Small Business
Working with AIDS
February 10, 1999: 2:17 p.m. ET

Businesses see new challenges as more HIV-infected people rejoin workforce
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NEW YORK (CNNfn) - When Jeff Owens, a clubhouse manager at a country club in rural North Carolina, told his boss he was HIV-positive, he was asked to disclose his medical status to the entire staff.
     And that wasn't all.
     A few months down the line, when Owens was running a carnival-style dunking booth at a company event, managers asked Owens to let a colleague, whom they said needed to leave early to catch a plane, get "dunked" ahead of him.
     Owens later learned supervisors were concerned he would contaminate the water and infect others if he entered the pool first.
     That was in 1989, only a few years after AIDS entered the public arena in full force and long before Congress passed the Americans With Disabilities Act that protects people with HIV from discrimination. But Owens doesn't believe much has changed.


     "There is still a great deal of misunderstanding out there," says the former clubhouse manager, who now works as an AIDS prevention specialist. "I feel comfortable saying that ignorance in the workplace still exists and that the need for aggressive education… is strong."

Confronting new realities

     With thousands of people with AIDS returning to the workplace each year, the need to address prejudice and other issues associated with the life-threatening disease has taken on new urgency.
     One in six large work sites and one out of 15 small companies now employ people with AIDS or HIV, thanks to a series of medical breakthroughs that have enabled these workers to lead longer, more active lives.
     AZT, drug cocktails, the much-touted protease inhibitors and antiretroviral drugs are just a few of the treatments that have made the once-debilitating disease manageable. Among the most significant advances has been the easing of rigorous drug regimens that subjected many HIV patients to dozens of doses of medication a day. Today, many people with AIDS and HIV can live comfortably on as few as three doses a day.

Prejudice alive and well

     However, despite more than a decade of public education about AIDS, discriminatory incidents such as the one involving Jeff Owen are not uncommon, even in the politically correct atmosphere of the 1990s.
     Reports of workers getting physically abused, having their cars vandalized or being called unseemly names persist, according to Jeff Monford, director of the workplace resource center at the National AIDS Fund.
     In a particularly daunting case, a manufacturer berated a well-known Southern employment agency for sending him what he called "damaged goods," a worker who was HIV-positive.
     A recent survey found that more than 30 percent of employees believe an HIV-infected employee would be fired or placed on disability at the first sign of illness. When asked what employers should do about HIV-positive workers, more than 21 percent of those surveyed favored firing or restricting the infected employee.
     "If you have a business with 20 people and they are typical of most Americans, they will generally support fairness," Monford said. "However, a minority of them will have real attitude problems."
     Such attitudes can be particularly devastating at small companies, as employees who do not understand the facts about the transmission and prevention of AIDS bolster false fears. Morale and productivity can be adversely effected, as malicious gossip and misperceptions take hold.
     "Small businesses can less afford to have coworker complaints, negative offhand remarks and other fear-based behavior because those remarks have a bigger impact than at large companies," Monford said.
     As smaller companies regularly cite finding and keeping good employees as a top concern, ensuring the comfort of both employees with AIDS and their coworkers simply makes good business sense as well. An employee who gets infected with HIV or AIDS may represent years of training. Recruiting and hiring a replacement can be a costly and time-consuming process.

The law and litigation

     From a business standpoint, legal concerns may be at the forefront of most employers' minds when it comes to AIDS in the workplace. HIV/AIDS is one of the most litigated diseases in the United States and a discrimination charge can cost as much as $50,000 to $240,000, never mind the negative publicity and potential damage to a company's reputation that can accompany such a suit.
     The best way to avoid legal difficulties is to make sure you and your staff understand the federal, state and local laws that protect employees with HIV or AIDS. Most notable is the Americans with Disabilities Act, which applies to public- and private-sector employers with 15 or more workers who have been on the job at least 20 weeks. Under the ADA, employers may not discriminate in hiring, promoting or terminating an individual with AIDS or HIV if the person otherwise qualifies for the job.
     The law also requires companies to protect the medical privacy of disabled workers, mandating all employee medical information be kept confidential and separate from personnel files.


     The ADA also requires companies to make "reasonable accommodations" for qualified employees with AIDS or HIV to enable them to continue working.
     Some employers believe people with disabilities are difficult to accommodate, but in practice, many companies find it actually involves minor effort and expense. In fact, more than half of all accommodations cost less than $500, according to the Job Accommodation Network.
     Reasonable accommodation can be as simple as moving someone's desk closer to the bathroom if they are experiencing increased nausea or diarrhea, a change that makes their symptoms less conspicuous to coworkers. Supplying AIDS patients with small cube refrigerators is another common (and inexpensive) accommodation, allowing workers to store their medications away from the probing eyes of nosy coworkers.
     By far, the majority of accommodations are related to flexibility. Allowing employees to adjust their schedules for doctor's appointments or for breaks to take prescribed drugs with meals can do a lot to facilitate their work.
     "This is not about special treatment," Monford said, pointing out that workers can stay late or skip their lunch breaks to make up for lost time. And flexibility costs employers nothing.
     Accommodations are most successful when employer and employee work closely together to determine what is needed to help someone function productively in the workplace.
     "This is supposed to be an interactive process," says Katherine Bissell, supervisory trial attorney for the Equal Employment Opportunity Commission. "The law requires that the parties sit down and discuss what they need to do to allow the worker to continue the job."
     There are exceptions. If a company suffers what the ADA calls an "undue hardship" by employing a person with AIDS or HIV, they are exempt from the law. But proving an undue hardship, defined as a substantial or unduly costly accommodation that "fundamentally alters the nature or operation of the business," can be challenging. Several provisions of the ADA require firms to seek outside funding (i.e. from a vocational rehabilitation agency) to cover the costs of accommodations or to let affected workers pay for changes themselves.
     Some financial assistance is available to businesses for accommodations. The Disabled Access Credit, targeted at small companies, pays as much as $5,000 for accommodations made to comply with the ADA. It is available for one-half the cost of "eligible access expenditures" that are more than $250 but less than $10,250. A full tax deduction of up to $15,000 a year also is available to any business to pay for the changes that involve architectural or transportation barriers, such as inadequate restroom facilities, narrow doors and inaccessible parking spaces.

Bigger burdens for small firms?

     While discrimination against those with HIV is clearly unacceptable on legal - and ethical - terms, small-business concerns regarding the potential costs of employing someone with AIDS are not necessarily unfounded.
     The burden of healthcare costs on small companies is very real, and in many cases, unfair. However, because of the stigma associated with AIDS, it is sometimes hard to remember that it is not much different than any other serious or chronic disease.
     "What makes AIDS hard to deal with is the remaining prejudice and unreasonable fear. Even today, 20 years after the epidemic started, a number of people have still not been personally affected and remain uninformed and reluctant to address the issue seriously," Monford says.
     While AIDS can affect a company's health- insurance coverage by increasing the premium paid, the average cost of treating an AIDS patient is comparable to the cost of treating someone with cancer or heart disease.
     "You can't single out a disability not to cover," the EEOC's Bissell says. "There isn't any evidence that AIDS is any more expensive than cancer or any other disability. That's a false fear."

Implementing an AIDS policy

     Because they lack the human-resource structures and administrative experience of larger companies, small firms may have to turn to outsiders to help them put an AIDS policy and education program into place.
     Luckily, a wide range of resources, including the Centers for Disease Control and Prevention's Business Responds to AIDS program and the National AIDS Fund, are available to help these companies, providing brochures, videos and phone assistance. Some organizations, such as the Job Accommodation Network, can help employers determine what kind of workplace changes a HIV-positive worker may need.
Business Responds to AIDS
(800) 458-5231
National AIDS Fund
(202) 408-4848
Job Accommodation Network
(800) 526-7234
Equal Employment Opportunity Commission
(800) 669-4000


     A comprehensive AIDS policy reinforces the company's commitment to the law, by clarifying hiring, promotion, transfer, accommodation and dismissal guidelines. It should emphasize workers' right to confidentiality and define ways management will address workplace discrimination.
     EEOC attorney Bissell also recommends establishing job descriptions.
     "If you set forth what the job requirements are, it's easier to determine what someone can and can't do," she said. "You want to do that ahead of time, not when someone is suing."
     A strong AIDS policy should also include an education component that promotes HIV prevention and understanding about AIDS among the staff.
     Educating staff members about HIV does not have to be difficult or costly, but there are a few important factors to bear in mind.
     First of all, simply handing out a brochure is inadequate. A proper introductory program can be completed in a few hours during staff meetings, lunch breaks or even after work with employees and their family members.
     Workers must understand information that is presented to them. Materials about AIDS and HIV are available in several languages and at several reading levels. Make sure the information you provide is catered to your staff and address the most pressing questions they may have. Bring in respected AIDS sources and experts to provide insights and guidance.
     By establishing a supportive environment, you will significantly bolster the ability of employees with AIDS - and those around them - to remain productive. Your efforts can mitigate potential costs and reduce other staff members' own risks of HIV infection. Link to top
     -- by staff writer Nicole Jacoby


AIDS drug boosts Trimeris - Nov. 3, 1998

FDA approves once-daily HIV drug - Sept. 18, 1998


Job Accommodation Network

Centers for Disease Control and Prevention

CDC Business/Labor Responds to AIDS

National AIDS Fund

Equal Employment Opportunity Commission

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