Business and HIV / AIDS


By

Dr. Devendra Prasad Pandey
Director
Rajiv Gandhi P.G. College
Kotwa, Nyaya Nagar, Jhusi, Allahabad
 


As a good corporate citizen Cipla issued an advertisement on World AIDS day, December 1, "What's the use of developing life-saving medicines, if you can't make them affordable to the patient". It further said, "A belief that inspired Cipla to manufacture anti-AIDS drugs in 2000. It brought down the cost of medication from $ 15,000 a year to under a dollar a day. The result is equally inspiring: Survival rate among AIDS patients increased by 80%, from 1997 to 2003 (based on a study conducted by YRG Centre for AIDS Research and Education, Chennai, and Brown University, USA, published in Clinical Infectious Diseases, USA, 2005), as millions could afford the drugs." Former US President Bill Clinton has reached on an agreement with eight pharmaceutical companies worldwide, including India's Cipla and Ranbaxy, to drastically lower the prices of AIDS tests and drugs. Qualpro Diagnostic and Strides Acrolab from India are also involved in the deal. Lauding the companies, Clinton said it would help thousands of poor people in 50 developing countries across the world. As a result of their agreements with the Clinton Foundation, countries will be able to reduce the cost of HIV diagnosis by 50 percent. Cipla, Ranbaxy, Strides, Acrolab and Aspen Pharmacare (South Africa), which rely on supply of active pharmaceutical ingredients from Matriy Laboratories (India), will offer the Anti-retroviral (ARV) enfavirenz for 240 dollars per patient per year, and Cipla will offer the ARV abacanir for 447 dollars.1

Already, a staggering 5.2 million people in India are infected with HIV, and if unchecked, the killer bug could push 4.3 million people deeper into poverty and shave billions of dollars off India's GDP. Though health groups in India have rejected government figures showing a 95% slide in the annual growth of HIV infections, calling the drop "beyond comprehension". An Indo-Canadian joint study published in Lancet says that HIV infections have fallen by a third over a four-year period in Southern India. Tracking HIV prevalence among 2,04,500 young women and 60,000 men between 2000 and 2005, the group found that HIV prevalence among women aged between 15 and 24 in the south had fallen from 1.7 to 1.1 percent – new infections had fallen by almost 35 percent. The southern success is attributed to increased condom use, reduction in multi-partner sex and ongoing AIDS awareness campaign by government and private sector. It is clear that real powers – to beak back disease and improve public health – lies not only with the medical fraternity, but equally or more with the people themselves.

The National Intelligence Committee of the USA, much to the determines disbelief of Government of India, believes that there will be 20-25 million HIV positive people in India by 2010. Statistics reveal that it is the productive workforce between the ages of 15-44 that is most affected and comprises 87.7 percent of the HIV infections in India. The World Health Organization set a target for India to provide anti-retroviral therapy (ART) to 3,55,000 people living with HIV by the end of 2005. In India, so far only about 15,000 people living with HIV are provided ART through the government ART centres.2

Considering the affect of HIV/AIDS in the productive workforce, too little is known about its effect on businesses in hard-hid countries, which lose upward to 3 percent of their labour forces to the virus every year. On an average, 5 litres of blood continuously travels through the human body. Our life cycle depends, to a great extent on its quality. Blood banking is serious business. Yet, shortages, poor maintenance, infections, arbitrary pricing and indifference make blood prospecting in India a traumatic experience. It's not surprising that patients or their kin – who have the resources – prefer to depend on trusted relatives and friends for safe blood transfusions. For, to depend on the anonymous blood-seller - the mainstay of public and private blood banks in India – can cost you your life. It is reported that sizeable component blood-sellers and drug addicts look for easy money and sell their poor quality blood. It is more likely to be contaminated with infectious diseases like HIV-AIDS because of risky behaviour and unhygienic lifestyle.

It is mandatory for all blood banks and hospitals to make available blood for transfusions only after it is declared infection free. However, very often, the window period – so necessary to rule out infection – is overlooked in an emergency or when supplies fall short of demands. When infection is detected in a unit of 'donated' blood, it is dumped – that is, if it has not already been passed on to a needy patient unwittingly. Once it is confirmed that blood from a particular donor – professional or otherwise – is unsafe for transfusions, blood banks and hospitals should be bound by law to track down and inform the donor of the infection. Fear of rejection, ostracism or prejudice cannot be cited as reason enough to not inform the donor. Or it would lead to fewer donations. The consequence of protecting donor's right to privacy would encroach on patient's right to life. The argument that an informed professional donor will push his blood in another market becomes invalid if all blood banks and hospitals in the country are made to confirm to testing regulations. Thus blood business with ethics and a sense of social responsibility will certainly help in the reduction in HIV/AIDS number.

Measurement of the financial impact of the HIV/AIDS has been serious concern of various agencies. In its recent Global Business Survey 2006; Business and HIV/AIDS, the World Economic Forum found that only 9 percent of businesses surveyed conduct risk assessment of HIV/AIDS. Most found that the presence of HIV/AIDS adversely affected their profit margins. But while the impacts on productivity (sales per head) or profitability are easier to report, that of successful intervention is harder to capture. The survey proposed a net present value (NPV) exercise to determine costs and benefits. It studied the effect on sales of a hypothetical company in South Africa over a five year period in three scenarios – workforce with AIDS without company intervention, workforce without AIDS, and workforce with AIDS with intervention. Certain revenue assumptions were made (wage costs: 40 percent of sales; other costs: 10 percent of sales; HIV/AIDS costs: 17 percent of sales, using the worst case example of Anglogold). In 'with AIDS, no intervention', cash flows decreased and NPV dropped dramatically. But NPV improved if the company intervene, although it remained marginally lower than a 'no AIDS' scenario.

Truck drivers are the most affected group by the HIV/AIDS. These drivers are working for transport companies and transport companies are transporting the goods of business organizations. Considering the impact of epidemic, TCI Foundation, promoted by TCI group of companies, is undertaking a project on HIV/AIDS with the assistance of Bill & Melinda Gates Foundation, a foundation promoted by Microsoft Chairman Bill Gates.

The International Labour Organization (ILO) conducted an economic impact survey of the Singareni Collieries Company Ltd. (SCCL) in 2004. Its findings estimated that there were atleast 1,038 infected employees in the company, although official SCCL records put the number at 311. Most of those who disclosed their status are underground mine workers. Of course, 311 or even 1038 is but a fragment of the Rs. 2,109 crore government – owned company's 90,000-plus employees. So far, SCCL has shelled out Rs. 65 lakh in terminal benefits to 29 employees who were declared unfit due to AIDS-related illness. The ILO study points out that all 311 infected employees became unfit to work, it will cost SCCL Rs. 9.33 crore in compensation in the coming years.

A study by Sydney Rosen and others, which appeared in the February 2003 issue of the Harward Business Review, highlighted that it was from year seven onwards – peaking in year 10 – that HIV – infected employees impose heavy costs on companies. Looking at six companies in Botswana and South Africa, Rosen and her team found that AIDS could take up between 0.4 percent and 5.9 percent of their annual wage bill in 10 years. A World Economic Forum report on 'AIDS and Asia' cited that the virus cost the Asia Pacific region $7.3 billion in 2003 – nearly 1 percent of its gross income. This is expected to go up to $ 17.5 billion per year by 2010.

It is not only the Bill & Melinda Gates Foundation, John Soros Foundation and Ford Foundation, the business community has always been proactive in coming forward to contribute to AIDS awareness in society at large. Confederation of Indian Industry (CII) has been working on HIV/AIDS programmes since 1996. The Indian Business Trust for HIV/AIDS was set up in 2000 under the leadership of Tata group Charmin Ratan Tata. USAID initiated an Indo-US Corporate Fund for AIDS. Within a month, six companies – GMR group, Essar group, Adani Exports, Jai Prakash Group, ABG shipyard and Punj Lloyd – pledged $ 1.2 million.

CII and ILO have been trying to get companies to devise workplace policies for HIV/AIDS. Pepsi has put a workplace policy in place in November 2005. As part of huge supply chain, Pepsi has an extended family of nearly one million people, which includes truck drivers, bottlers, and other associates. Many of these belong to high-risk groups – especially the truck drivers (an estimated 7-10 percent of truck drivers in India are living with HIV). Pepsi in partnership with ILO conducted 79 awareness sessions covering 1,374 of its employees across the country in the last six months. With the great deal of interest and enthusiasm, many employees have signed up as volunteers in the programme.

The global workforce has lost 28 million economically active people due to HIV/AIDS. It will loose 48 million workers by 2010 and 74 million by 2015. By 2015, 19 countries will have lost more than 10 percent of their labour force, 3 of them (Botswana, Lesotho and Swaziland) more than 30 percent, and Zimbabwe more than 40 percent. In over 40 countries with HIV epidemics, an average 0.2 percent of the annual rate of growth of GDP was lost between 1992 and 2002, equivalent to $25 billion. Due to HIV/AIDS, the GDP growth in 30 sub-Saharan African countries will fall by 0.8 – 1.4 percent per year.3

Companies like Bajaj Auto in Pune and some IT companies in Bangalore have set up voluntary screening booths where their employees can get themselves tested in anonymity. Groups like Gujrat Ambuja Cement, BEST and Indian Railways are providing anti-retroviral treatment to their infected employees. Providing ARV treatment makes sound business sense. The SCCL study by ILO demonstrates that if a company treats its sick employees rather than terminates them, it will prove more economical in long run. If SCCL provides treatment for 10 years to its infected employees, it would cost it just Rs. 5.59 crore (instead of Rs. 9.33 crore) in compensation. Not only would it save Rs. 4.34 crore, it would also enhance the working life of infected employees, reduce absenteeism and help them sustain their families.

National AIDS Control Organization (NACO), a body of Ministry of Health and Family Welfare, has been allocated Rs. 900 crores, the budget is far short of the estimated $ 1 billion (Rs. 4,500 crore) that is needed for prevention and treatment of HIV. This money could have been spent otherwise on education, infrastructure or healthcare if proper care was ensured alongwith awareness generation.

Since 1986, when the first HIV case was detected among sex workers in Chennai, it has soared 5-20 million. If unchecked, the situation could soon reach epidemic proportions (Technically, a country is said to be facing a generalized AIDS epidemic, when at least 1 percents of the adult population is HIV positive). According to UNAIDS forecast, if AIDS continues with its relentless march across districts in the country, it will be impossible for the government to deliver on its Millenium Development Goals (MDGs) of reducing the population of people below the poverty line to 15 percent by 2015. For the affected families, the consequence can be traumatic and ruinous. Since HIV is more prevalent among sexually active people in the age group of 14 to 49, the working age group for business, it not only hit immediately the family income, but also increases costs in terms of treatment and better diet. An ILO study revealed that such families start spending more on food and medical treatment and less on education. If the parents get infected, then the family has no choice, but to take its children out of school and put them to work, so AIDS has also been linked to an increase in child labour.

National AIDS Control Programme (Phase III) is being designed to include all the stakeholders including government, NGOs, global partners and private sector. Unhappy with the slow pace of functioning, Ministry of Health has asked IIM-Ahmedabad and Bangalore, John Hopkins University, Tata Constancy Services and McKinsey – to review and assess NACO. Planning for changes in NACO, health minister A-Ramados said, "NACO lacks visionaries. It also lacks creativity". After spending Rs. 3000 crores in the last 15 years on advertisements on AIDS, still there is much misinformation and lack of awareness. Ramados said he is interested in more rural and youth oriented messages. 4

One reason why the HIV issue has not received the kind of attention and urgency it deserve has to do with the profile of its typical targets. In India, 86 percent of the HIV transmission is through the heterosexual route commercial sex workers, truck drivers and migrant labourers – all of whom come from rural areas to the big cities in search of a livelihood – constitute the high risk group for HIV transmission. 57 percent of the infected adults have a rural background. Around 30000 patients are being treated, that's a miniscule 0.5 percent of the affected population.5

Money and the social stigma are two principal reasons for not getting an accurate count of HIV infected population. NACO arrives at its estimates through a random sampling of cases from 750 sentinel surveillance sites set up in the districts with high HIV prevalence. Each site contributes 400 samples, which are then tested and verified. The results are extrapolated to the denominator of a billion people, and that's how the figure of 5.2 billion is obtained. Even this estimate is driven by the supposed lower prevalence of HIV in North India (that, in turn, means NACO has fewer surveillance sites here for sample collection and tests.). Therefore critics argue, the national prevalence rate of 0.91 percent does not reflect reality.5

If curbing the spread of HIV has not been easy, it's due to the stigma attached to it. According to the 2002 ILO study, 70 percent of the affected people experience discrimination and ostracism. Often, the worst culprits are the victim's own family members.

The Indian Business Trust (IBT) for HIV/AIDS came out with an overarching policy to deal with the issue. The cornerstones of this policy include education of employees and their families, care and support for the affected employees and non-discrimination. It also promises no pre-employment testing. Still more corporates are not worried about the HIV problem. There could be two reasons for it. One is that many of them don't see their white – collar employees under threat from the disease. The other is that, unlike in the UK or USA, insurance companies in India do not offer insurance to HIV positive people. While insurance companies blame the lack of reliable information on the affected populace for not offering cover, the bigger reason could be lack of pressure from industry. That will come with awareness, when people realize just how devastating AIDS could be to their companies and societies.

The world's biggest pharmaceutical and healthcare company has announced a groundbreaking collaboration with the international umbrella body promoting AIDS research to develop an experimental, low-cost vaccine for use in severely HIV-affected developing countries such as India and South Africa. GlaxoSmithKline claimed that the public-private partnership with the International AIDS Vaccine Initiative (IAVI) was unprecedented. Sections of the medical community agreed that it is the first time AIDS vaccine research had taken a giant leap between half-hearted, poorly-funded government-led endeavour and frenzied, money-soaked private initiative with a gross commercial motive. Twenty-four years after the fight against AIDS began, more than 30 AIDS vaccines are now in clinical trials around the world. But scientists admit none are as stiff with credentials as the new initiative. Jean Stephenne, head of GlaxoSmithKline Biologicals (GSK), its vaccines arm, said the deal would speed research into a novel way of stopping the virus. AIDS campaigners said the announcement could literally be life-changing for heavily HIV-affected countries. Research by scientists at AIIMS in Delhi declared that Indians infected with the AIDS virus were more likely to contract the disease than people in the west because of lower immunity. India admits it has more than five million HIV-infected people, second only to South Africa, but activists insist the Indian government's figures are overly optimistic. This explicitly commits GSK to making the successful AIDS vaccine available in developing countries at affordable prices.6

The Darbar Mahila Samanvaya Committee (DMSC), registered in 1995, is an organization working for the rights of sex workers. It has registered a steady rise in everything from membership (currently 65,000 at 66 branches across the country) to the turnover of their landmark Usha project (from Rs. 3 lakh in 1995 to Rs. 5.30 million in 2004). The later involves a daily contribution of nightly earnings; the interest goes to tide over quotidian crises, and major ones.7

Individual celebrities are also doing good efforts to eliminate HIV/AIDS. Cricketers Rahul Dravid, Graeme Smith, Virender Sehwag, Murali Kartik have joined the fight against AIDS as UNICEF brand ambassadors. Actor Abishek Bachchan who not only acted in a HIV/AIDS related film 'Phir Milenge', has also been involved actively in the children's home 'Ashray', a temporary residence for children living with HIV/AIDS. He visits these children whenever he gets free time, organizes movie trails for them and has donated his earnings to the home. Celebrities have the power of persuasion, of spreading awareness and there is no dearth of Celebes who have, in their own way, done their bit for the cause. The sports world and film industry is playing its right role. Richard Gere came to India in 2002 and hosted a star – studded carnival to raise awareness and funds for HIV/AIDS. The carnival was launched by Gere Foundation India Trust and Godrej, with Parmeshwar Godrej at the helm of matters. Film producer Smita Thakeray formed Mukti Foundation and organized annual concerts for the cause of AIDS that brings together celebrities. She has also hosted a 13-part television programme "The Red Ribbon Show" where a star guest chats with and shared the anguish and thoughts of HIV positive person.

With her business like approach giving orders to subordinates to meet deadlines, no one would ever think she is HIV positive. She heads the community kitchen of an NGO, that prepares about 150 dibbas (lunch boxes) for the sex workers in Pune. A former sex-worker Ruby is reliving life at her own terms and conditions. She takes multi-vitamins, eat healthy nutritious food and try to remain happy. At the age of 16, she was sold to a brothel. Left with little choice, she worked. A day she was told by the hospital authorities that she and her daughter is HIV positive. Thanks to a local NGO, she underwent training on 'How to live with AIDS' in Geneva and Philippines and 'picked up the pieces of her life'. Now she is doing her 'community kitchen' business. She serves free meals to about 18 women everyday, 10 of whom are infected with HIV.8 So, the enterprising skill had given her a lease of life.

At present many companies are producing condoms. Male condoms are available at government health centres, free of cost. A survey was commissioned in Mumbai Kolkata, Kerla, Andhra Pradesh and Maharashtra to study the acceptability and feasibility of female condoms among users and non-users in India and the feedback from the acceptability studies was favourable. The study examined the barriers and enabling factors which affect the use of FCs, determined how the FCs fostered communication between partners and explored how socio-cultural, gender-related environmental and economic factors influenced use. Health Minister A. Ramodas said that female condom will prevent HIV/AIDS and will be available alongside condoms for men in health care centres. Researches have revealed that due to poor quality of condoms, refusal by male partner to use a condom, drunk and abusive behaviour of male partner, women need self-initiated methods to avoid unwanted pregnancies and HIV/AIDS. Called 'Femidom' the female condom made by UK based the Female Health Company will initially be imported by Indian contraceptive makers Hindustan Latex Ltd. (HLL). After six-month period, HLL will start manufacturing the female condom on its own9.

AIDS epidemic is spreading within an environment of stigma, discrimination and denial. People living with HIV/AIDS (PLWHA) face serious rights violations. HIV positive people have lost their livelihoods and homes and some have been subjected to violent attacks. Children have been prevented from attending school and many PLWHA have been denied access to basic and life saving medical care.

The vast majority of women remain economically and socially dependent on men, with limited power to make decisions over their own lives or to protect themselves from HIV. There are many girls and women, whose journey in search of greater livelihood options ends in trafficking for commercial sexual exploitation, making them vulnerable to both severe human rights abuses and HIV. Recognizing these complex factors that feel the epidemic, what is required is comprehensive and above all rights based response. A response that seeks to build an environment where the rights of all members of society, especially the most vulnerable, are protected; where social space is created to talk openly about HIV and related issues; and where PLWHA and vulnerable groups are empowered to play a central role in response. Creating such on enabling environment involves action at legislative, policy and community level. Policies and laws are needed to empower marginalized groups and create a supportive framework for action, as well as to provide protection against discrimination.

For human rights to be meaningful and accessible at community level there must also be a transformation within the social and normative environment. This means developing a comprehensive response to HIV/AIDS that includes medical and public health interventions, strong human right based legislation and policy and social transformation within communities and institutions.

The international community has embraced this approach to HIV/AIDS policy by recognizing the importance of strong protection for the rights of PLWHA and the urgent need to address the social and economic vulnerabilities of marginalized groups. The 'Declaration of Commitment on HIV/AIDS' passed by United Nations General Assembly Special Session (UNGASS) 25-27 June, 2001, noted that "some negative…legal factors were hampering awareness, education, prevention, care, treatment and support efforts." The Declaration called on all countries to "enact, strengthen or enforce, as appropriate, legislation, regulations and other measures to eliminate all forms of discrimination against and to ensure the full enjoyment of human rights and fundamental freedoms by people living with HIV/AIDS and the members of vulnerable groups". The Declaration of Commitment also stressed the importance of respecting privacy and confidentiality, and highlighted the need to develop strategies to combat the stigma and social exclusion associated with HIV/AIDS.10

Corporates and industry associations like ASOCHAM, CII, FICCI have been proved to be good corporate citizen through increased and sincere involvement in social responsibility practices. Strong human capital is core necessity of healthy and prosperous business. It is hoped that industry captains will share their expertise, resources, will networks and many other things to fight with HIV/AIDS. Their involvement is needed in producing and marketing drugs and medicines at affordable prices, strong counseling and advocacy in media, treatment at their hospitals, preference in employment to PLWHA, education and training to dependents of PLWHA, equality at work and other positive steps for the well being of PLWHA.

References:

1. Shourie, Dharam 2006. "Pharma firms to lower cost of AIDS test, drugs", Press Trust of India, January 31.

2. Acharekar, Aparna 2005. "Sense and sensibility, Please", Times of India, December 1.

3. Narayanan, Chitra 2006. "Why India Inc. Should worry about AIDS", Businessworld, May 29.

4. Sintra, Kounteya; "Ramados diagnoses NACO as visionaries", Times News Network.

5. Dagar, Shalini S. 2006. "The Real Cost of AIDS", Business Today, June 4.

6. Lal, Reshami Roshan; "GSK to develop AIDS Vaccine", Times News Network.

7. Karkaria, Bagchi 2005. "You've come a long way, shady lady", Erratica Times Editorial.

8. Sharma Parul 2006. "HIV positive woman heads community kitchen of NGO", Hitvada, March 11.

9. Sinha, Koutenya; 2006 "Female condom joins war against AIDS", Times News Network.

10. Rana, Sanam Yangchen 2004. "Law, Ethics and HIV/AIDS in South Asia", A study Report of United Nations Development Programme.
 


Dr. Devendra Prasad Pandey
Director
Rajiv Gandhi P.G. College
Kotwa, Nyaya Nagar, Jhusi, Allahabad
 

Source: E-mail March 28, 2008

          

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