RFI: HIV/AIDS and how it impacts on absenteeism from work (2)
some abstracts from the Barcelona AIDS conference. Please send me a
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[TuOrG1245] Cost savings and affordability of antiretroviral therapy
for private sector employees in developing countries
S.S. Forsythe1, C. Laurence 2, J. Stover 1, J. Bausch 2, J. Deering
1, K. Foreit 1 1 The Futures Group International, 1050 17th Street,
Suite 1000, Washington DC 20036, United States; 2 The Futures Group
Europe, Bath, United Kingdom
Background: Various multinational corporations have recently decided
to offer ARVs and other medical care to their HIV-infected employees
in developing countries. This decision has been justified, at least
in part, on the economic grounds of keeping employees productive and
reducing the financial burden on companies associated with HIV-
related illnesses and the cost of replacing trained workers. This
analysis was designed to review the existing literature and to assess
the affordability, as well as the economic costs and benefits, of in-
troducing such a policy.
Methods: Workplace analyses were conducted in 3 countries (Ghana, Bu-
rundi, Thailand) to assess the affordability, costs and benefits of
implementing a policy of corporately-provided ARVs. In addition, a
literature review was conducted to identify the main factors that
have influenced companies in other countries that have established
such a policy.
Results: The economic analysis indicates that ARVs are affordable, at
least for multinational companies, and have potential to slow down
employee turnover. However, most businesses will not realize cost
savings as a result of paying for ARVs for all infected employees.
Experience shows that businesses are more concerned about afforda-
bility than about cost savings. Consequently, it appears that af-
fordability is a sufficient argument for many businesses to pursue
such a policy.
Conclusions: Multinational corporations that have pursued a policy of
offering ARVs have done so based on the relative affordability of
ARVs, rather than based on an empirical demonstration of cost sav-
ings. Corporations that currently do not offer such care are also
likely to be more influenced by arguments of affordability than of
Presenting Author: Steven Forsythe
[MoOrB1096] The socio economic impact of HIV/AIDS infection and of
investment in antiretroviral therapies (ARVs) on a private company of
Abidjan, Cote d'Ivoire
S.P. Eholie, E. Bissagnene, A. Gaumon, J. Mambo, J. Guiza, A. Kakou,
A. Kadio Service des Maladies Infectieuses et Tropicales, Service des
Maladies Infectieuses et Tropicales, BP v 3 Chu Treichville, Abidjan,
Objectives: To assess the socioeconomic impact of HIV infection on a
private company of Abidjan and to demonstrate interest of providing
care and ARVs to HIV(+) employees.
Methods: The study was conducted in a private company of 3500 employ-
ees with the approval of the management team, and informed consent
was requested from each participant. We analyzed social (absenteeism,
employees replacement) and economic (low productivity, cost of care,
replacements and funerals) impact of HIV infection. For two time-
periods (1998 to 1999 vs 1999 to 2000), we compared direct and indi-
rect costs for offering care and ARV to HIV (+) employees.
Results: Main effects were absenteeism, employees redeployment to
other positions, and social impact (fear, funerals). Economic effects
included low productivity, and increased number of medical consulta-
tions and hospitalizations. The average cost for treatment of oppor-
tunistic infections was about US $15,385 per patient. Additional
costs included solidarity funds (US $26,154) and funeral expenses (US
$107,692). A coping strategy elaborated by the management team in
collaboration with employees union included a solidarity fund for
ARV, and promotion of voluntary HIV counseling and testing (VCT).
From 1998-1999 to 1999-2000, costs for caring for HIV(+) employees
decreased from US $338,462 to US $153,846, and opportunity costs from
US $1,539,077 to US $61,538. We also observed a 10-time reduction in
Conclusions: Company-level strategy including workplace-based preven-
tion activities, VCT, and provision of care and ARVs has signifi-
cantly decreased the company health and social expenditures.
Presenting Author: Sp Eholie
[MoPeE3762] The impact of HIV/AIDS on health care staff at a rural
South African Hospital, 1995-2000
A. Unger1, T. Welz 1, D. Haran 2 1 Africa Centre for Health and Popu-
lation Studies, 7629 North 22nd Place, Phoenix, Arizona, 85020, South
Africa; 2 Liverpool School of Tropical Medicine, Liverpool, United
Background: The Hlabisa District Hospital caters for about 200 000
South Africans in rural northern KwaZulu-Natal, an area with an ante-
natal HIV prevalence of 32%. The HIV/AIDS epidemic has placed sub-
stantial demands on health care staff in this resource-poor setting.
High inpatient to nurse ratios and understaffing limit nurses' abil-
ity to care for patients and are a major cause of overwork and subse-
quent staff transfers, resignations, early retirements, and sick
Methods: This study combines an analysis of: (1) hospital records on
staffing levels, vacant posts, length and number of illness episodes
among staff, and causes of staff attrition, and; (2) a questionnaire-
based survey among approximately 200 nurses at Hlabisa Hospital on
workload, job satisfaction, and knowledge and risk perception relat-
ing to HIV/AIDS.
Results: Between 1995 and 2000, total hospital staff increased from
620 to 683 persons, an increase of 10%. In the same period, absentee-
ism increased by 310% from 316 to 981 days. Mortality among staff
rose from 2 to 13 persons (0.23% to 2% of all staff per year). Pre-
liminary results from nurses show high rates of job dissatisfaction
(58%) and sick leave caused by working conditions (46%). Amongst the
88% that reported overwork, the majority claimed that overwork re-
duced their ability to provide quality care (98%), maintain adequate
occupational safety (95%) or sensitivity to patients (93%).
Conclusions: HIV/AIDS is having a major impact on health workers' ca-
pacity to respond to systemic demands for inpatient services. The ef-
ficient allocation and support of human resources are crucial to the
health system's ability to cope with the demands of the epidemic.
These findings have implications for health system prioritization and
preparedness for HIV/AIDS in South Africa and developing countries
facing similar challenges.
Presenting Author: Unger Alon
[TuPeC4684] The impact of HIV/AIDS on individual and household labor
productivity in Kenya
J.L. Simon1,W.B. MacLeod 1, S.B. Rosen 1, M.P. Fox 1, M. Bii 2, L.H.
Elson 2, K.M. Wasunna 3 1 Center for International Health, Boston
University School of Public Health, Boston, Massachusetts, United
States; 2 U.S. Army Medical Research Unit-Kenya, Kericho, Kenya; 3
Kenya Medical Research Institute, Nairobi, Kenya
Background: Although the natural history of HIV infection is well de-
scribed, the timing and impact of HIV/AIDS on individual and house-
hold workforce participation and labor productivity as the disease
progresses is not. A better understanding of how HIV/AIDS affects in-
dividual productivity will improve cost-benefit analyses of interven-
tions and allow governments and businesses to allocate health re-
sources more efficiently.
Methods: The study site is a set of agricultural estates in western
Kenya which keep records of the weight of crop harvested per day by
>25,000 workers who are resident on the estates. From estate hospital
records, we identified approximately 200 workers and dependents who
died of AIDS-related causes between 1997 and 2001. From estate pay-
roll records, we extracted the daily attendance and productivity (in
weight of crop harvested) for the 48 months prior to the death of the
each worker who died or lost a dependent to AIDS. Controls were work-
ers on the same estates who are still in the workforce. We used mul-
tivariate regression to estimate the contribution of an AIDS death to
explaining differences in daily productivity and attendance.
Results: Results will show 1) the effect of HIV/AIDS on individual
and household work attendance (absenteeism) and quantities of crop
harvested per day (productivity) in the years preceding death due to
AIDS; 2) the impact of losing a spouse or child to AIDS on worker
productivity; 3) the substitution of family labor to maintain house-
hold income; 4) differences in impact by age and sex of the worker or
dependent; and 5) the progression of these impacts over time. This
will allow a comparison of the "productivity natural history" of the
disease to the medical natural history.
Conclusion: The results will provide estimates of the impact of AIDS
on absenteeism, productivity loss, and labor substitution.
Presenting Author: Jonathon Simon
[TuPeC4841] Development of survey instruments to quantify HIV/AIDS
impacts and response capacity at school level: Lessons from field
testing in sub-Saharan Africa
G. Schierhout, A. Kinghorn, S. Johnson, E. McKay, J. Rugeiyamu Abt
Associates, 7 Barnton Road, Greenside, Johannesburg, 2193, South Af-
Background: The HIV/AIDS epidemic has significant impacts on educa-
tion in severely affected countries. There is a need for instruments
to quantify HIV/AIDS impacts at school level. Such instruments may be
used to identify types and scale of needed interventions, to assist
evaluation and to track changes over time. This paper describes the
development and application of such tools.
Methods: The instruments were intended to describe HIV/AIDS impacts
in a nationally representative sample of schools. Factors to be in-
cluded were informed by available literature and prior experience.
Owing to potential respondent bias, it was necessary to select more
than one category of informant. Existing indicators were reviewed and
extensively modified. Data were captured to allow cross mapping onto
the existing Education Management Information Systems. Concurrent
qualitative fieldwork was used to inform instrument development.
Results: The instrument comprised three questionnaires targeting
school heads, teachers and pupils. Measurement issues included im-
pacts amongst staff (teacher absenteeism, employee attrition, manage-
ment impacts); impacts of orphanhood; and response capacity. Data
analysis from two sub-Saharan African countries indicate that na-
tional and regional level data do not show dramatic impacts, but
marked variation between schools and categories of schools is evi-
dent. Potential indicators of school vulnerability including school
size, rural-urban location, and teacher absenteeism are discussed.
Conclusion: Many impacts at the aggregate level are currently diffi-
cult to illustrate. Interpretation of some data remains challenging.
However the instrument shows promise for highlighting vulnerable in-
stitutions or areas. Measurement problems identified in this study
are relevant to the monitoring and evaluation of system-wide inter-
ventions. Future work should focus on refining indicators of vulner-
ability to enable resources to be targeted to areas of greatest need.
Presenting Author: Gill Schierhout,
[C11067] The economic impact of AIDS on the education sector of Zam-
bia: application of the Ed-Sida model
K. Desai1, N. Grassly 1, L. Drake 1, D.A.P. Bundy 2 1 Imperial Col-
lege, Dept of Infectious Disease Epidemiology, Imperial College at
St-Mary's, London, W2 1PG, United Kingdom; 2 World Bank, Washington,
Background: Evidence suggests that teachers in Zambia (20% preva-
lence) are dying faster than new ones can be trained. Thus impact of
HIV/AIDS can be seen to affect supply of education, impairing na-
tional Education For All (EFA) goals. We model how AIDS affects the
primary teacher population and determine the economic impact AIDS has
had on the Ministry of Education (MoE) of Zambia.
Method: A flexible spreadsheet based compartmental model called Ed-
Sida projects number of teachers and HIV status to 2010 by capturing
the dynamics of the teacher population in terms of recruitment, re-
tirement, HIV infection and death. HIV incidence is based on Zambia-
specific estimates of adult prevalence from HIV sentinel surveillance
sites. Data for teacher numbers and recruitment were obtained from
the MoE and Teacher Training Colleges. The model outputs teacher num-
bers to 2010, required recruitment levels relative to EFA goals, and
teacher losses and absenteeism due specifically to HIV/AIDS. Costs of
teacher training and salaries and sensitivity analyses allowed esti-
mation of the economic impact of AIDS from the perspective of MoE.
Results: Current primary teacher population numbers 37500 of which
7,900 are estimated to be HIV positive. The estimated number of pri-
mary school teachers who died from AIDS in 2000 is 815, corresponding
to 45% of all teachers trained that year. This figure will grow to
1250 by year 2010. MoE must double it annual teacher output from
training colleges (already implemented as new initiative) to meet EFA
goals. The major projected financial cost to 2010 associated with
HIV/AIDS occurs at the level of teacher training (US$15,045,000; 61%)
followed by absenteeism (US$8,097,000; 33%).
Conclusions: A proper understanding of the impact of HIV/AIDS on edu-
cation in Zambia is necessary to mitigate the shortfall of required
qualified teachers, meet the real costs of facing AIDS in education,
and assure EFA goals.
Presenting Author: Kamal Desai,
[D11216] The management of HIV/AIDS in the world of work. A South Af-
rican academic and business response
J.B. du Toit, J. Augustyn Professor, Department of Industrial Psy-
chology, University of Stellenbosch, Private Bag X!, Matieland, 7602,
Issues: A joint programme of the Department of Industrial Psychology
at Stellenbosch University and the National School of Public Health
at MEDUNSA, South Africa with the support of the Presidency of South
Africa, the UN Theme Group in South Africa and the International La-
bour Organization and business in South Africa
Description: The Programme is designed to reduce the impact of this
devastating epidemic in the workplace and by so doing, positively af-
fect the disease in the communities of South Africa. The pandemic
primarily affects working-age adults, and far exceeds any other
threat to the health and well being of South African employees. By
2010, it is estimated that approximately 15% of highly skilled em-
ployees will have contracted HIV. It has further been estimated that
a medium sized South African Company with a payroll of $4.2 million
per year could find HIV/AIDS absenteeism and worker disability cost-
ing $500,000.00- $700,000.00 per year over the next number of years
if no intervention methods are implemented.
Recomendations: For the millions already infected with HIV, develop-
ment of a feasible and effective course of treatment is essential.
Students come from diverse backgrounds and with equity as our watch-
word the Postgraduate Diploma in the Management of HIV/AIDS in the
Word of Work transfers a repertoire of skills and knowledge that are
vital for the development of the workplaces and communities of our
students and the realization of individual learning. In collaboration
with knowledge partners like Goldfields, we believe that we are mak-
ing a significant contribution in reducing the devastating personal,
social and economic consequence of HIV/AIDS in South Africa by train-
ing and the development of business leaders.
Presenting Author: Jan du Toit
[ThOrG1508] AIDS and the workplace: Maintaining employee benefits
versus the transfer of costs to the household
M. Stevens Ms, CHP, P. O. Box 1038, Johannesburg, 2000, South Africa
Issues: Employers are not bound to provide any benefits to their em-
ployees. Costs for supporting a PWA are easily transferred from the
employer to the state to the household. Arguments have emerged sug-
gesting that it may be cost effective for business to provide bene-
fits to HIV positive skilled workers, the assumption being that it
would be crippling to provide benefits to semi-skilled and unskilled
workers, even though the costing for this rationale has not been cal-
Description: This paper is based on a stakeholder analysis involving
public, private and trade union sectors, in which responses to HIV
and employee benefits were reviewed.
Lessons learnt: HIV/AIDS in the workplace is not a core management
issue for all sectors. It has been left to the human resources de-
partment. Planning for the impact of HIV and responses are based on
adhoc data largely controlled by consultants hired by employees or
insurance brokers. Partly as a response to HIV, there has been a
shift in the employee benefit environment essentially recusing em-
ployers and make employees individually liable to negotiate their own
benefits. Costing of impacts generally uses direct costs as opposed
to including indirect costs, which make up the bulk of the costs.
Transferring costs of supporting PWAs to households may be counter
productive in the long run as it will reduce the pool of unaffected
households from which to re-hire.
Recommendations: While benefits for skilled workers as a cost effec-
tive practice is important, the danger is to divide the workforce and
to assume that for unskilled workers and semi-skilled workers it is
not cost-effective. This is of concern in terms of equity and dis-
crimination. By supporting marginal workers with benefits, one sup-
ports households and contributes towards development. Enterprises
have to be profitable yet balanced with just and socially responsible
practices. In considering the role of employers more public and neu-
tral data is needed for planning.
Presenting Author: Marion Stevens
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