The Aids-related deaths we are seeing now are the result of infections from six to eight years ago. This means that even if SA were to see a reduction in infection levels as a result of behavioural change, the positive effect in terms of sickness and mortality is five years away.
This is according to Metropolitan Group Aids research head Stephen Kramer. He says: "What you're seeing now in terms of the large numbers of funerals is not a reflection of present infection levels. There's a delayed impact. In the next two to three years, we're going to see a huge increase in mortalities. But at the same time, we may see a dramatic drop in infections."
Corporate SA has a dilemma . Treating Aids without antiretrovirals will result in many untimely deaths, as well as orphans. Antiretrovirals can keep HIV-positive employees alive for up to 19 years. But providing therapy for that length of time to infected members of the workforce could put an employer out of business.
"Companies must acknowledge that they could be paying for someone to take antiretrovirals for 19 years," says Steve Watson, executive director of underwriting agency Fusionry. "It's not just a one-off cost ."
Watson says antiretrovirals are only part of the answer and administering them in isolation will achieve little. "Therapy doesn't necessarily increase productivity; it doesn't necessarily stop claims; it doesn't necessarily achieve anything; this all depends on compliance and the overall Aids management programme adopted."
But therapy will keep people alive.
Watson concedes that "from a moral and emotional point of view it may seem the right way to go. But on a practical level it's not necessarily the right approach."
Fusionry manages risk on behalf of the Hollard insurance group. Watson argues that a pragmatic approach is the correct one. He cites the example of a client company in KwaZulu Natal, where 16% of the population is HIV-positive.
"This client has done a prevalence audit and has a 4%-5% HIV prevalence rate," says Watson. "I don't particularly believe that, but it also has a staff fluctuation rate of 30%/year.
"So even if it does have this low figure, it's losing 30% of its staff every year to normal attrition and is re-employing in an area that has an HIV prevalence rate of 16% - it has a bigger problem than when it started.
"Before this company offers antiretroviral therapy, it should be trying to stop its natural attrition or reducing it to a manageable level."
Good corporate governance should come first. "And good corporate governance includes pragmatic issues such as retaining staff," says Watson. "If companies spend more money there first, they will have a bigger effect on the successful management of Aids in the workplace."
A recent study of 500 SA companies by finance group Sanlam shows that 75% of companies do not know the prevalence of HIV/Aids in their organisations and more than 60% have no strategy to manage the pandemic.
Dr Denis Cronson of Health InSite believes that among smaller companies as many as "90% or more are doing terribly little".
Health InSite provides workplace HIV programmes for corporates. Clients includes companies from the financial services sector to the IT and mining sectors. Johnnic Publishing is benefiting from Health InSite's website and e-mail programme, which provides a curriculum of HIV information.
The cost of what Cronson describes as a comprehensive strategy for a large organisation could be R200 000. For a smaller company, it could be as little as R50 000. "The present value of an HIV-positive employee to a company, including health care, productivity, replacement and death and disability benefits, could be as high as five to seven times his or her annual salary. So, compared with this, the cost of a strategy is minimal.
"We try to build a lot of internal capacity to run an HIV programme," he says. "A company could spend R200 000 and put in place a powerful programme that would affect every employee."
In new disclosure requirements from next year, the JSE Securities Exchange will require all listed companies to report on employee HIV prevalence; the effects of HIV/Aids on costs, productivity, revenue and customers; full disclosure of workplace programmes to manage the pandemic; and information on community-based care programmes and wellness clinics.
Prevalence is one thing, but the effect of HIV/Aids on a business is another and include the deaths, early retirements, loss of skills, financial effects and the effect on productivity.
"There's a range of effects that companies have to wrap their minds around," says Cronson. "And at the moment they're not doing it at all. That's a big problem.
"Let's say 25% of companies are doing something. But I'd say that less than 10% have actually determined the financial impact of HIV on their organisations."
Even among the small percentage of doers, the question must be posed: are they doing the right thing?
With the best intentions, a company might embark on a free condom distribution campaign, thinking people who use condoms don't get Aids. "But people don't want to touch those condoms," says Cronson. "If they do, they're going to be seen as promiscuous. So the programme fails and puts the company back a step."
Before free condoms, you've got to have what Cronson describes as "the upfront sensitisation of the staff".
"They have to learn about HIV and what it is. You've got to debunk the misconceptions that are prevalent and people must understand that when they take a condom they will be seen as smart. It's a smart company thing to be doing and this is the way to go."
Cronson says companies have to think it through properly first. "Some say: We've got to have an HIV policy.' But often they hack this out without doing the correct policy audit and leave some gaps.
"People think peer educators are the way to go: running seminars, giving discussions and being a link for people with HIV in the organisation. Make no mistake, they are a good thing, but if the process is run without the upfront sensitisation, nobody wants to speak to a peer educator because they'll think: If I speak to this peer educator, my colleagues will think I've got Aids.' "
The answer, says Cronson, is to engage employees throughout the organisation in an HIV programme. "They have be interested in learning about HIV, not only because it can save their lives but because they can make a contribution at home, at work and as a member of the community. They have to realise they can be smart; they can be HIV-savvy. Empower them and they'll want to interact with a peer educator."
One gauge of the importance a company places on an effective HIV programme is at what level the programme is handled within the corporate hierarchy. And who talks to the media when asked what the company is doing. Is it the chief executive (which it would be in a truly committed organisation) or the PR consultant?
Often it's left to human resources (HR). "The HR department alone is probably not the best place from which to run a programme, though the HR department is usually lumped with it," says Cronson. "This is because HIV becomes an HR problem or is seen as a social investment issue, which is wrong.
"It should be a top-level core strategy issue because HIV is so pervasive in its impact on business. And unless a company has an HIV/Aids task team, which we usually set up in an organisation when we implement our programme, it will not survive.
"Unless this task team is heavily endorsed by senior management, or includes a senior manager, it won't have legitimacy in an organisation.
"Often HR is the backwater of corporate authority. They don't have the impact a CEO or an executive task team would have in running an HIV programme."
