缅北禁地

Reality is dawning on companies in Zambia: Unless they initiate effective policies to combat HIV/AIDS, they risk seeing their workforces wiped out. "The devastating effect of HIV/AIDS on the corporation's human resources is a great concern," says Ms. Chileshe Kapwepwe, managing director of the National Airports Corporation Limited (NACL), a public enterprise overseeing Zambia's airports. An increasing number of employees are dying, she notes, including the company's most "skilled, experienced and productive." And as a result, the NACL has joined a growing number of Zambian companies that have adopted policies and programmes to respond to the disease's economic and social impact.

In a country where one out of every five people in the sexually active and productive age group of 15-49 is HIV-positive, it is not just homes, churches, governments and other institutions that are losing members to HIV/AIDS. The corporate world is also counting its losses. The rising number of employee deaths has serious economic repercussions, reflected in lost labour time, compensation for sick and dying workers and their survivors, and higher training costs for the many new workers who must be hired.

Protecting investments

Since the epidemic tends to claim the most skilled and productive sections of the population, it seriously impedes the Zambian economy's broader efforts to build up its human capital base and increase overall productivity. Company chief executives are aware that they not only have to contend with the loss of their own human resources, but also with the danger HIV/AIDS poses to investment and growth more generally.

High death rates associated with the disease may send negative signals to shareholders, making them wary of investing in such companies, fears Mr. Albert Wood, chairperson of the board of the Zambia State Insurance Corporation. "There is therefore need to forestall this impending threat to investment and economic growth," he says. As a result, his corporation has put in place an HIV/AIDS policy that includes the provision of male and female condoms at "strategic" locations on the company's premises. Like many similar schemes at other firms, this policy assures confidentiality to employees, since only doctors and staff administering anti-retroviral drugs (ARVs) are authorized to know an employee's HIV status.

The Zambia Electricity Supply Corporation (ZESCO), the monopoly power company, fears that its position as the sole provider of hydroelectric power would be threatened if the pandemic claims much of its staff. To forestall that, the firm has introduced a programme that includes providing ARVs to infected employees and their spouses, with the corporation contributing 75 per cent of the cost and the workers shouldering the remaining 25 per cent.

"Management sat down and looked at how we were losing the experienced human resource," said a ZESCO spokeswoman, Ms. Angela Cifire. To those concerned about the costs of the programme, she argued, "What we should be looking at is not the cost [of the policy], but what we will gain."

To consolidate and coordinate such efforts in the workplace, private companies have formed the Zambia Business Coalition on HIV/AIDS (ZBCA). Its formation was inspired by a UN-sponsored trip to the Thailand Business Coalition by a group of Zambian business executives in 2000. The ZBCA's goals include advocating business action on HIV/AIDS, helping alleviate the impact of the disease on company employees, strengthening and supporting responses aimed at prevention and control of HIV infection and linking companies to technical and community services.

Under the patronage of former President Kenneth Kaunda, now an active campaigner against AIDS, the coalition involves more than 40 companies (many more firms, including small and medium enterprises, also have some form of HIV/AIDS programme). The ZBCA has trained peer educators in affiliated companies, who serve as contact persons on matters of prevention, treatment and ARVs.

Zambia's trade unions, which draw their strength from the workers, support the company initiatives. Their representatives sit on the joint management-employee committees set up to oversee the treatment programmes. "If the workers are not in good health as a result of HIV/AIDS," says Zambian Congress of Trade Unions President Leonard Hikaumba, "employers may be compelled to lay them off on account of their being unproductive."

Combating discrimination

The stigma associated with HIV/AIDS in Zambian society remains a major obstacle. Without addressing the problem of stigma, says ZBCA Executive Director Chileya Nkandu, simply introducing ARV programmes and other measures will leave the problem only "half solved."

To insure that infected employees agree to join such efforts, the policies that companies have put in place so far all pledge to respect workers' privacy and to avoid discrimination on the basis of their HIV status. The National Airports Corporation Limited, for example, provides ARV medicines to infected employees and their spouses. But it affirms that no employee will be subjected to mandatory testing upon hiring. While the company encourages all employees to undergo voluntary counseling and testing, it promises not to discriminate on account of HIV status when considering job promotion, training, transfer or employment benefits.

The government also is aware that discrimination can be detrimental to combating HIV/AIDS. "It is a well known fact that stigma and discrimination, if not properly addressed, can undermine our efforts of conquering HIV/AIDS," says Zambian Vice-President Nevers Mumba. "This is because stigma, silence and discrimination, as well as lack of confidentiality, can undermine HIV prevention, care and treatment."

There is now no specific legislation to outlaw discrimination on the basis of one's HIV status, but such discrimination can be sanctioned as an abuse of human rights, including the right to employment, under Zambian law. The government has pledged to enforce anti-discrimination regulations by 2005. In addition, some HIV/AIDS campaigners are lobbying for a law specifically outlawing discrimination on the basis of HIV status.

The World Health Organization (WHO) agrees on the importance of safeguarding rights in order to make anti-AIDS programmes effective. "Treatment must be based on human rights," says the WHO country representative, Dr. Stella Anyangwe.

Multisectoral response

The government supports the initiatives of the business community, and has instituted policies to combat HIV/AIDS among its own employees. All government ministries now have programmes and policies in place. "HIV/AIDS programmes are expensive," notes Health Minister Brian Chituwo, "but only on the surface. The returns are much higher." In addition to the provision of ARVs by the Ministry of Health, each key ministry has a budgetary allocation for HIV/AIDS awareness programmes for its staff.

By December 2003, US$4.5 mn had been released towards HIV/AIDS programmes, according to Finance and National Planning Minister Ng'andu Magande. Under the government's Poverty Reduction Programme, a further $6 mn was released last year specifically for purchases of drugs, including ARVs.

According to the latest survey conducted by the Ministry of Finance and National Planning, Zambia's HIV prevalence rate was 18 per cent for adult females and 16 per cent for males in 2001/02. There are about 800,000 AIDS orphans in the country, and HIV-related infections take up half the country's hospital beds.

"A crosscutting problem needs a crosscutting solution," says Ms. Margaret Mwanakatwe, chairperson of the National AIDS Council, a government body that plans HIV/AIDS activities countrywide. In the absence of a cure, these efforts rely on prevention and treatment.

So far, only 10,000 Zambians are receiving ARVs, but the authorities hope to increase this number to 100,000, in line with the WHO's 3 by 5 campaign to put 3 million people worldwide on ARVs by 2005. To help increase the number in Zambia, the government has this year requested $600 mn from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

If the funds are approved, non-governmental organizations with viable initiatives will likely receive a significant portion, as they have so far been very active in combating the scourge, in partnership with the government. In this context, company workplace programmes may provide useful guidelines for efforts to care for and prolong the lives of other Zambians living with HIV/AIDS.