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PRESENTS

PRACTICAL SOLUTIONS TO MANAGING THE RISK OF HIV AIDS

COURTESY
Monique TERRAZAS

(SOUTH AFRICA)

Practical solutions to managing the risk of HIV AIDS
The HIV AIDS pandemic is one of the greatest risks that companies face, but there are some practical solutions to manage this issue with diligence and care.

An HIV programme
The Global Business Coalition on HIV AIDS (GBC) has identified the key elements of any effective programme as: risk assessment; a non-discrimination policy; a prevention and awareness programme; voluntary counselling and testing; and care, support and treatment. Each of these elements is discussed separately, but must be viewed as parts of a holistic integrated programme.

HIV AIDS programmes have a two-pronged intervention approach. Firstly, creating awareness to prevent further HIV infections, and secondly, providing care and treatment to help those already infected to remain healthy and productive for as long as possible.

Workplace programmes and policies should be developed in consultation with all key stakeholders, including trade unions and employee representatives, to ensure employee support. Identifying a champion to drive the initiative, supported by a team of employees, could well give the HIV programme the momentum it requires.

Examples of existing company programmes are available at www.gbcaids.com, under “Managing HIV in the Workplace”. The South African Business Coalition on HIV AIDS (www.sabcoha.co.za) has also collected a number of South African case studies and has created a Workplace HIV AIDS Toolkit, as a step-by-step guide to formulating and implementing a workplace HIV AIDS programme. It also creates an opportunity for corporates, whose supply chains are threatened by HIV AIDS, to engage smaller partners and associates, and extend assistance by providing them with the Toolkit.

Risk assessment and risk management
HIV AIDS risk management must be seen within the general scope of the risk management process, says Peter Smanjak, Business Development Executive at Nova Group.

HIV AIDS is a pure risk, which is the possibility of a loss or no loss, e.g. an employee could contract HIV, says Smanjak. The elements of HIV AIDS uncertainty include:
        - How many employees are infected with the virus?
        - How many new infections will occur over a given period?
        - What will the outcome of this be on the company’s bottom line?
Samanjak explains: “HIV risk management includes the identification (understanding the risk exists), evaluation (investigating what this risk entails for the company), control (finding ways to prevent the risk materialising) and finally, if the risk materialises, ways of financing the risk."

The first step in managing this risk is to identify HIV AIDS as a strategic business risk to the sustainability of the company.

The next step is to evaluate the severity of the risk. This can be done through a number of different analyses and studies, for example, a Knowledge, Attitude & Practices (KAP) study; actuarial risk or impact assessments; anonymous, enterprise-wide surveillance, prevalence or saliva testing; and voluntary counselling and testing (VCT) programmes.

The GBC says that initial risk assessments to evaluate the scale of the HIV problem have been crucial in helping companies devise targeted programmes. These risk assessments focus on:
        · the existing level of HIV AIDS within the workforce and surrounding communities
        · the cost to company of HIV AIDS-related absenteeism, reduced productivity and death, and the resulting recruitment and training
        · the cost to the company resulting from hospitalisation and any existing prevention activities

The third risk management step (the control stage) involves determining how to minimise the risk of occurrence and the severity (cost) thereof. These decisions have a direct correlation to the fourth (financing) stage. The risk can be retained for the company’s own account or the consequences of the risk can be transferred to another party, usually an insurance organisation, that will - in exchange for a premium - take on a number of insurable risks associated with HIV AIDS.

“Companies have considered other alternatives to manage the risk of HIV AIDS, such as the medical scheme or reserving funds for the future via the balance sheet, however none have yet proved to be viable,” says Smanjak.

Non-discrimination policy
The HIV workplace policy should address the full spectrum of issues relating to HIV, including the company’s position on HIV, the HIV programme, the employment issues related to HIV, such as testing, employee benefits, performance management, sick leave, grievance procedures, confidentiality and discrimination, as well as the assistance available to employees, and details regarding the implementation, responsibilities, monitoring and evaluation of the HIV programme.

A good starting point is the Department of Labour’s Technical Assistance Guidelines (www.labour.gov.za) and the various Codes of Good Practice on HIV AIDS. Reviewing samples of policies used by other companies could also be helpful. It is advisable to have the wording of the policy checked by legal and HIV AIDS experts.

The HIV policy should be incorporated into the existing policy and training structures, to create an enterprise wide impact. Regular communication will keep HIV AIDS issues in focus and suggestions include newsletters or brochures distributed with salary slips, fact sheets and information posted on bulletin boards and guest speakers and special events during AIDS Awareness Week.

Training: prevention and awareness
High levels of awareness, with the emphasis on ABC methodologies: Abstinence, Being faithful and using Condoms, is the first step in preventing the spread of HIV AIDS.

Mark van der Merwe, MD of Computainer, a company focussed on making HIV AIDS prevention and management affordable and therefore available to all employers, says that their interventions “were inspired by the reduction in new HIV infections in Uganda. We studied the model used and discovered that success was mainly due to the high levels of awareness, based on raised levels of education with the emphasis on ABC methodologies.”

Training should be designed to educate employees about their rights and responsibilities in terms of the company policy, providing a link between the policy and day-to-day work activities. At the same time, the training must focus on reducing the stigma and fear associated with HIV, while raising awareness of prevention methods.

Training methods range from touch-screen computer kiosks to structured personal training sessions to peer educator programmes. The Computainer touch-screen computer kiosks are designed to be situated on the shop floor. The computer-based training retains interest through its novelty value, and the content is refreshed every three months to keep the interest and to adhere to legislative changes.

This training is outcomes based and offered in a number of South African languages. The system has a full management-tracking database and will collect results based on outcome questions so management can determine the level of understanding gained during the training.

The most expensive kiosk is priced at a fully inclusive price of R34 000, but each kiosk can support a 1 000 learners per year. Many small companies, who may not be able to afford the purchase of their own system, can rent a kiosk through an agreement with NAPWA (National Association of People Living with HIV AIDS). These rented kiosks are made available to smaller companies through donations from larger corporates, who include this sponsorship in their Corporate Social Responsibility (CSR) activities.

According to SABCOHA, many businesses are missing the opportunity to use the Skills Development Levy to set up formal programmes to educate employees about HIV AIDS. Each Seta has a list of priorities for training and grants are awarded accordingly. HIV AIDS training has been identified as a priority by all 25 SETAs.

The funds available from the SETAs could contribute greatly to the cost of providing training to the company’s employees and the community. Information on how to take advantage of the levy can be obtained from the relevant SETA or the Department of Labour at www.labour.gov.za.

Voluntary counselling and testing (VCT)
“Once awareness has been created,” says van der Merwe, “the next step is to understand HIV status, and this starts with an HIV test.”

Companies could investigate options such as providing testing through an in-house counsellor or healthcare worker, or partnering with local clinics or NGOs to facilitate voluntary counselling and testing.

By law, HIV testing must be accompanied by pre- and post-test counselling. A VCT programme can only be successful if it is offered along with HIV AIDS awareness training, guaranteed confidentiality and the option of treatment should the test be positive. Some business leaders have volunteered to be publicly tested to motivate their colleagues and employees to determine their HIV status.

CompuTainer, for example, supplies HIV 1 and HIV 2 rapid test kits at less than R16 per kit, and test results are available within 15 minutes. The test kits are approved by the Centre for Disease Control and on par with the Ilisa Test used in labs and clinics. The kits can be provided to the company, if the company has its own councillor or healthcare worker. If this is not the case, the test kits can be supplied to the nearest clinic.

Care, support and treatment
An employee who has tested positive for HIV can be productive for many years before Aids sets in.

Wellness programmes include ongoing social support and counselling dealing with issues such as nutrition, managing stress and avoiding opportunistic infections, such as pneumonia, TB and hepatitis C.

"We have made available nutritional supplements at less than R85 per month per employee based on RDA (Recommended Daily Allowance), especially designed to meet the nutritional requirements of HIV+ employees to assist with Antioxidants, Micro-Nutrient Supplements, Energy Booster, Immune Booster and Anti-Carcinogenic. A provincial government has recently acquired over 200 000 nutritional packs, attesting to the results the nutritional intervention produces," says van der Merwe.

Access to treatment and care can be provided through medical aid schemes or in-house treatment programmes. Many companies that provide discounted or free medication and antiretroviral treatment to their HIV positive employees, have found that the benefits in reduced absenteeism and increased productivity are well worth the costs.

This treatment can also be provided in partnership with local government or NGOs. There are 18 government facilities providing antiretroviral treatment in Gauteng, with a further five facilities scheduled to open by March 2005. Recently opened facilities are at the Zola, Hillbrow, Empilisweni, Discoverer and Lillian Ngoyi clinics, and Carletonville and Sebokeng hospitals.

The services offered include HIV-testing, medical examinations and laboratory tests; providing interventions that delay the progression of the disease, including nutritional and micronutrient supplementation; and ensuring those that qualify for anti-retroviral therapy are prepared for treatment.

Tax issues
One option to ensure a tax efficient HIV programme could be to create a separate trust, as a Public Benefit Organisation ("PBO"), to receive the subsidised payment and to provide the HIV AIDS benefits, says Claire van Zuylen and Betsie Strydom of Bowman Gilfillan.

PBO status would exempt the trust from income tax on subsidies and donations, while permitting a deduction in respect of the donations to the trust. However, the SARS interpretation is that a public benefit activity must be rendered for the benefit of the public at large, which excludes a company's HIV AIDS programme. Without an amendment to the definition of a PBO, a specially described deduction would be desirable.

Whether the employer will be able to claim a deduction for income tax purposes of the expenses incurred in making such donations, will depend on whether the employer can show that:
        * the expense was incurred in the production of income. It is generally accepted that if an expense is aimed at securing a happy, contented workforce, the expense is incurred in the production of income. The employer must show that the expenses incurred in maintaining a healthier workforce with a longer life and period of productivity, is such an expense; and
        * the expense was incurred for the purposes of trade. The employer would need to demonstrate that sound business principles require that medication be given to employees and that the cost of training new workers outweighs the expenses aimed at keeping current employees alive and productive for longer.

It is possible that all company HIV AIDS management programmes are susceptible to a demand by SARS that fringe benefit tax be deducted from the salaries of those employees enrolled on the programme. This poses a problem, especially in light of the fact that confidentiality must be maintained according to various pieces of legislation.

Succession planning
Creating a strategic succession plan should start with identifying the departments in which the highest impact is likely. Key individuals must be identified and a succession plan implemented to train other employees to fill these key positions. Considering the extent of the pandemic, it would be wise to identify and train at least two employees for each key position.

This pre-emptive training will create multi-skilled, mobile workers who can take over various positions in a short time period, without the loss of job-specific, tacit know-how. The plan must further extend to filling the positions created as key positions are filled, and filter down to recruitment and training of new employees on the employee entry level.

Succession planning must also include the reasonable accommodation of employees who become too ill to perform their regular tasks and strategies to accommodate them in less demanding jobs.

Again, companies may find it useful to investigate the training and funding available via the SETAs.

Community involvement
Companies can extend their HIV AIDS programmes into the communities they operate in as part of their corporate social responsibility. This may include a public education campaign, providing funding and expertise or allowing employees paid time off to volunteer. This involvement ensures the company remains visible as a caring corporate member of society, while ensuring sustainable markets and resource pools from which to recruit labour in the future.

Corporate governance
In the end, HIV AIDS should be approached with the same business and corporate governance principles as any other business risk. Two main issues cannot be ignored: top management must drive the initiative, and immediate action is critically important.



COMMENTS

I would like to know how South African businesses manage employees who are affected by families infected with the hiv aids virus.
If their are any policies can you e - mail them to me.
Thanking You
Pariksha Ramsurab
University Kwa-Zulu Natal
South Africa



A RESPONSE FROM MARK VAN DER MERWE

Hi Pariksha
This is a very interesting question.
Many different companies have different policies for employees.
Not all have policies that cover infected employee family members.
As an example the Department of Education has there HIV Policy available at
http://education.pwv.gov.za/HIVAIDS_Folder/AIDSPolicy.htm

You will notice in Section 3 that all reference is made to learner, student or educator and no reference is made to family members.
I notice that your university policy does not contain any reference to family members.
http://www.heaids.org.za/policies/institutions/269907.htm

Other Higher Education policies can be found at
http://www.heaids.org.za/policies/ and no mention is made of family members.

There is an interesting article on the SABCOHA website that talks about what companies are doing and it never talks about families.
http://www.redribbon.co.za/business/user_page.asp?page_number=5781&prev_page=5429

Bottom line is that I do not believe that many companies extend their HIV Policy Management to families. Remember that if a company extends ART to their staff it is seen as a fringe benefit and as such taxed. If it is part of the medical aid then the member is covered. I would assume that family members are covered by medical aid so hence covered by the company depending on ones medical aid.

If you have further questions please feel free to call me or email me.
Regards
Awareness, Status, Nutrition
The Key to Wellness in Africa
Mark Van der Merwe
Managing Director
ASN AFRICA
markvdm@telkomsa.net

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