FIGHTING AN INVISIBLE WAR
Written by me, commissioned by the Oxford Business Group,

South Africa is finally getting to grips with it’s AIDs pandemic, but there is still a long way to go before the battle will be won.


The HIV/Aids epidemic in South Africa has reached that of epic proportions, the consequences of which are also expected to be unthinkable. Thankfully this epidemic has reached a plateau, so the experts say, and with many campaigns being run not only on HIV prevention, but also on treatment, those on the inside say it is finally reaching a manageable state when compared with five years ago.

Other changes taking place are that corporate South Africa is finally taking some responsibility in the treatment of Aids for its labour force by initiating policies that deal with the problem in terms of treatment. And in addition, programmes targeting the youth population are bringing about changes in cultural stereotypes, needed in order to combat the virus, while creating a fundamental change in educating a nation that is believed to have an infection rate of up to 21.5% in adults between the age of 15 to 49 years according to an independent survey by ORC Macro, a research corporation based in Calverton, Md, the study was funded by the U.S. Agency for International Development, other international donors and various national governments in the African countries. Estimations have been widely debated and a study conducted by the Department of Health in 2005, reported that 10.8% of all South Africans over the age of 2 years were living with HIV in 2005, with those between 15 and 49 years old estimated at having a HIV prevalence of 16.2% in 2005. The reason for such widely debated numbers are that there is still a large proportion of the population who have not been tested.

In 2005, it was widely documented that by the age of 21 years one in every four women are already HIV positive, and the statistics on men are not far behind. The study by the Department of Health reported that among females, HIV prevalence is highest in those between 25 and 29 years old; among males, the peak is in the group aged 30-39 years. According to these results, males aged 15-49 years old are 58% as likely to be infected as are females in the same age group (11.7% in men versus 20.2% in women). Theses rates are down on 2004, where HIV prevalence according to the Department of Health Study was 24.6% amongst people aged 15-49 years old.

In 2006, deaths from HIV were set at around 1000 people per day, and although the epidemic has stabilized in terms of infection in the period 2003-2006, there has been a rising phase in mortalities with approximately 25,000 to 30,000 deaths being recorded on average per month, this figure is expected to rise according to Professor Andre Roux, Head of the Institute for Future Research told OBG in April 2006, “With the current rates on infection we estimate that within five years the total number of deaths from HIV/Aids will reach 40,000 per month.” Of course with such statistics now very much a reality corporate South Africa is having to take notice as the future productivity of the country is very much at stake. Roux added that the expected rise in mortalities will shave .5% off GDP.

TAKING RESPONSIBILITY: The first company to pioneer a HIV/AIDS treatment programme for its employees was Anglo American, South Africa’s leading mining company. Understanding that there was a problem due to high turnover of staff and absenteeism the firm took action. The initiative to conduct an employee survey in order to secure a labour force that is sustainable began in 2000. The latest surveys conducted in Eastern and Southern Africa by the firm in 2004, showed that almost 23% of the company’s work force, including all subsidiaries, have a HIV prevalence. The decision pushed through by Dr. Brian Brink to develop a way of saving lives at Anglo American seems to have paid off with absenteeism having been reduced from an all time high of approximately 6600 days per month for employees who were HIV positive in 2000, to around 2000 days per month in the first year of the programme.

With 80% of South Africa’s mining population living away from home it created an environment which was perfect for the spread of AIDS, and with no health insurers recognising HIV or even STDs in medical-plans, as is the case in most countries throughout the world, there was a definite problem in ignoring the issue. This helped the epidemic take hold, along with the general unhealthy living that these labourers practise.

Anglo American aware of the country’s Aids crisis started its campaign for prevention as early as 1986, however, the programme for treatment was not introduced until 2000. At that time Anti-Retroviral Treatments (ARTs) were showing positive signs in clinical trials and it was then that Anglo American committed itself to developing a programme to deal with its own crisis of sorts.

The programme entails that all employees who tested positive for HIV be offered enrolment in a wellness programme, which supplies treatment in the form of ART, therapy and advice on healthy living. The total number of employees who enrolled in the wellness programme as of April, 30 2005 was 7358. While 4459 employees began preventive therapy for opportunistic infections. These numbers have huge implications in terms of financial commitment from employers, however, with future productivity at stake, as well as a high absenteeism seen in pre-ART companies simply could not ignore the problem anymore. Although it does require a serious investment, Anglo American claim that over the first 12 months of introducing the treatment programme, up to 70% of its cost were covered by the reduction in absenteeism.

These days the firm actively promotes Voluntary Counselling and Testing (VCT) to normalise the stigma which surrounds HIV/AIDS in South Africa. This is being realised, says Anlgo American, by creating an environment which is conducive to testing. This requires developing a climate of trust, non-discrimination, confidentiality, empowerment, efficiency, caring and access to treatment.

With programmes such as Anglo Amercan’s being a positive step towards creating a work force that will ecru higher productivity, many companies have followed suit. One particular sector which has also dealt with the crisis in a similar vain is the automobile industry. South Africa has the tenth biggest automobile sector in the world and in terms of GDP has a worth of 7% to country’s economy. BMW and Vaults Wagon followed in the footsteps of the Anglo American model and also introduced healthcare plans for all employees to cover HIV/AIDS. In fact industry insiders say that Anglo American has revolutionised the way in which corporate South Africa is investing in the crisis, and maybe in the way the world at large will make up health care plans in years to come.

STARTING AT THE GROUND UP: The other aspect of the crisis is one that begins at an earlier stage, that of the country’s youth population. South Africa recognised that it not only had to treat its aging workforce but would have to focus on prevention in order to create a generation of negatives that would boost productivity in the future.

Among teenagers infection rates are still fairly low, but when girls leave school there is an explosion in infections. A national survey of HIV and sexual behaviour among 15-24 year olds conducted by LoveLife in 2003, South Africa’s youth campaign for prevention of HIV/AIDS, showed that HIV prevalence in girls aged 15-19 was 7.3% where as the rate in 20-24 year olds was much higher with some 24.5% recorded. Boys on the other hand were much lower with all 15-19 year olds surveyed having a HIV prevalence of 2.5% and 20-24 year olds 7.6%. Looking at these figures the over all negativity in children aged 15-19 regardless of age is 95.2%.

The campaign exclusively targets 12-17 year olds and seeks to build on the high negativities in this age range. LoveLife told OBG in April 2006, that in 12-17 year olds there is a 3.7% prevalence of HIV, which although lower than the older generation is still ten times higher than rates recorded in Western Europe and ten times higher than that of the United States.

A late starter due to government being slow in the recognition of the extent of the crisis, LoveLife began campaigning in 1999. Major funding initially came from the Henry J. Kaiser family Foundation and the Bill and Melinda Gates Foundation with additional funding from the South African Government, the Global Fund to fight AIDS, TB and Malaria, and the Nelson Mandela Foundation. LoveLife has gone through cuts in funding over the last 12 months with funding from the Global Fund being cut from some 200m Rand in 2005 to 140m Rand in 2006.

Today LoveLife reaches millions of young people through a number of different vehicles: television programmes reach a weekly audience of 4m teens; radio programmes have an estimated 6m listeners; UNCUT, LoveLife’s national newspaper has a circulation of over 1m; Tetha Junction helpline receives an average of 25,000 calls per month; an estimated 50,000 young people participate in activities each month at the 16 Y-centres across the country; 900 adolescent-friendly health services service local communities; Over 100,000 children are reached through school-based outreach programmes every month; and over 1m young people participate in activities related to the LoveLife Games – a year-long sports programme which builds confidence, competitiveness and motivation in young people.

“The most vital part of getting the message to the youth was to communicate with them on their level by creating a youth friendly environment where we could meet face to face with our target audience.” said CEO of LoveLife David Harrison.

OUTLOOK: If South Africa can keep the epidemic in check as it seems to being doing, the future of the country lies on a very different path. Harrison told OBG in April 2006, “We must focus on keeping this level of negativity high,” adding that, “If we do this then we will change the future of South Africa.”