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HIV prevalence increasing amongst skilled employees

It appears from the results of joint AIDS research conducted by Markinor and the BMR, that HIV prevalence rates among the skilled, the employed and the affluent are higher than generally expected and are also increasing more rapidly than expected. However, current studies and models appear to be flawed and a reliable estimation model does need to be built to ensure more accurate HIV prevalence estimates for South Africa, the SAMRA conference heard last week.

Mari Harris and Carel van Aardt from Markinor presented a paper called: 'Creating a revolutionary tool for South African employers by fusing HIV/AIDS risk segmentation and demographic modelling'. Their paper centred around their assertion that there is an urgent need to develop a reliable estimation model based on empirical evidence to provide HIV prevalence estimates for South Africa.

In the joint Aids research conducted by Markinor and the BMR, two competencies were integrated, namely KAPB data collected in annual omnibus studies from 2002 onwards and the use of the Spectrum model to estimate HIV prevalence rates among specific sub-groups in South Africa.

Devastating diseases like HIV/AIDS, TB and malaria often occur in places that are potentially attractive to business. Business operations are adversely affected as infectious diseases increase costs, fuel new risks, restrict economic growth, impact current markets and reduce potential market size. Effective intervention may create the opportunity to bring about political stability and business continuity, as well as improve the lives of millions of people infected with and affected by these diseases.

However, in the case of HIV/AIDS, global perceptions differ notably from those people most affected - i.e. the sub-Saharan region in Africa. The World Health Organisation found that - should a country experience a 20% HIV/AIDS infection rate amongst adults - it translates into an annual GDP reduction of 1%. In areas dependent on agriculture, infectious diseases reduce food production, as infected workers are less able to work in the fields.

Annual per capita growth of the worst affected countries will be diminished by 1% to 2% in future as a result of HIV/AIDS. This means that after two decades, the economies of affected countries will be 20% to 40% smaller than would have been the case in the absence of HIV/AIDS. Currently (2005) it is estimated that there are nearly 40 million HIV-positive individuals worldwide. More than two-thirds of them are living in sub-Saharan Africa - making it undoubtedly the world's AIDS hotspot. Indications are that although South Africa is the most developed country in the region, it may also be experiencing the fastest growing HIV/AIDS epidemic in the world. In fact, currently a sixth of all HIV-positive people in the world reside in South Africa. The adult HIV-prevalence rate in South Africa is about 23% while that of the whole population (including children) is about 15%.

The picture in the rest of sub-Saharan Africa is also rather bleak, especially if one takes it into account that these countries and populations might also be vulnerable for other reasons like political instability, slow economic growth and problems with food security.

Worldwide HIV/AIDS related deaths totalled about three million in 2004, with nearly 500 000 of these deaths in South Africa. By 2011, HIV/AIDS could be responsible for five million deaths in South Africa and this figure could rise to nine or ten million by 2021.

Reasons

The reasons behind the high HIV-prevalence and AIDS-related death rates in South Africa can be summarised as follows, the researchers stated:

  • Social and family disruption due to apartheid and labour migration.
  • Inadequate knowledge about avoiding HIV/AIDS, the stigma associated with contracting HIV/AIDS and a fear of social isolation.
  • High-risk sexual behaviours and blatant denial by those infected.
  • High levels of poverty.
  • High levels of inequality and the low status of women, combined with traditional practices in many communities.
  • The relative ineffectiveness of HIV/AIDS-related programmes, combined with conflicting messages in the media.
  • Crime and rape.
  • Lack of leadership and the South African Government's ambiguity when discussing HIV/AIDS issues.

From the findings of continuous research projects it is clear that South Africans are aware of the HIV/AIDS crisis in the country and see a real risk that they themselves or someone in their family could contract the disease. Almost all (94%), considered HIV/AIDS to be a very serious problem, although it was ranked below unemployment (40% vs.18%) as the country's most serious national problem in 2001.

It appears from the 2002 to 2005 MBus results that South Africans are generally aware of the link between HIV/AIDS and risky sexual behaviour and know about methods of protection, yet the groups displaying medium to high-risk sexual behaviour grew from 37% in 2002 to 43% at present.

Harris and Van Aardt say it is clear from the risk group results and HIV-prevalence estimates shown in this paper at the SAMRA conference, that there appears to be a very strong predictive relationship between sexual risk in the face of HIV/AIDS on the one hand, and the probability of being HIV-positive on the other hand.

Five risk groups

It also became evident from the analyses conducted for the purposes of this study that people who can be classified in all five risk groups identified are customers, suppliers and employees of businesses in South Africa. Both Markinor and the BMR have applied the HIV/AIDS risk scale used in this study and have found similar results, namely; that all five HIV/AIDS risk groups are present and that the number of sexually active adult customers and employees who are in the medium and high risk groups are on the increase.

Having shown the increasing sizes of the medium and high risk groups and the high (and increasing) HIV-prevalence rates estimated from such risk data, it must be clear to businesses that HIV/AIDS will impact on many aspects of the economic lives of South Africans, South African businesses and the natural economy, i.e.:

  • Reduced savings and disposable income as a result of illness, higher expenditure on healthcare and premature death.
  • Reduced foreign investment.
  • Redirection of resources from national needs such as education and infrastructure towards increased spending on healthcare.
  • Depletion of the major economic base of a community through higher mortality rates among the worker and consumer populations aged 25 to 45 years.
  • Prospective revenues of businesses are jeopardised as the consumer base dwindles and becomes increasingly impoverished.
  • Changes in family expenditure priorities, lower individual and family purchasing power and reduced potential for accumulating savings.

    Increased number of orphans and socially dependent groups.

  • Education - both in terms of supply and demand. Disease works in combination with other factors to promote instability in vulnerable societies in that it exacerbates political instability by provoking political and social fragmentation, and economic decay.

In the face of this mounting impact of HIV/AIDS and here especially in the light of the high (and increasing) HIV/AIDS risk and HIV-prevalence estimates pertaining to the affluent, educated and employed, the imperative to address this situation to avoid large-scale negative impacts of HIV/AIDS on businesses is clear, say the researchers.

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