United Press International - Monday, 9 July 2001
Ed Susman, UPI Science News

"When we did the actuarial studies," said Tsetsele Fantan, a human resources manager at Debswana Diamond Co. in Botswana, "we found that the cost of antiretroviral therapy exceeded the cost of doing nothing for the workers."

But Fantan said company officials recognized when they considered the intangible of loss of morale, loss of motivation, the cost of accidents that could occur due to untreated illness and the loss of organization memory due to the deaths of workers -- at every level of the company -- that offering effective treatment for human immunodeficiency virus and acquired immune deficiency syndrome was the proper course of action.

"The study estimated that it would cost the equivalent of 10.7 percent of the entire company payroll to provide antiretroviral drugs to the workers who were infected by HIV," Fantan said.

Dr. Helene Gayle, director of the Division of HIV/STD/TB Prevention at the Centers for Disease Control and Prevention in Atlanta, said the Debswana study shows how deeply the AIDS epidemic affects nations and industries and indicates "we are recognizing that it makes economic senses to pay for treatment than to replace workers."

Botswana, a country of 1.7 million people in the heart of southern Africa, has the highest AIDS rate in the world, with 38.5 percent of the adult population infected with the virus.

Fantan reported Monday to the International AIDS Society's Conference on HIV Pathogenesis and Treatment in Buenos Aires that the company, which is half owned by the government of Botswana and half owned by DeBeers, the international diamond producer and merchandiser, is experiencing the ravages of the disease that threatens the very existence of the nation.

More than 75 percent of Debswana's 6,000 workers, from those in unskilled jobs to those at the highest executive levels, took part in a non-invasive screening program. The check found that 28.8 percent of the workers tested were infected with HIV, the virus that causes AIDS. In addition, Fantan said 60 percent of the deaths among the work force at Debswana were caused by AIDS. That amounted to 25 deaths in both 1999 and 2000, an increase from five deaths in 1997 when the company first began looking at the impact of HIV/AIDS.

The company had worked on numerous prevention programs but the prevalence of the disease continued to increase. Fantan said in the lowest job levels it was about 30 percent, but even in the highest levels of the company the rate neared 20 percent.

She said the study indicated if the cost of the antiretroviral drugs used to treat AIDS were decreased by 40 percent, the worker treatment program would reach a break-even monetary cost. Lowering the cost of drugs by more than 40 percent would make the program cost-effective.

African governments are working with large pharmaceutical companies to reduce costs of antiretroviral drugs, which can run as much as $20,000 per person every year for the lifesaving treatment.

However, 90 percent of the 36 million people in the world with HIV -- including 23 million in sub-Saharan Africa -- have no access to these drugs, said Dr. Stefano Vella of Italy, the chairman of the Stockholm-based International AIDS Society.

Antiretroviral drugs are credited with turning the lethal disease into a chronic illness in industrialized countries, allowing HIV patients to live near normal lives and continue work.

The disease typically strikes people in their most productive years. In the Debswana study, the most affected group was workers between the ages of 30 and 34, Fantan said.

Fantan said since May 14, when Debswana initiated its treatment program, more than 50 employees have signed on. The employees' names are kept confidential and part of the treatment involves telemedicine consultations with doctors in South Africa.

In addition to Debswana, the government of Botswana, the Bill and Linda Gates Foundation -- the charitable organization set up by the founder of Microsoft and his wife -- and the United States pharmaceutical giant Merck & Co. have established a partnership to create in Botswana a nationwide treatment program.

It will be set up first in the major cities, including the capital of Gaberone, where more than 40 percent of the adults are infected with the virus, said Benedict Moyo, program manager of the African Comprehensive HIV/AIDS Partnership.

Moyo said if the program can prove successful in Botswana, then it may be able to export the program to more populous and similarly devastated nations of southern Africa that surround Botswana.

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