AFRO-NETS> RFI: HIV/AIDS and how it impacts on absenteeism from work (2)

[Igor Schillevoort <ischille@hsph.harvard.edu>]

RFI: HIV/AIDS and how it impacts on absenteeism from work (2)
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Dear Sir/Madam,

some abstracts from the Barcelona AIDS conference. Please send me a 
copy of other material you receive.


Igor Schillevoort
mailto:ischille@hsph.harvard.edu

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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 
cost savings.

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, 
Cote d'Ivoire

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 
absenteeism. 

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 
Kingdom

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 
leaves. 

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-
rica

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, 
United States

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, 
South Africa

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-
culated. 

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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