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As AIDS spreads,
"human capital" is at risk
A new study paints a bleak picture of the economic and social impact of HIV/AIDS in sub-Saharan Africa. Not only is the epidemic far more severe than previously thought, but it will seriously undermine the development prospects of affected countries. At risk is Africa's "human capital". This report examines the extent of the crisis, and what can be done about it.
GENEVA - If a cure for HIV/AIDS ever becomes widely available in sub-Saharan Africa, will anyone be there to administer it?
The impact of AIDS on "human capital" - the labour force which provides countries with services ranging from health care and education to administration and security - is the subject of a new study 1 prepared for the ILO Global Programme on HIV/AIDS and the World of Work.
The study says the epidemic, now entering its third decade, will affect social and economic life in ways never seen before.
Here are some of the areas most at risk:
The full text of the study "Human capital and the HIV epidemic in sub-Saharan Africa", is available on line at:
www.ilo.org/public/english/protection/trav/aids/publ/index.htm
Scope of the epidemic
The epidemic is primarily concentrated in the working age population (15 to 49 years), placing a disproportionate burden on an age group with critical social and economic roles. In Africa, the epidemic places a greater burden on women, who experience more infections at an earlier age than men, with a consequent greater loss of healthy years of life and a greater share of the burden of care.
AIDS killed an estimated 2.3 million Africans in 2001, and has caused a cumulative total of about 20 million deaths since the start of the epidemic, according to the United Nations Joint Programme on HIV/AIDS. UNAIDS reported an estimated 3.4 million new infections in 2001, and estimates that some 28 million Africans are currently living with HIV.
Some 50 million people will have died of HIV/AIDS before the end of the present decade, the report says, adding that assuming about five people within each immediate family are affected for every person who dies, some 250 million Africans will be closely affected by HIV/AIDS within ten years.
Efforts to address these onslaughts on African lives and economies will have long-term implications because of the difficulty in training new workers, the loss of opportunities for on-the-job learning due to the deaths of more experienced workers, and the increase in the number of children who must go to work, who will thus miss opportunities for education and skills training.
Sectors at risk
One of the most worrying developments is the impact of the epidemic on education in sub-Saharan Africa, worsening the performance of an already underperforming sector, the report says. Among secondary school teachers in Malawi, for example, the rate of excess mortality due to AIDS is nearly double the expected mortality due to non-AIDS causes, while an additional 60 per cent of primary school teachers may die due to the epidemic.
"It is hard to see how the stock of human capital can be maintained, given the erosion of capacity in the education sector presently underway," the report says. "The implications of this for sustainable development in the region cannot be assessed accurately, given our present knowledge of the complex interactions that are involved. However, even the most optimistic assessment is that indicators of social and economic development are significantly lower as a result of the epidemic."
In the public sector, overall mortality in some countries has risen by ten times over the past decade, largely due to AIDS, and will result in governments losing the ability to supply essential goods and services. In Botswana, for example, increased mortality of health care workers is reducing the capacity to meet higher demands for care for people with HIV and AIDS. Meanwhile, among police officers in Malawi, the epidemic is having a severe impact on junior officers aged 20 to 40 years, thus affecting the quality of service and the structure of security.
In the informal sector, which in most African societies accounts for the majority of workers, especially in agriculture, data on the impact of HIV/AIDS is limited due to lack of research. However, studies in Kenya and Côte d'Ivoire found that sickness and mortality due to AIDS resulted in the dramatic depletion of savings, the loss of key skills and organizational capacity, and a fall of up to 50 per cent in food production in households where only one member was sick with AIDS.
Rethinking policy
The report says a "rethinking of policies and programmes are needed to reconsider current policies and adapt those to the new reality of a world characterized by AIDS." These include:
The ILO report also called for greater involvement of both employers and organized labour in efforts against HIV/AIDS, and for support to governments in assessing and mitigating the impact of the epidemic.
"There have been no consistent workplace programmes for AIDS," Mr. Lisk said. "We must remedy this by providing advice and technical assistance for workers and employers, based on the ILO Code of Practice on HIV/AIDS and the World of Work, launched at the UN General Assembly Special Session on AIDS [in 2001]. So far, the resources allocated to this effort have been pitifully inadequate. The international community and African leaders must work together to find the resources and the will to establish workplace policy and programmes across the continent."
1 Desmond Cohen, "Human capital and the HIV epidemic in sub-Saharan Africa", ILO/AIDS Working Paper 2, Geneva, 2002, ISBN 92-2-113238-2.
2 UNAIDS estimates that annual per capita income of half the countries of sub-Saharan Africa is falling by 0.5-1.2 per cent, and that GDP in the hardest hit countries may decline by 8 per cent by 2010.
AIDS in South Africa:
Despite challenges, a glimmer of hope
In order to manage time off taken by employees, one company in KwaZulu-Natal, South Africa, has limited workers to attending a maximum of three funerals a week for people who have died of AIDS. But is the impact of AIDS really sinking in with company managers? In some cases, yes, but in many others, denial is still rife. South African journalist Alan Fine reports on how South Africa is handling the crisis.
JOHANNESBURG, South Africa - For Clem Sunter, a director of Anglo-American Corporation, the epidemic of HIV/AIDS in his country poses a stark choice: "There are two possible responses by business to HIV/AIDS, either denial or total onslaught," he says. "Most of us - government, business and the general public - are still in denial."
How can this be? Latest estimates show about 10 per cent of South Africa's population infected with HIV. Among the economically active population, the figure is higher, especially in the 25-35 year age group. So far, deaths from AIDS appear to be about half those due to other causes. But that may change. According to one Government study, by 2010, four out of five deaths of employees will be AIDS-related.
The mining industry is the hardest hit. Most of its workers are migrants, living away from their rural families much of the time. Gold Fields of South Africa estimates that 26 per cent of its workforce in South Africa is HIV-positive. The equivalent figure in white collar occupations is perhaps 5 per cent. And it is in the mining industry that companies are beginning to take action.
One of the first to announce plans was AngloGold, which employs about 70,000 people in South Africa. Though educational programmes aimed at preventing AIDS in the 1980s had limited success, the company has announced plans to use its extensive network of mine-based hospitals and clinics to treat opportunistic AIDS-related infections, primarily tuberculosis. The company is also establishing a network of clinics in rural areas for families of miners, and a more comprehensive "wellness programme" which includes voluntary HIV-testing and counselling.
AngloGold chief executive, Bobby Godsell, says his vision is for the company to become a leader in the evolving world response to HIV/AIDS. The economic purpose of the programme is to ensure that HIV-infected employees, trained at a cost to the company, are able to continue working for as long as possible. It is also necessary to assure shareholders that, while HIV/AIDS is a challenge for the company, it is being managed as effectively as possible.
Gold Fields, the second largest South Africa goldmining group, employing 48,000 people in the country, also announced a major programme late last year to deal with HIV/AIDS. As with most corporate AIDS programmes, consultation and cooperation with the unions - in this case the National Union of Mineworkers - is a crucial part of the development of the programme.
The Gold Fields programme is, like AngloGold's, focused on prevention, voluntary testing and counseling, and a "wellness management programme for all employees living with chronic diseases, including HIV".
The obvious limit on these programmes is the absence of antiretroviral treatment for workers with AIDS. Triple therapy currently costs between 15,000 and 18,000 Rands a year in South Africa (the current exchange rate is about 11.50 Rands per US$). Since this is more than half the annual income of the average semi-skilled mineworker, it is not considered economically feasible. For white collar and other skilled workers, the picture changes. Most private medical aid schemes and the schemes covering state employees, are finding it possible to finance triple therapy because its cost has declined in recent years.
Some industrial companies employing mostly skilled blue collar workers with different cost structures and lower HIV infection rates, have begun supplying those advanced forms of medication, along with the normal educative programmes aimed at prevention and treatment of opportunistic diseases. DaimlerChrysler's South Africa operation, for example, announced such a programme in 2001, in conjunction with the technical cooperation agency of the German Ministry of Economic Cooperation and Development.
So while in most of South Africa business is still seen to be in a state of denial, there are signs that an increasing number are seeing the urgency of the situation, and are putting comprehensive strategies in place to deal with it.