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ILO, social partners adopt comprehensive strategy
for HIV/AIDS in Africa's world of work
Meeting under the auspices of the ILO in Namibia, representatives of governments, and employers' and workers' organizations from 20 African states recently adopted a blueprint for a region-wide response to HIV/AIDS. The Platform for Action adopted by the meeting said HIV/AIDS had taken a "catastrophic toll in Africa, decimating its population, tearing apart the very social fabric of its society and threatening its economies".
WINDHOEK, Namibia - When scores of government, worker and employer representatives from across Africa gathered here recently to discuss HIV/AIDS 1, it was not long before the sense of the meeting was clear: AIDS, the delegates agreed was no longer a health problem. It was a "developmental crisis with potentially ominous consequences for Africa and the world".
With that, the officials from some 20 countries, as well as the ILO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), non-governmental organizations and observers 2, proceeded to accept a ringing call for action against the disease, declaring AIDS "the most serious social, labour and humanitarian challenge of our time".
"A culture of silence, fear and denial continues to reign and prevent action," the unanimously adopted Platform said.
"The stigma and the fear engendered by AIDS fuels discrimination, persecution and ignorance. Despite this, the spread of AIDS can be prevented. In the absence of a cure, what is needed is a "social vaccine" which includes such elements as social inclusion, income and job security, social security and solidarity."
The meeting, organized in collaboration with UNAIDS and stemming from calls for urgent action by the Organization of African Unity (OAU) at a meeting held in Windhoek earlier this year, was the first such tripartite conference to gather such a wide range of representatives of governments, workers and employers from the region. In addition, it was the first in a series of activities to be carried out at national and regional levels, in collaboration with the ILO and other concerned international organizations and donor agencies. It would also lead to an African Platform of Action which could eventually be adopted at the ILO's African Regional Labour Conference in December, in Abidjan, Côte d'Ivoire.
The scope of the problem
The meeting opened with a report on the dire consequences of the HIV/AIDS epidemic, showing that the disease is increasingly threatening all sectors and levels in the world of work. The report shows that the pandemic is "affecting and ultimately killing the most productive members of the labour force" in many African countries with increasing rapidity".
The AIDS pandemic... is the most serious social, labour and humanitarian challenge of our time. AIDS
and HIV have taken a catastrophic toll in Africa, decimating its population, tearing apart the very social
fabric of its societies and threatening its economies. Its toll of debilitating illness, widespread and
indiscriminate death, deteriorating quality of life and life expectancy, threatens to reverse the hard won
social and economic gains of African countries...
- Windhoek Platform for Action
"The true cost of this pandemic is almost incalculable and its repercussions in terms of deteriorating child survival, diminishing life-expectancy rates, overburdened health-care systems, the increasing number of orphans and substantial financial losses in the business world, are enormous," the report says.
In the past two decades, nearly 50 million people have been infected with HIV. As of the end of 1998, UNAIDS said over 33 million persons were living with HIV/AIDS worldwide. Some 14 million people have died of AIDS, with some 2.5 million deaths recorded in 1998 alone.
Of the global total, UNAIDS said 95% of all HIV-infected people live in the developing world. Globally, women comprise 43% of all people over 15 with HIV or AIDS. HIV infections occur at the rate of 11 every minute of every day. About two-thirds of the world's people with HIV/AIDS - or 22.5 million - live in sub-Saharan Africa. In Botswana, Namibia, Swaziland and Zimbabwe, between 20 and 25% of all persons aged 15 to 49 are now infected with HIV or have AIDS, although in some areas infection rates are as high as 50%.
UNAIDS said that in 1998, 90% of all newly diagnosed HIV infections occurred in Africa, despite the fact that the continent has only 10% of the world's population. Some 95% of all AIDS orphans in the world - children who have lost their mother or both parents before their 15th birthday - live in Africa. ILO and UNAIDS data indicate that AIDS has now become the number one cause of morbidity
and mortality in Africa, surpassing malaria.
In addition to expanding cooperation with other organizations on AIDS issues and considering co-sponsoring the UNAIDS programme, delegates also called on the ILO to:
• apply "concepts, methods and tools it has developed on labour and social issues for responding
to the design of research and programmes on HIV/AIDS;
• expand its capacity to deal with HIV/AIDS, especially in its multidisciplinary teams through
training, resource mobilization and secondment of experts from UNAIDS;
• undertake research and surveys to determine the implications of HIV/AIDS for the world of
work, including its efforts on the growth of the labour force and participation rates, women, child labour,
union membership, productivity, informal sector and small enterprise development;
• document and disseminate information through all appropriate means on national experiences
including best practices;
• engage in advocacy and training on HIV/AIDS and the world of work, targeting the political
leadership, workers' and employers' organizations and civil society;
• include HIV/AIDS in its regional meetings and consider organizing a special session on the
subject at the International Labour Conference;
• integrate HIV/AIDS issues and gender components in all ILO programmes and technical
cooperation projects in the region;
• develop a policy, programme and structure to address the issue of HIV/AIDS in the world of
work; and,
• strengthen the capacity of its social partners to formulate and effectively implement programmes
and activities at the national and enterprise levels.
Case study: Rwanda, Tanzania, Uganda and Zambia
An ILO study carried out on the labour force in Rwanda, Tanzania, Uganda and Zambia showed that 80% of persons infected in those countries are between the ages of 20 and 49. "In other words, AIDS is affecting, and ultimately killing, the most productive labour within the formal sector. Many were experienced and skilled workers in both blue collar and white collar jobs." 3
In Zambia, the report said, 96.8% of all AIDS-related deaths in 18 firms covered, occurred among workers aged 15 to 40. Between 1984 and 1992, mortality had risen fivefold, with AIDS-related illness accounting for 56% of the deaths among general workers, 71% among lower level workers, 57% among middle level workers, and 62% among the top level managerial workers.
The pandemic has manifested itself in the world of work - the area of the ILO's mandate - in the
following ways: discrimination in employment, social exclusion of persons living with HIV/AIDS
(PLWHA), additional distortion of gender inequalities, increased numbers of AIDS orphans, and
increased incidence of child labour. It has also disrupted the performance of the informal sector and
small and medium enterprises (SME's).Other manifestations are low productivity, depleted human
capital, challenged social security systems, and threatened occupational safety and health, especially
among certain groups at risk, such as migrant workers and their communities, and workers in the
medical and transport sectors.
- Windhoek Platform for Action
"Employers naturally tend to worry about the backbone of their businesses - their employees - and the affect the pandemic could have on their businesses," the ILO study says. "HIV/AIDS makes the cost of doing business more expensive, while at the same time lowers worker productivity and decreases overall demand for goods and services."
General impact on work
The ILO report says HIV/AIDS has wreaked havoc on both the formal and informal sectors, among women at work and in the home, the elderly and children. In the case of the formal sector, HIV/AIDS has led to skyrocketing illness and death among employees at all levels, absences due to illness, the need to care for ill family members or attend funerals, increased costs for insurance, retraining and disability.
"AIDS does not discriminate among the level of workers," the ILO report says. "It decimates management and the skilled labour force. Finding qualified top management and skilled line workers to replace those who die or can no longer work can be extremely difficult. Productivity suffers; it takes time to replace workers, particularly skilled or senior workers."
In the case of employers, the report says, "many fear addressing AIDS in the workplace could be too costly, while others are concerned they don't know how best to approach the issue. Surveys reveal that few companies have established comprehensive prevention, care and support interventions in their workplace."
AIDS has also had considerable impact on the informal sector, where many unsuccessful aspirants or retrenched workers surface alongside those who are without adequate education and skills. Many workers living with HIV/AIDS and working in this sector either lose their means of livelihood or see their businesses collapse due to their inability to work. Even if they enter a period of remission or recovery, it is often difficult to resume work because personal resources have been depleted.
Women are also seriously affected, both due to their greater vulnerability to transmission, as well as their lack of empowerment in the workplace and in their personal lives. Some women may lose the ability to care for their families, others who admit to being infected with HIV may be denied it. In some cases, women with HIV are beaten and ejected from their homes by husbands, even if the man infected them. The death of either spouse often leads to a decline in income or depletion of savings, but the death of the woman invariably has serious consequences for children, as well as the elderly in the household.
In the case of children, many find themselves orphaned at an early age, or forced to leave school to care for families where a mother has died. Children often find themselves thrust into the position of head-of-household by the deaths of both parents, and are unable to meet such demands. Many children surveyed have said failure to meet these needs would force them into delinquency, the streets or prostitution. Orphaned boys may turn to paramilitary activity for protection and subsistence.
WINDHOEK - Is the empowerment of women one of the keys to preventing the further spread of HIV/AIDS? "Economic empowerment of women is absolutely vital to slowing or stopping AIDS," said ILO Executive-Director Mary Chinery-Hesse. "Women need voice, women need choice. Only then can we hope to stop AIDS."
During a discussion on gender issues today, delegates were told that women around the world, and African women in particular, were more often than not ruled by men in their professional as well as personal lives, dramatically increasing their vulnerability to infection with HIV and other sexually-transmitted diseases.
Information provided to UNAIDS and others included that:
Ms. Chinery-Hesse said that while gender promotion programmes, such as those being carried out by the ILO, ought to have more HIV/AIDS components, and any new strategy for combatting HIV/AIDS must include elements addressing gender as a critical issue.
Social partners agree: AIDS must be stopped
The clear message from all those at the meeting was that a means was needed to combat AIDS, and that no time could be lost in finding such a means. Said Mary Chinery-Hesse, Executive Director of the ILO Social Protection Sector and the most senior ILO official at the Windhoek conference, "While the whole world is waiting for a vaccine in the medical field to prevent HIV/AIDS, let us make use of ILO facilities and values such as tripartism, equality, and social justice, to effectively develop a social vaccine'."
This call found support from both workers and employers. Noting the workshop was "long overdue," the representative of the workers' participants, Mr. M. Besha of the Organization of African Trade Union Unity-OATUU, called the impact of HIV/AIDS in the workplace alarming. While OAUTUU had already organized programmes to fight HIV/AIDS, he said he hoped the ILO would develop effective strategies which would include workers and their representatives.
The ILO should strengthen its activities in fighting HIV/AIDS in the Region through improved knowledge,
vigorous advocacy and expanded services. The ILO tripartite structures provide a unique mechanism
for intensifying the response to HIV/AIDS.
- Windhoek platform
The representative of the employers' participants, Mr. R. Iacona of the Ethiopian Federation of Employers, added that employers could not fight HIV/AIDS in the world of work alone and that action was required by all social partners.
Other delegates raised points including confidentiality and the need for employers to support infected workers who were normally breadwinners for a large number of dependents; the need to counter the taboo around sexually transmitted diseases; concern that women were bearing more than their share to cope with the disease; implications on the training of infected employees; and the difficulty in counselling at company level given the premise of confidentiality was highlighted.
Noting, however, that even in the absence of a vaccine or cure, the transmission of AIDS was preventable, delegates endorsed the concept of a "multi-dimensional response" involving a so-called "social vaccine" which would include such elements as preventing social exclusion, protecting incomes and social security schemes, and promoting solidarity with people with AIDS.
1 HIV stands for the human-immunodeficiency virus, which causes AIDS. AIDS is the acronym for Acquired Immunodeficiency Syndrome.
2 In addition to the ILO and UNAIDS, participants in the "Regional Tripartite Workshop on Strategies to Tackle Social and Labour Implications of HIV/AIDS" included representatives of governments, workers and employers invited from Botswana, Burundi, Cameroon, Central African Republic, Democratic Republic of the Congo, Côte d'Ivoire, Djibouti, Ethiopia, Ghana, Kenya, Namibia, Nigeria, Rwanda, Senegal, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. In addition, participants included the Organization of African Trade Union Unity (OATUU), United Nations agencies and offices including the United Nations Development Programme (UNDP) and United Nations Children's Fund (UNICEF), the African Development Bank (ADB), and other governmental and non-governmental organizations concerned about the impact of HIV/AIDS in the world of work.
3 Data collected by the ILO for the ECA Joint Conference of Ministers of Finance and Ministers of Responsible Economic and Social Development and Planning, in Addis Ababa, May 1999.