An investigation into how the transport suppliers employed by multinational companies contributes to the spread of HIV in Sub-Saharan Africa urges companies to take action.
Long-distance truck drivers have long-been identified as the primary dispersers of HIV in Sub-Saharan Africa. Truck drivers lead difficult lives with frequent overnight stays away from home, fewer social controls and excessive waiting periods in ports and border crossings, where the availability of commercial sex increases their vulnerability to infectious diseases and other health problems.
Multinational companies predominately outsource their transport supplier to international or local operators as part of their Sub-Saharan supply chain to save cost. Yet, according to a 2006 baseline report on business and HIV/AIDS by GBCHealth, the transport industry ranked last in their efforts to protect their employees against HIV and other infectious diseases.
Now, an investigation of organisational awareness of the risks of HIV transmission within the transport supply chains of Dutch multinational enterprises has resulted in a series of recommendations to help combat the spread of HIV/AIDS. These include companies providing more, and better, HIV/AIDS education, and them seeing HIV/AIDS as an HR priority.
Dr Rodney Irwin, who carried out the research as part of the Master of Studies in Sustainability Leadership at the Cambridge Programme for Sustainability Leadership, said: "There is no cure for HIV but it has become a manageable illness with the global incidence of AIDS declining but they are still major issues for the transport sector. The Millennium Development Goals have made significant progress at a macro level but this vulnerable group remain primary victims and vectors of the virus. This research aspires to spur action in Dutch businesses to step up to the issue in their supply chains and offer as much intervention as is possible."
Irwin's study focused on 11 Dutch multinational companies that conducted business in southern Africa. Although Dutch multinationals are three times more likely now to advocate a global HIV policy for their supply chain and associates, many of the findings speak of a decrease in the multinationals' efforts to stem the transmission of this disease. Despite 80% of the Dutch companies having identified HIV/AIDS as an issue, the study found little improvement in the management of HIV/AIDS since the 2006 GBCHealth global survey.
For instance, 36% report having no counselling and testing initiatives in place (15 % in 2006), and 36% provide no access to care, support and treatment services (9% in 2006).
Irwin points to the existence of disagreement between business and government as to who should bear the cost of HIV interventions, as well as the stigma of the disease and prevailing attitudes towards safe sex, HIV testing and other policy actions remaining a strong barrier to tackling the problem. He also suggests that the strong focus on cost-saving as a reason for outsourcing has added to the problem, saying: "Smaller transport companies, who themselves engage in subcontracting, are unable to provide HIV/AIDS interventions if their revenues are eroded by customers seeking costs savings."
On the basis of his findings, he recommends that companies should support fixed and mobile clinics to provide HIV education, testing and treatment for 'at risk' groups such as truck drivers and sex workers. This would open up lines of communication, and impress upon both parties (employer and employee) their own personal responsibilities.
He further recommends that companies should conduct an HIV/AIDS risk assessment not only with direct employees, but also with other stakeholders, especially the transport supply chain. It should also be followed up by a workplace HIV/AIDS policy.
"It's important to adopt a human capital approach that places a high value on employees, including outsourced and sub-contracted labour," he said. "HIV/AIDS should be a priority for human resources, rather than a function of corporate social responsibility."
Finally, he recommends that border crossings must be made more efficient in order to minimise nights away from home for truck drivers, and the encouragement of truck drivers to have their spouses accompany them on long trips where possible.
Irwin hopes that his recommendations will be taken up by companies in order to tackle an escalating problem. Today long-distance truck drivers have an HIV infection rate believed to be at least twice that of the general population in Sub-Saharan Africa. In South Africa, a 2001 study found that 56 per cent of long-distance truck drivers were HIV positive, with 95 per cent of those tested at one truck stop infected. In Malawi, another study concluded that AIDS-related illnesses were truck drivers' primary killer, above malaria and road traffic accidents.
"HIV and sex are inseparable. Taking about sex is not something you often do in the board room but for transport companies and their users this taboo subject urgently needs to be on the agenda," he added. "HIV and AIDS are occupational illnesses for the transport sector. I urge these companies and their customers to acknowledge their responsibility. Just as the UK's HIV awareness campaign in the 1980's said "Don't die of Ignorance", transport companies should step up, confront the stigma and not allow this vulnerable group to die of ignorance."
Rodney Irwin's research was carried out as part of a Master of Studies in Sustainability Leadership at the Cambridge Programme for Sustainability Leadership. www.cpsl.cam.ac.uk/Accredited-Programmes
Insights from truck driver Charles Makomba
Charles Makomba is a long-distance truck driver; in the picture above he can be seen as he drives out of Chirundu, a key transit point on the border of Zambia and Zimbabwe and a significant hotspot of HIV/AIDS transmission. Talking to Northstar Alliance, a group of NGOs committed to delivering health services throughout Africa, he commented on the problems caused by the long waits for customs clearance.
"It's a difficult journey because of the problems at the border. There is too much congestion and they are too slow to process our papers. Recently I waited for six days.
"Usually I get a girlfriend, and the following day maybe another girlfriend. It's high risk because of this dangerous disease. I always use a condom because I'm aware of this disease. Except with my wife, I use condoms every time.
"I don't think all truck drivers are the same. Some of them are reckless maybe if they've got that disease. The trucking companies encourage us to use condoms, because they are losing many drivers and it is hard to replace them."