Business in a quandary over HIV/AIDS treatment costs

Workplace HIV/AIDS treatment programmes in South Africa are making "catastrophic mistakes" and may be doubling the cost of the epidemic on business, a new report has found.

Studies conducted by HIV consulting firm FutureForesight and the Wits Health Consortium found that businesses using poorly designed HIV strategies were doubling their HIV costs.

"The theory is that it is cheaper to treat [HIV/AIDS] than ignore it. But companies are running their [treatment] programmes badly and this is not happening," Chris Barker of FutureForesight, told PlusNews.

The hype surrounding recent announcements by some major companies in South Africa of their plans to provide HIV-positive workers with antiretroviral (ARV) drugs has been accompanied by a growing realisation of the financial reality of treatment.

According to the study, timing is critical. Audits of patients across several treating companies showed that some were in an advanced stage of the disease, while 60 percent should not even be receiving treatment yet.

"Thus, most employees currently being treated in [South Africa] are not examples of a cost saving, but examples of cost doubling - treatment plus the past productivity losses," the report said.

The study also called for better clinical management of HIV and the follow-up of patients. A firm's treatment programme would not produce any savings, unless the actual clinical management of HIV was "good enough to keep the employee healthy and productive," it warned.

A recent audit of HIV management across some of the countries most advanced treatment companies revealed that 55 percent of audited patients were not visiting their doctor for monitoring and testing, and 32 percent were failing therapy and developing resistance, placing a "substantial productivity burden" on their company in addition to treatment costs.

If HIV-positive employees were identified early through voluntary counselling and testing (VCT), savings in lost productivity could be realised.

Businesses were now recognising that antiretroviral therapy uptake rates on medical aid and HIV/AIDS management programmes were "completely unacceptable," the report said.

In August 2002, South African diamond company De Beers announced that it would provide ARVs to HIV-positive staff and their spouses. But its campaign has been delayed by "problems and obstacles beyond our control", the company's HIV/AIDS coordinator Keith Markland, told PlusNews.

One of the problems is that South African tax laws make the provision of free or subsidised medication to employees a taxable benefit, defeating the whole purpose of providing free drugs. The company was also in danger of falling foul of the Medical Schemes Act, as it was providing services similar to those offered by medical aid schemes.

Markland admitted that it would also be difficult to encourage HIV-positive employees to come forward for ARV treatment. Consequently, the company will employ an advertising agency to develop a VCT campaign "to get the message across properly," he added.

"The complexities of this issue are very deep and there is no quick and easy solution here," Markland said.

But companies had to "act fast" and develop an HIV assistance programme motivating employees to apply for voluntary counselling and testing (VCT), as a high uptake was essential for successful treatment initiatives.

"What people don't realise is that this situation could implode and all these well-meaning interventions could undermine treatment," Barker said.

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