World AIDS Day: HIV/AIDS & work in a globalizing world
The theme of World AIDS Day 2005 is "Stop AIDS - keep the promise" - of the international community to control the epidemic and help those affected. As current chair of the UNAIDS Committee of Cosponsoring Organizations, the ILO is marking this day by focusing on workplace action in the community at large and in the UN. Odile Frank, ScD, Senior Research and Policy Adviser and Head, Research and Policy Analysis Unit of the ILO Global Programme on HIV/AIDS and the World of Work recently completed a new study on "HIV/AIDS and work in a globalizing world" and gave this interview to ILO Online.
Question: Before we discuss globalization, can you explain just what you mean when you say that AIDS is a workplace issue?
Odile Frank: AIDS is a workplace issue because it affects labour and productivity and because the workplace is a vital platform for the wider struggle to control the epidemic. Right now, over 38 million adults of working age are living with HIV/AIDS around the world. The vast majority of them are in the world of work, in other words, working in some way, and this means also the vast majority of people with HIV/AIDS are adults in their peak productive years. The significance of this cannot be overstated: by threatening the livelihoods of many workers and those who depend on them - families, communities and enterprises - the epidemic also weakens national economies.
Question: How do you characterize the relationship between HIV/AIDS and globalization?
Odile Frank: Basically, it's a puzzle with four interlocking pieces. Poverty and HIV/AIDS interact, movement in search of work or for work interlocks with HIV/AIDS, and globalization opens opportunities for movement. We know that movement of people can be a factor in disease epidemics. What's remarkable about HIV/AIDS is that it can move stealthily, wherever people travel or work. And these days, globalization is stimulating more travel and wider-ranging work than ever before.
Question: The truck drivers in Africa and India, the people migrating from various parts of Asia and Europe in search of work? What forms of work make people vulnerable to HIV/AIDS?
Odile Frank: That's right, and there's more. Greater air transport, lower airfares, more travel and tourism. Not only that, but more migration. Millions of poor people are migrating in search of a better life. Searching for work leads to risk of HIV/AIDS in young single migrants for a variety of reasons. In addition, of the world's estimated 12.3 million forced labourers, many are youth and 2.3 million are trafficked - over 40 per cent for sex work. People who move as part of their work (in road, rail, sea and air transportation, for example) are also exposed to risk of HIV/AIDS when separated for long periods from home. People who travel are exposed to the risk of HIV/AIDS and some are sexual tourists having contacts with sex workers and people in the hospitality industry, all of whom are at increased risk.
Question: What is the economic impact of this?
Odile Frank: HIV/AIDS has lowered life expectancy in 40 countries of sub-Saharan Africa from 62 to 47 years. But longer life expectancy is good for foreign direct investment (FDI): it is 2 per cent higher for each additional year of life expectancy. Thus FDI is forfeited when HIV/AIDS lowers life expectancy. We calculated that for one sub-Saharan African country 0.4 per cent of FDI was lost per year of life that was lost due to HIV/AIDS.
Question: Does HIV/AIDS cause poverty and who is at greatest risk?
Odile Frank: A higher prevalence of HIV/AIDS is associated with less economic growth, more income inequality and more poverty. As young women are at least three times as likely to become HIV positive as men, we calculated the potential risk of HIV for young women in poverty. Global estimates of their risk of HIV/AIDS due to poverty show that of 52 million working-age women 15 to 24 years in Sub-Saharan Africa, for example, 12-13 million (or 1 in 4) are at risk because they are female young, poor, living on less than the equivalent of US$2 per day, and living in urban areas with little/no urban infrastructure, and 7-8 million of them (or 1 in 7 of all young women) are at great risk because they are living under US$1 per day.
Question: What other forms of migration can be attributed to HIV/AIDS?
Odile Frank: Sometimes, the fear of AIDS makes people move. For example, in 11 sub-Saharan African countries, the greater the number of daily deaths due to AIDS, the greater the number of nurses who leave to work overseas, e.g. in South Africa there are 1,000 AIDS deaths a day, and 5 nurses leave the country each day when South Africa has only 1 nurse per 3,000 HIV patients.
Question: What can we do about this?
Odile Frank: First, the workplace is an excellent entry point for HIV/AIDS prevention and extending the reach of treatment. The ILO Code of Practice on HIV/AIDS and the world of work offers principles and practical guidelines to implement HIV/AIDS policies and programmes. Second, on the national level the issue of HIV/AIDS needs to be integrated into national planning, with achievement deadlines, allocation of real resources, and donor coordination. On the global level, rights-based international laws are needed to protect all persons, and especially workers and migrants. For example, successfully enforcing non-discrimination at work stops rights violations that legitimize stigma and hamper efforts to control HIV.
Question: In summary then, what are some of the key issues or proposals that ILOAIDS is advocating people to think about?
Odile Frank: Let's find new ways of looking at HIV/AIDS as a social issue. Let's think about new forms of global governance, a new architecture for our societies to deal with this global challenge. Let's look again at trade issues and intellectual property rights. Let's explore how debt relief may help alleviate poverty and help stop HIV transmission. Let's think about our global social responsibility and explore the notion that treatment may be a public good. These are all factors in making globalization not only fair, but also safe - and to keep the promise to stop AIDS.
Note 1 - HIV/AIDS and work in a globalizing world 2005, International Labour Office, Geneva 2005 (forthcoming).