Just one generation ago, HIV/AIDS was regarded as a relentless and indiscriminate killer. In the early 1980s, when the federal government first started tracking the disease, a newly diagnosed patient had a maximum two-year life expectancy, and HIV/AIDS related illness was the second-leading cause of death in American men. Today, it's not even in the top 10.

Thanks to advances in treatment protocols, and greater education and awareness about the disease and how it's spread, a large number of newly infected people now can live 30-to-40 more years after diagnosis, according to the Antiretroviral Therapy Cohort Collaboration.

Managing HIV/AIDS is arguably now easier than managing diabetes. Instead of encouraging employees to adopt hard lifestyle changes like eating less and exercising, HIV/AIDS patients now can take one pill a day, with little-to-no side effects, to maintain health. Thus, the disease has changed from a virtual death sentence to a chronic condition - a big change from previous treatment regimens that included drug cocktails that wrought side effects like vision impairment, diarrhea, severe stomach pain, vomiting and nightmares.

Yet despite the great strides of progress in the last 30 years, it's estimated that more than 1.1 million Americans currently live with HIV and more than 56,000 people in the United States become infected each year. In the 1980s and early 1990s - when public fears about HIV/AIDS were at their height - many employers launched workplace education programs to combat stigmas and miseducation. In fact, the Centers for Disease Control and Prevention created a national Workplace HIV/AIDS program, but funding for the initiative dried up in the mid-2000s, according to CDC spokesperson Anne Marie Borrego.

Today, not many employers still have these stand-alone in-house programs, with HIV/AIDS resources generally folded into wellness programs. However, Levi Strauss and Co. - one of the first businesses to respond to the then-unknown illness in the early 1980s - is working to reverse that trend, recently rolling out an employee assistance program specifically for HIV/AIDS.

"We have a new generation of employees and leaders, and what we're seeing everywhere is that they have a difference sense of awareness compared to the 80s and early 90s, when it was an acute emergency," says Paurvi Bhatt, senior director of strategic health initiatives and the Employee HIV/AIDS Program at Levi Strass and Co.

Launched in July in partnership with its EAP, Ceridian, the program, called HIV Connect, draws on resources from AIDS United and AIDS.gov. It's a free counseling and referral service offered to all Levi Strauss employees in distribution centers, retail outlets and corporate offices to help them navigate what can be a complex web of HIV/AIDS-related services.

"While we may not pay for the actual point of service, we heard loudly that it is complicated to reach available government and nonprofit resources, and this might be the next- best solution to connecting this web of services to our employees," Bhatt says.

Thus, the mission of HIV Connect is to improve access to HIV education, testing, treatment and care for employees and their families.

She says total startup costs for HIV Connect were low, and the program's projected return on investment could be quite high, given that employees or dependents with HIV or AIDS can obtain the services they need to stay healthy and productive. Still, Bhatt admits that locating community resources in some parts of the country provided road blocks for the program.

"Our distribution centers are located in the most heavily resource-strapped communities; it was not easy finding partners in these communities because resources are so thin," she says. One distribution center for example, is located in Canton, Miss., a locality with a median household income of $36,764 and a poverty rate of 21.8%. "Even if an employee needed something, they're inside a community that is struggling."

HIV Connect is one part of Levi Strauss' larger Employee HIV/AIDS Program, which targets employees in the workplace, in part by training managers to deal effectively with HIV issues.

"How we make [HIV] relevant is [by] understanding the importance of prevention and how it affects people at work," Bhatt says. "Addressing HIV isn't just addressing the health side, but learning how to manage the issue at work. This, like a lot of issues, can affect teamwork and collaboration. That's where we've seen other employers start to understand the relevance of the issue for their own employees."

Describing the program as " HIV education in a box," Bhatt says the multi-day, five minutes per day program hits home in a targeted and efficient way for managers and rank-and-file workers "that are driven by goals in their shift."

Bhatt hopes other employers will look at the EAP and think about bringing something similar to their workplace (the Levi Strauss program is available for purchase through Ceridian).

Programs like HIV Connect are necessary now in a way they weren't three decades ago, when oftentimes employees with HIV/AIDS would simply leave the workforce entirely - either too sick or too stigmatized to remain in their jobs.

"For the most part, it used to be that you'd transition out of work and you never went back," says Erin Loubier, director of public benefits at the Whitman Walker Clinic in Washington, D.C.

Adds Mark Misrok, president of the National Working Positive Coalition: "Part of the story is that a far larger percentage of people living with HIV/AIDS now do not need to leave the workforce ... and there are still many people living HIV/AIDS who [previously] left the workforce who need and want ... to go to work." With the passage of the Americans with Disabilties Act in 1991, employers were required to make accommodations for people associated with HIV/AIDS, but with the medication advances, there is little to no need for reasonable accommodations.

In fact, according to Anne E. Hirsh, co-director of the Job Accommodation Network, a service of the Office of Disability Employment Policy, calls about HIV/AIDS from employees and employers make up about 1% of their calls each year.

"For most workers living with HIV/AIDS, the only accommodation that would most frequently be requested, if any, [is the additional] the time required to participate in medical appointments and for a large number of them, it could be perhaps [as few as] three or four times a year," Misrok says.


The business case

Now that employees with HIV/AIDS are healthier for longer periods and don't require disability accommodations as often, retaining such employees could even benefit companies, as "employers don't have to worry about the cost of losing talent and retraining new people and reducing absenteeism rates," says Robert Bailey, public health analyst at the National Center for HIV/AIDS, Viral Hepatitis, STDs and TB Prevention, at the CDC.

"That person living with HIV has a lot they can contribute in terms of the work itself; it's a great business case to be supportive."

Keeping people in the workforce also prevents the spread, one health advocate believes.

"Workforce development is a condom," says Jeff Rindler, managing director of program services and evaluation at the Gay Men's Health Crisis. "When people have money in their pockets and feel better about themselves, they take better care of themselves in all areas."

In addition to legal services and a clinic, GMHC launched a workforce development program in 2003 after noticing a peak in clients asking for career services as their health improved. The organization currently works with some 300 people each year and has successfully placed 1,000 people in jobs since its inception.




Employer ordered to pay for firing HIV-positive employee

Maverik, a Utah-based convenience store chain, has agreed to pay $115,000 to settle a federal lawsuit alleging it improperly fired an HIV-positive bakery clerk in Wyoming.

The lawsuit, filed by the Equal Employment Opportunity Commission last year, charged Maverik with violating the Americans with Disabilities Act by allegedly failing to accommodate, and then firing, the HIV-positive bakery clerk.

According to public filings in the lawsuit, Maverik learned of the employee's HIV status during a workers' compensation proceeding. The employee, who had worked for the company more than three years, was fired two weeks later because of alleged fears about him working with food. The EEOC also said Maverik failed to make reasonable accommodations for the employee.

In addition to the monetary settlement, the decree resolving the lawsuit requires Maverik to provide ADA training to its Wyoming workforce and to higher-level supervisors and managers companywide. The chain also must post an ADA notice in each of its Wyoming locations and make periodic reports to the EEOC.

Maverik is further prohibited from discriminating based on disability and must review its written ADA nondiscrimination policy.

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