Mail & Guardian Online - July 3, 2008
Ian Sanne**

Individual companies, communities and the South African economy are under threat if companies do not initiate expertly managed, independent and outsourced HIV/Aids programmes for their employees.

Failure to expertly manage programmes effectively means money spent on them is wasted, with consequent negative impacts on the individuals concerned, and workplace productivity and morale. Companies that try to cut corners are undermining themselves, as well as the entire local treatment initiative.

Companies can easily meet the challenge by recognising a simple economic reality: sick employees cost the employer money, and treatment costs less.

The challenge to business posed by the pandemic demands far more urgent attention from business leaders. Company shareholders should be asking their boards whether they are addressing the HIV/Aids risk to both their employees and the business through a well-supported, independent and outsourced HIV treatment programme.

Such an initiative needs to target the early identification of those living with the virus in need of treatment and give clients reassurance that they are being tested and treated in complete confidence.

Unfortunately, many directors are destroying shareholder value by holding off on treatment or taking just the minimum measures, in the misguided belief that they are managing the HIV risk while saving money.

Five key value drivers are essential for a successful workplace programme.

# Timing: If one treats too late, the employee will have cost the company in lost productivity and then again in drugs. The business impact of HIV is effectively doubled.

# Volume: Treating one employee saves the company money. Treating many saves more money. Thus, the programme needs to identify and manage as many employees as possible.

# Disability management: Treated employees may not respond well to treatment and be unable to do their jobs, thus costing the company lost productivity. But in such unusual cases disabilities can be identified and responded to as quickly as possible, to everyone's benefit, particularly the employee's. This includes processing insurance benefits.

# Pricing: Drug prices will drop and the paying employer will reap the benefit. Fixed premium models (which many companies are using) negate this benefit and programmes become unnecessarily expensive or non-viable. It is more cost-effective to agree a programme that will adjust per capita costs as the treatment costs fall.

# Successful and ongoing treatment: Poorly managed patients get sick several times over, each time hurting the company's bottom line as well as damaging the individual's health.

Right to Care (a non-profit organisation specialising in HIV disease management) has analysed 140 South African companies and shown that employer-funded treatment is viable. It is cheaper to treat than to ignore.

Treatment quality is possibly the single most important factor in managing workplace HIV, yet is frequently given the least consideration. The economic case can be made simply by examining a single HIV-positive employee. During the last two years of life (full-blown Aids), this employee will take at least 55 days' sick leave (this figure is based on extensive research in South Africa by Boston University). The result is a minimum 25% drop in productivity.

When the company dismisses the employee on the grounds of incapacity, the disability insurer will apply a three- to six-month waiting period, the costs of which the company carries. Lost time can be conservatively valued at three times the daily salary. However, a well-managed waiting period should cost no more than the salary involved.

Right to Care's analysis has exposed the alarming reality that by far the majority of companies are failing in at least one key value driver. In 2005, the Actuarial Society of South Africa put the average workforce HIV infection rate at 18,8% -- ranging from 10% to 59% in different industries -- with a huge detriment to the economy resulting from workforce deaths, high rates of absenteeism, and higher production and health costs. While the economic impact of HIV/Aids is uncertain, the International Monetary Fund estimates that its adverse effect on annual growth rates runs from 0,5 to 2,5 percentage points.

** Dr Ian Sanne is managing director at Right to Care, a Johannesburg-based non-profit organisation specialising in HIV management

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