HIV/AIDS remains a major health and development challenge in Africa. According to the 2009 AIDS Epidemic Update by the UNAIDS and World Health Organization, 22.4 million Africans live with HIV/AIDS. At least 1.9 million Africans contracted HIV in 2008 and 1.4 million died of AIDS in the same year. Every day in Africa, about 5200 Africans contract HIV and at least 3800 Africans die of AIDS. Most of the dead, sick or dying are men and women in their economically productive years. We know that in Africa, a breadwinner is responsible for not only his immediate nuclear family but also provides support to numerous relatives and friends. Africa is home to 14 million AIDS orphans, and counting. These children face serious health, education and social challenges as they struggle to become the kind of adults that contribute positively to the economic well being of their societies. 

If you are business executive in Africa, AIDS is already having an impact on your business. The UNAIDS estimates that AIDS costs Africa at least US$7 billion a year. The Global Fund against AIDS, TB and Malaria report that 50 percent of countries in Sub-Sahara Africa are recording a decline of 0.5% to 1.2% in their per capita growth due to AIDS. Per capita GDP in hard hit Southern Africa countries may drop by as much as 8 percent in the next few years due to AIDS. By 2020 in Africa, labor force in 32 African countries may be reduced by between 5 and 35 percent principally due to AIDS. Life expectancy in Sub-Sahara Africa is now 48 years instead of 62 as a result of the devastating impact of AIDS. In Swaziland, the country with the severest form of HIV infection in the world, life expectancy was cut by half between 1990 and 2007 to 37 years. Untreated employees living with AIDS may cost businesses three times their annual salaries compared to uninfected colleagues. Even uninfected employees still cost businesses money due to unscheduled absence to care for loved ones sick or dying of AIDS or to attend funerals.  

Even the future pipeline of healthy, educated middle class, a major focus of business activities is already under siege. We now know that wealthy households in Africa are increasingly at risk of HIV infection. The UNAIDS reports that a recent survey of eight African countries show that HIV infection is more prevalent in the wealthiest quintile of the population compared to the poorest quintile. AIDS is already overburdening health systems in Africa from both human resource and infrastructure standpoints. AIDS is killing off teachers, causing school closures. The epidemic has not spared agricultural production as farmers succumb to AIDS and investments fall on irrigation projects and purchase of mechanized equipments. The police and Military are on the receiving end of AIDS, with grave future implications for public safety and defense in many African countries.

African business executives have a major role to play in the fight against HIV/AIDS. This role is crucial for three major reasons. First, although nine of the ten top recipient countries of AIDS international assistance are in Africa, the per capita domestic public expenditure on AIDS by governments in the continent is six times higher than other parts of the world. African governments are increasingly tapped out in the fight against AIDS.  Second, the global financial crisis has the capacity to scuttle hard won gains in the fight against AIDS. UNAIDS estimates that if the global financial crisis leads to drastic cuts in international AIDS assistance, more than 100 countries, including those in Africa will be at grave risk. In Sub Sahara Africa, South Africa, Botswana and perhaps Nigeria, may be the only countries that may continue the implementation of viable AIDS programs if international assistance withers. Third, the fight against AIDS in Africa is showing evidence of what works. Based on what works, African business executives can make strategic interventions, with tremendous upsides. Mining companies and other conglomerates in Southern Africa already have experience with workplace HIV/AIDS programs. What is needed now is for African business executives to ramp up their participation in the fight against AIDS beyond traditional workplace initiatives.

How African Business Executives Can Make Strategic Interventions on AIDS

African business executives can best contribute to the fight against AIDS by focusing on areas of comparative advantage and on areas where they can make immediate, substantial impact. I briefly discuss these areas. 

1.Expand Workplace HIV/AIDS Programs to non Nuclear Relatives and  Dependants of Employees and to the Immediate Operational Communities.

Mining companies in Southern Africa already implement programs targeting their workers and immediate relatives. It is now necessary for large businesses in Africa to expand the coverage to non-nuclear relatives and dependants of the employees. It is also important to expand support to the residents of the immediate operational communities. This expansion should go beyond token preventive programs and “community mobilization” activities. This envisaged role is important as cash strapped African governments are unlikely to invest significantly in the immediate operational areas of successful businesses. 

2.Support Scaling Up Successful Programs.

One of the major difficulties in  the fight against HIV/AIDS is how to scale up promising programs. The fight against AIDS in Africa has shown evidence of successful programs. Africans on antiretroviral therapy increased from 2 percent in 2003 to 44 percent in 2008, putting nearly 3 million people on treatment. The UNAIDS estimates that 1.2 million deaths may have been averted in Africa following the implementation of AIDS treatment programs. The proportion of pregnant women receiving antiretroviral therapy increased from 9 percent in 2004 to 45 percent in 2008, sparing at least 134,000 newborns from contracting HIV. African business executives now have the opportunity to provide assistance on programs that really work. 

3.Strategically Focus on Programs that can have Immediate Impact.

Today in Africa, 300,000 African children are born with HIV from their seropositive mothers. Yet, the administration of antiretroviral prophylaxis during pregnancy, during labor, at delivery or the immediate post partum period can cut the risk of maternal transmission from 30-35 percent to 1 or 2 percent. African business executives in each country can provide financial and logistics assistance to end the eminently preventable maternal transmission of HIV to newborns. UNAIDS wants this tragedy to end by 2015. African business executives can make it happen sooner. 
                         
Another area of potential, immediate impact is the issue of AIDS orphans. Business executives in each African country can come together to support grandmothers that are largely taking care of AIDS orphans in the continent. In hard hit countries, AIDS has successfully degraded the famed extended family system in Africa, leaving grandparents scrambling to care for their grandchildren. In our 2006 book on AIDS orphans in Africa and their grandparents, a colleague and I noted that modest petty cash to meet household expenses can make a significant difference in the lives of AIDS orphans. We also noted in the book that the impact of the private sector in the care of AIDS orphans in Africa is negligible. The issue of AIDS orphans in Africa is one of the worst scandals in the global fight against HIV/AIDS as millions of affected children are often left alone with ailing grandparents.

African business executives can also have a major part on HIV prevention programs. These programs are no longer as effective and funding is slipping in the continent. The UNAIDS estimates that it cost US$9 a year to reach young people with effective preventive programs. African business executives have experience with managing information, education and communication (IEC) marketing campaigns. The same skills are transferable to HIV prevention programs with appropriate content modifications. HIV prevention programs have struggled with the message, the messenger and the audience in the continent. African business executives can assist from their insights on marketing products to similar target populations. 

In addition, business executives can plan better and execute more decisively with access to updated, valid data on HIV/AIDS. For example, the UNAIDS indicates that 15 major cities in East and Southern Africa are responsible for nearly 15 percent of the global AIDS epidemic. Armed with this information, African business executives can better tailor their interventions. It also well known that significant geographical and regional differences in HIV/AIDS prevalence and incidence occur in the same country, creating opportunities for better targeted interventions. 
 
4.Strategically Invest or Support Efforts to make Medicines and other PublicHealth Goods available in Africa.

Efforts to improve access to AIDS medicines in Africa exposed an underlying problem. Although more than 75percent of individuals on AIDS medicines worldwide live in Africa, 80 percent of these medicines are imported from abroad. Since millions of Africans must be on lifesaving AIDS medicines for the rest of their lives, an unsustainable scenario is emerging. African business executives should step up to the plate to establish drug manufacturing plants in Africa capable of producing AIDS medicines and other drugs needed in the fight against endemic diseases in the continent. The African Union already has a continental plan on pharmaceutical products. The head of UNAIDS, Michel Sidibe is a strong supporter of a single “African Medicines Agency” similar to the agency in Europe and to the Food and Drug Administration of the United States. The African Medicines Agency will enforce international standards, encourage Africa-based manufacturing capacity and reduce the menace of counterfeit medicines.
 
The organized business sector in Africa should work closely with the African Union, African professional associations and the UN system through Michel Sidibe, the head of UNAIDS to establish an African drug regulatory agency and to establish viable African-based research pharmaceutical industry capable of producing enough quantities of AIDS medicines and other drugs to satisfy continental needs. The role of African business executives on this issue is crucial since African governments are unlikely to bear the burden of financing the development of indigenous research pharmaceutical industry in the continent. Similar dedicated investments may be needed from the organized business sector to meet the needs of individuals living with other significant health conditions.  Similar attention may also be needed in the quest for vaccines against endemic diseases in the continent.

The fight against HIV/AIDS in Africa requires strong collaboration between the government and the private sector. It also requires the active participation of the civil society. It is important for African business executives to become central to the fight against AIDS in the continent. By strategically leveraging their areas of comparative advantage and bringing to the table formidable skills in financing, operations management and logistics, African business executives can make a substantial impact in the fight against one of the gravest challenges of our time.

By Chinua Akukwe.

Chinua Akukwe is the Chair of the Technical Board of the Africa Center for Health and Human Security at the George Washington University, Washington, DC. He has written extensively on health and development issues in Africa, including four books.