Business Response to AIDS

Ramping up the fight against AIDS (Article published on Shell World Online, July 4 2008)

With more than 33 million people already infected, the growing impact of HIV/AIDS threatens to cripple some economies in the coming decades. Now major companies around the world are stepping up their efforts to combat the virus, often using imaginative tactics to overcome cultural barriers.

By RUSTOM DAVAR
July 4, 2008

When her husband died of AIDS at a hospital in Lahore, Pakistan in 1995, Shukria Gul learned that she too was HIV-positive – shattering news for a mother with two small children to care for. Her immediate concern was that they might also be infected. “My children are my life, my pride, my joy,” she says. “I don’t know what I would have done.” To her relief, both children later tested negative for the virus.

Friends and family, however, shunned Gul and her neighbours tried to have her evicted. Difficult years followed in which she endured her illness without treatment, and with little information. Now, more than a decade later, Gul’s situation has improved considerably. She receives treatment that allows her to lead a near-normal life, and uses her experience to help companies like Shell provide counselling to people infected with HIV, as well as to their families.

Shukria Gul's courage has given hope to many

On World AIDS Day 2007, for example, Gul told her moving story as part of Shell’s efforts in Pakistan to help employees deal with what, in a highly-traditional Islamic culture, remains a taboo subject. Guls openness was remarkable – all the more so for a woman. The audience listened in silence as she spoke with courage and conviction, then burst into applause.

Shell’s approach in Pakistan is typical of what many major companies are doing to help stem the spread of a virus that can potentially cripple businesses, especially in developing economies. HIV/AIDS can lead to absenteeism, a depleted work force and high health-care costs. Many companies also feel duty-bound to help staff facing an incurable disease that can ravage generations of families. In a 2006 survey of nearly 11,000 companies, the World Economic Forum found that 46% believed that HIV/AIDS would affect their operations in the next five years. In countries where the HIV infection rate was high, 58% of firms had strategies to tackle the problem. Often, cultural sensitivities mean that such companies must take imaginative steps if they are to succeed.

The scale of the challenge is immense, however. Worldwide in 2007, some 33.2 million people were living with HIV, with 2.5 million new infections recorded, according to UNAIDS. In 2006, the mining company Anglo American found that 23,500 of its South African employees – 21% of those who had taken part in a voluntary testing programme – were HIV-positive. In Kenya in 1999, Standard Chartered bank reckoned that 10% of its employees were off work at any one time due to HIV/AIDS. Yet, says UNAIDS, two in three people with HIV go to work every day to support themselves and their families. In places where there is no clear policy about HIV, such people live in fear of discrimination, and sometimes dismissal.

“For us it’s an obvious and significant business issue,” says Dr Brian Brink, Group Medical Consultant at Anglo American. “What concerns me is that in countries where there is a lower burden of disease, people might think that HIV doesn’t affect them. The truth is that there is no population that’s immune to the growing HIV threat.”
Prejudice and myths

Although less than 1% of its people have HIV, Pakistan is a “high-risk culture”, according to UNAIDS, because of its large number of intravenous drug users who are sexually active. They can spread the disease to sex workers, who in turn can help spread the disease among other groups such as truckers, who make up a large part of Shell’s contractor workforce in the country and are offered counselling and testing by the company at depots. UNAIDS says it is also concerned that while it estimates that some 85,000 Pakistanis currently have HIV, only around 1,000 are officially registered with the health authorities.

A young girl gets the message across on World AIDS day 2007

Some social discrimination still exists against people with HIV in Pakistan, while cultural sensitivities can obstruct education efforts. Open talk of sexual health, homosexuality and drug-use is usually off-limits as many believe they are linked to “sinful behaviour”. Promoting the use of condoms is frowned upon because it is seen as encouraging sex. Women may feel uncomfortable talking to male counsellors or doctors.

The Shell Pakistan programme helps tackle these hurdles in line with local cultural beliefs. It promotes abstinence, and female counsellors are always available at Shell Pakistan’s voluntary counselling and testing clinics. Counsellors broach the subject of HIV indirectly. One successful method is to talk about similarly-transmitted diseases such as Hepatitis B and C – which are less well known and have less stigma attached – and then bring up HIV. Another is to focus on facts about the HIV virus and how it spreads, while avoiding statements about behaviour or values. “Being too direct about a topic like this could alienate people from what we are trying to say,” says Fauzia Pesnani, Occupational Health Nurse at Shell Pakistan.

Misconceptions and cultural values throw up challenges elsewhere, too. In Nigeria, for example, some believe HIV is a punishment from God; others that it can be transmitted from afar, even from other countries, or contracted by sharing food with or hugging an HIV-infected person. And on the east Russian island of Sakhalin, home to the Sakhalin II gas project, a joint venture in which Shell has a 27.5% share, health workers often avoid publicly distributing condoms for the same reason it is discouraged in Pakistan.

To counter some of these obstacles, Shell health staff in Nigeria have educated communities about HIV and advised on ways to prevent spreading or contracting it. The company has also formed partnerships with local community groups and non-governmental organisations (NGOs) to find suitable ways to address HIV. In Sakhalin the joint venture donated $10,000 to the Sakhalin Region HIV/AIDS centre to support a school awareness programme and to assist in training volunteers. It also gave $7.2 million to improve hospitals in the region.
Joining forces

Some companies have set out to try to address the problem through customers. A Standard Chartered programme includes advice on how to prevent infection as well as tips on nutrition and lifestyle to those caring for people with HIV. In 2006 the bank publicly pledged to reach one million people with its campaign over the coming years. On the bank’s cash machines in Thailand, for example, customers see a message flashed on screen encouraging them to find out their HIV status. The bank urges its business partners to start their own HIV programmes for staff, and provides education materials and expertise to help. Standard Chartered also gives employees two days’ paid leave a year to work on its HIV education programme.

Coca Cola, meanwhile, has an HIV campaign across 100 cities in China – targeting women and young people with exhibitions, pamphlets, posters, and videos – which it says has reached close to 71 million people so far.

Shell focuses most of its efforts on staff and contractors and their families, and the local communities they come from. In Kenya in 2003, however, the company ran a wide-reaching campaign, including urging truckers to use condoms. Shell tankers were branded with the message “Choose life”.

These companies are part of a coalition of 220 businesses formed in 2001 to fight the threat from HIV/AIDS and other widespread deadly diseases. “We’ve got to do everything in our power to stop the numbers of infected people from increasing,” says John Tedstrom, Executive Director of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria. No single business can win the battle alone, he believes – it’s only when businesses, NGOs and governments work together and share their resources effectively that the growth of HIV/AIDS will be halted.
Hope and inspiration

People used many colourful ways to mark World AIDS Day 2007

Shukria Gul owes the turnaround in her health to anti-retroviral drugs, which can dramatically improve the quality of life for someone with HIV. They are often the critical factor that allows a company’s workforce to withstand the impact of the virus. Such drugs are expensive and not easily available from local health authorities, so some large companies provide them free to staff.

The effects, some companies believe, justify the expense – and can be remarkable, as in the case of Nombuyiselo Mapongwana, a member of Dr Brink’s staff at Anglo American’s Johannesburg office. Her day typically starts with a workout at the gym at 6am. Two hours later she is in the office to begin a busy schedule, seeing clients, counselling employees and administering HIV tests. In her own words, she leads “a positive and productive life”. But just a few years ago, Mapongwana weighed just 28 kilograms (less than 62 lbs) and her immune system was close to collapse because of AIDS. She would have died, but for anti-retroviral treatment. When she joined Anglo American two years ago that treatment continued, now provided by the company. Her health returned to something like normal, enabling her to continue work and enjoy life again. “That was the best thing that ever happened to me,” says Mapongwana.

Shukria Gul also continues her work with the Pak Plus Society, an NGO dedicated to helping people with HIV. She calls for mandatory counselling for those having HIV tests; and for the Pakistan government and international organisations to increase testing and treatment in rural areas, which she says have so far been neglected. She believes businesses should provide funding, set up facilities for voluntary counselling and testing, and give jobs to people with HIV.

Gul’s work – and her message – is gaining attention. A Pakistani band recently wrote a song about her struggle with HIV. She was also featured in a BBC television documentary. Gul says, however, that she still feels “lonely” because of her status: few people, she believes, understand what it means. Her children, now teenagers, remain her chief source of inspiration. “They are very proud of their mother,” she says.

Kerosene vs. Modern Energy

Kerosene is still a vital fuel for cooking and lighting for people in the developing world. With global prosperity increasing, though, they are likely to switch to more modern forms of energy in the years to come.

Turning down the wick on kerosene (Shell World Online, March 14 2008)

by RUSTOM DAVAR
March 14, 2008

On Mumbai’s Port Trust Road, an artery that runs past the Indian city’s major refineries, cars vie for space with bullocks that amble along, each one pulling a cart bearing a large cylindrical tank. The tanks are painted either red or yellow, depending on which national oil company they belong to. The bullocks are heading for shops across the city where the kerosene they carry in 1,000-litre loads will be sold at government-subsidised prices. Not an uncommon sight in a country where 100 million homes still use kerosene lamps for light, and even more use it for cooking.

In India, and other parts of the developing world, kerosene is a fuel used by people on the middle rungs of the energy ladder – midway between basic, traditional fuels such as dung, agricultural residues and wood; and more modern energy such as liquefied petroleum gas (LPG) and electricity. Developing countries, in fact, consume nearly half the world’s production of kerosene. The developed world mainly uses kerosene as jet fuel, although it is used as home heating fuel in Japan and is commonly used elsewhere for cooking in remote areas.

Kerosene’s days as a domestic fuel in the developing world, however, may be numbered. As global wealth increases, rapidly developing countries such as India and China push up demand for more modern energy forms. Rural communities want better lighting and heating and more efficient cooking fuel. People abandon traditional methods of transport such as bullocks and donkeys in favour of cars and trucks. (The newly-unveiled Tata Nano car – one of the world’s cheapest – is expected to help triple India’s car sales by 2015.) And, of course, they take flights for the first time.

By 2030, says the International Energy Agency, the share of India’s population with access to electricity will rise to at least 96% from a 2005 level of 62%. It may even reach 100%.

Lighting up

Kerosene has been around since the earliest days of the oil industry. In the latter half of the 19th century, kerosene lamps lit up homes in cities like London, Paris and New York. Many in the oil industry, such as the Rockefellers and the Rothschilds, owed their fortunes to kerosene’s brisk sales. By the beginning of the 20th century, however, kerosene was no longer the first-choice lighting fuel. Advances in science – the invention of the incandescent electric light bulb by Thomas Edison, for example – had led the world’s richer nations to switch to more effective forms of energy, such as electricity.

However, even today, the benefits of electricity still haven’t reached many in the developing world, and – at least until that gap is bridged – they still need kerosene.

“I use kerosene for cooking, boiling drinking water and heating bath water,” says mother-of-six Mrs Jayashree Prakash Yadav, from the village of Vashinaka, near Mumbai. “The government-allotted quota is often insufficient for the needs of my family – it lasts about 15 days.” Yadav finds kerosene cheaper than LPG. Stoves that use LPG can cost 10 times as much as a kerosene stove, a significant investment for a low-income family like Yadav’s.

Rajni Ram, a domestic worker from Kandhar in the north Indian state of Himachal Pradesh, also prefers kerosene. “It’s cheaper than electricity, so it’s used for lighting in poorer homes in my village.”

Expanding the grid

The Indian government’s subsidies, which it offers under its public distribution system, are one reason why many still use kerosene. However, the system has come under scrutiny, with calls for reform or for subsidies to be available only to those below the poverty line. If this happens, the affordable appeal of kerosene will vanish for many.

The United Nations says that of India’s 700-million rural population – 70% of its total – only a third receive generated power. Extending the electricity grid is often the easiest option for the government as it seeks to supply power to rural India. It believes dependence on kerosene will not last and has no plans to increase kerosene quotas for each state. “Kerosene usage will decrease in the future as electrification continues and more and more people switch to LPG for their cooking needs,” says Ratan Panda, Maharashtra State Co-ordinator for Oil Industries.

For now, though, the bullocks of Port Trust Road will continue to ply their well-worn routes daily, oblivious to the question marks over their future.

Indoor Air Pollution (Shell World Online, Feb 1 2008)

More than half the world’s population cooks and heats with open fires or inefficient stoves. Their smoke is a lethal source of indoor pollution that kills 1.5 million people each year. A pilot programme in India has created self-sustaining businesses to sell improved clean-burning stoves. Now the programme is going global.

Fresh air for the world's poorest homes

by RUSTOM DAVAR
February 01, 2008

Swati Dadasukhatar lives with her family in a pink cement hut, just a few doors down from the tiny local post office in the Indian village of Kapsi. Sheaves of corn ripen in her courtyard amid old pots, discarded slippers, and here and there a stray plastic toy. The hut’s single living room contains a bed, an old television, and a phone connected to the exchange at Pune, the nearest city. In the dimly lit kitchen Dadasukhatar squats on the ground, cooking on her wood-burning stove. Here she makes everything from flat breads to spicy vegetable dishes, lentils and potatoes.

Four years ago this kitchen was a lot less comfortable. Smoke from Dadasukhatar’s traditional cook-stove filled the air, made her eyes burn and congested her lungs. “My walls used to turn black and the stove also used a lot of wood-fuel, which is scarce over here as there aren’t many trees in the area,” she says.

Nowadays the air is clean and safe to breathe thanks to her improved stove, which she first learned about when a local charitable organisation ran an awareness programme in her village.

Silent killer

More than half the world’s population still uses open fires or inefficient stoves for heating and cooking. The smoke they give off is a lethal source of indoor air pollution that causes 1.5 million deaths each year, or about one every 20 seconds, according to the World Health Organisation. Carbon monoxide, soot and other toxins present in the smoke cause severe respiratory illnesses and eye-related problems. The W.H.O. lists indoor air pollution as one of the top 10 global health risks, and the most lethal killer in developing countries after malnutrition, HIV/AIDS, and lack of safe water and sanitation. The most affected regions are China, India, and sub-Saharan Africa. Women and children suffer the most, as they spend a greater proportion of their time at home, tending fires and cooking.

Government-led efforts to address the problem by encouraging the use of clean-burning stoves have so far had mixed success. Government subsidies can only go so far in addressing an issue of this magnitude. Moreover, state-run programmes sometimes fail to address the needs of people using the stoves, both in terms of the stoves’ design and the way they are distributed.

But an ambitious programme running in India and other developing countries for the past few years aims to foster a more effective long-term solution by creating a viable, self-sufficient industry to manufacture and distribute cleaner-burning stoves. The programme, called Breathing Space and run by the Shell Foundation, an independent charitable organisation based in London, has so far sold more than 200,000 clean-burning cook stoves worldwide and improved the lives of more than a million people. By running the programme like a business, instead of as a non-profit – addressing the needs of consumers, and providing profit incentives to suppliers – the Shell Foundation aims to create a sustainable solution to the issue and roll it out around the globe.

“The problem with just handing out aid cheques is that you end up treating people as victims instead of as consumers,” says Simon Bishop, Policy and Communications Manager at the Shell Foundation. “In our model, people are making a profit all the way along the supply chain – thus fostering independence, creating sound market-feedback loops, and adding to the country’s economic growth.”

Sceptical consumers

To achieve the foundation’s goal, the programme is working to overcome a number of hurdles. One of the most daunting is marketing the stoves effectively to sceptical consumers who are often unaware that there is anything wrong with the old-fashioned way of doing things.

This resistance is partly due to the demographic of those affected by indoor air pollution. “Indoor air pollution affects the silent majority – the woman who doesn’t have a voice,” says Anuradha Bhavnani, Regional Manager of Shell Foundation, South Asia. Millions of rural women in India have little or no status in society, and are therefore used to tolerating all kinds of hardship without complaint. These women are often ignorant of the health risks posed by inefficient stoves. An important aspect of the foundation’s work is raising social awareness and educating people about the health benefits of improved stoves, through the grassroots efforts of local women’s self-help groups. These groups of village women contribute money to a collective pool, which is tapped for low-interest loans to individual members at times of need, or for important purchases. By connecting with these groups the foundation has managed to reach individual members, who are able to purchase the improved stoves with the group’s support.

Even so, it remains difficult to convince consumers to abandon their traditional, primitive methods of cooking and heating. Open fires are a way of life, and in order to abandon them, consumers need additional incentives.

“What we’ve found,” says Bhavnani, “is that consumers aren’t necessarily compelled to buy the products for health reasons. So instead, we win them over by promising a cleaner living environment and other conveniences – such as the fact that pots don’t turn black on improved stoves and are therefore easier to clean.” The health benefits then come as added perks, rather than being the main focus when the consumer is making a decision to switch.

“I bought an improved stove mainly to reduce the soot deposits on my kitchen walls and to save fuel, but as a result I’ve noticed that I now have less eye problems,” says Archana Gardi, another resident of Kapsi who has been using a Shell Foundation stove for the last three years.

Volatile gases

Other challenges that the foundation faces are effectively designing its improved stoves, as well as manufacturing and distributing them in a cost-effective manner.

There are two main categories of stoves – built-in stone or concrete ones with an attached chimney costing about $10, and portable metal ones costing about $25 that can be easily transported and used for camping or other outdoor uses. In both cases manufacturing costs must be kept down without sacrificing efficiency.

For instance, the stoves designed by the Shell Foundation’s regional partner, the Appropriate Rural Technology Institute (ARTI), have addressed this problem by using technology that allows wood to burn more efficiently and cleanly than in conventional stoves. A steady current of air ensures that volatile gases are completely consumed during combustion. Unlike some stoves, the foundation’s models require no battery-operated fans to produce the necessary airflow, reducing costs significantly. A study of 110 households in the state of Maharashtra, published in the journal Energy for Sustainable Development, found that these improved cook stoves reduced particulate matter by 24% and carbon monoxide by 39% one year after installation.

Designers must also make stoves work efficiently with a multitude of fuel types used by consumers in rural areas and villages, including twigs, wood chunks, coal and agricultural wastes. Dadasukhatar, for example, uses waste chilli and aubergine plants, and the dried branches of the babul tree. The foundation markets one stove that burns wood and wood chips. Another model burns dry leaves, sugarcane waste and ground-nut that have been converted to charcoal.

Local manufacturing

The foundation also faced difficulties with distribution and manufacturing as it expanded its reach in India. Improved stoves have never before been distributed through organised supply chains in rural India, so the idea is new to private companies and artisans responsible for manufacture and distribution. They need to be convinced that the new stoves are viable commercially before they agree to invest their own capital. This reluctance has gradually been overcome with the help of demonstrations run by the Shell Foundation’s regional non-profit partners and testimonials from satisfied customers who reflect growing demand for the new stoves.

The small companies that manufacture and distribute portable stoves are typically located in towns and cities, since their customers can carry their purchases home. Built-in stoves, on the other hand, are heavy and difficult to transport, so they are usually manufactured within about 10 kilometres (six miles) of the homes where they are installed. The foundation’s non-profit partners train local stonecutters and masons to build them.

One of the training centres is located in Phaltan, about a half hour’s drive from Dadasukhatar’s home in Kapsi. The centre boasts an array of demonstration models, some of which are used to cook meals for trainees. Artisans from neighbouring villages stay for several weeks while they learn to make the stoves. When necessary, the foundation has provided the initial investment to help stove makers tool up to make the new models. Breathing Space’s organised approach to the issue, its use of monetary incentives, and its partnerships with small NGOs that have strong relationships with the consumer have helped it achieve most of its goals. The pilots run by its regional partners in India have sold tens of thousands of stoves in the Bundelk-hand region of North India as well as in the western state of Maharashtra, with more than 80,000 stoves sold nationwide. Those pilots are now being expanded. Further pilots are being set up in the southern states of Karnataka and Tamil Nadu.

“The business-based model is unique,” says Ajit Abraham, Manager at the Shell Foundation, India. “With our pilots, we’ve proved that it works.”

Going global

In addition to the programme’s efforts in India, it also set up similar pilots in 2002 in Guatemala, Mexico, Ghana, Ethiopia, Brazil and Kenya. A review of the efforts in these regions by consultancy Accenture led to a scale-up of operation in 2006, focusing on China, Guatemala, Brazil, India and a region straddling Uganda and Kenya. India was chosen as the lead country, due to the notable successes achieved there.

The goal now is for Breathing Space to sell 10 million clean-burning cook stoves in these five regions over the next five years. The Shell Foundation recently partnered with a US-based environmental non-profit, Envirofit International, to help expand the programme’s reach.

Envirofit, launched in 2003 as a result of research at the Colorado State University Engines and Energy Conversion Laboratory, is the recipient of a World Clean Energy Award for its leadership in providing energy solutions. Envirofit will take over day-to-day management of the programme, building on the lessons learned from pilot programmes like those in India.

The Foundation will continue to set business objectives, raise funds and act as an investor. It will also measure the impact of the programme, and work on general advocacy and awareness of the issue of indoor pollution.

The partnership will initiate operations in India, while compiling data for Latin America and East Africa, where it plans to replicate the programme.

Meanwhile, back in the village of Kapsi, Swati Dadasukhatar is so pleased with her new built-in stove that she recently ordered a portable one. She also gladly lets the foundation use her courtyard for demonstrations and helps organise attendance.

As Dadasukhatar and other satisfied users spread the word, more and more of their friends and neighbours will begin to make the transition to a healthier lifestyle.