Cablegate: Business Slow to Act On Hiv/Aids

This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 05 HARARE 000967

SIPDIS

DEPARTMENT FOR G, OES/IHA, OES/PCI, AF/S, AF/EPS, IO/T
WHITE HOUSE FOR ONAP
USAID FOR AFR/AA/AIDW AND BUREAU FOR GLOBAL HEALTH
DHHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS
BANGKOK FOR WIN DAYTON

E.O. 12958: N/A
TAGS: KHIV SOCI ECON ZI HIV AIDS
SUBJECT: BUSINESS SLOW TO ACT ON HIV/AIDS

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SUMMARY
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1. Zimbabwe has one of the highest HIV infection rates in the
world but the private sector has done surprisingly little to
help stem the spread of the disease. The sector only
recently began actively supporting HIV initiatives in the
workplace, in part because absenteeism and deaths had begun
to affect profits. In September 2002, the National AIDS
Council and local business leaders created the Zimbabwe
Business Council on HIV/AIDS to coordinate private sector
activities in HIV/AIDS care and prevention, but unless the
economic situation in the country improves, the business
sector,s initiatives will most likely have limited success.
END SUMMARY.

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PRIVATE SECTOR SLOW TO ACT
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2. PolOff met with CEOs and Human Resource (HR) directors
from four major companies (Unilever, Unifreight, Coca-Cola,
and PG Industries), the Policy and Advocacy Manager of the
Zimbabwe National Chamber of Commerce, the interim chairman
of the Zimbabwe Business Council on HIV/AIDS, researchers at
the Biomedical Research and Training Institute, the Executive
Director of the National AIDS Council, and staff from
Zimbabwe AIDS Prevention Services Organization and the
Zimbabwe AIDS Prevention Project to discuss the sector's
response to HIV/AIDS and the effects of the pandemic on
business. The general consensus among our interlocutors was
that the business sector has not done enough to curb the
spread of the disease or to improve the quality of life for
HIV-infected workers and their families. Over the last three
to five years, however, business has shown more of a
commitment to HIV programs. Unfortunately, the economic
situation during the last three years limited business
contribution and will most likely continue to constrain
initiatives.

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Majority of Chamber of Commerce Members No HIV Policy
--------------------------------------------- --------
3. On March 27, PolOff met with James Jowa, Policy and
Advocacy Manager of the Zimbabwe National Chamber of Commerce
(ZNCC) to get an overall picture of how the business sector
has been addressing the HIV/AIDS issue. Jowa told PolOff
that less than ten percent of the ZNCC membership has an
HIV/AIDS workplace policy. Most small businesses, he said,
do not even offer health insurance and think little about the
health of their workers, particularly the unskilled ones,
because of the high unemployment levels. The ZNCC has been
trying to encourage businesses to adopt HIV policies and for
the last three years has been giving an award to the company
with the best HIV/AIDS policy.

4. Of those companies with HIV/AIDS policies, most are large
multinationals with on-site clinics. The smaller, often
indigenous companies usually cannot afford on-site clinics.
Jowa said the ZNCC has proposed setting up clinics in
industrial areas where several smaller-scale firms are
located so the companies could pool their resources to run
the clinics. Jowa also said that prior to the land
redistribution exercise, many commercial farms had HIV/AIDS
policies and on-site clinics but these have since closed,
leaving the commercial farm workers and their families more
vulnerable.

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HIV/AIDS Advocacy Groups Spearhead Development of Workplace
Policies
--------------------------------------------- ---------------
5. The developers of most business HIV policies are the NGOs
Zimbabwe AIDS Prevention Project (ZAPP) and Zimbabwe AIDS
Prevention Services Organization (ZAPSO). In the 11 years it
has been in existence, ZAPP has helped more than 90 companies
with HIV/AIDS policies while ZAPSO has helped more than 150
companies in 5 years. Both ZAPP and ZAPSO cited increased
absenteeism (workers attending funerals or given long sick
leave), health care costs, and funeral expenses as well as a
loss of skilled personnel as the primary reasons businesses
have offered for wanting to set up HIV programs in the last
two years. ZAPSO told PolOff that some health insurers urged
their business clients to implement programs because the
claims for HIV-related illnesses had increased dramatically.

6. Prior to 2001, many businesses felt HIV/AIDS would not
affect profits; apparently thinking the disease would affect
only blue collar, the more expendable, employees. In recent
years, companies have noticed more mid- and senior level
staff succumbing to AIDS. ZAPP recounted a story of a firm
with about 30 employees which three years ago refused ZAPP,s
help in formulating an HIV plan because the company had had
no deaths. In the last year, this same company has lost two
people to AIDS and reported that 3 to 4 employees were not
looking well.

New Business Initiative
-----------------------
7. Evaristo Marowa, Executive Director of the National AIDS
Council (NAC) told PolOff that during the 1990s businesses
were very resistant to implementing AIDS programs because
most did not categorize AIDS as a threat to production equal
to fuel, foreign exchange, and electricity shortages. He
told us the reluctance has begun to change in the last year
or so, particularly with the creation of the Zimbabwe
Business Council on HIV/AIDS (ZBCA) in September 2002. ZBCA
was created by both the NAC and a handful of private sector
CEOs who felt the need to coordinate private sector efforts
and bring them up to scale. These business leaders realized
that HIV/AIDS was not only affecting their present work force
but their future pool of labor and present and future
consumer bases as well. The ZBCA is partly modeled after the
Kenya HIV/AIDS Private Sector Business Council and Global
Business Coalition on HIV/AIDS. Malcolm Hughes, Chairman of
Unilever South East Africa and interim chair of the ZBCA,
told PolOff that even though NAC helped create it, ZBCA would
be a separate, independent organization.
(NOTE: Marowa told PolOff that in light of political
leaders, reticence about publicly speaking about HIV/AIDS,
the NAC was trying to catapult business and community leaders
and advocates into the leadership position, hoping the
movement can be as successful in affecting change as the
Treatment Action Committee has been in South Africa. END
NOTE)

8. Hughes, a white British expatriate, said he is probably
not the most appropriate leader of ZBCA in the prevailing
climate, so he has offered to act only as the interim chair
until a permanent one is found. Hughes and the rest of the
executive board (Colgate CEO, Davis Kanyama as vice-chair;
Kadenge (sp) from the Zimbabwe Economic Society as Secretary;
and Phipps Makipa of Standard Bank) hope to convince at least
nine more companies to actively participate in the council.
Each member must agree to attend two meetings per year, to
commit their HR directors, and to make a small donation to
get the project started. Among the ten or so companies, the
executive board has approached, only one has refused to
participate. Hughes envisions the council having workshops
with HR directors; sharing best practices; supporting NGOs
and other groups; and helping increase awareness within the
community at large.

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WIDE RANGE OF HIV/AIDS POLICIES
---------------------------------
9. Prior to 1998 when the GOZ implemented Statutory
Instrument 202 ensuring nondiscrimination because of HIV
status, few companies had HIV/AIDS policies although, by that
time, ZAPP had been working with 40 companies to set up peer
education systems. The 1998 and 1999 legislation prohibited
discrimination because of HIV/AIDS status and established
guidelines for business to follow. It also set up an AIDS
Levy--a 5-percent payroll tax now called the National AIDS
Trust Fund--designed to help improve HIV/AIDS services. In
addition to the AIDS Levy, the GOZ implemented the Labor
Relations Amendment, which offered limited financial
protection for employees. Under the amendment, an employee
could not be dismissed because of a positive HIV status, and
an employee was also entitled to six months of paid sick
leave (three months at full pay and three months at half pay)
before being forced to leave.

10. Beyond the bare bones policies, our interlocutors
expressed interest in including a nutrition component,
wellness programs (to include families), ARV treatment, and
community education and outreach as a part of their coverage.
Unfortunately, most companies have not been able to expand
their health services because of the economic crisis griping
the country. ZAPSO cited capacity constraints, such as not
having enough HIV/AIDS policy specialists, as an impediment
to helping more companies design AIDS policies. At least one
company has managed to offer a nutrition component. Unilever
offers a balanced lunch and dinner for a mere $Z2 each.
Unilever Chairman Malcolm Hughes said it was not worth it to
even charge for the meal anymore because the cost of
collecting the money far exceeds the price of the meals.

Company Policies
----------------
11. Unifreight, a British owned company offering long-haul
freight transportation and luxury buses for hire within
Zimbabwe, has had an HIV/AIDS policy in place for 15 years
and is regarded as a leader in workplace HIV policies, at
least for the transportation industry. PolOff met with
Executive Director of Personnel and Training, Francis Masuku;
the nurse in charge of the company's on-site clinic; and Mr.
Gurugena, a human resource officer, on April 3. Unifreight's
HIV/AIDS policy goes beyond the mandatory requirements
stipulated in Statutory Instrument 202 of 1998 by encouraging
family time and monogamous relationships by limiting the
amount of shift work and time away from family. The policy
also encourages top management involvement both in reviewing
progress and monitoring compliance with the company's HIV
policy and employees to report cases of sexual harassment.
The company incorporates AIDS education into all its training
sessions, including at the driving school. It also funds two
drama groups in Bulawayo and Harare that perform plays on the
causes of HIV/AIDS, care, counseling, and nutrition.

12. The transportation industry is in the process of hiring
eleven outreach agents to work at border posts. They will
communicate with truckers on AIDS awareness and distribute
condoms and other materials and report back to the National
AIDS Council, the national entity responsible for
coordinating a national multisectoral response to the disease.

13. Geoffrey Magadza, the HR Director of PG Industries, a
Zimbabwe based regional company involved in glass, timber,
and building supplies, admitted that his company's HIV/AIDS
policy is in its infancy and that the industry has not been
as engaged as it should be. The policy thus far does not
veer much from that required by law. The company also offers
counseling sessions on HIV prevention to employees who are
transferred to the offices in Mozambique, Malawi, and Zambia.
PG Industries is one of ZAPSO,s clients.

14. Unilever South East Africa, part of the international
manufacturing company, has become increasingly committed to
its HIV/AIDS policy in the last three years, according to
Chairman Malcolm Hughes. Its counterpart in Kenya helped
establish the Kenya HIV/AIDS Private Sector Business Council
in 2000. Sherree Shereni, Regional External Affairs Manager
of Coca-Cola Central Africa Region, told PolOff that all the
bottlers in her region (Zimbabwe, Zambia, Malawi, Botswana,
Lesotho, Angola, and Swaziland) are trying to set up ARV
treatment programs for their employees and were in the
process of improving the procurement and delivery systems.
She said Coca-Cola has money to spend on HIV/AIDS programs
and she asked PolOff for help in identifying some. (NOTE:
Shereni seemed willing to discuss Coca-Cola's HIV policy and
the effects of the disease on productivity but needed to
check with her supervisor in London. Unfortunately, her
supervisor's secretary said the supervisor was very
tight-lipped and most likely would not approve Shereni
discussing the issue externally. END NOTE.)

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LIMITED INSURANCE COVERAGE FOR HIV
------------------------------------
15. CIMAS Medical Aid Society, one of the main health
insurance companies in Zimbabwe, plans to introduce, in July,
a Chronic Disease Cover, which will pay for HIV treatment,
according to local press reports. The plan is an add-on to
traditional packages offered by CIMAS and is available to
interested employers, at additional cost, who wish to enroll
their employees. (NOTE: Embassy locally employed staff are
covered under CIMAS and will be offered coverage--at
Embassy/Agency expense--under the Chronic Disease Cover.
CDC-Zimbabwe is working with CIMAS to help ensure that the
HIV care component is of the highest quality. END NOTE.)

16. Geoffrey Magadza, HR Executive for PG Industries, told
PolOff that the company provides good life insurance coverage
but that senior management could opt to increase their
coverage if they took an HIV test. Magadza said few people
opted for the additional coverage.

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HIV/AIDS EFFECT ON INDUSTRY
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17. Industry representatives said HIV/AIDS has increased
their labor costs through loss of person hours, loss of
skills, the loss of potential, and absenteeism. The HR
directors told PolOff that existing laws governing sick leave
have increased costs associated with long-term illnesses.
Under the law, workers are entitled to six months of paid
sick leave, so employers often hire contract workers to
substitute for these ill workers, thereby more than doubling
wage costs. Malcolm Hughes from Unilever said his company
offered very attractive retirement packages to its employees
and encourage those with long-term illnesses to take
advantage of them. This allows the company to fill the sick
employee's position with a permanent hire rather than a
temporary, contract worker, thus reducing costs.

18. Industries with on-site clinics were keeping track of the
health of their workers to help determine how AIDS is
affecting their bottom line. At Unifreight, the personnel
department, through the on-site clinics, compiles monthly
reports on sick leave management, the types of illnesses, and
lost days that affect the work force. The results of these
reports indicate that deaths from AIDS-related illnesses
within Unifreight fan across occupations from office managers
to truck drivers. In 2002, truck drivers appeared to have a
slightly higher incidence of AIDS-related deaths than other
groups but not of the magnitude the literature on HIV and the
transportation sector would suggest. Compared to the 2002
statistics, Unifreight is on pace to nearly double the number
of deaths due to AIDS in 2003. In 2002 there were a total of
42 deaths (out of 2600 employees) but by the end of March
2003, the number was already at 15. (NOTE: The law prohibits
employers from requiring employees to disclose their HIV
status but based on the cause of death on the death
certificates submitted for benefits, most of the deaths are
from AIDS complications such as TB and pneumonia. END NOTE.)

19. ZAPP recently concluded discussions with several focus
groups representing the informal and formal sectors to get an
understanding of how HIV/AIDS is affecting workers. In
general, workers were concerned that revealing an
HIV-positive status would endanger their jobs, especially in
the agriculture field. According to ZAPP, the workers did
not feel the law against discrimination would protect them,
preferring to work themselves to death than risk being fired.
The high unemployment levels are a disincentive for
(informal sector) employers to adopt any HIV policies because
it is more profitable for them to fire the sick person and
hire someone new. Informal sector employees were even more
reluctant to disclose their HIV status or to ask for sick
days because they are not covered under existing HIV
legislation and have no job security.

20. PolOff spoke with three researchers, E. Dauya, Ronnie
Matambo, and Liz Corbett from the Biomedical Research and
Training Institute (BRTI), an institute affiliated with the
University of Zimbabwe, about the effect of HIV/AIDS on the
business sector. The project, funded by the U.K. based
charity Wellcome, is designed to compare the efficacy of two
VCT strategies at 22 factories in Harare, of which PG
Industries is one. The strategies are providing HIV testing
at work or giving vouchers to get off-site HIV testing at the
USAID-sponsored, HIV Voluntary, Counseling and Testing (VCT)
New Start Centers. Patients also receive general health care
at the clinics as well as antibiotics (isoniazid for TB and
cotrimoxazole for pneumonia) to treat opportunistic diseases
associated with AIDS. The study will not be completed until
July 2004, but preliminary results suggest that on-site
testing is more successful. More than 55 percent of those
offered on-site HIV testing accepted the offer and were
tested as compared to five percent of those offered vouchers
to get tested at a New Start Center. BRTI also found that 19
percent of the 4800 people tested were HIV positive and in
companies that employed more women overall prevalence rates
were higher.

21. ZAPP's project enjoyed similar successes with on-site
HIV/AIDS facilities. ZAPP, which began as a collaborative
research project between the University of Zimbabwe and
Stanford University to establish the prevalence of HIV in
workers, showed that having peer educators on-site was much
better at reducing the incidence of new HIV cases than
referring workers to off-site VCT centers. HIV-negative
workers with on-site facilities were 34 percent less likely
to become HIV-positive than workers without such facilities.

22. PG Industries' HR Director Magadza told PolOff that the
collaboration with BRTI is mutually beneficial to all parties
because not only is BRTI collecting data, but participating
companies get to keep experienced, AIDS-infected workers in
the work force longer, and the employees are improving their
quality of life. Magadza said the company does not know how
many of its employees are infected with HIV or how many have
died from AIDS but hypothesized that one could deduce the
latter from the cause of death on the death certificate.
Magadza commented that since BRTI began its program,
absenteeism has diminished somewhat.

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CONCLUSION
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23. The meetings with private sector representatives were
both disconcerting and encouraging. It was troubling, for
instance, to discover that after nearly 20 years of HIV/AIDS
in Zimbabwe, the business sector, except for a few large
companies, is only now mobilizing to address this disease
effectively. If one believes in the Best Practices promoted
by UNAIDS and other HIV/AIDS advocacy groups, then one must
assume that without committed senior-level government
leadership, the business community's efforts will most likely
fall short of their objectives. The companies seemed
committed to fighting HIV/AIDS and seemed to want to do more
for the community at large. However, they were all
frustrated with the lack of leadership among senior
government officials and saw that the economic environment
and the dearth of foreign currency also constitute major
obstacles to their efforts.

24. With between a quarter and one-third of adults in
Zimbabwe HIV positive, the business sector faces an ominous
task. Their desire to help workers with health care,
including pharmaceuticals; introduce nutrition programs;
conduct outreach programs to include and treat family
members; and conduct community programs will demand more
resources than are currently available in Zimbabwe. The
deteriorating economic climate has made sustaining HIV/AIDS
initiatives more difficult as many companies have eliminated
non-essential programs, of which HIV care is one. The recent
decision by CIMAS to expand coverage to include HIV/AIDS is a
positive step, but depending on the conditions (mandatory
testing, costs, etc.) of this additional coverage, may help
only a limited number of people. It definitely will not help
the 70 percent of the population that is not employed in the
formal sector and, in some cases, it may exclude spouses and
other family members of workers eligible for the benefits.
The BRTI initiative, if successful and sustainable, may
provide a better way to reach large numbers of workers in the
delivery of HIV care. END COMMENT.
WHITEHEAD

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