Understanding the role of business in the global AIDS crisis

Just as no country has remained untouched by AIDS so too has no sector remained entirely immune. Until recently, most in the business sector assigned responsibility for the pandemic to governments, activists, or the public health community. There is a growing experience however, from multinational companies to small and medium enterprises, that becoming involved in the fight against HIV/AIDS is crucial, not only for reasons of good corporate citizenship, but increasingly out of a more comprehensive understanding of corporate self interest.

If you use your cell phone, log on to your computer, visit your doctor or go to your bank, the odds are good that an Indian employee of a major American company has made the process easier. India is quickly becoming the engineering, customer service and manufacturing backbone for major segments of the American and international business community. Bangalore and Hyderabad have emerged as global centers for innovations in information technology and biotechnology. Multinational companies are racing to take advantage of India’s well-educated and low-cost talent to staff call centers and service desks.

In the face of such swift development, a less enviable growth statistic is a rapidly escalating HIV/AIDS epidemic. The virus, too, is efficient, spreading silently and perniciously, almost without notice. In 2002 alone, the number of people living with HIV/AIDS increased by more than half a million from 3.97 million to 4.58 million. India’s one billion strong inhabitants mask the prevalence of the epidemic, while in reality India stands only second to South Africa as the country with the greatest number of infections.

HIV/AIDS is much more than a medical emergency. Devastating the fabrics of society in much of sub-Saharan Africa and escalating dramatically in the world’s fastest growing markets including China, India and Russia, the pandemic stands to alter economic potential and political stability in our world’s most important emerging economies. AIDS, left to run rampant, places in jeopardy accurate risk profiles and measures of policy stability, fiscal responsibility and ensuing exchange rate stability, and a host of other factors crucial to accurate projections of profitability in the medium-term. While firms may have the flexibility to draw on plentiful labor markets when AIDS takes its toll on productivity, they do not have similar ability to operate in isolation of the broader environment in which they exist.

The business sector in sub-Saharan Africa has begun to take action against HIV/AIDS, but globally the private sector as a whole is only doing 5% of what it could be doing. This is not just an African problem. The unfortunate reality is that very few Asian and Eastern European companies are addressing this issue, either in their workforces or in the communities where they operate. With over 7 million people already infected, Asia is on its way to becoming a new epicenter of the AIDS pandemic. Eastern Europe has the fastest growing rates of infection in the world.

Asian and Eastern European business leaders would be wise to listen to the lessons of South Africa. At a recent conference organized in New Delhi by the Global Business Coalition on HIV/AIDS (GBC) and the Confederation of Indian Industry (CII),Brian Brink, Medical Director for the South African mining giant Anglo-American, made a dramatic and passionate warning: “Don’t make the same mistakes in India we made in South Africa – we saw this coming but the first reaction of business was that it wasn’t our problem, that it wasn’t threatening us now, that we’d let the government sort it out.” Now, twenty-five percent of Anglo’s employees are infected with HIV/AIDS and the disease has begun to affect corporate profits, productivity and morale.(As a result, Anglo-American has made a dramatic change in its policies, establishing a wide ranging set of new programs that have made it a leader in this field.)

The role of the business sector

Led by over 150 international companies, the GBC believes that business can respond to the AIDS epidemic in a variety of ways; such as, taking action in the workplace and extending programs into communities, by using products, innovation, skills and services creatively and by advocating for greater action by all sectors of society.

Companies have made significant headway in their response to HIV/AIDS by developing comprehensive approaches that link their HIV strategies to the communities where they operate. Leveraging their existing infrastructure and in-country relationships, manufacturers in countries most affected by HIV/AIDS can provide mechanisms for service delivery and can influence outcomes in the communities where they function by providing comprehensive non-discrimination, prevention, testing, and treatment programs to workers and members of the broader community.

Capitalizing on their unique strengths, businesses have matched their proficiencies to HIV program areas where they can add most value. Companies in the consumer products industry have applied marketing, advertising, messaging, and brand promotion capabilities to public awareness and education campaigns on HIV/AIDS. In addition to these programs, consumer product firms have developed highly effective workplace programs for employee education, testing, and treatment.

Companies in the media and entertainment industry are uniquely positioned to harness their media access, messaging, programming, networking, and use of celebrity figures to deliver HIV/AIDS awareness and education programs in the workplace and community and to reach millions of households in the United States and abroad.

The oil and extractives industry has been severely affected by HIV/AIDS, with some companies reporting prevalence rates as high as 25 percent in their workforce. These high prevalence rates and the high cost of AIDS-related deaths, absenteeism, and healthcare for sick employees has led companies in the industry to implement comprehensive workplace initiatives and treatment programs. Many companies in the industry have begun to create synergistic partnerships with the public sector to help shape the local response.

Gaps in the Response: The Need to Know

Despite the progress and new commitments, business leaders admit that the take up of HIV services by their employees remains extremely low. Managers report that employees are afraid of coming forward for testing for fear of discrimination by the company if they are HIV positive. Even those companies with explicit HIV policies report the same experience.

It is not only in the business community that faces this challenge. The UN estimates that over ninety percent of those who are infected don’t know their HIV status. Since someone who is infected can carry the virus for seven to ten years before any symptoms become apparent, these people unwittingly infect others along the way, and often pass the disease along to their children. Learning one’s status provides incentive for those testing negative – and that is still the vast majority – to stay negative and helps people living with HIV/AIDS and their sexual and needle sharing contacts to prevent transmission of new infections.

Currently, of the six million people in need of antiretroviral therapy, only 400,000 have access to these life-saving medicines. Conscious of the mounting crisis, the World Health Organization and UNAIDS launched the “3 by 5”Initiative in early 2003 to focus on a target of bringing three million people on treatment by the end of 2005.Inorder to achieve this goal,5,000 people will need to be brought onto treatment every day, over the next 17 months. This will require the provision of 250 million HIV tests: to bring 5,000 people on treatment daily, 500,000 people will need to be tested each day, assuming that 50,000 will test positive in high prevalence countries and 10% of those who test positive will require immediate access to treatment. But without a dramatic change in testing strategy, this goal will not stop the spread of AIDS, it will only slow it down.

The business sector has a significant opportunity to advance access to testing services through existing networks, relevant products and marketing expertise. As detailed in the Expert Meeting Report:” The Role of the Business Sector in Scaling-up Access to Antiretroviral Therapy” from June 2003,GBC has done extensive work to determine the role of the business sector in scaling-up access to antiretroviral therapy, drawing from this experience the business community can offer a range of skills and resources to integrate in national responses to the epidemic including:

• Community mobilization and awareness: use communications and marketing expertise to mobilize communities and raise public attention on the importance of HIV testing;

• Sustainable supply of products and distribution networks: Development of innovative products and donation and distribution of HIV test kits and diagnostics;

• Responding to needs for testing scale-up: Building capacity and training to support scale-up and delivery of routine testing and counseling;

• Integrating HIV testing and counseling into health services and community networks: Offer existing infrastructure in the form of clinics, trained professionals, laboratory facilities, distribution networks to support testing service delivery.

Governments, companies and communities want individuals to take advantage of prevention, education, testing and treatment programs – yet in order for these programs to be genuinely successful, individuals must know their HIV status. The difficult truth is that unless we place considerably more attention eradicating the stigma and discrimination people face if they are HIV positive, we will not be able to scale up HIV testing programs and the numbers of HIV positive individuals accessing the increasingly available and affordable HIV treatment will remain low. The challenge is enormous, but attainable, with increases in funding and attention from donor governments and business leaders, reductions in drug and diagnostic pricing, integration of public-private delivery of healthcare, and overarching shifts in policy.

Business leaders have the unparalleled opportunity to tackle head on stigma and discrimination that has enabled this virus to spread, often unchecked, over the last twenty years. Their leadership within their own companies and their advocacy with government leaders are critical tools in forcing their societies to address AIDS openly and honestly. A better example could not be found than that of GBC member Chris Kirubi, Chairman of Haco Industries of Kenya. He took the extraordinary step of taking an HIV test on prime-time national television in order to help break the taboos surrounding the disease and to encourage the general public to seek testing as well.

Business leadership and action on AIDS is crucial, but alone, it cannot not solve the AIDS emergency. It can never replace the leadership needed by governments and political leaders. Rather, the business community can support and pressure governments to act, through examples of good practice, demonstrating that prevention, testing and treatment services can be provided effectively. We must hope that the growing mobilization of governments, businesses and community groups can be harnessed as rapidly and effectively as possible to avert the dire predictions of100 million cases of HIV by the year 2010.business in the global AIDS crisis..