Examination of Witness (Questions 140
- 155)
TUESDAY 20 JUNE 2000
PROFESSOR ALAN
WHITESIDE
140. Has that been reflected in the foreign
investment that has come in over the past five years?
(Professor Whiteside) I do not know. I suspect that
it is affecting it. Maybe the people you should ask—I see
that they are down to give evidence—are the Crown Agents
and the Commonwealth Development Corporation. They would have
a much better feeling than I would on that. I do not know whether
in the merchant banking circles in Britain and in the United States
that people take HIV into account. I know that if I were advising
them, they would, but I do not know whether they do. I am afraid
that it would be a negative response. You have to look at what
is going on and if you are to invest in a society where there
is a great shortage of skilled labour, then you have a real problem,
particularly if the government will not allow you to bring in
that skilled labour. On that point, Botswana is particularly interesting.
Botswana will buy in the skills. It has a huge epidemic, but it
buys in the skills. It buys in Sri Lankans and Bangladeshis and
people from the Far East who are cheaper than people from Europe
and America, and it will test them before they come.
141. Do you think that that is a wider solution?
In order to get through this epidemic in Southern Africa, should
they encourage the immigration of people who can fill those particular
niches?
(Professor Whiteside) If one looks at the scale of
the problem one has a simple choice. Either one says, "We
have very few skills, a real shortage of skills and cannot fill
them from within our society, therefore we will allow in other
people", or one says that the jobs will not be done. If they
say that the jobs will not be done, then you have to live with
the consequences.
Chairman: Mr Khabra will go on to deal
with what happens in the workplace.
Mr Khabra
142. On the role of the private sector, what
are the responsibilities of the private sector faced with an HIV/AIDS
epidemic? Is their workplace an effective environment in which
to spread both information on prevention and condoms? How should
such interventions interface with the community? Are there cases
where employment practices can in fact undermine the prevention
message?
(Professor Whiteside) I may have to ask you to repeat
your last question. The private sector is caught in a difficult
situation because their first responsibility has to be to make
a profit. If they do not make a profit they cease to be in the
private sector. That is a real problem for the private sector.
The private sector tries to deal with a hierarchy: at the top
of that hierarchy is profitability and then comes the legal framework
in which it operates which includes everything from the international
conventions that they sign right the way down to the shop floor
agreements that they have with the workers, and then come issues
like responsibility and publicity. For any company, we can change
the legal framework. That is where a group like this has a role
to play. Profitability always has to be the bottom line. For the
private sector to try to respond to the epidemic it has to balance
the various demands that are made on it. With regard to whether
it is an appropriate place, it is absolutely the appropriate place.
People spend eight hours of their day in their workplaces, and
perhaps longer in some settings. It is a very good place in which
to get across messages. But, unless you run a very slack company,
people do not get infected in the workplace, so we have to go
out into the community and we have to interact with the community
in order to deal with the epidemic in partnerships. The interaction
between the workplace and the community is where perhaps I would
like to see far more being done over the next few years. Basically,
we are talking about building civil society in these countries—it
sounds very woolly—a caring, committed society in which
everyone has a role to play. Perhaps you could remind me of your
last point.
143. Are there cases where employment practices
can undermine the prevention message?
(Professor Whiteside) Yes, absolutely. There are employment
practices that undermine the prevention message, for example,
the use of migrant workers. That is a major issue in relation
to prevention. If you bring in hundreds of thousands of men to
work in your sugar fields or in your mine, you will create an
environment in which HIV can be spread. Equally, there are some
imaginative things that can be done about that. Some years ago,
I advised a CDC company, in Swaziland. We looked at the problem
of them bringing in sugar cane cutters from all over the country
to work on an estate. After the workers were paid on a Friday,
they got drunk, the local ladies sold them sex and so you had
a nexus for HIV transmission. We asked, "What can we do about
this?" They needed the workers and they did not want to put
in automatic cane cutters because that would put the people out
of jobs, so perhaps they could look at using local people, people
on the estate; perhaps they could look at busing in people every
day to do the cane cutting; or perhaps they could look at not
paying the workers but paying their wives back in the villages
instead. That was not a popular idea among the workers. Those
were some of things that could be done. At the moment I am running
a workshop at the University of East Anglia. A group of participants
from all over the world is looking at HIV/AIDS in the private
sector. They came back and said, "We have decided that we
are going to do HIV testing in the private sector". We said,
"What do you mean? Haven't you been listening when we speak
about human rights and all the fuzzy issues?" They said,
"No, we mean that anyone who enters a company or gets promoted
has to take part in a written test on HIV/AIDS issues and they
have to pass that before they can be inducted into the company
or promoted". I said, "What a good idea". That
is a fairly costless exercise and it shows that the company is
taking the issue seriously. That is one of the recommendations
that will go into any report that I do from now on, that companies
do HIV testing, but I do not mean testing for HIV, but testing
for knowledge.
144. You mean that the private sector's motives
are mostly profit and that means that they have a big dilemma
over social and moral consciousness.
(Professor Whiteside) I think that is right. You also
have to distinguish between companies that are resource-based,
such that they have to be in Swaziland because that is where the
sugar cane plantation is, or they have to be in South Africa because
there is where the gold mine is, and companies that can move.
In an era of globalisation it is increasingly difficult to pin
companies down. When I look at what is happening in the world
that my children will inherit, for me it is a world with an AIDS
epidemic that will affect many millions of people, particularly
in Africa and Asia, but it is also a world in which we seem to
be losing control of the conscience of business. I do not know
where that goes, and that is not the topic of this Committee,
but it is one that worries me.
Mr Colman
145. You came out strongly against companies
compulsorily testing. Do any companies compulsorily test? What
has happened in that community? Has it led to the surrounding
areas having a big reduction in HIV/AIDS?
(Professor Whiteside) There are companies that test
as a basis for admission and there are companies that test as
a basis for training overseas. There are certainly companies in
Botswana where testing is carried out. On the training front,
I do not have a problem. I think that there are good grounds to
be made for testing someone before you send them away for an extended
period. On testing for entrants, it is universally illegal and
certainly immoral. I believe that it has no effect on communities.
On the other hand, there are companies that have carried out testing
using saliva in order to get an idea of the level of HIV prevalence
in the companies. That provides very useful epidemiological information
that we can use to look at the future of the companies and to
see what sort of problems they might have. However, such testing
is anonymous and unlinked. In other words, a person can never
be identified by a test result.
146. Would you recommend that companies provide
voluntary testing facilities where the results would be known
to the employee?
(Professor Whiteside) Absolutely. That is a prevention
route that has to be taken more broadly anyway. You have to be
able to offer something; it is no good just saying, "We will
test you and tell you".
147. What effect has HIV/AIDS had on life assurance
premiums and on the provision by employers in the private sector
of sickness benefit and pensions? Is there any discrimination
between skilled and non-skilled workers in the private sector?
(Professor Whiteside) The cost of life assurance obviously
has gone up. Testing is carried out at certain levels. For example,
I took out a policy that is worth over 100,000 rand and, therefore,
I was required to have an HIV test. At lower levels one may not
be required to have an HIV test. Basically, it is risk pools.
Life assurance companies used to be mutual companies which meant
that we all shared in the costs and the benefits. I do not have
a problem with that. I certainly think that we are seeing the
cost rising and that will be a problem for many countries. Again,
of course, the life assurance industry is limited to a very few
countries: basically, Botswana, Swaziland, South Africa and Zimbabwe.
148. What has happened in terms of private sector
employers providing sickness benefit or pensions? Is there any
discrimination in that provision between skilled and non-skilled
workers?
(Professor Whiteside) Not that I am aware of. Companies
are looking at the benefit profile in the light of HIV/AIDS and
trying to work out what to do. I do not see discrimination taking
place.
149. Is there a code of practice among employer
confederations in countries in terms of what they are doing? Do
you see an improvement in benefits being offered to workers?
(Professor Whiteside) I really could not answer that.
There are codes of practice. In the same way as we are, companies
are battling to come to terms with doing business in an environment
where HIV/AIDS is so prevalent and where one has to rethink the
way in which business is conducted. You have to rethink the way
in which development is carried out and companies have to rethink
the way in which they carry out business.
Chairman: I now have a problem in that
many members of the Committee want to ask questions, but I have
to leave enough time for Mr O'Malley to give his evidence to us.
I shall ask everyone to be as quick as they can.
Ann Clwyd
150. I apologise for missing the start of your
evidence. I remember the breakfast that we had in Pretoria when
you woke us all up very early in the morning. I want to bring
you back to political leadership, particularly as you singled
out President Museveni as being a good example of what political
leadership can do. What is President Mbeki's problem? Is there
resentment that other countries are saying, "This is what
you should be doing"? What holds him back and leads him to
challenge the concepts of AIDS and what caused AIDS in the first
place, and what is the appropriate treatment. Can you tell us
your views of the problem there?
(Professor Whiteside) I wish I knew. I am actually
a member of the Presidential AIDS Panel, for my sins. I tried
to avoid it in the first round, but I have been sucked in and
I am now a member. I can only think that there are two possibilities.
One is that the problem is so serious in senior governmental levels
that they really are aghast and they are a bit paralysed. I described
the effect of being on the track and watching the train coming
at you and you look for any siding that may give you hope. I think
that is part of it. I think the other part is that we really failed
the Government because essentially we told them that there was
a huge problem, but we did not tell them what to do about it.
I think the South African Government is also looking for a quick
fix. It is looking for a technical solution. AIDS does not have
a technical solution; it does not have a quick fix. We could be
meeting in this room 10 years from now and we shall not be going
over the same ground, but we shall be charting an epidemic that
has been hugely serious. I only hope that, as a result of the
panel, the President will take on board this epidemic and will
begin to try to address it in a logical, structured manner. The
tragedy is that his havering has had repercussions across the
world, not just in South Africa and not just in Southern Africa.
Throughout the world, people know that a world leader of great
stature has asked these questions. They do not know what the questions
are and they do not understand the intricacies of the situation,
but they just understand that the questions have been asked. That
has done a huge amount of damage.
Mr Worthington
151. Earlier you talked about the stigma and
a senior official not wanting anyone to know what was happening.
When looking at causes of deaths, sometimes in this country it
is difficult to get "asbestosis" written on a death
certificate or other issues. What happens about causes of deaths
in relation to HIV/AIDS?
(Professor Whiteside) South Africa has developed a
death certificate which has a tear-off strip so that you can record
AIDS as the cause of death and it will not be stigmatising, but
it will allow us to collect the data. We are ahead of the game
on that one. Obviously, one could get physicians to write AIDS
as the cause of death if they are prepared to, but that cannot
happen while the president is saying that AIDS does not exist.
So you have this real problem of mixed messages. By the way, the
president has not said that AIDS does not exist; he has just said,
"Let's examine the issue".
152. So you have two death certificates?
(Professor Whiteside) No, there is a death certificate
with a tear-off strip, so that the family can have a death certificate
and the bottom part you send to whoever collects the cause of
mortality data. The bottom bit does not have the name on it; it
will have an identifier, but I could not turn round and say that
someone from your village died of AIDS. I can just record that
in that province there were so many deaths from AIDS and so many
in relation to pneumonia or whatever.
153. So the family may say it was pneumonia
but the state would say it was AIDS?
(Professor Whiteside) Yes, that is right.
Mr Robathan
154. On the matter of testing, human rights
and all those fuzzy issues, I understand that healthcare in parts
of Africa is patchy, to say the least. In this country a good
employer would provide regular medical check-ups and treatment
by private insurance. Would you say that if there was a good employer,
such as that in South Africa, that they would provide regular
medical check-ups, including testing the blood and treatment?
(Professor Whiteside) I think that is the way that
one would go, but you run into the real problem which is the issue
made by Barbara Follett, about how to discriminate. You may do
that for the general manager and the engineers in the gold mine,
but you would not do it for the guy at the rock face. Then you
would have to have levels of response, as indeed there are in
this country. The chap working in the factory does not go to the
BUPA hospital but the managing director does.
155. Some of them do.
(Professor Whiteside) Do they? All right. I believe
that the problem is that one has to look at the different levels
in society. As we come to grips with the reality of the epidemic,
employers increasingly will have to say that they have to take
care of their employees in every way that they can and that they
have to deal with the epidemic and protect their health and ensure
that they live longer, more productive lives. There is an alternative.
You can say, "Okay, let us go the capital intensive way".
That is an entirely rational business response, but for South
Africa, Southern Africa and Africa in general that is a social
and employment disaster, but it could happen.
Chairman: On that note, we say thank
you very much indeed for answering our questions and for giving
us an insight into this terrible problem. We are very grateful
to you for spending the time with us and giving us the evidence.
We hope that our joint efforts will have beneficial effects on
those affected. Thank you.
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