OpiniãoIt is now recognized that loss of health workers due to HIV and TB requires urgent attention (Ncayiyana 2004, Menzies 2007). Hitting hardest in countries that are already severely affected by the global health human resource crisis, this situation is negatively affecting the goal of universal access to HIV services (Schneider 2006). It has been identified that together HIV and TB account for an extremely high proportion of the mortality and morbidity experienced by health workers in high burden countries (Harries 2002, Tawfik 2003).
The World Health Report (WHO 2006a) identified that healthcare systems worldwide are plagued by difficulties in recruitment and retention. One reason for this situation is that healthcare workers face increasingly difficult working conditions. It is now widely established that health workers globally have witnessed massive changes in their day-to-day practices and workloads (Smit 2005). Occupational health concerns include musculoskeletal injuries, violence, stress, biological, chemical and physical hazards. Infectious diseases, and particularly HIV and TB, put an enormous strain on the health workforce. The epidemic has increased occupational stress and burn-out, demand for services, and risks of occupational exposure. This is especially true in low and middle income countries (LMICs) where health workers are subject to extensive out-migration. According to the International Labour Office's report, HIV/AIDS and Work: Global Estimates, Impact and Response, (ILO 2004) in the absence of increased access to treatment, an estimated 74 million workers will be lost to the workforce due to HIV by the year 2015.
The health service sector has a vital role to play in delivering prevention, diagnosis, treatment as well as care to the population it serves, and in combating stigma and discrimination. To do so, health workers' own health, rights and working conditions must be protected. The ILO, International Organization for Migration (IOM) and WHO note that, "although health workers are at the frontline of national HIV programmes, they often do not have adequate access to HIV services themselves" (WHO 2006b). These guidelines were designed to focus on reinforcing and accelerating the implementation of best health practices for health workers living with HIV or TB, or those who risk being exposed to HIV or TB in the workplace.. The ultimate goal is to contribute to the improved health of health workers and to retain them in the workforce.