THINK (TB and HIV Investigative Network) is a globally recognised not-forprofit organisation focused upon conducting clinical research on behalf of providers of medication to alleviate suffering arising from Tuberculosis and HIV infection. Whilst its area of influence incorporates the African Continent, THINK is based in KwaZulu- Natal where infection rates are particularly prevalent.

DRG Outsourcing, as a human resources support partner to THINK, have applied our expertise in facilitating the development and delivering of a training programme, founded upon THINK's knowledge and experience to share bestpractices in addressing the debilitating consequences of these two pandemics consuming our people, our workforce and therefore, our economy.

THINK's dedicated team of experts, in close collaboration with other knowledge- expert entities, have produced the highest quality but, practical content currently available.

Our wish is to influence a collaborative and connected future for healthcare - where teams work together in ensuring that a heightened awareness of and effective response to the TB HIV pandemics.

Please join us in this mission by inviting us to present our awareness training to your organisation. Please contact Nomtha Cele 031 767 0625 to hear more. Siyabonga Nzimande - Director THINK)

Why is HIV a business issue?

HIV/AIDS is impacting on economic activity and social progress around the world. Only now are the hidden costs of HIV/AIDS to business coming to light. Besides the costs to individual companies, HIV/AIDS is hampering human resource development, undermining the skills base and driving away foreign investment. The benefits of a proactive approach far outweigh the costs of doing nothing.

Over 90 percent of people with HIV/AIDS are in the most productive period of their lives, be they workers, managers or employers. According to the International Labour Organisation as many as 36 million of the 39 million people living with HIV are in some form of productive activity. There is no doubt then that HIV/AIDS affects business causing costs to escalate and markets to contract. While many would argue that business has a moral responsibility to help tackle the worst health crisis the world has seen in 700 years, there is also the matter of the bottom line.

Research shows that if companies invest in prevention and treatment programmes, the savings outweigh the costs. Providing care and treatment for HIV-positive employees can reduce the financial burden of HIV/AIDS by as much as 40 percent.

How badly are companies affected?

For anyone doing business in South Africa, 10 to 40 percent of the workforce is likely to be infected with HIV. But the impact and potential impact of HIV/AIDS varies from one company to the next. Labour and capital-intensive industries, as well as those with a high mobility of labour, are most affected. Research in South Africa shows that the mining, metals processing, agribusiness and transport sectors are most affected by the pandemic, with more than 23 percent of employees infected with HIV/AIDS and with prevalence rates two to three times higher among skilled and unskilled workers than among supervisors and managers.

What are the direct consequences of HIV/AIDS on companies?

Companies are directly affected by lower productivity, greater absenteeism, vacant posts, the need to retrain and rehire workers, reduced productivity due to staff inexperience or illness, loss of morale among employees, poor labour relations, less reliable supply chains and distribution channels the list is endless. Other direct costs to companies depend on whether they offer employment benefits, funeral cover, pensions and inhouse medical facilities.

On a general level, HIV/AIDS is affecting business by increasing poverty and therefore lessening the demand for goods and services. It is also increasing demands for state spending, placing strain on the government's capacity to deliver health and welfare services. When breadwinners die or lose their jobs due to illness, poverty spreads. When students and school children drop out of learning institutions because they or their family members are ill, the skills base is continuously eroded. Years of development, skills building and intellectual knowledge are undermined by the loss of productive members of our economy.

Why is business perfectly positioned to get involved?

Business has direct access to those most affected, the productive members of our society. The workplace is the ideal environment for tackling the epidemic as employers and employees group together regularly in an environment where communication systems to disseminate information and undertake education programmes exist.

Business is good at making things happen: with its focus on problemsolving, target-setting and speedy delivery, programmes can be run effectively and efficiently. Core skills of business such as media, marketing or training can also be harnessed for in-house programmes or to support community or NGO initiatives.

What are the benefits of involvement in Business Sector?

There is no doubt that HIV/AIDS has an effect on markets generally and on consumer behaviour. A healthier labour force generates more spending power and a more vibrant economy. Besides the moral imperative to save lives and the direct financial savings to the company resulting from more productive employees whose health and lives are prolonged with ARVs, there are other direct benefits too.

• Some companies have achieved recognition and accolades around the world for their involvement in combating HIV/AIDS.
• Companies risk falling behind as others take the lead in the fight against HIV/AIDS.
• Sound programmes have been shown to boost staff morale and improve labour/employer relations.
• With the business sector now facing growing pressure from organised labour to do their bit, proactive measures can head off the potential for industrial conflict.
• The public/private partnerships being forged to strengthen HIV/AIDS programmes can result in mutually beneficial cooperation in other areas.

Every company should have an HIV/AIDS policy and a programme in place, with four key elements:

• Prevention
• Care and support
• Protection of infected or affected employees from stigma and discrimination
• Monitoring and evaluation of the programme.

The ins-and-outs of HCT

HIV Counselling and Testing (HCT) programmes must be part of a broader HIV/AIDS programme that enables the employee to access HIV prevention, care and if necessary treatment. HCT should also be part of a broader health service delivery for employees so that they don't view the initiative as an attempt to screen them. Unless a Voluntary Counselling and Testing programme is run in a climate of confidentiality and nondiscrimination, it will fail.

HCT campaigns in the workplace have been shown to be only partly successful, with uptake rates seldom more than 45 percent, due to stigma, denial, fear and ignorance. This means that uptake for treatment, even if offered free, by the company is also low.

Research shows that compulsory counselling and voluntary testing ensures better testing rates among employees. Also, campaigns led by senior management and characterised by short, intensive know your status drives, have significantly increased uptake rates.

Treatment programmes

Employers can prolong the health and productivity of employees living with HIV/AIDS by offering care, treatment and support services either in the company or by partnering with health care providers in the private or public sector. Research shows there are large savings to be made regarding a reduction in death, disability and sick leave costs as well as human resource and medical costs. A service, whether in-house or not, needs to include the treatment of other sexually transmitted diseases, opportunistic infections, particularly TB, counselling support, antiretrovirals (ARVs), home-based and palliative care.

Due to partnerships with government, medical aids, international donors and NGOs, ARVs are now far cheaper and easier to access.

Condom distribution is an important component of any HIV/AIDS prevention strategy. Scientific research shows that latex condoms are highly effective in preventing the transmission of HIV and other STDs when they are used consistently and effectively.

Project Promote has developed out of the urgent need to comprehensively address the issue of the re-supply of condom dispensers at non-traditional sites. The condom-distribution project is a unique partnership between the South African business and government Department of Health.

Two major approaches (ideally they should be integrated):

• Interventions which focus on individual behaviour change
• Interventions which focus on a universal test and treat.

Tuberculosis TB is especially a concern in Africa and it will only get worse as the AIDS epidemic spreads. Businesses in Africa have been at the forefront of managing AIDS in the workplace. It makes sense to include TB in these programmes, particularly in countries with high rates of TB such as South Africa.

TB ranks as one of the world's most lethal but also most treatable infectious diseases in adults. Better still, when properly given, treatment means cure. Yet, two million people die each year from TB - 5,000 to 6,000 people a day.

Three quarters of these are men and women between the ages of 15 and 54 - people in the most productive age group. This results in significant economic consequences:

• For businesses. In high prevalence settings, many workers are vulnerable to TB. A sick worker means disrupted workflow, reduced productivity, weeks or months of absenteeism and, potentially, the direct costs of treatment. In Uganda, 80% of wage earners stopped working due to TB with the average time lost from normal activities being 9.5 months. All this can add up to substantial costs to companies.
• For businesses and communities. In high prevalence settings, TB is a major contributor to ill health and poverty in a community. The success of a business is closely linked to the health and prosperity of the community. The community is a source of workers, services, contractors and business; it is a key part of the overall business environment.

The workplace

The workplace is a win-win setting for TB management - for both the worker and the company. For the worker, the workplace is a convenient location to gain awareness and receive treatment for TB. For companies, TB management can save costs by reducing absenteeism and staff turnover - through prompt diagnosis and effective treatment - and by reducing transmission to other workers with attendant costs.

Cost saving at the workplace is not the only reason for starting a workplace programme. As part of corporate responsibility programmes, many businesses have a broad commitment to improving the well-being of their community. Where TB prevalence is high, TB management at the workplace is an opportunity for businesses to concretely demonstrate their social commitment, as showing that they are concerned for their well-being, as part of a local licence to operate.

DRG Outsourcing (Pty) Ltd
T; 031 767 0625
F: 031 767 3280
david@drg.co.za
www.drg.co.za