The HIV/AIDS pandemic is an unfolding human tragedy in Asia, where new infections are increasing faster than anywhere else in the world. The point many government agencies miss is the multifaceted nature of HIV/AIDS, requiring a multi-sectoral response: they are only slowly beginning to understand that HIV/AIDS is more than a medical problem. In recognition of the pervasiveness of HIV/AIDS in all aspects of society, Malaysia initiated a Code of Practice on the Prevention and Management of HIV/AIDS in late 2001 for employers and employees. The Code is probably the first substantive non-health Ministry initiative in the area of HIV/AIDS policy formulation and implementation in Southeast Asia.

 HIV/AIDS in Malaysia

In 2000, Malaysia had a population of about 23 million, of whom 9.3 million were employed. By April 2001, a cumulative total of 40,049 HIV infections had been reported to the Ministry of Health, 5103 pertaining to fullblown AIDS cases. Most people had contracted HIV by injecting drugs, while heterosexual transmission accounted for almost 11% of HIV cases and 24% of AIDS cases. From a low prevalence rate at the start of the pandemic in the mid-1980s, Malaysia has progressed into a medium prevalence rate of 0.42%.

A study carried out by the Department of Occupational Safety and Health (DOSH) in 2000, covering 154 enterprises from a wide range of industries, indicated that the level of awareness among employers about HIV/AIDS and its potential destructive impact on business and the economy was still very low. The survey also revealed that more than half of the employers (54%) saw HIV/AIDS as a serious or very serious problem at the national level. However, few employers (18%) considered HIV/AIDS a serious problem at a specific industry level, and only 20% perceived HIV/AIDS as a serious or very serious threat to the economy in general. It appears that most employers consider HIV/AIDS as a serious or very serious problem at the national level, but few see it as a problem for their industry.

Many companies carry out pre- and/or in-employment HIV testing. All foreign (migrant) workers are required by law to show proof of being HIV free at the time of employment. The law does not require the same of expatriate (management) employees, although employers may request pre-employment testing for them as well. Although there are no official figures of the numbers of people living with HIV/AIDS (PLWHAs) in the workforce, dismissals have occurred after in-employment testing. PLWHAs are generally excluded from work-related group hospitalisation schemes. Any inclusion is rare and only because of a hugely compassionate key management figure or a trans-national company extending its parent company's policy position.

Developing the Code

In October 2000, more than 200 participants representing the corporate and public sectors and non-governmental organisations attended a national seminar on "HIV/AIDS in the Context of the World of Work". The participants recommended that guidelines be developed for employees dealing with HIV/AIDS issues at the workplace. DOSH undertook a coordinating role to develop these guidelines. A working committee was formed that included the Ministry of Health, Department of Labour, Department for Public Services, Malaysian Trade Union Congress, the Civil Service Employees Union, Malaysian Business Coalition on AIDS, Malaysian Employers Federation, UNAIDS, UNDP, ILO (Bangkok) and the Malaysian AIDS Council (MAC). A key section of the Code is "Managing HIV/AIDS in the Workplace", which includes guidelines for developing a workplace policy and defines the responsibilities of employers and employees.

Some salient points in the Code include:

• A written policy should clearly state the employer's commitment to preventing the spread of the virus as well as discrimination and stigmatisation of HIV-positive employees in the workplace.
• Employment practices should be based on the scientific and epidemiological evidence that PLWHAs do not pose a risk of HIV transmission to co-workers through ordinary workplace contacts.
• HIV status should not be the sole criterion for disqualification from any form of employment.
• HIV-positive employees should have the right to continue in employment as long as they are able to work and as long as they do not pose any danger to themselves, their co-workers or other individuals in the workplace.
• The procedure for termination of employment on medical grounds for HIV-positive employees should be the same as for any other disease.
• An employer should ensure that HIV-positive employees are not required to disclose their HIV status to the employer or anyone at work. In situations where the employee needs to reveal his/her HIV status, confidentiality and privacy regarding all medical information related to his/her status should be maintained at all times.
• Employers should not practice HIV-testing as a precondition to employment, promotion or other employee benefits.
• Employees should not discriminate against, or stigmatise co-workers who are HIV-positive or perceived to be HIV-positive. Disciplinary action should be taken against any employee who does so.
• Employers should recognise the gender dimensions of HIV/AIDS in workplace activities.
• Employers should recognise that HIV/AIDS is a workplace issue that needs to be treated like any other serious illness in the workplace. This is necessary not only because it affects the workforce, but also because the workplace, as an integral part of the local community, has a very significant role to play in the wider struggle to limit the spread and impact of the problem.

Reflections on the process

Although the process of developing the Code did not directly include representatives of PLWHAs, women and youth groups, the involvement of employers' and employees' organisations, AIDS and business organisations, relevant UN and government agencies was as important as the establishment of the Code itself. Most key stakeholders came to recognise the importance of being partners in HIV prevention, treatment and care.

The process also revealed the still lingering moral and judgmental issues regarding HIV/AIDS, e.g., beliefs that HIV infection is a result of "free or promiscuous sex", homosexuality, visiting sex workers or sharing infected needles. Such beliefs lead to misunderstandings about risk groups and risk behaviours.

In Malaysia, issues such as poverty, gender inequity, lack of life/reproductive health education and harm-reduction modalities are still not linked to HIV/AIDS. Transmission of HIV is viewed through a skewed lens of "choice", rather than associating it with a lack of information (i.e.., people are believed to become infected because they choose to be gay, visit sex workers or take drugs).

Next steps

DOSH is organising a road show in the first quarter of 2002 to take the Code to employers nation-wide. Partners will assist DOSH by developing IEC materials and exhibition units; they will provide technical support and train DOSH staff to answer queries regarding HIV/AIDS-related issues during the course of the road shows. Resource persons will be available when necessary to provide back-up support and a manual is being developed to accompany the Code.

The work has just started. DOSH and others must help translate the Code into company policies that work towards creating critical awareness, informed employees about HIV/AIDS and an enabling environment for PLWHAs. Action is necessary now to prevent the devastating HIV/AIDS scenarios of Africa. The loss, as in Africa, will not just be to lives but also to economies.