US embassy cable - 03HARARE967

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 
 
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SUMMARY 
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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. 
 
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PRIVATE SECTOR SLOW TO ACT 
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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. 
 
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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. 
 
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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. 
 
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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.) 
 
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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. 
 
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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. 
 
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CONCLUSION 
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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