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Breaking the HIV taboo

25 Oct 19 Temporary working, living away from home, poor diets and stress can all take their toll on workers’ physical and mental health. But should the sector also include HIV testing in workplace health screenings? Emma Crates reports on a groundbreaking pilot

It is estimated that 101,600 people are living with human immunodeficiency virus (HIV) in the UK. While a substantial majority – 92% – have been diagnosed, Public Health England estimates that one in 12 sufferers is unaware that they are carrying the virus. This puts them at risk of passing it on, mainly through sexual contact. 

You might be wondering what all this has to do with construction, but the sector has been identified as having proportionately more workers at risk of infection due to their lifestyles and background. As ever, it’s all down to demographics: large numbers of migrant labourers come from countries with high prevalence of HIV; many low-wage manual workers that are more likely to be misinformed or have incorrect knowledge about health; an industry dominated by men who could be living far from home and potentially indulging in more risky sexual behaviours. 

Then there is the problem of reaching temporary workers who tend to move around from job to job without easy access to healthcare facilities. 

If these factors build a compelling argument for HIV testing, Dr Holly Blake, associate professor of behavioural science at the University of Nottingham’s Faculty of Medicine & Health Sciences, points out that construction workers are also at risk of a range of more commonly recognised health problems.

Having an HIV infection is no longer a death sentence says Dr Holly Blake
Having an HIV infection is no longer a death sentence says Dr Holly Blake

“Construction and transport workers have the highest prevalence of cardiovascular risk, even when you control for age and gender,” she says. Health studies have found that the sector also has a high prevalence of smoking, alcohol and substance abuse, physical inactivity, poor diet, obesity and musculoskeletal disorders.

Blake points out that construction workers that are overweight have poorer ‘work-ability’ – a term used to describe someone’s capacity to remain employed in their current job, given its demands on their physical health. Obesity can make musculoskeletal disorders and cardiovascular problems worse. Construction workers are more likely to receive disability benefits as a result of such problems.

Then there is the well-publicised issue of poor mental health in the sector, with much higher rates of suicide than in other occupational groups. 

“A high proportion of male workers, younger men in particular, are less likely to seek help for physical and, particularly, for mental health problems,” Blake says. “This is important because mental health directly impacts on other behaviours and lifestyle choices.”

She adds: “We know that health behaviours don’t occur in isolation. They are all connected, clustered together and often interlinked.” 

Blake is targeting construction in an 18-month pilot project run by the University of Nottingham to monitor the effectiveness of health interventions in the workplace. Test@Work is open to any size of company, and will be offered to both office and site workers. Blake is hoping to capture workers in poorly-resourced SMEs but also wants to work with larger firms to deepen their existing health offerings.

“A lot of initiatives focus on diet and physical activity, and a few core initiatives, but sexual health is very rarely included,” she says.

The pilot is currently being offered to companies and sites in Rutland and Leicestershire and the cities of Nottingham and Leicester. A team including nurses, health psychologists, medics and health promotion specialists will come to a location and offer a menu of confidential health checks, covering weight, body mass index, blood pressure, diabetes risk and musculoskeletal health. The service is free and participating companies just need to provide a private room for testing and advice.

Blake says that the HIV test is embedded in the list of options to normalise it and remove the stigma that some people feel around the subject. 

If workers are reluctant to take the HIV test, they are free to focus on other aspects of their health. In this softly-softly approach, they will also be given educational materials about HIV, and can sign up to a text messaging service where they find out about other opportunities for getting tested at other facilities at a later date.

Blake says that one of the aims of the pilot is to monitor how workers react to the HIV offer.

“We’re looking at the reach, uptake and demographic. Our overall aim is to increase access to HIV testing in the workplace setting, to increase knowledge of HIV and raise awareness of the importance of early diagnosis,” she adds.

Catching the problem early can have significant impact on outcomes. According to official statistics, 43% of adults carrying HIV in the UK were diagnosed at a very late stage. People diagnosed late have a tenfold risk of dying within the first year of diagnosis.

“Having an HIV infection is no longer a death sentence. If you diagnose early and get people on effective treatment, they can live a normal life into older age,” Blake says.

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But there is no denying that HIV remains a sensitive issue. A Public Health England study of other sectors found that 90% of employees felt that it was acceptable to include HIV in health checks. But some employers were hesitant to participate in the pilots, concerned about how to handle the situation if an employee disclosed an adverse test result. 

As a result, the Test@Work pilot has developed an online digital toolkit for employers, offering guidance on health promotion and how to address the subject with staff.

Blake emphasises that all testing will be kept confidential with results sent directly to individuals, along with tailored advice. She adds that the pilot is also not storing information about workers.

So far, the pilot has completed testing on one small construction site. Blake says that uptake of the service was “reasonable” and the team had positive feedback. She adds: “More and more organisations are beginning to accept that workplace wellbeing is a corporate social responsibility. There’s a strong business case for doing it. If employers look after the health and wellbeing of their staff, it can impact on things important to the organisation such as sick leave, turnover, recruitment, job satisfaction and morale.” 

The Test@Work pilot is running from August 2019 to early spring 2020 and is funded by American biotechnology research company Gilead Sciences. For more information or to take part in the pilot, contact project researcher Sarah Somerset.

What do employers and employees think of HIV testing?
In a previous pilot in other sectors, the Healthy Hub Roadshow, researchers delivered general health screening including HIV testing, with tailored advice to 776 employees at 20 events hosted by 11 different workplaces. 
On evaluation, all employers were positive to the idea of introducing workplace HIV testing, but the majority thought it important that such tests should be embedded within a general health check. They recognised the importance of having the support of senior management. 
Companies raised few concerns about the principle of testing, but were worried about budgets for health promotion, and how much time it would take to get workers tested during the working day.
The 776 employees that took part in the pilot represented 50 countries (51% male; 30% migrant workers). Just over half of attendees chose to take the HIV test, and 75% were first-time testers. 
Almost all employees surveyed thought HIV testing was an acceptable element of workplace health checks; 60% subscribed to a phone text message service about HIV testing. This led to some workers getting HIV tested independently outside of the pilot.

Hiv and aids

HIV – or the human immunodeficiency virus - damages the cells in the immune system, weakening a sufferer’s ability to fight everyday infections and disease.

If the immune system is severely damaged by the HIV virus, it will struggle to fight off a number of potentially life-threatening infections and illnesses, and AIDS (acquired immune deficiency syndrome) can develop. 

AIDS cannot be transmitted from one person to another but the HIV virus can.

There is no cure for HIV or AIDS, but advances in medical treatment can prolong life into old age.

In 2017 it was estimated that there were 101,600 people living with HIV in the UK. 

• 92% of those living with HIV in the UK have been diagnosed.

• 98% of those that have been diagnosed are receiving HIV treatment. 

• 97% of those being treated have an undetectable ‘viral load’. This means that they are highly unlikely to pass on the virus.

• More than a third of people (39%) receiving specialist HIV care are now aged 50 or over compared to fewer than one in five in 2007.

• An estimated 7,800 people are undiagnosed and potentially unaware that they are carrying the virus.

This article was first published in the October 2019 issue of The Construction Index magazine(magazine published online, 25th of each month.) 

UK readers can have their own copy of the magazine, in real paper, posted through their letterbox each month by taking out an annual subscription for just £50 a year. Click for details.

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