ORIGINAL -

BUSINESS BRIEFING - AIDS IN THE WORKPLACE
BY

C. EVERETT KOOP, M.D., SC.D.
SURGEON GENERAL
OF THE
U.S, PUBLIC HEAETH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO. AMFAR MEETING OF
CHAIRMEN ‘AND CHIEF EXECUTIVE
OFFICERS OF MAJOR USS, CORPORATIONS

WASHINGTON, D.C.
OCTOBER 22, 1987:
| I WOULD LIKE TO THANK DR. MATHILDE KRIM AND DR. MERVYN
SILVERMAN OF THE AMERICAN FOUNDATION FOR AIDS RESEARCH FOR THIS
OPPORTUNITY TO MEET WITH THE LEADERSHIP OF THIS COUNTRY’S MAJOR
CORPORATIONS TO DISCUSS THE ISSUES SURROUNDING AIDS AND THE
WORKPLACE .

DR. KRIM WILL BRIEF YOU ON THE MAJOR EPIDEMIOLOGIAL,
FINANCIAL, RESEARCH, AND SERVICE DELIVERY IMPLICATIONS OF AIDS.
WHAT I WANT TO SPEAK TO YOU ABOUT ARE SOME SPECIFICS CONCERNING
THE WAY IN WHICH YOU AND I WORKING TOGETHER CAN PROVIDE THE
NECESSARY LEADERSHIP TO STEM THE TIDE OF AIDS,
SINCE I FIRST BEGAN TO WORK ON AIDS OVER 20 MONTHS AGO I
HAVE FELT THE NEED FOR INVOLVING THE BUSINESS SECTOR. IN
DRAFTING THE SURGEON GENERAL’S REPORT ON AIDS I CONSULTED WITH
THE WASHINGTON BUSINESS GROUP ON HEALTH AS THE HEALTH
REPRESENTATIVE OF THE FORTUNE 500 COMPANIES IN WASHINGTON, D.C.
THEY BROUGHT IN REPRESENTATIVES FROM THE DAYTON-HUDSON DEPARTMENT
STORE CHAIN WHO EMPHASIZED THE NEED FOR A COMPANY TO BEGIN THE
EMPLOYEE EDUCATION PROCESS BEFORE IT HAS ITS FIRST CASE OF AIDS
OR HIV POSITIVITY. ALSO EMPHASIZED WAS THE NEED FOR BUSINESSES
TO TREAT AIDS EXACTLY AS THEY WOULD ANY OTHER CHRONIC DISEASE.

I WOULD LIKE TO SUGGEST FOR YOUR CONSIDERATION THE FOLLOWING
COMPANY POLICIES:
o AIDS SHOULD BE TREATED CONSISTENTLY WITH EXISTING
MEDICAL, BENEFITS, OR EMPLOYEE POLICIES COVERING SICKNESS
OR OTHER DISABILITIES.

o EMPLOYEES SHOULD BE OFFERED THE RIGHT TO CONTINUE WORKING
AS LONG AS THEY ARE ABLE TO PERFORM THEIR JOBS
SATISFACTORILY AND AS LONG AS THE BEST AVAILABLE MEDICAL
EVIDENCE INDICATES THAT CONTINUED EMPLOYMENT DOES NOT
PRESENT A HEALTH OR SAFETY THREAT TO THEMSELVES, OTHER
EMPLOYEES, OR CUSTOMERS.

o REASONABLE EFFORTS SHOULD BE MADE TO ACCOMMODATE
SERIOUSLY ILL PATIENTS BY PROVIDING, WHERE POSSIBLE.
FLEXIBLE WORK AREAS, ASSIGNMENTS. AND HOURS.
SATISFACTORY PERFORMANCE WILL BE EXPECTED AS CONDITION
FOR CONTINUED EMPLOYMENT.
EMPLOYEES WILL BE ASKED TO BE SENSITIVE TO THE NEEDS OF
CRITICALLY ILL COLLEAGUES.

EMPLOYEES WILL NOT BE GRANTED TRANSFER RIGHTS OUTSIDE OF
EXISTING TRANSFER POLICIES TO AVOID WORKING WITH PERSONS
WITH AIDS OR THOSE WHO ARE HIV POSITIVE.

CONFIDENTIALITY OF EMPLOYEES’ MEDICAL RECORDS, CONSISTENT
WITH ACCEPTED LEGAL, MEDICAL AND MANAGEMENT PRACTICES.
WILL BE MAINTAINED.

IN ALL CASES RESPECT FOR THE INDIVIDUAL, CONSISTENT WITH
COMPANIES’ EXISTING PRACTICES, WILL BE STRESSED BY
MANAGEMENT, COLLEAGUES, AND SUBORDINATES.
o AN EDUCATIONAL PROGRAM BASED ON THE BEST CURRENTLY
AVAILABLE MEDICAL KNOWLEDGE SHOULD BE IMPLEMENTED TO HELP
EMPLOYEES UNDERSTAND WHAT AIDS IS AND IS NOT. AND WHAT
POLICIES THE COMPANY HAS IN PLACE TO COVER EMPLOYEES WITH
ALL DISABILITIES, INCLUDING AIDS.

EMPLOYEES NEED TO UNDERSTAND THERE IS NO RISK OF CONTRACTING
OR TRANSMITTING AIDS THROUGH CASUAL CONTACT. THEY NEED TO KNOW
THAT THEY CAN WORK SIDE BY SIDE WITH A PERSON WHO HAS AIDS AND
NOT BE CONCERNED ABOUT CATCHING THE VIRUS FROM THAT PERSON. THEY
NEED TO REALIZE THAT AIDS IS A RATHER PECULIAR DISEASE IN THAT IT
TRAVELS AROUND MAINLY IN A PERSON’S BLOODSTREAM OR IN SEMEN. IT
DOESN’T HANG AROUND ON WATER FOUNTAINS OR DOOR-KNOBS, IT CAN’T
BE FOUND ON SWEAT TOWELS OR BROOM HANDLES OR ANYTHING ELSE.
ABOVE ALL, EMPLOYEES NEED TO UNDERSTAND THAT WE‘RE FIGHTING
‘A DISEASE...NOT PEOPLE. WE'RE FIGHTING A VIRUS THAT HAS NOVEL
BIOPHYSICAL CHARACTERISTICS AND REQUIREMENTS...WE ARE NOT AT WAR
WITH A LIFESTYLE. SOME MEMBERS OF THE PUBLIC GENUINELY MISTAKE A
GIVEN LIFESTYLE AS BEING -- ITSELF -- THE CAUSE OF AIDS. BUT
THERE'S NOT A SHRED OF SCIENTIFIC TRUTH TO THAT.

HOMOSEXUALS, BISEXUAL MEN, AND- INTRAVENOUS DRUG ABUSERS DO
COMPRISE THE VAST MAJORITY OF: AIDS YECTINS S@ FAR...ABOUT 9 OUT
OF 10. BUT, AS YOU MAY KNOW BY NOW, THIS IS NO LONGER AN
EXCLUSIVE CLUB.
ABOUT 4 PERCENT OF ALL REPORTED AIDS VICTIMS ARE
HETEROSEXUALS...MEN AND WOMEN WHO ARE NEJTHER HOMOSEXUAL NOR I.V,
DRUG ABUSERS, APPARENTLY THEIR ONLY HIGH-RISK ACTIVITY WAS TO
HAVE HAD SEXUAL RELATIONS WITH SOMEONE ELSE HAD AIDS. IT’S THE
SAME STORY WE IN PUBLIC HEALTH HAVE BEEN TELLING FOR YEARS IN
REGARD TO THE TRANSMISSION OF HERPES. SYPHILIS, GONORRHEA,
CHLAMYDIA, AND OTHER SEXUALLY TRANSMITTED DISEASES. BUT AIDS HAS
PUT A NEW TWIST ON THAT OLD STORY. THE AIDS INFECTION DOESN'T
END WITH A SHOT OF AN ANTIBIOTIC. IT ENDS IN DEATH.

TO PREVENT THESE AIDS DEATHS WE NEED YOU AS ENLIGHTENED
MANAGERS TO TAKE ACTION, WE NEED YOU TO SET THE EXAMPLE FOR
BEING FAIR AND OBJECTIVE AND NOT SUCCUMBING TO GROUNDLESS
HYSTERIA. WE NEED YOU TO BE INFORMED ABOUT AIDS TO INFORM YOUR
EMPLOYEES ABOUT AIDS, AND TO ENCOURAGE YOUR EMPLOYEES TO EXERCISE
APPROPRIATE PREVENTIVE MEASURES,
IF YOU FAIL,--IF YOU DO NOT GET THE AIDS PREVENTION MESSAGE
ACROSS--YOUR FAILURE WILL BE MEASURED IN THE LOSS OF PRODUCTIVE
MEMBERS OF YOUR WORKFORCE AND IN HIGHER HEALTH CARE COSTS. I AM
CONCERNED THAT WITHOUT PROPER PLANNING AND MANAGEMENT AIDS WILL
"BREAK THE BANK”.

o THE TYPICAL EMPLOYEE HEALTH CARE PLAN IS HOSPITAL
BASED. HEALTH CARE COSTS CAN BE SUBSTANTIALLY REDUCED BY
ENCOURAGEING ALTERNATIVES TO HOSPITAL. CARE. RECENT |
STUDIES SEEM TO SUGGEST THAT NATIONALLY THE COST OF
TREATING ONE AIDS PATIENT IS IN THE $50,000 TO $75,000
RANGE. THE AVERAGE COST IN SAN FRANCISCO IS $25,000 TO
$32,000, A MAJOR REASON FOR THIS DIFFERENCE IS
INDIVIDUAL CASE MANAGEMENT PROGRAMS AMONG WEST COAST
HEALTH CARE PURCHASERS.
o IN SAN FRANCISCO THE TYPICAL HOSPITAL STAY FOR AN AIDS
PATIENT IS 11.4 DAYS VERSUS 31 - 50 DAYS IN OTHER CITIES.

o THE DIFFERENCE IS EMPLOYER, FAMILY, AND COMMUNITY SUPPORT
TO INSURE THE APPROPRIATE LEVEL OF CARE THROUGHOUT THE
COURSE OF THE ILLNESS.

o CASE MANAGEMENT IS DESIGNED TO CUSTOMIZE CARE FOR
INDIVIDUALS WITH CATASTROPHIC ILLNESSES. THE PROCESS
REQUIRES COST ANALYSIS AND COORDINATION BY AN INDIVIDUAL
CASE MANAGER, OFTEN A NURSE. THE CASE MANAGER COMPARES
THE COST AND QUALITY OF CARE PROVIDED AT DIFFERENT HEALTH
CARE PROGRAMS AND TAYLORS THEM TO THE PATIENT'S NEED IN
CONSULTATION WITH THE PATIENT, FAMILY. AND HEALTH CARE
PROFESSIONALS. THE RESULT IS A HEALTH CARE PLAN
PRESENTED TO THE PURCHASER FOR APPROVAL.
10

IN 1980 THE UNITED STATES PUBLIC HEALTH SERVICE ISSUED A
REPORT ENTITLED OBJECTIVES FOR THE NATION WHICH SPECIFIED
MEASURABLE HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES FOR
ACHIEVEMENT BY 1990,

AMERICAN INDUSTRY RESPONDED TO THESE OBJECTIVES BY
DEVELOPING INNOVATIVE PROGRAMS THAT HELPED THOUSANDS OF EMPLOYEES
SUCCESSFULLY CHANGE DESTRUCTIVE BEHAVIORS RELATED TO SMOKING,
WEIGHT CONTROL, PHYSICAL FITNESS AND OTHER LIFESTYLE FACTORS.

I CHALLENGE YOU TODAY TO USE WHAT YOU LEARNED FROM THESE
PROGRAMS TO DEVELOP EQUALLY SUCCESSFUL BEHAVIOR MODIFICATION
STRATEGIES TO CONTAIN THE FURTHER SPREAD OF AIDS,
1]

I AM PLEASED TO SAY THAT MANY COMPANIES HAVE ALREADY BEGUN
TO DO THIS. FOR EXAMPLE, PACIFIC MUTUAL COORDINATED AND STAFFED
THE DEVELOPMENT OF A MANUAL ON “FACILITATING AIDS EDUCATION IN
THE WORK ENVIRONMENT”, OTHER LEADERS IN WORKPLACE AIDS EDUCATION
HAVE BEEN PACIFIC BELL. LEVI-STRAUSS AND BANK OF AMERICAN. AND
THAT LIST IS NOT EXHAUSTIVE BY ANY MEANS.

WE'VE GOT A MAJOR TASK AHEAD OF US...AND WE’VE GOT TO DO IT
TOGETHER...OR IT WON’T GET DONE AT ALL. GOVERNMENT CANNOT DO THE
“JOB ALONE, WE NEED THE FULL COLLABORATION AND COMMITMENT OF
AMERICAN BUSINESS AS WELL. NONE OF US CAN DEFAULT ON THIS
RESPONSIBILITY. TOO MANY INNOCENT LIVES DEPEND ON US. WE‘RE
TALKING NOT ONLY ABOUT THE HEALTH AND WELL-BEING OF AMERICA’S 100
MILLION WORKING PEOPLE...WE’RE ALSO TALKING ABOUT THE HEALTH AND
WELL-BEING OF THEIR FAMILIES AND THEIR COMMUNITIES.
12

YOU MAY FEEL AWKWARD DEALING WITH THE TABOO SUBJECT OF AIDS
AND WITH EMPLOYEES WHO HAVE THE DISEASE.

EMPLOYERS HOWEVER ARE LEGALLY AND ETHICALLY BOUND TO TREAT
EMPLOYEES WITH AIDS THE SAME WAY THEY, TREAT OTHERS WITH
CATASTROPHIC AND DISABLING CONDITIONS,

AS NOTED, SOME COMPANIES HAVE ALREADY DEMONSTRATED COURAGE
AND COMPASSION IN THEIR AIDS EDUCATIONAL AND HEALTH POLICIES. BY
FOLLOWING THEIR LEAD YOU WILL HELP ELIMINATE THE FEAR AND
DISCRIMINATION THAT SURROUNDS PERSONS WITH AIDS. BY BECOMING
NATIONAL LEADERS IN THE FIGHT AGAINST AIDS YOU CAN HELP ME AS
SURGEON GENERAL SET THE TONE FOR THE NATION’S BUSINESS IN DEALING
WITH A SERIOUS THREAT TO THE VERY EXISTENCE OF THEIR MOST
IMPORTANT NATURAL RESOURCE -- THEIR EMPLOYEES,

THANK YOU.