As AIDS becomes more visible, so does the need for the workplace to take on a new more proactive function, and thereby turn the tide.

Asked about their company’s response to South Africa’s exploding AIDS epidemic, many employees would scratch their heads and reply, ‘What response?’ A few, on the other hand, might grasp your arm like the Ancient Mariner, and enthuse about the new meaning AIDs work has given their workaday world.

For while many CEOs haven’t yet grasped that this silent, stealthy enemy has crept, like a Trojan horse, right into their camp, ever-more visible sickness has galvanized numerous businesses, big and small, into dynamic action. The results are sometimes surprising, bringing not only an antidote to despair but also a more compassionate awareness of the workforce as vulnerable human beings.

While this may seem difficult to relate to rands and sense, in the long run it may well serve both. For, as Lee Kingma, Human Resources Manager at Securicor, and Chamber of Commerce representative on the Western Cape AIDS Council, told businessmen at a recent breakfast, `Managing the pandemic needs combined effort from government, business and the NGO sector. As business has a ‘captive community’ – a large part of the nation’s workforce – their impact could be dramatic if they committed themselves to an AIDS strategy and implemented it effectively.’

‘Corporates in South Africa have notoriously tried to ignore the impact of HIV/AIDS’ says Dr Bridget Farham, editor of AIDS magazine, Perspective. Numerous surveys seem to bear this out. Change is slow and painful. Only one in four companies in the Western Cape, for instance, has developed an AIDS strategy, according to the Bureau for Economic Research.

Clem Sunter, South Africa’s favourite scenario planner, as well as being chairman of Anglo American Chairman’s Fund, puts the situation bluntly: `”Ready, aim, fire” is what scenario planning should be about,’ he says. ‘In America it tends to be “ready, fire, aim”. But in South Africa, it’s “ready, aim, attend a conference!” Talk is not progress! There has not been nearly enough fiery action, fuelled by passion.’

In cold business terms, which tend to suppress any emotion as dangerous as passion, three things bring a company to the point of firing at HIV/AIDS: 1. What it finds profitable to do, in terms of its business interests. 2. What it must do, because of legislation, regulation, public expectations etc; and 3, What it should do, from personal conviction.

There are signs, amid the gloom, that the pump behind all these pressures is being primed. `With the escalating loss of loved ones, colleagues and respected members of society, comes the realisation that denial will no longer do,’ says Veni Naidu, a chartered marketer doing his PhD on this topic. `A concerted multi-dimensional response from all decision makers is evolving.’

Among advances has been the establishment of SABCOHA, the South African Business Coalition Against HIV/AIDS. This supports the many businesses which lack the money, time and resources to give the disease the attention it demands. SABCOHA’s most recent contribution has been developing an HIV/AIDS toolkit for businesses, itemising the most effective and efficient way forward.

Another great national weapon is Metropolitan’s Red Ribbon website. Here businesses can download free material, get contacts, information, examples of best practice and so on. It gives (and is one itself) superb examples of partnerships that work – big business twinning with small business, industrial organisations taking the initiative etc. The message is, `You can manage HIV/AIDS. It is not a catastrophe nor an automatic death sentence. But it is tough, and you can’t go it alone.’

Many mistakes have been made and lessons learnt. Key is that a company’s AIDS strategy should come from the top down and from the heart, not just the rule-book. The most exemplary (and costly) plans can go wrong. An example is the copy-book Voluntary Counselling and Treatment Programme provided by one manufacturing company, to which hundreds of employees responded. But less than half of those tested ever returned to hear their results, making the exercise largely pointless. The sensitive psychology of the matter had somehow been botched. More expert counselling was needed – more about this later.

External pressure on business to raise its head from the sand came from the Second King Report on Corporate Governance. Henceforth, said King, company reports should specify whether a company had developed an appropriate HIV/AIDS strategy, and whether there were policies in place to address and manage the disease. `King 11 has for first time ensured that good governance cannot be present if HIV/AIDS is ignored,’ says Bridget Farham.

However, surveys show that the majority of companies still see HIV/AIDS as a soft issue, to be handled by human resources. `Best practice suggests that either the managing director or the board take responsibility. This will ensure that the full business risk is assessed and managed, not only the employee risk,’ says the Deloitte survey.

Some respondents to this survey argued that their company was ‘low risk’ because of a predominantly high-skilled and white workforce. This, in a country where six times more white people than anywhere else are infected, may be dangerous thinking. It bears out a finding by the World Economic Forum Global Health Initiative that ‘Businesses appear to be making decisions based on a patchy assessment of the risks they face’. Those companies who do prevalence testing are on much firmer ground.

Antiretroviral Therapies

Treatment and care is another big issue. Less than five percent of companies are providing antiretroviral therapies, and although they are being urged to, many CEOs ask `Now that the government is rolling out ARTs, why should we provide them?’ `Twenty per cent of AIDs victims are economically active,’ Dr Jack van Niftrik, CEO of Life Works, responds. `This will result in an economic loss of at least R154 billion over the next seven years.’ Dr Fareed Abdullah of the Western Cape Department of Health adds: ‘Without any medical intervention five million people will die over the next 10 years. This is a camel’s hump of mortality. With treatment this ‘hump’ could be spread over 30 to 40 years. The difference will be between an economy that struggles to develop, and a good future.’ He warns that even in the Western Cape, which is way ahead of other provinces, the ART roll-out is extremely slow.

Kingma’s support for AIDS strategies was born out of personal experience at Securicor. `We have a responsibility towards our labour force- most of them young men – and helping them manage their disease, first out of compassion, and second because it makes good business sense. Without it medical aid costs increase, absenteeism rises (by as much as 37 percent in some companies) and productivity drops.’

Clem Sunter is proud that Anglo was the first company to offer free HIV treatment to its staff. Today 1 200 miners are on anti-retrovirals at a cost to the company of R12 million.

‘But this is better,’ he says, ‘than not putting employees on the pills. Don’t even waste your time trying to work out if this is more expensive than doing nothing. You can’t. For a mining company coping with sick labourers underground could be disastrous.’

Other Solutions

Business leaders whom Sunter dubs `foxes’ are those who use their wits to survive by considering two factors: First, the things they have control over, and those they don’t; and second, the facts that are certain and those that are not. Foxes on `the HIV high road’ first accept that HIV/AIDS will impact hugely on their business. `Disease management’ is then a necessary option, starting with a survey of that impact.

Surveillance

Accurate prevalence rates are a crucial first step for any company. A manufacturing business in KZN, for instance, conducted voluntary anonymous blood screening tests and found a prevalence of 4,3 percent among top management, 18,2 percent among supervisors, 9 percent among technical staff and 20,4 percent among shop floor employees. So much for the myth that only the unskilled are at risk.

On the other hand, a construction industry group faced with growing absenteeism, found good news when anonymous saliva testing proved that only eight percent of the workforce was positive instead of the 25 percent they’d feared. This made viable proactive strategies such as providing ARTs.

A further advantage of surveillance is that when external agencies are brought in, measurable targets can be introduced. Indeed this is the yardstick of a good intervention. At a sugar mill in Northern KZN, for instance, condom distribution increased by 400 percent, treatment of STDs decreased by 88 percent and an estimated 11 new infections were averted, in the 12 months following their survey. Another company identified its primary target group for reducing the further spread of HIV and other STDs.

Woolworths commissioned an actuarial analysis, despite believing their staff were low-risk. To their surprise, this showed that by 2010, 16 per cent would be HIV positive, slashing productivity by up to three percent – equal to closing down one big store. This led to a long-term strategy focussing mainly on awareness, condom distribution, and education about sexually-transmitted infection. `The aim is to reduce prevalence by 20 per cent by 2010,’ says medical officer Dr Tony Davidson. `For every rand spent on peer education, the organisation could save R10′.

Actuarial models don’t have be highly sophisticated – they can be simple snap-shots. They highlight cost increases which may not have been factored in, such as absenteeism, recruitment and training costs, and the impact on employee benefit and medical aid costs. It is estimated that the costs of ignoring HIV/AIDS in the workplace are between 3.5 and 7.5 times higher than the cost of managing it. For example, very restrictive employee benefits can reduce morale and discourage early disclosure, making responses such as succession planning more difficult.

One company used actuaries to assess the current and future impact of HIV/AIDS on 40 individual product items, using demographic data relating to customer segments.

New jargon has been inevitable – `KAP studies’, for example. KAP stands for `knowledge, attitude and practice’, and such studies help companies to focus their education efforts more effectively. The sometimes surprising results inform everyone. For instance, half the respondents in one company believed they were at risk of contracting HIV/AIDS; many expressed fear of discrimination, stigmatisation and safety. Significant myths in various surveys included that: HIV/AIDS is a punishment; sleeping with a virgin may cure it; that African traditional medicine may have a cure; that TB causes AIDs; and that mosquitoes are carriers.

Prevention

Of the many ways businesses can change the way AIDS unfolds, prevention is obviously the gold standard. Five key components have emerged, and many lessons have been learnt.

Education and awareness

The most basic component is an awareness and education programme, although three out of four small companies don’t even have these. The second is voluntary counselling and testing (VCT) – crucial since the data informs other policies. Third is communication of the company’s HIV/AIDS policy to the workforce; fourth, training leadership and management in how to deal with the disease, and fifth, engaging with communities by, for instance, extending education efforts to spouses and dependents. A good example is the Bata shoe factory in Estcourt, KZN. There, 98 percent of the staff are women, and many of their husbands are unemployed. They begged the company to approach the chiefs for permission to educate the men about AIDS too, since a common attitude among them was that since lobola had been paid, they could do what they liked with their wives!

Leadership makes all the difference. A picture speaks a thousand words, and one of the CEO with his sleeve rolled up having a blood test goes a long way to removing stigma, as Tony Trahar, Chief Executive of Anglo American, demonstrated.

`Edutainment’ by means of videos, plays, music and so on has flourished, being an effective way of reaching (sometimes illiterate) blue collar workers. Eskom staff, for instance developed their own play. `We worked on the script, the sets and the music,’ says Renier Venter, who eventually became mentor for many peer educators. `We took the play to communities all over, including schools and prisons. Later it won an award.’

Training staff as peer educators has also proved effective, not least because they speak the same language, both literally and figuratively, as their colleagues. Often, this has brought forth individuals with such passion for the work that they have been made `champions’. A publishing company uses a focus group to identify and encourage such people. An excellent example is Harold Bokaba of Unilever. A warehouseman for 25 years, his idealism led him into union work. Seeing AIDS spread, he developed a burning desire to help, and started a shop floor awareness programme. When Unilever made training for peer educators available, Harold was first in line. `Once equipped with counselling and education skills I started doing voluntary work in the AIDs clinic at Boksburg,’ he says. `Many patients needed pre- and post-test counselling. Sometimes I would see 15 in a morning.’ Soon he was giving talks at churches and schools too. But after several years, he suffered burn out and was unable to sleep. A compassionate Unilever nurse arranged for psychotherapy. `After only three sessions I was a changed person!’ Harold says. `I rediscovered my passion for the work.’ Subsequently he was offered a post as `AIDs champion’, and now advises on AIDs programmes in Unilever’s seven South African sites, plus other companies.

Treatment and Care

Many agencies offer complete HIV/AIDS management packages and avoid the pitfalls of inadequate counselling. Sixty-three percent of companies encourage counselling, pre-test, post-test and on-going. Of these, nearly 40 per cent contribute to the costs – the larger the company, the more likely this is. One in four outsource their employee assistance and wellness counselling programmes (EAP) to a national provider, whose counselling often includes not only HIV/AIDS but also family, social, violence and drug abuse counselling. Advantages are that the counsellors are more effective; and confidentiality is more obvious (and perhaps more real!) Also, separation of work and HIV/AIDS issues ease the objective evaluation of those issues.

Seventy per cent of large companies provide on-site treatment. Occasionally they go even further and treat the broader community. A well-known example is the Lesedi project run by the Harmony gold mining company in partnership with the South African Institute for Medical Research, Family Health International and the Institute of Tropical Medicine in Antwerp. The mining industry, relying as it does on migrant labour, is reaping the whirlwind, since the use of sex workers by men deprived of their families is high. Miners are a significant source of STIs and HIV infection. The Lesedi project targeted not only them, but also women in the surrounding communities. In the first nine months, the incidence of gonorrhoea and chlamydia was reduced by 42 per cent and there was a 77 percent reduction in genital ulcers. These dramatic declines were mirrored in the women, and the project spread. A computer model estimated that this treatment averted 39 percent of HIV infection among the women, and 48 per cent among the miners, saving the mining companies at least R6,8million.

Union support was crucial in garnering such co-operation. Small businesses, which struggle to implement HIV/AIDs programmes, find such help invaluable. The SA Clothing and Textile Workers Union (SACTWU) is an excellent example – it runs its own VTC programme which has trained 2000 shop stewards and more than 80,000 workers countrywide. Dr Feroza Mansoor, director of the programme, also sees SACTWA Union providing antiretroviral therapies to its members soon, and has plans for an orphanage and a hospice.

There’s no doubt that small and medium businesses need any help they can get. For although 90 per cent of them believe they have a responsibility to decrease the impact of HIV/AIDS on their business, only 34.5 percent are doing anything about it. Why? The main reasons are lack of time, and financial constraints, although 13 percent don’t feel HIV/AIDS will have enough impact to justify action. They should be aware of what happened in Uganda, when supply of cheap replacement labour ran out. Faced with a rotting coffee crop and no-one to harvest it, land concessions had to be given to Korean nationals in return for labour to pick the coffee beans.

One solution that has often proved fruitful is to develop local partnerships. In cape Town, for example, Securicor offered free security services to the local Trauma Centre who, in return, offered free counselling to all Securicor staff.

On a more sophisticated level, the Chris Hani Baragwanath Hospital, Soweto, obtained invaluable help from two small companies in providing internet solutions for its HIV vaccine trial. The hospital, with around 146,000 patients a year, is doing much research into HIV/AIDS, in conjunction with the University of the Witwatersrand, the World Health Organisation and UNAIDS. It has 25 PCs and 90 users, all internet enabled. A coalition of two small businesses, InfoStat and CubiICE, offered a satellite business solution on a private network, which halved the costs. They got excellent coverage out of their sponsorship, in return for which they received the latest information on the virus.

`Businesses of any size can contribute to battling AIDS. They only need to do what they do well, where it matters.’ Says Peter Piot, director of UNAIDS. `The fight against AIDS needs to be part of every aspect of business life: In providing for workforces, in participating in community life and in dealings with other businesses.’

Business Associations

Business associations and coalitions to tackle HIV/AIDS have also joined in the fight, sometimes with great success, as firms have a greater incentive to participate in and sponsor prevention activities if they can focus on the problems facing an industry sector or geographical area. The haulage industry has been particularly well organised, offering posters and training courses.

Benefit plans

Aid benefit plans with higher premiums provide a level of funding for HIV/AIDS treatment and care. But small print should be checked to see whether the HIV/AIDS funding limits override the `unlimited’ hospital benefits, warns the Red Ribbon site. In the current environment where dedicated HIV/AIDS benefits have not been widely introduced, there is serious risk that existing benefit structures may be inappropriately applied. Low cost medical aid schemes limit their HIV/AIDS benefits to wellness programmes and drug management programmes only, without funding the cost of care or medication. These schemes do however normally fund medication to HIV positive mothers, prevention drugs to prevent mother to child transmission and medication to rape victims. A number of insurers are now in the market with HIV/AIDS cover to enable employers to cover their workers. Capital Alliance Life, for instance, has made its mark in providing a comprehensive range of products specially targeted at the C and D income groups.

Conclusion

Clearly the challenge HIV/AIDS presents for businesses both great and small is enormous. But as all these examples prove, there is no need to feel powerless. Every initiative counts, and South Africa’s proud, gutsy heritage of tackling ‘impossible’ problems will, in the end, enable us to triumph.