Private initiative for AIDS prevention advisable

By Meike Hensmann

JAKARTA (JP): Imagine one day the person you have been working next to for years finds out that he or she is HIV-positive, and decides to confide this to you.

What will you say? How do you react? Will you treat them differently than before? Few of us are really prepared for such a situation, but is it that unlikely to happen?

Equally unprepared are most employers in this country. What if one of your employees confided to you that he or she is HIV- positive or, worse, if you found out indirectly through co- workers or an insurance company. What would you consider an appropriate action? Do you really know enough about the HIV and AIDS to make an informed decision?

Indonesia is beginning to experience the first signs of the HIV epidemic. However, cases have been occurring since 1987, but the response has been slow. Without effective prevention efforts, the World Health Organization predicts that the country will soon see an infection rate and a number of new cases that could surpass Thailand and India.

But why should this interest employers and employees in particular? For one simple reason: Most people affected by AIDS are at a working age, and most are not members of such marginalized populations as homosexuals or commercial sex workers. They are those people standing next to you in the office, on the production line, on the construction site.

AIDS-related diseases always have a direct, devastating effect. Not only do those with AIDS face an untimely death, preceded by a period of severe illness, many have to bear the psychological burden of stigmatization and exclusion from society.

But entire economies are also affected.

Modeling shows that once 20 percent of the adult population is infected with HIV, the average mortality of a 30-year-old is equal to that of a 70-year old. It is not hard to imagine what this means in terms of employee turnover (due to death or disability), health care and medical costs, absenteeism, recruitment, disruption, training costs and productivity. In industries that require highly skilled workers, the extent of output loss can be significant.

If this still seems too theoretical, turn your eyes to some of the countries in sub-Saharan Africa. There, preventive and preparatory measures were -- if at all -- only implemented when the epidemic reached noticeable proportions. In Zambia, for example, firms have reported that the number of employees that have died has increased eight-fold between 1987 and 1993 -- almost exclusively due to AIDS. Productivity was indeed negatively affected -- and projections estimate that per capita income growth will slow down by 0.6 percent every year. On a more personal note, in Uganda, if an employee merely took time off to attend funerals he or she would be absent for an entire month every year!

Most studies in this field are of a macroeconomic nature, and the World Bank, the United Nations Development Program, and the World Health Organization alike warn of the potentially devastating effect the AIDS epidemic could have on the economies of Southeast Asia if there are no concerted national efforts to halt it in time.

But why look at the macroeconomic level, individual businesses and companies? Simply because private industries can implement services for workers much more quickly than the government.

AIDS is not simply a health problem. HIV/AIDS awareness and education programs is also in the interest of every company for economic reasons. Their effects will be hard to notice, since the absence of disease is typically harder to detect than its occurrence, but that should not lead one to conclude that such programs are not highly desirable.

Some companies in Indonesia have already had the foresight to look for and implement AIDS prevention programs for their employees. The Kusuma Buana Foundation, for example, in collaboration with PATH (Provide Appropriate Technical Health), an NGO, offers two strategic approaches for businesses, and both have been successfully taken up.

In the first, in depth approach, the foundation assigns outreach workers to companies for a period of around 6 months.

National Gobel (electronics), PT Busana Rama (garment) and PT Sangra Ratu Indonesia (laundry) have chosen to prepare for AIDS in the workplace by this method. The other less intensive but very effective approach is through several days of small-group seminars to all levels of the company. While this may disrupt the usual work activities briefly (half-day per group), it requires less of a time commitment from the company. Such seminars have been held by the Kusuma Buana Foundation at PT Gillette Indonesia and PT Unitex (textile).

One hopes that more businesses will follow the lead of these exemplary few, as only a concerted effort from the private and public sectors will prevent the human and economic catastrophes that AIDS could inflict on this country.

Meike Hensmann, M.A. Ph.D., currently an M.P.H. student at Yale University, U.S.A., is a summer volunteer at the Yayasan Kusuma Buana.