Health and Safety

PSAC POLICY 28
Infectious Diseases: PSAC Policy on AIDS and HIV

This policy only addresses one aspect of Infectious Diseases.
Further policies may be developed in this area.

The Public Service Alliance of Canada has a vital interest in protecting the employment rights of its members, including those that pertain to health and safety and those that pertain to human rights. As well, the Alliance believes that the social climate surrounding these rights affects our members in the workplace and, thus, the union has an obligation to actively promote the protection of the health and safety and the human rights of all members of our society.

In order to perform these tasks, the Alliance adopts the following principles as they pertain to AIDS and HIV.

All workers have the right to full and on-going education concerning infectious diseases, including the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), their prevention and safe working procedures.

Workers who may be exposed to the virus because their duties could bring them in contact with contaminated blood or blood products have the right to specialized education. Such education should include information about prevention and infection control guidelines, including the concept of universal precautions. Workers must be provided with the necessary protective clothing and equipment and trained how to use it.

The PSAC opposes all mandatory, universal, pre-employment and employment HIV and AIDS testing, except when the Canadian Human Rights Commission has identified a Bona Fide occupational requirement for testing. (See Background Paper pp. 11-12-13).

Persons who are HIV positive or have AIDS have the right to continue working. As with any worker who suffers a disability, they have the right to reasonable changes in their working arrangements, if necessary, to accommodate their illness. Those who are unable to work must be entitled to full benefits and union protection.

The PSAC is unequivocally opposed to segregation or quarantining of persons who are HIV positive or who have AIDS.

Workers who are HIV positive or who have AIDS must be provided the right to privacy in the disclosure of their medical status. There must be no obligation to inform the employer of the HIV or AIDS status but, where the employer has been informed, the employer has an obligation to maintain confidentiality. This same principle holds for union officials.

In order to ensure these principles are implemented, the Public Service Alliance of Canada will undertake the following activities.
The PSAC will continue to develop and provide educational materials on AIDS and HIV in consultation with groups concerned with AIDS and ensure that these materials are readily available on union courses and through the regional offices. The PSAC will encourage and assist Locals and Components to offer AIDS awareness sessions specifically tailored to their membership.

Through joint consultation, the Alliance will pressure Treasury Board and other employers to ensure that all AIDS and HIV guidelines are jointly developed, implemented and disseminated.

Through collective bargaining, consultation and the National Joint Council, the Alliance will ensure that those testing HIV positive are protected by all existing health benefits and that special accommodations that may be required are fully provided. As well, the PSAC will ensure that the right to confidentiality and privacy are maintained. For those working in a workplace where exposure is possible, the PSAC will ensure that the Employer develops with the Union and implements universal precautions guidelines, infection control guidelines and safe working practices. As well, the employer must make available appropriate protective clothing and equipment.

The PSAC will continue to work with other groups that have similar concerns in this area to pressure the government to expand community education and counselling services; to increase support to the health care system and assist those who are HIV positive, persons with AIDS and their families; to guarantee that those who are HIV positive and persons with AIDS will receive sufficient medical and non-medical assistance; and to significantly increase resources for family support services and to assist the search for a cure or a vaccine for AIDS.

INFECTIOUS DISEASES:
PSAC Policy on AIDS and HIV Background Paper
This Background Paper is intended as a companion document to the
"PSAC Awareness Program on AIDS and the Workplace".

The Public Service Alliance of Canada has a vital interest in protecting the employment rights of its members, including those that pertain to health and safety and those that pertain to human rights. As well, the Alliance believes that the social climate surrounding these rights affects our members in the workplace and, thus, the union has an obligation to actively promote the protection of the health and safety and the human rights of all members of our society.

It is estimated that there are 30,000 to 50,000 Canadians already infected with HIV. Most of those infected are between the ages of 20 to 50 and many are not presently ill and continue to work.*  Among these people are members of the Alliance, our relatives, our neighbours and the public that we serve.

(* Federal Centre for AIDS)

Research has demonstrated that our lack of knowledge as a society about AIDS is a major problem in that we have allowed myths to determine how we deal with AIDS and people with AIDS. In some unfortunate instances, misconceptions and fears have led to grievances, refusals to work, discrimination, unwarranted termination of employment and rejection by friends and co-workers.

So, what are the facts?

WHAT IS AIDS?

Acquired Immune Deficiency Syndrome, or AIDS, is a name that basically describes the overall failure of the body's immune system, which is the system that enables the body to fight off a wide variety of infections. HIV weakens the body's defense system and the person affected becomes more prone to a number of rare or difficult to treat infections, such as certain types of pneumonia or cancer, which usually cause death. AIDS is the final stage of the disease and is caused by the Human Immunodeficiency Virus (HIV).

The modes of transmission are clearly established, but the manner in which the disease progresses has not been fully identified at this point. We know that after a person has been infected with HIV, or shows HIV positive on a test, they may show no symptoms for many years. They are, however, capable of transmitting the disease to someone else. ARC, AIDS Related Complex, may be the next step, where a person shows positive on an HIV test and has some symptoms. AIDS is the final step.

It is not yet known whether every person infected with the HIV will eventually develop AIDS, but we do know that it can take up to ten years for an HIV positive person to develop AIDS.

HOW IS HIV TRANSMITTED?

Given the information currently available, several facts are clear. HIV is a fragile virus. It cannot survive for more than a few hours outside the human body and is quickly inactivated by a number of disinfectants.

In fact, thus far, only three modes of transmission have been identified: blood, semen, vaginal secretions. Activities where one would be at risk include: unprotected sexual activity, intravenous drug use, blood transfusions, (blood collected prior to the current testing methods), birth (i.e. a fetus can contract HIV from its mother while in the womb). While other bodily fluids, such as saliva, perspiration, spinal fluid and so on, may contain the HIV, it has not been found to be in high enough concentration to cause infection.
It is clear, then, that in most workplaces it would be almost impossible for HIV to be transmitted.

HIV AND AIDS IN THE WORKPLACE

Based on present scientific information, AIDS is not considered an occupational disease. Outside of the modes of transmission already outlined, there are no other ways to become infected.

Medical and scientific opinion accept that HIV is not spread through casual contact, such as: touching or hugging; handshakes; coughing or sneezing; water or food; cups, glasses, plates; toilets; using communal swimming pools or public baths; using communal dining facilities; or using communal dormitories. Nor is HIV spread by insects. The normal mixing and mingling of infected persons with others therefore carries no danger.

The proof that HIV cannot be passed in the workplace is based not only on the documentation of how HIV is transmitted, but also on research disproving other ways of spreading it. Study after study has shown that there is no risk of spread in homes where people live with and care for others who are infected, even when children, not known for their hygiene, are involved. Although many examples have been investigated, no research has shown HIV to be passed by saliva or bites, or any kind of other, more casual, contact.

Given these facts, it is clear that those who are HIV positive must have the right to continue working and there would be little point to segregation or quarantine. As well, HIV positive workers, as with any disabled worker, must have the right to reasonable adjustments in their work arrangements to assist them in remaining in the workplace.

From an occupational health and safety perspective, there is no justification for pre-employment or employment testing for HIV. A person can be infected with HIV and can transmit the virus and show negative on a test. It can take more than 3 months for the virus to develop. This is one of the reasons that mandatory and universal testing is not recommended. Further, the knowledge that a co-worker or that people we come in contact with in the workplace are HIV positive or HIV negative does not increase or decrease the potential risk of infection in almost all workplaces.

In some workplaces, however, the Alliance recognizes that there is a potential for exposure to HIV. This may be true for health care workers, laboratory workers, corrections workers, emergency workers and institutional workers among others . Where a real risk is present, the Alliance is committed to ensuring that those at risk receive full protection, through jointly developed safe working practices, educational programs, protective equipment, infection control guidelines and means to adhere to universal precautions. Beyond this, it is essential to underline that cutbacks in staffing and the subsequent reorganization of work can increase risk to our members, particularly where emergency situations or violence are present. When there are too few workers to respond effectively to emergencies or violent situations involving potential exposure to HIV, the workplace safety of these workers is imperiled unnecessarily and without justification. Such circumstances strengthen the Alliance's current demands for sufficient staffing and involvement in appropriate work organization.

It is important to note, however, that even in very high risk occupations, such as those in health care, very few cases of AIDS have been related to occupational exposure. For example, it is predicted that less than 1% of those health care workers exposed through needle injuries will become infected and may eventually develop AIDS.

Where members feel they have come into contact with HIV, the Alliance encourages these members to seek medical advice.

Information pertaining to accidental occupational exposure to HIV must be documented and kept on record in compliance with present legislation and policies.

UNIVERSAL PRECAUTIONS

Universal precautions are a set of work procedures detailing how to handle potentially hazardous materials associated with blood and body fluids. They are based on the premise that unknown hazards present the greatest risk, therefore labelling of only known biohazards does not provide adequate protection to workers. Universal precautions are therefore applied to all materials equally. Under universal precautions, blood and certain body fluids are considered potentially infectious not only for HIV, but also for hepatitis B virus (HBV), and other infection-causing agents. Universal precautions apply to blood and to other body fluids containing visible blood. They also apply to semen and vaginal secretions. These body fluids always have to be handled as infectious. They do not apply to saliva, feces, nasal secretions, sputum, sweat, tears, urine and vomitus unless they contain visible blood, but infection control guidelines should apply. The risk of transmission of HIV and HBV from these fluids and materials is extremely low or non-existent.

In 1988, Health and Welfare Canada, Centre for Disease Control, recommended that blood and body fluid precautions (universal precautions) be consistently used for all patients regardless of their blood-borne infection status. Universal precautions don't apply only to health care workers. Everybody should be aware of the risk of handling body fluids and know how to do it safety.

For those members, such as corrections workers and institutional workers, who may be faced with violent clients, wounds and bites are of concern. There is no evidence that HIV is transmitted through bites, and it has been estimated that it could take up to 4 litres of saliva to transmit the virus. In any case, as noted above, most bodily fluids contain such a low concentration of the virus that infection is not likely. In other situations, however, increased staffing and universal precautions, when cleaning a blood spill for example, are essential. Due to the existence of other infectious diseases which are more highly contagious and just as potentially deadly, such as Hepatitis B, a simple response of quarantine for HIV positive clients, is not a solution. Safe working conditions are. Beyond this, human rights taken from the clients, through allowing them to be quarantined, isolated, submitted to unnecessary testing or having their privacy breached, may well end up down the line as human rights others will argue to take from Alliance members.

The PSAC Awareness Program on AIDS and the Workplace details the particular risks and the precautions that can be taken in each occupation where there are or may be some specific risk of infection to workers.

AIDS AND THE LAW

Health and Safety

AIDS in the workplace has to be treated in the general context of protection against infectious diseases. As such, it can be dealt with using the present health and safety legislation.

The majority of Canadian workers are now protected in some form or other by health and safety laws. These laws guarantee the legal right to participate in workplace committees, the right to know about workplace hazards and the right to refuse dangerous work. Workers can use their legal health and safety rights under Part II of the Canada Labour Code and other provincial and territorial health and safety laws to protect against accidental exposure to AIDS and other infectious diseases.

Under the Right to Participate, workers should insist that they be involved in all decisions made with respect to AIDS in the workplace, decisions about policies, education programs, infection control programs, reporting and follow-up of accidental exposures to HIV and safe work practices.

In many workplaces, the joint health and safety committees can be used to provide widespread worker input into decisions about AIDS and other infectious diseases. Just because AIDS is caused by a virus, not a chemical, and just because the risks of being exposed to AIDS in the workplace are very low does not mean that workers should not participate in decisions about control programs designed to minimize accidental exposure to AIDS and other blood-borne diseases.

The most effective weapon we have in dealing with this virus, until a cure is found, is education. Under the Right to Know, workers should insist on being given current, accurate information about HIV and AIDS. It is crucial that all workers understand the disease, the infection control guidelines and safe work practices. Only information and openness will assure workers that their health is being protected, while reducing fears of the disease so that workers can deal compassionately with those who are HIV positive. Employers have, in most jurisdictions, a duty to provide the health and safety committee with information which will allow the committee to carry out its duties.

Unions have become increasingly active in providing information to their members about HIV and AIDS. This is an important role for the union. It should not, however, relieve the employers of their obligations under health and safety law.

It should be noted, however, that the Right to Know includes respect for the privacy of infected persons. Since AIDS cannot be transmitted by everyday contact in the workplace, there is no need for anyone who has casual contact with a person with AIDS to know.

In health care settings, generic warning labels, such as «blood-borne infection» or «body fluid precaution» should be used. They will alert all workers to follow the appropriate procedures, while at the same time protecting confidentiality.

If an accidental exposure should occur, however, the worker does have the right to know that there has been an exposure to HIV in particular and that worker should be monitored on an on-going basis at the employer's expense. This monitoring, like all medical monitoring in the workplace, should be voluntary, confidential and carried out by the doctor of the worker's choosing.

Workers across Canada have won the Right to Refuse unsafe work. There are grounds for refusal to work if adequate provision of protective equipment or infection control guidelines do not exist.

Although workers may have used the first step of the refusal process (notifying a supervisor) to get additional protection, such as gloves, against accidental exposure, to date there have been very few reported cases of workers refusing to work either with a co-worker or a client who is infected with HIV. In one case, correctional officers refused to work with inmates they suspected had AIDS or Hepatitis B. The Public Service Staff Relations Board did not uphold the refusal with respect to the AIDS part of the refusal, saying:

"A speculative possibility of illness being caused is not enough to constitute a «danger». I have no alternative but to conclude, on the basis of Dr. Jessamine's evidence, that there can be no reasonable expectation of contact of the kind feared by the applicant resulting in AIDS, and, therefore, that there was no «danger» within the meaning of the Code."
(Walton, PSSRB, No. 165-2-21, June 1987)

Any Refusal to Work because of fear of AIDS should be undertaken carefully.

There is no basis for fearing casual contact with an infected co-worker. Nevertheless, the employer has an obligation to provide protective equipment and to develop adequate work guidelines. The PSAC encourages members to work with the union members of the workplace health and safety committees to make sure these guidelines are in place.

Using these rights properly, is the tool we have to force the employer to provide a safer workplace by developing policies, workplace procedures and infection control guidelines to reduce the risks of occupational exposure to infectious diseases including AIDS.

Human Rights

The two pieces of legislation that touch on this issue are the Privacy Act and the various human rights codes and acts at federal, provincial and territorial levels.

In a report released in March 1990, the Privacy Commissioner concluded that it was not necessary for any government department to initiate a program of mandatory AIDS testing in order to carry out existing statutory mandates. That being the case, the Privacy Act prohibits government institutions from requiring such groups as public service workers, federal inmates, immigrants and long-term visitors to undergo HIV antibody tests.

Our policy, to oppose mandatory, universal, pre-employment and employment testing for the HIV, is clearly in line with Canadian law and the medical facts as known to date.

The Canadian Human Rights Commission has also clearly put forward a policy on the rights of those who are HIV positive. The Commission will accept complaints concerning discrimination based on the grounds of disability, sex, race, colour or national or ethnic origin. This prohibits discrimination against those who are HIV positive or who belong to a group regarded as especially vulnerable to the virus, such as homosexual and bisexual men, members of specific cultural and racial groups and persons with hemophilia.

The Commission does, however, recognize three "bona fide occupational requirements" (reasons why being HIV-free would be necessary to a specific job). An individual may be found unsuitable for a job if that worker must: perform invasive procedures (any procedure that involves the insertion of a medical device, such as a needle or tube, into the body); travel to countries which bar those who are HIV positive; perform job duties which impinge on the safety of the public and performs these duties alone. It must be shown that there is no other arrangement of work possible and that these tasks are essential to the job.

The Commission policy also notes that employer or employee preference is not acceptable as the basis for discrimination in these situations.

It is important to acknowledge that part of the reason for people's concern about HIV and AIDS is the social stigma that has been attached to it. This is in part due to the fact that the virus is often passed through unprotected sexual activity, which is not a subject about which our society feels great ease. As well, HIV first became evident among the homosexual community in North America and this is a subject about which our society feels even less ease. It should not be surprising, then, that the Commission prohibits discrimination on the basis of belonging to a group identified with AIDS. Concern has been expressed that as well as a lack of information about the disease, some people's fear has been based on homophobia (fear of homosexuality) and, possibly, racism.

In line with this, it should be noted that all human rights codes and acts prohibit discrimination on the grounds of race and colour and that Manitoba, Ontario, Québec and the Yukon legislation prohibits discrimination on the ground of sexual orientation. The Federal Commission has also recommended that this ground be incorporated in the Canadian Human Rights Act.

CONCLUSION

HIV and AIDS have raised questions for Canadians and the Public Service Alliance of Canada that may appear contradictory on the surface. If we examine the facts, however, it is clear that we can protect the health and safety of our members and the public at the same time that we provide dignity and privacy for our members and the public. This is the intent of the Infectious Diseases: PSAC Policy on AIDS and HIV.