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### Viewing cable 03HARARE967, BUSINESS SLOW TO ACT ON HIV/AIDS

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
03HARARE967 | 2003-05-20 08:57 | 2011-08-24 16:30 | UNCLASSIFIED | Embassy Harare

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    This record is a partial extract of the original cable. The full text of the original cable is not available.

` `

    UNCLAS SECTION 01 OF 05 HARARE 000967

    SIPDIS

    DEPARTMENT FOR G, OES/IHA, OES/PCI, AF/S, AF/EPS, IO/T
    WHITE HOUSE FOR ONAP
    USAID FOR AFR/AA/AIDW AND BUREAU FOR GLOBAL HEALTH
    DHHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS
    BANGKOK FOR WIN DAYTON

    E.O. 12958: N/A
    TAGS: KHIV SOCI ECON ZI HIV AIDS
    SUBJECT: BUSINESS SLOW TO ACT ON HIV/AIDS

    -------
    SUMMARY
    -------
    ¶1. Zimbabwe has one of the highest HIV infection rates in the
    world but the private sector has done surprisingly little to
    help stem the spread of the disease.  The sector only
    recently began actively supporting HIV initiatives in the
    workplace, in part because absenteeism and deaths had begun
    to affect profits.  In September 2002, the National AIDS
    Council and local business leaders created the Zimbabwe
    Business Council on HIV/AIDS to coordinate private sector
    activities in HIV/AIDS care and prevention, but unless the
    economic situation in the country improves, the business
    sector,s initiatives will most likely have limited success.
    END SUMMARY.

    --------------------------
    PRIVATE SECTOR SLOW TO ACT
    --------------------------
    ¶2. PolOff met with CEOs and Human Resource (HR) directors
    from four major companies (Unilever, Unifreight, Coca-Cola,
    and PG Industries), the Policy and Advocacy Manager of the
    Zimbabwe National Chamber of Commerce, the interim chairman
    of the Zimbabwe Business Council on HIV/AIDS, researchers at
    the Biomedical Research and Training Institute, the Executive
    Director of the National AIDS Council, and staff from
    Zimbabwe AIDS Prevention Services Organization and the
    Zimbabwe AIDS Prevention Project to discuss the sector's
    response to HIV/AIDS and the effects of the pandemic on
    business.  The general consensus among our interlocutors was
    that the business sector has not done enough to curb the
    spread of the disease or to improve the quality of life for
    HIV-infected workers and their families. Over the last three
    to five years, however, business has shown more of a
    commitment to HIV programs.  Unfortunately, the economic
    situation during the last three years limited business
    contribution and will most likely continue to constrain
    initiatives.

    --------------------------------------------- --------
    Majority of Chamber of Commerce Members No HIV Policy
    --------------------------------------------- --------
    ¶3. On March 27, PolOff met with James Jowa, Policy and
    Advocacy Manager of the Zimbabwe National Chamber of Commerce
    (ZNCC) to get an overall picture of how the business sector
    has been addressing the HIV/AIDS issue.  Jowa told PolOff
    that less than ten percent of the ZNCC membership has an
    HIV/AIDS workplace policy.  Most small businesses, he said,
    do not even offer health insurance and think little about the
    health of their workers, particularly the unskilled ones,
    because of the high unemployment levels.  The ZNCC has been
    trying to encourage businesses to adopt HIV policies and for
    the last three years has been giving an award to the company
    with the best HIV/AIDS policy.

    ¶4. Of those companies with HIV/AIDS policies, most are large
    multinationals with on-site clinics.  The smaller, often
    indigenous companies usually cannot afford on-site clinics.
    Jowa said the ZNCC has proposed setting up clinics in
    industrial areas where several smaller-scale firms are
    located so the companies could pool their resources to run
    the clinics.  Jowa also said that prior to the land
    redistribution exercise, many commercial farms had HIV/AIDS
    policies and on-site clinics but these have since closed,
    leaving the commercial farm workers and their families more
    vulnerable.

    --------------------------------------------- ---------------
    HIV/AIDS Advocacy Groups Spearhead Development of Workplace
    Policies
    --------------------------------------------- ---------------
    ¶5. The developers of most business HIV policies are the NGOs
    Zimbabwe AIDS Prevention Project (ZAPP) and Zimbabwe AIDS
    Prevention Services Organization (ZAPSO).  In the 11 years it
    has been in existence, ZAPP has helped more than 90 companies
    with HIV/AIDS policies while ZAPSO has helped more than 150
    companies in 5 years.  Both ZAPP and ZAPSO cited increased
    absenteeism (workers attending funerals or given long sick
    leave), health care costs, and funeral expenses as well as a
    loss of skilled personnel as the primary reasons businesses
    have offered for wanting to set up HIV programs in the last
    two years.  ZAPSO told PolOff that some health insurers urged
    their business clients to implement programs because the
    claims for HIV-related illnesses had increased dramatically.

    ¶6. Prior to 2001, many businesses felt HIV/AIDS would not
    affect profits; apparently thinking the disease would affect
    only blue collar, the more expendable, employees.  In recent
    years, companies have noticed more mid- and senior level
    staff succumbing to AIDS.  ZAPP recounted a story of a firm
    with about 30 employees which three years ago refused ZAPP,s
    help in formulating an HIV plan because the company had had
    no deaths.  In the last year, this same company has lost two
    people to AIDS and reported that 3 to 4 employees were not
    looking well.

    New Business Initiative
    -----------------------
    ¶7. Evaristo Marowa, Executive Director of the National AIDS
    Council (NAC) told PolOff that during the 1990s businesses
    were very resistant to implementing AIDS programs because
    most did not categorize AIDS as a threat to production equal
    to fuel, foreign exchange, and electricity shortages.  He
    told us the reluctance has begun to change in the last year
    or so, particularly with the creation of the Zimbabwe
    Business Council on HIV/AIDS (ZBCA) in September 2002.  ZBCA
    was created by both the NAC and a handful of private sector
    CEOs who felt the need to coordinate private sector efforts
    and bring them up to scale.  These business leaders realized
    that HIV/AIDS was not only affecting their present work force
    but their future pool of labor and present and future
    consumer bases as well.  The ZBCA is partly modeled after the
    Kenya HIV/AIDS Private Sector Business Council and Global
    Business Coalition on HIV/AIDS.  Malcolm Hughes, Chairman of
    Unilever South East Africa and interim chair of the ZBCA,
    told PolOff that even though NAC helped create it, ZBCA would
    be a separate, independent organization.
    (NOTE: Marowa told PolOff that in light of political
    leaders, reticence about publicly speaking about HIV/AIDS,
    the NAC was trying to catapult business and community leaders
    and advocates into the leadership position, hoping the
    movement can be as successful in affecting change as the
    Treatment Action Committee has been in South Africa.  END
    NOTE)

    ¶8. Hughes, a white British expatriate, said he is probably
    not the most appropriate leader of ZBCA in the prevailing
    climate, so he has offered to act only as the interim chair
    until a permanent one is found.  Hughes and the rest of the
    executive board (Colgate CEO, Davis Kanyama as vice-chair;
    Kadenge (sp) from the Zimbabwe Economic Society as Secretary;
    and Phipps Makipa of Standard Bank) hope to convince at least
    nine more companies to actively participate in the council.
    Each member must agree to attend two meetings per year, to
    commit their HR directors, and to make a small donation to
    get the project started.  Among the ten or so companies, the
    executive board has approached, only one has refused to
    participate.  Hughes envisions the council having workshops
    with HR directors; sharing best practices; supporting NGOs
    and other groups; and helping increase awareness within the
    community at large.

    ---------------------------------
    WIDE RANGE OF HIV/AIDS POLICIES
    ---------------------------------
    ¶9. Prior to 1998 when the GOZ implemented Statutory
    Instrument 202 ensuring nondiscrimination because of HIV
    status, few companies had HIV/AIDS policies although, by that
    time, ZAPP had been working with 40 companies to set up peer
    education systems.  The 1998 and 1999 legislation prohibited
    discrimination because of HIV/AIDS status and established
    guidelines for business to follow.  It also set up an AIDS
    Levy--a 5-percent payroll tax now called the National AIDS
    Trust Fund--designed to help improve HIV/AIDS services.  In
    addition to the AIDS Levy, the GOZ implemented the Labor
    Relations Amendment, which offered limited financial
    protection for employees.  Under the amendment, an employee
    could not be dismissed because of a positive HIV status, and
    an employee was also entitled to six months of paid sick
    leave (three months at full pay and three months at half pay)
    before being forced to leave.

    ¶10. Beyond the bare bones policies, our interlocutors
    expressed interest in including a nutrition component,
    wellness programs (to include families), ARV treatment, and
    community education and outreach as a part of their coverage.
     Unfortunately, most companies have not been able to expand
    their health services because of the economic crisis griping
    the country.  ZAPSO cited capacity constraints, such as not
    having enough HIV/AIDS policy specialists, as an impediment
    to helping more companies design AIDS policies.  At least one
    company has managed to offer a nutrition component.  Unilever
    offers a balanced lunch and dinner for a mere $Z2 each.
    Unilever Chairman Malcolm Hughes said it was not worth it to
    even charge for the meal anymore because the cost of
    collecting the money far exceeds the price of the meals.

    Company Policies
    ----------------
    ¶11. Unifreight, a British owned company offering long-haul
    freight transportation and luxury buses for hire within
    Zimbabwe, has had an HIV/AIDS policy in place for 15 years
    and is regarded as a leader in workplace HIV policies, at
    least for the transportation industry.  PolOff met with
    Executive Director of Personnel and Training, Francis Masuku;
    the nurse in charge of the company's on-site clinic; and Mr.
    Gurugena, a human resource officer, on April 3.  Unifreight's
    HIV/AIDS policy goes beyond the mandatory requirements
    stipulated in Statutory Instrument 202 of 1998 by encouraging
    family time and monogamous relationships by limiting the
    amount of shift work and time away from family.  The policy
    also encourages top management involvement both in reviewing
    progress and monitoring compliance with the company's HIV
    policy and employees to report cases of sexual harassment.
    The company incorporates AIDS education into all its training
    sessions, including at the driving school.  It also funds two
    drama groups in Bulawayo and Harare that perform plays on the
    causes of HIV/AIDS, care, counseling, and nutrition.

    ¶12. The transportation industry is in the process of hiring
    eleven outreach agents to work at border posts.  They will
    communicate with truckers on AIDS awareness and distribute
    condoms and other materials and report back to the National
    AIDS Council, the national entity responsible for
    coordinating a national multisectoral response to the disease.

    ¶13. Geoffrey Magadza, the HR Director of PG Industries, a
    Zimbabwe based regional company involved in glass, timber,
    and building supplies, admitted that his company's HIV/AIDS
    policy is in its infancy and that the industry has not been
    as engaged as it should be.  The policy thus far does not
    veer much from that required by law. The company also offers
    counseling sessions on HIV prevention to employees who are
    transferred to the offices in Mozambique, Malawi, and Zambia.
     PG Industries is one of ZAPSO,s clients.

    ¶14. Unilever South East Africa, part of the international
    manufacturing company, has become increasingly committed to
    its HIV/AIDS policy in the last three years, according to
    Chairman Malcolm Hughes.  Its counterpart in Kenya helped
    establish the Kenya HIV/AIDS Private Sector Business Council
    in 2000.  Sherree Shereni, Regional External Affairs Manager
    of Coca-Cola Central Africa Region, told PolOff that all the
    bottlers in her region (Zimbabwe, Zambia, Malawi, Botswana,
    Lesotho, Angola, and Swaziland) are trying to set up ARV
    treatment programs for their employees and were in the
    process of improving the procurement and delivery systems.
    She said Coca-Cola has money to spend on HIV/AIDS programs
    and she asked PolOff for help in identifying some.  (NOTE:
    Shereni seemed willing to discuss Coca-Cola's HIV policy and
    the effects of the disease on productivity but needed to
    check with her supervisor in London.  Unfortunately, her
    supervisor's secretary said the supervisor was very
    tight-lipped and most likely would not approve Shereni
    discussing the issue externally. END NOTE.)

    ------------------------------------
    LIMITED INSURANCE COVERAGE FOR HIV
    ------------------------------------
    ¶15. CIMAS Medical Aid Society, one of the main health
    insurance companies in Zimbabwe, plans to introduce, in July,
    a Chronic Disease Cover, which will pay for HIV treatment,
    according to local press reports.  The plan is an add-on to
    traditional packages offered by CIMAS and is available to
    interested employers, at additional cost, who wish to enroll
    their employees.  (NOTE: Embassy locally employed staff are
    covered under CIMAS and will be offered coverage--at
    Embassy/Agency expense--under the Chronic Disease Cover.
    CDC-Zimbabwe is working with CIMAS to help ensure that the
    HIV care component is of the highest quality.  END NOTE.)

    ¶16. Geoffrey Magadza, HR Executive for PG Industries, told
    PolOff that the company provides good life insurance coverage
    but that senior management could opt to increase their
    coverage if they took an HIV test.  Magadza said few people
    opted for the additional coverage.

    ---------------------------
    HIV/AIDS EFFECT ON INDUSTRY
    ---------------------------
    ¶17. Industry representatives said HIV/AIDS has increased
    their labor costs through loss of person hours, loss of
    skills, the loss of potential, and absenteeism.  The HR
    directors told PolOff that existing laws governing sick leave
    have increased costs associated with long-term illnesses.
    Under the law, workers are entitled to six months of paid
    sick leave, so employers often hire contract workers to
    substitute for these ill workers, thereby more than doubling
    wage costs.  Malcolm Hughes from Unilever said his company
    offered very attractive retirement packages to its employees
    and encourage those with long-term illnesses to take
    advantage of them.  This allows the company to fill the sick
    employee's position with a permanent hire rather than a
    temporary, contract worker, thus reducing costs.

    ¶18. Industries with on-site clinics were keeping track of the
    health of their workers to help determine how AIDS is
    affecting their bottom line.  At Unifreight, the personnel
    department, through the on-site clinics, compiles monthly
    reports on sick leave management, the types of illnesses, and
    lost days that affect the work force. The results of these
    reports indicate that deaths from AIDS-related illnesses
    within Unifreight fan across occupations from office managers
    to truck drivers.  In 2002, truck drivers appeared to have a
    slightly higher incidence of AIDS-related deaths than other
    groups but not of the magnitude the literature on HIV and the
    transportation sector would suggest.  Compared to the 2002
    statistics, Unifreight is on pace to nearly double the number
    of deaths due to AIDS in 2003.  In 2002 there were a total of
    42 deaths (out of 2600 employees) but by the end of March
    2003, the number was already at 15.  (NOTE: The law prohibits
    employers from requiring employees to disclose their HIV
    status but based on the cause of death on the death
    certificates submitted for benefits, most of the deaths are
    from AIDS complications such as TB and pneumonia. END NOTE.)

    ¶19. ZAPP recently concluded discussions with several focus
    groups representing the informal and formal sectors to get an
    understanding of how HIV/AIDS is affecting workers.  In
    general, workers were concerned that revealing an
    HIV-positive status would endanger their jobs, especially in
    the agriculture field.  According to ZAPP, the workers did
    not feel the law against discrimination would protect them,
    preferring to work themselves to death than risk being fired.
     The high unemployment levels are a disincentive for
    (informal sector) employers to adopt any HIV policies because
    it is more profitable for them to fire the sick person and
    hire someone new.  Informal sector employees were even more
    reluctant to disclose their HIV status or to ask for sick
    days because they are not covered under existing HIV
    legislation and have no job security.

    ¶20. PolOff spoke with three researchers, E. Dauya, Ronnie
    Matambo, and Liz Corbett from the Biomedical Research and
    Training Institute (BRTI), an institute affiliated with the
    University of Zimbabwe, about the effect of HIV/AIDS on the
    business sector.  The project, funded by the U.K. based
    charity Wellcome, is designed to compare the efficacy of two
    VCT strategies at 22 factories in Harare, of which PG
    Industries is one.  The strategies are providing HIV testing
    at work or giving vouchers to get off-site HIV testing at the
    USAID-sponsored, HIV Voluntary, Counseling and Testing (VCT)
    New Start Centers. Patients also receive general health care
    at the clinics as well as antibiotics (isoniazid for TB and
    cotrimoxazole for pneumonia) to treat opportunistic diseases
    associated with AIDS. The study will not be completed until
    July 2004, but preliminary results suggest that on-site
    testing is more successful.  More than 55 percent of those
    offered on-site HIV testing accepted the offer and were
    tested as compared to five percent of those offered vouchers
    to get tested at a New Start Center.  BRTI also found that 19
    percent of the 4800 people tested were HIV positive and in
    companies that employed more women overall prevalence rates
    were higher.

    ¶21. ZAPP's project enjoyed similar successes with on-site
    HIV/AIDS facilities.  ZAPP, which began as a collaborative
    research project between the University of Zimbabwe and
    Stanford University to establish the prevalence of HIV in
    workers, showed that having peer educators on-site was much
    better at reducing the incidence of new HIV cases than
    referring workers to off-site VCT centers.  HIV-negative
    workers with on-site facilities were 34 percent less likely
    to become HIV-positive than workers without such facilities.

    ¶22. PG Industries' HR Director Magadza told PolOff that the
    collaboration with BRTI is mutually beneficial to all parties
    because not only is BRTI collecting data, but participating
    companies get to keep experienced, AIDS-infected workers in
    the work force longer, and the employees are improving their
    quality of life.  Magadza said the company does not know how
    many of its employees are infected with HIV or how many have
    died from AIDS but hypothesized that one could deduce the
    latter from the cause of death on the death certificate.
    Magadza commented that since BRTI began its program,
    absenteeism has diminished somewhat.

    -----------
    CONCLUSION
    -----------
    ¶23. The meetings with private sector representatives were
    both disconcerting and encouraging.  It was troubling, for
    instance, to discover that after nearly 20 years of HIV/AIDS
    in Zimbabwe, the business sector, except for a few large
    companies, is only now mobilizing to address this disease
    effectively.  If one believes in the Best Practices promoted
    by UNAIDS and other HIV/AIDS advocacy groups, then one must
    assume that without committed senior-level government
    leadership, the business community's efforts will most likely
    fall short of their objectives.  The companies seemed
    committed to fighting HIV/AIDS and seemed to want to do more
    for the community at large.  However, they were all
    frustrated with the lack of leadership among senior
    government officials and saw that the economic environment
    and the dearth of foreign currency also constitute major
    obstacles to their efforts.

    ¶24. With between a quarter and one-third of adults in
    Zimbabwe HIV positive, the business sector faces an ominous
    task.  Their desire to help workers with health care,
    including pharmaceuticals; introduce nutrition programs;
    conduct outreach programs to include and treat family
    members; and conduct community programs will demand more
    resources than are currently available in Zimbabwe.  The
    deteriorating economic climate has made sustaining HIV/AIDS
    initiatives more difficult as many companies have eliminated
    non-essential programs, of which HIV care is one.  The recent
    decision by CIMAS to expand coverage to include HIV/AIDS is a
    positive step, but depending on the conditions (mandatory
    testing, costs, etc.) of this additional coverage, may help
    only a limited number of people.  It definitely will not help
    the 70 percent of the population that is not employed in the
    formal sector and, in some cases, it may exclude spouses and
    other family members of workers eligible for the benefits.
    The BRTI initiative, if successful and sustainable, may
    provide a better way to reach large numbers of workers in the
    delivery of HIV care.  END COMMENT.
    WHITEHEAD

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