and among some groups. For example, in 2014, 83.5% of the total number of cases of people living with HIV/AIDS reported nationwide were recorded in just 12 provinces, including Beijing.

Between 2010 and 2014, the number of reported HIV/AIDS cases (including those living with HIV who subsequently developed AIDS) rose from 96,000 to 205,000 – whilst deaths rose from 16,000 to 21,000.12 According to the US Department of State, despite protections offered by the Employment Promotion Law, discrimination remains widespread (affecting, in some cases, whether patients receive treatment at hospital). In May 2013, Guangdong was the first province to end HIV testing for teachers. In most provinces, persons with HIV are disqualified from civil service jobs, including teaching and policing, and candidates are subject to mandatory testing.13

Egypt: The adult prevalence rate in Egypt is less than 0.1% (2014 latest figures) - equivalent to around 8,800 adults.14 The authorities report that prevalence is high amongst men who have sex with men (with rates for this demographic at 5.7% in Cairo and 5.9% in Alexandria) and injecting drugs users (with rates for this demographic at 6.8% in Cairo and 6.5% in Alexandria).15 UNAIDS reported in 2014 that there were positive developments in the country's implementation of prevention programmes, specifically those targeted at people injecting drugs and men who have sex with men. Homosexuals and persons with HIV/AIDS face significant social stigma both in society and the workplace. In an April 2007 report, Concluding observations of the Committee on the Protection of the Rights of All Migrant Workers and Members of Their Families, the UN Committee on Migrant Workers reports that foreign migrant workers seeking permission to work in Egypt must provide a certificate proving that they do not carry HIV/AIDS.16 This contravenes the ILO Code of practice on HIV/AIDS and the world of work. Although the law does not explicitly criminalise homosexual acts, police arrest homosexuals and persons with HIV/AIDS on charges of "debauchery."

India: The estimated HIV adult prevalence rate is 0.3% (2012 latest figures) – equivalent to 2.6 million people.17 Cases are concentrated in a relatively small number of states, with the southern states of Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu accounting for 55% of all HIV infections. Sex workers (and those who participate in unprotected sex with them) and injecting drugs users suffer particularly high prevalence rates. Relatively conservative sexual mores in the wider population are reportedly stemming the spread of the epidemic in the wider population.18 The US Department of State quotes the ILO in 2012 as saying that as many as 70% of those with HIV/AIDS faced discrimination in India. According to social activists, such individuals claimed they were being denied basic rights with respect to education, employment and nutrition.19

Indonesia: The adult prevalence rate in Indonesia is 0.50% - equivalent to 660,000 people (2014 latest figures).20 Key affected populations include injecting drug users and those partaking in unsafe sexual practices.21 According to the US Department of State, stigma and discrimination against those with HIV/AIDS is "pervasive". Although official policy encourages tolerance – it is not always adhered to. According to NGO reports, mandatory testing of job applicants occurred and some employees were dismissed on grounds of their HIV- status.22

Mexico: The adult prevalence rate in Mexico is 0.20% - equivalent to 190,000 people (2014 latest figures).23 According to the International HIV/AIDS Alliance, "HIV-related stigma and discrimination have a serious impact" – with (amongst other things) people with HIV being denied jobs. The rate of infection is reported to be highest among marginalised groups that include sex workers, men who have sex with me and transgender people.24

Nigeria: The adult prevalence rate in Nigeria is 3.2% - equivalent to 3.4 million people (2014 latest figures).25 According to the government, this means it has the second highest HIV/AIDS burden in the world. Although high risk demographic groups contribute to the spread of HIV, ‘low risk' heterosexual sex accounts for around 80% of infections. Mother-to-child transmission and unsafe blood transfusions are believed to be the next most common means of infection.26 Geographically, HIV prevalence was highest in the South South zone and is increasing: it was measured at 3.5% in 2007 and 5.5% in 2012. There is widespread discrimination against those with HIV/AIDS, which is often considered by society as a disease resulting from 'immoral' behaviour – and as a ‘punishment' for homosexuality in particular. Persons with HIV often lose their jobs or are denied health care services as a result of their status.27 Such discrimination is believed to be undermining efforts to provide effective prevention education, diagnosis, and treatment.

Russia: The adult prevalence rate in Russia is estimated at between 0.80%-1.40% - equivalent to 730,000-1.3 million people (2014 latest figures).28 According to the US Department of State, those with HIV/AIDS often encounter discrimination. Although there is a federal law in place that includes anti-discrimination measures, its provisions do not appear to be rigorously enforced – with infected individuals faced discrimination within their families, employers and medical service providers.29 In 2014, the Supreme Court upheld a law prohibiting persons with HIV from adopting, on the grounds that they might infect the adoptee. By law, foreign citizens who are HIV positive can be deported.

South Africa: The adult prevalence rate in South Africa is 18.9% - equivalent to 6.8m people (2014 latest figures).30 This means it has the largest national epidemic in the world. HIV is one of the primary causes of death in South Africa and there are 2.3 million orphans aged 0 to 17 years due to AIDS. The country has developed a National Strategic Plan for STIs, HIV and TB for 2012-2016 – which places particular focus on vulnerable populations such as young women, those living close to national roads and in informal settlements, people from low socio-economic groups – as well as more ‘traditional' high-risk demographic groups.31 Social stigma around HIV/AIDS is believed to be in decline due to the availability of ART treatments that are helping prolong the lives of infected people – as well as proactive de-stigmatisation campaigns driven by a range of stakeholders.32 The country has focused heavily on rolling out ART treatment to infected individuals – and has one of the largest ART programmes in the world with around 2 million participants. This has had a material impact on stemming the number of HIV/AIDS-related deaths. In August 2013, Health Minister Aaron Motsoaledi was quoted as saying "We know it is a long way, still quite a journey, but we've definitely turned the corner".33

Viet Nam: The adult prevalence rate in Viet Nam is 0.5% - equivalent to 250,000 people (2014 latest figures).34 According to the government, the epidemic remains relatively ‘concentrated' with high prevalence rates amongst men who have sex with men (3.7%), injecting drug users (10.3%) and female sex workers (2.6%) – with many of these groups heavily focused on the country's urban centres.35 Vietnam's government is committed to eradicating AIDS by 2030. According to the US Department of State, the law protects those with HIV/AIDS from unfair dismissal and doctors may not refuse treatment on grounds of HIV status. However societal discrimination continues to affect victims of HIV in practice and can restrict their access to effective treatment. 36

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General HIV/AIDS risks

Because stigma and discrimination have such a direct impact on the effectiveness of companies' HIV/AIDS management programmes, the risks posed by failing to address these issues are essentially the same as for HIV/AIDS itself. These include:

• The loss of valuable human skills as a result of HIV/AIDS-related deaths
• Reduced workforce productivity as a result of HIV/AIDS-related illnesses
• Increased safety risks as a result of psycho-emotional stress, as well as potential transmission of HIV/AIDS between workers
• Increased absenteeism as a result of illness, family demands (such as taking time off to care for sick members of the family) or mourning
• High healthcare and insurance costs as a results of HIV/AIDS and linked conditions/diseases
• Increased labour costs as a result of HIV/AIDS-related death and retirement benefits
• Increased recruitment and training costs in order to find replacement skills/talent

For example, Brian Brink – chief medical officer at Anglo American – is quoted as saying that the company's US$10 million annual expenditure on ARTs has tangible commercial benefits. This includes a reduction of absenteeism of 1.9 days per month, reduced turnover and a reduction in use of the company's in-house medical services. Per individual, it is calculated that the total savings amount to US$219 per month – 174% of the cost of providing ART treatment to each individual per month (US$126).37

Similarly, IBM South Africa has estimated that the successful implementation of a treatment programme could avert 42% of US$10.6 million in HIV/AIDS related expenses over 10 years. The company estimated the costs associated with the death of an employee in South Africa from AIDS as being:

• US$4,700 in skills development
• Average pension and death benefits of US$100,000
• 25% lower productivity while in the symptomatic stages of the disease38

Specific HIV/AIDS risks

Aside from undermining effective HIV/AIDS management programmes, discrimination on the basis of HIV status can entail many of the risks associated with any form of serious discrimination. These include, for example, reputational damage, which has the potential to be particularly compelling given the well-publicised and very serious human challenge posed by HIV/AIDS. This has the potential to affect:

• Consumer demand
• Employee recruitment and retention
• Investor interests, particularly amongst ethical investors

According to the ILO, the ILO Discrimination (Employment and Occupation) Convention, 1958 (No.111) may be used in cases of discrimination related to HIV status.39 As a result, relevant legislation is likely to be in place in many jurisdictions that provide for legal sanctions against companies unfairly discriminating against their employees - whether on the grounds of their actual or perceived HIV status, or otherwise.

For example, in January 2009 a former soldier sued US private security company Triple Canopy after he was ejected from its training programme in November 2005 and told that the company's government contract required that employees have no contagious diseases.40

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For a company to address responsibly HIV/AIDS within its workforce, it should first look to comply with relevant national laws. Where national laws are set lower than international standards on HIV/AIDS, privacy, confidentiality and discrimination, then companies should strive to meet these higher standards.

According to the UN ‘Protect, Respect and Remedy' policy framework41 as updated and elaborated last year in the Guiding Principles for the Implementation of the UN ‘Protect, Respect and Remedy' Framework42, businesses have a responsibility to respect all human rights. This responsibility requires businesses to refrain from violating the rights of others and to address any adverse human rights impacts of their operations.

To meet this responsibility to respect human rights, the framework notes that a responsible company should engage in human rights due diligence43 to a level commensurate with the risk of infringements posed by the country context in which a company operates, its own business activities and the relationships associated with those activities.44

The framework, as clarified by the Guiding Principles, specifies the main components of human rights due diligence:

• A policy statement articulating the company's commitment to respect human rights and providing guidance as to the specific actions to be taken to give this commitment meaning: This policy should be informed by appropriate internal and external expertise and identify what the company expects of its personnel and business partners. The policy should be approved at the most senior level and communicated internally and externally to all personnel, business partners and relevant stakeholders. In addition, it should be reflected in appropriate operational policies and procedures
• Periodic assessment of actual and potential human rights impacts of company activities and relationships: Human rights due diligence will vary in scope and complexity according to the size of a company, the severity of its human rights risks and the context of its operations. Impact assessment must be continuous, recognising that human rights risks may change over time as companies' operations and operating contexts evolve. The process should draw on internal and external human rights experts and resources. Furthermore, it should involve meaningful engagement with potentially affected individuals and groups, as well as other relevant stakeholders
• Integration of these commitments into internal control and oversight systems: Effective integration requires the responsibility for addressing the impacts by assigning it to the appropriate structures of the company. It also requires appropriate internal decision-making mechanisms, budget allocation and oversight processes
• Tracking of performance: Tracking of performance should be based on appropriate qualitative and quantitative metrics and should draw on feedback from both internal and external stakeholders. In addition, it should inform and support continuous improvement
• Public and regular reporting on performance: When reporting, companies should take into account the risks the communication of certain information may pose to stakeholders themselves, or to company personnel. In addition, the content of the reports should be subject to the legitimate requirements of commercial confidentiality
• Remediation: Where business enterprises identify responsibility for adverse impacts, they should cooperate will all relevant stakeholders in their remediation through legitimate processes

While designing its Human Rights Impact Assessment, businesses may wish to consult existing guidance documents, such as the International Finance Corporation (IFC), UN Global Compact and International Business Leaders Forum's (IBLF) Guide to Human Rights Impact Assessment and Management.45 This latter guide provides companies with a ‘process to assess their business risks, enhance their due diligence procedures and effectively manage their human rights challenges.' The online guide takes users through different stages of the impact assessment process, including Preparation, Identification, Engagement, Assessment, Mitigation, Management and Evaluation.

In addition, the ILO has developed a document providing comprehensive guidance on managing HIV/AIDS within the workplace. The ILO Code of Practice on HIV/AIDS and the World of Work46 addresses a wide range of issues, including non-discrimination and confidentiality.

Related actions recommended for employers and their organisations relate to:

• Workplace policies
• National, sectoral and workplace/enterprise agreements
• Education and training
• Personnel policies
• Grievance and disciplinary procedures
• Confidentiality
• Reasonable accommodation
• Support for confidential voluntary HIV counselling and testing

The ILO has also developed Implementing the ILO Code of Practice on HIV/AIDS and the world of work: an education and training manual to accompany the Code and guide its application.47 Relevant modules include those relating to:

• HIV/AIDS and human rights
• The gender dimensions of HIV/AIDS and the world of work
• Workplace programmes for HIV/AIDS prevention

• Care and support

UNAIDS and the International Organisation of Employers has also developed the Employers' Handbook on HIV/AIDS, which provides guidance on (amongst other things):

• Developing an HIV/AIDS policy
• Providing HIV-prevention education in the workplace
• Providing care, support and treatment
• Implementing fair employment practices48

A further resource has been developed by the Global Business Coalition and IFC, called Fighting HIV/AIDS in the Workplace: A Company Management Guide. This provides guidance on:

• Identifying/engaging stakeholders to develop collaborative HIV/AIDS strategies
• Establishing the key components and management structures needed for an effective response to HIV/AIDS
• Implementing a programme suitable for the targeted population through risk-based methodologies
• Awareness-raising, education and prevention within the workplace – as well as de-stigmatisation49

In addition to this guidance, further suggestions for responsible businesses include the following:50

1. Develop appropriate HIV/AIDS policies

Companies should consider committing themselves to a clear policy on HIV/AIDS that explicitly addresses (amongst other things):

• The protection of employee confidentially in the context of internal HIV/AIDS testing and/or management programmes
• Non-discrimination against those who have been identified as having HIV or who belong to a group considered to be at higher risk of HIV than others

For example, the IFC has an extensive Good Practice Note on HIV/AIDS in the Workplace, which includes a boilerplate policy. Amongst other things, this states that the company will:

• Treat HIV/AIDS the same as other life-threatening illnesses and handicaps in terms of policies and benefits where they apply
• Not discriminate against a qualified individual with regard to job application, hiring, advancement, discharge, compensation, and other factors
• Recognise that an employee with HIV/AIDS may wish to continue in as many of their normal pursuits as their illness allows, including work
• Be supportive of and make reasonable accommodation for the employee who is medically able to perform their job
• Treat employees' medical information as confidential

The IFC notes that a balance must be struck, however, with the company's obligation to provide a safe work environment for all employees. It likewise commits the company to be sensitive to co-worker's concerns and to put emphasis on educating employees about HIV/AIDS.51

According to the ILO Code of Practice on HIV/AIDS and the World of Work, employers should: "consult with workers and their representatives to develop and implement an appropriate policy for their workplace, designed to prevent the spread of the infection and protect all workers from discrimination related to HIV/AIDS." In addition, the Code recommends that: "Employers should not engage in nor permit any personnel policy or practice that discriminates against workers infected with or affected by HIV/AIDS."

More specifically, this means employers should:

• "not require HIV/AIDS screening or testing unless otherwise specified in section 8 of this code (e.g. VCT);
• ensure that work is performed free of discrimination or stigmatisation based on perceived or real HIV status;
• encourage persons with HIV and AIDS-related illnesses to work as long as medically fit for appropriate work; and
• provide that, where a worker with an AIDS-related condition is too ill to continue to work and where alternative working arrangements including extended sick leave have been exhausted, the employment relationship may cease in accordance with anti-discrimination and labour laws and respect for general procedures and full benefits."52

The ILO advises that a workplace policy provides "the framework for action to reduce the spread of HIV/AIDS and manage its impact".53 In particular, the ILO notes that a policy:

• Makes an explicit commitment to corporate action
• Ensures consistency with appropriate national laws
• Lays down a standard of behaviour for all employees (whether infected or not)

• Gives guidance to supervisors and managers

• Helps employees living with HIV/AIDS to understand what support and care they will receive, so they are more likely to come forward for voluntary testing
• Helps to stop the spread of the virus through prevention programmes
• Assists an enterprise to plan for HIV/AIDS and manage its impact, so ultimately saving money

For example, pharmaceutical company Pfizer provides an example of the kinds of measures that a company could consider in the development of their HIV/AIDS policy. Their policy includes provisions to ensure:

• Those who engage in HIV/AIDS-related harassment or discrimination will be subject to corrective discipline – potentially including termination of employment
• HIV/AIDS will be treated the same as any other illness in terms of employee policies, benefits, insurance, disability benefits and leaves of absence
• Reasonable accommodation is made for those with HIV/AIDS
• Routine testing and counselling is encouraged but not required – and that all results are confidential
• Employees, dependants, job applicants and other third parties are not required to undergo HIV testing as a condition of employment or receipt of benefits
• Pfizer is concerned about the wellness of colleagues and their families. Company-provided benefits and programs have an important role in preserving the dignity of those colleagues infected with or affected by HIV/AIDS. They serve to help them maintain normal and productive lives. The Company will provide, either directly or through third parties, an integrated education and awareness program focusing on prevention. Such programs, to be determined by global workplace sites, could include:

• Training is provided to managers and supervisors to communicate/ensure compliance with the policy – including medically accurate information on HIV/AIDS prevention and treatment – as well as voluntary HIV/AIDS testing, referral and counselling services54

One less obvious area in which policy can focus is on employee benefits. For example, a number of companies in South Africa have policies in place relating to non-discrimination with respect to retirement and life coverage. This includes Standard Bank, which states that the group retirement fund will not discriminate on the grounds of HIV status to the extent that all new employees join the fund regardless of their HIV status and enjoy retirement benefits. Benefits include life coverage, which is included under the group retirement fund - although not necessarily where an employee has a pre-existing condition when they join the fund (which may include HIV, if it is disclosed by the employee).55

• De Beers operates a strict policy of non-discrimination and confidentiality in order to ensure those infected do not suffer any further disadvantage with respect to their employment, working environment, career prospects or otherwise. See:
• De Beers Family of Companies (southern Africa) - in depth
• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

2. Adopt a responsible approach to testing

Although VCT forms an essential part of any HIV/AIDS management programme, companies should put in place certain restrictions in order to ensure testing does not undermine the human rights of employees.

For example, the ILO recommends that:

• HIV testing should not be required at the time of recruitment or as a condition of continued employment. Mandatory testing should also not be included in routine medical testing
• HIV testing should not be required for occupational and other insurance schemes and companies should not facilitate testing for insurance companies or share confidential testing information with them
• Any anonymous, unlinked surveillance or epidemiological HIV testing in the workplace should only be undertaken in accordance with the ethical principles of scientific research, professional ethics and the protection of individual rights and confidentiality. Employees should be consulted and informed it is occurring and the information should not be used to discriminate against individuals or groups
• VCT should normally be carried out by community health services rather than in the workplace. Where adequate medical services exist, VCT can be undertaken at the request and with the written informed consent of the employee, with advice from their representatives if requested56

ILO VCT@WORK Initiative (Mozambique) – According to UNAIDS, the HIV prevalence rate in Mozambique is 10.6%, the equivalent of 1.5 million people. The ILO states that Voluntary Counselling and Testing (VCT) is a key component in HIV prevention because it is the gateway to treatment, care and support, as well as behaviour change. In 2014, in order to embed VCT in businesses in Mozambique and ensure more people take HIV tests, the ILO began collaborating with partners from both the public and private sector, including the Business Coalition on HIV and AIDS (ECoSIDA), Mozambique Railways Company (CFM), the sugar industries, Mozambique Airlines, the Ministry of Health through its Provincial Directorates, the National AIDS Council (NAC), the Ministry of Transport, and the Ministry of Labour.57

Volkswagen do Brasil instituted an AIDS Care programme as early as 1996. In addition to treatment and care, the programme focuses on education and counselling, using a range of media including videos, radio, internal newspapers and the intranet. As part of the company's non-discrimination policy, assistance is given to those living with HIV to help them reintegrate into the workplace. Anti-discrimination measures prohibit mandatory testing, protect HIV-positive employees from dismissal and commit to the protection of confidentiality.58

Anglo American's VCT programme has been running more than a decade. In 2003, less than 10% of its staff based in southern Africa participated in VCT – but by 2010, 94% of staff were checking their status each year. If an employee tests positive they can enrol on the company's Wellness Programme and – when appropriate – receive ART treatment. In 2010, around 12,000 of the company's employees were HIV positive and 4,000 were receiving ART. VCT is at the cornerstone of Anglo American's HIV/AIDS programme because as soon as an employee tests HIV positive they can enrol in the HIV Wellness Programme and when appropriate, they can start receiving ART. This assists Anglo American in achieving its "three zeroes" goals: zero new infections; zero employees falling sick or dying from AIDS; and zero babies born HIV positive in employees' families.59

In December 2009, Brewer SABMiller extended HIV testing to the spouses of farmers in Uganda who provide the company with sorghum for their beer. This is in a context in which the company not only provides VCT, ART and condoms to its employees, but also to its supply chain, including truck drivers, farmers and bar staff. At the point of writing, a total of 4,800 people had been through HIV awareness training, and 29% of these had been tested.60

• De Beers has successfully promoted VCT (with an employee participation rate of 70% at the end of 2008) through de-stigmatisation, guaranteed confidentiality, annual testing campaigns and the offer of routine testing during medical consultations. See:
• De Beers Family of Companies (southern Africa) - in depth
• The International Council on Mining and Metals (ICMM) states that a key aim of any HIV/AIDs program is to ensure employees know their status. It emphasizes that VCT is central to channelling HIV-positive employees into treatment and care programs. See:
• International Council on Mining and Metals (ICMM)
• Dow Chemical has been commended by the Global Business Coalition (GBCHealth) for its workforce engagement programme in South Africa – which has helped it achieve a VCT participation rate of 90%. See:
• Dow Chemical (South Africa)
• Del Monte Kenya recognised by Global Business Coalition (GBCHealth) for its ongoing efforts to raise awareness, promote education and provide counselling on HIV/AIDS – including the delivery of free onsite testing. See:
• Del Monte Kenya (Kenya)
• Apollo Tyres commended by the Global Business Coalition (GBCHealth) for its programme targeting HIV/AIDS within India's trucking networks – including through the provision of clinic-based testing services. See:
• Apollo Tyres (India)
• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

3. Reduce stigma through education

Education and training can do much to tackle stigma and discrimination, and thus to encourage uptake of VCT.

The ILO Code of Practice on HIV/AIDS and the World of Work recommends that training should, amongst other things:

• Be based on consultation between employers and workers, their representatives and, where appropriate, government and other specialist stakeholders
• Emphasise that HIV cannot be contracted through casual contact, and that people who are HIV-positive do not need to be avoided or stigmatised, but rather should be supported and accommodated in the workplace
• Explain the debilitating effects of HIV/AIDS and the need for employees to show understanding and to not discriminate against colleagues living with HIV/AIDS
• Be sensitive as to gender, race and sexual orientation

In addition to formal training, many companies rely on peer education in order to tackle HIV/AIDS, as well as associated issues of stigma and discrimination. This is not only effective from a costs point of view, but many employees are more likely to engage in open dialogue about some of the sensitive issues surrounding HIV/AIDS when talking to peers rather than qualified specialists.

In Ghana, for example, Newmont Mining worked with its health service provider International SOS to implement a programme at its Ahafo gold mine in July 2005 to train employees and community members to act as peer educators. As the programme progressed, it switched to a peer-nomination process as this appeared to increase the willingness of workers to discuss HIV/AIDS related issues. New HIV infections fell from an average of four per month during the construction of the mine between 2005 and 2006 to two per month between January and September 2008. During the latter period, the programme educated 10,100 workers, distributed 30,250 condoms and encouraged 230 people to participate in VCT.61 The Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) recently recognized Newmont Ghana with its 2011 GBC Business Excellence Award: Workplace for combating HIV/AIDS, TB and/or malaria through a comprehensive, workforce-focused program.62An anonymous case study cited by SABCOHA found that not one of 330 employees turned up to an anonymous surveillance testing event prepared by a company's HIV/AIDS committee. Upon investigation, it was found that employees could not understand why the results would be of benefit to them, and were suspicious about managers' motives for the testing - including possible replacement of African workers by those from other ethnic groups. Employees were subsequently subject to an education programme framed within the health and safety context. Prevalence testing was then re-launched, with more than 95% of all employees provided saliva samples and survey responses.63

At Nedbank Group, they use a "holistic and inclusive wellness strategy covering lifestyle diseases and HIV/Aids". This includes a move away from exclusive HIV education and testing towards a more holistic health approach. In part, this is driven by a desire to normalise and destigmatise HIV/AIDS – and to expand the number of people taking part in overall health testing for blood pressure, cholesterol, glucose, body mass index and HIV. During the relevant defined reporting period (2012), 2,076 employees underwent comprehensive health testing – of which 1,337 chose to incorporate HIV testing into the process.64

• Standard Chartered is trying to reduce new HIV infections by reducing stigma amongst employees through 'HIV Champion'-led education, and amongst young people through its innovative online AntiHIVirus initiative. See:
  Standard Chartered (Global) - in depth
• Schlumberger prioritises training about HIV/AIDs in the approximately 85 countries where it operates. Training about HIV is mandatory for all Schlumberger employees who work in or visit high-risk HIV/AIDS countries. It occurs through online training and workshops for the local workforce and their families. See:
• Schlumberger (Global)
• The Global Business Coalition is working with a range of multi-national companies, including Anglo American, BP, Daimler, Eskom, LaFarge, Unilever, Volkswagen and others, to reduce stigma, tackle discrimination and raise awareness of HIV/AIDS through its membership pledge. See:
  Global Business Coalition (Global) - in depth
• Warner Bros. developed (with the U.S. President's Emergency Plan for AIDS Relief) an action-based video game to deliver HIV prevention messages to young people in East Africa.
• Warner Bros.(East Africa)
• Apollo Tyres was commended by the Global Business Coalition (GBCHealth) for its programme targeting HIV/AIDS within India's trucking networks – including through the provision of clinics, awareness-raising and peer education. See:
• Apollo Tyres (India)
• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

4. Train managers to address discrimination

The ILO recommends that managers, supervisors and personnel officers receive specific training (in addition to general education efforts to reduce stigma).

In particular, this includes training to:

• Enable them to explain and respond to questions about company HIV/AIDS policy
• Equip them with the information to help other employees overcome misconceptions about the spread of HIV/AIDS within the workplace
• Explain reasonable ways in which HIV-positive employees can be accommodated within the workplace
• Identify and address workplace behaviour, conduct or practices that discriminate or alienate HIV-positive workers
• Enable them to give advice on available health services and social benefits65

At Old Mutual training on HIV/AIDS includes specific components on employee rights. In addition, training provided to managers includes a focus on 'managing HIV-positive employees'.66 Where relevant, the training of managers should be supported by clear non-discrimination policies.

For example, under South African financial services company Nedcor's HIV/AIDS policy:

• Employees will not be dismissed based on their HIV status
• Prospective or existing employees will not be required to undergo HIV testing as a condition of the selection procedure for employment or job advancement
• There will be no discrimination in the allocation of employee benefits based on HIV status67

Levi Strauss & Co have developed a guide called Managing HIV/AIDS In The Workplace: A Guide For Managers And Their Teams, which includes content on how to ensure discrimination does not take place. It includes a number of practical, scenario-based case studies where this is a potential issue.68

• Chevron provides HIV/AIDS awareness training to employees globally. Training for Chevron managers is required and should be retaken every two years. Training includes modules on HIV/AIDS awareness and prevention, awareness of company HIV/AIDS Policy, and stigma reduction. See:
• HIV/AIDs Case Studies
• Please contribute your commentary or suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

5. Maintain confidentiality

According to the ILO Code of Practice on HIV/AIDS and the World of Work, employers should adhere to the following principle: "HIV/AIDS-related information of workers should be kept strictly confidential and kept only on medical files, whereby access to information complies with the Occupational Health Services Recommendation, 1985 (No. 171), and national laws and practices. Access to such information should be strictly limited to medical personnel and such information may only be disclosed if legally required or with the consent of the person concerned."

Recommendation No.171 says that:

• Provisions should be adopted by countries to ensure the protection of employee privacy and that health surveillance is not used for discriminatory purposes or in any other manner prejudicial to employee interests
• Occupational health service personnel should have access to personal health files only to the extent that the information contained in the files is relevant to the performance of their duties. Where files contain personal information covered by medical confidentiality access should be restricted to medical personnel
• Personal data relating to health assessments can only be communicated to others with the informed consent of the worker concerned
• The management of personal health files should otherwise be prescribed by national laws or regulations or by a "competent authority" or, in accordance with national practice, governed by recognised ethical guide-lines

Similar restrictions should be put in place with respect to all related information, including that relating to counselling, care, treatment and receipt of associated benefits - including that held by third parties. UNAIDS' Interim Guidelines on Protecting the Confidentiality and Security of HIV Information offer information on data transfer, guiding principles, and the disposal of information to help maintain patient confidentiality.

Key recommendations aimed at public authorities, but which can also be applied to private health providers include:

• The need to balance the use of health data against individual rights to privacy and confidentiality
• Policies, procedures and technical methods should balance both individual and public rights
• Knowledge of relevant privacy and confidentiality requirements amongst all persons accessing health data
• The development and review of laws [for the purposes of companies, policies] and procedures with the active participation of relevant stakeholders, including people living with and affected by HIV, health care professionals, and legal and ethical experts

Standard Bank in South Africa uses an external service provider, Independent Counselling and Advisory Service, to ensure confidentiality and uptake of VCT. Meanwhile, employee benefits, including medically appropriate access to anti-AIDS drugs, are made available separately through the bank's medical aid, Bankmed.69

• Anglo Coal has achieved an HIV testing rate of 94% amongst employees, partly as a result of its strong confidentiality guarantees and widespread communication of its non-discrimination policy. See:
  Anglo Coal (Australia)
• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

6. Provide sensitive treatment, care and support

The ILO recommends that HIV/AIDS should be managed within the workplace no less favourably than any other serious illness or condition. Infected employees should receive the same benefits, workers' compensation and reasonable workplace accommodation as provided to any other employee with a serious illness or condition. Employees living with HIV should be afforded the same job security and opportunities for advancement as other employees. This – as well as the potential provision of ART treatment - can be a vital factor in encouraging people to participate in VCT and providing an additional incentive to know their own HIV-status.

BMW South Africa, for example, notes that its comprehensive prevention and treatment programme owes much of its success to the level of trust amongst employees – as well as the provision of therapy and rehabilitation measures that "enable HIV-positive employees to lead normal private and professional lives as far as possible". For example, HIV-positive employees and those with AIDS (as well as their families) receive comprehensive healthcare, including vitamin supplements, nutritional and lifestyle advice, medical examinations and psychological counselling. The company reports that it has lost only 17 employees to the pandemic so as a result of its anti-HIV/AIDS campaign – in which 90% of employees participate.70

Likewise, Gold Fields provides free Highly Active Anti-Retroviral Treatment (HAART) to HIV-infected employees through its own internal clinics. In 2014 there were 282 employees in South Africa and West Africa receiving HAART treatment through this means. In addition, employee dependants can receive HAART through the company's medical aid schemes. Furthermore, support is provided to HIV-infected employees through the company's holistic '24 Hours in the Life of a Gold Fields Employee' programme – including primary healthcare, psychological counselling and social services. Such support is also extended to medically-retired employees residing in labour-sending areas as part of a home-based care programme.71

• De Beers provides free ART to employees (as well as their spouses, life partners - and in Botswana - children) in southern Africa, as well as holistic care and support including physical and psychoemotional wellbeing. See:
  De Beers Family of Companies (southern Africa) - in depth
• In 2015, Ontarget Interactive, a premier Digital Marketing Agency based in the United States, won a Business Action on Health Award, awarded by GBC Health for supporting the development of an online platform that facilitates better care for HIV-exposed infants. See:
• Ontarget Interactive (global) – in-depth
• Levi Strauss is extending comprehensive HIV/AIDS treatment and care to its employees and their families following a 2006 commitment to the Clinton Global Initiative - making it the first apparel company to provide such a comprehensive programme. See:
  Levi Strauss (Global)
• Anglo Coal's HIV/AIDS workplace programme follows a five pillar approach, focusing on voluntary counselling and testing; awareness, education and prevention; care, support and treatment; partnerships; and commitment to Anglo American's six values. See:
  Anglo Coal (Australia)
• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

7. Implement relevant disciplinary procedures

Companies should implement clear and strong disciplinary procedures for those who breach confidentiality or who discriminate in relation to HIV/AIDS. Given the serious implications of the disease, as well as the heavy psycho-emotional burden it often brings with it, sanctions should be proportionately serious.

According to the ILO Code of Practice on HIV/AIDS and the World of Work, employers should implement grievance procedures that: "specify under what circumstances disciplinary proceedings can be commenced against any employee who discriminates on the grounds of real or perceived HIV status or who violates the workplace policy on HIV/AIDS."72

• As noted above, pharmaceutical company Pfizer explicitly explains the potential consequences of any HIV/AIDS-related harassment or discrimination – including the potential for the termination of employment.73 Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

8. Accommodate those with HIV/AIDS to enable continued work

Where possible, companies should accommodate employees living with HIV/AIDS within the workplace, in order to ensure they are able to continue working and earning a wage whilst at the same time taking a responsible approach both to their health, and the health of their colleagues.

For example, the ILO Code of Practice on HIV/AIDS and the World of Work recommends that employers: "in consultation with the worker(s) and their representatives, should take measures to reasonably accommodate the worker(s) with AIDS-related illnesses. These could include rearrangement of working time, special equipment, opportunities for rest breaks, time off for medical appointments, flexible sick leave, part-time work and return-to-work arrangements."

In addition to accommodating the practical medical needs of HIV-positive employees, companies can also consider approaches to extending the productive work life of HIV-positive employees. These might include, for example a change of role to one that represents a lower health risk both to themselves and their colleagues, (e.g. moving people from less physically demanding tasks or ones that represent higher safety risks, to more administrative or clerical roles).

For example, the US Department of Labor's Office of Disability Employment Policy has developed an Employment and Living with HIV/AIDS Toolkit, which includes guidance for employees, employees and service providers. This includes links through to its Job Accommodation Network (JAN), which provides detailed advice about how employers can reasonably accommodate workers with HIV/AIDS. This includes, for example, advice relating to:

• Fatigue/weakness (e.g. rest breaks, flexible working conditions, job-sharing, tele-working, etc.)
• Problems with concentration/memory (e.g. increased job structure, written instructions, self-pacing of workload, etc.)
• Visual impairment (e.g. screen-breaks, special visual equipment, screen-reading software, improved lighting, etc.)
• Light sensitivity (e.g. window blinds, lower-wattage lighting, specialist lighting, etc.)
• Weight loss (e.g. ergonomic office furniture, alternate working positions to present sores, etc.)74

• Coca Cola's Africa Charter on HIV/AIDS, launched in 2003, specifically states that the company believes in the principle of reasonable accommodation. This means that employees with HIV/AIDS are free to continue with their work until they are considered medically incapable. See:
• Coca Cola (Global)
• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

9. Partner with business and expert organisations

Work in partnership with health services, expert NGOs and other organisations to address the sophisticated and sensitive challenges that companies may not have the skills to manage.

In its 2013 Report on the Global AIDS Epidemic75 UNAIDS noted, for example, that national coalitions or task forces – bring together both government officials and civil society, and act as an effective platform for the private sector response to the epidemic. It likewise noted that some companies do not know how to mitigate the risk of HIV/AIDS, despite being fully aware if the impact that HIV/AIDS can have on operations. The report outlines how business coalitions can fill this gap and act as a voice for the private sector - for example through representation on national HIV/AIDS committees and by interacting with other key stakeholders. They can also support the business response to HIV/AIDS through the design, development and implementation of workplace programmes.

The Global Business Coalition (or GBCHealth) is a high-profile global initiative that acts as a hub for business engagement on global health issues – including HIV/AIDS – affecting the workplace and communities in which companies operate. More than 200 global companies and related organisations participate in the coalition including (for example) Coca-Cola, Exxon Mobil, Merck, Siemens, Unilever, Chevron and Volkswagen. GBCHealth's work is focused on the following four areas of action:

• "Workplace programs and policies
• Community programs and support
• Advocacy and leadership
• Core competency application"76

UNAIDS cites a regional example of a business coalition in the form of the Ethiopian Business Coalition against HIV/AIDS (EBCA),77 which has implemented a pilot programme with the GTZ Engineering Capacity Building Program, the World Bank Institute and the Rapid Results Institute. In 2008, the programme brought together 180 members of staff from 12 companies who attended workshops aimed at enabling participants to identify HIV/AIDS focus areas, set ambitious targets and develop work plans.

At a national-level, the Asia Pacific Business Coalition on AIDS (APBCA) was launched by former US President Bill Clinton in 2006 in order to lead the region's private sector response to HIV/AIDS. Participants include ANZ, Pfizer, IBM, L'Oreal, Rio Tinto, Westpac, Qantas and BHP Billiton. APBCA is supported by a dedicated website, which includes case studies on company HIV/AIDS programmes. These include efforts by Ok Tedi Mine Limited to boost VCT participation through a "Know Your HIV Status" campaign, through the use of local radio and mobile VCT. In addition all team leaders, supervisors and managers underwent mandatory HIV training in order to pass on knowledge to the broader workforce.78

• The Global Business Coalition is working with a range of multi-national companies, including Anglo American, BP, Daimler, Eskom, LaFarge, Unilever, Volkswagen and others, to reduce stigma, tackle discrimination and raise awareness of HIV/AIDS through its membership pledge. See:
  Global Business Coalition (Global) - in depth
• Shell works with the United Nations, Institute of Human Virology, Planned Parenthood Foundation Nigeria, Population Service International, Family Health International, Society for Family Health and PharmAccess Foundation in the implementation of its workplace HIV/AIDS programmes in Nigeria. See:
  Shell (Nigeria)
• In 2008, Chevron became the first-ever Corporate Champion of the Global Fund to Fight AIDS, Tuberculosis and Malaria's - committing US$30 million over three years to Global Fund activities in a number of countries in Asia and Africa.
• Chevron (Global)
• In 2012, SABMiller worked in partnership with Men for Development in South Africa (MEDSA) and the South African Business Coalition on HIV and AIDS (SABCOHA) on the development of the Tavern Intervention Programme (TIP). TIP is based on local taverns and offers men a six-week course aimed at inspiring behavioural change. Modules include: (1) Responsible Alcohol Consumption; (2) HIV/Aids; (3) Gender-based Violence; and (4) Children's Rights and Parental Responsibilities.
• SABMiller (South Africa)
• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

10. Monitor key indicators on stigma and discrimination

Companies should monitor a range of indicators to ensure that all other measures taken to minimise stigma and discrimination are having effect.

According to UNAIDS, indicators of successful programmes to reduce stigma and discrimination in the context of workplace HIV/AIDS programmes include:

• Reduced discrimination complaints
• Increased numbers of workplace volunteers participating in HIV/AIDS programmes
• Increased openness of HIV-positive employees about their status
• Increased willingness of employees to work alongside people known to be living with HIV
• Increased uptake of voluntary counselling and testing
• Enhanced uptake of treatment services offered by workplaces
• Supportive HIV workplace policies and practice79

• Please contribute your comments and suggestions to our online discussion forum:
• HIV/AIDS online discussion forum

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The nature of the epidemic

According to UNAIDS, 36.9 million people were living with HIV at the end of 2014. The worst affected region is sub-Saharan Africa, where 24.7 million adults were living with HIV (58% of whom were women).In terms of the population living with AIDS, the region is followed by Asia and the Pacific (4.8 million), Latin America (1.6 million), Western and Central Europe and North America (2.3 million), Eastern Europe and Central Asia (1.1 million), the Caribbean (250,000), and the Middle East and North Africa (230,000).80

The region with the highest prevalence rate among adults (aged 15-49) in 2014 was East and Southern Africa (7.4). This region is followed by West and Central Africa (2.3); the Caribbean (1.1); Eastern Europe and Central Asia (0.9); Latin America (0.4); Western & Central Europe and North America (0.3); Asia and the Pacific (0.2) and the Middle East and North Africa (0.1)81

Some progress has been made in the fight against the epidemic – with the number of newly infected people declining worldwide (although at a national level, prevalence is continuing to worsen in certain cases). For example, the number of people contracting HIV in 2014 (2 million) was 36%lower than in 2001 – with the most significant declines taking place in the Caribbean (49%) and sub-Saharan Africa (34%). However, since 2001 the number of newly infected people in the Middle East and North Africa continued to increase. In Eastern Europe and Central Asia, the number of new infections is believed to be stable.82

Prevention and treatment

Although there is currently no cure for HIV/AIDS, global efforts are focused on prevention and treatment - both of which have a vital role to play in fighting the epidemic. For example, Voluntary Counselling and Testing (VCT) prevents the spread of the disease by allowing people to know their status and adapt their behaviour accordingly. It also allows people to access treatment, care and support before the symptoms of infection manifest themselves, potentially prolonging their lives.

In addition, Anti-Retroviral Treatment (ART) is used to stop or interfere with the reproduction of the virus in the body. If used correctly, ART can slow the spread of HIV within the body almost to a stop. This can, along with appropriate care and support, maintain an infected person's quality of life and productivity for a long period of time.

The positive impact of ART (and other factors) is showing. Between 2005 and 2011, for example, there was a 24% decline in AIDS-related mortality compared with 2005 – although the number remains very high at 1.7 million. This fall was most marked in sub-Saharan Africa, which experienced a 32% fall over this period – although it still accounts for 70% of all deaths from AIDS.83

According to the World Health Organisation the high cost of these drugs meant that by the end of 2007 only 3 million people in low- and middle-income countries were receiving ART.84 In recent years, however, there has been a significant increase in access to ART as a result of lower prices, stronger international political will and improved levels of financing. For example, by the end of 2011, UNAIDS estimated that a total of 8 million people were receiving ART – "a 20-fold increase since 2003".85 This number had increased to 12.9 million people in 2013, although it still only represents 37% of all people living with HIV.86

UNAIDS has articulated 10 targets to guide collective action on HIV/AIDS,– under which countries have pledged (amongst other things) to take steps to achieve a range of ambitious goals by 2015. The targets articulated by UNAIDS include:

"1. Reduce sexual transmission by 50%.

2. Reduce HIV transmission among people who inject drugs by 50%.

3. Eliminate new infections among children and substantially reduce the number of mothers dying from AIDS-related causes.

4. Provide antiretroviral therapy to 15 million people.

5. Reduce the number of people living with HIV who die from tuberculosis by 50%.

6. Close the global AIDS resource gap and reach annual global investment of US$ 22 billion to US$ 24 billion in low- and middle-income countries.

7. Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV.

8. Eliminate stigma and discrimination against people living with and affected by HIV by promoting laws and policies that ensure the full realization of all human rights and fundamental freedoms.

9. Eliminate restrictions for people living with HIV on entry, stay and residence.

10. Eliminate parallel systems for HIV-related services to strengthen the integration of the AIDS response in global health and development efforts"87

Vulnerable groups

Some population groups tend to be more vulnerable to HIV/AIDS - both in terms of risk of infection and the impact of infection. Groups considered vulnerable by UNAIDS include women, children, minorities, indigenous people, people living in poverty, migrant workers, refugees, sex workers, people who use drugs, men who have sex with men, and prisoners.

Women, for example, accounted for 58% of all HIV infections in sub-Saharan Africa.88 At a biological level, women and girls are twice as likely as men to acquire HIV from an infected partner during unprotected sex.89 Many women have less access to education and economic opportunities, resulting in greater financial dependence on men. This can limit women's power to refuse sex or to negotiate condom-use. In many societies women and girls also often lack full human rights protection and may face high levels of sexual violence.

In the business context, vulnerable workers tend to include those who are highly mobile, away from their families and who have a high degree of interaction with local communities. These include, for example, transport workers, miners and maritime workers.

Social and human rights consequences of HIV/AIDS

People who are HIV positive are at risk of social, cultural and economic exclusion. The socio-economic consequences for women are also often more severe than for men. Women are more likely to assume care responsibilities when male partners, children and parents fall ill as a result of HIV/AIDS. Women and girls who are widowed or orphaned as a result of HIV/AIDS can face discrimination or even abandonment. This can have serious financial consequences for them and their families that are likely to push them into activities that put them at higher risk of HIV infection, or compromise their ability to seek treatment and care.

Associated human rights violations, including discrimination, violence and degrading treatment, particularly against vulnerable groups such as women, children and men who have sex with other men, compound the stigma attached to infection. Violations can lead to further marginalisation and restricted access to preventative resources and treatments.

UNAIDS has cited a number of drivers behind the HIV/AIDS epidemic, including:

• Gender inequality
• Stigma and discrimination
• Deprivation
• Lack of protection for human rights
• Human rights impact90

Other human rights that are typically associated with the management of HIV/AIDS in the workplace include:

Right to life (ICCPR, Article 6):91 Restricted access to medicine and healthcare services impact the right to life. Where access is limited, proactive businesses may act to disseminate information about HIV/AIDS and implement disease management programmes for employees and stakeholders.

Right to freedom from cruel, inhuman or degrading treatment (ICCPR Article 7): This right is likely to be violated if people are subject to mandatory HIV/AIDS testing - particularly if associated with the use of force, or if a refusal to be tested results in non-employment or dismissal.

Right to liberty and security of person (ICCPR Article 9): Demographic groups that are particularly vulnerable to HIV infection (including women, children and men who have sex with men) should be free from violence, including sexual violence.

Right to privacy (ICCPR, Article 17): There is a danger that poor management of VCT could result in the leak of high sensitive and personal information about participants. Any disclosure of a person's HIV-status may result in discrimination in hiring and firing patterns, pay and training, as well as stigma in the workplace.

Right to protection of the family and right to marry (ICCPR, Article 23): HIV/AIDS can affect workers' families in two key ways. The first is direct infection through sex and/or other forms of close contact. The second is through the economic, psycho-emotional and practical consequences of a member of the family being infected or dying as a result of infection. This is particularly the case if they are the main bread-winner or care-giver in the family. Women may also be ostracised when widowed as a result of HIV.

Right to equality before the law, non-discrimination (ICCPR, Article 26): Persons with HIV/AIDS are vulnerable to discrimination and stigma, both in society and the workplace. This includes discrimination in access to basic services such as healthcare and education.

Right to work (ISESCR, Article 6): Those infected with HIV/AIDS are at risk of not be hired, fired or discriminated against in career advancement on the basis of their HIV/AIDS status. The right to work is closely linked to the rights of just and favourable working conditions and the right to non-discrimination.

Right to enjoy just, favourable conditions of work (ICESCR, Article 7): In working locations with a high prevalence of HIV, there is a heightened risk of infection within the workplace. This may be through interaction between employees or with local communities, or in a health and safety context (e.g. workplace accidents and injuries). The right to enjoy just, favourable conditions of work is closely linked to the right to non-discrimination.

Right to health (ICESCR, Article 12): When operating in a context where HIV/AIDS prevalence is high, companies may face an expectation to provide access to HIV prevention, education and information as well as health care services, for employees and even the wider community.

Right to education (ISESCR, Article 13): People may find that their access to education and training - including HIV education and information - is compromised as a result of HIV/AIDS. This may be as a result of discrimination, poverty or the need to care and support for infected family members. Within a workplace context, this may result in negative professional development impacts, compromising the equality of opportunities for those with HIV/AIDS or affected by HIV/AIDS.

Right to benefit from scientific progress (ICESCR, Article 15): Many people with HIV/AIDS will find that their ability to access advanced medications, equipment and/or other medical/scientific assistance is severely restricted due to inadequate financial resources and/or logistical challenges. This may have direct consequences for their survival and/or quality of life. This is a particularly severe issue in those low income countries where so many infections take place.

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