As the heavy burden of Aids around the world continues to grow, the expanding role of business offers a glimmer of hope in a diversifying and intensifying response to the epidemic. The latest figures from UNAids, the United Nations’ specialist Aids advisory agency, are stark. Forty million people globally are living with HIV, 4.3m became newly infected this year, and nearly 3m died. The figures are at an all-time high.
Growing political commitment and government funding has expanded treatment to record levels: at least 1.6m people in the developing world are now on antiretroviral therapy. But its further extension – into poorer and more rural areas – is an ever more uphill struggle, placing fresh burdens on weak health systems as more lives are saved.
Current efforts to respond face twin pressures: the rising logistical difficulties and costs of expanding treatment; and the urgent need to extend effective prevention measures to reduce new infections, without which all treatment benefits will be negated.
Peter Piot, head of UNAids, says: “Even with robust progress on antiretrovirals, the gap is still widening. Prevention is a total failure. If we continue this way, treatment will be unsustainable. We just can’t hold up.”
Against such a backdrop, businesses have an important and often neglected role to play: as employers, taxpayers, and responsible corporate citizens; as direct service providers; and as a force for economic and political change. They are responding more than ever before. Companies are coming up with fresh ideas, such as l’Oreal with its HIV prevention training programe to hairdressers worldwide.
Business leaders such as Bill Gates have funded important work on Aids prevention and treatment. Former US President Bill Clinton has helped raise awareness and mobilise the business community, persuading private sector specialists to lend their skills to improve healthcare management and drug supply chains.
The pharmaceutical industry has been at the forefront of the battle, above all through its medical work in continuing to develop a range of medicines to treat HIV and the opportunistic infections it causes, despite the considerable scientific challenges of the constantly mutating virus. Drug companies were slower to recognise their social obligations – and the sound economic sense – of reducing prices to raise volumes and sustain life in poorer countries, and of scaling up production through more innovative partnerships with low-cost generic companies. But industry executives insist they have made great strides and been unfairly singled out because of their products and profits, arguing that governments should be taking the lead. Donor and recipient nations alike need to spend more to strengthen health systems, fight the “brain drain” of medical staff, and remove tariffs on imported drugs.
There are “win-wins” for companies where the resources and attention given to Aids are creating markets, and a need for improved efficiency is pushing for greater openness to innovative private sector solutions – such as in medical insurance, social marketing and the provision of health management services. “I would like mandatory, comprehensive private health insurance for our workers,” says Brian Brink from Anglo American, who has championed groundbreaking HIV programmes for his group’s employees. “Governments need to realise that they don’t have to own, operate and control health services.”
For those companies which turn their back on HIV, there is a risk of “lose-lose”, as the fast-growing burden of infection increasingly spreads from Africa to the important commercial and investment centres of eastern Europe, China and India.
“The business community hasn’t begun to scratch the surface of what it can do,” says John Tedstrom, head of the Global Business Coalition on HIV/Aids, which has 220 members. “This epidemic continues to infect 10 times more people than we are able to get on to antiretrovirals. We mustn’t lose our sense of urgency and emergency.”
In the worst affected countries, where Aids threatens markets, productivity and health costs, corporate interventions may make sound commercial as well as moral sense. But with data scant, that argument remains an act of faith, and an honest debate is needed. The International Labour Organisation estimates that Aids may have killed 75m adults by 2015; and a study last year by F&C Asset Management and UBS argued that HIV/Aids in the workplace in South Africa adversely affects company profit margins.
However, a University of Stellenbosch analysis this year suggested that, while Aids was a humanitarian tragedy in South Africa, it was less of an economic one because it largely affected the underclass. The failure of many African governments to tackle Aids more comprehensively has certainly failed to destabilise them politically as some predicted.
At the level of individual companies, the economic payback of workplace prevention, let alone treatment, in countries with weak health systems, is not clear-cut. Sydney Rosen, from Boston University’s School of Public Health, argues that except where there are severe shortages of skilled staff, benefits may not always be as great as costs. “I don’t think there’s ever been as compelling an economic case as some advocates would claim,” she says.
Workplace policies to fight discrimination and stigma should be a minimum corporate commitment. Ultimately, investment and growth is needed to bring people out of the poverty that perpetuates Aids. “The pressure is not off,” says Robert Davies, chief executive of the International Business Leaders Forum. “The worst of the cost and suffering is still ahead, and companies need to integrate this. There is a real need now for businesses to work together to make a greater impact on the public health system.”
