GENEVA - The new ILO report on HIV/AIDS in the world of work contains stark data; it estimates that in the absence of increased access to treatment, the number of workers lost to the labour market due to HIV/AIDS will increase to 48 million by 2010 and 74 million by 2015, making HIV/AIDS one of the biggest causes of mortality in the world of work.
"This amounts to the disappearance of a large country's population from the face of the earth," says report author Odile Frank of the ILO. "We cannot underestimate the impact this will have on the global economy."
The new analysis of 50 countries ( Note 2) in sub-Saharan Africa, Asia, Latin America and the Caribbean, and two developed regions, says HIV/AIDS is expected to have a severe impact on the rate of growth in gross domestic product (GDP) and in GDP per capita by destroying the "human capital" built up over years, and weakening the capacity of workers and employers to produce goods and services for economies.
"HIV/AIDS is not only a human crisis, it is a threat to sustainable global, social and economic development," says ILO Director-General Juan Somavia. "The loss of life and the debilitating effects of the illness will lead not only to a reduced capacity to sustain production and employment, reduce poverty and promote development, but will be a burden borne by all societies - rich and poor alike."
The report was presented at the XVth International Conference on AIDS in Bangkok, Thailand, held on 11 to 16 July. It was prepared on the basis of newly developed demographic and epidemiological data from the United Nations and other sources which allow for such global projections of the impact of HIV/AIDS on the world of work for the first time.
Among the key findings in the report (Note 3):
- The ILO report says that of the 35.7 million persons between the ages of 15 and 49 estimated by UNAIDS to be infected with HIV, over 26 million are workers. If all working-age persons, including those aged up to 64, and others performing informal work either inside or outside their homes are added, the estimated number of persons with HIV climbs to 36.5 million.
- The direct impact of HIV/AIDS on workers is twofold. While tens of millions have already died, millions more are dropping out of the labour force. The ILO estimates that in 2005, 2 million workers globally will be unable to work - up from 500,000 in 1995. By 2015, the number will double to 4 million people who are unable to work due to HIV/AIDS.
- Other economically active workers will be forced to shoulder an increased economic burden as the result of their colleagues dying of HIV/AIDS, estimated to be 1 per cent greater globally in 2015 than in the absence of HIV (5 per cent greater in sub-Saharan Africa).
- Other adults in the household of a person with HIV/AIDS will have to shoulder an increased burden of care, estimated to be 1 per cent greater globally in 2015 than in the absence of HIV (6 per cent in sub-Saharan Africa).
- Adults of working age, whether or not they are formally considered labour force participants, may have to drop economically productive activities to divert time to care, especially in developing regions of Africa, Asia, Latin America and the Caribbean. This means that if 2 million workers are unable to work because of HIV/AIDS, approximately 2 million more persons of working age will be unable to work because of care duties; i.e., the indirect impact of care can double the direct impact of the illness where the burden of care is in the household and on the family.
"These effects of HIV/AIDS on the labour force and on all persons of working age are measurable in their overall impact on economic growth and development," says Franklyn Lisk, Director of the ILO/AIDS programme. "By causing the illness and death of workers, the HIV/AIDS epidemic reduces the stock of skills and experience of the labour force. This loss in human capital is a direct threat to the Millennium Development Goals of reducing poverty and promoting sustainable development."
By far the majority of countries most affected by HIV/AIDS are in Africa, where the regional average HIV prevalence (among 15 to 49 year-olds) is 7.7 per cent. The impact on individuals, households, the society and the economy in Africa and elsewhere was assessed using a number of measures and indicators, several of them developed for this purpose.
Macroeconomic and social impact
The direct and indirect impact of HIV/AIDS on the labour force is measurable in macroeconomic terms, the ILO study says. In countries where the impact was measurable between 1992 and 2002, the rate of growth of GDP was lower by 0.2 per cent per year (equivalent to US$25 billion per annum) and the rate of growth of GDP per capita was lower by 0.1 per cent per year (equivalent to US$5 per capita per annum).
The report also notes that:
- The epidemic will have a multiple impact on women in the countries most affected by HIV/AIDS. Whether women work productively inside or outside the home, their work time will be displaced by the fact that they are primary caregivers. In addition, young women are now showing the largest increases in HIV-prevalence rates. Finally, where women are responsible for subsistence farming (across most of Africa), if they themselves are not ill, the burden of caring for family members ill with AIDS, the demand to earn income to replace the lost income of the person living with AIDS, and the burden of care for other family members - notably young children and older persons - may displace available time for farming, which jeopardizes their capacity for providing food to the household, and/or ensuring the well-being of all household members.
- The impact of HIV/AIDS will affect a vast cross-section of the labour force in the public and private sectors, as well as agriculture, the informal economy, and women and children in the most affected countries. The report says the impact of HIV/AIDS will be especially severe in the educational and health sectors, where the proportion of educators and health-care providers dying of HIV/AIDS may reach as high as 40 per cent by 2010 in some instances.
- In rural areas of the most affected countries, HIV/AIDS is worsening the economic situation of impoverished rural households, exhausting the ability of rural communities to withstand shocks, and seriously aggravating existing food insecurity, the report adds.
- Children will suffer from a lack of parental care and guidance, or find themselves forced to abandon schooling and seek work which not only threatens their physical well being but will deprive them of education, skills and training, thus threatening the goals of eliminating child labour and promoting sustainable development.
"The challenge for national policy is to address human capital issues, and develop means to sustain the supply and quality of public goods and services," the report says. "Furthermore, to reach a critical mass of response to the epidemic, a supportive and enabling policy environment needs to be fostered, with specific focus on the legal framework, sustaining educational and employment capacity, integration as a goal of development strategies, and reduction of poverty."
What can be done?
- The response to the HIV/AIDS epidemic in the world of work is manifold, the report says. The ILO established a programme in 2001, and drafted a Code of Practice the same year to guide responses to the epidemic as a workplace issue.
- Several countries have drafted enlightened legislation in the form of revised or new laws which can play an important role in mitigating the impact of HIV/AIDS at the workplace and protecting the rights of persons who are living with HIV/AIDS.
- There are efforts in numerous countries in a range of response areas focusing on both prevention and treatment, which include developing national sectoral policies, community efforts to reduce stigma and discrimination, private sector initiatives to promote prevention, behavioural change, communications for workers and, finally, treatment programmes in the workplace, which are increasingly seen by a range of enterprises as the least costly option to maintain profitability and ensure growth.
Still, while the ILO underscores the dramatic impact which HIV/AIDS has on the labour force, on rural societies and on the economy, it stresses that the workplace holds out extraordinary promise as part of the solution.
"The workplace is an ideal medium for a comprehensive approach to HIV/AIDS," said Odile Frank. "Work provides a venue - the workplace - where talking about HIV/AIDS is especially relevant, where prevention skills can be directly transmitted, and where treatment can be exceptionally productive."
The ILO's unique tripartite system also allows it to do what no other international organization can - work with governments, workers and employers to reach all corners of the world of work with vital care and prevention messages.
The workplace takes centre stage in fight against HIV/AIDS - ILO leadership forum calls for intensified effort
With some 36.5 million working age people presently living with HIV/AIDS, the workplace is taking a direct hit from the epidemic. On the other hand, the workplace is also uniquely positioned to be part of the solution for curbing the pandemic, according to business, labour and government leaders who participated in the ILO-organized World of Work Leadership Forum at the XVth International AIDS Conference in Bangkok. Citing this opportunity, the leaders called for increased resources and commitment to fight HIV/AIDS in the workplace.
"The workplace provides a vital entry point for provision of education, care and treatment, and activities to combat discrimination," they said. "This joint statement gives voice to that recognition, hereby calling governments, employers and their member organizations, and trade unions and their members to give the issue the highest priority."
The world of work leaders agreed that efforts need to be expanded and resources mobilized to develop and implement effective responses to the humanitarian and development challenges of HIV/AIDS. They also expressed concerns that "stigma, silence, denial and discrimination against people living with HIV/AIDS increases the impact of the epidemic and constitutes a major barrier to an effective response. Addressing these issues lies at the heart of successful workplace programmes."
"The strong and effective presence of leaders in the world of work - represented by the ILO's tripartite constituents - in the International AIDS Conference attests to the importance and contribution of the 'workplace' to national efforts to combat HIV/AIDS," said Franklyn Lisk, Director of the ILO Programme on HIV/AIDS in the world of work.
The participants in the forum also called for increased access and involvement of people living with HIV/AIDS in the planning and implementation of workplace programmes.
"We reaffirm that the ILO Code of Practice on HIV/AIDS and the world of work provides a framework for workplace action, and the promotion of good practice in policy formulation and programme implementation," the statement said. "We call on all leaders in the world of work to generate the resources urgently required for the financing of a sustainable expansion of workplace activities in all regions."
Government participants in the leadership forum included Ms. Bakoko Bakuru, Minister of Labour, Gender and Social Development, Uganda; Mr. Thapabutr Jamasevi, Deputy Permanent Secretary of the Ministry of Labour, Thailand; Ms. Zulmia Yanri, Director, OSH Standard Division, Ministry of Manpower and Transmigration, Indonesia; and Dr. Anna Marzek-Boguslauska, Director of the National AIDS Centre, Poland.
From the employers' side: Mr. Antonio Peñalosa, Secretary General, International Organization of Employers, Switzerland; Ms. Siriwan Romchatthong, Executive Director, Employers Confederation of Thailand; and Mr. Anthony Pramualratana, Executive Director, Thai Business Coalition on AIDS, Thailand.
From workers' organizations: Mr. Andrew Kailembo, General Secretary, ICFTU AFRO, Kenya; Ms. Clementine Dehwe, Global Unions HIV/AIDS Coordinator, ICFTU, Brussels; and Mr. Surat Chanwanpen, Deputy Director-General, LCT, Thailand.
Note 1- HIV/AIDS and work: Global estimates, impact and response 2004, The ILO Programme on HIV/AIDS and the World of Work, International Labour Office, Geneva 2004, ISBN 92-2-115824-1, available at www.ilo.org/aids.
Note 2 - The countries covered in the report include 40 countries with an estimated HIV prevalence over 2 per cent in 2001, 5 countries with an estimated prevalence between 1.5 and 2.0 per cent in 2001, and 5 countries with a population of persons living with HIV/AIDS of a million or more. They include 35 countries of sub-Saharan Africa, 8 countries of Latin America and the Caribbean, 5 countries of Asia, and 2 countries in the more developed regions. (See report, Main Table 1, for country-by-country and regional data in the report, beginning page 72.)
Note 3 - In the 50 countries of the world affected by HIV/AIDS and included in this report, HIV prevalence in persons aged 15 to 49 was estimated to range from under 1 per cent to nearly 40 per cent at the end of 2003. The HIV prevalence rate by country can be seen in alphabetical order by region in every main table, and all other data are presented in that order. Each table also shows the regional average HIV prevalence weighted for population for the regions of sub-Saharan Africa, Asia, Latin America and the Caribbean, and for the more developed regions, as well as for all 50 countries.