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.