CHAPTER 7

THE ROLE OF EAP IN THE WORKPLACE

7.1 INTRODUCTION

This study investigates the role of EAP in relation to infected and affected women in the
workplace. It is therefore important to outline the historical emergence of EAP, both
internationally and locally. This chapter looks at the state of EAPs and key roles of
workplace counselling.

7.2 EMPLOYEE ASSISTANCE PROGRAMME (EAP)

7.2.1 Definition

EAP is defined by the EAP Association of South Africa (2005:6) as a work site-based
programme, designed to assist in the identification and resolution of productivity
problems associated with employees impaired by personal concerns, but not limited to
health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal
concerns which may adversely affect employee job performance. Employee Assistance
Programmes has been used as part of the business strategy to enhance employee
functioning, loyalty, and performance in organisations around the world.

7.2.2 The Concept of EAP

Beidel, and Brennan (2006:36) refer to EAP practice as an approach with core
technology dealing with:

• Identification of employees’ behavioural problems on the basis of their job

performance. The emphasis is on delineating job stressors.
• Provision of consultation with supervisors, managers, and shop stewards in assisting
them with training regarding EAP utilisation and accessibility.
• Appropriate use of constructive confrontation.
• Development of linkages with external other community resources.

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• The centrality of employees’ alcohol problem as the focus of programme

In addition to change in the conceptualisation of EAP core technology, managing the

HIV and AIDS scourge will be necessary within the framework of EAP. There has been a
change in focus from earlier EAPs internationally. Van Den Bergh (2000:2) seeks to
offer insight and pragmatic information on evolving themes for EAPs, which highlight the
impact of changing workforce demography as it influences the need for workplace
sponsored services which will assist caregivers and older workers. Secondly, the
development of intervention skills broader than generic assessment and referral, to help
organisations manage crisis, change and evolution.

De Jong and Miller (1995) and Saleeby (1997) encourage the use of concepts for a
strength–based employee assistance intervention as empowerment, suspension of
disbelief, dialogue and collaboration, membership, resilience healing and wellness and
synergy. Strength employee assistance intervention can therefore mean finding
opportunities of strengths in the clients. The opportunities may be formulated from the
assumption that every environment is full of resources, trauma, illness and struggles that
may be a resource of challenge, opportunity, and change. Every individual has strengths
and clients are best served when they are experiencing the abovementioned challenges.

In addition, to keep up with the efforts in managing the HIV and AIDS scourge, it is the
researcher’s opinion that HIV and AIDS present with specific challenges that may
require specific focus interventions in the workplace. For that reason the researcher
proposes the addition of development of a comprehensive HIV and AIDS programme to
be considered as one of the EAP's core technologies. This suggestion does not
overlook the fact that core technologies include already interventions on health and
welfare in a broader term, but the suggestion seek to enhance the technologies of EAPs
and acknowledges the uniqueness of HIV and AIDS challenges.

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7.3 HISTORICAL PERSPECTIVE OF EAP

An EAP is easily seen to be the descendant of a long life of programmes combining

concerns for production and compassion. There are many reasons why companies
adopt an EAP; some believe that helping employees solve their problems is good for
workers as well as for the company, some use EAPs to avoid unionisation and retain
control of the workforce.

An EAP is a work-based counselling programme that needs to be implemented

strategically in order to impact on the life of employees. Involving key important people
such as the Chief Executive Officer (CEO), the Chief Operating Officer (COO), and
Unions is important to the success of an EAP.

7.3.1 International Perspective

The EAPs practiced internationally today, have their roots in the earlier Occupational
Alcoholism Programme (OAP) model of 1940, established in the United States of
America. These programmes were started during World War II. It was launched by the
Kemper Group (USA) in 1962. Drinking was interfering with job performance, which in
turn impacted productivity and ultimately economic efficiency. These OAPs saved
companies money because of increased production and ultimately skilled workers were
rehabilitated. The approach adopted was constructive confrontation, meaning
supervisors were encouraged to confront employees with evidence of their
unsatisfactory job performance, coach them on job improvement, encourage them to
use employee assistance programmes and explain the consequences of continued poor
performance. The assumption therefore was that the approach could be effective for
other human problems, thus the establishment of EAPs.

In some countries, EAPs and occupational social work are seen to be one and the same
discipline, due to the overlapping tasks. Some countries that have a strong background
of occupational social work are still reluctant to introduce an EAP, or due to their culture
do not accept EAPs. Such are France, Germany, Greece, Israel, Italy, Spain,

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Switzerland, the Czech Republic, Korea, Norway, the Philippines, Portugal and Sweden.
In other countries, the EAP concept is steadily growing and gaining momentum such as
in Belgium, Ireland, India, Denmark, Jamaica, Mexico, Taiwan and the Netherlands
(Masi, 2000).

Generally, EAPs are established in many countries and have started similarly as in the
USA as a chemical dependency programme. Important to note is that in Brazil and India
there is a strong cultural relevance and acceptance and Masi (2000) warns that one
must not evaluate such services negatively. She noted that EAP in Brazil is more
‘Brazilianized”; similarly in South Africa, there is call for a more “Africanised” EAP, Du
Plessis in (Maiden, 2001:112). The emphasis is that business needs to parallel their
culture with the socio-political changes. Countries that have seen the benefit of EAPs
significantly include those with strong substance abuse incidents such as Puerto Rico,
Bermuda, Russia, Jamaica and Trinidad and Tobago. In Singapore, EAPs is seen as a
tool for enhancing both the individual and the workplace collectively to achieve their
utmost potential. EAPs are seen as mechanisms for overcoming barriers that impact on
personal and corporate success.

Interestingly, some of the South American and other countries that have implemented
EAPs, have done so due to the existing USA companies in their countries. This raises a
question whether they would have done so if they were no USA based companies.
Johnson and Johnson, Levi Strauss, and other motor companies are examples of this
phenomenon. Motorola in Japan has an interesting way of providing counselling to
employees. They don’t call it an EAP, but the psychologist is reimbursed whenever an
employee has consulted. This could be similar to the Netherlands style, which tends to
rely on existing EAP vendors. According to an EAP consultant at the 2007 EAP
International Conference held in San Diego, California in October 2007, he found it
common that in Bermuda there are no internal EAPs due to the fact that companies tend
to have only a few employees as a result most of the EAP services are offered by
consultants and through external models.

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The countries that have strong EAPs include the USA, Canada, New Zealand, United
Kingdom, Australia and South Africa. In these countries the EAP external models seem
to be more popular. It is noted that currently in the United Kingdom, EAPs provide
services to between 5% and 6% of the workforce, covering 1 285 000 employees
(Berridge et al., 1997). Today in the USA large corporations without an EAP, is the
exception. From 1970 when the OAP was formed, to 1990, EAPs have progressed very
positively, expanding emphasis on work-family balance, cultural diversity, and health
promotion programmes. In addition, EAP staff members became expert consultants in
critical incidence debriefing and the prevention of violence in the workplace, which was
seen as effective during 11 September 2001, as reported by Maiden in a 2003
presentation, during a visit to the University of Pretoria in South Africa.

Sweden, even though the emphasis is not on EAPs, has identified the importance of HIV
and AIDS education through the occupation social work programme. In Greece, Masi
(2000) notes that there is a strong history of family norms, and interestingly, AIDS is
viewed as a threat to the integrity of the Greek family and viewed as an outsider’s
problem. There is a strong proactive attempt at AIDS prevention, similarly in Jamaica the
high prevalence of AIDS has necessitated an EAP that deals with the HIV and AIDS
pandemic and substance abuse in a proactive way. In South Africa, employees are
beginning to fall ill as a result of the HIV virus. Companies are expected to assess their
responsibility towards their employees, home-based care, and education interventions.

7.3.2 South African Perspective

South Africa, like many other developing countries and the international world, is not
unique with regard to problems in the workplace. Thus the concept and practice of EAPs
are seen as vital in addressing workplace problems. EAPs were introduced in South
Africa in the 1980s (Padiachy, 1996:44). Some of the first companies to introduce EAPs
were the Chamber of Mines, Iron and Steel Corporation, which is now known as
ArcelorMittal, Electricity Supply Commission, Alpha Limited, Everite (Fibre Cement
Division), South African Breweries, Sabax and the Council for Scientific and Industrial
Research. According to Du Plessis (1990: 246), there is no accurate information on

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exactly how many EAPs there are in South Africa, however she cites Terblanche’s study
done in 1988 that 64 companies in an audit of companies with EAP in South Africa
reported having an EAP. Currently, the implementation of EAPs is on the increase in
South Africa. In 1995/96 a survey by Harper (1996) of the top hundred companies
revealed that 42% companies had EAPs in the workplace. The study looked at the
prevalence, model design, and services rendered. In 2005 it was estimated that about
65% of the top hundred companies surveyed have EAPs, ranging from internal to
external models. In the 1980s, the preferred model was an in-house or coordinator
model. There is a growing trend to outsourcing and combination / mixed models. In the
1980s there were only four recognised national service providers with a number of
excellent regional players. Today, there are a higher number of service providers with
even international recognised partners.

Due to the South African political history, counselling services are mostly run by NGOs
and the emphasis on primary mental health services is high. Some companies still feel
strong to involve primary mental health coordinators in dealing with problems
experienced by employees, such as trauma debriefing and depression. One would
therefore still find that employers would use service providers such as the Family and
Marriage Society of South Africa (FAMSA), Lifeline, and The South African National
Council for Alcohol and Drug Abuse (SANCA) for specialised services. SANCA has
encouraged the development of counselling services for alcohol dependent employees
by emphasising and publicising most importantly the hidden costs of alcohol abuse to
organisations and that alcoholism is a treatable condition, Du Plessis in
(Maiden, 2001:101).

EAPs in South Africa have been established for a variety of reasons, ranging from
seeking alternative ways to manage poor performance to giving expression to the
concept of internal responsibility and preventative approaches to crisis intervention
(Du Plessis, 1990: 35). Due to the South African political history, an EAP often plays a
role in encouraging trends, such as moving from an authoritarian culture to a more

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participative one, from an exclusive to an inclusive style, from secrecy to transparency,
from withholding to empowering, and a culture of ownership and belonging.

EAPs in South Africa are not only engaged in clinical or curative interventions, but have
developed creative preventative programmes to address employee needs. The following
are some of the programmes that various EAPs have introduced in companies in South
Africa (Maiden, 1992:4):
• A development of a Visiting Wives Programme for miners by Anglo American Gold
and Uranium Division’s (West Rand Region), after it was found that miners were ill at
home. This stemmed from a family-focused need and could be seen as a supportive
approach type programme.
• The Chamber or Mines offers a wide range of EAP services to the mining industry.
The services offered include assessment, diagnosis, and treatment, with emphasis
on the core technology and incidence debriefing. Most South African companies offer
similar kind of programmes, either through internal model or external models.
• The Electric Supply Commission of South Africa (ESKOM). ESKOM was one of the
companies with a comprehensive HIV and AIDS programme in the early 1990s.
Maiden’s (1992: 2-7) observation was that the ESKOM programme tended to focus
on education for all employees from rural and remote areas, including Zimbabwe,
Mozambique and Botswana. This programme could be seen as a preventative
approach type programme.

A study by Liebenberg (1990:21) makes two observations:

• That EAPs in South Africa have unique third world characteristics in that some of
the facets are still complicated by issues such as malpractice liability, insurance,
and clinical accountability.
• The second observation is that traditional patterns of EAPs in South Africa tend to
focus mainly on early identification, and on treatment as a reactive rather than a
proactive response. The strength of EAP in SA is that EAPs are empowered to
identify problems earlier due to the problem identification skills that are inherent in

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 their social work background. Early problem identification precipitates good
prognosis and a well-defined treatment plan.

These observations are in contrast with Maiden’s observation that South African EAPs
tend to be rather advanced and have developed rapidly and have become sophisticated
in a short period (Maiden, 1992:2). Du Plessis (1990:35) adds that EAPs in South Africa
are growing at an unprecedented rate, using both micro and macro perspective
approaches. Harper (1999:12) reports that EAPs in South Africa evolved from internal
social responsibility role changing social and legislative conditions within the workplace
to being integral part of the business. Some of the changed issues include, among
others, managing diversity, effective HIV and AIDS management, and managing
transformation and affirmative action.

Many EAPs in South Africa are involved in bio-psychosocial health prevention and
lifestyle disease management, in spite of the above observation in the study done by
Terblanche (1992:27) where it significantly notes that EAPs in South Africa have just
taken off, but are still not utilised to their fullest potential. The study suggests that EAPs
in South Africa lack operational specifics, such as comprehensive training for managers,
union representation, development of a sophisticated record keeping system that
enhances confidentiality and staffing of the EAP by personnel with appropriate
experience. It is the researcher’s observation that it is becoming common practice in
South Africa that EAPs, in addition to offering counselling are focusing on training and
coaching of managers and employees in various workplace aspects. The training
includes basic EAP referral, dealing with alcoholism and HIV and AIDS in the workplace,
and life skills training.

A study done by Padiachy in 1996 made an observation that EAPs in South Africa were
still applied predominately in blue-collar environments. Padiachy’s study looked at the
Standard Bank of South Africa Limited as a white-collar environment and the results
were that Standard Bank has come to terms with the challenges of business and society
and recognised that the establishment of an Employee Wellbeing Programme was a
business imperative. (Padiachy, 1996:4).

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Top problem categories in South African EAPs, as reported by Masi (2000: 134), include
marital problems, depression, anxiety and suicide, financial problems, bereavement,
gambling, hostility, domestic violence and rape, post-traumatic stress - related to violent
crime, substance abuse and interpersonal workplace conflict.

There appears to be an emergence to broaden EAP in South Africa to include both

employee psychosocial needs and organizational needs. The DPSA strategy document
(2007:30) categorises the programmes into three:

• Employee Assistance Programme (EAP)

• Wellness Programmes (EWP)
• Work Life Programmes (WLP).

All three programmes even though they are defined differently it would seem that
according to DPSA the focus is on service offerings that covers the traditional areas
which addresses the entire spectrum of psycho-social stressors in the workplace in
order to enhance individual and organisational wellness and ultimately productivity.

With the establishment of EAPs in South Africa, which then gave rise to formulation of
EAP standards in 1996, it is hoped that EAP principles and ethics will be adhered to.
The standards include the definition of EAP, core activities, and guidelines on
evaluations.

7.4 REASONS FOR IMPLEMENTING EAP

There are two major reasons for EAP in the workplace. Firstly, the identification of social
problems at work stemming from issues such as violence, strikes, high turnovers, high
costs of recruitment, low productivity, the need to motivate workers towards greater
productivity, counselling for personal, psychological or alcohol-related problems.
Secondly, and the most important reason, is the employers’ positive regard for
employees. This could therefore be seen as the employers’ social responsibility. If the

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view is that employees experience problems at one point or the other in their lives, it will
be therefore important to establish an EAP to address those problems so as to minimise
problems and maximise profit. Sometimes these efforts are just more than internal
initiatives but do enhance the company’s image on an external basis.

Some companies see EAPs as integrating management concerns for productivity with
humanitarian values, a management tool that reinforces the management principles,
policies and procedures. A good EAP, established with union buy–in, reinforces the
supervisor’s responsibilities and create forums for employee debates. Dickman, Emener
and Hutchinson (1985) emphasise that labour involvement is important to secure
employee participation in any programme. The union’s primary objective in the
workplace is to look after the interests of employees. The union often has a strong
background of social policy on a national level and ensures that the Human Resources
Department implements key policies such as the Employment Equity Act, where the
focus is on non-discrimination and equity.

The important reason for an EAP is to provide timely, professional help for employees
whose personal problems are interfering with their work performance; such problems
may not be limited to marital, HIV and AIDS, transport problems, day care problems,
mental health, and work-related problems such as absenteeism, accidents, and conflicts
in the workplace. Van Den Bergh (2000:2) suggests that EAPs in the 21st century
should focus on human intervention strengths, rather than pathologies with emphasis on
new paradigm words such as strengths, resiliencies, hardiness, empowerment and
solution-focused approaches. Not many managers and union officials alike enjoy
disciplinary processes. EAP offers an alternative to a misunderstanding of workplace
processes and an EAP remains a better option to a disciplinary process.

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7.5 THE TROUBLED EMPLOYEE

The term troubled employee will be used in this research as defined by 'those individuals
whose personal problems such as HIV and AIDS; alcohol and drug addiction; marital
difficulties; emotional distress preoccupy them to the extent that is on either own, or
supervisors judgments, work performance is disrupted'. The term troubled employee is
often used interchangeably with problem employees. Bruce (1990) defines a problem
employee as an employee whose behaviour in the workplace causes reduced
productivity and lowered morale for self, colleagues, or supervisors. An employee can
be troubled by personal problems as major as death of a spouse or an HIV and AIDS
infected family member. It is important that unless those troubles spill over into the
workplace as behaviour that lessens effectiveness, that the employee will not be
considered a problem employee.

The effect of one problem employee or troubled employee can change organisational
goals. Problem behaviour of one employee will have a ripple effect that can destroy the
productivity of every employee in a work unit. Employees do not often leave their
troubles at home. The problems stay with them, haunt them and sometimes reduce work
performance. Troubled employees are described by Bruce (1990) as the most difficult
cases, as one must continuously deal with difficult and diverse challenges that often
require control that most EAP practitioners have no expertise in. He further cites family
problems as the major concern for escalating conflicts between work and family life;
stating that 44% of the work force is female, and that 60% of those women have children
under the age of six. In addition, some of the personal problems, which may be caused
by employee deficiencies, include developmental issues, alcohol drug, emotional,
financial, health care, legal, mental and physical issues. It has become common
practise to define troubled employees not only as those with personal problems, but
include those with several work-related problems such as discrimination, skill
deficiencies, management style, sexual harassment, expatriate re-entry, job condition,
job structure and role conflict.

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With the call for more integrated EAPs, a need analysis of the company will guide where
most of the programmes are needed. This will require cost benefit and workplace impact
studies on various employee problems. The costs of mental health illness can add up to
major costs annually, if not managed. Mental illness definition can be understood from a
mental health perspective. Mental health is a term used to describe either a level of
cognitive or emotional well-being. From the perspective of the discipline of positive
psychology, mental health may include an individual’s ability to enjoy life and maintain a
balance between life activities and efforts to achieve psychological resilience
(About.com, 2006).

The World Health Organisation (2001) argues that there is no 'official' definition of
mental health. Cultural differences, subjective assessments, and competing professional
theories all affect how 'mental health' is defined. This background therefore suggests
that how an organisation is going to calculate the cost of mental illness on their
workforce will primarily be influenced by their definition and their organisational culture.
Therefore mental illness can be described as a state of the mind, thoughts, mood, or
behaviour that causes distress which can result in a reduced ability to function
psychologically, socially, occupationally, or interpersonally.

The methodology to calculate the costs of mental illness can therefore be formulated
along the lines of subdividing the cost that results from a reduction of productive activity
among the mentally ill; the cost of treating the mentally ill; the cost of illegal and other
undesirable behaviour that can be attributed to the effects of mental illness; and the
measurable and visible psychological loss indicators such as; fear, frustration, and
despair which are often as a result of idleness and rejection.

Occupational mental health however is associated solely with the psychiatrically ill
worker, whose symptoms interfere with his effective functioning on the job. In a broader
sense, occupational mental health is concerned with thought, feeling, and behaviour -
both healthy and unhealthy - as it occurs in the workplace, organisation, or as it relates

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to the performance in a job. In a larger context, the mental health field deals with factors
in the work environment, which supports mentally healthy behaviour as well as those
that may be involved in triggering the development of symptoms of emotional
disturbance.

Today we have begun to realise that a person cannot ignore either his concern with
social, financial, and spiritual obligations or his very personal likes, dislikes, attitudes and
temperamental traits when he comes through the office door or factory gates. EAP, for
some companies is a component of Occupational health and Safety. The goal of
occupational health or mental health in industry is therefore to promote and maintain the
highest degree of physical, mental, and social well-being of all employees. The
employee can be a bit fearful, a bit forgetful, a bit suspicious, a bit compulsive, irritable,
and angry, and still be very much normal. When confronted by stress and strain in the
form of worries, whether they precipitate in the home or at work, there may be an
exaggeration of these particular traits. In a research involving the top 100 companies in
South Africa, Harper (1999:4) identified that of the 42 companies who have EAP
services, 45% were located in the Occupational Health. This according to Matlhape
(2003: 32) tends to give EAP a health and health promotion focus to the exclusion of
other broader organisational development issues affecting employees.

7.6 MODELS OF EAP

Whatever the reason for an EAP, the benefits are evident for both economic and
humanitarian reasons. From the employee point of view the benefits may be
summarised as cost effectiveness, i.e. reduction of health care cost and improvement of
social functioning and self-esteem (Kurzman & Akabas, 1993:27).

On the other hand, from the company’s point of view the benefits are:

• An EAP provides a mechanism that reinforces basic management practices.

• An EAP enhances corporate image.

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• Measurable cost savings: this may be evident in measurable variables as reduced
absenteeism, improved error judgment, and less late-coming.
• Minimises appeals, grievances, and arbitrations - especially when there is an
improved relationship between union and management.

It is with these benefits in mind that a company considers a model that will address core
issues and bear these benefits. Every model will distinguish clear functions for both the
employer and the employees. The EAP model is the structure that the company uses to
plan, design, and implement programmes to address the needs of the troubled
employee. As a result, a need assessment and programme plan will assist in
determining which model to use. The programme plan should be flexible enough to
allow appropriate changes, which will yield to an intended goal and prove to be useful
and valuable to the organization. (Warley, 2004:8).

There has been a rapid growth in the number of EAPs. This study will focus and narrow
the models to only two as defined by Bruce (1990) as internal and external models.
Organisational employees staff internal models, while personnel who are employed by
an organisation that sells EAP services operate external programmes. The internal
models are employers and union monitored while external models may be hot-line,
consortium or contractor-driven. Union programmes may be totally union-operated and
maintained. A union member may volunteer for the programme. Highlights of this model
may be self-development activities, crisis intervention and peer confrontational.

The internal model (Appendix 11) is the one that is designed, implemented, and
managed by the company’s personnel. In this model, the employees either refer
themselves or are referred and the counselling takes place onsite. The office is
accessible and the cost for travelling and loss of time is minimal. The role of the
counsellor is to perform case monitoring, aftercare, and job re-entry of employees and
assist management in the planning of organisational functions. It is widely observed that
confidentiality and anonymity are the two principal disadvantages of the internal
programme (Bruce, 1990).

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External models (Appendix 12) are models where many functions are provided by
external agencies with various EAP specialists. There is a contract between the outside
agency and the company. The advantage of this model could be that employees may
feel comfortable to discuss their problem with someone who is not part of their company
and feel their confidentiality is guaranteed. The external models often include hot-line
services. There are currently a few major EAP service providers in South Africa, namely
ICAS, Ndawo, The Careways Group, Leaders Culture Innovators and Agility. According
to Sithole (2002:159), the external model is the most common model in South Africa and
it seems to be yielding successful results to a successful EAP.

Both external and internal models may provide services for employee dependants.
Assessment skills for practitioners include assessing dependent care as an underlying
problem, even if the employee’s presenting problem does not include care giving
responsibilities. Given that EAPs offer structured limited sessions to most employees,
the practitioner’s knowledge of community resources, health care systems and
community educational support services assist in addressing some of the complex
issues related to dependant care. According to Hoffman (2002:29), a survey of EAP
counsellors in New York found that less than one quarter of respondents had ever
attended a seminar or training regarding dependent care. The recommendation
therefore is that EAPs must provide their counsellors with comprehensive training that
addresses practical skills building opportunities in identifying dependent care. Some of
the dependent care issues may include care for people with HIV and AIDS and other life
threatening diseases, parenting and child care, physical and mental health and issues
relating to death and dying. The involvement of an EAP in dependent care may help in
minimising the impact of dependant care stressors on employees.

Dr Volpe (CEO Leadership and Culture), one of the experts consulted in this study,
believes that more has to be done to diversify the services offered through EAPs. She
emphasised that given diversity in various countries, an EAP's core technology may no
longer be applicable in its totality in the running of a day-to-day EAP. As such, she
indicated that creativity is required to change employees’ behaviour. This approach, she

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said, it is not only one-on-one counselling, but could include diversity training, change
leadership and identification of cultural strengths.

7.7 SUCCESS OF THE EAP

Whether the company chooses an internal or external model, the EAP needs to be well
implemented. To yield a positive and successful EAP, Dickman et al., (1985) advise that
the company should consider a policy guideline, which recognises that problems are
part of life for every employee. The company’s policy should be informed by the core
ingredients of a successful EAP, which are:
• Accessibility
• Training for managers and supervisors
• Management orientation
• Insurance coverage
• Broad service components, which covers all various employee problems
• Professional leadership
• Programme evaluation and follow-up
• Confidentiality and anonymity.

This researcher therefore concludes that when an EAP has been successfully
implemented, the following will be indicators of some of the management benefits:

Popularity of the programme: When employees understand the referral procedures

and believe in the confidentiality of the programme, they are likely to use the
programme. The popularity may be promoted through intervention techniques, referral
procedures, review, and alignment of policies and procedures.

Mobilisation role: When union and management work together cooperatively under the
auspices of an effective EAP to help troubled employees, work morale tends to increase
and apathy diminishes while there is a significant high turnover and low absenteeism.
An effective EAP mobilises all stakeholders for high utilization.

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Satisfactory feedback: It is important to allow employees who utilise EAP to give
continuous feedback regarding service offered. When more challenged employees are
helped, feedback by employees indicate timely assistance and positive wellness.

Enhanced productivity: EAPs are designed to reach intended goal of its existence in
any organization. The goal of EAP is to restore employees to a more functional state
after any personal or work related challenge.

Resilience building: The role of EAP is to give employee alternative option to problem
resolution and offer skills that contribute to employee resilience, personal growth and
empowerment.

7.8 SUMMARY

Motivations for providing human services in the workplace are related to cost savings,
increased productivity and humanitarian reasons. EAPs emphasise the kind of
programmes that offer a holistic approach focusing on physical, mental, and emotional
wellness. Evidently, as seen in this chapter, there is little information and scientific
research about EAP in South Africa. There are still conflicting debates about its
development and effectiveness. It is however important to note that there is academic
interest in the subject and enthusiasm among authors that EAPs in South Africa are
here to stay.

There is a clear difference in the historical development of EAPs in the USA and EAPs
in South Africa. The scope of EAPs in the USA focuses on broad interventions, while in
South Africa the focus seems to be on individual interventions. The focus in the USA in
the past was on alcohol programmes and in South Africa it looks like the focus will be on
HIV and AIDS. As evidently noted, organisations have already in the 1990s been
implementing HIV and AIDS programme. This means that HIV and AIDS had been
identified as a threat to the business and prioritised as an integral part of the EAP
programme. The next chapter takes a look at HIV and AIDS in the workplace as a
responsibility of EAP.

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 CHAPTER 8

THE ROLE OF EAP IN ADRESSING ISSUES OF HIV AND AIDS INFECTED

AND AFFECTED WOMEN IN THE WORKPLACE

8.1 INTRODUCTION

Drawing on the interrelationship between personal problems and job performance, the
thrust of EAP lies in broadened EAP services; including problems that affect, or have the
potential to impact negatively on an employee’s job performance. An intervention that
can reduce the stress, associated with high job strain, has the potential for immediate
benefits. EAP clientele will include among others, risk populations, e.g. single parents,
substance abusers, mentally ill workers, and persons with HIV and AIDS and family
members of each of these groups.

8.2 HIV AND AIDS PROGRAMME

In South Africa, EAP practitioners have begun to assume a major role in the area of HIV
and AIDS. A recent survey conducted by Markinor across 130 small, medium and large
JSE Securities Exchange listed companies in South Africa, reveals that 59% of the
companies are not aware of the HIV and AIDS prevalence within their workplace
(Succeed/Essential…, 2004:5). The results indicated that only 62% of participating
companies provided counselling for those infected in the workplace. One company’s
response to HIV and AIDS was evidently seen within the restructuring process whereby
the wellness programme was designated as responsible for HIV and AIDS management
(Steven, 2004:10). EAPs are involved in managing HIV and AIDS programmes,
including designing and implementation of the programmes.

Three important aspects are training, education, and counselling of those infected and
affected. In the area of HIV and AIDS risk prevention, Purcell, Degroff, and Wolitski
(1998: 282) mirror this sentiment, suggesting that the first task of social workers (EAP
practitioners in this case) is to assess risk behaviour. Valid assessment of high risk
sexual behaviour related to HIV is important, because this information is used to

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determine who receives education services and EAP interventions. It is suggested that
individuals do not accurately self-report their sexual practices, especially behaviour
related to HIV and Sexually Transmitted Infections (STIs). Under-reporting of high risk
behaviour and over-reporting of protected sex have been found to occur more frequently
in face-to-face interviews than in more anonymous conditions
(Scandell et al., 2003: 120). This could explain the EAP statistic reports presented at
various local EAP conferences and during benchmarking sessions among various SA
corporates. However, according to Du Plessis in (Maiden, 2001:115), statistics shared
by EAP practitioners in a meeting held in Johannesburg in 1995, health issues such as
HIV and AIDS and Sexually Transmitted Infections were on the increase. This means
the EAP forums are platforms to discuss best practice and confidential statistics that are
not otherwise discussed in the companies' published newsletters.

EAP and occupational social work use some of the frameworks and skills borrowed from
psychiatry. With the impact of HIV and AIDS in the workplace, the treatment of
employees in the environment with focus on casework is helpful. In addressing HIV and
AIDS, practitioners face death and dying on an ongoing basis. In psychiatric
management, the treatment of HIV and AIDS is treated and understood in causality with
other mental health problems such as depression, grief responses, irrational guilt,
diminished self-esteem and at times pronounced suicidal thoughts. This management
requires psychological debriefing according to Lewis (2004:10). In most cases the
symptoms are related to conscious and unconscious conflicts about how the disease
was acquired. One of the common psychiatric interventions for patients with psychiatric
disorders is the ability to create a structure for the patient. The importance of limit setting
appropriate to the patient’s current capacities, decrease unreasonable preoccupations,
and reducing self-destructive behaviour can refocus the patient. Similarly, HIV and
AIDS can first present in the form of cognitive or emotional symptoms, thus the need to
follow structured counselling may be necessary. Warley (2004:8) encourages adoption
of a pre-treatment model that uses quantitative and qualitative data collection methods:
The model, which the researcher believes, is important in counselling of people living
with HIV and AIDS includes the following theoretical frameworks:

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 • Psychodynamic questions: the technique that makes enquiry about the impacts
of the client’s past history as it affects the present and the hidden fears and
anxieties.
• Cognitive-behavioural queries: the focus here is on the thoughts about self,
others and the future.
• Life model questions: the enquiry is about phase of life, interpersonal processes
and environmental barriers.
• Solution- focused queries: the focus here is about assessing the strengths and
motivation of the client.
• Psycho-education: this process is important in particular to all clients facing life-
threatening illness. The focus is understanding and acceptance of the illness.

It is not uncommon to find some AIDS patients remaining unreasonably hopeful about
recovery, despite the presence of their fatal illness. In cases where denial in some
patients has become so extreme that it interferes with the patient receiving medical care,
it is recommended to confront the patient and treatment be instituted. The psychological
problems caused by AIDS are psychosocial stressors particular to death and dying.
These include ostracism by family, friends, and lack of a supportive social network. As
more people are infected daily, the need for counselling by trained mental health
professionals is growing. Most therapists can offer psychotherapy to treat grief, anxiety,
depression, alienation, and avoidance behaviour. Although self-help groups and support
groups are available, some individuals may have unique problems concerning
confidentiality and anonymity preventing them to participate.

Persons who are HIV negative - but who are at risk for HIV infection - are often
psychologically distressed, despite their HIV negative status. This may include
individuals whose recent behaviour (intravenous drug use or unsafe sex) has placed
them at risk of HIV infection. The distress, which is often acute, may be related to fear of
pending test results. Stress may also result from the fact that the person must now alter
their future behaviour to avoid infection. Providing counselling reduces the psychological
problems and helps to prevent the spread of the disease.

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8.3 HIV AND AIDS COUNSELLING IN THE CONTEXT OF EAP

Counselling is widely used as a strategy in health care and in the workplace

(Summersfield & Oudtshoorn,1995: 55). Many people offer AIDS counselling, such as
telephone counselling and / or face-to-face counselling. AIDS counselling has some very
particular characteristics, but also shares many familiar resemblances with other forms
of counselling. According to Burnard (1992), counselling people with AIDS involves
counselling in three categories, namely: educational issues, advice, and psychological
issues.

Nurses are one group that find themselves in the counselling role for HIV and AIDS
patients. Klonoff and Ewers (1990) in Burnard (1992:11), administered a questionnaire
to the nursing staff of a teaching hospital in the USA to determine sources of stress in
caring for AIDS patients, to determine perceived sources of stress in being an AIDS
patient and to investigate attitudes towards other various illnesses. This study revealed
a number of factors related to increased stress, including: general concerns about the
care of these patients; specific concerns in crisis situations; and concerns regarding the
personal / social implications of caring for these individuals.

Another study in New Zealand by Will (1990) quoted by Burnard (1992: 14), was carried
out to examine the nurses’ attitudes to a wide range of matters relating to the
management of patients and persons with AIDS. Prevention of HIV infection showed a
strong support for public health measures and showed that most nurses believe AIDS
patients should not be treated differently than other disease sufferers. The nurses’
attitudes were that treating AIDS patients is not different from treating other patients.

Given this background regarding the attitude of nurses found in various studies, it is
evident that nurses need to have education about HIV and AIDS, modes of transmission
and become acutely aware of the vocabulary in the field. Advice is a form of counselling.
Having AIDS is not an automatic indicator of a person’s knowledge about it. Information
about AIDS does not always change people’s behaviour. Burnard (1992) emphasises

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that counsellors should explore their own attitudes about believes related to AIDS before
assuming the role of advisors.

Many writers on counselling have advocated a client-centred approach. This counselling

style that advocates that the counsellor remains in the background while the client takes
the lead in clarifying the problem and perceptions about the problem (Burnard, 1992:12).
Counselling of HIV and AIDS patients may involve advice, confrontation, prescriptive
mode and education, cathartic, catalytic and supportive approaches.

There are various psychosocial problems in AIDS counselling. An example of a

psychosocial problem includes the client’s own perception of himself / herself as a
person with AIDS. In addition to the fact that the person has AIDS, they bring to the
counselling sessions cultural beliefs, fears, anxieties, attitudes and mental health
problems. After all these factors have been explored, issues of meaning, purpose, and
dying may emerge.

AIDS counselling cannot be professionalised, particularly within the context of the

medical and health professions. The aim of AIDS counselling is to encourage the person
with AIDS to live as fully and as independently as possible. The emotional aspect of the
person in AIDS counselling is important. HIV and AIDS people have a wide range of
emotions, ranging from fear, guilt, anger, apprehension to worries about the likelihood of
infecting others and future relationships. Burnard (1992:69) identifies the following
emotions that are associated with the experience of having AIDS: shock, relief, anger,
guilt, decreased self-esteem, loss of identity, loss of a sense of security, loss of personal
control. Many people, including lay counsellors, religious leaders, and community
volunteers who have been trained to work with HIV and AIDS people, can conduct AIDS
counselling.

George, Green and McGreaner (1989) identifies the following counselling skills as
important in counselling people living with HIV and AIDS:

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• Minimising Uncertainty

The emphasis here is on the fact that HIV positive people have the right to know
about their physical health. A therapist who becomes vague and evasive does not
help people with life threatening diseases, but rather increases their mistrust and lack
of confidence in the service offered. It is important that counsellors remain sensitive
and confrontational.

• Understanding And Correcting Misconceptions

When a person is informed about his / her HIV positive status, checking
misconceptions and clarifying myths set a good foundation for education. It is also
important at this stage to reassure the person about confidentiality. Given the
stigmatisation that accompanies HIV and AIDS, the emphasis on confidentiality is
necessary.

• Examining Personal Resources

Examining personal information and who in the family needs to know about the HIV
diagnosis and who does not, is important. Enquiring about housing, employment
and finance will help prevent stress at a later stage. If work is an important part of the
person’s life, it may be important to discourage the person not to leave their work
immediately. The person should be encouraged to consider options of limiting
working hours. This will also largely depend on the kind of reasonable
accommodating attitudes and support in the workplace.

• Death And Dying

Clients should not be forced to talk about the death or dying process. Gentle, tactful
and sensitive enquiries are enough to ensure that the person understands the
significance of the prognosis and who can answer questions pertaining to the
disease. Death and dying should only be discussed when the client is ready. At the
stage of death and dying, it may be important to discuss practical matters, such as

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 the will, children custody if necessary, the estate, etc. It may be advisable to link the
client with community resources if any assistance falls outside the counsellor’s area
of expertise.

• Developing A Sense Of Purpose

Developing a sense of purpose aims to maximise the client’s quality of life in a

realistic way. Encourage the client to maintain realistic ambitions and alternative
sense of purpose. The client with HIV and AIDS may feel that life is already over. It
is important not to deny the difficulties the clients have, the feelings they are
experiencing, as this may lead to alienation and isolation.

• Choice And Dignity

Most clients respond with realistic hope when their dignity is restored during
counselling. HIV and AIDS can leave clients with a sense of dependency and
unrealistic perceptions that they are not dignified. It may be important to encourage
the client to exercise their choices in instances when it is necessary, particularly with
regard to cultural and religious matters.

• Setting Boundaries

People with HIV and AIDS need to know whom they can rely on in cases of crises.
This knowledge gives them a sense of security and privacy to their issues. Trust in
the counsellor provides a sense of privacy. Refraining from over-involvement, over-
helping and encouraging independence can only help the client's sense of
boundaries and limits.

8.4 SKILLS FOR COUNSELLORS HELPING PEOPLE AFFECTED BY HIV AND

AIDS

The following skills have been compiled by the researcher from various research reports
over the years of experienced and are continuously tested and used by the researcher
when counselling employees living with HIV and AIDS.

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8.4.1 Ability to overcome Health Worries

It is important to educate caregivers about People living with HIV and AIDS (PWA) and
the disease itself to avoid misconceptions. It may be difficult to care for a PWA when
experiencing nagging fears about one’s own health. The caregiver needs to be
reassured about what is possible and what is not.

8.4.2 Role Reversal

In the case of role reversal, the caregiver needs to be taught how to cope with the
changes, such as taking more charge, be more assertive and take responsibilities for
more practical matters if this was the role of the PWA. In the case of couples, the roles
may fluctuate and it is important that open communication regarding who may survive
the other do happen. Children may also be involved in these communications and
planning.

8.4.3 Dealing With Betrayal

In the case of couples, issues about who infected who may be raised. Allowing the client
to ventilate and own their feelings may be essential. Verbal expression of feelings is
often enough to ease the deep sense of hurt, pain and blame. It is important to remain
neutral and not to take sides, as this will not help the client to move on. Listening and
reflective feelings will alleviate anger and blaming.

8.4.4 Handling Sexuality Issues

Couples may not know how to deal with their sexual needs initially. Education on sexual
matters, i.e. how to create enjoyment and the importance of safer sex is essential. It
normalises their sexual needs and empowers them to take responsibility. Counsellors
should always recognise the couple’s need for intimacy and help them to realise it
through safer methods.

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8.4.5 Adjustment to Multiple Issues

Multiple issues may include loss of income, grieving in advance of the death of the PWA,
accommodation and some family fun activities. This may often become a reality to the
caregiver when the PWA’s health starts to decline. As with other serious illnesses, such
as cancer, heart disease or stroke, HIV can be accompanied by depression, an illness
that affects mind, mood and behaviour. Depression undermines people’s ability to deal
with the problems of everyday life. It will be a mistake to assume that prolonged or
intense depression is natural. It is reported that one in three persons with HIV may
suffer from depression (Dbsaalliance.org:.., 2005). When assessing the mental status of
a PWA, it is important to look for symptoms of depression as identified by the American
Psychiatric Association (1987).

8.4.5.1 Affective Symptoms

Affective symptoms are symptoms of mood and mental status. The following signs steps
should guide the counsellor in identifying the patient’s mood symptoms:

• Ask about moods, especially over the past few weeks.

• Enquire about changes in enjoyable activities. Things often seem pleasurable. It
may be important to ask how this aspect has been during the last two weeks.
• Enquire about a loss of libido; distinguish fear and loss of interest.
• Enquire about irritable moods and emotional instability. Usually the depressed
person would report being more easily upset than usual.

8.4.5.2 Cognitive Changes

Depressed people see themselves usually as worthless and unlovable this may result in
a loss of self-esteem. They look at themselves in a negative way and highlight their
shortcomings. Sometimes they tend to be neglectful regarding their appearance. It is
important to enquire how they feel about themselves. Typical related symptoms are:

• Feeling of failure;
• Loss of hope; the future often looks bleak in their minds and eyes;

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 • Difficulties in concentrating;
• Forgetfulness.

8.4.5.3 Somatic Symptoms

Somatic symptoms are symptoms that are experienced by the patient as real, even if
there is no medical confirmation or a diagnosis of sort.
• Look for changes in sleep patterns.
• Assess eating disturbances and food appreciation.
• There may be multiple physical complaints, e.g. headaches, joint pains, and / or
stomach problems.

8.4.5.4 Behavioural Symptoms

When people are infected, everything seems like too much effort to do. People with
depression may feel less energetic than usual. They would often do less than they used
to do.

8.4.5.5 Suicidal Tendencies

Many people who are depressed contemplate suicide at one point or another. The
dangerous time for suicidal people is usually the time when they just come out of a
depression. Green (1989: 4) identify the following steps to take in consideration when
counselling people with depression:

• Putting things in perspective

It helps to clarify depression symptoms to the client, reassure them that
depression does not last forever and help them to focus on the future. Reassure
them that depression is treatable.

• Sorting out problems

Assess what is causing the depression and help the client to sort out the problem.
Once this is sorted out the client may feel better.

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 • Increasing activity
Helping the client to focus on activities that bring pleasure may defocus attention
on the problems at hand. This may also help the person to find new activities that
help to focus more on future plans.

• Identifying inaccurate thoughts

Challenging the client’s inaccurate thoughts may empower them to take
responsibility for their emotions and life. This skill could be applied by asking the
client to write down their views and thoughts.

• Working with the family

This is one of the most important aspects when counselling depressed people.
The family’s understanding, support, and encouragement help the depressed
person in the process of a speedy recovery. Should the depressed client not
improve after family intervention, psychiatric intervention should be considered.

8.5 SPIRITUAL COPING MECHANISM FOR WOMEN WITH HIV AND AIDS

There have been various changes in the world of work to make the workplace a
friendlier place for employees and to enhance job performance. Evidently, in the late
1990s, workplaces became faith-friendly, incorporating policies that respected all
religions through leave policies accommodation. Studies indicate that this in turn
encourages workplaces to allow employees to live their lives openly and bring the value
of their spiritual identities, their souls and their faith to the workplace, making it for them
a great place to work at (Miller, 200513).

Research on other life-threatening illnesses has indicated that individuals often turn to
religion and spirituality to cope (Dein & Stygall, 1997, Demi, Moneyham, Sowell & Cohen
1997). It can be assumed that spiritual awareness contributes to lower levels of
psychosocial distress as it provides a sense of meaning in the face of threat to
existence. On the other hand, it is reported that an individual, battling with a life-

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threatening illness, use religious coping in complex and variable ways, making it difficult
to identify the mechanisms by which it operates (Smith & Hill, 1993).

Pargament (1997) suggests that prayer allows expression of anger and disappointment,
emotions that are common among HIV positive women, particularly upon knowing their
status. On the other hand it is suggested that prayer assists one in repairing damaged
relationships, letting go of the past, achieving a sense of closure and provides hope of
an ultimate victory (Carson et al., 1990). There is however a view that some clinicians
see spirituality as detrimental to emotional functioning and believe that it fosters
passivity, dependency and denial (Jenkins & Pargament,1995:131). Studies indicate
that HIV is associated with greater religiosity and spirituality among HIV positive and HIV
negative partners of men with AIDS (Folkman, Chesney, Cooke, Boccellari, & Collette
1994:746). Qualitative research regarding spirituality is needed to give conclusive
evidence of the role it plays as a coping mechanism of those with life-threatening
illnesses in general. The use of spirituality-based coping has been found to be prevalent
among women. Studies have consistently indicated a greater use of spiritually-based
coping activities among samples of women than in samples of gay men (Demi et al.,
1997:173) and (Potts, 1996:16). Faith can be a source of solace and nurture and healing
in difficult times, such as when one has just been diagnosed with HIV.

When the usual human coping resources are ineffective or are threatened, as in the
case of a life threatening disease such as HIV and AIDS, spirituality may be an available
resource. Drawing from the perspective of Pargament (1997), spirituality may help
individuals conserve meaning and transform their sense of significance through
integration of the stressor into existing definition of self, thus providing a greater sense
of control and aiding in psychological adjustment.

In a study by Simoni, Martone and Kerwin, (2002:137) that aimed at examining

spirituality and its correlation to spiritually-based coping among women with HIV the
researcher found that spirituality and spiritually-based coping mechanisms may lead to
better well-being. Furthermore, the study concluded that women who feel better

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psychologically are more optimistic and appreciative regarding spirituality in their lives.
The study however found that there was a high level of depressive symptomatology,
which suggested counsellors should pay more attention to suicidal ideation in the group.

The best way forward regarding spiritual counselling would be for a workplace to
develop policies that help create faith-friendly cultures in the workplace. Employees
need to be given permission to bring their whole being to work. According to Miller
(2005:15), companies that allow this perspective in the workplace are likely to avoid
major accidents and become better places to work

Even at a professional level, faith and work are leadership issues and can make such
difference in the executive coaching and mentoring (Miller, 2005:14). Increasingly,
leadership training and seminars tend to emphasise inherent spiritual values such as
respect for individuals, care, sharing and improved relationships. Some religious beliefs
play an important role in encouraging greater tolerance of, and respect for employees.
McAninch (2006:16) highlights that understanding spirituality is essential in addressing
any traumatic event, including dealing with HIV and AIDS, particularly because every
incidence has social, political, and spiritual impacts. He encourages EAP professionals
to be comfortable talking about the spiritual dimension, as it can be a major factor in the
recovery of workers.

8.6 PHYSCHOSOCIAL IMPACT OF HIV AND AIDS ON COUNSELLORS

There is a perception that health workers are able to cope with all related health matters.
However, studies indicate that coping in the work environment is difficult for nurses
because of lack of support from employers and most of the health workers do not have
access to any form of official support such as counselling for work-related stress. A
study in Uganda among health workers showed the same results indicating inadequate
counselling and lack of facilities and equipment (Mungherera, Van der Straten, Hall,
Faigeles, Fowler & Mandel, 1997; Hall, 2004:111). Bateman (2001: 3) reported that
since 1999, the Health Professions Council of South Africa has had an increase in cases
of alleged impaired doctors.

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Bateman describes “impaired”, as a mental or physical condition, or abuse of substance,
which affects the competence, attitude, judgment, or performance of a health
professional. It can be assumed that the impairment may be related to lack of support,
which then ultimately leads to stress in the workplace. A study by Hall (2004:113) in
South Africa found that confidentiality of a patients’ HIV status posed challenges to
health professionals in their work. Evidently in Hall’s study, the stigma attached to HIV
and AIDS in communities led to an influx of very ill patients. Nurses then found
themselves taking care of terminally ill patients, who were becoming increasingly taxing
as dying patients generally need supplementary support.

A study by Aiken and Sloane (1997a) in Hall (2004:111) found that the organisational
form of the unit and hospital in which AIDS care is provided has a significant impact on
the emotional exhaustion experienced by nurses. HIV work is extremely intense and
difficult. Counsellors and EAP practitioners are constantly exposed to people who are in
an intense emotional state. To protect themselves from becoming overburdened and
incapacitated, counsellors develop a variety of ways to cope. One mechanism is to
create and maintain an emotional and cognitive thinking process that gives the
counsellor a sense of invulnerability; seeing the client as different from himself or herself
enables the counsellor to work with the client. It is noted that some counsellors would
then skip all the emotional counselling and concentrate on the medical and educational
aspects of the disease and ending up lecturing rather than listening to the client
(Fowley, Rosenthal, & Levine, 1990:286).

Nurses, like EAP professionals, found themselves having an additional load of

counselling added to their daily work routine due to the HIV and AIDS challenge. Hall
(2004:110), in a study about the challenges HIV and AIDS poses to nurses in the work
environment, found that the secrecy surrounding the disease reduces nurses’
productivity, confronts them with ethical issues and hinders them from curbing the
spread of HIV and AIDS. O’ Grady (2004:205) agrees that the lack of disclosure of HIV
is the compounding difficulty in managing HIV and AIDS. Similarly, EAP practitioners

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face ethical dilemmas about high sick leave rates of employees with HIV and AIDS and
assisting managers to manage productivity and create reasonable accommodating
environments for sick employees. In a survey of NGO managers in South Africa in 2002,
several senior managers reported difficulties to cope with managing employees with
long-term illness (James & Mullins, 2003:4).

Psychosocial support has been evidently documented to be one of the most effective
tools of assisting HIV and AIDS patients in gaining access to antiretroviral treatment. In
South–East Asia and in many other countries, there is considerable evidence of the
psychological benefits of self-help clubs for HIV infected and affected people
(UNAIDS, 2002:158).

Research suggests that EAPs should be moving towards integrating resources. Kramer
and Ricket (2006:23) stress that by incorporating resources, EAPs can both validate
health and productivity services while also providing a strong growth product on EAPs.
Kramer and Ricket (2006:24) suggest the following components to be included in the
integrated programme offering:

• Tracking and administration of employee absences.

• A toll-free “Life Enhancement Line”.
• A health risk assessment.
• Employee group interventions.
• Organisational effectiveness interventions.
• Employee interventions.
• Return on investment analyses.

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8.7 SUMMARY

HIV and AIDS counselling present difficulties for most EAP practitioners, due to the fact
that it is a new field of counselling. The ethical dilemma of confidentiality and workplace
management of HIV and AIDS is a continuous problem for most practitioners. It is
therefore very important that EAP practitioners be abreast of new changes and
education on HIV and AIDS as they remain in the forefront of the management of the
pandemic. Employees need comprehensive care regarding HIV and AIDS management,
as well as understanding and creation of reasonable accommodating environments for
employment opportunities. EAP practitioners are the best advocates to assist
employees. However, there is limited information on HIV and AIDS counselling by EAP
practitioners, which necessitates future research and studies in this area. In addition,
spirituality and spiritually- based coping should be explored as part of a strategy of
identifying and bolstering cultural strengths, particularly in relation to HIV and AIDS.

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