Two-thirds of the nearly 40 million people living with HIV today are workers

An interview with Franklyn Lisk, Director, ILO/AIDS

At the XVth International AIDS Conference (Bangkok 11-16 July), the AIDS programme of the International Labour Office (ILO) is launching a new report on "HIV/AIDS and work: global estimates, impact and response". Franklyn Lisk, Director of the ILO Global Programme on HIV/AIDS and the World of Work talks about the ILO report and the expanded response of the ILO to AIDS in the workplace.

The new ILO report paints a grim picture of the impact of HIV/AIDS on the world of work (see ILO press release ILO/04/35). What is the ILO's role in fighting the epidemic and how will this be presented at the Bangkok conference?

We estimate that more than two-thirds of the nearly 40 million people living with HIV today are workers, either in the informal or formal economies. That makes HIV/AIDS a major concern of the ILO. The epidemic affects all our tripartite constituents; workers through loss of earnings and livelihoods; employers and businesses through loss of skilled and experienced workers, reduced productivity and a decline in profits; and governments because this affects revenue and their economic performance overall. Socio-economic issues such as poverty and under-development are where the ILO can make the greatest contribution. In sum, we are moving on from the fairly narrow view of the epidemic as a public health issue, making sure AIDS is seen a threat to sustainable social and economic development.

So, as progress is made on the public health aspect of the epidemic, and HIV positive people are healthier for longer, the question of how they support themselves becomes more urgent?

For me, the important issue is that HIV/AIDS is about people. What we call human "capital" is needed by both the public and private sectors, in both developed and developing economies, in order that they develop and grow. We know that with care and support people who are HIV positive can remain productive for a fairly long time. So it's important that we focus on people who can continue to make a contribution and benefit from development efforts.

What are the key components of the ILO's approach to AIDS in the workplace?

There are three pillars of our work. The first is to ensure that rights at work are respected and that stigma and discrimination are addressed. This is why one of our first initiatives was the development of an ILO Code of Practice on HIV/AIDS and the world of work. The key principles include the protection of rights, non-discrimination in employment, gender equality, social dialogue, prevention, care and support. The second pillar is to give our social partners the capacity to address the epidemic through their own activities. The third pillar concerns partnerships. The ILO is one of the co-sponsors of UNAIDS. This gives us the opportunity to work with our UN colleagues to create a more coherent and cost-effective approach at the national level. These kinds of partnerships typify the ILO's approach to development, which is based on the social partners working together.

What is the ILO position on testing for HIV in the workplace?

We believe there is a high risk that tests done in the workplace could be used to discriminate against workers. However, the ILO is not categorically against workplace testing. For example, we believe it is important that people know their HIV status. If the only facilities available happen to be the workplace then testing is okay as long as it is confidential, and based on consent, information and counselling are available, and it is not used to screen people or encroach on the rights of workers.

What do you say to those who might be scared to work with people who are HIV positive and who want compulsory workplace testing?

First and foremost I think this position comes from ignorance. I would emphasize the need for public education about HIV. Of course there is the issue of stigma, and the cult of denial. I have found employers in the Caribbean tourism sector who didn't want to be identified with HIV issues because they feared people would react negatively, rather than seeing them as an enlightened employer. I've also been told that in Botswana many people do not take free treatment because they don't want to be stigmatized. This kind of stigmatization is holding back efforts to prevent the spread of the epidemic.

Many small businesses may feel they can't afford to implement the Code of Practice. What do you say to them?

The implementation of the code in the informal economy and among small and medium sized enterprises is a big challenge for the ILO. This is why we advocate the integration of the code into national strategies and national action plans. That way the burden doesn't fall entirely on the employer and they can access state or government facilities. Another way is for larger companies to help smaller companies, for example their suppliers. This help isn't necessarily financial, it could simply be information. Increasingly employers are realising that it is in their own economic interest to take action, it makes good business sense. If they lose key workers they have invested in and who have acquired skills and experience, they may be difficult to replace. We will also encourage people, particularly leaders, to speak up in public about the epidemic and its impact on their activities. I think this would contribute significantly to de-stigmatizing the epidemic.

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