Despite years of workplace education campaigns and the enactment of protective federal and state legislation, U.S. companies still face challenges dealing with HIV- and AIDS-related issues.
Even in San Francisco--where an estimated one in 50 residents is HIV-positive--misconceptions, irrational fears and discriminatory workplace practices persist.
The irony was not lost on Yong Lee, contract compliance officer of the San Francisco Human Rights Commission, as he recounted two recent cases he handled, in which an AIDS organization was unwilling to hire HIV-positive workers, and a law firm denied reasonable accommodations to a fatigued HIV-positive employee.
"There's still quite a stigma," Lee said. "Some people come right out and say, 'We don't want to work with someone who's HIV-[positive].' "
U.S. employers may be growing complacent about HIV- and AIDS-related workplace issues, said Nancy Breuer, partner at the Positive Workplace consulting firm in West Hollywood. Both Breuer and Kandy Ferree, president and chief executive of the National AIDS Fund in Washington, have noted a decline in employer requests for HIV and AIDS education programs.
"There's a general impression that the crisis is over, that AIDS is declining, so the workplace doesn't have to confront the problem anymore," Breuer said. But, if anything, the converse may be true.
Though AIDS-related death rates are declining, new-infection rates (about 40,000 annually) are rising again. HIV and AIDS primarily affect Americans of working age. And California has the second-highest number of reported AIDS cases (New York has the most), according to the San Francisco AIDS Foundation.
New combination drug therapies are enabling more than 200,000 HIV-positive Americans to retain their jobs longer, or to return to work after protracted health-related absences. But not all individuals on the therapies will remain healthy on the job. About 25% won't respond to the new drugs, according to the National AIDS Fund.
Others will find the therapies lose their efficacy over time or cause debilitating side effects such as nausea, diarrhea and nerve damage, Breuer said. Employers of such individuals need to be well-versed about their legal obligations. They also must be sure their employees are educated about HIV/AIDS transmission to counter irrational fears.
Three years ago, a National AIDS Fund survey showed that 63% of Americans said they would be uncomfortable working with someone who was HIV-positive. Twenty-one percent added that they believed the HIV-positive employee should be fired or put on disability at the first sign of illness.
Such phobias and misconceptions aren't always harmless. They can lead to discriminatory actions, harassment and, in some cases, lawsuits.
AIDS education specialists report that many U.S. workers still believe they can become infected by being coughed or sneezed on by a person with AIDS, or by sharing a telephone or drinking fountain with an HIV-positive co-worker.
"I've done presentations in front of really upscale, highly educated groups, and I'm still getting asked, 'Can you get it from a toilet seat?' " said Philip Curtis, a representative of AIDS Project Los Angeles.
A visit to Internet newsgroups and forums such as http://www.thebody .com/Forums/AIDS/Workplace /Archive/Discrimination/index.html reveals that HIV- and AIDS-related workplace concerns, fears and prejudices have changed little over the last decade.
One HIV-positive worker posts that his employer won't assign him new accounts because management worries he might get sick. Another writes that he's afraid he'll soon lose his job; his supervisor has publicly threatened to fire him if she finds out he's gay and has AIDS. A woman posts that she was terminated one week after telling her boss she is HIV-positive; but the boss won't say why she was let go.
The Americans With Disabilities Act protects HIV-positive individuals from discrimination in hiring, firing, compensation, advancement and training. But ADA has limitations. It doesn't cover firms with fewer than 15 employees and doesn't protect individuals who are no longer able to perform their major job functions.
Though ADA prohibits employers from asking disability-related questions or inquiring about immune status during pre-job interviews, AIDS educators say this sometimes occurs.
"It's a difficult situation," Lee said. "At presentations I give, people are always raising their hands and saying, 'Well, at the last two interviews, the employer asked me if I was sick.' "
He added, "This puts people in a hard situation because if they say, 'That's an illegal question,' they're pegged as troublemakers."
After making a job offer, an employer has the right to require a medical exam of new hires--provided the employer requires such an exam of all new personnel.
Under ADA, employers also must provide reasonable accommodations to HIV-positive individuals and those with AIDS--provided that doing so won't cause undue hardship. According to the Journal of Business Ethics, two-thirds of accommodations for disabled individuals cost less than $500; half cost no more than $50.
This year, an amendment to the California Fair Employment and Housing Act broadened the scope of reasonable accommodations that in-state employers will be expected to make to qualified individuals with disabilities, said attorney Diane Kimberlin, a partner at Littler Mendelson in Century City.
Such accommodations may include job restructuring, job sharing, modified work schedules, reassignment or transfer.
The most frequently requested accommodations by HIV-positive individuals and people with AIDS are flexible work schedules to accommodate medical appointments and rest breaks because of fatigue, say AIDS workplace experts.
Many HIV-positive workers struggle over whether to disclose their immune status to employers and co-workers. They worry that doing so might cause them to be shunned, gossiped about, passed over for promotions or denied health benefits. AIDS workplace experts warn that it's a decision to be made carefully.
"We tell people you only get one chance at confidentiality," Lee said. "Once you tell people, things spread."
Disclosing one's status can bring social support but also can lead to alienation, disruption of work relationships and discrimination, said Sheila Fesko, senior research associate at the Institute for Community Inclusion in Boston.
In a 1999 study, Fesko compared the workplace experiences of people with cancer with those of individuals who were HIV-positive. She found that 100% of workers with cancer disclosed their condition to employers and co-workers, compared with only a third of HIV-positive workers who did.
Moreover, some of the HIV-positive employees who disclosed their status reported unpleasant reactions from co-workers and, in four cases, potentially discriminatory repercussions, whereas those with cancer reported overwhelmingly supportive responses from their firms.
Concealing one's immune status can bring other burdens, such as stress and isolation, however. Beverly Hills hairstylist Guy Richards has been HIV-positive for 16 years, but he didn't disclose his status to clients until five years after his diagnosis. Even then, he selectively shared the information with "some of my older, more sophisticated clients and those in the film industry" who might better understand his condition, he said.
"The mental stress is great because you're trying to hide something that you have," Richards said. "Even with the suggestion of HIV, clients might leave you because you're touching them."
Some HIV-positive workers take extraordinary measures to prevent employers and co-workers from learning their status. They pay for private insurance out of pocket or pass up reasonable accommodations that would help them better perform their jobs. A few attribute their health problems to other, less stigmatized causes.
Employers can reduce the likelihood of HIV and AIDS prejudice and discrimination in their workplaces by instituting education programs for supervisors and other employees, Breuer said.
"There are managers who don't know how to manage someone with a stigmatized disability whose health is worsening," she said.
Firms can hold seminars about AIDS transmission and prevention, outline standards of behavior for managers and workers and host employee meetings about their anti-discrimination policy and confidentiality requirements.
The National AIDS Fund's Ferree worries that the growing apathy on the part of some U.S. employers about HIV- and AIDS-related workplace issues might continue.
"There's really a resistance right now," she said. "It's off their radar screen. The reaction is 'Been there, done that; we developed our policy years ago.' It's troubling."