AIDSCAP's "Businesses Managing AIDS" Project and other efforts to help owners and managers understand the potential impact of HIV/AIDS on their businesses -- and the benefits of HIV/AIDS prevention -- are the key to encouraging greater private sector involvement in slowing the spread of the epidemic.
Every day, another 7,500 people become infected with HIV. As the numbers of AIDS cases and lives lost continue to mount, it is easy to become discouraged. But experience shows that when sufficient resources are committed to comprehensive HIV/AIDS prevention programs, it is possible to slow the spread of the epidemic.
Among developing countries, the best example of an effective, comprehensive program is in Thailand, where the government has devoted more than $50 million a year and considerable political capital to support HIV/AIDS prevention and care. Unfortunately, such a response is rare. Although it is possible for governments in every region to follow Thailand's example in establishing policies that encourage and support prevention, few governments in the developing world have the same level of financial resources to spend on HIV/AIDS.
The public sector supports most HIV/AIDS prevention and care activities in developing countries. Significant funding sources include international donors, such as the U.S. Agency for International Development (USAID), the Overseas Development Authority and the European Community, and international banking institutions such as the World Bank. Local nongovernmental organizations (NGOs) and international private volunteer organizations (PVOs) implement many of the grassroots prevention and care efforts in developing countries but often require support from donor agencies.
Another sector with an important stake in the health of those at risk of HIV infection -- the private commercial sector -- has played a minor role in supporting HIV/AIDS prevention and care to date. The conventional wisdom is that the private sector is not interested in funding HIV/AIDS prevention and care. However, recent experience in many countries suggests this is not necessarily true.
A number of enlightened local and multinational companies are beginning to recognize the importance of protecting their workers from HIV infection. Many of these businesses are motivated by a sense of moral obligation, but most also view support for HIV/AIDS prevention as a cost-effective investment.
Since HIV/AIDS predominantly affects the most economically productive age groups, the epidemic will have a significant impact on private industry. AIDS morbidity leads to increased absenteeism, lower productivity and rising health expenditures for employers. AIDS mortality increases training costs for replacement employees and, in some countries, results in losses in productivity when employees attend funerals of relatives and friends. AIDSCAP studies in Kenya, Senegal, Thailand and the Dominican Republic have documented the potential impact of HIV/AIDS on local businesses. In Kenya, for example, HIV/AIDS could increase labor costs for some businesses by 16 percent by the year 2005.
HIV/AIDS programs for the workforce are one of the most important approaches to involving the private sector in HIV/AIDS prevention and care. They usually include policies to minimize discrimination in the workplace, HIV/AIDS prevention programs for employees and their families, and support and care for employees and family members living with HIV/AIDS.
This type of workforce program is a cost-effective way of reaching people in the age groups targeted by HIV/AIDS programs and of reinforcing prevention messages transmitted through other channels. The powerful influence of corporate culture can also help change social norms related to HIV/AIDS, and workplace policies can serve as models for national policy.
Perhaps most important, workplace programs help leverage additional resources for HIV/AIDS prevention and care from the private sector. The Transport Corporation of India (TCI), for example, matches AIDSCAP's funding for a project to prevent HIV/AIDS and other sexually transmitted diseases among transport workers and their partners in towns on the India-Nepal border (see page 10). In Tanzania, businesses and AIDSCAP share the cost of workplace prevention programs conducted by the Organization of Tanzania Trade Unions.
Helping private sector owners and managers understand the potential impact of HIV/AIDS on their workers is the key to leveraging financial support for prevention and care. "Businesses Managing AIDS," AIDSCAP's package of private sector AIDS policy (PSAP) materials that provide managers with information and guidelines for establishing HIV/AIDS prevention policies and programs in the workplace, includes models for determining the costs and benefits of implementing or failing to implement HIV/AIDS programs. Managers who participated in field tests of PSAP workshops in several African countries said they would be willing to pay to attend such workshops in the future.
HIV/AIDS programs can also benefit from the private sector's considerable experience in commercial service delivery -- particularly its expertise in management, marketing, research and financial management -- and from the efficiency and quality often fostered by competition in the private market. Social marketing of condoms is an excellent example of this approach. In most countries nonprofit organizations such as Population Services International (PSI), the Futures Group and the Contraceptive Retail Sales Company work with private wholesalers and retailers to expand access to condoms. In others, social marketing programs use the distribution network of a private company. In the Dominican Republic, for example, AIDSCAP-supported NGOs sell condoms provided by USAID to a private pharmaceutical firm, Sterling Products International, for nationwide distribution.
During the past five years, condom social marketing programs have dramatically increased condom availability, accessibility and use in many developing countries. In Africa, PSI programs have increased condom sales from 1 million to 150 million in eight years. In contrast, public sector condom distribution programs have made little progress. Other areas worth exploring for private sector involvement are social marketing of prepackaged therapy for selected STD syndromes and commercialization of HIV testing and counseling services.
A more traditional area of private sector involvement is research and development. This approach is primarily limited to industrialized countries because such efforts are too expensive for the private sector in most developing countries. Unfortunately, profit-motivated private sector involvement in HIV/AIDS research and development may lead to products that are neither available to nor affordable for most people in the developing world. An example is the antiviral drug AZT, which costs about U.S.$2,000 per patient per year. New antiviral therapies may be even more expensive.
The private sector has a critical role to play in the development of AIDS vaccines, HIV and STD test kits, microbicides and other barrier methods such as male and female plastic condoms. The need to test some of these products in the developing world among large numbers of people at risk of HIV and against different strains of the virus offers opportunities to negotiate more equitable access to the fruits of such research. Governments, donor agencies and foundations should work with the companies to ensure that the products developed will be available to those who need them most.
A fourth type of private sector approach involves direct cash or in-kind contributions to the HIV/AIDS prevention activities of governments and NGOs. Multinational corporations, large local businesses, and private foundations and institutions currently play a limited role in funding HIV/AIDS prevention and care in developing countries. But a number of institutions are leading the way in contributing some of their profits to reduce the burden of HIV/AIDS prevention and care on the communities where their businesses are based.
Examples of multinational companies that make significant contributions to HIV/AIDS prevention projects include DKT International, Levi Strauss and Unilever. In Brazil alone, DKT has donated nearly U.S.$2 million worth of condoms for AIDSCAP HIV prevention activities during the past four years. A local company in Nepal, General Paper Industry, established an NGO that receives 10 percent of the company's annual export value to support development and health programs, including HIV/AIDS prevention outreach.
In-kind media contributions of broadcast time and advertising space are particularly helpful in raising awareness about HIV/AIDS and encouraging changes in social norms. In the Dominican Republic, for example, local mass media and international cable stations donated the equivalent of U.S.$2.5 million in television, radio and newspaper exposure to an AIDSCAP mass media campaign for youth.
As the HIV/AIDS epidemic continues its relentless progress, it is obvious that the local public sector and donor agencies cannot provide the resources needed to undertake national-scale prevention programs or to manage and care for those with HIV/AIDS. Public sector resources for health and other development programs are already stretched thin in most countries and are unlikely to increase significantly for AIDS prevention and care. The decline in international donor support further compounds the problem. For example, funding for USAID -- the largest international donor for health programs in developing countries -- is expected to be reduced by about 25 to 30 percent in fiscal year 1996.
The current partnership of donor agencies, the public sector and the private noncommercial sector of NGOs and PVOs has been vital to HIV/AIDS prevention and care in developing countries. However, in order to slow the rapid spread of the epidemic and to provide care and support for those with HIV/AIDS, we need to expand this partnership to include institutions of the private commercial sector -- corporations, foundations and businesses. This is one battle the developing country public sector cannot win alone.
-- Peter Lamptey
Peter Lamptey, MD, DrPH, is director of the AIDSCAP Project and senior vice president for AIDS programs at Family Health International.
