If HIV/Aids infection continues at its current rate, the gap in the productive workforce could be devastating. Aaron Nicodemus reports
For a country like South Africa, the worst part about Aids is who it kills. Unlike the bubonic plague that devastated Europe centuries ago, Aids does not prey upon the weak, the old and the sick. Its main victims are the strong, the vibrant and the sexually active. And it leaves behind children and the elderly to pick up the pieces.
By the year 2020, there is a very real possibility that within the heart of South Africa’s workforce – people 20 to 40 years old – one in every three will be sick with HIV/Aids. These are the people on whose backs the new South Africa should be built: nurses and teachers, government officials and construction workers, farmers, bankers, factory workers and truck drivers. These are the caregivers of society, the mothers and fathers. These are neighbours and business associates. Your children. Your spouse. Yourself.
In numbers of people dying, the Aids epidemic is approaching bubonic plague levels. Some 11,5-million people (a quarter of them children) have already died from Aids in sub- Saharan Africa, according to UNAids.
In 1998 alone, Aids was responsible for more than two million funerals on the continent. By the end of 1998, an estimated 21,5-million men and women will be living with HIV in Africa, plus another one million children, UNAids says. And four million people contracted the disease on the continent last year alone.
The latest figures available in South Africa indicate that nearly four million people, and probably several hundred thousand more, are already infected with HIV. More than 1 500 people become infected every day. It is not alarmist to say that these four million people will die within the next five to seven years, replaced by four million more people living with HIV.
When the bubonic plague wiped out a major portion of the population, it did its work relatively quickly. There was no missing the signs, because the bodies piled up. But Aids is insidious. People die slowly, usually at home. Because of the stigma attached to a sexually transmitted disease, the cause of death is often listed as something else, like tuberculosis or influenza.
Ironically, the economic effect of the bubonic plague was beneficial: wages went up, and overall gross domestic product of the countries hardest hit went up, too. That’s because after the plague had run its course, those left standing were productive members of society.
Aids will have the exact opposite effect. It preys on people in the prime of their lives, killing them when they have the most to contribute. The resulting gap in productive workforce could be devastating, not only on a human level, but an economic level as well.
Simply put, those most capable of doing the work will be unable to do it. They’ll either be sick with HIV, or caring for someone who is.
When asked what he thought Aids will do to South Africa in the next 20 years, University of Natal professor and Aids researcher Alan Whiteside had this immediate response: “It will be an absolute fucking disaster.”
Dr Clive Evian, a consultant to the Department of Health and an Aids clinician at Johannesburg hospital, says, “South Africa has the most explosive Aids epidemic in the world. We have a unique set of circumstances that make us particularly susceptible.”
The factors playing into the spread of Aids in South Africa are numerous, he says: poverty, the stigma of Aids that makes the disease unspeakable, the breakdown in family structures due to apartheid, and the hostel system, to name a few.
Since Aids is a chronic disease, Evian says, the effect will be gradual. Hospitals with no room will force people into hallways and waiting areas, while people with less immediate health needs will be refused admission.
Businesses will have to spend more money to retrain workers to replace those lost to the disease, and productivity will fall due to missed work days. Government services will slow even further as key officials (or their loved ones) get sick and die. And education will lose innumerable days of learning when teachers become sick.
Then there is the human side of the disease. Aids is an impoverishing disease in a country already racked by poverty. As people with Aids slowly die, their families lose their incomes, medical bills pile up and family members are forced to care for the sick. When a person living with Aids finally dies, left behind is a family who will struggle to cope, impoverished psychologically, emotionally and financially.
Since those dying of Aids are also the primary caregivers, the number of Aids orphans, already estimated to be nearly three million, will continue to grow.
Business has been as slow as the government and society to respond to the epidemic. “Most companies in South Africa don’t believe the threat is there. It’s only when your customers and your employees fall down dead that you believe it,” says Charles Harebottle, consultant for Occupational Care South Africa. “Aids is as much a threat to businesses as it is to individuals.”
But Aids will not affect all businesses in the same way. A company that exports all its products abroad, for example, will not worry about its customers dying from Aids. But a local furniture company, that sells exclusively to South Africans, could be doubly hit: its customers will become sick, and families hit by Aids will have less money to spend on furniture.
Harebottle says that one food manufacturer is altering its product line to include more painkillers, which people living with Aids would buy, and fewer luxuries, which someone with Aids could not afford.
Internally the effects on industry are much more devastating. Eskom commissioned a survey in 1995 to determine the effect of Aids on the 37 000 members of its workforce. “We’re looking at 18% to 20% of our workforce being infected by 2005,” says Charles Roos, Eskom’s chief medical officer. Eskom estimates it will be spending up to R400- million every year from 2005. That money will be spent on pension costs, medical aid expenses, lost productivity and recruitment for new employees. The figure represents a quarter of the company’s wage bill.
“Once you’ve quantified the impact, it helps you to focus attention and get management commitment,” Roos said. “Management didn’t know where to start until they received that data. It became a strategic priority once it was quantified.”
Roos says Eskom has begun an aggressive campaign to educate all its employees about the dangers of HIV/Aids, as well as how deal with the disease should they contract it. Condoms are freely distributed and there is a discussion among the company’s managers on creating an in-house hospice centre to care for those employees who are already sick. “We’ve found that HIV/Aids cases aren’t being attended to as they should be in the public and private sectors.”
At Iscor, the numbers are similarly startling. Diane Ritson, the company’s project manager for HIV/Aids, says the disease will cost Iscor R600-million over the next seven years. She was hesitant to release percentages of Aids infection within the workforce, but agreed the numbers approached those unearthed by Eskom. Iscor will spend R45-million this year on an aggressive HIV education campaign for all its employees and their families, in addition to providing condoms and treating other sexually transmitted diseases.
At a 1998 rally, Deputy President Thabo Mbeki said: “For too long we have closed our eyes as a nation, hoping the truth was not so real. At times we did not know that we were burying people who had died from Aids. At other times we knew, but chose to remain silent.”
If South Africa really wants to know what it’s like to be a country devastated by Aids, it should look no further than its northern neighbours. In Botswana, Namibia, Swaziland and Zimbabwe more than one person in five between the ages of 15 and 49 is living with HIV/Aids, according to UNAids. The organisation has 25 surveillance sites in Zimbabwe, where blood from pregnant women is anonymously tested for infection. In 1997 between a fifth and half of all pregnant women had HIV, and a third of pregnant women were likely to pass HIV on to their children.
With the economies of many of these countries in flux it is difficult to say exactly how Aids is affecting national economies as a whole, says UNAids. But there are some indicators.
In Zimbabwe life insurance premiums have quadrupled in just two years because of Aids deaths. In Botswana, companies estimate that Aids-related costs will soar from less than 1% of the wage bill to 5% in six years’ time. Large companies in Zambia and Tanzania report the costs from Aids illnesses and death exceeded their total profit for the year, according to UNAids.
Aids is a disease that is spreading, in large part, because people pretend that it isn’t there.
Whiteside cites two statistics from the United States Bureau of the Census which he says are vital to understanding how Aids will affect South Africa: life expectancy and infant mortality.
In 1998, the agency determined the life expectancy of the average South African citizen to be 55,7 years. If Aids were not killing hundreds of thousands of South Africans, this figure would rise to 65. The gap grows even wider by 2010, according to the agency. Without Aids, the average South African would live to the age of 68; with Aids, the life expectancy will drop to 48.
Infant mortality tells a similar story. In 1998, 10 out of every 100 South African children died before the age of five. By taking Aids out of that equation, the US agency estimates that figure would drop to seven out of every 100 children.
By 2010, one out of every 10 children born in South Africa will die before age five, as opposed to one out of every 20 if Aids were somehow erased from the equation.
Evian is pessimistic that anything short of a vaccine will slow the spread of the disease. “It’s not going to tail off suddenly, or even level off. Aids is going to be with us for a long time. I think a vaccine is the only chance we’ve got.”