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Accommodation and Compliance Series:
Employees with HIV/AIDS

Preface

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about HIV/AIDS

What is HIV?

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS. An HIV positive test result does not mean that a person has AIDS. The AIDS diagnosis is made by a physician using certain clinical criteria (CDC, 2005).

What is AIDS?

AIDS (Acquired Immunodeficiency Syndrome) is the diagnosis an HIV-infected person receives after developing one of the AIDS indicator illnesses defined by the Centers for Disease Control. An HIV positive person who has not had any serious illnesses can also receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts) (CDC, 2005).

How is HIV transmitted?

HIV is passed from one person to another through blood-to-blood and sexual contact. HIV transmission can occur when blood, semen, vaginal fluid, or breast milk from an infected person enters the body of an uninfected person.

Following are the most common ways that HIV is transmitted from one person to another:

Small Triangle Blue Bullet By having sexual intercourse (vaginal, anal or oral sex) with an HIV infected person
Small Triangle Blue Bullet By sharing needles or injection equipment with an injection drug user who is infected with HIV
Small Triangle Blue Bullet From HIV infected women to babies before or during birth, or through breast-feeding after birth
Small Triangle Blue Bullet HIV can also be transmitted through transfusions of infected blood or blood clotting factors (Since 1985 all donated blood in the U. S. has been tested for HIV therefore the risk for transmission is extremely low) (CDC, 2005).

Some health-care workers have become infected after being stuck with needles containing HIV infected blood or, less frequently, after infected blood contact with the worker's open cut or through splashes into the worker's eyes or inside of the nose. There has only been one instance of patients being infected by an HIV infected health care worker according to the CDC (CDC, 2005).

For more information on HIV transmission and health-care workers please note the following CDC publications:
Are Health-Care Workers at Risk of Getting HIV on the Job?
http://www.cdc.gov/hiv/pubs/faq/faq28.htm
Are patients in a dentist's or doctor's office at risk of getting HIV?
http://www.cdc.gov/hiv/pubs/faq/faq29.htm

How is HIV/AIDS treated?

Over the past 10 years many therapies have been developed to fight both HIV and its associated infections and cancers. The Food and Drug Administration has approved a number of antiretroviral drugs for the treatment of HIV. Antiretroviral drugs do not provide a cure for HIV or AIDS. The drugs may also cause severe side effects such as depletion of red or white blood cells, nerve damage, nausea, diarrhea and other side effects (CDC, 2005).

HIV/AIDS and the Americans with Disabilities Act

Is HIV/AIDS a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet. Therefore, some people with HIV/AIDS will have a disability under the ADA and some will not (EEOC, 2002).

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment. For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Accommodating Employees with HIV/AIDS

(Note: People with HIV/AIDS may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with HIV/AIDS will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with HIV/AIDS experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with HIV/AIDS been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with HIV/AIDS to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding HIV/AIDS?

Accommodation Ideas:

Large Blue Triangle Bullet Weight Loss:

Small Triangle Blue Bullet Ergonomic chair with extra padding
Small Triangle Blue Bullet Arm supports
Small Triangle Blue Bullet Alternate working positions to prevent sores from forming (i.e., sitting & standing)
Small Triangle Blue Bullet Have access to refrigerator (To store food supplements or medications)

Large Blue Triangle Bullet Chronic Diarrhea:

Small Triangle Blue Bullet Work-site near restroom (Inconspicuous)
Small Triangle Blue Bullet Flexible work schedule to allow for restroom breaks

Large Blue Triangle Bullet Vision Impairment: Reading information from computer screen (For those who benefit from magnification and other modifications):

Small Triangle Blue Bullet External screen magnifier
Small Triangle Blue Bullet Screen magnification software
Small Triangle Blue Bullet Larger sized monitor
Small Triangle Blue Bullet Anti-Glare or anti-radiation computer screen guard
Small Triangle Blue Bullet High resolution monitor
Small Triangle Blue Bullet Special computer glasses to reduce glare
Small Triangle Blue Bullet Change font size or contrast in existing software application
Small Triangle Blue Bullet Frequent breaks to rest eyes when fatigue is a factor
Small Triangle Blue Bullet Additional training

Large Blue Triangle Bullet Vision Impairment: Reading information from computer screen (For those who do not benefit from magnification):

Small Triangle Blue Bullet Screen reading software
Small Triangle Blue Bullet Refreshable Braille display
Small Triangle Blue Bullet Dual channel headset if using a computer with speech output and the telephone at the same time
Small Triangle Blue Bullet Providing a Qualified Reader
Small Triangle Blue Bullet Additional training

Large Blue Triangle Bullet Vision Impairment: Reading information from printed materials (For those who benefit from magnification and other modifications):

Small Triangle Blue Bullet Hand/Stand magnifier
Small Triangle Blue Bullet Improved lighting or task lighting
Small Triangle Blue Bullet Reduce glare on paper copy (Close blinds on windows, change lighting in area, etc.)
Small Triangle Blue Bullet Closed circuit television system (Desktop & Portable models are available)
Small Triangle Blue Bullet Enlarge information on photo copier
Small Triangle Blue Bullet Optical wear (Eye glasses, Low Vision Enhancement Systems, Flip-down magnifiers, etc.)
Small Triangle Blue Bullet Frequent breaks to rest eyes when fatigue is a factor
Small Triangle Blue Bullet Additional training

Large Blue Triangle Bullet Vision Impairment: Reading information from printed materials (For those who do not benefit from magnification):

Small Triangle Blue Bullet Optical character recognition system (Also known as a scanner with speech output - PC based & portable models are available)
Small Triangle Blue Bullet Providing a Qualified Reader
Small Triangle Blue Bullet Additional training

For a more detailed description of accommodation ideas for vision impairments, please go to Work-site Accommodation Ideas for Individuals with Vision Impairments at http://www.jan.wvu.edu/media/Sight.html.

Large Blue Triangle Bullet Sensitivity to light:

Small Triangle Blue Bullet Lower wattage overhead lights
Small Triangle Blue Bullet Task lighting
Small Triangle Blue Bullet Broad spectrum lighting
Small Triangle Blue Bullet Install flicker free lighting
Small Triangle Blue Bullet Optical wear (Protective eye glasses)
Small Triangle Blue Bullet Move work station to another area
Small Triangle Blue Bullet Place blinds on windows

Large Blue Triangle Bullet Fever:

Small Triangle Blue Bullet Flexible work hours
Small Triangle Blue Bullet Ability to work at home

Large Blue Triangle Bullet Fatigue/Weakness:

Small Triangle Blue Bullet Accessible facility (Ramps, parking etc.)
Small Triangle Blue Bullet Reduce/eliminate lifting, walking, etc.
Small Triangle Blue Bullet Flexibility to sit or stand (Adjustable workstation)
Small Triangle Blue Bullet Rest area with cot
Small Triangle Blue Bullet Later start time
Small Triangle Blue Bullet Frequent rest breaks
Small Triangle Blue Bullet Shorten work day and extend work week
Small Triangle Blue Bullet Job sharing

Large Blue Triangle Bullet Respiratory difficulties (Problems breathing):

Small Triangle Blue Bullet Good ventilation
Small Triangle Blue Bullet Clean work environment free from dust, smoke, odor and fumes (Air purifier, appropriate ventilation, working windows, etc.)
Small Triangle Blue Bullet Avoid temperature extremes
Small Triangle Blue Bullet Educate coworker to wash hands frequently and to stay at home if sick

Large Blue Triangle Bullet Decreased cognitive abilities (Problems with concentration, memory, etc.):

Small Triangle Blue Bullet Increase levels of job structure
Small Triangle Blue Bullet Provide written job instructions
Small Triangle Blue Bullet Prioritize job assignments
Small Triangle Blue Bullet Flexible work hours
Small Triangle Blue Bullet Rest periods to reorient
Small Triangle Blue Bullet Memory notebook or scheduler (Can be electronic or paper)
Small Triangle Blue Bullet Minimize distractions
Small Triangle Blue Bullet Self-paced workload
Small Triangle Blue Bullet Reduce job stress
Small Triangle Blue Bullet Educate coworkers about psychological implications if needed (Keep the individual with HIV/AIDS and his/her disability confidential)
Small Triangle Blue Bullet Evaluate safety hazards

Large Blue Triangle Bullet Neurological complications (Problems with numbness in fingers, legs, feet or difficulties with seizures, headaches, noise, dizziness, mood swings and concentration):

Small Triangle Blue Bullet Eliminate need to use sharp objects
Small Triangle Blue Bullet Provide protective clothing/equipment
Small Triangle Blue Bullet Modify job tasks requiring fine finger dexterity
Small Triangle Blue Bullet Reduce noise (Use partitions, white noise, environmental sound machines, headsets and/or move employee to a more quiet environment)

Large Blue Triangle Bullet Skin Infections (May include open sores, bruises, lesions and rashes):

Small Triangle Blue Bullet Avoid infectious agents & chemicals
Small Triangle Blue Bullet Avoid invasive procedures (activities that could be harmful to person due to their skin condition)

Large Blue Triangle Bullet Psychological Implications (Difficulties adjusting to having a disability, stress, etc.):

Small Triangle Blue Bullet Identify stressors and reduce stress
Small Triangle Blue Bullet Educate coworkers, but keep person and his/her condition confidential
Small Triangle Blue Bullet Peer counseling
Small Triangle Blue Bullet Allow telephone calls to emotional supports
Small Triangle Blue Bullet Open door policy to supervisor
Small Triangle Blue Bullet Negotiating time for accommodations
Small Triangle Blue Bullet Time off for counseling or therapy
Small Triangle Blue Bullet Provide praise and positive reinforcement

Large Blue Triangle Bullet Other Medical Considerations:

Small Triangle Blue Bullet Flexible work schedule
Small Triangle Blue Bullet Time off from work to seek medical care (Many clinics are only open during the day)
Small Triangle Blue Bullet Reassignment
Small Triangle Blue Bullet Health insurance that does not exclude preexisting conditions
Small Triangle Blue Bullet Health insurance that does not single out HIV in order to cap medical benefits

Situations and Solutions:

A computer operator was experiencing weight loss and chronic diarrhea as a result of having HIV. She was provided with an ergonomic chair with extra padding and began to change seating positions often. This prevented her from getting sores from sitting in one position for prolonged periods of time. Employee's workstation was also moved closer to a restroom to provide her better access. Total cost to move employee to another workstation was virtually nothing. Total cost of ergonomic chair was $500.

A pharmacist was having difficulties standing for 8 hours a day on a tile floor. This employee was responsible for filling prescriptions for medication. The work area was carpeted using extra padding, which assisted in reducing fatigue, and a sit/stand/ lean stool was purchased to assist employee when standing. Employee was also permitted to take frequent rest breaks throughout the day. This was possible since the employee cut his lunch hour down to 30 minutes which provided him with 30 minutes that could be used at other times of the day whenever a break was needed. Also another pharmacist was available to cover his breaks. Approximate cost $2,500.

A secretary with HIV could only go to the HIV clinic during work hours. The employer provided the employee with a flexible work schedule, so that she could go to the clinic for medical attention and counseling. The employee made up the hours throughout the week by staying later and by coming in early. Cost of accommodation was $0.

A machine operator was experiencing difficulties remembering the steps involved in changing a part on his machine. The employer provided the employee with a step by-step checklist and directions explaining how to do this. Cost of accommodation was $0.

An accountant was experiencing eye sensitivity to fluorescent light in her office. As a result, she was unable to clearly view her computer screen or written materials due to glare. The accommodation solutions were to lower the wattage in the overhead lights, provide task lighting, and a computer screen glare guard. The cost for these accommodations amounted to $80.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

Centers for Disease Control & Prevention. (2005). Frequently asked questions on AIDS and HIV. Retrieved July 1, 2005, from http://www.cdc.gov/hiv/pubs/faqs.htm

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved April 29, 2005, from http://www.jan.wvu.edu/links/ADAtam1.html

If you have a question about accommodations and/or the employment provisions of the Americans with Disabilities Act (ADA), click here:
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