way to block this process may benefit not only those with AIDS, but a much broader population as well. How does the study of HIV/AIDS help in the treatment of other diseases? HIV/AIDS therapies may be critical in the treatment of other diseases. For example, lamivudine and adefovir can help patients with hepatitis B who have no other options. In addition, protease inhibitors are being developed to combat infections, such as hepatitis C, influenza, and most recently, SARS is based on a concept similar to that of an anti-HIV entry inhibitor called enfuvirtide, or fuzeon, which was approved for use in 2003. A modified version of another AIDS drug called cidofovir, used to treat CMV eye infections in AIDS, is now being developed to treat and possibly prevent smallpox infection. AIDS drugs have been used to eliminate diseases in plants. Two of them, adefoir and tenofovir, can eradicate the banana streak virus, which infects a substantial proportion of the world’s banana harvest. Since HIV is a virus that attacks the immune system, what does AIDS research teach us about autoimmune disorders or immune-based therapies for other diseases? HIV-positive people often develop autoimmune problems, such as psoriasis or blood abnormalities associated with lupus. For these autoimmune diseases, treatments developed for AIDS should also apply when the same conditions occur spontaneously. Certain hormones that modify the function of immune cells are now being tested as treatments for AIDS. Some of the most recent include IL-12 and TNF ( tumor necrosis factor)-alpha inhibitors, which may also boost the immune systems of cancer patients. Specific legal boundaries of reasonable accommodation Employers and employees trying to determine appropriate accommodations should be aware of the specific legal boundaries of “reasonable accommodation.” Many of the employers profiled in these case studies provided assistance and accommodations that went above and beyond what the law would require. As a general rule of thumb, given that the ADA governs many of the actions in this area, employers should consider the ADA implications of any decisions involving an employee with HIV infection or AIDS. This includes any decisions about disclosing an employee’s HIV status. The ADA has strict rules about maintaining confidentiality of such information, and employers should ensure that they do not violate these rules. As awareness of the ADA and its employment provisions increases, more and more employees are stepping forward to disclose their HIV status to their employers, managers, coworkers, and friends. Disclosure often takes courage and is unlikely to happen without an environment in which the disclosure will be met with cooperation and support. Because of the stigma still associated with HIV, this disclosure — especially in the workplace setting — too often does not occur until a crisis forces the issue out into the open. By this time an otherwise manageable situation can become a crisis, and everyone loses — the HIV-positive employee, the employer, the manager, coworkers, and the worksite. Many employers believe that encouraging disclosure may not be desirable because it creates certain obligations that might not have otherwise existed. An environment that discourages or is hostile to disclosure, however, may present altogether different problems, legal and otherwise, just as a company experiences similar problems when it does not encourage employees with harassment complaints to come forward. Most human resource professionals agree that providing an environment where complaints or situations (such as the existence of a disability and the need for an accommodation) can be discussed and remedied without the fear of retaliation is a sound policy for both overall productivity and legal reasons.
activity of these hormones is a strategy first used experimentally to treat kaposi’s sarcoma, a cancer found in patients with HIV/ AIDS. Now it is also being tested in bladder, vulvar, and breast cancers and has shown some exciting recent success in treating colon cancer. In addition, small proteins and drugs that can block the growth of new blood vessels ( which is critical to the survival of tumor cells) were originally developed to treat Kaposi’s sarcoma, but are now being tested in many other cancers as well. Are other treatments for major diseases likely to emerge from AIDS research any time soon? Absolutely, AIDS research is helping to improve treatments for Alzheimer’s disease and heart disease. Alzheimer’s disease is a progressive, global dementia whose cause is unknown. Profound dementia is commonly seen in the late stages of AIDS as well, so drugs that are successful in lessening nerve damage and dementia in AIDS, for example, may benefit patients with Alzheimer’s. The characteristic plaques that fill the brain cells of an Alzheimer’s patient are formed partly by enzymes called proteases, so scientists are now investigating the use if protease inhibitors to treat this debilitating dementia. Many HIV positive children and adults also suffer heart attacks and strokes because HIV appears to affect small blood vessels in the heart and the brain, which makes them vulnerable to spasm, blood clots, and early atherosclerosis. The small arteries of a two-year-old child with AIDS often resemble those of a 50 -year-old man. In HIV infection, a process of programmed cell death injures the cells that line the small blood vessels of the heart. Similar damage occurs in HIV-negative people with atherosclerosis. Discovering a Workplace accommodations for employees with HIV/AIDS People living with HIV infection and AIDS can be productive workers for many years. Even in the best of circumstances, the challenges associated with HIV can be significant. In addition to complex medical and legal concerns, AIDS raises difficult emotional issues such as fear, stigma, death, and dying. HIV/AIDS is an increasingly important issue in workplaces throughout the country. Two-thirds of large businesses and one in 10 small businesses have already encountered an employee with HIV infection or AIDS. More than 75 percent of all AIDS cases occur among people between the ages of 25 and 44 — the same group comprising the bulk of the U.S. workforce. Employment provisions under the Americans with Disabilities Act of 1990 The Americans with Disabilities Act (ADA) prohibits discrimination against all people with disabilities or perceived disabilities, including people with HIV infection and AIDS. A detailed explanation of the ADA is beyond the scope of this publication but can be found at www.ada.gov Similar legal requirements have been in place for employers covered by the Rehabilitation Act and by certain State and municipal ordinances covering disability discrimination in employment. The employment provisions of the ADA also require employers to provide “reasonable accommodations” for employees with disabilities. Reasonable accommodations are changes or adjustments in the job or work environment that permit individuals with disabilities to perform the essential functions of a job. The term “reasonable accommodation” is a legal term that refers to certain changes and adjustments in the workplace. An employer may choose to go beyond the ADA and provide an accommodation that would not be required under the law. For example, removing an essential function from an employee’s job description and providing HIV education for all employees are not examples of reasonable accommodations. Similarly, while allowing an employee to work part-time is a type of reasonable accommodation, continuing to pay that employee a full-time salary is not required by the law. The ADA establishes a baseline — a floor, not a ceiling.
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