0 C TO B E R 2 0 01 A PROGRAM OF THE C6NSULTATIVE GROUP ON INTERNATIONAL AGRICULTURAL RESEARCH ~CGIAR) .HIV/AIDS. inthe.,- CGlARVWor,k p'lacel: Model Policies a~nd Practices PREPAREb BY:NANCYJALLEN working paper gender diversity - ~~~~~~ PRG1GAM OF TSEi%SULTATIVE GCROUP ON y INTERNATIONAL AGRICULTURAL RESEARCH (CCIAR) CGIAR ' * a The Consultative Group on lnternational Agricultural In 1'999, this proguam was broadened to include Research (CGIAR) was created in 1971 from an- diversity. The progratm provides support to the asso'ciation of pablic and private memb,ers that bCenters through small grants, technical assistance, } . . - . R ~~~~and management consulting, training, an'd' support a system ef O international agricuuwal tnude and - ' - research centers known as Future Harvest Centers. Diversity Program is hosted by ICRAF (Nairobi, Working in more than 100 countries~, The Futbre , Kenya) and the Program Leader, is Vicki Wilde - Harvest Centers mobilize cutting-edge science to (v.wildeAcgiar:org). reduce hunger and0povertyl improve human nutrition The Gender and Diver,ityjProgram seeks to use and health, and protect the environment.'The tenters diversity to sirengten internal and external * \ are located in 12 developing and 3 developedE partnerships that enhance the relevance and impact countries and are sponsored by The World Bank, the of the Centers, by creating and maintaining an. Food and Agriculture Organization (FAO), and the organizational culture that: United Nations Dlvelopment Program (UNDP) The ' i -' CGIAR budget in 200' was J $340 million. All*; X *-l Attracts and retains the world's best women and -new technologies arising from the Center's research men; are freely available to everyone. For more Encourages the recruitment and promotion of unde-ersne rus - ' information about the CGIAR, see: www.cgiar.org der-represented groups; Establishes a workplace climate' of genuine GENDER AND DIVERSITY PROGRAM . respect, equity and high morale; The CGLAR Gender and DiversityProgtam serves to * Promotes a healthy balance between cultiyate a workplace where diversity is celebratej professional and private lives; *ancA all staff are empowered to give th,ir best to, * Inspires world-class eQmpetency in multi- enrich fouti're harvests. Its overall goal is to assist the ' cultural teamwork, cross-cultural '- - - . ~~~~~~~communication aind internatiorial mnanagement; 16 CGIAR Centers to seek out,and.collectively gain * c , i mne, from the diversity inherent within the global ' . * Empowers and enthuses all women and men in -organization. The Gender and. Diversity program , the sye o maximizepoeson and -and collectively contribute their best; and grew out of a 1991 C(iIAR ihitiativelon gender - the.. ' . . . * Rewards leadership, creativity and innQvation staffing aimed at assisting the Centers to proipote thateemploys and celebrates diversity ik the recruitmen$, accomplishment, advancement and - Centers. retention of wbmen scientists an4 professionals. , , - CIAT Centro Internarional de Agrieultura Tropical (COLOMBIA) CIFOR Center for Intematronal Forestry Research (INDONESIA) CIMMYT- Centro Interdacional de Mejoramiento de Maiz y Trigo (MEXI6O) ; - CIP Centro Internacional de la Papa (PERU) ICARDA International Center for Agricultural Research in the Pry Areas (SYRIA) ICLARM International Center for Living Aquatic Resources Management (MALAYSIA) ICRAF International Center for Research in Agroforestry (KENYA)'' .* - . .lICRISAT' ,International Crops Research Instftute for the Semi-Arid Tropics (INDIA) IFPRI IntemationiA Food Policy Researdh Institute (U$A , * ' IWMI Intemational Water Management Institute (SRI LANKA)' 1ITA Internationial Institute of Tropical Agriculture (NIGERIA) ILRI Intemational Livestock Research Institute (KENYA) , IPGRI International Plant Genetics Resourwes Institute (ITALY) 'IRRI 'nternational Rice Research Institute (PHILIPPINES). ISNAR-` Intenational Service for National Agricultural Research (THE NETH4ERLANDS) WARDA West Africa Rice Development Association (COTE D'IVOIRP) CGIAR GENDER AND DIVERSITY PROGRAM WORKING PAPER No. 28 HIV/AIDS IN THE CGIAR WORKPLACE: MODEL POLICIES AND PRACTICES Prepared by Nancy J. Allen May 2001 Draft for discussion Table of contents Table of contents CHAPTER I: INTRODUCTION 1 Statement of objectives 3 HIV/AIDS workplace policies and programs 4 CHAPTER II: MODEL HIV/AIDS POLICY FOR FUTURE HARVEST CENTERS 8 Preamble 8 Principles 8 Education statement regarding HIV/AIDSs 9 HIV/AIDS program in the workplace 9 CHAPTER III: MODEL GUIDELINES FOR EDUCATION AND PREVENTION 13 Basic elements 13 Additional provisions 14 Content of education programs 14 Condom distribution and prevention counseling 15 CHAPTER IV: MODEL GUIDELINES FOR VOLUNTARY HIV/AIDS TESTING AND COUNSELING 18 CHAPTER V: MODEL RECOMMENDATIONS FOR TRAVEL AND PEP KITS AND WORKPLACE INFECTION CONTROL 20 Travel kits 21 Post-exposure prophylaxis 21 Basic principles of workplace infection control 22 Questions for CGIAR Human Resource Division 23 CHAPTER VI: RESOURCES ON THE INTERNET FOR HIV/AIDS MANAGEMENT IN THE WORKPLACE 24 Centers for Disease Control 25 Family Health International 25 Society for Human Resource Management 25 UNAIDS 26 Centre for African Family Studies 26 APPENDICES 27 1 Dr.i i Nay I. Al::Bien rciv e :::L:t :Ad her Ph.D in Orgaizatioa BehavEiord fromE Harar Unierity,aS Cjoint A 0degeoftheHrvr 2 Busiess School an thie Deatmn of4 Sociology She als hods:i an M A.ro the Unvrst ofSat Caa an aBS. in Arabi andJ Midl EasttS Stuie fro Gerge}townl Uniersty.Dr Ale haswored extensively in the prv ate setr ;andjl 00 mor reenl in 'h puli setr. Fro~ 1994 to 200,sh the Minitryo FianctSe in ndneia.InInonsia shtae specidaHlized00000 inat devlopen. I te erodafater heEst sianeonomicaS crisis, sh develpe .addtinaxprie in e aras ofompeition poicy bankrupaee0tc law ciievce rfom,as well .ast cororae andgpublicgovernane. She000 Sis crrntl wringas anideeniden oslant, base bd inNaroi, S Kenya, andis delihtd Stobe worin aain nherfieXaqldof exp~ertie a-e-f oramaioa deig focooi devlomet Her k W currn cliensts |EAT include te,, COJR ede DiestyPoramh (onsutin na vaiLetyV }¢onf internatioaluan resourc policy isses)an othe Rockefeller; d&evelopentof agricutua resacan ex tensionVge in Uganda).ee ee; ii CHAPTER 1: Introduction Introduction The HIV/AIDS pandemic is a pressing challenge for the CGLAR. HIV/AIDS affects the health of friends and colleagues, the quality of research, and ultimately, prosperity and development throughout the world. In light of these challenges, the CGIAR has established a "Systemwide Initiative on the impact of HIV/AIDS on Agriculture, Agricultural Research and Development" (SWIHA). The CGIAR Gender & Diversity program has taken the lead to address the problem of HIV/AIDS in the CGIAR workplace. While HIV/AIDS is a sobering issue, immediate and positive action is fully possible. In order to address HIV/AIDS in the CGIAR, the Gender & Diversity Program has assumed responsibility to serve as an immediate resource on the best workplace practices, policies and programs. In the long-term, the policies and programs adopted by Future Harvest Centers should act as a model for national research partners. This document sets this process in motion by providing policies and guidelines in the following areas: 1. Model Code of Conduct and Policy for HIV/AIDS 2. Model Guidelines for Education and Prevention of HIV/AIDS 3. Model Guidelines for Voluntary Testing and Counseling 4. Model Guidelines for Post Exposure Prevention and Travel Kits and Workplace Infection Control 5. Worldwide Web Resources on HIV/AIDS in the Workplace These draft policies and guidelines can be adapted to fit the special needs and circumstances of each Future Harvest Center. Additional material exists for these topic areas and the CG Gender & Diversity program is prepared to serve as a resource center for further exploration of these issues. STATEMENT OF OBJECTIVES There is no clear data on the incidence of HIV/AIDS at Future Harvest Centers. Precise numbers are always difficult to establish, as cultural barriers often preclude candid disclosure of HIV/AIDS status. However, HIV/AIDS is a serious problem in sub-Saharan Africa and will likely become a significant problem in other regions, such as Southeast Asia. A serious aspect of HIV/AIDS is the enormous number of people affected indirectly or directly by the disease. However, it is important to remember that people with HIV can lead productive lives for decades. The preservation of life and prevention offurther infection are as important as compassionate care for those suffering and dying from AIDS. It is the aim of the CG Gender & Diversity Program to encourage the adoption of HIV/AIDS policies and programs throughout the CGIAR, in order to: * Prevent further HIV infection among all CGIAR employees and their family members. * Preserve the lives of those employees and their family members currently infected with HIV/AIDS. * Provide compassionate care for those employees and their family members suffering and dying from AIDS. * Encourage a commitment to provide HIV/AIDS insurance coverage to all international and local CGIAR staff members. * Foster a workplace that does not discriminate on the basis of disease. * Set an example for our communities, and particularly national research partners, for the compassionate management of HIV/AIDS. The HIV/AIDS pandemic is an intimnidating reality and often the first reaction is imagining the worst possible outcome - numerous individuals incapacitated and dying of AIDS. It is important to remember, however, that most individuals infected today with HIV may lead productive lives for 15 years and more. There is also hope that medical advances will continue to improve the longevity of HIV-positive individuals. 3 There are three phases of HIV infection. During the first phase, the virus exerts no serious effects and employees can lead normal and productive lives. In the second phase, the immune system begins to weaken and the employee succumbs more frequently to illness. Currently, the first and second phase can last for 15 years. However, with improved treatment, the latency period of infection is increasing. Currently, the health and longevity of HIV-positive individuals are greatly improved with use of a "triple treatment," a drug regime employing three different anti-retroviral drugs. In the third phase, colloquially termed "full-blown AIDS," the employee becomes incapacitated and is likely to die. It is encouraging to note that in April 2001, significant progress was made between developing country governments, international organizations, and the multinational pharmaceutical industry to improve access to affordable retroviral drugs.I The focus of workplace policy has moved beyond issues of incidence to the impact of HIV/AIDS in the work environment. Impact in the workplace is experienced in various ways. In the most extreme case, there is the loss of productive employees and the cost of replacement and training. With advanced HIV infection, there is increased absenteeism and the concomitant loss of productivity. In a broader context, employees with family members infected with the disease will lose time at work to attend funerals, and will carry a higher financial burden as family members die and they undertake the care of orphaned nieces and nephews. Other areas of impact include the breakup of research teams as a result of illness and death, and the isolation and withdrawal of the HIV-infected employee. Human Resources (HR) must address these realities when developing compassionate HIV/AIDS policies and programs. HIV/AIDS WORKPLACE POLICIES AND PROGRAMS The best workplace policies clearly define the management of HIV/AIDS infection and prevention. Ideal policy (and there are many models currently available) includes the following: Sheryl Gay Stolberg. "AIDS Drugs in Africa: If Cedes to When." New York Times, 10 March 2001. 4 Fundamental policy commitments International Labor Organization guidelines, and UN and World Bank standards, provide the basic policy for most international organizations2 in addressing the problems of HIV/AIDS in the workplace: 1. No pre-employment screening for HIV/AIDS. 2. Voluntary HIV/AIDS testing available, counseling encouraged, and confidentiality assured. 3. No termination of staff infected with HIV/AIDS. 4. Health Insurance Benefits for international staff with HIV/AIDS. 5. Health Insurance Benefits for national or local staff with HIV/AIDS. 6. Health Insurance Benefits equal for internationally recruited staff (IRS) and nationally recruited staff (NRS). The most difficult policy goal to achieve will most likely be the provision of equal health and insurance benefits to international and national staff. Individual centers will need to explore the constraints imposed by national insurance coverage and determine how to compensate for these inadequacies and limitations. In the immediate future, the most glaring inequity will continued to be access to anti- retroviral drugs. Fortunately, great progress has recently been made between pharmaceutical companies and developing country governments, which will improve access to affordable anti-retroviral drugs. Compassionate message and assurance of non-discrimination In one form or another, effective programs emphasize the organization's understanding and commitment to the issue of non- discrimination with respect to individuals affected by HIV/AIDS. While there is no official CGIAR policy document on HIV/AIDS, the Centers should support all employees affected by the disease in a non-discriminatory manner. 2 See Appendix C for an overview of policies and practices of comparative international development organizations. The CGIAR Gender and Diversity Program completed this comparison via e-mail questionnaire. 5 Education andprevention programs Education and prevention programs are essential in reducing the impact of HIV/AIDS in the workplace. Education and prevention programs ideally strive to induce effective behavior change. Many organizations continue to find it necessary to begin with initial awareness programs designed to remove irrational fears about HIV/AIDS. Educational programs take many forms, and resources are growing to develop appropriate programs worldwide. Supportfor the bereaved A significant impact of HIV/AIDS results from the death of family and friends with HIV/AIDS. Depending on local cultural practices, this may require increased time off for funerals and increased financial stress. Centers may wish to address these issues through counseling programs and improved supervisory training. Participatory process Successful HIV/AIDS programs involve representatives from all levels of the organization in becoming involved in policy planning and implementation. Compliance with local law As always, employment policies must comply with national, sub- national, and local laws and regulations. Compliance with local law, however, often sets minimal standards and does not assure a compassionate, sensible, or non-discriminatory policy. On the following pages, a model HIV/AIDS policy document, and model guidelines document are presented. In addition, in the Appendix A-C, information on HIV/AIDS policy at ICRAF, the World Bank and other international organizations is given. 6 -_A CHAPTER 1: Model HIV/AIDS policy for Future Harvest Centers Model HIV/AIDS policy for Future Harvest Centers3 PREAMBLE The Center: * acknowledges the seriousness of the HIV/AIDS epidemic (this may be accompanied by statistics relevant to the region and institutional location); * seeks to minimize the social, economic and developmental consequences of HIV/AIDS to the Center and its staff: and * commits itself to providing resources and leadership to implement a compassionate HIV/AIDS program. PRINCIPLES The Center affirms that: * staff living with HIV/AIDS shall be protected against discrimination and accorded with the dignity and respect due all staff members; * HIV status shall not constitute a reason to preclude an-y person from employment; * no staff member shall be required to undergo HIV testing. Where testing is done it will be at the voluntary request of the employee and will be accompanied by counseling; * confidentiality of HIV status of any staff member shall be maintained at all times; * individuals infected with HIV/AIDS are entitled to the same rights, benefits (e.g. pension, life-insurance) and opportunities as people with other serious or life- threatening diseases 3 This model policy draws heavily on the European Union's Guidelines/for developing a wor-kplace policy anid programme on HIV/AIDS and STDs. (March 1997 8 * continuing development and implementation of HIV/AIDS policy and programs will be done in consultation with staff and their representatives; and * a spirit of compassion and understanding for HIV-infected people will be fostered throughout the organization. EDUCATION STATEMENT REGARDING HIV/AIDS The Center understands that: * AIDS (Acquired Immunodeficiency Syndrome) is a condition in which the body's immune system breaks down, and the person typically develops a variety of life- threatening illnesses. HIV (Human Immunodeficiency Virus) causes AIDS. * HIV/AIDS is not transmitted through casual contact in the workplace. A person becomes infected by engaging in unprotected sexual intercourse, sharing needles or syringes with infected persons, and infected blood transfusions, HIV-infected mothers transmit the disease to their children through pregnancy. childbirth, or breastfeeding. HIV is not transmitted through air, food, water, utensils, toilet seats or anything else that does not involve blood, semen, vaginal fluids or breast milk. - Individuals with HIV/AIDS may live productive lives for 15 years or more. With the aid of anti-retroviral drugs, longevity is improving. HIV/AIDS PROGRAM IN THE WORKPLACE Co-ordination and implementation The Center appoints the Human Resources Department to: * communicate HIV/AIDS policy to all staff; * identify and liaise with local HIV/AIDS service organizations and other resources in the community; * foster a supportive and non-discriminatory working environment for those infected with HIV/AIDS; * implement, monitor and evaluate the Center's HIV/AIDS program; and * advise management of program implementation and progress. 9 Program components The HIV/AIDS program shall provide staff access to: * information, education and media materials; * voluntary testing and counseling (VTC) for HIV/AIDS; * health insurance coverage for all staff members, whether recruited nationally or internationally, for the treatment of HIV/AIDS and associated illnesses. (Details of health insurance coverage should be clearly documented in the general policy statement or under separate cover); * barrier methods (male condoms) to prevent transmission of HIV; * protective materials in the form of HIV prevention travel kits and post-exposure prophylaxis kits for staff inadvertently exposed to HIV/AIDS; and * workplace support for all staff affected indirectly or directly with HIV/AIDS. Planning The Center shall conduct regular impact analysis to understand the evolving epidemic and how it affects the future of the Center, its structure, and functions. Budget The Center shall allocate an adequate budget to implement the H1V/AIDS program. Interactions with partner organizations The Center recognizes a potential to serve as a positive model for partner organizations in the region and will strive to share educational materials and policy documents for the prevention and management of HIV/AIDS whenever and wherever possible. Questions for center management To achieve basic standards of HIV/AIDS management in the workplace, each Center must ask the following questions: 10 1. Do current insurance policies reflect a difference in IRS and NRS coverage? If so, how can equitable insurance be obtained, and at what financial cost? 2. Is HIV/AIDS treated differently than other chronic, life- threatening diseases and serious medical conditions? 3. What is the local availability and cost of "triple treatment?" How can access to this medication be improved? 11 CHAPTER III: Model guidelines for education and prevention Model guidelines for education and prevention A strong education and prevention program is vital to the management of HIV/AIDS in the workplace. Though data remains limited, preliminary analysis in sub-Saharan Africa suggests that the financial impact of HIV/AIDS to an organization exceeds the cost of a prevention program. In other words, a strong HIV/AIDS education and prevention program is both a moral obligation and a good business practice. Education and prevention programs take many forms and each center must determine what is appropriate, technically and culturally, for its particular task and risk environment. Most education and prevention programs begin with an assessment of the local problem, followed by campaigns to increase awareness, and disease prevention and management. BASIC ELEMENTS The basic elements of an effective education and prevention program include: 1. Communication of well defined, well understood and consistently applied HIV/AIDS policies and practices. 2. Provision of on-going, updated formal and informal education for all staff. 3. Access to condoms on a consistent basis. 4. Voluntary access to HIV/AIDS diagnosis with counseling. 5. Counseling and support services for employees and families. 13 ADDITIONAL PROVISIONS In areas where there is high-risk of disease, or in instances when employees travel to high-risk regions, additional components of an education and prevention program are necessary and should be made available: 1. HIV travel kits or information about them. 2. Post-Exposure Prophylaxis (PEP) kits and education about them. 3. Basic principles to control workplace infection. 4. Information on how to obtain safe blood in a given region. CONTENT OF EDUCATION PROGRAMS The specific content and delivery of education programs will differ from region to region depending on HIV/AIDS risk and the existing knowledge base within the employee community. As mentioned above, the design of education programs most likely begin with a needs assessment. As HIV/AIDS discussions involve personal issues, there is a need to be sensitive to what is culturally acceptable and understandable to target groups within the Center. The piloting of HIV/AIDS educational activities and materials is a good first step in the design and feedback process. Additionally, Centers need to identify HIV/AIDS educational resources in the community. In large metropolitan areas, HIV/AIDS education consultants are growing in number and professionalism. In other areas, general health services, various NGOs, church groups, etc. are improving HIV/AIDS educational strategies and programs. A number of international consultants also provide HIV/AIDS education services. The following section draws heavily on information provided by the international consultant. Family Health Intemnational (FHI). FHI suggests the following core issues be covered in formal and informal education programs: 1. Organization's policy or position on HIV/AIDS. 2. How HIV/AIDS is and is not transmitted. 3. Why there is no risk of casual transmission of HIV/AIDS. 14 4. How to prevent the spread of HIV. 5. How to respond to a co-worker with HIV/AIDS. 6. How to assess personal risk and fonnulate behavioral change plans. 7. Benefits available to employees and family members with HIV/AIDS. 8. Confidentiality and privacy requirements. 9. Where to go for help, additional information, and counseling. HIV/AIDS educational materials and messages may be communicated in a variety of formats: formal lectures, work group training sessions, videotape presentations, posters, brochures and pamphlets. Maximum impact will be achieved if educational messages and prevention activities are delivered in a complementary, regular and updated manner. Finally, an important element in successful education programs is the use of local consultants and peer educators where possible. Local consultants can relate to particular fears prevalent in local communities and credibly dispel persistent and pernicious myths about HIV/AIDS (e.g. imported condoms are purposefully damaged to spread HIVIAIDS). The use of peer educators has also proven an important component of effective HIV/AIDS education programs. Peers, by definition, are similar in age, background, experience and interests, and people are more likely to listen and follow advice from peers. Peer educators have been useful in initiating condom distribution programs. CONDOM DISTRIBUTION AND PREVENTION COUNSELING Condom distribution must be done as part of an education program. Employees who are well informed about the use of condoms are less likely to be offended by their sudden appearance in the workplace. Centers need to decide whether to provide free condoms or to charge a small fee for condoms to acknowledge their value. Peer educators have proven particularly valuable in initiating condom distribution programs. Prevention counseling andfamily support services should also be available and well publicized. The goal is to 15 provide a safe opportunity for people to learn their HIV status, encourage people to initiate and sustain behavioral change, and assist people to obtain referrals for additional medical and preventive care. Counseling services are likely to require the assistance of HIV/AIDS service providers or consultants in the community. 16 CHAPTER IV: Model guidelines for HIVIAIDS testing and counseling Model guidelines for voluntary HIV/AIDS testing and counseling Voluntary testing and counseling is considered to be one of the most important steps in the effort to control the worldwide spread of HIV/AIDS. At the community level, increased testing promotes acknowledgement of the disease and provides a contact point for education and prevention efforts. At the individual level, attitudes and behaviors of people infected with HIV/AIDS highly depend on how confirmation of infection is relayed. If the person did not suspect HIV exposure, the shock can be extreme and may cause depression or retaliatory sexual behavior. Even when testing was undertaken voluntarily and HIV-positive status was suspected, counseling can reduce depression and family tension and therefore aid in continuing workplace effectiveness. The principles components of testing and counseling (VTC) programs are now well established. They are: 1. Testing must be voluntary. 2. Informed and written consent is obtained from the employee before testing. 3. Program provides pre-test counseling. 4. Program provides post-test counseling. 5. Confidentiality of test results is assured. 6. Individuals are informed of the results in person. 7. Referral to appropriate counseling for HIV-infected personnel is provided. No Future Harvest center can be expected to assume testing and counseling services independently. VTC resources are growing and improving in most major cities worldwide and are provided by specialized AIDS service providers or regular healthcare services. An early step in establishing an HIV/AIDS program is to identify VTC resources in the community. HR managers should ascertain the 18 VTC service provider meet the criteria listed above and will cooperate effectively and fully to ensure employee confidentiality. 19 k) CHAPTER V: Model recommendations for travel and PEP kits and workplace infection control Model recommendations for travel and PEP kits and workplace infection control Many international organizations regularly provide staff with Travel Kits intended to provide materials for the prevention of HIV/AIDS and Post-Exposure Prophylaxis (PEP) Kits for use in the event of suspected exposure to HIV/AIDS. These kits contain: TRAVEL KITS 1. Condoms 2. Disposable Syringes/Sterile Injection Material 3. Latex gloves 4. Information sheet on use 5. Official certificate for customs and immigration personnel to explain the nature of the kit. POST-EXPOSURE PROPHYLAXIS In the event of suspected exposure to HIV/AIDS, in cases of rape or contact with contaminated blood, some organizations provide Post- Exposure Prophylaxis (PEP) Kits for immediate use in the field. The contents of the kits differ from organization to organization, particularly in the case of health-care work-ers where occupational risk of exposure to contaminated blood is high. Outside the healthcare field, the contents of these kits typically include: 1. Pregnancy Test. 2. Morning-After-Pill. 3. Three days worth of two (2) anti-retroviral drugs. 4. Information sheet on appropriate and correct use of kit contents. 21 Data on the efficacy of prophylactic anti-retroviral drugs are highly encouraging. Ideally, these drugs should be taken immediately after a suspected exposure, though they may be taken up to 72 hours after exposure. Statistics show that the sooner prophylactics are taken after exposure, the greater reduction of risk of HIV infection.4 However, the employee should seek medical attention as soon as possible following suspected exposure. On a cautionary note, concerns have been raised in the healthcare community that resistant HIV might emerge due to misuse of PEP. BASIC PRINCIPLES OF WORKPLACE INFECTION CONTROL For most Future Harvest Centers the basic principles of workplace infection control for HIV/AIDS are similar to those standards already in place for all first aid. HIV/AIDS behooves organizations to communicate first aid standards and precautions clearly and widely. The basic principles of workplace infection control are 1. Anyone administering first aid in the workplace should assume all patients have HIV/AIDS and should avoid contact with blood and other body fluids. To avoid contact with blood or body fluids, cuts or sores are covered with waterproof bandages. Plastic or latex gloves should always be worn. Blood spilling onto the skin of the first aid provider must be immediately washed off with hot soapy water. 2' First Aid Kits must be available in the workplace and should contain: plastic or latex gloves; waterproof band- aids, cotton, bandages, and antiseptic. 3. Blood spilled on floors or other surfaces should be treated with disinfectant and cleaned with absorbent paper. 4. Soiled clothing or fabrics should be boiled for 20 minutes and then placed in the sun to dry. 5. Centers should include basic principles of infection control in introductory seminars for new employees or in employee manuals. 'Charles Flexner, MD., (1998) Post Exposure Proplhylaxis Revisited: New CDC Guidelines. Johns Hopkins University AIDS Service, Division of Infectious Diseases. 5 The basic principles of infection control cited here are taken from the European Union's Guidelines for developing a workplace policy and programnme on HIVIAIDS and STDs. (March 1997). 22 6. Employees should be encouraged to carry First Aid Kits in their automobiles, in the event of a roadside accident. 7. Employees and their families should know how to obtain safe blood through the circulation of a regularly updated list of blood centers in the country. Any Future Harvest Center, branch, or department, involved in health care or blood-based laboratory work should employ the services of an occupational health and safety consultant to ensure the highest standard of infectious disease control in the workplace. QUESTIONS FOR CGIAR HUMAN RESOURCE DIVISIONS: 1. Are assembled PEP and Travel Kits readily available through local health providers or pharmacies? 2. Should staff members be responsible for obtaining PEP and/or Travel Kits? 3. Should the center provide kits free? 4. Should the center provide kits at cost? 23 CHAPTER vi: Resources on the Internetfor HIV/AIDS management in the workplace Resources on the Internet for HIV/AIDS management in the workplace Numerous sources on the Worldwide Web provide useful informnation on HIV/AIDS. The following sites are specifically related to the management of HIV/AIDS in the workplace. CENTERS FOR DISEASE CONTROL The Centers for Disease Control (www.cdc.gov) in the United States provides comprehensive information on HIV/AIDS. In association with BRTA (Business Reacts to AIDS) and LRTA (Labor Reacts to AIDS), the CDC addresses specific workplace issues at: www.brta- Ita.ortg FAMILY HEALTH INTERNATIONAL Family Health International (www.fhi.org) is an international consultant active in various areas of family and reproductive health. FHI provides the most readable and useful information on the prevention and control of HIV/AIDS on the Internet. Information on private sector workplace policy on HIV/AIDS is found at: www.flli .or~/en/aids/ai dscap/aidspubs/1olicv/psapp.html SOCIETY FOR HUMAN RESOURCE MANAGEMENT The Society for Human Resource Management (www.srhm.org) provides useful workplace policy and educational guidelines for HIV/AIDS at the following website: www.shrm.org/diversity/aidsguide 25 UNAIDS UNAIDS, the United Nations Program on HIV/AIDS is a global source of information on the HIV/AIDS pandemic. UNAIDS provides information on workplace issues, including the UNAIDS HIV/AIDS personnel manual, at its website: www.unaids.org CENTRE FOR AFRICAN FAMILY STUDIES The Center for African Family Studies (www.cafs.org) is a regional organization dedicated to strengthening capabilities of sub-Saharan African organizations and networks to curb the spread of HIV/AIDS in sub-Saharan Africa. The information provided at the following website indicates the resources available through local and regional agencies in sub-Saharan Africa: www.cafs.org/hiv/html 26 to Appendices Appendix A: Education and prevention program of ICRAF HIV/AIDS SEMINARS AT ICRAF I" Seminar: An overview and Impact of HIV/AIDS at the Workplace 24 March 2000 Facilitator: Dr. Sabina Beckman GTZ-Reproductive Health Project 2nd Seminar: HIV/AIDS at the workplace: Coping with the disease 19 May 2000 Facilitators: Jane Muriuki and David Kidi Kenya Aids Society 3rd Seminar: Emerging Policies and Trends on HIV/AIDS at the Workplace 1 December 2000 Facilitators: Joel Momanyi and Diana Kageni Federation of Kenya Employers and UNDP respectively INSTALLATION OF CONDOM DISPENSERS HIV/AIDS is a global tragedy that affects every individual in one way or another and is likely to have far-reaching social and economic effects on employees and employers. ICRAF is directlv concerned as an employer based in Africa, with staff in areas of high infection, and as a farmers' partner. So far, the Human Resources Unit has conducted a couple of interventions (including seminars, staff surveys and e-mail 28 exchanges) to sensitize staff, raise awareness and better understand the staff members' and supervisors' view points, level of understanding and controversies on the issue. The first general seminar on 'HIV/AIDS at the Workplace' tackled questions and concerns on HIV/AIDS issues and how to handle them. The second seminar facilitated by Mrs. Jane Muriuki of Kenya Aids Society and Mr. James Kidi of KELC delt with 'Coping with the Disease'. In their presentation the facilitators emphasized on the importance of learning how to positively cope with the disease. The facilitators gave a personal and intriguing account on how it is to live with the disease and also gave a demonstration on proper use of condoms in order to reduce risks of contracting HIV/AIDS. To emphasize on the perils of HIV/AIDS that face its workforce and make follow-up of the points raised during the HIV/AIDS seminars, HRU has taken the responsibility of introducing condom dispensers in several washrooms within ICRAF House and the Research Building. The condoms and dispensers were donated to ICRAF through the courtesy of Dr. Hombergh of the GTZ-Reproductive Health Project. 29 MEMORUNDUM: SURVEY ON AIDS AT THE WORKPLACE FROM: Hulda Mogaka - HRU TO: ICRAF Staff DATE: 19th October, 1999 Subject: Survey on AIDS at the workplace AIDS continues to be a principal cause of death in Africa, especially for ages between 25 and 44. This is the age bracket that constitutes the most productive years of workforce. The epidemic is spreading faster than prevention strategies. Diseases resulting from HIV (the contributing agent of AIDS) have already had a negative impact on a large proportion of workforce in the world. HIV, a virus that attacks the immune system of the body's defense mechanism against infections can take upto 10 years to develop in an individual. The infected person can work and lead a long life as long as he/she feels strong or well enough to work. However, when the virus overcomes the immune system, then the full-blown AIDS begins to take toll. At this stage, it becomes increasingly difficult for the infected employee to maintain balanced work attendance and productivity. In respect to the above, ICRAF intends to formulate Policy Guidelines on AIDS for use by all employees. Your input to this exercise will go a long way in formulating a policy that will guide all ICRAF staff in addressing issue on AIDS at the workplace. I therefore kindly request you to complete the attached questionnaire and return it to Hulda Mogaka of HRU or by email to address Hmogaka@cgiar.org by 25th October 1999. 30 QUESTIONNAIRE: SURVEY ON AIDS AT THE WORKPLACE / STAFF CATEGORY GSS NP I I IRS STUDENT SECONDED 1. Do you think AIDS is a concern which need to be addressed by ICRAF . . .Yes/No Why? .....................................................................................I........................ 2. According to you, what are the issues related to H1V/AIDS at the workplace? .............................................................................................................. ...................I....... ................................................................................... ........................................................................................................... ........I................................................................................................... 3. Have you ever lost a close friend through AIDS? i.e. family member, workmate? ... Yes/No 31 4. What impact has it had on your a) Social life b) Productivity at work 5. Are you taking care of an AIDS infected friend/relative Yes/No 6. If an infected colleague approached you for guidance on HIV/AIDS, would you be informed enough and willing to counsel him/her Yes/No Why? 32 ............. v.............v.................................................................................... 7. If you were diagnosed HIV positive, whom would you most likely disclose it to: a) Spouse d) Fellow worker g) No one b) Parents e) Supervisor c) A friend f) Relatives 8. If you discovered that you are HIV/AIDS infected, would you feel free to share the information with your supervisor Yes/No Why? .............................................................................................................. ....................................I.................I........................................................ ........I...................................................................................................... .................................................................I............................................ ............................................................................................................. 33 9. Do you agree with the statements below? i) HIV/AIDS test should be among the pre-employment medical examnination m A Agree B Neither agrees nor disagrees m C Disagree ii) Employees should have a right to know if any of their co- workers are HIV positive. m: A Agree m B Neither agrees nor disagrees C Disagree iii) The organization should have the right to terminate regular staff in employment who is HIV positive A Agree B Neither agrees nor disagrees C Disagree iv) The organization should have the right to terminate employment of staff who has full-blown AIDS ED A Agree a B Neither agrees nor disagrees m C Disagree 34 10. Do the discussions on AIDS make you feel uncomfortable? Yes/No Why? 11. ICRAF is formulating a Policy on AIDS, what are some of the issues you would like to see covered in the Policy? (If you are a supervisor, kindly answer the following question) 12. If you were aware that an employee under your supervision is ailing due to HIV/AIDS: a) Would you feel able to discuss the issue with the employee? A Would definitely do this z B Might do this z C Not sure whether I would do this 35 D Might not do this b) Would you be prepared to explain the reason why it is important to discuss AIDS? A Would definitely do this EZ B Might do this C: C Not sure whether I would do this m D Might not do this 13. List below any general comments that you might wish to contribute Thank you very much for taking your time to answer the questions above. Your contribution is well appreciated. 36 Appendix B: Comparison of responses from international development organizations ePr;7ne- lu ~ Termination Healtihurnc Impact on the Organizaton Education and Prevention testing testing and becaus o benefits include benefts saime for inter. Code of Conduct .neI ..-----... . . infection HV/AIDS national and local staff Asian No official monitoring program, but Brochures and posters available No Yes No Yes Yes No Development medical claimis suggest negligible impact. at the medical center. Bank Travel Kit available for traveling staff. Food and Yes, aware of impact. Absence, disability, Yes, particularly in the field, in No Encouraged No Yes Yes Agriculture and death from HIV/AIDS is monitored collaboration with other UN Organization annually by FAO or UN Pension fund. organizations. IMF Significant impact in selected areas. At this Extensive global awareness No Yes No Yes General Code of time, sub-Saharan Afiica is the most campaigns with seninars, Conduct does not affected but SE Asia may soon become UNAIDS booklets, and condom address HIV/AIDS equally impacted. Difficult to monitor dispensaries in field locations. '.explicitly," but inter objectively because of cultural issues Active AIDS Working Group alia states that the basic regarding admission of HIV/AIDS. with initiatives in education, values of impartiality. testing, medical advice via integrity and discretion global network of AIDS should govem. specialists, confidential medical advice through Health Services Department, anti-retroviral purchasing programs where possible. Medical evacuation when medically and culturally appropriate. IAEA (UN) To best of our knowledge, HIV/AlDS has Provide literature on an on-going No Yes Only upon "Code of Conduct" is not had a major impact. Impact of the basis. Brief travelers on payment of outlined in the policy disease can only be reflected indirectly HIV/AIDS. disability booklet, entitled AIDS through the approval of long-term Condonis available tax-free in pension. and H' IVIfection: disability. the commissaly. h7fonnalion foi United Extensive activities on World Nations Employees anid AIDS day, inclutding videos, their Families. desk-to-desk circulars and promiinently displayed posters. _ 37 WORLD Aids Response Group for country HR/Staff Assoc./HSD has produced No Yes No Yes Yes Although other policy BANK office staff was formed in 12/99. folders with educational materials for documents exist, the HIV/AIDS No active surveillance, but one-to- cotntry staff. Folder materials include: Yoti cannot You cannot be Health insurance Health insurance is current "code of (Health one confidential medical advice to UNAIDS booklet (in several languages), be forced to denied is available for all available for all eligible conduct" is embodied in Services HlV-infected country staff offered. an explanation of medical benefits for take an employment, eligible employees employees and their the definitive Coordinator) So far there are 12 cases (10 HIV/ AIDS, information on disability HIV/AIDS confirmation, and their dependents regard-less HIV/AIDS statement patients on triple anti-retroviral regulations, information on filing claims test. promotioni, or dependents regard- of HIV status. issued by John regimens) and several HIV- related directly to HQ, personal letter from a be terminated less of HIV status. Wolfensohn. President questions from non-infected staff, staff member living with AIDS. 23 WB You do not solely because Health insurance of the World Bank in country offices have ongoing AIDS have to report of HIV status. Health insurance premnitums are not February 2000. activities. Their main goal is to in-crease your HIV premiums are not affected by HIV status. aware-ness and pro-mote stigma status to the affected by HIV Additional Comnments: reduction activities. Banik. status. Medical insurance HSD has facilitated the WB plans to participate in the Post- covers all drugs and establishment of a Exposure Prophylaxis initiative with You have a Medical insurance treatment for network of HIV the UN family, so staff in the field will right to keep covers all drugs HIV/AIDS, includinig clinicians in Africa to have access to anti-retroviral in cases of your medical and treatment for anti-retroviral serve as referral points rape or other exposure. treatment HIV/AIDS, medication, which have for treatment and care confidential. including anti- dramatically reduced of HIV infected retroviral AIDS-related deaths, employees and medication, which dependents. HSD is have dramatically In case of disability setting up a "secure reduced AIDS- resulting from AIDS, the internet site" it related deaths. Bank's disability collaboration with the insurance applies. Intemational AIDS In. case of Society of Anterica disability resulting For national staff (LAS). The African froti AIDS, the concerned with the clinicians will have Bank's disability institution of policy and access to latest insurance applies. practice that preserves infortlation and free confidentiality, the consultations from IAS option to file medical Bd. of Directors. claims confidentially was establish-ed on 1/00. Stiff caln selnld medical claim forms directly to HQ. 38 Termination employment Voluntary bmu ofHI insurance Heallth Insurance Impact on the Orptizatlon Education and Prevention etng testiptg and iebenefitg include benefits same for inter. Code of Conduct c.unseling mHIVAIDS.. national and lwtl stafr EBRD So far this has been a non-issue. We provide medical benefits for all staff. We have medical tests to screen people with health risks that wouild incapacitate them from working at the institution. So far there is no one with HIV. There have been AIDS cases. but these are covered by long-term disability insurance. WHO As there is no mandatory testing, Distribute UNAIDS publication entitled No Yes No Yes Yes No code of conduct for can only monitor those cases 'AIDS and HIV Infection. Information at HIV/AIDS. where staff members seek for United Nations Employees and Their HQ Same as other International and services through VCT or for Families." medical national staff have same AIDS. Monitoring is a challenge conditions. 80%c of insurance scheme. because of the stigma inherent to Worked with UNAIDS. UNICEF and expenses AIDS. UN Medical Services to establish local reimbursed up to a HIV/AIDS care and support for UN staff threshold (based and dependents. Distribute PEP on salary level) treatment kits at the country level. over and above Condoms included in travel kits since which expenses 2000. are reimbLirsed at 1 00%~'. Distribution of free condoms for staff at HQ and in some country offices. 39 Appendix C: World Bank human resource documents on HIV/AIDS 40 The World Bank Washington, D.C. 20433 U.S.A. JAMES n WOLFENSOHN President A Message from President Wolfensohn to Staff. No job Discrimination Because of HIV 1/3/2000 My best wishes to all of you as we enter the new Millennium. The first message that I would like to send to you in this special New Year concerns AIDS. We must recognize that AIDS is a special illness. It is highly stigmatized; it means facing fear, denial and shame. Many Bank Group staff are afraid to talk about it. They are not aware that the impact of the disease can now be dramatically reduced, and that the Bank Group has cLear policies regarding recruitment, employment and medical coverage related to HIV/AIDS. I have learned that lack of knowledge about your rights and the institution's policies has caused unnecessary stress and concern, and may even have stopped some staff from taking advantage of treatments to improve their health and save their lives. Therefore, I am restating our policies and procedures for easy reference for all staff. I also want to remind you about the confidentiality and sensitivity surrounding health matters in general and HIV/AIDS in particular. Staff may choose to share information related to health issues with colleagues, but it must remain their choice. Whatever their choice, it is the responsibility of all of us co create a compassionate and caring environment for colleagues with any type of illness, whether it is in Washington or in a Bank Group office elsewhere. Nondiscrimination You cannot be denied employment, confirmation, promotion, or be terminated solely because of your HIV status. Health insurance coverage is available for all eligible employees and their dependents regardless of HIV status. Heaith insurance premiums are not affected by HIV status. Confidentiality You cannot be forced to take an HIV/AIDS test. You do not have to reporr your HIV status to the Bank. -You 'nave a right for your medical treatment to be kept confidential. Access to Treatment & Insurance Our medical insurance covers all drugs and treatments for HIV/AIDS, including anti-retroviral medications. These medications have been widely used in developed countries, where they have dramatically reduced AIDS-related deaths. As for any other illness, the same co-payment rates apply to expenses related to HIV/AIDS, up to established out-of-pocket ceilings, after which the Bank's medical insurance will pay 100%. If adequate treatments are not available locally, non-emergency evacuation procedures can be used for HIV/AIDS and its related illnesses. In case of disability resulting from AIDS, the Bank's disability insurance is available. In case of death resulting from AIDS, the applicable benefits are payable to your beneficiaries. You can also find basic information on policies related to HIV/AIDS, in the UNAIDS booklet, 'Information for United Nations Employees and Their Families." HSD has recently distributed them to all staff. To ensure this receives urgent attention, a Working Group has been established, under the leadership of Richard Stern, HRSVP, to develop and implement an institutional approach to managing AIDS in the workplace. The immediate goal is to ensure staff take full advantage of existing policies and procedures. For that purpose we have asked Dr. Ana Maria Espinoza, an HSD physician experienced in treating HIV/AIDS, to handle staff questions about the medical aspects of HIV/AIDS. In addition, the Working Group will be consulting you to develop an action plan for managing AIDS in the workplace. We can only win this AIDS battle by working together. The objective is simple: no more Bank Group staff or their family members should die from AIDS. James D. Wolfensohn Bank Disability Coverage for AIDS and Other Medical Conditions FOR YOUR INFORMATION FYI/99/005 February 23, 1999 To All Local Staff: CHANGES IN BENEFITS FOR LOCAL STAFF 1. I am pleased to announce a number of important changes that will improve your and your family's financial security, and bring your benefit programs into line with those at Headquarters. 2. For the first time, you are now covered by a comprehensive disability insurance program. Also, your survivors have increased protection in the form of a larger amount of Bank-paid life insurance at no cost to you. These changes became effective January 1, 1999. Later this year we will introduce mandatory contributions to the Staff Retirement Plan (SRP). We will also introduce a program under which you will have the option to convert your service under the former termination grant program to the SRP. This will provide greater financial security for you after retirement. More details on each program are provided below. Sick Leave and Disability Insurance Program 3. The new disability insurance program provides income replacement if you become disabled while working at the Bank. The full cost of the program is paid hy the World Bank Group, and enrollment in the program is automatic. 4. In the event you are no longer able to work because of sickness or injury, you will receive a monthly benefit equal to 100% of your salary while using sick leave, and 70% of your salary after your sick leave is exhausted. These benefits will be paid to you as long as you remain disabled. Benefits will discontinue on recovery, death, or upon reaching mandatory retirement. 5. To qualify for these benefits, your absence must be certified as medically necessary by the plan's insurer, UNUM Life Insurance Company of America (UNUM). Decisions regarding disability benefits and the duration of disability rest with UNUM. Absences of 20 days or more must be reported in the Benefits Unit at Headquarters by you, your leave coordinator of your manager to the disability administrator, Theresa Ramos, at (202) 473-0974, or via email to "Disability Insurance'. Please note that without medical approval by UNUM, you may not use accrued sick leave for absences of20 adeys or longer. even ifvou have accrued sick leave to cover your complete absence. Further details are provided in Annex 1. -2- Death in Service Benefits 6. Death in service benefits of two times salary will increase to three times salary for all staff enrolled in the Staff Retirement Plan. Staff Retirement Plan (SRP) 7. Introduetion of Mandatory Conributions Effective July 1, 1999, all Local Staff in the SRP will be required to make mandatory contributions of 5% of net salary to the cash balance component of the SRP. This coincides with the Implementation of the new payroll system for all staff and brings Local Staff into line with other SRP participants. 8. Survivor Benefits For participants receiving pensions the Bank will provide an automatic death benefit that may be in the form of either a survivor annuity (i.e.,-a pension payable to a designated beneficiary following the death of the retired participant), or a lump sum (i.e., one cash payment). Participants will have the option to reduce their pensions in order to provide greater survivor annuities. 9. Conversion of Termitnation Grant to SRP Later this year all Local Staff who were covered by the former termination grant program will be given the option to convert their termination grant benefit to the SRP 10. Further details on SRP changes will be communicated by Pension Administration. Darius Mans, Manager, Compensation Management Attachment -3 - Annex 1 SICK LEAVE AND DISABILITY INSURANCE PROGRAM EFFECTIVE JANUARY 1, 1999 FOR NATIONAL STAFF This summary provides an overview of the new Disability Insurance program and how it works with sick leave. This coverage is effective January 1, 1999. General Provisions Eligibility: All National staff except those holding Short-Term Consultant, Short-Term Temporary, or Special Assignment appointments. You must be actively at work and work at least 20 hours per week to be covered. Enrollment: Coverage begins on your entry on duty date. Enrollment is automatic. End Date: Coverage ceases when your-service with the Bank ends. Your employment status: While you are receiving a disability benefit under the Sick Leave and Short Term Disability program, you will continue to be a staff member until the earlier of your appointment termination date or a period not to exceed 2 years from onset of disability. Insurance Provider UNUM Life Insurance Company of America (UNUM) Onsite Disability Administrator: The Disability Administrator's office is located in the HR Service Center (Room H3-388) at Headquarters. The Disability Administrator can be reached at (202) 473-0974 or via email to Disability Insurance. Sick Leave and Short Term Disability Sick LeaveAeeruak 15 days per year with unlimnited carryover to future years. Up tO 10 days' advance sick leave may be approved by your manager. You may be granted additional sick leave at 70% of net salary for a period not greater than two years from onset of disability or your appointment termiination date, which is earlier. Sick Leave for more than 5 days but less than 20 working days: For sick leave to be approved, you must give your supervisor a statement from a licensed medical practitioner which indicates the period of illness or injury. Sick Leave of2O working days or more: To be approved as sick leave, medical certification for absences of 20 days or more must be submitted to UNUM via the disability administrator's office in the HR Service Center. You must notify the disability administrator as soon as you anticipate an absence will extend beyond 20 working days. A claim form should be completed by you and your doctor and sent directly to the Bank's disability administrator. If you are absent from the office due to an illness or injury, your leave coordinator or your manager must contact the disability administrator. -4 - Annex I Definition of Short Term Disability: You are disabled when after a continuous absence of 20 working days, UNUM determines that due to sickness or injury (a) you are unable to perform any duty for which the Bank might reasonably call upon you to perform and for which you are reasonably qualified by education, training or experience or (b) you are unable to perform the material and substantial duties of your own occupation for which you are reasonably qualified by education, training or experience with any other employer and (c) you have a 20% or more loss in your monthly earnings due to the same sickness or injury. Monthly benefit 100% of net salary while using sick leave. After your sick leave is exhausted, vour monthly benefit is 70% of your monthly net salary. Your disability payments may be reduced by certain sources of income (such as any other employer retirements benefits, retirements benefits from the Staff Retirement Plan) and any earnings from any other employer. Duration of Beneft. Sick Leave/Short Term Disability benefits are paid as long as you remain disabled for a period not to exceed two years from onset of disability or appointment termination date, whichever is earlier, as determined by UNUM. Long Term Disability Definition of Long Term Disabilit: You are disabled when UTNUM determines that due to sickness or injury (a) you are unable to perform the material and substantial duties of any occupation for which you are reasonably qualified by education, training or experience and (b) you have a 20% or more loss in your indexed monthly earnings due to the same sickness or injury. Monthly Benefit: 70% of your monthly net salary. Your disability payments may be reduced by deductible sources of income (such as income from the Staff Retirement Plan) and any disability earnings. Your monthly benefit will be indexed to an annual cost of living adjustment. Duration of Benef;: Monthly benefits are paid as long as you remain disabled, as determined by UNUM, and will cease on recovery, death or on attainment of age 62 (or to age 65 if hired before July 1, 1974). Exclusions: The policy excludes disabilities as a result of intentionally self-inflicted injuries, active participarion in a riot, act of war, loss of professional license, occupational license or certification, commission of a crime for which you have been convicted or certain pre-existing conditions Complete derails of plan coverage are contained in the insurance policy issued by UNUM Life Insurance Company. If there are any differences berween this summary and the insuance policy, the insurance policy governs. Coverage for HIV/AIDS for Staff under the Medical Insurance Plan !:31aE Q . Does the Bank/s Medical Insurance Q: How do I know ifl am a member of the Plan (MIP) cover HITV/AIDS treat- plan? ment,? What about the Retiree MIP? me-t WhaaouteetreMPA: You are eligible to enroll in the MIP, with- A: Yes, both plans cover HIV/AIDS out questions asked on your health, if you do treatment the same way they do other so within 31 days of your appointment under serious illnesses. the following categories: Regular, Open-ended, Term, or Fixed-Term. Long-term Consultants Q: Does the MIP cover anti-retroviral and Temporaries who were hired prior to July drug therapy? 1, 1998 are also eligible to enroll. If you fail to A: Yes, the plan covers anti-.etroviral enroll within the this 31-day period, you will need to provide evidence of good health satis- drulg therapy at 80%. If you are factory to our insurance administrator. Con- enrolled in the MIP, yourtreatment for tacr Benefits Administration, ext. 32222, tO all ailments (including F{IV/AIDS relat- verify your enrolment. ed illnesses and drugs) is. reimbursable according to the schedule of benefits Q: Whatabout my spouse and children? Are applicable to your MIP enrollment they eligible to enroll and receive coverage for option. You may access http:// HIVIAIDS? wbln 1023.worldbank.org/HRS/ I yournet.nsf to review the schedule of A: If you have eligible dependents at the time benefits under the Insurance Program of your enrollment, you may elect coverage for information. them as well within the 31-day enrollment period without providing evidence of good Q: Does the MIP cover HIV tests? health. However, if you do not enroll them during this 31 -day period, or within 31 days of A: Yes, at 80% if done in a physician's thi elgblt shudyuaqieyu ' . ~~~~~~~~their eligibility should you acquire yourI office. The charge is subject to your dependent after joining the Bank Group, your annual medical deductible..I dependents would need to provide evidence of Q: What else does the plan cover? good health satisfactory to our insurance administrator. MIP benefits for HIV/AIDS for A: Please refer to the above Website for enrolled eligible dependents are the same as plan information. You may also contact that for the staff member. rhe MIP administrator (Aetna US Healthcare), an external vendor, at 1-800-723-8897 to verify if a specific procedure or charge is covered. 2 Q: Even though the MIP reimburses much of A: A staff member's job security should not be my medical expenses, co-payments and deductibles affected if he/she has the HIV virus. The Pres- can add up quickly. Is there a provision in the ident of the Bank, last January, wrote a message MIP for extraordinarily high medical bills? to all staff assuring them that they would not A: Yes, the MIP has a stop-loss provision, be discriminated against because of their HIV A' . Yes, the MIP has a stop-loss provision, status. which offers financial protection from extreme- ly high medical bills. You reach the stop-loss Q: What happens to my income if I am no when your co-payment expenses have reached longer able to work because ofAIDS? the specified limit according to your MIP enrollnent option. Once the stop-loss has A: You are covered by a comprehensive dis- been reached, the MIP pays the remaining eli- ability insurance program. You are responsible bible expenses at 100% for the rest of that cal- for the first 20 working days of continuous endar year. absence. Income Replacement at 70% of salary is provided on the later of, upon Q: I am afraid to submit my medical claims exhausting sick leave or on the 21st working because someone at the office may find out that I day of continuous disability. While you are have been testedfor HIV; or that I am infected on approved disability by the plan insurer, What other options do I have? benefits will continue until the earlier of, on A: The Bank's MIP.claim . administrator isan recovery, death, or upon reaching mandatory A: The Banks MIP claim adrminstrator iSin rtemt age external vendor - Aetna US Healthcare. The retrement age. Bank Group and Aetna do not share confiden- Q: How do I enroll in the disability insurance tial medical informaton for MIP particpants. ,, The only information released to Bank man- progrem. agement, including the Health Services A: Enrollment is automatic, that is, coverage Department, is aggregate information on spe- begins on your entry on duty date. All head- cific illnesses or injuries. That information is quarters and country office staff who are used to assess whether plan changes or specific actively at work and work at least 20 hours per wellness programs should be reviewed. week are covered, except those holding Short Term Consultant, Short Term Temporary, or Q: How secure is my job if I declare my HIV- Special Assignrent appointrments. positive status? Country Office Staff: You Can Call i Washington with Your Private .e fu/791 HIV/AIDS Questions he Health Services Departrent at head- * advice for yourself or a family member who quarters has formed an AIDS response has discovered that he/she is HIV positive; group that staff in the field may write or * questions about the Bank's health insurance call for information. All consultations or medical evacuations; are absolutely confidential, and national * concern over transmission of the virus from a staff are encouraged to call if they have relative who is HIV positive; questions. * advice about a treatmnent that a doctor has The group consists of Dr. Ana Maria ordered for you or a relative; Espinoza; Mary Pim Margulies, a regis- * worry about sending insurance daims to the tered nurse; and Nicole Marchint, an local administrator in the field. executive assistant. Dr. Espinoza says, "The group's primary rele is to support The telephone numbers to call are: the individual... [We] have lready Dr. Espinoza (who speaks Spanish and can worked with staff membersin the field." understand Portuguese), 458-1372; Margulies, Margulies says staff membmrs are 458-5183; Marchant (who speaks French), invited to call with the followmig ques- 458-1357. nons (or any orhers on the topic):. For HIV/AIDS and Other Serious Illnesses: National Staff May File Medical Claims Confidentially L.nlike headquarters staff, national staff If you have already paid rhe doctor or cln- in country offices have not had the ic, Mary will make arrangements for Account- option to file medical claims confiden- ing at HQ to reimburse you (through Payroll) tialy. Yet national staff may have the the amount that you are owed by the Bank. same serious or sensitive illnesses, such Alternatively, if you have not paid the medical as HIV/AIDS, cancer, or psychological provider, you can send Mary the invoice and problems. she will make arrangements for Accounting at These staff may be reluctant to risk HQ to pay the provider directly. In that case, having their medical insurance daims your co-payment will be taken out of your pay- go through their country office. Now, a roll (unless you have reached your stop loss for new arrangement will alLow them to file the plan year, in which case you will not owe confidential daims directly to head- anything). quarters. The staff can se,nd their med- ,Staff who wish to be tested privately for ical claim form, the bills, and-MBP HIV/AIDS are especially urged to use this con- claims spreadsheet directly to Mary Pim fidential way of filing for the cost of the test Margulies in the Health Services (80 percent of the cost will be paid by the Department [MC 2-450, (202) 458- Medical Benefits Plan). For HIV/AIDS and all 5183, Mmargulies@worldbankorgl. illnesses, your daim will be treated with the utmost confidentiality. Frequently Asked Questions 173 about HIV/AIDS 010 How do people get AIDS? involve blood, semen, vaginal fluids, A: AIDS stands for Acquired Immun- or breast milk. odeficiency Syndrome. It is a condition Here are some measures you can take to in which the body's immune system ensure both your safety and that of the person ineaks dowhich nd the body' mne sys who is diagnosed with AIDS or is sick from breaks down, and the person tyial th H. ineto.n ed ae develops a variety of life-threatening ill- the HIV mfecuon and needs care: nesses. AIDS is caused by the HIV U Wash your hands often, especially after you virus. go to the bathroom and before you fix food. A person becomes infected with Wash your hands again before and after feed- HIV when the virus is introduced into ing a person living with AIDS, bathing his/her body. The ways one becomes them, helping them go to the bathroom or infected with HIV are: - giving other care. Wash your hands if you - benaigiun tctdsmsneeze or cough; touch your nose, mouth or * by engaginging unarodal genitals; handle garbage or animal litter; or an infetero erseo(vaginal,anal,oral)wit clean the house. If you touch anybodys blood, semen, urine, vaginal fluid or feces, * by sharing drug needles or syringes wash your hands immediately with warm, with an infected person soapy water for at least 15 seconds. * HIV-infected women can pass it on * If you have any cuts or sores, especially on to their babies during pregnancy, your hands, you must take extra care to not birth or breastfeeding. infect the person with AIDS or yourself. If * infected blood transfusion. you have cold sores, fever blisters or any other skin infection, dont touch the person with AIDS or their things because you could pass your skin infection to them. If the rash- living with Hl'VorAIDS ?. es or sores are on your hands, wear dispos- A: It is useful to remember how HIV able gloves. Do not use the gloves more than is transmitted (through unprotected sex; one time; throw them away and get a new sharing needles or syringes; pregnancy, pair. A person with AIDS often cannot fight birth or breast-feeding; and blood off colds, flu or other common illnesses, so, transfusions). One doesn't get infected if you or anybody else is sick, stay away from with HIV from the air, food, water, the person with AIDS until you are well. dishes, knives, forks, spoons, toilet A person with HIV infection or AIDS seats, or anything else that doesn't s should not share razors, toothbrushes,: pierced earrings or any other item which however, people infected with HIV can devel- might have their blood on it. Clothes and op many health problems. These can indude bedsheets used by someone with AIDS can extreme weight loss, tuberculosis, severe pneu- be washed the same way as other laundry. monia, some forms of cancer and damage to However, if the sheets or clothes have blood, the nervous system. These illnesses signal the vomit, semen, vaginal fluids, urine or feces onset of AIDS. In some people, these illnesses on them, use disposable gloves and handle may develop within a year or two of the begin- the clothes or sheets as little as possible. Put ning of the HIV infection. Others may appear them in plastic bags until you can wash healthy for as long as 10 or more years before them. symptoms begin. * A person living with AIDS does not need Q U Aperson I I D e n: Afier being exposed to the virus, how long do separate dishes, knives, forks or spoons. I need to wait before I take the HIV/AIDS test? Their dishes don't need special deaning How is that test done? How long does it take to either. They can eat almost anything they get the result? want; in fact, the more food the better. There are however, some precautions you A: It takes an average of 25 days after a person should take: gets infected with HIV for a blood test to show - Don't use unpasteurized milk or raw eggs positive ("positive" means that the infection is Dont us npsteuizedmilkor rw egs present). 99% of infected persons will show - All meat and fish should be cooked very positive after 3 months. If the first test (called well ELISA) is positive, the blood will be tested again with another kind of test (called Westem - Don't use raw fish or shellfish Blot) to make sure the person is actually infect- - Wash your hands before handling food ed. Results are usually back in 7-10 days. and wash them again between handling different foods, and wash fresh fruits and Q: What are the methods ofprotection? vegetables very well A: They are quite dear-cut: The Center for Disease Control and the * Safe sex. To protect yourself, always use a American Red Cross have a website which condom during penetrative sexual acts - provides further advice on caring for people and learn how to use a condom correctly. living with AIDS. The address is http://www.hivatis.org/caring/. * Do not share needles to inject drugs. 0: Can one physically identify*a person with m Avoid blood transfusions. If you are injured AIDS? C han one physicallgdnts a perslong wosith tand lose blood, consider using a plasma sub- AIDS? What arenshappear? stitute. If severe blood loss has occurred, before the first signzs appear? make sure the blood used has been screened A: AIDS is caused by the HIV virus. From for HIV and Hepatitis B. the time a person is infected, he/she can infect others, even if no symptoms are present. HIV can hide in a person's body for many years without producing any symptoms. Eventually, Q: Do children/babies show the same signs and Combination therapy (consisting of 3 experience the same side effects of HI//AIDS as drugs) has been shown to suppress viral adults? What are the signs of HIV/AIDS in replication for long periods of time and to children? decrease the chances of drug-resistant virus. In clinical studies this combination therapy has A: Children and babies have different symp- demonstrated a significant impact on the toms than adults. These are: unexplained progression of the disease and has increased fevers, failure to grow at the expected rate, fre- survival time. quent viral and bacterial infections. The decision about when to start treatment is taken after additional medical tests.are done. Q: What are the methods of prevoention.for mother-to-child transmission? Q: In Washington, D. C, where can I get tested A: If a mother is HIV positive, the chances of confidentially for HIV? passing HIV to the baby are 15-25% if mother A: The Whitman Walker Clinic offers confi- does not breastfeed, and 25-45% if mother dential HIV counseling & testing to the gener- breastfeeds. If the mother uses antiretroviral al public. drugs-like AZT-and replacement feeding, The Clinic does testing at three sites: the risks of transmission to the child decreases to 5-10%. 1. the Elizabeth Taylor Medical Center, at 1704 14th Street NW. Call for testing times. Q: What does the word "TREATMENT" really Call (202) 332-EXAM to schedule an mean when it comes to HIV/AIDS? anonymous appointment for testing (no name, number assigned). Pre and post test A: There are many different types of drugs for counseling is also available. H IV infection: 2. the Max Robinson Center, 2301 Martin * protease inhibitors Luther King Jr. Ave. SE. Call (202) 678- * nucleoside reverse transcriptase inhibitors 8877 for information on how to schedule an anonymnous appointment. * non-nucleoside reverse transcriptase inhibitors. 3. the Whitman-Walker Clinic of Northern VA. Call (703) 237-4900 for information. Each class of drugs works on a different part of a replicative cycle of the virus. A Personal Message from a Seropositive Staff Member Dear Friend- I have worked at the World Bank since 1980 and I have had the HIV virus since about 1984. Thus, I have been hiving for 16 -_ years with a disease that is kiUling millions of people aroundc the globe. How have I done this? What is my life like? I would like to share the answers to these questions with you. I got tested as soon as the test for AIDS became available. 'When my test came out positive, there was litde which could be done at that time. After getting over a depression triggered by the diagnosis, I concentrated on making the best of the time I thought I had, both at work and with my family and friends. During the decade before the advent of triple drug therapy, my strong immune response to the virus kept me alive. Once the triple drug therapy for suppressing the virus became available, I began taking those medications. This drug therapy has been very successful, and I now look forward to a much longer life span. I have a good life, without any symptoms of full-blown AIDS. I work hard, feel well, and enjoy myself-because I faced the possibility of HIV, and then took my health into my own hands, actively seeking out the best medical treatment available. If I had not done so, I probably would not be alive today. My supervisors at the Bank have long known that I have the AIDS virus. Yet they have given me two promotions, and I have received academic awards for my work. The managers of the Bank are not allowed to discriminate against staff members who are HIV positive; President Wolfensohn said so in a letter to all staff in January. My managers have not discriminated against me. How do I pay for the drugs that help me lead a healthy life? The Bank pays for 80% of the cost of the medicine and doctor's visits. And, once the cost to me personally reaches a certain point each year, the Bank pays 1 00%. The medicine and doctors are not cheap, but with the Bank's medical insurance they are affordable. There is one other practice that I strongly believe in. I do not want to pass my HIV virus to anyone I love, so I always use condoms when engaging in sex. This is very frank talk-but it can save lives, and it is vitally important. I urge you to follow my example. Take your health care into your own hands now. Use condoms when engaging in sex. Get tested for HIV, confidentially. And if you test positive, as I did, begin the medical treatment that will sustain your life. If you want to discuss any of this with me personally, I would be happy to talk with you confidentially. Please send me an e-mail or call me at my office in Washington (202/473- 1871). During evenings or over the weekend, you are welcome to call me collect at home at 202/483-8965. I speak Spanish and French too. And your secrets will be perfectly safe. I sometimes am away on travel, and you can also call my personal assistant, Dean Housden, who always knows how to contact me. He too will keep all discussion confidential. His office number in Washington is 2021473-6637, and his home number is 202/332-1728. He too will be happy to receive collect calls. Hans Binswanger Sector Director, Rural Development and Environment AFTRE Some HIV/AIDS Web Sites The following list provides electronic address- medical and epidemiological angles. Informa- es whereyou mayfind more information tion is technical and comprehensive. on HITV/AIDS. Your feedback on the use- fuiness of these sites, on discontinuations/re- http://www.niaid.nih.gov/publications/aids.htm. locations, or on other sites notfeatured here The National Institute of Health (NIH)'s Insti- will help us keep the list up-to-date. Please tute of Allergy and Infectious Diseases' website. send any comments to: betiennemillot@ Facts, and recent news releases on AIDS basics, worldbank.org prevention, vaccines and therapies. A mostly medical outlook with an epidemiological and http://www.unaids.org If you visit only social emphasis. one site, this should be the one. An enormous amount of up-to-date infor- http://www.noah.cuny.edu/aids/aids.htril. mation on every single aspeict, f The New York Online Access to Health, HIV/AIDS, at the woMrldFi ithe indi- (NOAH) provides quality health information, vidual level, and from dpxAi-logical, in English and Spanish. Basic facts, glossary, medical, social, economic, psychological prevention, complications, different treatments standpoints. This is the ultimate source (induding for AIDS-related illnesses), research, of support materials and link to other and a host of other information resources. resources. ' Legal, as well as financial and insurance issues, are highlighted. A very detailed, informative, General information -on accurate, person-oriented and user-friendly site. HIV/AIDS:Basic facts, New York Online Access to Health (NOAH) pro- prevention, treatment & care porciona infonnracin de calidad sobre salud, en inglisy espaiioL Hechos bdsicos, glosarios, preven- Note: All the following sites are de- cidn, complicaciones, deferentes tratamientos- signeed primarily for Western rdesip. inclso de enfermedades relacionadas con el SIDA-, investigacionesy un cumulo de otros http://www.ama-assn.org/special/hiv/ recursos de informaci6n. Se destacan les cuestiones hivhome.htm. Site of the Journal of the juridicas, asi como tambien financierasy de seguro. American Medical Association's special Un sitio sumamente detalldo, informativo, pre- site on HIV/AIDS. Updates, in-depth ciso, orientado a las personasyfdcil de usar. reports, conference coverage, the latest from the literature, dinical guidelines, htRp://www.thebody.comlindex.shtml. The treatment reviews, resources for patients Body carries information provided by various and professionals, prevention facts, pharmaceutical groups. Its stated objective is to updates and references. Mostly from demystify HIV/AIDS and its treatment and help improve patients' quality of life:.Holds ing Infections During Travel, Tuberculosis: A forums on fatigue and anemia, hepatitis, man- Guide for Adults and Adolescents with HIV, aging side effects, diet and nutrition, women Voluntary HIV Counseling and Testing, etc.) and children, and other topics. User-friendly which can be read at this address. site, patient-focused, clear presentation. La Divisidn de Prevencion del V7HiSIDA del The Body contiene informacio'n suministrada por Center for Disease Control and Prevention varios grupos deproductosfarmaceuticos. Su obje- (CDC) publica varios fblletos uitiles en ingls y tivo declarado es desmitificar el VIHISIDA y su espafiol (Viviendo con el SIDA, Prevencidn de tratamiento, y ayudar a mejorar la calidad de infecciones durante viajes, Tuberculosis: A Guide vida de los pacientes. Organiza foros sobrefatiga for Adults and Adolescents with HIV; Vluntary y anemia, hepatitis, efctos secundarios, dieta y HIV counseling and testing, etc.), que pueden nutricion, la mujery el ninio, y otros temas. Sitio leerse en ese sitio electrdnico. electr6nico facil de usarpara elpaciente, que con- tiene informacidn presentada con claridad. hap:/Iwww. ifrance.com/Seb V Ce site cre' et animt par un jeunepassionn'i de sciences est tres http:n www.thebody.comn/poz/poz.htrnl. A site bien documenti en donniesfactuelles sur le SIDA dedicated to bringing information to HIV- et le VIH. Le language estparfois un peu tech- positive people with the hope of helping nique, les expk'cations d4tailees, mais c'est dans le extend or improve the quality of their lives. It souci de clarifier de nombreux aspects de l'infec- aims to engage both the full-time activists (the tion et de la maladie ds l'intention des lyciens et most empowered patients) and those who are e'tudiants. La bonne organisation du site et la not going to read the technical newsletters and netteti de sa prisentation en facilitent l'usage et attend meetings. Provides informaton and sto- en accroissent l'efficaite. ries of survival in an inspiring and hopeful manner, but only, unfortunately, from a North http://www.worldbank.org/aids A socio-eco- American point of view. nomic perspective on AIDS with descriptions of the Bank's worldwide efforts to counter the http://www.ashastd.org/nah/lvghiv.html. The pandemic. American Social Health Association (ASHA) operates a National AIDS Hotline under con- http://wwwteleeport.com/-celinec/aids.shtml. tract from the Center for Disease Control and An HIV/AIDS links page. Prevention (CDC). Its website covers general AIDS information in and for the US and offers http.//wwuwhivnet.ch. Le service ilectronique to answer questions, provide referrals and send suisse d'infrrmation et d'echange sur le VIHI publications by email. A very good page enti- SIDA, dedie aux associations en lutte contre le tled "Your HIV test is negative. Great news! SIDA De tres bonnes ressources, publications, Now, what next?" mariels didactiques sont affichies, la plupart de ces dernieres pour commande. hrtp://www.cdc.gov/hiv/pubs/facts.htm The Center for Disease Control and Prevention http://cyberdiet.com/modules/hiv/oudline.html. (CDC)'s Division of HIV/AIDS Prevention Helpful advice for everyday living with publishes a series of useful brochures in English HIV/AIDS, written in everyday language. and Spanish (Living with HI/AIDS, Prevent- http://www.catie.cal. The Community AIDS http://www.hivpositive.com. Comprehensive Treatment Information Exchange (CATIE), a resource to improve quality of life with HIV/ Canadian non-profit organization, provides AIDS. Covers all aspects of living with AIDS treatment information (symptoms, diag- HIV/AIDS. nostic, prevention, access to medication, research ...) in an effort to encourage people http://www.avert.org This site focuses on infor- living with HIV/AIDS to get actively involved mation about educating to prevent infection in making decisions and developing strategies with HIV; information for HIV positive people to optimize their health care. A comprehensive and the latest news and statistics. Topics Web site, with two electronic mailing lists, include: statistics; faqs; becorning infected, test- numerous and current print publications and a ing and condoms; young people; transmission; bilingual, and a toll-free phone service. women and children; homosexuality; living Le ]iseau communautaire d'info-traitements sida with HIVIAIDS (induding personal stories); (CATIE), organisme Canadien a but non- healthcare; sex, AIDS & relationships; news & lucratif e'onne accˇs a des renseignements sur les conferences; history, pictures & origins of traitements du SIDA (symptomes, diagnostic, AIDS; AVERT's AIDS Resources (induding prevention, acces aux medicaments, recherche ...), downloadable versions of the booklets). en vue d'encourager les personnes vivant avec le VIHISIDA a prendre une part active au processus http://www.wwc.org The Whitman-Walker dcisionnel et a la mise en place de mnyens per- Clinic's website. Information on how to access mettant de leur assurer les meillurs soins de santi services (a toll-free information line, 24 hours a possibles. Un site fourni offrant de nombreuses day, staffed by English and Spanish-speaking publications tris a jour, un centre de ressources, educators and volunteers; and a separate HIV un acces a ies bases de donnies, deux kstes dmen- counseling and anonymous testing program) in voi informatis6es, et un numero vert (appelgra- Washington, D.GC tuit) oui l'on vous rdpondra en Franfais ou en Anglais, selon votreprifrence. International websites with a focus on developing countries http://www.hivatis.org/caring. Sponsored by the Center for Disease Control and the Ameri- http://www.icaso.org The International Coun- can Red Cross, this site offers an invaluable cil of AIDS Service Organizations (ICASO) is guide for caring for someone with AIDS at a network of community-based AIDS organiza- home (how to get ready to take care of some- tions. Not a funding agency, nor a medical one at home; what you need to know about organization, it is an interactive global focus HIV and AIDS; giving care; bedsores; exer- point on HIV/AIDS. The website links the cises; breathing; comfort; providing emotional reader to one of its five Regional Secretariats support; guarding against infections; deaning (African, Asian/Pacific, European, Latin Ameri- house; laundry, personal items, children with can/Caribbean, and North American) for local AIDS, changing symptoms, etc). information. The Regional Secretariat can in turn provide a listing of regional National Focal Points. http://www.comminit.com. T'he Drum Beat: This is an email and web network sprung from http://europa.eu.int/comm/development/aids. "The Communication Initiative" partnership The European Union's HIV/AIDS Program in (Rockefeller Foundation, UNICEF, USAID, Developing Countries. The site includes online WHO, BBC World Service, CIDA, Johns and in print publications, a good links list, a Hopkins Center for Communication Pro- newsletter. Of general interest. gramns, Soul City, The Panos Institute, and UNFPA). It offers information, ideas, and dia- Websites in or on African logue on commnunication, development and countries change, including sexual health and HIV/AIDS issues. (You may enter "HIVIAIDS" in the http://news.bbc.co.uk/hi/english/static/ keywords field to search previous issues of the in depth/africa/2000/aids in africa. Journalis- Drum Beat). An excellent, if limited, source of tic overview on the epidemic in Africa. A spe- innovative ideas for raising awareness and pre- cial report with correspondents' dispatches, key vention against AIDS. facts, audio, video and interviews. Illustrates the scale of the AIDS crisis in sub-Saharan http://www.fhi.orgl. Family Health Internation- Africa, and asks why the devastation continues. at publishes 'Impact on HIV', a semiannual Case studies of Uganda and Senegal are fea- magazine about HIV/AIDS prevention and care. tured. The site also provides an audio-link to a It also provides a useful series of downloadable one-hour BBC radio documentary on AIDS in training materials on HIV/AIDS (http:/ Africa. www.ffii.org/en/gen/ntranmtlt.htDl), as well as a list of local partner agencies worldwide. http://www.healthgov.za/hiv aids/index.htrn. The official site of the HIV/AIDS and Sexually http://www.oneworld.org. OneWorld, a com- Transmitted Disease Directorate of the Depart- munity of more than 350 organizations, pro- ment of Health of South Afiica. It indudes motes human rights and sustainable develop- information directly related to government ment by harnessing the democratic potential of activities, general information and useful links. the Internet. For information on HIV/AIDS, see the Health section (or use Search). http://www.safaids.org. The Southern Africa AIDS Information Dissemination Service http://www.hivnet.ch/f/index-frame.html. The (SAfIDS), a subregional NGO, collects and Global Network of people living with HIV/ disseminates data/information (news bulletins, AIDS (GNP+), designed for and by people reports, occasional papers, booklets, feature with HIV/AIDS, seeks to improve the quality articles, printed press and electronic media) on of life of PLWAs. The network has 4 opera- the epidemic, its socio-economic impact, pre- tional regional secretariats in Asia/Pacific, Latin vention, care and coping, promotes and under- America, the Caribbean, and North America. takes research; conducts evaluations, strategic Hosted by the Swiss information/exchange analysis, advisory work; facilitates debate and AIDS site hivnet, the GNP+ websire is not analysis of ethical, human rights and policy totally operational at this stage and provides issues around AIDS. The website contains less- links only to its Asia/Pacific and Latin America er known but very relevant publications, fact secretariats. sheets, policy statements, statistics, descriptions of its initiatives, as well as further links. context, such as "Workplace Guidelines" issued by the National Depatrment of Health, or http://www.aidsinfo.co.za. The Beyond Aware- papers written by African University ness Campaign is a project of the HIV/AIDS/ researchers. STD Directorate of the South Afiican Depart- ment of Health. This site details a wide range http://www.vihinternet.org. Par sapage a Pole of communications activities undertaken as Migrants: Afiique >*, le CRIPS (Centres regionaux part of this project. Many useful documents d'information et de prevention du SIDA) Ile-de- which are relevant in Africa and internationally France propose lepoint epiAdmiologique par pays can be downloaded. Also a starting point to afiicain, un catalogue de supports pidagogiques most African HIV/AIDS links on the Web. produits en Afrique pour les africains, une methodologie de diagnostic du VTH, une selection http://www.health.gov.zalhiv aids/commrl.htm. des organismes afnicains par pays, des bibliogra- Within the South African Government's phies sp6cifiques h la lCote d'Ivoire, au Burkina "Beyond Awareness Campaign", a manual is Faso et au priservatiffeminin. Le kiosque donne available in electronic format which provides l'acces en ligne iaplusieurs revues, telles que Tran- an overview of strategies for conrmunicating scriptase, Transcriptase Sud, la Lettre d'informa- about AIDS. Though concerned with large- tion du CRIPS, Chritiens et Sida, ainsi qu'i une scale communication efforts, this book pro- selection d'articles. vides many analyses which can help and inspire very small groups trying to fight the spread and http://www.refersn/sngal ct/rec/rars/rars.htm. damage of HIV/AIDS (see in particular Chap- Le Rdseau Africain de Recherche sur le Sida, ter Five: "Communication for Social Change"). structure scientifique multidisciplinaire a but non lucratif cherche a itablir des reiseaux de commu- http://www.positive-action.org. The Positive nication et de collaboration entre les spicialistes et Action Society, based in Lesotho, seeks to raise chercheurs du continent afiicain. Le site publie the awareness and prevention of HIV/AIDS; une liste de contacts-SIDA dans les pays help people living with AIDS (PLWAs) help suivants: Senigal Nigeia, Guinie, C8te themselves; help generate income for and pro- d'Ivoire, Sierra Leone, Burkina Faso, Niger vide nutritional assistance to PLWAs. This Cameroun, Benin, Mali, Gambie. charity is involved in peer education, condom distribution, manufacturing and marketing of safco@hivnet.ch SAFCO (SIDA en Afiique du goods with PLWAs, designing slogans, erecting Centre et de l'Ouest) est lepremierforum 6lec- billboards and engaging participation of the tronique africain en languefranfaise axi sur le business community in these efforts. SIDA. Riunissant plus de 700 membres, il a pour but de stimuler la discussion et la dision http://www.redribbon.co.za/portal.asp. A electronique de l'information sur les questions South African website apparently sponsored relatives au VIHISIDA dans la region. Pour par- by a local Financial Services Group. Navigation ticiper aux ichanges, il suffit d'envoyer un mes- tends to be painstainking, the site is not well- sage a I'adresse sus-mentionne'e. updated, and documents sources are not always dear or reliable. But some documents are both http://www.aids.org.za/afOl fl.html. The AIDS interesting and hard to come by in an African Foundation of South Africa is a non-profit organisation based in Durban. Its main mission don and community. The site describes Reme- is to link donors with community-based dios' Counseling and Information/Education/ HIV/AIDS groups which are not in a position Comnnunication activities, Resource Center, to raise their own funds. Some of their proj- and Support services to PLWAs. ects, such as the FACES project which aims to put a face on the epidemic in communities http://www.doh.gov/aids/. AIDS website of the and, as a result, reduce the stigma that sur- the Philippines' Department of Health. Lists rounds PLWAs, could be used as a basis for local AIDS partners, hodlines, screening labs, AIDS in the workplace initiatives. NGOs, support groups and other places to go for assistance. http://www.stratshope.org. Strategies For Hope aims to promote informed, positive thinking http://www1.rad.net.id/aids. This site provides and practical action by all sections of society, in information in Bahasa to support individuals dealing with HIV and AIDS. It consists in a and organizations in Indonesia who are con- series of books and videos which focus mainly cemned with AIDS prevention, counseling and on sub-Saharan Africa and includes a training care for people with AIDS. It also provides package called 'Stepping Stones'. Issues covered links to the archives of WartaAIDS, a twice- encompass counselling, home-based care, monthly newsletter for PLWAs and those car- workplace-based prevention, orphans, young ing for them, and of HindarAIDS, also a twice- people, gender, etc. Very pragmatic tools. monthly newsletter on prevention and Strategies pour 1'espoir veutpromouvoir la counselling. rfexion positive et 1'action pratique dans le domaine du VIHISIDA, etpropose une serie de http://www.unchina org/unaids. UNAIDS in livres, videos, ainsi qu'un guide pour La formation China has launched a bilingual website, in intitule ( Parcours *. On y trouve toutes sortes de Chinese and English. The site presents contact stratigies pratiques pour les soins, le traitement, le lists of resource persons in various fields of soutien et la prevention du VIHISIDA en par- interest to HIV/AIDS in China. ticulier en Afrique subsaharienne. Une orienta- tion pragmatique trˇs app riciable. http://www.naco.nic.in. Website of the Gov- ermnent of India's National AIDS Control Asian countries Organisation, established in 1992 as an execu- tive body in the Ministry of Health and Family hrtp://www.best.com/-utopia/aids.htmn. A list Welfare at New Delhi. It provides addresses of of AIDS resources (hotlines, support groups, state AIDS program offices voluntary blood NGOs, projects etc.) in East Asian countries. testing centers, HIV reference/counseling cen- ters, a toll free counseling hotline and a list of http://www.3 1 stcenturv.com/apcaso/index. NGOs. shtml. Homepage of the Asia/Pacific Council of AIDS Service Organizations (see ICASO hap://education.vsnl.com/sexualhealth/ above). HomeISH. A webpage of the Interventions for Sexual Health (ISH) Project of the Indian http://www.remedios.com.ph/. The Remedios Medical Association. ISH operates out of a tea AIDS Foundation of the Philippines provides plantation in South India, in the context of a HIV prevention services to vulnerable popula- regional effort by leading business to support HIV/AIDS Workplace Initiatives. This is a very http://sida.udg.mx. En este sitio electrdnico, engaging, interactive site which hosts a mass of respaldlado por la Universidad de Guadalajara, practical information on various aspects of Mxico, se presenta informacion basica HIV/AIDS. Its section on counseling uses an del VIHISIDA (efectos, aspectos sociales, psicolSgi- excellent hands-on didactic approach. cos, vivir con el VIHISIDA, mujeres, ninos, ali- mentos, contdn, prueba, tuberculosis y sida, etc.). Latin American countries Lamentablemente, alparecer no se actualizw periddicamente. http:/lwww.aids.gov.br. Website do programa AIDS DST (Doen,as Sexualmente Transmissiveis) http:l/wwwvinternet.ve/accsi. Este sitio electroni- do Governo brasileiro. Este site oferece acesso a un co contiene informaci6n sobre Accidn Ciuddeana grande nuimero de informa,ces sobre AIDS/HIV Contra el Sida (ACCSI), una ONG de (virus de imunodVeficiencia humana) no Brasil Venezuela que se ocupa fundamentalmente de bem como informa,ces sobre promo,do da sazde e cuestiones relacionadas con los derechos humanos comunica,do, epidemiologia, promocao de recursos y el VIHISIDA. ACCSI es un centro de coordi- para a sazide, diagnostico, tratamento e apoio. nacion del Consejo de America Latina y el Caribe de Organizaciones de Servicios sobre el SIDA htW:/Ivmed.com.br/aids.htm. Pdgina AIDS do (LACASSO). Virtual-Med, criada e mantida por umestuiante em medicina no Brdis e cujo objetivo eifornecer Russian Federation um espa,o de divulga,do de servi,os medicos na Internet, bem como prestar um servico de infor- http://www.spiral.com/infoshare/home.html. na6oes midicas e pesquisas a todos os navegantes, AIDS infoshare is an NGO in Moscow. Its web leigos ou profissionais. site provides access to artides, a newsletter and a directory of HIV-related organizations in the Russian Federation. Medical Insurance Coverage i&i for National Staff (HIV/AIDS and All Medical Conditions) Does the Bank's Medical Benefits Group. (If you did not join then, you are not Plan (MBP) for national staff cover a member.) Staff who are eligible to become HTV/AIDS treatmente members must be in one of the following A: Yes, in exactly the same way as the appointment types: open-ended, regular, term, plan covers other serious ilnesses, or fixed term. Long-term consultant and tem- porary appointments who were hired prior to 0: Is anti-retroviral thera July 1, 1998 will also be eligible until the end s drug tpy cov of their current contracts. The following indi- ered by the plan? viduals are not eligible for the plan: consult- A: Yes, the plan covers anti-retroviral ants and temporary appointments on or after drug therapy at 80%. If you are July 1, 1998. enrolled in the Medical Benpefts Plan, your treatment for ailltei (includ- Q: What about my spouse and children? Are ing HIV/AIDS related illnesses and they eligible to belong to the plan and receive cov- drugs) will be reimbursed at 80% for erage for HIVIAIDS ? outpatient treaunent and prescription A: If you have just joined the Bank within drugs, and at 100% for hospitalization the last 31 days, and you are eligible to be a in a semi-private room, plus hospital member of the plan, then your spouse and all services and supplies, your children up to age 25 may also be mem- bers of the plan. You should fill out Form l: Does the plan cover HI-V tests? 2367. A: Yes, at 80% if done on an out- If you have been at the Bank a longer time patient basis. than 31 days, and you did not enroll your spouse and children in the plan within the first Q: What else does the plan cover? 31 days, then they cannot be members of the A: The table at the end of this docu- plan. If you are currently a member of the plan, and you get married or have a child in the Q: How doI know flam a member future (or adopt a child), your spouse and child(ren) can join the plan within 31 days of your marriage or the child's birth (or adop- A: You are a member if (1) you are tion). You should fill out Form 2367 for this. eligible and (2) you completed an MBP enrollment form (Form 2367) within 31 days of joining the World Bank Q: What other household members may be Q: Where do Ifind more information on the eligible? Medical Benefits Plan? A: A: Information can be found on the web site * The MBP does not cover pareits even if at http://mbp.worldbank.org. Induded is the they depend on you financially. Neither plan document in English, French, and Span- does it cover brothers, sisters, in-laws. ish. Also, the web site contains many addition- * In some countries, legislation exists which questions and answers, and al the MBP addresses opposite sex domr* twrt fQrns you wil need. who live together but do not formally narry Q: I am afraid to submit my medical claims to through the govemmrnnt or religious forums. :Ia fadt umtm eia list through the governmt o ri tke administrator at the country office because If a coupfe meets the standards for cornmon thy somene else might learn that I have been law marriages and this marriage is 4ocu- mented by the local government, then the tisedo I hateh MBP covers the partner if you have enrolled tiois do I have? him/her as a dependent. A: You can send your medical daim form, vthe bills, and the MBP daims spreadsheet The Plan does not otherwise cpver opposite directly to Mary Pirn Margulies (MC 2-450, sex domestic partners. It does not cover more (202) 45 M margulies,woMCban4org , , ~~~~(202) 458-5183, Mmargulies@worldbank org3 than one spouse in polygamous pr polyan- in the Health Services Department. She will drous societies. make arrangements for Accounting at HQ to * The MBP covers same-sex demes* prt- reimburse you the amount which you are owed ners who are registered with the Bank. See by the Bank Your claim will be treated with Staff Rule 1.01 for information about filing the utmost confidentiality. the affidavit of domestic partneF#4w Q: Should claims be sent via pouch then? Q;19 I understand that the plan witl cover 80 #%: Yes, via pouch, NOT by fax. percent of most costs, but that stil leaves me pay- ing a 20 percent co-payment. Is tbere 4 stap-loss 4: How can I be sure the claims I sent by pouch provision, that is, a provision for txtraordinarly won't be opened by others? high medical bills? A: Yes, the stop-loss offers you fin~ncial pro- A: You should put a confidential sticker on A: Ys, te stp-lss ofersyoufinacialpr the envelope. tection from extremely high mcdia bills. You reach the stop-loss when your ca-paynment ex- . H s p 0~~~~: How secure iS myjob ifl declare my HIV- penses have reached 5 percent of your net an- pontwt.v status? nual salary. Once this point has Ieeen reached, iest the plan pays all of the eligible expensss fpr the A: A staff member's job security should not patient for the remainder of that pln year. bk affected if he/she has the HIV virus. The President of the Bank, last January, wrote a message to all staff assuring them that they would not be discriminated against because of their HIV status. (You can look up this state- ment in several languages in the Country Q: Who approves medical evacuatons? Office Handbook, on the intranet. It is fea- tured in one of the subsections of the 05.Series A: In a medkca emeIgency, the head of the "Health and Medical Guidelines"). country office can approve the evacuation to the closest location where appropriate medical Q: What happens to my income if I am no treatment can be provided, if such treatment is longer able to work because of AIDS ? not available locally. This decision is based on the recommendation of a local doctor. In a A: You are covered by a comprehensive d1is- -emer the approval of the Health ability insurance program. You will receive a Services Department (HSD) at headquarters monthly benefit equal to 100% of your salary must be obtained. In such cases, a medical while using sick leave, and 70% of your salary report from your doctor should be sent to after your sick leave is exhausted. These bene- HSD, where the report will be kept confiden- fits will discontinue on recovery, death, or tial. The report should indicate the diagnosis, upon reaching mandatory retirement. durtion of the condition to date, treatment given so far, and the reasons for recommending Q: How do I enroll in the disability insurance evacuation. Once approved, the evacuation program ? can be provided to the closest location where A: Enrollment is automatic, that is, there is appropriate medical treatment. coverage begins the day you begin working Q: DoestheBankpayforaltheexpensesofthe for the World Bank Group. Additional in- mes ev Ban? formation on the disability insurance meical evacuatin? program can found on the Intranet, at A: The Bank (i.e., your own cost center) will http://hrs.worldbank.orgldisability pay for the travel and foodllodging costs. The medical expenses are submitted for reimburse- About Medical Evacuations ment to the Medical Benefits Plan, according to the table below. Q: Wllthe Bank pay for me togo to a difer- ent location for treatment (a medical evacuation) Q: Where can Ifind more information about if I have HIV/AIDS and cannot get adequate medical evacuations? treatment at my duty station country? A: The mcdical evacuation guidelines are also A: Yes, under the conditions listed below. featured in one of the subsections of the Q: Who is eligible for a medical evacuation? 05.Series "Health and Medical Guidelines". A: Bank Group staff on open, regular, term, fixed-term, and long-term consultant appoint- ments are eligible for medical evacuations. The evacuation policy covers not only the staff member but also his/her eligible dependents. J4 SUMMARY OF BENEFITS Medical Senrice Plan pays Preventive health exams for adults 90% Routine pediatric health exams 90% Routine gynecological exams 90% Eye examinations 90% Surgeon's charges during hospitalization 90% Routine childhood immunizations 90% Adult immunizations 80% Corrective lens (eye glasses) 80% Obstetrical and other medical services by qualified practitioners, and private duty nursing 80% Out-patient technical services, e.g., x-rays, lab tests, etc. 80% Prescription medications (outpatient) 80% Dental care 80% In-patient hospital services and supplies; semi-private room 100% In-patient hospital private room 70% In-patient hospital private room where no semi-private rooms exist 100% In-patient hospital private room for children 12 years of age and under 100% Out-patient psychiatric care 50% a IV FItTesting Process at "No Needles, No Blood, No Pain." tmnitman-Wa[ker Clinic Eseryone registers at the same time and attends a pXeSentation prior to testing during which trained staff anfid'volunteers provide basic informatio.n and answer questions about safer sex, HIV, and risk reduction. WNhitman-Walker Clinic uses OraSurel, a simple, safe and _4 accurate oral collection method. Individual test results are back in about a week. Results are given in person only during private counseling sessions and never in the mail or over the phone. Testing is available several times a week by appointment. HIV testing is offered as a free service. Special arrangements may be made for Whitman-Walker's HIV Counseling and Testing Program to come to you to 4 L provide on-site HIV testing for vour group or organiza- tion. Call 202-332-3926 for more information. To schedule an HIV antibody test appointment call: 202-332-EXAM (3926) 202-939-7845 (TDD/TTY) For more information about other Whitman-Walker Clinic Services call: 202-797-3500 or access our website at www.wwc.org Whitman-Walker Clinic has two testing locations: Elizabeth Taylor Medical Center 1701 14th Street, NW Washington, DC 20009 (Corner of 14th & R Sts., NW) Mvletro: Green Line - U St./Cardozo Max Robinson Center 2301 MLK, Jr. Ave., SE Washington, DC 20032 / (At Chicago & MLK, Jr. Aves., SE) i- , WHITMAN-WALKER CLINIC Metro: Green Line - Anacostia _ Paid for by the D.C. Department of Health/Agency for HIV/AIDS. 4/00 ooklet talks about How Does the HIV Test Work? Whitman-Walker Clinic uses the OraSurel method to testing for HIV, the virus collect samples from those taking the HIV test. Most other test sites still require the collection of blood for that causes AIDS. Deciding testing. With OraSure', a small pad is placed in your mouth to collect the sample that will be studied. Regardless of the sampling procedure, after each sample test is one of the most is collected, an HIV test (the ELISA test) is used to detect the presence of HIV antibodies. It is one of the most important steps that you valid and reliable tests in medicine today. If the ELISA result is positive, it's done again. If the repeat test is can take to protect your positive, one additional test - called the Western Blot - is perforned. And then only if the Western Blot test is health and the health of positive is an HIV positive result given. Al HIV tests taken at Whitman-Walker Clinic are analyzed on premis- others. We want you to es in our own federally licensed laboratory. understand how the test What do the Test Results Mean? works, and what it wll and The HIV antibody test tells if your immune system has produced antibodies in response to HIV infection. It does will not tell you. W e also not show if you have developed AIDS or measure any other health information. want you to understand the A negative test result means that no HIV antibodies have been found in your blood. This is the case with about behaviors that may put you 96% of those who take the HIV antibody test at risk for infection, Whitman-Walker Clinic. Two things can cause a at risk for HIV inection, negative result: and the things that you - You have not been infected with HIV. You have been infected with HIV, but you are in the should consider before you "window-period." decide to take the test. The time between when-you become infected and when your body develops HIV antibodies is called the 'window period." If you have been infected, HIV antibodies take from three to six months to develop. During this time, even if you have not developed antibodies to the virus, you can still transmit HIV to others. Have you: A positive test result means that you are infected with known for sure whether all of your sex partners are the HIV virus and can pass it on even though you may HIV negative? have no symptoms at all. The HIV antibody test is not an had sex with someone you know has HIV or AIDS? AIDS test A positive result doesn't mean that you have *had a sexually transmnitted disease such as herpes or AIDS, nor does it predict if you will ever get AIDS. syphilis? (Having these diseases makes it easier for Heredity, lifestyle choices (such as limiting the use of you to get HIV.) alcohol/ drugs! tobacco), exercise, stress reduction, and *had sex without a condom or other barrer? the type of medications that you take may delay the onset of symptoms. had sex with many different partners or with someone who has had many partners? What Puts You At Risk For had sex with someone who has used needles HIV Infection? to take drugs? HIV is spread through the exchange of certain body ever shared needles or works to take drugs? fluids - blood, semen (cum), pre-seminal fluid (pre- cum), vaginal fluids, and breast millk Our skin provides If so, you should consider taking an HIV antibody test some natural protection, but it occasionally tears, cuts or breaks and can produce an opening for HIV and other infections. You might also consider evaluating whether you have ever been at risk v for HIV infection. || The use of drugs and alcohol can impair your judgement and impact the decisions you make about safer sex behaviors. - WI'TNI'AN-WALJER CLINIC When will results be available? Most public health clinics take two to three weeks to get your result. Doctors offices and others may be able to have your results sooner for a higher fee. Whitman-Walker Clinic wil have your results in one week or less. How To Choose A lace To Test You can test at your private doctor's office, local health Should I Tell About My clinic, or hospital. If youineed information about test lest Result? sites nearest you or about HIV antibody testing at When someone receives a positive test result, Whitman- Whitman-Walker Clinic, you can call 202-332-EXAM Walker Clinic recommends using caution in deciding (3926) between the hours of 9 am - 5 pm, Monday whom to tell. Discrimination at various levels still exists through Friday, except holidays. against those who are HIV positive. Only tell people who ought to know, such as your sexual partner(s) or medical Do they offer anonymous or confidential testing? provider. Some insurance companies can legally deny you Anonymoused testiang mdeansif tha nou name Mor t inf ony insurance if you are HIV-positive, have AIDS or have mowl besuse an identify Mos n seen a doctor to treat an HIV-related condition. Generaly, m ust tes ting sites use a special code to identifj your employers don't need to know your HIV status, nor do test result - they have a right to require that you take an HIV Confidential testing means that your name is collected antibody test. If you have any questions or concerns and can be linked to your test result While this informa- about insurance or employment rights, please phone tion, like any other medical information, is supposed to the Whitman-Walker Clinic Legal Services Department be kept secret, the law may require the agency to release at 202-797-3527. confidential medical records in certain situations. In HIV related counseling services may be arranged for up to every jurisdiction, the law requires AIDS cases to be 8 sessions at Whitman-Walker Clinic. Call 202-939-7846 reported to the Department of Health. to get more information on counseling Is counseling offered with testing and results? or appointment - Both pre-and post-test counseling is part of HIV testing information. In Vurginia, cases of HDV inaection moust be reported by' namne to the at Whitman-Walker Clinic. Trained counselors will also HIV testing is free. Health Department. In the District answer your questions about HIV, address emotional of Columbia and Maryland, cases answer your questions about HIV, address emotlonlof HiV infecticor. are reorted In a issu nce elp you interpret your coded manner -- using a unique identifier -- to protec the identity testX | gw a of the patient. This information mav influence the decision of .where you wit! take the test.