Leadership in HIV and AIDS makes front-page news time and time again and it is also the theme for this year's World AIDS Day. In this edition we focus on "Leadership in HIV and AIDS" in the business world. Leadership is needed in the private sector as much as in the public sector if we are to achieve the ambitious goals set in the National Strategic Plan on HIV and AIDS, 2007 - 2011 (NSP). Few people realise the scale of the collaboration that is needed to achieve a 50% reduction in new infections and an increase in access to treatment, care and support to 80% of HIV positive diagnoses by 2011.

We have the honour of publishing an article by Peter Doyle, who has been an acknowledged business leader in the fight against HIV and AIDS in South Africa since the late eighties. Peter takes a look at why business should provide leadership with regards to HIV and AIDS by focussing on the current skills crises. He believes it is not unreasonable to speculate that one of the factors that causes South Africa to be so uncompetitive in Employment, Education and Health is the existence of a widespread HIV and AIDS pandemic. Peter explains why Business should support the NSP and calls for collaboration and partnerships as well as leadership and role models.

Two prime examples of leadership with regard to HIV and AIDS in the business world is the outstanding work done by two main players in the motor industry in South Africa. The theme of leadership, role models and partnerships is highlighted by the initiatives of BMW SA and DaimlerCrysler SA. Read further about the 93% of employees at BMW in Rosslyn, Pretoria who have undergone an HIV test and the leadership provided by BMW SA's Managing Director and Senior Managers who have all publicly tested as well. DaimlerCrysler SA provides us with a very valuable role model around Public-Private Partnerships with their Siyakhana Project. This project, which has been acknowledged internationally as a benchmark, offers comprehensive HIV and AIDS voluntary counselling and testing, treatment and infection mitigation to small and medium sized businesses.

Based on research by Metropolitan, HIV prevention and social collaboration are key to achieve the best case scenario for a future South Africa. Today more than ever we need strong leadership to focus on prevention and to drive partnerships with civil society and government to stop HIV and AIDS. May we all be inspired by the excellent work done by some leaders in the business world and may we help each other in achieving the goals set by the NSP. It is with pleasure that I introduce the final AAAO edition for 2007. I would like to thank Desiree Daniels for a super bumper edition whilst I was involved in the business of babies!

Have a blessed Festive Season.

Together we can beat HIV and AIDS.

Nathea

Peter Doyle qualified as an actuary in 1983 and began research and development for a model to forecast the demographic impact of the HIV and AIDS epidemic in South Africa in 1989. He published the first AIDS and Demographic model in South Africa in 1992. Since then he has played a significant role in addressing the impact of HIV and AIDS in South Africa through his leadership and understanding of the epidemic. Peter is currently the Chief Executive Officer of Metropolitan Holdings Ltd, a position that he has held since 2001.

The business of business is to create profitable and sustainable growth - any sober analysis of the issue shows that HIV and AIDS has the potential to reduce both current profit and the sustainability of future profits of businesses in South Africa.

Why is it a business problem?

In terms of population size, South Africa is a big country. At 47.5 million people it is the 27th most populous country in the world and the 5th most populous country in Africa.

South Africa has an abundant supply of natural resources, capital and people - but it lacks sufficient and appropriate skills to generate fast economic growth: growth is required to ensure prosperity, or at least the absence of poverty, for all. Fast economic growth follows a cycle of:

• More skilled people
  
• adding more value to our natural resources
  
• generating more valuable exports
  
• paying higher wages and salaries
  
• increasing both spending and savings
  
• creating additional domestic consumption
  
• creating more jobs for better skilled people, and so on.

These required skills, however, come from people who can be infected and definitely affected by HIV and AIDS. According to the Labour Force Survey (LFS), March 2007, of our 47.5 million people, only 12.6 million people are employed. This represents approximately 42% of the working-age population.

Those 12.6 million employed people have to generate wealth to feed and develop the whole nation. We are in business not just to make a profit for our shareholders, but also to generate wealth for our nation. Currently (2007) it is estimated that 4.4 million people within the working ages of 20 to 65 are HIV positive¹.

How real is this skills crises?

Quoting from the Centre for Development and Enterprise (CDE) study: "The South African Skills Crises - Report from the corporate coalface"² we read:

• By far the most important need articulated by business is for "experienced and acquired competence".
  
• Businesses pay inflated wages and salaries for scarce skills.
  
• The skills issue was not merely a matter of ease of management or operations performance, but was intimately related to core issues of productivity, prospects for expansion, growth and profits.
  
• The conclusion of the study was that the skills shortage is not only the most difficult issue companies have to deal with, but also erodes the competitiveness of the South African economy.

The 2007 IMD World Competitiveness Yearbook ranked 55 nations in terms of 20 critical factors that influence a nation's global competitiveness. It is no coincidence that South Africa was ranked worst (55/55) on the following three factors:

• Employment
  
• Education
  
• Health and environment

It is not unreasonable to speculate that one of the factors that causes South Africa to be so uncompetitive in these three areas of Employment, Education and Health is the existence of a widespread HIV and AIDS pandemic.

What is the National Strategic Plan (NSP)?

In response to all these issues, Government has established a new National Strategic Plan (NSP) to deal with HIV and AIDS over the next five years³.

Quoting from the NSP, the following goals and priority areas have been identified for 2007 - 2011:

"The primary aims of the NSP are to:

Why business should support the NSP?

The goals of the new NSP are measurable and achievement will be monitored. This is in line with normal business thinking and should be supported by the private sector. There are additional reasons why business should support the NSP:

• Businesses need to create a sustainable business environment.
  
• Businesses have skilled human and financial resources that can assist in achieving these goals.
  
• Businesses have daily contact with employees.
  
• Businesses have access to employees at its workplace.
  
• Social collaboration between Business and Government is vital for the NSP to be successful.

How can business support the new National Strategic Plan?

• Business leaders should read the plan!
  
• Provide resources to improve the health of its employees, prevent new HIV infections and prolong the onset of AIDS related illnesses in HIV infected employees.
  
• Encourage wider access to health knowledge for families.
  
• Provide leadership in communities and business circles by engaging with Government and with Civil Society.
  
• HIV disease managers can make statistics available on total people on treatment to assist with the monitoring of take-up on anti-retroviral treatment.
  
• Most HIV positive South Africans do not know their status and hence unknowingly continue to spread the disease. Businesses must encourage employees to "know your status".

Business can provide real leadership. For example, the private sector introduced anti-retroviral treatment ahead of most governments in Africa and has already been seen as a leader in addressing HIV.

In summary, every business should identify for itself which of the specific NSP goals and priorities it is able to address in its own workplace - and then do so!

Lessons learned from the past

After setting goals and priorities, the difficulty remains "how" to address these issues? The South African landscape is littered with spectacular failures - and a few successes - in tackling these issues. Business leaders, please network with others in business and in the NGO sector. Start with The South African Business Coalition on HIV and AIDS (SABCOHA), identify the business leaders in this field and learn from them.

Lessons learned from the future

Metropolitan recently funded the development of a set of scenarios that have become known as "Live the Future scenarios". These scenarios clearly identified that the fragmented approaches of the past have failed. Collaboration and partnerships are essential.

A comprehensive set of materials to support this project is available to anybody or organization that wants to make a difference in the fight against HIV and AIDS.

We need real role models and leaders to stand up and make a difference, now.

HIV and AIDS poses a real threat in today's communities, workplaces and the market place. The loss of employees, absenteeism and lower productivity are some of the challenges facing businesses, creating the need for a strong and committed reaction. BMW South Africa has faced these challenges head-on by implementing a pro-active, effective HIV and AIDS workplace programme.

BMW sees HIV and AIDS as a people development issue with a strong focus on primary prevention. BMW initiated a major pro-active campaign against HIV and AIDS at the end of 2000 with the launch of its HIV and AIDS policy. The purpose of the campaign was to reduce the impact of the disease on employees, their families and the company. The programme focuses on self-responsibility and taking ownership of the disease by knowing one's HIV status, and it is structured in such a way that employees, the community and company itself benefit.

The BMW HIV and AIDS policy

The company's HIV and AIDS policy was finalised in December 2000 and updated in September 2006, and on both occasions communicated to all staff.The knowledge and understanding of the policy was tested in 2001. The contents of the policy are in line with BMW's company guidelines, good practice and current legislation.

Staff & Resources

A multi-disciplinary team with participation from human resources, union representatives, medical practitioners and management was appointed to drive the process under chairmanship of a senior member of the Board.

A smaller working group has since been appointed to manage ongoing HIV and AIDS initiatives and activities. The group has a dedicated internal budget for their projects and reports directly to the Management Board.

A fully-fledged drive to put the necessary support systems in place was launched in 2001. Nursing staff at the company's Occupational Health Clinics were trained, a full-time doctor and a dedicated HIV and AIDS champion were appointed to assist with the programme. This programme is an ongoing process with all facility services offered to all employees.

Voluntary testing and counselling

In a full-throttle drive against the AIDS pandemic, BMW South Africa has reached a record level of voluntary HIV and AIDS testing and counselling. About 2800 of approximately 3000 employees at the Rosslyn manufacturing plant outside Pretoria and the company's head office in Midrand, have taken the step of getting to know their HIV status. The level of participation shows the commitment of our employees to a strong internal HIV and AIDS programme.

The company advocates the full process of pre-test counselling, laboratory blood sample testing and post-test counselling. This system was preferred above anonymous testing to ensure that the employee knows his/her status, can actively take control of his/her health and can be personally treated. This enables the company to offer holistic care and support to HIV positive employees, giving them access to counselling, wellness advice and a complete range of treatment options.

The VCT started on April 1, 2002. The company MD was one of the first to be publicly tested and counselled which encouraged the whole of the company to follow suit. In March 2007, a "re-test" campaign was started and to date (26 November), 56% of all employees currently know their status. This campaign is scheduled to end in April 2008.

The company's Occupational Health staff conducts tests strictly within the legal requirements for testing, with the consent of the employee. The privacy and dignity of the individual are fully guaranteed. Departments and teams have challenged each other to achieve maximum test numbers and this positive spirit together with word of mouth has proved very effective in encouraging employees to be tested.

"Our programme focuses on individual responsibility and each and every one of our employees is being developed as an HIV and AIDS prevention advocate," says Dr Natalie Mayet Head of BMW's Occupational Health Services. "Knowing one's status is key to getting treatment. Employees have taken ownership of our drive against HIV and AIDS and every individual who has been tested is making a difference and is an inspiration to colleagues. The culture of trust between our employees, the company's medical staff and management has also played a major role in the success of our testing programme."

BMW SA's Managing Director and Senior Managers have taken the lead by being publicly tested and encouraging their colleagues to do the same, without fear of any form of discrimination. All the members of the Board know their status and many of them were tested in the on-site facilities.

Employees who are too ill to work are put on a managed programme with the intention of bringing them back to work.The success of this programme is as a result of nutritional support, prescribed exercise, ARV`s, management of opportunistic disease and regular home visits from one of the Occupational Health Nurses.

Community Outreach

At the beginning of 2002, BMW South Africa entered into a Public-Private Partnership with SEQUA, an agency of the German Federal Ministry for Economic Cooperation and Development. SEQUA provided funding for a holistic community-based Centre known as the Soshanguve Health & Wellness Centre which was handed over to the Tshwane North Department of Education on 21 April 2005.

The site and project partners were identified in Soshanguve - a community of about 700 000 near BMW's Rosslyn Plant where approximately 17% of all BMW employees live. The Centre houses a Clinic that provides services to 4000 - 5000 patients per month by way of HIV and AIDS information, counselling, skills development and training facilities.

To ensure the success of the project, BMW has established a resource base of available health and social support services in surrounding communities. The centre is self-contained with the ongoing guidance of BMW SA and forms part of their Corporate Social Investment Programme.

BMW SA supports HIV and AIDS awareness and treatment in the Eastern Cape Province through the construction of a primary health care facility and school in the remote rural village of Ndonga during 2001 and on 8 November 2007, opened a Lovelife Centre in Knysna..

Partnerships

As part of our networking and the sharing of resources, BMW has also provided HIV and AIDS management training to local doctors who are consulted by BMW employees on a regular basis.

The company has also arranged HIV and AIDS related training for local traditional healers and leaders of religious groups.

As an extension of its internal HIV and AIDS programme, BMW is in the process of rolling out its HIV and AIDS programme to its nationwide supplier and dealer networks, to encourage them to implement their own internal programmes.

BMW is a member of SABCOHA, an organization representing the South African business sector in its campaign against HIV and AIDS.

For further information, please contact Dr Natalie Mayet, General Manager: Medical and Occupational Health on telephone number (012) 522 3025 or Jacqui Hocking, Manager: Internal Communications on telephone number (012) 522 2755.

The DaimlerChrysler Chamber Health Trust Siyakhana Project has amply demonstrated the value of Public-Private Partnerships (PPP) as an appropriate vehicle for a sustainable and comprehensive response to the HIV and AIDS pandemic, in workplaces and in the communities from which employers draw their labour.

The importance of forging a response to HIV and AIDS, grounded in a Private-Public Partnership approach has underpinned the project since its conceptualisation. Both the DCSA HIV and AIDS Workplace Project and the Siyakhana Project were presented as a combined case study at the Global Business Coalition's (GBC) on HIV and AIDS, Tuberculosis and Malaria/Transatlantic Partners Against AIDS (GBC/TPAA) meeting in Russia in October. GBC hosted top policy-makers, business leaders, and dignitaries from China, India, and Russia, among other countries, for the Leaders Forum on Public-Private Partnerships (PPP).

"The forum included two unique workshops to identify, launch and establish a sustainable framework to guide new Public-Private Partnerships (PPPs) in the fight against HIV and AIDS and TB in Russia, China and India," DaimlerChrysler's Group Health and Safety Advisor, Dr Clifford Panter said.

Siyakhana - a new PPP

The Siyakhana Project offers comprehensive HIV and AIDS voluntary counselling and testing, and treatment and infection mitigation to 17 participating companies. It is a response to the economic reality that small and medium size businesses in South Africa absorb more than half the people formally employed in the private sector and contribute about 42% to the country's GDP. HIV and AIDS is already having a significant direct and indirect impact on SMME's and very few have implemented event rudimentary HIV and AIDS interventions in the workplace.

In view of this, then DC chairman Jurgen Schremp along with GTZ and local DCSA counterparts, began developing the Siyakhana model.

The partners to the Siyakhana Project PPP include DaimlerChrysler, the Border-Kei Chamber of Business, German Development Agency (DEG), BroadReach Healthcare LLC (BRHC) which funds a GP network, the Eastern Cape Development of Health which funds Anti-retroviral (ARV) treatment and the 17 participating companies.

In the two years since its operation Siyakhana Project has offered VCT to 4 656 employees of whom 3 078 have been tested and 268 tested positive.

Like the DaimlerChrysler workplace policy, the Siyakhana Project is widely viewed as an international benchmark, and is set for significant expansion in 2008. The project aims to reach 50 more companies in its next cycle and provide a comprehensive package of services. Participating companies pay a nominal fee to benefit from the extensive programme. Some of the areas the Siyakhana Project aims to address next year are family access to the programme, capacity building in ten clinics and incorporating tuberculosis testing and treatment in its model.

"We are finding that spouses and children are not accessing the project in the way we envisaged and there are a number of complex factors that account for this, not least of all poor communication patterns, denial and stigma. However, we are working on this," Siyakhana Project manager Simeon Odugwu said.

"Amathole District has been identified as a crisis area when it comes to incidence of multiple drug resistant (MDR) and extreme drug resistant (XDR) tuberculosis. People with compromised immune systems are far more likely to become HIV positive if exposed to the virus."

Odugwu recently visited Germany to give feedback to DaimlerChrysler's Politics and Health Management Departments. "They were impressed with what can be achieved, what is possible if one implements a comprehensive programme that tackles things holistically."

Since the project was showcased in Russia, Panter says he has received numerous telephone calls from interested parties in China, India and Russia keen to hear how the project assists people who are not on medical aid to access ARV treatment.

For more information contact Dr Clifford Panter on +27(0)43 706 2231 or e-mail: clifford.panter@daimlerchrysler.com

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Can a 12 year old child consent to an HIV test without the parents' knowledge and consent?

The new Children's Act No. 38 of 2005 was amended and signed into law by the President on 8 June 2006. The new Children's Act provides access to HIV testing to children above 12 years of age without parental knowledge and consent. Even though the President has signed the new Children's Act, it is not yet in effect and is expected to come into force during 2008. The Child Care Act of 1983 therefore still governs allowing children access to and consent to HIV testing above 14 years of age.

Source: Quote from Proudlock, P. Children's Bill Update. Cape Town: University of Cape Town, 2006 with comment by Leonie Engelbrecht, Metropolitan AIDS Risk Consulting.

Source: David Harrison is CEO of LoveLife. This article first appeared in The Star newspaper on October 15 2007.

Source: Extract from BMW Group's Drive against HIV/AIDS in South Africa compiled by the HIV/AIDS committee of BMW SA

AIDS deaths per day	1000
New HIV infections per day	1400
People living with HIV	5,5 million
Total AIDS deaths	360 000
Total new HIV infections	520 000
Total AIDS sick	620 000
Adults with AIDS, not on ART	510 000
Children with AIDS, not on ART	27 000
Adults on ART	260 000
Children on ART	32 000

Published by
Metropolitan Holdings

Editorial Board

Leonie Engelbrecht
(021) 917 3294
lengelbrecht@metropolitan.co.za

Nathea Nicolay
(021) 917 3090
nnicolay@metropolitan.co.za

Nosipiwo Ngxabazi
(021) 940 5150
nngxabazi@metropolitan.co.za

Tjaart Esterhuyse
(021) 940 4950
testerhuyse@metropolitan.co.za