The potential costs of HIV/AIDS to African businesses have been documented in AIDS Analysis Africa and elsewhere. Companies that decide to manage these costs have three basic strategy options. Firstly they can invest in HIV prevention programmes designed to reduce the incidence of the disease in their workforces. Secondly they can provide treatment care and social support to employees with HIV illness or AIDS with the objective of keeping these employees in the workplace and delaying or avoiding the costs of AIDS. And finally firms can alter their benefits policies contract structures and hiring practices to reduce their exposure to AIDS-related costs. This last strategy which we have called the shift is the one we document in this article. Our focus is not on the absolute magnitude of the AIDS burden but on its allocation among various levels and sectors of society. We argue that the shifting of the burden of AIDS is an important social and economic phenomenon to which a thoughtful and deliberate public policy response is needed. (excerpt)
I am stunned by the ignorance and insensitivity around the issue of HIV/Aids that still persist with the South African public at large. Peter McLaren’s letter in The Star of January 11 headed “Put simply Aids is contracted through amoral sex” filled me with great despair. More than 50% of the estimated 5-million HIV-positive people in South Africa are women who were in most cases undempowered to negotiate safe sex with their partners. Many of these women are poor rural wives of the migrant labourers who work in the cities. Women are three times more likely to contract the disease than men due to their anatomy. If they have been faithful to their husbands where is the amoral behavior and why die by the sword as McLaren put it? His arguments are flawed and speak of ignorance and self-righteousness. White apartheid South Africa benefited from the labour of young black men working on the mines and the roads without caring about the destruction that migrant labour was causing to the family structure in South Africa. Single-sex mining hostels are now being phased out by some forward-thinking mining companies that realize the role they played in making it difficult for miners to live close to their families. (excerpt)
Since 1999 MSF has been working in the Khayelitsha township outside of Cape Town with what was then the only government-supported prevention of mother-to-child-transmission project in the country. In April 2000 MSF founded three dedicated HIV/AIDS clinics in Khayelitsha adjacent to the maternity units of primary health care centres. These clinics were initially created to provide treatment for opportunistic infections. The clinic staff currently serves over 3000 clients. In May 2001 the infectious disease clinics began to offer highly active anti-retroviral therapy (HAART) to a cohort of people with HIV/AIDS. The primary objective of this project at inception was to offer comprehensive care for HIV to a cohort of people with HIV/AIDS and show that the use of combination anti-retroviral therapy in a primary health care setting in a resource-limited environment is feasible affordable and reproducible. As a second objective the pilot project aims to demonstrate that it is possible for developing countries to provide affordable care for people with HIV/AIDS immediately through the use of low-cost anti-retrovirals whether generic or patent-protected. By utilising the availability of generic fixed dose combinations of these drugs MSF provides a simplified twice-daily regimen which minimises the burden of pills renders adherence easier. (excerpt)
Much has been said in the popular press about the provision of anti-retroviral therapy (ART) in both the public and the private sector. Whilst plans are being made for this provision in the public sector ART provision has been taking place in the private sector for some time - albeit in a limited fashion Funding of ART is being made possible through medical schemes direct employer arrangement and private self-funding. Whilst access to treatment started slowly in South Africa there is an increasing trend for this provision within the private sector. This increase has been fuelled by rapidly decreasing costs of treatment activist pressure legislative and financial reporting requirements for listed companies moral and ethical considerations and risk management factors. Increasingly it is being recognised that provision of treatment is a cost- effective manner of managing the potential risks posed by HIV infection within selected risk pools. The advances made in the management of HIV infected patients has seen this condition transformed from being a terminal one into a chronic manageable illness much like hypertension diabetes and asthma. This successful management can result in HIV infected individuals living long productive lives. (excerpt)
The South African Cabinet statement on anti-retroviral (ARV) access in early August this year overcame or at least indicated the political will to overcome what appeared to be the biggest obstacle to a stepped-up programme of care for HIV/AIDS in South Africa - mobilising and allocating the financial resources to pay for such a programme. The work of the Joint Health and Treasury Task Team 1 was thorough going beyond a simple calculation of drugs costs to an assessment of the investments required to build health system capacity. For the time being at least money is not the problem to scaling up. In addition a number of well-documented ARV projects in poor communities have shown conclusively that socio-economic status in and of itself is not a barrier to long term adherence to drug therapies. These developments have allowed the other challenges of scaling up to become foregrounded. These challenges are two-fold and can be summarised into the demand and supply sides of the health system. On the demand side stigma discrimination and widespread mistrust of the public sector will delay presentation for care by potential beneficiaries to the point where the risks of initiating treatment are considerable. As generic ARVs become available many will seek care from private practitioners preferring to pay out of pocket for drugs than face long queues and often hostile reception in the public sector. However as has been shown with other conditions such as sexually transmitted infections (STIs) issues of affordability may compromise standards of care in this sector especially where long-term therapy is needed. On the supply side is a health system that has historically managed chronic diseases poorly is beset by inequities in capacity and resources and staffed by a stressed and demotivated workforce that is increasingly being lured to the industrialised world. (excerpt)
