Introduction

The effective diagnosis, treatment and prevention of STDs is one of the more important ways in which transmission of HIV can be reduced.

These prevention programmes include:

• awareness programmes
• education programmes
• condom distribution programmes
• universal precautions
• STD management

In addition to these programmes, there are a number of practical steps that your organisation can undertake to reduce the risk of HIV transmission among employees. These are discussed in the section Risk Reduction Programmes.

The effective diagnosis, treatment and prevention of STDs is one of the more important ways in which transmission of HIV can be reduced. It is thus one of the more important prevention techniques. However, the issue of STDs is discussed the section on Wellness Management. This is because there are important elements of care related to both HIV and STDs. These include counselling and notifying partners.

The aspects of prevention programmes listed above are not successful if implemented only in isolation. Their effectiveness lies in the integration of individual aspects into one prevention programme.

For example:

A condom distribution programme will fail dismally if it is not accompanied by raising awareness and using education to change attitudes towards existing sexual practices.

Providing information alone, without developing skills and confidence in people to enable them to protect themselves, will not result in any behaviour changes required for reducing the risk of HIV transmission.

(i) Risk reduction programmes
The introduction to the Guidelines highlighted the socio-economic conditions that increased the risk of HIV transmission. It is important for you to look at the extent to which your organisation creates these factors through its housing policy, recreation possibilities, support for families of employees and so on. Therefore, to start reducing the risk of transmission, your organisation's HIV/AIDS and STD committee must critically assess its role in promoting these factors.

(ii) Awareness programmes
People need to be well informed about AIDS, so they can understand clearly how the virus is transmitted and what activities and interactions are safe. This in itself is undoubtedly not enough to promote widespread, effective behaviour change, but is an essential part of what is needed. Greater understanding and awareness should remove irrational fears and lead to supportive attitudes toward infected people. If people living with HIV/AIDS can expect to be accepted and supported, they need no longer keep their diagnosis a close secret. They also need to feel that they are not going to be blamed for having become infected in the first place.

Creative awareness-raising campaigns are an important component of a prevention programme. Awareness programmes should provide information that is relevant, accessible in terms of language and literacy levels of employees and which is culturally sensitive. The HIV/AIDS and STD committee has a crucial role in making sure that these principles are kept. The information should also be provided on an ongoing basis in order to make any impact.

Awareness-raising activities can include exhibitions and theatre productions on HIV/AIDS and STD themes, campaigns linked to World AIDS Day, National Condom Week or AIDS Memorial Day. Awareness-raising activities are valuable in that they create awareness around HIV/AIDS and STDs in an informative, fun, non-threatening way. Awareness-raising activities can also be included in open days or induction days for new employees and their families. Community members may also be included in awareness campaigns, thereby increasing the number of people reached by the programme.

EDUCATION PROGRAMMES
Education programmes go beyond just providing information through campaigns. Education programmes aim to provide people with skills that can help them adopt behaviours that will protect them from HIV and STDs (e.g. negotiation and assertiveness skills). Education is a two-way process of sharing information and understanding beliefs, attitudes and feelings.

1. Reasons for conducting education programs

(i) Preventing the spread of HIV and STDs
There is presently no vaccine or cure for HIV/AIDS. The most effective way to slow down the spread of HIV/AIDS is to reduce the rate of transmission from infected to uninfected people. The first step towards lowering a person's risk of becoming infected is providing knowledge and awareness of HIV. Knowing about and practising safer sex is the best way of remaining HIV negative, since the most common way of being infected with HIV is through sexual intercourse.

HIV/AIDS education can take place most effectively in the workplace, even though most HIV transmission occurs outside the workplace. The workplace is where employees spend a large part of their time, where they are trained and where they interact with their peers.

However, HIV may be transmitted in the workplace through contact with another person's blood (for example, if there has been a workplace accident). Education programmes should include training around what to do if there is an accident in the workplace and how employees can perform first aid and handle blood spills safely in an emergency. (See Section 5.5 for further details.)

STDs are important in the HIV/AIDS epidemic because there is a greater chance of a person being infected with HIV if they already have an STD. Because STDs are curable, STD prevention and treatment is an effective way to slow down the spread of HIV/AIDS. Preventing unfair discrimination against employees with HIV

Many people experience intense confusion and anxiety about how HIV could affect their job security and their relationships in the workplace (with managers and colleagues) and outside it (with their families and friends). Many people have heard of others who have lost their jobs or pensions because they have HIV. Some people living with HIV/AIDS have been discriminated against by their employers, co-workers, friends or family. These irrational responses and prejudices and the fear they produce in employees can have a serious impact on productivity and industrial relations. Fear and prejudice can be reduced by appropriate education around the employer's attitude to HIV/AIDS, the facts of transmission and the rights of employees in relation to HIV.

(ii) Facilitating the fair management of employees living with HIV
An education programme for employees at all levels of a company or organisation, including managers, can greatly facilitate the management of those employees who have HIV. Taking active steps to prepare for the full impact of HIV/AIDS will allow a more reasoned, appropriate and effective response.

(iii) Demonstrating management's commitment to addressing HIV/AIDS in the workplace
Management support for the HIV/AIDS programme demonstrates that management is sincere about addressing HIV/AIDS in the workplace, the welfare of employees and the well-being of the company.

In this context, management should provide a budget specifically for the HIV/AIDS and STD programme.

Management should participate in the AIDS committee and in HIV/AIDS education and training programmes.

2. Contents of a successfull education program
In this section we highlight some of the characteristics of a successful HIV/AIDS and STD education programme:

Education should be on-going, rather than a once-off or annual training course. This allows the effectiveness of the programme to be monitored as it takes place and the content changed as necessary. It also keeps people thinking about HIV/AIDS, so that the issue remains accepted and visible in the workplace.

Education and awareness-raising around HIV can easily be integrated into existing training courses such as industrial relations, personnel management, first aid, occupational safety, literacy, induction and supervisory and management courses. This entails no extra costs if HIV-related examples are used to get people thinking about how HIV could affect their situation in the workplace.

Education should take place in small groups in an informal workshop setting, so that employees feel comfortable to ask questions and discuss their feelings openly.

Peer educators can be used in almost any workplace, whether small or large. Peer educators are employees who are trained to deliver HIV/AIDS education and/or counselling to fellow-workers. Peer educators should be volunteers or be selected by their colleagues, but should have certain qualities such as empathy, maturity, good communication skills and popularity among their colleagues. Peer educators are well-placed to initiate a condom distribution programme.

Another source of peer education is contact with peers with HIV from within or outside the workplace. Contact with peers with HIV can remove myths and fears very effectively, but should be handled very sensitively, in small groups and only as one part of a comprehensive education programme. This type of education is only possible if some employees with HIV are prepared to disclose their HIV status.

The specific content of an education programme should be decided in consultation with the HIV/AIDS committee and/or outside agencies which specialise in workplace HIV/AIDS and STD education.

3. Principles of education programs
These principles should underlie any education programme that you implement, but they can also be used to evaluate your programme and other programmes offered to you by another organisation.

• Start where people are, with their existing knowledge, beliefs, fears and hopes, attitudes and practices.
• Take into account the socio-economic and cultural context of people's lives.
• Correct information in a supportive way.
• Help people express their feelings and describe their own experiences.
• Help people to identify, understand and articulate their own problems and to explore opportunities for change and development.
• Do not try to take responsibility away from people by telling them what to do. The decisions must be theirs.

4. Selecting and training peer educators
The age, language, social and work status of peer educators should correspond, to some degree, with those of their co-workers. For example, each peer educator could be responsible for education in his/her specific section or 'floor' of the workplace.

Peer educators need to be highly motivated since they perform a difficult task on a voluntary basis. Group training sessions will help them remain motivated through sharing the experiences and problems they encounter.

You should consider cultural and gender issues when selecting peer educators. Some of the issues relating to HIV/AIDS and STDs are highly personal and people may only be comfortable discussing them with someone of the same gender and cultural background.

The language(s) used by the peer educators must be taken into account: people need to be educated in a language that they feel comfortable using.

Peer educators should be trained as necessary, either in-house or externally through an AIDS training organisation.

Family members of employees or others outside the workplace may also work as peer educators, working in the broader community to educate sex workers, school children and non-working mothers.

5. Issues to be covered in an education programs
There are a number of issues that should be covered within an education programme.

(i) Transmission of HIV

• how HIV can be transmitted between people;
• how HIV is not transmitted; and
• most common mode of transmission (unprotected sex).

(ii) STDs

• the role of STDs in transmission of HIV/AIDS;
• the importance of prompt treatment for STDs;
• where to get treatment;
• importance of using condoms during treatment;
• informing your partner that you have an STD; and
• the importance of your partner being checked or treated too (see the STD Diagnosis and Treatment section).

(iii) Safer sex

• the advantages of safer sex for preventing HIV/AIDS, STDs and pregnancy;
• problems people may encounter in introducing safer sex into a relationship;
• how to deal with a partner who does not want to practice safer sex;
• communication around safer sex; and
• techniques for safer sex (including the importance of using condoms and non-penetrative sex).

(iv) Condoms

• the role of condoms in preventing HIV/AIDS, STDs and pregnancy;
• how to use a condom; and
• practice in applying a condom. The use of both male and female condoms should be explained.

(v) Attitudes, myths and misconceptions
There are many myths and misconceptions about HIV/AIDS and STDs which should be addressed by an education programme. Universal precautions

(vi) Legal and ethical issues
Information on the rights and obligations of employers and employees with regard to HIV/AIDS and STDs should be provided and discussed.

(vii) Women's rights
In educating women about their rights with regard to sexuality and reproduction, specific efforts should be made:

• to provide women with skills for employment; and
• to empower women to make their own informed decisions about their bodies and their sexuality.

6. Link with educational services outside
Many organisations provide HIV/AIDS and STD educational materials and/or educators who will visit workplaces on a regular or once-off basis. These organisations may also help an organisation to develop an HIV/AIDS policy or a workplace programme. A database of organisations which provide these resources is available from the Department of Health: Directorate HIV/AIDS and STDs.

UNIVERSAL PRECAUTIONS

• You should be aware of the possibility of accidental transmission of HIV/AIDS in the workplace when you are developing your HIV/AIDS and STD programme.
• This may occur when either the victim of the accident or the person(s) who gives first aid has HIV.
• Any accident or blood spillage should be considered a possible source of infection since in the workplace every person's HIV/AIDS status is not known.
• It is very important to make sure that the necessary equipment and skills are available to protect all workers. These should be applied consistently with any accident and/or injury, no matter what the person's HIV status is.
• Universal infection control procedures also control the spread of other dangerous infections such as hepatitis.

BASIC PRINCIPLES OF INFECTION CONTROL
Those giving first aid should assume that all patients have HIV and should avoid any contact with blood or other body fluids. This is done by covering any cuts or sores with waterproof plasters and wearing plastic or latex gloves. If no gloves are available the hands can be covered with plastic bags tied around the wrists. If blood does get onto the skin it must be washed off in hot soapy water as soon as possible.

• Blood spills on floors or other surfaces should be treated with a disinfectant (for example, bleach) before being wiped up with absorbent paper.
• Soiled clothing or fabrics should be boiled in water for 20 minutes, placed in the sun to dry and ironed.
• All workplaces should include universal precautions in an induction course or manual given to new employees. If a first aid or safety course already exists for workers, training in the use of universal precautions can be easily included.
• A first aid kit must be available and should contain the following:
  • plastic or latex gloves
  • waterproof plasters
  • cotton wool
  • bandages
  • antiseptic
• Employees who are most at risk of being exposed to HIV at work are health care personnel. However, in health care facilities, universal precautions should already be established.

What to do if it is suspected that an employee has been infected with HIV in the workplace
Employees are covered by the Compensation for Occupational Diseases and Injuries Act. They may therefore be compensated for diseases and injuries contracted in the course and scope of their employment. Specifically, an employee who gets HIV as a result of an accident at work will be entitled to compensation.

The employer must report the accident to the Workman's Compensation Commissioner if there was a chance of an employee having been exposed to HIV. Normal medical procedures must be followed (treatment of injuries and so on) to support the claim. The employee must be tested for HIV immediately and at three-month intervals for nine months thereafter.

CONDOM DISTRIBUTION
It is important to remember that condom distribution must be done as part of an education programme. Employees who are well informed about the function of condoms and how to use them will not be offended by their sudden appearance in the workplace. Peer educators can play important roles in initiating discussions on the advantages of using condoms and in supporting the condom distribution programme.

Many people are self-conscious about being seen buying or taking condoms from a dispenser or from a health worker. Various creative strategies for making condoms more acceptable and accessible can be used, such as a workplace advertising campaign or industrial theatre. Different ideas should be listed by the HIV/AIDS committee and investigated thoroughly to find the best one(s).

A multi-faceted strategy might be possible in a larger workplace. This strategy could include free distribution at the workplace clinic, social marketing through condom vending machines and peer educators who distribute condoms. Smaller workplaces may appoint a specific person who can distribute condoms confidentially, or may simply choose to provide information to employees about nearby outlets (for example, a family planning clinic or pharmacy).

An increase in the number of condoms distributed, occurring together with a decrease in the incidence of STDs, could indicate that employees are changing their sexual practices as a result of the education programme.

Issues to consider when setting up a condom distribution programme
(i) Availability of condoms
Condoms are available free of charge from various outlets such as family planning clinics and the Department of Health. They can also be bought from commercial distributors such as pharmacies. The list of resources provided at the end of the document includes the addresses of the ATICCs where condoms can be accessed.

(ii) Social marketing
You should carefully consider whether condoms should be distributed free of charge or whether a nominal fee will be charged. One important advantage of charging for the condoms is that people will tend to make better use of them, when compared to free distribution.

Social marketing of condoms includes encouraging people to use condoms effectively and consistently through:

• education and information around condoms and safer sex (for example, done by peer education)
• providing accessible condoms where and when they are needed at a cost that is affordable
• targeting information and access to condoms at people in the broader community (such as sex workers and indeed all women)
• using tried and tested advertising techniques to 'sell' the concept of condom use
• marketing both the male and female condoms as this provides women with more control over their use

(iii) Locations and types of distribution points
There are many places and ways to distribute condoms and the successful strategy is different for each workplace. Vending machines which sell condoms are available, as are condom dispensers which do not need the employee to pay for them.

THE ROLE OF HEALTH WORKERS IN PREVENTION
A number of steps can be taken to involve health workers in the HIV/AIDS and STD prevention programme if the workplace has a clinic offering basic health services or has links to a public primary health care clinic.

STD treatment can be integrated into basic health services if these are offered in the workplace. The health workers should be trained in diagnosing and treating or referring STD cases and also in counselling about safer sex. Health workers can also be responsible for maintaining statistics on the numbers of STD cases seen every month in the workplace.

Clinics can be useful condom distribution points, although they should not be the only ones. Health workers can monitor the number of condoms distributed through the clinic. This is another way to measure the impact of an HIV education programme, though it should not be used only on its own. In other words, even if large numbers of condoms are distributed, there is no guarantee that they are being used properly or at all.

You are here : Home AIDS Zone Organising AIDS Awarness Programs