Managing People with AIDS

Today, AIDS is the second leading cause of death among adults between the ages of 25 and 44. With more than half of the nation’s 126 million workers in this age group, managers cannot afford to ignore this deadly disease. As more effective drug therapies, such as protease inhibitors, are extending the lives of HIV positive people, an increased number are able to return to the workforce and stay productive. One in six large companies has had an employee with HIV/AIDS and one in 15 companies with 15 to 49 employees has had at least one worker with HIV/AIDS (according to the CDC in Atlanta). The World Health Organization estimates that by the year 2000, there will be 15 million new adult HIV infections, with six million people exhibiting symptoms of the disease. Since 25 % of new cases are in between the ages of 13 to 20 years old, this means that the teenagers of today who are HIV positive are the workers who will develop AIDS in 10 years. In order to be successful into the future, companies need to address HIV-infected workers and workers with AIDS. However, HIV and AIDS pose special challenges to employers.

HIV (Human Immunodeficiency Virus) is the retrovirus that causes AIDS, or Acquired Immune Deficiency Syndrome. While AIDS itself does not kill a person, the disease weakens the person’s immune system, allowing other diseases like Kaposi’s sarcoma invade the body. These opportunistic diseases eventually overwhelm the person’s body. The virus is found in blood and other body products like saliva, sweat, and tears, and can only be transmitted by the exchange of blood, body products, or by sexual contact. Once the HIV virus is exposed to air, it dies instantaneously. This means that someone cannot spread the virus through breathing the same air, or by casual contact such as shaking hands. A person can be infected if he/she has an open wound that comes into contact with infected blood or body products. However, the risk of infection for most employees is very low, since there are a limited number of occupations where a worker will encounter blood or body products.

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Employees with AIDS and their Co-workers

HIV-infection and AIDS can be expensive to an employer both directly and indirectly. One issue that managers confront is employee absenteeism. “Those with AIDS spend approximately 16 days a year in a hospital at an estimated cost of $1,000 per day, plus an additional $1,000 a day for medicine, and many more days at home not well enough to come to work.” (Paul and Townsend, p. 9)

Another issue that a manager faces is what to do when the employee cannot perform the duties of their job any longer. The manager must decide whether to restructure the employee’s job, or transfer him or her to another position. Another matter that a manager needs to face is that eventually the employee will be too sick to continue to work. The manager needs to determine when this time has come and how to handle the situation.

The psychological issues that an employee with AIDS faces is also important to consider. Facing death is not easy, and an employee diagnosed with AIDS faces severe psychological stress. Managers must realize that the job performance of the employee may suffer, as they try to come to terms with their fate.

The insurance industry calculates that a typical AIDS patient’s medical bills cost an average of $140,000 from diagnosis to death. According to a study by the Medical College of Georgia, treatment costs for AIDS patients have risen from $12,000 a year in 1992 to $18,000 in 1997. (Greene, p2) Since many employers provide health insurance for their workers, their premiums may go up, especially as more people make AIDS-related insurance claims. The costs for medical, disability, life insurance, and retirement benefits could reach $315,000 for an employee making $75,000 a year. Experts estimate that lost productivity of workers with AIDS could be as high as $500 billion worldwide. (Paul and Townsend, p. 9)

Another issue that AIDS patients face is the potential loss of their insurance coverage. More and more people who left highly skilled jobs when they developed AIDS, are recovering their health with the help of protease inhibitors. However, some employees are afraid to go back to work because of the way their insurance programs are set up.

If a person with AIDS starts a new job and becomes sick within the first six months, their old insurance carrier will still cover them. However, if the person becomes sick again once the six months pass, they will not have any insurance coverage. The reason is that most disability insurance policies do not go into effect until the employee has been with their company for a year. Someone who becomes too sick to work will not retain insurance coverage under either the old or new employer’s policy.

Not only do managers have to deal with the direct costs and problems of employees with AIDS, but they must also deal with the indirect costs and problems with the feelings of those working with someone with AIDS.

People are afraid of contracting AIDS from the infected person. Such fear can affect an entire organization’s productivity, if other employees refuse to work with an AIDS-infected person. Since there is no cure for AIDS, some people feel uncomfortable around AIDS patients because they are forced to deal with their own mortality. Some people still believe that AIDS only affect certain groups of people, specifically homosexual men and intravenous drug users. Of course, the dramatic increase of heterosexual men and women contracting the disease shows that these stereotypes are not true. These people may allow their stereotypes affect how they treat people with AIDS.

Employers also could face increased recruiting costs. There are people who feel that they would rather quit rather than associate with an AIDS-infected co-worker. Replacements may be difficult to recruit because potential employees may withdraw when they learn that the firm employs AIDS-infected workers. Employers may need to offer wage and benefit premiums in order to attract workers.

The Americans with Disabilities Act of 1990 prohibits discrimination against disabled applicants and employees who satisfy the job requirements and can perform essential job functions. The ADA defines an individual with a disability as someone who has a physical or mental impairment that substantially limits one or more of the major life activities, who has a record of such impairment, or who is regarded as having an impairment. The ADA considers people living with HIV and AIDS to be disabled, so the act protects these people from discrimination. The ADA states that employers must make “reasonable accommodations” to the known disabilities of the person. Such accommodations can include extra time off with pay for medical appointments or illness, a flexible work schedule, and adequate ventilation to prevent airborne opportunistic infections. If the employer demonstrates that this would constitute an “undue hardship”, then they are not obligated to provide an accommodation, but the company must be prepared to prove that assertion.

Occupational Safety and Health Act of 1970

The Occupational Safety and Health Act of 1970 provides job safety and health protection for workers through the promotion of safe and healthful working conditions through the nation. (Ivancevich, p. 633) In July 1992, OSHA passed the Bloodborne Pathogen Standards, which apply to all workplaces with employees who could reasonably be expected to be exposed to blood or body fluids. In these work environments, employers must produce, execute, and follow a set of safety guidelines, which are:

 They must develop an exposure control plan

 Take universal precautions to avoid contamination

 Have workers wear personal protective equipment

 Communicate the presence of hazards

 Inform, train, and keep records of all possible incidents

However, there are few occupations preventing employees from performing reasonable job functions because they have AIDS/HIV. In addition, whether or not someone has HIV, all employees must follow the safety guidelines set by the organization. For jobs where employees cannot perform their job functions, under the ADA, the employer must provide reasonable accommodations. These adjustments can include using different equipment or changes in work assignments.

The Employee Retirement Income Security Act of 1974 (ERISA)

Under this act, employers cannot discriminate against their employees for the purpose of interfering with their right to claim benefits under an employee benefit plan. This includes health, disability, or life insurance programs, but does not include previously offered benefits that are neither vested nor accrued. (Paul and Townsend, p. 4) One case involved a woman who claimed her company fired her because she developed multiple sclerosis, which would raise the their insurance premiums. The court decided against the employer, ruling that their action violated ERISA. This act can be applied to AIDS patients also who have their health insurance taken away.

The first step an organization should take to deal with AIDS is to draft and implement an AIDS/HIV policy. First, the company must decide what type of policy they wish to put in place. While some companies choose to implement a specific AIDS policy, others have a broader infectious disease policy, or an even broader disabled employee policy which would also cover AIDS. Whatever type of policy a company decides to go with, it should support the following:

 The policy should provide a foundation for the organization’s entire AIDS/HIV program. An AIDS/HIV policy that is not clear and well defined will not be effective.

 It must establish consistency within the company. If the company does not follow their own policy on a consistent basis, then none of the managers or employees will follow the policy either. The company must also be consistent in how they enforce the policy, meaning they should not show favoritism.

 The policy should supply a standard for communication about HIV/AIDS. Avoiding the subject will only create fear among their employees. Despite all the publicity about AIDS, companies should not automatically assume that everybody knows how the virus is transmitted.

 The policy should tell all employees where to go for assistance. At the very least, the policy should let the employees know that they will be treated with decency

and respect if they have HIV or AIDS.

 Protecting an employee’s privacy is perhaps the most important objective because employees will be afraid to come out if they know their co-workers will harass them.

 The policy should set standards of behaviour expected of all employees, and show that any harassment or discrimination against any co-worker because he/she has AIDS will not be tolerated.

 It should instruct supervisors on how to address HIV/AIDS in their workgroups.

 The policy should insure full health and disability benefits to employees. By law, a company cannot discriminate against an employee for the purpose of interfering with their right to claim benefits under an employee benefit plan.

 The policy should guarantee that the worker will not be isolated from other workers.

 It should also keep AIDS victims productive as long as they are able to work because showing compassion will create an environment of trust and open up the doors of communication.

Just having a policy in the company handbook will not be effective until the managers understand the policy. Therefore, the company puts an AIDS/HIV policy in effect, they should also supplement the policy with mandatory training for managers, supervisors, and union leaders. Training objectives should include the following:

 The training should present the facts on HIV and AIDS and teach employees how the virus is transmitted. If the managers are uncertain about how a person can contract HIV, then they will not be able to tell their employees.

 Managers should be able to address personal concerns about AIDS in the workplace. Employees who have apprehensions or concerns about working alongside an employee with AIDS should be able to discuss those concerns with their manager.

 The training should reiterate the company’s policy so that the managers are aware of the guidelines.

 The training can teach the managers how to handle job restructuring. This way, when the time comes that an employee cannot manage the duties their job, their manager is prepared.

 The training should also prepare the managers to deal with the other employees’ concerns.

Research shows that programs relying solely on written literature are not as effective in changing attitudes and behaviours because they are not interactive. The best HIV training programs for creating a compassionate workplace give employees both an insider source such as a company official, and an outside source, like an external field expert. A single designated contact person can provide an outlet and a channel for employees to discuss private or personal matters. Affected employees have someone inside the company to go to. This way they are not forced to go to a lawyer or a government agency if they feel that their employer has discriminated against them.

In addition to a written policy, an organization can provide AIDS/HIV education and create an employee assistance program. Before setting up such a program, the firm must determine their specific goals. Do they wish to provide “surface” medical knowledge about the virus, or should they build a framework for continuous education and long term reform of attitudes and behaviours? A good program can be valuable for an employee with HIV or AIDS, as well as their coworkers.

An education program should fulfill the following:

 The program should explain the company’s AIDS/HIV policy.

 calm worker’s fears about HIV

 The program should explain the symptoms of AIDS, so that co-workers know what to expect.

 It should educate and present the facts on transmission as well as teach employees how to prevent themselves from getting the disease.

 The company’s program should also provide updates on new research developments to keep their employees continuously informed.

 The program should encourage empathy for AIDS victims.

 Finally, it should provide workshops or forums for frank and open discussions. This way, co-workers can ask questions as well as discuss their fears or concerns.

Companies should also incorporate counseling in their employee assistance program for employees who are infected with HIV or have AIDS, as well as to assist others in coming to terms with an HIV infected co-worker. These counselors can also explore with supervisors the issues involved in managing AIDS.

What does a company that has to handle food do when one of their employees contract HIV? One example of what a company should do is DAKA International, a Massachusetts based company that runs cafeterias and Fuddruckers restaurants. DAKA has become a pioneer in the food service industry for implementing AIDS awareness programs. They began to develop an AIDS policy in 1988, after a female cafeteria worker married a man with AIDS. Her co-workers refused to work with her, and the customers picketed and boycotted the cafeteria. The woman eventually quit, and, consequently, DAKA kept the contract. However, instead of hiding the incident, DAKA took a proactive approach by implementing a company AIDS policy and an AIDS education program. They instituted an AIDS policy office where employees can receive counseling, and have begun an in-house AIDS hotline. Under DAKA’s policy, workers with AIDS can stay at their jobs as long as they are physically able and take leaves of absence when they are too weak to work. DAKA says that at least 100 of their 9000 employees have told their supervisors that they are HIV-positive. (Stern, p. B2) They believe that their AIDS policy will save money in the long term by avoiding the cost of defending civil-rights lawsuits by stricken employees and by preventing a mass exodus of frightened workers. (Stern, p. B2) In one case, a Fuddruckers customer found chewing gum stuck to a piece of broccoli and sued DAKA, claiming that the gum could have carried saliva tainted by the AIDS virus. The suit was later dismissed, and DAKA’s president, Allen R. Maxwell, says that they have never lost an account due to their AIDS policy.

One DAKA employee found out that a co-worker whom she had worked with for six years had AIDS. She said that she “feared for her safety, worrying that the infected man would somehow transmit his disease to her through knives, dishes and food he handled, or even the air.” After calling up the AIDS hotline, she felt reassured and said, “‘I didn’t worry anymore.’” (Stern, p. B2)

All companies should follow their example and take this type of approach to AIDS. Even if scientists discover a vaccine for AIDS tomorrow, it still will not help those who already have the disease. Since 25% of all new cases are teenagers who will soon enter the work force, companies will have to deal with this issue into the twenty-first century.

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Business and Health, Vol. 10 (April 1992), p. 64.

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Greene, Jay. “Employers Learn To Live With AIDS.” HRMagazine, Vol. 43 (February 1998), p. 96-101.

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Paul, Robert J., and Townsend, James B. “AIDS in the Workplace: Balancing Employer and Employee Rights.” St. John’s University Review of Business, Vol. 18

Pranschke, Sibyl C., and Wright, Barbara M. “HIV and AIDS: Employers Grapple With Difficult Issues.” Benefits Quarterly, Vol. 11 (Third Quarter 1995), p. 41.

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Managing People with AIDS. (2018, Jun 06). Retrieved from