AIDS in the Workplace: Current Practices and Critical Issues
Franklin, Geralyn McClure, Gresham, Alicia Briney, Fontenot, Gwen F., Journal of Small Business Management
Experts at the U.S. Centers for Disease Control (CDC) believe that every U.S. company will have at least one employee with Acquired Immune Deficiency Syndrome (AIDS) at some point. Some experts have even predicted that AIDS will become the number one problem facing American businesses in coming years (Naglieri 1987). Therefore, small businesses must learn to deal proactively with the issue of AIDS in the workplace.
This article provides basic background information about AIDS, discusses the legal and medical implications of AIDS in the workplace, and examines prior research on this topic. Results of a survey, which measures how large and small businesses are handling the AIDS crisis, and a 10-point strategy for developing AIDS policies and education programs also are presented.
AIDS-related problems primarily arise in the workplace because, as the San Francisco AIDS Foundation has stated, many small employers are "in a total vacuum on how to deal with AIDS; they are unaware of the potential legal and benefits issues and are simply uninformed about the medical picture--like most Americans" (Singer 1987, 37).
For a number of reasons, this apparent lack of knowledge has great potential to cause problems for small businesses. First, having a single employee with AIDS can cause significant increases in health care premiums for employee benefit plans. Also, small businesses take significant financial risk if they have self-insured for health care or have their premiums determined by their own experience. The latter is particularly true for businesses that pay hefty premiums for (or do not have) insurance that covers catastrophic illnesses (Singer 1987, Pollick 1987).
Johnson & Higgins, a benefits consulting group, has estimated an employer's average annual cost for an employee who contracts AIDS, becomes disabled as a result, and dies of the disease. The costs of medical, disability, life insurance, and retirement benefits are included in the estimates. For an employee earning $25,000 annually, the estimated cost was from $98,000 to $198,000. For an employee earning $75,000 annually, the estimated cost was from $215,000 to $315,000 (Singer 1987).
These cost estimates for treating AIDS-afflicted individuals vary substantially, depending upon how the medical insurance policy deals with hospitalization and whether it allows flexibility.(1) Adding a package of cost-containment measures and alternatives to hospitals (such as hospices or home care) can lower health care costs (Naglieri 1987, Singer 1987, and Nussbaum 1988).
In addition to the devastating financial burden of AIDS, another problem facing small businesses is the threat of litigation by AIDS-afflicted employees who feel they are being unlawfully treated. According to the legal services director of a leading AIDS clinic (the Whitman Walker Clinic in Washington, D.C.) small businesses "don't have the time or inclination to do the research and create simple personnel policies that will allow everyone to be treated fairly, no matter what the circumstances" (Singer 1987, 37). Nevertheless, some employers have recognized that it is in their own best interest, as well as in the interest of their employees, to institute AIDS policies and education programs.
AIDS: THE DISEASE
In 1981, the medical community discovered the highly unusual occurrence of pneumocystic carinii pneumonia (PCP) and Kaposi's sarcoma (KS), a rare form of cancer, in several dozen individuals (U.S. CDC 1981). These infections, which occur only in immunodeficient individuals, focused medical attention on the condition now known as AIDS (Choi 1986).
As originally defined by the CDC, AIDS is "a reliably diagnosed disease that is at least moderately indicative of an underlying cellular immunodeficiency in a person who has had no known underlying cause of cellular immunodeficiency nor any other cause of reduced resistance reported to be associated with that disease" (U. …