The impact of HIV/AIDS on business

Francis Kimani Njnang’iru, program manager, Kenya HIV/AIDS Business Council.

Initially businesses viewed the HIV/AIDS pandemic as a medical issue that concerned only the so-called "high-risk" groups.

Now, however, it has become a much broader threat to communities, businesses and the economy. Those affected include women, children, agricultural and industrial workers, technicians and civil servants at all levels. What should also not be forgotten is that where a worker might not be HIV-positive, if one of the family is, this will almost certainly impact on the worker. Concerns about the family member, costs to the worker and hence lower morale, pre-occupation with family issues, absenteeism as a result of having to attend to the family member's needs… all of these and more will impact on the worker's productivity.

Businesses, organisations and governments have generally embarked on information or educational campaigns to reduce the amount of risky behaviour by the target audiences, and typically these campaigns include billboards warning against risky behaviour or brochures describing the medical and epidemiological aspects of AIDS.

The trouble is, the messages are often threatening and stigmatizing, and they sometimes fail to include basic information: ‘Go and be tested' people are told - but they are not told where to go for the test. They are also not told what the test involves - so the person seeing the poster doesn't know whether the test will take some time, be painful or not and so on.

In other cases, depending on the social and religious mores of the community, the use of condoms, for instance, might not be mentioned.

The end-result is that these strategies sometimes reinforce the stigma HIV-positive people face in their community and workplace.

It is clear therefore that a "one-size-fits-all" approach is not effective and a far more targeted approach is required.

People fear the disease because often they are ignorant of what exactly it is and what impact it has. Furthermore, since other members of the community are known to be hostile to those with the disease, the ignorance and fear is combined with denial – firstly that the individual in question will become infected, and if he or she already suspects they are infected, they will deny their condition and refuse to be tested – which will confirm it.

A key to changing how people behave is by creating a far more enabling, tolerant and less threatening situation comprising confidential testing, counselling and care. Where a more sympathetic and empathetic approach is taken, people will tend to make more use of what the programs offer.

It is in the message

In Botswana, for example, the Botswana Network of People Living with HIV and AIDS encouraged people to be public about their HIV status through special events like the 2006 "Mr. Positive Living Pageant", which puts a very different emphasis on the pandemic and those who are HIV-positive.

Business can play a substantial role in such programs; in fact, business must play an active and substantive role in promoting AIDS awareness and associated programs with positive messages that encourage workers to come forward…

According to Francis Kimani Njnang'iru, program manager, Kenya HIV/AIDS Business Council, in his address The Blueprint for Business Action against HIV/AIDS to the Pan African Health Congress 2007 on September 18, the cumulative loss of the workforce in sub-Saharan Africa by 2005 was about 25 million. Without intervention, it will approach 74 million by 2015.

‘With 12 to 25% of workers HIV-positive the annual cost can be between half and up to three-and-a-half times the worker's annual salary - and that will have a massive impact on the bottom line,' he said.

Direct costs can include impacts on insurance, retirement funds, health and safety, medical insurance, recruitment costs for new staff – advertising and training, for instance, HIV testing for new and existing staff and funeral costs.

Indirect costs include absenteeism, staff churn, loss of skills, loss of tacit knowledge, and a decline in worker morale.

All of these add up to major costs and a loss in productivity.

Typically, a timeline study of how the pandemic will affect a workforce would follow this pattern:

0-7 years – workers are outwardly healthy and fully productive: no cost to company
7-9 years – illness begins to manifest itself in some workers: company begins to incur costs associated with illness
9-10 years – employees leave or begin to die: company incurs end-of-service costs
10+ years – company incurs recruitment, training costs, suffers loss of efficiency and productivity, as new workers ‘get up to speed'.

In an effort to assist businesses in meeting these challenges, MSD (Merck Sharp & Dohme, a leading global pharmaceutical company) has created its Blueprint for Business Action on HIV/AIDS, which can be downloaded from http://www.hiv-msd.info/Blueprint/index.php.

‘This easy-to-use tool has been designed to assist companies in developing programs to meet the challenge of HIV/AIDS in the workplace,' says Njnang'iru.

The free web-based tool is presented in seven independent modules – policy, partnerships, prevention, voluntary counselling and testing, treatment, monitoring and evaluation, care and support. All can be used in concert with the others, or individually.

Case history:

In a company with 1907 employees comprising 2 managers, 5 supervisors, 200 skilled workers, and 1700 unskilled workers and with an overall HIV-positive rate of 25%, on an annual wage bill of R7.5 million, HIV-related costs will amount to about R600000.

If one plots the progress of the pandemic over 15 years, if no program is instituted, 551 workers will be lost to HIV/AIDS over the period. If a preventative program is instituted, the death toll will be 407 and if a fully comprehensive program is applied, 198 workers will die.

Even in the best-case scenario, the impact on the workforce will be severe, and still constitute a significant cost to the bottom line.