Hiv-aids workplace Programme for National Personnel Here: contracts with consulting firms and institutions




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HIV-AIDS Workplace Programme for
National Personnel

Here: contracts with consulting firms and institutions

Frame and range of the policy


  • Context & objective

  • Target group

Core elements:


  • Prevention

  • Non-discrimination

  • Tests

  • Confidentiality

  • GTZ benefits



The context and the objective


On the basis of the BMZ position paper "HIV/AIDS in German TC", GTZ contributes worldwide to preventing the spread of the HIV/AIDS epidemic and reducing its impacts.

The theme "Workplace Policy" is becoming increasingly important internationally. Globally operating companies are developing their own policies for dealing with HIV/AIDS at the workplace, frequently with advisory support from GTZ.

Regrettably, cases of HIV infections and AIDS are increasingly becoming known among GTZ national personnel (NP) and their families.

GTZ is responding to its responsibility and establishing its own HIV/AIDS Workplace Policy for GTZ staff and the National Personnel of consulting firms and institutions it commissions.

The core objectives of the policy are:


  • GTZ staff are informed of the risks, suitable prevention measures and the impacts of the HIV/AIDS epidemic.

  • The GTZ working environment and climate is free of prejudice and discrimination with respect to HIV/AIDS illnesses.

  • National personnel and their close families are provided with special support in a spirit of solidarity.

With this policy GTZ acknowledges the special importance and complexity of the theme of HIV/AIDS at the workplace.

Target group


The policy applies basically for all project staff, expert and auxiliary personnel of consulting firms and institutions commissioned. However, financial benefits within the frame of the HIV-AIDS Workplace Programme will only be provided for national personnel and their families.

Since the degree of suffering caused by HIV/AIDS, the legal framework conditions and the social protection systems vary widely in our partner countries, the policy can only represent a framework that must be adapted to local conditions and implemented accordingly.



Prevention by information and training


Information and education programmes will be conducted regularly in updated form.

The programmes are to enhance awareness of the HIV/AIDS problem complex and are to be adapted to the local conditions, as well as to the relevant target group with special consideration given to age and gender aspects.

They essentially contain information about:


  • The transmission of the HIV virus

  • Possibilities of reducing risk

  • Medical aspects of treatment

  • Advisory packages provided by internal and external bodies

Where expedient and necessary, upgrading sessions will be offered or financed by GTZ for managerial staff and staff representatives enabling them to perform their support and advisory role appropriately. The consulting firm/institution undertakes to inform the National Personnel and where necessary the latter's superior of the upgrading programmes and to release this Personnel for the relevant period.

Non-discrimination


All managers and staff are obliged to prevent discrimination connected with an assumed or actual case of HIV/AIDS infection.

This applies especially for all policies and practices connected with the employment relationship:

appointments, transfers, promotion, remuneration and social benefits, workplace equipment, upgrading sessions, assessment procedures, disciplinary measures, termination of the employment relationship.

Tests


Information on the HIV status of a staff member shall not be required, either at the time of an application for employment nor as a condition for continuing the work relationship or for promotion.

If staff members request the GTZ Medical Service or a local health service to conduct an HIV test on their own initiative, the blood samples must be analysed by an external facility. The results are to be transmitted directly to the staff member with observation of strict confidentiality.



Confidentiality


Information provided voluntarily by staff about their HIV status shall be stored separately from the personnel files.

Any such information shall be treated in the strictest possible confidence, in harmony with GTZ rule on protecting personnel data.



GTZ services


GTZ develops appropriate packages in the field together with local professional health service providers for advising, testing and treating national personnel and their families.

GTZ nominates a person responsible for the HIV-AIDS Workplace Programme for each country who is available as a contact person.

GTZ shall bear the costs worldwide for testing and treating illnesses caused by HIV/AIDS, including antiretroviral therapy, for all member of the national personnel and their core family members (permanent partner and children related in the first degree up to the age of 18), provided that and insofar as such assumption of the cost of preventive care and treatment is customary on the local market, and provided that no government or other adequate care systems exist.

The assumption of costs shall start after the probationary period and shall end at the expiry of the employment relationship.

The consulting firm/institution undertakes to participate in the HIV-AIDS Workplace Programme for National Personnel; here: contracts with consulting firms and institutions, and to join the workplace programme in place in the country. The rules stipulated in the workplace programme of the relevant country apply for prevention, tests and counselling and for the treatment of HIV-AIDS.

The costs will be reimbursed directly by the GTZ Office. In countries without a GTZ Office, a GTZ project will be nominated to handle the processing.

The consulting firm/institution cannot bill any costs. 

Explanatory notes

Frame and Range of the Policy


  • Target group

  • Framework of the GTZ HIV-AIDS policy

  • Why HIV/AIDS?

  • Benefits

Prevention and Tests


  • Confidentiality

  • Preventive measures

  • Voluntary counselling and testing

Occupational Safety Medical Treatment


  • Occupational safety medical treatment

  • ART (antiretroviral therapy)

  • Post-Expositions Prophylaxis

  • Mother-to-child transmission


To whom does the policy apply?


The measures include the partner of the NP staff member and children under 18 years of age.

A partner is understood to be:



  • the person to whom the staff member is married or

  • the person with whom the staff member has a long-term relationship similar to a marriage. This includes same-sex partners.

Married staff members must present their marriage certificate. Unmarried partners must sign a declaration, in which they attest that they maintain a long-term relationship and that they have lived with the partner for at least a year.

A partner cannot share the benefits of this Workplace Program unless such a declaration has been signed. A false declaration will result in disciplinary measures.

Furthermore, only one partner can be accepted.

What is the framework of this policy?


Our Policy for National Personnel states that adequate protection must be provided against important life risks. This HIV/AIDS policy recognizes that HIV/AIDS belongs to this category. We view the conditions of UN organizations as an established minimum standard for the level of protection. In addition, the measures must take into account the degree to which staff members are affected by HIV/AIDS, local legal framework conditions (for example, in some cases, the law requires a longer benefit period than the contract term), and social protection systems, to the extent they exist.

Why HIV/AIDS and not other chronic illnesses?


In the case of HIV/AIDS, we are confronted with a special degree of stigmatisation of and discrimination against those affected and their environment. This is because the mains forms of transmission (sexual intercourse, illegal use of drugs) and the (despite treatment) deadly outcome are surrounded with taboos in most societies.

Furthermore, particularly since life-extending medications have been on the market, health insurers, above all in developing countries, have reacted by excluding AIDS treatment from their benefit packages or excluding members or applicants in the case that they are HIV-positive.

In this latter case, this means that the employee has insurance coverage neither for treatment of so-called opportunistic illnesses nor for specific AIDS therapy.

International guidelines that aim to counteract these stigmatisation and discrimination processes thus demand that firms and organizations recognize HIV/AIDS as a problem and treat it like all other illnesses, in other words, in a non-discriminatory manner. An integral part of these guidelines is a revision of national legislation in the light of HIV/AIDS. This is expressed, for example, in labour law. Countries such as the Philippines or those of the SADC region have now introduced specific HIV/AIDS legislation. This applies to every firm/organization active in the country that employs local personnel.

The productive class in a society is particularly affected by HIV/AIDS. This not only has catastrophic results for individuals and families, but in many countries, above all now in southern Africa, it also has very negative consequences for the economy of a country.

HIV/AIDS is an infectious disease and as such is viewed internationally as a matter of public interest (public good).


What benefits does GTZ provide?


GTZ assumes the costs of

  • planning and organisation

  • possible training measures

  • prevention: information and awareness-raising programs

  • provision of condoms

  • voluntary counselling and testing (VCT)

  • treatment of opportunistic illness (sexually transmitted diseases, tuberculosis, fungus diseases, etc.)

  • antiretroviral therapy (ART) including monitoring

  • identification of therapy-induced side effects and their treatment

  • medical prevention of mother-to-child transmission (PMTCT) of HIV

  • post-exposure prophylaxis (PEP) 


What does "confidentiality shall be respected" mean?


All persons with HIV or AIDS have the legal right to privacy. Employees are therefore not legally required to disclose their HIV status to their employer or other employees.

Where an employee chooses to voluntarily disclose his or her HIV status to the employer or to other employees assuming a representative or supportive role, this information may not be disclosed to others without the employee's written consent. The employer and employees within GTZ environment shall not disclose information about employees' HIV status entrusted to them due to their line function. Disclosure of such confidential information constitutes a breach of contract and may warrant disciplinary measures.


What are preventative measures?


Preventative measures include information and awareness-raising campaigns and the provision of condoms and VCT.

AIDS information in the workplace

Counselling and information are not only necessary when there is a tangible reason for them. It makes sense to have staff members and also superiors deal with the topic of HIV and AIDS in the workplace already beforehand. Timely information and awareness can counteract problems that may arise:


  • when the transmission paths of the virus are understood, unfounded fears or discrimination can be prevented;

  • knowledge of the course of the disease can prevent hasty or incorrect decisions pertaining to labour law;

  • information on occupational safety and first aid can prevent incorrect behaviour.


What is Voluntary Counselling and Testing (VCT)?


Voluntary Counselling and Testing (VCT) offers individually tailored counselling before and after a HIV test. It enables clients to behave in ways appropriate to their HIV status and has been shown to result in greater willingness to use preventative measures. A prerequisite for the acceptance of the service is the guarantee of confidentiality and quality standards for the performed HIV tests that correspond to those stipulated by the WHO.

What do occupational safety and treatment consist of?


The GTZ shall ensure that the working environment of GTZ field offices and project offices is healthy and safe for all personnel.

If exposure to human blood, bodily fluids, or tissue occurs, immediate measures shall be undertaken to advise this person on how to cope with the incident. This includes information about the medical consequences, the desirability of testing for HIV, the availability of post-exposure prophylaxis (PEP), and referral to appropriate medical facilities, as well as provision of basic supplies, such as disposable gloves. Training in measures to prevent infection in the case of accidents on the job and first aid shall be made available in the framework of other educational and training programs.

Treatment includes:


  • voluntary counselling and testing (VCT)

  • treatment of opportunistic illnesses (sexually transmitted diseases, tuberculosis, fungus diseases, etc.)

  • antiretroviral therapy (ART) including monitoring

  • identification of therapy-induced side effects and their treatment

  • medical prevention of mother-to-child transmission (PMTCT) of HIV

  • post-exposure prophylaxis (PEP)  



What is ART? How does ART work? What can be expected from this therapy?


See also http://www.gtz.de/aids/english/publik.html

Since the mid-1990s, a therapy has been available with which it is possible to stop the replication of HI viruses. This therapy is commonly called HAART (highly active antiretroviral therapy) or antiretroviral therapy (ART). It consists of a combination of three or more different drugs that are effective against the HI virus, which should be taken for the duration of one's life.

The objective of the therapy is to reduce the viral load in the body. Complete elimination of the virus from the body cannot be achieved with current scientific knowledge; however, in most cases, the ability to work is restored.

The observation period, also in industrialized countries, has still been too short to draw conclusions on the average extension of life. Side effects of the therapy are frequent - though seldom severe or deadly - and in addition, resistance to the utilized drugs can develop; both require an adjustment in the therapy. If the therapy, which now is intended to be life long, is discontinued or becomes ineffective, the viruses again replicate, leading to progression of the disease and possibly the death of the patient. ART is used very effectively (in combination with Caesareans and no breast-feeding) to reduce mother-to-child transmission of the HI virus.

Additional Documents:

www.gtz.de/aids/download/arvmümü21.pdf size: 521.1 KB

What are the rules for post-exposure prophylaxis?


After exposure to HIV, a short-term treatment with antiretroviral drugs can prevent the infection.

It must be noted that the treatment must be initiated as soon as possible, at the latest within 48 hours, for it to be successful.

GTZ assumes the costs of the treatment (post-exposure prophylaxis - PEP)


  1. for staff members with work-related exposure (work in the health sector)
    (see: Grad der Exposition und angepasste Vorgehensweise laut Robert-Koch-Institut,Epid. Bull No 30/2000) http://www.rki.de/INFEKT/AIDS_STD/AZ_ENG/AZ_E.HTM?HIVPEPL_E.HTM&1.

  2. for staff members who have been raped by a perpetrator suspected to be HIV-positive

  3. after exposure during working hours (e.g. rendering first aid)

PEP/ART shall not be used as a prophylaxis for voluntary, unprotected sexual contact, because that is counterproductive to all prevention efforts, is not medically indicated, and is not affordable.

Mother-to-child transmission


Transmission of HIV from mother to child is the most frequent source of HIV infections in children under 10 years of age worldwide. Transmission can occur during pregnancy, during birth, and after birth through breast-feeding. Without intervention, around 30% of the children of HIV-positive mothers are also infected with the virus. Through a combination of Caesarean or prevention of obstetric complications, short-tern treatment of mother and newborn with medication, and avoidance of breast-feeding, transmission can be reduced to 1-2%.

Instructions on the theme:

Occupational Safety Medical Treatment


  • Occupational safety medical treatment

  • When should ART (antiretroviral therapy) treatment start?

  • Mother-to-child transmission


Health at the workplace, occupational safety and treatment


First aid at the workplace

In work areas dealing with blood serums or tissue fluids there is a risk of infection if staff have skin injuries of their own. The same applies for accidents. However, if the generally customary hygiene and accident prevention regulations are observed consistently, there is no risk of becoming infected with the HI virus.

There is thus no reason to refuse to give first aid due to fear of acquiring an HIV infection!

First-aiders should be familiarised with the precautionary measures against infection during their first aid training. However, since in principle anyone may be required to provide first aid if the occasion arises, it is important to know a few basic rules and protection measures:


  • If possible use disposable gloves if blood contact occurs (for example when dressing open injuries or if fresh blood has to be removed from the scene of an accident).

  • Cover your own hand injuries with plaster or a dressing as a preventive measure.

  • If you have been in contact with other people's blood, wash the relevant skin areas with soap and water. If this blood touched injured skin, disinfect the area with a virus-active disinfectant (for example with 70-85% alcohol or PVP-iodine).

  • When providing respiratory assistance select mouth-to-nose respiration.

In the event of bleeding face injuries, the possibility of HIV infection in the case of mouth-to-nose respiration cannot be ruled out completely. However, the risk of contagion is relatively low. Respiratory equipment such as the manual respirator Ambu Bag or a Lifeway Tube are helpful here.

From: Information zu AIDS in der Arbeitswelt, AIDS-Aufklärung e.V.; Frankfurt


http://www.aidsaufklaerung.de/

Antiretroviral therapy (ART)

The treatment with antiretroviral therapy should be carried out in accordance with the guidelines applicable in the country and adopted for this purpose by the national AIDS Council or the Ministry of Health. This is most likely to secure a process adapted to the situation in the partner country. If no such guidelines have been adopted in a country yet, the procedure suggested by the WHO in "Scaling Up Antiretroviral Therapy in Resource-Limited Settings, Guidelines for a public health approach" 


(http://www.who.int/hiv/pub/prev_care/pub18/en/) can be taken as a standard. This describes the indication for the start of therapy, selection of drugs, expedient changes if resistance or side effects develop, and the procedure to be adopted for different patient groups.

Opportunistic infections

The same is suggested for the prophylaxis of opportunistic illnesses (i.e. specific infectious diseases occurring once HIV/AIDS has been contracted). Essentially this comprises the provision or financing of medicaments to prevent tuberculosis, Pneumocystis carinii pneumonia, toxoplasmosis and cryptococci infections. Other illnesses may apply depending on the epidemiology of the partner country.



Tuberculosis as the most frequent opportunistic disease

In the few cases in which there is no national tuberculosis control programme specifying an adapted therapy strategy, we recommend that the WHO guidelines be observed. The special procedure for Tb therapy in conjunction with co-infection with HIV or the application of ART at the same time is set out in the "Scaling up..." guideline cited above.



Treatment of sexually transmitted illnesses

Here too priority should be given to the national therapy guidelines adopted as a standard. If none are available, we would recommend the treatment proposed by the WHO.


http://www.who.int/docstore/hiv/STIManagemntguidelines/who_hiv_aids_2001.01/

When can ART be recommended?


The ideal time to start treatment is still a subject of scientific discussion in industrialised countries too. Here, however, ART is always applied when boundary levels are exceeded in certain laboratory values (number of viruses in the blood, CD4-cells), even if no signs of illness are visible yet.

For countries in which these laboratory measurements are not possible, the WHO has suggested a simplified procedure that is oriented to the stage of the illness for reasons of practicability. This can be carried out with restricted laboratory facilities and less qualified staff. Despite this these staff still require special training and supervision in view of the complexity of the treatment. The additional workload involving education and information, observation and treatment of the patients is high and application of ART requires a fundamentally functioning health system.

The minimum standard could be considered as


  • access to voluntary and confidential HIV-tests and counselling,

  • health facilities in place that can conduct treatment and can be reached by the patients,

  • adequate training of the staff providing treatment to ensure safe and effective use of medicaments and good counselling for patients,

  • laboratory standard as formulated by the WHO in "Scaling up..." as a minimum

  • continuous supply of antiretroviral medicaments of an acceptable quality.


Mother-to-child transmission


The medicinal treatment of mother and child is carried out in accordance with the relevant national policy for transmission from mother to child. Various methods are possible. The simplest and cheapest is a single application of Nevirapine to the mother when labour starts and single administration of a dose to the child during the first three days after birth. Nevirapine can be obtained free of charge via the donation programme of the German pharmaceutical enterprise Boehringer Ingelheim http://www.viramune-donation-program.org

To avoid transmission of HIV the child should not be breast-fed if substitute nourishment and the possibility of preparing this safely are available. If this is not the case, the child should be breast-fed only and weaned quickly after 3-6 months. Mixed nourishment (breast feeding and additional feeding) represents the highest risk of HIV transmission for the child.



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