ILO Online: The adoption of the HIV and AIDS Recommendation by the 99th International Labour Conference (ILC) has been said to be of historical significance. How does the Recommendation change the international landscape in relation to the HIV response?

Dr. Sophia Kisting: The discussions held around the Recommendation at the ILC in 2009 and 2010 highlighted the great urgency of scaling up the global response to the pandemic by optimally utilizing the immense opportunities provided by the structures of the world of work. Despite progress achieved in providing treatment to more than 4 million HIV positive persons, more than half who are in need still lack access to life-saving medication. The global economic crisis has led not only to a job crisis, but also a health crisis. Most of the persons affected by HIV are of working age, and the workplace is already playing an important role in reaching them with prevention and treatment services but this needs to and can be scaled up enormously especially for prevention in high and low prevalence countries. Rapid, harmonized and targeted action and more effective prevention programmes through the world of work are essential to achieving the Millennium Development Goals (MDG’s) of putting a halt to new HIV infections, ensuring universal access to prevention, treatment, care and support for all and addressing the priority areas in the UNAIDS Outcome Framework.

In adopting the HIV and AIDS Recommendation by an overwhelming majority vote, governments, employers’ and workers’ organizations around the globe have committed themselves to greater collaboration in scaling up and harmonizing the global HIV response and have given the international community an invaluable tool to assist in achieving this goal. The Recommendation provides guidance on actions to be taken at the global, regional, national and enterprise levels and paves the way for new innovative partnerships and synergies. It always centrally includes representatives of networks of Persons Living with HIV (PLHIV).

ILO Online: The HIV and AIDS Recommendation is the 200th Recommendation to have been adopted by the ILO. Yet it is a “first” in many respects. What makes it unique?

Dr. Sophia Kisting: ILO Recommendation No. 200 is the first international human rights instrument to focus explicitly on HIV and AIDS and the world of work, recognizing that the response to HIV and AIDS contributes to the realization of human rights and fundamental freedoms and gender equality for all. The Recommendation also calls for measures to be taken to ensure gender equality, the empowerment of women and a greater emphasis on enhancing the all important positive role men can play in the response. It explicitly promotes the empowerment of workers regardless of sexual orientation as well as the protection of sexual and reproductive health and rights of both women and men.

The Recommendation is also a unique ILO labour standard with regards to coverage. It is the first international labour standard in the history of the ILO to explicitly extend its coverage to the armed forces and uniformed services. It provides for the broadest possible scope of application, covering persons working in any employment or occupation working under all forms or arrangements, including job applicants and job seekers, persons in training, laid-off and suspended workers. It covers all sectors of economic activity, including the public and private sectors and the formal and informal economies.

ILO Online: How will the Recommendation assist with efforts to halt the HIV pandemic, and help bring about change?

Dr. Sophia Kisting: We can curb the pandemic by making HIV totally preventable in two ways. First, equal access to HIV voluntary testing and counselling for all must be ensured. Second, an enabling work environment must and can be created. Our experience in the ILO indicates that early testing and early access to lifesaving treatment and support services happen where confidentially of medical information is ensured, where job security, irrespective of HIV status, is ensured and where access to treatment is provided. These measures can only happen through a negotiated and agreed upon workplace policy between employers and workers that is owned and implemented collectively at individual workplaces. Hence the central importance in the new standard on the development of national tripartite workplace policies that can then be implemented at specific workplaces and contribute to the HIV response as an integral part of the national policy or programme of the member State.

Stigma and discrimination against people living with HIV, or who are believed to have positive HIV status, represent major barriers to the promotion of HIV prevention and impact mitigation. Workers will be reluctant to seek voluntary HIV testing, counselling, treatment and support services if they fear that as a result they may be exposed to loss of employment or other negative consequences. Gender inequalities, including inequalities in relationships between men and women, also contribute to poor participation in “Know your status” campaigns. Protection of human rights at work is of paramount importance for efforts by ILO constituents to be successful in helping to stop outpacing our interventions. The ILO Recommendation also recognizes that HIV and AIDS have a more severe impact on “vulnerable and at-risk groups”. In this respect, the standard underscores the need to engage with key populations, including women and girls, migrant workers, and children and young persons.

ILO Online: What protection does the ILO HIV and AIDS Recommendation provide?

Dr. Sophia Kisting: The ILO Recommendation focuses on all the different human rights potentially threatened in the face of HIV and AIDS in the world of work. It establishes protection against discrimination in recruitment on the basis of HIV status as well as unjustified dismissal. There should be no mandatory HIV testing or mandatory disclosure of HIV status for employment purposes. In addition, there should be no discrimination against or stigmatization of workers, in particular jobseekers and job applicants, on the grounds of real or perceived HIV status or the fact that they belong to regions of the world or segments of the population perceived to be at greater risk of, or more vulnerable to HIV infection. The Recommendation protects confidentiality of personal medical data, the right to equal employment opportunities and treatment and promotes equal access to income opportunities and social protection benefits. The Recommendation provides that all persons covered — including workers living with HIV, their families and dependants — should be entitled to free or affordable health services including voluntary HIV counselling and testing, antiretroviral treatment and adherence information, proper nutrition consistent with treatment, and treatment of opportunistic infections and other HIV-related illnesses such as tuberculosis.

ILO Online: What positive impact will the ILO HIV and AIDS Recommendation have at the global level?

Dr. Sophia Kisting: The ILO constituents provided us with a standard very well suited to their needs. The Recommendation can respond to specific national conditions and HIV epidemics to ensure maximum impact at country level. ILO constituents decided unanimously on a Resolution to accompany the Recommendation to promote its dissemination and implementation. The Resolution invites the ILO Governing Body to allocate greater resources to give effect to the new standard and request that a Global Action Plan be established to achieve its widespread implementation as well as regular reporting from ILO member States.

ILO Online: Now that the Recommendation is adopted, what are the next steps?

Dr. Sophia Kisting: All 183 ILO member States have the obligation to submit the HIV and AIDS Recommendation, 2010 (No.200) to the attention of the competent national authorities, usually the national parliament, for consideration. The Recommendation calls for member States to develop national HIV workplace policies and programmes through an inclusive dialogue process involving governments, organizations of employers and workers, as well as organizations representing persons living with HIV. These national HIV workplace policies and programmes can then be implemented at individual workplaces as part of a national workplace plan or strategy and are of critical importance to optimally engage with the actors of workplaces. These should be an integral part of the National Programme or Strategy of member States.

In addition to the development of national HIV workplace policies and programmes of action, the provisions of the Recommendation may also be implemented through national laws and regulations, collective agreements and sectoral strategies, particularly in sectors in which persons covered under the Recommendation are considered to be most at risk. Under the ILO Constitution, all member States are required to report within one year to the ILO on the steps taken to implement the Recommendation. The ILO Governing Body could decide to request regular follow-up reports from member States at a later stage.

As a Co-sponsor of UNAIDS the ILO will further build on the excellent support and working relationship with fellow Co-sponsors and the UNAIDS secretariat under the leadership of Mr Michel Sidibe.