Combating HIV/AIDS through workplace-based action

TUC Submission

to the Department for International Development on the Consultation Document on the UK Strategy on tackling AIDS in the developing world

1 The TUC appreciates the significant contribution that the Department for International Development is making to the fight against HIV/AIDS in developing countries and welcomes this opportunity to put forward its views on the UK strategy set out in the consultation document.

2 The TUC is disappointed that the UK strategies on prevention, treatment and care fail to take account of the critical role that trade unions are playing in combating the pandemic through workplace-based action in collaboration with employers and civil society organisations. In our submission [1] to the House of Commons International Development Committee Inquiry into the impact of HIV/AIDS on developing countries' social and economic development in 2000 and in our representations [2] to the DFID in 2004, we reiterated the need for active trade union involvement in the fight against the disease and emphasized that the Department could considerably enhance the effectiveness of its interventions through close collaboration with trade unions in developing countries.

3 We should also like to point out that the key UN agencies - ILO, WHO, UNAIDS [3] - and international campaigning organisations like the World AIDS Campaign (WAC) and international and national NGOs explicitly recognize that the workplace as a focal point for action on the disease and are actively collaborating with the international trade union movement. The ILO estimated in 2005 that 28m workers had been lost to the global labour force due to HIV/AIDS and projected that 48m would be lost by 2010 [4] .

4 The international trade union movement led by the International Trade Union Confederation (ITUC) and Global Union Federations (GUFs) in co-operation with their affiliates have long been in the forefront in the workplace response to the pandemic. They re-affirmed their firm commitment to intensify their involvement in November 2006. Trade union action consists in maintaining workplace-based programmes of prevention, treatment, care and support, developing workplace policies on the disease in order to protect and promote employment and human rights of people living with HIV/AIDS and in advocacy at international level to influence on global response. In 2006, the international trade union movement held a Labour Forum in Toronto, Canada, in advance of the International AIDS Conference and provided significant input to the IAC.

5 The TUC is a member of the ITUC Task Force on HIV/AIDS, has supported the international trade union action on the disease in addition to its work [5] in the UK carried out through the Equality and Employment Rights Department in collaboration with the AIDS agencies and encouraged collaboration [6] with employers in this regard. The TUC has also supported ITUC-AFRO HIV/AIDS programmes in Africa and funded the shop stewards training and development, translation and distribution of training and education material into Swahili.

6 This Submission answers the questions most relevant to the workplace-based response to the disease and takes the opportunity to express the views of the trade union movement on some other pertinent issues. The TUC hopes that the Department will give serious consideration to its views, that it will recognize the role and importance of the workplace-based action on the pandemic and that it will take effective action to support collaboration with trade unions in combating HIV/AIDS.

1 What is the UK's comparative advantage in changing the course of the AIDS epidemics?

? What is the UK's comparative advantage in relation to the other big donors in AIDS: the US, UN, WB, GFATM and the EC?

The UK is firmly committed to the achievement of Millennium Development Goals, three of which are relevant to the fight against the pandemic. Moreover, a substantial proportion of UK development assistance is earmarked for the health sector [7] , which enables it to make a significant difference, if it is properly targeted.

The UK has a pragmatic approach to the issue [8] and is in a position to focus its strategy on groups most exposed to risks of infection - women, young people, intravenous drug users, men having sex with men etc and on protection of their rights to testing, treatment, care and support. The UK has a well-developed voluntary sector including trade unions with extensive links with the countries concerned, and with considerable experience, expertise and skills that can be readily harnessed for the purpose. Its knowledge of, long-standing relations and familiarity with institutions in, the countries [9] heavily affected by the pandemic should stand it in good stead in its interventions.

? How can the major donors work together better to improve the response to AIDS and effort behind country plans?

Major donors need to work together to ensure co-ordination, coherence and complementarity of their initiatives at country level. The adoption of the principle of 'Three Ones' in 2004, should, in theory, facilitate collaboration between development partners through the Country Co-ordinating Mechanisms. CCMs in many countries include multilateral and bilateral donors [10] .

? How can the UK work most effectively to ensure the involvement of major Foundations (e.g. the Bill and Melinda Gates Foundation, the Clinton Foundation HIV/AIDS initiative)?

The health sector in the UK has a wealth of expertise and experience in some of the potentially determining factors relating to HIV/AIDS - development of vaccines, effective condoms, microbicides etc. The UK could facilitate research into an effective vaccine, a safe and affordable female condom in partnership with the Foundations concerned.

It could also help build capacity of trade unions and other civil society organizations in developing countries to make successful applications to the Foundations concerned for projects aiming to expand access to effective prevention methods.

? How can the UK best influence global and country progress to integrate SRHR within the AIDS response?

The TUC believes that the heightened awareness of sexual and reproductive health rights is integral to a successful strategy on HIV/AIDS and that it should be instilled in people at an early stage in life, preferably through the school. In this connection, the DFID should consider collaboration with Education International [11] . EI has, in collaboration with the World Health Organisation and the Education Development Center in the US, launched a comprehensive programme of HIV/AIDS education [12] with a view to preventing new infections among teachers and learners and mitigating the negative impact of AIDS on Education for All. The Programme has been introduced in 35 countries. Some 150, 000 teachers in about 40,000 schools have been trained under the Programme.

The DFID should explore the possibility of integrating SRHR in the Programme in consultation with the EI and its partners and support its expansion.

2 How can the UK best support the scale up to universal access to comprehensive HIV prevention programmes, treatment, care and support by 2010?

? Different regions and countries are experiencing different epidemics. How can the UK ensure that appropriate and comprehensive AIDS responses are defined for different epidemics?

The profile of the epidemic in some parts of the world, notably in Asia, is significantly different from that in Africa. Governments in countries with low rates of prevalence may not be keen to commit resources due to competing demands on them. However, an effective response at the early stage could avert a major epidemic with the now well-known consequences for development. The UK should continue to support interventions targeted on high-risk populations, especially, migrant and/or displaced workers, internally displaced populations, AIDS orphans, intravenous drug users [13] , sex workers and men having sex with men [14] . Moreover, the UK could help countries to improve their blood-screening facilities and to prevent mother to child transmission by providing the necessary drugs and technical expertise. In addition, it could also help the countries concerned with cheaper HIV diagnostic test kits so that more people from high-risk groups could be tested and appropriate treatment and counseling provided for those in need.

? What can the UK do to improve access to medicines and SRHR supplies that prevent and treat HIV and AIDS, through better pricing, availability and delivery mechanisms?

The UK needs to support the global effort to increase the supply of generic drugs by encouraging the manufacture of generics by developing countries with the capacity to do so and provide financial support for others to import generic drugs from countries like India and Brazil. In countries with fragile health infrastructure or inefficient delivery systems, the UK should provide funds for organizations like Médecins Sans Frontières [15] to procure generic drugs.

Moreover, it should support the efforts by developing countries to ban the practice of patenting 'new drugs' by pharmaceutical companies through the process known as 'ever-greening' in order to acquire new patent rights.

? How can the UK contribute to ensuring long-term, sustainable funding is available to cover the costs of universal access, and strong mechanisms for spending it?

The UK should take the lead in persuading other nations, especially, developed countries, to set up a scheme similar to the International Financing Facility for Immunization to fund the costs of universal access to treatment. This could be achieved either by extending the remit of the current IFFIm or by establishing a new International Financing Facility on universal access to treatment. The TUC, through the ITUC, will mobilize international support for the establishment of such a scheme.

? How can the UK take action to ensure that developing countries themselves lead national AIDS responses, and that developing countries are adequately supported to improve their universal access plans?

Under 'the three ones' principle, the Governments or health authorities in the countries concerned are in charge of national plans on HIV/AIDS.

The UK should, through its influence with the recipient governments, ensure that trade unions are adequately represented on the Country Co-ordinating Mechanisms so that they are able to play their role in national plans through their institutions, structure and networks. The success of national plans for universal access critically depends on, inter alia, the availability of adequate resources - both human and material -, their efficient management and co-ordination and the functional integrity of the national health care system. In many developing countries, the bulk of UK development assistance is already directed at improving access to health and education for vulnerable sections of society, which in our view is one of the most effective ways of supporting the countries in the long-term.

3 How can the UK work within the international system to improve the overall response to AIDS?

? How can the UK support UN reform and Global Task Team processes both internationally and in country to ensure closer, more effective working between agencies in support of national AIDS plans?

The DFID took part in the work of the Global Task Team, which published its final report in June 2005. The UK should support the implementation of its recommendations [16] .

? What role on AIDS, including integration of sexual and reproductive health and rights (SRHR), should the UK seek for the Global Fund, World Bank, UN, EC and Foundations working on AIDS in different epidemics and fragile states?

The UK should encourage their collaboration with Civil Society Organizations, notably trade unions in different epidemics and fragile states. In Zimbabwe, the formation of a coalition of national partners [17] including the Zimbabwe Network of People living with HIV/AIDS has given new impetus to the fight against the disease.

4 What should be the respective roles of DFID, the Foreign and Commonwealth Office (FCO) and other government departments in supporting national AIDS responses for different epidemics?

In our view, the FCO should take the lead on the human rights aspect [18] of the pandemic, as it is within its remit. The denial of appropriate and adequate treatment for people living with HIV/AIDS and of their employment rights and other human rights amounts to a violation of fundamental human rights. The promotion of gender equality, child rights [19] and empowerment of women should be an integral part of the FCO programmes. At present, the children of the locally recruited staff of the British Council are not entitled to free treatment, which contradicts the UK stance on universal access to treatment. [20]

Moreover, the FCO should use its influence with governments to protect and promote the rights of people affected by the disease, including those of men having sex with men and support the work already being carried out by the International Trade Union Confederation and the Global Union Federations in this regard.

The Department of Health should step in where its expertise is appropriate and needed and should continue to seek the strict adherence to the ethical recruitment code concerning the employment of health professionals from countries already faced with shortage of doctors, nurses and other health professionals [21] .

Failed asylum seekers are currently denied free treatment by the NHS, which is in contradiction with the UK's support for access to universal treatment [22] . The UK Government should review this policy and make the necessary changes to enable failed asylum seekers to receive proper treatment.

5 How can the UK support stronger and more effective engagement by civil society, particularly networks of People Living with HIV and AIDS, and vulnerable groups (women, adolescents, males who have sex with males, sex workers, injecting drug users, and prisoners) in the global response to AIDS?

The UK Government should collaborate more closely with trade unions involved in a number of initiatives specially focused on vulnerable groups. Trade unions have a wealth of experience and expertise in promoting gender equality and reaching out to women workers both in the formal and informal sectors. The Kenya Railway Workers' Union has a successful programme of awareness raising on HIV/AIDS targeted on women workers and their communities. The Zimbabwe Furniture, Timber and Allied Trades Union and the Swaziland Agricultural and Plantation Workers Union, in a project supported by the Norwegian Wood Workers' Union, have analysed the impact of the disease on women workers in the wood sector and looked at ways and means of mitigating it. Sex workers in Cambodia have benefited from peer education under a project supported by Australian People for Health, Education and Development Abroad (APHEDA) - Development arm of the Australian Council of Trade unions. The International Transport Federation has launched an initiative to reduce the impact of HIV/AIDS on truck drivers in Africa - in the Northern Transit Corridor linking Kenya, Uganda, Tanzania, Rwanda, Burundi and the Democratic Republic of Congo - through the signing of a memorandum of understanding to ensure the respect of their members' employment and human rights [23] . The Unison International Development Fund (UIDF) committed resources to funding 10 HIV/AIDS projects in Africa in 2006 [24] .

6 What should the UK do to ensure the needs of Children Affected by AIDS are met?

? What should the UK do to ensure the scale up of prevention of mother to children transmission services?

It is important to note that the G8 countries agreed to support efforts to increase coverage of prevention of mother to child transmission to 100% by 2010 [25] . The UK needs to fulfill its share of the commitment made in Berlin.

A comprehensive strategy to prevent mother to child transmission should include prevention of primary infection in women, unwanted pregnancies in women living with the disease and appropriate and adequate perinatal treatment and care for both mother and child. The UK should pay special attention to the gender dimension of the disease in all its programmes for the empowerment of women and respect of children's rights. In this regard, the UK Government could draw on the experience of trade union initiatives like the pioneering project on sexual and reproductive health for Filipino youth [26] successfully implemented by the Trades Union Congress of the Philippines and support similar initiatives in other parts of the world.

The UK should continue to provide financial support for programmes delivering family planning advice and information on sexual and reproductive health rights and, where appropriate, it could also provide technical expertise on them.

Research has shown that developed countries have been able to minimize the risk of mother to child transmission through medication and that this could be achieved in resource-limited settings under appropriate conditions. The UK could provide medical advice and drugs essential to prevent mother to child transmission and support training programmes on the prevention of mother-to-child transmission for doctors and midwives.

? How should the UK support countries to develop and implement national plans of action for the care and protection of children affected by AIDS?

The UK should

Provide more resources for UN specialized agencies like the UNICEF;

Support national plans for care and protection of children through the CCMs

Support the voluntary sector involved in providing the services concerned in developing countries.

Provide expert advice on the protection of children's rights including their right to education in school

The most effective way of helping children is to enable their parents, especially mothers, living with the disease to live longer. Therefore, all programmes on HIV/AIDS should contain elements that address the needs of women and those of children in affected families.

? How can the UK effectively support efforts to increase access to pediatric treatment?

Early diagnosis and treatment is vital for saving lives among children, as the infection in children is considered to be more severe. The WHO has revised guidelines [27] that take into account the specificities relating to ART given to children. It covers a number of issues including toxicity, nutrition and clinical and laboratory monitoring.

The UN estimates that only 25% of the funds necessary for treating children are currently available. The UK is one of the governments that have promised funds for interventions specifically targeting children with HIV/AIDS. It should play a leading role in persuading other nations to do so.

Access to pediatric treatment and care cannot be easily increased in countries where there is an acute shortage of general practitioners, let alone, pediatricians [28] . The UK should explore possibilities of obtaining the services of doctors and/or pediatricians from some other developing countries [29] . Moreover, given the urgency of the situation, it must consider providing short courses in pediatric care for nurses and other appropriate health professionals in resource-constrained countries. In the long-term, it is necessary to develop affordable diagnostic tests, carry out research into child specific treatment and improve drug delivery systems in developing countries.

? What are the best approaches to providing comprehensive sexual and reproductive health and rights (SRHR) and AIDS education to children and young people?

Please, see answer to Question 1.

7 How can the UK best contribute to addressing AIDS related stigma and discrimination?

? What can the UK do to ensure increased action on AIDS related stigma and discrimination?

While we appreciate the commitment by the UK Government to act on stigma and discrimination associated with the pandemic, we believe that the DFID can enhance the effectiveness of its interventions by supporting trade union action directed at eliminating them at workplace. Trade unions, in partnership with employers, are in a position to play a decisive role in a comprehensive strategy, not only of elimination of discrimination and stigma, but also of prevention, treatment, care and support. Trade unions have successfully campaigned against discrimination based on gender, race, sexual orientation [30] , ethnicity etc for decades. They are able to address the factors conducive to the spread of the disease, educate members on them and build alliances with other interested parties to reach out to the community at large to campaign for behavioural changes. They have been instrumental in formulating national and international policies, signing global framework and workplace agreements [31] , carrying out community projects, world-wide education programmes [32] and in building sectoral alliances. The rights-based approach has characterized trade union action in this field and contributed significantly to the protection of employment and human rights of people living with HIV/AIDS. The UNAIDS [33] , ILO and World AIDS Campaign, WHO and the Global Fund for AIDS, Tuberculosis and Malaria have explicitly recognized the importance of making use of the workplace as a focal point for action on the pandemic. Trade Unions have also demonstrated their willingness and capacity to collaborate with governments, employers and AIDS agencies on this.

As we pointed out in our earlier submissions, not only does workplace bring together a significant percentage of the age group at risk, but it also possesses the necessary infrastructure for educating them on many aspects of the disease. Discrimination at workplace has become a major impediment to efforts at prevention, treatment, care and support. Many workers are unwilling to go for voluntary counseling and testing for fear of discrimination at workplace. In many instances, they are acutely conscious of the risk of losing their livelihood.

The DFID is supporting programmes in a large number of countries where the trade unions are also involved in the battle against the disease. The collaboration with trade unions at workplace will not only increase the effectiveness and outreach of DFID interventions, but it will also lead to important synergies essential for the global response to the disease.

? How can the UK support action to promote social and cultural change, address institutionalized discrimination, and promote reform of legislation?

The UK Government should support action by trade unions in this regard. Trade unions can play a critical role in promoting social and cultural change, as they are familiar with the economic, social, political and cultural context in which they function and can effectively deal with myths and prejudices associated with the disease. Trade unions are organizations with mass membership, which make extensive use of participatory training programmes run by peer educators and are in a position to reach out to their members, families and the community to persuade them to change behaviours conducive to the spread of the disease. An HIV/AIDS initiative launched by International Transport Federation (ITF) in Southern Africa has provided education for truck drivers on how to act on factors contributing to HIV infections.

The international trade union movement led by the ITUC, its regional organizations and Global Union Federations has identified HIV/AIDS as a priority for trade union action, campaigned against discrimination and stigma associated with it and sustained a series of workplace-based training and education programmes throughout the world [34] . These programmes aim at eliminating discrimination and stigma through awareness-raising of employment and human rights of workers and at negotiating collective bargaining agreements with employers. National trade union centres and their affiliates have lobbied governments to amend relevant legislation outlawing discrimination against people living with HIV/AIDS.

As we pointed out in our submission to the House of Commons [35] , there are a number of international instruments including the 1998 ILO Declaration on Fundamental Principles and Rights at Work that cover protection against discrimination, ratified by developing countries. Trade unions have long campaigned for effective enforcement for existing laws that give effect to the rights enshrined in the ILO conventions or for the introduction of new laws. There is a good opportunity for the UK Government to contribute to the reform of legislation and/or to the effective enforcement of existing legislation on discrimination through its support for trade union action on discrimination and close collaboration with them.

8 What approaches should the UK promote for HIV prevention?

? How can the UK contribute to addressing the social factors that drive the epidemic, particularly amongst women and girls?

Women account for some 60% of adults living with HIV/AIDS in Sub-Saharan Africa. Any preventive strategy needs to take into account social and cultural factors contributing to the disproportionately high burden carried by women and girls. Social and economic inequalities between men and women, often reinforced by cultural factors in many developing countries, have weakened the position of women in society, which has left little choice for her in sexual matters. While there is no quick remedy to this, the DFID is in a position to contribute to reversing the trend by supporting action on girls' education, gender equality, sexual exploitation of women and children in all its interventions.

? What prevention approaches work best?

The TUC believes that prevention and treatment need to go hand in hand, as people living with the disease without receiving appropriate treatment hamper preventive strategies. Prevention, treatment and care, in our view, are the three key elements in a comprehensive strategy, for they combine to reinforce each other.

The use of condoms is considered one of the most effective methods of prevention. This should be combined with empowerment of women [36] through promotion of gender equality, protection of children's rights and strengthening of health delivery systems. The availability of safe, effective and affordable female condoms and microbicides also should help prevent the spread of the disease.

? What should be the UK's role in ensuring new technology (e.g. microbicides, male circumcision) is introduced as part of a comprehensive HIV prevention package?

Any effective microbicide, if available at reasonable prices, will enable women to protect themselves with or without the consent of their partners. A cost-benefit analysis carried out in the UK [37] points to its possible use to prevent infections and shows its potential impact on the global situation. There is some evidence on the effectiveness of circumcision as an additional protection against infection. However, circumcisions carried out under unhygienic conditions often lead to serious infections. The DFID should support medically supervised circumcisions, if proven effective against HIV/AIDS [38] . Moreover, the UK needs to support research into possible vaccines against the pandemic.

9 How can the UK support efforts to ensure that the response to AIDS strengthens national health services and the delivery of basic services?

How can the UK promote national AIDS responses that strengthen the public sector - including, but not limited to, education; health; access to justice; legal reform, social protection and welfare; water, sanitation and infrastructure?

A holistic approach to the fight against the disease is necessary, as it has very serious implications for development. In this context, the UK needs to ensure that national plans on HIV/AIDS are an integral part of a viable, coherent, well-articulated long-term development strategy based on consensus achieved through dialogue and consultation with all social partners including trade unions. Moreover, national plans on HIV/AIDS should be complementary to, and part of, a national health strategy, as the improvements in the provision of primary health are conducive to a successful strategy on AIDS. This, in turn, needs to be connected to the outcomes in other sectors. For instance, there is ample evidence that the waiving of school fees has increased attendance, which should facilitate the dissemination of information on HIV/AIDS through schools. The treatment and care for people living with the disease enable them to continue to work and look after their families, which reduces expenditure on social protection borne by the state. In sum, the UK should support the development and maintenance of a strong public sector, which enables all sections of the population to have access to basic services like health, education, water and sanitation etc.

In many instances, the UK contribution alone may not be adequate for a significant impact to be felt on the ground. It is therefore necessary for the UK support to be co-ordinated with that of the international community, relevant UN agencies and international and national aid agencies. In sum, the UK support should be consistent with the principles enshrined in the Paris Declaration on aid effectiveness.

? How should the UK take action - at national and international level - to ensure AIDS and SRHR services are integrated into the delivery of basic services?

The UK should lead efforts to reach consensus among donors, including the US [39] on the best approach to integrating AIDS and SRHR services into the delivery of basic services. Consensus is important, as donors like the US are unlikely to commit resources to programmes that include elements they are opposed to, for instance, availability of safe abortions and lack of emphasis on abstinence in the case of the US. When a consensus is reached on the issue, the implementation of a programme at country level through the CCM should be the responsibility of the health authorities of the countries concerned. SRHR services include sensitive issues that evoke strong emotions in many societies. It is therefore necessary to allow a degree of latitude for the authorities to modify the contents without compromising on the essential elements.

The UK development assistance in many countries is focused on improving access to basic services. The UK should, where appropriate, be in a position to exert influence on the integration of AIDS and SRHR into the delivery of basic services.

10 What is the UK's role in gathering evidence and fostering innovation?

? What should the UK's research and development priorities on AIDS be?

The UK should continue to encourage research into cheaper and more effective female condoms which would help prevent unwanted pregnancies as well as sexually transmitted diseases including HIV/AIDS. In addition, research into more effective microbicides should be encouraged, as they offer an alternative preventive method which women will be able to rely on without the co-operation or consent of her partner [40] .

More funds need to be made available for research into an effective and affordable vaccine against HIV. In this regard, initiatives such as the Global HIV Vaccine Enterprise - an international alliance dedicated to accelerating progress on a vaccine - should be encouraged and supported.

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[1] Appendix 12, TUC Memorandum to the House of Commons International Development Committee inquiry into the impact of HIV/AIDS on developing countries' social and economic development

[2] TUC Submission to the Department for International Development on the Consultation on Paper on the UK Government's HIV/AIDS Strategy on Treatment and Care, 2004

[3] Global Reach: how trade unions are responding to AIDS: Case Studies of union action: UNAIDS best practice Collection, Joint Publication by ILO, ITUC, Global Unions and UNAIDS, 2006

[4] HIV/AIDS and Employment, GB 292/ESP/5, ILO, Geneva, March 2005.

[5] See, for instance, HIV/AIDS and the Workplace, Basic advice for trade union members and representatives, http://www.tuc.org.uk/equality/tuc-12059-f0.pdf

[6] See TUC-CBI Joint Statement on HIV/AIDS, 2006, http://www.tuc.org.uk/international/tuc-12721-f0.cfm

[7] For instance, health sector accounted for 18% of bilateral aid in 2005-6.

[8] See HRW Report on Access to Condoms and HIV/AIDS information for controversy on US Government attitude to condoms. http://hrw.org/backgrounder/hivaids/condoms1204/condoms1204.pdf

[9] Two-thirds of people living with HIV/AIDS are Commonwealth citizens.

[10] See, for instance, the composition of CCM in Ghana or Nigeria.

[11] See http://www.ei-ie.org/efaids/en/index.php

[12] Education For All HIV/AIDS Programme

[13] 44% of infections in China are said to be due to intravenous drug use, UNAIDS Update on Asia, 2006.

[14] 28.3% of gay men in Bangkok were reported to be infected with the virus in 2005, ob cit.

[15] MSF says that some 80% of AIDS patients treated in their projects are given generic drugs, MSF website.

[16] Global Task Team, Improving AIDS co-ordination among multilateral institutions and international donors, June 2005.

[17] National Partnership Forum in Zimbabwe includes CSOs, People living with HIV/AIDS, UNAIDS and the donors.

[18] Article 11, Political Declaration on HIV/AIDS, UN General Assembly, 2 June 2006.

[19] GOF Programme for 2007/08 includes child rights.

[20] ' ART is limited to staff or their long-term partner; ART is not extended to children or other dependants,' British Council HIV/AIDS Policy

[21] 80-90 nurses migrate to the UK from Swaziland every year while fewer than 90 graduate from Swazi schools, points out the WHO, quoting a recent study, with reference to the new Health Worker Migration Policy Initiative.

[22] The International Development Committee raised this issue in its Report published on 01 December 2006.

[23] Agenda, Challenging HIV/AIDS in Transport, ITF, Issue 1, 2007

[24] UIDF, Annual Review, 2006

[25] Summit Declaration, Growth and Responsibility in Africa, 8 June 2007, para 50

[26] Family Planning and Reproductive Health for Young Workers, Success Stories, UNFPA, Philippines - Programme launched by the Trades Union Congress of the Philippines.

[27] Paediatric HIV and treatment of children living with HIV, WHO, August 2006

[28] According to WHO (2007) Ethiopia had only 1,936 physicians in 2003 for a population of some 71.3m

[29] Cuba seems to have the highest density with 5.91 physicians per 1000 of its population, WHO 2007

[30] See Negotiating Equality for Lesbian, Gay and Bisexual Workers, Equalities in Unison, Bargaining Support Guide. http://www.unison.org.uk/acrobat/B1191.pdf

[31] See Anglo-Gold Agreement with National Mineworkers Union (South Africa), Anglo-Gold website.

[32] Education International has developed education material for teachers.

[33] 'The workplace is well recognized as a key location for informing people about how to protect themselves and for providing care and support for people living with HIV/AIDS and those close to them.' Peter Piot, Executive Director, UNAIDS, Foreword, Global Reach, how trade unions are responding to AIDS: Case studies of union action, 2006.

[34] The ITUC Regional Organisation for the Americas- ORIT - has done an extensive survey of discrimination at workplace.

[35] The human and legal rights of those living with HIV/AIDS in developing countries, TUC Submission to the House of Commons. See footnote 1

[36] Global Coalition on Women and AIDS, quoted by Dr Peter Piot, Director, UNAIDS, in his speech to the International Women's Summit, July 2007, Nairobi.

[37] By the London School of Hygiene and Tropical Medicine

[38] New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications, WHO/UNAIDS, 2007.

[39] US position on AIDS and SRHR is different from that of the DFID, Commons Hansard, 6 Feb 2006

[40] Microbicides: why they are important, WHO Website