How is HIV and AIDS a problem for YOU?

By Neil Orr & David Patient

Empowerment Concepts 2005

At the heart of apathy, indifference, hostility, and discrimination are issues of motivation: Why should I care? Why should the wealthy care about the poor? Why should the healthy care about those who are ill? Why should people with a job care about the unemployed? Why should you and I care about a war, refugee crisis, or disaster in some distant place?

Without an answer to this real question, those that have resources will simply get on with life, pushing the have-nots to the edges of day-to-day awareness and concern. When the answer to the question is found, resources are mobilised, and things change.

It is bizarre: People are getting infected and dying in huge numbers. Villages and communities are being torn apart. The problem is obvious! Or is it? "So? What has that got to do with me?" says one. "If they didn't do (whatever), and did more of (something else), they wouldn't be in this situation!" says yet another.

Therefore, when we enter into a company, community, organization, or faith based organization, we always ask each person to identify how HIV and AIDS is a problem for them, as an individual, and then as a collective group: How is HIV and AIDS a problem for you - personally, for your business, for your family, for your investment portfolio?

There are people out there with huge resources - creativity, finances, marketing ability, and influence - who are simply not involved in the struggle to deal with HIV and AIDS. How is HIV and AIDS a problem for these people? For example: How does the plight of the poor affect the average wealthy person in any meaningful way? They can afford to distance themselves from the misery and desolation of poverty and waiting in long queues for medical attention. How is HIV and AIDS a problem for them?

It is true that heroic efforts are being made to contain and reduce the enormous challenges accompanying - and contributing to - HIV infection and AIDS. It is also true that there is hardly anyone who does not know about it, in some way or the other. Yet, how many of the general public, small and large businesses, ordinary public servants, and congregations, are actively and voluntarily involved in changing things? Not many. How do we know this? Because rarely are these individuals and groups making hard decisions - and implementing them with vigour - to fundamentally change the situation. Instead, the community at large seems to be perennially waiting for external leadership, policies, and programmes - i.e., for someone else to tell them what to do, and when.

At the same time, we have spontaneous community protests regarding poor service delivery, child abuse, and other social ills. For HIV and AIDS, we seem to reserve our protests for one day each year, the 1st of December. We dutifully pin on our red ribbons, do our good deeds, and then wait for another year. The exception thus far has been the Treatment Action Campaign. Despite their efforts, few other activist spin-offs have occurred. Perhaps we are not sure what to protest against, and what we want instead?

When you ask people why they are not concerned, they reply "But I am! I just don't have time to do anything about it!" Perhaps we need to take their word at face value, and recognise that, for most people (and businesses, organisations, etc), their primary process is getting on with life as they know it. Social issues - poverty, HIV, etc - are secondary processes. We assert that, until we can show how the 'secondary' issues impact deeply upon the primary concerns and processes, mobilization does not occur. The question is 'how?'

We hear all the standard altruistic patter about helping our fellow man and that it's the 'right things' to do. We hear of friends and family who have become infected, got sick and often died. We also hear other motivations that are less than altruistic - but as valid - such as how much it costs.

"I was mugged and held hostage by a couple of teen age kids, at gun point, and during my captivity they told me that they were orphaned - at ages 9 and 11 - when their parents died of AIDS many years earlier. They had grown up as street children", one person told us. Before this unfortunate incident, this person had always thought AIDS was someone else's problem but now it had become a real problem for her. She may not be infected, but was certainly affected.

"I'm tired of the conditions of our roads. They are riddled with pot-holes and I have to replace a couple of car tyres each year. So I called my local council to complain. When I finally reached the Town Clerk he told me that the council didn't have money to repair the roads. In the course of our discussion, the town clerk said that the municipality budget for road repairs had been cut back by 25% due to non-payment from rate payers. I asked what was causing this delinquency, thinking it was a mind set of non-payment. Instead, he told me that too many people were sick or dead from AIDS and the municipality's income was down as a result", another man told us.

"As a Human Resources practitioner, I am spending more and more time doing paperwork for medical disability, medical claims, disciplinary hearings for absenteeism, death and funeral benefits, and counseling bereaved family and co-workers. I am falling behind in my normal core business functions. AIDS is creating an intense workload and backlog for my department." AIDS was now a problem for this person and the department she headed.

"I roster 20 people for a shift and at least a couple of times a week I have to call in several casual/temporary staff to cover the shifts because my full-time staff are either sick or taking family responsibility leave and it's not only affecting our operational requirements, it's really impacting on our budget." With this particular person, his performance bonus was based on how much his department's bottom-line profit was. Sick employees were affecting this bottom-line and therefore his pocket. AIDS was a real problem for him because it affected his income.

All these 'non-socially-oriented' concerns may be far from what many of us (self-righteously) want people's motivations to be, in order to be concerned enough to do something. However, if it's how they get active and involved, then who are any of us to judge their motivation? As long as they get involved!

In conservation efforts we have no problem with finding ways for surrounding communities to benefit - usually economically - from conserving nature. Employment opportunities are created through tourism and other ventures. This pragmatic - and effective - approach is becoming the norm, simply because people in general need jobs, food, clean water, and other basic amenities. To ask people to simply 'care enough' at an abstract level does not put food on the table. Why are we not adopting a similar pragmatic - and ecological - approach to the prevention and treatment of HIV and AIDS?

Quite frankly, we believe that businesses - large and small - are crucial in the fight against many social ills, including HIV and AIDS. Why? Because we spend more than half of our waking life at work. What happens there affects everything else. However, a business is exactly that: A business: Its' reason for existence is to receive financial reward for services rendered. It exists to make a profit. If it failed in this, it would close down, and all jobs would be lost. It is the duty of the CEO (chief executive officer) and CFO (chief financial officer) to prevent this from occurring. That's what they are paid to do.

There are many businesses that still need convincing that HIV and AIDS is a problem for them. With unemployment levels as high as they are, the loss of workers is not perceived to be a major (financial) problem. The 'doom and gloom' or 'alarmist' approach does not work here. Instead, the issue is: Prove it - show me the numbers.

Therefore, when we are approached by business to do a wellness intervention, we find that proving costs savings to the company is the best way to get the buy-in from the boardroom level. In order to achieve this, a base-line has to be established to show where the company is, where they have come from, and where they are headed if nothing changes. All of this needs to occur at the level of finances - cost-to-company. If the cost-to-company is higher to do nothing - compared to the costs of intervening - then you have action, as you have engaged the true motivation of business: money.

This is not all that difficult: Every day at work costs the company, in terms of a salary. Therefore, every working day lost to illness or other reasons, is a reduction of profit. How much are HIV and AIDS costing, and how much will it cost if nothing is done?

To do this we take all their sick leave data and family responsibility leave, and produce a graph of the past and present wellness status of the company. Has it changed? If so, how much has this cost directly, in lost payroll? Then add the indirect costs: lost production, recruitment, training, lower morale, disciplinary actions, absenteeism, casual labour, administration costs ... the list is long. In general, indirect costs amount to about three time the direct (payroll) costs. Finally, with the employee headcount kept constant, annual salary increases stable, and the annual illness levels increasing at the same rate into the future, what will this cost in five years time? That's the cost of doing nothing. Compare this with the cost of doing something: Improved nutrition in canteens, onsite primary health care clinics, antiretroviral access, VCT and counselling services. Surprisingly enough, doing something is cheaper!

Let's use an example: A company has 2,500 employees, of which 40% have elected to be on medical aid due to higher salary levels. These staff may be assumed to be management. The balance (60% of staff) were not on medical aid. From the late 1990's, sick leave levels have increased from below 0.4% of all working days, to about 2% of all working days. This represents a 500% increase over those years. Is this HIV related? Or, as some are prone to assert, is this merely an increase in taking days off because the law says you are entitled to do this?

So we eliminated all 1-day leave from the analysis, as abuse of sick leave is most likely to occur in this category, simply because a sick note from a doctor is not required for 1-day sick leave. When such 1-day sick leave was removed, there was no difference whatsoever in the trends over time. I.e., the annual increase in sick leave remained the same.

Then, illnesses were categorized according to 'possibly HIV related' (respiratory tract infections, gastro-intestinal illnesses) versus 'unlikely to be HIV related' (injuries, sinusitis, ulcers, arthritis, backache, etc). Changes in levels of the two illness categories were then compared over several years: Levels of illnesses that are possibly HIV related had increased dramatically over several years, while those unlikely to be HIV related remained relatively stable and constant over the same period of time.

Finally, to drive the point home, the levels of illness per year were correlated with HIV infection prevalence rates (new infections) currently, and for years before. As expected from the average profile of the clinical progression of HIV infection, current sick leave levels were found to have no correlation with current (new infections) prevalence, nor with prevalence rates for the five years previous - the expected asymptomatic stage where T-cell counts range from normal to 350. However, correlations with new infections 6 and 7 years before ( i.e., those expected to experience pre-AIDS symptoms currently, T-cell count 350 to 200) were strong: approximately 0.7. Furthermore, correlations between current sick leave levels and new infections 8 and 9 years ago (i.e., those expected to enter the AIDS stage of infection, with T-cell counts of 200 or lower) reached an astonishing 0.9 level.

What this implies is that current sick leave levels are a reflection of new infections 8 to 9 years ago. Therefore, even if we reach a stable HIV prevalence plateau now (i.e., new infections equal deaths, thus cancelling each other out in the total prevalence), sick leave levels will continue to rise for at least another 8 to 9 years, before returning to current levels. It was also estimated that, on average, about 11% of all staff would be either experiencing recurrent pre-AIDS illness symptoms, or AIDS-related illnesses, for the next decade or so, in a more-or-less 50:50 pre-AIDS: AIDS illnesses ratio.

What is also important to note is that there was no statistical difference in the percentage of sick leave levels between those on medical aid, and those not. I.e., managers are as affected (and presumably HIV infected) as general staff members. Furthermore, although only 40% of the total staff headcount was on medical aid, this group constituted 60% of the total direct cost-to-company for sick leave, due to their higher salaries, and thus loss per day of sick leave.

The previous example is not intended to show how business is impacted by HIV and AIDS. Instead, it is used as an example of how we need to engage each sector in a meaningful manner, if we want them to get genuinely involved, concerned, and mobilised to deal with issues such as HIV and AIDS. I.e., 'How is HIV and AIDS a problem for you?'

We can similarly ask ourselves how HIV and AIDS affects religious organisations in a meaningful and measurable way? For example: It is commonly found that the heads of religious organisations are deeply concerned about HIV and AIDS, but that this concern does not seem to be matched at the lay preacher level. How do we engage the self-righteousness in a meaningful manner, so that the enormous power of religion is harnessed to deal with the realities facing our society?

How do we engage parents of school children to truly understand the impact of do-nothing, say-nothing, in terms of the sizes of classes per teacher, and the quality and cost of education? How do we present this in such as manner that resistance to issues of sex education are overcome?

How do we persuade public servants to understand that efficient and integrous service delivery is of paramount importance, to themselves?

In our view, we need to start being a little more pragmatic about these issues: We need to move from the abstract notions of 'rights' to making those 'rights' real, visceral and measurable for the ordinary person, the businessperson, the religious person, for everyone. For example: How does gender equality put food on my table? Hoes does economic empowerment of the poor affect the price of bread?

Ghandi once said something to the effect that there is no such thing as rights without duties (responsibilities). We would add that principles with realistic measurable actions flow from the awareness of the consequences of action and non-action for the Self: 'How is this a problem for me?' i.e. personal ownership of the problem, and thus involvement in developing solutions.

David R. Patient (M.H.;M.H.T.)
Empowerment Concepts

Ph. +27-83-226-9466
Fax to email +27-086-674-7940
E-mail david@empow.co.za
http://www.empowermentconcepts.com
http://www.empow.co.za

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