22nd March 2003

Dealing with Aids in the workplace

Faith Magero, Clinical Officer and John Kimondiu, Human Resources Co-ordinator at the Hotel Intercontinental work on the HIV/Aids policy for their staffers. Pictures by Thomas Omondi.

On February 6, 18 companies decided to recognise HIV/Aids as just another disease that plagues its employees. WAYUA MULI explores what it means to thousands of HIV positive Kenyans.

There are 2.2 million Kenyans living with the HIV virus. Almost half of them have been, or will be fired or retrenched once it is revealed that they are HIV positive. And yet, they are healthy, productive people, who need their jobs more than any other segment of society, specifically because a salary will guarantee their ability to stay healthy. And like Boniface, whose story is recounted below, many feel frustrated of being healthy and professionally under-utilised, as well as discriminated against.
Boniface Muyonga is 30 and is married with two children, a boy aged 6 and a girl aged 3. His wife has also tested positive for the HIV virus and is also currently out of a job.

“I was forced to take work as a driver nine years ago at a company in Westlands. I was overqualified for the job – I have a degree in International Relations from USIU – but I had no choice. The economic situation in Kenya does not often allow you to choose the job you love, so you do what you have to.

“In February last year, all the employees of the company, numbering about 150 people, were asked to go for a medical test at one of the big hospitals in the city. There was no choice about it; if you refused to go for the test, you were fired. And if you turned out HOV positive, you were fired anyway.

“The results were ready in a few hours time and by late afternoon, they were on the boss’s table. The next day, he called everyone into his office one by one and told them their results. I think this was very unfair; it is my right to know my results before anyone else because this is my body. Those who, like me, were HIV positive were retrenched on the spot. About 80 people were fired that day. Some of them had been working there for over 20 years.

“We were to be paid our dues, but until now, we have not received them. And there is nothing we can do about it. Some of my former colleagues went to Kituo Cha Sheria to see if they could get some legal help. I don’t know whether they succeeded. I decided not to join them because I was so depressed about the situation that I just wanted some time alone to digest it and figure out my next move.

“Since then, I have applied for countless jobs. I have been called for two, on condition of my medical test results. Naturally, when I go for the test, I turn out positive. They never tell me that they cannot take me because of my medical status. They say that my application was not successful. In some companies, it is almost like you have to bribe them to get a job. And yet we are poor, which is why we are looking for jobs!
“My wife also suffered the same fate when it turned out that she was HIV positive, so we were both jobless. We survive each day by the grace of god and the goodwill of friends and family. Medication is expensive. It costs roughly Sh10,000 a month for myself. But I am still healthy, and it is now that I really need a job. Landlords are not willing to understand that things are hard on us; when the first of the month comes, they want their money without fail. I have bills to pay as well. And every time I leave the house, that’s additional money spent on bus fare, lunch and so on. I wish I could rely in diet alone to help me, but you can only eat a good diet if you are on a payroll. When you are not working, you live on a diet of sukuma wiki and life goes on.

“In developed countries, people with HIV live healthy for even 20 years. I feel what happened to me is discrimination. The bosses who fired me don’t understand that anyone can get HIV. Perhaps they should have gone for medical tests first before they started firing employees. They just might have the virus! In spite of all this, I prefer to have the attitude that even if I am HIV positive, it does not affect my life and my ability to work. If only I had the chance to prove it.”

There is a dark cloud that surrounds many of Kenya’s work-places. The dark cloud is HIV/Aids. Hundreds of Kenyans acquire the HIV virus every month. Most of them, like Boniface Muyonga, are people between the ages of 18 and 35, the most productive segment of society.

HIV/Aids in the work place has long been a tricky issue. Many companies, facing a disease that May cripple both their work force as well as their financial ability to care for their employees’ medicals needs, opt to take the problem off their hands by retrenching anyone carrying the virus. Many other companies simply refuse to hire anyone who is HIV positive, subjecting job applicants to pre-employment tests to determine whether they are medically suitable or not. And for those employees who find that they have acquired his immune deficiency syndrome in the course of their working life, the spectre of ending up jobless looms so large that their ability to be productive is severely impaired. And once fired, where is the healthy, productive HIV positive worker, who still has bills to pay, rent to make and medical need to cater for, meant to go if every other company won’t hire an HIV positive person?
Every cloud May have its silver lining, but it is difficult to see one in this particular nimbus. And yet, thanks to a group of companies that have re-thought their policy on HIV/Aids, that silver lining to about to start shining.

18 companies, under the auspices of the French Business Club (FBC), have banded together to implement a policy that assures HIV positive members of their workforce access to medical care, counseling, job security and medical status confidentiality. Members of the FBC are drawn from Kenyan companies that have French interests, and include the Hotel Intercontinental, Bamburi Cement Company Ltd, Kencell communications Ltd. Nestle Foods (Kenya) Ltd, Total (Kenya) Ltd and Haco Industries Ltd.

According to Mr. Phillipe Vandebrouck, the current Chairman of the FBC, the 18 members felt that the government and NGO’s alone could not fight HIV/Aids. It required action from the private sector, to eliminate stigmatization and discrimination and to encourage voluntary testing, education, counseling and positive living. It had to start in the place where many adults spend the majority of their time – the office.
One of the primary components of the policy is education; companies signatory to the HIV/Aids policy are required to train peer counselors, as well as disseminate information on HIV/Aids.

Different companies have found innovative ways of doing this; at Kencell, employees are encouraged to participate in essay competitions about HIV/Aids. The company newsletter serves as a forum for information distribution and any new information acquired by the heads of the company is shared via e-mail. At the Hotel Intercontinental, the Human Resources director, Mr. John Kimondu, plans on adding signature footnotes to his e-mail, so that anyone receiving his mail will additionally read something informative about the HIV virus. At Bamburi Cement, staff parties are a great forum for employees to stage plays that disseminate positive messages about HIV.

It is the peer counseling, however, that has made the greatest impact, not just with employees who may be HIV positive and looking for information, but amongst the peer counselors themselves, who may have had misconceptions about the disease and now view it differently.

Betty Mwango, 39, who has been a secretary at the Bamburi Cement factory for the last 16 years, says that her peer education training ‘freed her from her prison’. “I used to treat people with HIV different,” she remembers. Although she interacted with a number of people who were HIV positive, Betty recalls scrubbing her hands clean after greeting people whom she knew had HIV, and consciously but secretly ostracizing them. She was selected to join the Bamburi Cement peer counseling programme in 1998, and since then, has proclaimed herself free of prejudice. “Now I know better,” she says.

Hassan Salim, 43, a system analyst with the same company, remembers that Bamburi first started its HIV/Aids peer education programme in 1998, way before the FBC made it compulsory. He was amongst those picked to be an educator; currently, there are about 20 peer educators, each of whom was picked for their approachability, openness and friendliness with the rest of the staff.
“When you are talking to others, that’s when you discover just how much people don’t know,” Hassan says. “For example, when we are teaching the ABC’s of HIV prevention, I have discovered that many people really don’t know how to use a condom.”

While their job is to talk to people who are both HIV positive and negative, Hassan, Betty and their fellow peer educators do not need to know whether their co-workers are HIV positive. “We talk to everyone – over lunch at the cafeteria, for example,” Hassan says, “and if anyone wants to ask any questions, whether in confidence or not, they are quite welcome.” The encourage co-workers to visit VCT centres, as well as encouraging them not to discriminate against others whose status may be know to be positive.

Leo Muhaji, 38, an accountant at Bamburi Cement for the last 11 years, is aware that being a peer educator takes up company time. “We attend seminar to up-date ourselves, and the company allows us to attend, and transports us from Nairobi to (our Mombasa office) where the seminars are held.” They are also given afternoons off, occasionally, to walk around the communities that live around the Bamburi factory in Athi River, talking to people they meet about HIV/Aids. “Bamburi takes this seriously,” he says.

Peer education is just one of the elements. Confidentiality in terms of HIV status is another. What this means is that prospective employees are not required to take HIV tests, unless they choose to, and that these results remain private, unless they choose to disclose them to their employer. Therefore, no one is hired or fired on the basis of their HIV status.

However, this makes medical insurance a tricky issue; insurance companies insist that all employees of companies that they cover must submit to a medical test, in order to judge whether they should be covered. Most insurance firms will not cover HIV positive employees. Only one, Apollo Insurance, will, but they still require a medical test, since they charge higher.

Alvin Okari, peer counselor

Vincent Odhiambo, peer counselor

Phillipe Vandebrouck, MD Kencell Communications


The French Business Club HIV/Aids Policy

The policy statement that the members of the French Business Club signed is outlined below:

“Our genuine concern for the dignity, health and safety of our employees is part of our companies’ values. As far as our employees are concerned, we do not accept discrimination or breach of privacy. What is at stake is not only HIV/Aids, but also malaria, tuberculosis, STDs and treatment of similar disease.

1. Neither direct nor indirect screening for HIV/Aids should be carried out at any pre-employment assessment, unless it is to the detriment of the health of our customers.

2. Company employees are not discriminated against on the basis of their assumed or known HIV status. This applies to all aspects of the employment including promotion opportunities and training.

3. A formal education programme is instituted by each company; it includes as a minimum requirement, a peer education programme; volunteers shall be selected from the workforce; they will be permitted absence for their training activities.
4. Voluntary tests are encouraged and remain strictly confidential. Confidential HIV/Aids counseling services shall be made available to all staff.

5. The company shall do its best to keep the employee in the company in a position compatible with his/her medical status, when the HIV/Aids related disease results in partial ineptitude.

6. The company takes all due precautions to ensure that staff and customers are not exposed to HIV/Aids infection, with a special focus on the prevention during medical procedures.

7. The company shall support the progress of the Kenyan legislation with the target that anti-retroviral drugs could be offered at an affordable cost with adequate medical conditions.”

18 companies signed this policy.

View form an HIV / Aids spokesperson

Ms Asunta Wagura is the Executive Director of the Kenya Network of Women With AIDS (KENWA). She has been HIV positive for the last 14 years.

Asunta Wagura strongly believes that among the myriad of rights that HIV positive people in Kenya are denied is the right to employment. “The government policy is that HIV positive people should not be denied employment, but there is no organ to enforce this,” she says.
Every week, she says, she receives at least two people who comes to her office to complain that they have been fired because of their medical status. “Many of them don’t want to go forward and make it a court case because of the stigma,” she says. “They are not ready to fight the full fight, because it might involve the press and people will then know their status.” And it is stigma, again, that causes them to lose their jobs in the first place. And yet, HIV positive people can live as long as most HIV negative people realistically hope to live. “HIV does not kill,” Asunta says, “Aids does. As long as opportunistic infections are dealt with, HIV positive people can live a long and fruitful life.”

Jobs are not all that HIV positive people are denied; green card status applicants are subjected to a medical test by the relevant embassy, and refused visas if they are HIV positive. “This is done without counseling the applicants, and the results are just dropped on them,” Asunta says. Life insurance is no longer accessible, and housing and mortgage companies won’t even let them buy a house, because they are ‘high risk’.

“All of these things make HIV positive people bitter,” Asunta continues. “They feel that they do not want to continue living. Some kill themselves, or resort to infecting as many people as they can, as a way to make society pay for what they are going through.”

All of this comes down to public perception. “If people saw HIV as a disease, just like any other terminal disease like cancer or diabetes, they would not treat HIV positive people like this.” Unsaid goes the fact that anyone, including those who are victimizing those who are HIV positive, may end up positive as well.

premiums for HIV positive employees. The participating companies have had to find innovative ways to deal with this problem. At Kencell, each employee is covered for all but HIV-related infections. Therefore, the company does not need to know one’s HIV status, and neither does the insurance firm. At the Hotel Intercontinental, all medical expenses are currently covered by the hotel out of its own pocket. Bamburi also had the same policy, but they have since switched to a policy that also covers their HIV positive employees.

No matter what sort of opinion the general public may have about the life-span of someone with HIV/Aids, the FBC recognizes the fact that someone with HIV still has many years of productivity to give their company. So among their policies is non-discrimination in terms of job training and promotion.

One of the companies that has almost fully implemented this HIV/Aids policy is Kencell Communications, where employees are fully aware of what the policy states and what it means to them. Muthoni Njogu, 29, a corporate sales executive at the company, heard of the policy soon after it was sent via e-mail to all the staffers. “We also had an awareness campaign last year for all the staffers, about HIV/Aids.”

Muthoni has come close to HIV/Aids – as has each and every person in this country – through the death of a close friend. “I was with her until the last minute, taking care of her. With the information that I got from the HIV/Aids seminar, I was better informed about how to take care of her.” Thanks to the information that she kept getting, Muthoni has also learnt to treat HIV as a disease just like any other.

Vincent Odhiambo, a budgeting and reporting leader at the same company, is also a peer counselor and a church elder who has to deal with people around him confiding in him about their HIV status. “People need to know that HIV is not about immoral behaviour,” he says. “There are other ways to catch HIV apart from sexual contact,” he says, pointing out that people need to stop putting an ‘immoral’ banner on people with HIV.

And Alvin Okari, 23, a customer care representative, feels that he knows much more about HIV and how to protect himself as well as interact with HIV positive friends and colleagues thanks to the policy. All three agree that it is a great boost to their morale to know that they do not risk being fired should any of them turn out HIV positive. “Your morale is boosted,” Muthoni says, “and your productivity is also improved. You don’t have any hang-ups, worrying about tomorrow.”

In the service industry, though, the HIV/Aids policy takes on a different dimension. Potential clients may still harbour stigma about the people serving them transmitting the virus, thus affecting sales. And, it must be confessed, there are areas where it is entirely possible to do this. This is where Faith Magero, the Clinical Officer at the Hotel Intercontinental, steps in. “We don’t fire staff who are HIV positive,” she says. “We just move them to areas where they will not be in direct contact with our guests.” In areas such as the kitchen, stringent safety measures are incorporated to make sure no body fluids come into contact with food. At the health club, staffers with HIV are advised not to come into direct contact with guests especially through activities such as massage therapy, in case of cuts or abrasions on either or the guest’s skin. Staffers who develop full-blown Aids are moved to areas where they will be less taxed by their jobs. And no employee is allowed to discriminate against another whose status may be known. “Thankfully, there is no more discrimination here,” Ms Magero said.

However, in such situations, it is important that the relevant parties – in this case the HR Co-ordinator – are informed of a particular staffer’s HIV status. “That way, when we treat them at the hotel clinic, we know exactly what we are dealing with, and we treat HIV-related infections aggressively.”

Opportunistic infections such as pneumonia and TB are strictly guarded against, and employees – whether HIV positive or not – who catch any of these is sent on sick leave. “We pay the costs of their treatment,” says Magero, “and as soon as they are free of their infection they can come back to work.” Has their policy of holding on to HIV positive staff members affected their guests? “No,” says Mr. Kimondiu, the Human Resources Co-ordinator. “In fact,” he says, “the more enlightened amongst them make it a point to come to our hotel because they know that we care for our staffers.”
One of the biggest question is what the companies get out of such policies. The truth is, they are all here to make money, not to spend it on their employees. And since HIV/Aids affects a significant portion of staff members and is quite costly to treat, there is no way to justify treating it. Well, that’s where most of these company heads would disagree with you.

“The truth is,” Mr. Kimondiu says, “that a company’s biggest resource is its employees. If you don’t take care of them, they will not take care of the company’s interests.” He also feels that this is an ideal way to bring HIV levels down, by educating staffers, who will go out and talk to their friends and families, thus educating the community.

At Kencell, Mr. Vandebrouck feels that every company has a social responsibility to the community around it. And at Bamburi, Mr. Epimach Maritim says that the decision to tackle HIV/Aids was taken as a preventive measure, to prevent them losing skilled manpower to the disease, as well as to minimize its social impact. Bamburi spent about Sh7 million last year on HIV/Aids. “We feel that taking care of our employees does not take huge chunks of our profits – on the contrary, we feel that it is our responsibility.” All that is left is for the government to subsidise the cost of anti-retroviral drugs, so that more companies, especially smaller ones with smaller medical budgets, will also be able to afford to take care of their HIV positive staffers.
It must be said that most of the FBC member companies did not wait for the HIV/Aids policy to start initiating such programmes; all they have done is put down in writing what they have been going for many years. And it must be said that many other companies who are not members of the FBC are beginning to define staff policies on HIV/Aids. Very soon, stories like Boniface Muyonga’s will look like archaic artifacts from our ignorant past. How’s that for a silver lining?

View from an insurance company

Apollo Insurance Company is currently the only insurance agency to offer medical cover for HIV positive people. The Divisional Director, Health Insurance, Ms Atia Yahya spoke to the Saturday Magazine about this policy.

The HIV/Aids limited health insurance policy is the first of its kind in Kenya, and is a sign that we are coming to recognize HIV/Aids as a disease like any other.

According to Atia, the policy was introduced in response to market needs. There was a need to cater for HIV/Aids infected employees and they decided to fill that gap. “We realized that we were treating it anyway,” she adds. Apparently, employees of companies they covered would keep their HIV status quiet while still benefiting from the medical cover they received. This would, of course, cost the company more. So Apollo Insurance Company decided to streamline its HIV/Aids policy.

The policy was introduced in the mid 90’s when the economy was at its worst, so they got very few companies to register. However, the popularity of the policy has been growing, with more companies recognizing the need and registering with them.
The policy is open to corporate entities with a population of over 50 employees.
Minimum limit is Sh100,000 and the maximum is Sh250,000; this cover both in and out-patient therapy, anti-retroviral therapy and viral load monitoring. The premiums are higher, but quite a number of companies ate willing to fork out the extra expense to cater for it’s HIV positive staff members.

In fact, according to Atia’s calculations; the more employers ignore HIV/Aids, the more they stand to lose. “When an employer loses an experienced employee, he has to replace that employee with a recruit who has to be trained. It would be so much cheaper to retain the older employee and take care of their medical needs.” Many work-places are affected by employees who are obviously sick, but are too scared to admit that they may be suffering from HIV-related infections, thus bringing productivity down. “In some industries,” she says, “productivity is down to 25 percent due to employees with Aids.”

Confidentiality is a big issue; naturally, any employees hoping to be covered have to reveal their medical status; medical test results are released to a team of doctors that the insurance company retains, to deal with HIV/Aids. The utmost effect is made to retain the client’s confidentiality except for those involved in the treatment of the person.

However, Atia emphasizes that the biggest challenge is to remove the stigma attached to the disease. “It’s a disease like any other,” she says. “In fact, we are re-evaluating how much it costs to treat someone with HOV/Aids. The cost is about the same.”

Early recognition of the virus in the body is essential if the employee is to live long, healthy, productive life. “Most people wait until they are on their deathbeds to go for a test,” says Atia. An HIV positive person without treatment will live for approximately seven years; conversely, an HIV positive person with treatment can look forward to 15-20 productive years. Also, because counseling is part of the insurance cover, employees who go for the test are also assured that they will be taught to live positively, and stall the onset of Aids.
At the crux of the matter is the moral obligation that the company feels towards society. “People with HIV can still live long years. I would like to see more of them healthy,” Atia says.