HAART for the HIV-infected employees of large companies in Africa.

The International AIDS Conference held in Durban in 2000 was a watershed for highly active antiretroviral treatment (HAART) in Africa. Since then, HAART in sub-Saharan Africa has been fi rmly on the international agenda, and access to treatment in resource-poor settings has become a top priority. Multiple initiatives were developed to realise the goal of expanding treatment access (The Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President’s Emergency Plan for AIDS Relief, the World Bank’s Multi-country AIDS Programme, and many others). Although private sector employers in Africa were some of the fi rst to embark on HAART for their workers (eg, Anglo-American, Compagnie Ivoirienne d’Electricité, Volkswagen South Africa), public sector approaches have now largely surpassed these eff orts. Few large companies in Africa have launched comprehensive AIDS treatment schemes for their workers and dependants. Most employers in Africa hesitate to take responsibility, and refer employees to government HIV programmes that are benefi ting from international fi nancial support but struggling with implementation. There is an encouraging trend among companies in countries with high prevalence to have HIV policies, but even in countries with prevalences between 5% and 20%, less than half of companies claim to have an HIV policy. In sub-Saharan Africa, only 26% of the companies that have HIV policies provide antiretroviral treatment to their workers. In 2001, Heineken decided to add HAART to the package of medical benefi ts for employees. Where the existing medical policy extended to spouses and family members, dependents would also benefi t from HAART. The programme was implemented in collaboration with PharmAccess Foundation, a non-government organisation from the Netherlands dedicated to sustainable quality AIDS treatment in resource-poor settings. In many business meetings, Heineken was asked what justifi ed the decision to off er treatment to their employees, but on those occasions the question was reversed and other companies asked why they did not off er HAART to employees. Various reasons were given; here we point out why such justifi cations are not valid.