The Case for Strong Workplace HIV/AIDS Programs
At the 2016 AIDS Conference in Durban, South Africa, over 18,000 leading stakeholders in HIV/AIDS treatment and prevention met to discuss the shared goal of ending the pandemic. As premier figures in science, policymaking, government, civil society and private sector gathered under one roof, one could not help but look back on the momentous steps in HIV/AIDS treatment and prevention since the International AIDS conference was last held in Durban in 2000.
Since the turn of the century, there has been a huge number of advancements in the technology to detect and treat HIV/AIDS. While there has been sustained global engagement by governments, the private sector and civil society, there is still work to be done in charting a forward course to ending the epidemic. Workplace programs are great potential contributors to this lasting change and an important part of the private sector commitment.
Businesses operating in affected countries need to view HIV/AIDS as a business imperative and not merely a corporate social responsibility issue. And they need strong cross-sector partnerships. This, coupled with structured and sustainable programs that are well resourced across various areas of a business, will be crucial to ending the scourge of AIDS by 2030.
The Importance of Workplace Programs
According to UNDP, more than 40 million people worldwide are infected with HIV, and an estimated 26 million of those are age 15-49 -- in the prime of their employable years. As such, the impetus is on workplaces in affected countries to create employee wellbeing programs.
Apart from the obvious -- and absolutely paramount -- moral and human incentive for encouraging testing and treatment, the benefits of workplace testing can have a ripple effect: bettering the lives not only of those infected, but also of their families, co-workers and the population at large. The strength of a prevention program is preventing new cases from occurring. Research has shown that continuous gender inequality and poor knowledge about sexual and reproductive health, certainly among adolescents, feeds the spread of the virus.
Everyone from employers to co-workers benefits when those infected are detected as early as possible and provided with the correct treatment to allow them to survive. It is now well established that a correctly treated person living with HIV has much less chance of transmitting the infection to his or her partner.
But there is a psychological dimension here, too. Effective treatment programs are necessary not only to protect those affected, but also to maintain morale among staff members. At the end of the 20th century, colleagues would become ill and eventually die due to the uncontrolled infection. The perceived lack of control, emotional strain and negative external signaling is demoralizing and can inculcate learned helplessness in our teams. Even if HIV is not directly affecting our own health, it is having a huge impact on our daily lives.
This is why employees and their managers have such a crucial role to play as advocates in encouraging testing and treatment among their peers. It does appear that fear of stigmatization is still strong and inhibits people from getting an HIV test. Stigma exists even in company that for more than 20 years has pledged and maintained the promise not to discriminate.
While a secondary consideration in the importance of workplace testing, the positive economic impact of productive workplace antiretroviral programs has been well documented. We researched the effect of antiretroviral workplace treatment programs at nine Anglo American operations and found that the cost savings is 5% of overall cost, translating into an average saving of $1.6 million -- with most of these savings due to reductions in benefit payments and in-patient care costs.
Regional Significance in South Africa
For HIV infection, Southern Africa is still the most severely affected part of the world. This has particular resonance in the mining industry, which is a strong private sector player in the region, and particularly for Anglo American, whose historical roots in the continent continue to this day. We are operating in the midst of a society that is still suffering from HIV and where new cases are still occurring. Fortunately, fewer people are dying from HIV than before, and more and more people have access to treatment. At the same time, the number of new cases continues unabated. This, frankly, is unacceptable, when we are more than 30 years into the epidemic.
This only reinforces why, for miners, this cause should be paramount. If we hone in on HIV/AIDS treatment and prevention, we will benefit the industry as well as have, perhaps, the greatest possible impact on regional health. We should bring new infections down and ensure that people start treatment immediately and continue it for the rest of their lives. But the first step is getting tested. If we can demonstrate that this is possible, it will encourage others to take bold steps to reach the same goals.
In the early 1990s, the HIV prevalence in the South African mining industry was around 1%, but by 2000, this number had snowballed to 25%. Immediate action was necessary, and we were swift to set up workplace testing within Anglo American, offering free treatment to all employees in 2002. Taking into account this ripple effect, we soon extended the program to include dependents of infected employees.
We now run the world's largest private sector testing program for HIV/AIDS and TB, as both diseases are closely linked. After so many years of encouraging voluntary testing, we might be seeing the first signs of "testing fatigue": less interest by management and employees in sustaining testing efforts. The success of drugs to suppress the disease may have led to complacency and the perception that we are in control. This complacency is dangerous, as we again are seeing workers coming very late for testing, and we still have too many colleagues dying from the disease. The good news is that the number of our employees enrolled in HIV disease-management programs increased 10 percent from 2014 to 2015. Now, 88 percent of our HIV-positive workforce is enrolled. By following the expert advice to start treatment early, we hope to increase this number even further.
The Generation to End It
At AIDS 2016, there were many lessons learned and pioneering conversations about how to stop AIDS finally. Businesses have a huge role to play in this, and as leaders in the private sector, their employee workplace programs need to engage and commit to ending AIDS in line with the UN goals.
But as long as we have a single worker infected with HIV, we are not yet there. This is not to diminish the strides made so far in the 21st century. Rather, it is to ask another, more aspirational question: Could we be living in a society free of AIDS as a major public health problem 15 years from now? We think it is possible and look forward to working with governments, civil society, and fellow business leaders to make this happen.
Stefaan Van der Borght is the global head of health at Anglo American.