Centre for Health Policy

This report reflects the first activity in a three-year research project, funded by the European Union, which is part of a programme of support to NGOs which are working with communities to combat discrimination against and provide support for people with HIV/AIDS. The aim of the project is to investigate, using a variety of methods, the world of AIDS and the workplace with a specific focus on employee benefits. These benefits include medical schemes and other health benefits, death, disability and pension funds. The research will concentrate on the experience of formally employed, unskilled or semi-skilled workers who are vulnerable because employers consider them dispensable or replaceable should they get ill or die, and whose employee benefits may be eroded in the face of HIV. By creating workplaces which are supportive of individual employees, one sustains households and, in turn, the broader society. This report presents the findings of an initial situational analysis of responses to HIV in the workplace, using a policy analysis methodology, which combined documentation review and key informant interviews with 27 players in the field.

The report starts with a review of the South African literature and documentation on HIV/AIDS and the workplace. Available evidence on the direct and indirect impacts of HIV on workplaces and the current models used to project impacts are presented; the legal and policy frameworks relevant to AIDS in the workplace are summarised; and a chronology of key events and processes that have informed this area are noted.

The main body of the report outlines responses to HIV/AIDS of the three major players: government, the private sector including NGOs, and trade unions. In each sector consideration is given to the areas of: leadership and organisational responses, networking and policy processes, and workplace policies and programmes including health care.

While a legal framework and a set of legal precedents for a rights-based orientation to HIV in the workplace have been established, prohibiting, for example, pre-employment HIV testing, a consistent and sound response to HIV in the workplace has yet to emerge. The report concludes that there is a need for strong, bold and coherent leadership in all sectors of society.

Responsibility for workplace HIV/AIDS programmes has generally been delegated to human resource departments, rather than being seen as a core management issue. The overall view noted by stakeholders was of strategic failures in managing HIV/AIDS in the workplace due to the lack centralised responsibility and commitment within organisations. The business sector and the trade union movement need to ensure that HIV/AIDS is fore-grounded as an issue and that it is the concern of the most senior leaders in their sectors. Many interviewees also felt that there was a need for better alliances and networking on workplace issues, and that government needed to play a leadership role in this regard.

Respondents across sectors called for planning to be informed by better data. These data need to be independent, open to scrutiny and separate from private interests.

Workplace benefits have undergone considerable restructuring in response to HIV. In the early-nineties schemes changed from defined benefit to defined contributions, motivated by the perceived impact of HIV on risk benefits. During the late-nineties some schemes evolved from group schemes to individualised packages, anti-retroviral drugs became more available in medical schemes, the outsourcing of unskilled functions appeared as a particular response to HIV and new HIV insurance packages became available for workplaces. During v AIDS and THE WORKPLACE WITH A SPECIFIC FOCUS ON EMPLOYEE BENEFITS: ISSUES AND RESPONSES 2001. Centre for Health Policy. 2001, several companies announced their intentions to provide anti-retroviral treatment for semi-skilled and unskilled employees. These changes have been in response to assessments of direct and indirect HIV-related costs and the requirement to adapt to the reforming legal framework. Developments in the field have prompted the emergence of a range of new players dealing with disease management and impact assessments.

The effect of this restructuring has been several fold. Individuals often have to negotiate for benefits directly with insurance companies, as opposed to their companies taking responsibility for this. This has left employees more vulnerable. While routine pre-employment testing is no longer legal, it is apparent that many individuals are losing cover through pre-benefit testing. As a contrary trend, there is a growing realisation, in the face of declining drug prices, that HIV/AIDS treatment is affordable and cost effective in managing the health of employees. However, there is the danger that anti-retroviral therapy, for example, will be offered to some employees and not others. This is clearly of concern in terms of equity and discrimination.

Finally, there is a need to counter the notion that businesses will be able to cope with the HIV/AIDS pandemic because of ‘the ease of substitution’ . This rationale is neither positive nor constructive. Businesses need to balance their fiduciary duties by remaining profitable and viable yet being fair and socially responsible.