In Africa

Labour Protection Department

Social Protection Sector

INTERNATIONAL LABOUR OFFICE. GENEVA

An initiative in the context of the world of work

A publication based on the proceedings of the Regional

Tripartite Workshop organized by the International

Labour Office in collaboration with the Joint United

Nations Programme on HIV/AIDS (UNAIDS) in

Copyright © International Labour Organization 2000

First published 2000

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Action against HIV/AIDS in Africa

ISBN 92-2-111916-5

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V Preface

1 HIV/AIDS and the world of work: Problems, implications and pointers for action

29 The views from Africa: Proceedings of the Regional Tripartite Workshop

61 Draft Platform of Action

71 List of participants

Preface

The HIV pandemic continues to pose major challenges in the world of work and African society at large. Nearly 34 million people are currently living with HIV/AIDS, and one-third of these are young people between the ages of 10 and 24. Sub-Saharan Africa is the most affected. More than 11 million Africans have already died, and another 22 million are now living with HIV/AIDS. Nearly 10 million more deaths are expected by 2005. Among the HIV-infected globally, six out of ten men, eight out of ten women, and nine out of ten children live in Africa.

The disease kills both old and young, but mainly strikes people in their prime years, in their productive years. Over 80 per cent of AIDS deaths have been in the age group of 20 to 49 years. Consequently, it profoundly disrupts the economic and social bases of families. The primary goal of the ILO is to promote opportunities for women and men to obtain decent and productive work, in conditions of freedom, equity, security and human dignity. This goal is being threatened by the HIV/AIDS pandemic. People living with HIV/AIDS are victims of discrimination in respect of employment and occupation. The pandemic is impacting negatively on employment, especially in the small-scale enterprises and the informal sector, and on the overall supply and quality of labour. Large sections of Africa’s experienced labour force are decimated by the pandemic. The problem of child labour is exacerbated by the large number of orphaned children thrown into the streets and the labour market. Young women of childbearing age are especially affected, thereby worsening the social and economic situation of women. Social security systems in many countries are threatened with bankruptcy. This list is by no means exhaustive.

For these reasons, there is growing concern among African member States for a more vigorous engagement by the ILO to help them combat the spread of HIV/AIDS and provide protection and support to its victims. In response, the ILO organized in Windhoek (11-13 October 1999) a successful Regional Tripartite Workshop, which led to an extensive exchange of views and experiences, and which concluded with a draft Platform of Action to be submitted to the Ninth African Regional Meeting (Abidjan, 8-11 December 1999) for final adoption. This booklet contains some of the basic documents and conclusions of this meeting.

HIV/AIDS.

The ILO will ensure that its work complements the ongoing effort by other organizations. With this in mind it would link up and work closely with all those concerned especially UNAIDS and other members of the UN system, international and regional financial institutions, and bilateral donor agencies.

Mary Chinery-Hesse

Executive Director

HIV/AIDS

In Africa

HIV/AIDS and the world of

Work: Problems, implications

And pointers for action

The problem

HIV/AIDS is undoubtedly the single most important and daunting health problem facing Africa. Globally too, this is one of the most serious health, medical and social pre-occupations of our time. The figures from UNAIDS and the WHO provide a grim picture.

• The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health

of deaths to about 2.5 million.

• The total number of children living with HIV/AIDS stands at 1.2 million.

For Africa, HIV/AIDS is perhaps the single most important obstacle to social and economic progress. AIDS is no longer a health problem. It is a development problem with potentially ominous consequences. At least two-thirds of the world’s HIV/AIDS population – 22.5 million– live in this sub-region. Countries like Botswana, Namibia, Swaziland and Zimbabwe have been among the hardest hit nations. Between 20 and 26 per cent of people aged 15 to 49 in these countries are living with HIV/AIDS. AIDS is expected to be the cause of death of two million Africans this year. According to the International Labour Organization’s East Africa Multidisciplinary Advisory Team, AIDS has surpassed malaria as Africa’s number one killer.

And the rate of new infections is not slowing. In 1998, nine of out every ten newly diagnosed people were African, and at least 95 per cent of all AIDS orphans are African. Even sub-Saharan countries that had lower infection rates than their neighbors just a few years ago seem to be catching up. South Africa, which at the beginning of the 1990s trailed the other nations in the region, now accounts for one in seven new infections. In Zimbabwe, where there are 25 surveillance sites in which blood is taken from pregnant women and tested anonymously, only two of the sites had HIV-positive results below 10 per cent.

The remaining 23 sites reported infection rates between20 and 50 per cent.

Social and economic implications

Child mortality will also be much higher, since while many HIV-infected children survive beyond their first birthday, few survive their second birthday. For example, child mortality in Kenya is expected to be twice as high by the year 2010 as it would have been without AIDS.

What would be the impact on the labour force? Very severe indeed, since a large proportion of the HIV-infected population is in the age group of 20-49 years. It would lead to increased morbidity and mortality, reduced population and supply of labour. Other effects may include increased absenteeism, early entry of children into active labour force, early retirements, changes in labour force participation, increased labour costs for employers, mismatch between available human resources and labour requirements, curtailed remittances from migrant workers, and an increase in female headed households.

Firstly, it would also impact upon the population size. The latest population projections by the UN Population Division for 1998 considered the impact of AIDS in 34 countries, with a population of one million or more and the adult HIV prevalence of 2 per cent or higher in 1997.

Two more countries, Brazil and India were also included, even though the HIV prevalence there is below 2 per cent; their population size, however, implies that the number of HIV-infected persons is sizable even at the lower rates. Out of these 34 countries with 2 per cent or more HIV infection, 29 are in Africa, three in Asia, and two in Latin America and the Caribbean

The projections show a significant impact of HIV/AIDS on population size and the size of the labour force. For the 29 African countries, the population in mid-1995 was estimated at 441 million, about five million fewer than it would have been in the absence of AIDS. By 2015, however, the total population is expected to reach 698 million, about 61 million less than it would have been in the absence of AIDS. At the country level, the populations of Botswana, Namibia and Zimbabwe are expected to be about 20 per cent lower by the year 2015 than these would have been in the absence of AIDS. However, the population size is not expected to decline, and the population growth would still remain positive, because of the high levels of fertility.

Examples of two countries, one with high HIV prevalence (Zimbabwe), and the other with relatively low prevalence (Togo). In both countries, the onset of HIV/AIDS was in the 1970s, (1976 for Zimbabwe and 1978 for Togo) though the estimated percentage of adult population that were HIV positive in 1997 is very different: about 21 per cent for Zimbabwe, compared to less than 7 percent for Togo. Division for population affected by AIDS, and comparison computed using the ILO software, POPILO. For labour force projections, the ILO labour force participation rates have been used. While the projections have been made for longer duration, the discussions here relate to the period 1995-2015. Projections beyond that period are much less reliable.

The relative decline in the population size and distribution are striking in the case of Zimbabwe; a lot less so in the case of Togo. In Zimbabwe, the labour force is estimated to be about 2.3 per cent less because of the impact of HIV/AIDS, but 20 years later, it would be about 17.5 per cent lower than what would have been, without HIV/AIDS.

It would otherwise have grown by about 68 per cent. In the case of Togo the labour force population would be about 4 per cent less than it would have been in the absence of HIV/AIDS, and the total labour force would grow by 65 per cent, instead of 70 per cent

AIDS, business and the economy

Because HIV/AIDS cuts into the size and quality of the workforce, it is of fundamental concern to business and economic policy makers. It is estimated, for example, that in South Africa’s mining sector as many as one out of five workers are HIV-positive. Data collected by the ILO in May 1999 on the labour force in Rwanda, United Republic Tanzania, Zambia and Uganda revealed that 80 per cent of the persons infected in those countries were between 20 and 49 years old. In other words, AIDS is affecting, and ultimately killing, the most productive labour force within the formal sector. Many are experienced and skilled workers in both blue – collar and white – collar jobs. In Zambia, for instance, 96.8 per cent of all deaths in the 18 firms covered occurred among workers aged 15 to 40. Between 1984 and 1992, mortality had risen fivefold, with AIDS-related illness accounting for 56 per cent of the deaths among general workers, 71 per cent among lower level workers, 57 per cent among middle level workers, and 62 per cent among the top level managerial workers. Employers naturally are concerned about the backbone of their businesses– their employees – and the effect the pandemic could have on their businesses.

HIV/AIDS makes the cost of doing business more expensive, while at the same time lowers workers’ productivity and decreases overall demand for goods and services. It decimates manage-ment and the skilled labour force. Finding qualified top management and skilled line workers to replace those who die or can no longer work can be extremely difficult.

Productivity suffers; it takes time to replace workers, particularly skilled or senior workers. There are other costs as well. In Mauritius, AIDS resulted in increased health care costs, medical insurance costs, death benefits, and disability and pension payments.

In Zimbabwe, life insurance premiums quadrupled in just two years because of AIDS-related deaths. Other countries also reported that their health bills had doubled. In the United Republic of Tanzania and in Zambia, large companies reported that AIDS illness and heath costs surpassed their total annual profits. In Botswana, companies estimated that AIDS-related costs will increase from under 1 per cent of salary costs to 5 per cent in only six years due to the rapid rise in infections in the last several years.

At the national level, the effect could be even more serious. For example in the United Republic of Tanzania, the World Bank predicted a 15 to 25 per cent drop in the Gross Domestic Product because of the AIDS crisis. Employers face daunting challenges. Many fear that addressing AIDS in the workplace could be too costly, while others are concerned that they do not know how best to approach the issue.

Surveys reveal that few companies have established comprehensive prevention, care and support interventions in their workplace. A study of Kenyan companies done by UNAIDS showed that while most managers believed HIV/AIDS would have some effect on their business, only one half of them provided HIV/AIDS education.

In the informal sector, where many unsuccessful aspirants or retrenched workers surface alongside those who are without adequate education and skills, AIDS has also had a considerable impact. Many in this sector, especially women, trade in perishable goods such as vegetables, fish, fruit and cooked foods. But many of the HIV-positive or AIDS-infected workers in this sector are forced to forfeit their stalls in the market, causing their businesses to collapse. If there is a period of remission or recovery, it is often difficult to resume in the market because personal savings may have depleted.

Gender dimension

Women are especially vulnerable. Young women of childbearing age – ages 15 to 24 – are twice as likely to be infected as males in the same age group. The most common route of transmission is through heterosexual sex. Widely held cultural practices that accept multiple partnering by males, the lower socioeconomic status of women, and the greater efficiency of male to female transmission all make women particularly vulnerable to the disease.

Wartime conditions are also fertile breeding grounds for HIV/AIDS. In Rwanda, for instance, rapes during that country’s armed conflict earlier this decade is blamed in no small part for spreading the virus there.

According to USAID, four out of five HIV-positive women live in Africa. In many African countries, where women are generally responsible for running the house-hold and caring for family members, the death of the wife can make it difficult for the others who then have to take on her responsibilities. Regardless of the gender of the deceased, the death of a family member because of AIDS, leads to a reduction in savings and retirement benefits.

Impact of HIV/AIDS on children

For children, HIV/AIDS means hard labour and diminished life expectancy. Zimbabwe illustrates the frightening prospect of orphanhood, where more than 25 per cent of the adult population is HIV-positive, the Government is estimating that within two years, 2,400 Zimbabweans a week will die from AIDS. With most of these deaths concentrated in young families, this means a considerable increase in the number of orphans. When a child is thrust into this position or forced to become the head of a household, he/she has to quickly find a way to provide for more needy siblings. Many end up becoming delinquents, drift onto the streets, or into prostitution. Orphaned boys often turn to the armed forces, or paramilitary forces, for comfort and camaraderie.

Studies have shown that girls who face sexual abuse are more likely to drift into prostitution, which itself carries a sizable risk of infection.

Stigma and the fear it engenders fuel the spread of HIV, since those with risky behavior in the past may be reluctant to change that behavior in case the change is interpreted as an admission of infection. Fear of acknowledging HIV infection can stop a married man from raising the subject of condom use with his wife. Fear of advertising her HIV status may prevent an infected woman from giving her baby replacement feeding to avoid transmitting the virus through breast milk.

The stigma attached to HIV affects both sexes. However, the consequences may be more severe for women, who risk being beaten and even thrown out of their house if their status is revealed. This may still be the case even when the husband was the source of the woman’s infection. An HIV-infected woman may be blamed for the death of her children, and be deprived of care. Many people simply do not want to know if they are HIV-positive, even when counseling and testing are offered. The culture of silence can continue to reign even when people with HIV are ill and dying. Since AIDS is the name for a cluster of diseases that immune deficient people develop, patients and their care-givers can simply choose to view their illness as just tuberculosis or diarrhea or pneumonia.

A report by UNAIDS and WHO cited an instance from southern Africa where, in a study of home-based care schemes, fewer than one in ten people who were caring for HIV-infected patients acknowledged that their patients were suffering from HIV or AIDS. Patients themselves were only slightly more likely to acknowledge their status, and several told researchers that they had not disclosed their status to anyone, including the person caring for them. The self-imposed silence is hard on the patient, and it can also be hard on caregivers, particularly when they are children or adolescents.

Some thoughts on future action

Much of the work in the ILO in the past was concerned with rights and discrimination issues. It is now obvious that the AIDS pandemic is more than a health or rights problem. It affects the very social fabric of communities and the future of the economy. HIV/AIDS could well be the single most important impediment to social and economic progress in Africa; it can therefore be best described as a develop-ment crisis.

This frightening reality has prompted the ILO constituents to seek assistance to address this problem. For example, during the 1994 African Regional Meeting in Mauritius, the ILO was requested to provide technical assistance and include activities aimed at helping governments and employers’ and workers’ organizations to respond to the threat posed by the high incidence of HIV/AIDS infection. A similar request was made at the last OAU Labour and Social Affairs Commission Meeting at Windhoek, Namibia. The ILO’s tripartite structure and extensive collaborative work with governments, employers and workers on social, labour and employment policy puts it in a somewhat unique position to assist member countries deal with what is certainly an exceptionally daunting humanitarian challenge. The problem of HIV/AIDS is multi-faceted.

The approach to deal with it would inevitably have to be multi-dimensional. Here though, we will emphasize two particular lines of action: the prevention of the disease and the protection and well-being of those affected by it.

Combating discrimination

In 1998, WHO and ILO issued a major statement on AIDS and the workplace, which serves as a point of reference at the international level concerning the principle of non-discrimination. It encompasses the essential elements of the policy to be followed on AIDS at the workplace; and these are stated as follows:

Protection of the human rights and dignity of HIV-infected persons, including persons with AIDS, is essential to the prevention and control of HIV/AIDS. Workers with HIV infection who are healthy should be treated the same as any other worker. Workers with HIV-related illness, including AIDS, should be treated the same as any other worker with an illness. Most people with HIV/AIDS want to continue work-ing, which enhances their physical and mental well-being and they should be entitled to do so. They should be enabled to contribute their creativity and productivity in a supportive occupational setting.

The World Health Assembly resolution (WHA41.24) entitled, "Avoidance of discrimination in relation to HIV-infected people and people with AIDS" urges

Member States:

The approach taken to HIV/AIDS and the workplace must take into account the existing social and legal context, as well as national health policies and the Global AIDS strategy.

Consistent policies and procedures should be developed at national and enterprise levels through consultations between workers, employers and their organizations, and where appropriate, governmental agencies and other organizations. It is recommended that such policies be developed and implemented before HIV-related questions arise in the workplace.

Policy development and implementation is a dynamic process, not a static event. Therefore, HIV/AIDS workplace policies should be:

(a) Communicated to all concerned;

(b) Continually reviewed in the light of epidemiological

and other scientific information;

(c) Monitored for their successful implementation;

(d) Evaluated for their effectiveness.

These WHO/ILO principles should provide a good basis for the development of suitable legislative frame-work, collective agreements and codes of practice. The ILO could and should mobilize the social partners and civil society to develop and apply these principles and to disseminate them widely as a basis for training jurists, counselors, doctors, workers and employers.

Prevention and assistance

Though protecting the human rights of affected workers and combating discrimination against them remain important, action against HIV/AIDS should give particular importance to prevention and assistance. A coherent labour management policy is needed to ensure that all aspects of the problem are addressed in a mutually supportive manner. The willingness of employers and workers to take action should be enshrined in multisectoral national policies to combat AIDS. It is necessary to promote private sector initiatives on an urgent basis and to undertake AIDS training (prevention and community assistance) at the workplace. It is also indispensable for the public sector, which is still the major provider of salaried employment in developing countries, to develop the resource structures for the dissemination of a permanent message of solidarity among public employees. For activities of this magnitude and urgency, major political awareness and commitment are vital. Important also is a multi-media and information campaign. Such a campaign should cover the following areas:

• Providing information about the facts and myths

• Safe sex education;

• Protection in jobs where there are risks of

• Preventing drug and alcohol abuse leading to

• Specific support for groups at high risk, such as

Information and training materials need to be developed to enable industry, employers’ and workers’ organizations to conduct training activities. Attention should also be given to the large number of workers (hospital and health-care personnel, firefighters, police etc.) who are at risk of becoming infected with HIV because they come in contact with blood, semen, or body fluids containing blood. Guidelines should be elaborated and implemented systematically through appropriate educational and ongoing programmes in the workplace

Social security

The ILO has initiated work on the impact of AIDS on the future structure of the population. A long-term model has been built to assess the demographic impact of AIDS. This model is an important tool for actuarial work on social insurance schemes in countries with high AIDS prevalence, notably in southern and eastern Africa. This basic tool will be further improved and completed in order to simulate the medium- to long-term impact of AIDS on labour supply, employment, productivity, growth and poverty levels. It will make possible a projection of various social expenditures such as health, education and social services, as well as cash benefits in formal sector social insurance schemes. It will then establish the links between social expenditure and the government budget by estimating changes in government social expenditure and revenues over time. In addition, the combination of an AIDS mortality model and a social budget model will permit cost benefit analysis of different degrees and intensities of early awareness campaigns. The model assumes that early awareness will reduce infection rates, morbidity and mortality and thus avoid a major part of later negative impacts on government spending and income and economic growth. The ILO is prepared to collaborate in the application of the model and share experiences with African countries.

Statistics

Statistics are important for advocacy and public awareness campaigns and to develop policies and programmes to mitigate the adverse effects of this epidemic. With this is in mind, the ILO will undertake the following kinds of activities to assist member States and non-governmental and international organizations in documenting and revealing the nature, magnitude and extent of the problems.

future supply of labour.

Concluding remarks

It has been said many times before, but needs to be said again, that HIV/AIDS is probably the most serious humanitarian challenge of our time, especially here in Africa.

HIV/AIDS does not discriminate; it can infect persons of any race, age and sex. It has no cure. It is transmitted in only a few specific ways: sexual contact, blood-to-blood contact and mother-to-baby. In other words, it can be prevented.

The world labour force is estimated at close to 3 billion workers. They are all vulnerable. But they can all serve as agents of change, an enormous work force which can be deployed in the cause of a healthier, safer and longer life and a better world. What is needed is to provide it with the awareness essential for action and commitment and the assistance to effect prevention and protection. The challenge therefore for the ILO and the member States is to develop a programme of action of prevention and protection that encompasses: statistics to document the problem and make it more visible and amenable to action; a multi-media information and education campaign and direct assistance to industry and communities to stimulate and support action at all levels; the promotion of a culture of fairness and ethics that can embrace the weak, vulnerable and diseased; a legal and social security protection to victims and society at large.

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Population Programme Development Policies, September 1999.

Mehra-Kerpelman, Kiran, "The Organized Sector Mobilizes Against

Center, Population Division, July 1998.

of Health and Nutrition, Division of HIV/AIDS, 15 March 1999.

Office of Health and Nutrition, Division of HIV/AIDS, 15 March

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Action against

The views from Africa:

Proceedings of the Regional Tripartite

Workshop

Background

The African Regional Tripartite Workshop on Strategies to Tackle Social and Labour Implications of HIV/AIDS was held in Windhoek, Namibia, from 11 to 13 October 1999. It was organized by the International Labour Office (ILO) in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS). The meeting was organized in response to the request of the members of the OAU Labour and Social Affairs Commission at its last session in Windhoek in April 1999, for the ILO to be more involved in the fight against HIV/AIDS in Africa.

Fifty-four governments’, employers’ and workers’ participants from 20 African countries attended the Workshop. Observers from donor, scientific, regional and international organizations concerned with and involved in combating HIV/AIDS also participated at the meeting. The list of participants and observers is included at the end of this report.

The aims of the Workshop were to exchange views and experiences and to promote action against HIV/AIDS at and through the world of work. It was also expected to lead to an African Platform of Action which could eventually be adopted at the ILO’s African Regional Labour Conference to be held in December, 1999, in Abidjan, Côte d’Ivoire.

Opening ceremony

Honourable Walter Kemba, Deputy Minister of Labour of Namibia, was the Chairperson for the opening ceremony. He stressed the importance of this Workshop not only for Namibia but also for Africa as a whole given the extent to which HIV/AIDS was ravaging through the continent. This intervention of the ILO was therefore particularly timely.

Mr. Kemba welcomed the participants to Namibia and challenged everyone to work hard at finding solutions during the Workshop. Ms. Mary Chinery-Hesse, Executive Director, Social

Protection Sector, ILO, welcomed the participants and spoke extensively on the extent, magnitude and consequences of the problem and the need for the constituents to combat the ravages of this terrible pandemic affecting the world of work. She highlighted the issues of greatest concern to the ILO which could provide opportunities or entry points for intervention: discrimination against HIV/AIDS-infected persons in employment; the impact on child labour; the impact on the quality of labour and productivity and its negative effects on the growth of small enterprises and the informal sector; the differential impact of AIDS on men and women; the linkages with migration and the adverse consequences on social security, for example the implications for government expenditure and social services.

She pointed out that the ILO was prepared to assist in slowing the spread of HIV/AIDS through a wide range of interventions. These could include sensitizing employers and encouraging them to make HIV/AIDS a corporate priority, emphasizing the collective responsibility of workers through the ILO workers’ education programmeand sensitizing governments to the impact of the problem on development efforts. She expected the

Workshop to help the ILO define an integrated and coherent approach, which would enable it to make a difference, and a realistic Platform of Action, which would provide a basis for cooperation. She concluded by saying that "while the whole world is waiting for a vaccine in the medical field to prevent HIV/AIDS, let us make use of ILO facilities and values such as tripartism, equality and social justice, to effectively develop a social vaccine".

The representative of the workers’ participants, Mr. M. Besha of the Organization of African Trade Union Unity (OATUU), noted that the Workshop was long over-due. He noted that the ILO had taken certain initiatives, and that his organization had also organized many workshops, undertaken research and studies, run training of trainers and of workplace level unionists. He noted that the impact of HIV/AIDS in the workplace was alarming.

To what extent had the ILO really attacked the problem of this killer disease? He hoped that this Workshop would lead to the development of effective strategies that would include workers and their representatives. The representative of the employers’ participants,

Mr. R. Iacona of the Ethiopian Federation of Employers, endorsed the support given to this important Workshop by the workers, stressing that employers could not fight HIV/AIDS in the world of work alone. Action was required by all social partners. This Workshop should help arrive at strategies not only covering prevention but also protection of already infected persons.

The representative of the Joint United Nations Programme on HIV/AIDS (UNAIDS), Dr. A. Sy, Director of the Sub regional Southern African Programme, recalled that throughout history, societies had been affected by epidemics and other natural catastrophes, and individuals, families, communities and nations had mobilized and developed responses to them. That kind of mobilization was now needed for HIV/AIDS. As the pandemic threatened Africa’s gains in health and socio-economic develop-ment, the UN family had recognized the need to address its multiple facets by creating UNAIDS which coordinated and facilitated the responses of the whole UN family. UNAIDS wanted to be partners with the participants present at this Workshop and looked forward to the strategies that would be worked out for action at the inter-national, regional, sub-regional and national levels.

The opening speech on behalf of his Excellency, President Sam Nujoma, President of the Republic of Namibia, was delivered by the Minister of Health and Social Services, the Honourable Dr. L. Amathila. Recalling the frightening spread of HIV/AIDS especially in Africa, he noted that the biggest impact had been on the labour force and overall economic performance in African countries.

The President had already warned, at the April 1999 meeting of the Organization of African Unity Labour and Social Affairs Commission, that Africa was not taking HIV/AIDS seriously. This Workshop was a concrete follow up to that warning, and he thanked the ILO and the participants for taking that call seriously. The Workshop should advise on comprehensive information-sharing strategies and on successes in tackling the pandemic. SADC had a Code of practice on HIV/AIDS and Employment, and Namibia had adopted a National Code on HIV/AIDS and Employment in 1998. That Code had, no doubt, seen both negative and positive experiences in its implementation, and other countries may have had similar experiences.

In giving the Vote of Thanks, Mr. E. K. Andoh, Director, ILO Office, Pretoria, thanked the participants for making the time to attend the Workshop. He also expressed his thanks to the Honourable Minister, Dr. Amathila, and all dignitaries who had graced the Opening Session with their presence and their speeches. Mr. Andoh assured the speakers that, during their deliberations, the Workshop's participants would take seriously the challenges thrown at them.

Election of officers

The following persons were elected to the Bureau:

Chairperson: Mr. C. Schletwein, Namibia

Vice-Chairperson (Workers): Mr. F. Abena Fouda, Camer-oon

Vice-Chairperson (Employers): Dr. J. P. Murphy, SouthAfrica

Rapporteur: Mr. Solomon Tatah, Cameroon

The Chairperson and Vice-Chairpersons gave brief statements thanking the participants for the confidence in their leadership and called on the Workshop to take the opportunity to exchange experiences and make proposals for practical strategies to fight HIV/AIDS especially for prevention and control.

Fighting the culture of denial

Plenary Session 1

In addition to the adverse impact on the quality of labour, meager national funds had to be diverted to this problem to the detriment of other social programmes and services. Other important areas affected by HIV/AIDS were productivity, social protection and social security. He cited social dialogue as the niche where ILO had a comparative advantage based on its tripartite structure. Four key issues were to be considered, especially for people living with AIDS: security (social and economic), participation by all, income and solidarity.

Mr. Sy (UNAIDS) began his presentation by providing statistics to underline the gravity of the HIV/AIDS scourge in Africa. He noted that while Africa made up only 10 per cent of the world population, at the end of 1998, 70 per cent of those suffering from HIV/AIDS (22.5 million people) were to be found in Africa, out of a world total of 33.4 mil-lion.

This compared unfavorably with 1.4 million people in Latin America and 6.7 million in south and southeast Asia. HIV/AIDS infection was associated with substantial decline in life expectancy at birth, which had eroded the gains that had been achieved after such great effort. Citing the cases of Botswana and Malawi, he noted that the life expectancy at birth had fallen from 60 to 50 years in the former and from 40 to 35 years in the latter. There was a large variation in infection rates among countries and also within regions in the same countries.

He stressed that the mode of transmission was known, i.e. through heterosexual sex, blood transfusion and from mother to child. While the number of infections was declining in other regions it was rising in Africa. The socioeconomic impact was very negative given the age of those affected (i.e. 20 – 49 years), the most productive age group. While a better understanding of the factors fueling the pandemic was crucial, real behavioral change was critical, i.e. change in attitudes at the work environment. Stigma and discrimination led to denial at the individual level and further led to collective denial which, in turn, led to more and more infection.

Poverty was another important dimension of the vulnerability of groups to HIV/AIDS. Among the poor, it was those who were better off who were more vulnerable. The most vulnerable were not necessarily the poorest. It was thus critical that there was a deeper understanding of the pandemic and the structural factors fuelling it in order to develop an adequate response. Responses would be needed at different levels – individual personal behavior, people living with AIDS, the workplace and at the national level. It was critical to mobilize different sectors to support an expanded response. It was also critical to support individuals and communities to minimize impacts among individuals, families and society.

Openness rather than denial had been shown to lead to good practice – as in Uganda and Zambia – in the type of response of communities and the country. Finally, it was critical to build partnerships and alliances to share information and resources..

Panel Session 1:

Impact of HIV/AIDS on the labour force, enterprise and the economy in Africa

The Session, moderated by Mr. K. Andoh (Director, ILO Office Pretoria), concentrated on the impact of the pandemic on socioeconomic factors relating to individuals, enterprises and governments.

Dr. D. Ogaram (Government of Uganda) said that the workplace deserved particular attention with respect to HIV/AIDS as people spent 8 -10 hours of their time every-day there and social interactions relevant to HIV/AIDS took place there. Therefore, correspondingly, preventive material assistance and advocacy services were required there. These should be extended to all workers, including management, since all participated in social interactions and were equally exposed to HIV/AIDS and so have equal risk. Dr. Ogaram used the equation

Risk = Constant x Hazard x Exposure

to demonstrate that the only doable way of reducing the HIV/AIDS risk was to reduce exposure. He proposed that workplace based strategy should include a multi-sectorial, multi-disciplinary, and participatory approach taking into account legitimate interests. Dr. Ogaram confirmed that the strategy worked as the experience of Uganda had shown. Dr. J. P. Murphy (Business South Africa - BSA) described the experiences of AIDS programmes in the workplace stating that large organizations in South Africa such as Eskom, Anglo American Barlows, and SAB had instituted AIDS prevention programmes during the 1980s and 1990s. He outlined the characteristics of successful HIV/AIDS programmes of organizations as follows: AIDS was considered as a strategic business issue; there was commitment from the top; they were participative, i.e. involved unions and their representatives; they had a strategic plan. He further elaborated that these programmes included both prevention and help to HIV/AIDS infected people to cope with the disease. The preventive programmes, which included information and education, condom distribution and syndromic management of STDs, were extended to families and communities of the workers.

Ms. Steele (South Africa Workers) elaborated on the activities of the labour movement on HIV/AIDS. She reported that the three major labour federations i.e. COSATU, NACTU and FEDUSA had put together a Labour Movement Draft Workplace Policy. The objective of this policy, which was to be implemented in all workplaces by October 2000, was to reduce the number of new infections among employees and their families and to ensure that the rights of employees with HIV were fully respected. The policy covered all employers and employees. She further talked about the partnership that had been forged against HIV/AIDS, bringing together the government, trade unions, business, women and youth. Success stories included HIV/AIDS projects in mining, transport and manufacturing sectors. Concerns highlighted included fear of disclosure of HIV/AIDS status in the absence of a conducive environment, and the need to decentralize HIV/AIDS programmes to the local level.

Ms. Odhiambo, (Women Fighting AIDS in Kenya -WOFAK), dealt with the impact of HIV/AIDS on individual women in the workplace especially regarding psychological manifestations such as anger, depression, fear of un-known, panic, blame, demoralization and loss of direction, denial and sometimes suicidal tendencies result-ing from extreme stress. These impacted negatively on productivity at the workplace. Ms. Odhiambo informed the Workshop that her organization had initiated a workplace intervention programme that targeted HIV-infected working women. It provided psychological support in the form of counseling and education and helped the women to cope and continue to be productive. Follow-up on the women living with HIV at their workplaces had revealed that women who had received support coped very well both at workplace and at household level. WOFAK’s intervention had proved valuable for the usually neglected psychological manifestation for which appropriate programmes needed to be developed at the workplace.

Mr. Sylvester Young, (Bureau of Statistics, ILO), presented some statistical issues relating to HIV/AIDS. He explained that existing statistics on HIV/AIDS were mainly demographic and health related and that statistics on the economic characteristics of HIV/AIDS individuals came largely from case studies, anecdotal evidence, circumstantial arguments and logical interrelationships. These latter statistics were however necessary for both the long-term objectives of reducing the incidence of HIV/AIDS and the medium-/short-term objectives of developing strategies for coping with, and mitigating the adverse consequences for individuals and their households, enterprises and their workers and governments and their citizens. Using an example of an African country, he illustrated some analysis that could be done on the impact on projections of the labour force and the sectorial price differential for labour.

Mr. Pierre Plamondon, (Social Security Department, ILO), presented the ILO long-term model on HIV/AIDS and social security that had been built to assess the demographic impact of AIDS. As such, this model was an important tool for actuarial work on social insurance schemes in countries with high AIDS prevalence, notably in southern and eastern Africa. When finalized, this basic tool would allow for the projection of various social expenditures such as health, education and social services, as well as cash benefits in formal sector social insurance schemes. This would be followed by links between social expenditure and the government budget by the estimation of changes in government social expenditure and changes in government revenues over time.

In addition, the combination of an AIDS mortality model and a social budget model would permit cost benefit analysis of different degrees and intensities of early awareness campaigns. Such early awareness would reduce infection rates, morbidity and mortality and thus avoid a major part of later negative impacts on govern-ment spending and income and economic growth.

In questions and observations from the floor, the view was expressed that the negative impact of AIDS was compounded by the impact of Structural Adjustment Programmes (SAPs) which had increased unemployment through retrenchments, loss of income, weakening of families and labour unions and their power to negotiate and bargain collectively. Concern was expressed about the difficulty in reconciling between confidentiality and the need for employers to support infected workers who were normally breadwinners for a large number of dependents. A suggestion was made that action be taken to counter the taboo around sexually transmitted diseases. It was lamented that women were bearing more than their share in coping with the disease. They had to care for ill family members often abandoning their jobs, and that had a negative impact on food production. The issue of confidentiality was singled out and it was suggested that a mechanism for disclosure to the spouse would avoid future orphans. Issues relating to stigma and pre-employment tests as well as to implications on training of infected employees were mentioned. AIDS should be part of a corporate policy, including counseling, but the culture of denial and confidentiality was a stumbling block. ILO assistance in this field was requested. The importance and sustainability of voluntary programmes such as those used by the Zimbabwe Farmers Union were underlined. Finally the difficulty in counseling at company level given the premise of confidentiality was highlighted.

The discussant Mr. George Ruigu, (ILO East Africa Multidisciplinary Team), based his summary of the session on the findings of the study on "The impact of HIV/AIDS on the productive labour force in Africa (1994)" which covered Rwanda, United Republic of Tanzania, Uganda and Zambia. The study examined the impact of HIV/AIDS on both formal and informal sectors, plantation workers and training institutions. The negative impacts were underlined as loss in productivity, erosion of skills, increased training costs, increased costs of health services and collapse of micro and small enterprises. At national level, it was noted that HIV/AIDS had exacerbated the already weak performance of the African economies, which were implementing Structural Adjustment Programmes. The retrench-ment of workers tended to mitigate the negative impacts of HIV/AIDS at the firm level, by providing a ready pool of labour that could be used to replace those who were dying from AIDS, especially among the unskilled level categories. In the agricultural sector, the substitution of low value crops for high value crops was stressed as negative-ly impacting on national economies. The increased burden on women as health care providers further reduced supply of agricultural labour. In parallel, child labour was also increased by the death of parents caused by AIDS.

In concluding, the discussant noted that ILO needed to give continuous and greater attention to the impact of HIV/AIDS on employment. Since many activities which could assist in combating the scourge fell outside its man-date, ILO should establish institutional linkages with UNAIDS and other existing programmes through networks to facilitate the exchange of information among countries.

Combating HIV/AIDS in the world of work

To protect lives and promote social and

Economic security

Panel Session 2:

— Concrete actions undertaken and lessons learned from them;

— Opportunities the organizations see for future action.

Ms. J. Hodges, (ILO Southern Africa Multidisciplinary Team), introduced ILO’s work on HIV/AIDS in the world of work which had knowledge, service and advocacy as its axis. In the field of research and dissemination of know-ledge, the ILO had undertaken specific studies in the area of the impact on employment in four eastern African countries, published various manuals for explaining the disease, contracted research on legal frameworks and enterprise policies which were summarized in a volume and organized meetings intermittently over the last decade. In the area of services, the ILO had developed the model for plotting the social security cost of HIV/AIDS to assist governments in their assessment of current AIDS strategies; projects existed to develop income generating activities for persons living with and affected by AIDS and provided technical assistance to SADC in the adoption and implementation of its Code of Practice on HIV/AIDS and employment. In the area of advocacy, the ILO was active in national country teams of the United Nations (UNDAF).

According to Mr. As Sy, (UNAIDS), UNAIDS worked at the country level with people with HIV/AIDS and collaborated with interested parties (mainly business, organized labour, NGOs etc.) by providing funding for innovative activities aimed at fighting HIV/AIDS. It was involved in identifying best practices in the world of work.

Dr. Roland Msiska, Chief Technical Adviser of the UNDP regional project on HIV/AIDS indicated that the project collaborated with organizations working in the area of HIV/AIDS prevention. Emphasis was placed on the private sector, especially the informal and the small-scale enterprise sector, which it had identified as a marginalized area in the fight against HIV/AIDS. The project looked forward to the possibility of future co-operation with the ILO in this sector.

The representative of the UN System-wide Special Initiative on Africa (UNSIA), Ms. Zemenay Lakew, stated that UNSIA is a unique collaborative arrangement with clustering of Africa-determined priorities under the leadership of agencies such as the Bretton Woods institutions. It facilitated working together to create synergy among the efforts of various agencies through joint formulation of programmes and implementation strategies, as well as monitoring and reporting of progress. At the country level, it worked through the UN country team and as such it could support the work of UNAIDS through expansion of agency participation and facilitating the mainstreaming of HIV/AIDS into other clusters such as education and governance. Following the decision of the First UN Regional Coordination meeting held in Nairobi in

March 1999, it could also facilitate coordination work at the sub-regional and regional level. According to its representative, Ms. Alice Hamer, the African Development Bank (ADB), worked closely with African governments. Since 1990, it had made credit resources available to 12 countries in Africa to finance HIV/AIDS activities under wider health projects. This had been in the areas of drug procurement, training of health personnel, information, education and communication in HIV/AIDS prevention, blood safety, and institutional strengthening of national HIV/AIDS programmes.

Recently, the ADB had made attempts to mainstream HIV/AIDS in other projects it financed in diverse areas such as transport, education and micro-credit. The ADB welcomed partnerships with UN agencies to combat HIV/AIDS. Ms. Renée Saunders, who represented the Office of National AIDS Policy of the White House and the Centers for Disease Control and Prevention (CDC), referred to some of their activities in collaborating with business and trade unions in the fight against HIV/AIDS in the work place.

In the African region CDC had developed co-operation with the three trade union federations in South Africa, namely, COSATU, NACTU and FEDUSA. With funds provided by USAID, the project carried out education and training activities for all levels of trade union leaders. It assisted trade unions to develop HIV/AIDS workplace policy. Technical support and grants were provided to help the trade unions to implement HIV/AIDS programmes.

The President of the United States had launched an initiative targeting 14 African countries in a bid to fight HIV/AIDS. The components of this initiative were as follows: prevention, assistance to HIV/AIDS orphans, home- and community-based care, capacity building and surveillance. In comments and questions from the floor, some participants declared that they would prefer to see the direct impact of the interventions of regional and international organizations at the field level. They expressed concern that the institutional approach of meetings and workshops might not have sufficient impact on the ground. In reply to this, it was pointed out that in order to have a coordinated action between all organizations involved, and to have a medium-term vision, these exchanges of information were essential. It was however conceded that there was a need for a better monitoring of these actions. On the actions conducted in the informal and small enterprise sector, it was mentioned that, unlike large trade unions in the fight against HIV/AIDS in the workplace.

In the African region CDC had developed co-operation with the three trade union federations in South Africa, namely, COSATU, NACTU and FEDUSA. With funds provided by USAID, the project carried out education and training activities for all levels of trade union leaders. It assisted trade unions to develop HIV/AIDS workplace policy. Technical support and grants were provided to help the trade unions to implement HIV/AIDS programmes.

The President of the United States had launched an initiative targeting 14 African countries in a bid to fight HIV/AIDS. The components of this initiative were as follows: prevention, assistance to HIV/AIDS orphans, home- and community-based care, capacity building and surveillance.

In comments and questions from the floor, some participants declared that they would prefer to see the direct impact of the interventions of regional and international organizations at the field level. They expressed concern that the institutional approach of meetings and workshops might not have sufficient impact on the ground. In reply to this, it was pointed out that in order to have a coordinated action between all organizations involved, and to have a medium-term vision, these exchanges of information were essential. It was however conceded that there was a need for a better monitoring of these actions.

On the actions conducted in the informal and small enterprise sector, it was mentioned that, unlike large enterprises, this was a difficult sector because of the very nature of this environment.

In summarizing the discussions, Ms. R. Vejs-Laursen (Job Creation and Enterprise Department, ILO), pointed out that we should all keep in mind the complex nature of the HIV/AIDS problem. Not only did the impact manifest itself on the individual, family, community and society levels, it also had dimensions that were both quantifiable and non-quantifiable. Among the lessons learned so far, we had:

• A lot of activities had been implemented for the formal sector, so we were not starting from scratch;

• The nature of the problem was complex and multidisciplinary. The response would also have to be multidisciplinary;

• SADC code was an important reference for pre-sent "best practice" in labour law reform and how to address discrimination at the workplace;

• Partnerships and strategic alliances between different ministries, UN agencies, other organizations and civil society were essential;

• Several organizations were active and willing to continue addressing this issue and all recognized it as a priority area;

• There was a need to be focused, realistic and yet patient as shown by the experience from the United States;

As opportunities for further action, it was necessary to:

• Address the situation in the informal sector and for micro and small enterprises, which catered for the majority of employment, in addition to the work that had so far been done with large enterprises;

Plenary Session 2:

National experiences

Twelve presentations were made comprising of four from governments, four from employers’ organizations and four from workers’ organizations. According to these presentations, national structures for the prevention and control of HIV/AIDS were in place and had embarked on activities to create awareness about the HIV/AIDS pandemic. Increasingly the focus of attention was being shifted to the impact of HIV/AIDS at the work-place. This could be attributed to the active involvement of the social partners in the fight against HIV/AIDS. The workers’ and employers’ organizations at the national levels had embarked on many activities in the areas of awareness creation, formulation and implementation of workplace policies on HIV/AIDS and distribution of condoms at the workplace, etc.

Although the social partners had realized the need to go beyond sensitization of their general membership they had been constrained by lack of funds and technical expertise in expanding their activities. Activities carried out so far had been dependent on donor funding. The other major constraint had been lack of legislation to protect the rights of workers with HIV/AIDS, and where legislation existed, lack of proper implementation on the ground. The complexity of the HIV/AIDS issue necessitated the need for concerted effort by the social partners in an integrated manner instead of the current one-off activities being implemented by employers’ and workers’ organizations.

Attempts by the social partners in fighting HIV/AIDS had been limited to the formal sector workforce despite the fact that the majority of the working people were found in the urban informal and rural sectors. Given the financial constraints faced by employers’ and workers’ organizations, the sustainability of the activities being implemented by them to fight HIV/AIDS was very much uncertain in the medium- to long-term.

Request for ILO’s assistance in the areas of financial support for educational activities and, most importantly, technical support for mainstreaming HIV/AIDS in the work of employers’ and workers’ organizations were strongly put across. A specific request for ILO’s assistance in setting up health insurance schemes which would cover both formal and informal sector workers and thus would help them to meet their medical expenses was put forward. The issue of enhancing capabilities of the social partners to address HIV/AIDS concerns in the workplace through collective bargaining was also raised, as well as the enactment and enforcement of legislation to protect HIV/AIDS infected workers.

The political will as well as the commitment of the public authorities towards HIV/AIDS prevention came out as critical issues which would go a long way to determine the success of HIV/AIDS initiatives taken by concerned organizations, such as the employers’ and workers’ organizations.

52Panel Session 3:

Gender sensitive national and workplace policies on

HIV/AIDS

Mr. Touré, (Deputy Regional Director, ILO Regional Office, Abidjan), was the moderator for the session. He pointed out the necessity to conceptualize the "social vaccine" that was required to cope with the impact of AIDS. Furthermore, he underlined that it was not only a question of having a social vaccine but also to ensure access by all to the vaccine. Emphasizing the particular vulnerability of women, he gave the floor to the two panelists. Ms. Mendoza, (UNAIDS, Geneva), presented five primary gender-linked trends of the pandemic and then shared with the participants the 10 major lessons learned from UNAIDS work globally. These were as follows:

The second panelist, Ms. Amri-Makhetha, (ILO Area Office, Pretoria), emphasized in her presentation that both men and women were vulnerable to this pandemic. Nevertheless, women were particularly vulnerable and this was the reason for focusing on a gender component. The panelist referred to the ILO mandate; the need to have short-, medium- and long-term strategies, and the need to incorporate AIDS in technical programmes. Therefore, the panelist presented ideas and recommendations on how the ILO should introduce the AIDS component in its various capacity building programmes.

During the discussions, several comments were made on what should be the specific gender policies. It was pointed out that women would have to participate fully in the decision-making processes. An intervention pointed out that, given the current economic circumstances in many countries, the international labour standards and Conventions were too expensive to implement. In general, the concerns were on how best to reach out to the informal part of the economy and to those enterprises in rural areas.

Group work: Draft Platform of Action

Four working groups focused on the social and labour issues of HIV/AIDS, possible responses and strategies, roles of governments, employers and workers, expected ILO assistance on the pandemic. Group work resulted in the drafting of a Platform of Action.

Discussion and adoption of the draft

Platform Action and Workshop Report

The draft Platform of Action was discussed at length and then adopted as amended by the participants. The Workshop Report was also adopted by the participants with amendments in writing to be incorporated later.

Closing ceremony

In her closing remarks, Dr. F. Fall, the representative of the participating employers' organizations praised the cordial atmosphere with which deliberations had taken place during the Workshop. The adoption of the draft Platform of Action was only the beginning in the fight against this pandemic which was threatening the already fragile African economies and the productivity of African businesses. Participants on return to their countries should bring to the attention of their member organizations the conclusions reached and should continue to strengthen the tripartite dialogue started during the Workshop. She thanked His Excellency, President Sam Nujoma, for his interest in the prevention of HIV/AIDS and also the people of Namibia for their warm welcome. Dr. Fall expressed the gratitude of the participating employers' organizations to the ILO for organizing this Workshop and looked forward to the immediate implementation of the Platform of Action. Ms. M. Makoffu, the representative of the participating workers' organizations, stressed on the importance of the draft Platform of Action in guiding the work of all stake-holders in HIV/AIDS, when making her closing remarks.

She stated that the workplace was ideally suited for combating this pandemic which had to be fought at all levels and by everyone through the forging and building of partnerships and alliances. The draft Platform of Action should now be translated into concrete action by all participants on their return home. Ms. Makoffu thanked the ILO for its continued interest in responding to the needs of the working people of Africa as demonstrated by the organization of this Workshop in collaboration with UNAIDS.

Dr. Sy, the representative of UNAIDS, exhorted the participants to engage in a journey of real partnership and collaboration "from fear and despair to hope, from denial to openness, from stigma and discrimination to compassion, from exclusion to inclusion (no more them and us, but WE)." He expressed the commitment of UNAIDS to work with the ILO to respond to this pandemic through support for activities in the world of work. Dr. Sy thanked everyone for the hard work done during the Workshop.

Ms. Chinery-Hesse, Executive Director, Social Protection Sector, ILO, thanked the Honourable Minister of Labour, Mr. A. Toivo Ya Toivo, for gracing the occasion with his presence and agreeing to formally close the Workshop. She emphasized that given the spirit with which all participants had worked during the Workshop, we were all now friends-for-a-cause, the eradication of HIV/AIDS in Africa.

Ms. Chinery-Hesse expressed her thanks to the participants as well as all those who had contributed tirelessly to the organization and implementation of the Workshop. Finally, she thanked His Excellency, President Sam Nujoma, and the people of Namibia for agreeing to host the Workshop and receiving all of us so warmly in their country. Honourable Andimba Toivo Ya Toivo, the Minister of Labour of Namibia, reminded the Workshop of the concerns of all African countries about the threat of the HIV/AIDS pandemic. Not only were the most productive skilled section of the population dying but also innocent children were dying or being orphaned. He expressed the hope that the sharing of experiences in the fight against this pandemic during the Workshop had led to concrete strategies being proposed. The implememation of these strategies, he asserted, was the responsibility primarily of governments and their social partners. While thanking the ILO for their efforts in this regard, the Honorable Minister stressed that it was up to Member States to inform the organization of the help they desire and to ensure that this help was properly utilized. He expressed his appreciation to UNAIDS and UNDP for their help and requested all participants to implement the conclusions reached on their return home. The Honorable Minister then declared the Workshop officially closed.

Platform of Action

On HIV/AIDS in the context of the