Strategies for dealing with AIDS in the laboratory setting.
Labs and hospitals have to protect the interests of the individual and the organization in planning for the real possibility that a staff member will contract AIDS.
As the AIDS epidemic continues to grow, so does its impact on organizational life. Today, supervisors and managers at all levels in the clinical laboratory must be able to handle complex legal and practical problems that may arise when an employee tests positive for the antibody to human immunodeficiency virus.
Many organizations, including laboratories, will eventually have a person with AIDS (PWA) on staff. More than 85,000 AIDS cases have been reported in the U.S., and mortality is running at 56 per cent.
The Centers for Disease Control estimates that another 1.5 million people are infected with HIV. Some 20 to 30 per cent of this group is expected to develop fullblown AIDS by 1991; another 30 per cent will show symptoms of immune deficiency.
Those who run the laboratory and its sections must make policy decisions that will serve both the ill employee and the organization. A diagnosis of AIDS can spell big trouble: It has the potential to spark fear and dissension among uninformed workers and managers who do not know how to deal with the fallout.
Education is a strong weapon. Learning about the medical, legal, and ethical aspects of AIDS helps supervisors and managers reduce conflicts and disputes. To see how well you measure up to the challenge of managing AIDS in the workplace, take the quiz shown in Figure 1.
Managers have several interests at stake when they begin formulating the necessary personnel policies. They want to retain a dedicated employee despite the onset of a debilitating illness; they want to maintain a productive work force; and they want to encourage employee cooperation and understanding through education.
Productivity is a primary concern. A person with AIDS may not feel up to carrying a full load and eventually will not be able to work at all. When the PWA can perform without any loss of output, co-workers may undermine his or her efforts out of fear, which hampers their performance as well.
The point is that employees are likely to slack off, and managers must be aware of this possibility and deal with it. Start by encouraging compassion. Discuss the various stages of the disease and help the PWA-as well as the rest of the laboratory staff-through the process.
The motivation for managerial efforts is simple and must be acknowledged: 1) a direct impact on the organization's bottom line, 2) maintaining organizational stability, 3) insuring sound management practices, and 4) protecting the hospital's public image (allaying any fear of coming to the hospital because a staff member has AIDS).
It is easy to see the importance of long-range planning. It is always better to have a policy in effect before a problem arises than to have to resort after the fact to crisis management.
*Formulating an AIDS strategy. In the final analysis, each hospital or lab should choose the best approach for its organizational priorities. Certain concerns are universal, however. Policies are important, but managers must also prepare themselves for leadership by increasing their personal knowledge of AIDS and examining their attitudes and behavior. Only then can they begin to educate their employees.
It is important to protect the rights of all employees by insuring fair treatment based on the medical facts, legal requirements, and the organization's values and philosophy. For example, the staff has the right to work in a safe environment, and you must not lose sight of this in your concern for PWAs.
In formulating a strategy to effectively deal with AIDS, we must also be prepared to address the business aspects of the AIDS dilemma. Too many persons still look at AIDS as a medical problem, but it is much more than that. AIDS cannot be buried in the department where the PWA works. The impact of AIDS on both staff and clientele, plus the rising cost of health care benefits, makes this an institutionwide concern.
We must impart several basic messages to employees: AIDS is not a mystery killer, and AIDS in the workplace is not a public health issue but rather an employee relations issue. AIDS education equals AIDS prevention. All staff members must deal with the fear of AIDS-their own as well as that harbored by other managers and employees. Keep these messages in mind as you proceed through the following five-step approach to developing an AIDS strategy:
1. Form a strategy team. Bring together key personnel to develop alternative approaches for the laboratory or the hospital. This team must include representatives of departments that will ultimately implement the AIDS strategy-for example, the hospital's health benefits coordinator, a personnel specialist, a member of senior management, legal counsel, AIDS experts, a public relations specialist, and employee-assistance personnel. If the strategy requires union cooperation, ask a union representative to take part. 2. Assess the hospital's policies and needs. At this stage, members of the strategy team should understand the effect that various AIDS issues will have on the organization. One of the team's first tasks is to analyze current policies and do a needs assessment to determine what the hospital has in the way of AIDS policies and procedures and education programs and what it lacks.
3. Identify organizational options. The strategy team should develop a list of all possible policy questions and their implications. Typical issues include educating lower- and senior-level management, communicating the AIDS policy to the work force, teaching managers how to respond to AIDS cases, counseling employees, and formulating alternative benefit packages.
The team must remember that there are organizational considerations. For example, the potential cost to the laboratory and the PWA cannot be ignored, The lab will be carrying a full-time employee on the payroll, even though he or she can only function on a part-time level. The employee is also likely to face staggering medical bills for hospitalization, medication, and home health care. This brings us back to the need to reevaluate or expand the benefit package.
A PWA unable to shoulder a full share of the workload may not be treated compassionately by coworkers. From a legal standpoint, the employer faces the prospect of litigation from all sides. The PWA, for instance, could make a case for discrimination, while a co-worker might sue for a violation of the right to safe working conditions.
Then there are all the new materials and supplies that must be purchased. As many hospitals have learned, it is difficult and expensive to keep these items in stock. Technologists do not have to wear gloves and a mask to work side by side with a PWA, but they may demand such precautions for their peace of mind and employers will have to provide them.
4. Implement the plan. Before management approves the strategy, the team should devise means of implementing it.
5. Follow up. Monitoring is essential to judge the effectiveness of the strategy. The team can look at several indicators, such as how many employees call with questions, the number of letters sent to the house organ, and feedback from managers and supervisors. An anonymous survey can also yield pertinent information. As the program progresses, the team should reconvene to discuss strategy development and necessary changes, update the information, and assess current policy.
* Legal implications. An employer has a dual obligation to accommodate a physically disabled employee and to protect the health and safety of the work force. Overreaction to AIDS, along with fear and misconceptions of the disease, can lead lab managers and supervisors to make hasty decisions in carrying out this obligation.
There are no absolute rules delineating what employers owe a staff member with AIDS. Legal experts, however, have made some preliminary recommendations that are based on analogous areas of law.
A number of Federal, state, and local laws regulate the relationship between AIDS victims and their employers. The most significant are those barring job bias against handicapped persons. Does a PWA fall under this definition? In the only Federal judicial decision reported to date on this issue, a U.S. District Court in California held that AIDS 'is a protected handicap under Section 504 of the Rehabilitation Act.
Although there have been no higher court rulings dealing directly with AIDS, the fact that such decisions have included analogous diseases in the definition of handicap is noteworthy. Both hepatitis B and tuberculosis have been deemed handicaps within the meaning of the Rehabilitation Act.
On March 3, 1987, the United States Supreme Court 'Issued a decision in School Board of Nassau County, Florida v. Arline, a case involving a school teacher discharged because she had tuberculosis. The court found that Ms. Arline's chronic, contagious disease constituted a handicap. Many legal scholars agree that the Arline decision foreshadows a similar conclusion with regard to employees who have AIDS and AIDS-related complex, especially where physical symptoms or actual impairment are manifested.
Most states also have laws banning employment discrimination against the handicapped. Each statute provides its own definition of what constitutes a handicap.
States with AIDS statutes include California, Colorado, Connecticut, Florida, Illinois, Maine, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Texas, Washington, West Virginia, and Wisconsin, plus the District of Columbia. In addition, Georgia, Louisiana, Montana, New Hampshire, and North Carolina have unofficially indicated that AIDS-based discrimination is unlawful.
*Strategies for policy, education, and settling disputes. Because of the legal complexities, employers usually avoid facing the AIDS issue. Relatively few have written policies. But ignoring the AIDS dilemma is unrealistic, for most organizations will eventually have to deal with an HIV-Infected employee.
Management must try to limit the fear and disruption likely to follow such a diagnosis. First, a policy defining the employer's general philosophy regarding discrimination against AIDS victims must be written and distributed throughout the organization. Then management must educate employees and dispel misconceptions about AIDS.
Although the particulars may vary from organization to organization, certain basic elements should be included in any AIDS policy. For example, the policy should recognize the hospital's corporate responsibility and societal role in the AIDS crisis and provide for formation of a strategy team. Federal, state, and local laws and regulations that apply to the hospital or lab should be enumerated, and all employees-management and non-management alike-should be directed to support the AIDS policy. The policy should also call for the development of broad-spectrum coverage in the benefit package.
It should be stated that each situation will be treated on a caseby-case basis within the framework of the overall policy. It is also important to emphasize the organization's commitment to educational programs, for both managers and employees, to address the factual and emotional issues of AIDS.
The policy of one large corporation spells out the firm's philosophy toward employees with serious or disabling illnesses or conditions and reads as follows:
"This company recognizes that employees with serious illnesses including but not limited to cancer, heart disease, and AIDS may wish to continue to engage in as many of their normal pursuits as their condition allows, including work. As long as these employees are able to meet acceptable performance standards and medical evidence indicates that their conditions are not a deterrent to them or others in doing their jobs, managers should be sensitive to their conditions and insure they are treated consistently with other employees, and that their rights to confidentiality are observed."
Any educational program must cover the nature of the disease and its various stages, methods of transmission, legal ramifications, and the organization's policy on AIDS.
Particular attention should be placed on how AIDS is transmitted. It is often difficult to convince employees that the virus cannot be spread by casual contact. Neverthless, providing information to support that point helps reduce unfounded fears.
Managers and supervisors have to recognize that, sooner or later, AIDS may well strike their organization. And, when policy and education programs do not work, they may be called upon to settle disputes of this nature:
Can an employee with AIDS, or one who is antibody-positive, be fired?
Can a co-worker refuse to work with a PWA?
Can an employer refuse to hire someone with AIDS or AIDS-related complex, or someone who tests seropositive?
Can health care workers refuse to provide services to PWAs?
Can the organization test either prospective or current employees for HIV antibody?
These same situations might arise if the PWA is a family member or partner of an employee.
Mediation and arbitration by an impartial umpire are two ways to settle such disputes. They can help ease pressures in the workplace by letting employees know that a forum exists for a timely and effective settlement of AIDSrelated disputes, by linking these activities with appropriate educational programs, by promoting negotiated settlements of AIDS-related disputes in the workplace, and by demonstrating management's concern and sensitivity.
In summary, an effective AIDS strategy should be ongoing and established before someone in your organization contracts the disease. The strategy should be written and available to all employees. It must have both content (information) and process (steps) and should use internal and external support.
Managers and supervisors must recognize and dignify employees' fears and understand hidden agendas. Management should provide appropriate information and tap the total interpersonal support system-co-workers, PWAs, care givers, and family members.
It is not possible to predict what issues will arise from a particular AIDS-related employment problem. But management can prepare for the inevitable by developing a strategy to handle potential problems and by developing a policy for managing PWAs. Disseminating such a policy and educating employees and supervisors before AIDS strikes will minimize disruption.
Booth, L. Where "boss" stops and "friend" begins. Working Woman February 1987.
Fruen, M.A AIDS, a looming financial commitment. Business and Health January 1988.
Griffith, J.L AIDS: How to protect your lab on legal issues. MLO21(2):27 32, February 1989.
Leishman, K. Heterosexuals and AIDS. Atlantic Monthly February 1987
Singer, I D AIDS in the workplace Nation's Business August 1987.
Wyatt, D., et al, AIDS Legal and ethica concerns for the clinical laboratory J Med. Tech. 4: 3, May/June 1987.
Yankauer, A. AIDS and public health Am. J. Public Health 78: 4, April 1988
Test your AIDS I.Q.
Mark each statement true or false. Answers appear on page 64.
1. A significant number of new AIDS cases habe been the result fo direct contact with blood spills on the job.
2. Most adults infected with the AIDS virus have been infected by direct contact with semen or blood.
3. If you have a condition that has damaged your immune system and a co-worker with AIDS coughs on you, you are more likely to become infected with the AIDS virus.
4. Most gay people have AIDS.
5. An employee who is concerned can be tested for AIDS.
6. A cafeteria worker who is suspected of being infected with the AIDS virus should be banned from preparing food.
7 The Alb virus is fragile and can be rendered inactive by using bleach or alcohol.
8. If a co-worker has a nosebleed, you should put on rubber globes before administering first aid.
9. Women cannot transmit the AIDS virus through sexual intercourse.
10. If a worker needs mouth-to-mouth resuscitation, it is not necessary to use a mouthpiece while ad ministering it.
11. The company nurse who is infected with the AIDS virus can easily give it to other employees.
12. People can look and feel healthy and still transmit the virus.
13. Receptive anal intercourse is the sexual activity with the highest AIDS risk.
14. Opportunistic infections often seen in people with AIDS are easily transmitted in the workplace.
15. If you shoot drugs with your own needle and never share it, you cannot get AIDS from shooting up.
16.AIDS has been transmitted through saliva in the sharing of telephones, computers, pencils, and other office equipment supplies.
17. There is evidence that new forms of the AIDS virus are transmitted through the air.
18. Employees with AIDS are remaining in the work force longer because of currently available drug treatments.
19. An employee with AIDS may tire easily at work like someone receiving chemotherapy for cancer.
20. A oreghant co-worker is more susceptible to contracting the AIDS virus than a worker who is not pregnant.
The Institute for Prevention of Disease in the Workplace, Albany,N.Y.
AIDS I.Q. quiz answers
1. False 6. False 11. False 16. False
2. True 7. True 12.True 17. False
3. False 8. True 13. True 18.True
4. False 9. False 14. False 19. True
5. True 10.True 15.True 20. False
If you had 17 or more correct answers, you have a bery good grasp of AIDS issues; with 13 to 16 correct, you have an average AIDS I.Q.. below 13 correct, you need remedial study