version11 agl – autonomous group learning agl 80 – management of hiv/aids/tb in international...

Version11 AGL – AUTONOMOUS GROUP LEARNING

AGL 80 – MANAGEMENT OF HIV/AIDS/TB IN INTERNATIONAL BUSINESS (Basic Version – Business – 2 days)

DAILY WORK PACK - PART I - DRAFT (Not retained)

A group-based (8-24) or a self-instruction partner-based (2) program.

Source: Dr Bob Boland MD, MPH (Johns Hopkins), DBA, ITP (Harvard) ex ILOand UN Volunteer Team (Geneva)

Copyright: RGAB/KH 2006/6 Copies with permission. [email protected]

AGL 80 – MANAGEMENT OF HIV/AIDS/TB IN INTERNATIONAL BUSINESS

Planning: Versions for different organizations: Business, University, Health Care, Government.

Languages: English, Spanish and for Russia, Africa, India, China etc.


“When a “normal annual medical examination” begins routinely to include

tests for Hepatitis B, Diabetes, TB and HIV , then the pandemic of HIV/AIDS will at last, be under control”


A worker with an HIV positive result must be re-tested … immediately … to avoid laboratory error … which could cause unnecessary pain to the worker!


A highly exposed worker with an HIV negative result … may need to be re-tested after six months … because … the anti-gen reaction may have been delayed … giving a false negative result …


“When the TV sports stars of football, rugby, basket ball and tennis, and their doctors, agree to do such “normal annual medical examination” then the public stigma of HIV/AIDS, will at last, be under control”


”Personal health and illness is a private confidential matter for each worker and his family, but when the infection of one worker, can infect other workers in the workplace, the infection becomes a management responsibility”.


• “In 2006 …effective health management

of HIV … seems to depend more on political skills … than on management skills …”

• “Instant HIV self testing is available

but not yet allowed to be used

extensively! ”


“Current treatment for HIV/AIDS with HAART (one pill a day) has a success rate of prolonging life for about 13 years, which compares favourably with the well accepted treatment for cancer and coronary artery disease.”


UNAIDS – WORLD HIV/AIDS INCIDENCE – 2006

(000)Latin America 1,600USA & Canada 1,300Caribbean 330North Africa 440Sub Saharan Africa (Nigeria 2,900m, Mozambique 1,800m, Kenya 1,300m,

Congo 1,000m, South Africa 5,500m Uganda 1,000m, Tanzania 1,400m, Zambia 1,100m) 24,500Western Europe and Central Europe(France 130m, UK 68m, Germany 49m, Suisse 15m) 720Eastern Europe and Central Asia(Russia 760m) 1,500Eat Asia(China 650m) 680South East Asia (India 5,200m) 7,600 Oceana 80

Total 37,150

OVERALL ROUGH ESTIMATE 2006 - 38- 40 MILLIONSSource: UNAIDS data website. Detail by country, age, sex etc. available.


WELCOME TO THE PROGRAM

1. Good morning. Welcome to the 2 day AGL No. 80 Management of HIV/AIDS in Organisation. AGL - Autonomous Group Learning. It can be a group-based (8-24) or a self-instruction partner-based (2) program.

2. AGL training in management, represents years of development and testing in 30 countries around the world, in ten languages with so many managers.

3. After two days of learning with the AGL method you will begin to understand the basic management issues related to the epidemic of HIV/AIDS at national, organisational. group and individual level.


4. While you may be used to traditional educational methods, you will be agreeably surprised by your learning results over the next two days. We provide you with a controlled environment for learning ion which you learn from each other.

5. It may seem strange for you to learn without an instructor, but be assured that we have structured the course to enable you to find the answers to all your questions in the learning materials provided.

6. Your course organiser is trained to run the program and to help you obtain the most benefit from the course. You will have to work hard, but you will learn a great deal, and to retain the knowledge. So now let us start with some abbreviations ….


AGL ABBREVIATIONS

AGL - AUTOMATED GROUP LEARNINGIND - INDIVIDUALSG - SMALL GROUPCSG - COMBINED SMALL GROUPMG - MAIN GROUPL - LECTURED - DISCUSSIONCH - CHAPTERLRT - LEARNING RECALL TAPE

ASSIGNMENT 1.0 INTRODUCTION (30 minutes)

1.1 SPECIFIC OBJECTIVES

The specific learning objectives are to:

(a) Understand HIV/AIDS language and concepts at an individual, social, organisational and national level.

(b) Evaluate the impacts and risks of HIV/AIDS.

(c) Identify the difficulties in the management of HIV/AIDS in the organisation/enterprise.

(d) Develop new alternatives and opportunities for action

(e) Motivate further study in the future.

•

ASSIGNMENT 1.0 INTRODUCTION (30 minutes

The syllabus of the program includes: language, concepts, diagnosis, treatment, cultural barriers, infections, TB control, prevention, impacts, risks, difficulties, strategy, HIV/AIDS committee, organisation, staffing, action planning with objectives, criteria, OTP, EAP, PGEP, staffing, reporting, control and audit.


1.2 AUTOMATED GROUP LEARNING (AGL)

The AGL method is designed to achieve rapid individual learning using special material and the stimulus of group activity without a formal instructor. The groups learn best by using the material to find the answers to all problems and questions.


1.3 GROUP ARRANGEMENTS

The work will be done:

(a) IND - Individually, or (b) SG - Small Group (4 members - change half daily), or (c) CSG - Combined Small Group (two small groups together), or (d) MG - Main Group (short lectures with visual aids).

1.4 SG - SMALL GROUPS

Group names provided on the course lists. Note the name of your SG and the names of the other SG members.


1.5 LEARNING MATERIALS

a. Retained by members

Notebook - for recording key points Course Diary Technical Glossary Learning Recall Tape Articles Texts: ILO Code of Practice Joint ILO/WHO Guidelines


1.5 LEARNING MATERIALS

(b) Used but not retained by members:

Daily work pack and guide, including: introduction, lectures, cases, role plays, exercises and key learning points

NOTE: Please use your notebook. Do not mark the Daily Work Pack which must be handed back at the end of each day. You receive all the materials in your SG.

Don't look ahead in the work pack until you are specifically asked to do so!


1.6 METHOD

Try to complete every task in the time allowedA pattern of learning methods will be used Including: Lecture

SG discussionCase analysisQuizLearning patternsRole PlayHomework readingLearning Recall Tape (LRT)

•


1.7 KEY OBJECTIVE OF THE AGL METHOD

To provide efficient and effective learning for every member of the group, in terms of knowledge, skills and attitudes, which motivate further study in the future.


1.8 LEARNING PATTERNS – REVIEW

ADD


1.9 INSTRUCTIONS

(a) Assemble in SG to introduce yourself, indicate your past experience in HIV/AIDS management and what you hope to contribute to and gain from the course.

(b) Complete the registration sheet in the Daily Course Diary.

NOTE: Please check that you have a full set of learning

materials

ASSIGNMENT 2.0 QUIZ(450 minutes)

2.1 INSTRUCTIONS – INDIVIDUAL WORK

(a) Assemble in SG

(b) Answer the quiz of 100 questions; mark your answers a, b, c, or d with a clear "x" on the special form provided in the course diary

(c) Work as quickly as possible but don't guess - leave blanks

(d) Hand in your answer sheet to the Organiser who will mark it and give you a quantitative measure of your knowledge at the start of the course

(e) Reassemble in MG when the bell rings

ASSIGNMENT 3.0 – STUDY/DISCUSSION – HIV/AIDS REALITIES (45 minutes)

3.1INSTRUCTIONS

a. Assemble in SG

b. This gentle activity is designed to creates a

relaxed learning environment, where changes in

knowledge, skills and attitudes can be easier to

achieve.

c. Reassemble in MG when the bell rings

4.0 - LECTURE - BASICS OF HIV/AIDS (30 minutes)

4.1 METHOD

Read aloud, listen and respond verbally to any questions.


4.2HIV/AIDS DATA

a. There is almost complex HIV/AIDS data available which is so hard to understand and to believe.

b. Much of it is “estimate” based upon assumptions”, some of which, prove to be invalid”. Thus some accepted 2006 data may prove to be completely wrong in 2008.


c. In 2005 rough estimates of current world HIV/AIDS incidence needing treatment and % receiving treatment is:

Europe 160m (13% treated) Latin America 465m (68% treated ) South East Asia 1,100m (16% treated) North Africa 75m (5% treated) Sub-Saharan Africa 4,700 (17% treated).

Could these double every year? See WHO Progress on Global Access March 2006.


d. African incidence by country is available from UNAIDS website, but the quality of the data is difficult to verify.

e. HIV/AIDS is a highly emotional secret, embarrassing, stigma and sickness.

f. HIV/AIDS is non infectious by daily normal body but

the AIDS TB (60% get it) is also pandemic - highly infectious, without any body contact at all.

4.0 - LECTURE - BASICS OF HIV/AIDS

(30 minutes)

f. Although there is no “cure”, current treatment for HIV/AIDS/TB with HAART (one pill a day) has a success rate of prolonging life for about 13 years, which compares favourably with the well accepted treatment for cancer and coronary artery disease.

g. Thus, as with cancer and coronary heart disease, rapid diagnosis and treatment, is a priority for all.So no more discrimination for HIV than for cancer!


4.3 INFECTION STAGESStage 1 – three months healthy with perhaps

a fever.Stage 2 - & 3 – Healthy but symptoms of

common infections.Stage 4 – Diagnosis of HIV+ with CD4 (cells

that support the immune system) lower than 250, with chest infections. HIV/AIDS is treated with HAART (only 1 instead of 3-10 pills daily) starts only at this stage, with various regimes and side effects.


• 4.4 DISCRIMINATION

• HIV/AIDS people may suffer discrimination at work in many different cultures. Hence the fear of disclosure.

• Need to take HIV “out of the cupboard”, with no more discrimination for HIV than for cancer.


4.5 MANAGEMENT RESPONSIBILITY

Can we accept that there are a number of reasons why it is necessary to manage the impact of HIV/AIDS in the organization:

1. Firstly, because, HIV/AIDS may possibly (in all environments) have a huge impact the world of work - reducing the supply of labour and available skills, increasing labour costs, reducing productivity, threatening the livelihood of workers and undermining their rights.

2. Secondly, because the workplace is a good place to tackle HIV/AIDS. Standards are set for working conditions and labour relations.

3. Thirdly. Workplaces are communities where people come together.

4. HIV testing and care for every worker, needs Trade Union and Management support, with no more discrimination for HIV than for cancer.


4.6 BASIC FACTS – GENERALLY

a. The Human immunodeficiency Virus (HIV) which causes AIDS is transmitted through body fluids — in particular blood, semen, vaginal secretions and breast milk.

b. Transmission of Infection takes place in four ways:

1. Unprotected sexual intercourse with. an infected partner (90%)

2. Blood and blood products through, infected transfusions and organ or tissue transplant

3. Use of contaminated injection or other skin-piercing equipment

4. Transmission from infected mother to child in the womb or at birth and breastfeeding.


Not transmitted by casual physical contact, coughing, sneezing and kissing, by sharing toilet and washing facilities, by using eating utensils or consuming food and beverages handled by someone who has HIV; it is not spread by mosquitoes or other insect bites.

However, HIV/AIDS often leads (60%!!) to TB which is highly infectious without any body contact at all. Such TB is sometimes resistant to current medications.


4.7 BASIC FACTS – SYMPTOMS\

HIV weakens the human body’s immune System, making it difficult to fight infection. A person may live for ten years or more after infection, much of the time without symptoms or sickness, although they can stilltransmit the infection to others. Early symptoms of AIDS include:

1. Chronic fatigue2. Diarrhea3. Fever4. Mental changes such as memory loss5. Weight loss6. Persistent cough7. Severe recurrent skin rashes8. Herpes and mouth infections9. Invasion of the lymph nodes.


4.8 BASIC FACTS - OPPORTUNIST DISEASES

Cancers, meningitis, pneumonia and tuberculosis may also take advantage of the body's weakened immune system.

4.9 BASIC FACTS - VACCINES & TREATMENT

HIV is such an innovative and complex virus - hundreds of variations - that vaccine may be impossible! Research is currently under way into vaccines, but none is viable as yet.

Antiretroviral drugs are now available that slow the progression of the disease and prolong life. Initially such drugs were expensive and unavailable to most sufferers. Now governments pay and lower-cost drugs are becoming available...


4.10 BASIC FACTS - PREVENTIONHIV is a "fragile virus, which can only survive in a limited range of conditions. It can only enter the body through naturally moist places and cannot penetrate unbroken skin. Condoms - best prevention.

Prevention therefore involves ensuring that there is a barrier to the virus, for example condoms or protective equipment such as gloves and masks (where appropriate), and that skin-piercing equipment is not contra-indicated.


4.11 TB – TUBERCULOSIS

a. HIV has led to rapid growth of the TB epidemic. The incidence (new cases) and prevalence (total active cases) 2004 (latest available) a was estimated as:

Incidence Prevalence (000) (000)

Africa 2,600 3,700 The Americas 400 500Eastern Mediterranean 600 1,100Europe 400 600South-East Asia 3,000 5,000Western Pacific 1,900 3,700

Global 8 900 14,600


b. TB is a leading cause of death among people who are HIV-positive (13% of AIDS deaths worldwide). In Africa, HIV is the most important factor determining the increased incidence of TB.

WHO and its international partners have formed the TB/HIV Working Group to set a new strategy (see later lecture).


4.12 COMPLEXITIES

HIV/AIDS is still presented publicly as a “normal” disease … but it is not treated as “normal” – but rather as a highly emotional sickness, where secrecy…or pseudo –secrecy … is maintained because of cultural values.

HIV/AIDS is presented as “non infectious” by daily normal body contact, but this omits the impact of HIV/AIDS on the TB epidemic. TB is highly infectious, without any body contact at all.

HIV/AIDS medication, with possible serious side effects, starts only at Stage 4.

4.0 - LECTURE - BASICS OF HIV/AIDS 4.13 OVERALL

a. Critical impact when incidence rises from .5% to 5%. It may double every year.

b. Developed countries with adequate resources - relatively un-challenged by the HIV/AIDS epidemic.

c. Developing countries with poverty environments critical challenge at national, organization, group and individual levels, for survival.

d. The impacts of HIV/AIDS are as yet uncontrolled by legislation and culture and practice.

e. The web is full of HIV/AIDS free sites offering data and advice. f. How to make management of HIV/AIDS efficient an effective until HIV

“comes out of the cupboard of personal secrecy” and universal annual testing becomes a accepted normal, required routine? There is nothing “normal” about HIV/AIDS yet!


• EXHIBIT A - HIV/AIDS STATISTICS - 2006

• • 1. HIV transmitted most often? heterosexual sex• 2. Children orphaned by AIDS? 15 million• 3. People newly infected with HIV in 2005? 4 million• 4. People worldwide living with HIV/AIDS? 40 million• 5. People infected with HIV per day? 11, 000• 6. People died of AIDS in 2005? 3 million

• 7. Region most people living with HIV/AIDS? Sub-Saharan Africa• 8. Countries in the world report HIV cases? poor ones• 9. HIV most common in which age range? 25 - 34

years • 10. Percentage of infected with HIV women? 50%• 11. People are living with HIV/AIDS in the USA? 1 million• 12. Adults living with HIV in Botswana 2005? 24%

4.0 - LECTURE - BASICS OF HIV/AIDS• EXHIBIT A - HIV/AIDS STATISTICS - 2006

• 13. Female-controlled method HIV prevention? condom• 14. More likely HIV infected with HIV+ partner? woman• 15. Abstains sex until marriage can still get HIV? yes• 16. Women living with HIV globally? 17 million• 17. South Africa teen girl more likely to get HIV+ 5 times • 18. Pregnant woman with HIV no preventive drugs, • chance that her baby will be HIV positive? 30%

• 19. HIV+ pregnant woman takes correct drugs and • doesn't breastfeed, likelihood o baby HIV? 2%• 20. Woman pass on HIV to baby with breast milk. true• 21. How to see easily that a man has AIDS? not easy • 22. Best protect against HIV transmission in sex? condom• 23. HIV+ woman progress AIDS quicker than man. false• 24. First woman diagnosed with AIDS? 1982• 25. Women HIV infected mostly through ... unprotected hetero-

sex• •


• 4.14 LEARNING PATTERNS


4.15 INSTRUCTIONS (10 MINUTES)

(a) Reassemble in SG.

(b) Study the lecture very carefully and record key points in your notebook.

(c) Discuss any outstanding questions in SG.

(d) When the bell rings carry on with the case study which follows.

ASSIGNMENT 5.0 CASE STUDY - HF - HUMAN FACTOR OF HIV/AIDS

5.1 INSTRUCTIONS

(a) General:

HF is a case study; it is the story of a manager in an organization trying to manage HIV/AIDS. The questions are to help you to analyse the problems.

(b) Individual and SG work (45 minutes)

Read the case and study it carefully. Analyse all the key problems. Answer all the questions in your notebook and record them on the SG flip chart provided. Discuss all

the points together and formulate a specific plan of action you need not all agree but you

must decide.

(c) Combined small group work (30 minutes)Groups will assemble as follows A+D B+E C+FGroups A, B and C will present the answers to all of the questions using their own the

SG flip chart; they should try to achieve a consensus of the CSG on what has happened and what should be done.

(d) Re-assemble in MG when the bell rings.


• 6.1 STORY OF THE CASE

• in 1999, the pandemic of HIV/AIDS in the country has reached 30% with national risk of reduced GNP and business risk of cost of care for HIV+ employees which is three times average wages. 60% of mine workers are HIV+!!! 3 million will die of AIDS by 2010. Huge risk to business survival.

• Mkhize founder and owner of business sub-contractor is worried about HIV/AIDS policy for his company. He has 280 workers (150 skilled) operating since 1948 and listed on stock exchange 1996.

6.1 STORY OF THE CASE

• Mkhize trained himself in HIV/AIDS and began to train all workers (20 a t time) with one day courses, initially on the company but mainly on HIV/AIDS testing, treatment and prevention.

• Two cases in detail. Michael whose treatment failed through non-compliance due to government delayed administration. James whose treatment achieved longer life and working capacity.

• Mkhize takes full responsibility for the health of his workers. He is worried about how to manage HIV/AIDS efficiently and effectively.


• 6.2 What impacts on the individual?

• Shame, and fear• Anxiety• Low productivity and loss of job• Test uncertainty• Cash for family and children• Symptoms and suffering• Side effect of treatment• Wife infection and orphan children


• 6.3 What impacts on the group in which he works?

• Suspicion• Secrecy• Aggression• Fear of transmission• Absence and low contribution• Confusion on how to help


• 6.4 What impacts on the organisation?

• Productivity• Loss of profits• Share value decline• Organizational negative attitudes• Cost of testing, diagnosis and care• Labour replacement costs• Confusion about action and survival


• 6.5 What is lacking in the management of HIV/AID in this organization?

• Cooperation with other business and organizations• Good incidence data.• Supervisor training• Peer group supporter• Testing motivation• HIV/AIDS Strategy


• 6.6 What elements should be in the HIV/AIDS policy?• HIV /AIDS Committee

• Strategy• Objectives• Criteria• Resources• Policy on testing and discrimination• Policy on benefits to employees who become HIV+• Responsibility of employer• Responsibility of employee• Frequent timely incidence data• Testing, treatment and control• Policy on prevention etc.


• 6.7 Write out and justify a plan of action to deal with the problems.

• Set up HIV/AIDS Committee of managers, workers and trade union.• Set strategy with objectives and criteria to measure efficiency and effectiveness.• Introduce EAP - Employee Assistance Program• Monitor diagnosis and treatment of both HIV/AIDS and TB• Cooperate with other business and organizations.


•6.8 LEARNING POINTS

•a. HIV/AIDS and TB are pandemic with incidence of 1-30% which could double each year.

•b. The enterprise is the best place to age the HIV/AIDS challenge because it threatens the survival of the business - so motivation is high!

•c. The impacts on the individual can destroy the will to live.


• d. The impacts on the enterprise are business survival challenges.

• e. The impacts on the group create low productivity, isolation, frustration.

• f. General care for workers is not enough.


• g. An HIV/AIDS strategy is needed with an HIV/AIDS Committee of mangers, workers, trade union, community etc.

• h. The strategy needs objectives, criteria, good incidence data, resources, staffing etc.

• i. An EAP is supportive and can motivate a high level of annual testing which is the key to

prevention.


• 6.9 LEARNING PATTERNS• INSERT


• 6.10 INSTRUCTIONS (10 minutes)

• (a) Re-assemble in CSG• (b) Study carefully the lecture on the case• (c) Record key learning points in your • notebook• (d) Discuss outstanding questions• (e) When the bell rings it is time for lunch …

hooray!

ASSIGNMENT 7.0 – STUDY/DISCUSSION – REALITIES

• 7.1 INSTRUCTIONS

• a. Assemble in new SG.

• b. Read the topics described below and relate selected items to specific challenging

problems in your own organisation.

• c. Share experience and discuss reactions. Record results on the flip chart.

• d. Re-assemble in MG when the bell rings.

8.0 - LECTURE – IMPACTS & RISKS

• 8.1 INTRODUCTION

• a. Critical risks at every level, national, organization, group and individual, which change all the time.

• b. Need for reliable HIV/AIDS data. So much published data based upon assumptions that prove to wring. Whose fault? Nobody knows …we are all estimating

•• c. Risk increased by poverty, emotional and

cultural norms leading loss job, home, partner, money, opportunity … everything! That is why so many intelligent people … including doctors … refuse to take the HIV test!

• d. HIV test result is a “snapshot” of someone’s infection status today. It’s no guarantee that he or she will not become infected tomorrow, or next month.

• It should also be remembered that people with HIV may remain perfectly fit and healthy for many years.

• e. But what about TB? Highly infectious from HIV … without any body contact at all?


• 8.2 GROUP REACTIONS

• Group reactions to a positive HIV+ may include:

• Workers refuse to eat with, or use the same toilet as, a worker known to have HIV.Workers demand protective clothing because of their fear of being at risk of HIV infection.

• Management proposes to remove a worker known to be HIV+ from a post where she/he meets the public.

• 8.2 GROUP REACTIONS

• First-aiders may resign their positions because they fear they areat risk from HIV/AIDS infection if they carry out first aid procedures (e.g. mouth-to-mouth resuscitation).

• Key managers and workers may leave to avoid contact with HIV/AID workers.

• Productivity may fall with worker health absences.


• 8.3 RISKS – NATIONAL

• a. Political – HIV/AIDS mortality crisis and possible revolution,

• b. Health systems – overwhelmed by HIV/AIDS and TB, unable to cope, loss of credibility, loss of trained staff, possible complete breakdown of

health care system.• c. Economic – budget and foreign exchange

deficits, inflation and economic breakdown, necessary external funding may be denied.

• d. Cultural - HIV mortality of parents resulting in an “orphan crisis”, blame always placed on women; stigma of STD, marriage breakdown and rejection, new grandparent role.


• 8.3 RISKS – ORGANIZATION/ENTERPRISE

• a. Production – delays in delivery and loss of orders.

• b. Human Resources – challenge to provide worker direct and indirect of care, negative environment, some good staff may leave, untested workers may promote infection in other workers with HIV or TB.

• c. Marketing – customer and supplier negative reactions, delays and loss of orders.

• d. Finance – higher health care and other costs may lead to severe losses; cash shortages may affect survival of the organization.

• e. Cultural – fear may lead to aggressive reaction to HIV/AID cases when known.


• 8.4 RISKS – GROUP

• a. Fear of infection• b. Sexual contempt• c. Aggression• d. Challenge• e. Cultural


• 8.5 RISKS – INDIVIDUAL

• a. Emotional - fear of public exposure• b. Health - fear of hardship and death• c. HIV/AIDS Treatment - fear of cost• d. Money & Work – fear of losing the job• e. Family – fear of infection and children as orphans


• 8.6 TB – TUBERCULOSIS

• a. Tuberculosis (TB) is a contagious disease, spreading through the air. Only people who are sick with TB in their lungs are infectious.

• When infectious people cough, sneeze, talk or spit, they propel TB germs (bacilli) into the air.

• A person needs only to inhale a small number of these to be infected.

• Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year.



• b. People infected with TB bacilli will not necessarily become sick with the disease.

• The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years.

• When someone's immune system is weakened, the chances of becoming sick are greater.



• c. Overall, one-third of the world's population is currently infected with the TB bacillus. 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.

• d. WHO DOTS program treats TB with daily/weekly drugs for 8 months to affect cure. Failure to complete the treatment, allows the individual to live on, and to infect others. New drugs requiring only 2 months of treatment should be available in 2010.



• e. Some TB are now resistant to single drug treatment. Inconsistent or partial treatment, causes drug resistance.

• A multi-drug-resistant TB (MDR-TB) has developed mostly in former Soviet Union countries, for which treatment is 100 times more expensive and more toxic to patients.


• 8.7 OVERALL

• a. Critical impact when incidence rises from >1% to 20%.

• b. Challenge at every level – HIV & TB - especially for the organization.

• c. There is nothing “normal” about HIV/AIDS yet!


• 8.8 LEARNING PATTERNS

• Insert


• 8.9 INSTRUCTIONS (10 MINUTES)

• (a) Reassemble in SG.• (b) Study the lecture very carefully and

record key points in your notebook.• (c) Discuss any outstanding questions in

SG.• (d) When the bell rings carry on with the

case study which follows•

ASSIGNMENT 10.0 - LECTURE: MINICASES

• !0.1 INTRODUCTION

• Wide variety of alternatives and responses for action by the manager


• 10.2 MINICASE REACTIONS

• 1. HIV+ worker refuses HIV treatment despite high risk of TB infection. Other workers complain.

• Move worker• Interview on HIV testing• Family visit• OHP meeting• TB test• Provider care • Treatment when HIV+


• 2. Worker exposed to customers in food sales. Customer complains that the worker is sick and requests another contact.

• Listen to customer• Show risk as zero• Medical examination for HIV and TB• Check with group• PGEP - worker to worker• Provider care to encourage testing


• 3. New CEO suggests that because of the rise of TB infection in the community every manager and worker and new staff applicants, should have an annual health check up including TB and HIV testing

• Check legality for HIV and TB• Get TU cooperation• Show benefits to every worker• Reduce risk of job loss• PRTP• Introduce slowly


• 4. Doctors and nurses refuse to take an HIV testing before treating patients?

• Check legality• Discuss fears• Ensure employment• Social pressure to encourage workers• |Reward for public disclosure• Social impact• Provider care motivation - "I did it too ... for me ...

and for you all !"


• 5. CEO refuses to hire any more HIV positive workers because of the high cost of health care insurance for all.

• Check legality of HIV and TB restrictions• Insurance cost analysis• Social impacts• TU impacts• Productivity • Profit and share price impact


• 6. Worker with undeclared HIV resigns. The manager knows about HIV and is concerned that the worker will lose all company aid benefits if he resigns too soon.

• Family visit• Child care medical examination• Better alternatives available• TU cooperation for benefit of all• Provider testing for HIV and TB• EAP


• 7. Cash taken from the till. Worker fired. On appeal he reveals he has HIV and need cash for feeding children.

• Peanuts or coconuts?• Past history• Family visit• EAP• PRTP

• Treatment and care


• 8. Temporary 11 month workers not covered for health care for HIV treatment.

• Check legality• What alternatives available• Cost analysis - peanuts or coconuts?• Public relations• Organisational impact (concealment - transmission -

like leprosy in India)• Other supportive care


• 9. Should management be informed about possible infectious disease of staff …and the progress of the treatment, because of risk to other staff?

• Yes - risk of TB infection to other workers - 60%• Testing impact• EAP and PGTP functions• OHP monitoring• Training • Culture change to open-ness


• 10.3 LEARNING POINTS

• a. Check HIV/AIDS legal regulations and reality• b. Check alternatives• c. Show care for the worker and his group• d. Use Provider Care to motivate 100% annual

testing• e. EAP


• f. PGEP • g. Family visits to care for child impacts• h. Cost analysis - peanuts or coconuts?• i. Public relations - community and share price• j. Productivity and profit impacts• k. Training and education for workers and

management• l. Continuous need to learn more about

management of HIV/AIDS• m. TB - 760% of HIV/AIDS - transmits infection

without body contact.



• (a) Re-assemble in CSG

• (b) Study carefully the lecture on the cases

• (c) Record key learning points in your notebook

• (d) Discuss outstanding questions

• (e) When the bell rings … re-assemble …•

ASSIGNMENT 11.0 - SUMMARY LECTURE FOR PART 1

11.1 OBJECTIVES The specific learning objectives are to:




(d) Develop new alternatives and opportunities for action.




•a. Too much complex HIV/AIDS data available which is hard to understand. Some “valid” 2006 data may prove to be completely wrong in 2008.

•b. In 2005 rough estimates of current world HIV/AIDS incidence needing treatment and % receiving treatment is:

• Europe 160m (13% treated)• Latin America 465m (68%)• South East Asia 1,100m (16%)• North Africa 75m (5%)• Sub-Saharan Africa 4,700 (17% treated)

• Will these double every year? See WHO Progress on Global • Access March 2006.


• c. African incidence is given in Exhibit B.

• d. HIV/AIDS is a highly emotional secret sickness. Non infectious by daily normal body but the AIDS TB epidemic is highly infectious, without any body contact at all.


• 11.3 INFECTION STAGES

• Stage 1 – three months healthy with perhaps a fever.

• Stage 2 - & 3 – Healthy but symptoms of common infections.

• Stage 4 – Diagnosis of HIV+ with CD4 (cells that support the immune system) lower than 250, with chest infections. HIV/AIDS medication starts only at this stage, with various DAILY regimes and side effects.


• 11.4 DISCRIMINATION

• People infected or affected by HIV/AIDS may suffer discrimination at work in many different cultures. Hence the fear of disclosure. Need to take HIV out of the cupboard.

• Although there is no “cure”, current treatment for HIV/AIDS has a success rate of prolonging life for about 13 years, which compares favourably with the well accepted treatment for cancer and coronary artery disease.

• Thus, as with cancer and coronary heart disease, rapid diagnosis and treatment, is a priority for all.


• 11.5 IMPACTS

• Developed countries with .5% incidence and adequate resources have little HIV/AIDS impact and can control aid with care for drug users and bi-sexuals and the “Condom Culture”.

• By contrast the poverty of developing countries and no CC, have critical political, economic, human, and cultural impacts which make control almost impossible without a change of culture.


• 11.6 RISKS

• a. Critical risks at every level, national, organization, group and individual, which change all the time.

• b. Need for reliable HIV/AIDS data. So much published data based upon assumptions that prove to wring. Whose fault? Nobody knows …we are all estimating

• c. Risk increased by poverty, emotional and cultural norms leading loss job, home, partner, money, opportunity … everything! That is why so many intelligent people … including doctors … refuse to take the HIV test!


• d. HIV test result is a “snapshot” of someone’s infection status today.

• It’s no guarantee that he or she will not become infected tomorrow, or next month.

• It should also be remembered that people with HIV may remain perfectly fit and healthy for many years.


• e. But what about TB? Highly infectious from HIV … without any body contact at all?

• f. Developed countries with .5% incidence and adequate resources have little risk and have adequate resources.

• g. By contrast the poverty of developing countries the critical risk are political, economic, human, and cultural, and could lead to complete

breakdown at national, organizational and social levels.


• 11.7 MANAGEMENT IN ORGANIZATION

• The workplace is the key location for HIV/AIDS prevention and control.

• Thus the manager in the business organization has the key opportunity to influence HIV infection and to control the treatment of AIDS.

• This will critical to the success and even survival of business organizations in these developing country environments.

•


• 11.8 SOME CONCLUSIONS

• a. The program was designed to help you to develop HIV/AIDS language, concepts, confidence, with new knowledge, skills and attitudes.

It gives you confidence to handle HIV/AIDS and TB management well in the future.

Perhaps, it is going to get worse from 2006 ... before it gets better!

• 11.8 SOME CONCLUSIONS

• b. Management of HIV/AIDS and TB is a priority in 2006 even if company incidence is less than 1% in 2006. It could double every year!

• c. Workplace is the best place to manage HIV/AIDS testing, treatment and prevention. Incidence data is poor and can change radically each year.


• d. Need to motivate testing to reach 100% annually. Culture change is the key. But a HIV/AIDS test result as “negative” may not be valid, until repeated as negative 6 months later!

• e. Strategy needed with objectives, criteria, organisation, resources. No more discrimination for HIV than for cancer!

• f. An HIV/AIDS Committee is necessary to motivate change for the benefit of all. This mixed

committee (managers, workers, trade ions, community) is a vital part of company strategy.


• g, External annual professional audit is vital, to avoid repeating unrealistic assumptions about HIV/AIDS and TB.

• h. AIDS cure currently impossible but good survival 10 years. EAP & OHP & PGEP can all help both the individual. The social group and the organisation.

• i. New motivations for HIV/AIDS and TB cooperation, are needed at national, organization, group and individual level.


• j. Difficulties: stigma, cost, culture, etc. can be overcome, when national sports heroes play a role in promoting100% annual testing with no shame at all!

• k. Government finances treatment but poor administration may bring fatal delays.

• l. Training for managers and workers


• m. Prevention is less costly than treatment.

• n. Taking an HIV test currently, in many countries, may negatively affect employment, insurance, health care, pensions, bank accounts – even when the result of the test is negative!


11.11 INSTRUCTIONS (20 minutes) (a) Reassemble in SG

(b) Study the Summary Lecture for Part I in the course and discuss questions arising.

(c) To get the best out of Part II of the program, complete ALL of the following homework tonight:

1. Study the ILO code 2. Study the complete diary and articles 3. Review your notes for Part I of the course and

list outstanding questions to resolve in Part II

(d) Now, would you please return the workpack to the organiser?

AGL – AUTONOMOUS GROUP LEARNING

AGL 80 – MANAGEMENT OF HIV/AIDS/TB IN INTERNATIONAL BUSINESS (Basic Version – Business – 2 days)

DAILY WORK PACK - PART 2 - DRAFT (Not retained)

Source: Dr Bob Boland MD, MPH (Johns Hopkins), DBA, ITP (Harvard) ex ILOand UN Volunteer Team (Geneva)

Copyright: RGAB/KH 2006/6 Copies with permission. [email protected]

ASSIGNMENT 1.0 - REVIEW


• (a) Assemble in new SG.• (b) Discuss outstanding questions from Part I• (c) Then, role play the two cases and discuss

results• (d) List learning points on the flip chart• (e) Reassemble in MG when the bell rings

ASSIGNMENT 2.0 - STUDY/DISCUSSION - REALITIES


• a. Assemble in new SG.• b. Read the topics described below and relate

selected items to specific challenging problems in your own organisation.

• c. Share experience and discuss reactions. Record results on the flip chart.

• d. Re-assemble in MG when the bell rings

3.0 - LECTURE – DIFFICULTIES

3.1 INTRODUCTION

a. The challenges to and efficient and effective HIV/AIDS management arise from: stigma,

incidence, testing, culture, resources.

b. A negative HIV test may result in loss of: employment, bank account, insurance claim, health insurance, cash, partner, children.

c. These all affect both the individual and the company profitability and survival.


3.2 STIGMA

a. In many cultures sex and STI are never discussed openly and bring shame upon the individual.

b. Often women are blamed and excluded from thefamily home, being blamed for the STI even

though innocent.

c. This prevents effective management of HIV/AIDS diagnosis, treatment and prevention.


3.3 INCIDENCE

a. Incidence data is limited and unreliable due to Stigma.

b. Research published on incidence of HIV/AIDS infection, often fail to meet 2006 epidemiology standards.

c. Incidence of .5% can grow rapidly to 5% ...or even ... 20% unless managed.

d. Incidence above 10% can create economic crisis.


3.4 CULTURE

a. Key opposition to HIV/AIDS management.

b. Associated with deeper values, religion etc.

c. Changes over time with pressure.

d. NEED: No more discrimination for HIV than cancer!


3.5 RESOURCES – LACKING

a. Resources for quick easy local testing and diagnosis.

b. Resources for treatment. Government will pay.

c. Resources for monitoring compliance

d. Resources for prevention.

e. Poverty is the key to infection.


3.6 OVERALL

Although there is no “cure”, current treatment for HIV/AIDS/TB has a success rate of prolonging life for about 13 years, which compares favourably with the well accepted treatment for cancer and coronary artery disease.

Thus, as with cancer and coronary heart disease, rapid diagnosis and treatment, is a priority for all.


Can we accept that there are a number of reasons why it is necessary to manage the impact of HIV/AIDS in the organization:

1. Firstly, because, HIV/AIDS may possibly (in all environments) have a huge impact the world of work - reducing the supply of labour and available skills, increasing labour costs, reducing productivity, threatening the livelihood of workers and undermining their rights.

2. Secondly, because the workplace is a good place to tackle HIV/AIDS. Standards are set for working conditions and labour relations, that influence community values and support for every member.


4. HIV testing and care for every worker, needs Trade Union and Management support, with no more discrimination for HIV than for cancer.


• 3.7 LEARNING PATTERNS - REVIEW


3.8 INSTRUCTIONS

(a) Reassemble in SG

(b) Study the lecture carefully and record key points in your notebook

(c) Discuss outstanding questions

(d) When the bell rings continue with the case study which follows.

ASSIGNMENT 4.0 CASE - SPECIAL SUPPLY (A)

4.1 INSTRUCTIONS

(a) Reassemble in SG

(b) Study the case and answer all the questions in your notebook and on the SG flipchart (30 minutes)

(c) Then work in CSG as follows:

A + D B + E C + F

with groups A, B, and C responsible for the CSG discussion

(d) Reassemble in MG when the bell rings


• 5.1 STORY OF THE CASE

• Special Supply Company is Global Enterprise with hypermarkets in many developed and developing countries around the world and over 1,00 employees. Top Management recognizes the need to relate business practices to the variable cultures and variable ethics of each location, in the “appropriate” acceptable way.

• Top Management also recognizes the obligation in each location to contribute sustainable benefits to local communities and to the employees , with an EAP (Employee Assistance Program) and an OHP (Occupational Health Practitioner) and a PGEP (Peer Group Education Program).


• Thus Top Management demonstrates concern and responsibility for the health of employees and the local community, which enables profitable business operations, sustainability. growth and survival in risk environments.

5.2 HOW EFFICIENT AND EFFECTIVE IS THE EAP?

• The Employee Assistance Programme (EAP) is a worksite-based programme managed by OHP and designed to assist in the identification and resolution of Personal concerns which may or may not impact on productivity or work performance.

• • Not limited. Can include problems of: health,

HIV/AIDS, marital, family, financial, alcohol, drug, legal, emotional, social or work stress, and anything that adversely affect job performance, productivity or safety.

5.2 HOW EFFICIENT AND EFFECTIVE IS THE EAP?

• The EAP appears to be efficient - dong the right things :• a. Uses clearly defined procedures• b., Gets support of management, workers and

trade unions• c. Staff with OHP and health care clinic.• d. Empowered to pay for outside treatment when

needed.• e. Paid fully with company funding.

• EAP may not be effective (doing the right things) because::• a. Not used extensively by the workers - lack of

confidence?.• b. Not able to achieve 100% HIV/AIDS testing (only

40%).• c. Not recognizing the risk of TB infection• d. Poorly publicized.• e. Paperwork!

5.4 HOW EFFICIENT AND EFFECTIVE IS THE OHP?

•The OHP appears to be efficient in:– a. Providing an integrated health service within the , with

education, training (at every level) promoting awareness of health and well-being.

– b. Providing short term interventions– c. Referral to external professionals.– d. Management of EAP

•The OHP may not be effective in:• a. An attitude which deter workers.• b. Encouraging worker voluntary care requests.• c. Encouraging HIV testing but requiring 90 minutes

of counseling.• d. Following up treatment effectiveness.• e. Coping, with too high a volume of activity for only

one OHP

5.4 HOW EFFICIENT AND EFFECTIVE IS THE PGEP?

• Peer Group Educational Program. An excellent idea of worker to worker Company sponsored help using selected of key workers (natural leaders).

• They volunteer for special training in human relations so that they can help to care for and educate fellow workers in health, work and social problems, including HIV/AIDS.

• .

5.4 HOW EFFICIENT AND EFFECTIVE IS THE PGEP?

• PGEP appears to be efficient in:• a. Providing worker to worker for a healthy

lifestyle.• b. Informal interaction• c. Motivating trade union cooperation.

• PGEP may not be effective in:• a. Achieving change in the work culture.• b. Prevention rather than curative health

care.• c. Limiting STI which is the critical worker

health problem

5.5 WHAT IS THE EFFECT OF THESE PROGRAMS ON HIV/AIDS

• By company policy HIV/AIDS is to be treated like any other employee chronic illness.

• However all HIV/AIDS data and care are to be kept secret from managers and other workers and there must be no discrimination. This must be an illusion ]rather than reality.

• However OHP, EAP and PGEP all contribute to HIV/AIDS by:• a. Changing attitudes• b, Encouraging workers to help each other• c. Promoting 100 % testing• d Creating tolerance• e. Promoting EAP and OHP utilization.

• With more effective training and better incidence data, greater progress could be made in: testing, diagnosis, treatment ...and above all ...prevention.

5.6. IMPROVEMENTS THAT COULD BE INTRODUCED

•a. Promote EAP.•b. Better staffing and training of OHP•c. Expand PGEP•d. Coordinate better with HIV/AIDS strategy

and objectives to achieve 100 % testing annually.

•e. Change of culture and attitudes towards STI.•f. Get all health staff to publicly do HIB/AIDS testing every six months.

5.7 LEARNING POINTS

• 1. Key to efficient and effective HIV/AIDS management is motivation of the workers

towards a healthy life style.• 2. OHP provides on site professional help for

every worker on demand.• 3. EAP provides help with both work and

personal family problems.• 4. PGEP uses natural worker leaders to achieve

cultural change for the mutual benefit of every worker.

• 5. Confidential culture is unproductive for HIV/AIDS prevention.

5.7 LEARNING POINTS

• 6. Rapid care and treatment is critical tool for prevention of transmission.

• 7. Group and family involvement helps to change attitudes.

• 8. Company activity is rewarded by the community reaction./

• 9. Health care of the individual worker directly affects incidence of HIV/AIDS

• 10. Time is critical in prevention planning and activities. Aid and treatment too late may have no value at all!!

ASSIGNMENT 5.0 - LECTURE - SPECIAL SUPPLY (A)

• 5.8 LEARNING PATTERNS– INSERT

ASSIGNMENT 5.0 - LECTURE - SPECIAL SUPPLY (A)


• (a) Re-assemble in CSG• (b) Study carefully the lecture on the

cases• (c) Record key learning points in your

notebook• (d) Discuss outstanding questions• (e) When the bell rings it is time for lunch

ASSIGNMENT 6.0 - BILL BROWN


• (a) Reassemble in SG• (b) Role play selected mini-cases.• (c) List learning points on the flip

chart.• (d) When the bell rings, stop for

lunch! Hooray …•

ASSIGNMENT 7.0 GROUP/DISCUSSION - REALITIES


• (a) Reassemble in new SG• (b) Raise outstanding questions for

discussion,• (c) Record learning points on the flip chart.• (d) Reassemble in MG when the bell rings

8.0 LECTURE – OPPORTUNITES AND ACTION

•8.1 INTRODUCTION

•a. Opportunities depend upon leaderships and resources, which are highly political, and subject to other priorities.

•b. When incidence begins to rise rapidly despite current HIV/AIDS management, it becomes a priority at every level.

•c. Action must have political priority and reliable data.


• d. Poorly estimated world incidence. In 2005 current world HIV/AIDS incidence needing treatment and % receiving treatment is estimated: Europe 160m (13% treated), Latin America 465m (68% treated), South East Asia 1,100m (16% treated), North Africa 75m (5% treated , Sub-Saharan Africa 4,700m (17% treated)

• Will these double each year? See WHO Progress on Global Access March 2006.


• e. Universal regular testing for diabetes, hepatitis B, TB, STI, HIV etc. with good motivation, is a critical need HIV/AIDS prevention and care. When the worker knows he is HIV+, he can begin to demand help for himself and his family!

• f. Although there is no “cure”, current treatment for HIV/AIDS/TB has a success rate of prolonging life for about 13 years, which compares favourably with the well accepted treatment for cancer and coronary artery disease. Thus, as with cancer and coronary heart disease, rapid diagnosis and treatment, is a priority for all.


•g. Current CDC recommendations:

•1. Universal routine testing.•2. free testing and treatment.•3. strengthening health services.•4. training.•5. care for poverty and nutrition, and •6. international funding.

8.2 OPPORTUNITIES AND ACTION – NATIONAL

• a. Political – open discussion, end of secrecy, end of guilt, face issues, clear strategy for managing HIV/AIDS which attracts public, private and international support.

• Cooperation with WB and UN Regular publication of valid data on real incidence (not disguised).

• Preventive and curative strategies to attract international funding.


• b. Health systems – changes in the whole reproductive health system, training of staff, resource mobilization.

• Making HIV/AIDS treatment a standard routine (but not the only priority), Extensive HIV testing enforced as Provider Service Care. TB and HIV preventive and control.

• Clear strategy, training, funding, health research and reporting of results regularly each quarter, with valid epidemiological data on HIV/AIDS incidence and care.


• c. Economic – cooperation with UN and World Bank to manage the economic crisis, waste and corruption control.

• d. Cultural – change of attitudes towards STI, tolerance of women and, minorities and HIV/AIDS sufferers, with stronger values of caring for all. No exclusion of HIV.

• • NOTE” Need to get cooperation from major national

sports heroes of football, rugby, tennis, basketball, boxing, wrestling etc. to accept and promote annual HIV.AIDS/TB testing for all. Radio/TV/Papers – a great marketing campaign. Then testing it will be so common, that the stigma will fade away!

8.3 OPPORTUNITIES AND ACTION – ORGANIZATION

• a. Leadership: Employers and trade unions are leaders in their communities and countries. Leadership is crucial to the fight against HIV/AIDS.

• Productivity - so many economic, human, production, marketing implications at the organizational enterprise level, which threaten their

very survival,

• Cuts the supply of labour and reduced income for many workers. Increased absenteeism raises

labour costs. Valuable skills and experience are lost.


• Mismatch - often a mismatch between human resources and labour requirements is the outcome.

• Along with lower productivity and profitability, tax contribution in decline, while the need for public services increases.

• Possibilities need to be activated and productivity maintained.


•b. Human Resources – “HIV/AIDS Committee”

(managers, trade unions, and workers) with a strategy of action. with clear objectives and criteria for measuring them.

Education and training, new personnel policy for care, counseling, testing, discipline, risk reduction, reasonable uni-sex accommodation, cooperation etc.

• Positive organizational environment maintained.


• Set objectives and criteria for measuring achievement; set up organization and staffing to achieve public recognition as a caring organization.

• Implementing workplace programmes to protect workers against HIV infection and its consequences. Along with trade unions, put networks and resources at the disposal of broader HIV/AIDS campaigns.

• The need for committed action with all relevant parties.


•c. Health – set up nursing and psychological care staff to handle HIV/AIDS problems with workers using EAP, OMT and PGET.

•d. Marketing – involve key customers in the committee. Customer and supplier relations and orders maintained


• e. Finance – set up alternative outside funding to handle possible cash crisis of HIV/AIDS

care activities. Get government to pay major treatment costs. Strict cost control to ensure profitability and cash flow maintained

• f. Culture – Move away from secrecy to “normal” HIV testing for everyone every year, create an ethic of caring for all workers. Change to

motivate for 100% annual testing, tolerance and care in all areas of HIV/AIDS management. Secure and more positive organizational environment for benefit of all.

8.4 OPPORTUNITIES AND ACTION – GROUP

•a. Productivity – find new ways to help others to overcome the uncertainty of HIV/AIDS

•b. Human resources – support for the “HIV/AIDS Committee” with worker education teams to help workers prevent HIV/AIDS.

•c. Health – preventive self care and helping others to achieve full compliance of treatment.

• •d. Economics - avoid wasted costs and help to

maintain profitability and cash flow. Cooperation to avoid wasted costs and maintain profitability.•e. Culture – change to motivate testing , tolerance

and care in HIV/AIDS.•f. Helping – find ways to help others with HIV/AIDS

problems.

8.5 OPPORTUNITIES AND ACTION – INDIVIDUAL

•a. Emotional – testing and treatment if needed. Cooperation with others and church and NGOs.

•b. Health – regular diet exercise, care and disciplined life style.

•c. HIV/AIDS treatment and education for compliance. Testing for HIV and TB as a Provider Service when getting other health care. HAART!

•d. Money & Work – build honest relationships with the organization •e. Family – special care of infection and orphaned children.•f. Money & Work – confident honest relationship with the

organization which offers support.

•g. Family – care to avoid infection of children and plans for care in the future with grandparents.

•h. Helping others to share the HIV/AIDS problems.

8.6 TB – TUBERCULOSIS

•a. WHO has developed in 2006, the new ”Stop TB Strategy”.

•b. The new six-point strategy is:

• 1. Pursue high-quality DOTS treatment, expansion and enhancement.

• 2. Address TB/HIV, MDR-TB and other challenges. • 3. Contribute to health system strengthening. • 4. Engage all care providers (public, private,

corporate and NGO). • 5. Empower people with TB, and communities. • 6. Enable and promote research.

•c. This directly relates to the management of HIV/AIDS/TB.


•8.7 OVERALL

•a. Cultural change for the benefit of all•b. End of secrecy – with 100% testing of all managers

and staff every year for diabetes, hepatitis b, TB, HIV etc. with cooperation of the great national

heroes of sport, running, football etc. •c. Prevention and care priorities•d. Management has the key responsibility•e. Critical impact when incidence rises from >1% to

20%.•f. Challenge at every level – especially for the organization.

8.0 LECTURE – OPPORTUNITES AND ACTION• g. Can we accept that there are a number of reasons why it is

necessary to manage the impact of HIV/AIDS in the organization:

1. Firstly, because, HIV/AIDS may possibly (in all environments) have a huge impact the world of work - reducing the supply

of labour and available skills, increasing labour costs, reducing productivity, threatening the livelihood of workers and

undermining their rights.

2. Secondly, because the workplace is a good place to tackle HIV/AIDS. Standards are set for working conditions and

labour relations, that influence community values and support for every member ..


4. HIV testing and care for every worker, needs Trade Union and Management support, with no more discrimination of HOV

than for cancer


• 8.8 LEARNING PATTERNS REVIEW


•8.9 INSTRUCTIONS (10 MINUTES)

•(a) Reassemble in SG

•(b) Study the lecture carefully and record key points in your notebook.

•(c) Discuss outstanding questions.

•(d) Reassemble in MG when …

ASSIGNMENT 9.0 CASE - SPECIAL SUPPLY (B)


•(a) Reassemble in SG

•(b) Study the case carefully and answer all the questions in your notebook and on the SG flipchart (45 minutes)

•(c) Work in CSG as follows:• A + E, B + F, C + D• with groups D, E, F responsible for the CSG. • D, E, F represent the SSC. • A, B, C represent the trade union.

•(d) Reassemble in MG when the bell rings•

ASSIGNMENT 10.0 - LECTURE – SPECIAL SUPPLY (B)

•10.1 STORY OF THE CASE

•Special Supply company is a Global Enterprise with hypermarkets around the world and over 1,000 employees. HIV/AIDS Program is high priority even though company incidence is estimated at only 1- 5% compared with local community 10-25%.

•The HIV/AIDS program integrated with business strategy. HIV/AIDS Committee of managers, workers and trade unions active to monitor strategy. Training programs for managers, supervisors, workers, PGEP’s etc.

•Outsourced: HIV testing and treatment will be outsourced to independent medical clinic.

•Company commits to HIV/AIDS education and prevention. Treating STI rapidly, reduced transmission of HIV by 50 %.

10.1 STORY OF THE CASE

• All permanent employees access to a HIV Clinical management programme. Many lower paid workers refuse to join because of cost. All employees have access to the EAP, OHP and PGEP, but many do not bother.

• Strategy is reviewed on an annual basis and any policy changes communicated to managers, employees, trade unions, communities and governments.

The system works well within limits. OHP’s may be too dominant. Only 44% employees volunteer for annual HIV test. Some test too often but carry on with risky life styles. Employees find it hard to believe that a negative test is NOT VALID until another negative test is done 6 months later. 100% annual testing and cultural acceptance not yet achieved.

• The published policy for HIV/AIDS management is given in Exhibit A

10.2 IS HIV/AIDS A CRTICAL MANAGEMENT ISSUE WHEN THE INCIDENCE IS LOW?

• Yes because incident data is poor and rapid change (doubling each year) is possible and TB risk is high.

• Company key objective is survival in global business. This which requires not only profitability and share price support, but national and community acceptance in so many foreign counters and cultures.

• Thus the company cannot afford to be publicly perceived in failing to take proper care of employees in the current world HIV/AIDS pandemic.

10.3 STRATEGY AND OBJECTIVES

• a. STRATEGY: The HIV/AIDS programmes will be integrated with the Special Supply business strategy. HIV/AIDS Committee active. Training programs for managers, supervisors, workers, PGEP’s etc. HIV testing and health care treatment outsourced to independent medical clinic.

• b. OBJECTIVES: To publicly show care for every employee in the HIV/AIDS crisis To motivate HIV testing. To arrange rapid treatment. To make a priority of HIV prevention.

•

10.4 PREVENTION OF HIV/AIDS

• Company commits to provide HIV/AIDS education and prevention programmes to give people personal responsibility and make positive decisions regarding their health and wellness.

• Immediate access to ESAP and OHP to deal with possible HIV problems. Free condoms in all toilets as the most cost-effective intervention available to reduce transmission, with a new “Condom Culture”. Prompt treatment of STI's may reduce transmission of HIV by 50 %. and be a key to prevention.

10.4 PREVENTION OF HIV/AIDS

• OHP also trained to refer for STI for treatment with free voluntary counselling and testing service, utilising a standard protocol based on World Health Organisation guidelines.

• Free testing for any STI immediately available on request, but the employee must undergo 90 minutes of questions and counselling. Testing for STI by external service providers or sometimes by OHP. | Actual test time for HIV only 2 minutes with feedback of result in 15 minutes. Cost about $12.

10.5 CRITERIA FOR MEASURING RESULTS

• Positive organizational impacts at every level• Incidence reduction• Treatment increase • Compliance increase • TB detection and treatment• Absence of employees for sickness• Productivity• Family care• Trade union support

10.6 ANNUAL EXTERNAL AUDIT

• Considerable outsourcing of: testing and treatment and incidence estimates.

• But no overall external audit of efficiency and effectiveness which would be professionally objective and would compare the company results with other organizations

10.7 FUNCTION OF HIV/AIDS COMMITTEE

• Part of the key strategy. Independent but dedicated committee of managers, workers, health staff, trade union and consultants. Responsible for key decisions on: strategy, objectives, resources, control etc.

• Very effective in achieving worker cooperation within existing cultural

• Not actively engaged in management. Always, comparing HIV/AIUDS/TB with other companies and changing attitudes.

10.8 CHANGES

• Culture• Values• Attitudes• Stigma• Fear• Need • External professional advice on efficiency and effectiveness• Movement from 44% to 100% annual testing• Preparation for possible HIV/AIDS incidence disaster

10.9 PLANS OF ACTION

• a. Company: Annual professional audit, cost control, better training for all levels. Videos to influence culture change, taking "HIV/AIDS out of the cupboard of secrecy" .Public acceptance (like cancer). Reward systems for every level. Training at every level. Movement towards “standard annual medical examination” including blood tests for Hepatitis B, TB, Diabetes and HIV

• b. Trade Union: Change secrecy policy for the benefit of every worker; establish job security confidence with

cooperation, train all members with positive attitude to win health and care for every employee.

• c. Community: Join company and trade unions in changing the culture towards care, treatment and prevention for all without secrecy; follow up compliance; check TB risk etc.

10.10 LEARNING POINTS

• 1. HIV/AIDS and TB, is a critical management problem even when the current incidence APPEARS to be low.

• 2. Incidence data is poor and can change by 100% in a year.

• 3. HIV/AIDS management strategy is just one part of the over all business strategy for profitability and survival.


• 4. A mixed HIV/AID Committee is a vital part of the strategy.

• 5. Objectives and criteria for measurement must be objective and realistic.

• 6. Resources of staff and funding must be adequate to overcome the epidemic.


• 7. External audit is vital to avoid repeating illusions.

• 8. Local community benefits essential for long term business survival in developing countries.

• 9. Prevention is less costly than treatment at group and individual level.


• 10. Need for “standard annual medical examination” including blood tests for Hepatitis B, TB, Diabetes and HIV.

• 11. Need for the TV stars of football, rugby, tennis etc to accept a new “standard annual medical examination”

• 12. Need for every doctor and health care worker to accept a new “standard annual medical

examination”

• 13. New motivation for cooperation, needed at national, organization,

10.11 LEARNING PATTERNS

• INSERT

10.12 INSTRUCTIONS (10 minutes)

• (a) Re-assemble in CSG• (b) Study carefully the lecture on the

case• (c) Record key learning points in your

notebook• (d) Discuss outstanding questions• (e) When the bell rings reassemble in MG

ASSIGNMENT 11.0 QUIZ

• 11.1 INSTRUCTIONS•• (a) Reassemble in SG• (b) Do the quiz of 100 questions on the

answer sheet in the diary• (c) Check your answer with the organiser

and resolve outstanding questions• (d) Complete the first feedback form in the

course diary and give to the organiser.• (e) Reassemble in MG when the bell rings

12.0 SUMMARY LECTURE FOR PART II•

•12.1 SPECIFIC OBJECTIVES

The specific learning objectives are to:




(d) Develop new alternatives and opportunities for action


12.0 SUMMARY LECTURE FOR PART II

12.1 SPECIFIC OBJECTIVES (continued)

The syllabus of the program includes:

language, concepts, diagnosis, treatment, cultural barriers, infections, TB control, prevention, impacts, risks, difficulties, strategy, HIV/AIDS committee, organisation, staffing, action planning with objectives, criteria, OTP, EAP, PGEP, staffing, reporting, control and audit.

12.2 IMPORTANCE OF THE ORGANIZATION – FOR MANAGEMENT OF HIV/AIDS/TB

• Can we accept that there are a number of reasons why it is necessary to manage the impact of HIV/AIDS in the organization:

1. Firstly, because, HIV/AIDS may possibly (in all environments) have a huge impact the world of work - reducing the supply of labour and available skills, increasing labour costs, reducing productivity, threatening the livelihood of workers and

undermining their rights.

2. Secondly, because the workplace is a good place to tackle HIV/AIDS. Standards are set for working conditions and

labour relations, that influence community values and support for every member.


4. HIV testing and care for every worker, needs Trade Union and Management support, with no more discrimination for HIV

than for cancer..

12.3 WORK COMPLETED

• Basics• Impacts & Risks• Difficulties• Opportunities & Action

12.4 POINTS ON CASES

• Human Side of HIV/AIDS - care, concern, seeking alternatives, dangers of delay, need for strategy and organisation with management and employees working together.

• Minicases - developing alternatives in reacting to employees for the management of HIV/AIDS

• Bill Brown - role playing to develop change in knowledge, skills and attitudes.

• Special Supply (A) - motivating and caring for employees with EAP, OHP, PGEP working efficiently and effectively to support HIV/AIDS strategy.

• Special Supply (B) - HIV Committee, strategy, objectives, staff and resources to minimize the risks of HIV/AIDS on business survival.

12.5 DIFFICULTIES

• The challenges to and efficient and effective HIV/AIDS management arise from: stigma, incidence, testing, culture, resources.

• These all affect company profitability and survival.

12.6 HIV/AIDS STRATEGY

• a. Strategy for management of HIV/AIDS must include: objectives, criteria, organization, staffing, resources and annual external audit.

• b. An EAP - Employee Assistance |Program , OHP - Occupational Health Practitioner and PGEP - Peer Group Educational Program can all work together to create a positive organisational environment for both workers and management.

• c. The key role in strategy is the HIV/AIDS Committee.

• d. An external annual audit is a valuable source of reliable management data and new ideas

12.6 HIV/AIDS STRATEGY

• e. Although there is no “cure”, current treatment for HIV/AIDS/TB with HAART, has a success rate

of prolonging life (as with cancer) for about 13 more years, which compares favourably with

the well accepted treatment for cancer and coronary artery disease.

• g. Thus, as with cancer and coronary heart disease, rapid diagnosis and treatment, is a priority for all.

• h. Current CDC recommendations: 1. Universal routine testing, 2. free testing and treatment, 3. strengthening health services, 4. training, 5.

care for poverty and nutrition and 6. international funding.

12.7 CONCLUSIONS – REPEATED

• a. The program was designed to help you to develop HIV/AIDS language, concepts, confidence, with new knowledge, skills and attitudes. It gives confidence to handle HIV/AIDS and TB management well in the future. Perhaps, It is going to get worse from 2006 ... before it gets better!

• b. Management of HIV/AIDS and TB is a priority in 2006 even if company incidence is less than 1% in 2006. It could double every year!

• c. Workplace is the best place to manage HIV/AIDS testing, treatment and prevention. Incidence data is poor and can change radically each year.


• d. Need to motivate testing to reach 100% annually. Culture change is th key. But a HIV/AIDS test result as “negative” may not be valid, until repeated as negative 6 months later!

• e. Strategy needed with objectives, criteria, organisation, resources.

• f. An HIV/AIDS Committee is necessary to motivate change for the benefit of all. This mixed

committee (managers, workers, trade ions, community) is a vital part of company strategy.


• g, External annual professional audit is vital, to avoid repeating unrealistic assumptions

about HIV/AIDS and TB.

• h. AIDS cure currently impossible but good survival 10 years. EAP & OHP & PGEP can all help both the individual. The social group and the organisation.

• i. New motivations for HIV/AIDS and TB cooperation, are needed at national, organization, group and individual level.


• j. Difficulties: stigma, cost, culture, etc. can be overcome, when national sports heroes play a role in promoting 100% annual testing with no shame at all!

• k. Government finances treatment but poor administration may bring fatal delays.

• l. Training for managers and workers


• p. Family HIV orphan impacts can be horrendous.

•• q. TB pandemic - 20% in Africa. HIV/AIDS leads

to 60% to TB - sometimes untreatable.

• s. TB treatment must be maintained weekly for full 8 months or the individual lives on to infect others, without any physical contact. Community support and discipline needed. New 2 month drugs are coming … in 2010 …


• u. HIV/AIDS and TB, is a critical management problem even when the current incidence APPEARS to be low.

• v. HIV/AIDS management strategy is just one part of the overall business strategy for profitability and survival.

• w. Objectives and criteria for measurement must be objective and realistic.


• x. A company must provide HIV/AIDS and TB benefits to local communities, to justify its long term business survival in the poverty of so many developing countries.

• y. Need for the TV stars of football, rugby, tennis etc to accept a new “standard annual medical examination” examination”. Need for every

doctor and health care worker to accept the same annual examination.

• z. Resources of staff and funding must be adequate to overcome the epidemic, with no more discrimination for HIV than for cancer.

12.8 END OF THE PROGRAM – ALMOST

• In HIV/AIDS and TB management good luck … is very helpful …. so please remember:

• Napoleon ... who said: • “I want good generals ... but ... I want lucky • ones too!

• and Gary Player ... who said: • “The more I practice .. the more luck I seem to get”.

12.8 END OF THE PROGRAM – ALMOST

• This ends our AGL program; the first of a series. We hope it has inspired you to develop your knowledge, skills and attitudes skills by practical applica tion.

•• Thank you for your interest and hard work. Keep the

AGL materials and glossary handy as a daily reference for HIV/AIDS language.

• We hope that you have much enjoyed the AGL experience and that it motivates you to read widely on HIV/AIDS and to continue your studies in the future.

EXHIBIT ALEARNING MAINTENANCE PROGRAM

DAYS 4-34• Now reinforce your learning from the program by

using the LRT (Learning Recall Tape) to help you with the "Learning Maintenance Program" (Exhibit A which follows), as explained by the organiser.

• Then please send us the Final Feedback Summary and quiz results on day 34.

• We trust that you have found AGL to be both "efficient" (doing things right) and "effective" (doing the right things). Thank you for being a member of our AGL program.

• RGAB/KH 1.10.2006

EXHIBIT ALEARNING MAINTENANCE PROGRAM

DAYS 4-34•

• 1. Objective ‑ to ensure that learning from the

course is both maintained and reinforced !!!

•2. Make contact and discuss problems arising with a member of your local HIV/AIDS

Committee.

•3. For other outstanding questions or ideas, do not hesitate to email us: [email protected], for whatever assistance may be needed.

•4. Routine study follows …

3. ROUTINE STUDY

•a. Play the LRT (Learning Recall Tape) several times to reinforce the your learning recall, achieve deeper understanding of EVERY aspect of the course, and to identify the learning materials that will require extra study time.

•b. Study the ILO & WHO HIV/AIDS/TB codes.

•c. Review all the course learning materials.

•d. From day 10 onwards, study the ILO & WHO HIV/AIDS web sites.

•e. On day 34, complete again the quiz of 100 questions (on email

request) and return it the Organiser with your mature feedback on the course content and its direct application to your area of responsibility.

12 - CONTRAVERSIAL ISSUES FOR DISCUSSION

• 1. HIV/AIDS/TB is a world pandemic problem, which differs in every region, thus standard international solutions cannot work.

• 2. In HIV management, political skills are more important than management skills.

• 3. HIV prevention and control cannot be achieved by “voluntary testing”.


• 4. Reframe the HIV stigma from … “shame to test” … to … “shame not to test” … to show care for children and family.

• 5. The “ethics” of HIV management must meet local standards … not international standards … of acceptable behaviour.

• 6. Failed HIV failed projects … are almost never reported objectively … by donors, by receivers, by managers or by governments.


• 7. HIV integration with primary health care can only happen … when it recognizes and uses local culture, values, tradition and health care organisation.

• 8. HIV based TB is highly infectious without any sexual contact at all.

• 9. Workplace HIV testing and care for every worker, needs Trade Union and Management support, with no more discrimination for HIV than for cancer.


• 10. The illusions of some major HIV projects must begin to be recognized.

• 11. Vaccination of HIV (with 60 or more virus variations) should not be expected soon.

• 12. Two days of HIV training for every manager could significantly change management responsibilities and community attitudes, towards HIV testing, care and prevention.

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