Aids and the workplace with a specific focus on employee benefits: Issues and responses
Date
2001
Authors
Stevens, Marion
Journal Title
Journal ISSN
Volume Title
Publisher
Centre for Health Policy - School of Public Health - University of the Witwatersrand
Abstract
EXECUTIVE SUMMARY<p>
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.<p>
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.<p>
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.<p>
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.<p>
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.<p>
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.<p>
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.<p>
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.<p>
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.
Description
Keywords
aids, workplace, employee, equity, health care, NGO