Good Practice Note | December 2002 | Number 2 Good Practice Note HIV/AIDS in the Workplace 26730 A ccording to the United Nations, the past medical and health insurance costs, funeral costs Environment and Social Development Department two decades have seen 60 million people and death benefits, as well as recruitment and infected by HIV/AIDS and 20 million training needs due to lost personnel. In addition, deaths. Ninety-five percent of the infected firms experience decreased revenues as a result of population currently live in developing countries. higher absenteeism and staff turnover, reduced While Africa continues to be the productivity, declining morale and a region most severely impacted by "It is inevitable that a shrinking consumer base. While a the pandemic, infection rates in firm doing business in company's revenues decrease, its What’s Inside: other regions (notably Eastern and costs of doing business increase 2 Costs and Benefits Central Europe and Asia) are the developing world will because its suppliers, distributors 4 Getting Started climbing rapidly. The UN predicts and the public sector are also 68 million more deaths over the pay for AIDS. It is just a affected, leading to similar 7 Taking Action 9 Education and Prevention Programs next twenty years unless efforts at question of when and disruptions in the supply chain. 11 IFC Against AIDS prevention and treatment are 16 Care and Treatment Programs increased (”Report on the Global how much." This Good Practice Note is an 18 Monitoring Effectiveness HIV/AIDS Epidemic”, July 2002, — Lee Smith, Former President, introduction to the issue of 19 Extending the Reach of the Private Sector UNAIDS). Levi Strauss International HIV/AIDS in the workplace and is 22 A Corporate Road Map on HIV/AIDS targeted at the private sector in The social and economic impact of the disease is developing countries. As part of IFC’s ongoing intensified by the fact that AIDS kills primarily young commitment to sustainable development, the Note and middle-aged adults during their peak seeks to provide companies with practical guidance productive and reproductive years. At the macro and a range of options, based on corporate level, an effect of this nature on the workforce can experiences, for designing and implementing impact the economies of entire countries. By prevention and care programs in support of reducing the labor supply and disposable incomes, employees and the communities in which they AIDS impacts markets, savings rates, investment work and live. and consumer spending. While assessing the economic impact of AIDS is very difficult, studies This is a learning process for many companies suggest that some of the hardest-hit countries may which means that good practice approaches are forfeit 2% or more of GDP growth per year as a continually evolving. The examples in this Note result of the epidemic. come from publicly available sources such as agency publications and company websites. IFC has not At the micro level, businesses will feel the impact of verified the accuracy of such information nor the HIV/AIDS most clearly through their workforce, companies' practices, and in certain cases it is simply with direct consequences for a company's bottom too soon to judge the success of various programs line. These include increased expenditures on and initiatives. Page One HIV/AIDS Costs and Benefits recruitment and training costs on the one hand, and increasing incidence of HIV on the other. In such It is difficult to generalize about the costs and cases, taking no action may prove the bigger risk. benefits to companies of implementing workplace UNAIDS estimates that the annual cost to a programs to address HIV/AIDS because there are company of prevention per employee is $5, so many variables to consider. For example, a whereas the costs of AIDS can be far higher. business operating in an existing high prevalence The social and region or locality where the epidemic is well- The key is to find the most affordable solution to fit economic impact of advanced may have a very different cost-benefit a company's particular needs. With this in mind, scenario than a business located in an area where studies have been undertaken to explore the costs the disease is HIV incidence is relatively low but increasing. The and benefits associated with business action on former may see care and treatment programs for HIV/AIDS. Researchers from the Center for intensified by the fact its workforce as a priority whereas, for the latter, an International Health at Boston University have that AIDS kills education and prevention campaign would bring developed a costing model that estimates the cost-effective benefits. Other variables affecting cost present value of new HIV infections in the formal primarily young and may include: size of company, setting, industry business sector in southern Africa. The study found middle-aged adults sector, cost margin, ratio of skilled to unskilled that new infections can cost between 3.4 percent workers, risk factors, HIV prevalence in the and 10.7 percent of annual salaries depending on during their most workforce, availability of government or NGO skill level, associated benefits, and prevalence in the supported programs and facilities, etc. area. While treatment costs will vary considerably productive years. among companies depending on what segment of Companies themselves are at varying stages with the workforce is targeted and the type of care respect to engagement on workplace HIV/AIDS offered, the researchers concluded that even for issues. Some know they have a problem and are low-cost companies, the benefits associated with taking action on multiple fronts to address it, others interventions appeared to outweigh the costs. (For suspect they may have a problem but don't know more details go to: www.international-health.org/ how or where to start, and still other companies AIDS_Economics). are unaware that a problem exists even when it may already be having a negative impact on their Similarly, a University of California-San Francisco bottom line. In order to accurately weigh the costs study used an economic model to compare HIV- and benefits of taking action, it is critical for a related business costs for large Ugandan companies company to understand the extent of the threat (500+ employees) with the cost of providing HIV/AIDS poses in its area of operation and the full prevention, care and treatment to employees. The range of direct and indirect costs associated with study concluded that even programs offering the the impacts of the disease on its workforce (see most expensive treatment — anti-retroviral care — box p. 3 on “Progression of HIV/AIDS Impacts on can be cost-effective especially in light of 85% price the Workforce and Associated Costs”). For reductions offered by drug manufacturers for sub- example, businesses may not make the connection Saharan Africa (UCSF electronic newsletter between such things as decreased productivity, Daybreak, 7/14/2000, http://www.ucsf.edu/ increased absenteeism, staff turnover, higher daybreak). Page Two Good Practice Note | December 2002 | Number 2 Progression of HIV/AIDs Impacts on the Workforce and Associated Costs Progression of HIV/AIDS Economic Impact of Economic Impact of All Cases in the Workforce Individual Case Employee becomes infected No costs to company at this stage No costs to company at this stage with HIV virus HIV/AIDS-related morbidity » Sick leave and other absenteeism increase » Overall productivity of workforce begins » Work performance declines due to declines employee illness » Overall labor costs increase Businesses will feel the » Overtime and contractors’ wages increase » Additional use of medical aid benefits to compensate for absenteeism causes premiums to increase impact of HIV/AIDS » Use of company’s on-site health clinics » Additional medical staff must be hired increases at the company health clinics » Payouts from medical aid schemes » Managers begin to spend time and most clearly through increase resources on HIV-related issues » Employee requires attention of human » HIV/AIDS interventions are designed their workforce, with resource and employee assistance and implemented personnel direct consequences for a company’s Employee leaves workforce » Payout from death benefit or life insurance » Payouts from pension fund cause due to death, medical scheme is claimed employer and/or employee bottom line. boarding, or voluntary » Pension benefits are claimed by employee or contributions to increase resignation dependents » Returns to training investments are » Other employees are absent to attend reduced funeral » Morale, discipline, and concentration of » Funeral expenses are incurred other employees are disrupted by » Company loans to employee are not repaid frequent deaths of colleagues » Co-workers are demoralized by loss of colleague Company recruits a » Company incurs costs of recruitment » Additional recruiting staff and resources replacement employee » Position is vacant until new employee is must be brought on hired » Wages for skilled (and possibly » Cost of overtime wages increases to unskilled) employees increase as labor compensate for vacant positions markets respond to the loss of workers Company trains the new » Company incurs costs of pre-employment » Additional training staff and resources employee training (tuition, etc.) must be brought on » Company incurs costs of in-service training to bring new employee up to level of old one » Salary is paid to employee during training New employee joins the » Performance is low while new employee » There is an overall reduction in the workforce comes up to speed experience, skill, institutional memory, » Other employees spend time providing on- and performance of the workforce the-job training » Work unit productivity is disrupted as turnover rates increase Source: HIV/AIDS in the Commonwealth 2000/01, London: Kensington Publications, 2000. The Response of African Businesses to HIV/AIDS, Jonathan Simon, Sydney Rosen, Alan Whiteside, Jeffrey R. Vincent and Donald M. Thea, Final, 2000, p. 4. Page Three HIV/AIDS While these results are illustrative, businesses will infection of the workforce which, in most cases, can need to make an evaluation based on their particular be assumed to be similar to the rate for the local circumstances, areas of operation, level of risk and population. Collecting this baseline information is not available resources and partners. It is also important only important in focusing company efforts, but it also to note that beyond the motivations of financial enables monitoring and measurement, and helps in incentive and risk management, an increasing engaging other actors in the fight against AIDS. number of companies are motivated by a sense of The rate of infection corporate social responsibility to sponsor programs Data on rate of infection can be gathered through for the workforce can and interventions that benefit the wider community, various means — a good starting point is usually target particularly vulnerable segments of society, the national Ministry of Health or specialist AIDS- be assumed to be and help safeguard the health of future generations. control agency. A review of recent mortality data among the general population may also provide similar to the rate for insights into the situation. the local population. Getting Started From the company's side, a review of general Before embarking on any program, there are three personnel data such as absenteeism, staff turnover, initial steps a company should take: (i) define the and insurance claims, combined with health statistics nature of the problem and the company's level of from the company clinic (such as STD rates among risk with respect to HIV/AIDS; (ii) identify ongoing employees which indicate high risk behavior), initiatives, resources and stakeholders in the wider should provide a useful baseline. This information area of operations; and (iii) adopt a collaborative may be complemented by a more qualitative approach to devising an HIV/AIDS strategy based assessment such as a survey of managers, foremen, on the building of partnerships and the integration and employees to determine general attitudes and 1 of key action areas and stakeholder groups. perceptions about the impact of the disease on operations and whether people feel they are at risk. Define the Problem Identifying Risk Factors In reality, many companies cannot gauge the In defining the extent of the problem, a company magnitude of the threat posed by HIV/AIDS to their needs to look at its operations in light of the risks to business and whether it poses a serious enough risk which its workforce is exposed. There are a to their workforce to warrant action. Since level of number of risk factors to be considered regarding risk often drives company action, it is important to HIV transmission. Some sectors may be more risky define the extent of the problem up front. This of than others because their operations rely on a course will vary considerably depending on the workforce separated from their families for long type of business, the region of operation, and the periods of time. Such conditions have systematically specific characteristics of one's surroundings. contributed to a growing sex industry and high risk behavior as is often the case in such sectors as Determining the Rate of Infection mining, infrastructure construction, long-distance A first step in assessing the extent of the problem transportation and trucking, and agribusiness. Other might be to determine the approximate rate of factors such as a mobile population, employees Page Four Good Practice Note | December 2002 | Number 2 whose salaries are significantly higher than the duplication of efforts. In addition, since AIDS general population and can support a sex industry, programs are not the core business of the private as well as rural settings which — unlike more sector, companies need not feel they have to urbanized areas — often lack government health, undertake all the work in-house. Businesses may education and prevention programs, can increase choose to contract these services out. Small 2 the level of risk. businesses, in particular, may want to join together and pool their resources in hiring an external party to assist in program design and implementation. Certain types of jobs Adopt a Collaborative Approach will tend to put Once a company has determined that the existing or Integrating Four Spheres of Action potential risks of HIV/AIDS to its workforce are Through various experiences with its clients, IFC employees at higher sufficient to warrant action, it should not assume that has found it effective to encourage companies to risk for HIV/AIDS it must tackle the problem on its own. Although a view the issue and consider potential interventions company can take precautions to ensure the disease in four key areas: Operational, Medical, Managerial, infection. is not transmitted in the workplace, it cannot isolate and Community. One of the reasons this approach itself from the reality that a large part of the problem has been successful is that these four spheres bring — as well as the solution — lies outside the walls of together stakeholders from the private and public a company's operations and medical facilities. The sectors as well as civil society in order to establish a vast majority of employees contract the disease coordinated action plan and clarify roles and outside of the work environment, therefore efforts responsibilities. to control the spread of HIV/AIDS must involve a wider partnership with stakeholders in the area. The four areas of responsibility might then be Identifying what resources exist in the wider formalized within “Four Spheres of Action.” community, and who is doing what, can save Members of the committees formed in each of the companies both time and money and avoid a four spheres will identify their needs, key issues, What is HIV/AIDS? HIV stands for Human Immuno Deficiency Virus (HIV), the virus which causes the Acquired Immuno Deficiency Syndrome (AIDS). HIV attacks and slowly destroys the immune system by entering and destroying the cells that control and © UNAIDS/G. Pirozzi support the immune response and system. After a long period of infection, usually 3-7 years, enough of the immune system cells have been destroyed to lead to immune deficiency. The virus can therefore be present in the body for several years before symptoms appear. When a person is immuno-deficient the body has difficulty defending itself against many infections and certain cancers, known as “opportunistic infections”. It is possible to monitor the development and degree of immuno-deficiency, and while the impacts of the disease can be mitigated with proper treatment, there is no cure for AIDS once a person is infected with HIV. There are three main ways in which HIV is transmitted among people: (i) by sexual contact; (ii) when infected blood is passed into the body (e.g., through blood transfusion or use of unsterilized material); and (iii) from an infected mother to her child during pregnancy, childbirth or breastfeeding. Page Five HIV/AIDS AIDS is Everybody’s Business Maximizing the Chances of Success through Action in Four Spheres Due to the complexity of the problem and the pervasive nature of the disease, a company acting alone may be unsuccessful in controlling the impact of AIDS on its workforce as a result of external factors. IFC’s experience in working with companies through its “IFC Against AIDS Program” shows that the most successful interventions often involve coordinated action among four separate but interrelated spheres: Operational, Medical, Managerial, and Community. Within each of these spheres lie particular skills and resources which need to be identified and leveraged if the fight against HIV/AIDS is to be won in the company's area of operations. There are often other Operational: Representatives from this sphere include mmittee Managerial: Committed leadership is essential for companies to l Co resources in the wider individuals from the operational level of a company. In addition tiona address HIV/AIDS effectively. The Managerial Committee may include a to company employees it may also include peer educators, staff senior management representatives and Board members, whose er community from which from human resources, contractors, and union representatives. Op responsibilities include championing the program, allocating budgetary mmuni ty and staff resources, and undertaking a periodic review of the various The Operational Committee can identify: (i) risks ca l Co companies can that they see at the working level; (ii) di activitie activities. e M opportunities that exist for promoting on-the-job Community: Representatives drawn from the local benefit. education and prevention; and (iii) specific needs community may include prominent citizens such as of employees in terms of health programs and l village chiefs, religious leaders, or school ia Focal Point er services. representatives, as well as community organizations, g na women's groups and NGOs. Ma Medical: The medical sphere comprises clinical staff from the company as well as from public M Members from this committee can serve as a liaison hospitals, NGOs or local health offices. The betwee the company and community, strengthening between Committee can identify the general health trends in the area, communication and cooperation on efforts to combat HIV/AIDS. prioritize concerns and coordinate medical programs and services. capabilities, etc. and progressively develop the Health and Safety briefings are performed on a details of an HIV/AIDS Action Plan. Neither all regular basis and could be extended to include committee members nor all actions need to be AIDS education and prevention. Similarly, the decided at once: both represent a work in progress Medical Committee's responsibilities will be and members are likely to be added over time as targeted at the health problems they confront and review of progress and valuable actions or solutions that they propose for their area. For individuals are identified. The objectives of this example, if TB has had a dramatic resurgence, one structure are to: foster a sense of ownership over of the activities that the committee would diverse projects/sites; define roles in the company undertake is more systematic TB prevention. Such (senior management, human resources, operational a move would lead to cooperation with the management, clinical services), and extend the Managerial Committee on budget allocation for TB program to the community. prophylaxis, the Operational Committee for flexible working schedules to accommodate For example, the Operational Committee may treatment regimens, and the Community identify opportunities that exist at the level of Committee for grassroots mobilization and company operations for HIV/AIDS education and awareness. prevention. In mining operations, Occupational Page Six Good Practice Note | December 2002 | Number 2 Smaller companies with limited capacity may find it (iii) develops educational materials for Unilever staff; more practical to partner with other local (iv) promotes and distributes condoms; and businesses or participate through industry (v) advocates for increased attention to HIV/AIDS associations or local Chambers of Commerce. issues (Unilever). Forging Partnerships Most of the time, companies who want to address the issue of HIV/AIDS in their workplace need not Taking Action Employees need to be start from scratch. There are often other resources Once the scope of the problem has been defined aware that there is no in the wider community from which companies can and key stakeholder groups and partners identified, benefit including NGO activities, public programs companies can then begin to focus internally. This personal risk to any undertaken by Ministries of Health or National involves establishing company-specific goals and employee working with AIDS Committees, and initiatives launched by other objectives, creating an internal focal point to businesses, employer associations or medical coordinate program development, implementation a colleague living with organizations. Partnerships can help private sector and monitoring, and developing a company policy HIV or AIDS. 1 firms analyze their risk factors; design and on HIV/AIDS to guide company action. implement focused programs; leverage their resources; learn from the experience of others; and Be Clear about Goals and Objectives ensure independence and confidentiality of employees' condition and care. Typically, companies have two objectives in undertaking a workplace HIV/AIDS program: (i) to Plantation Workers Benefit from NGO limit the incidence of new infections among staff and Partnership with Unilever in Ghana the surrounding community and (ii) to manage the Fearing the devastating effects HIV/AIDS may have impact of existing infections on the company, staff on workers on its oil palm plantations, Unilever and community. In order to achieve these partnered with the Ghana Social Marketing objectives a company's program might set goals in Foundation (GSMF) to improve the company's two areas: (i) changing behavior and increasing the existing workplace program. The partnership was use of preventative measures and (ii) improving brokered by Commercial Market Strategies, a medical care and support to persons affected by USAID-funded project designed to increase private HIV/AIDS and other infectious diseases. In some sector participation in reproductive health issues cases, a company's goal may be to raise its globally. corporate citizenship profile in the area of HIV/AIDS. They may choose to take a leadership The program will reach almost two thousand oil role in mobilizing the business community, get palm plantation employees, their families, and the involved in advocacy at a regional or national level, two communities surrounding the plantations or support social programs such as mother-to-child (estimated at 100,000 people). Unilever provides prevention programs or assistance to orphans. staff hours, facilities, and transportation while Whatever a company's goals, it is important to GSMF: (i) trains peer educators; (ii) educates and define them up front. informs the community about HIV/AIDS; Page Seven HIV/AIDS © Photo by Peter Mwakabwale/World Vision ILO Code of Practice on HIV/AIDS 2 Create an Internal Focal Point Appointing a staff person or committee to serve as focal point for handling all company HIV/AIDS Key Principles related activities brings accountability and focus to the process. The person(s) may be chosen from The following principles are part of the International Labor Organization's Code of Practice on HIV/AIDS and the World of existing staff or be recruited from the outside, but it There is now a large Work. The code is voluntary and meant for use by the private is important that they be vested with authority over sector in the development of workplace policies and body of work including guidelines. activities and given a direct line of communication Recognition of HIV/AIDS as a workplace issue with senior management. In some cases, the voluntary codes and HIV/AIDS is a workplace issue, not only because it affects the formation of a committee may contribute to workforce, but also because the workplace can play a vital role in limiting the spread and effects of the epidemic. enhanced coordination and ownership of the issue. guiding principles to Non-discrimination This person or persons can play an important role assist businesses in There should be no discrimination or stigmatization against in representing the company in multi-stakeholder workers on the basis of real or perceived HIV status. forums and coordinating company representation developing workplace 3 Gender equality among the four spheres (see box p. 6). More equal gender relations and the empowerment of women policies on HIV/AIDS. are vital to preventing the spread of HIV infection and enabling women to cope with HIV/AIDS. Develop an HIV/AIDS Policy Healthy work environment The work environment should be healthy and safe, and adapted to the state of health and capabilities of workers. Due to the sensitive nature of the subject, it is important that both staff and management have a Social dialogue A successful HIV/AIDS policy and program requires clear understanding of how the company intends to cooperation, trust and dialogue between employers, workers, and governments. deal with employees who either are, or become, infected with HIV/AIDS. An official company policy Screening for purposes of employment HIV/AIDS screening should not be required of job applicants or serves to inform employees of their rights and persons in employment, and testing for HIV should not be responsibilities, articulate the commitment of carried out at the workplace except as specified in this code. management, clarify expectations on both sides, Confidentiality Access to personal data relating to a worker's HIV status should and in certain cases protect a company from be bound by the rules of confidentiality consistent with existing liabilities. In addition to being readily accessible and ILO codes of practice. visible in many locations, the company HIV/AIDS Continuing the employment relationship policy should be communicated to employees in a HIV infection is not a cause for termination of employment. Persons with HIV-related illnesses should be able to work for as manner that explains the significance of the policy's long as medically fit in appropriate conditions. terms. Staff should feel confident that the company Prevention is dedicated to maintaining employee privacy and to The social partners are in a unique position to promote prevention efforts through information and education; and taking reasonable strides to safeguard the health of support changes in attitudes and behavior. the workforce. Care and Support Solidarity, care and support should guide the response to AIDS There is now a large body of work including in the workplace. All workers are entitled to affordable health services and to benefits from statutory and occupational voluntary codes and guiding principles to assist schemes. businesses in developing workplace policies on Source: www.ilo.org Page Eight Good Practice Note | December 2002 | Number 2 HIV/AIDS. Key elements of such a policy generally and low-cost ways to raise awareness of HIV/AIDS include a statement endorsing the company's among employees, including: commitment to addressing HIV/AIDS, a respect for the confidentiality of HIV status, and the w Posters, billboards and condoms in high-traffic establishment of non-discriminatory practices in areas throughout company facilities; relation to People Living with HIV/AIDS (PLWA). w Messages included with condoms in paycheck (For further guidance on workplace policies, please packages; see boxes on p. 8 and p. 21.) w Posting the Company HIV/AIDS policy in public To control the spread places in the local languages; of the disease, efforts Education and w Placing a 'Health Questions Box' in the canteen or other convenient locations so that employees can must be designed to Prevention Programs 1 anonymously submit questions on health and reach well beyond a HIV/AIDS; Raise Awareness w Public posting of Q&A by the nursing staff via company’s four walls. bulletin boards or flyers; Awareness programs include information, w Taking advantage of local resources by bringing in education and communication activities that address trained counselors from local hospitals and the facts and fiction of HIV transmission and participating in government and NGO initiatives, promote preventive measures, while at the same including World AIDS Day on December 1st. time seek to de-stigmatize the disease. Employees need to be aware that there is no personal risk Training from casual contact with colleagues living with HIV The workplace is an ideal location for raising or AIDS. Awareness activities should inform awareness because professional training of various employees about the risks and educate them about sorts exists in one way or another in the operations ways to minimize their exposure. It is also of most companies. Safety or technical briefings and important for people to understand the multiple new employee induction programs present a good impacts of the HIV infection on relatives, friends, opportunity to provide AIDS education for staff. To casual encounters, and the overall community. be more effective, training materials could be Messages could emphasize the costs that an adapted to their audience in terms of format, HIV/AIDS infection can have for individuals and culture, gender and language. Separating male and their families including the reduction of income as a female employees — at least at the beginning of the result of poor health and consequences for children training — can often result in more open and who lose their parents. productive discussions. Getting the Message Out Going Beyond the Workforce To be most effective, information should be Since activities undertaken outside company walls communicated in local languages, and in areas often account for a significant percentage of where literacy rates are low, special consideration employee infections, many businesses find it useful might be given to non-written forms of and necessary to extend their education and communication. There are many simple, effective awareness efforts beyond the workplace. This Page Nine HIV/AIDS includes working with their suppliers and curriculum and materials; and (iv) linking the contractors as well as the local communities in their education program to other services such as access area of operations. Particularly vulnerable groups to condoms, medical care and voluntary HIV such as women and youth can be targeted through counseling and testing (Best Practices Collection, local schools, employees' wives, and local women's www.unaids.org). Similarly, formation of HIV/AIDS organizations whereas high risk groups such as committees with a budget for activities has also 2 temporary construction workers, migrant laborers, proven effective in some companies. Peer education is one truck drivers, or sex workers may require of the most widely specifically adapted awareness messages. Promote Prevention used strategies for De-stigmatizing the Disease Awareness and education programs go hand in raising awareness on Discrimination in the workplace reinforces hand with prevention efforts. There are a number stigmatization of people living with AIDS. At the of cost-effective prevention measures a company HIV/AIDS. same time, the workplace offers a unique may consider to support behavior change among opportunity to confront societal discrimination and its employees and reduce the risk of transmission. stigma by dispelling myths and communicating that there is no need to fear people living with HIV. Review Occupational Health and These messages can be further reinforced by Safety Procedures workplace-based, anti-discrimination policies and While there is no risk of HIV being transmitted in programs which demonstrate that people can live the workplace through casual contact between and work with HIV, often for many years. coworkers, workplace accidents or injuries that Encouraging an HIV/AIDS support group for cause bleeding can be a concern. At the most basic employees, or involving people living with level, companies should review their existing HIV/AIDS (PLWA) in company awareness activities, occupational health and safety procedures and can also be a powerful means of breaking down associated supplies and make changes or misconceptions and fostering understanding and improvements where necessary to address the acceptance. concern of blood borne infectious diseases. Some simple guidelines (see box p. 12 for a checklist) can be posted in company clinics or at emergency First Peer Education Aid Stations on shop floors to help reduce the risk Peer education is one of the most widely-used of HIV infection in the event of a workplace strategies for raising awareness on HIV/AIDS. Peer accident. education typically involves training and supporting members of a given group to affect change among Condom Distribution their peers. A project coordinated by UNAIDS and An important element of any HIV/AIDS prevention several other partners in Jamaica identified program is a reliable supply of free or affordable, principles and components that affect HIV/AIDS high-quality condoms. Ensuring condoms are peer education program quality and effectiveness. available in the workplace addresses a primary These include: (i) providing training for peer limiting factor of their use — the stigma associated educators; (ii) compensating them in some way; with purchasing them. Condoms can be made (iii) involving them in the design of training Page Ten Good Practice Note | December 2002 | Number 2 IFC Against AIDS IFC is seeking to leverage its exposure and reputation in the developing world to focus the business community's attention on the issue of HIV/AIDS. Our efforts are encompassed within a corporate program: “IFC Against AIDS”, through which IFC has sought to raise awareness and to provide its clients with the tools necessary to begin controlling the spread and effects of the disease. Through the program, we encourage our client companies to consider HIV/AIDS programs from a risk management and investment perspective. The “IFC Against AIDS” program assists IFC clients in the following areas: w Awareness: We help client companies to understand the impacts of HIV/AIDS on their business and assess their risks. This can be done as part of appraisal missions for new investments or during supervision of existing projects. w Guidance on developing HIV/AIDS action plans: IFC can provide advisory services based on the circumstances, needs and resources of individual companies that draw upon lessons from an international range of corporate experiences and good practices. w Networking: When the time comes to start implementing a program, many companies can benefit from the technical capacity of local organizations and programs. IFC can © Photo by IFC Staff provide a valuable service by introducing clients to existing NGO, public and private programs based on the needs of a particular company. Contact us at: ifcagainstaids@ifc.org The Case of Odebrecht in Angola As a result of the cooperation, Odebrecht has ADPP has begun to implement in the Mozal adopted an HIV/AIDS policy for all of its area is modeled on a “Total Control of the In 2001, IFC extended a $280 million operations worldwide. The Angola program Epidemic” (TCE) program, which consists of corporate loan to Odebrecht, the Brazilian will serve as a pilot, potentially setting the intensive, repetitive, face-to-face encounters construction and engineering group. $1 stage for a corporate-wide roll-out of between trained field workers and million was earmarked to support efforts HIV/AIDS education, prevention and care community members. related to the fight against HIV/AIDS in programs. Angola, a country where Odebrecht is already present and HIV incidence is on the rise. Corporate Citizenship Facility (CCF) Supporting HIV/AIDS Awareness: In light of the increasing HIV/AIDS risks to the In keeping with IFC's commitment to Mozal in Mozambique workforce and related construction and mining sustainable development, IFC has operations, Odebrecht and IFC decided to established the Corporate Citizenship Facility In 2000, IFC collaborated with launch a joint program addressing HIV/AIDS (CCF) which provides support and assistance Mozambique's Mozal Aluminum for a second to IFC projects that demonstrate the benefits in Odebrecht's areas of operations while also time, financing the expansion of a project of a progressive approach to environmental contributing to the fight against HIV/AIDS at critical to the country's economy while also and social responsibility in business activities. the broader country level. The program supporting Mozal's efforts on HIV/AIDS. An CCF provides technical assistance and other consists of education, prevention and care agreement was made between the Mozal forms of support in areas such as community components targeted at Odebrecht operations and surrounding communities at five sites in Community Development Trust (MCDT) and development, HIV/AIDS, labor practices and Angola, reaching about 30,000 people. The IFC to support years 2 and 3 of an HIV/AIDS environmental stewardship. Sponsors are program also contributes to the overall AIDS awareness program already in place. The expected to work proactively with CCF in the strategy of Angola by: (i) placing a large NGO supported by MCDT known as ADPP process and to cover part of the program emphasis on women's health and prevention is Mozambican and a member of a network costs. For more information, please visit our of HIV transmission from mother to infant, and of NGOs affiliated with the organization website at http://www.ifc.org/enviro/ (ii) assessing the provision of anti-retroviral Humana People to People. The program that EnvironmentFacilities. therapy in one of the company's sites. Page Eleven HIV/AIDS readily available at a company's clinic or through status. For instance, a USAID report estimates that self-service dispensers in bathrooms and clinic 1.8 million Zimbabweans are infected but that 90% waiting rooms. It's advisable to provide condoms of them are unaware of this fact (www.usaid.gov/ free of charge at the beginning of any program, and regions/afr/sucess_stories/zimbabwe.html). From a later, to maintain one location for free condoms behavior change and treatment perspective, this even if they are available through vending machines knowledge is critical. VCT has proven effective in at other locations. If a company uses peer promoting prevention for those who test negative An alarmingly high education as part of its awareness program, the and behavior change for those who test positive. percentage of those peer educators can be given condoms for distribution to their co-workers. It is vitally important that voluntary counseling be infected in the included both before and after testing. The pre-test The female condom has also proven effective in counseling should be designed to fully inform the developing world are certain situations because the woman is in control patient of the meanings of both a positive and a unaware of their HIV of its use. However, because the female condom negative result while post-test counseling can serve tends to be significantly more expensive than male to reinforce the need for behavior change. Due to status. condoms, its costs may need to be subsidized. the immense responsibility embodied in the counseling function, any workplace program that Voluntary HIV Counseling and proposes to offer a VCT component should first Testing (VCT) ensure confidentiality and job protection. Sufficient An alarmingly high percentage of those infected in availability of trained counselors is also necessary. the developing world are unaware of their HIV Fortunately, companies need not bear this Measures to be incorporated into an Occupational Health and Safety Checklist for Occupational Blood Exposure include: » Careful handling and disposal of sharps such as needles or other sharp objects; » Use of single-use or auto-disable syringes in clinics; » Hand washing before and after accidents/procedures; » Use of protective barriers such as gloves, gowns and masks for direct contact with blood or other body fluids; » Ensuring that adequate supplies are available; » Proper disinfecting of instruments and contaminated equipment; » Safe disposal and proper handling of waste (soiled linen and other material) contaminated with body fluids or blood; » Reporting of any incidents of exposure; » Ensuring that referral hospitals for blood transfusions have processes to ensure safe blood supplies, such as blood banks; and » Provision of post-exposure prophylactics (PEP packs) for clinical and laboratory staff. Based on the Universal Precautions originating from Center for Disease Control and Prevention, USA. See www.cdc.gov/hiv/pubs/facts for guidance, including Business Response to AIDS/Labor Response to AIDS Programs at www.hivatwork.org. Also refer to IFC's General Health and Safety Guidelines. Page Twelve Good Practice Note | December 2002 | Number 2 responsibility alone. VCT offers a good opportunity All participants were then brought in at 6 months for partnerships to develop between companies and asked to complete another survey. For those in and government agencies or NGOs who may the VCT group, intercourse with non-primary already offer these services on an ongoing basis. partners fell 35% and 39% for men and women respectively. Those who participated in the passive health information program demonstrated only 13% Voluntary Counseling and Testing Leads to and 17% reductions in intercourse with non-primary Behavior Change partners for men and women respectively. This study There are a number of A study conducted by researchers from the bears out the point that combining counseling with cost-effective University of California-San Francisco demonstrates testing is a much more effective means of the superiority of VCT techniques over generalized emphasizing the risks of HIV/AIDS prevention measures health information interventions. The study was (http://www.caps.ucsf.edu/publications/VCTS2C.pdf). conducted in Kenya, Tanzania and Trinidad. As a a company may base starting point, all participants answered survey consider to support questions related to their sexual habits and were Prevention and Treatment of STDs then randomly assigned to one of two groups. The A strong positive correlation exists between sexually behavior change first group received counseling and testing, and the transmitted diseases (STDs) and HIV transmission. among its employees second group participated in a more passive The presence of STDs within a company's program wherein a video was shown. Participants workforce not only indicates high-risk sexual and reduce the risk of could ask questions following the video after which behavior, but STDs increase both a person's free condoms were provided. transmission. susceptibility to HIV/AIDS and the possibility of Reducing Risks of Transmission in Mining Communities The mining industry in southern Africa has relied for over a century on a system of migrant mine labor wherein miners are absent from their families for extended periods of time while living in all-male hostels at remote mine sites. Extended separation from their families has often led miners to resort to alcohol and prostitution for entertainment. This combination of pursuits has become ©Corbis lethal with the advent of the HIV/AIDS epidemic, serving as one of the main reasons mine workers are two and a half times more likely to be HIV positive than members of the general population. In response to the risks associated with the migrant nature of mine labor, Lonmin Platinum, a South African mining firm, has begun to transition its hostel housing system to family housing units. This change will permit miners to bring their wives and children to the job site, greatly decreasing the likelihood miners will turn to prostitution. Lonmin has spent $5 million to build over 1,000 family dwellings, with plans to build another 2,000 already underway. With over 16,000 laborers to house, this initiative is just a start but a positive one nonetheless. Work done by the South African Medical Research Council estimates that a change from hostel to family-based living arrangements for miners could reduce HIV transmission by as much as 40% within the mine population. Source: Associated press — Nicole Itano; http://allafrica.com/stories/200209120057.html Page Thirteen HIV/AIDS transmitting the virus through sexual intercourse. short course antibiotics for syndromes, and Even without the HIV epidemic, STDs are one of condoms) may be stocked in company clinics and the most common health problems among local public health facilities. workers and pose a significant public health risk that should be addressed in company clinics or in collaboration with government health posts, Mobile Clinic Services and Peer Education NGOs, and mobile clinics. Harmony Mine A strong positive The Lesedi Project, in and around the Harmony correlation exists Treatment of STDs also offers a prime entry point Mine community in South Africa, is the result of a for HIV awareness raising and education activities. partnership between USAID, Family Health between sexually Prevention of STDs calls for precisely the same International and mine management. The project measures: abstinence, sex with only one non- established mobile sexually-transmitted disease transmitted diseases infected partner, or condom use. Preventing STDs (STD) health clinics and peer education services for (STDs) and HIV in the first instance, and providing proper treatment the women living in the communities surrounding for those already suffering their effects should form the mine. transmission. integral parts of an HIV/AIDS prevention program. Antibiotics are the most commonly prescribed The peer educators, chosen from among the means of treating STDs. STD treatment kits (which community, were a vital link in that they acted as a include simple diagnosis management guidelines, referral service for the mobile STD clinics. All Addressing Gender Inequality to Fight HIV/AIDS Gender inequality — especially women's lack of economic empowerment — is an important factor in the spread of HIV/AIDS. Social and economic relations between women and men, the role of power in sexual relations, and physiological differences between males and females determine their respective risk levels for infection, their respective ability to protect themselves effectively, and their respective share of the HIV/AIDS burden. In sub-Saharan Africa, 55 percent of those infected are women, and in some African countries, females aged 15-24 have prevalence rates of up to six times higher than that of males the same age (UNAIDS, 2001). Therefore, as companies operate in an increasingly diverse workplace and draw their workforce from very wide risk pools, they need to take into account the differing needs of men and women with respect to workplace HIV/AIDS strategies. A starting point for a gender-sensitive HIV/AIDS strategy is an understanding of gender-differentiated vulnerabilities and risks. These include: traditional norms of femininity and masculinity; enhanced physiological vulnerabilities of women and young girls; the culture of silence around sex and sexual matters; societal notions and "tacit" condoning of male risk-taking, including multiple partners; and occupational hazards for many males (long distance drivers, miners, migrant workers, etc.). In all societies and business environments, gender norms influence people's attitudes on sex, sexuality, fidelity, risk taking, and access to information and services relating to sex. Integrating gender-specific information into a company's HIV/AIDS policy can increase the effectiveness of its awareness, prevention and care programs through greater targeting of efforts and help to ensure non-discriminatory practices and equitable access to legal, medical, insurance, disability and other benefits and services. Key resources outlining gender issues in the HIV/AIDS context can be found at: http://gender/genaids (World Bank) and http://www.ids.ac.uk/bridge/Bri_bull.html (IDS, Sussex). Page Fourteen Good Practice Note | December 2002 | Number 2 women who visited the clinics were offered demonstrated that some short course anti-retroviral counseling, tested for STDs, and administered treatment for the mother and the baby after birth therapeutic doses of antibiotics (as presumptive may significantly decrease the risk of transmission. treatment) regardless of symptoms. Presumptive More importantly, such treatments can cost less treatment — the administration of antibiotics than $5 to administer. before the patient's STD status is even known — is an accepted method for the treatment of at-risk patients because the antibiotics are quite safe and Preventing Mother-to-Child Transmission Many children acquire the at-risk patient is a threat to further spread of Through a Company Clinic HIV from their STDs if infections are not brought under control Brooke Bond Tanzania (BBT), a company of the immediately. Unilever group, has undertaken a program to mothers before, during prevent transmission of the disease between or after birth. During the first nine months of the project, STD mother and child through its on-site hospital. Over prevalence among women who visited the clinics two hundred pregnant women seeking antenatal fell by 70-85 percent; rates of gonorrhea and services at the hospital were nominated to chlamydial infection among local miners dropped by participate in the program. As of April 2002, 97 43 percent; and reported incidence of ulcers percent agreed to participate (i.e., get an HIV test, decreased by 78 percent. Self-reported condom and receive a treatment of nevirapine if they were use rose from nearly zero to 20-30 percent of found to be HIV positive). The protocol involves a commercial sex encounters. A cost-benefit study one-time dose for mother and child, and costs concluded that the project (which costs US$1.00. So far, BBT has paid for the drug, approximately $54,000 per year to operate) was although the Tanzanian government has recently generating annual medical savings of nearly committed to cover the cost of nevirapine within $540,000 due to avoided cases of STDs. At the antenatal prevention programs (Unilever). end of the project's first year, Harmony Mines, with support from the South African Department of Health, assumed the management and implementation costs of the project, and expanded © Photo by Sheryl Watkins/World Vision its geographical and demographic coverage (“Family Health International: A Leader in the Fight Against HIV/AIDS,” U.S. Department of State, International Information Programs). Prevention of Mother-to-Child Transmission Many children acquire HIV from their mothers before, during or after birth. The process is sometimes referred to as “vertical transmission” and constitutes a serious problem in developing countries. Fortunately, new studies have Page Fifteen HIV/AIDS Care and Treatment company to develop a TB treatment and prevention program. Programs After treatment has started and patients no longer Beyond awareness and prevention activities, some pose a risk of infection, employees on TB companies may choose to offer more treatment should be encouraged to continue to comprehensive medical care, treatment and work — provided that they are not too ill or TB is fueled by HIV support programs for employees suffering from debilitated — so that the DOTS (Directly infection and is the HIV/AIDS or other opportunistic diseases stemming Observed Treatment Short Course) strategy can be from the weakened immune system of AIDS applied and patients can be carefully monitored in most frequent cause patients. (These can include tuberculosis, forms of the clinic (i.e., weighed regularly and observed for pneumonia, septicemia, fungal and viral diseases, any side effects). Issues such as shift work could be of death in people and certain cancers.) Provision of drug therapies addressed for these employees, for example, no living with HIV. and medical monitoring of HIV/AIDS patients can night shift for three months to alleviate fatigue and keep employees working and maintain their quality ensure daily compliance with TB treatment of life for as long as possible. Care and support regimens. 2 programs may also include counseling on coping skills, work difficulties, and depression; and can link people to support networks. Anti-retroviral Care 1 Anti-retroviral treatments, a generic term describing Treatment of Tuberculosis medications, and HAART (Highly Active Anti- Retroviral Treatment) have considerably increased One of the leading opportunistic infections is life expectancy among AIDS patients and made tuberculosis (TB). Fueled by HIV infection, TB is the AIDS a manageable disease in wealthy nations. most frequent cause of death in people living with Until a few years ago, however, the most that poor HIV. This is because HIV contributes to the countries could hope for was preventing new cases reactivation of latent TB and makes individuals with of HIV/AIDS through educational programs, recent TB infection more susceptible to rapid prevention, and treatment of opportunistic progression of the disease. infections. Active TB is also of concern in the workplace But today in some of those countries, HIV/AIDS because it can be contagious if left untreated. This drug supplies have become more widely available. can be addressed through a proven course of TB Drug companies have acknowledged the need to treatment. In addition, a preventive therapy in the charge less for their products in developing form of TB prophylaxis has been shown to increase countries, while a loosening of trade regulations the survival of HIV-positive people who are at risk has permitted the production of generic anti- for TB (e.g., individuals who test positive on a TB retroviral drugs. Finally, nongovernmental groups skin test or who live in areas where TB is endemic). such as Médecins Sans Frontières, PharmAccess, In certain cases, it may be cost-effective for a and the International Center for Equal Healthcare Page Sixteen Good Practice Note | December 2002 | Number 2 Access (ICEHA) have worked to promote collaborating in this effort with PharmAccess treatment for patients in resource-poor settings by International, a foundation which is responsible for improving existing medical infrastructure and training, monitoring drug supply, and quality control. assisting with the provision of drug therapy at a As for prevention programs and onsite assistance, sustainable cost. Heineken receives support from the German Development Co-operation ( GTZ) in a number of Brazil has made HAART available to all eligible HIV- their countries of operation (Heineken International). Follow-up and moral 3 positive Brazilians, free of charge. The move has cut in half the number of people dying from AIDS support is enormously since 1996 and has proven cost-effective with Support Systems avoided treatment costs outstripping the cost of meaningful to people providing HAART (www.economist.com, Article, Follow-up and moral support is enormously living with HIV/AIDS. “Hope for the Best”, July 11, 2002). meaningful to people living with HIV/AIDS. To this end, some companies take a pro-active role in A number of multinational companies have also creating support groups or networks to help recently started to include HAART as part of the employees and family members who are HIV medical coverage available to their employees, and positive. One illustration of an effective support many are working in partnership with specialist group is a program in South Africa known as organizations to implement treatment policies. “Mother to Mother-to-Be”. In this program, HIV- positive women who have participated in a prevention of mother-to-child transmission Heineken program, counsel other HIV-positive women who Heineken has important operations in Africa and, are newly expectant (Oral presentation, “Mothers to like other companies operating in the region, has Mothers-to-be: Peer Counseling, Education and been affected by the fact that HIV/AIDS is now the Support for Women in Pregnancy in Cape Town, South leading cause of mortality in young adults. In July Africa”, XIV International AIDS Conference, 2001, the Executive Board of Heineken, a member Barcelona, July 8, 2002). of the PIA Group (see page 19) decided that treatment of HIV-positive people with specific anti- Another option employed by some companies is retrovirals would be included in the existing medical home-based care for terminally ill patients with programs for employees. AIDS. Companies wishing to support such a service may administer it through Heineken has been implementing programs against their own medical staff HIV for over 10 years now in its African companies who could visit the with an emphasis on prevention. The 2001 decision community ©Corbis signals a move by the company into the area of periodically or treatment and care. The new treatment program is by training being rolled out gradually, and in order to be home assured of a high quality approach, several training caregivers. sessions have been organized. Heineken is Page Seventeen HIV/AIDS Monitoring Effectiveness Quantitative indicators may include productivity measures such as absentee rates and additional Monitoring is an important part of any corporate weeks/months gained on the job for employees HIV/AIDS program because it enables a company receiving care; or behavior-change indicators such as to measure its progress against its stated goals and condom use, number of requests for VCT services, make informed decisions about the effectiveness of number of volunteer peer educators, incidence rates various interventions relative to costs. To be most of STDs reported in the company clinic, etc. The nature of effective, a monitoring system should involve Qualitative indicators such as staff morale, general HIV/AIDS is such that reporting throughout the chain of command with awareness and attitudes towards HIV/AIDS, and accountability to senior management. satisfaction with company programs and services can in an area with a high be evaluated through questionnaires, focus groups Effectiveness may be measured in terms of both and key informant interviews. prevalence rate, no quantitative and qualitative indicators, assuming that company will go good baseline data exists or has been collected at the These results can then be reviewed in light of start of the program to enable comparison. Tracking expenditures to determine the overall cost- unaffected. HR statistics and clinical data can provide a low-cost effectiveness of a company's activities. To assist in monitoring alternative, although some firms find it this analysis, many companies find it useful to track useful to specifically tailor indicators to their HIV/AIDS their annual expenditures by establishing a efforts. dedicated cost center for all HIV/AIDS activities AIDS and the Private Sector in Thailand Since 1993, the Thailand Business Coalition on AIDS (TBCA) has been working with businesses “to create AIDS-supportive work environments by providing HIV/AIDS education and prevention seminars and promoting the adoption of appropriate HIV/AIDS workplace policies” (TBCA, 2000). In addition to providing services to more than 80 member companies, the © Photo by Field Staff/World Vision TBCA has helped in the development of sister organizations for the private sector in Malaysia, South Africa, Botswana, and Zambia. International businesses with branches in Thailand have often led the way. For example, Shell Thailand launched a program with UNICEF called “Peer Education at the Pump”, providing AIDS education to more than 800 young people working as service station attendants. The American International Assurance company, the largest life insurance company in Thailand, will offer as much as a 10% reduction in the life insurance premium to their policy holders if they have workplace HIV/AIDS education programs. Smaller-scale businesses have also had an impact on raising awareness and sponsoring services. In Phayao province, the Business AIDS Network for Development (BAND) — a coalition of small businesses, government, NGOs, and Public Health agencies — helps youth who are infected or whose parents have AIDS through a referral network that includes technical training, scholarships, social support, and income generating projects. Source: Thailand’s Response to AIDS: Building on Success, Confronting the Future, Thailand Social Monitor, World Bank, p. 37. Page Eighteen Good Practice Note | December 2002 | Number 2 including budgetary allocations, staff time, and in- The Private Investors for Africa (PIA) kind contributions or subsidies of supplies and HIV/AIDS Working Group infrastructure. The Private Investors for Africa (PIA) is an informal group of international companies (Barclays, CFAO, Diageo, Heineken, Unilever and Standard Bank) Extending the Reach with interests in Africa. The group was formed with of the Private Sector the objective of improving the business environment in Africa through constructive dialogue The private sector in The nature of HIV/AIDS is such that in an area with and cooperation with the principal international developing countries a high prevalence rate, no company will go development institutions. Combined, these unaffected. Where a company is making efforts to companies employ over 95,000 people, with the has the potential to reduce the rate of infection within its own potential to reach many more through dependents, become an important workforce, it is in that company's best interests that the communities where they operate, and their its neighbors — even its competitors — do value chains. and legitimate partner likewise. Recognizing the potential benefits of cooperation, business associations around the In response to the potential impact of HIV/AIDS on in the fight against world have begun to turn their attention to fighting their businesses in Africa, the PIA formed a Working HIV/AIDS. the spread of HIV/AIDS. By pooling resources and Group to identify areas where shared experience sharing successes and failures, businesses can and joint action, both within the private sector and significantly broaden their sphere of influence while the broader community, could improve the simultaneously improving the efficiency of their effectiveness of their individual company efforts to efforts. This is particularly important for small tackle AIDS. Although the policies followed by the businesses who otherwise may not be able to individual companies differ, the PIA Working participate due to financial and human resource Group's combined experience in prevention, health constraints. support and therapy for HIV/AIDS patients has resulted in a common checklist for management to Cooperation within the private sector can also track the implementation of comprehensive open the door to constructive alliances with the company programs. The checklist operates as a public sector and civil society. The private sector road map in assisting this process (see p. 22). The can extend its reach in other ways by scaling up PIA is also working actively with the World Bank company programs, engaging business and industry Group and the European Commission to advocate associations in partnerships, contributing to a larger the importance of a business response to HIV/AIDS body of information on best practices or investing in at the international and local levels (PIA Secretariat, private health. In this way, the private sector in c/o CS, Brussels). developing countries has the potential to become an important and legitimate partner in the fight against HIV/AIDS. Page Nineteen HIV/AIDS Eight Corporate Lessons in Response to HIV/AIDs In 2000, UNAIDS along with The Prince of Wales Business Leaders Forum and the Global Business Coalition on HIV/AIDS compiled a series of lessons learned from various corporate responses to the epidemic. From this, a number of key lessons were distilled which provide guidance for businesses in their approach to addressing HIV/AIDS: 1. Ensure a committed leadership (CEO, Board and management) and understanding at all levels of the workforce, particularly through demonstrating the business case for addressing HIV/AIDS. 2. Go beyond the workplace and address issues within the local community to ensure real The World Bank’s effectiveness (e.g., by commemorating World AIDS Day on December 1st with the wider community). 3. Demonstrate business costs and benefits and human resource implications of HIV/AIDS Multi-Country AIDS initiatives. 4. Undertake a consultative approach with all stakeholders to ensure that initiatives are appropriately Program is premised directed. 5. Enter into partnerships with other businesses, NGOs, governmental and intergovernmental on partnerships, organizations to provide the necessary expertise and knowledge of HIV/AIDS issues and to enable the scaling-up of responses. including support to 6. Involve the use of peer educators/leaders from the target groups in the dissemination of education and prevention information. the private sector. 7. Utilize low cost creative tools to ensure sustainability and replicability. 8. Undertake continual monitoring, and review the effectiveness of HIV/AIDS initiatives with a willingness to adapt the programs accordingly. Source: The Business Response to HIV/AIDS: Impact and Lessons Learned, p30; UNAIDS, The Prince of Wales Business Leaders Forum and the Global Business Coalition on HIV and AIDS. Geneva and London 2000. Funding Sources: The World Bank’s Multi-Country AIDS Program (MAP) The World Bank’s Multi-Country AIDS Program (MAP) supports the implementation of multi-sectoral national HIV/AIDS strategies. Its overall goal is to scale up existing HIV/AIDS projects quickly and engage new partners in the struggle against the epidemic. MAP has so far set aside $1 billion for African countries. Roughly half of this money is expected to flow to communities, non-governmental organizations and the private sector to carry out activities of their own design. MAP is premised on partnerships, including support to the private sector. Uptake of this support needs to accelerate, however, if HIV/AIDS programs are to reach their full potential. In the private sector, companies are encouraged to design and propose activities that are consistent with the national strategy and seek MAP support from national AIDS authorities. The Bank is working with the private sector in select countries to help kick-start engagement. Early lessons suggest the importance of having a designated focal point within the business community, country-specific information to spur action, and strong leadership to overcome resistance and stigma. As of October 2002, MAP has committed $550 million to 16 countries: Benin, Burkina Faso, Burundi, Cameroon, Cape Verde, CAR, Eritrea, Ethiopia, Gambia, Ghana, Kenya, Madagascar, Nigeria, Senegal, Sierra Leone and Uganda. For information on how to submit proposals for funding or to suggest priority actions that could scale up the activities of your company, please contact the national AIDS council or secretariat in your country or go to www.worldbank.org/aids. Page Twenty Good Practice Note | December 2002 | Number 2 © Photo by Oliver Ryan/IFC AIDS in the Workplace: A Sample Human Resources Policy Statement YOUR COMPANY NAME will treat HIV/AIDS the same as other life-threatening illnesses and handicaps in terms of our policies and benefits where they apply. YOUR COMPANY does not discriminate against a Discrimination in the qualified individual with regard to job application, hiring, advancement, discharge, compensation, training, or other terms, conditions or privileges of employment. workplace reinforces YOUR COMPANY NAME recognizes that an employee with HIV/AIDS or another life-threatening illness stigmatization of may wish to continue in as many of his/her normal pursuits as his/her illness allows, including work. YOUR COMPANY NAME will be supportive of and make reasonable accommodation for the employee who is people living with medically able to perform his/her job. An employee’s medical information is personal and will be treated as confidential. AIDS. While accommodating employees with life-threatening diseases and other disabilities, however, YOUR COMPANY NAME recognizes its obligation to provide a safe work environment for all employees. YOUR COMPANY NAME is sensitive and responsive to coworker’s concerns and will emphasize employee education. We will continue our efforts to be adequately informed about HIV/AIDS and will make this information available to employees on a regular basis. The following work practices are an adaptation from those developed by the Allan Vincent Smith Foundation, in Hamilton, Bermuda. The work practices should be modified to suit the needs of the environment of YOUR COMPANY NAME, but the meaning of each point should remain the same. » People with AIDS or HIV infection are entitled to » YOUR COMPANY NAME will communicate the same rights, benefits and opportunities as policies and practices to employees in simple, people with other serious or life-threatening clear, and unambiguous terms. illnesses. » YOUR COMPANY NAME will provide » Employment practices comply with local laws and employees with sensitive, accurate and up-to-date regulations and/or the practices of the parent information about risk reduction in their personal company, which ever is greater, and where lives. applicable. » YOUR COMPANY NAME will protect the » Employment practices are based on the scientific confidentiality of employee’s medical insurance and epidemiological evidence that people with information. AIDS or HIV infection do not pose a risk of » To prevent work disruption and rejection by transmission of the virus to coworkers through coworkers of an employee with AIDS or HIV ordinary workplace contact. infection, YOUR COMPANY NAME will » Senior management unequivocally endorses undertake education for all employees before such nondiscriminatory employment practices and an incident occurs and as needed thereafter. education programs or information about AIDS. » YOUR COMPANY NAME does not require HIV screening as part of pre-employment or general workplace physical examinations. If you have any questions or concerns regarding this policy, please contact the Manager — Human Resources and Administation. Source: “The HIV/AIDS Crisis: How are Businesses Responding?” Background paper prepared for the Plenary Session on HIV/AIDS, AGOA Forum, Washington, DC, October 30, 2001, (USAID). Page Twenty-One HIV/AIDS A Corporate Road Map on HIV/AIDS Awareness, Education and Prevention Program Item Description Status Rating HIV/AIDS Policy The “public” policy statement endorsing the company's commitment In draft 1 with respect to HIV/AIDS for internal briefing and also provision to Formally adopted 2 third parties. Communicated actively and reviewed 3 Tools for Awareness Posters, signs, ribbons, news clips on notice boards, talks, video, live 1-5 of these elements in place 1 theatre, radio, television, competitions (e.g. posters), sponsored events, 6-8 of these elements in place 2 messages in pay packets, in-house magazine articles, “Health Question Maintained and updated 3 Box”. Training Modules HIV/AIDS education is a component of the company's training, Employees module 1 (e.g., recruitment process, new employees' induction programs, Plus management training module 2 health education, safety briefings, module for managers). Ongoing training exists 3 Targeting and High risk (long-distance drivers, migrant workers) and vulnerable Analysis to identify groups 1 addressing high risk groups (women and youth), should be targeted for education and Programs for these groups in place 2 and vulnerable groups prevention programs. >50% trained or analysis confirmed no 3 high risk/vulnerable groups in company Workplace discussion A key step in the educational process is to engage in a dialogue Discussion leaders identified 1 forum and the opportunity for this should be established (with union Discussion clearly scheduled 2 involvement) in all workplaces. Discussion sessions once a month 3 Peer educators Informed dialogue is essential for properly developing an Process for group formation 1 understanding of how HIV is spread and the impact it can have on Peer educators in training 2 people. Target ratio should be 1 educator : 50 employees. Ongoing peer education programs 3 People Living With The involvement of People Living with Aids is a powerful way of PLWA involved in education as visitors 1 HIV/AIDS (PLWA) strengthening the educational process, especially if they are PLWA in discussion sessions 2 involved representatives from the immediate community. PLWA as peer group educators 3 Condoms distributed Condom distribution (male and female) is an essential component Available through clinics 1 of an education and prevention program. They should be free of Through dispensers at a cost 2 charge (or a nominal cost) and readily available. Through dispensers free of charge 3 Trained HIV/AIDS Trained counselors are a pre-requisite to ensure appropriate At least one trained counselor available 1 counselors support available to those affected by HIV/AIDS and to implement All clinical staff trained 2 Voluntary HIV Counseling and Testing (VCT). Counselors should be Ongoing training for counselors 3 available in the company but visiting counselors can also supplement the company's staff. Voluntary HIV Access to safe, confidential and convenient voluntary HIV testing VCT available 1 Counseling and and counseling integrated in the company's activities (e.g. VCT available and actively advocated 2 Testing (VCT) communication efforts, medical examinations, disease prevention). VCT taken up by >50% employees and 3 The test is performed within the company's clinics or externally. extended to the community Prevention of vertical Many children acquire HIV from their mothers before, during or Available to employees 1 transmission (mother- after birth. The company can undertake or support such a program Available to employees and their partners 2 to-child transmission) with VCT and anti-retroviral drugs for mother/child to invest in “the 80% pregnancies covered 3 next generation”. Page Twenty-Two Good Practice Note | December 2002 | Number 2 Treatment and Care Program Item Description Status Rating HIV and Occupational The company has adopted and enforced a procedure for In draft 1 Health and Safety occupational blood or body fluids post-exposure to prevent Formally adopted 2 (OH&S) accidental HIV transmission in the workplace. Implemented 3 Clinical staff training Continuing professional training on HIV/AIDS and infectious Some staff members trained 1 diseases is ensured to the clinical and laboratory staff of the All clinic’s staff attended one training 2 company. Continuing training attended yearly 3 Nutritional program Appropriate dietary supplements to support good general health Advice available on diet to support health 1 and resistance to opportunistic infections will significantly delay the Target program > affected employees 2 onset of AIDS. Free supplements available 3 Opportunistic The impact of a decline in the immune system with the onset of Treatment protocol in draft 1 infections, TB, STDs AIDS can be prevented or mitigated by prophylactic and/or Treatment available for some infections 2 medication for other infections and quick response when they occur. Treatment and prophylactics available 3 Anti-retroviral (ARV) The company considers implementing therapy with medical staff or Feasibility study 1 treatment by partnering with others possessing experience in this treatment so Available to some employees as a pilot 2 highly-active anti-retroviral therapy (HAART) becomes part of the Available to all employees 3 medical coverage of HIV+ employees and possibly dependants. Home-based care Terminally ill patients with AIDS require specific care. This could Home-based care under development 1 include hospice or home-based care developed in the support of Access for >20% of terminally ill patients 2 appropriate third parties. Access for >50% of terminally ill patients 3 Monitoring and Leveraging the Program Monitoring Indicators/items are used for monitoring, incentives, accountability Evaluation method identified 1 effectiveness and and evaluation. Qualitative information includes general awareness Qualitative data used to measure 2 results of HIV/AIDS evaluated through questionnaires or Knowledge, effectiveness of the program Attitudes, Practices and Behavior (KAPB) Studies. Quantitative Quantitative data and qualitative 3 information includes productivity measures, absenteeism averted, information used to measure effectiveness condom use, requests for VCT or counseling. and make adjustments Advocacy with Business partners should be encouraged to have their own Program information provided 1 customers, suppliers programs and to ensure they have assessed and dealt with relevant Formal advocacy/educational meetings 2 and other business risk. For key suppliers, the latter could involve a system for supplier Accreditation scheme for key suppliers 3 partners compliance certification. Commemorate World World AIDS Day is a unique opportunity, every year, to go beyond Day commemorated 1 AIDS Day the workplace and to highlight the profile and reach of the Activities open to employees' families & 2 December 1st company's program. community Activities open to suppliers/service providers 3 The Road Map contains a list of possible interventions that can be put into place in the private sector. The “status” and “rating” columns Copyright UN, 2002 provide companies with a means to set targets and evaluate their progress. Source: Unilever, the PIA Working Group on HIV/AIDS, and IFC Against AIDS. Page Twenty-three HIV/AIDS Acknowledgments Good Practice Publications available at Useful References “HIV/AIDS in the Workplace” is the second in a series of Good Practice Notes developed by the Environment and Social http://publications.worldbank.org/ecommerce “Workplace HIV/AIDS Programs: An Action Guide for Managers” produced by Family Health International (FHI). FHI works Development Department (CES) of the DOING BETTER BUSINESS THROUGH with businesses in more than 60 countries on International Financial Corporation to EFFECTIVE PUBLIC CONSULTATION: prevention and management of HIV/AIDS. promote learning and sharing of best A GOOD PRACTICE MANUAL http://www.fhi.org practice experience among IFC clients and A publication providing practical, "how to" the wider private sector. The publication guidance for IFC clients and the private UNAIDS (www.unaids.org) is the joint was developed in partnership with the sector in planning and carrying out public United Nations Program on HIV/AIDS “IFC Against AIDS” program which assists consultation activities. The Manual involving several UN Agencies, the ILO, IFC clients through awareness, advisory, offers advice on managing the WHO and the World Bank. The web site and networking support. Sabine Durier expectations of local communities, features publications and links including a serves as coordinator of this program. tailoring consultation to a private recent Employers Handbook, co-written sector context, and encouraging with the International Organisation of The Good Practice Note was prepared consultation between companies and Employers. http://www.ioe-emp.org under the auspices of the CES Market their local stakeholders throughout a Development Group by a team led by project's lifecycle. Debra Sequeira and comprising Sabine The POLICY Project of the Futures 74 pages | ©1999 IFC | ISBN 0-8213- Group International maintains an Durier, Harry Pastuszek and Diana Baird. 4312-4 | $25.00 Design and layout were done by Maria HIV/AIDS Policy Compendium Database that Gallegos with administrative support houses most available national HIV/AIDS INVESTING IN PEOPLE: provided by Vanessa Manuel. policies. Consult this website for information SUSTAINING COMMUNITIES about public sector policy on HIV/AIDS in THROUGH IMPROVED BUSINESS Thanks are due to the following IFC staff your company's area of operations. PRACTICE who provided their input during the draft http://209.27.118.7 A publication geared towards IFC private sector clients that serves as a resource guide stages: Imoni Akpofure, William Bulmer, in establishing effective community development programs. The Guide also includes 3 Merunisha Ahmid, and Desmond Dodd. in-depth case studies that demonstrate different ways of doing community The World Economic Forum's Global The Good Practice Note also benefitted development innovatively and effectively — and not just an "add on" to doing business. Health Initiative has a “Business Tools” from a public comment period in which 90 pages | ©2000 IFC | ISBN 0-8213-4891-4 | $25.00 web page offering corporate case studies, valuable feedback was received from best practices and a networking directory. external parties including: Steven Phillips of HANDBOOK FOR PREPARING A RESETTLEMENT ACTION PLAN http://www.weforum.org ExxonMobil, Gina Dallabetta, Bill Rau and A good practice guide to designing and implementing resettlement action plans for IFC Steve Taravella of Family Health clients and private sector companies. Based on the collective resettlement experience The Global Business Coalition on International, Keith Hansen, Kate Kuper, of IFC staff in applying the World Bank Group's policy on involuntary resettlement to HIV/AIDS has compiled a web page of links Elizabeth Ashbourne and Waafas Ofosu- IFC investments, the Handbook takes the reader step-by-step through the to workplace-related resources produced by Amaah of the World Bank, Barbara Addy resettlement planning process and includes practical tools such as implementation third parties. of Deloitte, Tim Meinke and Mary Jordan checklists, sample surveys and monitoring frameworks. http://www.businessfightsaids.org of USAID, Julian Stanning of Unilever, 100 pages | ©2002 IFC | ISBN 0-8213-5153-2 | $25.00 Stefaan van der Borght of Heineken, The Corporate Council on Africa, a Abigail Jones and Alisdair Gray from the GOOD PRACTICE NOTE: Addressing Child Labor in the Workplace and consortium of U.S.-based corporations doing PIA Secretariat (CS), Stephen Davis of the Supply Chain (June 2002) business in Africa, has published a report of ConGo Group and Sydney Rosen of The first in a new CES publication series, this Good Practice Note offers a unique their task force on HIV/AIDS which offers Boston University. private sector perspective on the topic of harmful child labor. It seeks to share case studies and best practices in policy and corporate learning and experiences by providing companies with a range of basic, program design and implementation. Photos on pages 8, 15 and 18 courtesy of good practice approaches that other businesses have successfully applied in managing www.africacncl.org World Vision. Copyright 2001 World risks associated with child labor in their own workplaces and those of their vendors Vision, Inc. All rights reserved. Used with and suppliers. Asia Business Coalition on AIDS permission. 1-888-5116598. provides best practices, case studies, and key For more information, or to purchase any of these publications, please NGO and private sector contacts in many call 202-458-5000, fax 202-522-1500 or email Asian countries. infoshop@worldbank.org. http://www.abconaids.org Disclaimer The purpose of the Good Practice Note series is to share information about private sector approaches for addressing a range of environmental and social issues. This Good Practice Note provides guidance and examples of basic good practice approaches that businesses have successfully applied in addressing HIV/AIDS issues in the workplace. IFC has not financed all the projects or companies mentioned in the Good Practice Note. Some of the information in the Note comes from publicly available sources such as company websites. IFC has not verified the accuracy of such information nor the companies' practices. This Good Practice Note does not represent a commitment by IFC to require projects it finances to take certain or all of the actions specified in the Good Practice Note in dealing with HIV/AIDS in a particular project. Instead, any issues arising in an IFC-financed project will be evaluated and addressed in the context of the particular circumstances of the project. Printed on Recycled Paper Page Twenty-Four