Task Force meeting on HIV/AIDS in the UN Workplace

(Teleconference, UN HQ, New York, 12 February 2002)

UNAIDS was requested to prepare an update on the agencies’ activities in connection with HIV/AIDS in the workplace as well as recommendations for further action. The draft paper included information on policy, access to care and treatment (ACT), medical insurance, prevention and training, and coordination and collaboration.

UNAIDS stated that the purpose of this draft paper was:

1. to ensure that organizations/agencies continue to give their commitment to reinforcing UN policy through support and the monitoring and evaluation of HIV/AIDS activities. (It was also pointed out that the guidance notes would need to be evaluated.)
2. to ensure that HIV/AIDS continues to be a standing item in all UN meetings.

3. to secure adequate resources for the effective implementation of the policy (e.g. financial support for medical services, an inter-agency post in the ACC secretariat, and focal points at country, regional and global levels.)

Concerns were expressed regarding the content of the activities, as presented in the table annexed to this report. It was stated that the table did not fully reflect all the hard work done by all the agencies so far and that this should be recognized in the paper.

It was decided that the agencies would be given the opportunity to present comments on the table of actions by 14 February. It was also confirmed that, in the final report, all agencies would be represented in the document which is to be presented at the IAAG in April 2002 (to be chaired by the ILO).

The UN pointed out that the work of the hotline, which included counselling, had been carried out by volunteers previously. Now it is a full time position in the staff counsellor’s office.

UNAIDS gave a brief description of the information contained in the CD-ROM and mentioned that some 600 copies had recently been distributed to all Heads of Agencies, HR Departments, ICTs and CPAs. UNAIDS added that it would like to have feedback on the user-friendliness of this tool.

UNAIDS also stated that a strong recommendation should be made to the organizations to ensure that the information contained in the CD-ROM is posted on their respective intranets. It was also felt by many that the contents of the CD-ROM should be posted on the internet sites as well.

UNAIDS suggested the possibility of developing an e-learning tool around the CD-ROM (e.g. which would include guidance notes to resident coordinators and instructions on mapping and implementing key steps at the country level). The idea of developing an e-learning tool was generally supported and UNAIDS confirmed that its secretariat will develop a concept paper and budget to proceed with this initiative. It was added that this could possibly be completed within the year, with an outline available by the beginning of April. UNHCR stated that it is in a position to provide funding towards this project.

It was pointed out that DPKO had requested 10,000 copies of the UNAIDS booklet. There followed a brief discussion regarding an outstanding invoice with DPKO and the printing cost of the UNAIDS booklet, which is included in the CD-ROM. It was suggested that it might be cheaper to print at the point of delivery. The Medical Service would enquire about this upon receipt of the CD-ROM in New York.

Regarding training activities, UNAIDS stated that two additional training projects are planned in 2002 namely the development, together with UNICEF, of a learning strategy on HIV/AIDS for the organizations and the development of a module on HIV/AIDS by the UN Staff College and CCA/UNGASS on how to mainstream the issue of HIV/AIDS.

UNHCR confirmed that it received daily enquiries regarding the PEP kits, treatment, medical evacuation, etc. which indicates that the demand for information is very real.

UNAIDS pointed to the financial and administrative concerns regarding the PEP kits. One problem was that UNAIDS had still not received any payment from DPKO for the kits. In this respect, the UN Medical service will follow-up with DPKO on the status of this payment

There followed a discussion on ways in which a commitment by the organizations to the PEP initiative (both in principle and financially) could be confirmed. UNICEF proposed that each organization confirm its commitment to this initiative by letter. UNDP proposed that a separate meeting be convened to discuss the PEP kits. UNICEF supported this proposal and added that the distribution of PEP kits was becoming burdensome and that it needs help with the process. UNDP supported this statement and added that other organizations should contribute to the distribution of the kits or at least pay overtime for this activity and that this should be charged to the agencies. UNDP could pay overtime or pay temporary staff for distribution purposes.

UNICEF confirmed that it would convene a meeting on PEP kits on 21 March, to fine-tune administrative issues, including distribution expenses. UNICEF also stated that the Secretary of the CEB would be contacted with a proposal regarding the distribution charges.

UNAIDS stated that the data which had been collected by the CEB Secretariat in July 2001 for security cost arrangements would be used as a basis for calculating cost-sharing among the organizations for the PEP kits. Associated administrative costs would also be factored in.

It was agreed that some exchange of correspondence on this subject would be necessary to record the organizations’ commitment to this project.

UNAIDS stated that, at the last IAAG meeting, a proposal for a framework for access to care at the local level, as well as key steps in this framework, had been drafted. A rough description of the project had been put together with WHO. UNAIDS had identified 10 countries where there is a large UN population, a high prevalence of HIV/AIDS, and an access-to-care programme. The countries identified were Burkina Faso, Costa Rica, Ethiopia, India, the Ivory Coast, Nigeria, Rwanda, Senegal, Uganda and Zambia.

A visit would be made to Rwanda and Uganda during the last week of February to develop the next steps for this framework, evaluate the existing infrastructure, and document best practices. UNAIDS confirmed that this programme would be assessed country by country, on the basis of visiting two countries in one week, and that agencies would be kept fully in the picture. The visiting team would also look at which issues need to be taken up with the staff and which need to be addressed by the management. In any case, a clearer idea of the form and time frame for reporting would be known after the first mission in March 2002.

It was reported that this programme was doing very well in Kigali, and the staff from New York would be willing to join the team if necessary. It was also confirmed that the report on the mapping of local resources in Ivory Coast would be sent to the Geneva Medical Service.

4. Other business

It was stressed that using the HR network was strategically important to remind HR directors of the different issues involved in the "HIV/AIDS in the UN workplace policy". This network might also be reminded of the need to post the information contained in the CD-ROM on the organizations’ websites and of the need for feedback on various issues. It was also suggested that the issue of cost sharing for the distribution and cost of PEP kits should be raised at the next meeting of the network, which will be held in Rome from 3 to 5 April 2002.

Members of the Task Force were requested to provide input for a paper that would be prepared by UNAIDS on behalf of the Task Force for the forthcoming meeting on 3-5 April.

FICSA asked whether any progress had been made regarding the harmonization of medical insurance schemes, particularly regarding coverage for local staff.

It was stated that, as the discriminatory ceilings applied at the field level in the past had been adjusted, and as the cost of medications had decreased, the issue of adequate medical insurance coverage for those with HIV/AIDS was no longer a major problem. However, it was noted that there are currently more than 18 different medical plans across the system and that the harmonization of medical insurance schemes is also a political issue as it is linked to the cost of after-service care.

It was also stated that the CEB had hired a consultant to develop a framework for a study of the various health insurance schemes and that this study had been sent to the CEB Secretariat which is presently considering it.

UNAIDS confirmed that with the decreased cost of medication, all organizations medical plans deal on a case-by-case basis. They report that insurance is not an issue. Not reporting on the issue was more problematic as is the use of various contractual arrangements.

UNAIDS highlighted the successful initiative of the country team in Uganda which managed to negotiate a contract for private medical insurance for SSA holders which covers HIV/AIDS. These kinds of initiatives should be monitored.

FICSA asked about the Healthnet project and whether funding had yet been committed in light of the Deputy Secretary-General's recent involvement with this project.

It was stated that the Deputy Secretary-General felt that the organizations should finance the Healthnet and not institutions like the UN Foundation. Regrettably, no resources have so far been earmarked for this project.

On the question of whether troops should be tested before being sent to peacekeeping missions, it was reported that the study carried out on this subject was commendable. The report concluded that it was no mandatory for peacekeeping forces to undergo testing. UNAIDS confirmed that it would send a copy of this report to all members of the Taskforce. It was also recommended by the New York Medical that this report be shared with all agencies.

The report concluded that it was not mandatory for peacekeeping forces to undergo testing. UNAIDS will send a copy of this report to all members of the Taskforce.

Chair: Dr. Pascale Gilbert-Miguet, WHO

Geneva: Representative from Joint Medical Service, Geneva

Devendri Sandrasagren, UNAIDS

New York: Dr. Narula and Dr. Pasquier-Castro, Medical Service, UN NY

Marta Helena Lopez and Elizabeth Velander, UNDP

Mercedes Gervilla, UNICEF

Anne Marie Pinou, FICSA

WHO pointed out that, so far, the total cost for the PEP kits is $5,815. It was confirmed that the kits are now ready and these are expected to arrive at UNICEF’s office in Geneva on 26 March.

WHO asked where the funds for the financing of the PEP kits should be held. It was initially suggested that these be held by the medical services, but the Medical Service, UN NY did not think it appropriate that the medical services be involved in financial matters. UNDP suggested the funds be held by WHO or by UNICEF’s office in Geneva. UNDP could not do so as it has a very small office in Geneva. WHO then suggested that its office would be a better option than the Joint Medical Services. It was decided that UNICEF and WHO offices in Geneva would be requested to handle the funds for the PEP kits.

To determine the cost-sharing for the PEP kits, the WHO pointed out that a breakdown of the number of staff per agency is needed, as well as further information on the number of staff involved in peacekeeping operations. The figure it had at present indicated that there are only 355 UN staff members. The Medical Service, UN NY confirmed that, in DPKO, there are approximately 10,000 civilian staff, 8-10,000 civilian police and military observers and a huge number of troops, bringing the total number to more than 40,000. It was added that where troops are stationed, there are also military medical facilities.

UNDP asked whether non-staff members should also be counted, as in the past only the numbers of regular staff members had been considered due to the fact that the numbers relating to staff in peacekeeping missions fluctuate. UNDP also took the view that the same numbers as those used when determining the cost-sharing formula for security should be used in this case, i.e. based on the 18 July 2001 headcount. This would mean counting the total number of regular staff in the UN (without distinguishing DPKO separately). It was agreed that this would be the most sensible approach but that the Medical Service, UN NY would double check on the numbers of UN staff.

The Medical Service UN NY suggested that someone from DPKO should also attend the task force meetings on HIV/AIDS. This was supported by UNDP.

WHO pointed out that it is a lot of work for UNICEF to carry out all the distribution of the PEP kits and asked whether any cost sharing formula should not include extra help for this purpose. UNDP preferred using temporary agency staff or overtime to handle this and suggested that UNICEF come up with a proposal.

UNICEF stated that a note had been sent to all officials regarding a list of isolated locations which had been cleared by UNHCR and UNICEF. UNICEF now wished to know whether this list had been finalized. WHO confirmed that this list had been finalized. However, UNDP and the Medical Service UN NY indicated that they had not yet seen this list and asked the Joint Medical Services to provide this. The list also contains information on who is responsible for each location.

WHO confirmed that it would consult with each agency regarding the list of isolated locations.

WHO suggested that a note be sent to each Resident Co-ordinator pointing out that the PEP kits will be renewed (i.e. that we are re-stocking for next year - for capital cities) and that the kits are still valid for one month after the expiry date.

UNDP suggested that the note also ask whether the Resident Co-ordinators agree with the list of isolated locations and whether this list is adequate.

UNICEF asked whether it would be possible for UNDP to send a reminder to the Resident Representatives pointing out their role with respect to the PEP kits protocol. It was recognized that some representatives are aware of the protocol, while others are not. WHO felt it would be a good idea to attach to the note a copy of the emergency protocol which included such details as where the kits are located.

UNDP concluded that one message would be sent to the Resident Co-ordinator which would cover all the aspects mentioned. However, it requested that the Joint Medical Service provide it with a copy of the protocol circular which it had not yet received. Similarly, the Medical Services UN NY had also not received this circular. UNDP also wished to have clarification as to whether the Resident Co-ordinator is still responsible for checking [the need for PEP kits] with other agencies located outside the capital city or whether this is the responsibility of the designated official in those locations.

WHO also questioned whether a note should not also be sent to the Field Security Officers in those locations. UNDP pointed out that a distinction needs to be made between those responsible for the custody of the PEP kits with UNHCR, WHO and UNICEF and the specific agency designated for the distribution of the kits in each location. WHO agreed with this point

WHO pointed out that as this is a specialized item, more in-depth technical research is needed to assess whether another medication should be added to this type of therapy. It was mentioned that the CDC still use dual therapy, even in cases where, for example, health workers may have accidental cuts.

The Medical Service UN NY confirmed that in cases where exposure to HIV/AIDS is higher, triple therapy is used. It was pointed out, however, that there’s a need to look at the third component of the therapy because of the side effects. 16% of those on triple therapy do not continue with it because of the adverse side effects. Unfortunately, there is not enough data on this issue as most of the research which has been carried out relates to occupational hazards. It was also pointed out that less than 60% of those receiving the dual therapy complete the four week course of treatment because of the side effects and that, among rape victims, only one sixth have been known to complete the treatment. The dangers of adding another medication were also highlighted and it was stated that further information on the use of this therapy is available on the CDC website: CDC.gov.

WHO asked whether, in certain settings, PEP kits could not be provided for locally. Reference was made to some organizations based in Kigali, Rwanda where the local physician might be made responsible for the renewal of the PEP kits, on a local basis. The Medical Service UN NY stated that as only 3 kits are administered per capital, it is unlikely that a good price could be negotiated for obtaining the kits locally. Concern was also expressed about the need for uniform standards to be maintained as this also makes the administration of PEP kits easier to monitor. The Medical Service UN NY felt strongly that the administration of PEP kits should be centrally organized for it to be consistent.

WHO confirmed that 500 PEP kits are reserved for all the capital cities and 500 are reserved for other field locations. The Medical Service UN NY approved this figure.

WHO pointed out that the UNHCR office in Kampala, Uganda had indicated that the need assessed by UNHCR, HQ did not correspond to the real need in certain locations. The Medical Service UN NY stated that the UN Resident Co-ordinators were asked to assess the local needs but that this had not been done.

WHO also pointed out that UNHCR had requested a stock of approximately 150 PEP kits to use in emergency situations, e.g. situations where UNHCR suddenly need to send staff to certain locations. The Medical Service UN NY confirmed that security issues and HIV/AIDS issues were very linked. UNDP stated that it would create a lot of problems to comply with this request but that we should agree to have a strict limited number of emergency kits.

The Medical Service UN NY pointed out that some of the stock in Geneva could be used as emergency replacements. UNDP suggested, as a back up mechanism, that 10 emergency kits should be earmarked for UNHCR and 10 for WHO. UNDP stated that granting UNHCR 150 PEP kits gives the impression that each agency does what it wants.

The Medical Service, UN NY pointed out here that there is a very important need to be cautious with the use of these medications. It was emphasized that it is both bad policy and bad medicine to let anyone order any number of kits that they want. The dangers of uncontrolled use of medication could also lead to mutations in strains of the HIV virus. It was mentioned that so far, there had been one case reported where the kit was used - in Zambia where someone had jabbed himself with a needle.

The Medical Service UN NY pointed out that the UN dispensaries, although managed by the Resident Co-ordinators, are technically managed by the Medical Service, UN NY and as such, the lines of responsibility should be clear and respected by everyone. Any changes concerning the UN dispensaries should come through the Resident Co-ordinator to the Chief of the Medical Services UN NY.

UNAIDS asked UNDP for its confirmation that it would provide an outline of a working paper for the HR network. UNDP confirmed that it would be working on this paper together with UNAIDS.

It was decided that there should be a very brief meeting just before the IAAG to clarify what the agencies are doing with respect to these issues. This meeting is scheduled for 8 April (9am NY time, 3pm Geneva time). Further details to follow.