The scourge of contagious disease is not just a problem for the poorest countries. It is a problem for the world – and one that can only be addressed by true cooperation between the public and private sectors, NGOs, philanthropic organizations, grassroots workers and activists. To assess what is being done and must be done to meet this challenge, Global Agenda asked representatives from all these sectors – WHO director-general Gro Harlem Brundtland, US health secretary Tommy Thompson, Global Fund executive director Richard Feachem, Bill & Melinda Gates Foundation president Patty Stonesifer, Anglo American chief executive Tony Trahar, De Beers executive Jonathan Oppenheimer and Ugandan Aids worker Milly Katana – for their views –

LIVING DANGEROUSLY
By Gro Harlem Brundtland, director-general of the World Health Organization

Over the past few years, investments in health have gone from being mainly a domestic issue – and a luxury that developing countries should not allow themselves until they reached middle-income status – to becoming an issue of global concern and a key factor in development.

Several factors have contributed to this new view of health: the re-emergence or new spread of diseases such as tuberculosis, malaria, sleeping sickness and dengue fever; the appearance of West Nile fever in the US and Rift Valley fever in Saudi Arabia; and the new threat of biological weapons in the hands of terrorists.

More than anything, however, the global AIDS pandemic has taught us that the separation between domestic and international health problems is losing its usefulness.

At the same time, a fast-growing body of scientific evidence is showing that a healthy population is a prerequisite for economic growth and development as much as a result of it. Investing in health early in a country’s development curve will reduce overall poverty, improve productivity and stimulate economic growth.

The World Health Organization’s Commission on Macroeconomics and Health in its December 2001 report estimated that the return on investment could be six-fold: if the world does what it takes to tackle the major infectious diseases and improve child and mothers’ health, the poorest developing countries would see a combined boost of their economic growth of $360 billion per year by 2015.

Through the UN Millennium Declaration two years ago, through the creation of the Global Fund to Fight AIDS, TB and Malaria, and through declarations by the G8, the World Health Assembly and groupings of African leaders, the international community has made numerous commitments to improve the health of the world’s poorest populations.

In 2002 world leaders had a real opportunity to act on this new evidence and on their commitments. Through the International Conference on Financing for Development in Monterrey in March, a number of industrialized countries committed new resources to development assistance.

A substantial part of this was aimed at investments in health. At the same time, several developing countries addressed the need for a more effective use of existing resources, including prioritizing investments in health and education and tackling corruption.

Only the Scandinavian countries and the Netherlands live up to the international commitment of spending 0.7% of GDP on development assistance. Yet, although the pledges at Monterrey were positive, they fall far short of what is needed to realize any of the goals of the Millennium Declaration.

The needs in health alone, according to the Commission on Macroeconomics and Health, are $66 billion in investments per year. More than half of this will have to be provided by the developing countries, but it will still mean that development assistance for health will have to grow to nearly $30 billion per year. This is a tremendous challenge in the years to come.

Each year lost makes it all the more difficult to limit or reverse the burden brought on us by diseases such as AIDS, malaria and TB. Updated AIDS figures show how the pandemic is threatening to increase drastically in Asia.

The Global Fund to Fight AIDS, TB and Malaria became operative in 2002 to award and disperse the first round of money to countries in need. But the needs for funding far outstrip donor commitments. The fund is already in danger of running out of money in 2003 unless new pledges are made.

Some 42 million people are living with HIV/AIDS, 95 % of them in developing countries. As the prices for effective drugs to treat AIDS have been cut by as much as 95%, it has become a moral as well as economic and social imperative to treat as many people living with HIV as possible.

Today, only 300,000 people in developing countries can access these medicines. In December, a large number of donors, developing nations and non-governmental organizations came together in an International HIV Treatment Coalition so at least half of the 6 million people who would benefit from treatment for AIDS in developing countries will have access to it by the end of 2005.

One of the breakthroughs to achieve this came in April, when WHO released new guidelines for treatment of AIDS in resource-poor settings. One of the main obstacles to AIDS treatment in developing countries was the danger of side effects and drug resistance from medicines that must be taken in combinations and at regular intervals. This obstacle has been overcome through the new simplified guidelines and the development of combination pills and easier packaging.

The AIDS pandemic has also thrown a dark shadow over the humanitarian crisis that unfolded in southern Africa over the past year. Failing crops, combined with social and political shortcomings, have caused a famine situation, threatening 14 million people with starvation. However, the large death toll is as much a result of a population already weakened by HIV/AIDS and other diseases succumbing to yet an extra burden.

This was a stark reminder that the future is already here, when 60,000 people gathered at the World Summit for Sustainable Development in Johannesburg in August and September. The discussions about the perils of our environment and our livelihood on an abused planet took place against a background that these were not hypothetical questions – they surrounded us. The conference ended without new ambitious declarations of intent, but it was a concrete step on the road towards sustainable development.

Over the past few years, the WHO has looked at how we can more effectively go beyond treating the main diseases and chronic conditions that dominate the global burden of disease. The result of this work, one of the largest research projects the World Health Organization has ever undertaken, was published in October in the World Health Report.

We began with two simple questions: what are the main risks to health for the world as a whole? And what can we do to reduce these risks?

The findings in the report are a wake-up call. The world is living dangerously. A large part of the population does so because they have little choice. But a large part does so because they make the wrong choices. The report shows that human behaviour is changing around the world, and that these changes have a serious impact on people’s health.

The report provides a road map for how societies can tackle a wide range of preventable conditions that are killing millions of people prematurely and robbing tens of millions of a healthy life. It argues that healthy life expectancy can be increased by five to 10 years worldwide, if governments and individuals make combined efforts against the major health risks each population is facing.

The report quantifies some of the most important risks to health, and also assesses the cost-effectiveness of measures to reduce them. We found that the top 10 risks account for about 40% of the 56 million deaths that occur worldwide annually and one-third of global loss of healthy life years.

These 10 risks are: childhood and maternal underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water, sanitation and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency and overweight/obesity.

Reducing risks to health is a main responsibility of governments – but it also remains a vital preoccupation of all people, and of all those who serve them. In this report, therefore, there is a message for everybody.

A number of challenges were laid down in 2002. And 2003 is the year when these challenges must be met if we are to prevent millions of unnecessary deaths in the coming decade.

A DUTY TO STOP AIDS
By Tommy Thompson, US secretary for health and human services

The call to charitable action is rooted in the noblest impulses of the human soul. It is in that spirit that the private sector members and guests of the World Economic Forum fulfil the individual moral call to help the needy of our world.

The nations of the world must answer to a different moral impetus – the wellbeing of their citizenry – but they can certainly join in endorsing and assisting the work of what president George W Bush calls “the armies of compassion”.

At the intersection of national self-interest and private compassion lies the opportunity to perform some truly extraordinary work for humanity. A prime example of this intersection is the worldwide fight against AIDS.

In the developing world, and particularly in Africa, AIDS threatens peace and stability as it wipes out entire generations, orphans communities, and cripples nations. Three million people died from AIDS last year, and it is estimated that at least another 68 million will die in the next two decades.

Of those deaths, 55 million will be in Africa. Life expectancy is suffering concurrently. A child born in Botswana now cannot even expect to see his or her 40th birthday – a level not seen there since 1950.

As AIDS cuts its wide swathe through the afflicted populations, nations themselves begin to falter – with predictable effects on peace, justice, and public order. The Report of the XIV International Conference on AIDS tells a sad tale.

“When the impact of AIDS causes essential services to falter, the state’s legitimacy can also be damaged,” it reads. “Through its combined impact on state, enterprise and community capacity, AIDS can thus contribute to social disruption and perhaps even civil unrest, which invariably hurts the most vulnerable sections of society most.”

It adds: “Children orphaned as a result of AIDS, for example, are left especially vulnerable in such circumstances and, in some settings, can be lured into military/paramilitary activities with the prospect of ‘family’ bonds and the promise of food and consumer commodities.”

I’ve been to Africa and seen the damage. The sorrow and the horror defy description and, it sometimes seems, the powers of science. Where other illnesses fall to modern medicine, AIDS marches on.

But we will stop it because we have the will, the means, and the compassion to do so. The administration of president Bush is doing its part. For starters, the president has proposed $1.1 billion to help fight HIV/AIDS in the developing world next year – a 13% increase over 2002. This is on top of the $144 million the Centers for Disease Control and Prevention will spend on global AIDS prevention strategies and programmes. Overall HIV/AIDS spending by the US government has increased from $14.2 billion in fiscal year 2001 to well over $16 billion for fiscal year 2003. That includes a doubling in international HIV/AIDS funding over the same period.

From the Mother and Child Transmission Prevention Initiative, to the Pan-Caribbean Partnership Agreement, to our research efforts at home, we and our partner nations are leading the attack on AIDS on every front. And we have the results to show for it.

On November 13, researchers at our National Institutes of Health began human clinical trials on a promising new HIV vaccine. Our efforts are bringing the promise of an HIV-free world ever closer.

That’s not all. Because we believe in the importance of the armies of compassion, we have committed ourselves to supporting the Global Fund to Fight AIDS, TB and Malaria.

The fund is an indispensable component of the worldwide effort against AIDS. A true public/private partnership, it provides financial assistance to nations and communities in desperate straits. This assistance shores up health and medical infrastructures, gives families a fighting chance, and most important, saves lives.

As US representative to the board of the fund, I am proud to report that the Bush administration’s commitment to it and its work is stronger then ever. The president has requested almost $500 million for the Global Fund – far more than any other nation.

Let there be no doubt that the United States is doing its utmost to meet this threat – and defeat it.

As we meet in Davos for this year’s World Economic Forum, we cannot forget the simple truth that our resources and our energy in the fight against AIDS are the direct results of our liberty to innovate at will, our capacity to research as we wish, and our ability to communicate freely. Truly, individual freedom is the greatest public health measure of all.

We believe that “life, liberty, and the pursuit of happiness” is the fundamental birthright, not just of Americans, but of all mankind. Our sense of duty to our fellow man demands that we help our fellow nations along the road to this same end.

That’s why we have undertaken projects like the president’s Millennium Challenge, instituted to help developing nations improve their economies and strengthen good governance. And that’s why the Bush administration is building a women’s health clinic in Kabul – even as American soldiers do their part to secure a lasting peace for the Afghan people.

Almost 170 years ago, Alexis de Tocqueville observed the charity and generosity of ordinary Americans to one another. In what could be a metaphor for the work of the World Economic Forum and good works everywhere, he wrote: “Countless little people, humble people, throughout American society, expend their efforts in caring and in the betterment of the community, blowing on their hands, pitting their small strength against the inhuman elements of life. Unheralded and always inconspicuous, they sense that they are cooperating with a purpose and a spirit that is at the centre of creation.”

At this year’s forum, and especially at ground-breaking meetings like the first-ever G20 conference of health ministers, we will discuss what can and must be done by individuals and by governments to meet the many challenges of the 21st century.

As we do, we too must seek our guidance and our motivation from the “spirit that is at the centre of creation”. I am confident that we will.

A TOUGH FIGHT AHEAD
By Richard Feachem, executive director of the Global Fund to Fight AIDS, TB and Malaria

Today’s diseases of poverty are a worldwide disaster that is already more damaging than the Black Death. The situation will get much worse before it gets better, and its wake will leave nobody unaffected.

This is a reality that we must confront together as a global community to wage a credible and effective fight and to make a real impact on health and development in the years ahead.

Some 10 million children live as orphans due to AIDS, enough to populate a small country, and this figure will quadruple in this decade. Teachers in parts of southern Africa are lost at twice the rate they are trained. Disease and premature death among African agricultural workers is worsening famine and increasing starvation.

Economic growth and foreign direct investment is stunted by the lost productivity of local companies. And the ranks of healthcare workers and the military are being significantly depleted in even the wealthiest African states.

The full impact and reach of the disease are still unfolding, and will continue to grow until 2050 unless there is a dramatically increased response. A hundred million more people will be quickly infected as the epicentre moves east, with continued growth in eastern Europe as well as east and west Africa, accompanied by explosions in India and China, where the geopolitical and economic ramifications will be immense.

Tuberculosis and malaria, which double the number of annual deaths due to AIDS, share with it the distinction of getting rapidly worse. They must not be relegated as a lesser priority.

TB, an airborne contagion, is directly fuelled by HIV. Treatment of multi-drug-resistant TB can be more expensive than an antiretroviral cocktail. Ask any mother in Africa what she fears most, and the answer is malaria, as children under five are more likely to die of this disease than any other cause.

Yet each of these three diseases can be effectively treated and entirely prevented. Comprehensive responses are possible with proven interventions. Recognizing this, global leaders committed at the turn of the millennium to new targets in the fight against AIDS, TB and malaria.

A year later, the international community agreed that a global trust fund, a new financing mechanism, should be a new tool in that fight, and $2.2 billion was pledged to the concept. And in 2002, representatives of both rich and poor governments, civil society and the private sector joined to create The Global Fund to Fight AIDS, TB and Malaria. They promised that it would bring to the landscape of international aid a wholly unique opportunity for innovation, partnership and scale.

The Global Fund has been designed to operate on a foundation of trust. Potential recipients trust that sufficient resources exist to support high-quality programmes. Donors trust that the fund will make investments where the prospect of a strong return is high and will disburse on the basis of demonstrated results and programmatic capacity.

A year into its work, the fund has advanced this trust considerably. The core business of the fund is to review and fund proposals. Despite the challenges inherent in any start-up, the fund has successfully established mechanisms and begun funding over 150 country-led proposals worth $1.5 billion over the first two years.

To do so it has created a review mechanism that balances central accountability against country-driven applications and demands rigorous standards of technical best practice and implementation readiness. The proposals approved are distinctive in their comprehensive approach, their scale, and their innovation.

In Tanzania, for example, pregnant mothers will now receive, at antenatal clinics, vouchers to purchase insecticide-treated nets from private vendors in any village throughout the country.

They can choose a net that fits their tastes and needs and will receive, at the child’s first vaccination, a packet of insecticide to renew the net’s efficacy. Though the government manages the subsidies, the manufacture and distribution of the nets are the result of private entrepreneurship.

Proposals to the fund are developed by new partnerships among government, civil society and the private sector, the Country Coordinating Mechanisms. In requiring proposals from partnerships as opposed to governments, the fund has been able to act as an incentive to good governance, while still building local capacity among governments, civil society, faith-based organizations and business.

Oversight has been contracted to local offices of independent agents, such as PricewaterhouseCoopers and KPMG, in order to outsource the task to those with specialist expertise and avoid the growth of The Global Fund into a large bureaucracy.

The policies adopted by the fund itself are also innovative. For instance, procurement of medicines will be conducted on the basis of the lowest price resulting from open competition between suppliers of assured quality products, in a manner consistent with national law and agreements.

This approach helps to correct previous market failure by opening the door to generics without eroding the incentive of research-based pharmaceutical companies to develop desperately needed new products to fight these diseases, or compromising on quality.

After only nine months, this model is up and running. The fund has been signing grant agreements since November, and millions of dollars are now being disbursed to programmes around the world. Nearly three-quarters of a billion dollars will be available to countries to fight these diseases in 2003. This is record time in the development world.

A critical aspect of the Global Fund’s approach is that sustained support is given only on the basis of documented outputs and outcomes, against milestones set by the grantee. While the results achieved by the fund to date are important, the only results that will make an impact on the epidemic are those achieved by its grantees – more people benefiting from HIV voluntary counselling and testing, more people sleeping under malaria nets, more people completing TB treatment or enrolling in antiretroviral regimens.

While partnerships on the ground will drive results, they can only do so with adequate resources. Without new financing, the work of partners will be impotent, as will be the programmes they are in a position to support.

Billions of dollars of new commitments are needed as soon as possible to multiple channels in the fight against these diseases. No one should be fooled by a $10 billion or $15 billion price tag. Much more is needed, as is clear when estimates are adjusted to account for the cost of building infrastructure, the human and physical resources which underlie any programmatic intervention.

Without sufficient resources, the diseases will continue their spread unchecked and the future costs of the response will rise exponentially. However, the measure of such a moral failure would not be the billions of additional dollars required but the millions of lives sacrificed.

The Global Fund is but one channel for the new resources required. Most of the resources available to the fund have now been committed. For the fund to approve new high-quality proposals, it needs an additional $2 billion to be pledged and contributed in 2003. Over double this amount in new resources will be needed in 2004. These are minimums to allow the fund to fulfil the mission for which it was established.

The future course of the great pandemics of AIDS, TB and malaria hang in the balance, and the trust we have placed in one another is being tested. The Global Fund was charged with the responsibility to efficiently channel additional resources to programmes that would effectively implement proven interventions.

Now that the money is moving, we must decide together how to go forward. Will local partnerships mobilize to support implementation and to quickly demonstrate results? Will donors recognize the results to date and commit substantial new resources? Will we jointly find new and innovative ways to unleash the power and capacity of the private sector? Success demands that the answer to these questions is a resounding yes.

MOVING TO SOLUTIONS
By Patty Stonesifer, co-chair and president, Bill & Melinda Gates Foundation

For too long, the goal of achieving global health equity – ensuring that a child born in Nairobi has the same chance for good health as a child born in New York – has seemed unattainable.

But in recent years, world leaders have increasingly understood that fighting disease is not only a humanitarian imperative – it is also critical to economic development and global stability. More importantly, there is a growing recognition that it is within our power to make major advances against seemingly intractable health problems.

The inequities in health between rich and poor countries are striking. Children in developing countries are 10 times more likely to die of vaccine-preventable illness than children in the industrialized world.

While people in the US and other wealthy countries can expect to live to age 75, AIDS has slashed life expectancy to less than 40 in some African countries. And 99% of people with tuberculosis and malaria live in the developing world.

But the future deaths of millions from infectious disease are not inevitable. We have the means to prevent needless human suffering through basic tools such as a measles vaccine that costs just 25 cents, a hepatitis B vaccine that costs 50 cents, or oral rehydration therapy that can prevent a child’s death from diarrhoea for 33 cents.

We can close the health gap between rich and poor if we expand access to affordable, effective solutions, accelerate research into prevention technologies such as vaccines, and expand our knowledge by answering some of the most challenging scientific questions in the global health arena.

Such efforts could have an especially important impact on one of the world’s leading killers: HIV/AIDS. The US National Intelligence Council recently reported that the rapid spread of HIV in five of the world’s most populous countries, including Russia, China, and India, could have a dramatic impact on global stability.

The WHO and UNAIDS have warned that the number of people with HIV worldwide could increase sharply, with 45 million new infections by 2010 – but they also project that almost two-thirds of these infections could be averted if we greatly expand existing HIV prevention strategies.

We have the power now to contain and even reverse the global AIDS epidemic. Low-cost, high-impact interventions such as targeted education campaigns, condom distribution, and HIV counselling and testing have proven highly effective in containing epidemics in countries such as Senegal, Thailand, and Uganda.

But today, fewer than one in five people at risk of infection worldwide has access to these HIV prevention interventions. We must rapidly transform successful pilot projects into comprehensive programmes that reach many more in need – in Africa and in the world’s most populous countries where HIV is set to explode. Experts estimate that achieving this global scale-up of prevention will require at least $4.8 billion annually. This sum, while substantial, is within our means – roughly $5 for each resident of the US and Europe.

If donor and developing countries invest now to deliver existing prevention interventions, the results will be dramatic. Nearly 800,000 newborns contract HIV each year from their mothers – but for less than $4 per birth, a drug called nevirapine can reduce the risk of transmission by almost 50%. The Elizabeth Glaser Pediatric AIDS Foundation has already established more than 200 sites worldwide to provide the drug to mothers and infants.

We’re also seeing important progress in vaccine delivery. Three years ago, when immunization rates were dropping in many countries, the Global Alliance for Vaccines and Immunization (GAVI) was launched here in Davos. Today, GAVI is working in 55 countries and has delivered approximately 130 million vaccine doses – efforts that have already saved an estimated 100,000 lives.

As we work to roll out the prevention interventions we have, we must also push the frontiers of science to develop new technologies, such as vaccines for AIDS and malaria, and better treatments for tuberculosis. Of the $70 billion spent globally every year on medical research and development, only 10% is devoted to the diseases that cause 90% of the world’s health burden. We need increased investment and collaboration to find answers to the great scientific questions facing the field, in the same way that the world has come together on other formidable issues of our time – from the eradication of polio, to the international fight against terrorism.

The world leaders gathering in Davos are well aware of AIDS and other health problems. The danger is that not enough of us believe that there are solutions, or that we have the power to make the changes that are needed. Let’s commit to take the solutions we have, deliver on them and challenge others to do the same.

THE ROLE OF BUSINESS
By Tony Trahar, chief executive, Anglo American plc

As the world rightly worries about the possibility of rogue states possessing biological weapons of mass destruction, a natural human health catastrophe continues virtually unabated.

The HIV/AIDS epidemic has already killed millions and each year millions more become infected. The burden of disease in sub-Saharan Africa is staggering and is set to worsen. Moreover, there are signs that the epidemic may acquire critical mass in countries like China, India and Russia. If this happens we will be facing a truly global disaster.

The world must be mobilized to fight the epidemic with renewed vigour and intensity. We need new ideas, new strategies – taking into account, and learning from, the failure to contain the epidemic in sub-Saharan Africa.

Moreover, in a globalized world we cannot assume that any society will be able to stand apart from the onward march of the virus. The devastation caused by AIDS is not inevitable – we can reverse its impact, but we must act now.

An effective response to AIDS, especially in developing countries, is beyond the capacity of any single organisation. We will only succeed if we can establish partnerships between governments, businesses, labour and civil society.

These partnerships apply not only within countries that are highly affected by HIV/AIDS, but also to the entire global community. Business should take a leading role in forging public-private partnerships at both the national and the international level.

The Global Fund to Fight AIDS, TB and Malaria is a good example of a new global public-private partnership, specifically created to deal with the scourge of these diseases in the developing world.

Business should be a key partner in that initiative – not so much because of the money required, but because of the business products, methodology and management expertise that can be brought to bear in the fight against AIDS in communities that would otherwise not have the capacity to respond. Drug donations, for example, are a hugely valuable resource in the global response to these diseases.

On a national level, businesses have a crucial role to play in highly affected countries. Anglo American has been running award winning HIV/AIDS programmes for more than a decade at our African operations.

Without the programmes the progress of the epidemic might have been even worse. But we have also had to recognize the limitations of the achievement when anonymous prevalence testing in our South African operations indicates that a quarter of our workforce may be infected with HIV.

Our programmes have consistently involved reaching out to surrounding communities. HIV/AIDS is principally sexually transmitted and infections can only be effectively tackled on both sides of a mine’s perimeter fence.

Hence we use techniques like: working with traditional healers to spread prevention messages; devising income creation schemes for women to divert them from sex work; setting up peer education schemes for sex workers; and extending treatment of sexually transmitted diseases to local communities. Whenever possible – at Carletonville in the heart of the goldfields, in the coal mining “Powerbelt” of Mpumalanga, in the forests of Kwazulu-Natal, or at Namakwa Sands in the Western Cape – our operations seek to mobilize partnerships with other companies, community groups and local government to prevent the spread of the epidemic and to support and treat these who are infected or affected by HIV.

More recently, Anglo has decided to make anti-retroviral therapy available to employees. This is in addition to our existing wellness programmes – which consist principally of improving nutrition and preventing and treating opportunistic infections with antibiotics.

Together with AngloGold, we employ some 135,000 people in southern Africa, so we are shouldering a significant potential responsibility. We believe it is the right decision for three reasons.

First, only if more people are given a real incentive to come forward and be tested will we be able to increase the numbers of people who confront the reality of their HIV status – and thereby chip away at the wall of stigma and denial.

Second, because in South Africa there is currently no consistent leadership in pushing a comprehensive and effective response to HIV/AIDS. The experiences of Senegal, Uganda and, increasingly, Zambia are that only through single minded and consistent leadership can the epidemic be forced into retreat. We hope that through our lead we can help to break the logjam, which afflicts policy.

Third, it is the right thing to do for our workforce. Moreover, from a financial standpoint, we anticipate some balancing savings from keeping infected workers active and productive for longer. Our focus is on helping people, often at the peak of their potential economically active lives, and to continue to support their families – a major factor in the battle against poverty.

Thus, we believe that voluntarily counselling and testing for HIV and access to anti-retroviral therapy are critical. Business can take the lead in piloting treatment access programmes in resource-poor settings. HIV prevention efforts will be futile unless linked to improved care and support for people with AIDS. In the long term we need to find an effective vaccine against HIV/AIDS. The work on that vaccine requires accelerated efforts now and business needs to be an active partner in that search.

Because of the role of poverty in accelerating death and in creating conditions in which the virus is spread more easily, private sector investment is crucial in developing countries to sustain economic development.

This is one of the most important contributions that can be made by global business. We must not forget that the greatest impact of the HIV/AIDS epidemic is focused on the economically active segment of the population.

If the fragile economic engine of developing countries falters we will lose ground in seeking to close the divide between rich and poor nations. With leadership and planning, the epidemic can be managed and businesses can flourish to the benefit of shareholders and of the three-quarters of the population still free from HIV infection.

The Global Health Initiative launched by the World Economic Forum is a unique collective attempt by business to address the scourge of HIV/AIDS, TB and malaria in developing countries. This initiative has produced many innovative ideas and opportunities for business engagement in this increasingly important field of corporate social responsibility. The executive statement of the GHI task force gives excellent guidance on how to commit to greater business involvement. This initiative and the work of the Global Business Coalition against HIV/AIDS deserve the active support of all members of the forum.

AFRICA’S CHALLENGE
By Jonathan Oppenheimer, head of Africa producer relations at De Beers and a Global Leader for Tomorrow

The HIV/AIDS pandemic is one of the greatest challenges facing Africa and the international community. According to a recent UNAIDS report the number of people living with HIV/AIDS increased from 40 million in 2001 to 42 million in 2002. Five million people were infected in 2002, while 3.1 million died as a result of the disease in the same year.

Africa is the worst affected region. It accounts for 70% (29.4 million) of those living with HIV/AIDS, 70% (3.5 million) of those infected in 2002 and 77% (2.4 million) of those who died of AIDS in 2002. These figures are as much a challenge to Africa as they are to the international community’s failure to effect a robust global response to combat the spread of HIV/AIDS.

De Beers and its partner companies, Debswana (in Botswana) and Namdeb (in Namibia) are committed to play a leading role in the battle against HIV/AIDS. Some years back De Beers elevated HIV/AIDS to a strategic leverage area, on par with other strategic business issues that are central to the company’s commercial success.

The company believes that, unmanaged, the impact of HIV/AIDS would be catastrophic for the people, communities and economies of highly affected countries. The main focus of the company’s initiatives is to minimize the impact of HIV/AIDS on employees and the organization through care and support for those affected and reduction in prevalence rates among those not yet infected.

Education and awareness programmes are an essential element of a comprehensive prevention strategy that, among other things, aims to save lives by encouraging those who are not infected to stay so. We believe that the prevention of infection is the most critical aspect of any strategic attempt to contain the disease.

However, care and support for those who are HIV positive is also very important. They are encouraged and assisted to adopt a holistic approach to health and wellness. The education and awareness initiatives are run for employees and, where appropriate, their families and surrounding communities in order to empower them through the provision of relevant information on HIV/AIDS and how to cope with it.

Our company actively engages all relevant stakeholders, especially the National Union of Mineworkers, government and other companies, to maximize the effectiveness of its efforts to manage HIV/AIDS.

This also enables the company to share its experiences while simultaneously learning from emerging best practice in the field. Linked to this is the need for continuous tracking and monitoring of the various impact indicators and the efficacy of all HIV/AIDS interventions.

The company also supports primary healthcare initiatives, including the treatment of sexually transmitted diseases and other opportunistic infections. Condoms are freely available to employees.

We have also led the way in extending our response to HIV/AIDS in the workplace by providing infected employees and a spouse or life partner with access to the required medical treatment. The provision of antiretroviral therapy is one of the components of the company’s holistic response to HIV/AIDS in the workplace that is located within a broader employee wellness philosophy.

Through its corporate social investment vehicle, the De Beers Fund, the company has also tripled its investment in HIV/AIDS over the last two years. It now supports 31 projects directly associated with HIV/AIDS prevention and care. HIV/AIDS poses serious challenges to Africa’s prospects for growth, development and human security. Africa’s global competitiveness, productivity and attractiveness as an investment destination of choice partly hinges on the effectiveness of its response to this challenge.

NEPAD and the future of the African Union are dependent on all countries facing up to the HIV/AIDS challenge.

With full commitment from both the public and private sector the terrible human and economic cost can be limited and Africa can become the attractive environment that its potential promises.

A VIEW FROM THE FIELD By Milly Katana, representative of the Health Rights Action Group-Uganda and a board member of the Global Fund to Fight AIDS, TB and Malaria

The scale of the HIV/AIDS epidemic poses unique challenges. Yes, there has been a lot of work done since the start of the epidemic in the early 1980s – particularly in the areas of prevention and education. But these efforts seem to bear very little fruit, with only a handful of countries showing stabilization in the level of new infections. At the grassroots level, frontline fighters are growing tired of pushing the rock uphill.

HIV/AIDS in developing countries strikes at the very heart of standards of living and development. In terms of life expectancy, literacy levels, infant mortality and nourishment, it is threatening the very foundations of people’s lives and livelihoods.

The challenges are vast – in the complexity and scale of the epidemic, in the biting levels of poverty in affected communities and countries, in the extent of the money required to combat it and the slow pace at which it is arriving, and in the feeble infrastructure systems.

There is also a huge psychological challenge. HIV/AIDS touches the most taboo areas of humanity – death and sexuality. Deep in people’s minds is the conviction that the epidemic is a killer and little or nothing can be done to deal with it.

Denial is a natural response to imminent death. But this denial has created the environment for HIV/AIDS to proliferate, threatening to overwhelm humanity altogether in some countries.

It is the same with sexuality. People find it hard to talk about sex. In many communities, people are left to discover by themselves. If they are told anything, it is often only that sex is difficult and dangerous – with no options offered on how to address the difficulty or danger.

Breaking the norms and talking about death and sexuality as part of normal social dialogue is vital – above all in so many communities where the majority of people living with HIV/AIDS die before their 40th birthday, and the majority of children born to parents with HIV/AIDS die before they are six.

It is vital because the impact of the epidemic goes well beyond the families affected to the extended communities. The numbers of children who are orphaned and who need the basic essentials of life and education makes the problem exceptionally difficult to deal with.

The epidemic needs substantial extra financing – to tackle education, social welfare, health and community development. The UN estimates that the world needs an additional $10 billion a year to bridge the financing gap for the three most life-threatening diseases: HIV/AIDS, malaria and tuberculosis.

Most of this gap is felt at the grassroots level. This is the frontline where: children lose their parents and ageing parents lose their children; young people stand in the queues of the infected; family incomes are disproportionately spent on healthcare rather than on food; farm labour is reduced or lost altogether – depleting the family granary stores even further; and care volunteers cannot even find painkillers for their patients.

There is a limit to what communities can offer to families affected by HIV/AIDS in the villages. Technologies are required now which can only be provided by specialist referral infrastructures. Testing for HIV/AIDS, which is the entry point to personal commitment in terms of protecting oneself and others from HIV/AIDS, is minimal.

In many developing countries, education on prevention which is not proportionately supported by technology has had very little impact in the long run.

Many treatable HIV/AIDS-related opportunistic infections – including TB and cryptococcal meningitis – are not diagnosed properly or on time, accounting for many preventable deaths among people with HIV/AIDS. Effective medicines are not used because they are not affordable.

HIV/AIDS cannot be fought at at the grassroots level alone. The global community must step in and change the nature of the fight. The impact of the epidemic on communities is manageable, although it is not necessarily reversible in the short term.

But the human suffering can be brought under control now, as long as there is sufficient global action. HIV/AIDS does not have to be a death sentence. Once people come to terms with this, we can start to reduce the vicious circle of denial, hopelessness, further infection and further suffering. We can start to cultivate hope.