Select Committee on International Development Minutes of Evidence

Memorandum submitted by UNAIDS (continued)


Impact on the military and military/civilian interactions

  4.6.1  HIV/AIDS is rapidly becoming a key global human security issue. Apart from the macroeconomic consequences already mentioned, its effects are felt in two other interrelated ways: Firstly, in the impact of HIV/AIDS on the military and on military/civilian interactions. War is an instrument for the spread of HIV/AIDS. The armed forces (both military and police) constitute a major population block in many societies, highly mobile and often called upon to serve at borders or to deploy outside of national boundaries. HIV infection poses a more serious threat to military populations than the inherently hazardous nature of their occupation. The impact of HIV on the military lies in the impact on human capital—compromising armed forces' readiness. The impact of HIV on civilian populations lies in the high rates of sexual interaction between military and civilian populations whether through commercial sex, or in rape as a weapon of war; and in the extreme vulnerability of displaced and refugee populations to HIV infection. People are six times more likely to contract HIV in a refugee camp than in the general outside population.

  4.6.2  The fact that the infection rate for the armed forces is higher than for the civilian population is an important factor to be aware of when foreign military and police play a role in peacekeeping. But HIV transmission is a two-way street, and peacekeepers may be at risk of bringing HIV home with them as well as at risk of transmission to others if they bring the infection with them on the mission. For example, Nigeria's President Obasanjo announced in May 2000 that about 11 per cent of Nigerian soldiers in the West African peace-keeping force (ECOMOG) stationed in Sierra Leone and Liberia were infected with HIV. The Defence Minister said the increasing involvement of Nigerian armed forces in operations abroad and the long separation of servicemen from their spouses had been identified as risk factors in the spread of the disease.

Impact on fragile Geo-Political systems

  4.6.3  Secondly, the effect of the epidemic is felt in its impact on already fragile and complex geo-political systems, especially—though not exclusively—in Africa. There were 27 conflicts in the world at the start of 2000, eleven of them are in Africa. Fifteen sub-Saharan countries are faced with food emergencies, while protracted drought in east Africa threatens further food shortages. A new, unprecedented generation of orphaned children in resource-poor environments may surely risk producing a generation of disaffected adolescents. Against this canvas, AIDS is a serious threat to the political stability of many countries.



  5.1.1  The relationship between HIV/AIDS and training budgets and programmes has rarely been examined systematically up to now. Nevertheless, anecdotal evidence suggests that companies have to increase their training budgets in order to deal with the HIV/AIDS-related mismatch of human resources and labour requirements in terms of qualifications, training and experience (cf 4.1.4.).

  5.1.2  Some companies have already begun to hire or train two or three employees for the same position, if it is feared that employees in key positions may be lost due to AIDS. Training staff in a range of important skills so that they can be deployed to fill gaps as the need arises, requires considerable forward planning, as it often takes a long time for a fresh recruit to become a fully productive specialist. Employees can also be replaced by importing labour from neighbouring countries, at the risk of creating a bigger immigrant sub-population, which is often more vulnerable to HIV infection.


Identifying the need for action

  5.2.1  Businesses do not work in isolation, and so the impact of HIV/AIDS on all productive sectors, on the business supply chains, the effective labour supply and intellectual capital directly impacts on individual companies. These impacts can significantly affect the ability of business to operate. The importance of identifying the impact of HIV/AIDS on individual companies is two-fold:

    —  Long-term sustainable business responses will only be achieved if all stakeholders (leadership, managers, personnel, shareholders) within companies are convinced of the real business rationale for action.

    —  A clear understanding of the specific impacts of HIV/AIDS on a company and of the context in which these occur (eg modes of transmission) are critical factors in the development of effective and appropriate policy and programme responses.

  5.2.2  The actual motivation for business responses to HIV/AIDS within the workplace is highly variable and dependent on factors such as the HIV prevalence rate within their area of operation, the level of benefits available to the workforce and the level of knowledge and awareness by the business leadership of the real and potential impacts.

Workplace prevention programmes

  5.2.3  Some employers have started prevention programmes in the workplace at their own initiative with a view to protecting their investment in human capital. The programmes vary according to company size, resources, structure and employee culture, as well as public policy. In some cases, employers' initiatives have preceded the action taken by governments in the area of public policy. No one programme can therefore serve as a model for all to follow. However, the experience so far indicates that components of an effective HIV/AIDS programme tend to include the following:

    —  ongoing formal and informal discussion and education on HIV/AIDS for all staff;

    —  an equitable set of policies that are communicated to all staff and properly implemented, including protection of rights at work and protection against any discrimination at work;

    —  the availability of condoms;

    —  prevention and rehabilitation programmes on drugs and alcohol;

    —  diagnosis, treatment and management of sexually transmitted diseases, for employees and their sex partners;

    —  voluntary HIV/AIDS testing, counselling, care and support services for employees and their families.

  5.2.4  For example, at Volkswagen in Brazil, which employs 30,000 people, the potential impact of HIV was assessed early on. By 1996, the company considered that AIDS was accounting for high treatment costs and employees were experiencing frequent interruptions, precocious illness and shortened life expectancy. It quickly established an AIDS Care Programme that included medical care, clinical support, information and installation of condom machines. Volkswagen also adopted a technical protocol detailing the standard of assistance and care it should provide. Three years later, hospitalizations were down by 90 per cent and HIV/AIDS costs by 40 per cent.

  5.2.5  Increasingly, companies are recognising that their ability to protect their employees is limited if education and oureach efforts are not extended to the local communities. The disease is easily passed from the wider community to employees and their families. Moreover, HIV/AIDS is not just a biomedical problem; its spread is influenced by behaviours and socio-economic pressures, which are present within the communities in which the workforces live.

  5.2.6  Therefore, in localities of importance to companies where the risk of infection is high, companies have engaged in social investment programmes to confront the disease. Anglo Coal and Eskom of South Africa have both recognised the importance of community involvement in order to prevent workforce initiatives being undermined. The various activities they have undertaken include focusing on wider causes of the spread of the epidemic, particularly in terms of sexual behaviour with regard to commercial sex workers. Another example is Chevron, Nigeria, whose community outreach programmes have also extended to the local youth, in recognition of the importance of early education and prevention.

  5.2.7  In India, the Tata Iron and Steel Company has evolved its own AIDS policy in recognition that the fight against the epidemic cannot be the responsibility of governments alone. In its own words, "Tata Steel will take measures to prevent the incidence and spread of HIV/AIDS in our society. In case of need, the company will arrange to provide counselling and medical guidance to HIV/AIDS patients and their families." To do this, it set up a core group of professionals in medicine, community services and education. It also targeted information and education programmes to young people, migrant labourers, truckers, and army and police personnel. "As a result, our employees also benefit." Tata's work also includes media promotion, installation of condom vending machines, work with non-governmental organizations, training and awareness programmes at Tata Main Hospital, counselling and help-lines.

Business coalitions

  5.2.8  In a growing number of countries, employers have formed business coalitions on HIV/AIDS to pool resources and improve their response to the crisis in their workplaces and communities. For example, American International Insurance, Thailand's largest life insurance company, began its efforts close to home by providing training on HIV and AIDS in its own offices. In 1995, it began a nationwide fundraising "AIDSathon", which in turn led to the development, with the Thailand Business Coalition on AIDS, of group insurance benefits to policyholders that demonstrated they had effective policies for combating HIV and AIDS.

  5.2.9  In Botswana's relatively recent HIV epidemic, the tidal wave of deaths has yet to break. Recognizing that a massive increase in sickness and death is on its way, several companies joined forces to fund the Botswana Business Coalition on AIDS in order to share information about prevention and care in the workplace and keep up to date on legal and ethical issues raised by the epidemic. The Coalition also works in close collaboration with the Government and trade unions to coordinate approaches to policy and HIV prevention programmes in the workplace. The Government's occupational health service provides training to companies that wish to initiate HIV prevention in the workplace.

Provision of health insurance

  5.2.10  Certain health insurance providers have also established facilities specifically designed for persons with HIV infections, which guarantee and at the same time cap payments for HIV-related treatment. These schemes currently provide enough benefits to cover a significant share of the cost of treatment, but employers are already worried that, as the proportion of HIV-infected workers rises, they will not be able to maintain benefits at these levels. Other responses include radical changes in the way that insurance schemes work. For example, death benefits were traditionally paid to the family by many such schemes only when the employee died in service. Some schemes are now agreeing to pay benefits to employees who are certified as terminally ill, so that they can retire and spend their final days in peace at home, without forfeiting the benefit due.

  5.2.11  While the measures taken by health and social security insurance schemes to take into account the specific needs of people living with HIV/AIDS are encouraging, it has to be emphasized that only a tiny fraction of the population in the countries most affected by HIV/AIDS is covered by formal health insurance and benefits schemes. Even those who are covered will inevitably see their health and death benefits fall significantly over the next few years, as insurance companies and employers pass on at least part of the rising costs to beneficiaries and employees, including those who are not HIV-infected.

  5.2.12  Premiums on some group life insurance policies in certain countries have already doubled, even though they are still at a relatively early stage of the pandemic, with the vast majority of young adult deaths still to come. Employers will not be able to absorb all of these costs. While the practice is certainly followed of recruiting staff on casual or short-term contracts to avoid paying disability, death or other benefits, a number of employers have begun to work together with the insurance industry to develop policies and benefit packages which meet the needs of people with HIV/AIDS and their families without bankrupting the companies themselves.

Disadvantages of HIV screening

  5.2.13  With a view to anticipating the loss of workers due to HIV/AIDS, many companies would like to know the proportion of the workforce they are likely to lose through AIDS. However, increasingly, employers are beginning to recognize the tremendous negative impact of pre-employment and on-the-job HIV screening. Testing the existing workforce is not only unethical, but leads to great hostility and is incompatible with effective HIV/AIDS prevention and care programmes at the workplace. Companies are beginning to find that, by abandoning testing requirements, a conducive climate can be created for workplace prevention programmes. A steadily increasing number of employers in the worst affected countries are reaching the conclusion that prevention is much more cost-effective than HIV-screening in the long term, and that respect for the rights of workers is a powerful prevention tool in its own right.


  5.3.1  Many factors in vulnerability - the root causes of the epidemic—can best be understood within the universal principles of human rights. Vulnerability to AIDS is often engendered by a lack of respect for the rights of women and children, the right to information and education, freedom of expression and association, the rights to liberty and security, freedom from inhuman or degrading treatment, and the right to privacy and confidentiality. Where human rights such as these are compromised, individuals at risk of HIV infection may be prevented or discouraged from obtaining the necessary information, goods and services for self-protection. Where people with AIDS risk rejection and discrimination, those who suspect they have HIV may avoid getting tested and taking precautionary measures with their partners, for fear of revealing their infection; they may even avoid seeking health care. Promoting human rights and tolerance is thus important in fighting AIDS as well as in its own right.

  5.3.2  Experience has also shown that the incidence and spread of HIV/AIDS is significantly higher among groups which already suffer from a lack of respect of their human rights and from discrimination, or which are marginalized because of their legal status. These include women, children, people living in poverty, minorities, indigenous peoples, migrants, people with disabilities, sex workers, homosexuals, injecting drug users and prisoners. These populations often have less access to education, information and health care because of the discrimination they face in relation to their economic opportunities, political and social influence, or gender and sexual relations.

  5.3.3  Without a rights-based response, the impact of HIV/AIDS and vulnerability to the disease will inevitably increase. As often highlighted by the late Jonathan Mann, the protection of the uninfected majority is inextricably bound up with upholding the rights of people living with HIV/AIDS.


(A)  Bilateral Funding

Difficulties in reporting funding

  5.4.1  Although the UNAIDS Secretariat has made significant progress in establishing sustainable processes for the monitoring of donor country resource flows to HIV/AIDS on a long-term and sustainable basis, some key issues remain. For example, several major DAC members including France and the European Commission continue to have major difficulties in the reporting of their official development assistance allocated to HIV/AIDS.

  5.4.2  Moreover, there continue to be differences in the ways that different donors define HIV/AIDS activities. Particularly problematic is the monitoring of HIV/AIDS components within integrated development projects or HIV/AIDS allocations within sector wide approaches and common basket funding schemes.

  5.4.3  Because of administrative differences among the DAC member countries, including differences in fiscal years, there is a significant delay in reporting donor country HIV/AIDS expenditures.

Recent indications

  5.4.4  Recent indications from donors are encouraging. For example, funding by the United States for global HIV/AIDS activities increased by US$ 65 million in 2000 and is set to increase by as much as an additional US$100 million in 2001. The donor response to the International Partnership Against AIDS in Africa has also been positive. This important new initiative (see below) includes donors as one of its five key constituencies. Representatives of donor countries are participating in all phases of its development, and their greater understanding of, and involvement in, national planning processes are paying off in increased support.

  5.4.5  In addition, the increasing recognition that HIV/AIDS is not only a major threat to development, but also a threat to peace-building and human security has resulted in higher levels of political awareness and more substantial financial commitments. An additional US$180 million in donor funding for activities in Africa was announced at the historic Security Council meeting in January 2000.

Analysis of donor funding

  5.4.6  There is no doubt that wealthy countries provide substantial support to the international fight against AIDS. Reliable data suggests that in 1998, 14 of the largest donors in the OECD Development Assistance Committee provided US$300 million for HIV/AIDS activities. This donor assistance to HIV/AIDS has increased substantially over time. In 1987—soon after it was first recognized that HIV had spread massively in many developing countries—levels of official development assistance (ODA) funding to AIDS were only at 20 per cent of the levels seen a decade later. This increase has occurred at the same time that overall ODA contributions to developing countries have steadily declined.

  5.4.7  Unfortunately, as spectacular as this increase appears, it has not kept pace with the spread of the epidemic—or even the most basic requirements for HIV programmes of the most affected countries. During the same period, the number of infections has risen from 4 million to 34 million, a figure that continues to grow given the more than 5 million new infections annually. Furthermore, increases in donor support had begun to level off between 1996 and 1998, and it remains less than just 1 per cent of donor countries' total annual ODA budgets. Against the backdrop of soaring infection rates, this trend is of critical concern.

Table 1


Donor country
(US$ million)
Percent of total 1998 HIV/



  5.4.8  The United States was by far the largest donor of HIV/AIDS ODA, disbursing US$147.3 million (49 per cent). The United Kingdom and the Netherlands were the next largest donors disbursing US$26.3 million (9 per cent) and US$ 21.5 million (7 per cent) respectively. But when allocations are broken down as a proportion of gross national product (GNP) for each country, the picture is quite different.[1] Luxembourg and Norway disbursed the largest proportion of their country's GNP to HIV/AIDS activities in developing countries with US$117 and US$103 per US$ million GNP respectively (Figure 1). The United States and the United Kingdom disbursed US$17 and US$19 per US$million GNP respectively.

Figure 1

HIV/AIDS ODA as reported by 14 donor countries:

Total amount obligated, 1998, in US$million and obligations reported by donor countries per US$ million 1998 GNP

  5.4.9  Another way to assess the level of HIV/AIDS ODA by individual donors is to consider HIV/AIDS ODA as a percentage of total ODA. In this case, Luxembourg, the United States and Australia disbursed the highest percentage of total ODA to HIV/AIDS activities with 1.8 per cent, 1.7 per cent and 1.3 per cent respectively. On the other end of the scale, Japan, Switzerland and Germany disbursed 0.1 per cent, 0.2 per cent and 0.3 per cent of total ODA to HIV/AIDS activities respectively. Overall, the US$300 million allocated to HIV/AIDS by the fourteen DAC member countries in 1998 represent 0.7 per cent of the US$41 450 million that they disbursed in total ODA for that year.


  5.4.10  Of the US$ 300 million in ODA that were allocated to HIV/AIDS in 1998, 20 per cent was channelled through multilateral agencies. Of the funds channelled through the Untied Nations and its specialized agencies, almost all (95 per cent) were core budget contributions or supplemental funding for general agency HIV/AIDS activities. Only 5 per cent of the funds channelled through multilateral agencies were multi-bilateral—or channelled through multilateral agencies for projects in specific countries. The large majority of the 1998 HIV/AIDS ODA reported (80 per cent) was transferred directly to recipient governments or channelled through non-governmental organizations and other private institutions.

  5.4.11  An additional way to assess the flow of HIV/AIDS ODA is to review the regional distribution of these funds. Over one third (35 per cent) of the US$300 million reported was earmarked for "global or inter-regional activities." It is not possible to disagregate these funds though a substantial proportion—including core contributions to the UNAIDS Secretariat—are eventually allocated to regions. Of the remaining 65 per cent (US$195 million), 56.8 per cent was earmarked for activities in sub-Saharan Africa (Figure 2), 26.5 per cent was allocated to activities in Asia/Pacific; 13.8 per cent to activities in Latin America/Caribbean; 2.3 per cent to activities in Eastern Europe; and 0.5 per cent to activities in the Middle East/North Africa region.

Figure 2

Distribution of regionally allocated HIV/AIDS ODA disbursements for selected donor countries, 1998

Trends in official development assistance to HIV/AIDS, 1987-98

  5.4.12  The 1998 data for the 10 donor countries for which data are available over time—Australia, Canada, Denmark, Germany, Japan, the Netherlands, Norway, Sweden, the United Kingdom and the United States—confirm most of the trends highlighted in the "Level and flow of national and international resources for the response to HIV/AIDS, 1996-97."[2] When inflation and changes in purchasing power parity are taken into account, the flow of HIV/AIDS ODA from these 10 countries increased each year from 1987 to 1996, remained stable between 1996 and 1997and continued to increase between 1997 and 1998 (Figure 3).

Figure 3

Total HIV/AIDS ODA Disbursements by Selected Donor Countries at 1997 Prices and Exchange Rates, 1987-98

  Similarly, when trends in the flow of HIV/AIDS ODA are compared to the trends in overall ODA for these countries, the proportion of HIV/AIDS ODA within the total pot of ODA does increase slightly between 1987 and 1988 from 0.2 per cent to 0.7 per cent.

  Finally, the trend in the decreasing flow of HIV/AIDS ODA through United Nations agencies is also confirmed with the 1998 data. This trend has been longstanding (since 1987), but reviewing only the last three years; donor countries decreased the HIV/AIDS ODA that they channelled through multilateral and multi-bilateral channels from 26 per cent of all HIV/AIDS ODA in 1996 to 22 per cent in 1997 to 20 per cent in 1998.

1   Information on donor country GNP was taken from "Development Assistance Committee International Development Statistics." OECD website:,22May2000. Back

2   Trend information also based on Mann J & Tarantola D, ed., AIDS in the World II (New York, Oxford: Oxford University Press, 1996) and Mann J, Tarantola T, eds., AIDS in the World (Cambridge, London: Harvard University Press, 1992). Back

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