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Volkswagen in the global war against HIV/AIDS
Authors
Cláudio Bruzzi Boechat
Nísia Duarte Werneck
Temba Masilela
Participation
Letícia Miraglia
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Volkswagen in the global war against HIV/AIDS
Case Abstract
The HIV/AIDS epidemic became a global disease and threatens humankind.
Volkswagen decided to face the challenge of facing it in global and local approaches.
This case study shows how the VW group and its Brazilian and South African branches
are organizing themselves to fight HIV/AIDS throughout their workforces as well as they
look for ways to cooperate with national and regional communities in prevention and
treatment of this terrible disease.
Introduction
The HIV/AIDS epidemics surprised the world when the first victims of the still-unknown
disease appeared in the end of the 1970s and beginning of the 1980s. It took the world
some time to understand that the Acquired Immunodeficiency Syndrome was a disease
that could hit any person, not only hemophiliacs and homosexuals. And most
importantly, it also took some time to find out what exactly should be done in face of this
terrible threat.
Approximately 42 million people are infected with HIV in the world. In the most affected
countries, one adult out of three is infected. More than two thirds of Aids deaths
happened in Africa, South of Sahara. UNAIDS1 2002 statistics for this region are: 29.4
million people infected with HIV; 70% of all world cases; 3.5 million new cases; 2.4
million deaths caused by Aids. Statistics may show higher figures as the current
decade progresses.
In June of 2001, the International Labour Organization launched its code of practice on
HIV/AIDS and the world of work. Through this code, ILO intends to increase its support
for international and national commitments to protect the rights and dignity of workers
and all people living with HIV/AIDS. In its preface, Juan Somavia, ILO’s DirectorGeneral, declares “The HIV/AIDS epidemic is now a global crisis, and constitutes one of
the most formidable challenges to development and social progress. In the most
affected countries, the epidemic is eroding decades of development gains, undermining
economies, threatening security and destabilizing societies. In sub-Saharan Africa,
where the epidemic has already had a devastating impact, the crisis has created a state
of emergency.” And says more, “Beyond the suffering it imposes on individuals and
their families, the epidemic is profoundly affecting the social and economic fabric of
societies. HIV/AIDS is a major threat to the world of work: it is affecting the most
productive segment of the labour force and reducing earnings, and it is imposing huge
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The Joint United Nations Programme on HIV/AIDS, UNAIDS, is the main advocate for global action on
the epidemic. It leads, strengthens and supports an expanded response aimed at preventing
transmission of HIV, providing care and support, reducing the vulnerability of individuals and communities
to HIV/AIDS, and alleviating the impact of the epidemic.
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costs on enterprises in all sectors through declining productivity, increasing labour costs
and loss of skills and experience. In addition, HIV/AIDS is affecting fundamental rights
at work, particularly with respect to discrimination and stigmatization aimed at workers
and people living with and affected by HIV/AIDS.
In an attempt to reverse the situation, many countries are investing more heavily in
preventive measures. Considering the disease’s high prevalence, however, even
extremely successful campaigns will only gradually reduce mortality rates.
The Brazilian Aids program, considered a model for developing countries, combines
free access to treatment with antiviral drugs and aggressive preventive campaigns.
Treatment became free in 1996 and, according to the Brazilian Business Council, 135
thousand patients are currently being treated.
The Brazilian government reduced costs negotiating with the pharmaceutical industry
and manufacturing generic medicines. Authorities estimate that mortality rates dropped
50% and hospital internment of 360 thousand patients could be avoided, a cost
reduction in excess of 1 billion dollars.
When Brazil was awarded the 2003 World Health Gates Prize, in recognition for his
national Aids control program, the physician William Foege, director and board member
of the Foundation, emphasized, “Brazil showed that, with perseverance, creativity and
compassion, it is possible to make the Aids epidemics recede. Brazil is saving lives and
money at the same time, a feat to be imitated by other countries.” Nils Daulaire, the
board’s executive president, declared the Brazilian program was able to escape the
debate’s deadlock on Aids treatment, demonstrating what a developing country is able
to do and evidencing the fact that treatment and prevention are mutually reinforcing.
The following parts of this study deal with the actions taken by the Volkswagen Group
and its operations in Brazil and South Africa to face challenges imposed by HIV/AIDS
epidemics.
First Part
Volkswagen Group, the Corporation – VW AG
The Volkswagen Group develops, manufactures and markets automobiles and services
throughout the world in order to provide its customers with attractive solutions for
individual mobility. The Group refers to around 330,000 employees who, in 2002,
produced vehicles at 45 production sites in 18 countries in the five continents. Its
headquarters is in Germany.
Volkswagen, as one of the world’s largest international car manufacturers, supports the
values expressed by the Global Compact.
At VW, the model of sustainable
development is the benchmarking for corporate policies over a long time-scale,
accepting not only economic but also ecological and social challenges. VW looks on the
concept of sustainability not only against the background of society’s ethical
expectations but also with regard to ensuring and enhancing its own global
competitiveness. Foresighted environmental protection and social skills enhance the
company’s long-term future prospects.
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In the words of its CEO, Bernd Pischetsrieder, “Responsibility in thought and deed have
long been traditions at the Volkswagen Group”. He declares that in the 18 countries in
which the company operates, VW has been an active member of the regional
communities, especially in the developing countries.
In South Africa, for instance, the company has been established for over 50 years, and
is proud of “having been proactive locally in supporting human rights, work standards
and environmental protection even during the difficult days of the apartheid regime”.
The policy of human resources is supported by successful cooperation between and
with employees’ representatives. The early creation of the European Group Works
Council in 1992 and the Global Group Works Council in May 1998 mark the
internationalization of this cooperation. The Council meets at least once per year with
the managing board and international human resource managers in order to discuss
important issues for the group. These include the employment situation at the various
locations, productivity and cost structures, development of working conditions. The
group directors provide the Council with early information about cross-border production
movements, giving them the opportunity to state their case.
The Council, made up of freely elected employees, representatives and union members
from the individual countries, has a presiding committee with 6 members, including the
chairman and the secretary general. All costs are borne by the VW AG.
The growing competition for internal work positions requires a function balancing
throughout Europe, and an intensive cooperation mainly between unions and work
councils represented in the Global Council. Around 80% of VW’s workers are
associated to Unions in the entire world, and the Global Council is a guarantee that the
high administration and management will not throw workers one against the other.
On 06 February 2002, in Bratislava, VW AG and the Global Group Works Council sign
the “Declaration on Social Rights and Industrial Relations”, committing the entire
company and its employees to social rights and corporate policies that couple
globalization with social responsibility. Premised upon the pertinent ILO conventions,
the declaration makes a particular social commitment to the security and development
of jobs. The integral text of the Declaration is in Annex 1.
Health Protection and Promotion at VW AG
The Health Policy is based on the general philosophy of VW AG, and applies to all the
group. Health protection and promotion are principles of the humanitarian and social
responsibity and are a major concern common to both management and the Global
Works Council, and it is an integral part of personnel policy.
This is defined in the Guidelines on Health Protection and Health Promotion. These
guidelines, signature-endorsed by both the Group Board of Management and the Group
Works Council, are applicable for the entire VW Group and ensure all employees proper
healthcare, irrespective of the various national statutory regulations. VW achieves this
through defined minimum standards, binding directives and recommendations.
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The following is a listing of some of the requirements mandatory throughout the Group:
- Priority is given health -conscious work design,
- The health of the workforce must be monitored by way of preventive medical
screening,
- Work-related health risks must be identified,
- Management, employee representatives and employees must be advised on health
matters,
- Guaranteed demand-oriented general and emergency healthcare,
- Works doctors must retain professional independence for the fulfillment of their
duties,
- Occupational Health Service must have a certain number of personnel and technical
resources at its disposal.
As major goal, health policy looks for adequate care to all employees of VW AG,
independently of national regulations.
Against AIDS, VW AG orientates itself concerning:
- high scientific understanding about HIV/AIDS,
- the epidemiological situation,
- existing and proposed legal standards,
- its own health and personnel policies.
Supporting ILO’s declarations in favour of understanding, solidarity, dignity and human
rights, VW declares that it is its policy to avoid any discrimination and to protect
diagnosis confidentiality of HIV infected and AIDS sick persons.
Brazil and South Africa occupy the central point of VW’s interest about HIV/AIDS.
Different programs were started in the two countries, envisaging combat the illness and
its consequences.
Second Part
The Response of Volkswagen do Brasil - VWBr
In 1996, VWBr launched a comprehensive program to prevent and protect against
HIV/AIDS. Supported by pedagogical films and presentations, information and articles
published by in-house organs, notices on bulleting boards and the issuance of special
brochures on HIV/AIDS, VWBr settled a fundamental mark of its program, a system that
offers standardized support and help but, at the same time, was organized in a
sufficiently flexible way to accommodate individual needs and requirements.
Fifty years in Brazil – a touch of history
VWBr grew together with Brazil along the past fifty years. In 1953, after intense
scrutiny, the company decided to open its first plant outside Germany in Brazil. Today,
this is one of the most important VW units and its sales account for 9.5% of the group’s
world total sales.
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On March 23, 1953, VWBr started operations in São Paulo. A total of twelve employees
assembled, with parts imported from Germany, the first Brazilian ‘beetles’ in a shop
rented in the Ipiranga district, São Paulo. The first Kombis would also be produced
there.
Three years later, the construction of the Via Anchieta plant started in São Bernardo do
Campo, city in São Paulo’s metropolitan area. It was a very favorable period for the
automobile industry: Juscelino Kubistchek had been elected president of Brazil and
investments in transportation and roads increased.
The economic growth and the presence of foreign capital favored the creation of an
automotive pole in the ABC region of São Paulo state, where São Bernardo lies. In
1959, the Via Anchieta plant was inaugurated and, in two years time, it was already
producing ‘beetles’ and Kombis using 95% of Brazilian-made parts. Most cars in the
country were still imported at that time.
Between 1962 and 1974, VWBr introduced models that became historic in Brazil such
as the sports car Karmann-Ghia, the station wagon Variant, the Brasília and the Passat,
the latter very well adapted to Brazilian needs. But the ‘beetle’ was the best-seller and,
in 1972, reached the one-million mark of cars sold.
In the beginning of the 1980s, with a second plant already operating in Taubaté, São
Paulo, VWBr started producing trucks and introduced the Gol, a car that would soon
achieve the same success as the ‘beetle’ and remain the best-seller for 14 consecutive
years. In the following year, production of the ‘beetle’ in Brazil was discontinued.
In 1985, Brazil elects its first civil president after the military regime established in 1964.
In 1987, VWBr and Ford joined forces to create a new company, Autolatina. The
country’s economy experienced a downturn and the consequent reduction of the market
led the two companies to look for a better and common use of their resources. The socalled ‘hybrid’ models Apolo, Logus and Pointer (VW) and Verona, Royale and
Versailles (Ford) were produced.
Two years later, Fernando Collor is elected president in the first direct election after the
military regime. In the short period of his mandate, interrupted in 1992 by an
impeachment, the Brazilian market was opened to the importation of automobiles and
technology. The domestic industry was forced to update itself to compete with imported
cars and new automakers entering the market.
Following Collor, Itamar Franco becomes the new president and offers advantages to
car manufacturers who agree to produce popular automobiles. The ‘beetle’ came back
to the streets.
In 1994, the Plano Real (Real Plan) is launched and its creator, Fernando Henrique
Cardoso, is elected president. It is a moment of hope and stability. The VWBr-Ford
alliance is broken up and Autolatina is shut. It was time for the two manufacturers to
compete in the growing market. In 1996, two new VWBr plants are inaugurated: an
engine-production plant and a truck-production plant. In the following year, the Gol is
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awarded the title of Brazil’s ‘most lovely car’ and São Paulo instituted the ‘beetle’ day,
on January 20.
Two years later, the VW/Audi plant is inaugurated in São José dos Pinhais, Paraná. In
2000, the company celebrates 13 million cars produced and sold in Brazil e starts to
restructure its first plant, the Via Anchieta, in São Bernardo do Campo.
In 2002, Luiz Inácio Lula da Silva is elected president. A metallurgical worker in São
Paulo’s ABC region, he had started his political career in São Bernardo’s labour unions.
In this same year the Anchieta plant is inaugurated again and named Nova Anchieta
(New Anchieta). It is among the most modern plants in the world, featuring more than
400 new robots in the production line. The New Polo was the car to be produced where
less than fifty years ago ‘beetles’ were created almost by hand.
How VWBr handles the health issue
The VWBr Medical Care Plan was created in 1980 and currently serves approximately
70 thousand employees, dependents and retirees. Being self-managed, the Plan allows
better adequacy between supply and use of health care services. This adequacy is one
of the foundations of the company’s health care policy and essential in the creation of
important programs of the Medical Plan such as the Home Care and the AIDS Care.
In addition to health care plans, VWBr is also concerned with preventive campaigns.
The campaign ‘For a Healthy Life in VW’ (Para uma Vida SaudáveI) combines
preventive and treatment activities in all company’s units, aiming at the promotion of
health and well being of employees and their dependants.
Themes to be addressed are established based on incidence among health care plan
users, on possibility of prevention, on level of knowledge about the disease and on
costs both to company and society. Among the themes frequently addressed are
arterial hypertension, diabetes, smoking, mammary and prostate cancer and sexually
transmitted diseases. In case of epidemic diseases such as dengue, special campaigns
are carried out.
Dr. Murilo Alves Moreira, physician in charge of VWBr’s services area, demonstrates
the importance of preventive programs: “treating diseases is very expensive and brings
undesirable consequences for the company. Investment in prevention is immensely
cheaper and contributes to productivity and quality of products and services”.
AIDS in Brazil and in VWBr: What to do?
In 1982 the first AIDS occurrences were reported in Brazil. At that time, little was known
about a disease that was killing throughout the world, especially homosexuals. The
attack on the immune system seemed implacable. Authorities started to pay attention
to the epidemic as it spread over continents and the society, showing that, despite the
existence of ‘risk groups’, no one was completely at safe.
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In the following years, researchers from both the United States and France tried to find
out more about the disease. Isolated in both countries, the virus, later known as HIV,
became the greatest enemy of modern medicine.
In 1985 it was already possible to detect the virus in the blood and, in the following year,
the first AIDS case appears among users of the VWBr Medical Care Plan, warning the
company’s health team of a global threat that had just become local.
AIDS had arrived at VWBr. Quick action was needed to prevent new HIV occurrences
among employees and to find treatment alternatives for confirmed patients. But how to
do that, when all the information available on the disease was full of uncertainties and
prejudices?
The AIDS cases pointed the need for the definition of the carmaker’s health care policy.
But how should this policy look like? The government had just started to define specific
policies. Would a targeted program be more convenient or could the existing programs
cope with the specificity of the disease? Given all prejudices and stigmas related to
AIDS, how could both health care and privacy be assured? To make these decisions,
the company counted on its knowledge on the internal reality and on autonomy to define
rules for its health care plan. Its premise was to keep commitment and consideration to
employees.
Even considering the advantages of a self-managed health care plan, it was difficult to
answer the question: ‘What can the company do for its employees that carry the HIV?’
Since no treatment was known at the time, the only alternative was to avoid new
occurrences. Because little information was available on the disease, preventive
campaigns and policies related to AIDS, both in the country and in the company, were
isolated and disorganized.
Those infected with HIV were treated under the Volkswagen Health Care Plan.
Hospitalizations were frequent and long, increasing risk of infection and favoring
opportunistic diseases. Accredited hospitals and professionals did not have the
necessary specialization to deal with AIDS patients and some, as a dentist for instance,
refused to provide services to AIDS patients. Adhesion to the scarce resources offered
was low, medicines too expensive and government supply inconstant. Costs incurred
by VWBr with HIV/AIDS patients were high but neither their clinical condition nor their
life quality seemed to be improving.
Between 1986 and June 1996, 115 HIV/AIDS occurrences were registered at VWBr.
From these, 45 have passed away and 25 left the company or retired. The challenges
posed to the managers of the medical care plan were enormous and prospects narrow.
Since 1994, an original and powerful experience would allow improvements of
assistance and reducing of costs of dealing with this terrible challenge.
Volkswagen Home Care
The management of the Volkswagen Medical Care Plan includes constant monitoring
and audit inspections on hospitals and other covenanted establishments. In 1991,
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based on information gathered by means of this work, Volkswagen found out it was
necessary to look for an alternative for chronic patients supported by the company’s
medical assistance plan. Prolonged and recurrent hospitalizations are both prejudicial
to the quality of life of patients and their families and risky in terms of the possibility of
contracting other infections in the hospital. Indexes of clinical evolution were not
satisfactory, despite the high cost of hospitalizations incurred by the Volkswagen
Medical Care Plan.
The Chronic Patient Care and Guidance Plan was then created, in partnership with the
carmaker’s social service sector. After survey conducted in general hospitals of the
accredited network the need was detected to create a structure that allowed patients to
receive adequate medical care at home, after being discharged from hospital.
Initial mistrust of Volkswagen directors, fearing the company could be held responsible
in case patients died at home, was overcome. Arguments presented were related to the
criteria applied to choose those to be included in the program. Families had to be well
structured and capable of treating the patient. In addition, there must be a clinical
possibility that home treatment was beneficial. Besides that, cases presenting risk of
death would not be initially included in the program.
In December 1994, the Home Care Program was launched. On this year’s Christmas
Day, employees of Volkswagen’s health area celebrated both the occasion with their
families and a victory: the first patient was taken home, where a complete structure to
welcome him had been prepared. Employees were on stand-by, ready to intervene in
case of emergency. This was not necessary and his own family treated the patient,
from that day on.
The first stage of the Home Care process consists in selecting patients capable of
participating in the program. In audit surveys conducted by the Volkswagen Medical
Care Plan in accredited hospitals, potential cases are detected. The Home Care team
discusses with the physician responsible for each patient and explains the program,
asking if, in such conditions, the patient could be discharged from the hospital.
If discharge is already scheduled and the physician agrees with treatment at home, a
social assistant speaks to the family to check if it is possible to proceed with the
program. It is important that the house is easily accessible and materially able to
receive the infrastructure necessary for treating the patient. Besides that, parents must
demonstrate interest in welcoming and treating the patient at home. The Home Care is
an optional program; those who prefer hospital treatment have the right to choose it.
Once the fulfillment of the program’s requirements is attested, the necessary structure
to handle the disease is assembled. A group, accredited by the medical care plan is
responsible for the supply of all materials and medicines, for the medical and
pharmaceutical monitoring and for physiotherapy. The family may call upon this group
at any time, if the patient has any problem. If needed, he is taken to the hospital. In
some cases, nurses permanently assist the patient.
The Home Care team monitors home care closely, visiting houses where patients are
being treated, talking over the telephone with relatives and by means of interviews,
reports prepared by the responsible medical team and follow-up meetings. For Maria
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Teresa de Santi, coordinator of the Social Service area, this is an activity that requires
great care. “Even considering we act delicately, we are aware we are invading a home.
We have to be careful, accept people the way they are, avoid labeling them, respect
their habits and take their limitations into consideration.”
During monitoring meetings, discussions take place regarding the appropriate moment
of ‘weaning’. This is how it is named the moment the family is considered sufficiently
responsible and informed to handle the patient without the medical group’s help. The
‘weaning’ process is launched when both the patient and his relatives are sufficiently
adapted to the home treatment, when the clinical condition improves and when there is
no evident risk of return to hospital. In Maria Tereza’s opinion, it is necessary to take
the stage of development of each family into consideration. Childless young couples,
couples with teenage children and older couples, whose children are already leaving
home, react differently. Each case is different and requires a different approach. “
Infrastructure and care provided by Home Care are gradually withdrawn, but patients
are never detached from the program. Visits, though rare, continue to happen as well
as telephone conversations and periodical meetings where relatives – not the medical
group anymore – provide the program’s team with information about the patient’s
general condition. In case intensive care is needed again, the accredited group returns
to restart treatment.
In Home Care’s first year of operation, thirty patients have benefited from the program.
From these, seven died and eight remained ‘weaned’. Among those who died at home,
an average 95-day additional lifetime was confirmed. The number of hospitalizations
dropped 67.52%. The total number of days spent in hospitals 94.20% and costs
63.65%. Between 1995 and 2003, the Home Care program served 1,129 patients.
The program helped solving the problem of chronic patients of the VWBr Health Care
Plan and unveiled another urgent problem the company would have to deal with:
patients infected with HIV/AIDS.
The AIDS Care
With the advent of Home Care, the situation of the ones infected with HIV improved,
since many of them had been subject to long and repeated hospital internment, now
reduced by home care. Satisfaction increased and absence from work dropped. But
the main question remained unanswered: what to do to avoid the disease progression
among VWBr employees and their dependants? What preventive policies should be
adopted? How to improve life of those infected with HIV? What is the best posture for
the company in regard to these cases?
It was already certain that VWBr Medical Plan could do more for AIDS patients but,
considering the disease’s peculiarities, employees in the company’s areas of health and
social assistance felt that a specific focus on these cases was needed.
The number of infected had already reached 115 in 1996, when the AIDS Care program
was launched.
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Worried with the situation of VWBr Medical Plan users infected with HIV, VW Medical
Department started to think about a program that could provide AIDS patients with the
needed care and attention.
Pedro Faso, Human Resources Director, was convinced that the implementation of the
AIDS Care program was necessary. The arguments used to convince him were that the
initiative would better organize service provided to patients and rationalize control and
treatment activities and resources, enabling the company to reach high benefits at
average costs.
Prevention, treatment and reintegration to the company of employees infected with HIV.
AIDS Care was created based on these three foundations. It is a program for global
integrated and managed social assistance that serves VWBr employees, dependents
and retirees infected with HIV. The link between the three action areas of the program
helped define a prevention strategy that is also part of the employees’ reintegration
efforts. Always focused on Contaminate/Do Not Contaminate aspects, campaigns
educate and alert employees against AIDS and prejudices.
Prior to the creation of the program, the educative material distributed and presentations
carried out in the company used to follow the same line of reasoning applied to national
campaigns, when not directly provided by the Government. With the AIDS Care
program, the strategy to instruct employees became more precisely directed and
adequate to VWBr’s reality.
The prevention program is carried out by means of educative presentations, videos,
information over the intranet, in-house organs and bulletin boards, distribution of an
internal brochure on Sexually Transmitted Diseases/AIDS and a condom-dispensing
machine installed in the plant.
The treatment encompasses therapeutic activities and support by the social assistance
team, to help patients accept the disease and plan their lives with HIV. Ambulatory
medical care operating in São Bernardo do Campo counts on infectologists, nutritionists
and psychologists as well as structure to carry out CD4, viral load and genotype
examinations. Medicines are distributed there. In the beginning, VWBr paid all costs
related to the combination of medicines. Currently, the Ministry of Health provides the
medicines to be given to participants in the AIDS Care program. Medicines are given
directly to patients, because this is an opportunity to provide guidance and to control the
disease’s evolution.
Reintegration of the patient to the company is a consequence of health improvement.
Back to work and free from long periods of absence, the employee executes his
ordinary tasks fearless of dismissal and prejudices.
Certainty of confidentiality was another guarantee AIDS Care offered users of VWBr
Medical Plan. Before the launching of the program, patient’s privacy was not a priority.
Now, it is as important as prevention and treatment. The employee has the option to tell
colleagues about his health condition and even bosses are not informed of the
employee’s health. This is a guarantee that he will not feel AIDS may interrupt his
progression in the company. Even when a change in activities is necessary, due to the
peculiarities of each specific activity, the change is made without explaining its real
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reason. If HIV-infected employees have no need to fear negative discrimination, on the
other hand they cannot count on positive discrimination either. If he or she behaves
improperly at work he or she will be fired, just like any other VWBr employee.
The conscience he is capable of remaining healthy, active and of keeping his
professional perspectives is important to show those infected with HIV that a positive
outcome of the examination is not a death sentence. According to AIDS Care social
assistance team, the most difficult moment is when the disease is detected. “It is a time
when everything hurts,” says Maria Tereza, social assistant. Many refuse to believe the
result but the possibility of treatment stimulate them to go after the program. Others
look for it because they have been instructed by physicians; sometimes the family seeks
help.
Although AIDS occurrences have been detected in all hierarchic levels of the company,
those occupying higher positions show stronger resistance in participating in the AIDS
Care program.
Right after a patient’s enrollment in the program, social assistants, together with the
ambulatory team, start working to help HIV infected accept, understand and face the
disease, learning to live with it. First of all, it is important to understand the life each
patient has led so far, if he comes from a structured family, if he is married, if he is
dependent on chemical drugs. At this stage, interviews are conducted and visits made.
Many times, an employee finds it difficult to tell the family he has been infected with the
AIDS virus, especially if he is married and was contaminated in an extramarital
relationship. Social assistants stimulate him to tell a relative or friend about the disease,
to avoid having to face the problem alone. To disclose it to the family is part of the
process of accepting the disease.
The AIDS Care social assistance area also acts to strengthen the family. They suggest
familiar or couple therapy. In some cases, the woman cannot forgive her husband the
cheat and does not accept having to take care of him. In such cases, the patient,
helped by the program, looks for other relatives that may wish to assume the
responsibility for the treatment, if he needs special care, especially in case of home
assistance.
In Maria Tereza’s opinion, the social assistants who participate in the program need to
be respectful and flexible, essential characteristics for the success of the AIDS Care
program. “It is important to be able to listen carefully, without judging other people. For
us, it is not important how a person contracted AIDS. The patient tells us what he or
she wants to tell,” she explains.
The social assistants get together monthly with the ambulatory and medical areas
teams to exchange information on each patient. The program’s team is especially
concerned with HIV patients who are also chemically dependent. In many cases, the
dependency itself has resulted in the patient contracting the disease and makes the
acceptance process even more difficult.
The results of the AIDS Care may be measured by the satisfaction of those served by
the program. A survey carried out by VWBr social assistance team shows that of the 13
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HIV patients surveyed, ten consider the level of improvement in the treatment of cases
like theirs to be good or excellent, after implementation of the AIDS Care program.
Despite feeling better, nine of them still find it very difficult to tell other people about their
disease. Four of them said they are already able to admit their condition to relatives,
friends and colleagues at work, especially those with higher level of education. Only
three among the surveyed said they have already faced prejudice problems in treatment
units. One of them said he had problems with a dentist, another in the AIDS Care
ambulatory service reception and the third in the center for recuperation of chemical
addicts.
The survey was an opportunity for patients to reveal some of their life projects. Some of
them want to enter the university, go back to school or study English. Some want to
buy their own houses, set up a business, live with a brother or establish an NGO. One
of them said he wants to lead a calmer life.
Results and Recognition
Currently, 90% of those served by the AIDS Care program are active and
asymptomatic. Only one patient is being treated at home and hospital internment
dropped 95%. The cost of an HIV patient for the company is now US$ 300 per month,
spent in examinations, laboratory consultations and medicines. Prior to the launching of
the program, each patient cost between US$ 1,500 and US$ 2,000 per month.
Besides that, adhesion to the program is increasing and it is possible, through AIDS
Care, to obtain a better clinical control of patients, preventing the manifestation of the
disease. Absence is lower, life quality is better and the level of satisfaction of
employees is higher.
VW AG registered and presents the following results achieved by VWBr:
- Reduction of 90% in the period of hospitalization
- Reduction of 40% in treatment costs
- 90% of those infected with HIV and AIDS who participate in the prevention and
protection program remain asymptomatic and apt for work
- Evident improvement in quality of life both at work and in society
In 2003, up to now, 55 patients infected with HIV have been already treated by VWBr.
VWBr’s program was considered exemplar and internationally distinguished by the
United Nations General Secretary, Kofi Annan.
Because of the success achieved by its AIDS prevention and care projects, VWBr was
invited, in 1998, to take part in the CEN - Conselho Empresarial Nacional de Prevenção
ao HIV/AIDS (National Business Council for the Prevention of HIV/AIDS), an initiative of
the Health Ministry based on the Global Business Council for the Prevention of
HIV/AIDS, created by UNAIDS. CEN’s objectives are to merge private enterprise and
government efforts against AIDS and to stimulate programs to prevent the disease at
work. Companies that take part in the Council commit themselves both to advise the
Health Ministry in the development of preventive policies and to transmit such policies to
13
their employees and to the communities they share. Another function of CEN is to
recognize and make public positive experiences companies have carried out in
response to the HIV epidemic.
According to IBGE, Brazil has a population of 160 million people, 80 million being
economically active. This means they are engaged in formal or informal activities and
sometime will establish contact with large, average or small size companies. This
reinforces the importance of preventive campaigns at work.
Besides VWBr, some of the most important companies operating in Brazil participate in
CEN: Bradesco, Editora Abril, GM, Nestlé, Varig, Philips, SBT, Unibanco, Unilever,
Natura and Brasil Telecom. They have been invited by the Health Ministry due both to
their importance for the domestic economy and to the development of their policies for
HIV prevention and assistance to those infected with the virus. Eighty percent of these
companies have been developing programs related to AIDS for more than five years
and all of them have health care systems that include employees’ relatives.
The Council assembles at least twice a year and the Executive Committee every two
months. Extraordinary meetings may be called by the President. Nestlé occupied the
presidency between 1998 and 1999 and VWBr, represented by Dr. Murilo Alves
Moreira, is in charge of the office for the period 2000 – 2004.
In 1999, VWBr’s AIDS Care program was awarded an international prize granted by the
Global Business Council. The work carried out to prevent and treat the disease was
recognized.
Third Part
The Response of Volkswagen of South Africa – VWSA
The response of VWSA and its employees to the challenge of HIV/Aids in the workplace
and in the surrounding communities is framed by a number of parameters.
First, the vision of VWSA as it drives into the future and addresses the challenges and
changes that influence its journey. In the context of its vision, VWSA has identified the
following critical challenges and changes:
- Global instability (trade uncertainty, market sentiments, exchange rates)
- African renaissance (potential of Southern African and African markets)
- The VW Group (competition within the group for new contracts)
- Technology (advances in special features and electronics)
- Quality expectations (international standards)
- Customer satisfaction
- The environment (legislative regulations, government policy, industry standards)
- Global epidemics (HIV/AIDS and SARS2)
2
Severe Acute Respiratory Syndrome
14
The response of VWSA is also framed by three other parameters. Second, the
dimensions of the HIV/Aids challenge in South Africa and the particular responses of
society, government, organized labour and social activists in South Africa. Third, the
corporate history of VWSA in its fifty years of operating in the Eastern Cape province South Africa’s poorest province. And fourth, the corporate policies of VW AG and the
expressed commitment of the global group works council to socially responsible
globalization. Within these parameters and given the stage of the HIV/AIDS epidemic in
South Africa, the primary contemporary issue of public contention for all stakeholders is
the provision of treatment for people in the latter stages of the disease, although
prevention remains a priority.
At the community level, the activities of VWSA and its employees in the face of the
challenge of HIV/Aids have been undertaken in the context of two sets of public-private
partnerships. First, between a group of private doctors in Uitenhage - the location of
VWSA’s plant - known as the Uitenhage and Despatch Independent Practitioners
Association (UDIPA) and the provincial Department of Health. The second is the
partnership between VWSA and the Agency for Technical Cooperation (GTZ) of
Germany’s Ministry of Co-operation and Development.
Company Profile
VWSA, which is a wholly owned subsidiary of VW AG, was established in 1946 in
Uitenhage, an industrial town 35 kilometers from the Indian Ocean, in the Eastern Cape
province. Assembly of Volkswagens began in 1951 and today VWSA is one of the
largest foreign employers in South Africa, employing approximately 5 100 workers in a
facility that includes a Press Shop and Engine Manufacturing section. The Volkswagen
family in South Africa encompasses over 120 suppliers and a national network of 122
franchised dealerships. In 1992 VWSA won an order to export 12 500 left-hand-drive
Jettas to China and was awarded in 1998 an ongoing export contract of 30 00 Golf 4’s
to the European market. In 2002 it was one of the largest car manufacturers on the
African continent, building 77 000 vehicles for the South African and overseas markets,
and had an overall passenger vehicle market share in South Africa of 22%.
On 17 March 2003, the 2 millionth car produced by VWSA left the Uitenhage factory.
VWSA has a turnover of about 10 billion Rands a year and has been accredited with the
ISO 90013, VDA 6.14 and ISO 140005 quality and environmental management systems.
VWSA has a history of supporting human rights during the apartheid era and in the
1970’s was one of the first South African companies to recognize a black trade union.
In 1980 it had its first full-time shopstewards and soon after this was among the first
companies to train black artisans. Since that time the company has pursued a proactive
corporate social responsibility agenda. In 1989 the VW Community Trust was
established to focus on education, the youth, business development, and the upliftment
of women in the surrounding region. The Uitenhage Self-employment Centre was
3
International Quality Management standard. (ISO means International Organization for
Industrialization).
4 German Quality Management Standard to the automotive industry. (VDA means Verband der
Autmomobliindustrie).
5 International Environmental Management standard.
15
established as an independent entity in 1997 after Volkswagen started it as a preemployment center three years before. It provides technical skills development
programmes and supports the development of small, medium and micro-enterprises.
In September 2002 the Uitenhage Despatch Development Initiative (UDDI), previously
known as the Uitenhage Job Creation project, was launched to stimulate new business
startups and encourage labour intensive projects. VWSA, the East Cape Development
Corporation, and the Nelson Mandela Metropolitan Municipality each contribute equal
amounts of seed capital. The objective is to reduce unemployment and create longterm economic growth in line with government policies and strategies. The first projects
identified are the Innovation Campus, the Automotive Cluster, Urban Renewal, and
Skills Development.
This agenda of social responsibility has been in part a response to the economic and
social imperatives in the Eastern Cape province. The Eastern Cape is the poorest of
the nine provinces in South Africa in terms of average monthly expenditure. It covers
13.9% of the total surface area of South Africa, has 14.4% of the total population, and
generates 7.6% of the total GDP. The unemployment rate (broad definition) among
people between 15-65 years of age stands at 54.6%, the highest rate of all nine
provinces.
In the context of the HIV/AIDS situation in South Africa, Mr. Han-Christian Maergner,
the Managing Director of VWSA, says VWSA has “a special and broad understanding of
social responsibility”. It is an understanding that goes beyond the relationship between
management and labour as manifest in the Global Council. It goes beyond the
relationship between the company and the surrounding communities and the region. “It
is important to also take the country along with us. We have to look beyond business
activities. We are dealing with an epidemic that affects all aspects of human life. We
must have a broader view”. Until recently the problem had not received the required
attention at a political level. Time had been lost, “but we now have a common
understanding in the country. It is the responsibility of all stakeholders to now address
the problem in the right manner, with the requisite seriousness,” he said. VWSA had
launched its comprehensive HIV/AIDS project because fundamental things needed to
be done and the epidemic had to be addressed in a professional manner, he added.
VWSA’s broad understanding of social responsibility is also manifested through its
active participation in the Partnership on Cooperative Development between South
Africa and Germany. This partnership, which involves business enterprises, faith-based
organizations and other civil society organizations; compliments the South Africa –
German Binational Commission established by the governments of the two countries.
Amongst other objectives, the Partnership on Cooperative Development mobilizes
resources and supports HIV/AIDS projects focused on orphaned and vulnerable
children.
16
The HIV/AIDS challenge in South Africa
The numbers of South Africans estimated to be infected with HIV (4.7 million) and the
numbers estimated to be at an advanced stage of AIDS (400,000) 6 “represents a
fundamental crisis for the country”7.
The South African government reports that the prevalence of HIV/AIDS as estimated
from public antenatal clinics showed an increase from 0.7% in 1990 to 26.5% in 2002.
The HIV prevalence rates, however, seem to have been stabilizing between 1999 and
2002. The overall prevalence rates are reported as being 22.4% in 1999, 24.5% in
2000 and 24.8% in 2001.8 This stabilization, which is disputed9, is primarily attributed to
declining prevalence in the 15-24 age group due to increased abstinence and condom
use.
Despite the evidence of the impact and successful outcomes of some aspects of the
government’s HIV/AIDS strategic plan, the responses of both the political leadership
and the business sector in South Africa have been criticized as being slow, fragmented
and largely ineffective. “In South Africa the coherence and effectiveness of official state
anti-AIDS programmes have been undermined by the highly public articulations of
AIDS-denialist positions by President Thabo Mbeki and Health Minister Manto
Tshabalala-Msimang. At the core of this position is a denial of the viral causation of
AIDS, as well as of the extent of the infection and the efficacy and safety of antiretroviral therapy.”10
In addition to this, the late and limited responses of other sectors of society to the crisis
have been criticized. “Despite a clear economic case for intervention, business has
largely failed to take a lead in this crisis. According to the South African Business
Coalition on HIV/AIDS, the majority of companies have yet to assess the risk within their
own workforces, let alone begin to mount a response to this risk”. 11 The leadership
exercised by organized labour on the issue of HIV/AIDS has also been criticized for
being patchy and sporadic. In addition, for the labour movement, AIDS has for a long
time competed as a political priority with issues such issues as housing, unemployment,
poverty and violence.12 More generally within society, a major stumbling blocking to
effectively addressing the HIV/AIDS is the stigma attached to HIV positive status and
the perceived or possible consequences of public disclosure.13
6
Policy Co-ordination and Advisory Services (2003) Towards a Ten Year Review: Synthesis report on
implementation of Government Programmes. Pretoria, South Africa: Government Communication and
Information System. Page 22-23.
7 Mbali, Mandisa (2003) “HIV/AIDS policy making in post-apartheid South Africa” in State of the Nation:
South Africa 2003-2004 (eds) John Daniel, Adam Habib and Roger Southall. Cape Town: Human
Science Research Council Press.
8 Policy Co-ordination and Advisory Services ibid. pp22
9 See “Academics cast doubt on new AIDS survey” Business Day, Tuesday 21 October 2003 pp3.
10 Mbali ibid. pp318
11 Dickinson, David (2003) “Managing HIV/AIDS in the South African Workplace: Just Another Duty?”
South African Journal of Economic and Management Sciences Vol. 6 No. 1 pp25.
12 See Grawitzky, Renee (2002) “HIV/AIDS in the workplace: Whose responsibility is it?” South African
Labour Bulletin Vol. 26 No.1 February 2002 pp 72-74 and Betton, John (2002) “HIV/AIDS and corporate
responsibility?” South African Labour Bulletin Vol. 26 No. 2 April 2002 pp 68-71.
13 Grawitzky, Renee (2002) “Is it safe for people to talk out about HIV/AIDS?” South African Labour
Bulletin Vol. 26 No.2 April 2002. pp 72-73.
17
At a macro level, for both managers of South African motor manufacturing facilities and
overseas investment analysts of the global motor industry, the relatively high infection
and prevalence rates in South Africa are seen as posing a serious threat to the human
resource base of the South African motor industry and its ability to compete effectively.
The primary concern is that direct and indirect costs will escalate, and the ability to meet
global sourcing requirements will be negatively affected (see Annex 2 for a cost impact
study, and Annex 3 for a study of costs that VWSA will incur in the future). In addition,
“among the many implications of HIV/AIDS for the motor business in South Africa is that
the pandemic might aggravate the social and economic problems caused by the
increasing pace of automation in vehicle and component manufacturing.” 14
From about 1999, a number of large corporations in South Africa, particularly in the
mining and motor manufacturing industries, took the lead and began implementing
comprehensive HIV/AIDS programmes that replaced prior more ad hoc interventions.
Chronology of the VWSA response
Beginning in 1997, VWSA started conducting regular HIV/AIDS awareness and
prevention education campaigns at the Uitenhage plant. In October 2001 a Task Force
consisting of representatives from the National Union of Metalworkers of South Africa
(NUMSA), VWSA’s human resource and medical staff and GTZ was established to
agree on ways of enhancing the HIV/AIDS education and awareness program. In
January 2002 Mr. Maergner announced that there would be a new HIV/AIDS project
launched in the plant “to tackle this major threat to our people and our business,” and
that a partnership agreement had been signed with GTZ in this regard.
On 06 February 2002 VWAG and the Volkswagen Global Group Works Council sign the
“Declaration on Social Rights and Industrial Relations” committing the entire company
and its employees to social rights and corporate policies that couple globalization with
social responsibility. Premised upon the pertinent ILO conventions, the declaration
makes a particular social commitment to the security and development of jobs.
On 23 July 2002 a comprehensive HIV/AIDS prevention and management programme
is launched as a partnership with GTZ. The objective of the partnership is to create
awareness, plan interventions and contain associated costs. The launch was a high
profile event involving the President of NUMSA and the Managing Director of the
company. All workers were given one hour off from work to participate in the event and
the music concert. Speaking at the launch, Mr. Maergner said, “the devastating impact
of HIV/AIDS is rolling back decades of development progress in Africa and is impacting
on every element of our society – from teachers, to farmers, to workers, to managers –
all of us are under attack from AIDS. As more and more people become sick, there will
be pressure on families, the workplace, the community and our country’s economy.”
On 29 July 2002, the company commenced with the prevalence testing of its workforce.
This snapshot of the problem was used to inform the company’s HIV/AIDS strategy, the
restructuring of employee benefits, and human resource planning.
Bruton,
Neil
(2003)
“AIDS
(http://www.autocluster.co.za/id203.htm).
14
and
18
the
South
African
Motor
Industry”
In November 2002, the Corporate Research Foundation rates VWSA as one of the best
companies to work for in South Africa as well as one of South Africa’s top companies in
an independent survey. The assessment takes into account the core values of
companies, and their competitiveness and potential to take the country into the future.
VWSA is given an excellent rating for its flexibility and innovation, quality of
management and international orientation. It also receives high marks for human
resource priorities and growth of markets. The citation states “VWSA has transformed
itself through an often painful process into a world-class supplier of high-tech vehicles
and components. The biggest challenge facing the company is that it is a ‘low-volume’
manufacturer in global terms. It has to justify its existence in the face of worldwide overcapacity, perceptions of labour volatility, crime, HIV/AIDS, regional unemployment,
currency fluctuations and problems elsewhere in Africa.”
December 2002, VWSA announces a planned investment of 2.1 billion Rands (US$
300 millions) in plant infrastructure, product upgrades and improved facilities at it
Uitenhage plant over the next six years, which is seen as vote of confidence in the
country.
As a result of negotiations with the trade unions, as of January 2003, all VWSA
employees and their dependents have sufficient medical coverage for anti-retroviral
treatment for the year as a result of the topping up by the company of the medical
scheme run by the UDIPA.
In March 2003, to commemorate the production of the 2 millionth car, VWSA announces
a 2 million Rand donation to community projects. One million Rands (US$ 140, 000) for
the Volkswagen Trust with the balance to go to job creation projects and to support
community initiatives around the HIV/AIDS pandemic in Uitenhage and surrounding
areas.
In June 2003, the Task Force makes the decision to train a small number of volunteer
employees and peer educators as “story tellers” to encourage more employees to
participate in the voluntary counseling and testing programme.
Main features of the VWSA HIV/AIDS programme
The HIV/AIDS policy of the company states as a premise that “HIV/AIDS-related
absenteeism, loss of productivity and the cost of replacing workers lost to AIDS pose
serious threats to VWSA in an increasingly competitive world market.” The policy
defines how the company will respond to the HIV/AID epidemic in the areas of
information, prevention, care and support while protecting the rights of employees. The
three general principles of the policy are equity (protection against unfair discrimination),
confidentiality (in order to encourage employees to know their status), and rights and
responsibilities.
The policy statement is comprehensive in its scope. For this reason it is acknowledged
in the 2003 edition of The South African Automotive Yearbook whose editors quote from
the policy and state: “The full VWSA policy statement is reproduced in the Yearbook’s
database as a comprehensive briefing on the disease, its implications for automotive
19
companies, and the measures that need to be taken to help both employees’ and
corporate interests.”15
The HIV/AIDS policy was developed after extensive consultation within the company
(encompassing the occupational health staff, the social workers responsible for the
Employee Assistance Programme and the benefits section of the Human Resource
Department) and with NUMSA at the plant. The policy was subsequently also given to
both the local and national offices NUMSA for comment and amendments. The policy
has the complete support of the local and national offices of NUMSA and meets the
standards for exclusivity and the full participation of all stakeholders in the HIV/AIDS
policy and programme as set out in the NEDLAC Code of Good Practice on Key
Aspects of HIV/AIDS and Employment16.
A peer education system was established in early 2002 to enhance the understanding
of HIV/AIDS issues within all parts of the company, to alter risk behavior among
employees and encourage the workforce to participate in the prevalence testing. A total
of 93 peer educators, who were nominated by their fellow workers, were trained and at
the time of the case study 74 peer educators were still active. According to the Peer
Educator Coordinator, Ms Cynthia Muthasamy, this reduction can be attributed to
natural attrition.
A voluntary unlinked HIV prevalence survey stratified by job band was then conducted
among the work force.
The survey included thorough Knowledge, Attitude,
Practice/Behavior (KAP/B) profiling, and an impact assessment. The management
board and shop stewards were tested first and the photographs of their being tested
were put up on notice boards in the plant. Over 70% of the entire workforce was tested
during the week of the survey, with shop stewards and peer educators encouraging
participation. An average prevalence rate of 6% was found which translated to an
estimate of about 300 employees infected with HIV. This compares with an estimated
prevalence projection of 25% for the Eastern Cape Province.
The HIV prevalence levels found at VSWA by race, sex, age, job band and behavioral
variables were consistent with data from other workplace studies in the Eastern Cape.
HIV prevalence cut across all racial groups but race was a powerful predictor of HIV
status. In the predominantly male workforce, men were found to be at risk until they
reached the age 60 years old. HIV prevalence was established across all job bands
and correlated with the level of skill, with the relatively unskilled bands having the
highest levels. There was a high incidence of sexually transmitted infections, condom
usage was relatively low, and the numbers of people with non-regular sex partners was
“AIDS and Your Business: Tackling the South African Motor Industry’s Biggest Human Resource
Challenge” (http://www.autocluster.co.za/id205.htm).
16 The National Economic Development and Labour Council (NEDLAC) is the primary formal institution in
South Africa for social dialogue between organised business, government, labour and organised
community groupings on issues of social and economic policy. The Code of Good Practice on Key
Aspects of HIV/AIDS and Employment can be found at
http://www.nedlac.org.za/docs/agreements/main.html Nedlac has been the stage for disputes between
HIV/AIDS advocacy groups like the Treatment Action Campaign (TAC) and government over a national
treatment plan.
15
20
relatively high. Stigma was obvious still a major problem as about 300 employees were
HIV positive but very few had disclosed their status.17
A cost-benefit analysis focused on HIV incidence rather than prevalence was conducted
in order to discount the future costs of HIV/AIDS and account for the time value of
money.18 It was projected that preventing all new infections in the year 2004 would
save the company R5.7 million (about US$ 800, 000) – see Annexes 2 and 3. The
projections in the cost-benefit analysis were a major factor in the remodeling of
employee benefits.
The survey, profiling and impact assessment were then used to develop a
comprehensive health care strategy to ensure that all employees had access to quality
and effective health care services both within and outside the company. This was
accompanied by a communication strategy which focused on ‘prevention through
condoms and safe sex’, ‘voluntary counseling and testing’, ‘sexually transmitted
diseases’, ‘tuberculosis’, and ‘living with HIV’.
The peer educators, who work with groups of up to 20 people, normally conduct their
sessions during lunchtimes and during pre-shift team talks. They are required to
provide regular, standardized feedback. One of peer educators interviewed, Mr. Victor
Burton, said the most frequently asked questions were about the effectiveness of the
available drug treatments, the increases in the cost and adequacy of medical aid
coverage, and the confidentiality of HIV testing.
This peer education system was supplemented by the pilot testing and deployment of
trained “story tellers”, who worked with smaller groups of workers (8 to 9 people in each
group) and told customized and realistic but fictional stories about HIV/AIDS. These
stories, which are illustrated with faceless cut out figures, have story lines about the
sexual relations between various characters, and build up the suspense to a common
climatic ending – death from AIDS. The purpose of the narratives is to personalize the
issue of HIV/AIDS, focus on what constitutes responsible behavior, highlight the value
of knowing your HIV status, and encourage participation in the voluntary counseling and
testing (VCT) programme.
The HIV/AIDS communication strategy at VWSA revolves around the centrality of the
VCT programme. After the successful prevalence survey, VWSA made the decision
that the key purpose of the survey from a communication standpoint was to highlight the
fact that HIV/AIDS was a strategic business issue that affected the entire company and
all ranks of employees. Therefore the breakdown of the distribution of infection within
various units within the company was not communicated. The objective was to make
enrollment in the VCT programme rather than participation in the prevalence survey the
“defining moment” in the HIV/AIDS campaign.
Mr. Isgaak Sookdin, one of the 13 storytellers at VWSA, said that after the group story
telling sessions, individuals seeking support for their decisions to get tested normally
approach him in private. He said that as a result of the “magic” of storytelling, the
numbers of people going to the Medical Centre for VCT had increased from a handful of
These key findings of the prevalence survey are outlined in “VWSA HIV/AIDS Program: Information
Education and Communication Program 2003.”
18 See the model of the impact of HIV/AIDS on productivity and costs at VWSA in Annex 2.
17
21
people to more than 35 people per month. The VCT monitoring data at the Medical
Centre confirmed this. They show an increase in the number of tests conducted from
an average of 19 tests a month in April, May and June 2003 to 66 tests done in July
2003. The peer educators ascribe the jump in the numbers of workers participating in
VCT to the impact of the storytellers. According to Dr Govender, the systematic
implementation of the entire HIV/AIDS workplace programme had contributed to the
success of VCT. He indicated that 296 tests were conducted in October 2003.
Company brochures on the VCT programme encourage employees to ask a friend or
peer educator to accompany them when going to make appointments for pre-test
counseling. Mr. Sookdin said that because of his role as a storyteller he often physically
accompanied fellow workers to the Medical Centre to enroll in the VCT programme. In
recognition of the success of the technique, the impact of storytellers was the lead
article in the July/August 2003 edition of the bi-monthly in-house newsletter produced by
VWSA.19
Beyond the plant itself, the Volkswagen Community Trust was used to initiate
awareness and care programmes for people living with HIV in the broader Uitenhage
community. This had been an on-going programme for a number of years. Current
programmes include, the conducting of a situation analysis in the Nelson Mandela
Metropole and the establishment of a coordination forum for non-governmental
organizations working with AIDS orphans. The latter programme is a collaboration
between the VWSA workplace programme, the Volkswagen Community Trust and the
Global Group Works Council. Children living in the streets and children orphaned by
HIV benefit from the Än Hour for the Future”fund raising campaign initiated by the
Global Group Works Council. The Community Trust also plans to conduct an
awareness and peer educator campaign in four primary schools in collaboration with
local government.
VWSA is also concerned about the impact of HIV/AIDS on its supply chain. It is
therefore making its HIV/AIDS program framework and content available to its suppliers
and advising them on how they can manage the impact of the epidemic.
Key Actors in the VWSA HIV/AIDS Programme
The HIV/AIDS programme is run by the staff of the Medical Centre at the plant in
Uitenhage led by Dr Álex Govender, the Health and Safety Manager who reports to the
Employee Services Manager. The staff who are directly responsible for the programme
are the HIV/AIDS coordinator, the two social workers who work in the Employee
Assistance Programme – one of whom is the Peer Educator Coordinator, and the five
nurses who are also trained counselors. They manage a programme that has four main
components: information and education, comprehensive health care, risk management,
and community involvement. Voluntary Counseling and Testing is a cross cutting
concern that runs through the first three components.
Another key actor at VWSA is the National Union of Metalworkers of South Africa
(NUMSA) that represents the majority of the workers at the plant. NUMSA is the
19
“Stories trigger fresh approach to HIV/AIDS” in Masibambane July/August 2003 Vol.1 Issue 2
22
second biggest trade union in the country. Nationally NUMSA represents workers in the
car manufacturing, components manufacturing, tire and rubber sector, small garages
and engineering sectors. What this has meant for VWSA is that its key internal
stakeholder, through its national leadership, brings to bear at the Uitenhage plant
experiences with HIV/AIDS workplace programmes and concepts of best practice from
other car manufacturers in South Africa. Some of these car manufacturers in South
Africa launched HIV/AIDS workplace programmes before VWSA.
As part of a long-standing albeit sporadic campaign against HIV/AIDS, Congress of
South African Trade Unions (COSATU) issued a Declaration on HIV/AIDS after its
special congress in August 1999. The declaration resolves among other things that: (1)
COSATU will fight to ensure that the minimum benefits under the Medical Schemes Act
provide affordable and effective treatment benefits for people with HIV/AIDS; and (2) As
part of fighting the silence of those who are living with HIV/AIDS, COSATU will
encourage its leadership and membership to voluntarily take HIV/AIDS tests and break
the silence.20 In addition to this stance on benefits and breaking the silence, COSATU’s
comprehensive guide for shop stewards states “The most important thing the union can
do to support a member with HIV infection is to help the worker remain at work. Staying
at work means that workers keep their pride, dignity and health-care benefits. Workers
with HIV infection or AIDS should be assisted to do their jobs as long as they are able.
The union must help them by protecting their benefits and protecting them from
discrimination.”21
These particular issues were confronted by VWSA management and NUMSA early on
in the programme when decisions had to be made concerning a union member whose
HIV positive status had become public knowledge and who eventually accumulated an
excessive absenteeism record because of full blown AIDS.22 The NUMSA shop
stewards said the disagreement about how to handle this particular case showed that
the company’s absence policy had not been updated and aligned to accommodate the
HIV/AIDS policy. They indicated that the issue of an AIDS specific incapacity policy
was being taken up in negotiations with VWSA. Mr. Richard Kasika, the Industrial
Relations Manager at VWSA, said HIV/AIDS was treated like any other chronic illness.
The VWSA Policy Statement on HIV/AIDS in the Workplace states that: “HIV/AIDS
status alone shall not be a reason for dismissal of an employee nor for refusing to
conclude, continue or renew an employment contract. However, the symptoms and
effects of AIDS may eventually be such that the employee may be unable o continue
with his/her normal duties. Under these circumstances the employee is required to
seek medical advice and to request Human Resources to inform him/her of the
procedures for sick leave entitlements, disability application, incapacity procedures and
the Aids for AIDS program as appropriate.” Mr. Kasika said that beyond these
procedures, on a case-by-case basis additional accommodation for employees who
knew their status was possible. This had happened with respect to the case highlighted
“Declaration on HIV/AIDS” Adopted by COSATU Special Congress, 20 August 1999.
(http://www.cosatu.org.za/congress/cong99/dec-hiv.htm)
21
“COSATU
Campaign
Against
HIV/AIDS:
A
Guide
for
Shopstewards”
(http://www.cosatu.org.za/docs/2000/hivbook.htm)
22 Interview with VWSA Numsa shop stewards Xola Blouw, Mthunzi Tom and Bongani Nkosana, 19 th
September 2003. The shop stewards interviewed represented the new generation of younger
shopstewards who came into office in 2000 after an illegal strike and the dismissal of a substantial
number of workers.
20
23
by the NUMSA shop stewards. Both the management of VWSA and the supervisor of
the employee had made a number of adjustments to accommodate the employee until a
point was reached when she was no longer able to be fully productive.
The only other area of divergence between NUMSA and VWSA was about the
outsourcing of disease management by the company and thus the non-provision of
antiretroviral treatment by the company at the Medical Centre. The shop stewards
interviewed said, “There should be provision of drug treatment by all establishments at
the workplace.” This would be a sign of a “comprehensive and genuine commitment”.
They said the company’s position was that treatment was covered by the Aid for AIDS
programme23 or other AIDS specific benefits offered by other medical schemes. The
issue is related to the question of who funds and provides continued treatment after an
employee leaves the employment of the company that supplied his/her anti-retroviral
drugs, if treatment is not freely and widely available in the public sector.
Apart from these two specific issues where there was disagreement, the shop stewards
said that the union and management were on “common ground” on the issue of
HIV/AIDS and “we are satisfied with the fact that the Advisory Committee drives all
aspects of the HIV/AIDS program.”
Stakeholders roles and partnerships in the HIV/AIDS programme
When compared to other workplaces in South Africa, a distinctive feature of the
implementation of the HIV/AIDS programme at VWSA is the fact that it is being
implemented in the context of a public-private partnership between the private doctors
in Uitenhage and the provincial Department of Health. This partnership preceded the
launch of the comprehensive programme at VWSA and the HIV/AIDS related
modifications to the medical schemes of employees. This partnership in the public
health sector, a backdrop to the HIV/AIDS programme at VWSA, benefits the lower paid
workers at VWSA most – the workers most disadvantaged by the lack of an
antiretroviral treatment programme in the public sector.
Partly as a result of the re-prioritization in public health expenditures that occurred in the
early 1990’s, the services provided by many public hospitals in the Eastern Cape
deteriorated and many doctors left the public service. Fee-paying insured patients also
shifted to private hospitals, which proliferated and thrived. At the same time, a group of
local doctors in Uitenhage established the Uitenhage and Despatch Independent
Practitioners Association (UDIPA) and negotiated a public-private partnership with the
department of health. UDIPA consists of 45 members representing the majority of the
medical practitioners in private practice in Uitenhage. In exchange for renovating an
unutilized ward at the Uitenhage Provincial Hospital, UDIPA negotiated an agreement
with the department that allowed them to see their private patients at the Uitenhage
Provincial Hospital and at nearby government clinics.
23
Aid for AIDS is a disease management programme available to beneficiaries and employees of
contracted medical funds and companies Africa who are living with HIV or AIDS. Although the majority of
patients have been funded by medical schemes, an increasing number are uninsured, and are being
funded directly by their employer. See Cowlin, R. G. et al (2003) “Counting the cost of care: Do HIV/AIDS
disease management programmes deliver?” in AIDS Management Report Vol.1 No.3 pp20-23.
24
UDIPA, which functions as a managed care association, also developed a health plan
under which contributors would pay a fixed monthly fee for comprehensive health care.
The cost of the premiums under this plan were 30% lower than alternative plans
available at VWSA and 60% of the workers at VWSA joined this plan. The contributors
who gained the most from the plan were lower-paid workers, who benefited from the
introduction of a more affordable, preventative and intermediate level of care from local
doctors with whom they had long standing personal relationships.24 According to Mr.
Johann Rautenbach, the Employee Services Manager at VWSA, a critical factor in
ensuring the cost effectiveness of benefits provision has been the galvanizing of medial
practitioners in Uitenhage and the provision of training in HIV/AIDS treatment protocols.
UDIPA’s HIV/AIDS benefit, initiated in February 2003, is comprehensive package that
encompasses testing and counseling, nutritional supplements, a baseline investigation
of patient circumstances, and for patients on anti-retroviral drugs – monitoring of
adherence and toxicity, and checking on social support systems. According to the
Chairman of UDIPA, Dr L.M Naidoo, who is also one of the four UDIPA doctors who
specializes in the treatment of HIV/AIDS patients, the doctors use the guidelines of the
International Association of Physicians Against HIV/AIDS and apply a Holistic HIV Care
Model. This model requires: specialized, private and discrete infrastructure (the Life
Centre), dedicated personnel and laboratory resources, outcome analysis, sustainability
(for as long as the patient lives) and integration (company, family and community).
For the VWSA employees who contribute to the UDIPA health plan, the disease
management process that they go through often starts at the Medical Centre with VCT,
is followed by referral to their off site UDIPA doctor, and culminates with the provision of
support at the Life Centre. Dr Naidoo said “the trajectory of the process and the
provision of treatment at an arms length from the company ensures confidentiality and
integration in the community.” As of June 2003 there were 36 HIV positive patients
registered with the Life Centre. An additional benefit of the Life Centre facility, which is
staffed by a full time counselor, is that it is used on Monday afternoons by local AIDS
support groups - the National Association of People Living with Aids (NAPWA) and the
AIDS Training, Information and Counseling Centre (ATICC).
With respect to treatment, UDIPA provides each patient with a R20, 000 benefit per
year and anti-retroviral treatment costs R1, 300 per month (R15, 600 per year). This is
consistent with the findings of Aid for AIDS at the national level that “medicine is by far
the biggest cost center in HIV/AIDS treatment. In patients on Highly Active Antiretroviral
Therapy (HAART), medicines account for 70% of total treatment costs. One of the
biggest HIV related challenges facing medical schemes is to ensure that HIV positive
beneficiaries enroll on their disease management programmes early enough to
commence Antiretroviral Therapy (ART) at the optimal time. To date, 44% of Aid for
AIDS patients have enrolled later than minimum guidelines for commencement of ART,
defined as CD4 count  200 cells/L.”25 Given this, the contention that South African
companies can earn positive returns on their investments if they provide HAART at no
See “Successful Public/Private health Partnerships: The Uitenhage Experience” in The Equity Project
Case Study Series Issue 1 of 1999. http://www.equityproject.co.za/pdf/CASE1a.pdf
25 Cowlin, R. G. et al (2003) “Counting the cost of care: Do HIV/AIDS disease management programmes
deliver?” in AIDS Management Report Vol.1 No.3 pp22.
24
25
cost to employees26 is credible depending upon the profiles of the companies and the
applicability of the assumptions in the mathematical model.
Another distinctive and critical feature of the implementation of the HIV/AIDS
programme at VWSA is the partnership between VWSA and the German Agency for
Technical Cooperation (GTZ) under the auspices of the Public Private Partnership
(PPP) Programme of the German Federal Ministry for Economic Cooperation and
development. The PPP programme is directed at those areas where the objectives of
private business enterprises (beyond their core business activities) and development
policy goals of the Federal Ministry broadly overlap. In general GTZ acts as an advisor,
intermediary, project manager and specialist, all in one.
The specific agreement between VWSA and GTZ envisages a “role-model project that
will give a clear public statement about the seriousness of the epidemic in South Africa.
It combines in this sense a double advocacy role for the industry and as well for public
policy to accept leadership for further prevention and care efforts to finally curb the
epidemic in South Africa.”27
The project partnership agreement between VWSA and GTZ covers the workplace
policy on HIV and AIDS, and three programmatic priority areas:
(1) Integrated Health Care (improvement of existing health services including
Sexually Transmitted Diseases [STDs] and Tuberculosis Services);
(2) Human Resource and Benefit Schemes (re-organization of employee benefit
schemes) and the structuring of programs to minimize the effects of
absenteeism, labour turnover and reduced productivity; and
(3) HIV/AIDS awareness and education (Information, Education and
Communication campaigns/health promotion).
The programme also includes a community strategy. In terms of the agreement, GTZ
contributes technical expertise to develop a conceptual framework for the development
and implementation of the project, assures quality control of the technical input, and
provides technical advice to the VWSA HIV/AIDS task force.
The overall project goal is to reduce the further spread of HIV infection and other
sexually transmitted diseases among the workforce of VWSA and their families and to
effectively manage the impact of HIV/AIDS on VWSA.
The planned results of the project agreement are:
(1) Increase effectiveness of VWSA health services related to HIV/AIDS prevention
and care.
(2) Ensure adequate and cost-effective benefit schemes and other programmes in
order to meet employee’s needs in the HIV prevalent environment while
minimizing the cost of HIV/AIDS impact on VWSA as a company (including
absenteeism, labour turnover and reduced productivity).
(3) Increase information, education and communication about HIV/AIDS and the
new services at VWSA among all employees in order to decrease the stigma
attached to the disease, and increase preventive and care seeking behavior.
26
27
Rosen S. et al (2003) “AIDS is your Business” Harvard Business Review February 2003.
The VWSA HIV/AIDS Project. A Public Private Partnership with the GTZ (PN 98.4203.0-103.13)
26
In addition to these partnerships, through the VW Community Trust, VWSA is a
participant in and contributes to HIV/AIDS programmes in the broader community. In
addition, Mr. Welile Moss, the manager of the Community Trust, is part of the Aids
Council of the Nelson Mandela Metropole.
Key Impacts and Outcomes
In terms of the project agreement between VWSA and GTZ, an overall evaluation of
HIV/AIDS Workplace Programme is scheduled for September 2004. The impacts and
outcomes of the project at the time of the case study are indicated in monthly monitoring
data.
Total number of
Employees
Visits to Medical Centre per month
Tests done (VCT programme)
Disclosures to company
Male condoms distributed
Female condoms distributed
Active peer educators
Informal sessions held by peer
educators
Formal sessions held by peer
educators
Feedback forms received from peer
educators
Active story tellers
Sessions held by story tellers
Employees reached by story tellers
Feb
Mar
Apr
May
Jun
Jul
5046
5030
5018
5009
4974
4967
6463
8689
8127
8646
9395
9399
1
4
20
20
16
60
3
6
0
2
0
1
22300 17300 19200 15800 16100 14600
48
96
52
44
10
48
91
80
78
78
74
77
6
13
20
15
11
15
4
39
5
9
14
5
10
52
25
24
14
20
----
----
----
6
---
6
13
85
4
8
79
The use of the story telling mechanism was not part of the original Information,
Education and Communication and proved to be a vital trigger in the VCT programme.
The HIV/AIDS Coordinator, peer educators and story tellers at VWSA were unanimous
in their contention that the story telling technique was successful in encouraging people
to going for HIV testing. This they attributed to the fact that it simplified a complex
message, encouraged rational consideration of risky behavior, and “triggers people on
an emotional level to take responsibility for their own behavior.”28 Matt Gennrich, the
General Manager of the Communications Division, attributed the success of the
storytellers to the fact that they were more personal and interactive in their
communication, and worked in smaller groups.
They had been successful in
overcoming a key problem in any communication situation, “getting people to want to
pay attention to the communication,” he said. These explanations for the efficacy of
story telling in getting people to know their HIV status – an existential turning point, are
plausible but should be further researched.
The uptake of male condoms increased from an average of 4,000 a month, when
condoms were only available at the Medical Centre, to an average of 17,550 per month
28
“Stories trigger fresh approach to HIV/AIDS” in Masibambane July/August 2003 Vol.1 Issue 2
27
(first half of 2003) after the programme had been running for a year and condoms had
been made available from 40 dispensers in the plant.
A number of different factors, both within VWSA and within the broader community,
could be driving and sustaining the relatively high uptake levels of condoms. The Peer
Educator Coordinator at VWSA, Ms. Cynthia Muthasamy, who is also a social worker
noted that the increased visibility of deaths in the community and the impact of
HIV/AIDS campaigns run by faith-based organizations needed to be taken into account.
The question of the impact of VWSA’s workplace programme on the broader community
raises the associated question of the extent to which the HIV/AIDS activities of the VW
Community Trust compliment the workplace programme beyond targeting different
beneficiaries. In addition to the project that assists children orphaned by AIDS, the
workplace programme and the Community Trust collaborate on the provision of training
on disease management to local medical practitioners. Other opportunities for joint
projects may exist. The VWSA shop stewards said it was difficult to decide which
“structure” was the most appropriate vehicle for HIV/AIDS interventions in the
community – the workplace programme or the Community Trust. Because a relatively
young and new crop of shop stewards are a proxy for ‘community representation’ in the
workplace programme, what appears to be at issue is standing in the community and
legitimacy rather than efficiency.
It is clear from the relatively small numbers of disclosures to the VWSA programme that
stigma is still a big problem within the company and in the country generally. Other
research evidence in South Africa29 supports the conclusion that: “People with HIV face
repeated episodes of disclosure roulette, risking stigma by disclosing their disease or
the loss of potential social support by failing to disclose.”30 At VWSA this is despite the
company’s strong message of solidarity that is depicted in the logo of HIV/AIDS
Workplace Programme (four hands clasped at the wrist) and reiterated in the slogan of
the programme - “Working together, stronger forever.” It is also despite the social
support networks available through the UDIPA Life Centre.
It does, however, underline the fact that a HIV/AIDS support group at VWSA has not yet
been established. This establishment of the support group may be given impetus by the
increase in the numbers of employees coming forward to participate in the VCT
programme. The complex of variables hampering the establishment of a support group
could be surfaced by the implementation of the GIPA (Greater involvement of people
living with or affected by HIV/AIDS) Workplace Model.31
Varga, C. (2003) “HIV disclosure dynamics among women attending PMTCT services in
Johannesburg, South Africa” a paper presented at the SA AIDS Conference 2003 (http://www.saaidsconference.com)
30 Rebecca Cline and Nelya Mckenzie (2000) “Dilemmas of Disclosure in the Age of HIV/AIDS: Balancing
Privacy and Protection in the Health Care Context” in Balancing the secrets of private disclosures (ed)
Sandra Petronio. Mahwah, N.J.: Lawrence Erlbaum Associates.
31 UNAIDS (2002) The faces, voices and skills behind the GIPA Workplace Model in South Africa.
UNAIDS Best Practice Collection. Joint United Nations Programme on HIV/AIDS. Geneva: Switzerland.
29
28
Fourth Part
Conclusions: Perspectives and new challenges
Even after being awarded and recognized for its strategies to face Aids, Volkswagen,
together with companies and governments all over the planet, still has many challenges
to face. In the area of Aids prevention, the company is now facing an international
dilemma: what to do to reduce prejudice and demonstrate the possibility of a normal life
for those infected with HIV without decreasing individual efforts to prevent the disease?
The combination of medicines developed in the end of the 1990s substantially improved
the quality of life of Aids patients but this should not result in relaxation in the use of
condoms and disposable syringes and the consequent increase in the number of HIV
infected people.
A debate about the real causes of Aids, led by South Africa’s president Thabo Mbeki,
shed uncertainty on everything currently known about the disease. Information is one of
the most important weapons in the struggle to block HIV’s progression. Opinions like
those of the president of South Africa, suggesting that poverty is one of the causes of
immunodeficiency, generate confusion and may result in skepticism in regard to the
relevance of proven methods of Aids prevention. One has to be able to deal with what
people hear about the epidemics and to help them separate facts from suppositions.
In November 2003, BBC reported that a survey carried
out on its behalf in fifteen countries showed that significant
portions of many countries’ populations do not believe
Aids and HIV may cause death. Brazil showed one of the
highest levels of ignorance about the consequences of
Aids, despite the 8.4 thousand deaths caused by Aids in
the country in 2001, according to data released by the
United Nations.
Aids is not a life-threat to:
Brazil 61%
Nigeria 58%
Indonesia 41%
Bangladesh 12%
Lebanon 36%
Ukraine 34%
South Africa 34%
Mexico 31%
Russia 25%
China 22%
India 15%
Trinidad 15%
Tanzania 10%
Great-Britain 9%
USA 2%
In Mexico, 31% of those interviewed said they did not
believe the disease could be deadly while, in the United
States, this figure reached only 2%. Although the Brazilian
program to prevent and fight Aids was considered a model
for the world by UN, there is still a lot of confusion
regarding the way HIV is transmitted. The sharing of personal use objects such as
clothes, towels and cups does not cause virus transmission. Nonetheless, one out of
four Brazilian interviewees believes he may contract the disease sharing such items
with an infected person. Findings like these surprised the Brazilian government. They
show that it is important that companies divulge their experiences and help
governments fight Aids in all corners of the country and not only within their plants or in
the communities they share. Despite their relevance, projects developed by companies
reach only a small portion of the countries’ populations. Challenges - such as
evaluating successful examples, understanding the strategies applied, looking for
adequacy and reaching beyond limits in order to offer programs that represent
improvements in quality of life, in the relationship between companies and their
employees and in the country’s social panorama -, require hard work but recompense
those willing to face them.
29
ANNEX 1
Declaration on Social Rights and
Industrial Relationships at Volkswagen
Preamble
Volkswagen documents fundamental social rights and principles with this declaration.
The social rights and principles described in this declaration represent the basis of
Volkswagen Corporate Policy. The social rights and principles described in this
declaration take the Conventions of the International Labour Organisation concerned
into consideration.
The future security of the Volkswagen Group and its employees ensues from the spirit
of co-operative conflict management and social commitment, on the basis and with goal
of ensuring economic and technological competitiveness. A particular expression of
social commitment is in the security and development of employment opportunities.
The globalisation of Volkswagen is essential to secure the future of the company and its
employees. Volkswagen and its employees face the challenges of globalisation
together. Together they should utilise the opportunities for the success of the company
and the workforce, while limiting potential risks.
Volkswagen AG, the Group Global Works Council of Volkswagen AG and the
International Metalworkers’ Federation agree on the following goals for the countries
and regions represented in the Group Global Works Council. The realisation of the
following goals ensues under the consideration of applicable law and prevailing customs
in the different countries and locations.
§ 1 – Basic Goals
1.1.
Freedom of association
The basic right of all employees to establish and join unions and employee
representations is acknowledged. Volkswagen, the unions and employee
representatives respectively work together openly and in the spirit of constructive
and co-operative conflict management.
1.2.
No Discrimination
Equal opportunity and treatment, regardless of race, skin colour, sex, religion,
citizenship, sexual orientation, social origin or political persuasion (as far as it is
based on democratic principles and tolerance towards persons thinking
differently) is assured.
Employees will be chosen, hired and promoted only based on their qualifications
and abilities.
1.3.
Free Choice of Employment
Volkswagen rejects any knowing use of forced labour and indentured as well as
debtor servitude or involuntary prison labour.
30
1.4.
No Child Labour
Child labour is prohibited. The minimum age for acceptance for employment in
accordance with governmental regulations will be observed.
1.5.
Compensation
The compensation and benefits paid or received for a normal work week
correspond at least to the respective national legal minimum requirements or
those of the respective economic sectors.
1.6.
Work Hours
The work hours correspond at least to the respective national legal requirements
or to the minimum standards of the respective economic sectors.
1.7.
Occupational Safety and Health Protection
Volkswagen meets at least the respective national standards for a safe and
hygienic working environment and in this context will undertake appropriate
measures to assure health and safety in the work place so that healthy
employment conditions are assured.
§2
Realisation
2.1.
The employees of Volkswagen will be informed about all of the provisions of this
declaration. Within the context of the respective plant practice, unions or existing
elected employee representatives will have the possibility to inform the workforce
together with representatives of management.
2.2.
Volkswagen supports and expressly encourages its contractors to take this
declaration into account in their own respective corporate policy. It views this as
an advantageous basis for mutual relationships.
2.3.
At the suggestion of the Board of Management of Volkswagen AG or the
Volkswagen Group Global Works Council, this declaration and its realisation will
be discussed and considered with representatives of management of
Volkswagen AG within the framework of the meeting of the Group Global Works
Council. If necessary, appropriate measures will be agreed upon.
2.4.
Third parties cannot drive or enforce any rights from this declaration. This
declaration enters in to force on the day it is signed. It has no retroactive effects.
31
ANNEX 2
AIDS Impact on Productivity & Costs Analysis
Direct costs
Yr 0
Yrs 1 to 5
Yrs 6 or 7
Yr 7
Yr 7
Yrs 7 or 8
HIV Infection
HIV/AIDS Morbidity begins
(early mortality possible)
Employee leaves workforce due
to death, medical boarding,
voluntary resignation (long term
survivors possible)
Company recruits a
replacement
Company trains the
replacement
New employee becomes
productive
From a
individual
employee with
HIV/AIDS




From high
HIV/AIDS
rates in the
workforce
and society



Benefits payments* 
Medical care*

Recruitment and
training*
Overtime and casual
wages*
Market impacts on 
insurance premiums*
Market impacts on

wage rates
HIV/AIDS programs

Indirect costs
(70 – 80%)
Reduced onthe-job productivity*
Increased
absenteeism*
Supervisory
time*
Management
burden
Loss of
workplace cohesion
Loss of
workforce experience
Total Workforce-Related Costs of HIV/AIDS
Legend - * Factors considered
32
ANNEX 3
Projected Costs that VWSA will incur
The aggregate present values of future costs, which will arise as a result of new
HIV infections acquired in that year, were calculated to be:
Year
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Total in year
incurred
3.229,467
4,303,889
5,683,395
6,968,860
8,231,689
9,404,100
10,627,390
11,657,805
12,442,809
12,975,499
13,270,907
Present value
6,420,832
5,960,840
5,782,562
5,371,931
5,004,136
4,675.375
4,524,673
4,390,654
4,280,179
4,184,123
4,098,372
% of salaries
in year
incurred
0.52%
0.71%
0.92%
1.15%
1.38%
1.61%
1.82%
2.00%
2.13%
2.22%
2.27%
In Year 2004:
The present value of
costs associated with the
new infections in the year
2004, is R5.7 Mio (US$
800, 000)
ie.
If the projected new
infections in 2004 do not
occur, the Company will
save R5.7 Mio (US$ 800,
000).
Preventing each new
infection will reduce the
cost
33