Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

Monday
14 August
Oral
str ct
Abstract
Sessions

Track E
MOAE0101
The SMARTWork program's experience with
stakeholders and decision-making processes in
designing workplace HIV/AIDS programs and
policies: a blend of working smart, "muddling
through" development, and "all I really need to
know I learned from PEPFAR
M. Roberts'. Academy for Educational Development (AED), Center on AIDS
and Community Health, Washington, United States
Issues: Managing international projects and developing effective HIV/AIDS
workplace policies and programs depend on successfully engaging various key
stakeholders in critical decision-making processes. However, stakeholders often
have existing, complex, or even conflicting roles, responsibilities and relationships that make this process challenging.
Description: Internationally funded workplace HIV/AIDS projects - like many
other development programs - have numerous stakeholders, including: international funding agencies, host governments, implementing bodies, business
managers, labor representatives, community opinion leaders, and affected
workers. Funded by the U.S. Department of Labor, AED's SMARTWork program
in Dominican Republic, Haiti, Nigeria, Ukraine, Vietnam, and Zimbabwe works
to assist stakeholders to engage constructively in establishing sustainable
workplace interventions. The proliferating number, and sometimes unpredictable nature, of key stakeholders - who may also have differing levels of experience, expertise, values, and approaches - make the design of HIV/AIDS
workplace programs and overall development process increasingly difficult. This
paper will use the experiences of SMARTWork, political science theories of decision-making and international development models to explore these challenges
and make recommendations on overcoming them.
Lessons learned: Successful implementation of HIV/AIDS workplace programs requires understanding, engaging, and institutionalizing sustainable
relationships between a myriad of stakeholders, not all of whom are obvious,
familiar to each other, or team oriented. Often this is more of an art than science - requiring diplomacy, flexibility, knowledge of international development
and decision-making processes, and good brokering skills more than HIV/AIDS
health expertise.
SMARTWork has achieved considerable success using these strategies, having
assisted over 100 companies, employing some 1.6 million employees, to adopt
workplace HIV/AIDS programs and policies.
Recommendations: To promote comprehensive and effective HIV/AIDS workplace policies and programs, implementers should carefully identify and involve
the key stakeholders, assisting them to forge common sustainable ground. For
their part, stakeholders can assist the development process by focusing more
on evidence-based interventions affecting the workplace as well as sound development models, rather than on externally derived, values-driven approaches.
MOAEO102
The Debswana antiretroviral therapy programme
B. Mbakile', O. Johnson'. Debswana Diamond Company, HIV/AIDS Impact
Management, Gaborone, Botswana
Issues: This abstract describes Debswana's Disease Management Programme
(DMP) as part of the Company's Workplace HIV/AIDS Strategy. It describes its
beneficiaries, benefits and also provides outcome data.
Description: In order to extend productive lives of employees living with
HIV/AIDS, Debswana in May 2001, established an Anti Retroviral Therapy
(ART) programme administered through a comprehensive DMP. Through
this programme, Debswana provides free ART and related monitoring tests
including viral load and CD4 count to the defined beneficiaries. The DMP,
through stipulated guidelines, ensures use of correct drug combinations, at the
right stage and with appropriate monitoring and follow-up.
The beneficiaries of the DMP are HIV-infected permanent employees of
Debswana and their legally married spouses. Registration into the programme is
done via internet by doctors and clinical consultants. The programme currently
has 788 registered patients, their age disrtibution concentrated around 30 to 40
years and with a majority being on stages 3 and 4 of the disease.
Lessons learned:
(a) The tracked indicators of the DMP, i.e. deaths, ill-health retirements and
absenteeism have shown negative growths since the provision of ART, a clear
indication that the programme is bearing positive results.
(b) Patients tend to register on the DMP rather late, resultanlty, quite a number
of deaths on the programme have occured. Therefore, early registration into
the programme is vital.
(c) Fear of discrimination, coupled with inadequate publicity of the DMP amongst
beneficiaries has resulted in its sub-optimal utilisation. It is important to have a
robust information, education and communication programme.
(d) To ensure high levels of adherence to treatment, a DMP should have a

strong patient follow-up component, provision of ART alone is insufficient.
Recommendations: All businesses should have a workplace programme that
facilitates access to treatment, care and support as a way of minimising the
negative impact of the epidemic on the business.

MOAEO103
Building a sustained private-public partnership
to address HIV/AIDS and reduce stigma and
discrimination in the workplace: the case of Mexico
M.J. Negroni Belen', E. Hoadley', M. Kincaid2, J. Moody3. 'Futures Group,
Mexico City Offce, Mexico City, Mexico, 2Futures Group, Chapel Hill, United
States, 3Independent Consultant, Mexico City, Mexico
Issues: Two key elements have been shown to be important in an effective
response to HIV/AIDS in the past few years: reduction and stigma and
discrimination and building a sustained multi-sectoral response. One important
player in this response is private enterprise. Few successful strategies, however,
for scaling up the response of the private sector have been given international
attention.
Description: A survey of 20 key multinational companies in Mexico illustrated
a willingness to respond to issues of HIV in the workplace and highlighted
inconsistencies in international and national policies. With external technical
support, CONAES (Consejo Nacional Empresarial sobre SIDA) was formed in
2004. By the end of 2005, there were 28 member companies who agreed to
review and rewrite their HIV-related policies and make public presentations
on concrete action they undertake to address HIV/AIDS. A conglomerate of
NGOs acts as technical resource persons for the process. This group has begun
providing technical assistance to private companies as well as to the public
sector in Mexico.
Lessons learned: An independent business council is a successful means
of improving workplace policies and creating supportive environments for
dialogue and prevention. It can also provide a means to generating political will
to more openly address HIV as well as providing a medium for media coverage
that illustrates successful endeavours to addressing HIV/AIDS as opposed to
negative stories of decline and omission. The reduction of HIV-related stigma
and discrimination can be dealt with through such a broad-based project. By
2006, over 130,000 Mexican workers would be directly covered by HIV-specific
workplace company policies.
Recommendations: The next challenge is to bring this approach to a local
level so as to build better private-public partnerships at a state and municipal
level.
MOAE0104
An innovative private sector led response to
HIV/AIDS, targeting seasonal and permanent farm
workers
J. Hill-Mlatil, P. Craviolatti2. 'International Organization for Migration,
Migration Health Department, Pretoria, South Africa, 2ECI Africa, Trade
Competitiveness Project, Southern Africa Competitiveness Hub, Johannesburg,
South Africa
Issues: Development of an innovative private sector-led comprehensive
response to HIV/AIDS for small and medium size agri-businesses that employ
large numbers of migrant and mobile workers in Limpopo Province, South
Africa.
Description: The commercial agricultural sector in South Africa faces a number
of challenges; a high HIV prevalence environment exacerbates the situation. In
2005, a partnership against HIV/AIDS was born out of the need to address the
HIV impact on business and to reduce the HIV vulnerability of farm workers. 16
local agri-businesses are organised into a single cluster, coordinated by a local
NGO and supported by technical experts on issues such as migration, workplace
policy development, Behavioural Change Communication (BCC), capacity
building and access to care and treatment. The advantage of a cluster approach
is that it brings into play economies of scale (increases cost-effectiveness of
interventions) and resource pooling (all agri-businesses contribute to the
cluster's HIV/AIDS programme).
The project tackles HIV from a structural, environmental and individual level
and includes the provision of home based care, peer education, development of
workplace policies/programmes, evidence-based BCC campaign and a gender
intervention. Each intervention in the workplaces is designed and implemented
with the objectives of:
(i) reducing the HIV impact on the businesses (trade competitiveness
erosion),
(ii) improving the wellbeing of farm workers whether permanent or seasonal,
and
(iii) investing into the surrounding communities where farm workers come
from.
Lessons learned: The buy-in of the business owners is fundamental for the
success of the clustering, design and implementing of HIV/AIDS interventions.
Ensuring interventions are relevant to address the vulnerabilities associated
with seasonality and migrant workers. Clustering of medium size businesses
appears a viable option for cost sharing and resource pooling.
Recommendations: Although this is work-in-progress it is hoped that it will be
replicated in the Southern Africa Region.

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1