Module 5

On successful completion of this section you will be able to:

• Describe and explain the nature of HIV/AIDS;
• Describe and explain debates about the causes of HIV/AIDS;
• Describe and explain the transmission routes of HIV;
• Describe and explain HIV Testing;
• Describe and explain the symptoms and phases of the development of AIDS;
• Describe and explain the practices to prevent the risk of infection;
• Describe and explain the rights of people living with HIV/AIDS;
• Describe and explain the attitudes towards HIV/AIDS in the workplace;
• Prepare information session in the workplace on HIV and AIDS;
• Understand the legislative impact of HIV and AIDS in the workplace;
• Identify what the guidelines and assistance are available to support workers with HIV/AIDS and recognise own role in creating a caring working environment;
• Understand the implications of the HIV/AIDS pandemic for the society, the economy, a business sub-sector, an organisation and a specific workplace.

1.   INTRODUCTION

Employers, employees and their respective organisations have a right to continuing education and information relating to modes of transmission of HIV, the means of preventing transmission, the need for counseling and care and the social impact of infection on those affected by HIV/AIDS. Education is an important means of combating discrimination and irrational responses to HIV/AIDS in the workplace.

We have reached a point where we have to take initiative in educating and informing employees in regards to AIDS/HIV and issues relating to it. It is more effective to be proactive and manage HIV properly than to react only in treatment and letting people get sick and die. All of us can make a contribution by giving hope that the spread of AIDS/HIV can be reduced and fighting the stigma.

This module will assist your employees in understanding the fundamentals of the disease, the expected outlook for HIV-infected persons, the way in which the disease is and is not spread, the HIV test, and the many myths and misconceptions associated with AIDS, making a valuable contribution to our knowledge of AIDS and how to manage this new challenge to our country.

This module is a tool in helping you manage the issues related to AIDS/HIV and

the impact it has on your business.

2. WHAT IS HIV/AIDS?

AIDS (Acquired Immune Deficiency Syndrome) is a complex of diseases that affects the body as a result of HIV infection.

First a person is infected with the virus (HIV) then the virus begins to multiply and destroy the body's immune system.

When the destructive process reaches advanced stages, the body is no longer able to adequately defend itself from other minor infections; this is the stage that is called AIDS.

PART ONE

NATURE AND SYMPTOMS

1. WHO GETS HIV/AIDS

As the saying goes, “HIV does not discriminate.” Anyone who puts themselves at risk for HIV by having unprotected sex (having sex without a condom) and/or by sharing needles and syringes with an infected person, is at risk for getting the HIV virus. Also, babies can be born with the virus if their mother is infected. In the past, people also got infected from unscreened blood transfusions, but today donated blood is tested for the HIV virus.

2.  WHAT ARE THE SYMPTOMS OF HIV/AIDS?

HIV/Aids have a very long incubation period - meaning that a person can be infected for many years without showing any symptoms. 

It is also not possible to say exactly what symptoms and diseases will be associated with HIV-infection in a specific person. That is the reason why we talk about Aids as a syndrome.

HIV-infection can, however, theoretically be divided into the following phases or stages :

PHASE 1 (SERO-CONVERSION )

This is the point in time when a person’s HIV status converts or changes from being HIV negative to HIV positive.

PHASE 2 (THE ASYMPTOMIC LATENT PHASE) 

The second phase of HIV infection is the asymptomatic latent or silent phase. In this stage, an infected person displays no symptoms.

HIV-infected people can remain healthy for a long time, show no symptoms and carry on with their work in a normal way. In some cases the only symptom during this phase is swollen glands. 

PHASE 3  (THE MINOR SYMPTOMATIC PHASE)

In the third phase of infection, minor and early symptoms of HIV disease usually begin to manifest.

This phase usually starts when people with HIV antibodies begin to present with one or more of the following symptoms:

• Mild to moderate swelling of the lymph nodes in the neck, armpits and groin.
• Occasional fevers.
• Shingles. 
• Skin rashes and nail infections.
• Sores in the mouth that come and go.
• Recurrent upper respiratory tract infections.
• Weight loss up to 10% of the person’s usual body weight. 
• General feelings of tiredness and not-feeling-well.

PHASE 4  (THE MAJOR SYMPTOMATIC PHASE)  

At this point, the CD4 cell count becomes very low while the viral load becomes very high.  


The following symptoms are usually an indication of advanced immune deficiency:

• Oral and vaginal thrush infections which are very persistent and recurrent (Candida) 
• Recurrent herpes infections such as cold sores (herpes simplex)
• Recurrent herpes zoster (or shingles) 
• Bacterial skin infections and skin rashes. 
• Fever for more than a month.
• Night sweats.
• Persistent diarrhoea for more than a month.
• Weight loss (more than 10 percent of the usual body weight)
• Generalised lymphadenopathy (or, in some cases, the shrinking of previously enlarged lymph nodes) 
• Abdominal discomfort, headaches.
• Oral hairy leucoplakia (thickened white patches on the side of the tongue) 
• Persistent cough and reactivation of tuberculosis.
• Opportunistic diseases of various kinds .

PHASE 5  (AIDS-DEFINING CONDITION: THE SEVERE  SYMPTOMATIC PHASE)


This is the last phase of HIV infection where an individual can be said to have full blown Aids. It usually takes about 18 months for the major symptomatic phase to develop into Aids. 


The Aids patient in the final phase is usually plagued by many of the following problems:    

• The Aids patient is usually very thin and emaciated due to continuous diarrhoea, nausea and vomiting.
• Conditions in the mouth (such as thrush and sores) 
• Women suffer from persistent, recurrent vaginal infections and cervical cancer. 
• Persistent generalised lymphadenopathy (PGL) is present - lymph nodes are larger than one centimetre in diameter, in two or more sites other than the groin area for a period of at least three months. 
• Severe skin infections, warts and ringworm.
• Respiratory infections, persistent cough, chest pain and fever.
• Pneumonia, especially pneumocystis carinii pneumonia (PCP). 
• Severe herpes zoster (or shingles). 
• Nervous system problems - often complain of pains, numbness or “pins and needles” in the hands and feet.
• Neurological abnormalities with symptoms such as memory loss, poor concentration, tremor, headache, confusion, loss of vision and seizures. Aids patients may develop infections in the central nervous system or the brain.

• Kaposi’s sarcoma(see above), or a rare form of skin cancer (painless reddish-brown or bluish-purple swelling on the skin and mucous membranes such as in the mouth). Kaposi’s sarcoma can also occur in the lungs and gastro-intestinal tract. It reacts well to chemotherapy or to alpha-interferon, but it can develop invasive open lesions and cause death if not promptly treated.
• Lymphoma or cancer of the lymph nodes. 
• Tuberculosis is a very serious opportunistic infection which affects people with Aids. 
• Other sexually transmitted diseases.

PART TWO

THE TRANSMISSION ROUTE

INTRODUCTION 

 

Understanding how HIV can and cannot be transmitted is at the core of preventing new infections. HIV is a rapidly changing virus but, thankfully, it is also entirely preventable. 


Below are several key points to understand in order to avoid contracting the virus: 

HIV Must Be Present

Infection may only occur if one of the people involved in an exposure situation is infected with HIV. Some people assume that certain behaviors or exposure situations can cause HIV disease, even if the virus is not present. This is not true. 

There Needs to Be Enough Virus

The concentration of HIV determines whether infection will occur. In blood, for example, the virus is very concentrated. A small amount of blood is enough to infect someone. The concentration of virus in blood or other fluids can change, in the same person, over time. 

HIV Must Get Into the Bloodstream

It is not enough to be in contact with an infected fluid for HIV to be transmitted. Healthy, intact skin does not allow HIV to get into the body.

HIV can enter through an open cut or sore, or through contact with the mucous membranes. Transmission risk is very high when HIV comes in contact with the more porous mucous membranes in the genitals, the anus, and the rectum, which are inefficient barriers to HIV. Transmission is also possible through oral sex because body fluids can enter the bloodstream through cuts in the mouth.

Infectious Fluids – HIV can be transmitted from an infected person to another through:

• Blood
• Semen (including pre–seminal fluid)
• Vaginal secretions
• HIV can also be transmitted through breast milk expressed through feeding, in limited circumstances, where there is exposure to large quantities. 

 

PART THREE

CAUSES AND WAYS OF CONTRACTING HIV/AIDS

HIV is spread by the following:

• Sexual intercourse with an infected person is the most common mode of spread. The chances are greater if sexual intercourse is unprotected. Note that using protection only reduces but does not guarantee that you won't get the infection. 
• Needle/Sharp object sharing: Intravenous drug users who have the habit of sharing needles can get HIV if they share needles with HIV infected persons. Also sharing objects like shaving sticks and hair clippers can lead to infection if there are cuts. 
• Mother to child transmission: Children can be infected during pregnancy, at labour/delivery and through breast milk from infected mothers. The good news is that if an infected mother takes the proper treatment she can cut the chances of infecting her baby by over 50%. 
• Blood Transfusion: Being transfused with HIV infected blood or blood products can cause HIV infection. Blood is now routinely screened for HIV1 and HIV2, and treated with UV rays before transfusion in most reputable health care facilities.

PART FOUR

HOW DO YOU KNOW THAT YOU ARE INFECTED?

There is only one reliable way to find out your HIV status and that is to visit a doctor and take the HIV test.

Some people do not get tested as there is no cure for HIV, but there are drugs that can slow down the virus and protect the immune system.

2. TESTING FOR HIV

The HIV test is designed to detect antibodies to HIV in your blood or saliva. If you are infected with HIV, your body makes very specific antibodies to fight the infection.

NOTE: The HIV test does not tell you if you have AIDS or how long you have been infected or how sick you might be. It just tells you that you are infected with the virus.

3. WHAT IS “THE WINDOW PERIOD”

There is a window period and the window period is the time it takes for your body to produce HIV antibodies after being exposed to HIV.

The window period causes a lot of confusion. 

EXAMPLE

Let’s say someone had unprotected sex on Saturday night. On Monday, he goes to get an HIV test. The test will almost certainly come back negative, even if he was infected with HIV on Saturday night, because his body has not yet had a chance to make antibodies.

A good strategy would be to go back for a test 3 months after your possible exposure; the result you get after 3 months will be 99% certain. However, if you think you may have been exposed to HIV and are having symptoms of HIV infection, see a doctor right away.

                 

PART FIVE

PREVENTION

Knowing about HIV and how it is spread is the first step in preventing the disease. 

That way you will be in a better position to protect yourself and others from being infected.

NOTE: SPREAD THE MESSAGE AND NOT THE VIRUS! 

These are some measures that can help prevent HIV transmission: avoiding risky behaviours like:

• Unprotected sexual intercourse;
• Needle sharing; 
• Treating of infected pregnant mothers, screening blood and blood products.

To reduce the risk of HIV transmission:

HIV-related absenteeism, loss of productivity and the cost of replacing workers lost to AIDS threaten the survival of businesses and industrial sectors in the increasingly competitive global market. 

HIV/AIDS does not only affect workers. By claiming a large part of the urban population with disposable income and by impoverishing families and communities, it also affects the market base of African business.

PART SIX

ATTITUDES OF HIV/AIDS IN THE WORKPLACE

The question of attitude is one of the greatest and perhaps the most worrying problems related to HIV/AIDS. 


We need to consider our personal attitude, and the attitudes of others, towards the disease and those suffering from the disease.

HOW DOES HIV AFFECT THE WORKPLACE?

HIV and AIDS is a workplace issue, not only because it affects labour and productivity, but also because the workplace has a vital role to play in determining our quality of life. HIV and AIDS threaten the livelihoods of many workers and of those who depend on them - families, communities and enterprises and as a result national economies may be compromised.

Workers with HIV and AIDS often face discrimination in the workplace that may culminate in the loss of their jobs and/or access to training and promotional opportunities. 


The consequences of these losses reach critical proportions when they affect essential services and structures, such as that national security and health systems that are at the forefront of the response.

Some of the attitudes in the workplace might include:

Prejudice

A biased, unfair or unreasonable opinion of someone or something, especially when formed without enough thought or knowledge. People have been turned away from health care services, and denied employment.

Stigma

A feeling that other people have a bad opinion of you or do not respect you. There is a stain placed on your good name. Stigmatism describes "a process of discrediting an individual or group in the eyes of others.

Discrimination

This refers to action taken against a person or group because of perceived differences such as race, religion or disability. Segregation, rejection and violence are forms of discrimination as is any action that treats a person or group of people differently from anyone else.

Culture and religion issues

Ethical and cultural factors are all closely related to religious beliefs and play an important role in determining attitude. The expectations relating to sexual practices within an ethnic or cultural group are important factors in HIV prevalence. A number of cultural practices contribute to the spread of HIV/AIDS. These include male circumcision, rites of marriage, and indigenous healing practices.

Gender issues

Probably the most important factor driving the epidemic in sub-Saharan Africa is the fact that women are powerless to protect themselves from infection. Most women exist in a society where men dominate, sometimes by force. This domination is encouraged by the women’s acceptance of their position in society. The result is that women are subject to all manner of abuse by men. Women are subject to neglect, rape, incest, domestic violence, child labour, prostitution, economic abuse and even slavery.

This attitude towards women is at the very centre of people’s lives in Africa and is seen in relationships with parents, children, siblings and lovers.

Religion

Religion may influence HIV prevalence, especially where the religion imposes a strong code of acceptable and unacceptable sexual behaviour. Islam, for example, prohibits sex outside of marriage. Muslims consequently have had some protection from HIV/AIDS. It is often within these strict confines that there is greater prejudice and discrimination practised against those who are HIV infected.

PART SEVEN

UNDERSTANDING THE LEGISLATIVE IMPACT OF HIV AND AIDS IN THE WORKPLACE

The Code of Good Practice on key aspects of HIV/AIDS and employment is an excellent guideline in assisting employers to compile such a policy. 

The policy should contain acknowledgement that HIV/AIDS will be treated like any other life-threatening disease. It should encourage employees to be tested on a voluntary basis, at company expense, and should encourage employees to disclose their HIV status in confidence to the employer.

The policy must give assurances that confidentiality will be respected. Employers should arrange for education sessions for their employees to be educated on all the different tax rates of HIV/AIDS. The many myths that surround issues of HIV/AIDS are due only to a lack of education - employers will find it much easier to handle such issues in the workplace if the employees are properly educated on such matters.

Employers should also ensure that selected staff are properly trained in how to handle employees who may be involved in an accident causing bleeding. It is essential that the first-aid staff know how to handle such situations to minimise the chances of infection to other people. There must be a proper infection control procedure in place to prevent people from being exposed to infection via the blood of an injured person or via blood products.

Many employers introduce an Employee Assistance Programme, which can contain procedures for assisting employees with life-threatening diseases, and very importantly in terms of a certain percentage of the employee's salary being paid to the employee for as long as 12 or 24 months after the employee is no longer able to work.

Employers are encouraged to investigate the availability and advantages of the different programs available. Bear in mind that there is no obligation on any employer to provide such facilities - the decision is for the employer to make. A medical aid facility may be another answer - some medical aid facilities exclude all cover for HIV and AIDS related illnesses, others provide a limited cover, others provide hospital cover only and so on.

Pension and Provident funds should be investigated - some such funds already provide facilities for early retirement based on ill health due to HIV and AIDS, others make no such provision at all except for a simple ill-health retirement benefit. Sick leave could become a problem. Generally, and infected the employee will use up his 30 day or 36 day entitlement very quickly - possibly even within the first six months of the leave cycle.

Employers must decide how they are going to handle further sick leave requirement - perhaps a Group Benefit Scheme might be the answer, whereby say 75% of the employee's wages is paid for a further 12 or 24 months of the year is exhausted his statutory sick leave entitlement.

Employers can also consider allowing additional sick leave - for example, a certain number of days at 75% of wages, then a further allowance at 50% of wages, a final allowance at 25% of wages, after which the benefit falls away.

RIGHTS OF PEOPLE LIVING WITH HIV/AIDS IN THE WORKPLACE

A.            RIGHTS IN THE WORKPLACE

Workers living with HIV and AIDS are often discriminated against by their employers, supervisors or colleagues (other employees).  

Below you can find a summary of all the different laws that protect people living with HIV and AIDS in the workplace.

B.            GENERAL RULES THAT APPLY IN THE WORKPLACE

A person who is HIV positive does not have a duty to give this information to his or her employer because of their right to privacy.

• If you tell your employer about your HIV status, the employer cannot tell anyone else without your consent. If the employer tells anyone else, this is breaking your privacy and right to confidentiality, and it is possibly an unfair labour practice; 
• A doctor or health care worker who tells an employer about an employee's HIV status without their consent is acting against the law. This is breaking the employee's right to confidentiality; 
• An employer cannot demand to know if the cause of an illness is HIV infection; 
• An employer cannot refuse to employ you because you have HIV; 
• An employer cannot dismiss you because you have HIV 
• An employer cannot dismiss you because you have HIV, even if other employees refuse to work with you; 
• The Promotion of Equality and Prevention of Unfair Discrimination Act also protects an HIV-positive person from unfair discrimination in the workplace.

PART 8

MYTHS OF HIV/AIDS 

PART 9

Plan, prepare and offer an information session in the

workplace on HIV AIDS

Objectives of a workplace information session on HIV and AIDS

HIV-related absenteeism, loss of productivity and the cost of replacing workers lost to AIDS threaten the survival of businesses and industrial sectors in the increasingly competitive global market. The most important tool in preventing HIV/AIDS is information. 

Working together, business leaders and staff can be the source for credible and accurate information that can prevent the spread of this disease.

Simply put, educating people about HIV/ AIDS can save lives. And the workplace is a great place to start.

Developing a workplace policy on HIV/AIDS will require input and commitment from many people within your business, but the benefits are invaluable. 

Some suggestions with regards to this are :

• Present employees with the facts about HIV and AIDS and include contact information for Service. 
• Developing a Workplace Policy for HIV provides background information and direction for preparing and implementing an HIV/AIDS policy.

How AIDS Can Affect Your Business - THINGS TO THINK ABOUT

• HIV/AIDS and Health insurance issues, including information on hiring, testing, health care costs, why it is wise to evaluate your health plan, and why it is necessary to respond to HIV/AIDS in your workplace. 
• Accommodating Employees With HIV Infection and AIDS: implement policies for addressing workplace disclosures of HIV status. 
• The Financial Impact of a Workplace HIV/AIDS Programme

PART 10:

GUIDENLINES AND ASSISTANCE AVAILABLE TO SUPPORT WORKERS WITH HIV/AIDS

It is known that employees with life threatening illnesses, which may include, for example, cancer, heart disease and HIV/AIDS, often wish to continue in as many of their normal activities as their condition allows.

One of the most effective ways of reducing and managing the impact of HIV/AIDS in the workplace is through the implementation of an HIV/AIDS Policy and Programme.

HIV/AIDS WORKPLACE POLICIES

An HIV/AIDS policy is a written document that sets out an organisations position and practices as they relate to HIV and AIDS.

THE FUNCTION OF AN HIV/AIDS WORKPLACE POLICY

An HIV/AIDS policy should: 

• Define an organisation’s position on HIV/AIDS and sets out clear guidelines on how HIV/AIDS will be managed within the workplace;
• Align the workplace response to the broader legal framework;
• Ensure fairness;
• Identify and protect employers and employees' rights and responsibilities in the context of HIV/AIDS;
• Set standards of behavior expected of all employers and employees;
• Establish consistency within the company;
• Set the standard for communication about HIV/AIDS;
• Provide a good foundation upon which to build an HIV/AIDS workplace programme;
• Inform employees about assistance that is available;
• Indicate commitment to dealing with HIV and AIDS;
• Ensure consistency with national and international practices.

   
Key issues that companies should be thinking about in relation to HIV/AIDS policies;

• Recognition of HIV/AIDS as a workplace issue because it threatens productivity, profitability and the welfare of employees and their families. The workplace, as an integral part of the community, has vital role to play in terms of prevention.
• Promotion of equality and non-discrimination between individuals with HIV infections and those without, and between HIV/AIDS and other comparable health/medical conditions.
• Creation of a supportive environment so that employees living with HIV are able to continue working under normal conditions in their current employment for as long as they are medically fit to do so.
• Protection of the human rights and dignity of people living with HIV or AIDS – such protections are essential to the prevention and control of HIV/AIDS.
• Recognition of the fact that HIV/AIDS has a disproportionate impact on women – this should be taken into account in the development of workplace policies and programmes.
• Recognition of consultation, inclusivity and encouraging full participation of all stakeholders as key principles which should underpin every HIV/AIDS policy and programme.
• Recognition that HIV is preventable and that the workplace needs to promote effective prevention efforts.

WORKPLACE HIV/AIDS PROGRAMMES

An HIV/AIDS workplace programme is an action-oriented plan that an organisation can implement in order to prevent new HIV infections, provide care and support for employees who are infected or affected by HIV/AIDS, and manage the impact of the epidemic on the organisation.

Key elements of an HIV/AIDS Workplace Programme should include:

• HIV/AIDS awareness programmes;
• Voluntary HIV testing and counselling programmes;
• HIV/AIDS education and training;
• Condom distribution;
• Encouraging health treatment for STIs and TB;
• Universal infection control procedures;
• Creating an open accepting environment;
• Wellness programmes for employees affected by HIV/AIDS;
• The provision of antiretrovirals or the referral to relevant service providers;
• Education and awareness about antiretroviral and treatment literacy programmes;
• Counselling and other forms of social support for infected employees;
• Reasonable accommodation for infected employees;
• Strategies to address direct and indirect costs of HIV and AIDS;
• Monitoring, evaluation and review of the programme;

PART 11: THE IMPLICATIONS OF

HIV/AIDS ON OUR

SOCIETY, ECONOMY AND BUSINESS

SECTOR

In countries hard hit by the AIDS epidemic, the tragic and untimely loss of parents and productive citizens has not only affected families, but also farms and other workplaces, schools, health systems, and governments. The epidemic is touching almost every facet of life.

THE IMPACT OF HIV/AIDS ON SOCIETY

HOUSEHOLDS

Households experience the immediate impact of HIV/AIDS, because families are the main caregivers for the sick and suffer AIDS-related financial hardships. During the long period of illness caused by AIDS, the loss of income and cost of caring for a dying family member can impoverish households. When a parent dies, the household may dissolve and the children are sent to live with relatives or left to fend for themselves.

HEALTH CARE

Health care systems also experience enormous demands as HIV/AIDS spreads. The epidemic has already crippled health systems in Africa, where systems were weak before the epidemic struck. Expenses have been rising for the treatment of AIDS and AIDS-related “opportunistic” infections. Allocating scarce resources for HIV/AIDS can divert attention from other health concerns, and as public funds for health care grow scarce, the costs are increasingly borne by the private sector and by households and individuals.

THE IMPACT OF HIV/AIDS ON THE ECONOMY

With plus minus 5.3 Million people living with HIV/AIDS, South Africa is ranking top globally considering its high infection rate and the size of its population (approximately 43, 6 Million.). Considering its impact on the economy HIV/AIDS has become one of the critical priorities for the South African government as well as for the business community.

Economic stability is compromised as businesses and agriculture suffer.  It is difficult to account for the loss of human capital as children’s education, nutrition, and health suffer directly and indirectly due to AIDS.

Found mainly among adults between 20 and 40 years old, it has a direct impact on the workforce and the most productive years of a person’s life. 

REDUCTION IN LABOUR SUPPLY

The shrinkage of the labour force will be predominantly young people, with reduced knowledge and work experience leading to reduced productivity. An increase in workers’ time off to look after sick family members or for sick leave will also lower productivity. Increased mortality will also weaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents.

GOVERNMENT INCOME DECLINES

By the killing off of mainly young adults, AIDS seriously weakens the taxable population. It reduces the resources available for public expenditures such as education and health services not related to AIDS, which results in increasing pressure for the state's finances and slower growth of the economy. This results in a slower growth of the tax base, an effect that will be reinforced if there are growing expenditures on treating the sick, training (to replace sick workers), sick pay and caring for AIDS orphans.

THE IMPACT OF HIV/AIDS IN THE BUSINESS SECTOR

Business has also been seriously affected by HIV/AIDS. Employers are hard hit by a loss of workers, absenteeism, the rising costs of providing health-care benefits (including the expensive AIDS drugs), and the payment of death benefits.

In South Africa, however, most large companies have made allowances for the effects of HIV/Aids and have implemented strong strategies and policies to deal with the situation.

WHY SHOULD COMPANIES BE CONCERNED ABOUT HIV/AIDS?

LABOUR SUPPLY;

Not only does the number of workers decrease but so does the number of productive workers which in turn affects the productivity of a business.

PROFITABILITY

As productivity decreases so production increases with regards to costs for;

• Increase in payment of sick leave and compassionate leave;
• Higher health care costs e.g. medical aid costs increase;
• Increase in other areas of the business could be training, recruitment, labour turn over and HIV Programmes.

Other impacts include;

• Effects on morale;
• Labour relations e.g. workload carried by healthy colleagues;
• Reshuffling staff to allow ill persons a place to work.