While the government of South Africa wrestles with how to deal with the AIDS epidemic, the nation's largest employer can't wait.
Anglo American, a mining conglomerate here, estimates that 32,000 workers - 1 of every 5 employees - carry the virus. Faced with the costs of caring for and replacing a dying workforce, Anglo announced this week that it will begin providing free or deeply discounted anti-AIDS drugs to employees and their families.
With the disease beginning to affect their bottom lines, South African companies are starting to see AIDS as an economic as well as a humanitarian disaster.
Anglo American is the biggest of several companies taking the lead in providing treatments that mitigate, but do not cure, the symptoms of the disease. And they are giving new hope to one of the most AIDs-ravaged populations in the world.
"Companies are realizing that to invest money into managing the HIV/AIDS pandemic will be cheaper than addressing the aftermath of AIDS," says Brian Wasmuth, head of the South African Chamber of Business HIV/AIDS program.
Access to anti-retroviral drugs, which transform AIDS from a death sentence to a chronic illness, has become a high-profile issue in South Africa, where few of the nearly 5 million people believed to be infected can afford the drug regimes.
Last month, the South African government forced international pharmaceutical companies to withdraw a three-year-old lawsuit aimed at blocking the importation of cheaper generic AIDS drugs to the country. The campaign for access to affordable anti-HIV drugs has moved to Kenya, where activists urged Kenya's Parliament Thursday to pass a bill to allow exemptions to international patent law.
But South Africa's government has indicated that a publicly funded anti-retroviral program won't be coming anytime soon. Though the drug cocktails are widely used in Europe and the US, the South African government remains skeptical of their safety and cites a lack of infrastructure to distribute medicines and monitor patients.
"The arguments of capacity and infrastructure don't really apply in the same way to the private sector," says Mark Heywood, a lawyer with the AIDS Law Project at the University of Witwatersrand in Johannesburg. "It is theoretically possible to roll out key medical intervention to a large number of people within a short period of time."
Though AIDS activists and the government laud the efforts of Anglo and other firms to provide AIDS treatment to employees, both warned that the provision of anti-retrovirals is only part of an effective AIDS treatment scheme. "It makes very little sense to do anti-retrovirals if you're not doing prevention and managing the other related diseases," says Jo-Anne Collinge, Department of Health spokeswoman.
Brian Brink, Anglo's vice president of medical affairs, says that although details of the program are still being worked out, Anglo is committed to providing anti-retrovirals to employees and their dependents and hopes to include Anglo subsidiaries in the plan.
Anglo declined to give a cost estimate. The company is still in negotiations with pharmaceutical companies to purchase the medications, either from multinationals, or from the Indian-based generic producer Cipla, Ltd.
One likely reason mining companies are among the first to embark on anti-retroviral programs is that they already have company medical care systems through which AIDS drugs can be distributed. Another is that the industry, which has a tradition of single-sex hostels served by prostitutes, has been particularly hard-hit by AIDS. Anglo estimates that AIDS will claim 5 percent of its workforce annually for the next nine years.
The United Nations estimates that by 2010, the virus will reduce South Africa's gross domestic product by 17 percent.
On Thursday, a UN agency said AIDS could kill 26 percent of the labor force in hardest-hit African countries by 2020.
Chris Desmond, a research fellow at the Health Economics and HIV/AIDS Research Division at the University of Natal, says the initial response of many companies to the AIDS epidemic was to cut benefits in an attempt to insulate themselves from rising medical and life insurance costs.
Now Mr. Desmond says an increasing number of companies are beginning to recognize that providing some level of treatment, even if anti-retrovirals are out of reach, is simply good business.
Dr. Jack Van Niftrik, founder and director of a company called Lifeworks that helps businesses develop HIV/AIDS strategies, says even smaller companies are looking at providing AIDS care.
He is working with a manufacturing company in Kwa-Zulu Natal facing a 60 percent HIV infection rate among its 9,000 employees. Absentee rates are so high, that the company must hire two workers for every position. "They're actually going to go out of business if they don't do something," Dr. Niftrik says. "Medical aid is too expensive, and the state isn't working fast enough."
The company is preparing to implement a comprehensive medical program that will entitle HIV-positive employees to once-a-month doctor visits, regular tests to monitor immune levels, and, if needed, anti-retroviral drugs. The services will be provided through a closed network of doctors similar to a managed care system in the United States.
Niftrik says the program will cost an estimated $7 to $12 per employee and will be financed through company investments in an interest-bearing account for AIDS treatment. Nine other companies are also working to launch similar programs, though not all of them may offer anti-retrovirals.
The South African Chamber of Commerce is also working to develop an AIDS treatment program for its 40,000 member companies similar to the Lifeworks framework. Under the chamber program, AIDS treatment, including anti-retrovirals, would be offered through a network of 150 clinics around the country. The range of services would depend on how much the employer is willing, or able, to pay.
In addition to Anglo's program, another southern African mining company, the Botswana-based diamond firm Debswana, has announced that it will begin paying 90 percent of the costs of AIDS medications for its 6,000 employees and one legal spouse. Owned jointly by the government and Anglo subsidiary DeBeers, Debswana is Botswana's largest employer.
(c) Copyright 2001. The Christian Science Monitor