Universal Access to HIV Services: A Promise Yet to Be Realized

November 30, 2010
  • Mark Little

    Former Director, Healthcare, Advisory Services, BSR

More than 20 years after the first World AIDS Day on December 1, 1988, the theme for this year’s observance—“Universal Access and Human Rights”—is a sobering reminder of two challenges that characterize the fight against this epidemic. First, while the global AIDS epidemic has slowed, with UNAIDS reporting a 20 percent decrease in new HIV infections over the past decade, HIV continues to spread in developed and developing countries at rates that outpace treatment by more than 2:1. Second, the HIV epidemic has illuminated and continues to illuminate the inequities in our societies that result from a failure to fully realize human rights.

Human Rights Violations and HIV/AIDS: A Cause and a Consequence

Many of those most at risk of HIV infection are also those who, even if HIV-negative, face significant discrimination in countries around the world. For women and girls, men who have sex with men, sex workers, and injecting drug users, human rights violations—including discrimination or even incarceration—increase peoples’ susceptibility to the disease by deterring them from the counseling, testing, treatment, and support services that would otherwise mitigate the spread and impact of HIV/AIDS. At the same time, HIV infection itself can generate additional human rights violations in the form of discrimination, harassment, loss of privacy, and travel restrictions.

Strengthening the rights of women and girls is especially critical to stemming the epidemic in developing countries where women and girls typically represent the majority of those infected and also have the fastest rates of infection. Gender inequality increases the vulnerability of women and girls to HIV/AIDS by blocking their decision-making power with regard to when, how, and with whom to have sexual relations. In addition, the stigma of an HIV diagnosis represents the threat of a double-burden for women, and discourages them from seeking diagnosis in the first place. In several countries, including Namibia and Chile, many women report that they face forced (or strongly encouraged) sterilization if found to be HIV-positive. Discrimination against women and girls is also reflected in a lack of financial independence that would otherwise enable women to avoid relationships that place them at risk and to take a more active decision-making role in seeking treatment.

For injecting drug users, men who have sex with men, and sex workers, the very activities that increase their risk of HIV are also the same activities that most countries’ legal systems forbid. Fear of exposure of their HIV status keeps many people from seeking HIV testing and health services, thereby fueling the spread of the disease. In Cambodia, China, and Vietnam, drug users are routinely targeted by police and subsequently jailed for several years. Earlier this year in Kenya, HIV treatment programs were shut down following violent attacks against suspected homosexuals. In Uganda, once hailed as a model for AIDS control in Africa, proposed legislation would have doctors responsible for informing the partners of a patient that has sought HIV testing—a move that disregards a person’s right to privacy. These examples point to the fear, shame, and punishment that is too often associated with HIV/AIDS, and which curtails demand for HIV services that vulnerable populations fear may do more to endanger, rather than protect, them.

Successful Responses From the Private Sector

Business, however, can play a critical role in mitigating the human rights violations that both fuel and follow the spread of HIV/AIDS. Workplace human rights policies, and specific policies around HIV/AIDS, represent a starting place from which companies can provide protection from discrimination. But policies do not alone shift cultural practices and norms, and far more can be done to quell the fear that stops workers from seeking HIV services.

Standard Chartered Bank’s Living with HIV program, for example, seeks to minimize the devastating impact that HIV has had both on its employees and on the communities where it does business. Through the program, employee volunteers serve as HIV champions, conducting in-person education and awareness building sessions in conjunction with local NGOs. In several countries, including Thailand and Malaysia, ATM machines communicate information on local HIV and AIDS testing centers and "know your status" messages. Standard Chartered has partnered with student groups and developed a youth-focused website, www.vir.us, to target 15 to 24 year olds—a group that accounts for 40 percent of all new HIV infections.

The Coca-Cola Company has leveraged its marketing and brand power to send powerful messages that dispel stereotypes, discrimination, and stigma among consumers and employees across Africa, where Coca-Cola is the continent’s largest private-sector employer. The company’s support for the Love Life Caravan tour, for example, brought celebrities, politicians, and journalists to roving rock concert-like gatherings that touted messages of hope, love, and safe-sex to communities across Africa. The caravans specifically targeted vulnerable populations, including women and sex workers. Coca-Cola also sponsored a television drama, “AIDS in the City,” that followed the lives of people affected by HIV/AIDS. These efforts, and many others sponsored by Coca-Cola, speak to the strong role a consumer brand can take to change public perception, promote fuller realization of human rights, and thereby curtail the spread of the disease.

Companies can also join or start business coalitions focused on stemming the spread of HIV/AIDS. The South African Business Coalition Against HIV/AIDS, for example, works with hundreds of businesses and government agencies to fund and encourage testing for tens of millions of workers who may voluntarily seek HIV tests either at an off-site clinic or on-site through their employers’ health facilities. Best practice incorporates HIV tests in “wellness” programs that are offered as a package of tests that would include not only HIV, but also cholesterol and blood pressure. More holistic approaches help to reduce the fear that workers will be identified for seeking out HIV-specific services.

Innovation in Diagnostics and Medicines

Increased access to HIV services will require more than the redress of human rights challenges that so closely associate themselves with HIV/AIDS. Improved diagnostic and testing options are also critical to achieving the goal of universal access. For years, HIV diagnostics were associated with either being too slow (waiting weeks for results), or too imprecise (rapid tests resulted in many false-positives). While new HIV diagnostics are now both rapid and accurate, it remains impossible to conduct an at-home test. While diabetics can check their blood glucose level nearly anywhere (and with an increasing number of options that give patients significant choice in method), HIV testing and monitoring remains a centralized service that leaves behind millions who either cannot or will not make the trip to a health clinic. Diagnostics and treatment monitoring options that are closer to the patient can lead to both earlier detection and better treatment results as patients monitor their own viral loads, gain visibility into the treatment’s efficacy, and quickly identify the emergence of drug resistance.

Several challenges have yet to be addressed with regards to the medicines themselves, particularly for second-line drugs that remain expensive and scarce, particularly in the developing world. Pharmaceutical companies can help to address these challenges by joining patent pools, rolling out tiered pricing strategies, and, of course, continuing to dedicate resources to R&D.

Calling All Companies

Yet, the simple fact is that drugs, and even diagnostics, are often second-order challenges—meaning that individuals experience them only after they have overcome the first-order challenges associated with stigma, discrimination, and punishment. While only a few companies have the technical capabilities to improve diagnostics and therapies, all businesses have a role to play in curtailing human rights violations that deter individuals from seeking education, testing, and support services.

Every company can make a difference on this issue with the following strategies in place:

  • Robust HIV/AIDS workplace policies that clearly end discrimination and protect privacy
  • On-site, comprehensive health services that include education, testing, and treatment focused not only on HIV, but also on sexual health, and other important health issues
  • Employee training and awareness building, not only on HIV/AIDS but also around core human rights issues related to gender inequality, and other forms of discrimination and harassment
  • Communications and outreach both to employees and to communities/consumers, leveraging brand/consumer platforms wherever possible

Importantly, these activities are not only reflections of good corporate citizenship. They are critical to the long-term sustainability of businesses dependent on a workforce and consumer base that continues to be ravaged by the impacts of HIV/AIDS throughout much of the developing world.

With World AIDS Day on December 1, and Human Rights Day on December 10, it’s a good time of year to consider the response that each of our companies can take to strengthen human rights and stem the spread of HIV/AIDS—both among our employees and within the communities where we do business.

Let’s talk about how BSR can help you to transform your business and achieve your sustainability goals.

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