About the Embassy

The Policy of the U.S. Mission in India Regarding HIV and AIDS in the Workplace

April 2, 2007

I. PURPOSE

HIV and AIDS are increasing in India, as they are in many parts of the world.  The impact of this problem on employees and their families can be substantial.  This statement describes the policy of the U.S. Mission in India regarding HIV and AIDS in the workplace.

The objectives of this Policy are as follows:

• To provide a non-discriminatory working environment for all employees.
• To provide staff with guidelines on how to handle various issues relating to HIV/AIDS in the U.S. Mission.
• To provide information to staff and their families on how they can protect themselves from contracting HIV/AIDS.
• To inform employees/dependents living with HIV/AIDS on how they can be assisted by the U.S. Mission to remain healthful and productive for many years.
  

This policy applies to U.S. direct hire personnel, personal services contractors, and Locally Engaged Staff (Indians, U.S. citizens and third country nationals) who work within the U.S. Mission. However, specific sections of the policy, such as care and support, apply only to LE Staff. For all others, care and support will be provided following the appropriate State medical procedures.  This policy has been developed as a joint effort between the Management and employees of U.S. agencies in India. It reflects the HIV/AIDS Policy Guidelines, August 1995, of the Office of Personnel and Management, and HIV/AIDS workplace policies of U.S. agencies including the State Department, the United States Agency for International Development, the Department of Defense, and the Centers for Disease Control and Prevention.

II. BACKGROUND

The Acquired Immune Deficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV).  HIV works by attacking the infection fighting cells in a person's body, which ultimately leads to a loss of the body's ability to fight disease.  It typically takes between 5 to 10 years for a person to develop AIDS after they have been infected with HIV. At the moment there is no cure for HIV/AIDS.

A person who is HIV positive or has AIDS can continue to be a productive employee and an active participant in helping the Mission to achieve it's objectives.  HIV/AIDS may result in medical conditions, which may impair the employee's health and his/her ability to perform effectively.  Should the employee find himself/herself in this situation, he/she should consult this document, his/her supervisor, and/or Human Resources for guidance.

How HIV/AIDS is transmitted
The main transmission routes of HIV are through unprotected sexual contact, mother-to-child transmission, contaminated needles, and blood transfusions. Unprotected heterosexual intercourse and mother-to-child transmission are the two main methods of HIV transmission in India, although unsafe injection practices may also make a significant contribution, especially in the Northeastern states of India. Casual contact among persons in the workplace does not pose a risk for transmission of HIV.  A person cannot become infected with HIV from a sneeze, sharing cups, a handshake, dishes, telephones, drinking fountains or bathroom facilities.  There is no medical basis for concern regarding transmission when working with HIV positive people.

Sexual contact
Unprotected sexual intercourse accounts for the majority of new HIV infections in India.  Furthermore, certain additional factors can dramatically increase the risk of HIV infection during sexual activity.  One of these factors is the presence of other sexually transmitted infections (STI), like syphilis and gonorrhea, in one or both partners. STIs can cause ulcers and sores that facilitate the transfer of HIV from one person to another.  The other risk factor is simultaneous multiple sexual relationships.  Condoms, when used consistently and correctly during sexual intercourse, can significantly reduce the risk of HIV transmission, and can reduce the rate of new HIV/AIDS cases in India. (Male circumcision may also provide some protection although it is not as protective as condoms).  The Mission encourages any employee who believes he/she may be at risk to visit an HIV Voluntary Counseling and Testing center (VCT), and find out about his/her HIV status so that informed health care decisions can be made.  A list of local VCT centers will be made available to employees. Such testing is provided free of charge at government facilities. Employees who wish to use a private facility should refer to his/her health insurance plan for details on how expenses will be covered.

Mother-to-Child Transmission (MTCT)
There is a 30-40% chance that a baby born to an HIV positive woman will be HIV infected.  The child can become infected during pregnancy or at the time of birth.  Moreover, the newborn is at further risk of HIV contraction through the mother's breast milk.  When the mother takes Anti Retroviral Therapy (ART) this chance can be greatly reduced.  A study in Uganda demonstrated a 47% reduction in HIV transmission from mother-to-child after administration of a single dose of nevirapine - one of the antiretroviral drugs available in India - to the mother at the onset of labor and to the baby within 72 hours of birth.  If an employee or his spouse is pregnant, the employee is encouraged to find out more about how to protect the baby's health by contacting a VCT clinic or private physician.

III. POLICY

The following principles will guide the implementation of this policy:

• U.S. Mission employees with HIV infection or AIDS shall be given the same rights, benefits, and opportunities as employees with other serious illnesses.  
• Employment practices shall be based on the scientific and epidemiological evidence that people with HIV/AIDS infection do not pose a risk of transmission of the virus to co-workers through ordinary workplace contact.
• The highest levels of Management shall unequivocally endorse nondiscriminatory employment practices and the Mission shall provide education and programs to disseminate information about HIV/AIDS.
• The U.S. Mission shall communicate HIV/AIDS workplace policies and practices to employees in simple, clear and unambiguous terms and shall provide employees with sensitive, accurate, and up-to-date information about risk-reduction in their personal lives.
• The U.S. Mission shall protect the confidentiality of employees' medical information.
• To prevent work disruption and rejection by co-workers of an employee with AIDS or HIV infection, the U.S. Mission shall undertake education of all employees.
• Mandatory HIV testing shall be prohibited for LE Staff or job applicants.

There are special occupational settings where there may be a potential risk of exposure to HIV and other conditions which are transmittable in the same manner, such as hepatitis C.  The U.S. Mission shall provide specific, ongoing education and training, as well as the necessary equipment, to reinforce appropriate infection-control procedures and ensure that they are implemented.  Procedures shall be made available to any employee who has had an exposure incident.  Should there be exposure to blood through a skin puncture (needlestick), the exposed employee will be counseled and offered Post-Exposure Prophylaxis (PEP), if indicated, by the medical provider in the Embassy health unit. Refer to section VI for additional information.

Confidentiality
U.S. Mission employees are under no obligation to disclose their HIV status to anyone at work unless they are requesting reasonable accommodations for their condition.  Medical information submitted to U.S. Agencies or to the U.S. Embassy Medical Unit shall be treated confidentially. The Privacy Act also covers medical information for U.S. citizens.
Both staff and supervisors must maintain confidentiality regarding all medical information, including HIV/AIDS status.   The infected person may disclose his HIV status to any person of his choice.  

People affected by HIV/AIDS, just like those with other chronic illnesses, suffer periodic bouts of stress, requiring understanding, support and counseling.  To enlist the supervisors' sensitivity about health needs as they allocate responsibilities, any staff member who is HIV+ may disclose her/his immune status to the supervisor.  This should not be interpreted, however, as an obligation on the part of the employee to inform the employer/supervisor regarding his/her HIV status.  In such instances where the employee discloses the HIV status to the supervisor, the latter is expected to observe confidentiality and may not use this information to the disadvantage of the employee. 

IV. ELIGIBILITY

The Mission should be an environment that is supportive and free of discrimination against people living with HIV/AIDS. Employees affected by or perceived to be infected by HIV/AIDS must be protected from discrimination and stigmatization by co-workers, supervisors and employers.

U.S. Government employees infected with HIV are protected from discrimination by the Rehabilitation Act of 1973.  Discriminatory acts include not only actions by supervisors but also include actions by co-workers such as harassment or creation of a hostile environment.  Mission policy is to ensure fair and equitable treatment of foreign national employees, including Foreign Service Nationals under personal services contracts who are not U.S. citizens.

V. GENERAL GUIDELINES

There shall not be discrimination against employees who are infected or believed to be infected with HIV/AIDS in hiring, job assignments, promotions, performance appraisals, eligibility for benefits or termination because of their condition.

Employees with HIV infection or AIDS who continue working will be provided with reasonable accommodation in the same manner as other qualified individuals who need special accommodation.  Employees who are incapable of performing their duties due to illness or who have medical appointments may be granted sick leave, annual leave, or leave without pay to the extent they have accrued such leave under their terms of service, or as defined in the employee handbook. Supervisors shall seek ways to accommodate such employees through measures such as alternative work circumstances or duties, as possible, facilitating access to health services outside the workplace, and allowing time off, using annual or sick leave to attend clinics or counseling. 

LE Staff are authorized to use the Voluntary Annual Leave Transfer Program to help their fellow LE Staff colleagues. Once the physician appointed by the Embassy has certified the employee as chronically ill, other employees will be allowed to donate their annual leave days to the sick employee. In addition, the employee's supervisor may authorize leave without pay for up to 30 calendar workdays. Leave without pay in excess of 30 calendar days may be granted only in accordance with the Local Compensation Plan.

Those employees whose illness makes it impossible to continue working at an effective professional level, as determined by the employee's supervisor, shall undergo an examination by a physician appointed by the U.S. Embassy.  If the physician finds an employee unable to continue working due to health reasons, and in the physician's view unlikely to resume work again, the employee shall be eligible for medical retirement with benefits as described in the employee handbook.

Care Support and Treatment
Services outlined under the following section will be available to all LE Staff, their spouses, and children.  The U.S. Embassy will help ensure that 100% of the cost of Anti-Retroviral Drugs (ARVs) is provided for the employee and nuclear family for their lifetimes.  ARVs will be made available first, through the Indian government public health program (assuming it is of good quality as monitored by the U.S. Mission), and second, through the employee's health insurance plan. In the absence of the first two options, the U.S. Mission will pay directly to service providers.  Coverage for other non-ARV HIV/AIDS-related medical costs is provided on a 20% employee/80% medical insurance cost sharing basis after the employee's domiciliary benefit (Rs. 30,000 per calendar year) is exhausted under the medical plan, up to the annual insurance cap of 400,000 rupees for hospitalization. The 20/80 cost share provision applies as long as the employee is employed by the U.S. Mission.

VI. PROCEDURES

Voluntary HIV Counseling and Training Centers (VCT)
All employees, their spouses and children are encouraged to seek voluntary counseling and/or HIV testing from places of their choice so that they can either take steps to avoid future infection or seek early treatment.  Staff members may use annual or sick leave for this purpose and may go to the VCT of their choice (see Appendix A for details). Testing for HIV status is on a voluntary basis and done only with informed consent.

Treatment of Opportunistic Illnesses
Employees, their spouses and children who have HIV will have access to medications to treat or suppress opportunistic illnesses, such as TB, toxoplasmosis and certain types of cancer that are a direct result of lowered immune status due to HIV/AIDS. Every effort will be made to ensure that confidentiality is maintained.

Prevention of Mother-to-Child Transmission of HIV/AIDS
Employees, their spouses, and their newborn child will have access to brief courses of ARV drugs during pregnancy to prevent the transmission of HIV to the employee's child. The employee's personal physician will determine the duration of treatment in accordance with WHO or CDC guidelines. HIV positive women would be eligible for further ARV treatment in accordance with guidelines mentioned above.

Treatment with Antiretroviral Drugs (ARV)
Employees and their spouses will have access to antiretroviral drugs for long-term suppression of AIDS. This coverage is for employees, their spouses, and their children. All employees are encouraged to know their HIV status to begin treatment as early as possible. The Health Unit may limit or specify the clinics where employees can receive ARV treatment. Because ARVs are life-long, employees/spouses taking ARVs will continue to receive treatment even after retirement of the employee.

Post Exposure Prophylaxis (PEP)
The Embassy health unit will manage on-the-job exposure to HIV infection by counseling the employee and offering him/her PEP if appropriate. Alternatively, employees and their dependents can access PEP from their respective health care institutions, where they receive medical services. Cases of rape and sexual assault should be reported to the police immediately and voluntary counseling and testing should be pursued at a government clinic or private provider of choice. The employee's health insurance will be used to cover costs incurred at a private clinic. PEP must be administered within 72 hours of potential exposure to the HIV virus in order to be effective.

Peer Support and Counseling
Counseling is designed to help employees decide whether or not to be tested, and to provide information on how to prevent HIV transmission. Selected staff will be trained in peer support and counseling. All employees who take on this role must respect confidentiality at all times. This responsibility will be part of the employees' normal duties and therefore will be included in their job descriptions.

To provide more support to staff who are affected and infected with HIV/AIDS, agencies will provide referral information for cost-free counseling services.
 
VII. TRAINING

The U.S. Mission in India will conduct workplace education for all Mission employees to prevent HIV infection, misunderstanding regarding the disease, job disruption, discrimination, and rejection by co-workers of an employee with HIV infection or AIDS.  Workplace education will include provision of information on: HIV infection and AIDS, HIV transmission, and HIV prevention. All employees are encouraged to know their own HIV status. Information on where employees can go for anonymous or confidential testing is listed in Appendix A.

HIV/AIDS workplace education shall be incorporated into employee and family orientation programs.  Free male and female condoms shall be made available to U.S. Mission employees.

VIII.  EMPLOYEE PROTECTION

The U.S. Department of State has distributed policies for the management of occupational exposure to HIV. The U.S. Mission shall implement training on the use of universal precautions in dealing with blood and body fluids; disseminate procedures to assist employees claiming compensation in the event of occupationally acquired HIV infection; and, provide access to methods to prevent occupation related HIV transmission. These policies and educational sessions to support these policies shall be extended to persons working in settings where there may be a potential risk of exposure. These settings may include the Regional Security Office and the Motor Pool.

The following measures will be put in place for the benefit of all employees to ensure reduction of potential risk of HIV/AIDS and other infectious diseases in the workplace:

• Minimizing road accidents by reinforcing use of seat belts for all drivers and their passengers, setting acceptable and safe speed limits, and maintaining vehicles in good mechanical condition;
• Encouraging all employees to know their blood group and to write it in their personal documents as they move within the field;
• Putting a first aid box in field vehicles including latex gloves;  
• Training for all first responders and health center staff in first aid and infection control for emergency situations.
• Using gloves when drawing blood and the safe disposal of needles.
• Safe disposal of needles.

IX. AGENCY RESPONSIBILITY

Individual agency heads at the Mission are encouraged to implement and monitor this policy with respect to employees of their respective agencies.  The Deputy Chief of Mission will convene a meeting to discuss implementation of this policy with individual agency heads, medical unit professionals, and other employees with responsibilities under this policy six months after the policy begins and then on an annual basis.  The Human Resources Office, the Medical Unit, USAID and CDC will provide technical assistance and support when necessary to implement and monitor this policy.  The Human Resources Office can provide a letter, if necessary, to a health provider guaranteeing reimbursement of high-cost services by the insurance company.

X. RESOURCES

Employees who have questions about HIV infection and AIDS may contact the U.S. Embassy Medical Unit (2419-8088). Employees who have questions about this policy may contact the Human Resources Office (2419-8382).

Employees who want information on HIV/AIDS can contact the following AIDS Hotlines:

DELHI
Naz Foundation Trust - #6851970/6851971
Delhi State AIDS Control Society - #1097
Population Services International - #6485022/6487569/6428379

MUMBAI
PSI Saadhan Helpline - #23892222
Mumbai District AIDS Control Society (MDACS) - #024100088 / 24100099
GLAXO - #24983444
Salvation Army (HIV testing and Counseling center) - #23093566
Kripa Rotary Helpline - #26429158
Counseling and Allied Services (CASA) - #24445647
KEM Hospital - #24136051 (X: 2039)

KOLKATA
PSI Saadhan Helpline - #24007777

CHENNAI
Chennai Corporation AIDS Control Society (CAPACS) - #24987498/99,                   #24981097
PSI Saadhan Helpline  - #25345555
Tamil Nadu State AIDS Control Society (TNSACS) - #1097

Appendix A

Voluntary Counseling and Testing Centers

There are several free Government of India sponsored centers available in Delhi.  The following are located close to the embassy:  If a private clinic is chosen, the staff member will need to use their health insurance plan to cover the cost.

Safdarjung Hospital
Regional STD training and research Centre
5th floor (C-Wing)
New OPD Complex
Ring Road, New Delhi  110029
Tel  2619-6740
Timings:  9:00am to 4:00pm Monday through Friday
  9:00am to 1pm Saturday

DEFINITIONS OF TERMS USED IN THIS POLICY:

Employee: For purposes of the care and support provisions of this policy, employees must be locally-hired, either as direct hires or under the Personal Services Agreement (PSA) hiring mechanism. Such employees are typically referred to as Locally Engaged Staff (LES). They include Indians and third country nationals, as well as Americans locally-hired and covered under the Local Compensation Plan.

Nuclear Family: This includes the employee's spouse and legally dependent children up to age 24 at the time of diagnosis of HIV/AIDS.

Lifetime: Anti-Retroviral Drugs provided under this policy will remain in effect until the death of the covered employee or family member.

Spouse: An eligible spouse is the employee's legally-recognized spouse at the time of diagnosis of HIV/AIDS.

Children: Children include legally dependent biological or adopted children living with the employee or attending school up to age 24 at the time of diagnosis of HIV/AIDS.

Treatment: Treatment means the administration of medications by medical providers either for the suppression of opportunistic illnesses related to HIV/AIDS, on-the-job exposure to HIV infection or antiretroviral drugs for the long-term suppression of AIDS.

20/80 Cost Share: The cost of Anti-Retroviral Drugs is covered in full, normally through the Indian government public health program or, on a secondary basis, through the Mission's employee medical insurance plan. (In the absence of coverage under the first two options, the U.S. Mission will pay the cost.) Coverage for other non-ARV HIV/AIDS-related medical costs is provided on a 20% employee/80% medical insurance cost sharing basis after the employee's domiciliary benefit (Rs. 30,000 per calendar year) is exhausted under the medical plan, up to the annual insurance cap of 4 lakhs for hospitalization. The 20/80 cost share provision applies as long as the employee is employed by the U.S. Mission.

Health Insurance: This refers to the group medical plan insured through an independent insurance company that is made available to all Mission LE Staff employees.

HIV:  Human Immunodeficiency Virus

HIV Status:  Refers to whether or not a person is infected with the HIV virus. 
"HIV positive" status means a person is infected.
"HIV negative" means the person is not infected.

ARV:  Anti retro-viral agents   Medicines that help suppress the HIV virus in those infected.

VCT:  Voluntary Counseling and Testing   A confidential health center where people can obtain information on HIV/AIDS, learn more about their individual risks and have their blood tested for the virus.

PEP:  Post exposure prophylaxis   A medicine administered within 72 hours of a potential HIV exposure that lowers the risk of being infected.