37220 HIV/AIDS - Getting Results These reports describe activities, challenges and lessons learned during the World Bank Global World Bank's HIV and AIDS work with countries and other partners. HIV/AIDS Program IFC Against AIDS ­ Protecting People and Profitability Martin Lutalo AIDS has wide consequences for development, and Workers at the Mozal Company Smelter Expansion presents enormous challenges to businesses in the worst Project in Mozambique, an IFC Against AIDS client hit countries. The epidemic affects workers, managers and markets by increasing costs and reducing productivity. The International Finance Corporation (IFC), the private sector arm of the World Bank Group, works with client companies to mitigate the effects of the epidemic on their operations through its IFC Against AIDS program. The program works with companies in Africa and India, and efforts are underway to raise awareness among clients in China and assess program conditions in Russia. AIDS on IFC's Agenda IFC is a global investor and advisor committed to building a sustainable private sector in the developing world, helping to reduce poverty and improving people's lives. Recognizing that HIV/AIDS is as much a business issue as a development and humanitarian concern, the IFC Against AIDS program was launched in 2000 to accelerate the involvement of IFC client companies in responding to AIDS. The IFC Against AIDS mission is to protect people and profitability by being a risk management partner, HIV The Business Case for Action Against AIDS and AIDS expert and catalyst for action where AIDS is threatening sustainable development. There is a strong business case for action against AIDS. The epidemic increases costs for businesses ­ medical IFC takes AIDS seriously. Although clearly a health and other benefits, recruitment, and training; and lowers problem, AIDS is also a development challenge that productivity ­ through absenteeism, labor turnover, and threatens people's welfare, socio-economic advances, loss of experienced personnel. It can affect consumer productivity, social cohesion, and even national security. bases, savings, investments, and education. HIV impact The epidemic reaches into every corner of society, data make a clear business case for prevention and affecting parents, children and youth, teachers and health care. "If 20 percent of your factory were likely to burn, workers, rich and poor. Responding to AIDS is an integral you would invest in fire extinguishers wouldn't you?-- part of IFC's commitment to sustainable development. well, think of HIV in the same way," says Sabine Durier, Program Leader, IFC Against AIDS. Ninety five percent of people with HIV live in developing countries, where IFC operates. Sub-Saharan Africa, the Businesses that fail to act against AIDS face risks to hardest hit continent, accounts for almost two thirds of all their reputation, finances and even their viability. infections. In India, China, Russia, and Ukraine, HIV infections are increasing at alarming rates. IFC has Reputational risk observed that in highly affected regions, many companies The World Economic Forum's 2004 global survey on want to address the epidemic but don't know where to business response to HIV/AIDS concluded that risk to start. In less affected countries where companies have not their reputation may be the key motivator for large felt a direct impact, they are often unaware of the potential multinational businesses with high profile brands and for role they could play in preventing HIV infections. companies in certain sectors to take action against HIV and AIDS. Pharmaceutical companies in particular have calculated the annual "AIDS tax" on business at 6 been targets of activists advocating for reasonable AIDS percent of the corporations' labor costs. The study found treatment costs and price reductions for anti-retroviral that workplace AIDS programs including ARV provision drugs (ARV). Activism has taken place in highly visible could reduce this "tax" by up to 40 percent.1 demonstrations and in the more private setting of the boardroom. Impact on labor: In 2000, the International Labor Organization estimated that by 2020, the population of AIDS activists have targeted companies for not providing the 29 hardest-hit African nations would be 9% smaller treatment to their workforce. For example, at the XIV due to AIDS, and their workforces would be 12% International AIDS Conference in Barcelona in July 2002, smaller.2 Between 2000 and 2010, the projected number demonstrators criticized a leading beverage company and of employees lost to AIDS could equal 40 ­ 50% of the an extractive industry company for not providing life- workforce in some African companies.3 In fact the loss prolonging ARV drugs to their employees. of experienced personnel is one of the most common frustrations that IFC hears from business leaders when The extractive industry company was attacked for assessing the impact of AIDS and program opportunities reversing its policy of covering ARV treatment, in the face with investment companies. of implementation challenges. The beverage company was attacked because it was providing ARV treatment only to Impact on customer base: The shift in consumer employees in its core business, i.e. to only 2 percent of spending to medical care and treatment could reduce employees in its marketing and bottling network across the market for many consumer goods and services. The Africa. Demonstrators denounced the companies for epidemic also threatens the consumer base by raising employee expectations and misrepresenting their decreasing overall demand when households lose their generosity as corporate citizens. income earners. Vodacom, South Africa's largest mobile telephone network estimates that the HIV/AIDS epidemic In the following 3 months, both companies adopted will cut the country's market by one third.4 policies that include provision of ARV treatment for all employees. This highlights how firms can feel pressure to Threat to viability take action to protect their reputation. Activists watch for inconsistencies between rhetoric and action, and although Small and medium enterprises (SMEs) are particularly consumer spending is unlikely to be affected in the short vulnerable to AIDS due to their limited financial, clinical, term, companies whose brand reputations are in danger of and human resource capacity to proactively manage being tarnished are more likely to pay attention to AIDS. prevention and care interventions. The loss of a key employee can prove catastrophic for an SME where Financial risk larger firms might have access to multiple employees capable of performing comparable work. A study by the AIDS creates short and long term financial risks for the University of Port Elizabeth of small businesses in South private sector. In the long term, the epidemic could lead to Africa identified AIDS as one of the three main factors deterioration in the business environment, by affecting that cause the failure of nearly 80 percent of start-up labor and skills availability, diminishing markets and disrupting supply networks and services. In the short to medium term, AIDS creates financial risks by increasing the costs of doing business and reducing productivity. 1S. Rosen, J Simon, W. MacLeod, M. Fox, D. Thea and J Infections in the workforce have direct, indirect and Vincent. "AIDS Is Your Business", Harvard Bus Review, Vol. systemic costs. Direct costs to the company include 81, No. 1, February 2003. http://hbswk.hbs.edu/archive/3338.html employee benefits (health insurance, medical costs, funeral provisions) and additional recruitment and training 2HIV/AIDS: A threat to decent work, productivity and costs associated with labor turnover. Indirect costs arise development, International Labor Organization, 2000. from absenteeism, productivity losses, poor morale, and http://www.ilo.org/public/english/protection/trav/aids/publ/threat decentworkeng.pdf For table of projections: staff turnover. Systemic costs in the form of lost http://www.ilo.org/public/english/protection/trav/aids/facts/stats institutional memory, skills and workplace cohesion are _page.htm another negative consequence of AIDS for businesses, as 3 for all productive or public service sectors. Kaiser Family Foundation, The impending catastrophe: A resource book on the emerging HIV/AIDS epidemic in South Africa, 2000. http://www.kff.org/southafrica/20000515a- A 2003 Boston University AIDS impact assessment on six index.cfm corporations (mining, metal processing, agribusiness, 4"South African companies count the cost of AIDS". Financial utilities, retail, and media) in South Africa and Botswana Times. October 30, 2002. 2 SMEs every year.5, The smaller the company, the less 6 child transmission of HIV; and providing ARV treatment likely it is to have a program against HIV for its workforce.7 and associated medical tests to staff and their families. What does IFC Against AIDS do? The work of IFC Against AIDS is structured around three pillars of action--Guidance, Training, Development and IFC Against AIDS works mainly with companies in which Research. These respond to the epidemic's dynamics, IFC invests, and also reaches out to other parts of the opportunities for private sector participation in the HIV private sector ­such as SMEs­ through a dedicated response, and IFC's relative strengths. training program. Guidance IFC Against AIDS aims to achieve three objectives: Primarily in Africa, the guidance work equips relatively 1. Prevent new infections. Communicating messages of large client companies with the skills, tools and support awareness and prevention to uninfected staff is critical. needed to develop, implement and manage effective HIV Training staff as peer educators, organizing periodic AIDS programs in their workplaces and surrounding information sessions, and promoting diagnosis, treatment, communities. It includes systematic hands-on capacity and prevention of sexually transmitted infections can go a building within client companies (training client AIDS long way in preventing new infections. Committees and focal points), and within the non- governmental community (IFC Against AIDS identifies 2. Deal with or manage existing infections. and trains selected NGOs across Africa to enable them Interventions to meet this objective include promoting to be appropriate resources and partners to the private voluntary HIV counseling and testing so that people learn sector, and especially to IFC clients). their sero-status, and identifying and organizing care and treatment opportunities within or outside the company for In working with companies, IFC Against AIDS follows a people who are HIV positive. IFC Against AIDS and NGO client engagement process, with milestones to mark the partners assist companies to identify providers of ARV end of each program phase, typically over 24 months. A services for referrals. preparation phase (Pre-engagement) is followed by three program phases: 1) Foundations of an HIV/AIDS 3. Mitigate the effect of HIV on the company itself. This Workplace Program, 2) Program Implementation and includes organizing the company to enable staff to multi- Partnership, and 3) Sustainability and Maintenance. The task and handle each other's tasks, and strategic training Pre-engagement phase is essentially client identification. and hiring so that the company is able to continue Typically, IFC Against AIDS staff in collaboration with operating normally despite AIDS. IFC investment officers, consider whether new IFC clients should be engaged on AIDS. IFC Against AIDS works with clients to establish workplace and community programs and help them implement HIV The "Foundations of a Workplace HIV/AIDS Program" interventions in cooperation with NGO partners. The phase lasts about 6 months. It is dedicated to assessing interventions may include: providing condoms through program conditions, getting senior management buy-in, strategically placed dispensers in company premises; and exploring possible partnerships with providers of forming a group of peer educators among company HIV/AIDS services. IFC works with the company to employees to conduct HIV training within the company and highlight risk factors, vulnerabilities, and the likely impact in the community; treating sexually transmitted infections of HIV on its operations. By soliciting evidence from among staff and community members; providing voluntary various levels of the company--most of the time it's not counseling and HIV testing services for employees and the chief executive officer but people from lower levels of community members; medication to prevent mother-to- the company who see it--IFC Against AIDS is able to get senior managers to endorse the idea of engaging on AIDS. IFC Against AIDS asks the company to identify a 5 "Disease forcing enterprises to the wall, say researchers," focal point to coordinate the AIDS program, and to set Business Day, South Africa, July 11, 2001. up an AIDS committee, and offers guidance as the 6 S.Van Eeden, S.Viviers, and D.Venter, "An Exploratory Study of company drafts and adopts an AIDS policy statement, Selected Problems Encountered by Small Businesses in a South an AIDS action plan, and a budget. African Context," Jnl of African Business,. 5 (1) 2004: 45­72. 7 Deloitte & Touche Human Capital Corporation. Evaluation of During the second phase, "Implementation and Workplace Responses to HIV/AIDS in South Africa: A Rapid Partnership", the program begins operating and Situation Analysis. Johannesburg: South African Business partnerships are consolidated. The company negotiates Coalition on HIV/AIDS, 2002. 3 contracts with NGO partners and implements interventions An analysis of Odebrecht's impact data for 2005 gives a such as HIV education and awareness sessions for staff sense of the range of activities of the company's AIDS and peer educators, and voluntary counseling and testing. program. The company trained 1,022 peer educators and 34 peer education instructors, and trained medical In the final phase, "Sustainability and Maintenance", staff in the management of ARV therapy. Odebrecht also usually months 18 to 24 and on, the company and IFC trained 42 voluntary HIV counseling and testing capture monitoring and evaluation data, and consolidate counselors, and tested 1,872 people (including lessons learned. The company's AIDS program may be employees and community members) for HIV of whom extended to its customers, suppliers, and partners. 182 were found to be HIV positive. The company distributed 1.6 million male condoms and 15,000 female Companies to which IFC has provided guidance include condoms. To measure the impact of its program, Odebrecht in Angola and MTN in Nigeria (more details Odebrecht distributed 1,600 questionnaires in a survey below), Bonite Bottling Limited in Tanzania, K-Rep Bank, of the knowledge, attitudes and behavioral practices Magadi Soda and Serena Hotels in Kenya, and Hernic (KABP) of the staff and community reached by the AIDS Ferrochrome (Pty) Ltd in South Africa.. program. Clinic data show a reduction in sexually transmitted infections, which are an important risk factor Odebrecht, Angola: Odebrecht, an engineering and for HIV transmission. The company estimates that its construction company headquartered in Brazil, with large program has reached 100,000 people across Angola. construction, engineering and mining interests in Angola, earmarked US$1 million of an IFC loan to respond to AIDS Mobile Telephone Network (MTN), Nigeria: IFC in Angola. Together, IFC and Odebrecht launched an Against AIDS has provided guidance to MTN in putting education, prevention, and care program in the operations in place an extensive workplace and community and communities of the company, across the country. In HIV/AIDS program. Launched in 2004, the internal 2003, the Global Business Coalition on HIV/AIDS program extends to MTN's 2,000 staff and their families. commended Odebrecht as part of its Awards for Business A focal point works with an HIV/AIDS committee of nine Excellence, recognizing the company's exemplary members to manage the implementation of the program, contribution to the fight against AIDS, both in the workforce guided by the company's HIV/AIDS policy. As part of its and in surrounding communities.8 HIV awareness and education program, MTN has recruited and trained 220 peer educators -- about one Odebrecht Peer Educators Talk with Community peer educator for every 10 employees. In partnership Members with an NGO, Hope Worldwide Nigeria, MTN gives ARV therapy to infected staff and family members. In July 2005, the company started a community HIV/AIDS campaign, covering six states in Nigeria, through the MTN Nigeria Foundation. IFC has contributed US$60,000 through IFC's Corporate Citizenship Facility (CCF) to support the activities. This money is part of the company's HIV/AIDS program budget of 33 million Naira (US$ 257,450). Magadi Soda Company (MSC) in Kenya produces sodium carbonate (soda ash) which is used in manufacturing glass, detergents, chemicals, pharmaceuticals, baked goods and other products. The company's HIV/AIDS action plan serves its 500+ workforce and the semi-nomadic Maasai community living nearby. "AIDS is at the heart of all our activities within the company and in the community," says Dr. Sam Wendo, a senior medical officer at MSC and AIDS program coordinator. IFC Against AIDS has worked with MSC to move their 8To see a 12-minute video on Odebrecht's program, please go longstanding response to HIV to new levels. The to www.ifc.org/ifcagainstaids (click on the projects page) company has: 4 § AdoptedacompanyHIV/AIDSpolicyandroadmapfor MSC and IFC draw three lessons from their action collaboration: § AppointedanAIDScoordinator,andcreatedanAIDS 1. By involving the community in decision-making, the committee comprising human resource personnel, the company effectively brings the community in as an Community Development Officer, safety officers, peer active partner. educators and employee union representatives, and 2. Involving senior management and operational staff local school head teachers, to drive priority actions in the AIDS program is key to its success. § Steppedupeducationandawarenessactivitiesinthe 3. By positioning itself as a partner in development, a company and community through 35 peer educators. company can positively influence the health of an MSC provides vehicles, audio-visual equipment and entire community. videos for peer education in schools and churches. Training has been offered to local leaders to enable Training them to participate more effectively in advocacy and HIV prevention activities. Safety briefings and training Many SMEs lack financial, clinical, and human resource incorporate HIV and AIDS information. capacity to proactively engage in HIV education, § Providedfreevoluntarycounselingandtestingservices prevention, and care initiatives. In Africa, where SMEs to employees and the community, including nutritional often account for most of a country's private sector, IFC counseling to HIV positive people. Against AIDS and the Private Enterprise Partnership for Africa (PEP Africa) have developed a training program to § Providedfreeanti-retroviraltherapy(ART),treatmentto build the capacity of these businesses to mitigate the prevent mother to child transmission of HIV, and for impact of AIDS on their operations. PEP Africa, IFC's tuberculosis to employees and dependants. Treatment vehicle for providing technical assistance to the for sexually transmitted infections (STIs) is also free for development of Africa's private sector, works with the community members. Over 5 years, STIs cases have private sector, governments, and donors. dropped dramatically from 50 to 3 cases per month. The company hospital provides other treatment and services The "Managing HIV/AIDS in your workplace" training to community members for a nominal fee. program works with participants to achieve five § DevelopedpartnershipswithtwoNGOs,theAfrican objectives: Medical Research Foundation and PharmAccess for 1. Learn facts and discredit myths about HIV and AIDS training clinical staff. MSC is exploring partnerships with other organizations to offer free nutritional supplements 2. Raise awareness of the impact of AIDS on their and food to needy people living with HIV, and looking at businesses, employees, and communities, by greater collaboration with existing government making the business case for action programs. 3. Understand the process used to create an AIDS A Masaai woman and her child receive medical care program in the workplace from a nurse in a hospital run by Magadi Soda 4. Develop action plans for their companies Company, Kenya 5. Become aware of NGO resources available for implementation. A pilot program delivered 20 training sessions to 52 companies in Kenya, Mozambique, South Africa, and Tanzania in 2004 and 2005. As a result of the lessons learned in the pilot, the program was revamped to 1 day of initial training and 3 follow-up sessions over 12- months. Training manuals have been developed. In 2006, 53 participants from 45 more SMEs were enrolled in the program in Mozambique, Kenya, and South Africa. Thirty two of those companies are regularly attending the follow-up sessions. NGO partners were identified in Kenya and Mozambique to help participating SMEs to implement key elements of their programs. Mammy Flowers in Kenya and Spectrum Graphics 5 Limitada in Mozambique are two examples of SMEs The company has put HIV and AIDS messages on the trained that have used the training to good effect. invoices and receipts it sends to clients. Employees can help themselves to free condoms placed in the company Mammy Flowers, a Kenyan flower company, runs a toilets, reception area, and cafeteria. The company comprehensive HIV and AIDS awareness and prevention refers employees who need voluntary HIV counseling program for the 425 farmers with whom it works. After and testing and treatment for sexually transmitted attending the IFC Against AIDS training, Mary Ndungu, the infections to the nearby government health facilities CEO, crafted an HIV/AIDS policy. The policy has been where services are provided free of charge. The condensed into a poster and is displayed on the company company has also partnered with the Catholic volunteer walls for the farmers' benefit. Community of Sant' Egidio, to provide antiretroviral therapy. Mammy Flowers has partnered with St. Luke's Clinic, a Development and Research local health facility, to provide information and care to the farmers and local community. A nurse from the clinic The function of the Development and Research pillar is provides information about HIV and AIDS through formal three-fold: first, to systematically engage with sectors not and informal sessions and education, and communication traditionally involved in HIV and AIDS but where IFC has materials. The clinic provides the farmers with free strong leverage, such as Financial Markets and Advisory voluntary HIV counseling and testing and counseling on Services; secondly, to catalyze action in regions where nutrition for people who are HIV positive, prevention of the HIV epidemic is in an early stage but threatens mother-to-child transmission of HIV, and advice on home- sustainable development (hot spots/emerging based care for the sick. Farmers pay for treatment of epidemics); and thirdly, to initiate projects which are sexually transmitted infections and opportunistic infections. critical to the quality of the services IFC Against AIDS On average, the clinic sees about 10 Mammy Flowers provides. farmers a month. The company refers HIV-positive farmers who need ART to the nearby Kijabe Mission Hospital. Within the Development and Research function, the emphasis is on playing the role of a catalyst for greater Employees of Mammy Flowers at work private sector involvement in responding to HIV, as well as helping develop models and tools for the private sector to use. Research and Development enables IFC Against AIDS to seek more systematic engagement in new business sectors and departments of IFC, and to explore and develop appropriate responses to emerging epidemics, notably in India, Russia and China. R&D also facilitates program innovations to increase the quality and efficacy of services to clients and their HIV and AIDS programs. The criteria for setting R&D priorities and activities is how well they serve the IFC Against AIDS mission and contribute to the demonstration effect of IFC Against AIDS. Engagement in India According to the UNAIDS 2006 Report on the global AIDS epidemic, there has been a sharp increase in the Spectrum Graphics Limitada (SGL), a design and number of people living with HIV in India, from a few printing company in Mozambique, has a workplace HIV thousand in the early 1990s to around 5.7 million adults and AIDS awareness and prevention program for its 61 and children in 2005--more than in any other country. employees. An HIV and AIDS policy developed in With a population of over one billion, the HIV epidemic in December 2005 guides the implementation of the India will have a major impact on the overall spread of program. SGL's managing director is the HIV/AIDS focal HIV in Asia and the Pacific, and indeed, worldwide. point, assisted by an AIDS committee comprising the India's overall HIV prevalence rate is estimated to be marketing manager, warehouse manager, and an officer between 0.5 and 1.5% (among people aged 15-49 from the company's finance department. years), but in some areas (e.g. Mumbai) unofficial estimates are as high as 4%. 6 When IFC Against AIDS engages in Africa, the message is Apollo Tyres is using peer education to raise awareness primarily one of risk management (given the extent of the on HIV and AIDS in its general workforce. In addition, to impact of AIDS on corporate costs, and the impact it has enhance its clinical capacity to address HIV and AIDS, on the viability of small enterprises). In contrast, in India, Apollo Tyres will train all its factory medical officers on engagement is really a gauge of leadership from IFC and sexually transmitted infections and HIV including its clients. The vision is to show that private enterprises counseling skills to enable them work effectively with can be partners with the government and NGOs in curbing employees, truckers and nearby communities. This the epidemic in its early stages. Rapidly scaling up component of the program will be implemented in prevention and care efforts with populations at risk and partnership with the International Labor Organization. mainstreaming awareness are imperative in India. So IFC Against AIDS' objectives are to support projects by IFC Ambuja Cement, India: In July 2005, Ambuja clients in order to increase or scale-up their response to Cement, which employs 4,500 people, launched a HIV and to leverage these efforts among a larger group of workplace and community HIV/AIDS program in its eight corporations and stakeholders. manufacturing locations across India. The community outreach component targets truckers and migrant The program aims at increasing the ability of clients to workers. An AIDS policy is communicated on the proactively address HIV and AIDS in three possible areas: company's intranet and on large display boards at · various locations across the operations. their workplaces · their clinical facilities · AIDS Policy Displayed at Ambuja Cement Factory, their communities. Himachal Pradesh, India Four client companies (covering about 20 sites across India) are matching the funds they receive through IFC to proactively address HIV and AIDS in their workplaces, clinical facilities, and in communities at risk. Two of the four companies, Apollo Tyres and Ambuja Cement are profiled below. Apollo Tyres Company, one of India's leading automobile tyre manufacturers, has pioneered a holistic community program of awareness, education, prevention, and treatment of sexually transmitted infections among truckers. The program is reaching out to thousands of people nationwide through its outreach in the transport sector. This unique community program was launched in the Sanjay Gandhi Transport Nagar (SGTN), Asia's biggest transport township near New Delhi, and a central hub for trucks traveling all over India. Every day as many as 5,000 trucks pass through SGTN, which has a daily mobile population of 4,000 to 5,500. The company has established clinics in four other transportation hubs across India, where truckers and other community members are treated for various health conditions including sexually transmitted infections, and have access to condoms. In partnership with CARE India, Apollo Tyres has designed behavior change communication strategies. The project is working to raise HIV awareness among on-site vendors, local small businesses, and truckers. Workshops are conducted by qualified individuals from the Indian Network for People At Darlaghat, in Himachal Pradesh, one of the eight Living with HIV/AIDS. The company is playing a pivotal program locations, 40 Master Trainers have been trained role in bringing together an increasing number of on HIV and AIDS with assistance from the International stakeholders like transport unions and fleet owners into its Labor Organization (ILO). The Master Trainers have in education and prevention programs. 7 turn trained 247 peer educators. Within a short time of its The project team assesses that general health launch, by January 2006 the program had conducted 65 awareness among truckers, Ambuja employees, their AIDS sensitization workshops, and its peer educators had families and community has improved, and stigma talked with 532 people "one-to-one" and held 18 group related to AIDS has been reduced, thanks to targeted education sessions. There had been 343 performances of messages and access to services. Ambuja Cement is an AIDS films and street plays by peer educators. The example of how companies can be effective in achieving company has leveraged external resources such as films results on HIV among populations and in areas that are and videos on HIV and AIDS which are provided by the extremely difficult for government programs and NGOs local State AIDS Control Societies, and ILO. Large to reach because of their isolated locations. billboards with HIV and AIDS information are displayed at various locations across Ambuja's operations. Engagement in Russia A notice board displays HIV and AIDS awareness messages at a clinic at Ambuja Cement Russia has the largest HIV epidemic in Europe, and around two-thirds of all cases in the Eastern Europe and Central Asia region. According to the UNAIDS 2006 Report on the global AIDS epidemic, the estimated number of people living with HIV in Russia is rising towards one million. The engagement of IFC Against AIDS in Russia started in 2005 with an initial assessment of the HIV situation in the country. The next step is a study to understand employer and employee attitudes to HIV, in the context of other health challenges affecting the private sector in Russia: high rates of work-related accidents, alcoholism, and heart disease and cancers. The program determined that the potential for using workplaces as venues for health messaging, and the appreciation at corporate level of how the long-term health of employees affects companies' bottom line, would depend on how employers and employees think about health and health messages. In December 2005, IFC initiated an Occupational Health and HIV/AIDS Perceptions Study, in collaboration with the World Bank's Europe and Central Asia (ECA) region. The study is supported by the Finish Ministry of Foreign Affairs through the Finland/IFC Technical Assistance Trust Fund. The overall objective of the study is to gauge, collate and analyze perceptions of HIV and AIDS Ambuja operates clinics which treat employees and their and other occupational health issues in the private families, truckers, contractors, casual laborers, and sector in Russia. Using a variety of methodologies, community members. Operated primarily as out-patient mainly one-on-one interviews, a representative sample facilities, the clinics have laboratories and well-stocked of key decision-makers, mid-level managers, and pharmacies. By January 2006, a total of 30,420 condoms employees will be queried to find out how receptive they had been sold or distributed through the clinics and other would be to HIV prevention and other occupational locations. health education in the workplace. The study seeks to understand perceptions of HIV, how the perceptions A knowledge, attitude, behavior and practices (KABP) arise, and what can be done to address them. Based on survey was undertaken at the beginning of the program, the findings of the enquiry, the longer-term goal is to on a sample of 510 employees from all program locations, devise tailored interventions and a communications and 400 truckers and migrant workers. The study informed strategy for and by the private sector. program planning, and provided a baseline against which to evaluate program results. The study will be disseminated to multilateral and bilateral agencies, as well as the local and federal government in Russia so that they can use the results to 8 inform their own strategic decisions on AIDS and other Lessons Learned health issues in the workplace. It is scheduled to be completed by the end of 2006. As IFC Against AIDS has worked with clients to develop and implement AIDS workplace and community programs, several lessons have emerged. Engagement in China Coordinated action is essential: The most successful In January 2006, the Chinese government, with WHO programs typically involve coordinated action across four and UNAIDS, jointly estimated that 650,000 people were related spheres: operational, medical, managerial, and living with HIV in China, including about 75,000 people community. Each sphere has particular skills and with AIDS. Although national prevalence remains low, resources which need to be identified and leveraged for there are clusters of high prevalence, geographically and a successful response to HIV and AIDS. For example, among sub-groups. During 2005 there were around representatives in the operational area of the company 70,000 new HIV infections, most of them in injecting can identify risks that they see at the working level, drug users, and 25,000 AIDS deaths. These numbers opportunities for promoting on the job education and have to be considered in the context of China's prevention, and the health programs and services that extremely large population which is estimated at around employees need. Representatives at the managerial 1,300 million. level of the company can champion the program, allocate budgetary and staff resources, and undertake IFC has been paying close attention to the epidemic in periodic reviews of activities. In addition to identifying China and the possibility of leveraging IFC's reach to general health trends in the area, representatives in the private clients in the country, to encourage them to act. medical sphere can prioritize concerns and coordinate IFC Against AIDS believes that the business case for medical programs and services. Finally, community action on AIDS in China resides in the prospect of representatives can serve as a liaison between the companies enhancing their reputation and contributing to company and community, strengthening communication preventing the spread of HIV in China. and cooperation on efforts to combat HIV. As a first step, IFC has commissioned a briefing book on Accountability and responsibility matter: Appointing HIV and AIDS targeted at the private sector. The briefing a staff person to serve as a focal point, and an AIDS book will be distributed to all IFC clients in China as well Committee, responsible for coordinating activities across as to a broader audience. It will be published in Mandarin the different parts of the company, brings accountability, in the last quarter of 2006. Chinese and English versions ownership and focus to the process. will be available on the IFC Against AIDS website. Developing an HIV/AIDS policy is important: Given Demonstration effect and communication the sensitivity of the subject, it is important that staff and management have a clear understanding of how the Leveraging the demonstration effect of projects is essential company intends to deal with employees who either are, to the strategy of IFC Against AIDS. The three areas of or become infected with HIV. A company policy or policy engagement--Guidance, Training, Development and statement informs employees of their rights and Research--are rich in lessons learned. The program responsibilities, articulates the commitment of seeks to contribute actively to the body of knowledge on management, clarifies expectations, and in certain cases HIV and AIDS and the private sector, through IFC's protects a company from liabilities. communication channels and as a program. This involves distilling the lessons learned and sharing them with the Keeping close to the client is important: Many growing number of clients of the program, writing up case companies suspect that they may have a problem with studies, and coordinating with the World Bank, donors, HIV but do not know how or where to start. Other international organizations, NGOs involved in HIV, companies are unaware that a problem exists even business associations. when it may be hurting their bottom line. Working closely with the client, IFC Against AIDS assesses conditions for In communicating the business case, we highlight the workplace and community programs that will limit the evidence that IFC Against AIDS has collected about the number of new HIV infections, mitigate the impact of HIV impact of HIV on businesses, as well as the efficacy of on operations, and manage existing infections. IFC private sector engagement on HIV and AIDS and the Against AIDS has observed that keeping the link with returns from this engagement for the companies involved, senior management in a company should be a priority as and also for the communities that benefit from the it can have a significant impact on stigma and programs. discrimination, by reiterating a message of respect for 9 people who are HIV positive, and the importance of Conclusion prevention. It also influences the overall quality and strength of the program. As a result of IFC's work with companies on HIV and AIDS, many lives have been saved or changed. The Formalizing the engagement process boosts program program has worked with over 30 companies in Africa quality: Systemizing and formalizing the engagement and India, and is in the preliminary stages of raising process contributes greatly to the quality of the programs awareness among clients in China and assessing established with client companies, and the quality of IFC program conditions in Russia. IFC estimates that its Against AIDS services. The client engagement process AIDS program has reached out to about half a million helps IFC Against AIDS program team members to people. manage the workflow and communication with clients and IFC colleagues. Involving and training partners are critical: Since IFC is not an implementer, establishing relationships with, and where necessary providing training to NGOs and other service providers that will work with clients on their program implementation, is critical to the success and continuity of interventions. Monitoring and evaluation (M&E) matters: M&E is an important part of any corporate HIV/AIDS program. It enables a company to measure progress against its stated goals and make informed decisions about the effectiveness of various interventions relative to costs. IFC Against AIDS' Practical Guide to Monitoring and Evaluating Corporate HIV/AIDS Programs is designed to help measure the effectiveness of interventions and of the program overall. Engaging SMEs on HIV and AIDS works: The significance of engaging private enterprises to respond to HIV and AIDS should not be underestimated. The fact that employers have access to employees every day is their strongest comparative advantage in responding to HIV. Through its "Managing HIV/AIDS in Your Workplace" training program for SMEs, IFC Against AIDS leverages the untapped leadership and role of SMEs to increase the reach of HIV prevention messages and care referrals. This creates an additional channel for key interventions in the area of HIV education and prevention, and AIDS treatment. It also helps SMEs to mitigate the operational risks that they face through AIDS. Cost sharing yields results: IFC's financial contribution to clients' programs helps provide the necessary resources to catalyze their programs, and provides leverage. It shows very tangibly to clients how committed IFC is to responding to HIV and AIDS. 10 IFC AGAINST AIDS References, further information CONTACT INFORMATION § Formoreinformationvisitwww.ifc.org/ifcagainstaids Washington, DC, USA Sabine Durier About the author: Tel: +1.202.473.4176 Martin Lutalo is a Program Analyst in the IFC Against E-mail: sdurier@ifc.org AIDS unit in the SME department of the International Finance Corporation (IFC), part of the World Bank Gillette Conner Group. Tel: +1.202.473.4040 E-mail: gconner@ifc.org Martin Lutalo Tel: +1.202.458.1406 "HIV/AIDS - Getting Results" series editor: E-mail: mlutalo@ifc.org Joy de Beyer, Global HIV/AIDS Program, jdebeyer@worldbank.org Margaret Muir Tel:+1.202.473.5578 Email: mmuir@ifc.org Please visit www.worldbank.org/aids for notes on other topics in the "HIV/AIDS - Getting Results" series Johannesburg, South Africa Noleen Dube Tel: +27.11.731.3059 E-mail: ndube@ifc.org Tish Enslin Tel: +27.11.731.3062 E-mail: lenslin@ifc.org Maputo, Mozambique Ilídio Silva Tel: +1.258.84.3070.360 E-mail: idasilva1@ifc.org New Delhi, India Subrata Barman Tel: +91.11.4111.1019 Email: sbarman@ifc.org August 2006 11