HIV/Aids remains the number one cause of death amongst South Africans between 15 and 50 years old. Since this includes the bulk of South Africa's working population, World Aids Day provides an opportunity to reflect on the status of the fight against the epidemic in the South African workplace.
The battle against HIV/Aids is already a major part of the government's health strategy which supports the United Nations health theme for the next five years, namely, "Getting to Zero" - aimed at totally eliminating new HIV, TB and sexually transmitted infections.
Corporates should get involved
If South Africa is to achieve a zero rate of HIV infection in the workplace, "corporates need to align themselves with the various initiatives and programmes that government is running, and even be a step ahead, evolving innovative approaches to managing the epidemic where they can," says Dr Lerato Motshudi of Alexander Forbes Health.
With a R21.5 billion health budget, government is clearly the heavyweight in the fight against HIV/Aids. Yet even when the contribution of private companies towards their employees' awareness and treatment initiatives is factored in "figures show that the tide is yet to be turned - both in the reduction of new infections and in improved treatment," says Motshudi.
Certainly, from an organisational perspective, since HIV/Aids gives rise to a lot of death and disability claims, any strategy aimed at managing the pandemic needs to reduce claims and successfully manage infected employees back to work. While the Department of Labour's White Paper, Code of Good Practice for Key aspects of HIV and Aids in the World of Work, broadly envisions every corporation having an HIV strategy achieving just this, its prescriptions remain broad. For example, while it stipulates that all employees should have access to medical care "no detail is provided on the depth or extent of this care," explains Motshudi.
Even though the White Paper lacks detail in many areas it does push the boundaries of what it means to be an employee by including ex-employees, applicants and contractors as beneficiaries of corporate HIV/Aids management policies. What is also clear from the White Paper is that "the law will soon make it mandatory for all government and private organisations to have a comprehensive strategy dealing with HIV and Aids," says Motshudi.
Given the scale of the HIV/Aids epidemic, and now also the inevitability of legislation requiring all organisations to have a strategy dealing with it, organisations should focus on developing pro-active health policies that both prevent infectious diseases as well as deal with the behavioural and social implications of the virus on infected and affected staff.
Beyond being the right thing to do, and very shortly being a legislative requirement, having an HIV/Aids policy is a simple statement by management to staff, stating an organisation's commitment to supporting the health and wellbeing of all employees. An HIV/Aids policy also provides a very powerful value proposition providing employees with confidence that they will not be prejudiced on the basis of their illness while also educating them on the provisions and support that the organisation has put in place. "In spite of this, very few companies have HIV/Aids policies and those that do often fail to make the link, in the minds of employees, between what the policy states and what this means in practice in the workplace,” says Motshudi.
In short, improving health in the workplace requires more than just a policy. Instead, it takes a concerted effort on the part of management and staff. If this is lacking there will shortly be legislation to ensure that each company has, at minimum, a comprehensive HIV/Aids policy and perhaps a structured plan to improve organisational wellness. "Given the huge positive impact that this will have on the lives, productivity and health costs associated with the HIV/Aids pandemic the proposed legislation is to be applauded," says Motshudi.
"Since an effective health policy, including HIV/Aids management, takes time and effort rather than money to develop and implement, it is more about management commitment than budget,” adds Motshudi.
As such, "in developing and reviewing an HIV/Aids policy, it is best to secure the advice of a professional consultant who is aware both of the legislative guidelines as well as current best practice and other benchmarks," says Motshudi.
While putting an effective wellness programme in place is a challenge, "making the policy a reality with a structured wellness programme empowers organisations to begin measuring success over time as HIV and TB infections as well as Aids-related deaths and illnesses decline, translating into reduced death and disability claims and increased productivity,” concludes Motshudi.
ESKOM case study:
In 1988 Eskom started feeling the impact of HIV. In 1990 Eskom conducted an impact assessment which projected that if they did nothing about HIV, they should expect a 26% Aids prevalence in 10 years. The assessment also stated that 550 to 600 new Aids cases a year would cost Eskom R275 – 300 million per year.
As such, in 1999 Eskom started a programme including:
Identifying high risk areas
Education and training
Care and support
Communicating results of the programme
At the time of implementation in 1999 Eskom had an 8.9% HIV prevalence. By 2003 the original assessment projected that Eskom would have a 13.5% HIV prevalence. Thanks to their intervention, by 2003 Eskom had achieved a 10.7% Aids prevalence, with many of those infected remaining at work due to successful treatment.
In short, this case study demonstrated two effects of the intervention:
A lower HIV infection rate in the workplace
Details of the Eskom case study are available on request.
Source: Prepared by FTI Consulting (Tanja Vasiljevic) on behalf of Dr Lerato Motshudi, Medical Advisor, Alexander Forbes Health