This research was conducted under the auspices of the Comprehensive HIV AIDS Management

Programme (CHAMP) in Zambia, with financial and technical support from the National AIDS Council
through the STARZ Programme, IOM, FAO, and USAID, through the SHARe project. The views expressed
in this research document do not necessarily reflect the views or policy of any of the financial or
technical partners, the Ministry of Health, or the organisations that were included in this research.

Dr. Lynn Ilon (Florida International University) is the principal researcher and author, with Ms. Katy
Barwise (IOM), Mrs. Saskia Hüsken (FAO), and Margaret Tembo as co-authors. Dr. Ilon led the research
team during data collection and analysis.

This publication can be accessed from CHAMP’s offices in Lusaka, Zambia

September 2007 CHAMP Zambia

i
Acknowledgements
Appreciation is extended to the employers, employees and community members who worked with the
team to achieve this result. Many employees gave large amounts of time and energy to assure the
completeness and accuracy of data. Employees and community members answered questions and
participated in group discussions. Managers and HIV coordinators of the Global Development Alliance
partners provided information and made their staff available for interviews and discussions.

A number of people participated in the collection and analysis of data in this report. They are:

Role Affiliation Title

Lynn Ilon Principal Florida International Professor

Investigator University
Alphart Lungu Research Assistant University of Zambia Student

Chazanga Tembo Research Assistant Support to the HIV/AIDS Strategic Information

Response in Zambia Specialist
Crispin Sapele CHAMP Comprehensive HIV AIDS Monitoring and
Counterpart Management Programme Evaluation Manager
Joanna Dawes Research Assistant Voluntary Service Overseas Volunteer / Researcher
(VSO)
Justine Hamungole Research Assistant University of Zambia Student

Katy Barwise Researcher International Organization Project Officer

for Migration
Margaret Tembo Researcher Zambia Central Statistics Researcher
Office
Mike Buffo Research Assistant International Organization Project Assistant
for Migration
Moffat Ng’ombe Research Assistant International Organization HIV/AIDS Field
for Migration Coordinator
Saskia Hüsken Researcher UN Food and Agriculture Programme Officer
Organization HIV/AIDS and Gender
Scott Kinkelaar Research Assistant International Organization Project Assistant
for Migration
Stewart Nkowani Cost Accountant Independent Accountant

Violet Valema Cost Accountant Independent Accountant

ii
Central to the organizing and writing of this report were Anthony Morrison and Crispin Sapele of
CHAMP and Elizabeth Barnhart of the International Organization for Migration. Sharon Beverly
([email protected]) edited much of the final draft. Graphic design was undertaken by Nicholas
Mukupa of CHAMP.

While the research was coordinated by CHAMP (Comprehensive HIV AIDS Management Programme), it
did so with financial and research support from a variety of partner institutions. These are: Florida
International University (FIU), National AIDS Council through the STARZ Programme, International
Organization for Migration (IOM), Food and Agriculture Organization of the United Nations (FAO), and
SHARe, a USAID funded project.

Special appreciation is due to Mrs. Rosanna Price-Nyendwa and her staff at CHAMP for their tireless
efforts in structural, informational and logistical support.

iii
Acronyms
AIDS Acquired Immune Deficiency Syndrome
ARV Anti Retroviral
ART Antiretroviral Therapy
CBOs Community Based Organizations
CHAMP Comprehensive HIV AIDS Management Programme
CSO Central Statistics Office
DfID Department for International Development (UK)
DHS Demographic and Health Survey
ECA Economic Commission for Africa
FAO Food and Agriculture Organization of the United Nations
FASAZ Farming Systems Association of Zambia
FGD Focus Group Discussion
GDA Global Development Alliance
GRZ Government of the Republic of Zambia
HIV Human Immuno-deficiency Virus
ILO International Labour Organisation
IOM International Organization for Migration
MoH Ministry of Health
MoU Memorandum of Understanding
NAC National HIV/AIDS/STI/TB Council
NASF National HIV/AIDS Strategic Framework
NGO Non-Governmental Organisation
PEPFAR Presidents Emergency Plan for AIDS Relief
PLWH People Living With HIV
PMTCT Prevention of Mother to Child Transmission
SHARe Support to the HIV/AIDS Response in Zambia
STI Sexually Transmitted Infection
UNAIDS Joint United Nations Programme on AIDS
UNDP United Nations Development Programme
UNESCO United Nations of Educational, Scientific and Cultural Organization
UNZA University of Zambia
USAID United States Agency for International Development
USD United States Dollar
VCT Voluntary Counselling and Testing
ZESCO Zambia Electricity Supply Corporation
ZNFU Zambia National Farmers’ Union
ZSBS Zambia Sexual Behaviour Survey

iv
Table Of Contents
Executive Summary ..................................................................................................................................... 1
Background ................................................................................................................................................. 6
Objective ................................................................................................................................................. 7
Scope ....................................................................................................................................................... 7
GDA Programme ..................................................................................................................................... 8
Conceptual Framework ........................................................................................................................... 9
Literature Review ...................................................................................................................................... 11
Business Involvement In HIV ................................................................................................................. 11
Agriculture ............................................................................................................................................ 13
Non-Permanent Workers ...................................................................................................................... 14
Methods .................................................................................................................................................... 16
Findings ..................................................................................................................................................... 17
Cost Benefit Analysis ............................................................................................................................. 17
Employee Morale And Community Impact ........................................................................................... 39
Non-Permanent Employees .................................................................................................................. 56
Conclusion ................................................................................................................................................. 63
References ................................................................................................................................................ 70

v
List Of Figures
Figure 1: Organisational benefits of HIV workplace programme................................................................ 9
Figure 2: Breakdown of HIV workplace programmes benefits for seasonal workers ............................... 33
Figure 3: Relative costs of treating ARV, pre-ARVs and undiagnosed HIV and AIDS patients .................. 34
Figure 4: Sectoral comparisons of costs, benefits and net benefits per employee .................................. 35
Figure 5: Breakdown of programme cost by sector .................................................................................. 36
Figure 6: Breakdown of benefits derived from programme by sector ..................................................... 37
Figure 7: Correlation coefficients with years of funding HIV programme ................................................ 37
Figure 8: Knowledge of HIV ....................................................................................................................... 58
Figure 9: Attitudes towards PLWHA working ............................................................................................ 59
Figure 10: Respondents reported use of safe sexual practice .................................................................. 59
Figure 11: Respondents reasons for not using condoms .......................................................................... 60
Figure 12: Respondents reporting transactional sex ................................................................................ 61
Figure 13: Respondents reporting forced sex ........................................................................................... 61

List Of Tables
Table 1: Types of data gathered by cost team .......................................................................................... 17
Table 2: Net benefits of HIV workplace programme ................................................................................ 23
Table 3: Net benefits per employee of HIV workplace programme ......................................................... 23
Table 4: Programme costs ........................................................................................................................ 25
Table 5: Breakdown of education and training expenditures ................................................................... 26
Table 6: Rates of infection, avoided infections and ARV treatment ......................................................... 28
Table 7: Average annual cost of replacing an employee due to HIV ........................................................ 29
Table 8: Costs avoided due to lower employee turnover ......................................................................... 30
Table 9: Value of reduced productivity losses due to HIV for typical company ....................................... 31
Table 10: Frequency of events reported by employees ........................................................................... 45
Table 11: Benefits of workplace programmes to employees ................................................................... 46
Table 12: Frequency of events reported by community ........................................................................... 51
Table 13: Benefits of workplace program to community members ......................................................... 52
Table 14: Demographic information ......................................................................................................... 57
Table 15: Conjectured impact of AIDS on use and cost of factors of production in agriculture ............... 67

vi
Executive Summary
This study attempted to answer the question, “What are the costs and benefits of workplace HIV and
AIDS programmes in Zambia when viewed across several companies?”

Seven companies that are part of the Global Development Alliance Programme in Zambia 1 were
included in this research. The companies range in size from 350 to 10,000 employees, and each
company has an HIV workplace programme in place. All were within either the mining or agricultural
sectors. Four are located primarily in the Copperbelt and are mining-related firms. The agricultural firms
were headquartered in three different provinces in the country with productivity in an additional two
provinces.

Data were collected during the months of May and June 2007 from seven companies. All GDA
companies were included in the study. Four of the GDA companies are involved in the mining sector;
three in the agricultural sector. Several data collection and analyses methods were used: structured
schedules designed to elicit specific cost, programme structure, and labour structure information, cost,
structural and HIV data obtained from the CHAMP’s (GDA technical support partners’) databases,
printed information and staff, informal discussions, focus group discussions with employees, structured
interviews with community members and administrators, and observations.

The study was divided into three main areas: (1) a cost-benefit analysis of the workplace programmes,
(2) employee and community perceptions of the programme, and (3) the programme’s impact on non-
permanent employees.

Cost Benefit Analysis

The net benefit of an HIV preventative programme is the costs avoided and reduced (the benefit) minus
the costs of the programme itself. This analysis extended the usual definition to include costs and
benefits of treatment and care. Six of the seven companies examined showed net benefits for their
workplace programme. On average, these benefits amounted to 47 USD per employee for the year
2006. Companies with new HIV programmes appear to have smaller benefits than those with
programmes of longer duration.

The bulk of the programme costs are attributable to the education and training effort. Considerable
time and effort had been spent on educating and training peer educators in awareness, care, and
treatment of HIV and AIDS. About the same amount of value was spent on employee time - the value of
time spent in education, training, and workshops of employees who, under different circumstances,
would have other duties.

1
Funded under the U.S. Agency for International Development’s PEPFAR grant.

1
About 14 percent of employees are estimated to be HIV positive. Of 50,000 employees, employee
turnovers due to HIV and AIDS are estimated to be about 500 in the last year. Another 316 turnovers,
however, were likely avoided. One hundred and fifty-one employees are estimated to have improved
their health by converting from untreated HIV positive status to some sort of treatment. The figure
includes those who were HIV positive without treatment, to cases of HIV positive who received
treatment, possibly ARVs. Nearly seven percent or 3,296 employees avoided infection in 2006, while
two percent were on ARVs and enjoying improved health and productivity.

The typical company spends an average of nearly 9,000 USD per employee to both cover funeral costs
of an employee dying of AIDS, and to replace that employee. Replacement employee costs, whether
from early retirement or death, average around 8,000 USD. The largest cost was in the value of time
spent by a supervisor in helping the new employee to learn the job. Supervisors are expensive and the
time devoted to helping a new employee, particularly a skilled employee, is large. New employees’ low
productivity was also a high cost.

Twenty eight percent of benefits accruing to the GDA companies with HIV programmes can be
attributed to reduced productivity losses from sick employees. The typical company saved nearly half a
million dollars in productivity that otherwise would have been lost.

Uniformly, treating patients diagnosed with HIV or AIDS was cheaper than treating undiagnosed
patients. Costs of treating undiagnosed HIV positive patients were estimated to be about seven times
that of those who had been diagnosed and were on ARVs. Given that ARVs are free, and most ARV
patients are seen to be relatively healthy and stable, this is of little surprise. The estimated costs across
companies of treating an undiagnosed patient, neither monitored, nor on ARVs was 371 USD in 2006.
This contrasted with the cost of treating (but not medicating) an ARV patient, an estimated annual cost
of 55 USD.

Employee Morale And Community Impact

Knowledge and other benefits from the workplace programmes are also spreading to the surrounding
communities. Access to HIV related information, condoms, VCT, and in some cases, ARVs have
improved the lives of community members and these efforts are much appreciated. Most of the
employees in focus group discussions and interviews confirmed that the companies have implemented
the HIV workplace programme and most companies provide monetary assistance for funeral costs, to
purchase the coffin, and food for the funeral house.

Employees observed that seminars and workshops conducted in the workplace, which included workers
and some community members, have helped change their practices. Workers said they noticed lower
death rates among employees. Employees also observed that there has been an improvement in
workers’ productivity because of medical intervention provided by the company, such as free
medication for both employees and their dependants.

The most visible impact for employees of companies’ workplace programmes is raising awareness of
HIV and AIDS. As one employee suggested; “Knowledge is power.” This includes knowledge about HIV
transmission and prevention and services available, including VCT and PMTCT.

2
Despite the mainly positive effects of the HIV workplace programmes implemented by the respective
companies, the research also revealed less positive points. One aspect that came out of the focus group
discussions and interviews is that, some employees perceive the HIV workplace programme as
threatening to their employment contracts. It is a signal to the employees that greater clarity about the
HIV policies within companies is needed.

Employees in this research confirm that HIV and AIDS are having a negative impact on their lives, and
also on their families and their communities. Their main concern was that they would contract HIV and
eventually die. This would mean leaving their children as orphans without guarantees as to who would
take care of them.

HIV and AIDS were found to have a significant impact on the current and future plans of employees.
They reported in focus group discussions and interviews that their plans are sometimes blocked
because of the presence of an AIDS patient in the house or community. In particular, plans having
financial implications are disturbed if the resources have to be diverted to medical care for the patient.

Non-Permanent Employees
Monthly, non-permanent workers are paid an average of 65 percent of what regular workers are paid in
these three agricultural firms. About 17 percent of overall benefits to employers of HIV programmes to
seasonal workers derived from reduced medical costs for one company. The HIV programme for non-
permanent workers paid for itself. For the other two companies, the programme produced net
benefits. Over the three companies, benefits averaged 32 USD for each seasonal employee.

Although non-permanent workers are eligible for, and benefit from, most existing aspects of workplace
programmes, at present they are not specifically targeted in prevention campaigns, particularly
behaviour change and social change communications, and furthermore many say they are unable to
access workplace HIV activities. The amount of time that workers participate in HIV-related activities
varies greatly within each company, and in Company C workers stated that they spend between zero
and 24 hours per quarter in HIV-related activities. Workers at the same company were the most likely
to say that they were unable to access aspects of the workplace programme because they are non-
permanent.

Planning for the future is a key factor when assessing the vulnerabilities of workers, as research has
shown that if workers are preoccupied by short-term tangible needs, the prospect of a future chronic
illness might not factor into their everyday decision-making, i.e. whether to engage in risky sexual
behaviour. Amongst workers who took part in this research, many expressed that their family is of key
importance (the workers are generally providing for immediate and extended family); however
planning to look after families in the long term was difficult because contracts are short (in companies B
and C contracts last for less than one year, and in companies A and D contracts are two years).

The gruelling physical nature of the contract work also adds to vulnerability. In one discussion, a worker
stated that his job was risky and that workers are “always coughing and *their+ bodies get wasted”. In
another discussion a woman said she had to walk to the work site in the pre-dawn hours, a dangerous
time for women to be out on their own.

3
In most cases temporary workers are aware of HIV-related information being provided by the company,
although they are not well informed about where to get tested for HIV, and many are unsure as to
whether their company has a workplace HIV policy. Because families are not part of the local
community, workers express concern about the reach of the programmes.

At both sites basic knowledge about modes of HIV transmission was high. Most respondents had heard
of HIV, could name at least one correct mode of transmission, gave correct answers for what HIV is (a
disease, a virus) and showed few misconceptions about HIV transmission. There were high numbers of
correct responses about causes of transmission of STIs, the most common being sex without a condom,
followed by having more than one partner. However, this overall knowledge has not led people to
employ standard prevention techniques or to adopt risk-lowering behaviour. Respondents show low
levels of condom use combined with relatively high levels of multiple concurrent sexual partnerships.
Levels of transactional sex - often an indicator of unequal gender dynamics in the wider community -
were also high, with nearly a third of respondents at both sites stating that they had participated in
such relationships. In the farms, there were high levels of stigma surrounding working with people living
with HIV.

This discrepancy between knowledge and behaviour is consistent with existing research conducted with
mobile workers in the region. Although more longitudinal qualitative research is needed at these sites
to explain this, previous studies do offer explanations (for example see Campbell, 2003). These include
environmental vulnerability factors such as living and working conditions, lack of recreational options,
and mobility itself (distance from families), which workers themselves state can affect their health-
seeking behaviour.

Conclusions And Recommendations

Replacement labour may be less skilled, have less knowledge, and be more distracted, less committed,
more overworked, and less focused than original labourers. The major cost of HIV and AIDS for some
industries, then, might well be the loss of markets in the region or country.

Data obtained by companies was rarely organized in a manner to give accurate costs or benefits of HIV
programmes or human resource implications of the disease for the company. Given the overwhelming
evidence of this study that HIV and AIDS is a major cost and can be mitigated, it is a major
recommendation of this study that companies should look upon HIV as a strategic issue, design ways to
keep track of costs, benefits and counts, and look upon these figures as central to company planning in
the medium term.

The 2007 DHS survey should be extensively analyzed to establish a baseline for industries and the
national workforce. Given that the impact of HIV for companies is only partially captured by a company-
based examination, industry-based analysis is needed.

When there is a relatively large supply of unskilled labour in an industry that requires poorly educated
labour or skilled labour in the usual sense, the supply of such labour cannot shrink past a certain point
before the viability of the industry itself is threatened

4
From the employees and community members’ perspectives, there is room for improvement. For
instance, in the further implementation of the HIV workplace programmes, the language and
visualisation of prevention messages must reach the illiterate and non-English speaking members of the
communities, resulting in increased access to HIV related health care and services. For workplace
programmes to be effective, they need to be multi-sectoral, comprehensive, focused, and community
driven

While most people appreciate the work of the companies regarding HIV, some employees feel that the
companies are not doing enough to help families that are affected with HIV. Community members
expressed the need to translate the brochures’ information about HIV from English to the local
languages, which will help those who cannot read and understand English to have access to HIV
information.

Besides the need for more information about HIV in general, the research found that several
community members are not sure of the effects of ARVs, even though they can receive them gratis. The
communities need more information about the effects and efficacy of ARVs before people began taking
them.

The question of treatment and care for non-permanent workers remains largely unresolved. Companies
feel they cannot provide treatment to mobile workers, as it would be unethical to begin treatment if it
cannot be continued when the contract is over. Yet, the study reveals that even modest incorporation
of such workers in workplace programmes provides benefits to both companies and temporary
workers.

A more holistic approach to prevention programmes for non-permanent workers is required. Through
implementing broader workplace programmes – for example including the wider community and
addressing the environmental vulnerability factors of non-permanent workers – existing programmes
can be made more effective.

5
Background

“I’ve really noticed a big decline in the

number of employees who are sick
and leaving since we instituted the
HIV programme here.”
This was volunteered by a Human Resource Manager at a copper mine. Such comments were not
uncommon as our team did its work gathering data on the impact of private industry HIV programmes.
Yet, few executives could cite the value of benefits to the company other than anecdotally, and several
wondered whether the programme could produce enough benefits to outweigh its costs.

This ambiguity stems from at least two dominant sources - both of them addressed in this report. First,
whereas the literature abounds with evidence that HIV and AIDS are widespread in Africa and among
agriculture and mining sectors in Southern Africa in particular, it is nearly silent on research-based
evidence of its net benefits to companies which are market driven. Second, cost-benefit studies of HIV
and AIDS are rare worldwide. When health economists look at costs and benefits, they tend to compare
the costs of treatment of a disease with that of prevention. A company-wide programme does not fit
2
these parameters .

Companies, nevertheless, are implementing HIV programmes. Executives often feel strongly that such
programmes are beneficial-if only for employee morale and maintenance of employee health. They
recognize that some measures need to be taken to tackle a disease which threatens their workforce.
Yet, they have not turned their own numbers into an analysis that might show how much they lose
from the illness and how much of this loss might be regained in an effective HIV programme. Most
companies face impediments to integrating such programmes into targeted economic planning and
strategies. This study is intended as a first step in filling this gap. While only a targeted, comprehensive
investigation of each company can give definitive returns-to-investment estimates, this study outlines
major parameters across several companies and two important sectors of Zambia’s economy.

2
Neither is there much literature on HIV even in this more common health approach to cost-benefit analysis. A
search of health literature data bases yielded only two studies of this nature (using HIV, costs, and benefits as
search terms). There were 174 pieces of literature that appeared, and all but two were cost-effectiveness analyses.

6
This research attempts to extend the accuracy and scope of typical cost benefit analyses in several ways
by:
 Working closely with the companies over a period of time to hone estimates of major factors
which refined initial estimates
 Incorporating actual HIV testing counts (CT), estimates of ARV use-in companies with on-site
hospitals and programme administration costs of education and training inputs
 Visiting multiple company sites where cost variations were expected
 Capturing employee impressions, often using local language
 Capturing community impressions, gathered formally and informally within the community
settings
 Cross-checking structures, parameters and data with people who work daily with the
companies on these programmes

Objective
This study attempted to answer the question, “What are the costs and benefits of HIV workplace
programmes in Zambia when viewed across several companies?”

In exploring this larger question, several sub-questions were addressed:

 Is there a net benefit to companies of their HIV workplace programmes?
 What are the costs of such programmes and where are costs highest and lowest?
 What types of benefits accrue to these companies?
 What is the source of the benefits?
 How can costs and benefits be calculated using a combination of company data, programme
statistics, and industry parameters?
 What are the benefits to communities of HIV workplace programmes?
 How do employees perceive workplace programmes?
 How do workplace programmes impact on contract and seasonal workers?

Scope
Seven companies in Zambia were included in this research. Companies ranged in size from 350 to
10,000 employees. All were within either the mining or agricultural sectors. Four are located primarily
in Copperbelt Province and are mining-related firms. The agricultural firms were headquartered in
three different provinces in the country with productivity in two other provinces.

In response to the increasing impact of HIV on their workforce, and in response to the ILO call for
workplace programmes, the companies which took part in this research have started HIV workplace
programmes. Besides developing an HIV policy, most companies have recruited and trained peer
educators within their companies, who sensitize their peers within the workplace. Some companies
have also extended peer-education on HIV to the surrounding communities.

7
Topics of peer-education and awareness include modes of HIV transmission, ways through which HIV
cannot be transmitted, the importance of VCT and where this can be done, how to live positively, and
information on care and support. Often these companies work hand-in-hand with institutions such as
CHAMP and other civil society organisations, combining resources with technical expertise on HIV. In
most companies VCT is being offered, while recently some have started providing ARVs to their
employees.

The study started out with a simple strategy: within the narrow confines of the Global Development
Alliance (GDA) technical support partner’s resources, determine what types of benefits GDA companies
were deriving from their HIV Programmes. One benefit could not be captured through cost data - that
of employees’ morale. Another benefit could not easily be linked to costs using generally accepted
conceptual frameworks of workplace programmes - that of community behavioural and attitude
changes. Thus, in addition to cost data, a component intended to capture these non-cost benefits was
added.

The research benefits from its rather large scope. By looking at several companies in two different
sectors of the economy, a more general picture emerged and comparisons of sectors led to a greater
understanding of which parameters applied to specific sectors and which were general across most or
all companies.

The study grew in scope and sophistication as programmes and organisations involved in the HIV issue
within Zambia asked to become partners. The Department for International Development in the UK, the
International Organization for Migration, the Food and Agricultural Organisation of the United Nations,
and the USAID funded SHARe project, joined the research. A component which focused on non-
permanent workers was added and the research team grew.

GDA Programme
The Zambian HIV/AIDS Global Development Alliances (GDAs) were formed to address the development
problem of reducing the impact of HIV and AIDS on the mining and agribusiness sectors in Zambia.
Through funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID, and both
direct and indirect contributions from three of the largest agribusinesses, as well as five of the major
mining sector companies in Zambia, a three to five year public-private partnership was agreed upon to
expand the private sector’s response to HIV to the outreach communities.

The agribusiness GDA partners are Dunavant (Zambia) Ltd., Zambia Sugar PLC, and Mkushi Farmers
Association. The mining GDA partners are: Konkola Copper Mines PLC, Mopani Copper Mines PLC,
Copperbelt Energy Corporation PLC, Kansanshi Mines PLC, and First Quantum Mining and Operations
Ltd. (formerly Bwana Mkubwa Mines Ltd.).

In October 2005, the US Government signed a Memorandum of Understanding (MoU) with each of the
above-mentioned private sector organisations that contribute highly to Zambia’s economy, being the
first GDAs in the world that focus on HIV.

8
The US Government has contributed 3.26 million USD for technical support and direct inputs to the
GDAs, with over 7 million USD leveraged from the private sector through both direct and indirect
3
inputs . The GDA partners work closely with the Ministry of Health (MoH) and the National
HIV/AIDS/STI/TB Council (NAC) to ensure harmonisation of private and public sector responses and
approaches. Since 2006, the development of a public-private partnership for the expansion of good
quality ART services in Zambia has been in process. Currently, selected private sector organisations are
undergoing ART accreditation by the Medical Council of Zambia. Once accredited, the private sector will
be eligible to sign a memorandum of understanding with the Ministry of Health, and subsequently to
receive free ARV supplies under the national programme.

Conceptual Framework
HIV and AIDS affect the profitability and, thus, viability of companies in a range of ways. Primarily they
reduce worker productivity and increase costs. Organisations worldwide have recognized this drain and
this recognition might largely explain why many companies have active HIV programmes and cover the
costs of treatment for workers. Figure 1 below outlines the benefits to companies of such programmes.
It is adapted from a diagram of the International Labour Organisation (ILO) which shows the costs of
HIV to employers.

Figure 1: Organisational benefits of HIV workplace programme

Reduced HIV-related Costs Increased Worker Productivity

• insurance cover Less • less absenteeism
• retirement payouts recruit- • reduced new staff training
• health and safety ment • retention of skills & knowledge
• medical costs • higher morale
• funeral costs
Lower rates of
HIV/AIDS nationally
Lower Costs
Bigger markets,
better labour pool

More reinvestment
Increased Reliability

Greater Profits

3
These financial contributions include actual and committed USG funds up until FY07, and GDA partner actual
contributions up to March 2007.

9
The study followed this conceptual model. Specifically, we gathered data on the costs and productivity
issues diagrammed in the first row. We calculated cost reductions and productivity gains from the
programme in all the areas outlined, except employee morale. While these costs are readily
measurable, effects on individual and work unit productivity, morale, and discipline are much more
difficult to estimate (Rosen et al., 2002).

Thus, employee morale was handled separately in a non-cost form. We interviewed employees,
conducted focus groups, and spoke with HIV Coordinators at the companies to capture employee
morale issues.

We went beyond this conceptual model in one significant way. That is, we also studied community
effects of the workplace programmes. Education, counselling, and testing (CT) extended to the
outreach and surrounding communities of these companies. For many companies, employees live on
company grounds, or are clustered in nearby areas so that communities are really an extension of the
company environment.

It is noteworthy that not all the benefits of an HIV programme can be captured by looking through a
narrow company cost-reduction lens. For example, one company had an extensive programme, but
reaped few productivity gains, or reduced costs of their farmers, or unskilled workers. Yet the company
feels strongly that the programme is a worthy investment. Seen through the lens of a market, they are
likely to be correct. When too many small-scale farmers or unskilled labourers succumb to AIDS, the
intensity of production is jeopardized, the market is at risk and the true cost to the company may well
be the risk to its viability in the region. This is discussed more in a later section of this report.

10
Literature Review
Business Involvement In HIV
Studies in Kenya, Botswana, Zimbabwe, Malawi, and South Africa have found that increased health
benefit claims, increased absenteeism, and increased expenditures on recruitment and training are
among the largest HIV-related costs faced by companies (Rosen et al., 2002).

The supply of labour is evidently reduced by HIV and AIDS, and for companies operating in hard-hit
regions, HIV will have major consequences on profitability and productivity. In 2005, ILO estimated that
28 million workers globally were lost due to AIDS, and a projected 48 million will be lost by 2020 if no
measures are taken (ILO, 2005). The number of workers lost due to HIV, is, however, greater than the
number of workers who die of AIDS. Workers who are living with HIV might be able to work for years,
but their illnesses make them progressively unable to work, until they are fully unable to work. The ILO
estimated that in 2005, there were more than two million workers who are at any time fully or partially
unable to work due to AIDS (ILO, 2005).

In Zambia projections suggest that by 2010 the impact of AIDS will reduce the labour force by 21
percent. There was a labour force loss due to AIDS of 14,000 persons in 2005, alone, and an estimated
total of 105,000 people lost by 2010 (Kamocha et al., 2005).

In a 1997 UNAIDS survey of 203 companies in 14 countries, the main motives given for corporate action
on AIDS were: welfare of employees (46%), safety/prevention (34%), legal implications (24%), health
care costs (16%), and concern for the worldwide epidemic (12%), followed by: community problems
and absenteeism due to illness and public image (Bloom et al., 2001& Daly, 2000).

Increasingly, companies are recognising that their ability to protect their employees from HIV infection
is limited, if education and outreach efforts are not extended to the local communities. The disease is
easily passed from the wider community to employees and their families (Daly 2000). While workplace
programmes on HIV are primarily targeted at the employees of the company, surrounding communities
can also benefit from workplace programmes. Indirectly, information on HIV might trickle down to the
family and friends of employees, but several companies have been targeting communities surrounding
their companies directly. The Global Business Council on HIV/AIDS found that companies benefit from
HIV programmes that go beyond the workplace and address issues in the local community (FHI 2002).
Increasingly, companies understand that the HIV risk to their employees is inseparable from the HIV risk
in the surrounding communities and are exploring ways to bring awareness, Voluntary Counselling and
Testing (VCT), and Antiretroviral (ARV) access to the communities in which they operate.

Several studies detail this approach in the literature. Chevron Nigeria embraced the wider context from
the onset in 1997, providing HIV prevention and care services for its direct workforce and local
communities, including HIV workshops for employees’ children and other youths in the communities
where they operate (GBC, 2000). Heineken International’s comprehensive HIV and AIDS approach
provides access to ARVs for employees, partners, and children (GBC, 2000). In 1991, the Botswana Meat

11
Commission began an HIV prevention and care programme for its 1,500 employees, including ongoing
HIV education for all workers, provision of condoms, sexually transmitted infection treatment at the
workplace clinic, and HIV counselling for employees and their families (UNAIDS, 1998).

Several companies, such as Heineken, have invested in establishing a company clinic on the company
premises. These company clinics are often open to the surrounding communities. Some companies
collaborate with public health services near their premises, referring their staff to these external health
care providers.

Company workplace programmes that collaborate with the public sector and civil society are not only
more sustainable, but also more accepted by employees and communities. The oft-cited successful
awareness and prevention campaigns run by the South African electricity company Eskom, in
collaboration with local community groups and the government show the importance of the links
between public and private sector (Bloom et al., 2001, GBC, 2000 & Daly, 2000). Counselling and
treatment are provided for those infected with HIV. Eskom collaborates with government and NGOs on
an education campaign for the wider community, and it makes regular broadcasts on national and
regional radio stations. It also provides substantial funding for NGOs working on AIDS prevention and
for vaccine research. Studies have found a high level of HIV awareness among Eskom’s employees,
lowered levels of discrimination against staff living with HIV, and greater willingness to report HIV
status (Daly, 2000 & Bloom et al., 2001).

Good examples of such public-private partnerships within Southern Africa can be found in the mining
sector. Such HIV workplace programmes have tended to focus on a company’s employees and the
surrounding community, in particular, sex workers in that community. Anglo Coal in South Africa
collaborates with trade unions and surrounding communities on HIV programmes and formed
partnerships with local government authorities in providing mobile STI clinics for outside communities
and programmes promoting healthy lifestyles and better nutrition. Harmony Gold Mining Company
employs miners who come from different parts of South Africa and neighbouring countries. They have a
mobile clinic which offers antibiotic treatment, condoms, and information about HIV, including other
sexually transmitted infections (Bloom et al., 2001).

While evidence is still limited, the majority of case studies describing business incursions into the HIV
arena report positive results. Awareness amongst workers and communities has increased, morale has
improved, and, in some cases, infection rates are down (Bloom et al., 2001& Daly, 2000).

12
Agriculture
The impact of HIV and AIDS on the agriculture sector has received substantial attention both in Zambia
and in the Southern African region. Most of these studies focus on household effects such as on
poverty, food production, and household structure (Economic Commission for Africa, 2006; FAO, 2003;
FAO, 2004, Curry et al, 2006, Weigers et al, 2006) The cause-effects are fairly straight forward if not
always obvious. HIV and AIDS clearly reduce the labour quality and quantity from which rural farmers
can draw. The number of people who are available for farming land is reduced. Substitute labour may
either be unavailable or, when available, less knowledgeable than the original farmer. Additionally, sick
family members draw time and energy away from production. The result is poorer nutrition overall and
remaining energy reduced for education, social activities, and marketing.

As might be expected, AIDS-affected households in Northern Province [Zambia] were

more likely to state that they had reduced the area cultivated, shifted from growing
maize to cassava, and invested less in farm inputs such as fertilizer. (Wiegers et. al.,
2006).

Memfih (2005) points out that the effects on rural household iterate through a society to affect urban
households. Urban relatives may supply substitute labour or may send ill household members to stay in
rural home villages. Such interactions cause otherwise poor households to incur additional medical
charges, and reduce agricultural productivity. Memfih concludes:
In areas heavily affected by HIV and AIDS, the catalytic effects and systemic impact of
the epidemic on agricultural development may amplify existing development problems
to such an extent as to trigger structural changes (i.e. in adult and infant mortality);
and/or create new problems and challenges for agricultural development (child-
headed households, the breakdown of informal agricultural institutions, and thus, of
certain vital social safety net mechanisms.) (Memfih, 2005).

Jayne et al. (2005b) look at such structural changes in agriculture and conclude that the costs of
agricultural labour will rise and cause the industry to lose some competitiveness on an international
scale. As well as costs of labour, labour quality will deteriorate as the knowledge of abilities passed
from one generation to another decreases. They thus identify several processes that they believe have
been neglected in previous macro-economic studies of the effects of HIV on agriculture: slower
population growth, slower development of informal markets, declines in land-to-person ratios, and
shifts in cropping patterns. (Jayne et al., 2005a).

They conclude:
Macro-economic models that do not account for the complex effects of AIDS on
human capital and intergenerational knowledge transfers are probably
underestimating the economic and social consequences of the disease. (Jayne et al.,
2005b).

13
Kamocha et al. (2003) look entirely at the labour force size patterns of the Zambian economy. They
calculate that agriculture will loose about 15,755 persons annually due to AIDS. They feel, as have
others, that “Labour losses due to HIV and AIDS will be more profoundly felt by the female labour
force.” The women’s labour force will shrink an average of about 7,180 persons due to HIV and AIDS.”
(Kamocha et. al., 2003).

Wiegers et. al. (2004) highlight the gender dimension of HIV. Prevalence among women and girls is
higher than for men, women bear the burden of caring for the sick and orphaned, and certain social
norms encourage men to have multiple sexual partners which is often reinforced by migration and
mobility as a result of poverty. Gender inequalities, low status, social- and economic vulnerability, and
limited livelihood opportunities increase women’s risk for transmission and make women and girls
more likely to engage in transactional sex in order to survive. External factors such as drought worsen
this, as women and girls resort to sex in order to obtain food, goods or money.

The Centre for International Health and Development at Boston University has conducted a number of
cost studies on HIV. One study focuses on smallholder cotton growers (Larson et al., 2004). Not
unexpectedly, they find that these small agricultural households are affected by HIV. The effect is
substantially larger in households where labour supply is already stretched. In typical households as
well as those where labour is constrained, the death of a previously healthy working-aged adult causes
cotton output to fall by 14 to 33 percent. Adding a chronically ill, working aged adult causes a similar
decline. The death of such a person or the death of one youth has lesser effects-from five to 11 percent.
(Larson et al., 2004, Table 19, P. 28).

Using a household survey methodology for gathering data, Larson et al. (2004) find a number of other
results which give us insights into how productivity of small farmers and HIV are interlinked. Ten
4
percent of adults within sampled households reported to work sick during the past year . Deaths were
attributable mainly to tuberculosis, pneumonia and malaria, but nearly a quarter of deaths of working-
aged adults were unspecified. Members of a typical household attended at least ten funerals during the
year, three of which were not considered local.

Non-Permanent Workers
Mobile or non-permanent workers make up a large part of the workforce in the mining and commercial
agriculture sectors. Labour brokers recruit contract workers for the mining industry from countries in
the region, particularly Zimbabwe, Botswana, and South Africa. These workers travel to the mining sites
from their respective countries for two or more months at a time. Mining companies also employ
internal migrants - Zambians from other parts of the country - who travel back and forth between the
mining areas and their original homes where they have left their families.

4
In regression models of all four output measures (cotton and maize area planted and output), the portion of
working-aged adults who were sick regularly was a statistically significant factor.

14
The commercial agriculture sector employs a different type of mobile worker, those who undertake
seasonal work during the harvesting season. Some of these seasonal workers come from surrounding
areas, while others travel long distances in search of employment.

The relationship between population mobility and HIV is complex. Evidence suggests that migrants
become vulnerable to HIV as a result of the conditions and structure of the migration process. Mobility
contributes to concurrent multiple sexual partnerships, which is arguably one of the main drivers of the
HIV epidemic in southern Africa (Halperin & Epstein, 2004). Separated from partners and families, and
often working in harsh, lonely and isolating conditions, migrants may engage in multiple sexual
relations while they are away from home. Female migrants are particularly vulnerable to transactional
sexual encounters and sexual violence due to lack of economic autonomy and discriminatory gender
norms.

The nature of mobility makes migrant workers difficult to reach, as they are often not in one location
for a long time. Also, migrant workers may not understand/access existing interventions due to
differences in language and culture. Furthermore, migrants often live outside communities, in
temporary housing or hostel accommodation, where HIV prevention education, condom provision, HIV
testing, and post-infection treatment and care may be scarce or non-existent. Lastly, undocumented
migrants might be reluctant to access healthcare services due to fear of harassment or deportation.

15
Methods
Data were collected during the months of May and June 2007 from seven companies. All GDA
companies were included in the study. Four of the GDA companies are involved in the mining sector;
three in the agricultural sector. Several data collection and analyses methods were used: structured
schedules designed to elicit specific cost, programme structure, and labour structure information, cost,
structural and HIV data obtained from CHAMP’s (GDA technical support partners’) databases, printed
information and staff, informal discussions, focus group discussions with employees, structured
interviews with community members and administrators, and observations.

5
The research team consisted of a principal investigator , researchers from the Food and Agriculture
Organization, and International Organization of Migration. Some research assistants came from the
University of Zambia, and others were independently hired cost accountants. In addition, the team was
assisted by managers and counsellors at the various company sites and by CHAMP, a local civil society
6
organization .

The team of researchers were organized around three general themes:

 Cost Team: consisting of the principal investigator (a development economist) and two Cost
accountants
 Employee/Community Team: consisting of two qualitative research specialists and two senior
university assistants
 Migrant/Temporary Labour Team: consisting of two migrant labour specialists on mobility and
HIV

These teams were also assisted by the GDA technical support organisation, CHAMP. CHAMP provides
technical and administrative support to the GDA programme, has extensive databases on costs and
employee status, and frequently assisted our teams in the field with logistics, transportation, and
supplemental manpower.

Working with the research teams in the field were HIV Coordinators for the companies. They often
scheduled the interviews, focus groups, and questionnaires. They also arranged for employees and
community members to be interviewed.

The teams travelled by road to the sites during May and June 2007. Three of the companies had two
sites that required visits. Specifics of each group and its methodologies are given in each of the three
sections of this report.

5
Lynn Ilon, also a professor at Florida International University with over four years’ experience in the region.
6
CHAMP – Comprehensive HIV AIDS Management Programme

16
Findings
The bulk of the rest of this report is divided into the three main areas of investigation and findings: cost-
benefit analysis, employee and community perceptions, and non-permanent employee impact. Each of
these sections contains specifics of relevant literature, methods, analysis, and findings. The final section
of this report provides an overview of findings and recommendations.

Cost Benefit Analysis

Methods
Cost data included numbers on costs, counts and benefits. Data were gathered in categories organized
around company departments that would have the data:

Table 1: Types of data gathered by cost team

Type Data Gathered

Human Resources Counts of employees, sick leave, retirements, funerals, etc.

Financial Average salaries, medical pay-outs, insurance payouts

Estimates of recruitment, productivity, supervision times for new

Management
employees

HIV programme costs Salaries, management time, CT expenditures, training costs

Cost estimates of treatment, patient numbers, employee counts for

Medical costs
treatment

Information was obtained in several ways:

 Most often, team members used forms to direct questions and record specific data culled from
company information
 Some companies in some units had data prepared, and provided this data on wholly or
partially completed forms
 Sometimes, the structure or processes of the company were best captured by asking a
knowledgeable employee to describe a process (such as recruitment or training). Basic data
were then recorded which could later be analyzed into accurate costs or counts
 Each company was separately tabulated. When additional clarification was needed, team
members contacted company staff by email or phone

17
Data were generally gathered in one four to eight hour day with minimal follow-up needed. The team
met with company designated staff specifically in the areas of inquiry: finance, human resources,
medical care and treatment, and programme administration. Data were gathered for the 2006 calendar
7
year .

An issue faced in the analysis was the time lag between when an employee might first become HIV
positive and when he/she would retire, die, or leave the company due to the effects of AIDS. That time
lag has been estimated among medical experts in Zambian society to be about five-and-a-half years for
8
the working population . That period is extended when wellness programmes increase awareness of
nutrition and care. Doctors in the hospitals studied here estimated that a wellness programme could
extend this time period by about two years.

Any HIV programme that succeeds in lowering the rate of new infections realizes its benefits over a long
period of time. If companies merely replace workers who have left for AIDS-related reasons, then the
period between effectiveness of the programme (lowered HIV infection rates) and costs (new employee
orientation and training) is at least five years. Benefits accrue when the rate at which replacement
(new) employees are hired is reduced.

The literature generally treats such lags by assuming that a cost savings in the future (say, five years)
has less value than if that same cost savings were to occur today. The reason is that a company can use
the cost savings today for many purposes during the intervening five years. No one knows ahead of
time the actual value of being able to use money today relative to its availability in the future.
Nevertheless, economists frequently guess by applying what is known as a discount rate. The rate
chosen is largely arbitrary.

This study does not discount future benefits. Given the variability of parameters: time lag, value of
discount, and structure of savings; applying a discount rate is unlikely to make results more meaningful.
The variance of necessary parameters means the application of such a discount rate obscures results,
rather than improving them.

A good example of parameters variability is the time lag between infection and hiring a replacement
employee. Some companies in Zambia explicitly or implicitly hire two or more employees for some staff
positions assuming that deaths will dissipate their workforce. In this instance, the costs are immediate,
sometimes occurring before the event. Another parameter variation is benefit calculation. Most of
these companies have employee programmes which spread to the community. It is possible that for
every employee who avoids infection, one or more community members avoid exposure (or visa versa).
In turn, then, perhaps another employee avoids infection. Thus, it is not clear that one avoided
infection among employees should, in fact, be counted as one. Perhaps there is a multiplier effect over
time. Finally, the time lag between infection and replacement hiring is not clear even if each sick

7
This rule varied where companies kept books based on either their fiscal year or their programme (GDA) year
(April to March). All years were twelve months.
8
This is several years short of similar individual in wealthier countries which had better nutrition, health care and,
work conditions.

18
employee is replaced by only one new employee. Experts within Zambia now agree now that five-and-
a-half years are a reasonable estimate of the time period between initial infection and death of an
employee. But studies done in Zambia have used other time periods from eight to ten years. The choice
of a time period for lagging benefits drives the final benefits figures.

Nevertheless, there is enough data revealed in this study, however, that knowledgeable readers could
apply a discount rate of their own choosing, with a time period that satisfies them and makes estimates
of discounted benefits and net benefits.

Count Of Employees Living With HIV

Many companies and CHAMP had very accurate total counts for CT and ARV treatment. A major
problem however, was teasing out how many of each of these counts applied to employees,
dependents, contract employees and the community. CHAMP was able to discern which of the CT
subjects were employees and knew, in the aggregate, how many had tested positive. But, for CT done
by the company, it is not so clear. The percent of employees who go for CT when CHAMP is present
may not be the same percent as those who go for CT when done by the company, its clinic, or its
outside medical provider. As raised in the literature and our own focus groups and interviews,
employees are sensitive to having their employers know about their HIV status. Thus, they choose from
several venues to get tested.

We had CT numbers and results for all companies for four years. For 2006, we had CT numbers
tabulated by results and by reason for taking the test. We had further breakdowns for CT numbers
administered by the GDA partners (number and prevalence for employees tested). Some companies
that either purchased and distributed ARVs or treated HIV positive patients had ARV treatment
information, although many could not break down these counts by employees, dependents, and
contractors. We also had counts of employees and contractors and, in some cases, the percent of each
who accessed healthcare, or even HIV treatment.

Using known counts and percentages and applying these percentages when breakdowns of counts
were not available, we were able to get estimates for new and continuing ARV treatment uptake, those
diagnosed HIV positive but not yet on ARVs, total numbers of people living with HIV, and those yet
undiagnosed, but HIV positive. Using either employee numbers or percent of employees accessing
healthcare for HIV reasons, we could apportion these numbers across types of employees and
dependents. Because counts of ARVs, CT, and HIV prevalence were largely available for these
companies, reasonably accurate models could be constructed of the likely rates in employee turnover
and prevalence.

Assumed prevalence rates drive many of the results. We had data on average rates of prevalence for
regions, populations (urban, rural, miners, mobile populations), from the literature and, in two cases,
from studies conducted by two of the companies. Expected prevalence was based on those known from
studies, Zambian DHS survey results or, in one case, an actual prevalence study within the company.
We measured these expected prevalences against actual CT prevalence results with surprising results.
In general, the model took expected prevalences and adjusted for employees who had previously
tested positive, and those who had done CT because they felt sick. We could calculate what the

19
prevalence rate of this narrowed population would have to do in order to raise the entire company to
its expected rate of prevalence. We compared that rate to the known rate in 2006 of people who tested
positive among those going for CT. The differences were striking.

In each instance, the actual prevalence rate fell below the expected rate - sometimes marginally,
9
sometimes substantially. Some or all of this is attributable to the education and testing programme . To
avoid over-playing results, we made the conservative assumption that half the differences were
attributable to the programme.

Medical Costs
Three of the companies have fairly comprehensive clinics and hospitals on site, or nearby. These clinics
and hospitals can treat a wide variety of illnesses and injuries. Two of the companies attempt to provide
nearly comprehensive medical care for employees, dependents, contractors and, sometimes, retired
employees. One provides first-line care with a small hospital, but refers major cases to outside
hospitals, paying in large part, those charges.

Of those companies without their own hospitals, three had medical schemes that partially or fully
covered employee health costs. Two had medical allowances from which employees could draw. A third
provided medical insurance, but only covered a small portion of their workforce. The seventh company
had small on-site clinics for basic health care needs and would cover some or all of the costs of medical
care of outside clinics for their most senior employees.

In the case of those companies with hospitals, the medical personnel kept fairly good records of the
types of patients and their medical conditions. These figures could frequently be used as a basis for
estimating relative intensity of care. Using unit cost estimates (doctors’ hourly costs, cost of CT tests,
lab costs, and medication), the costs of treating new and continuing ARV patients and those diagnosed
HIV positive, but not yet on ARVs could be estimated with some accuracy.

Estimating the costs of HIV positive patient care of those patients who had not been diagnosed was
more difficult. Without testing, doctors cannot be sure who, in fact, is HIV positive and generally could
not keep accurate records if diagnoses were not confirmed.

9
Prevalence rates calculations were driven by the rates of prevalence of those currently being tested to what
would have been expected (adjusted for those already tested positive or those testing because they were sick). Any
explanation, then, must address why the newly tested population has a lower prevalence rates than would have
been previously expected. Although programme intervention is a clear explanation for some of this difference, the
research did not attempt to answer the question of what portion of this difference could be attributable to the
programme and what portion to other explanations. A large influx of new employees might change rates
dramatically. Equally, in some instances, employees have two or three places to get tested and may self-select
away from their employee testing sites or those administered by CHAMP in favour of private health facilities. This
difference will be important to explore in future research.

20
To capture these costs, we asked all the doctors who ran the hospitals to estimate the percentage of
both hospital and clinic patients who were HIV positive. We got estimates from five doctors and one
company that reported numbers while completing our forms. Estimates ranged from 11 percent (this
from the company that refers many cases to outside clinics), to 65 percent. Many had at least some
data from which to base their estimates. The resulting average was 34 percent of outpatients and 40
percent of hospital patients. By taking total clinic and hospital costs, subtracting the costs of patients
taking ARVs and those who are HIV positive, but not yet on ARVs, we could obtain the total expenditure
of all patients except those undiagnosed, but living with HIV or AIDS. We attributed residual HIV related
costs to these patients.

Using doctors’ estimates of per-patient costs for diagnosed patients and their estimates of total patient
load in hospitals and clinics due to HIV and AIDS, we were able to estimate the amount spent on
undiagnosed patients. We used these relative costs and apportioned medical costs of those companies
where per patient costs were not known.

Finally, we asked companies with hospitals to estimate the quantity of time and money spent on HIV
positive patients by types of expenditures. For example, we asked each to estimate the amount of
doctor time given to a patient beginning ARV treatment. We asked for lists of laboratory work and got
costs for each component.

Modelling New Employees

When the cost of replacing a worker approaches 8,000 USD as it does in this research, mostly through
lost productive and supervision times, it is important to understand why workers are leaving, even if
they are not retiring or dying while on the job. HIV takes a considerable toll on the Zambian working
population. Best guesses by professionals within Zambia are that a typical untreated adult lives only
about five-and-a-half years after contracting HIV. This is considerably shorter than a lifespan in
wealthier countries where someone recently infected, but remaining untreated might expect to live
some 10 or more years. Poor quality diet, demanding labour conditions and poor medical care all
conspire to shorten the life expectancy of an already ill Zambian.

Using the five-and-a-half year estimate, employee turnover was modelled. When employees go on
10
ARVs, many live an apparently full work life . Others who take ARVs do so at a very late stage in their
AIDS illness and thus, extend their lives only another year or so. A few who go on ARVs are not
responsive to the drugs and die in the same amount of time as those who never accessed ARVs. Using
these parameters, an estimate of employee work-life and turnover was modelled for employees with
undiagnosed (and untreated) HIV and those who have been diagnosed (and are regularly reviewed for
treatment).

10
Several doctors reported that they have seen employees on ARVs working normal time and workloads for years.
Free ARVs have only been available since 2005 in Zambia and companies who provided them before that time did
so for only a few years. So, for purposes of this study, an employee successfully on ARVs was assumed to
subsequently have a normal work-life. Only time will tell if, for the Zambian population, an assumption of a normal
work-life holds true over the long run.

21
Using company counts of deaths and retirements was not a reasonable substitute for this work-life
model. Ideally, each employer would be able to report the number of employees who left each year
either through death or retirement, and how many of these could be attributed to HIV. If such data
were accurate and readily available, one could replace the estimated five-and-a-half years with an
actual figure. When employee deaths and retirement numbers were calculated, they produced
unrealistic work life estimates - as high as 200 years. This is likely because many HIV positive employees
go uncounted; they simply leave the company rather than retire or die.

Even if employers endeavoured to keep very accurate information in this regard, it is not always easy to
know whether a retirement, in particular, or a death is due to AIDS. This is a medical judgment which
must be backed by adequate tests. When an employee has not had a test, or when the employee
chooses not to reveal the results of a test, even medical personnel are left to guess as to cause. An
employee seeking early retirement, possibly due to illness may not reveal the actual reasons for
retirement. Deaths while on-the-job would not be an accurate count of actual employee deaths due to
AIDS because some would retire before they died.

Overhead In Program Costs

A major cost of an HIV programme is the cost of employee time, either education or training. Only one
company reported the cost of employee time as a part of total HIV workplace programme costs. This is
separate and apart from salaries of staff involved in the programme. In order to judge the approximate
value of this employee time, the value of employee time devoted to training and workshop participants
multiplied by hours of training/workshops, multiplied by average hourly salary was calculated.

Findings

Net Benefits
The net benefit of an HIV prevention programme is the costs avoided and reduced (the benefit) minus
the costs of the programme itself. This analysis extended the usual definition to include costs and
benefits of treatment and care. Specifically, it included:
Costs:  Costs of Prevention (Prevention education and training)
 Costs of Care (Medical costs of treating those who are HIV positive and
under treatment)
Benefits:  Costs avoided because of reduced numbers of HIV positive employees
 Costs reduced because employees have shifted from being sick to
stable health due to ARV medications

As Table 2 shows, savings related to HIV workplace programmes are approximately three times the cost
of the programmes. This varied substantially across companies, with only one company showing a net
cost of their HIV programme, and the maximum benefit being 5½ times greater than their costs.

22
Table 2: Net benefits of HIV workplace programme
Aggregate Costs Aggregate
(USD) Savings (USD)

Savings due to ARV treatment 2,214,300

Savings due to new infections 5,385,073

Costs of prevention 1,659,627

Cost of care 802,074

Sub-total 2,461,701 7,599,373

Net benefits 5,137,672

Six of the seven companies examined showed net benefits for their workplace programme. On average,
these benefits amounted to 47 USD per employee for the year 2006. Table 3 shows net benefits and the
impact of these benefits on payroll.

Table 3: Net benefits per employee of HIV workplace programme

Net Benefit Percent of
USD Total Payroll

Mining 1 -276 -2.6%

Agriculture 1 58 1.2%

Mining 2 5 0.0%

Mining 3 412 2.5%

Mining 4 24 2.1%

Agriculture 2 76 0.7%

Agriculture 3 33 0.2%

Average 47 0.6%

23
Many company managers expressed their satisfaction with the programme, but often couched that
satisfaction in terms of doing the right thing for their employees, communities, and the nation. While
the doctors who oversaw company clinics were frequently eager to talk about the benefits to the
programme - observable differences in deaths, sickness, and hospitalizations, for example, managers
tended to view the programmes as necessary costs which supported a workforce and community upon
which it depended. One senior manager said, “I know that you won’t find a benefit here, but we do it
because it is the right thing to do. We’ll do it anyhow, whether there is a benefit or not.”

Two companies stand out as not showing net benefits. One company had an actual net cost while
another had nearly equal costs and benefits. While the explanations are likely complex, some
preliminary investigation revealed at least two important indications. The most striking result is that
both companies are fairly new to the programme. In both instances, 2006 was their first full year with
HIV programmes. The impact of programme timing is discussed in a later section of this report.

The company which showed a net cost had unusually high costs for the programme. They spent more
than three times as much per employee as the typical company (545 USD versus 154 USD), and three
times more than the next highest cost-per-employee company. While a number of costs were high, the
highest was the value of employee time spent at workshops. The total cost of employee time at training
and workshops was in the mid-range for all companies, not nearly as high as some, not nearly as low as
others. But, because this company is the smallest, when calculated as a per-employee cost, it was
relatively high. Because benefits accrue relative to the number of employees affected by early
retirements, medical costs, etc. in order to show a net benefit, costs must also be viewed within a per-
employee framework.

What makes employee time so costly for this one company is the fact that its programme costs must be
spread across fewer employees who are paid relatively high salaries, and because the company is new
to the programme. New programme entrants are likely to spend more time training staff than do older
programmes. Since training has a cumulative effect, this new, smaller company benefits neither from
costs-to-time benefits (increasing effectiveness of accrued training) nor costs-to-scale benefits
(spreading fixed costs across a large number of employees). The evidence from the other six companies
would indicate that this small, new company can expect to see its net costs disappear or turn into net
benefits as the years of the programme increase.

Costs

Cost Of Programme
Of all the data gathered in this study, probably the most problematic were the numbers supplied for
the costs of the HIV workplace programmes. Costs both for the medical and education efforts were
difficult to gather and often appeared inaccurate once put into a framework. Several means were used
to correct for errors, but resultant corrections cannot be assumed to be fully accurate.

Programme costs consisted of expenditures for training and workshops, costs of treating diagnosed
cases of HIV and AIDS, employee time involved in treatment and prevention (whether salaried for this
purpose or time taken from other work), and costs of counselling and testing. Some of these costs are
paid directly from the GDA programme. Where such costs were accrued by CHAMP, the costs were

24
accurately recorded and fully accounted for. Companies, however, bear a substantial portion of the
costs and often do not account for all of them.

For example, most companies did not consider the administrative time it took to oversee and
administer the programme. Many provided lunches, materials, and transport for the training and
workshops, but did not report such costs. Another problem encountered is that some of the companies
spend a considerable amount of their expenditures on community efforts. One agricultural company
purchases much of its product from independent farmers. Although these farmers are not their
employees, the small-scale farmers do represent the productivity of their market and are, therefore,
included in the programme. Yet, calculations for this analysis focused generally on the employed
11
workforce .

The investigator had rather constant access to the GDA partner that was administering the programme
along with its community workers. Using those with considerable knowledge of how each company
works, the reported costs of the programme were weighed against what was known of the structure
and scope of each company’s programme. Hence, adjustments were made to reported costs when it
was known that important costs had either been left out of the reporting, or were substantially
attributable to a non-employee base.

Table 4 shows the breakdown of programme costs by purpose. Across all companies, about 166 USD
was spent per employee per year.

Table 4: Programme costs

Amount spent % of total
per employee programme
(USD) costs

Education & Training 45.97 29.3%

All counselling and testing 3.37 2.0%

Salaries 36.62 21.5%

Other administration 17.89 10.5%

Employee time 46.91 27.6%

Cost of treating diagnosed HIV positive 15.46 9.1%

Totals 166.22

11
See a separate analysis later in this report that looks at this population.

25
The bulk of the costs are attributable to the education and training effort. Considerable time and effort
had been spent on educating and training peer educators in awareness, care, and treatment of HIV and
AIDS. About the same amount of value was spent on employee time, the value of time spent in
education, training, and workshops of employees who, under different circumstances, would have
other duties. The cost of testing kits is free when used within the context of the GDA programme, but
some companies spend their own money to make testing available on demand by their employees at
clinics, hospitals, and workshops.

Surprisingly, a comparatively smaller amount was spent on medical costs attributable to those who
have been tested and diagnosed with HIV or AIDS - approximately 15 USD per employee, or nine
percent of total costs.

Program Prevention
A substantial portion of the education and training component of the programme is devoted to
sensitizing peer educators, employees, and community members to the risks, causes, and prevention of
HIV. Getting the word out to the employees, their spouses and the surrounding community is a main
objective of the programme. Expenditures on this effort reflect this priority as shown in Table 5.
Although much of this effort involves the communities in which the company operates (and employees
live), when computed just for employees, about a dollar each was spent on sensitization in 2006.

Table 5: Breakdown of education and training expenditures

Expenditures
per employee % of total
(USD)

Sensitization 1.02 41.1%

Prevention 0.48 19.3%

Orphans and vulnerable children 0.25 10.0%

Prevention of mother to child transmission 0.10 4.0%

Palliative care 0.45 18.1%

Palliative care of TB and HIV - care giver's

0.10 4.0%
training

ARV Training 0.09 3.5%

26
Human Resources Time
On average, companies spent about 150,000 USD of employee time on the workplace programme. This
is separate and apart from salaried time explicitly devoted to the programme. Most of this time was
spent on workshops and training. When expenditures per company were averaged, they spent 27
percent of their programme costs on employee time.

Most of these trainings and workshops involved counsellors, educators, and care givers. What was not
estimated was the value of their time talking with colleagues. Neither was the value estimated of non-
educator colleagues in engaging in such conversation. Anecdotal evidence indicates that much of this
time was done after work hours and on weekends. But, no doubt, it also involved time at work. This
time was not captured as costs avoided, assuming those who have received information and
counselling take less educator and counsellor time once under treatment. Thus, although this time is of
value to the company, its undercount probably gets balanced by a similar undercount in benefits.

One company appeared to capture all types of employee time: time spent on training, time spent on
educating, and time employees spent being educated. Their estimate per employee was about twice
the average of time spent by other companies; even though the cost of employees was quite low for
this company. A rough estimate of time spent by employees might be twice that analyzed here.

Benefits
Benefits of the HIV workplace programme are, simply, the costs avoided because employees have not
contracted the disease and the costs reduced because employees have switched from being sick due to
the disease, to being relatively active while on ARVs. These benefits affect the productivity of the
workforce, the medical costs of treating them, and employee turnover.

Three types of prevalence rates provided the foundation for estimates of benefits. Across the
companies, the expected prevalence rate averages 27 percent. This was due to the anticipated
prevailing rate in mining companies short of any mitigating factors of 30 percent, as established by
previous studies, and one mining company with a known prevalence rate of 33 percent. The prevalence
rates measured by CT results across all companies were 16 percent.

It is likely that some, if not all of the difference between expected and measured rates can be
attributed to the success of the HIV workplace programme. This study made the conservative estimate
that about half of the difference between these rates might be attributable to the programme. Using
this conservative estimate, we measured the effects of the programme on the number of employees
12
avoiding infection, and having longer work lives due to conversion from sick and HIV positive to ARVs .

12
ARV work life is considered to pattern those who do not have HIV once-and if- an ARV patient has stabilized.
Most ARV employees have been on the drug three years or less. Within the last year, most just went on the ARVs
which became widely available and free. Using a set of known parameters, we modelled work life years for those
on ARVs. Parameters included: ARV failure, extended longevity, but eventual death of those testing late, and
success of those who tested in time.

27
In fact, HIV has a major effect over several years for companies. Infections avoided today result in fewer
turnovers in a number of years. ARV treatment today has a more immediate effect by possibly avoiding
a death within a year or two. Nevertheless, this data is calculated to show the effect that the HIV
programme conducted in 2006 would have on company costs and benefits in the future. Thus, any
savings due to the 2006 programme, whether accrued immediately or in the future, were calculated.
Many benefits will appear in the future and may, over time, have a cumulative effect although only one
year effects were estimated here.

Table 6 reflects the numbers that drove these calculations. About 14 percent of employees are
estimated to now be HIV positive. Of 50,000 employees, employee turnovers due to HIV and AIDS are
estimated to be about 500 in the last year. Another 316 turnovers, however, were likely avoided. One
hundred and fifty-one employees are estimated to have improved their health by converting from
untreated HIV positive status to some sort of treatment. The figure includes those who were HIV
positive without treatment, to cases of HIV positive who received treatment, possibly ARVs.

Table 6: Rates of infection, avoided infections and ARV treatment

Total % of Total Staff

Total number of employees 50,579

Currently infected 7,093 14%

Current turnovers due to HIV 496 1%

Infections avoided due to programme 3,296 7%

Turnover avoided due to lower infections 316 1%

Employees on ARV 1,100 2%

Turnover avoided due to ARVs 151 0%

Thus, nearly seven percent or 3,296 employees avoided infection in 2006, while two percent were on
ARVs and enjoying improved health and productivity.

Employee Turnover
Table 7 reveals that the typical company spends an average of nearly 9,000 USD per employee to both
cover funeral costs of an employee dying of AIDS, and to replace that employee. Replacement
employee costs, whether from early retirement or death, average around 8,000 USD. The largest cost
was in the value of time spent by a supervisor in helping the new employee to learn the job.
Supervisors are expensive and the time devoted to helping a new employee, particularly a skilled
employee, is large. New employees’ low productivity was also a high cost.

28
Table 7: Average annual cost of replacing an employee due to HIV

Average cost to a company of hiring a new employee

Recruitment 183

Supervision 5,028

Training 225

Lost productive time 2,711

Subtotal 7,959

Average cost to a company of an employee dying while on

the job

Funeral costs 367

Funeral lost productivity 361

Subtotal 728

13
Table 8 shows estimates of cost savings due to lower employee turnover . The typical company saved
over half a million USD due to lower employee turnover. The biggest savings are attributable to lower
rates of infection. Many companies estimated a considerable amount of time was spent in supervising
new employees (particularly skilled employees and, to a lesser degree, new management workers).

13
The cost savings here are high so it is worth noting that the costs are truly averages across companies. For
example, across all five companies, the cost of recruiting a new employee was calculated. The number in this table
reflects the totals of all seven companies divided by seven. Across all companies, then, the average cost of
recruiting one new employee was USD 2797.

29
Table 8: Typical company total savings due to lower employee turnover (in USD)
Cost
Costs
reduced
avoided
due to
% of total due to new % of total
employees
infections
on ARV
avoided
treatment

Average cost to a company of hiring one new employee

Recruitment 2,797 1% 4,700 1%

Supervision 89,917 45% 127,199 39%

Training 2,995 1% 1,346 0%

Lost productive time 90,290 45% 175,807 54%

Subtotal 185,999 309,051

Average cost to a company of an employee dying while on the job

Funeral costs 6,519 3% 9,793 3%

Funeral lost productivity 7,181 4% 8,569 3%

Subtotal 13,700 18,361

Grand Total 199,699 327,413

Most of these cost savings were due to reducing time lost when a new employee is learning the job
because there are fewer new employees. All companies estimated a productivity loss with new
workers. The exception, however, is of some companies with a number of unskilled labourers who
thought that the intensity of supervision of these employees changed very little from new hires to older
hands. The largest costs often appeared to be with skilled labour which required more supervision and
longer times to learn on the job than other employees. The costs of hiring new managers sometimes
brought them on par with new skilled labour costs due, largely, to the value of their time lost.

30
 14
Most companies would pay for funerals of employees and their dependents . This is just one instance
in many where the effect of HIV on employees overlaps with the welfare of their families and
communities and visa versa. Many cost-benefit analyses of HIV overlook the cost of lost productivity
when staff attend the funeral of an employee or close dependent. One company told of a recent
funeral of an employee where four employees were sent to another region of the country for four days
travel. The company paid for the transportation, kept salaries going, and paid for accommodations and
15
meals for these travelling employees . The calculations made here estimate that the cost of the funeral
itself is equalled to the cost of lost productivity of staff attending the funeral.

Productivity Loss Due To HIV And AIDS

Twenty eight percent of benefits accruing to the GDA companies with HIV programmes can be
attributed to reduced productivity losses from sick employees. The typical company saved nearly half a
million dollars in productivity that otherwise would have been lost. Table 9 indicates how these benefits
are distributed.

Table 9: Value of reduced productivity losses due to HIV for typical company
(averaged across companies)
Costs avoided Costs reduced Percent of total
due to fewer due to ARV lost
new infections treatment productivity

Productivity lost due to sick leave 97,104 32,365 25.2%

Sick but working lost productivity 284,701 99,236 74.8%

Totals 381,805 131,601

Most companies in this survey reported surprisingly few actual sick days. One company told us that
they had been downsizing in 2006 and employees did not want to take time off for fear of being
released from employment. Several companies reported that, particularly with their unskilled, seasonal,
and contract workers, sick days were few. Seasonal workers do not get paid for sick days and lower
level employees know that there are many people who could and would take their job, should they
appear unreliable. Thus, although companies did have losses of productivity due to sick days resulting
from HIV, these losses were minimal. The benefits of saving on such productivity losses were
minimized.

14
Although what was calculated here was the cost of an employee funeral, in fact, many companies funded more
than employee funerals.
15
As a result of such costs, some companies now have policies of how many employees will be allowed to go to the
funerals of staff and their dependents because the loss of productive time is so great.

31
Many managers reported that they thought a substantial percent of their workforce came to work even
when they were sick. Some were able to give fairly accurate counts (say five of every shift of 180), or 10
of a labour force of 120. We asked these same managers how much production was reduced when an
employee reported to work while ill. Across industries the answer was about 30 percent less
productivity from a sick employee. We used these parameters to estimate the cost of lost productivity
when an employee reports to work sick.

Using these figures and estimates from records and clinicians about the percentage of sick employees
who had AIDS symptoms, we were able to estimate the loss of productivity when employees report to
work feeling sick. Applying the estimates of HIV infection rates and workers on ARVs that no longer
report to work sick, we were able to estimate total cost savings. Roughly three quarters of those
productivity savings were attributable to avoided productivity losses when workers who report to work,
feel sick.

Medical
Uniformly, treating patients diagnosed with HIV or AIDS was cheaper than treating undiagnosed
patients. Costs of treating undiagnosed HIV positive patients were estimated to be about seven times
that of those who had been diagnosed and were on ARVs. Given that ARVs are free and most ARV
patients are seen to be relatively healthy and stable, this is of little surprise. The estimated costs across
companies of treating an undiagnosed patient - neither monitored, nor on ARVs - was 371 USD in 2006.
This contrasted with the cost of treating (but not medicating) an ARV patient, an estimated annual cost
of 55 USD.

The average annual cost across companies of caring for an HIV or AIDS patient that has not been
evaluated either put on ARVs, or is monitored for progression of the disease is 402 USD. This cost
translated into considerable savings when applied to the estimates of employees who either avoided
infections or successfully moved from undiagnosed AIDS to ARVs. The typical company will save about
200,000 USD annually on employees who did not get infected in 2006. They saved about 70,000 USD in
2006 on employees who were on ARVs and, hence, required less treatment, doctor time, and
hospitalization. Doctors observed that they had seen significant changes in both deaths and
hospitalizations since employees could access ARVs. They acknowledged, however, that there were
some additional burdens on outpatient services, as many employees now needed to be monitored
regularly. Firms who paid transportation costs to local clinics said that transport costs had gone up since
employees went on ARVs and needed monthly visits to the clinics.

Costs Of Non-Permanent Workers

As contract workers in the mining sector have benefits similar to those of regular workers, the cost
analysis of temporary workers focused on the three agricultural companies that employed seasonal
workers. Such workers have very different benefits, pay scales, and costs than their permanent
counterparts.

Monthly, seasonal workers in the commercial agriculture sector are paid an average of 65 percent of
what regular workers are paid in these three agricultural firms. Since they work only five to eight

32
months per year (for these firms at any rate), their annual pay is an even smaller percent of regular
workers’ annual pay. These workers sometimes can access company-provided health care. About 17
percent of overall benefits to employers of HIV programmes to seasonal workers derived from reduced
medical costs as shown in Figure 2.

Figure 2: Breakdown of HIV workplace programmes benefits for seasonal workers

benefit of
reduced
benefit of undiagnosed
increased employees, 17%
productivity, 46%

benefit of
reduced new
employment, 38
%

Whereas Figure 2 shows an overall average, the actual percent of total benefits to any of the three
companies varied widely, according to the structure of their costs. For example, one company covered
no health costs of seasonal workers but, because they employ seasonal workers for processing, not
harvesting or growing, their temporary workers require quite a bit of supervision when first introduced
to the job. Nearly all the benefits for this company were due to the reduction of the percentage of
seasonal workers who were new to the job. At present, they hired about 20 percent new workers each
year. They are losing about one percent of their seasonal employees each year due to HIV and would
have lost another one percent had there had not been a programme in effect. Company estimates
show that an additional 3,500 USD of supervisor time was required to get a new seasonal worker up to
full productivity.

Of the two companies that do provide health care, about 83 percent of their programme benefits
derive from reduced healthcare costs. Most of the remainder of the benefit for these two companies
derived from the increased productivity of workers when they reported to work feeling well rather than
sick while they were under treatment. Nevertheless, one of these firms derived no net benefit or net
cost to the programme for these workers. Therefore, the HIV programme for seasonal workers paid for
itself. For the other two companies, the programme produced net benefits. Over the three companies,
benefits averaged 32 USD for each seasonal employee.

33
Analysis

Cost Of Untreated Workers Vs. ARV Workers

Figure 3 illustrates estimates of the costs of treating ARV patients, the cost of HIV positive patients who
are not yet under treatment and both ARV patients and those who are HIV positive who remain
undiagnosed and, therefore, not treated or monitored for the disease. The relative costs reflect
anecdotal evidence from doctors that suggests that their hospitalisation loads have been greatly
reduced as they have been able to move patients from hospitals and general ill-heath to stable ARV
patients.

Figure 3: Relative costs of treating ARV, pre-ARVs and undiagnosed HIV and AIDS
patients

500

450

400

350

300
USD

250

200

150

100

50

0
cost of treating cost of treating
ARV patient (not cost of treating
HIV+ patient not undiagnosed
including drugs) yet on ARVS

Generally, doctors report that annual laboratory testing is done for each patient living with HIV. Usually,
stable ARV patients are relatively easy to care for and require little doctor and clinic time.

Our results parallel what is generally known among health care professionals. Once on ARVs or in a
treatment program to prolong health before ARVs, patients become relatively healthy and incur few
extra medical costs aside from the drugs which are rapidly becoming free and available for all
Zambians. The difference in cost between caring for someone who has undiagnosed AIDS versus the
cost of caring for that same person once he is on treatment underlies many of the benefits of the
workplace programme calculated here.

34
Agriculture Vs. Mining
There were net benefits across the companies for both the mining and agriculture sectors. However,
the characteristics of the two industries demanded different structures of both costs and benefits.
Mining firms pay substantially higher wages, have a much higher percentage of skilled workers, and
generally tend to pay higher amounts of medical costs. Figure 4 demonstrates the relative costs and
benefits for the two industries.

Figure 4: Sectoral comparisons of costs, benefits and net benefits per employee

300

250

200

150

100

50

Mining
0

total cost
Agriculture
total benefits
net benefits

Despite the relative differences in costs and in benefits, both sectors derive net benefits. Clearly, the
most striking comparison is that agriculture spends less, offers fewer benefits, and derives smaller net
benefits per employee than mining. Given the salary differences between the two sectors, this is not
surprising.

These same structural differences drive a variation in costs of the programme. Employee costs are
much higher in the mining industry than in the agricultural industry.

35
Figure 5 shows the programme cost differences which result.

Figure 5: Breakdown of programme cost by sector

40%

35%
Percent of total programme costs

30%

25%

20%
Mining

15% Agriculture

10%

5%

0%
Ed & All CT Materials Salaries Other Employee Cost of
Training & admin time treating
Supplies diagnosed
HIV+

As a percentage of total programme costs, the mining sector spent more on employee time and
salaries, while agriculture spent more on education, training, and administration. Overall, both
industries spent roughly the same amounts on their programmes. Per-employee costs were also
roughly comparable. Agricultural firms spent 143 USD per employee and mining firms spent 191 USD.
Note that the two sectors differed widely on how much they spent on treating employees diagnosed
with HIV. Annually, mining firms spent an average of 27 USD per employee for these costs whereas
agricultural industries spent about 2 USD. This reflects the relative amounts they spent on healthcare as
a whole.

The two industries were similar when comparing the breakdown of the derived benefits. New
employee recruitment and productivity were primary costs for both industries as reflected in Figure 6.
Loss of productivity due to existing employee leave or poor performance while sick was also a major
cost.

36
Figure 6: Breakdown of benefits derived from programme by sector

60%

50%

40%

30%
Mining
Agriculture
20%

10%

0%
Medical costs new employee employee sick leave or low
recruitment and retirement or productivity
productivity death while working

Time On Programme
Companies with new HIV programmes appear to have smaller benefits than those with programmes of
longer duration. This result was first noticed when two mining industry companies with new
programmes did not conform to expected net benefits. More investigation revealed that there was a
relationship between the length of time a company had participated in the programme and several
other interesting factors:

Figure 7: Correlation coefficients with years of funding HIV programme

Total costs of programme -.43

Total benefits of programme .57

Net benefits of programme .68

There are likely to be two factors at work. The nature of the GDA programme is to assist a company to
build or enhance it’s own capacity to deal with HIV and AIDS. Longevity of such programme
participation may be a good indicator of increased company capacity. For example, in the first year,
none of the peer educators are trained or sensitised. A year later, they have all had some, often
extensive, training and are getting more.

37
Another likely factor is employee awareness and sensitisation. Clearly, exposure to literature, training,
informal conversation, and informed counsellors creates a more informed employee base. Time will
only increase this awareness and probably propel the transition from awareness into action.

Finally, the longer a company has an HIV programme, the more employees and their dependents and
community have been tested. Self-monitoring may lead to action in the form of prevention or seeking
medical advice. It is noteworthy that all companies had lower than expected prevalence of HIV positive
employees.

38
Employee Morale And Community Impact
Knowledge and other benefits from the workplace programmes are also spreading to the surrounding
communities. Access to HIV related information, condoms, VCT, and in some cases, ARVs have
improved the lives of community members and these efforts are much appreciated.

From the employees and community members’ perspectives, there is room for improvement. For
instance, in the further implementation of the HIV workplace programmes, the language and
visualisation of prevention messages must reach the illiterate and non-English speaking members of the
communities, resulting in increased access to HIV health care and services. For workplace programmes
to be effective, they need to be multi-sectoral, comprehensive, focused, and community driven.

Literature Review

Employee And Community Perceptions

While evidence is so far limited, the majority of case studies describing workplace programmes report
increased awareness amongst workers communities, and morale. In some cases infection rates are
down (Bloom et al., 2001& Daly 2000).

The oft-cited successful awareness and prevention campaigns run by the South African electricity
company Eskom, in collaboration with local community groups and the government show the
importance of the links between public and private sector (Bloom et al., 2001, GBC 2000, & Daly 2000).
Annual monitoring of program costs found that the company spends approximately 20 USD per year
per employee, far less than the cost of recruiting and training new employees for most positions. Eskom
also collaborates with government and NGOs on an education campaign for the wider community, and
it makes regular broadcasts on national and regional radio stations. It also provides substantial funding
for NGOs working on AIDS prevention and for vaccine research. Studies have found a high level of HIV
awareness among Eskom’s employees, lowered levels of discrimination against staff living with HIV, and
greater willingness to report HIV status (Daly, 2000 & Bloom et al., 2001).

The exploratory research undertaken at Eskom by the Horizons Program and Development Research
Africa, shows that HIV-related stigma and discrimination can seriously affect the workplace, especially
employee morale. Non-discriminatory workplace HIV policies can make workers feel relatively secure
that they will not be fired from their jobs, and social isolation and ridicule should be addressed when
developing stigma-reduction activities (Population Council/Horizons, 2002). The study concludes that
the commonly reported interaction between workplace and community-based stigma calls for a
coordinated response, such as offering workers and their family members a choice of using VCT services
in either the community or workplace.

In 2004, Horizons Program undertook a study to evaluate the impact of the workplace programme at
Eskom, showing that Eskom’s programme successfully addressed gaps in HIV knowledge among
workers and catalyzed the dissemination of information by workers to family and community members.
Additionally, the program increased awareness of Eskom’s HIV policies, but workers want Eskom to
take a more direct role in providing HIV treatment. It was also found that Eskom’s efforts mobilized

39
peer educators and supervisors to confront stigma in the workplace and community, but more is
needed to address workers’ lingering concerns about stigma and confidentiality (Esu-Williams et al.,
2005). While the example and experiences from Eskom lead the way for other companies, it becomes
clear from the Horizons evaluation and other research that, workplace HIV programmes need
continued attention and programme challenges need to be identified and addressed.

Bloom et al. (2001) speculate that loss of staff members through sickness has theoretical effects on a
firm’s stock of know-how and the morale of other workers, as well as imposing recruitment costs. As
one Kenyan company manager puts it, “If you lose someone you have trained for twenty years, that is a
great loss. Condoms and AIDS education cost peanuts.” (Bloom et al., 2001 & UNAIDS, 1998).

The Thai Business Coalition on AIDS highlights poor morale as one factor facing businesses that fail to
deal with HIV in the workplace (UNAIDS, 1998 & Bloom et al., 2001). Community involvement by a
company can have a very positive effect on morale. As former Chairman Sir Allan Sheppard, of Grand
Metropolitan has said, “Of all the aspects of corporate life which influence employees’ attitudes and
motivation, none is more important than the active contribution made by the company to the
communities where it operates (Bloom et al., 2001).

Stigma, discrimination and intolerance towards workers with acute and chronic conditions at the
workplace have a great impact on the morale and well-being of the infected worker (Population
Council/Horizons 2002 & Maticka-Tyndale et al., 2002). Workplace programmes on HIV can play a key
role in reducing these harmful practices, through policy formulation and implementation (including
disciplinary actions). For successful implementation of any HIV workplace policy, the full involvement,
commitment, and leadership from senior and middle management are crucial (UNAIDS, 1998, GBC,
2000 & Daly, 2000 & Bloom et al., 2001).

Central to many of the workplace responses is the establishment of non-discriminatory practices in

relation to people living with HIV, coupled with the provision of confidential counselling. These are
crucial factors in providing good working environments and for building knowledge about HIV amongst
the workforce, making a positive impact on employees’ morale. (Daly, 2000).

Methodology
Several approaches were used to gather information on the impact of HIV workplace programmes on
employees and community members: literature review, informal discussions, focus group discussions,
structured interviews using questionnaires, and observations.

A total of 12 focus group discussions were conducted at the seven GDA partners involved in this
research, involving a total of 96 people, of whom only six were females. At each company, at least one
focus group discussion was held, with five to six people per focus group discussion, comprised of
permanent and non-permanent workers. Separate focus group discussions were held with migrant
workers where applicable. All employees who participated in a focus group discussion were randomly
selected by the researchers, often guided by the HIV Focal Person of the company.

40
Each focus group discussion took between 30 minutes and one hour, conducted by two researchers
using guiding questions. All discussions were recorded, while notes were being taken by the
researchers. Discussions were held in English mixed with the local language (Bemba or Nyanja), or local
language only. As the researchers mastered the local languages, no translators were used, therefore,
the chance of losing valid information was minimised. While the guiding questions were developed in
English, the researchers translated the questions into the local language before travelling to the
respective company.

All efforts were made to create a safe, comfortable environment, allowing the focus group discussion
participants to speak freely. The discussions were held in a staff room or office on the company’s
premises and measures were taken so that others could not disturb the session.

In addition, structured interviews were conducted through questionnaires with purposely selected
employees and non-employees from the community. At least five employees and a minimum of seven
community members per company were interviewed. The team interviewed 48 employees and 43
community members using these structured questionnaires. Each questionnaire took about 15 minutes
to conduct, and questionnaires were administered in various places: at market places within and
outside the community, at homes and hostels, and within company buildings.

All focus group discussions have been transcribed and additional information from the researchers was
captured, obtained through observations and informal chats with participants after the focus group
discussion or interviews. For the purpose of analysis, themes were identified of the different impacts of
HIV workplace programmes, and demonstrative (anonymous) quotes from participants were selected.

Ethical Issues
The research involved a broad range of people using a variety of techniques to collect data. Therefore,
these are the following principles to which researchers adhered:
 Consultation: in each company the relevant persons and authorities were consulted, so that
the guiding principles of the work were accepted in advance by all.
 Informed consent: participants were informed of the nature of the research prior to the
interviews or the focus group discussions and what their involvement would entail. They were
also given an indication of what would happen to the data, including its potential use in any
reports or publications. The wishes of those who did not wish to participate were respected.
Consent forms were signed by each participant prior to the interviews and the focus group
discussions.
 Privacy, anonymity and confidentiality: participants were not asked to provide personal
details. Supervisors were intentionally asked to stay away from the discussions, to allow
participants to speak freely. Anonymity was guaranteed and time for questions from
participants was allowed.
 Protection from harm: Participants were informed prior to the interview that they were not
required to answer any questions which they felt uncomfortable discussing.

41
Limitations
Participants included permanent, non-permanent employees and community members. Some focus
group discussions included peer educators as participants. Their presence in the focus group
discussions influenced the conversations, but at that stage, once invited, it was deemed impolite to ask
them to leave the discussion. To some extent, their presence may have limited the other employees’
comfort to speak freely.

Findings

Employee Perceptions
The employees involved in this research come from diverse backgrounds. Their household sizes range
from three to 11 members and most of them reside within the premises of their work places, others
residing within walking distance. Their communities are generally not densely populated and most
employees in this research have a medium level of education.

The employees in this research addressed how they perceive their company’s response to HIV and the
impact of the HIV workplace programmes. Most of the employees in the focus group discussions and
interviews confirmed that the companies have implemented the HIV workplace programme and that
most companies provide monetary assistance for funeral costs, to purchase the coffin, and food for the
funeral house. Most often, the company will buy the coffin outright. The company further provides
transport to and from the burial sites. These facilities do not apply only to permanent employees, but
also to dependants who pass away. One employee alluded:
“When I get sick, whether from HIV or from other illnesses, I don’t have to worry
because I know that the company will assist me transport to go and seek medical
attention from the clinic or the hospital and if all the cars are busy, maybe they are all
in the field, the company often give us cash to cater for transport and medication. Not
only that even when an employee dies or the dependant of that employee dies the
company provides money and transport and some of the company staff are given
maybe three to four hours to visit the funeral house. As a result feel more secured in
my job.”

While one of the respective companies has a clinic on its premises, employees interviewed stated that,
when an employee is sick and cannot be treated at the company clinic, the manager goes so far as to
take them to the hospital to which they have been referred. Other companies don’t have in-house
medical facilities, but refer sick employees to nearby clinics.

The researchers found that the respective workplace programmes have greatly benefited people’s lives.
One employee reported that the greatest benefit that the workplace program has offered is the gift of
life:
“…the most important benefit is one’s life. If you remember I said my CD4 count at
one time was one, if this programme was not there …… a lot of people would have
died…”

Employees noted the efforts by the respective companies around HIV workplace programmes:

42
 “Twalimonapo inshinta kwati 2-3 times apo baitapo ibumba nakalimo lya ba CHAMP
kwisa bombako umulimo wa VCT. Kwisa a fwilishako ukweba ati abantu beshibe
status yabo, nga nabalwala atemwa tabalwele.” (On two or three occasions we have
seen groups, probably from CHAMP, moving into this area and offering VCT services.
They want people to know their status.)

“…those people that are spearheading that programme they go department by

department to sensitize people about HIV. So the company has got a big role it is
playing to sensitize people, at least make them awake that there is such a disease.”

Additionally, workers said they noticed lower death rates among employees. They reported that before
the HIV workplace programme in a named company, at least one worker was lost on a monthly basis.
Employees also observed that there has been an improvement in workers’ productivity because of
medical intervention provided by the company, such as free medication for both employees and their
dependants.

Employees observed that seminars and workshops conducted in the workplace, which included workers
and some community members, have helped change their practices:
“…so far I have lost two friends as a result of HIV which is a lesson enough to change
my sexual behaviour.”

The most visible impact for employees of companies’ workplace programmes is raising awareness of
HIV. As one employee suggested; “Knowledge is power.” If employees can access adequate HIV
information, this will not only help them understand what HIV is, but also assist them in protecting
themselves and others from infection. One employee from an agricultural company stated:
“We have known HIV and AIDS from the NGOs like CHAMP, we live in the village
where houses are far apart from each other and we receive HIV information in
intervals.”

This indicates that communities in rural areas normally don’t have adequate information about HIV, but
it reaches them from the workplace programmes.

Employees reported that information on HIV was printed on their pay slips, so that the spouses could
obtain health information there. It was, however, recommended to have the information available in
the local languages and perhaps even with images, to pass on the information to illiterate spouses, or
to those less capable of reading English.

Direct Benefits For Employees

Employees stated in both the focus group discussions and the individual interviews that the workplace
programme provided vital health education. This includes knowledge about HIV transmission and
prevention and services available, including VCT and PMTCT. Other employees also gave personal
testimonies about how the HIV workplace programme has benefited them. Several employees gave
statements about their HIV positive status and shared experiences from the time they were seriously ill.

43
With an HIV programme operating at their workplace, these employees are now fit after receiving
medical attention from the hospital:
“…when I discovered that I am HIV positive and I had to inform my children and other
family members about it. My children thought that I was going to die soon, they
became more worried and their concentration at school was disturbed. However, with
the availability of ARVs now I have been able to maintain good health and this has
lead to the improvement of children’s performance.”

The employees remarked that the companies are encouraging them to be peer-educators, which
strengthens them to become active. Because employees feel that the knowledge they have acquired
about HIV is very beneficial, several of them have become peer-educators, ensuring that their
colleagues both within the company and in the communities can also acquire knowledge.

Negative Perceived Impacts Of Workplace Programmes

Despite the mainly positive effects of the HIV workplace programmes implemented by the respective
companies, the research also revealed less positive points. One aspect that came out of the focus group
discussions and interviews is that, some employees perceive the HIV workplace programme as
threatening to their employment contracts. As one employee observed:
“Knowing your HIV status may threaten the employment contract. This is because
when it comes to pruning of employees or termination of contract, the management
often targets those employees that are HIV positive to avoid the cost of medication,
hours lost for productivity and absenteeism. To us as employees, VCT works to our
disadvantage, so we would prefer not go for VCT in order to safeguard our contract of
employment.”

Whether or not this is true, this employee clearly feared termination of contract. It is a signal to the
employees that greater clarity about the HIV policies within companies is needed.

A few employees worried about the perception that bad behaviour sometimes resulted from VCT.
Some felt that those found HIV positive become sexually active after knowing their HIV status, to
purposely spread HIV to those that are not infected. As one employee stated:
“This has threatened our lives. Because those that are infected with HIV know very
well that they are going to die, so they feel that they should not die alone.”

The employee further explained that these people were having unprotected sex with other employees
16
and members of the community . When the researchers asked another employee whether one would
take care not to infect somebody else, the employee replied:

16
It is possible such behaviour does not represent an actual change in behaviour - that the person having sex had
unprotected sex previously. Rather, it is possible that people were more sensitive to such action when they knew
(or felt they knew) that the person had tested positive. Thus, the testing itself might not be the impetus for the
behaviour, but might have been the motive for observers to change their view of such behaviour.

44
 “If I am to be found HIV positive, I wouldn’t take care to infect others because the
person who infected me did not have sympathy for me.”

There is certainly a need for companies to be aware of these negative behaviours and perceptions and
to try to address them through raising awareness by peer-educators and through information about
positive living.

Impact Of HIV Workplace Programmes On Employees

Employees in this research confirm that HIV is having a negative impact on their lives, and also on their
families and their communities. Employees expressed much worry about the spread of HIV. Their main
concern was that they would contract HIV and eventually die. This would mean leaving their children as
orphans without guarantees as to who would take care of them. One of the employees stated:
“Aah, coming to the issue of AIDS, it affects us in many ways and you would find that
more especially with this family struck by this disease most family members you know
will get to support this person so that he doesn’t feel out of place and also not loved
by the family.”

Employees stated that the workplace programmes have caused behavioural changes. The knowledge
that employees have acquired through the workplace programmes has made them realise the
importance of condom use and faithfulness. The workplace programme activities at the respective
companies are evidenced through various events or activities, but in order to have an effect, analysis is
needed of how employees perceive the occurrence of such events and activities.

Table 10: Frequency of events reported by employees (N=39)

Rate of occurrence
Event
Happened Happened Didn’t
Not sure
a lot a little happen
Discussion of info from peer educators(by
48.7% 38.5% 7.7% 5.1%
fellow employees)

People go for VCT when staff are in area 41.0% 38.5% 2.6% 17.9%

Workplace program staff recognized 74.4% 20.5% 5.1% -

Management support HIV network 74.4% 15.4% 5.1% 5.1%

Colleagues discuss peer education 61.5% 25.6% 12.8% -

Workplace networks spreading information 66.7% 17.9% 2.6% 12.8%

People wait for workplace program services 66.7% 13.9% 8.3% 11.1%

45
The observed discussions among fellow employees of HIV-related information from peer-educators
reveals that these peer-educators play a key role in passing on the necessary information about HIV to
employees. Obvious findings from the research are that workplace programme staff is recognised and
that the majority of employees interviewed reported awareness of management support to the HIV
network.

Employees were also asked to state their perceived benefits of the respective HIV workplace
programmes. Those mentioned included: learning about abstinence, faithfulness and condom use
(ABC), free VCT services, ARV/PMTCT services, palliative care, reduction in stigmatization, openness
about HIV related issues, behaviour change, and company intervention such as taking responsibility in
case of employees’ sickness.

Table 11: Benefits of workplace programmes to employees

Amount of Benefit Total

Benefit mentioned: number
Benefited Benefited No (N)
Not sure
a lot a little Benefit

Awareness/Knowledge 94.3% 5.7% - - 35

ABC (abstinence, be faithful and

60.0% 33.3% - 6.7% 15
condom use)

VCT 73.3% 16.7% 6.7% 3.3% 30

ARV/PMTCT 81.8% - 4.6% 13.6% 22

Reduction of stigma 100% - - - 5

Openness about HIV issues 87.5% 12.5% - - 8

Behaviour change 75.0% 25.0% - - 8

Company intervention 72.7% 27.3% - - 11

Table 11 shows that awareness, knowledge, and VCT services provided by the workplace programme
are the most cited benefits for employees. Access to ARV and PMTCT are other employees’ benefits
that were often cited. This means that the most visible interventions have the most direct impact and
benefit to employees, and are, therefore, more appreciated. Indirect changes such as behaviour
change, openness about HIV-related issues and reduction in stigmatization are more difficult to observe
and usually take longer to come about and as a result, are less visible as benefits. The research period
was too short to capture these longer-term benefits to all employees. Changes might become more
evident with an evaluation of the workplace programmes after one year of operation.

46
Although rated by a minority of people, the researchers found evidence that behaviour changes and
openness related to HIV are already occurring amongst the employees, as the randomly picked
discussants felt free to ask several questions concerning HIV. Some employees gave personal
testimonies about their HIV status and about how HIV has impacted their families.

Further analysis of the benefits mentioned in the above paragraph shows that directly and indirectly,
the workplace programme interventions by the respective companies have a substantial impact on
employee morale.

Morale
From the focus group discussions and interviews, it was found that the companies’ responses to HIV
through the workplace programmes may be increasing employees’ contentment. During the discussions
employees indicated that they are happy with the companies’ responses, especially the fact that the
HIV workplace programme caters to their dependants as well. One employee stated:
“...it makes me feel a bit secure because I know my dependants, my family, is able to
access medical services at the hospital because [company] pays for the medical
expenses for their employees. Even if I am may be medically discharged due to HIV or
any other issues [company] puts an employee for five years on free medication. It
depends actually how I was medically discharged, if it was due to [company] I will
have medical for life. So at least there I am secure because the policy clearly states the
medical services, which are offered by the company.”

Employees interviewed also raised the concern that there is a minority of employees who persist in
working despite their illness, in a bid to continue providing for their families as breadwinners. This
worsens their health status since, instead of being attended to at a health facility they choose to work
to continue earning money. Employees indicated that this happens mostly by the prejudiced,
misinformed workers, who, despite the fact that their company has a workplace programme with a
policy of non-discrimination regarding HIV, they fear that management would dismiss them if they were
discovered to be ill. This disturbing sign needs to be addressed by companies as they continue
implementation of their workplace programmes, ensuring that all employees are fully and correctly
informed about the company’s policies and practices.

The research found, however, that the majority of employees know that they will not be dismissed on
grounds of their HIV status, which motivates them to work even harder. It also alleviates employees’
fears, knowing that their children are assured of continued education. In addition, employees state that
children who are aware of their parents’ HIV status are encouraged, knowing that their parents will
continue with employment despite their illness.

Employees at several companies have free access to medical care which makes them feel more secure
of their health and productivity at both work and family level. Dependants are also able to receive
medical treatment from nearby hospitals or clinics. Although at some of the companies, sick employees
are referred to other health care facilities for medication, this does not demoralize employees. The
researchers found that for these employees it is enough to know that the company takes care of them.
In addition, employees are reassured, knowing that VCT is offered to them, gratis. Another finding that

47
shows the positive impact of workplace programmes on employee morale is the observed reduction in
stigmatization, which is a result of the HIV information that employees have acquired:
“…you know information is power. People were so much in the dark especially the
employees…”

Employees from various companies stressed that stigma and discrimination among them have been
overcome, due to the HIV awareness raising activities within the companies’ workplace programmes.

While all companies involved recognise the importance of the communities surrounding their premises,
the respective companies have different ways of dealing with them. For some companies, it is enough
that information to the communities filters through via their employees. Others support their trained
peer educators to go out in the communities to talk to people about HIV and distribute condoms,
information, education, and communication (IEC) materials.

Planning
HIV was found to have a significant impact on the current and future plans of employees. They reported
in focus group discussions and interviews that their plans are sometimes blocked because of the
presence of a person living with HIV in the house or community. In particular, plans having financial
implications are disturbed if the resources have to be diverted to medical care for the patient:
“Ikhudzidwa chifukwa pa family olo wadwalapo ndi m’modzi, that means the whole
lot might be affected. Kayili nchito zonse za chitukuko zaima, m’zayamba ku
dealing’ana na matenda yamene yaja… matenda aya ni yoipadi.” (It *AIDS+ affects us
because even if only one person is sick in the family, everyone is affected. All
developmental plans are halted and the focus is on the patient. This disease is bad.)

“AIDS niyo dandaulitsa kwambili chifukwa chakuti ibwelesa chitukuko kumbuyo. So

ndife okwinyilila kwambili pa aya matenda osachilitsika. So tingoyesayesa chabe kuti
mwina tingayeseyese kuti bana amene ali kubwela manje, kubathandiza,
kubaphunzisa chilangizo chakuti mwina angapewe kuti basachitiwe involved
m’matenda yamene aya.” (AIDS draws us back in all our plans. This incurable disease
is saddening. We will do what we can to prevent the next generation from contracting
this disease.)

The employees indicated the importance of knowing one’s HIV status, is an important element in
making plans for the future. They are of the opinion that if one’s status is known, one can know how to
behave thereafter. For instance, if one tests negative, s/he could take the necessary precautionary
measures so that test results remain negative. Others will take an extra effort to avoid infecting other
people. On the other hand, if one tests positive, s/he could be advised by medical personnel on how to
live positively, prevent re-infection, how to avoid infecting other people, and teach them the
importance of adhering to a regime for those requiring drugs. One employee stated:
“…nga cakuti twapimisha twaishiba ati ine shilwelepo naba kashi bandi tabalwelepo
nomba apa plan iyala bapo yakweba ati mwe bakashi atemwa mwe balume tufwile
uku ichindika aikona bumenso-menso. Nomba icakuti twaisa ponena muli ubu

48
 ubulwele… abana besu bakalaikala fye fimbifimbi… Nakuchilisha lintu tulebomba
inchito, tulalusa sana nendalama ukwafwilisha balya indupwa shesu shilya
ishilelwala. (If we test negative as a couple, we can strive to remain negative, but if
we test positive the children will be badly affected. Worse still, a lot of money is lost
through assisting our relatives who are ailing.)”

Other employees state that knowing one’s HIV status has a negative side; once one tests positive, this
may affect plans negatively, and s/he is no longer able to plan for the future.
“…it has the positivities and negativities. On a positive ground it’s, if you know you
status it’s good because you will be able to plan nicely but, you know the negative
aspect is that if you know again it will keep you stressful for a period of time and
hence as you are worrying about your status before you recover so that you accept
your condition. A lot of programmes would have been affected.”

The feeling prevails amongst employees that once one tests positive, s/he is no longer able to plan for
his future.

Employees also indicated that, coupled with insufficient income, HIV makes it even more difficult to
plan. Salaries are not adequate enough to cover their household necessities as well as to take care of
those who are ill within the families. It becomes worse when the breadwinner is the one who is
infected. S/he may make plans for the family, but upon death, all plans are subject to change and there
may be problems regarding the care of the dependants.
“…the HIV problem actually has a great hindrance and it has really affected our
families. At times you find that the person who is affected by HIV is a bread winner
and that’s the person on which everyone depends on and then happens to die away
which means these others will have nowhere to lean on.”

“…I strongly believe that HIV can affect my family and planning in various ways. So if
a family member or be it a neighbour or a fellow employee, it means a planning is
disturbed on personal arrangements including on business arrangements.”

Some of the challenges most employees faced in their planning are lack of time to sit and plan. Since
most employees spend the whole day at work, decision-making by their wives becomes problematic, as
they often need to consult with their husbands. It rarely happens that a wife (woman) makes a decision
without consulting her husband.

This point is supported by additional input from employees, on the impact of planning at the household
level. They indicated that there are certain instances when the employee (as head of the household)
has to make a decision, but must wait since he spends a great deal of time at work, thus, upsetting
programmes at home:
“…my responsibility at work actually affects my family members in terms of their
planning also. There are certain decisions that they would prefer to consult me before
they make it. In cases where they fail to get in touch with that means that programme
is meant to hold on until I come back. So time factor it affects a lot of factors.”

49
 Yaah my job affects my plans because I go to work at 05h30, I am expected to go for
lunch at 12h30, come back and knock off at 18h00. So any other programme that I
would want to do I wouldn’t do because I am 100% linked to my work. Because if you
look at refuse it’s every hour, every minute people are cleaning up their compounds
and their gardens. So I need to be there 100%. So to do with my own programmes I
can’t, simply because of time limitation, unless at night.”

Another critical finding from the research is loss of confidence in the job; once the employee becomes
aware of his status, confidence in the job tends to be lost. Additionally, this affects team spirit at the
workplace, especially those employees that work in teams or groups, as absenteeism increases. Once
an employee’s positive status is public knowledge there is little encouragement from family members
to live positively with his/her status. Consequently planning suffers, especially long-term planning.

Absenteeism
There would be greater absenteeism if companies did not have HIV workplace programmes. Through
the workplace programmes, people are aware of the VCT services available, go for tests, and take
medication. This improves their health, reducing the period needed for sick leave. When this happens,
the company is assured of higher productivity, less expenditure on eventual funeral grants, and
subsequently less expenditure for training and recruitment. If employees who are currently taking ARVs
were not taking them, death rates would be higher and this would have entail recruiting and training
more people. As some employees stated:
“I think it would reduce absenteeism because they will be accessing treatment.”

“When we have a work force that is okay, that is not sick, there will be productivity
and the company will definitely gain.”

“The company gains in the sense that production has increased, we are not at a loss
as such.”

Additionally, if a family member of an employee is sick, the employee may be the one to take care of
them. When there are funerals the employees are required to be present, meaning they would need to
take time off from their jobs. Besides, employees may be required to make contributions (financial or
otherwise) for the funeral or the patient, further depleting their already meagre resources. In some
instances, they may have to forfeit part of their salary for the time that they are away.

Impact Of Workplace Programmes On Communities

The research showed that HIV workplace programmes in the respective companies have been
beneficial not only to the employees but also to their families and the surrounding communities.

Several communities surrounding the respective companies of the research would not have been able
to receive information about HIV. The only time they received information on it was when the CHAMP
mobile HIV unit visited the area for sensitization. As one community member alluded:

50
 “Without CHAMP staff coming here to sensitize us about HIV, it means that we will not
access any information about HIV in terms of demonstrations on how to use the
condoms and access free VCT.”

Table 12: Frequency of events reported by community (N=43)

Rate of occurrence
Event
Happened Happened Didn’t
Not sure
a lot a little happen
Discussion of info from peer educators(by
58.2% 30.2% 11.6% -
community members)

People go for VCT when staff are in area 76.7% 18.6% - 4.7%

Workplace programme staff recognised 65.1% 20.9% 9.3% 4.7%

Chiefs and headmen support HIV network 52.4% 19.1% 7.1% 21.4%

Community members discuss peer

67.4% 25.6% 7.0% -
education
Community networks spreading
62.8% 30.2% 4.7% 2.3%
information
People wait for workplace programme
67.4% 25.6% 2.3% 4.7%
services

Analysis of Table 12 shows that the majority of community members interviewed have been observing
the different events under the workplace programme. A remarkable finding is that a large majority
observed that people go for VCT when the workplace programme staff are in the area.

Community members were also asked to state their perceived benefits of the respective HIV workplace
programmes, as with the employees.

51
Table 13: Benefits of workplace program to community members

Amount of Benefit Total

Benefit number
Benefited Benefited No
Not sure (N)
a lot a little Benefit

Awareness 89.2 8.1 2.7 - 37

ABC 66.7 33.3 0.0 - 18

VCT 81.8 15.2 3.0 - 33

ARV/PMTCT 72.7 13.6 4.6 9.1 22

Reduction of stigma 75.0 8.3 8.3 8.3 12

Openness about HIV issues 100.0 - - - 3

Behaviour change 60.0 40.0 - - 5

Company intervention 80.0 20.0 - - 5

Palliative care 64.3 28.6 7.1 - 14

Analysis of Table 13 indicates that out of the 43 community members who were interviewed, the
majority indicated awareness as a benefit of workplace programmes. It is important to note that 14
community members (non-employees) mentioned palliative care as a benefit of the workplace
programmes, while none of the employees had recognised it as such.

Employees were happy with the HIV workplace programmes, as they have substantially impacted
people’s lives for the better. The programmes operate well and both employees and community
members benefit from the services they receive:
“…the company through the community development has trained some peer
educators around who are going, flood out into the township to sensitize the
community at large. And also it is in the forefront of allowing certain organizations
that are fostering the message or preaching AIDS, it has allowed several people to
come to our company to sensitize its workers.”

“…it has enabled a lot of us to know exactly what HIV is, the treatment, the general
information and also the community around us”

When an employee benefits from the workplace programme, it filters through to the family:

52
 “Our children are also able to go school with a free mind like me am a mother and I
am positive. I was at one time sick, but not very sick. But the fact that they came to
know that I was HIV positive it affected their studies a lot. They thought I was going to
die the following day. But fortunately, enough this programme was already in place,
so I went for the treatment and here I am. They are happy, they have continued with
their education and their results have improved even their performance, weekly
performance has improved a lot.”

“When I discovered that I am HIV positive and I had to inform my children and other
family members about it. My children thought that I was going to die soon, they
became more worried and their concentration at school was disturbed. However, with
the availability of ARVs now I have been able to maintain good health and this has
lead to the improvement of children’s performance.”

Through the workplace programmes, employees and community members have been trained as peer-
educators, who educate employees, as well as community members about HIV. In addition, the benefits
that the employees enjoy also reach community members. The workplace programme also offers free
VCT and PMTCT to community members and not only to employees.
“…both the company and the community benefits. When I talk about the community, I
must agree here that yes we have seen that [company] has gone beyond even to the
community to train peer educators.”

“We are actually reaching almost each and every member of this city as long as he has
agreed to test.”

“…we have trained peer educators drawing them from community groups and
church.”

The programme has made it possible for people to freely discuss sexual issues with their families and
friends. As one participant said:
“I feel there is a lot of change; a long time ago people could not actually talk about
HIV.”

If an employee’s family member is sick, the employee or any other family member has to take care of
them. It is a societal expectation that a member of the family has to be present to take care of them
even if they are attended by medial personnel. In the absence of a family member, members of the
community have to take responsibility. The following narrative is from an individual who only has one
child and a wife, but he is also taking care of three children whose parents died of AIDS. In spite of a
meagre salary, he still must provide for them.
“AIDS itself has affected my family personally in many ways. One a lot of people who
had their children have died and those children are now dependent on my small salary
that I have. I have three, I have one child and my wife, we are three in total but now it
comes to these others that keep in whose parents have died because of this AIDS
thing, you find that my budget is squeezed. So it has affected really my family.”

53
The common jobs in the agricultural sector are time consuming. Employees work long hours and thus,
spend less time with their families. The result of this, regarding the issue of HIV is that, although they
may be well versed with information about HIV which they get from their workplace, they may not have
adequate time to disseminate this information to their family members. In the process, while they will
benefit from the HIV workplace programme, their families may not. Regardless, when employees’
family members—who contract HIV due to ignorance—become sick, they will be affected and required
to attend to them. One employee complained about the amount of time they are left with (by their
demanding job) to spend with their families:
“You know when you are fully devoted to do the company job, that means that all the
programmes that I have written down have come to a stand still. Because there is no
time to attend to them and sometime you would find that during the weekend you
also not have time to look into your programmes because you will be held up with
job.”

Employees from one of the researched companies stated that the company had not (yet) extended its
HIV workplace programme to the community, and there are few peer-educators to sensitize the
community. These employees indicated the desire for the company to expand its programme and to
facilitate collaboration between the company’s social welfare department and peer-educators, enabling
the dissemination of information about HIV to the surrounding communities.

As some communities can only access VCT services from a hospital far away, they expressed their view
that the company should provide a VCT centre. VCT and other services should be confidential and
conducted at a neutral place, not at one of the community members’ houses, which is currently the
case.

Some elderly people in the community have avoided taking part in HIV- related activities because the
expression of human reproductive organs in English sounds insulting to them. Some of them have been
pressuring peer-educators to express the human reproductive organs in the native language in order to
show respect to them. However, the research also found that there is great commitment from local
community leaders in other vicinities, combating the disease through sensitization and education of the
youth. A community leader, aged 64, said:
“I educate the youths on the dangers of HIV and on how to use condoms if they are to
survive and live to my age. Above all change of behaviour in youths which leads to
abstinence is vital.”

Negative Impacts Of Workplace Programmes On Communities

While most people appreciate the work of the companies regarding HIV, some employees feel that the
companies are not doing enough to help families that are affected with HIV:
“I think there the company is doing less but I think it can do more. Doing less in terms
of help that is given, because recently the community development had a pilot
programme of picking how many orphans and the like trying to bring them closer to
the bread which is the company itself so that they might find a way of helping them.
So that is just on paper as of now but I know it will come into effect as time goes by.”

54
In addition, in as much as VCT benefits many people to learn of their health status and provides
knowledge about how to protect themselves from HIV infection, this service has, however, impacted
negatively on some employees and community members. In one of the surrounding communities,
people stated that there has been increasing numbers of divorce, which they attribute to VCT. One of
the discussants stated:
“There has been increasing rates of divorce due to VCT. If one of the spouses discovers
that he/she is HIV positive, especially the husband, then quarrel will ultimately begin
in the home. This is because the husband accuses the wife that she is responsible of
bringing the HIV in the home and the wife will argue vice versa. This creates tension
between the two to the point where the husband divorces the wife. Thus, people in the
compounds prefer not to go for VCT to avoid divorce and tension.”

Not all male employees who have access to counselling at their workplaces are sharing the information
they receive concerning HIV with their spouses. One female community member stated:
“I don’t know whether our husbands go for VCT at the workplace. What I know, for
example, is that my husband may surprisingly tell me that from today onwards we
shall be using a condom every time we have sex without explaining to me why. It may
be that he has been found with a disease but he does not want to tell me.”

Peer-educators requested to be up-dated with the latest HIV information about other related diseases
such as STIs. They expressed the view that:
“We do not have a resource centre were we can do research and access HIV materials.
Lack of this facility have contributed to people having scanty information about HIV in
the community.”

Community members expressed the need to translate the brochures’ information about HIV from
English to the local languages, which will help those who cannot read and understand English to have
access to HIV information.

Besides the need for more information about HIV in general, the research found that several
community members are not sure of the effects of ARVs, even though they receive them gratis. The
communities need more information about the effects and efficacy of ARVs before people began taking
them.

Other recommendations that community members made during the focus group discussions were that
companies should stress the importance of confidentiality by peer-educators, as in some cases, they
have disclosed the HIV status to other community members. It was also noted that female condoms are
not readily available in the community. A constraint in accessing ARVs is the CD4 count, as employees
and community members are forced to pay a certain amount of money to access the CD4 count, which
is perceived as a barrier in view of the poverty levels. If such practical recommendations from
community members could be implemented, this would improve and strengthen the efforts of the
respective companies. It would not only support their employees, but also reach out to the surrounding
communities in the fight against HIV.

55
Non-Permanent Employees
Zambia has a long history of economic migration. Zambian men and women workers have a fairly high
level of mobility. Large mobile groups in Zambia include truck drivers, sex workers, fisherfolk and fish
traders, seasonal agriculture workers, informal cross-border traders, miners, military personnel,
prisoners, and refugees.

High population mobility in Zambia has been identified as one of the key drivers of the AIDS epidemic
with the result that Zambia is one of the hardest hit countries in the SADC region. Although the AIDS
epidemic in Zambia is generalized, particularly at-risk populations include sex workers, seasonal
agricultural workers, long-distance truck drivers, mine workers, cross border traders, uniformed
personnel and employees of the transport sector.

On large farms, men often leave their families to work for up to six months during the harvest season. A
study conducted in Chirundu, a town situated on Zambia’s southern border with Zimbabwe, reveals
that farming communities have had a visible social impact on the social and sexual character of the
17
town given the seasonal and migratory nature of their employment.

This mini survey was designed to provide information on current programmes and future community
needs with non-permanent workers on two survey sites: contract workers at a mine in north-western
Zambia, and temporary workers at a commercial farm in central Zambia. The surveys were carried out
during one week in July 2007. A structured questionnaire was used to survey 153 people at the Mine
(13.9% of workforce). At the commercial farm, 165 people representing 100 per cent of available
temporary workers during the off-season were interviewed. Approximately 12,000 temporary workers
are present during peak season.

Informal sampling techniques were utilized. At the mine, convenience sampling of employees took
place during their breaks at the company canteen. Off-season temporary farm workers were
interviewed at the commercial farm. The surveys were interviewer-led, and the questionnaires used a
combination of open and closed questions.

17
Family Health International: http://www.fhi.org

56
Demographic Information
Table 14: Demographic information
Mining Sites Agribusiness Sites
Characteristics Total (N=319)
(N=154) (N=165)

Sex

Male 140 (91%) 113 (68%) 253 (79%)

Female 14 (9%) 52 (32%) 66 (21%)

Age

Under-24 33 (21%) 59 (36%) 92 (29%)

25-29 52 (34%) 45 (27%) 97 (30%)

30-34 27 (18%) 29 (18%) 56 (18%)

35-39 20 (13%) 14 (8%) 34 (11%)

40-44 9 (6%) 8 (5%) 17 (5%)

45+ 13 (8%) 10 (6%) 23 (7%)

Marital Status

Single - Never married 38 (25%) 31 (19%) 69 (22%)

Married 100 (65%) 117 (71%) 217 (68%)

Divorced 7 (5%) 8 (5%) 15 (5%)

Widowed 0 (0%) 6 (4%) 6 (2%)

Single - long-term relationship 9 (6%) 3 (2%) 12 (4%)

Staff Category

Senior Manager 4 (3%) 0 (0%) 4 (1%)

Manager 2 (1%) 3 (2%) 5 (2%)

Supervisor 32 (21%) 10 (6%) 42 (13%)

Non-supervisory staff 113 (73%) 137 (83%) 250 (78%)

Other 3 (2%) 15 (9%) 18 (6%)

57
Mobility
Just over half of respondents (56% at the mine and 52% at the commercial farm) had dependents living
outside of the district in which they work. However, at both sites, dependents living outside the work
district were largely located in neighbouring districts.

HIV-Related Knowledge
Figure 8: Knowledge of HIV

Have you heard of HIV?

(Copper Mine n=153, Commercial Farm n=165)

100%
90%
80%
% of respondents

Copper Mine
70%
Commercial Farm
60%
50%
40%
30%
20%
10%
0%
Yes No

One hundred and fifty-two (99%) respondents at the mine had heard of HIV. Only one (1%) had not.
The high level of awareness is representative of the country in general, according to the Zambia Sexual
Behavioural Survey (2003).

Slightly lower awareness levels were seen at the commercial farm, where 132 respondents (84%) had
heard of HIV, and 27 (16%) had not.

When respondents were asked the open question, “What is HIV?” the most common responses were: it
is caused by a virus; it is a disease which causes AIDS or is deadly; and it is a slimming illness. Zambians
refer to HIV as a slimming illness due to the severe weight loss and gaunt appearance of HIV affected
persons, largely due to opportunistic infections.

58
Attitudes
Figure 9: Attitudes towards PLWHA working

Should PLWH be allowed to stay at work?

(Copper Mine n=152, Commercial Farm n=138)
% of respondents who had heard of HIV

100%
90% Copper Mine
80% Commercial Farm
70%
60%
50%
40%
30%
20%
10%
0%
Yes No Don't Know

Of the respondents that had heard of HIV at the mine, 151 (99%) thought people living with HIV (PLWH)
should be allowed to stay at work. At the commercial farm, 138 respondents had heard of HIV. Forty-
two (30%) though PLWH should be allowed to stay at work while 94 (68%) said they should not. Two
respondents said they did not know.

Behaviours
Figure 10: Respondents reported use of safe sexual practice

Do you practice safe sex

(Copper Mine n = 154, Commercial Farm n = 165)

90
Percent of respondents

80
70
60
50 Copper Mine

40 Commercial Farm
30
20
10
0
Yes No

59
At the mine, 132 (86%) of respondents said they practice safe sex and 22 (14%) said they did not. At the
commercial farm 95 respondents (58%) state that they practice safe sex. Seventy (42%) said they do
not.

An open question regarding condom use was asked to all respondents. When asked why they do not
use condoms, the fact that condoms do not feel nice was the most frequent response (122). Twenty-
one people said they always use condoms, another 15 claimed to be abstaining and 77 said they were
being faithful. Sixteen people said they thought condoms cause disease or impotence. Thirty-three
people may have wanted to use condoms but were refused by their partners.

Figure 11: Respondents reasons for not using condoms

Reasons for not using condoms

(All respondents n = 318)

Condoms don’t feel nice

Being faithful

Condoms break

Partner refuses to use condoms

Always use condoms

Condoms not 100% effective

Abstain
Condoms cause disease or
impotence

Want children

Don’t know why

Ignorant of need

Against church rules

Careless/drunk

Waste of time to use condoms

Other reasons

0 5 10 15 20 25 30 35 40 45

(Percent of respondents)

60
Figure 11 shows reasons respondents stated they did not use condoms. Approximately 8% of the
sample gave other reasons for not using condoms. These reasons include: “embarrassed to ask for
condoms”, “too expensive”, “don’t fit”, “hard to find condoms”, “don’t care about health”, “not
natural”, “cause promiscuity”, “peer pressure”, and “want to infect others”. Several respondents
refused to answer the question.

Figure 12: Respondents reporting transactional sex

Respondents who have received gifts, food or money for

sex (transactional sex)
(n = 318)
Interviewer
error, 1%

Yes, 28%

No, 71%

Eighty-nine respondents (28%), male and female, from both sites claimed to have received or
exchanged gifts, food or money for sex. The remaining 225 (71%) state they have not engaged in
transactional sex.

Figure 13: Respondents reporting forced sex

Have you been forced to have sex

(Copper Mine n = 153, Commercial Farm n = 165)

100
Percent of respondents

90
80
70
60 Copper Mine
50
40 Commercial Farm
30
20
10
0
Yes No Interviewer error

61
At the copper mine, 26 respondents (17%) stated that they were forced to have sex at some point in
their lives. Twenty four of the 26 were men claimed to have had forced sex. At the commercial farm, 11
respondents (7%) claimed to have had forced sex. Two were women, and 9 were men.

No further prompting was conducted on the interpretation of this question. It is unknown whether men
were referring to themselves as the antagonist or as the victim.

Discussion

Knowledge Vs. Behaviour

At both sites basic knowledge about modes of HIV transmission was high. Most respondents had heard
of HIV, could name at least one correct mode of transmission, gave correct answers for what HIV is (a
disease, a virus) and showed few misconceptions about HIV transmission. There were high numbers of
correct responses about causes and modes of transmission about STIs, the most common being sex
without a condom, followed by having more than one partner.

However, this overall knowledge has not led people to employ standard prevention techniques or to
adopt risk-lowering behaviours. Respondents show low levels of condom use combined with relatively
high levels of multiple concurrent sexual partnerships. Levels of transactional sex - often an indicator of
unequal gender dynamics in the wider community - were also high, with nearly a third of respondents
at both sites stating that they had participated in such relationships. In the farms, there were high levels
of stigma surrounding working with people living with HIV.

This discrepancy between knowledge and behaviour is consistent with existing research conducted with
mobile workers in the region. Although more longitudinal qualitative research is needed at these sites
to explain this, previous studies do offer explanations. These include environmental vulnerability
factors – such as living and working conditions, lack of recreational options, and mobility itself (distance
from families) - which workers state can affect their health-seeking behaviour. In focus group
discussions with non-permanent or temporary employees, workers admitted that this distance from
family leads to extra-marital sexual activity:
We are forced to live far away from our families and our wives for 8 months, and you
know we are used to marriage so to some of us it becomes a temptation and as well
as our wives, we don’t know how she is behaving…so it’s really a great temptation…

The trends indicate a need for a more holistic approach to prevention programmes, which focus on the
wider community and address the environmental vulnerability factors of mobile workers.

62
Conclusion
Having a chance to look at several companies, examining them all for the same time period, and
covering two major sectors of the Zambian economy, provided a unique opportunity to gain insights
into the impact of HIV on the economy and how companies are dealing with the issue. Working in close
collaboration with CHAMP as the GDA technical support partner, this research team had access to data
not usually available: rates of testing for employees, dependents and community, estimates of
employees and others on ARVs, types of training, and costs of the programme.

Equally valuable was accessing those who worked with the companies and in the programmes for their
duration. Since an HIV employee’s status is not always known to an employer, and data is not always
linked to employment status (retirements, leave, etc.), models must be built around known parameters.
Working closely with the companies and CHAMP, we found that we could modify models to fit the
actual structure of the companies and programmes, getting closer to a likely reality.

As a result of this study there are a number of conclusions drawn. Below are those most salient, but
certainly not all of them. Some may not even be of significant importance. What is obvious from this
study is that HIV and AIDS have an enormous impact on all companies, big and small, low-skilled, and
high skilled. Evidence proves the benefit of having an HIV workplace programme, but given the impact
of the disease on company productivity and costs, just knowing that such a programme pays for itself
really raises more questions than it answers. Which aspects of a programme have the largest impact,
whether benefits outweigh costs, should the programme be expanded, and if so would benefits rise?
When the impact of the disease is so pervasive and widespread, should companies work together in
order to protect the country’s industry as a whole? How has the availability of ARVs changed the nature
of the disease’s impact on the economy? It surely makes it less costly for industries to do business and
to have a workplace programme, but how does it affect employees’ willingness to be tested and
treated?

Work With Companies To Get Accurate Cost Data

Companies frequently distance themselves from information regarding the health status of their
employees in order to protect their confidentiality and to reduce the role that stigma can play in
avoiding treatment. Companies are pressed in an increasingly global market and must make decisions
on how to spend their time and energy. Most companies do not maintain program function accounts.
They know how much their payroll, utilities, transportation, and machinery costs, but they do not know
how much of this is devoted to their HIV workplace programme, much less the HIV costs to the
company.

We visited companies for no more than a day at each site to collect data they and speak with
employees and community members. Many companies had data ready for us and/or had informed the
right personnel of our visit and they were waiting to work with us. We heard from several managers
that they were impressed with the type of data we required. They did not keep their records in a
format enabling them to readily answer our questions. In some cases, they could not provide the

63
required data. Many said that they now felt that they needed to begin to keep data so that they could
keep track of programme costs and HIV impacts.

Knowing how expensive it is to create accounts that show both expenditures by categories and by use
of money, the principal investigator neither encouraged nor discouraged this view. Ideally, all
companies would keep track of expenditures in both ways. In reality, it is a decision that required
weighing costs and benefits. At the end of this study, however, the principal investigator has changed
her mind. This changed even with the knowledge that data are somewhat variable. Models leave a
margin of error. Companies supplied data that might not match our definitions, as conclusions of
results sometimes need to be tempered. But the data trends here were so clear and consistent that the
same conclusion could be drawn even given a large margin of error. HIV is having a major impact on
these companies in ways they often are unaware of, or are revealed only in casual conversations with
managers and employees.

Most managers, for example, could cite examples of how funeral attendance was affecting productivity
in real ways in recent times. Few thought of this productivity loss as a bona fide cost of HIV to the
company. Line managers could readily guess how many employees in a shift reported to work feeling ill
and could even estimate the loss of productivity during an ill day of one of these employees. Few had
thought of this as an explicit cost of the disease. Many clinic doctors told us of the very real differences
that ARVs were making in employees’ health and hospital stays, but most thought of this as a cost
reduction rather than a productivity gain for employees.

Surprisingly, not all employers could provide a count of deaths and/or retirements in the company.
Those that could, generally had no idea how much was attributable to HIV. Part of this problem is
because human resources, which is most likely to track such number, is not linked to the medical
personnel who might be able to hypothesize as to cause. One company’s medical staff did a monthly
report of HIV related illnesses which included a count of deaths presumed to be caused by HIV related
illnesses, but that report did not breakdown the numbers by employees, retirees, dependents, and
contractors.

Keeping track of the impact of HIV which includes, but is not limited to the costs and benefits of the
workplace programme is more than an accounting function for these companies. It is apt to be a
strategic necessity. As the prevalence of the disease stabilizes in the country and given its known
pattern of health, illness, and treatment for given populations, projections of impact are becoming
increasingly more accurate. Combining these projections with company data of costs, healthcare, and
benefits could provide strategic direction. For example, could a company providing monthly healthcare
for employees benefit by providing for the cost of transport to and from local clinics once a month for
affected employees? Would this provision discourage employees from seeking treatment? Would
covering transport costs produce a net benefit to the company and help protect its market? How does
the inclusion of neighbouring communities affect the health and well-being of employees? Given that
the disease is a community-based, not necessarily a workplace-based disease, does educating, testing,
and even treating community members have the same benefits as it does for workers?

Given the strategic importance of the economic impact of the disease on these companies, the poor
quality of the data is sometimes striking. Researchers used models backed by known counts to project

64
the work life of employees on ARVs, those who were HIV negative, and those who were HIV positive,
either tested or untested. All companies were able to account for their employees.

Equally, it is important to work with healthcare givers to attempt to get good estimates of ARV use, and
testing and treatment rates categorized by workers, dependents, and community members. Why did
we find one company with a known employee prevalence rate of 34 percent, currently testing with a
rate of 11 percent? Do those who are positive know their status and that they are no longer part of the
testing pool? Is there some reason why those who suspect they are positive stay away from testing?
How much of the difference between expected (sometimes known) rates and prevalence rates of those
currently being tested can be attributed to the success of the programme?

A major recommendation of this study, then, is that companies should look upon HIV as a strategic
issue, design ways to keep track of costs, benefits and counts, and look upon these figures as central to
company planning in the medium term.

Investigate Scope Of Individual Vs. Company Vs. Economic Sector

Although the programme’s outcome of non-permanent workers was either a net benefit to the
company or paid for itself, the investigation raised an important issue. Companies expressed concerns
that, either their programme did not reap a net benefit for seasonal, low-wage, or small-scale
contracted farmers, or that the industry’s structure could not justify much expenditure on such
employees. This concern turned out not to be well-founded. Assuming that these companies are
rational, competitive, and often multinational operations, one could begin by assuming they would not
spend large sums to their detriment. Yet, companies often insisted that such workers should be covered
and, even without an economic justification, they would continue to be covered. Generally, managers
understand the scope of their businesses and, even when they cannot create an explicit economic
argument for an action, they know when it benefits the company. It is assumed that the insight of these
managers combines compassion with good economic sense.

The literature, however, did not provide much guidance in this respect. Most cost-benefit studies of
workplace programmes attempt to focus primarily, often exclusively, on those costs and benefits
related to employee health and productivity. The changes in the industry that might occur because of
HIV and the effects these may have on a company are not generally a part of the analysis. Most
analyses focus either on the macro/sectoral perspective, or on the company perspective.

Long-term systematic depletion of a workforce has tremendous productivity implications. Replacement

labour may be less skilled, have less knowledge, and be more distracted, less committed, more
overworked, and less focused than original labourers. As the ratio of land or labour becomes thinner,
the proportion of households which are labour constrained increases and so too does the impact on the
industry in which they work. Costs rise, quality deteriorates, and industry competitiveness falls. Whole
markets are put at risk. The major cost of HIV for some industries, then, might well be the loss of
markets in the region or country.

Equally, the interactions between community and employees are rather artificially separated in this
type of cost-benefit analysis. All of the companies reviewed here had extended their programmes to

65
surrounding communities and many covered dependents. Since HIV is not a workplace-based malady,
unlike for example, industrial accidents, its mitigation, spread, and treatment involve families and their
communities. An ill child affects the productivity and work life of a parent. An ill spouse means that the
healthy spouse must spend more time doing other activities.

These interactions are not neglected in the literature, but their costs and effects are not generally
modelled along with employee costs and benefits. It is difficult to do so without a multi-level analysis
which is both expensive and requires fairly comprehensive and correct data to have accuracy in
interpretation. Yet, simpler analyses are possible and would begin to paint a more comprehensive
picture. Community effects on industry need to move beyond description or theory and into cost
modelling, so as to assess their relative impact. At a minimum, such major effects need to be explicitly
included in future studies.

Inevitability Of Estimates Based On Expected Prevalence

Results reported here are sensitive to the assumed rate of prevalence in the population. This rate, plus
the actual rate of prevalence observed among employees currently being tested drove the estimates of
changes—turnovers - in work life. Both the literature and experts in the field in Zambia felt that the
2001/2002 Demographic Health Survey (DHS) provided reasonable estimates of current HIV prevalence
within the country. Nevertheless, this is just a best guess, not a verified fact.

The new DHS which is being conducted as of the writing of this report should provide new information.
This can be looked to for current prevailing rates both nationally and within subpopulations. The survey
should be used as a baseline for industries. Given that the impact of HIV for companies is only partially
captured by a company-based examination, industry-based analysis is needed.

What is happening to whole markets of labourers? Are industries being threatened or, perhaps
strengthened? Industries would do well to support careful analysis of this survey information, going far
beyond its usefulness as baseline data that is generally reported nationally. Strategic questions can be
answered with little cost since that data is already gathered, entered, and cleaned. Do workplace
programmes affect whole communities? Do workplace programmes impact employees more than
dependents? More than surrounding communities? What led the trend, the programme or the
community?

Non-Permanent Workforce
Most companies view their HIV workplace programme from the lens of permanent workers. Many do
not see how coverage of their seasonal workers necessarily benefits the company. Some include their
seasonal workers in the programme because it is the right thing to do. They do not care to differentiate
between seasonal and permanent workers when it comes to dealing with HIV and AIDS, and they see
the costs of this coverage as relatively small. Managers who work regularly with such workers often
know them personally and have a personal interest in their welfare. Yet, as one manager said, “As long
as there is a steady supply of labourers, we really don’t see a financial benefit to HIV programmes for us
among these workers.”

66
The view was that, whether fair or not, a seasonal worker who fell ill or quit could be replaced by
another worker who was relatively healthy. Supply of such labour, in this case, seemed to work against
an economic argument for a workplace programme for such workers.

Yet all three companies who had such workers included them in their programme, often seeing this
coverage as low cost and a way of showing workers that the company cared about them. What was
striking in our findings, then, was that there was a net benefit to covering such workers or, in one case,
costs equalled benefits.

An extensive conversation with one manager was held in the field and similarly, a brief conversation
with another manager indicated that their views went beyond the short-term, single, or multi-year
perspective. They understood that the quality and quantity of their labour force was deteriorating.
While there was not a visible financial impact at the moment, both were concerned that if workers
continued to get sick and fall out of the labour market, the viability of their presence would be
threatened.

This viewpoint is borne out by the literature and deserves mention. When there is a relatively large
supply of unskilled labour in an industry that requires poorly educated labour or skilled labour in the
usual sense, the supply of such labour cannot shrink past a certain point before the viability of the
industry itself is threatened.

Table 15 is from research which specifically examined the interaction between agriculture and HIV for
the Food and Agriculture Organization of the United Nations. The table is included here because it
shows the relationships between the industry and labour, a different angle of this paper, which is the
company and its labour.

Table 15: Conjectured impact of AIDS on use and cost of factors of production in
agriculture

Effect of AIDS on availability and cost of resources used in agriculture

Capital assets Knowledge /

Labour in
used in Land skills used in
agriculture
agriculture agriculture

Supply Cost Supply Costs Supply Cost Supply Cost

Hardest-hit countries: HIV

R    R  
prevalence > 20%
Countries with HIV
R  ? R  
prevalence between 5-20%
Key:  = increase;  = major increase;  = decline;  = major decline; R = redistribution from afflicted households to
others; ? = depends on policy and availability of underutilized labour in the informal sector; - = no anticipated major impact.
Source: Jayne, S. et al (2004).

67
While redistribution (“R”) from afflicted households to non-afflicted households (i.e. substituting a
healthy urban relative for one who is ill) may be viable in some instances, overall in both labour and
knowledge/skills, redistribution is not a viable alternative to healthy original workers. The supply of
knowledge, skills, and labour is at risk for these industries, raising costs and threatening viability.

The three agricultural firms did not miss this point, although they could not articulate their concerns in
purely economic terms. Nevertheless, for industries that rely on a large, low-skilled labour force, in
these companies well over half of all workers, HIV hits them hardest in terms of their industries’
viability for the region. In the short term, redistribution, substituting a healthy worker for an ill worker,
may provide a productive labour force, but in the longer run, it will drive up the cost of production and
make the industry and companies less competitive in a global market.

Employee And Community Impact

Information on HIV and AIDS should be delivered in local languages. Some employees have a difficult
time understanding English, but, more importantly, information cannot easily be shared with spouses,
family and community members if it is not in local languages.

Employers need to work harder to get the word out that getting tested and getting treated is looked
upon favourably by the company. Many employees still perceive the HIV workplace programme as
threatening to their employment contracts. This may involve increased openness about HIV-related
issues but also takes an understanding that stigmatization usually take longer to take effect than do the
benefits of medical treatment.

Employers will need to find a way to accommodate sick employees. Many work even when they are
sick. This detracts from both the employee’s health and the productivity of the company. Identifying
sick employees, encouraging them to get tested and rewarding them for getting treated rather than for
working while sick may have financial benefits for both workers and companies.

Finally, companies should stress the importance of confidentiality by peer-educators, as in some cases,
they have disclosed the HIV status to other community members. Many employees expressed to us
their distrust of confidentiality and may, therefore, resist either testing or treatment.

For industries that rely on a large, low-skilled labour force, HIV hits them hardest in terms of their
industries’ viability within a region. In the short term, redistribution, substituting a healthy worker for
an ill worker, may provide a productive labour force, but in the longer run, it will drive up the cost of
production and make the industry and companies less competitive in a global market. Thus, the
benefits of HIV programmes need to be assessed across an industry as a whole as well as within a given
company. Losing industry-wide competitiveness benefits no company.

Even the smallest of HIV interventions appear to have positive impacts for non-permanent workers and
their companies. Protecting this workforce from depletion, lower quality substitute labour and costly
replacement of workers from other communities means finding a stable means of getting them tested
and treated year long. With the government picking up the major cost of treatment (drugs and,

68
sometimes other treatment), employers would do well to work together as an industry to find ways to
help their temporary workforce to access year-round, stable medical care. Some efforts to assure that
medical records and treatment are “portable” by the government may help. But there is a clear
economic rationale for employers to work across an industry to help solve this problem.

Our preliminary findings indicate that communities are important factors in worker health. Across
permanent, contract and temporary workers, the health of family and communities was a large factor
in their continued health and productivity. Evidence suggests that much of the benefit of the HIV
programmes was in prevention. Vigilance in extending the programmes to surrounding communities is
likely to increase net benefits to companies and stabilize their productivity and industrial viability.

Many studies conclude by suggesting that more research needs to be done. This study has certainly
revealed areas where research would benefit whole communities, companies and industries. But the
need for specific research in this area is particularly compelling. Accurate projections of human
resources, costs and risks may impact a company’s strategic plan more than exchange rate or raw
material price fluctuations. The impact of successful programmes not only stabilizes workers, it
increases productivity and, possibly, has secondary benefits as it maintains healthier communities and
families. Temporary workers, long thought to be in surplus supply with little cost, it turns out, benefit
from HIV programmes as do their employers. The methodology and data collection here were limited in
breadth and scope but showed the weakness of good analytic data for understanding these problems.
A concerted effort to collect, catalogue, analyze and report such information may well benefit the
workers, employers, industries and nation. Targeted, thoughtful, strategic research is clearly a
compelling need.

69
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