1. Protecting health workers from occupational exposure to HIV through global campaigns Dr. Jorge R. Mancillas Public Services International 6 August 2008 International AIDS Conference

2. Health Worker risk of HIV infection Effectively tackling AIDS requires adequate numbers of skilled personnel Health workers are at high risk of occupational exposure to HIV The incidence of HIV infection amongst health workers is highest where the prevalence of HIV is highest, hampering treatment efforts

3. Global shortage of health workers Current global shortage: 4.3 million health workers (WHO) The infection of a HCW with HIV is not only another human tragedy, but also the loss of vital human resource needed to effectively fight the AIDS epidemic. Protecting health workers is the forgotten front in the global AIDS campaign

4. The need for international structures in the current global architecture of AIDS treatment ■ WHO & other Inter-governmental organizations Develop policy. No global enforcement mechanism. National policy implementation 1. GHIs & IFIs (IMF, WB) - De facto instruments for global policy implementation (GHI:GF,PEPFAR) or - Set framework for policy implementation (IMF) 2. MNCs ( pharma, medical ) -Promote products for diagnosis, ART -Lobby governments -Financial beneficiaries ■ Health workers unions & professional organizations -Unique in having both global and local perspective -Unique in having capacity for: policy development advocacy, implementation & monitoring Tasks a)Survey, monitor and communicate to identify universal concerns: integrate local (frontlines) to global b) Research & develop solutions: share resources c) Plan and implement campaigns

5. PSI structure : 651 unions - 160 countries / 24 sub-regional & regional networks Congress ► Exec B ► HSTF ► Weblog & publications Secretariat ► HQ & regional staff ► campaigns

6. Protecting health workers from AIDS 1. Research solutions and tools (universally applicable) ► set goals, identify partners and targets ■ Sources: PSI affiliates, PSIRU, WHO, ILO, academic sources 2. Develop evidence-based global campaigns: a. Implementation of preventive measures ► Global tools: AIDS guidelines (WHO/ILO) b. Ensure treatment of infected health workers: PEP & ART ► Global tools: PEP guidelines (WHO/ILO) c. Prevent workplace exposure by addressing major mode of transmission of HIV: needlestick injuries

7. Needlestick injuries Healthcare workers suffer 2 million exposures to Hepatitis and HIV/AIDS per year due to needle stick injuries Needle stick injuries are the mode of transmission for over 30 other blood borne pathogens (Malaria, Ebola, Hep C)

8. Retractable syringes

9. Safe for health care workers Safe for waste collectors Safe for patients: non-reusable (Prevent 1.3 million deaths, $535 million) Benefits of a campaign to make safe devices the universal standard: ► Protection of both health workers and patients ► Helps retain AIDS work force

10. WHO strategy

11. Safe devices campaign GOAL: Achieve widespread shift to safe devices by building economies of scale, country by country, and eliminating price differential Retractable syringes a) Develop & disseminate information and materials to affiliates b) Negotiate with government or employers Present data, mobilize members, build public support c) Negotiate lower prices with manufacturer – build sales volume First successes: a) Democratic Republic of Congo: decreed mandatory standard (Jan 5, 08) b) Nigeria (large scale purchases) c) Angola (technical decision)

12. Protecting health workers: the process a)Advocate at global bodies (WHO, ILO) ► Contribute professional expertise and view from the frontlines ► HCWs and allies: driving force for policy implementation ► governments & employers ► Involve multiple participants (academicians, patient org., NGOs, private sector) b) Pursue multiple mechanisms to change policy ► International organizations (WHO, IFIs)Policy, financing and guidelines ► Int. Financial Institutions, GHIsFunding, financing and guidelines ► Regional bodies – EUDirectives, agreements ► National DRC, Nigeria, AngolaDecrees, agreements, policies US, UKLegislation ► State/province Brazil: Rio, Santa CatarinaLegislation ► Employers Negotiations of CBAs c) Create conditions: Education of members, public relations (consensus), global policy instruments and financing

13. Thank you Dr. Jorge Mancillas PSI Health Services Officer Jorge.mancillas@world-psi.org +33 450 40 11 50 +33 617 54 38 74