Sunday Times (Johannesburg) - July 20, 2003
Sean Jelley*

HIV/Aids is a risk of doing business in Southern Africa. The results of more than 120 independent surveys conducted throughout the region show that well over 18% of employees are already living with HIV/Aids.

It is right up there with the other major identified risks in the region: personal and asset security; exchange rate volatility; and political and infrastructural risk.

While it is true that all of these particular risk factors exist across the globe, and some may be even greater in other parts of the world, nowhere else do they seem to combine with such severe implications to deter investment and raise the cost of doing business as in Southern Africa.

Like all of the risks identified above, HIV/Aids must be measured and proactively managed.

One of the problems, and there are many, with HIV/Aids as a business risk is that it is perceived by employers to be more a social or community problem than a company-specific risk.

Employers, largely through ignorance, tend to shy away from direct risk management - often applying the argument that it is the state's responsibility to provide education and healthcare.

Were business to apply the same logic to say, asset security, it would rely entirely on public security and judicial structures to provide risk management.

We would have no walls or fences around our factories, the multi-billion-rand private security industry would not exist, and less than 60% of our corporate assets would be insured against theft.

Let's run with this analogy - as business assets are being looted before our eyes, we would have a number of interesting responses.

Corporate managers would silently be hoping that the state would intervene through improved service delivery. We may even have an aggressive Crime Action Campaign demanding that more prisons be built immediately.

In reality, nothing much would happen and our asset base would be rapidly eroded. Ridiculous analogy? Possibly, but only because we know it will never happen.

In the real world, managers are highly proactive in managing their assets and invest billions of rands annually to protect them , regardless of the level of state infrastructure.

So why is HIV/Aids any different?

Why are managers sitting back and abdicating responsibility?

The results of inaction will be similar to those described above - or worse. The good news is that HIV/Aids is manageable. It requires specialised skills, investment and, crucially , management focus. As with other business risks, the response must be multi-dimensional:

Identify, measure and manage. Place HIV/Aids at the top of board agendas.

Appoint senior executives to manage the risk.

Regularly evaluate management structures and interventions.

How is HIV/Aids manageable as a business risk?

Education is the key: education of managers, not only employees.

Risk management must be total. For example, medical insurance without proactive patient management is useless. Treatment plans without funding are useless. Well-funded benefit plans without practical treatment access are useless.

As with asset risk management, no single intervention is enough. Asset insurance without the security fence is unworkable. So too with HIV/Aids.

What about the cost-benefit equation? If HIV/Aids is indeed a strategic business risk, then the investment required to manage it needs to be evaluated on usual business terms. In short, the risk management programme should be designed and managed to achieve a positive investment return.

In the experience of HIV/Aids management company Lifeworks, a positive return on investment is not only possible, but most of the time easily achievable, if well managed.

Interestingly, the key lies not so much in the provision of antiretroviral therapy (ART), but in early diagnosis and the provision of proactive medical care to all employees who are HIV-positive.

While the use of antiretrovirals is an essential component in the treatment of patients living with Aids, for a programme to be both medically and economically successful, the proactive treatment of healthy HIV-positive patients should never be ignored.

The reality is that most HIV-positive individuals learn of their status only at or after the onset of the final Aids stages of the disease (on average of six to seven years after infection).

This fact is probably the greatest hurdle to effective medical management, and educating employees why it is in their best interests to go for confidential individual counselling and testing is the right place to start.

Through early diagnosis, a patient may proactively manage his or her health with the objective of retarding the progression of the disease. Nutrition, lifestyle education and general medical care for unrelated infections (or intercurrent diseases) have all been shown to have major benefits, most often without the use of ART.

In fact, leading medical thinking is that doctors delay the use of ART as long as possible, particularly in resource-poor settings.

The positive effects of early diagnosis and the provision of proactive medical care both prior to and during the Aids stages of the disease are obvious.

As more patients receive early medical care , the economic benefits of HIV/Aids risk management programmes will surge.

Not only are the patients, by definition, healthy and productive, but the costs of care are significantly lower than the intensive drug treatment required by patients living with Aids.

It is estimated that around 90% of all employees living with HIV are still healthy in the asymptomatic, pre-AIDS stages.

They must not be ignored if we are effectively to manage the risk of HIV/Aids - both medically and economically.

Employers need to recognise this fact now and respond as soon as possible - time and ignorance are the real enemies here.

*Sean Jelley is the chief executive of Lifeworks

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