HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
HIV and AIDS in workplaces in Pakistan
2-06-2014
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Contents
List of tables .................................................................................................................................. 4
Foreword ........................................................................................................................................ 5
Executive Summary ..................................................................................................................... 6
Acknowledgements .................................................................................................................... 11
Abbreviations and Acronyms .................................................................................................... 12
Chapter 1: Introduction .............................................................................................................. 14
1.1 Purpose of the research ................................................................................................. 14
1.2 Background and context information ............................................................................ 15
1.2.1 HIV and AIDS in Pakistan ....................................................................................... 15
1.1.2 HIV and Workplace .................................................................................................. 17
1.2.3 ILO Code of Practice on HIV and AIDS and the World of Work ....................... 18
1.2.4 Workplace Policy on HIV and AIDS ...................................................................... 19
1.3 Research Questions ........................................................................................................ 20
1.4 Study Setting .................................................................................................................... 20
1.4.1 Sites of Data Collection ........................................................................................... 20
1.4.2 Study Population ...................................................................................................... 21
Chapter 2: Description of the research ................................................................................... 23
2.1 Purpose ............................................................................................................................. 23
2.2 Scope................................................................................................................................. 23
2.3 Methodology ..................................................................................................................... 23
2.3.1 Literature review ....................................................................................................... 23
2.3.2 Primary data collection ............................................................................................ 24
2.3.3 Data Analysis ............................................................................................................ 25
2.3.4 Report......................................................................................................................... 25
2.4 Limitations ......................................................................................................................... 25
3. Findings ................................................................................................................................... 27
Conclusion ................................................................................................................................... 40
Recommendations ..................................................................................................................... 45
1. For specific entities ............................................................................................................ 45
2. For specific issues ............................................................................................................. 47
References .................................................................................................................................. 49
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Annexure ..................................................................................................................................... 51
Annex 1: Profiles of the study participants ......................................................................... 51
Annex 2: Research instrument ............................................................................................. 61
Consent form........................................................................................................................... 61
Interview guideline ................................................................................................................. 62
Annex 2: List of respondents ................................................................................................ 70
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
List of tables
Table 1: Prevalence of HIV among MARPs in the focused districts .............................. 21
Table 2: Overview of the study participants................................................................... 21
Table 3: Summary of materials and methods ................................................................ 23
Table 4: Data collection activities .................................................................................. 24
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Foreword
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Executive Summary
Pakistan is in the high risk concentrated stage of HIV epidemic. Injecting drug use
followed by un-protective sex work are the main drivers of this epidemic. Estimates at
the end of 2011 showed that there are about 130,000 people with HIV in Pakistan.
The National Policy on HIV and AIDS placed its emphasis on a multi‐sectoral approach
that recognizes the full participation of employers and employer groups in the national
response. The role of these entities is to develop and implement HIV and AIDS
workplace policies that assist in reducing HIV risk and supporting workers and families
affected by HIV and AIDS.
HIV and AIDS at workplace is critical to understand and address as it has marked
impact on workers, their families and dependents, enterprises and national economies
but little is known in the workplace settings, policies, rights and issues related to stigma
and discrimination for people living with HIV and AIDS (PLHIV) in Pakistan. International
Labour Organization (ILO) in collaboration with UNAIDS is working to develop and
implement policies and programs to protect workers from HIV infection and facilitate
equal access to care, treatment and support and social protection for all those who are
living with or affected by HIV and AIDS.
The purpose of this baseline study was to understand the situation of workplaces in
Pakistan and identify ways and means to protect the rights of workers living with HIV
and AIDS. Broadly the study selected a representative sample of different workplaces
and validated the availability of policies and practices that support PLHIV in the
workplace. The study also assessed the existing knowledge and understanding of
employers towards the problems of People Living with HIV and AIDS (PLHIV) and the
support required by PLHIV at the workplace.
The study focused on three big cities of Pakistan (Islamabad/Rawalpindi, Lahore and
Karachi) and tripartite constituencies of workplace along with representation from
PLHIV. The study only considered the formal economy.
The research questions were:
1. To what extent employment sector is aware of and in compliance with R-200 ; is
there a difference in public sector vs the private sector in this regard?
2. To what extent the HIV and AIDS response is sensitive towards employment
concerns of PLHIV?
3. To what extent the PLHIV are taken on board while developing workplace
policies and laws?
4. Are employees’ social security systems in Pakistan sensitive towards special
needs of PLHIV?
5. To what extent stigma and discrimination are present in employment?
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
The study followed Grounded Theory methodology and used focus group discussions
(FGD) and in-depth interviews (IDI) methods. For this purpose the tool designed under
the guidance of experts was open ended, semi structured interview guide. Through
purposive sampling the respondents were identified and were engaged in qualitative
interviews. The data analysis was done through manual qualitative data analysis.
There is dearth of literature on workplace and HIV and AIDS in Pakistan. The available
literature suggests poor knowledge and understanding among workers in the formal
sector about HIV and AIDS and risk factors associated. Pakistan Demographic and
Health Survey (2012-13) assessed the level of stigma associated with HIV and AIDS
and found that overall only 17 percent of women and 15 percent of men expressed
accepting attitudes. A survey indicates that 35% PLHIV were denied jobs.
The Sindh HIV and AIDS Control, Treatment and Protection Bill, passed by the Sindh
Government on 18th Sept 2013 is an important development in the recent past. The Bill
addresses various aspects of HIV and workplace, especially confidentiality, screening
for employment, promotion, or training, awareness program at workplace and
prevention and prophylaxis for occupational exposure to HIV in healthcare setting.
The study findings from primary data are summarized in line with the key
recommendations of ILO R-2001
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No generic workplace policies or unified labour laws exist in Pakistan making it
difficult to approach and address all the labour force simultaneously. This state of
affairs is partly due to the advent of 18th constitutional amendment and
decentralization in 2010 that has brought a shift in the roles of federal and
provincial ministries. The devolved labour departments in provinces have not
developed their own labour policies.
The diction and dichotomy of formal and informal economy is grey and majority
of labour force is not catered under the existing labour laws
There is general agreement among the respondents that the current laws are
good in their own right but the real problem is the implementation of the laws
which is challenged by the absence of strict machinery to implement laws and
poor unionization of workers failing to attain collective bargain
The workplace policies generally do not target population groups (women
workers, men workers, migrants or PLHIV). However there is a special quota for
the special people (disabled) and harassment at workplace policies that
particularly benefit women.
Women have poor representation in the labour offices and workers
organizations.
HIV and workplace policies/programmes have not been raised as an issue by
national organisations (NGOs, social movements) or international groups as part
of policy /programme discussions.
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International Labour Office, Geneva, 2010. Recommendation concerning HIV and AIDS and the world of work,
2010 (No. 200)
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
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The HIV related social protection services are more focused on food, nutrition
and education; no legal supportive measures are being provided
Majority of the respondents were ill informed about HIV and AIDS
PLHIV are invisible in the employment sector because of low prevalence of HIV
in general population; majority of PLHIV do not work in formal job market (as they
are either IDUs or sex workers) and in case a worker is HIV positive, s/he will
have reluctance in disclosing of HIV status due to fear of stigma and
discrimination
PLHIV can face various job related constraints. The employers might be reluctant
to hire or promote a HIV positive worker. The job related challenges accentuate if
the person is female and belongs to poor household. Maintaining confidentiality
at the workplace or becoming the target of stigma and discrimination are other
risks. There is no workplace policy or programme for helping PLHIV workers to
improve their livelihood.
HIV and AIDS is out of the radar of labour issues and labour and employment
concerns of PLHIV are out of radar of programmes on HIV and AIDS
Although the National HIV and AIDS Policy recognizes the importance of
workplace, the labour sector has not been effectively approached by the
stakeholders in HIV response. The National HIV and AIDS Policy also does not
recognize the role of workers.
There seems little motivation in trade unions for promoting awareness about HIV
Training component of majority of the programs for workers/potential workers
lack education on HIV
Although the private companies in corporate sector are not legally bound to
support HIV and AIDS related activities, under CSR, some companies have been
working on awareness raising
The quality of awareness raising activities for at risk populations has been poor
The PLHIV can be best covered within general programs instead of policies
The recommendations are summarized as follows:
a. Departments of Labour:
1. There is a need to formulate a unified labour law applicable to all labour force.
The huge informal labour needs to be brought into formal sector through
legislation, policies and procedures. The process should encourage genuine
representation of the informal labour force. The unified labour laws should be
sensitive to the workplace and employment concerns of PLHIV
2. Under the post 18th amendment and devolution the provinces need to develop
their own labour policies. These policies should be sensitive to the workplace
and employment concerns of PLHIV
3. Affirmative actions are required to mainstream women in the employment sector,
especially those affected by HIV
b. AIDS Control Programs
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
1. The National Policy on HIV and AIDS needs to emphasize on the role of workers
and workers’ organizations as well.
c. Employers group
1. The employers need to develop and strictly implement workplace policies and a
clear code of conduct for the prohibition of discriminatory behavior. A clear
grievance procedure should be in place for the workers who suffer from such
discriminatory behaviors to exercise their right of recourse. HR staff should be
provided training so they can arbitrate fairly in the wake of any such incidences.
2. The employers need to ensure that the policies on maintaining confidentiality are
in place. There needs to be a set of rules and procedures to deal with the breach
in the confidentiality with consequential actions.
d. Trade unions
1. The trade unions need to take responsibility for taking on their comparative
strengths and mandate to incorporate HIV prevention and care and support as
well as policy as part of the collective bargaining issues.
2. Trade unions need to be the focus of advocacy efforts to sensitize them on the
workplace and HIV concerns and debunking the myths surrounding HIV.
3. Workers and their organizations should ensure that they access information and
services provided for as part of the workplace response to HIV and AIDS.
Workers should participate actively in the design and implementation of
intervention programs for the HIV and AIDS prevention, care and support. Hence
the policy should include the role of workers and workers’ association.
4. Affirmative actions are required to ensure women representation in the labour
unions, commensurate with their presence in the respective establishment
e. Civil society including PLHIV associations
1. The civil society and the development partners need to raise the agenda of work
related concerns of PLHIV as policy and practice issue at advocacy fronts
2. While the laws developed over time have been considered satisfactory, their
implementation has remained a challenge. To effectively monitor the
implementation of existing laws, it is important that the civil society, human rights
commission, representatives of workers and PLHIV’s associations become
actively engaged in such process.
f. UNAIDS cosponsors
1. Advocacy efforts should highlight the need for inter-sectoral collaboration in order
to enhance the effectiveness of response to HIV with special consideration of
workplace
g. Donors
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
1. The donor funded programs need to evaluate the process and outcome of
awareness raising activities and take remedial measures accordingly to address
any gaps.
(2) For specific issues:
a. Low awareness on HIV and AIDS
1. Behavior change communication (awareness raising, advocacy, improvement of
knowledge, understanding, etc.) should target PLHIV to counsel them for
participation in economic activities. These initiatives need to be gender
responsive.
2. The awareness raising and information, education and communication be
provided in local languages, be sensitive to local culture and preferably, be
developed with local people. The programs need to evaluate the process and
outcome of awareness raising activities and take remedial measures accordingly
to address any gaps.
3. Those entities in corporate sector that are promoting awareness about HIV and
AIDS under CSR should be encourage to mentor the other companies to work on
the similar lines on the neglected areas
b. Employment concerns of PLHIV
1. PLHIV, subject to their fitness to work, be provided and encouraged to avail
opportunities of vocational training, business development or self-employment,
sustainable income generation and livelihood.
2. A commission should be established to work out on the cases of denial of jobs to
people, based on their perceived or real HIV status.
C. Social protection for PLHIV and their families
1. Social safety nets for the workers should include PLHIV and their families
2. In order to ensure HIV sensitive social protection, the tripartite plus constituents
should monitor discriminatory exclusion of PLHIV in insurance programmes. The
tripartite plus constituents should advocate with insurance companies to include
PLHIV in insurance products to provide access to social protection. Insurance
schemes must be made HIV-sensitive.
3. Advocacy efforts should highlight the need for inter-sectoral collaboration in order
to enhance the effectiveness of response to HIV with special consideration of
workplace
d. Stigma and discrimination
1. Behavior change communication (awareness raising, advocacy, improvement of
knowledge, understanding, etc.) at workplace should target the general workers
for promoting acceptance of PLHIV and debunk the myths surrounding HIV.
2. The employers need to strictly implement workplace policies making it clear that
discriminatory behavior is not tolerated and there will be sanction if such
behaviours are identified.
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Acknowledgements
The consultant is grateful to the following for their technical and operational assistance
throughout this study and acknowledges that without their support this assignment could
not be completed:
ILO Office Islamabad, Pakistan
1- Syed Saad Gilani
2- Mr. Aftab Ahmed
3- Ms. Shahnila Azeem
ILO Office Bangkok
4- Mr. Richard Howard
ILO Geneva
5- Ms. Lee-Nah Hsu
UNAIDS Islamabad
6- Dr Shazia Abbas
7- Ms. Fahmida Khan
8- Mr. Samiullah Khan
TSF Asia Pacific, Kuala Lumpur, Malaysia
9- Ms. Sumathi Govindasamy
Dr. Muhammad Suleman Qazi,
[email protected]
Consultant
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Abbreviations and Acronyms
AIDS
Acquired Immunodeficiency Syndrome
CBO
Community Based Organization
CHBC
Community Home Based Care
CoCS
Continuum of Care and Care and Support Services
CSR
Corporate Social Responsibility
DU
Drug users
FGD
Focus Group Discussion
FSW
Female Sex Worker
EFP
Employer Federation of Pakistan
EOBI
Employees Old age Benefit institute
GAMCA
Gulf Cooperation Council GCC Approved Medical Center’s Associations
GLI
Group Life Insurance
HASP
Canada-Pakistan HIV and AIDS Surveillance Project
HIV
Human Immunodeficiency Virus
HSWs
Hijra (Transgender) Sex Workers
IDI
In-depth Interview
IDPs
Internally Displaced Persons
IDUs
Injecting Drug Users
IEC
Information-Education-Communication
ILO
International Labour Organization
MARP
Most at Risk Population
MNC
Multinational Company
MSW
Male Sex Worker
NACP
National AIDS Control Program
NSF
National Strategic Framework
OSH
Occupational Safety and Health
PESSI
Punjab Employees Social Security Institute
PDHS
Pakistan Demographic and Health Survey
PLHIV
People living with HIV and AIDS
PPE
Personal Protection Equipment
PVTC
Punjab Vocational Training Council
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SIRA
Sindh Industrial Relations Act
SOP
Standard Operating Procedures
STI
Sexually Transmitted Infection
TA/DA
Travel Allowance/ Daily Allowance
TB
Tuberculosis
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Chapter 1: Introduction
1.1 Purpose of the research
Evidence of the emergence of an HIV epidemic among key populations in Pakistan is
documented from early to mid-2000s, with infection occurring largely through injecting
drug use, followed by unprotected sexual contacts among transgender and, to a lesser
extent, among men and women involved in sex work. Estimates at the end of 2011
showed that there are about 130,000 people with HIV in Pakistan.
The National Policy on HIV and AIDS (National AIDS Control Program, 2007)
recognizes the increasing trend of HIV and AIDS in Pakistan and has prioritized fifteen
areas to be focused by Government and all other development partners. One of these
prioritized areas is ‘Ensuring a multi‐sectoral approach that includes the full participation
of civil society and community groups, religious leaders and the private sector’ and the
policy entails the following statement:
The participation of the private sector will be encouraged. Employers and
employer groups will be encouraged to develop and implement HIV and AIDS
workplace policies that assist in reducing HIV risk and supporting workers and
families affected by HIV and AIDS. Private‐sector development projects will be
encouraged to assess the HIV and AIDS impact of their projects and put in place
strategies to minimize HIV and AIDS risk, vulnerability and impact. Opportunities
for public/private partnerships that enhance the national and provincial HIV and
AIDS response will also be identified and supported.
HIV and AIDS at workplace is critical to understand and address as it has marked
impact on workers, their families and dependents, enterprises and national economies
but little is known in the workplace settings, policies, rights and issues related to stigma
and discrimination for people living with HIV & AIDS (PLHIV) in Pakistan
International Labour Organization (ILO) in collaboration with UNAIDS is working to
develop and implement policies and programs to protect workers from HIV infection and
facilitate equal access to care, treatment and support and social protection for all those
who are living with or affected by HIV and AIDS.
The ILO Recommendation concerning HIV and AIDS and the World of Work, 2010,
(No.200) and the ILO code of practice on HIV and AIDS and the world of work define
the rights and responsibilities for each of the constituents of the ILO, i.e. the
government, employers organizations and workers trade unions, to guide their
complementary or joint actions in relation to HIV in work settings.
ILO in 2013 conducted a baseline study to understand the situation of workplaces in
Pakistan in order to identify ways and means to protect the rights of workers living with
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HIV and AIDS. A consultant was engaged for the study with technical inputs from the
ILO.
Broadly the study will select a representative sample of different workplaces and will
validate the availability of policies and practices that support PLHIV in the workplace in
view of previous capacity development activities of ILO/AIDS. The study would also
assess the existing knowledge and understanding of Employers towards the challenges
faced by PLHIV and the policies and programmatic actions to safeguard the rights of
PLHIV at workplaces. The study methodology and instruments were developed by the
consultant and approved by the project steering committee.
1.2 Background and context information
1.2.1 HIV and AIDS in Pakistan
According to the 2012 UNAIDS estimates (UNAIDS, 2013) Pakistan is among the 12
countries that account for more than 90% of people living with HIV (PLHIV) and more
than 90% of new HIV infections in Asia and the Pacific. The country has witnessed an
eight-fold increase in the new HIV infections between 2001 and 2012 (from 2300 to
19000).
Pakistan has following a trend of a concentrated HIV epidemic among Key Affected
Populations. The drivers of the epidemic are Injecting Drug Users (IDUs) with highest
HIV prevalence at 27.2% followed by ‘Hijra’ (HSWs) or transgender and male sex
workers (MSWs) at 5.2% and 1.6%, respectively and female sex workers (FSWs)
exhibit the lowest prevalence of 0.6%, in 2011. The epidemic has spread from major
urban cities and provincial capitals to smaller cities and towns (National AIDS Control
Program, 2012).
Other at-risk and vulnerable populations, such as clients of sex workers and spouses of
Key Affected Populations, at-risk adolescents and prisoners, imprisoned populations,
specific occupational settings (including in some cases through nosocomial infection),
migrants and refugees and internally displaced persons (IDPs) were estimated to
number around five million in Pakistan in 2011. Hence besides a focus on the Key
Affected Populations, it is essential that prevention strategies and ‘low-threshold’
programs also be sustained for these larger segments of the population.
Pakistan had an estimated 98,000 people living with HIV (PLHIV) by the end of 2009,
with 5,256 PLHIV registered in 17 ART centers by end of 2011, including 189 children,
1,018 and 4,049 adult females and males, respectively. The 2011 Integrated Biological
and Behavioral Surveillance (IBBS) Survey conducted by the Government of Pakistan’s
HIV and AIDS Surveillance Project (HASP) confirms that HIV prevalence among Key
Affected Populations continues to rise, with an average prevalence of 27.2% among
IDUs as compared to 20.8% in 2008; 1.6% among Male sex workers (MSWs) as
compared to 0.9% in 2008; and 0.6% among Female sex workers (FSWs) as compared
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to 0.2% in 2007. Amongst ‘Hijra’ or Transgender sex workers prevalence was at 5.2% in
2011 lower than 6.1% in 2008 (National AIDS Control Program, 2012).
A national study conducted in 2011 among 26,500 women in antenatal clinics found
prevalence to be at 0.04% (National AIDS Control Program, 2011-a).
A 2011 survey of coal miners in Balochistan (National AIDS Control Program, 2012-a)
revealed that almost 90% of the sampled subjects had had sexual intercourse, with the
mean number of sexual partners being 4.2 in the past one year. The mean number of
paid female sex partners in this population was 6.1 in the last one year. Alarmingly,
condom use was very low, with only 2% always using a condom. This population has
interactions with both female and Hijra sex workers. While awareness of sexually
transmitted infections (STI) was relatively high (79%), more than half reported
experiencing STI symptoms.
Vulnerability to HIV also exists in the context of internal and external migration in
Pakistan. A substantial number of HIV cases have been being reported among returning
migrant workers from abroad as well as among their spouses and children. There has
been significant migration from rural areas of all provinces to the Gulf States. The net
outward migration rate from Pakistan is estimated at 3.3 per 1000 inhabitants. Gulf
States and other receiving countries require mandatory testing for HIV and other health
conditions from prospective visitors coming on work and residence visa. The visa
applicants are tested without appropriate pre and post test counseling at Gulf
Cooperation Council GCC Approved Medical Center’s Associations (GAMCA). Those
found to be HIV positive are denied visas whereas the migrants found to be HIV positive
in Gulf states are deported. Most deportees do not receive counseling, proper
educational information about their status and/or ensuring access to treatment, care and
support services upon return to their countries of origin (National AIDS Control Program,
2012).
In its recent round the Pakistan Demographic and Health Survey (PDHS 2012-13)
(National Institute of Population Studies, 2013) included questions regarding attitudes
toward PLHIV. The survey asked four questions from ever-married women and men
(15-49 of age) who had heard of AIDS, to assess the level of stigma associated with
HIV and AIDS2. Similar proportions of women and men reported that they would be
willing to take care of a family member with HIV at home (92 percent and 90 percent,
respectively) and that they would buy fresh vegetables from a shopkeeper who has HIV
(47 percent each). However, women were much more likely than men to think that a
female teacher with HIV should be allowed to continue teaching (65 percent versus 52
percent). Differences between women and men were minimal regarding the desire to
keep secret a family member’s HIV infection status (42 percent versus 38 percent,
respectively). Overall, 17 percent of women and 15 percent of men expressed accepting
2
The questions asked included if the respondents are willing to care for a family member with AIDS in the
respondent’s home; Would buy fresh vegetables from shopkeeper who has the AIDS virus; Say that a female teacher
who has the AIDS virus but is not sick should be allowed to continue teaching; and Would not want to keep secret
that a family member got infected with the AIDS virus.
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attitudes regarding all four situations. Among both women and men, accepting attitudes
toward those living with HIV and AIDS increase with increasing education and wealth.
Key Findings regarding HIV and AIDS -related knowledge, attitudes, and behavior as
reported in PDHS 2012-13 are summarized below:

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
Four in 10 ever-married women and 7 in 10 ever-married men age 15-49 have
heard of AIDS.
Comprehensive knowledge of AIDS is not widespread among either women (7
percent) or men (12 percent).
Only 12 percent of women and 18 percent of men know of ways to prevent
mother-to-child transmission of HIV.
Only 17 percent of women and 15 percent of men express accepting attitudes
toward people living with AIDS.
Thirty-six percent of men and 11 percent of women know of a place where they
can go to get an HIV test.
Sixty-one percent of women and 53 percent of men reported receiving a medical
injection from a health worker during the 12-month period preceding the survey.
1.1.2 HIV and Workplace
According to ILO (International Labour Organization, 2001) HIV and AIDS is a
workplace issue, and should be treated like any other serious illness/condition in the
workplace. This is necessary not only because it affects the workforce, but also
because the workplace, being part of the local community, has a role to play in the
wider struggle to limit the spread and effects of the epidemic. There are three reasons
why it is necessary to deal with HIV and AIDS in the workplace (International Labour
Office, 2002):
1. Impact on the world of work: HIV and AIDS reduces the supply of labour and
available skills, increasing labour costs, reducing productivity, threatening the
livelihoods of workers and employers, and undermining rights.
2. Workplace is a good venue to tackle HIV and AIDS: Workplaces are communities
where people come together and they discuss, debate, and learn from each
other. This provides an opportunity for awareness raising, education programs,
and the protection of rights.
3. Employers and trade unions are leaders in their communities and countries and
leadership is crucial to the fight against HIV and AIDS.
There is a dearth of literature on workplace and HIV and AIDS in Pakistan. The
available literature suggests a poor knowledge and understanding among workers in the
formal sector. In a study on factory workers in Lahore (Levi Strauss & Co., 2013), the
knowledge of the modes of HIV and AIDS transmission and protection was found to be
less than 50% among the respondents. Another study on female factory workers (Levi
Strauss & Co., 2010) found that women respondents had limited knowledge of AIDS,
and many had never heard of HIV and AIDS. Generally, the women felt the disease was
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not relevant to them. In focus group discussions with female factory workers in one
factory in Karachi, nearly three-quarters of them reported that they had never seen a
condom and they expressed extremely limited knowledge of sexually transmitted
infections and prevention. For example, though most had heard of AIDS, not a single
woman knew about HIV or how the virus was transmitted (BSR her+project, 2010).
Stigma Index (www.stigmaindex.org) reports that according to a survey 35 percent of
people living with HIV in Pakistan reported being denied jobs in the last 12 months
because of their HIV status. Association of People Living with HIV & AIDS (APLHIV),
(n.d.). states:
Employment status and monthly earning depicts a bleak picture as more than
half (52%) are not employed and not working at all. The average monthly income
of the PLHIV is PKR 6000/-. This is below the poverty line. They are living in
abject poverty making them difficult to meet the two ends of life. About 40% of
respondents had difficulty in obtaining enough food for their households in the
last month…. A matter of great concern is the fact that significant proportions of
the respondents had lost job or source of income or were refused employment
for being HIV positive.” Out of 422 who were employed in any category, 57.6%
lost their jobs with different frequency of occurrence. Out of 243 who lost their
jobs, 46.1 % lost them because of their HIV status, 34.6% as a combination of
HIV and some other reason. Out of 196 who lost their job due to their HIV status,
50% felt obliged to stop work due to poor health, 24.9% due to combination of
discrimination and poor health and 11% solely due to discrimination by the
employer or co worker. 35% respondents were refused employment due to their
HIV status. Out of 422 respondents 52% were refused promotion due to HIV
status. Out of 216 (52%) who were refused promotion or faced change in job
description, 48.8% was due to discrimination by the employer or co worker.
1.2.3 ILO Code of Practice on HIV and AIDS and the World of Work
This code, published in 2001, provides practical guidance to tripartite constituents
(policy-makers, employers’ and workers’ organizations) and other social partners for
formulating and implementing appropriate workplace policy, prevention and care
programs, and for establishing strategies to address women and men workers in the
formal and informal economy. The Code of Practice provides a set of guidelines to
address the HIV epidemic in the world of work, within the framework of the promotion of
decent work. It helps prevent the spread of the epidemic, mitigate its impact on workers
and their families and provide social protection to help cope with the disease. The code
identifies need for advocacy on key principles (recognition of HIV and AIDS as a
workplace issue, non-discrimination in employment, gender equality, screening and
confidentiality, social dialogue, prevention, care and support, and a healthy working
environment) as the basis for addressing the epidemic in the workplace.
The code covers the following technical areas: HIV and AIDS, Human rights and gender
equality, non-discrimination, confidentiality, social dialogue, capacity building, training
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and educational programs, gender-specific programs, voluntary counselling and testing,
care and support, and policy making.
The Code was followed by a set of recommendations (International Labour Office,
2010) developed for adoption as an international labour standard. The
Recommendation No. 200 constitutes an unequivocal commitment by the ILO’s
constituency of member States and the representatives of employers and workers, in
close collaboration with organizations of PLHIV and partner international organizations,
in particular Joint United Nations Programme on HIV/AIDS (UNAIDS), to tap into the
immense contribution that the world of work can make to ensuring universal access to
prevention, treatment, care and support.
1.2.4 Workplace Policy on HIV and AIDS
According to the ILO Recommendation 200, a workplace policy should provide a rights
based framework for action to reduce the spread of HIV and manage its impact. The
policy should reflect an explicit commitment of corporate action, ensure consistency
with appropriate national laws, lay down a standard of behaviour for all employees
(whether infected or not), give guidance to supervisors and managers, help employees
living with HIV and AIDS to understand what support and care they will receive (so they
are more likely to come forward for voluntary testing), help to stop the spread of the
virus through prevention programs, assists an enterprise to plan for HIV and AIDS and
manage its impact, so ultimately saving money and provide the basis for putting in place
a comprehensive workplace programme, combining prevention, care and the protection
of rights.
The most significant development at policy front is ‘The Sindh HIV and AIDS Control,
Treatment and Protection Bill’, passed by the Sindh Government on 18th Sept 2013. The
Bill addresses various aspects of HIV epidemic.
Chapter III clearly prohibits
discrimination based on a person’s status, or presumed, suspected and or alleged HIV
status, whether in the field of health care services, education, employment, provision of
general, utility and or any other form of services and or in relation to accommodation,
whether in respect of accommodation for lease, rent, to let or hire and or for purchase.
The Bill declares that except in accordance with the Act, it shall be unlawful to require,
or to coerce, a person to be HIV screened for purposes of employment, promotion, or
training.
The bill requires that all organizations having possession of health records of any
individual that pertain to HIV and AIDS screening and or HIV and AIDS Tests and or the
results thereof and or any other matter relating to HIV and AIDS shall keep the same
confidential and shall neither disclose nor release the same to any other third party
without the prior consent of the relevant individual; provided however in the event, such
records are required to be released to the Court pursuant to a Court Order than the
organization shall immediately file an application in the court that such records shall be
kept confidential by the Court and shall not be made part of the public record.
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The Bill also recommends that every workplace, public or private, having more than ten
employees, shall undertake an HIV and AIDS awareness program for the benefit of its
employees at least once every year.
The Bill states that no person shall be required to be HIV screened without their express
consent, for routine testing or diagnostic testing purposes by any public or private health
care facility. All public and private health facilities shall maintain confidentiality of
patients’ medical and personal information, including their HIV and AIDS status.
The Bill requires that every health facility where there is significant risk of occupational
exposure to HIV, shall provide free of cost universal precautions, and post exposure
prophylaxes to all workers in that facility who may be occupationally exposed to HIV and
appropriate training for the use of such universal precaution.
1.3 Research Questions
The research focused on the following key questions:
1. To what extent employers are aware of and implement workplace policies
consistent with the key principles of R-200; is there a difference between the
public sector vs the private sector in this regard?
2. To what extent the HIV and AIDS response is sensitive towards employment
concerns of PLHIV?
3. To what extent the PLHIV actively participate in developing workplace policies
and laws?
4. Are employees’ social security systems in Pakistan sensitive towards special
needs of PLHIV?
5. To what extent the stigma and discrimination are present at workplaces?
The detailed interview guidelines can be seen at Annexure 1.
1.4 Study Setting
1.4.1 Sites of Data Collection
The data collection was planned and undertaken in Islamabad/Rawalpindi, Karachi and
Lahore.
Islamabad, being the country’s capital, houses the ministries, government departments,
offices of the PLHIV association, employee and workers federation and chamber of
commerce that have stake in HIV and Workplaces.
Lahore and Karachi are the major hubs of economic activities in Pakistan. These two
provincial capitals house the recently devolved ministries/departments. The formal
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representation of the three constituencies can be accessed in these largest cities of
Pakistan.
Karachi is the largest and most populous metropolitan city of Pakistan and is the
financial and commercial capital of the country. It is the centre of industry, economic
activity and trade and is home to Pakistan's largest corporations, including those
involved in textiles, shipping, automotive industry, entertainment, the arts, fashion,
advertising, publishing, software development and medical research.
Lahore remains an economic, political, transportation, entertainment, and educational
hub. It is the capital of the most populous province of Pakistan.
The prevalence of HIV among 4 Most at Risk Population (MARP) groups in the focused
districts as reported in Round 4 of the HASP study (National AIDS Control Program,
2011) is provided in the table below.
Table 1: Prevalence of HIV among MARPs in the focused districts
FSW
MSW
5.9
Hijra Sex
Workers
12.0
Karachi
1.9
Lahore
42.2
0.5
1.7
5.2
30.8
0
0.6
4.2
-
Rawalpindi/
Islamabad
IDU
In non-generalized HIV epidemics the HIV status among the general population is
measured through a proxy i.e. prevalence of HIV among women obtaining services at
ANC centers. National AIDS Control Program, (2011-a) reported Antenatal SeroSurveillance for HIV in Karachi as 0.03 (Lahore and Islamabad were not surveyed).
1.4.2 Study Population
The study focused on tripartite constituencies of workplace along with PLHIV. Table
below gives a broad overview of the participants included in this study.
Table 2: Overview of the study participants
Employers &
Employer groups
Employer
Federation of
Pakistan (EFP)Karachi
World of Work Constituencies
Workers
- Pakistan Workers Federation
(Rawalpindi)
- Trade Union Workers of
Public sector companies
-
Government
National AIDS Control
Program, Islamabad
Provincial AIDS Control
Programs (Lahore and
Karachi)
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-
Ministry of Overseas
Pakistanis and HRD,
Islamabad
Departments of Labour,
Lahore and Karachi
Employees Old age Benefit
Institute, Islamabad
Employees Social Security
Institutes (PESSI and
SESSI)
Skill Development Council,
Islamabad
Sindh/ Punjab Technical
and Vocational Authority
(TEVTA)
Punjab Vocational Training
council PVTC
Association of PLHIV, Islamabad Secretariat
Gender and Reproductive Health Forum, Karachi
The list of respondents can be seen at Annexure 2 and the profiles of the respondent
bodies are furnished at Annexure 1.
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Chapter 2: Description of the research
2.1 Purpose
The purpose of this baseline research is to understand the situation of workplaces in
Pakistan and identify ways and means to protect the rights of workers living with HIV
and AIDS ‘People Living with HIV and AIDS (PLHIV)’. Broadly the study will select a
representative sample of different workplaces and will validate the availability of policies
and practices that support PLHIV in the workplace in view of previous capacity
development activities of the ILO. The study would also assess the existing knowledge
and understanding of employers towards PLHIV and the support necessary for PLHIV
at the workplace, consistent with the key principles of Recommendation 200.
2.2 Scope
Given the time and financial resource constraints, the assignment specifically focused:
- The main constituents of the World of Work i.e. employers & employer groups,
workers and government but not the civil society, media and academia, in
general (Association of PLHIV will be an exception)
- Only the formal economy
- Stakeholders in Islamabad, Lahore and Karachi
2.3 Methodology
In line with the guidance from the ILO’s experts in Geneva and Bangkok and UNAIDS
Pakistan, the research methodology was finalized. The research included literature
review and primary data collection. The summary of methodology is given in table
below.
Table 3: Summary of materials and methods
Methodology
Method
Tool
Sampling
Analysis
Grounded theory
FGD and IDI
Open ended, semi structured interview guide
Purposive sampling
Manual qualitative data analysis
2.3.1 Literature review
The literature review included the following documents:
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
-
-
ILO Recommendation concerning HIV and AIDS and the World of Work, 2010,
(No. 200)
ILOAIDS Report on Employment and Treatment Adherence, Dec 2013
The AIDS Accountability International Scorecard for workplace HIV programmes
National Strategic Plan (NSP)
Global AIDS Progress Reporting reports
Mid-term review report of NSP
UNAIDS HLM Target mid-term review report
Epidemiology/surveillance data/ report
Policy reports; global preview and best practices:
o The Department of Labor Code of Good Practice on Key Aspects of HIV
and AIDS and Employment
o International Confederation of Free Trade Unions. Framework of Action
Towards Involving Workers in Fighting HIV/AIDS in the Workplace
(Gaborone, Botswana, 2000)
o Congress of South African Trade Unions. Campaign Against HIV/AIDS: A
guide for Shop Stewards (South Africa, 2000)
o Family Health International. Private Sector AIDS Policy: Businesses
Managing AIDS, A Guide for Managers
o UNAIDS. AIDS and HIV Infection Information for United Nations
Employees and Their Families (Geneva, 2000)
Literature on workplace and HIV and AIDS including research instruments based
on previous work in other countries.
o ILO “A workplace policy on HIV and AIDS: what it should cover”
2.3.2 Primary data collection
In order to understand the situation of workplaces in Pakistan qualitative data collection
tools were developed. These included guidelines for focus group discussion (FGDs) and
In-depth Interviews (IDIs) for 4 major categories of respondents (Annexure 1). The
primary data was collected during February and March 2014. The study included 12
qualitative interviews (2 FGDs and 10 IDIs). The details of respondents are furnished in
table below.
Table 4: Data collection activities
Cities
Islamabad/
Rawalpindi
FGD
-
IDI
1. National AIDS Control Program
NACP,
2. Ministry of Overseas Pakistanis and
Human Resource Development
3. Skill Development Council,
4. PLHIV Association,
5. Employees Old age Benefit institute
(EOBI)
6. Pakistan Workers Federation
7. Overseas
Pakistanis
Foundation
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Lahore
Karachi
1. Labour Department,
2. Punjab TEVTA
(OPF)
8. Representatives of public
companies
Provincial AIDS Control Program
sector
3. Punjab Employees Social
Security Institute (PESSI)
4. Punjab
Vocational
Training council PVTC
Provincial AIDS Control Program
1. Labour Department
2. Representative
of
Employer Federation of
Pakistan (EFP)
3. HR
manager
of
multinational companies
MNC
After agreeing on the study participants and approval of the data collection plan
submitted by the consultant, ILO administration furnished the list of respondents and
their contact details, informed and invited the participants for the interviews.
A consent form was used for the study participants in order to ensure that the
participants are fully informed of the background and purpose of the exercise and take
part in the interviews voluntarily (Annex: 1).
2.3.3 Data Analysis
The primary qualitative data was recorded, translated, transcribed in English and coded.
The findings were categorised under predefined and emergent themes. The predefined
themes are based on the 10 core principles delineated under R-200.
2.3.4 Report
The report was written according to the table of contents suggested by ILO experts.
2.4 Limitations
The study participants came from two different spheres of life. Those from workplace
context had weak understanding of HIV and AIDS and those from HIV and AIDS sector
had limited knowledge of ‘workplace’. It took us a while explaining the issues and
relating the two spheres to the respondents. It is suggested to create venues where
both groups are engaged and the contexts, roles and expectations are discussed.
Despite regular reminders the participation was less than expected. It was difficult for
respondents to spare time for interviews which led to delay in completion of the report.
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The range of period of affiliation with the current job ranged from 6 months to 12 years.
Some of the respondents had, hence, limited background for their respective area of
work.
Women representation was less (only 4 out of 23 respondents were female).
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3. Findings
No generic workplace policies or unified labour laws exist in Pakistan
In Pakistan workplaces are being governed by Labour Laws and there are no workplace
policies. The existing laws are classified for various professions such as mines, shops
establishments, factories etc. In the absence of a generic law all the workplaces cannot
be simultaneously addressed. Subsequent to realizing the need of consolidation of
Labour Laws, an exercise was initiated at federal level which was abandoned after the
advent of 18th constitutional amendment3. The Operational Safety and Health Policy
(2010) was formulated but it was not approved and met the same fate after 18th
Amendment.
There are no unified labour laws. There are some set of practices and industry
specific laws. Big industries in the public sector make their own labour policies…
During 1956-2010 five labour policies were formulated. Different Labour laws
consider different definitions of worker in the context of worker, employee,
workman and labour. Child Labour is defined in different ways (age wise).
Minimum wages range from 10 to 15000 in different laws.
Representative of Labour Department
Decentralization has brought a shift in the roles of federal and provincial
ministries
Before the advent of decentralization the Federal Ministry of Labour and Manpower was
responsible for making laws and the provinces were responsible for implementing those
laws. As an aftermath of 18th constitutional Amendment the federal ministry has a
redefined and restricted role of reporting on international conventions, welfare of
overseas Pakistanis, and coordination between provinces in order to recommend that
the Labour laws in the provinces be made in accordance with the international laws.
The federal ministry has no more responsibility in the formulation or implementation of
laws and the provinces have the responsibility to make laws and implement.
The diction and dichotomy of formal and informal economy is grey
Labour laws consider a sector ‘formal’ where these laws are applicable. However there
is variation in terms of recognition of formal sector. Factory Act, for instance, recognizes
a workplace where a minimum of 10 people are engaged in production whereas less
than 10 people in manufacturing business are covered under Shop and Establishment
Act. Employees Old Age Benefit Institution (EOBI) Act applies on minimum 5 people.
The Labour Department’s role starts where 10 or more workers are working.
3
Under the 18th Amendment in the constitution of Pakistan (2010), 17 ministries were devolved to the provinces to
enhance their empowerment by transferring federal level resources and responsibilities including industrial relations.
These ministries included Labour and Manpower; health; women development and others.
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Representative of Labour Department
Even some very formal sectors can constitute a substantial number of informal workers.
Even formal sector is being pushed towards informal sector e.g. a huge bank
with country wide branches might claim of having only 30-32 employees and
designating the rest of the employees as cash “officers” or a famous passenger
transport company calls the ticketing clerk as ticketing “officer” giving them
artificial promotion/title promotion without benefits.”
Representative of Labour
The size of the formal sector is generally considered to be around 30% of the total
economy. However, there is a general perception that it is actually much less.
Formal sector is not even 30% as quoted, but it is around 22%
Representative of Labour Department
Participants from Punjab informed that a draft policy is underway that will address the
non-formal sector.
Majority of labour force is not catered under the existing labour laws
The non-formal sector comprises of the entities not registered under any law. Besides
agriculture (that constitutes the largest workforce), home based workers4, home workers
(domestic workers), self employed and workers in the commercial establishments
(which are different from manufacturing) all constitute non-formal sector who do not
come under any policy. In some settings there is no written policy but agreements
between employer and employee union exist. Non-formal sector is difficult to cover as
workers in the informal sector are scattered.
No authentic data is available on small establishments. Since the establishments
have to provide gratuity, group insurance and health coverage therefore the
owners hide their identity. And we monitor only those documented!
Representative of Labour Department
There is general agreement among the respondents that the current laws are
good in their own right but the real problem is the implementation of the laws
Most important features of some workplace laws and policies in Pakistan
4
Home based workers can be of three types: those who work with the formal sector but not recognized; those who
work through contractor /middle man and the self employed
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There are more than 70 Labour laws and 100 rules that protect the rights of employees.
These include their health and safety and their legal rights. In general, the formal,
public sector offers job security, social protection packages, some facility of
compensation, medical facilities, leave policies etc. Workplace policies are different in
industry, transport and mining areas. Workplace specific policies such as Occupational
Safety and Health (OSH) are implemented through respective Departments. It is
generally believed that non-formal sector has hardly any policies and the practices may
vary on individual basis, likes and dislikes.
Under the Employees Social Security 6% of a worker’s salary received from the
employer is used for the health coverage of the whole family including husband, wife, 2
kids and 2 parents and that covers treatment and medication from minor ailments to
expensive treatments
Employees social security covers employees treatment from Aspirin tablet to
heart surgery, locally and if needed abroad.
Employees Social Security representative
There is a service
disciplinary, medical
and OSH policy and
children are given
qualification.
structure, recruitment, promotion, deputation, retirement,
entitlement, welfare and group life insurance (GLI), TA/DA
SOPs. In case of in-service death (regardless of cause) the
job without test/advertisement according to a child’s
Public sector company representative
Implementation related gaps and needs
The labour laws in the books are excellent; they have been trialed, they have not
remained static as there have been amendments but still there are implementation
related needs to be improved.
Inspection regime needs improvement which requires developing the capacity of
inspectors. Health education of workers is required; at many places the
employers have provided support which is not being used by workers due to
myths or low perception of risk. Occupational safety and health drills at working
place are also required.
Representative, Labour Department
The implementation of law has two main challenges: absence of strict machinery to
implement laws and poor unionization of workers failing to attain collective bargain.
Due to weaknesses in implementation [of law] the [Labour] inspectors do not visit
the workplace [in order to check the compliance to the rules] and they develop a
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corrupt relationship with the employer. The most important thing is the clause 2
of the Standing Order Ordinance which is about appointment letter which is
worker’s fundamental right. If you visit any industrial area and at the end of day
enquire the workers leaving the area if they have an appointment letter, almost
all of them will have a negative reply.
Workers’ Representative
In general work policies are good irrespective of inclusion of HIV, but
implementation is not on equal basis. Every boss sitting in a particular setting
implements the policies to his level of understanding and therefore there is no
uniform implementation and hence inter-organizational differences.
PLHIV representative
The workplace policies generally do not target population groups (women
workers, men workers, migrants or PLHIV) with the exception of special people
(disabled).
In the law a worker is a worker, not a man or woman therefore, no gender /sex
disaggregated data is usually available, although our Labour inspection proforma
asks about the number of male and female workers in factories…There is no
compulsion for inclusion or exclusion of males or females although there is a
definite quota for the special people, under Disable Person (employment and
rehabilitation) Ordinance 1981, that has to be followed by the private sector as
well.
Representative of Labour Department
The existing laws have no reference on inclusion or exclusion of PLHIV. However, in
practice discrimination is reported:
There has been a ‘tradition’ in almost all government departments, and in
uniformed forces and law enforcing agencies it is “written”, that a person having
HIV is not allowed to serve. Once found, such a person is medically boarded out
from armed forces…The government … authorities are most ignorant about HIV
and AIDS. They don’t know what is HIV and AIDS, stigma and discrimination
associated with HIV
Representative of PLHIV
The workplace policies are operational under Factories Act, Mines act, Workman
Compensation Act, EOBI and Social Security; but none of these are sensitive of
population groups. The policies are not sensitive towards different gender groups, key
populations, rural versus urban residents. However, the law on Sexual Harassment at
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Workplace (Protection against Harassment of Women at the workplace Act, 2010) can
be considered an exception.
The respondents agreed that the policies per se are not biased but the practices might
vary.
No policy is discriminatory but the gender constructs or personal interest, mainly
for profit maximization; do play a role during dealing with the workers.
Representative of workers
Gender based polices are there to ensure that no discrimination on gender or
sexual basis be there but there are two problems, people are not aware of these
policies and implementation is not uniform
Representative of PLHIV
Women have poor representation in the labour organizations
In some professions more than 50% of the workers are women, such as pharmaceutical
and garments industry. But there is no representation of women in the respective labour
unions. Recently Sindh Industrial Relations Act (SIRA) 2013 has made it mandatory that
women representation in the trade unions should be proportional to women employed in
the establishment.
Sindh has also taken a lead in terms of gender mainstreaming as it has established a
Gender Unit within Labour Department that will work on the agenda of gender
mainstreaming within the Department and at workplace.
HIV workplace policies/programmes have not been raised as an issue by national
organisations (NGOs, social movements or international groups) as part of policy
/programme discussions.
The organization working for PLHIV (NGOs, private sector, government
agencies) interact each other to boost the unified efforts to fill up gaps in
provision of services, to identify gaps and take measures. However, not much
has been raised on workplace issues by these stakeholders (with the exception
of Employers Federation).
Representative of PLHIV
The HIV related social protection services are more focused on food, nutrition
and education; no legal supportive measures are being provided
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Social protection services are mainly being provided with the help of Global Fund.
These services are being delivered mostly by CBOs which are led by PLHIV.
Depending upon availability of funding, packages like food, nutrition and education
services are being provided on rotational basis only to registered people in the projects
but so far no legal supportive measures are being provided.
The government, general public and PLHIV all should know that someone’s HIV
status must not affect one’s human rights. Towards that end general awareness
on rights is required coupled with access to measure in the law of land in case
violation of PLHIV’s rights happens. There is no law in Pakistan to protect
violence, stigma and discrimination against people affected and infected…We
are not asking for special concessions or laws for PLHIV but whatever laws are
there should not be discriminatory.
Representative of PLHIV
Majority of the respondents were ill informed about HIV and AIDS
The respondents had different misconception and misperceptions about HIV and AIDS.
These misperceptions were about the causality, cure and vulnerability as can be learnt
from these comments:
People do not inform about HIV, although it is curable; once TB was incurable
but now there are medicines for it
Government representative
[HIV and AIDS] is a result of illegitimate relationship. God has made a system
and law and this disease results from deviation from this law. That is why it is
blameworthy.
Government representative
HIV is not our country’s problem because this is not a free sex country. It used to
be in Lahore which is no more there [referring to red light area]. That is why it
never came to us as an issue.
Workers’ representative
I think these are migrant workers who need information awareness (about HIV)
Otherwise in my view the poor man seldom gets HIV.
Workers’ representative
The PLHIV are invisible in the employment sector due to various reasons
Low prevalence in general population
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As mentioned earlier, Pakistan has overall low prevalence of HIV in the general
population. Some respondents maintained that given the low prevalence there is little
need to take positive measures such as assigning quota for PLHIV in the jobs.
The percentage of HIV positive in 15-49 age group is less than 0.1% among the
working class. Unless we document these HIV positive how can we make a
policy that certain quota be given to the positives.
Representative of Labour Department
HIV and AIDS is a problem of Africa. In Pakistan, from a workers’ point of view, it
is minimal. However, transport workers or internal migrant workers, e.g. those
coming from Swat to Karachi this could be an issue. Otherwise HIV is negligible.
Representative of workers
Majority of PLHIV do not work in formal job market
The infection is more prevalent in drug users (30%), followed by transgender, men who
have sex with men (MSM) and female sex workers (FSWs). All these groups are usually
not involved in mainstream employment/income generation activities.
Majority of PLHIV are IDUs (Injecting Drug Users), and all of them are
unemployed. They are mostly street based IDUs. Labourers who are infected
work on daily wages and there are housewives.
AIDS Control Program
Most of them belong to lower class. Around 60% are involved in syringe sharing
and in sex work. Among general population there are migrant labourers working
in factories or on daily wages. They contract virus from heejra or female sex
workers. Then there are people returning from Gulf countries who are carrying
virus. They do not disclose their status and some even get married. They mostly
work as sales men, hair dressers, make up men, and paramedics.
PLHIV Representative
The trade unions have not come across any case of a worker with HIV infection
needing protection of his/her and family rights. We have been active on training
and health education on topics such as Dengue fever, which is quite common,
but not on HIV.
Representative of workers
Reluctance to disclose
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The respondents were of the view that in general people in Pakistani society tend to
hide any kind of disability because they fear they might lose job if they are found with
some disability. In case of HIV this tendency accentuates because of the stigma
attached to it.
One can not disclose one’s [HIV] status because there is a constant stigma
attached… a patient comes from a distant district to us [at provincial capital] to
collect medicines every two months after telling a lie to his department. This is
choice of patient …he is not getting it from his own district….reason? Secrecy!
Society does not accept him/her as a patient but a culprit.
Provincial AIDS Control Program
PLHIV do not wish to disclose their status for the fear of losing job. For a person
who is HIV positive there are more than 90% chances that he/she will lose the
job. Although the law of the land is not supportive to the idea that someone
should lose a job on the basis of disease status, but there are so many
misconceptions around, such as HIV is a sexual activity oriented disease that
can be transmitted through even shaking hands and working together, and above
all, if somebody is known to be HIV positive it is most probable that his/her
character will be targeted and gossiped about. Hence there is a taboo attached
to it.
PLHIV representative
There could be various job related constraints PLHIV have to face.
Restricted job opportunities
The job providers are not sensitised with the real scenario of HIV and AIDS and they
carry misconceptions which could influence their decision regarding employing or
promoting a worker with HIV.
Life insurance companies do not give insurance…
Representative of PLHIV
A male/female/Hijra/transgender candidate for an employment who has HIV has
legally no constraint but socially and practically s/he will be rejected because of
taboo in the society.
Labour department
Gender-Poverty-HIV nexus
The workplace policies/programs might assist PLHIV with regard to gender equity and
employment
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HIV is a disease of poor people and poor people are generally not thought to be
qualified. You will also hardly find qualified people in community [of PLHIV] and
when you go for gender, the number of females drops down further.
Representative of PLHIV
No workplace policy or programme currently includes helping PLHIV workers to improve
their livelihood.
There are no employment assistance activities going on for PLHIV. But the
organizations working for PLHIV address the job needs on case to case and personal
contact basis. There is no active effort on the employment assistance but only in case a
PLHIV approaches for the purpose to the organisation, he/she is assisted.
If someone contacts us we can facilitate in exploring jobs. On my personal level 3
out 4 people were provided employment. The fourth one refused due to low
package. These cases approached us from Karachi (1), Islamabad (2) and
Larkana (1). We had approached the partners with a proposal that we might act
as a bridge between job providers and PLHIV and coordinate between the
government and private sector representatives and sensitise them on economic
issues of HIV community.
Representative of PLHIV
Maintaining confidentiality
As described earlier, the PLHIV try to maintain their confidentiality but that could be
threatened by various reasons. In case the informed employer or colleagues are not
sensitized and/or departmental procedures and record keeping fail to keep the record
confidential this might harm the PLHIV.
Stigma and discrimination at workplace
It was unanimously understood that people around at workplace will think negatively of
HIV positive person. First the people around will gossip about his/her character and
then people will avoid shaking hand for the fear of contracting the disease.
The first and foremost concern for PLHIV is to keep his/her status a secret. S/he
does not want to disclose because of the associated stigma. And this is a
perpetual challenge as HIV is a condition for life.
AIDS Control Program
The employer will definitely think that the applicant will be on leave every other
day or will fear that the infected person would come and spread the illness to us
as well
Labour department
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Health vs workplace related challenges
Access to the available treatment, care or support will be another problem as he/she
refrains from disclosing and hence is not in position to demand for the support.
Moreover, even if treatment is accessible, maintaining confidentiality might be difficult:
A PLHIV has to take medicine at specified time… twice a day …so if you take
medicine at workplace, the confidentiality might be compromised...
Representative of PLHIV
The complications may commonly arise or there might be medicinal side effects,
opportunistic infections etc. All these might conflict with the workplace policies. The
question ‘will work allow for sick leave?’, if yes then for how long?
A PLHIV can be afraid of his surroundings due to his/her health vulnerability:
The PLHIV is so scared from people around, e.g. those coughing around him will
make him scare.
AIDS Control Program
HIV and AIDS is out of the radar of Labour issues
Pakistan has more than 70 laws relating to Labour issues, however, there is no
reference to HIV.
Basically we have concentrated on risk groups IDU (injecting drug users), TG
(transgender), migrant population, MSM (men who have sex with men), and sex
workers but not on economic segments or workplaces.
AIDS Control Program
The [HIV/ AIDS] data is not segregated on jobs basis. However, in Round 10 we
found that majority of PLHIV work on daily wages. I do not think we need to
conduct full scale studies on job [employment] wise distribution of PLHIV as most
of them are jobless. Such data can be acquired from ongoing data collection
activities. A questionnaire or form can be circulated to treatment centres and
CBOs, Community Home Based Care (CHBC), Continuum of Care and Care and
Support Services (CoCS) sites run by NGOs focusing on DUs can be asked for
to assess the job status, this will require less of finances
Representative of PLHIV
Checklist in the Labour Inspection Tool Kit (notified in 2013) has nothing on HIV
although other aspects such as issues surrounding gender, GSP Plus, all Conventions
and Constitutions, even Code of Conduct are included in the checklist.
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Labour and employment concerns of PLHIV are out of radar of projects on HIV
and AIDS
Workplace seems an alien concept in the HIV and AIDS sector.
The HIV and Health sector strategies and policies and PC-1s [planning
commission proforma]….none consider workplace as an entity.
AIDS Control Program
For example, the Hello Plus project, the only round the clock, toll free helpline at
national level that caters the needs of the general public and PLHIV regarding HIV and
AIDS offers 4 services to caller: Provision of basics on HIV and AIDS and treatment,
referral, telephonic counseling and to receive complaints, grievances, suggestion or
feedback on services being given to community in treatment, care and support. But
there is no service for employment related counseling.
The labour sector has not been effectively approached by the stakeholders in HIV
response
HIV workplace policies/ programs have not been raised as an issue by civil society or
international groups as part of policy/program discussions. Only two of the respondents
informed that they have ever been approached by public sector institutions for the
health promotion/education on HIV and AIDS.
There seems little motivation in trade unions for promoting awareness about HIV
On enquiring if there are any activities/initiatives that trade unions would like to carry out
with PLHIV but have not been able to do so, the response was:
The fact of the matter is that we are struggling with much bigger issues like
Karachi garment factory fire incident5 that took a great toll and we are struggling
that such issues do not recur. HIV in contrast is a negligible issue.
Representative of Workers
Training component of majority of the programs for workers/potential workers
lack education on HIV
Technical, vocational training and education institutes offer various training courses for
different categories of workers. These training and/or diploma courses in general do not
address OSH issues. Some courses mention firefighting and training on Personal
5
In Pakistan OSH standards in the mostly labour intensive jobs are distressing. In particular the garment sector
where there are high fire hazards. The deadliest factory fire incident happened in September 2012 in Karachi, where
over 300 workers perished in a textile factory.
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Protection Equipment (PPEs) but not on prevention from HIV. Some of the training
initiatives are inclusive from different perspectives but do not focus awareness on HIV.
175 Punjab Vocational Training Centers (PVTC) are imparting vocational
trainings to the poorest individuals of 15-35 years age bracket. The beneficiaries
of these programs include non-Muslims and transgender as well who are offered
specialized courses in tractor repair and stitching, electrician and beautician
courses respectively. However, no topic on HIV is included in any of the 52
courses being offered.
Although the corporate sector has no legal binding to support HIV and AIDS
related activities under CSR, some companies have been working on awareness
raising
The activities under Corporate Social Responsibility (CSR) can be categorized into two.
Those that are required by the government, as per Labour Welfare Laws, and the
voluntary support provided under CSR. A company has social responsibility for workers,
their families and areas where they work. As a specific subject it is on the company to
decide on investing in prevention, treatment, care and/or support activities on HIV and
AIDS. Some of the Multi National Companies (MNCs) have been supporting in-house
awareness sessions and walks with employees against AIDS.
The quality of awareness raising activities has been poor
It was perceived that the few work place related awareness activities lacked quality and
objectivity.
In recent past there have been some awareness raising programs organized for the
labour in the government departments such as T&T, railways, electricity. These
programs actually were lectures for the labour. But to tell you the truth all these are
formalities because there is little impact …the speaker delivers a session for half an
hour and that’s it. It was not a two way communication.
Representative of PLHIV
An INGO arranged HIV awareness sessions for the mine workers in Balochistan.
The facilitator visited the mines area and delivered sessions. The mine workers were
all Pashto speaking people and the facilitator was not familiar with Pashto….such
workshops have little effect, if any. It would have been much better if they trained a
Pushto speaking, local molvi [religious leader] to educate those mine workers; it was
not the job of people in pent shirt.
Representative of PLHIV
The PLHIV can be best covered within general programs instead of policies
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Majority of the respondents recommended that the general programs can be a better
approach to cover PLHIV than through policies. General programs are considered a
better option because:
It takes decades to develop, table, pass out and implement policies.
PLHIV Representative
However, respondents from Labour Department spoke in favor of exclusive policies.
We cannot safeguard the rights of PLHIV properly unless there is a legal
framework for them and we also need to know if there is such a model in the
world. In case someone is refused a job on HIV grounds, we do not have a
remedy for it.
Representative of Labour Department
In the opinion of another respondent, Pakistani law, policies and/or programs, in public
or private sector, should not give provisions for the treatment, care and support of
workers, their families and their dependants, because:
A common person will ask why preference is being given to PLHIV, why not to a
patient of TB or Hepatitis? And above all (the common man might think) HIV was
contracted because of ‘dirty act’ and the people who have TB have no fault (in
terms of character) hence should also be privileged.
AIDS Control Program
Another respondent argued that the policies must not squarely address the issue of HIV
as this might lead to stigma and discrimination:
I don’t need extra rights but as a human being ‘the guaranteed rights’. The laws
and policies should not single out HIV and AIDS. But no human be stigmatized
for anything. If we are making specific policies for PLHIV we are increasing their
vulnerability…whole thing should be integrated within health systems.
AIDS Control Program
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Conclusion
Findings in line with the key principles of ILO R200
1. “The response to HIV and AIDS should be recognized as contributing to the
realization of human rights and fundamental freedoms and gender equality for all,
including workers, their families and their dependants”. (R200, III. 3.(a))
“Measures to address HIV and AIDS in the world of work should be part of
national development policies and programs, including those related to labour,
education, social protection and health” (R200, III.3.(j))
The National Policy on HIV/AIDS (National AIDS Control Program, 2007) states that
“employers and employer groups will be encouraged to develop and implement HIV
and AIDS workplace policies that assist in reducing HIV risk and supporting workers
and families affected by HIV and AIDS. Private sector development projects will be
encouraged to assess the HIV and AIDS impact of their projects and put in place
strategies to minimize HIV and AIDS risk, vulnerability and impact. Opportunities for
public/private partnerships that enhance the national and provincial HIV and AIDS
response will also be identified and supported”.
The National Strategic framework (NSF) (National AIDS Control Program 2007-a)
considers mobilization of private sector and parastatals an integral part of the national
response to HIV and AIDS. The private sector and parastatal organizations are
responsible for mainstreaming HIV and AIDS into their respective spheres; mobilizing
resources for combating the epidemic; and organizing and operating workplace
interventions (Information education communication - IEC, care and support) for their
workers and clients. NACP and provincial offices, in collaboration with relevant partners,
will facilitate a process where companies and firms can be assisted to develop well
targeted workplace programs. NACP and PACPs will also ensure that the capacity of
the private sector is built to implement, document and submit timely progress reports on
HIV and AIDS initiatives.
2. Recognition of HIV and AIDS as a workplace issue: “HIV and AIDS should be
recognized and treated as a workplace issue, which should be included among the
essential elements of the national, regional and international response to the
pandemic with full participation of organizations of employers and workers” (R200,
III.3.(b))
The study has found that Pakistani laws, policies and programs in general do not
recognize HIV and AIDS as a workplace issue. Worker and workplace are not
considered an important venue in the country’s HIV responses.
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Only 2 out of 23 respondents were familiar with the R 200. Both were from private
sector. One respondent had come to know about it during international meetings and
the other had worked on the guidelines.
When a new law is made tripartite consultations are organized. However, for small
amendments such consultations do not happen. In order to ensure true representation
of workers, the mostly represented (in terms of membership strength) body of
employers and workers is invited in these consultations. Since 1970s tripartite
consultation known as “National Labour Conference” always precedes formulation of
Labour policies. The involvement of PLHIV has never been sought during these
tripartite consultations.
The consultations are becoming minimal, especially after 18th amendment. Now
there are provincial level tripartite committees in some areas such as on wage
fixation, EOBI, ESSI and some committees are at federal level as well.
Workers’ representative
3. Non discrimination: “There should be no discrimination against or
stigmatization of workers, in particular jobseekers and job applicants, on the
grounds of real or perceived HIV status or the fact that they belong to regions of
the world or segments of the population perceived to be at greater risk of or more
vulnerable to HIV infection (R200, III.3.(c))
Although Pakistani laws, policies and programs (in public or private sector) are
generally non-discriminatory, in practice stigmatization against workers/job
seekers/applicants on the basis of their real or perceived HIV status is an eminent
possibility. A PLHIV in the workplace might not be socially acceptable due to perception
about his/her character, the myth of possible spread of disease to others and risk of
financial burden the person might be on the employer.
4. Gender Equality (R200, III.3.(a))
Women representation in the public sector labour and related departments varies. In
one provincial Labour Department there are only 2 women among 700 employees, in
another department there are 7 women out of 130 employees. However, in another
department, 55% of the staff is females.
Sindh government has taken two unprecedented steps in gender mainstreaming. A
Gender Unit has been established within the Labour Department. A law has been
passed that requires the labour unions to ensure women representation is
commensurate with their participation in the sector. The latter was needed because in
practice women’s inclusion was negligible even in unions that representing industries
(e.g. pharmaceutical and garments) that employ predominantly female workers.
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Case report:
The girls come from their homes and land in the factories. They have little exposure
and knowledge. I know of two girls who used to work in a garment factory. They
became infected with HIV and their male supervisor was responsible for it. The girls
left their job.
Representative of PLHIV
5. Healthy work environment: The protection of workers in occupations that are
particularly exposed to the risk of HIV transmission. (R200, III.3.(k))
According to one point of view the workplace can only play a role in access to services:
Provided one [PLHIV] is ready to disclose ones status and the environment is
conducive. However, the employer is in a better position to link up with the
services. But as an employer once you are aware about the status of employee
you have to maintain confidentiality.
AIDS Control Program
EOBI offers compulsory social insurance and under it two types of pensions are
relevant for HIV and AIDS:
Invalidity pension: there is only one clause that says in case of permanent
disability (which is understood as any disability that decreases the productivity of
an employee to less than 67%) makes the employee eligible for the grant, with
the exception of 3 occupational disease-Twister cramp, Byssinosis and Anthrax
(which are to be dealt with by Social Security Institutions). HIV and AIDS was not
mentioned.
Survivor's pension: In case an insured person expires the first right to this
pension is among his/her survivors is of spouse and children less than 18 or
female child till her marriage, or disabled child for life, or if the deceased person
was unmarried then parents are eligible for 5 years.
The most significant development at policy front is ‘The Sindh HIV and AIDS
Control, Treatment and Protection Bill’ that addresses various aspects of HIV
and prohibits discrimination based on a person’s presumed or real HIV status in
the different fields including employment. The Bill declares that except in
accordance with the Act, it shall be unlawful to require, or to coerce, a person to
be HIV screened for purposes of employment, promotion, or training. The bill
requires that all organizations having possession of health records or any other
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matter relating to HIV and AIDS shall keep the same confidential without the prior
written consent of the relevant individual; provided however in the event, such
records are required to be released to the Court pursuant to a Court Order then
the organization shall immediately file an application in the court that such
records shall be kept confidential by the Court and shall not be made part of the
public record.
The Bill also recommends that every workplace, public or private, having more
than ten employees, shall undertake an HIV and AIDS awareness program for
the benefit of its employees at least once every year.
The Bill states that no person shall be required to be HIV screened without their
express consent, for routine testing or diagnostic testing purposes by any public
or private health care facility. All public and private health facilities shall maintain
confidentiality of patients’ medical and personal information, including their HIV
and AIDS status.
The Bill requires that every health facility where there is significant risk of
occupational exposure to HIV, shall provide free of cost universal precautions,
and post exposure prophylaxes to all workers in that facility who may be
occupationally exposed to HIV and appropriate training for the use of such
universal precaution.
6. Social dialogue: “workers’ participation and engagement in the design,
implementation and evaluation of national and workplace programmes should be
recognized and reinforced” (R200, III.3.(f))
The tripartite constituencies have little if any mustering on the HIV and AIDS policies
and programs. The study has found that only two respondents were aware of R-200.
The Labour and HIV sectors are mostly working in silos. The representatives of labour
force generally do not consider HIV and AIDS as a priority.
7. No Screening/Prohibition of screening for purposes of exclusion from work: “No
workers should be required to undertake an HIV test or disclose their HIV status”
(R200, III.3.(i))
Most of public or private sector policies do not require mandatory screening for HIV or
require workers to disclose their HIV status. The government and private institution
have a policy of pre-employment and routine medical examination but that does not
entail screening for HIV. However, armed forces have a requirement for HIV screening
during pre-employment assessment of the candidate and in case an applicant or
employee is found positive s/he is declined the job.
Only one of the respondents informed about a case where a young person was
terminated from job for being HIV positive.
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Case report:
Our relative was a young boy who had done Bachelors in Pharmacy. He was serving
with a multinational medicine company. Eight months after joining that company, he
was diagnosed with HIV infection. The company moved him out of job- although gave
some financial support …now the young man is working in a medical store.
Representative of Labour Department
While for the domestic migrant workers no mandatory testing for HIV is required but in
case of migrant workers going abroad, pre-employment test is required by the inviting
country from a designated health institution.
8. Confidentiality: “Workers, their families and their dependants should enjoy
protection of their privacy, including Confidentiality related to HIV and AIDS, in
particular with regard to their own HIV status” (R200, III.3.(h));
The privacy and confidentiality of workers is not fool proof.
In case an employee contracts HIV, rather any disease, we refer him to
the medical board. They judge if the disease can be transmitted; for
example in case of detection of T.B., the effected employee is sent for
two years leave for treatment whereas for incurable diseases medical
grounds are used to retire the person. …However, There is no secrecy from laboratory to medical board they ensure the diagnosis of health
problem or disease, then they refer the case to the Department- at any
point the information about a person’s health condition can leak out.
Public Sector Company
9. Continuation of employment relationship
None of the respondents representing employer and employees had ever seen a
case of HIV. They have never heard of any HIV positive worker in need of support.
Only 2 respondents (one from Labour Department and the other representing
PLHIV) shared two incidents that have been mentioned in the boxes.
10. Prevention: Prevention of all means of HIV transmission should be a
fundamental priority; (R200, III.3.(d))
Strategic behavior change communication within tripartite context is lacking. At
present the HIV prevention activities are sporadic and confined to awareness
sessions. HIV is not in the mainstream agenda under CSR. The quantity and quality
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
of awareness sessions have not been evaluated but there is a general perception
that these activities are weak.
11. Care and support, including treatment: “workers, their families and their
dependants should have access to and benefit from prevention, treatment, care
and support in relation to HIV and AIDS, and the workplace should play a role in
facilitating access to these services” (R200, III.3.(e));
According to the respondents there have been no reported cases of positive
worker/s in their knowledge or record. It was however, mentioned that in case a
registered worker has this disease, s/he will be treated as any other chronic illness
by the social security institutes for the private sectors.
The research findings on key questions are summarized below:
The employment sector is by and large not familiar with the R-200. Only 2
respondents, one from the private sector and the other representing the labour,
had heard of it.
The HIV and AIDS response in Pakistan is more focused on the prevention,
treatment and care aspects. The employment concerns of PLHIV have gained
little attention.
Workplace policies are developed in consultation with the tripartite constituencies
however, PLHIV have never been invited to participate in these consultations.
Employees’ social security institutions in Pakistan have little knowledge of special
needs of PLHIV. They have not come across any PLHIV.
Despite a policy towards non discrimination in the employment sector, there is a
common perception that the practices are contrary to the policy. A person’s HIV
status might be a source of fear, anxiety, and prejudice against him/her during
various stages of his/her employment. PLHIV can face widespread stigma and
discrimination.
Recommendations
1. For specific entities
a. Departments of Labour
4. In the post 18th Amendment scenario, the provinces
supported/advocated for developing their own labour policies.
should
be
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5. There is need of advocacy to resume the formulation of a unified labour law
applicable to all labour force.
6. There is need to bring the informal labour into formal sector through legislation,
policies and procedures. The process should encourage genuine representation
of the informal labour force.
7. Affirmative actions are required to mainstream women in the employment sector
b. AIDS Control Programs
2. The National Policy on HIV and AIDS emphasizes on participation of employers
and employer groups in the national response but has laid no emphasis on the
role of workers and workers’ organizations. Workers and workers’ organizations
have important role in educating their members on the provision of the policies
and to ensure the proper implementation and compliance with the policies.
c. Employers group
3. Besides promoting acceptance of PLHIV and debunking the myths surrounding
HIV, the employers need to develop and strictly implement workplace policies
and a clear code of conduct for the workers making it clear that discriminatory
behavior is not tolerated and there will be sanction if such behaviours are
identified. A clear grievance procedure should be in place for the workers who
suffer from such discriminatory behaviors to exercise their right of recourse. In
addition HR staff should be provided training so they can arbitrate fairly in the
wake of any such incidences.
4. The employers need to ensure that the policies on maintaining confidentiality are
in place. There needs to be a set of rules and procedures to deal with the breach
in the confidentiality with consequential actions.
d. Trade unions
5. The trade unions to take responsibility for taking on their comparative strengths
and mandate to incorporate HIV prevention and care and support as well as
policy as part of the collective bargaining issues.
6. Trade unions need to be the focus of advocacy efforts to sensitize them on the
workplace and HIV concerns and debunking the myths surrounding HIV.
7. Workers and their organizations should ensure that they access information and
services provided for as part of the workplace response to HIV/AIDS. Workers
should participate actively in the design and implementation of intervention
programs for the HIV and AIDS prevention, care and support. Hence the policy
should include the role of workers and workers’ association.
8. Affirmative actions are required to ensure women representation in the labour
unions, commensurate with their presence in the respective establishment
e. Civil society including PLHIV associations
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
3. The civil society and the development partners need to raise the agenda of work
related concerns of PLHIV as policy and practice issue at advocacy fronts
4. While the laws developed over time have been considered satisfactory, their
implementation has remained a challenge. For the effective monitoring of
implementation of existing laws the civil society, human rights commission,
representatives of workers and PLHIV should come forward.
f. UNAIDS
Advocacy efforts should highlight the need for inter-sectoral collaboration in order to
enhance the effectiveness of response to HIV with special consideration of workplace.
For instance a close working relationship between the labour sector with the AIDS
control programme is imperative.
g. Donors
The donor funded programs need to evaluate the process and outcome of awareness
raising activities and take remedial measures accordingly to address any gaps.
2. For specific issues
a. Low awareness on HIV and AIDS
1. Behavior change communication (awareness raising, advocacy, improvement of
knowledge, understanding, etc.) should target PLHIV to counsel them for
participation in economic activities. These initiatives need to be gender
responsive.
2. The awareness raising and information, education and communication be
provided in local languages, be sensitive to local culture and preferably, be
developed with local people. The programs need to evaluate the process and
outcome of awareness raising activities and take remedial measures accordingly
to address any gaps.
3. Those entities in corporate sector that are promoting awareness about HIV and
AIDS under CSR should be encourage to mentor the other companies to work on
the similar lines on the neglected areas
b. Employment concerns of PLHIV
1. Besides advocacy for the employment opportunities for PLHIV, subject to their
fitness to work, it is also necessary to ensure that PLHIV benefit from
opportunities of vocational training, business development or self-employment
opportunities. They should be encouraged to participate in the economic
activities. They should be offered capacity building opportunities on sustainable
income generation and livelihood. For example, the ILO training programmes on
Start Your Business, Know Your Business, etc. plus market survey and
entrepreneurship training and assistance coupled simultaneously with
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
collaboration and cooperation of employers who will be willing to hire PLHIV. This
also requires occupational skills training per se’.
2. A commission should be established to work out on the cases of denial of jobs to
people, based on their perceived or real HIV status.
C. Social safety for PLHIV and their families
1. Social safety nets for the workers need to categorically include PLHIV and their
families as a target group
2. In order to ensure HIV sensitive social protection, the tripartite plus constituents
should monitor discriminatory exclusion of PLHIV in insurance programmes. The
tripartite plus constituents should advocate with insurance companies to include
PLHIV in insurance products to provide access to social protection. Insurance
schemes must be made HIV-sensitive.
3. Advocacy efforts should highlight the need for inter-sectoral collaboration in order
to enhance the effectiveness of response to HIV with special consideration of
workplace
d. Stigma and discrimination
1. Behavior change communication (awareness raising, advocacy, improvement of
knowledge, understanding, etc.) at workplace should target the general workers
for promoting acceptance of PLHIV and debunk the myths surrounding HIV.
2. The employers need to develop and strictly implement workplace policies and a
clear code of conduct for the workers making it clear that discriminatory behavior
is not tolerated and there will be sanction if such behaviours are identified. A
clear grievance procedure should be in place for the workers who suffer from
such discriminatory behaviors to exercise their right of recourse. In addition HR
staff should be provided training so they can arbitrate fairly in the wake of any
such incidences.
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References
Association of People Living with HIV & AIDS (APLHIV), (n.d.). An Index to measure the
Stigma and Discrimination experienced by People Living with HIV in Pakistan, 2009-10
International Labour Office (n.d), A workplace policy on HIV/AIDS: what it should cover
International Labour Office, (2002). Implementing the ILO Code of Practice on HIV/AIDS
and the world of work: an education and training manual
International Labour Office , (2010). Recommendation concerning HIV and AIDS and
the world of work, 2010 (No. 200)
International Labour Organization, (2001). An ILO code of practice on HIV/AIDS and the
world of work.
Levi Strauss & Co. (2010). Female Factory Workers’ Health Needs Assessment:
Pakistan
http://herproject.org//doc_repository/Female_Factory_Workers_HNA_Pakistan_FINAL.p
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National AIDS Control Program, (2011). HIV Second Generation Surveillance in
Pakistan - National report Round IV
National AIDS Control Program, (2011-a). Antenatal Sero-Surveillance for HIV in
Pakistan 2012
National AIDS Control Program, (2012). Country progress report Pakistan. Global AIDS
Response Progress Report 2012
National AIDS Control Program, (2012-a). Bio Behavioral Survey among Mine workers
in Balochistan, Pakistan
National Institute of Population Studies, (2013). Pakistan Demographic and Health
Survey 2012-13.
Provincial Assembly of Sindh, (2013). The Sindh HIV and AIDS Control Treatment and
Protection Bill, 2013
UNAIDS, (2013). HIV in Asia and the Pacific. UNAIDS report 2013
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National AIDS Control Program, (2007). National HIV and AIDS Policy- Final Draft
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National AIDS Control Program, (2007-a). National HIV and AIDS Strategic
Framework‐2007 – 2012
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BSR her+project, (2010). Investing in Women for a Better World
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Annexure
Annex 1: Profiles of the study participants
Employers & Employer groups
Employers Federation of Pakistan (EFP)
Employers Federation of Pakistan (EFP) was established in 1950. According to its
vision, EFP provides a forum for the employers of Pakistan to progress in the global
society through decent work and better human resource management while keeping in
view the corporate social responsibility. The mission of EFP is to strive for industrial
peace, harmony, poverty reduction and business promotion and pursue policies and
legislation conducive to investment, economic growth, employment generation, decent
wages and keeping peace with socio-economic development of country. Further the
mission statement also pledges to protect and promote employers’ interests through
effective and meaningful participation in consultation at National and International level
and provide assistance and guidance to the members through effective communication.
In 2006 the EFP signed a commitment urging upon its member organizations to
subscribe the ten principles of ILO’s Code of Practice on HIV and AIDS and take
effective measures at the workplace in their respective enterprises.
Every year EFP celebrates World Day for Safety and Health at Work on April 28th. In
2006, according to the then special theme of HIV and AIDS, EFP arranged a number of
events. But since 1st of December is designated World AIDS Day, EFP arranges
activities on the day.
The Employers’ Federation of Pakistan has been publishing the Bi- monthly Industrial
Relations Journal for the last two decades having its circulation on National and
International level. The journal disseminates information and knowledge on various
disciplines such as Industrial Relation, Human Resource Management, Occupational
Safety & Health, and HIV Aid including EFP Member Company’s profile. The Journal
also includes information on all activities in coordination with International Labour
Organization or in coordination with International Organization of Employers. Two
issues of ‘Industrial Relations Journals’ were published on HIV and AIDS.
Representatives of workers
Pakistan Workers Federation (PWF)
Determined to work together to promote and protect their rights by creating “Pakistan
Workers Federation” initially through merger of three national centres of Pakistan,
namely: All Pakistan Federation of Trade Unions (APFTU), All Pakistan Federation of
Labour (APFOL) and Pakistan National Federation of Trade Unions (PNFTU).
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PWF exists to:
(a) establish, maintain and develop a powerful and effective national organization
consisting of free and democratic trade unions, independent of any external domination
and pledged to the task of promoting the interests of working people throughout
Pakistan and enhancing the dignity of labour; co-ordinate, direct and guide the activities
of regional federations, the affiliated industry-wise unions and their industrial
federations, in all matters directly or indirectly affecting the workers;
(c) preserve, secure, maintain and seek universal recognition for the workers of
Pakistan in terms of i) freedom of association; ii) freedom of assembly; iii) freedom of
speech; iv) freedom of press; v) right of collective bargaining; vi) right of strike or
withdrawal of labour; vii) right to decent work, human dignity and social security; and
viii) equal rights and privileges in employment, irrespective of race, colour, creed and
sex;
(d) undertake and coordinate the defence of the free trade unions against any campaign
aiming at their destruction or at the restriction of their rights or at the infiltration and
subjugation of labour organization by totalitarian or other anti-labour forces;
(e) strive for the establishment of full employment; the elimination of discrimination on
grounds of race, colour, sex, nationality or creed; the improvement of working
conditions; health and safety standards for workers; the introduction, maintenance and
extension of social security for all; and raising standards of living of peoples of Pakistan;
(f) represent the free trade union movement in all regional and international forums
which exist or may be set up to perform functions affecting the social and economic
conditions of working peoples and to further the implementation of their decisions
whenever desirable;
(g) ensure the integration of women in trade union organizations and actively promote
gender equality in activities and decision-making at all levels;
(h) strive for elimination of child labour and all forms of forced/ bonded labour;
(i) endeavour to strengthen international solidarity amongst the working men and
women of the world and in particular to actively co-operate with the workers of other
countries to defend and promote fundamental and democratic rights of workers and
other common interests and to support and co-operate with national, regional and
international organizations of workers in their struggle against all forms and kinds of
exploitation and oppression and to create solidarity among national, regional and
international level workers’ organizations;
(j) defend and promote at the national, regional and international level the economic,
social and occupational interests of all workers;
52
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
(k) promote peace and security at the national, regional and international level for the
human welfare, particularly for the working men and women;
(l) seek universal recognition and enforcement of the trade union rights including the
rights of freedom of association and to bargain collectively;
(m) represent Pakistani workers at national, regional and international forums;
(n) furnish to all its affiliated units and the constituent regional federations information on
the economy, employment, labour legislations, wages and working conditions at
workplaces in different parts of the country, as well as at the regional and global level;
(o) endeavour to secure improved and better relationship between employers and
workers;
(p) promote and protect the interest of the affiliated units and endeavour to secure
legislative support for furthering the interests of the workers;
(q) work for abolition of contract labour in all its forms;
(r) help and guide the working men and women particularly the rural peasants to
organize themselves into trade unions and rural workers organisations for promotion
and protection of their rights, and also work for the introduction of land reforms as well
as abolition of feudalism;
(s) encourage and promote cooperatives and socio-economic projects and services for
the benefit of its affiliates and their members;
(t) promote literacy and skills amongst the workers through:
i. adult education; and
ii. universal and free secondary education, vocational training and technical
education;
(u) work for rapid industrialization of the country;
(v) seek for a social and policy dialogue to reflect trade union perspective in the
formulation of socio-economic policies and plans of the government in order to ensure
sustainable and equitable development;
(w) encourage, promote and provide trade union education for awareness raising
amongst the workers, organizing the unorganized and development of the affiliated
unions/federations;
(x) seek ratification and enforcement of all ILO Conventions especially the Core Labour
Standards;
53
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
(y) endeavour to have 40 hour week norm for workers without reduction in wages;
(z) promote, protect and defend all human rights and to establish and promote
cooperation with like minded organizations of civil society for protection and
advancement of all basic rights; and
(aa) endeavour for the establishment of rule of law, independence of judiciary and good
governance.6
Government institutions
National AIDS Control Program, Islamabad
National AIDS Control Programme ( NACP) was established in 1986-87 with a focus on
diagnosis of cases that came to hospitals, but progressively began to shift towards a
community focus. Its objectives are the prevention of HIV transmission, safe blood
transfusions, reduction of STD transmission, establishment of surveillance, training of
health staff, research and behavioral studies, and development of programme
management.
Subsequently, in 1994, the program was brought under the multi-donor financed Social
Action Program with a more pragmatic agenda including information education, blood
screening and establishing provincial implementation units. The program is now
implemented through federal and provincial implementation units. The government’s
commitment is reflected by the fact that about 80% of all expenditures on HIV & AIDS
has been financed by the Government of Pakistan (GoP).
In 1999 - 2000, GoP with the assistance of UNAIDS and other development partners
undertook a strategic planning exercise with input from all stakeholders. The framework
envisages multi-sectoral response and development of partnerships and collective
action, essential for decreasing the vulnerability of Pakistan’s population. The GoP is
committed to expand its response to HIV & AIDS by translating the Strategic framework
through this donor-financed enhanced program. The Enhanced HIV & AIDS Control
Program is being implemented at Federal Level under Enhanced HIV & AIDS Control
Programme (Federal Component).
Following are the major components of the enhanced programme:
Component 1: HIV Prevention and Treatment
•
•
•
•
•
6
Targeted Interventions for MARPs
National Truckers Project
Small Grant projects
HIV Care and Support
Blood Safety
http://pwf.org.pk/
54
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
•
•
STI Control
PPTCT
Component 2: Advocacy and Communication
• Advocacy
• Communication and Stigma Reduction
Component 3: Governance and Institutional Framework
•
•
•
•
•
Governance
Capacity Building
National & Provincial Reference Laboratories
Programme Management
Monitoring and Evaluation 7
Punjab and Sindh AIDS Control Program
In order to address and control the HIV epidemic these provincial programs8,9
contributed towards achieving the following objectives by June 2013:
-
To control or reverse the spread of HIV among the most at risk groups and to
keep the epidemic from establishing among the bridging groups and the general
population.
-
To create an environment in the country where People Living with HIV can
access medical and social services and enjoy life without facing stigma or
discrimination.
-
To coordinate a multisectoral, comprehensive and sustainable response to HIV
that is based on evidence, transparency and accountability and involves the
various line ministries, the civil society and the main target beneficiaries (the
PLHIV and the most at risk groups).
Ministry of Overseas Pakistanis and HRD, Islamabad
Formerly it was called Ministry of Labour, Manpower & Overseas Pakistanis that was
devolved to the province as an aftermath of 18 th Amendment in the Constitution of
Pakistan. In its present shape, the ministry came into existence in July 2013, from a
merger of the Ministry of Overseas Pakistanis and the Ministry of Human Resource
Development. The ministry constitutes the following organizations:
- Overseas Pakistanis Foundation (OPF)
7
http://www.nacp.gov.pk/about_us/
http://health.punjab.gov.pk/?q=Punjab_ACP
9
www.facebook.com/ESACP
8
55
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
-
Overseas Employment Corporation (OEC)
Employees Old-Age Benefits Institution (EOBI)
Workers Welfare Fund (WWF)
National Industrial Relations Commissions Islamabad (NIRC)
Bureau of Emigration & Overseas Employment 10
Departments of Labour, Lahore and Karachi
Labour Department is responsible to promote industrialization and industrial peace as
well as observance of labour laws and rules.
It is mandated to promote investment and employment in the province.
It is also responsible for the welfare of working labour force and enhancement of its
capacity through training and development. Its main functions are to:
-
Implement Labour Laws
Maintain industrial peace.
Manage Labour Courts.
Provide social security cover for secured workers.
Impart vocational & technical training to youth.
Provide jobs through Employment Exchanges.
Fix minimum wages of skilled and un-skilled workers.
Improve welfare conditions of Industrial and Mines Labourers.
In order to achieve the objectives, the Directorate of Labour performs the following
functions:
-
Registration of Trade Unions and other allied matters.
Determination of collective Bargaining Agents and holding of Referendums.
Settlement of Industrial Disputes.
Enforcement of Labour Laws relating to Factories, Shops, Commercial and
Industrial Establishments11
Employees Old age Benefit Institute
The vision of EOBI is to be a viable, credible, progressive Institution devoted
provision of Social Security to all persons in service of Pakistan. Its mission is
transform EOBI into a viable, progressive and self-sustained organization, capable
providing retirement benefits to all citizens in service of Pakistan with active support
employers and employees to promote economic prosperity of all stakeholders.12
to
to
of
of
10
www.ophrd.gov.pk
http://www.sindh.gov.pk/dpt/Labour%20%26%20HRM/introduction.htm
12
http://www.eobi.gov.pk/InstitutionalStrategy/Mission.html
11
56
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
EOBI was established to provide Old-Age Benefits to insured persons or their survivors.
Under EOB Scheme, insured persons are entitled to avail benefit like, old-age pension
(on the event of retirement), invalidity pension (in case of permanent disability), old-age
grant (an insured person attained superannuation age, but does not possess the
minimum threshold for pension) survivor's pension (in case an insured person is
expired).
Employees Social Security Institutes (PESSI and SESSI)
Established under the West Pakistan Employees Social Security Ordinance 1965
(renamed as Provincial Employees Social Security ordinance in 1970) operational since
1967, the mission of Punjab Employees Social Security Institute (PESSI) is to provide
medical care and cash benefit to employees working in industries or commercial
establishments and their dependents. 13
The main functions of Sindh Employees Social Security Institute (SESSI) is to provide
medical care and cash benefits to secured workers and their dependants in the event of
sickness, maternity, employment injury, death grant, iddat, disablement gratuity,
disablement pension, survivors' pension and ex-gratia grant. 14
Skill Development Council, Islamabad
Skill Development Council was established by the Government of Pakistan under
National Training Ordinance 1980. The council operates on Public-Private Partnership
with active participation of Employers Federation of Pakistan [EFP] and Private Sector
Businessmen. The council aims to identify, develop and arrange Vocational, Technical /
Professional and IT Training Programs and tailor-made courses, according to the
customers’ needs.
Punjab/Sindh Technical and Vocational Authority (TEVTA)
TEVTA was formed through an Ordinance (No XXIV of 1999) and replaced by TEVTA
ACT (ACT X of 2010) Punjab.
TEVTA’s mission is to enhance global competitiveness in Punjab, through a quality and
productive workforce by developing demand driven, standardized, dynamic and
integrated technical education and vocational training service.
Objectives of Punjab TEVTA are to:
-
13
14
Promote and provide demand driven technical education & vocational training.
Develop a dynamic technical and vocational training system to ensure horizontal
and vertical mobility.
http://pessi.gop.pk/
http://www.sessi.gov.pk/index.html
57
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
-
Regulate and develop standards of technical education and vocational training
including internationally recognized curriculum, examination and certification
system.
Upgrade teaching abilities, skills and knowledge of teaching staff.
Upgrade teaching equipment to the required standards.
Establish close relationship with various sectors of economy namely Agriculture,
industry, Services and Commerce.
Assess the manpower training needs in the context of domestic and global
markets.
Enhance the participation of Private Sector in training activities at Management
level.
Establish a system of public coordination through Boards of Management at
District level, coordinating all institutions in the District and their administration.
Motivate the local entrepreneurs to patronize the training programs of TEVTA
institutions, provide on-the-job training facilities and employment to the
graduates.
Set up regular Monitoring/Evaluation & Feedback system for the vocational
training and teaching education to respond efficiency to the existing and
changing demand of the economy.
Develop & regulate examination, Trade Testing & Certification System to ensure
uniformity of Education & Training Standards.
Prepare training plans, programs and projects keeping in view the local as well
as foreign manpower training requirements.
Study and propose changes in the existing training legislations.
Develop and offer need-based short courses in the sector of new technologies to
the Industry and also to offer services for solutions regarding associated
production problems.
Establish a staff development system to offer demand oriented teacher &
instructor training and upgrading performance.
Organize and conduct seminars & workshops for various types of personnel
associated with vocational training and technical education.
Establish Data Banks for skilled workers and technicians. 15
The mission of Sindh TEVTA is “Employment Through Skills”. Its vision is to develop
qualitative of workforce meeting local and international labor market needs by ensuring
excellence in training through research & development, effective management and
regulation of TEVT setup in the Province
The objectives of Sindh TEVTA are as follows:
Promote
- Technical Education and Vocational Trainings (TEVT)
Improve
- Teachings Methodology & Administration in TEVT Institutes
15
http://www.tevta.gop.pk/
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
- Infrastructure & Equipments of TEVT Institutes
- Employability for TEVT Students
- Faculty Competancies Through Trainings
Establish
- Model Institutions by Upgrading Existing Institutions
- Centers of Excellence
- Institute-Industry Linkages 16
Punjab Vocational Training Council PVTC
Punjab Vocational Training Council (PVTC) is an autonomous corporate body
established by the Punjab Government through the PVTC Act of 1998. Its mission is to
alleviate poverty through Muslim charity (Zakat) and private sector participation by
imparting demand driven skill training and enhancing employability for disadvantaged
youth.
Establishment of PVTC came through the realization that the less privileged sections of
the society eligible for Zakat should be so empowered economically that they are able
to sustain themselves and their families and engage in dignified economic activity. One
of the better ways to use Zakat was to provide technical and vocational skills to the
youth including girls and boys with certain minimum academic qualifications. This idea
of economic empowerment would generate a multiplier effect in terms of economic
activity and provide dignified monthly income to them and their families so that they
come out of the eligibility of Zakat bracket.
Imparting of skill training in market relevant trades would obviously bring much higher
rate of return than general education. With the establishment of PVTC, training the
young girls and boys into professionally equipped and trained craftsmen has brought
quantifiable dividends in the lives of these people.17
Representatives of PLHIV
Association of PLHIV, Islamabad
The Association of people living with HIV [APLHIV] is a national network of the HIV
community in Pakistan. It is to protect the rights of people living with HIV [PLHIV] in
Pakistan and to ensure the dignity of their lives across country. Advocacy, lobbying,
capacity building, policy dialogue, social mobilization, public private partnership,
empowerment of PLHIV and make the people infected/affected a productive member of
the society are the main areas of mandate of the APLHIV. The Association has
established the first network among PLHIV in Pakistan to provide a platform for them to
speak in unison and raise a common voice for their rights and to contribute to the
national response on HIV epidemic.
16
17
www.stevta.gos.pk
http://pvtc.gop.pk/
59
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Vision:-The vision of the Association is ” to ensure that PLHIV in Pakistan have equal
rights and live with dignity and peace.”
Mission:-To improve the quality of life of PLHIV in Pakistan and provide them and their
families a sense of belonging so that they may become an active member of the
society.”
The main goal of the APLHIV is “to work collectively for the community and to achieve
the national goal of HIV [to prevent HIV from becoming established in vulnerable
populations and spreading to the general population while avoiding stigma and
discrimination] and to advocate for the implementation of GIPA.
Objectives:
- Empowerment of people infected/affected through advocacy.
- To sensitize the general population to respect fundamental human rights of the
PLHIV in Pakistan.
- To promote positive image of the community in order to reduce stigma and
discrimination.
- Networking among PLHIV and the organizations working in the field of HIV.
- To exchange experiences, information, knowledge, skills and resources to
improve the quality of life of the PLHIV in Pakistan.
- Raise the awareness among general masses.
- To provide a platform to the community specially to the women and children to be
heard in unison across the country
- To advocate and lobby for strong legal and legislative measures to protect the
rights of the PLHIV.
- To organize the capacity building, training, advocacy and lobbying seminars for
the staff and the community.
- To promote efforts and research environments in different fields of life in relation
to HIV.
- To ensure the accessibility of the community to treatment, care and support
services.
- To represent the community at national, regional and international forums.18
Gender and Reproductive Health Forum
Gender and Reproductive health Forum (GRHF) is a registered non-profit and nongovernment organisation under Company’s Act 2000 and is working all over the
country. GRHF is a unique organisation working with a high risk population with a key
focus on male and female commercial sex workers, men having sex with men, drug
users and hijras. It has been actively participating in the social sector to address HIV
and AIDS, reproductive health and protection issues.19
18
19
http://www.theaplhiv.org.pk/index.php/aboutus
http://www.nswp.org/members/asia-and-the-pacific/gender-reproductive-health-forum
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Annex 2: Research instrument
Consent form
Assalam o Alaikum
My name is Dr. M. Suleman Qazi. On behalf of ILO and UNAIDS I welcome you and I
am grateful that you spared your valuable time for this important activity.
ILO in colLabouration with UNAIDS is working to develop and implement policies and
programs to protect workers from HIV infection and facilitate equal access to care,
treatment and support and social protection for all those who are living with or affected
by HIV and AIDS. HIV and AIDS at workplace is critical to understand and address as it
has marked impact on workers, their families and dependents, enterprises and national
economies but little is known in the workplace settings, policies, rights and issues
related to stigma and discrimination for people living with HIV and AIDS.
Our today’s interview is meant to obtain your views about the currently prevailing
policies and practices on workplace for PLHIV and seek your recommendations to
improve the situation. This will help us in assessing the existing situation and devise
strategies to overcome those challenges.
For the sake of data collection this discussion will be recorded. Otherwise if you prefer,
the written notes will be taken only.
You have full right not to participate in the study at all or not respond to any question
you don’t wish to.
If you agree, should we start the discussion?
61
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Interview guideline
Date of Interview _______________________________
Name of respondent/s
Responde
nt
General
Questions
from all
responden
ts
Gender (male-M/FemaleF/Other-O)
Institutional Affiliated with
Questions
1. What is your general view of the Workplace policies in Pakistan?
(do they work, are they funded, are they successful or not)
2. What in your opinion are the most important features of the
Workplace policies in Pakistan? (Are they positive or negative?)
3. Are these Workplace policies available only to those who work in
the formal economy?
4. Which population groups are targeted by these Workplace policies?
Women workers, men workers, migrants? How about people living
with HIV?
5. Do you think the Workplace policies covers all the workers
equitably? (different gender groups, key populations, rural versus
urban residents, others.)
6. How do you think these groups could be best covered through
policies or within general programs?
7. What about groups such as PLHIV. Are there policies and/or
programs that specifically target this population group? How can
policies and programs respond effectively to PLHIV in the formal
economy workplaces?
8. What is the role of your organisation/section/department in the HIV
or setting workplace policy (or programme)? (policy making,
managing benefits, funding, providing services, advocating for
programs, monitoring or regulating programs, reporting, etc.)
9. How, in your opinion, do workplace policies (or programme) assist
PLHIV with regard to gender equity and with regard to
62
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
employment?
1- Government
NACP/
1. What is the status of HIV and AIDS workplace policies in formal
PACP
economy in Pakistan?
a. Where does Pakistan stand vis a vis compliance to the ILO’s
“Recommendation concerning HIV and AIDS and the World
of Work, 2010 (No. 200)”
b. Do national development policies and programs (including
those related to labour, education, social protection and
health), address HIV and AIDS in the world of work?- do
these policies work, are they funded, are they successful or
not?
2. Has NACP/PACP done any mapping on the prevalence of HIV/
AIDS cases in provinces and concentration in particular economic
segments?
3. Has there been any research conducted in Pakistan to assess the
knowledge and understanding of employers towards the problems
of PLHIV and the support required by PLHIV at the workplace?
[look for any surveillance data in the transport sector]
4. Pakistan has more than 70 laws relating to labour issues. To what
extent these laws are sensitive towards HIV and AIDS at
workplace?
5. Are there any HIV workplace policies or programme/s? Can you
please share the details?
6. Has HIV workplace policies/ programs ever been raised as an
issue by civil society or international groups as part of policy
(programme) discussions?
7. What are the most important gaps that exist in the present HIV
workplace policies and programs at national/provincial and at
enterprise level?
8. Will you like to suggest any stakeholder that should be included in
this study? Why?
Ministry of
9. Do you think workers’ participation and engagement in the design,
Oversees
implementation and evaluation of national and workplace programs
Pakistanis
is recognized? What are the ways and means to ensure that?
and HRD
10. What is ministry’s take on the persons that were deported from
other countries due to their positive HIV status?
11. What is the status of testing of migrant workers, both domestic and
those going abroad.
12. Has HIV workplace policies/ programs ever been raised as an
issue by civil society or international groups as part of policy
(programme) discussions?
Pakistan
13. How does Pakistan Bait-ul-mal address the needs of the PLHIV?
Bait-ul- Mal
Do the eligibility criteria specifically include PLHIV, their children
and spouses?
14. Can you share any details (number, types) of the PLHIV who
63
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
EOBI
SESSI/
PESSI
Skill
Developme
nt Council
Punjab
/Sindh
Technical
&
Vocational
Authority
(TEVTA)
Punjab
Vocational
Training
council
PVTC
Departmen
ts of labour
received assistance from Baitulmal?
15. Has EOBI any specific reference to the benefits for the PLHIV?
16. Probe: invalidity pension (in case of permanent disability);
survivor's pension (in case an insured person is expired).
Do employees social security institutes have specific provisions for
PLHIV?
17. How discrimination against workers or their dependants based on
real or perceived HIV status in access to social security systems
and occupational insurance schemes, or in relation to benefits
under such schemes, including for health care and disability, and
death and survivors’ benefits are checked?
18. How does the organization ensure the effective confidentiality of
personal data, including medical data in general and for PLHIV in
particular?
19. What is the mandate of your organisation?
20. What are the provisions for PLHIV in your organization?
a. Does policy categorically refer to PLHIV?
b. Are there any specific initiatives for the PLHIV?
c. Can you share the details of PLHIV beneficiaries?
21. Are there any employment assistance activities? Do any HIV
workplace policy (programme) currently include to help workers to
improve their livelihood?
Where does the Province stand vis a vis compliance to the ILO’s
“Recommendation concerning HIV and AIDS and the World of Work, 2010
(No. 200)”
Do you have a Code of Good Practice on Key Aspects of HIV and AIDS
and Employment, as some other countries have?
22. If no, why? Are there any plans to develop?
23. If yes, when and how was that developed? what is the status of its
implementation?
Are there any HIV workplace Programme/s? Can you please share the
details?
Is there a labour administration/labour inspectors inspection check-list? ,
Does the checklist in accordance with ILO’s
“Recommendation
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
concerning HIV and AIDS and the World of Work, 2010 (No. 200)”,
includes HIV?
Do you think workers’ participation and engagement in the design,
implementation and evaluation of national and workplace programs is
recognized?
24. If yes, what are the ways and means to ensure that?
25. If no, why?
26. To what extent the national labour policies have been
provincialized after 18th amendment? What these policies
constitute for PLHIV?
What is the most important role of the government with regard to HIV
workplace policies/programs?
What is the role of the private sector in HIV workplace policies, programs
in the country?
What is the role of the civil society sector in HIV workplace policies,
program in the country?
2,3 Employer/Employers Group and Workers
Chamber
1- Have you ever heard of ILO’s “Recommendation concerning HIV
of
and AIDS and the World of Work, 2010 (No. 200)”- If yes, would
Commerce
you like to reflect on it?
and
a. To what extent each of the 10-11 points in
Industries
Recommendations 200 are being followed*
(Islamabad
and
2- What is the role of trade unions (or employer’s organizations) in
Lahore)
HIV prevention?
Employer
Federation
of Pakistan
(EFP):
Karachi
-Pakistan
Workers
Federation
(Rawalpind
i)
- Trade
Union
3- What is the role of trade union (or employer’s organization) in
protecting the rights of workers or their families who are HIV
infected)
4- What is the role of trade unions in providing access to social
protection including social health insurance and social support? (for
example, inclusion of social protection measures in collective
bargaining negotiations and agreements?)
5- Are you aware of any cases where workers’ rights have been
violated because of their HIV status? Did your trade-unions (or
employer’s organization) participate in solving the problem in such
cases? If so, in what way? If not, why not?
6- Does your trade union or employer’s organization find ways to
65
HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Workers of
shops and
factories
(from
medium to
large size)
assist PLHIV workers to get employment? Or keep them
employed? If so, how or what are the ways your organization
helped PLHIV workers?
Do any specific HIV and AIDS workplace policies exist in your
establishments? Why?
If answer is yes probe the following:
1.1 What areas do these policies cover?
1.1.1 Risk reduction and prevention of HIV and AIDS
1.1.2 Support to workers and families affected by HIV and
AIDS - Support in terms of finances, flexibility, medical
cover etc?
1.1.3 The protection of the human rights & dignity of those
affected by HIV and AIDS
1.1.4 Promotion of equality and non-discrimination between
individuals with HIV infections and those without, and
between HIV and AIDS and other comparable
health/medical conditions
1.2 PLHIV: How much supportive are the policies?
Probe: provisions, rules, standards and implementation
mechanisms
1.3 PLHIV: What hindrances or barriers the policies pose?
Probe: provisions, rules, standards and implementation
mechanisms
1.4 Have policies been translated into provisions, rules, standards
and implementation mechanisms?
1.5 Has the organization made specific budget allocations for
implementation of this policy?
1.6 How the policies/standards are monitored? Is there any
compliance of standards? Why?
1.7 What services or benefits would you add or remove from the
HIV workplace policies programs to make it more efficient and
more equitable?
1.8 What are the most important gaps that exist in the present HIV
workplace policies and programs at national/provincial and at
enterprise level?
If answer is no, probe the following:
1- Have you ever been approached by any government/non
government organisation in the context of HIV and AIDS in
workplace? If yes,
a. What did they offer?
i. Public Private Partnership?
ii. Technical assistance?
iii. Services?
iv. Facilitate equal access to care, treatment and support;
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
social protection; counselling and health education;
referral for PLHIV?
v. Projects/ HIV workplace Programme/s?
vi. corporate social responsibility policy and
programme/actions
b. What were their expectations from you?
2- Scenario: What does you experience/professional judgment say
could be the response of the employers to:
a. A candidate (M/F/ Hijra/transgender) for an employment who
has HIV
b. A (M/F/ Hijra/transgender) worker with HIV
c. Job related promotion/career development of (M/F/
Hijra/transgender) worker with HIV
3- Is there any formal Policy AND Practice on:
a. HIV and AIDS awareness and prevention training to the
employees [if yes, how many employees trained during last
24 months?]
b. Sexual Harassment awareness and prevention training [if
yes, how many employees trained during last 24 months?]
c. Establishment of Employee Assistance Programs (for AIDS/
Sexual Harassment) [if yes, details]
d. Maternity care
e. Inclusion of the “differently able” individual
f. Inclusion of the minority groups
g. Orphans, HIV and AIDS -infected children, HIV and AIDS
affected children, and children who are vulnerable to
commercial and sexual exploitation.
In your view:
- What could be the problems of PLHIV in the workplace?
- What support PLHIV may require at the workplace?
- What policies are required to address these issues? What kind of
support will be required for the development and implementation of
the policies?
Do you have any idea of/reference to the number of PLHIV working in
your establishment?
- What in your view are the ways and means to make workplaces
friendlier for PLHIV
- Is there a staff/Employees union to raise staff voice? How much
that union is aware of the workplace issues of PLHIV?
4- NGO (PLHIV)
Association What is the role and responsibility of your organization in regard to
of PLHIV
PLHIV?
(Islamabad
1. Prevention (e.g. education/ information campaign, voluntary
Secretariat)
counseling and testing, condom distribution)?
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
2. Provision of medication (e.g. ART, medication for opportunistic
infections)? Follow-up for treatment adherence?
3. Support for PLHIV (e.g. peer support, financial assistance, in kind
support, home care, food assistance, home care, employment
assistance, such as employable skills training or assistance in job
seeking)?
4. Other activities related to referral of social services for PLHIV?
5. Other activities related to medical aspects of HIV or AIDS?
6. Who is the main target/audience of your organization?
7. How is the community / and or PLHIV employees involved?
8. Do you report the outcomes/progress of your activities to anyone?
If so, to whom?
In your opinion:
1. Are there any activities/initiatives that you would like to carry out
with PLHIV but have not been able to do so? If so, what are those
activities/initiatives? Why haven’t you been able to carry them out?
2. Has the work of your organization affected how people of different
sexual orientation are treated? If so, how?
3. What is your experience with government and local authorities’
response to the social protection needs of people with HIV?
4. In what way, if any, does your organization interact with the
government?
5. What other organizations or institutions in your community provide
HIV social protection related services? What serviced do they
provide? (Probe: treatment, prevention, care & support, impact
mitigation and networking & advocacy; health insurances, cash
transfers, food aid )
6. In what way, if any, does your organization interact with other
organizations working with people with and affected by HIV?
(Probe for other NGOs, private sector, government agencies)
Has HIV workplace policies, ( programs) ever been raised as an issue by
national organisations (NGOs, social movements, etc) or international
groups as part of policy (programme) discussions?
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HIV and AIDS in workplaces in Pakistan Ref. No TA-RST/PK/006/2013
Do you think there is discrimination against or stigmatization of workers on
the grounds of real or perceived HIV status:
Probe:
Entry level
- Jobseekers and job applicants;
- In training, including interns and apprentices
- volunteers;
Performance level:
- retention in work
Exit level:
- laid-off and suspended workers
- Retired
Are there any NGOs who support PLHIV or key populations for
employment, livelihood or medical services access.
Are there any HIV workplace Programme/s? Can you please share the
details?
I am grateful for sharing your insights! If you have any question, I will be happy to
respond.
Thank you again
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Annex 2: List of respondents
1. Mr. Raja Faiz ul Hasan Faiz, Human Rights Advisor, Ministry of Oversees
Pakistanis and Human Resource Development
2. Mr. Javed Qadeer Qureshi, Director Skill Development Council, Islamabad
3. Mr. Zahoor Awan; General Secretary Pakistan Workers Federation, Islamabad
4. Dr. Soifia Siddiqui, Senior Program Officer, National AIDS Control Program,
Islamabad
5. Mr. Asghar Ilyas Satti, National Coordinator; Association of People living with HIV
6. Mr. Tahir Manzoor, Director, Centre for improvement of working condition and
environment (CIWCE), Lahore
7. Mr. Waheed Ali, Deputy Director Social Security (PESSI), Lahore
8. Mian Rizwan Akbar, Assistant Social Security Officer, (PESSI), Lahore
9. Syed Hamid Arshad, Lecturer Industrial Relations Institute (IRI), Labour
Department, Lahore
10. Mr. Mohammad Ashagr Raja, Deputy Manager Career Guidance and Job
placement, Punjab Vocational Training Council, Lahore
11. Rao Nasir Mehmood, Safety Engineer, Centre for improvement of working
condition and environment (CIWCE)
12. Dr. Tayaba Rasheed, Treatment Coordinator, Punjab AIDS Control Program
13. Dr. Muhammad Ahmed Kazi Provincial Program Manager, Sindh Aids Control
Program
14. Mr. Gulfam Nabi Memon, Joint Director, Labour Department, Karachi
15. Mr. Faheem, Assistant Director, Labour Department, Karachi
16. Syed Saoud Alam, OIC Employer Federation of Pakistan, Karachi
17. Mr. Atif Shahzad, Admin Manager, Shell Lube Oil Pakistan, , Karachi
18. Ms. Zehra, General Secretary, Home Based Workers Federation, Karachi
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19. Shehla Rzwan, Vice president, Home Based Workers Federation, Karachi
20. Mr. Muhammad Yousaf, Director Employees Old age Benefit Institute, Islamabad
21. Mr. Ghulam Rasool, Manager HR Islamabad Electrical Supply Company
(IESCO)
22. Mr. Mirza Aleem Beg, President, Gender and RH Forum; HIV Prevention
Program for FSW
23. Mr. Javed Iqbal, Regional Secretary, Pakistan WAPDA Hydro Electric Worker
Union, IESCO, Islamabad
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