Everybody's Problem

In the face of limited government resources and inadequate foreign aid, companies with operations in countries that are rife with AIDS are finding themselves having to pay the price. Jessica McCallin reports

The figures are frightening and almost too big to comprehend. Every day, 14,000 people are infected with HIV. In 2002, global infections increased by more than five million. Today, more than 42 million people have the virus. And over the next two decades, according to UNAIDS, the international agency tasked with coordinating attempts to stem the disease, it will kill at least 70 million people. Furthermore, the virus is changing. Drug resistant varieties are emerging to outwit the limited drug treatments that have been developed.

Africa continues to make the headlines, with good reason. Over 24 million infections are reported in sub-Saharan Africa alone. Botswana, with the world's highest rate of infection, says that 44% of pregnant mothers have HIV. This means that the infection will be passed on to the child. When the mother gets sick and dies, no one will be there to rear and educate the child. The coming generation will be sick, poverty-stricken and parentless. In several sub-Saharan countries life expectancy is now below 40.

Now the disease is breaking out of its African stronghold. The biggest percentage increase in infections last year was reported in Eastern Europe, where drug use and unprotected sex are the main culprits. The disease is beginning to make itself felt in Asia - especially in India and China - where 60% of the world's people live. China saw a staggering 67% increase in 2001.

At present, AIDS in China is mainly confined to the cities, drug users, prostitutes and their clients. But UNAIDS believes that it will soon reach the wider population and grow exponentially. If even 1% of China's population were to become infected, that would be 13 million people - more than in any of the most affected countries in Africa.

The UN warns that if no effort is made to step up prevention and education in China, the number of HIV-infected people there could rise from 1.5 million today to 10 million by 2010. India already has 4 million infections.

The disease is unique in many ways. It is fatal in, effectively, 100% of cases. There is some evidence to suggest that prostitutes in Kenya may be immune to the disease, but this is contentious and of little use to everyone else. It strikes people in the prime of their lives, when they are young and healthy and should be the most productive members of society. And it does not kill quickly. The average span from infection to death is eight years, but death is likely to be preceded by several years of debilitating ill health, with the sufferer unable to work and in need of intensive care and medical help.

In short, the economic and social consequences of the epidemic are profound, and threaten to wipe out 50 years of development in the countries it hits. "AIDS is currently one of the greatest threats to global development and stability," says Marika Fahlen, UNAIDS Director of Social Mobilization and Strategic Information. "Countries that fail to bring the epidemic under control risk becoming locked in a vicious cycle - as worsening socio-economic conditions render people, businesses and communities ever more vulnerable to the epidemic, and derail efforts to improve treatment and care."

The economic damage is already making itself felt in many countries. In Botswana, it is estimated that the Government will lose 20% of public revenue by 2010, due to the economic impact of AIDS. A recent study in three countries - Burkina Faso, Rwanda and Uganda - has calculated that AIDS will increase the percentage of people living in extreme poverty from 45% in 2000 to 51% in 2015. In the Caribbean, Jamaica and Trinidad and Tobago are expected to face a 5% loss in GDP by 2005 as a result of AIDS. In the Ivory Coast, the income of Aids-affected households is half the average.

Further, treatment and prevention are not keeping up with infection rates. UNAIDS says at least $10bn is needed for AIDS prevention programmes each year, but only $2.8bn is forthcoming. Studies show that the people most at risk are ignorant about the disease. The UN's children's agency survey of 60 countries found that more than half of 15 to 24 year olds have serious misconceptions about HIV/AIDS.

Corporate initiatives
All of which makes for a huge headache for business. A sick and dying workforce, a generation raised without adequate care and education, and crumbling economies are not the sorts of things to entice business. Many companies have no option but to operate in AIDS-affected countries. A mining company, for example, has to go to where the minerals are. Manufacturers may already have huge factories in countries such as India and China, and will find it prohibitively expensive to relocate. In the absence of adequate government action, companies are finding that it is up to them to tackle AIDS amongst their workforce and wider communities if they want to operate.

The New York-based Global Business Coalition on AIDS (GBC), a rapidly-expanding alliance of international businesses dedicated to combating AIDS, was founded in 1997 to coordinate the commercial sector's approach, and to develop expertise on workplace management of the disease.

Its first goal has been to increase the range and quality of business sector AIDS programmes, both in the workplace and in the broader community. It publishes details of existing company AIDS policies so that others can learn from them and prints guides to a whole raft of issues.

As a starting point, it advises companies to carry out risk assessments to evaluate the scale of the HIV problem in their workforce, market and countries of operation. Then, the costs of absenteeism, health care, reduced productivity, recruitment and training must be assessed. Together with the consultancy, the Futures Group, GBC has developed a modelling tool which aims to give a preliminary assessment of the costs.

Next, it advises companies to ensure there is no discrimination against employees on the basis of real or perceived HIV status, as well as guaranteeing employee confidentiality. Then it recommends starting an awareness and prevention programme. This can be through formal training, posters, or condom distribution; the route taken will depend on the particular company and the limits of its resources. But the GBC points out that in many affected countries, company education is likely to be the only source of AIDS information and is, therefore, crucial.

"Most companies are choosing prevention and education routes," says Jill Bausch, chief executive of the Futures Group Europe. "But that's not enough for all of them. Companies which operate in Africa, where infection rates already top 35% have no option but to offer medical care."

So the GBC also advises offering voluntary testing, counselling, health care and medication, through on-site clinics or in partnership with local health services, and recommends extending the service to employees' families.

The cost of providing such a service is a huge issue here, with many companies understandably wondering why they should be the ones to provide healthcare. The only answer to that is that they have to provide the service because no one else will. But companies should also know that the costs do not have to be prohibitive. One third of HIV sufferers die from opportunistic infections such as tuberculosis, which can be treated and prevented with inexpensive drugs. By providing basic treatment, companies can improve the heath of their HIV-positive employees and their families for significant periods. For example, Illovo, a medium-sized South African sugar company offers these drugs to its employees.

And providing anti-retroviral therapy (ARVs) to treat the actual virus need not be prohibitive either. Controversy has surrounded the high cost of AIDS drugs in recent years, but the pharmaceutical companies have largely capitulated, and the cost of ARVs has dropped significantly. Companies which do offer the drugs conclude that it provides longer term cost benefits through reduced absenteeism and hospitalisation.

Unfortunately, providing the drugs is not the end of the story. ARVs require ongoing supervision by trained medical personnel, for their considerable benefits continue only for as long as they are taken. Many people do not take them religiously and run the risk of developing drug-resistant strains of the illness. It is difficult for companies to make sure their employees take their medication, but solutions can be found if the companies work with local clinics and charities. GBC says both Daimler Chrysler and Heineken have developed effective monitoring and supervision programmes in conjunction with local organisations.

Many companies say they will mirror government health provisions, but with governments burying their heads in the sand, some are actually leading the way. For several years, Shell has been offering pregnant mothers drugs which prevent the virus being passed to the unborn baby . The Government is now following suit and offering the same.

Although intergovernmental attempts to stem AIDS are increasing, it is too late for large numbers of people. They have not come in time to help companies operating in AIDS-hit areas. Fairness or unfairness aside, companies have no option but to provide AIDS education and care.

Jessica McCallin is a freelance journalist

Assessing the risk
Insurance brokers and consultants in South Africa are advocating not just insurance programmes but intervention in the workplace to contain and minimise the adverse impacts of AIDS on corporate profitability, as well as to improve the lives of employees.

For example, Momentum Collective Benefits (MCB) carries out risk impact analysis to predict, assess and plan for the impact of the epidemic. It applies statistical modelling techniques to predict the pattern of HIV infection and AIDS-related disability and death, as well as the change in working patterns resulting from HIV. MCB says the outcome provides a credible projection of the likely future costs of the epidemic through their impact on the workforce and hence on corporate profits. This projection can in turn be used as a foundation for a programme of management action.