Health GAP Position Paper
www.globaltreatmentaccess.org | www.healthgap.org

In developing countries hardest hit by the AIDS crisis, employees of multinational corporations comprise a sizeable portion of people living with HIV/AIDS, and people at greatest risk of becoming infected. The International Labor Organisation (ILO) estimates at least 25 million people living with HIV are workers aged 15 to 49, or more than half the current estimated international population of HIV positive people worldwide.

Multinational Corporations (MNCs) have increasingly sought out low-cost labor, moving jobs from the US--through the gates of greater globalization--to countries where they can ignore basic rights of workers while reaping tremendous profits. While MNCs depend on the labor of millions of HIV positive people to maintain wealth and profit. Virtually all MNCs have flouted the most fundamental need among HIV positive workers in the developing world: the urgent need for access to affordable, life-extending HIV treatment and care.

Against a backdrop of intensified international attention to the global AIDS crisis, and increasing political commitment among policy makers in the developed and developing world, a flurry of announcements of MNCsÕ new AIDS initiatives have grabbed headlines, especially during the last two years. Initiatives have varied in scope and focus, with some MNCs attending to non-specific HIV "awareness building" in the workplace while others increased prevention efforts through marketing of HIV counseling and testing. With a few notable exceptions, these recent initiatives either sidestepped the issue of employee treatment or extended HIV treatment access to a strictly limited sub-set of employees.

Non-government organizations (NGOs), public health experts, and health care providers have convinced previously skeptical policy makers and politicians that antiretroviral treatment is feasible in the developing world, and must be implemented. Studies continue to point to business interest in providing treatment as part of a comprehensive program, and the World Health Organization and other experts have established tools and treatment modalities. Academics and foundations are working to partner corporations with community groups and operational NGOs for technical assistance. There is no excuse left for corporations not to adopt a policy of paying for comprehensive HIV/AIDS care, treatment, support, and prevention for workers and their dependents.

A wide network of AIDS activists, students, faith-based groups, socially responsible investors, and labor, working in coordination with groups in developing countries are poised to launch a new set of high profile campaigns against corporations declaring that time is up for corporations to:

* Implement comprehensive HIV/AIDS workplace programs including non-discriminatory policies, education and prevention measures, access to voluntary HIV counseling and testing (VCT), psycho-social support, and HIV treatment, including ARV therapy for workers and dependents. MNCs must continue wages, rights, and benefits, including access to care and support, to workers who are no longer able to work due to illness so they are not destitute.

* As a standard of care, MNCs and/or private medical insurance must provide for the diagnosis and treatment of sexually transmitted infections (STIs), prevention of mother to child transmission (MTCT), treatment of opportunistic infections (OI), appropriate monitoring and testing, home-based care and hospitalization, palliative care, and antiretroviral treatment. Treatment options should be consistent with those guided by current internationally recognized standards of care for people living with HIV.

* Redress the conditions and business practices that foster the spread of HIV such as single-sex housing and ensure the right to safe and healthy working conditions. This provision encompasses the prohibition of violence, harassment, and sexual assault of women in the workplace.

* Contribute to the social good through social investments to address HIV/AIDS and paying local taxes. Corporations have historically pursued tax rate reductions, tax concessions, and other forms of tax avoidance that have permitted them to under-fund social welfare and public health systems.

* Incorporate the needs of the community in the design, implementation, and continual monitoring on HIV/AIDS programs and work in collaboration with community-based programs and initiatives. Wherever MNCs have created single-sex workplaces, or rely heavily on migrant workers, MNCs must extend outreach, voluntary counseling and testing, and treatment--especially of STIs--and OIs to surrounding communities. Extra efforts must be made to reach sex workers and partners with the goal of improving the health of the overall community in addition to preventing transmission to workers.

AS PART OF THE "TREAT YOUR WORKERS" CAMPAIGN:

* Communities will pressure Coca-Cola to speed up its efforts and make good on its commitment to provide AIDS treatment to its entire workforce in Africa. The company must also be held accountable should the Program's cost burden on workers and smaller bottling partners prove a barrier to the rollout or uptake of services.

* Companies in the extractive industries, such as Exxon, will be targeted for refusing to adopt treatment policies and pressure will be brought to bear on ChevronTexaco, Shell, BP, Conoco and other major oil companies until treatment policies are implemented. The industry will be forced to address business practices that facilitate the spread of HIV such as single-sex housing and housing workers far from their families and communities.

* The monopoly of coffee buyers, comprised of Philip Morris/Kraft, Nestle, Procter & Gamble, Sara Lee, and Tchibo, will be held responsible for exploitative practices resulting in women exchanging sex for work and for the buyersÕ failure to pay for basic healthcare.

* Other US multinationals with operations in the developing world will be pressured to adopt comprehensive HIV workplace programs, including antiretroviral therapy. These include: 3M, Abbott Laboratories, Archer-Daniel-Midland, Boeing, Caterpillar, Citigroup, Colgate-Palmolive, Dell, Eastman Kodak, General Electric, General Motors Corporation, Hewlett Packard Corporation, Lockheed Martin, McDonalds, Merck, Monsanto, Motorola, Nestle SA, Pfizer, Phillips Petroleum, Raytheon, Royal Dutch Shell, Unilever.

The lack of access to affordable HIV treatment in developing countries, especially access to equitably priced antiretrovirals, has grave consequences. Every day more than 8,000 people in developing countries die of AIDS-related causes because treatment is unaffordable and therefore unavailable to them. These deathsÑmore than 3 million people each yearÑare unnecessary. It is the obligation and responsibility of MNCs to ensure the availability of life-extending treatment for infected workers and their dependents.