By Dr Moses Amweelo With the worldwide marked increase in the number of persons infected with HIV and suffering from AIDS mainly among the economically active part of the population, the 20 to 50 years age group, employers, employees and their organizations show a high level of anxiety in regard to the impact of the pandemic on the work environment. The Government of the Republic of Namibia has the commitment, and our resources are increasing, but the action is still far short of what is needed in the workplace. Significant new funding to fight the epidemic has been pledged, both by individuals, non-governmental organizations and governments through the global fund to fight AIDS. Our country has in place a broad national strategy to combat HIV/AIDS and many organizations both in the private and public sectors have adopted policies on HIV/AIDS in the workplace. In 1998, the Ministry of Labour and Social Welfare issued the guidelines for the implementation of the National Code on HIV/AIDS and employment under the Labour Act. These guidelines are based on the principles of the Constitution of Namibia, Labour Act and national policies. With the guidelines (National Code on HIV/AIDS and Employment) the government hopes to address most of the issues relating to HIV/AIDS risks in the workplace, in order to prevent new infections and to provide the best care and support for people in the workplace. The code applies to both government and the private sector. Generally speaking, precautions adopted in the health service to protect staff from other sources of infection are appropriate to prevent infection with the AIDS virus. These are laid down in national rules which are intended to guide staff to achieve safe work practices. They should lay emphasis on the following countermeasures designed to prevent occupational exposure to the AIDS virus. – Prevention of puncture wounds, cuts and abrasions in the presence of blood and body fluids, and the protection of existing wounds and skin lesions; – Application of simple protective measures designed to avoid contamination of the person or clothing and good basic hygiene practices including regular hand washing; – Control of surface contamination with blood and body fluids by containment and disinfection; and, – Safe disposal of contaminated waste, including sharps. Whether or not a patient is known to have the AIDS virus, all health care workers coming into contact with blood and body fluids should cover exposed cuts and abrasions (especially on the hands and fingers) with waterproof dressings and take care to prevent puncture wounds, cuts and abrasions from used needles, other sharps and glassware. If such accidents do occur, they should be treated immediately by encouraging bleeding and liberally washing with soap and water. Any puncture wound or contamination of broken skin, mouth, or eyes should be reported and recorded. In most of the workplaces there is often dangerous machinery and equipment, which can lead to injuries and even death of employees. With HIV or AIDS there is an additional risk. As we have seen, HIV is found in the blood of a person with HIV and it can be transmitted through contact with infected blood. If there is an injury at work, resulting in an open wound, there is a possibility that HIV can be transmitted, particularly if there is a lot of blood. Under the Labour Act, employers have a duty to take all steps to ensure the safety, health and welfare of employees at work. This includes having a safety plan, proper training in safety procedures and information on how to protect oneself from infection when there is a situation like the one mentioned above. Uniforms and overalls are forms of protective clothing and offer a degree of protection against contamination. But when dealing with AIDS patients there will be instances when there is a need to wear additional protection such as rubber gloves and/or an apron, e.g. when coming into contact with blood, body fluids or contaminated articles. The Labour Act requires employers to provide protective clothing and equipment. To prevent HIV infection, the employer should provide gloves and disinfectant to clean up the blood. With the use of universal precautions in the workplace, the possibility of workplace HIV infection through blood spills and accidents will be greatly minimized. Spillages contaminated by blood and body fluids should not be tackled without suitable protection and the work should be done strictly in accordance with regulations. All safety equipment and facilities, including personal protective equipment and clothing that an employer in required to provide in terms of any provision of the Act, shall be appropriate and effective for the purpose for which they are provided (Reg. 2 (6) of the Labour Act). The hands and any other exposed parts of the body should be washed after contact with contaminated material and on completion of duties, especially at meal times. All clinical waste from AIDS sufferers must be properly bagged and identified in accordance with local rules and all contaminated ‘sharps’ must be disposed of in a properly constructed ‘sharps’ container and not carelessly put down where they may find their way into plastic waste sacks and laundry bags which they can easily penetrate and then be the cause of an accident. Finally, let me highlight some necessary aspects with regard to the prevention and protection of HIV/AIDS risks in the workplace: – Eliminating discrimination and stigma. The National Code on HIV/AIDS and Employment states that: Persons affected by or believed to be affected by HIV or AIDS should be protected from stigmatization and discrimination by co-workers, employers or clients. We need to ensure that we replace widespread stigma and fear with hope, support and care. Each and every one of us can create such hope and provide support to our friends, colleagues and co-workers in our workplaces. – HIV infected employees should continue to work under normal conditions in their current employment for as long as they are medically fit to do so. When on medical grounds they cannot continue with normal employment, efforts should be made to offer them alternative employment without prejudice to their benefits. When an employee becomes too ill to perform his/her agreed functions, standard procedures for termination of service for comparable life-threatening conditions should apply without discrimination. – All of us need to commit ourselves to help employees living with HIV/AIDS not only to live longer but also fundamentally live normal lives. This requires breaking the barriers of ignorance and attitudes in the workplace. – The National Code on HIV/AIDS and Employment encourages employers and employees to jointly develop information, safety policies and programmes, and education, prevention, care and support programmes for HIV/AIDS in the workplace. According to regulation 3 (1) of the regulations relating to the Health and Safety of Employees at Work made under the Labour Act, an employer shall, in consultation with the workplace safety representatives, regularly prepare and review a written policy and programme on the protection of the health and safety of employees.
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