Discussion Paper:
Beyond The Workplace: Business Participation in
the Multi-Sectoral Response to HIV/AIDS
Plumley B, Bery P, Dadd C
The first and most crucial priority for business in the response to HIV/AIDS is to take action in the
workplace to protect employees and immediate communities from the epidemic, particularly for
companies operating in heavily affected regions. With AIDS threatening the future economic
prosperity of a nation, it is also in businesses own interests that the societies in which they operate
are also successfully reversing the spread and impact of AIDS. Given the global impact of the
epidemic, all companies can and should be engaged on this issue. Business has the potential to make
a significant contribution to multisectoral AIDS programs through the application of the very skills
that make business operations successful. Such expertise could include communication and
marketing, logistics and distribution, strategic and long-term planning, business administration, rapid
monitoring and evaluation, employee training and development, and use of information technology.
The business sector cannot replace governmental leadership, but can “add value” to collaborative
efforts to combat AIDS. Businesses should be actively represented on national AIDS controls and
other AIDS strategic planning mechanisms, including submissions to the Global Fund on AIDS, TB
and Malaria. This paper considers the possible options for greater business action, recognizing that
this is a relatively new and undocumented field.
The Impact of AIDS
UNAIDS predicts that over 70 million
people will have been killed by HIV by
the year 2020. This is an unprecedented
global menace, still in its early stages, that
will dwarf previous public health crises
like the Black Death that swept through
Asia and Europe in the 1300s.
Unchecked, AIDS will bring sociopolitical and economic destabilization to
regional epicenters of the epidemic, and
will threaten global security.
The business community is not immune
to AIDS. Companies with workforces in
heavily affected regions face a clear and
urgent threat. Their employees, in the
prime of their lives and the main familybreadwinners, are being
disproportionately infected. Earlier this
year, GBC member Anglo Gold reported
that between 25 to 30% of its entire
Southern African workforce is infected
with HIV. Data like these will have direct
implications for an individual company’s
productivity and profitability and a
devastating effect on the development of
the broader community in which the
company operates. AIDS threatens the
opportunities for companies looking to
expand into new middle-income markets
such as Brazil, South Africa, China and
India.
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An extraordinary and sustained emergency
response is required. Just as HIV/AIDS is
unprecedented in human history, so must
the response be – a massive mobilization
of every section of society. Leadership by
national governments is crucial - both in
the North and South. However, the
United Nations, civil society and the
business sector have to respond decisively
and in a radically different manner than
they have been used to. New, genuine
partnerships must be built, that pool the
individual strengths of each sector.
Corporate social responsibility needs to be
redefined to reflect the increasingly
complex and sophisticated relationship
business has with society. AIDS is no
longer just a niche issue for companies
wishing to demonstrate corporate
leadership to a particular group important
to their business. It is one of the defining
global issues that will affect market
development and the performance of
individual companies over the next half
century.
Yet despite the leadership of a few
visionary business people, the business
sector has been extremely slow to respond
to HIV/AIDS. The taboos that surround
both the modes of HIV transmission and
the groups in which HIV first appeared,
have made the business community,
concerned about their reputation in
society, deeply skeptical of being
associated with so controversial an issue.
However, in the face of the unparalleled
threat AIDS poses to economic
prosperity, the attitudes and activities of
the sector are now changing.
The Global Business Coalition on
HIV/AIDS
Following the United Nations General
Assembly Special Session on AIDS in
June 2001, business leaders with the
support of the United Nations and others
reinvigorated the GBC, originally
established in 1997, to undertake the
mobilization of the global business
community. Under its new President and
Chief Executive Officer, Richard
Holbrooke, and with start up support
from the Bill and Melinda Gates
Foundation, the Open Society Institute
and the UN Foundation, the GBC has
increased its membership from 17 to over
70 international companies in the last
twelve months and begun an ambitious
program of outreach and policy leadership
to increase dramatically the involvement
of the business sector.
Action in the Workplace is the Priority
Besides increasing the number of
companies committed to HIV/AIDS, the
GBC’s top priority is to promote greater
business action on AIDS in the workplace
– particularly by those companies
operating in heavily affected regions in the
world. The most pressing challenge for
businesses operating in these countries is
to protect their own workforce through
comprehensive HIV workplace packages
that cover both prevention and care. The
intention is not to develop potential
“alternative” public health systems that
cover an entire country. Rather, business
leadership has the potential to catalyze
greater government and donor
commitment to improve local HIV
healthcare provision.
The GBC is documenting examples of
good comprehensive HIV workplace
action by businesses as well as advising
individual companies. At the XIV
International Conference on AIDS in
Barcelona, the GBC presented an update
of its “Workplace Protocols and
Practices”, providing detailed advice to
managers on how to establish a
comprehensive HIV workplace program,
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documenting actual examples of good
practice already implemented by different
businesses around the world. This project
will be completed by the end of 2002 and
will be disseminated widely to businesses
around the world.
Beyond the Workplace
However the business response to AIDS
cannot be limited to the workplace. It is a
critical first step – and possibly most
important contribution an individual
company can make. With AIDS
threatening the future economic
prosperity of a nation, it is also in
businesses own interests that the societies
in which they operate are also successfully
reversing the spread and impact of AIDS.
Furthermore, business action on AIDS
should not be so narrowly defined as to
refer only to those companies with
interests in developing countries, such as
large workforces. There is sizeable
expertise and commitment from the
business community in other parts of the
world which needs to be harnessed.
AIDS is one of a new breed of challenges
to our increasingly globalized society.
Like drugs, terrorism and environmental
degradation, it transcend borders. There
isn’t a single country that has not been
touched by this virus. Its spread is
accelerated by rapid travel and improved
communications – the very benefits
brought to the world by globalization.
The word “globalization” elicits extreme
responses in people. Globalization is
viewed as either good or evil. In fact,
globalization is neither. It is a tool that
can be used for good or bad purposes.
The positive aspects of globalization are
self- evident: The dissemination of
knowledge, immediate communications
from any part of the world, rapid
transportation. Information technology
can help spread accurate AIDS education
and awareness to more people more
rapidly, than large public health
promotion programs were ever able to do
in the past. The international HIV
community, made up of people living with
the virus from the around the world, has
been able to mobilize so effectively
because of its access to the internet.
New advances in communications have
not always helped the dissemination of
accurate AIDS information. The internet
has been a primary tool of the so-called
AIDS dissidents who claim that HIV does
not cause AIDS. From their base in the
West Coast of the USA, their influence
can be seen – even in the highest reaches
of some governments.
The end of the Cold War broke down the
Iron Curtain in Europe and let ideas of
freedom flow from West to East, bringing
freedom and democracy to much of
Central and Eastern Europe. However, it
also resulted in drugs, laundered money
and criminal outfits to move from the
East to the West. In the years following
the end of Communism, HIV infection
has mushroomed in the region, caused
initially by injecting drug use, before
spreading to the general population.
UNAIDS now calculates that the number
of HIV infections in Eastern Europe is
rising faster than anywhere else in the
world. The latest figures reveal there were
more than 75,000 reported new infections
in Russia in 2001, a 15-fold increase in just
three years.
The spread of AIDS has also been
compounded by the migration of peoples
to cities and by the movement of goods
and services that accompany economic
development. The most vivid example of
this can be seen in the rapid increases of
HIV infection that follow the major
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trucking routes, for example in Eastern
Africa and South Asia.
Therefore, in order to develop an effective
response to AIDS, we must understand –
and act upon its pervasive reach. Beyond
protecting and supporting its workers, this
paper proposes that business expertise in
opening up and expanding markets could
be used to strengthen the impact and
reach of multisectoral AIDS programs.
Financial Contributions
The business community has traditionally
been viewed as an untapped source of
additional funding, both by civil society
organizations and the international
community. Corporate financial
philanthropy has a strong heritage,
particularly in the United States of
America. This approach has played an
important role in promoting initiatives
that might not be supported by other
funders, particularly in the public sector.
Corporate philanthropy tends to seek out
discrete initiatives to support, which
enhance the individual company’s
reputation. Corporations are less
responsive to requests for support of
existing initiatives, particularly in the
public sector. The shortfall in the 7 to 10
billion dollars needed annually to respond
to HIV/AIDS and other infectious
diseases as estimated by the United
Nations is unlikely to be met by the
business sector. The total philanthropic
financial resources available from the
corporate sector should not be overestimated, nor the sector’s ability to
sustain financial support over the long
term. The huge amounts of money needed
to mount an effective global response to
AIDS can only come from the public
sector, and donor countries in particular.
Undoubtedly more money is needed to
fund effective AIDS programs. Important
as corporate financial contributions are,
they do not represent the greatest
contribution business can make to an
emergency response to AIDS. Businesses’
great expertise is in making money, not
giving money away. Entrepreneurship,
the ability and flexibility to exploit new
ideas and products in the shortest possible
time - these are equally crucial in rapidly
expanding an international response to
HIV/AIDS.
Harnessing Business Expertise
Business often has the capacity to act
faster and more effectively than any other
sector. In the 1980s and 1990s, the
application of business skills to improve
public sector programs (across a range of
disciplines, not limited to health) became
an increasingly accepted component of
public policy in many countries. The very
skills that make businesses successful
could be utilized to significantly improve
the design and implementation of existing
HIV strategies. This need not be limited
to the public sector. Community-based
organizations that have been the mainstay
of AIDS responses around the world,
including groups of people living with
HIV/AIDS, could also be primary
beneficiaries and partners
Table 1 sets out some of the business
skills that could be brought to bear on the
response to AIDS, with the potential
benefits to any mutlisectoral AIDS
program.
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Corporate Expertise
Benefit to AIDS Response
Communications & Marketing
Behavior Change Programs, particularly
those targeting specific groups, like young
people
Logistics Expertise and Distribution
Capacity
Ensuring materials, condoms and treatments
are distributed promptly, and securely, on a
sustainable basis, particularly to hard-toreach areas, such as rural communities
Strategic and Long Term Planning
Identifying medium to long term priorities
in setting National AIDS Strategic plans
Business Administration
More effective, less bureaucratic
management of AIDS services
Rapid Monitoring & Evaluation
Ensuring programs can respond quickly to
changing environments and situations,
failing approaches can be adapted swiftly
Employee Training and Development
Maintaining performance and commitment
of both paid staff and volunteers
Application and Use of Information
Technology
Improved networking and access to
important AIDS-related information
Table 1
The GBC is currently identifying and
documenting examples of business action
in this manner, not only in the AIDS field
but in other areas, such as the
environment and improved sanitation.
This review will be used to help identify
opportunities for further action by
businesses, governments and civil society
groups. This is an emerging field, with
little review or analysis. The GBC has
undertaken a preliminary description of a
few initiatives to illustrate the value of this
approach.
Improved Public Sector Services and
Standards
As the Brazilian HIV/AIDS epidemic
exploded during the 1990’s, condom use
quickly became the main strategy for
AIDS prevention across governmental,
non-governmental and private sector
campaigns. Condom distribution during
public events, such as Carnival, became
commonplace. Strict government
guidelines for imported condoms,
however, resulted in a dramatic increase in
condom prices, smuggling from
neighboring countries, and poor quality
condom manufacture nationally. Leading
condom manufacturer SSL International
participated in discussions with the
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government in an attempt to reform
quality control legislation, resulting in the
government’s adoption of internationally
recognized quality standards. The
government benefited by guaranteeing the
quality of its condom supply, a crucial
component of its prevention strategy.
SSL, in collaboration with John Snow
International has been supplying the
Brazilian Ministry of Health with more
than 150 million condoms per year since
1997.
Communications and Marketing
There already exist some high profile
examples in the HIV/AIDS field, where
companies are collaborating with other
partners by using their communications
and marketing skills to improve the
impact and reach of awareness raising
(although the impact of such programs on
individual behavior change is harder to
evaluate). A leading example of this
approach is MTV’s “Staying Alive”
television programs, produced in
conjunction with the World Bank and
UNAIDS. Of particular note is the frank
and open way in which intravenous drug
use is addressed. Following one case
study, showing a young woman who
prepares to get tested, MTV is able to
present the reality of IV drug use in a
more forceful way than can be adopted by
many public sector programs, using
language and references understood by
young people. Three programs have been
produced so far, with a fourth currently in
production. The program is then made
available free of charge to broadcasters
around the world, in a range of languages
to over 150 countries worldwide. At the
XIV International Conference on AIDS,
AOL Time Warner’s subsidiary, HBO is
premiering “Pandemic: Facing AIDS” a
documentary by Rory Kennedy, which is
the centerpiece of a multi-faceted
campaign aimed to raise awareness of the
global AIDS crisis, through a website, an
international traveling exhibition and CD
of music from leading international artists.
The Austrian advertising agency Palla,
Koblinger & Partner collaborated with
the Viennese AIDS service organization
AIDS Hilfe Wien to develop a poster,
newspaper and magazine campaign to
promote greater AIDS awareness in
Austria. The advertisements were
headlined with “Humanity is infectious”
with a series of accompanying messages
including “Living with someone who’s
HIV positive is not” and “Playing with
HIV positive children is not.”
Gessy Lever, the Brazilian subsidiary of
Unilever, reinforced Unilever’s
internationally adopted HIV/AIDS
response with an HIV/AIDS Prevention
Program focused not just on employees,
but also on their families and the
community, with a strong emphasis on
teenagers and young adults. The
company’s AXE deodorant, popular with
14-25 year old males, promotes safe sex
messages.
Logistics and Distribution
Lack of infrastructure will increasingly
impede international efforts to improve
access to necessary commodities like
information, condoms and drugs in many
countries heavily affected by HIV/AIDS.
The assistance of firms with logistics and
distribution networks and expertise can
help developing countries address key
infrastructure issues. Coca-Cola’s Africa
Foundation program is still in its early
stages, and considerable attention has
focused on the question of extending HIV
workplace programs to the employees of
its bottlers. However, the program has
the potential to transform the distribution
of HIVAIDS related commodities,
particularly to hard-hit rural areas across
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the continent. The company has
committed to using its unique logistics
and distribution skills to bring AIDS
materials and commodities, such as
condoms, and initial programs are now
operational in Kenya and Zambia.
Strategic Planning & Business
Administration Skills
The field of management consulting,
which has so dramatically influenced
leaders in the business sector, must be
used to influence decision-making and
resource allocation at an international
level to combat public health needs like
AIDS. McKinsey & Company is
contributing its management consulting
expertise to assist with the establishment
of the Secretariat of the Global Fund to
Fight AIDS, Tuberculosis and Malaria,
and development of practical plans to
manage the handling of applications from
developing countries.
One innovative way of bringing the
expertise of a company’s employees to the
broader society is through volunteerism.
BP’s Global Employee Matching program
supports staff wishing to contribute time
and expertise to community-based
organizations on a volunteer basis. BP
employees totaled 56,000 hours of
volunteer time in 2001. Company policies
that encourage and support employee
volunteerism can be a powerful tool to
increase the ability of community-based
organizations to deliver service. Managers
should engage in strategic planning and
preparation to ensure that employee
volunteer programs utilize each staff
member’s unique skills and expertise
where they are most needed.
Information Technology
Expanding access to information
technology to poor communities has the
potential to leverage the power of this
new technology for improved HIV
awareness and prevention education.
Technology companies can use their
strategic business skills to help improve
the performance of community based
organizations that rely on networking
between different groups and individuals
infected and affected by HIV/AIDS.
Hewlett-Packard’s Digital Village
Program attempts to assist underserved
communities to participate in the digital
age. Thus far, the program has supported
three communities in the United States
through the investment of products,
services, consulting services and social
venture capital. HP assists students from
each community by making technology
accessible in the classroom, neighborhood
centers, and at home. Similarly, HP’s
technical expertise assists small business
from the area in an effort to increase
economic development opportunities.
Each community participating in the
Digital Village Program works with HP to
develop and implement a Community
Technology Partnership plan that
leverages existing HP programs to
develop a comprehensive approach to the
community’s unique technology,
economic and educational needs. The
company is looking to expand the
initiative to Brazil, India and South Africa,
extending the reach of general health
education and management, including
HIV/AIDS.
Partnerships by the Pharmaceutical
Industry
Over recent years considerable attention
has been paid to the role of the
pharmaceutical industry (both research
and development based firms and generic
companies) in improving the accessibility
and affordability of HIV therapies in
developing countries. New collaborations
have emerged, such as the Accelerating
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Access Initiative, and NGO driven pilot
programs such as those developed by
MSF and the Pangaea Foundation. While
the number of patients have increased
dramatically through such efforts, the
overall numbers are still insignificant,
given the need. More attention needs to
be directed toward the development and
promotion of combined efforts to
improve treatment access in both public
and private sector settings.
The treatment access issue has also
resulted in greater attention being paid to
the industry’s broader role in regions with
high prevalence rates, particularly in
countries which, for the most part, have
not been traditional markets for the
industry. Companies have responded by
developing innovative corporate
responsibility programs which both
provide financial support to community
based organizations, and which use the
industry’s significant expertise in such
areas as training and quality control, to
improve national health responses to
AIDS. There is suspicion in some
quarters about the genuineness of these
commitments. However, they offer the
opportunity to strengthen national and
community-based initiatives, while
improving the individual companies’
corporate reputation and supporting
longer-term market development.
The GBC will review these initiatives in
more detail to assess the value of and
lessons from these approaches for other
industries.
Company initiatives include:
Company
Initiative
Abbot
“Step Forward” program to
Laboratories improve the lives of AIDS
orphans and vulnerable
children around the world
Bristol“Secure the Future”
Myers
partnerships with South
Squibb
Africa, Botswana, Namibia,
Lestotho and Swaziland
GlaxoSmith- “Positive Action”
Kline
collaboration international
networks of people living with
HIV/AIDS
Merck & Co Improving national health
service delivery systems in
collaboration with the Bill and
Melinda Gates Foundation
and the government of
Botswana
Pfizer
Building a regional infectious
disease center of excellence in
Uganda with the Academic
Alliance for AIDS Care and
Prevention
Public-Private Partnerships
The term public-private partnerships is
ubiquitous, perhaps used more in
aspiration than application. Such
partnerships are loosely defined and can
cover a wide range of activities from
financial or in kind assistance, where the
supporter plays no active role in the
design and implementation of a project, to
the development of joint ventures,
bringing the expertise of the various
collaborators to bear on a particular
problem. This broad range of definitions
may not be such a bad thing: There is an
enormous diversity of groups needing and
offering different kinds of support.
However, such a flowering of varied
partnerships requires that the partners
agree openly in advance on what is being
delivered and by whom. Realistic
expectations of what can be achieved are
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crucial to the long-term success of the
initiative and of any future collaboration.
The HIV/AIDS epidemic places an
urgent priority on finding and promoting
effective collaborative solutions. There is
a specific need to expand national AIDS
programs using tried and tested
interventions. The approach described in
this paper is still a relatively new
proposition. The business community
and its potential partners are increasingly
viewing its contribution to great social
issues in this fashion. It offers a genuine
collaboration between different sectors,
where each party brings its unique skill set
to solve a common problem. It has the
potential to build greater business
participation in the development of
effective national HIV/AIDS strategies.
A limited preliminary review of existing
initiatives suggests that monitoring and
evaluation of collaborative initiatives does
not currently assume a high priority.
Evaluating the effectiveness of these
interventions is important if they are to be
promoted and adapted in other settings
and by different partners. The
incorporation of simple and effective
monitoring and evaluation techniques will
be considered further by the GBC during
its review of these initiatives.
Bringing a range of business skills into a
national AIDS program will require
coordination, while not restricting the
sector’s creativity and flexibility. Business
organizations, led by and made up of
business people could play an important
bridging role, helping to communicate
public sector and civil society needs to a
broad business constituency. The GBC
advocates for business representation in
national AIDS control councils and other
national strategic planning mechanisms.
As well as enhancing the impact of
business workplace programs, business
sector representation will facilitate closer
links between business, community and
government and civil societies. At the
international level, organizations such as
the GBC, World Economic Form and
International Business Leaders Forum will
have an important role to play in
facilitating links with the international
community and bilateral donors, such as
the United States and the member
countries of the European Union.
There are voices in the public sector and
civil society that oppose this kind of
collaboration. These may be born from a
fundamental ideological objection to
business involvement or concern about
the potential negative impact of the
involvement of a sector who’s primary
concern is profit. Business motivations for
collaboration are complex, including
corporate reputation, risk-management
and a longer term commitment to the
establishment of prosperous markets – as
well as short term commercial goals. This
paper argues that the expertise that has
been so successful in the “for profit”
sector needs to be combined with the
strengths of the public sector and civil
society, to forge a rapid and effective
emergency response to the HIV/AIDS
crisis.
Next Steps
The GBC’s first priority is to promote
greater business action in the workplace,
encouraging companies operating in
countries heavily affected by HIV/AIDS
to implement comprehensive HIV
prevention and care programs. However,
the role of the business sector can extend
beyond the workplace to participation in
broader multisectoral efforts combating
AIDS. The GBC is conducting a formal
review of company collaborative
programs, recognizing that this is a
relatively new and undocumented field. A
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series of national and regional meetings
with political and business leaders in
India, East Africa as well as with specific
industries in Southern Africa are being
planned to promote this approach in
2003. The GBC and other business
organizations will continue to work with
the Global Fund on AIDS, TB and
Malaria to determine how collaboration
between business and other sectors can be
more fully incorporated into the
development of national action plans
submitted to Fund.
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