This House Believes That Employees Should Be Compelled To Disclose Their HIV Status to Employers

Human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS) in people, a condition in which the patient’s immune system is progressively compromised until it is unable to combat opportunistic infections and cancers.  HIV progresses to AIDS at a very variable rate that depends upon the health of the patient but on average takes around 10 years. A person with AIDS will only survive for about a year without treatment, but in a Western state with access to the latest treatments life expectancy can be raised to several decades.  Like all viruses HIV is incurable and it has proven difficult to develop a vaccine.  The main routes of HIV infection are through blood transfusions (largely eliminated in the developed world by screening), unsafe sex, contaminated needles and mother-to-daughter transmission either in the womb or though breast milk.

 

HIV is therefore a disease which is very difficult to transmit, yet at the same time extremely lethal.  It’s been estimated that AIDS killed 25 million people between 1981 and 2005, making it one of the most destructive pandemics in recorded history.  Even in the developed world, HIV infection is a life changing event that will require the patient to carefully adjust many aspects of their life.  They will have to participate in a rigorous anti-viral treatment regime that requires taking drugs several times a day. 

 

An employer may (depending on the circumstances) have serious concerns about the HIV status of his employees given the possible risks to themselves, to other employees, and to their future within the business.

Title 
It’s in the interests of employers
Point 

It’s in the interests of employers. A long, incurable and debilitating condition has stricken one of their employees. They will have to make provision for possible sickness cover and replacement workers, potentially for medical and/or retirement costs. HIV can make people tired and can lead to being sick more often as it means the immune system will not be able to fight off infections as well as it normally would.[1] The employee’s productivity might be reduced to the point at which their continued employment is no longer viable. If things are made difficult for employers with HIV positive workers, then they are less likely in the future to employ people who (they suspect) are HIV positive. Employers must be listened to in this debate – in many HIV-stricken countries, they’re the last thing between a semi-functioning society and complete economic and social collapse. Traditional rights ideas such as concerns about privacy of medical records are less important than the benefit to society of being able to cope with the unique problem of HIV more effectively.

 

[1] Dickens, Carol, ‘Signs of HIV, AIDS symptoms’, AIDS Symptoms, http://www.aidssymptoms.org/Diagnosis/hiv-signs.html

Counterpoint 

It is in the interests of employers not to have to pay their employees.  It is in the interests of employers not to offer vacation time.  It is in the interests of employers not to spend money on ensuring health and safety measures are complied with. 

 

It is in the interests of employers to do many things that violate the rights of their employees and as a society we prevent them from doing these things because the benefit to the business (and the economy as a whole) does not outweigh the harm caused by the violation of those rights. Most people who are being treated for HIV are no less productive than any other worker – 58% of people with HIV believe it has no impact on their working life.[1]

 

[1] Pebody, Roger, ‘HIV health problems cause few problems in employment, but discrimination still a reality in UK’, aidsmap, 27 August 2009, http://www.aidsmap.com/HIV-health-problems-cause-few-problems-in-employm...

Title 
It’s in the interests of employees
Point 

It’s in the interests of the HIV positive employee. Right now, although in many countries it is illegal to fire someone for having HIV[1] prejudiced employers can claim that they didn’t know their employer had HIV when they fired him, so they must have been acting on other grounds. The employee then has to try and prove that they did know, which can be very hard. Furthermore, once informed the employer can reasonably be expected to display a minimum level of understanding and compassion to the employee.

 

[1] Civil Rights Division, Ouestions and Answers: The Americans with Disabilities Act and Persons with HIV/AIDS’, U.S. Department of Justice, http://www.ada.gov/pubs/hivqanda.txt

Counterpoint 

It’s not as if the employee can’t tell their employer at present – it’s that he or she could, but doesn’t want to. They get to decide what’s in their best interests (including what’s likely at trial) – and sadly, that will often be keeping quiet about his condition.

Title 
It’s in the interests of co-workers
Point 

It’s in the interests of other workers. The possibility of transmission, while very unlikely, is real and one they have a right to know about so as to be able to guard against it. While most of the time it will not be problem as transmission requires a transfer of bodily fluids this may occasionally happen in a workplace.[1] This is particularly true of healthworkers (e.g. doctors, nurses, dentists, midwives, paramedics, etc) who should have both a moral and a legal obligation to disclose if they are HIV-positive. Even outside the medical field industrial accidents may expose employees to risk. Employers have a duty to protect their workforce.

 

[1] Centers for Disease Control and Prevention, ‘HIV Transmission’, Department of Health and Human Services, http://www.cdc.gov/hiv/resources/qa/transmission.htm

Counterpoint 

Working with someone with HIV does not put you at risk. Suggesting that it does serves to perpetuate the myths that do such harm to HIV-positive people who already suffer too much. To clarify: AIDS cannot be transmitted through external, intact skin. It cannot pass through the air like cold germs. Sweat, urine, tears and saliva cannot transmit HIV. Whilst blood, seminal fluid, vaginal fluid and breast milk can, how often are such fluids encountered at work? Even if they are, and such fluids are HIV positive, they must enter another’s body through mucus membranes, directly into the bloodstream (e.g. via injection), or from mother to child via breastfeeding or in the womb. What workplaces risk such transferral?

Title 
Tackling HIV requires a responsible and active position by everyone
Point 

Businesses ought to take a responsible and active position on HIV. The issue isn’t going to go away. Successful programs designed to help HIV-positive employees remain in the workplace for as long as they want to do so should be developed. Procedures for treating personnel with fairness and dignity must be put in place. The potential fears and prejudices of other employees must be combated. The beginning of that process is ensuring they know about the problem and, crucially, the scale of it. Without knowledge of the numbers involved, employers may put in place inadequate medical and pensions arrangements that will ultimately prove inadequate.

Counterpoint 

All these worthwhile aims can be achieved without employees having to tell their employers of their HIV status on an involuntary basis. The scale of the problem can be easily inferred from national and regional medical statistics. For example, mining companies in South Africa have put in place excellent programmes to combat prejudice and treat sick employees without compulsory disclosure.

Title 
Employers have no right to private medical information
Point 

Employers have no right to know. This is an arena into which the state has no right to intrude, or to compel intrusion by others. Employers will know if their employee’s work is satisfactory or unsatisfactory – what more do they need to know than that? If employers find out, they might dismiss workers – which is exactly why many employees don’t want to tell them.

If workers are forced to disclose the fact that they have HIV, the merit principle will go out the window. Even if not dismissed, their prospects for promotion will be shattered – because of prejudice, or the perception that their career has in any meaningful sense been ‘finished’ by their condition (which is often not the case as sufferers can work and lead fulfilling lives after diagnosis; life expectancy after diagnosis in the US was 22.5 years in 2005[1]).

Even if not fired and career advancement doesn’t suffer, prejudice from co-workers is likely. From harassment to reluctance to associate or interact with the employee, this is something the employee knows he might face. He has a right to decide for himself whether or not to make himself open to that. Managers may promise, or be bound, not to disclose such information to other workers – but how likely is enforcement of such an undertaking?
For these reasons, even problems with huge HIV problems like South Africa haven’t adopted this policy.

 

[1] Harrison, Kathleen M. et al., ‘Life Expectancy After HIV Diagnosis Based on National HIV Surveillance Data From 25 States, United States’, Journal of Acquired Immune Deficiency Syndromes, Vol 53 Issue 1, January 2010, http://journals.lww.com/jaids/Fulltext/2010/01010/Life_Expectancy_After_...

Counterpoint 

Employers have a right to know about issue which will affect their business.  An employee with a serious incurable illness which requires a large amount of medication to control is inevitably going to affect the business in a way that the employer will have to know about in order to work around it.

 

Aside from the fact that HIV status need not be communicated to co-workers, managers and employers already have a duty to prevent harassment and prejudice in any circumstances and this would not change. 

Title 
The risks of ignorance and prejudice are too high
Point 

This measure could be actively dangerous for HIV-positive workers. Ignorance causes so much bad behaviour towards AIDS sufferers and HIV-positive men and women. A fifth of men in the UK who disclose their HIV positive status at work then experience HIV discrimination.[1]  The proposition seeks to institutionalise and widen the shunning and ill-treatment of HIV-positive workers that already happens when people find out about their condition. Even if not motivated by prejudice, co-workers will often take excessive precautions which are medically unnecessary and inflame unsubstantiated fears of casual transmission. 

 

In addition, many people who are HIV-positive choose not to reveal their condition for fear of violent reactions to them from their families and the rest of society. If disclosure to an employer is compulsory, then the news will inevitably leak out to the wider community. In effect, they will lose any right of privacy completely.

 

[1] Pebody, 2009

Counterpoint 

Employers can be trusted to use this information responsibly. They are already used to keeping sensitive information (e.g. about salaries, annual reports, or employees' addresses and telephone numbers) confidential. Nor is it in their interest to open themselves up to lawsuits for bullying and discrimination in the workplace. There is no reason to assume that businesses will be more likely to leak information about someone's HIV status than doctors or hospitals, who already have such information.

Title 
It is a disincentive to get tested in the first place
Point 

The requirement to disclose their condition if known would be a disincentive to get tested in the first place. This is especially the case for many people in places like sub-Saharan Africa, but also applies widely elsewhere. Their job is so important to them (since there’s no safety net to speak of if they lose it) that they’d prefer to go in ignorance of their HIV status than find out and risk being fired for it. The medical repercussions of that are obvious.

Counterpoint 

Some very few people may do this and it’s the job of the government to attempt to educate people about the enormous dangers of doing so to minimise that. Nevertheless, most people will quite properly prioritise their lives and health over their job, which in any case legislation should safeguard by stopping unfair dismissal.

Bibliography 

 

Centers for Disease Control and Prevention, ‘HIV Transmission’, Department of Health and Human Services, http://www.cdc.gov/hiv/resources/qa/transmission.htm

Civil Rights Division, Ouestions and Answers: The Americans with Disabilities Act and Persons with HIV/AIDS’, U.S. Department of Justice, http://www.ada.gov/pubs/hivqanda.txt

Dickens, Carol, ‘Signs of HIV, AIDS symptoms’, AIDS Symptoms, http://www.aidssymptoms.org/Diagnosis/hiv-signs.html

Harrison, Kathleen M. et al., ‘Life Expectancy After HIV Diagnosis Based on National HIV Surveillance Data From 25 States, United States’, Journal of Acquired Immune Deficiency Syndromes, Vol 53 Issue 1, January 2010, http://journals.lww.com/jaids/Fulltext/2010/01010/Life_Expectancy_After_HIV_Diagnosis_Based_on.19.aspx

Pebody, Roger, ‘HIV health problems cause few problems in employment, but discrimination still a reality in UK’, aidsmap, 27 August 2009, http://www.aidsmap.com/HIV-health-problems-cause-few-problems-in-employment-but-discrimination-still-a-reality-in-UK/page/1435795/

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