By Associate Prof Dr Jayakumar Gurusamy, Graduate School of Medicine, Perdana University, Serdang

THE stigma of being an HIV patient and the discrimination against them in employment remains a pressing problem in Malaysia. However, some multinational companies should be applauded as they have strict laws that forbid stigmatisation and discrimination.

The Human Resources Ministry's Department of Occupational Safety and Heath has a Code of Practice on Prevention and Management of HIV/AIDS at the workplace. It places emphasis on the employer's responsibility to be non-judgmental and to have in place non-discriminatory policies for HIV-positive employees.

They should have the right to continue to work as long as they are able to and do not pose any danger to themselves, their co-workers and other individuals at work.

The procedure for termination of employment on medical grounds for them should be the same as for any other disease.

Disciplinary action should be taken against any employer who discriminates against or stigmatises HIV-positive employees. However, many employers are oblivious to this code of practice.

Many companies mandate pre-employment HIV blood-testing as a prerequisite before gaining employment. Some doctors are caught in an ethical dilemma between divulging the HIV results to the employer, employee, or both.

The Malaysian Medical Council's guidelines states where a medical practitioner has contractual obligations to third parties, such as companies, insurance companies or managed care organisations, the practitioner shall obtain a patient's consent before undertaking any examination or writing a report for the third party.

But, though a written consent is generally obtained from a prospective employee before a pre-employment medical examination, the manner the consent is obtained raises questions. It places an employee in a Catch-22 situation. Refusal to take a pre-employment HIV blood test generally will result in non-acceptance for employment by the employer. The other concern is patient confidentiality.

Mandatory pre-employment HIV testing is a gross discrimination against HIV patients and is unacceptable. However, confidential voluntary HIV blood testing is encouraged, with proper pre- and post-testing counselling. HIV patients are functionally productive and can live a comfortable life till they evolve much later into the stage of full blown AIDS.

In many Western countries, laws prevent employers from discriminating against employees, and that includes for sicknesses. They prohibit employers and doctors from using pre-employment medical examination to exclude prospective employees from employment. These diseases include diabetes, hypertension, obesity to hepatitis B, hepatitis C and HIV.

It is timely for the government to create relevant laws and enforce our code of practice. An International Labour Organisation study released recently reveals that people living with HIV who are employed are almost 40 per cent more likely to stick to HIV treatment than those without a job. Studies also reveal that treatment reduces the risk of an HIV-infected person transmitting the infection to another by as much as 96 per cent.

Stigma and discrimination undermines prevention, treatment and care of people living with HIV and AIDS. These patients become reclusive, and are discouraged from informing their spouses or partners. Their opportunity for employment is curtailed.

There is no place in the present era to use HIV pre-employment blood test to keep a person from employment.

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