UN agencies draft guidelines for caring for people with HIV/AIDS

Proposing guidelines to protect the safety of those involved in the global struggle against HIV/AIDS, the United Nations labour and health agencies said health-care workers looking after infected people are facing not only the risk of infection, but also the psychological burdens of patients' deaths and the physical burdens of overwork.

"We have massaged and polished a very good draft into a set of guidelines that we can all live with so that others may indeed live," said physician and public health official at the New York State Department of Correctional Services Lester N. Wright, who chaired an International Labour Organization (ILO) and World Health Organization (WHO) expert meeting last week to complete the recommendations. The plan will be presented for approval in June by the ILO Governing Body.

"These guidelines are intended help to lessen barriers to prevention and care, whether these barriers are attitudes, gender, or race, or unsafe working conditions, or practices," he said.

The 64-page text provides wide-ranging and practical approaches to the ILO code on HIV/AIDS in the workplace approved by Member States in 2001, including prevention, protection, training, treatment, confidentiality, "no screening for purposes of employment," gender equality and minimizing occupational risk in a healthy work environment.

It notes, however, that "the scale of occupational risk in the health sector is unclear, in part because of the stigma and blame attached to the reporting of needle-stick injuries and the lack of available post-exposure prophylaxis. HIV/AIDS transmission therefore needs to be addressed in the workforce both as an occupational safety and health issue and as a social issue," that includes giving information about the risks of unprotected sex.

Care should be made available to health workers, regardless of the mode of HIV transmission, according to the recommendations from the experts, which include comments from Governments.

With the stress and long hours of work imposed by the pandemic, health care personnel in some developing countries have been leaving the public sector, "or migrating to work in other countries," the experts note.

Constraints on improving their work conditions have included International Monetary Fund (IMF) structural adjustment policies that have reduced public spending and employment in countries subject to such policies, existing weaknesses in health sector policy formulation and strategic management, as well as shortages of infrastructure, equipment and human resources, it says.

"The successful planning and implementation of national policies and legislation requires a process of extensive consultations with health service employers and workers, persons living with HIV/AIDS, and all other stakeholders, as well as effective enforcement systems," according to the text.

Meanwhile, however, because of the stigma the pandemic has given the health profession, "lower intakes are being observed in developing countries, in particular among front-line workers, such as nurses. This compounds the already existing shortage of staff and job stress," it says.

"A larger, well-trained health services population is needed to address the different layers of HIV/AIDS and to provide help for those infected. A key impediment to the success of the anti-retroviral (ARV) programme in Africa is the shortage of health workers available to administer drugs to patients," it adds.

The impact of HIV/AIDS is often hardest where health systems are weakest and deals a double blow: systems that already cannot cope with demand are weakened further by the HIV/AIDS deaths and disability of large numbers of health personnel, it says.