Adapting the HIV code of practice in the workplace
March 24, 2026
Seated (second from left): Dr Pravind Kumar Nagalingam, Dr Raudhah Abd Rahman, Dr Edrin Nazri Abdul Rasib, and Dr Zulkifli M Yunus.
Bridging the gap between policy and real-world implementation, the panel discussion titled 'From Policy to Practice: Responsibilities of Employers & Employees in Adapting the HIV Code of Practice in the Workplace' brought together key experts to address one of the most pressing workplace health and human rights issues today. Organized by the Malaysian AIDS Foundation and the Malaysian AIDS Council, the session focused on translating guidelines into meaningful action within organizations.
The panel featured a diverse group of leaders across public health, occupational safety, corporate health management, and social security. Among them were Dr Raudhah Abd Rahman, Public Health Medical Specialist and Head of the HIV, STI & Hepatitis C Unit at the Federal Territory of Kuala Lumpur & Putrajaya Health Department, Ministry of Health Malaysia; Dr Pravind Kumar Nagalingam, Medical Officer from the Occupational Health Division, Department of Occupational Safety and Health (DOSH); Dr Zulkifli M Yunus, PETRONAS Health Advisor, Group HSE; and Dr Edrin Nazri Abdul Rasib, Head of the Medical Board Division, Prevention, Medical and Rehabilitation at PERKESO (Social Security Organization). Together, they provided multidisciplinary insights into how employers and employees can move beyond compliance and foster inclusive, non-discriminatory workplaces for individuals living with HIV. Understanding HIV and its impact on the immune system HIV, or human immunodeficiency virus, targets the body’s immune system by attacking CD4 cells—a type of white blood cell essential for fighting infections. Once inside a CD4 cell, the virus replicates and gradually destroys it. Without treatment, this process continues, leading to a steady decline in CD4 cells while the amount of virus in the body increases. As CD4 levels drop, the immune system weakens and becomes less able to defend against infections. HIV is transmitted in three primary ways: through the sharing of contaminated needles among people who use drugs, through sexual contact, and from mother to child during pregnancy, childbirth, or breastfeeding. It is important to note that HIV is not spread through casual contact. Activities such as shaking hands, sharing food, using the same toilet, hugging, or kissing do not transmit the virus. It is also not transmitted through mosquito bites. Without treatment, HIV can progress to acquired immunodeficiency syndrome (AIDS), typically within five to ten years. Although there is no cure, HIV can be effectively managed with lifelong antiretroviral therapy. With proper adherence to treatment, individuals living with HIV can lead long, healthy lives comparable to those without the virus. Understanding U=U (undetectable equals untransmittable) The concept of “undetectable equals untransmittable” means that when people living with HIV adhere to treatment, doctors monitor their response to therapy. “Every six months, CD4 levels and viral load are monitored. When patients adhere to treatment, the virus is suppressed to an undetectable level. When this happens, HIV cannot be transmitted to others, even through sexual transmission. This means people living with HIV can get married and have children without transmitting the virus to their partners,” explains Dr Raudhah Abd Rahman. HIV trends and epidemiology in Malaysia HIV has existed in Malaysia since 1986, when there were only three recorded patients. Since then, new HIV cases have increased year by year until reaching a historical peak in 2002, with 7,000 new cases. At that time, the Ministry of Health launched a harm reduction program. “Most HIV cases then were among people who used drugs and shared needles. The harm reduction program aimed to reduce infections by providing clean syringes and needles so that they would not share them. They were then enrolled in opioid substitution programs, which subsequently led to a 60% reduction in new HIV cases after 2005. Since 2010, the number of new HIV cases has averaged around 3,000 per year.” After the 2020s, 90% of HIV cases are attributed to sexual transmission. In terms of age distribution, 80% of new HIV cases occur among individuals aged 20 to 49 years. The majority are male, about 90%, while females account for 10%. This is an increase compared to the early 1990s, when it was only 1%. Treatment for HIV at government clinics and hospitals is free. In Kuala Lumpur, there are 18 health clinics that offer HIV treatment, as well as hospitals providing similar services. DOSH perspective on HIV in the workplace From the Department of Occupational Safety and Health (DOSH) perspective, the initial approach was focused more on enforcement. However, for HIV, DOSH has shifted its approach to encourage support and reduce stigma and discrimination among employees, explains Dr Pravind Kumar Nagalingam. Corporate policy evolution: PETRONAS experience Dr Zulkifli M Yunus highlights that PETRONAS established its HIV workplace policy and standard operating procedures 14 years ago. This has led to an evolution in how stigma and awareness are managed among employees. “At the beginning, management focused on understanding the magnitude, the numbers, and the impact in terms of medical treatment. The cost of treatment was initially monitored. Monitoring individuals directly is actually against the principles of best HIV management. Employees living with HIV who are asymptomatic can work normally and may even be healthier than individuals with conditions such as diabetes. Over the past 10 years, we have stopped such monitoring because HIV treatment and management are handled similarly to other illnesses within the company. Therefore, medical benefits can be utilized,” he explains. Complications arising from untreated HIV When HIV is not properly treated, complications can become complex. These may include cancer, neurological complications, stroke, and recurrent chest infections. In such situations, the company is required to take action—not to eliminate the employee, but to manage the condition appropriately. The concept of “fitness to work” was introduced at PETRONAS to assess the work capability of employees living with HIV. This assessment is not based on HIV status itself, but on any resulting disability. The key principle is to treat HIV similarly to other medical conditions. Upcoming HIV workplace guidelines Dr Pravind Kumar Nagalingam reveals that a more detailed and updated guideline on HIV management in the workplace is set to be launched in May. This guideline aims to provide clearer understanding for employers on how to approach HIV in the workplace. "HIV workplace policy is fundamental. The upcoming guideline emphasizes increasing awareness and fostering a non-stigmatized, non-discriminatory work environment. Discrimination is not always about refusing to work with individuals living with HIV. It often manifests as limitations in promotions. Management may not explicitly cite HIV as the reason, but may avoid placing such individuals in certain roles, resulting in demotion. This creates a chain reaction that can lead to stress and psychiatric illness.” Legal framework and gaps in Malaysia Dr Edrin Nazri Abdul Rasib explains that in workplaces without specific HIV policies, employees living with HIV may face unfair dismissal. “Unfortunately, in Malaysia, there is no Disability Dismissal Act similar to that in the United Kingdom, where legislation such as the Equality Act 2010 and the Disability Discrimination Act 1995 allows employees to take legal action against employers,” he says. “However, in Malaysia, affected workers can bring their cases to the Industrial Court. In the meantime, the question arises as to who will support these employees. They often face challenges due to a lack of social security support. This is where PERKESO plays a role.” PERKESO support and Employment Insurance System “There is a scheme that provides monetary compensation until affected individuals can secure new employment. This falls under the Employment Insurance System. Workers who are unfairly dismissed while awaiting Industrial Court decisions can seek assistance from PERKESO. PERKESO provides financial support, job placement assistance, and training programs for upskilling or reskilling, all of which are funded.” “In today’s environment, employers must recognize that compliance is not solely driven by legislation. Investors evaluate companies based on ESG—Environmental, Social, and Governance—criteria. Companies that meet ESG standards are more attractive to investors. HIV management falls under the social and governance aspects.” “If companies fail to comply, they risk losing potential investors. Additionally, with the prevalence of social media, employees can voice grievances publicly, which may impact a company’s reputation. Therefore, even in the absence of strict legislation or a formal code of practice, it is beneficial for companies to adopt these standards,” adds Dr Edrin. In June this year, an additional scheme—‘Skim Keselamatan Sosial Bukan Bencana Kerja’—will be introduced by PERKESO to cover injuries unrelated to work. This falls under the Employee Social Security Act 1969. Efforts are also being made to ensure that individuals with insurance are aware of the benefits available under PERKESO. Some schemes have been rebranded as Lindung Pekerja, while the Employment Insurance System is now referred to as Lindung Kerjaya. Coverage of HIV under social security schemes HIV-related conditions may fall under several schemes, including the invalidity scheme or the Employment Insurance System. In cases of job loss, individuals can claim under the Employment Insurance System. “Consider a person living with HIV who later develops AIDS. Most individuals on treatment appear physically normal. However, complications arise when treatment is ineffective or adherence is poor, leading to increased susceptibility to infections such as cancer. In such cases, individuals may be unable to work and can claim benefits under the invalidity scheme, which includes rehabilitation and financial support,” explains Dr Edrin. “Bencana Kerja,” or employment injury, applies specifically to healthcare workers who are infected due to occupational exposure, such as needlestick injuries while treating patients with HIV. These workers are eligible for compensation under occupational disease provisions. For individuals who are unable to tolerate first-line antiretroviral therapy and must switch to second-line treatment, which may be costly, the Malaysian AIDS Foundation and PERKESO provide second-line treatment free of charge. This support is linked to return-to-work programs. Seamless treatment access in corporate settings Dr Zulkifli notes that PETRONAS fully funds treatment for employees at their hospital of choice, including government and university hospitals. Employees living with HIV are not required to seek HR approval for treatment, ensuring a seamless process. “The fundamentals of treatment remain the same. Medical leave and support for those unable to work are also consistent. This reflects a non-discriminatory approach toward employees living with HIV,” he says. Confidentiality and data protection in the workplace From the DOSH and policymaker perspective, confidentiality is critical. Dr Pravind highlights that employees cannot disclose an individual’s HIV status without written consent, except in legal circumstances. The new guideline specifies that one designated person will be responsible for maintaining confidential records. In many cases, HR practices may lack professionalism. Disclosure of HIV status can significantly impact how colleagues perceive and interact with the individual. Translating policy into practice Companies must apply these policies effectively in practice. The DOSH Code of Practice and International Labour Organization (ILO) guidelines, although established 25 years ago, remain relevant. However, many companies in Malaysia continue to struggle with adopting these best practices, and some have not yet begun implementation. HIV is expected to be treated like other chronic illnesses within the next 10 to 15 years. However, raising awareness and reducing stigma must begin with leadership. Leadership buy-in is essential, supported by regulatory requirements, ESG considerations, human rights principles, and employee welfare priorities. Secondly, companies must establish clear documentation that transparently outlines requirements and expectations. “So, it starts with a policy and related standard operating procedures—a document that ensures all levels of the organization operate consistently. There may be a primary HIV policy statement, but more importantly, there must be clear processes, typically managed by the HR and HSE,” adds Dr Zulkifli. Policies that remain in files or systems without communication are ineffective. They must be communicated clearly so employees understand their rights and can ensure accountability. If HIV status becomes known, stigma and rumors may arise, affecting the individual. When employees are aware of their rights, they can help maintain checks and balances within the system. Therefore, policies must be clearly communicated to all. Integrating HIV policies into existing organizational structures Dr Zulkifli notes that management may question whether such initiatives require additional budget or effort. These concerns can be addressed by integrating HIV policies into existing organizational structures. Every company in Malaysia is required to have an HSE committee. HIV-related initiatives, including awareness programs, can be incorporated into HSE committee agendas. HIV policies can also be integrated into HR frameworks, such as codes of conduct under industrial relations. Issues such as harassment can be addressed within existing policies, as individuals living with HIV may face stigma and harassment. Career progression and non-discriminatory employment practices In terms of career progression, HIV status alone must not be used as a basis to restrict advancement or terminate employment. When clearly stated in company policy, this becomes a standard requirement. Pre-employment screening and fair hiring practices The fundamental principle of HIV management includes embedding fair practices into pre-employment processes. According to established guidelines, including those from the ILO, HIV screening is not required during pre-employment unless justified by specific job roles, such as highly invasive healthcare professionals or sex workers. HIV status does not prevent an individual from being employed. Individuals living with HIV are capable of working normally and being productive members of the workforce. |
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