The workplace is a key venue for promoting health policies and especially HIV/STD prevention for the benefit of workers and employers. It also provides a particularly valuable channel for reaching men, who may see concerns around HIV/AIDS and other health issues as "women's problem".

Nevertheless, many workplaces need convincing that they have a role to play in HIV/AIDS and STD education, prevention and support. It is not immediately obvious to management that time and money spent on health programmes are costeffective expenditures. Occupational health and safety legislation and enforcement may be poor nationwide. Employers may not feel an obligation to safeguard the health of their workforce in general, let alone understand the implications of HIV and STDs.

The AIDS epidemic adds new impetus to arguments for good health policies on the part of employers. It has severe socio-economic implications at macro and micro levels in hardhit countries. AIDS primarily affects the productive age cohort; inevitably, it will have a serious impact on the workplace if the epidemic becomes severe. In many countries in central, east and southern Africa, 20% or more of the urban workforce is already believed to be infected. In parts of southeast Asia, Latin America and the Caribbean, infection levels are rising fast. Those living with HIV include people at all levels of employment, from top management and skilled professionals to general hands and farm labourers.

The primary costs of HIV/AIDS for formal employment are incurred through:

• reduced productivity as more employees are absent from work attending funerals, caring for sick relatives or off sick themselves with HIV-related illness
• increased costs of occupational benefits and social security measures
• the loss of skilled labour, professionals and managerial expertise as well as the loss of experience among workers
• increased costs of training and recruitment as staff turnover increases
• reduced morale, stigmatization, discrimination and subsequent industrial relations problems.

Even in countries where overall infection levels are not high, the illhealth and death of one or two work colleagues from AIDS can cause severe disruption in the workplace. Fears, stigma and discrimination are often worst in areas where experience with the epidemic is low. Awareness programmes and supportive policies are therefore needed in high and low prevalence areas alike, as indicated by the Research Notes in this issue of the Exchange.

In a supportive, enabling environment, HIV/AIDS and STD awareness and support programmes may be made effective through:

• Training peer educators to give information, address questions, help deal with conflicts around HIV and AIDS, and help workers develop personal awareness, motivation and skills to avoid risk and maintain safer sex behaviour. Peer educators may include staff at all levels: managers, personnel officers, shop-floor workers, health and safety officers, company clinic staff and others. 
• Providing support services such as counselling, STD referral and/or treatment.
• Establishing links between employers, government and NGOs to strengthen community action and further contribute to a supportive environment. Some workplaces have expanded education to include workers' families and the surrounding community to encourage prevention and compassionate care and support for those directly affected.
• Developing supportive workplace conditions, e.g., concerning recreational facilities, family housing and reduced migrancy/travel and distant postings.

Articles in this issue illustrate successful workplace programmes in settings as diverse as fishing villages in Tanzania, tea plantations in India, the University of Papua New Guinea and Ugandan army camps. Unions, private business interests, NGOs and government are involved as well as managers and health staff: HIV/AIDS and STD programmes are leading to new alliances and partnerships. One combined production is a training package on AIDS and the workplace produced by the Terrence Higgins Trust in partnership with leading manufacturers and retailers in the United Kingdom (Global Bulletin Board).

In addition to practical examples, the philosophy underlying successful programmes is also explored. Factors such as community leadership and management commitment, appropriate involvement of peer educators, developing participatory and on-going campaigns, and the distribution of condoms and access to STD treatment are stressed.

Welldeveloped monitoring and evaluation of programmes are also required: management commitment is crucial and will be more sustainable if programmes prove themselves in measurable ways. AIDSCAP has produced a users' guide on needs assessment for HIV/AIDS awareness campaigns at work, an important initial step.

Workplace-based HIV/STD prevention and wider health promotion programmes deserve active and sustained support. They will work best in the context of comprehensive, supportive health and HIV/AIDS/STD policies safeguarding workers and community rights at the work-floor, organizational, sectoral and national levels. In many countries, the HIV/AIDS epidemic is proving to be a catalyst for strengthening health and welfare programmes which is long overdue.