Crossing borders to fight HIV/AIDS

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Pete Lewis

with Anne-Grete Larsen and Arne Groenningsaeter (Fafo), and Moses Galeboe and Spambaniso Taneka (BNPC)

Crossing borders to fight HIV/AIDS

The Role Of South African Multinationals In The Private Sector Response In Botswana

Fafo-report 431

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Pete Lewis

with Anne-Grete Larsen and Arne Groenningsaeter (Fafo),and Moses Galeboe and Spambaniso Taneka (BNPC)

Crossing borders to fight HIV/AIDS

The Role Of South African Multinationals In

The Private Sector Response In Botswana

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ISBN 82-7422-425-6 ISSN 0804-5135

Cover page design: Fingerprint Co-operative Map: Nick Lindenburg, University of Cape Town

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Index of tables and charts

Table 1. Summary of SADC Code on HIV/AIDS and employment ... 21

Table 2. Summary of rights of employees living with HIV or AIDS, RSA... 35

Table 1. 3-digit industrial classifications, by sample ... 74

Table 2 Industrial classification by sample (paired companies) ... 75

Chart 1 Company size (number of employees) by sample ... 76

Table 3 Estimated use of non-standard employment contracts, by sample... 77

Table 4 Proportion of "non-standard" employees by type of contract, by sample ... 78

Chart 2 Use of "non-standard" employment contract, by main industry grouping...79

Table 5 Proportion of non-standard employment contracts, by sample for 14 paired companies (N=28)... 80

Chart 3 Gender composition of permanent labour force, by sample ... 81

Chart 4 Comparison of gender profile of labour force, by sample for paired companies ... 82

Chart 5 Comparison of age profile of Botswana subsidiaries of RSA companies, and Botswana national companies ... 83

Chart 6 "White and blue collar" profile of labour force, by sample ... 84

Table 6 Relationship between company size and gender profile, and "blue collar" profile of the labour force ... 85

Chart 7 Year of establishment of companies by sample ... 85

Chart 8 Year of establishment of company by sample, 15 paired (RSA/BW) companies ... 86

Chart 9 Organisational development of the companies ... 87

Chart 10 Distribution of labour force in different organisational environments, by sample ... 88

Table 7 Membership of national business coalitions against HIV/AIDS, by sample... 89

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Chart 12 The locus of decision-making as perceived from the Botswana side of the

border ... 91

Chart 13 The locus of decision-making as perceived from the South African side of the border (15 paired RSA companies... 92

Chart 14 The locus of decision-making as perceived from the Botswana side of the border (15 paired Botswana subsidiaries) ... 93

Chart 15 Number of companies that are franchises by sample ... 94

Chart 16 Proportion of labour force in franchises, by sample ... 94

Chart 17 Extent of disagreement about the locus of decision-making between RSA parent companies and their Botswana franchises ... 95

Chart 18 Presence of HIV/AIDS policy in the companies, by sample ... 96

Chart 19 Presence of HIV/AIDS policies, by company size ... 97

Chart 20 Proportion of the labour force in companies with an HIV/AIDS policy, by sample ... 98

Chart 21 Coverage of non-core staff ("non-standard") by HIV/AIDS policies ... 99

Table 8 Development process for HIV/AIDS policies, by sample ... 100

Chart 22 Communication of the HIV/AIDS policy to employees, by sample ... 101

Table 9 Communication of policy between RSA companies and Botswana subsidiaries ... 102

Chart 23 Content of written HIV/AIDS policies adopted by companies, by sample ... 102

Chart 24 Responsibilities outlined in company written policies on HIV/AIDS, by sample ... 103

Chart 25 Responsibilities outlined in PAIRED company written policies on HIV/AIDS, by sample ... 104

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Table 14 Responsibilities of line and middle management in HIV/AIDS policies, by sample... 106

Table 15 Responsibilities of employees in HIV/AIDS policies, by sample ... 107

Table 16 Targets and timeframes for specific objectives in HIV/AIDS policies, by sample ... 108

Chart 26 Progression of implementation of written HIV/AIDS policies across the border (12 PAIRED RSA/BW companies)... 108

Table 17 Relationship between employment level and financial position of companies over the past 5 years, by sample (N=99 responses)... 109

Chart 27 Qualitative estimation of impact of HIV/AIDS on companies, by sample ... 110

Chart 28 Estimated impacts of HIV/AIDS by median company size (multiple response, closed question) ... 111

Chart 29 Topics in research on HIV/AIDS conducted by companies, by sample ... 112

Table 18 Implications of HIV prevalence estimates by companies... 113

Chart 30 Manual/non-manual profile of companies, by estimated HIV prevalence rate... 114

Table 19 Matrix showing estimated HIV prevalence by core business activity... 115

Chart 31 Relationship between estimated impact of HIV/AIDS and reported skills shortages ... 116

Chart 32 Strategies to overcome skills shortages, by sample ... 117

Table 20 Strategies to overcome skills shortages are more diverse as HIV+ estimate increases ... 118

Chart 33 Coverage by medical insurance by sample ... 119

Table 21 Coverage by medical insurance, by company size (median number of employees) and sample... 120

Table 22Inclusion of HIV-related medical costs in company medical insurance schemes, by sample ... 121

Table 23 HIV-related medical services provided directly by companies at workplace clinics, by sample... 122

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Table 24 HIV-related medical services provided at workplace clinics attached to

companies, by sample ... 123

Chart 34 Work-time (paid) education and training for employees on HIV/AIDS, by sample.. 124

Chart 35 HIV/AIDS educators at the companies... 125

Chart 36 Participants in HIV/AIDS education and training at the companies ... 126

Chart 37 HIV/AIDS budgets ... 127

Chart 38 Authority to spend HIV/AIDS budgets... 127

Chart 39 Estimates of supply of condoms (male and female) at the companies, by sample ... 128

Chart 40 Estimates of supply of condoms (male and female) to the workforce, by sample ... 129

Chart 41 Difficulties companies face addressing HIV/AIDS issues... 130

Chart 42 Public reporting on company HIV/AIDS activities ... 131

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Acknowledgements

The research team gratefully acknowledges the following people and organisations for their generous contributions to this report:

Botswana National Productivity Centre

• Thembo Lebang, Executive Director, for his support and advocacy for the project at all stages

• Minah Maoto, for her administrative assistance in arranging workshops and conducting interviews with companies in Gaborone

• Peo Motshegare for her co-ordination of the BNPC input into the questionnaire design

• Moses Galeboe for his organising skills in arranging the successful workshop with participating companies in Gaborone to discuss draft findings, and the final public conference in Gaborone in November 2003 to launch this report (as well as his in- valuable contribution as a statistician and co-author)

• A very special thank you to Dr. Spambaniso Taneka for his research input, and for taking charge and conducting the fieldwork in Botswana (as well as his contribution as a co-author)

Fafo South Africa

• Line Eldring for her overall guidance, support, and management of the project, and her insightful comments

• Dolly Hlongwane for her excellent financial administration of the project, and organising the participants' workshop in Johannesburg, and the South African side of the final launching conference, ably assisted by Precious Dube

• Fanie Mohlahla for his desk research contribution

• Thabo Sephiri for his desk research contribution, and his active participation in the workshops to discuss draft findings in Gaborone and Johannnesburg

Production of the report

• Issy and all at Fingerprint Workers' Co-operative for the cover design and layout, and the printing

• Nick Lindenburg at the University of Cape Town for preparing the map on the cover in Arcview

Markdata Research Solutions Pty Ltd

• CEO Tertia Van Der Walt and her excellent staff and their enumerators for survey administration on the South African side of the border, data capture and assistance with questionnaire design

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The participating companies

• The CEO's and their nominated respondents for giving generously of their time to answer the survey questionnaire, and for attending our workshops in Gaborone and Johannesburg to discuss draft findings

South African Business Coalition on HIV/AIDS (SABCOHA)

• Managing Director Gaby Magomola and Project Officer Tracey King for giving the survey their unconditional support, and circulating this formally to all the companies which we approached for co-operation.

• The representatives of the all the stakeholder organisations who agreed to be inter- viewed to help us understand the context of the survey

Funders

• We gratefully acknowledge the generous financial assistance we received from The Norwegian Agency for Development Cooperation (NORAD) to carry out this project, and the launching conference in Gaborone in November 2003.

This report, with more technical details on the survey, will be available in pdf format in 2004 at http://www.fafo.no/pub/rapp/426

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List of acronyms

AGOA African Growth and Opportunity Act (USA).

AIDS Acquired Immune Deficiency Syndrome

ANC African National Congress

ARV Anti-retroviral (family of drug treatments for HIV) AZT Azathioprine (drug treatment for HIV)

BOCCIM Botswana Confederation of Commerce, Industry & Manpower

BW Republic of Botswana

CBO Community Based Organisation

CCA Common Customs Area

COSATU Congress of South African Trade Unions (RSA) DOH Department of Health (South Africa)

DOL Department of Labour (South Africa)

DTI Department of Trade and Industry (South Africa)

EEA Employment Equity Act (RSA)

ELWA Employees Living With HIV/AIDS

EU European Union

FEDUSA Federated Unions of South Africa

HIV Human Immunodeficiency Virus

HSRC Human Sciences Research Council (RSA) ILO International Labour Organisation

NAFCOC National African Federated Chamber of Commerce (RSA) NAPWA National Association of People Living With AIDS (RSA)

NCA Norwegian Church Aid

NEDLAC National Economic Development Labour Advisory Council (RSA)

NGO Non-Governmental Organisation

PLWA People Living With HIV/AIDS

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PMTCT Prevention of mother-to-child transmission of HIV

RSA Republic of South Africa

SABCOHA South African Business Coalition on HIV/AIDS SACOB South African Chamber of Business

SACU Southern African Customs Union

SADC Southern African Development Community SACP South African Communist Party

SDA Skills Development Act (RSA) SIC Standard Industrial Classification STD Sexually Transmitted Disease STI Sexually Transmitted Infection

VCT Voluntary Counselling and Testing (for HIV)

WTO World Trade Organisation

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Executive summary

This report compares what South African multinationals are doing on HIV/AIDS with what they are doing in their subsidiaries in Botswana, and with what Botswana national companies (i.e. those that have no connection with South African multinationals) are doing. In the process, we form a picture of the scale and depth of the interventions made by South African multinationals north of the border in Botswana, relative to the private sector in that country, and also to the expectations placed on the private sectors of both countries by their respective national policy frameworks on HIV/AIDS. Our data sources for this exercise were a desk study of the policy frameworks, both in general and in particular in the employment field, interviews with key stakeholders in the HIV/AIDS campaigns on both sides of the border, and a questionnaire survey of 100 companies, 33 of which were in South Africa, and 67 in Botswana.

Our key finding is that there is a long way to go before any of the companies we studied approach compliance with the SADC Code on HIV/AIDS and employment and by extension the various national codes that apply to them in both countries. On this background, however, there is in addition a definite hierarchy of responses to the pandemic, starting with the highest level of response in South African multinationals at home, the next (and considerably lower) level in their subsidiaries in Botswana, and the lowest level of response in Botswana national companies. More of the South African companies operate under formal HIV/AIDS policies at home, and these policies have more depth, focus, and clarity of objectives, and are better communicated to their employees, than those across the border in their subsidiaries, and especially those adopted by Botswana national companies. This is despite the opposite being the case when the policy environments of the two countries are compared. Where policies in South Afri- can multinationals have been adopted in their home country, they have been slow to roll them out to their Botswana subsidiaries, with the border crossing sometimes taking years. Company provision of voluntary testing and counselling and clinical treatment for pre-disposing conditions of HIV infection such as other sexually transmitted diseases, and for opportunistic infections of HIV/AIDS such as tuberculosis, is by no means ideal in South Africa, but it is much poorer in Botswana. Similarly, the coverage of employees and relevance of private sector health insurance to HIV/AIDS is less significant north of the border. Equally, South African company policies on HIV/AIDS at home frequently involve trade unions, but even this link to communities is not present in Bot- swana, quite apart from the absolute lack of involvement of employees' families and the broader communities in that country.

Education and training initiatives in our South African multinationals were generally not extended to their Botswana subsidiaries, and the use of peer methodologies for these was even less likely in Botswana than in the parent companies south of the border.

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Again, although the education methods used were generally top-heavy and hierarchical, and targeted managers rather more than employees, these negative traits were even more common in Botswana than in the South African parent companies operating at home. Assured budgets for HIV/AIDS activities were more likely to occur South of the border, and failed to cross it to Botswana subsidiaries, where resource limitations were the most commonly mentioned barriers to taking initiatives on the pandemic.

Investment by these South African multinationals in Botswana takes place through the legal instrument called "franchise" in which the local owner enters into a commercial relationship with the franchisor to pay for certain inputs in return for a share of the market established by the franchisor. In this arrangement, direct foreign investment is subsidised by local entrepreneurs, and is de-linked to some extent from employment.

Our study showed that the cross-border franchise relationship was fraught with vague- ness about who exactly has control over decision making in the subsidiaries, most criti- cally in the area of HIV/AIDS, but also in related areas of industrial relations, occupational health and safety, and industrial relations. This is one of the dynamics that is exacerbating the seeming paralysis of Botswana subsidiaries of South African multinationals with respect to the HIV/AIDS pandemic. It goes together with the pattern we observed that our South African multinationals have to some extent exported their predilection for "non-standard" forms of employment contract, especially casuals "hired by the day from a pool of casual labour", to their subsidiaries in Botswana, which use this form of contract much more frequently than Botswana national companies. This extends across the border the quantity of employees who have little or no social security net attached to their jobs in the form of medical insurance, pension/provident funds, funeral benefits, retrenchment packages, paid sick leave, as well as access to whatever company policies, programmes and services are offered to permanent employees with regard to HIV/AIDS.

The greater response to the pandemic by South African multinationals at home than abroad, and especially compared to the Botswana national companies, is reversed when we looked at perceptions within the companies of the potential impact of HIV/AIDS on the companies. South African companies seem to regard this as lower than their colleagues north of the border, both in terms of size and type of impact. The Botswana subsidiaries and national companies were more concerned that the pandemic would affect their financial sustainability and market position, whereas the chief concern of the

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suggested that, other things being equal, HIV/AIDS might impact less on the South African multinationals at home than on their subsidiaries, and especially on the Bot- swana national companies, because of the different demographic characteristics of their workforces. The extent to which this is a conscious strategy on the part of the South African multinationals, or a labour supply phenomenon, is not clear from our study, but needs investigation.

The report puts forward the view that regional equity in resource allocation within South African multinationals, and between foreign and domestic companies in Bot- swana (and by extension other countries in the region), can only be achieved by action by both governments and trade union movements in the two countries to pressurise them to implement the SADC code in all its particulars. This will require closer monitoring of their participation in and compliance with the national policy framework and strategies adopted in the fight against HIV/AIDS in both countries. The Botswana Ministry of the State President with the National AIDS Co-ordinating Agency has committed itself to a national survey of companies' participation in the programme, and this would be a good place to start. The South African government should follow suit and conduct a similar study, preferably in consultation with Botswana policy-makers on methodology so that results are comparable, and can identify cross border intra-firm trends, as well as national trends. Meanwhile, South African and Botswana trade union- ists would benefit equally from combined discussion over joint strategies to deepen and strengthen the response of their employers to the HIV/AIDS pandemic in the sphere of employment, and to galvanise their own approach to fighting it as leaders of their communities.

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Chapter by chapter

The first, introductory chapter deals with the origins of this research project in earlier collaborations between Fafo and Botswana National Productivity Centre, and describes its aims and objectives, and the methods we used. The second chapter then explores the regional context, briefly looking at the regional context of economic relations and dif- ferences between labour market regulation in the areas such as employment equity, and framework industrial relations law, between South Africa, which exhibits a much more regulated situation for employers, and Botswana.

The third, fourth, and fifth chapters then explore in some detail the national policy environments with regard to HIV/AIDS both generally and in the employment sphere specifically, as a background to help us interpret the findings of the survey of companies we conducted. They show how although formally the policy framework (as of recently) looks practically identical in the two countries, the process of arriving at it has been marked by chronic controversy and even social and political conflict south of the border, and this has determined in some ways a quite different climate with regard to issues related to the pandemic as we cross the border. Interviews with various key institutions and organisations of the various stakeholders in South Africa develop a nuanced picture of the contesting views and positions present in that country, and especially demon- strate the dynamic struggle between labour and business over key aspects of HIV/AIDS strategy, within the overall framework of employment equity and bipartite and tripartite labour relations at sectoral and national level.

The sixth chapter is a case study of the HIV/AIDS policy and programme of a South African multinational operating in Botswana, and gives an insight into the issues and dimensions we investigated in the questionnaire survey of the 100 companies on both sides of the border. Chapter 7 then wraps up the background qualitative information in the study attempting an overall comparison between the HIV/AIDS policy environments in South Africa and Botswana.

Chapter eight starts with a more detailed account of the survey methods we used, and then goes on to give the main findings from the data from the survey. The book ends on chapter nine, with our conclusions from the whole study.

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1. Introduction

Background

The project “Talking with Botswana Companies about HIV/Aids” was conducted in 2001 by a joint research team consisting of researchers from Botswana National Pro- ductivity Centre (BNPC) in Gaborone and from Fafo (Johannesburg and Oslo offices).

The project arose out of a previous research collaboration between Fafo and BNPC (“Phetogo 2000”), which investigated barriers to productivity improvement in a number of enterprises in different sectors in Botswana. In “Phetogo 2000”, HIV/AIDS was identified as a potential barrier to productivity in enterprises, and as an unpredictable factor in enterprise growth and development, but it remained a residual and under- investigated factor at that stage. "Talking with Botswana Companies About HIV/AIDS" was designed as a limited pilot project to develop an understanding of the dynamics of the impact of HIV on enterprise productivity using concepts of productivity elaborated and studied in Phetogo 2000. The main purpose was to develop the understanding of the impact of HIV/AIDS on enterprise level and how action should be taken. The report "The Impact of HIV/Aids on Enterprise Level Productivity" was finalised late 2001, and is available as part of the Botswana National Productivity Centre’s report series. BNPC and Fafo decided to continue their research co-operation into 2002/3 with the present study.

Objectives

The 2002/3 project focussed on possible disparities between the anti-HIV/AIDS activities of South African companies, and their associated Botswana companies. This cross-border focus arose because of the finding in "Talking to Botswana Companies"

that a South African multinational company was involved in an extensive multi- stakeholder HIV/AIDS programme in South Africa, but that its Botswana subsidiary was doing almost nothing. This seemed potentially very significant given the important role that South African multinationals play in the regional economy. The aim is to improve the understanding of the contexts in the two countries, and the possibilities for synergies that can harmonise and develop the response of employers and unions in enterprises across the border. The aim was to take the best practices from enterprises in both countries and develop an intra-company, cross border approach to the pandemic. The project investigates the initiatives on HIV/AIDS in South African companies, and

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compares them with those in Botswana subsidiaries or associated companies, and Bot- swana national companies not associated with South African parent companies. It pro- motes linkages between the RSA companies and their Botswana subsidiaries or associated companies concerning the approach to HIV/AIDS, drawing on the best practices currently existing in both countries, in line with the SADC Code on HIV/AIDS and employment.

Continuing the approach developed in "Talking to Botswana Companies", we again investigated the following areas for the RSA and their associated Botswana companies:

• The perceived and measured impacts of HIV/AIDS on the companies

• Company HIV/AIDS policy in relation to the SADC Code and national codes

• Measures taken in the companies to counter the effects of HIV/AIDS on the workforce and on enterprise development

• Possible areas for cross-border linkage between the RSA mother companies and Botswana subsidiaries to enhance the overall regional response by the companies to the pandemic, in line with the SADC Code.

The project aims to provide a basis for advocacy amongst employers, trade unions, and government bodies in RSA and Botswana to harmonise and raise the overall cross- border level of response to HIV/AIDS in the enterprises, drawing on the best practices and resources accumulated on either side of the border, taking into account the different policy, legal, and institutional contexts in the two countries.

Sources of data

We used three main sources of data for this study. The first was an extensive literature search focussing on the policy and implementation environments in the two countries, which form a backdrop for the interventions in the private sector employment sphere. The second was a series of interviews with officers and representatives of key stakeholder organisations on both sides of the border, to get behind the literature and gauge how actors in the HIV/AIDS field perceive the situation and what are the key issues confronting them as institutions and organisations as they face the pandemic in the Southern African region. The third and final method, informed by the first two, was a questionnaire survey of 100 companies (33 South African, 33 Botswana subsidiaries of

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2. The regional context

The SADC Code on HIV/AIDS and employment

The SADC Employment and Labour Sector (which was the only sector to include representatives from labour as well as government) developed the regional Code on HIV/AIDS and employment in 1997, in terms of which member countries were to draw up their own policies and codes in subsequent years. Subsequently, the SADC Employment and Labour Sector has joined efforts with other sectors to produce the SADC HIV/AIDS Strategic Framework and Programme of Action 2000-2004 to guide member states on managing the epidemic in the region (SADC 2001b: 7). The Code largely concurs with the approach in the ILO Code of practice on HIV/AIDS and the world of work (ILO 2001).

The SADC code, which is thus a non-mandatory instrument, contains the provisions shown in table 1, which are seen as a minimum standard for HIV/AIDS interventions and programmes in the workplace. These provisions therefore informed the research reported here, in terms of providing a benchmark against which to measure the performance of the participating companies in the survey.

Regional economic relations: the context for HIV/AIDS and employment initiatives

Economic relations between RSA and Botswana take place in the general context of World Trade Organisation (WTO) protocols and agreements, which are mediated through the South African Customs Union (SACU), and the Southern African Devel- opment Community (SADC) Trade Protocol. Both South Africa and Botswana are members of the WTO, and therefore inhabit a liberalising trade regime with shrinking trade barriers, and an export-oriented macroeconomic framework. SACU was formed as an agreement between South Africa, Lesotho, Botswana, Swaziland and Namibia in 1969, which replaced the 1910 Customs Union agreement that linked the former British Protectorates of Botswana, Lesotho, and Swaziland with South Africa (Republic of Bot- swana 2003b: 115). The SADC was formed out of the Southern African Development

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Table 1. Summary of SADC Code on HIV/AIDS and employment

MAIN ITEM PROVISION

Discrimination There should be no discrimination at work between:

• people with HIV infection and people who are not infected

• HIV/AIDS and other comparable life-threatening health/medical conditions Who and what

should national codes and practices include?

National Codes and practices should cover:

• all employees and prospective employees

• all workplaces and employment contracts

• job access

• workplace testing

• confidentiality

• job status

• job security

• occupational benefits

• training

• risk reduction

• first aid

• workers compensation

• education and awareness

• prevention programmes

• managing illness

• protection against vicitimisation

• grievance handling

• information, monitoring, review Education,

awareness and prevention programmes

• Employers and employees must develop these jointly

• education should include employees' families

• minimum requirements include prevention and management of STD’s, condom promotion and distribution, counselling on high risk behaviours

• the programme shall have access to national AIDS programmes

• Employees should be able to access programmes in the workplace

• no pre-employment testing

• no direct or indirect questioning about previous HIV tests or risk behaviour Workplace testing • voluntary testing only

• done by suitably qualified person in a health facility with informed consent and pre- and post- test counselling

• employee must be under no obligation to inform on status

• legal right to strict confidentiality - only waived by person concerned in writing Job status • HIV status should not be a factor in job status, promotion or transfer

• equality of opportunity, merit and capacity the only acceptable criteria HIV Testing and

training

• no compulsory testing for training Managing illness

& job security

• HIV status alone not a fair reason for dismissal

• Employees with HIV-related illnesses should have access to medical treatment & agreed existing sick leave provisions

• medical incapacity procedure:

• offer of alternative employment then:

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Table 1 (continued)

Risk management, first aid, compensation

• where there is any occupational risk of infection there must be clear, safe work procedures and training

• HIV infection from work should follow normal compensation procedures and benefits

• when people have to relocate for work, restrictions should be lifted to allow them to move with their families and dependants

• jobs with routine travel - info, condoms, adequate accommodation

• Protection against victimisation

• stigma and discrimination must be actively discouraged; employees are also to be protected against co- workers, employers or clients

• info and education must maintain the right climate of non-discrimination

• disciplinary action must be taken against employees who refuse to work with colleagues living with AIDS

• Grievances related to HIV must be handled the same as all other issues

• confidentiality of medical information

Information • GOV should collect and analyse data on HIV / TB / STD’s & put it in public domain

• SADC member-states should co-operate on national data and research

• Tripartite parties at national and regional level should monitor and review the code

• SADC employment and labour sector should monitor the implementation of this code.

Zimbabwe, Zambia, Mozambique, Lesotho, Botswana, Malawi, Swaziland and Tanzania (Torres 1998: 109).

Under the SACU agreement, members apply common customs duties, including tar- iffs and excise duties, sales anti-dumping, countervailing and safeguard duties to goods imported to the common customs area (CCA) from countries outside the Union. The SADC trade protocol, launched in 2000, aims to create a free trade area amongst member states by the year 2008, even though the negotiations over this have not yet been concluded. As part of the protocol, SACU countries agreed to make a combined tariff concession to non-SACU SADC member states. Rules of origin on textiles, motor vehi- cles, plastic products, wheat products, machinery and appliances and others have not yet been agreed, and negotiations on trade in services are ongoing.

Both Botswana and South Africa have gained preferential access to non-SADC mar- kets through the WTO Generalised System of Preferences agreements such as the AGOA (African Growth and Opportunity Act of the Clinton Administration in the USA), and the Cotonou Agreement with the European Union. AGOA expires in 2008, and the USA has expressed willingness to enter into negotiations over a free trade agreement with SACU (similar to the North American Free Trade Agreement between Canada, US, and Mexico). It is thus likely that SACU will become involved in negotiations with the US in the coming years. Unlike South Africa, Botswana has been able to negotiate "least developed country" status to allow it to source lower-priced raw materi- als from non-African countries and still qualify for AGOA preferences on textile exports to the US. This has acted as an incentive for other textile producers, such as South African, to relocate production to Botswana, as well as other countries with "least developed country" status. The Cotonou Agreement is also being renegotiated by 2007 because it does not comply with WTO provisions.

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Botswana, like South Africa, has been greatly affected by trade liberalisation during the mid-1990's onwards, due to the Uruguay Round of WTO talks, the implementation of the EU/RSA Agreement on Trade, Development and Co-operation (Cotonou agreement, which has increased competition amongst SACU countries for investment), and the SADC Protocol on Trade Co-operation. Also, the major restructuring of the RSA economy since the early 1990's (trade liberalisation, export orientation, internation- alisation of capital, downsizing in mining and manufacturing, and growth of the services sectors) is having many impacts on its neighbours which are not yet fully understood in Botswana (Republic of Botswana 2003b: 117). All countries in the region are now attempting to increase their export trade, and to attract foreign direct investment, but at the same time, Botswana is attempting to reserve certain sectors or niches of economic activity for companies that are wholly owned by citizens of Botswana. These include small general dealers, petrol filling stations, butcheries, fresh produce, bottle stores, bars (outside of hotels), village type restaurants and supermarkets (but not franchise operations), taxi services and security guard operations. This has led to a rapid growth of franchise operations in distribution, due to their nominal local ownership, as South Af- rican companies have expanded northwards across the border. This dovetails with the Local Procurement Programme introduced in 1997, to reserve 30 percent of Govern- ment purchases to locally based (but not necessarily owned) manufacturing enterprises (an attempt to attract foreign direct investment) and the Citizen Entrepreneurship Devel- opment Agency, which will provide loans to citizen-owned projects in all sectors of the economy.

These regional and national trade regimes have been monitored since the mid-1990's for their impacts on the relative economic development, growth and prosperity of RSA and Botswana (and other SADC states), in the light of South Africa's massively larger economy, with its historic hegemony over the entire region, and the new stance of the post-apartheid governments in South Africa since its first democratic elections in 1994.

In 1996, one study (Davies 1996) showed that in general South Africa had a massive trade surplus with the rest of Africa in the early 1990's, with South Africa's major trad- ing partners in the continent being the SACU countries. However, South Africa remained a relatively small supplier to the rest of Africa, and only amongst some of the non-SACU SADC countries (notably Zimbabwe, Zambia, Mozambique, and Malawi) was it playing a significant role as supplier of imported goods and services. Manufac- turing dominated South African exports to the rest of Africa, however, and this was

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where on the continent; thus far, however, there have been only very modest investments by South African firms in ventures in other African countries" (Davies 1996: 184)

In trade, South Africa continues to be the primary market for Botswana exports, and also to be the primary component of the country's imports (SADC 2001a). But despite its massive dominance in trade, Botswana's attempted diversification into high value- added manufacturing has not been supported by major increases in South African foreign direct investment. These economic relations between the countries overshadow issues of the distribution of resources by South African multinationals to turn around the HIV/AIDS pandemic in countries such as Botswana in which they operate, which is the subject of the research reported here.

The regional labour and employment context

In the labour field, both Botswana and South Africa have national programmes de- voted to skill development in the economy. The Skills Development Act 1998 in South Africa and the accompanying Skills Development Levies Act 1999 set up a national skills development fund using compulsory contributions from employers of 1 percent of the total wage bill. A national qualifications framework has been established for workplace-based training, and training is commencing, albeit sluggishly in sectors which did not possess artisan training structures and programmes before 1998, which could be adapted to the new structures. Botswana levies a consumer tax for the same purpose, and training institutions are numerous, at least in Gaborone. Nevertheless, Botswana will continue to rely on skills imported from outside because of a chronic shortage of skilled labour (Republic of Botswana 2003b: 128), and to this end is to expedite the merged processing of work and residence permits in its National Development Plan 9.

One major difference between regulatory frameworks in RSA and Botswana is that in South Africa there is a separate Labour Ministry, which has developed a wide range of transformatory legislation in the field of industrial relations and tripartite regulation since 1994, including basic conditions of employment, minimum wage legislation through sectoral determinations of low-wage and unorganised sectors, framework labour law governing the conduct of industrial relations, and employment equity and skills development legislation. However, in Botswana these matters are covered by one statute (Employment Act) and implementation is somewhat diluted in the Ministry of Labour, Home Affairs, and Social Welfare (all of which are large portfolios, and have separate ministries in South Africa). Although the same policy objectives of tripartitism and bi- partism in industrial relations are pursued in Botswana as in South Africa (with ratifica- tion by government of 13 ILO conventions in Botswana), there is a much less regulated labour regime, and, outside of the diamond mining industry, trade unions are relatively weak, and restricted in their development both by the existing regulatory framework and by their lack of recognition by employers in many sectors.

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This difference in the labour regimes in the two countries has also affected regulation of HIV/AIDS issues in employment. In South Africa, COSATU, the largest trade union federation, has been involved in policy formulation on HIV/AIDS since the early 1990's, and developed its own Code on HIV/AIDS in 1998, training material for its membership, and a vibrant alliance with the most active civil society organisations on HIV/AIDS. With this strong labour input (COSATU 1998, 2002a & 2002b) on HIV/AIDS and employment (and generally) COSATU has been able to exert a strong influence on national tripartite policy formulation on the issues, and has seriously challenged government on certain issues (this is dealt with in more detail below). Its affili- ated unions (especially the larger and better resourced ones) have been increasingly active in some sectors negotiating company wide and industry-wide programmes and interventions on HIV/AIDS (Bridge 2002: Fisher-French 2003), although these have by no means all been successful because of the intractability of the social and economic determinants of sexual behaviour (Campbell 2003), and lack of trade union commitment at the lower levels. The tripartite National Economic Development and Labour Council (NEDLAC) has been a major forum for the parties to come to agreement (and to dis- agree) over national approaches to HIV/AIDS and employment issues, and has pro- duced a Code of Good Practice on Key Aspects of HIV/AIDS and Employment (South African Government 2000b). It has also seen major disagreements so far (Inde- pendent Online 2003) on a draft Framework Agreement on a National Prevention and Treatment Plan for Combating HIV/AIDS (NEDLAC 2003). In terms of the Labour Relations Act and the Employment Equity Act (Smart & Strode 1999), the Department of Labour has recently issued Technical Assistance Guidelines on HIV/AIDS, which constitute a national non-statutory code on how employers should implement HIV/AIDS programmes in the workplace to comply with anti-discriminatory labour law in the Labour Relations Act and the Employment Equity Act (South African Gov- ernment 2003).

In contrast, in Botswana, all these initiatives on HIV/AIDS in employment are sub- sumed in a Code in the Public Service (Republic of Botswana 2001) and a policy statement in the National Development Plan 9 by the Ministry of Trade and Industry, as well as policy statements at all levels of the National Aids Initiative structures (Ministry of Health, Botswana 1998: Republic of Botswana 2003a). The regulatory framework for HIV/AIDS in employment is thus very weak by comparison with its Southern neigh-

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democratic framework. This theme of national policy versus HIV/AIDS employment framework is explored further below. The best way to encapsulate it is to say that in South Africa, employers have to comply with many more codes and laws on HIV/AIDS in employment than employers (including South African employers) in Bot- swana, but that employers in Botswana that decide voluntarily for business reasons to actively pursue HIV/AIDS issues do so in a much more uncontroversial, unified and purposeful national policy environment than their counterparts south of the border.

The national policy frameworks for the two countries are discussed in the next sections.

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3. South of the border: South Africa's national strategy and policy on HIV/AIDS

The national policy development process with respect to HIV/AIDS over the past nearly 15 years has been marked by a high degree of controversy, to such an extent that understanding responses to the pandemic in the sphere of employment in South Africa would be impossible without understanding the history of the policy process. This history, and the attendant controversies, are recounted in later sections of this report. The South African government has often stated that it has been misrepresented and that the scope and depth of policy has been underestimated due to possible failures in communication by government. It is certainly true that policy is comprehensive, and here we focus on a brief summary of the various aspects of the policy as it stands today, with some commentary on implementation, as follows:

• HIV causes AIDS. Official policy’s starting point is that HIV causes AIDS, and that there is no cure for HIV infection. Therefore prevention and awareness are very important parts of the HIV/AIDS policy. However, the link between HIV and AIDS has been a major area of public controversy during the development of South African policy, and this is discussed in detail below.

• Awareness and prevention. The awareness campaigns are geared towards behaviour and lifestyle changes, and call on all South Africans to take full responsibility and care for their lives. The awareness drive is based on multiple approaches, including compulsory HIV/AIDS education programmes in schools (the Cabinet believes there will be full implementation by the end of 2003) and working with organisations such as LoveLife to widely disseminate appropriate messages especially to the youth, and to evaluate the response scientifically. Government is confident that the campaigns have achieved a high level of awareness – over 90% - and is particularly en- couraged by what they see as a special impact on awareness amongst youth.

• Behaviour change and access to condoms. To support behaviour change, government proposes increased access to both male and female condoms, and part of this access should be through non-traditional outlets, for example shebeens.

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• Prevention of Mother-to-Child-Transmission (PMTCT). Another important element in the prevention strategy is what is being done to prevent peri-natal transmission of HIV. The government has several research sites for the use of Nevirapine for this purpose (18 research sites, accessed through 230 hospitals and clinics), and says it will implement a Constitutional Court ruling that government must provide Nevirapine for this purpose. The TAC, which has been the main advocate for a rollout of Nevirapine provision (and the main force behind the court cases brought against government on this matter) says that in most provinces the Constitutional Court ruling is being followed up appropriately. From December 2002, the Cabinet also said it would decide whether or not to roll out Nevirapine universally, but there is little information available as to the implementation of this.

The government is concerned that a comprehensive package should be offered in conjunction with Nevirapine provision. This package should include pre-test counselling, testing for HIV, then an informed choice concerning Nevirapine, multi- vitamins for strength during and after pregnancy for mother and child, prompt treatment of infection and formula-feed. Both mothers and babies should also be offered prophylaxis for opportunistic infections (OI) related to HIV. This is a very se- rious approach to prevention of MTCT, yet many of the interventions (such as prompt treatment of infections and the provision of multi-vitamins) are equally de- sirable for HIV negative mothers and their children. It is thus neither entirely clear that these interventions are absolutely necessary for a successful prevention of MTCT, nor that they should be restricted to mothers needing Nevirapine. In a climate of suspicion (see below), critics have accused government of “complicating”

provision of Nevirapine, because of reluctance to provide it in the first place.

• Voluntary Counselling and Testing. Government encourages voluntary counselling and testing (VCT) and links it to treatment, saying that it is ideal if those who suffer from opportunistic infections know their HIV status. According to the Cabi- net’s own figures there were 359 operational VCT sites in April 2002. VCT is the biggest part of the NEDLAC Treatment Plan draft agreement (see below), and is crucial as activists claim that only ten percent of HIV positive South Africans know that they are infected with the virus.

• Treatment of Opportunistic Infections. Government states that treatment of opportunistic infections can greatly improve the quality of life of HIV positive people, and stresses that such treatment is available regardless of HIV status. Despite this, activist bodies report that it is a persistent problem that many health care workers deny HIV positive people drugs and care, and that not all health workers know how to spot and treat the most common opportunistic infections¹.

1 This is implicit in COSATU’s “My comrade with HIV and AIDS is still my comrade” (COSATU 2002a), where the importance of asserting one’s right to treatment and how to speak to health workers in order to ensure this is discussed in detail. It is also put forward as a demand towards strengthening the

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Because it is a recognised problem that drugs are not always available, the government calls on people living with AIDS (PLWA) to help the government monitor the supply of such drugs. The government also commits itself to working on lowering the prices of drugs, yet is not very specific about how this will happen.

• Provision of comprehensive anti-retroviral therapy. This is an extremely recent addition to the national policy (by Cabinet decision), and has been marked by chronic controversy (see below). The Cabinet of the South African government rec- ognises that anti-retroviral drugs can improve the quality of life of People Living with AIDS, if administered at certain stages in the progression of the condition and in ac- cordance with international standards and protocols. This is a cautious statement and the Cabinet does not promise a universal roll-out of ARV’s in comprehensive treatment, pointing out that these drugs are costly and can cause harm if incorrectly used or if health systems are inadequate. Therefore government will rather continue to work for a lowering of the prices of these drugs, accessing money for ARV programmes through the Global Fund on HIV/AIDS, and continue the campaign for compliance with drug regimens for all patients, but especially those that are infected with TB and HIV. Given the urgent advocacy of treatment by high profile activist organisations of PLWA such as the Treatment Action Campaign, it is not likely that government will find it easy to work in peace with this project.

• Post-exposure Prophylaxis for health care workers and rape survivors. There are two other initiatives where ARV’s are involved in the public health sector. The first is for health care workers who have had occupational exposure to HIV, for example through needle-stick injuries. The government continues to make ARV available as a post-exposure prophylaxis for such cases. For rape survivors it was reported in the Cabinet Statement of April 2002 that government would endeavour to make a comprehensive package available to them, including counselling on the use of ARV’s for prophylactic purposes, and the drugs will be made available to them if they decide they would like to have them. In a follow-up statement in October, the Cabinet asserted that this programme was being implemented.

• Continue the South African search for an HIV vaccine. The South African government participates in the international search for a vaccine. In this area of vaccine development, the South African efforts have come unusually far in a short space of

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• Continued expenditure growth on HIV/AIDS. In terms of expenditure on HIV/AIDS, there has been considerable growth over the past few years.

• Battle poverty and malnutrition, improve home-based care, strengthen part- nerships and fight discrimination. Other government initiatives include a battle against poverty and malnutrition, for example through handing out food parcels and starter kits for vegetable gardens. Home-based care programmes are also to be strengthened through increased funds, and discrimination and stigma will be ad- dressed through more money to awareness campaigns.

• Maintain human rights-based approach to HIV/AIDS. The approach the South African government has taken to HIV/AIDS is human rights based, meaning that it has chosen to “consult and co-operate” rather than the more traditional public health approach of “control and contain” (Schneider 2002). This has however been an area of controversy, and is dealt with in more detail below.

• Department of Health, Presidential Task Team and South African National AIDS Council (SANAC) to maintain main responsibility for HIV/AIDS.

Recently, a Presidential Task Team has been created under the leadership of the Deputy President, where the “key” ministers are present. They in their turn work towards SANAC, the South African National Council on AIDS, in which the government has chosen to focus its work on AIDS.

Controversy during the development of the na- tional South African HIV/AIDS policy

HIV is newer to South Africa than it is to other parts of the continent. The first cases were spotted here in the early 1980’s, and were biologically linked to the epidemics in Western Europe and in North America. In the late eighties, there was a second wave of infections, and this time it was biologically linked to the epidemic in Eastern and Central Africa (Abdool-Karim, Mathews, Guttmacher, Wilkinson and Abdool-Karim 1997, in Schneider and Stein, 2001).

The first antenatal survey of HIV, showed a prevalence of 0.8 %, which had risen to 1.5 the following year, indicating that South Africa was in the beginning of a rapidly spreading epidemic. Because AIDS only really reached South Africa visibly by the late eighties, the country has had roughly ten years less than a country like Uganda to re- spond to the epidemic. The positive side of that is that South Africa has been in the position where it could potentially learn from others’ mistakes and successes.

The earliest responses to the growing AIDS epidemic came jointly from the Health Secretariat of the African National Congress, and the then Department of Health. They

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met as early as 1991, and convened a broad-ranging conference in Maputo in 1992.

Through broad consultation and a democratically inclusive process, a national AIDS plan was developed. In retrospect, the plan turned out to be far too ambitious, especially in terms of what could be achieved through a rapidly transforming civil service (Schnei- der and Stein, 2001, page 726), yet it laid out important fundamentals for the approach to HIV/AIDS in South Africa, including the human rights-based approach to AIDS in South Africa, the inclusion of People Living With AIDS in all HIV/AIDS work, and the emphasis on a consultative process (an element which as we shall see, rapidly became contested after 1994) (Schneider 2002).

When the new democratic government came into power, it quickly adopted this AIDS plan. Implementing it has, however, turned out to be rather more difficult. In this respect South Africa differs from many first-world countries. In the latter, arriving at a shared understanding of what should be done about HIV/AIDS has been very difficult, whilst the actual implementation of the policy, once adopted, has been a matter of mere administration. In South Africa it seems to have been easier to agree to the principles of the plan itself than to find effective ways of implementing it. In fact, implementation has proved to be a question of very careful strategic thinking.

The first implementation-linked challenge was the placement of responsibility for the AIDS programme. Initially it was planned as a so-called “Presidential Lead Project”, which was intended to give it access to extra funds and fast-tracking measures. In 1994 it was however placed in the Department of Health. This limited the scope of the programme to a narrower medical framework, rather than the inter-sectoral approach en- visaged by the AIDS plan. In the provinces the same placement was chosen, but there co-ordinators were mostly only in place from 1996. The implementers of the policy on AIDS were mainly at middle management level, largely from the old civil service and with little connection to NGO’s in the AIDS field. They thus had little authority and few connections with which to enlist public support.

The second important challenge for the implementation of the AIDS plan has to do with the major transformation of the entire civil service in South Africa. A multitude of separate administrations schooled more in control of the people than towards service delivery were to be merged into one, and had to learn to “Put People First” (the “Batho Pele” policy). Many of the top leaders of the civil service were from the democratic

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stitution. This means that it can be a long way from the Minister of Health to the actual implementation of a policy at provincial level. There has been a tendency towards weaker provinces wanting more direct assistance from the Minister, whereas stronger provinces have wanted to press ahead independently of other provinces, and have been very irritated with interference from the Minister (Schneider and Steyn 2001: 724-726).

A fourth problem with implementing the national AIDS policy had to do with the nature of state-civil society relationships. Signalling a swing from the very inclusive way in which the National AIDS Plan had been negotiated prior to 1994, to a much more state-driven approach, the then Minister of Health stated in 1996 that: “AIDS does not consult, it infects people” (Schneider 2002). The struggle over who should determine AIDS policy and who should be recognised as social partners in the AIDS field has dominated much of the political contestation around AIDS. The schism between large sections of AIDS researchers, NGO’s and activists on the one hand and the state on the other, has been detrimental to the state’s ability to mobilise social capital to boost its anti-AIDS campaigns.

On this background, a series of major controversies erupted in the field of HIV/AIDS in the later 1990's. The first was a scandal involving a R14 million contract granted by the Department of Health to make an AIDS musical play, called Sarafina II.

Reactions centred on the perceived secrecy of the process, the size of the contract (compared to its impact) and certain problematic HIV/ AIDS messages contained in the musical.

Shortly after the Sarafina II controversy, the government heralded a University of Pretoria finding on the drug Virodene as a major breakthrough. This was seen as a promising South African cure for AIDS. The Medicines Control Council was less en- thusiastic, and along with the University of Pretoria’s ethics committee turned down applications for Virodene’s further testing on humans. There was also a long media controversy over Virodene, and the government condemned both the media and the sceptical scientists for holding back a treatment that could save lives.

In 1997, the Director-General of the Department of Health issued a statement that suggested that the policy of confidentiality around HIV/AIDS should be reviewed. In the same year the Minister of Health announced that AIDS was to be made notifiable.

This approach was against the advice of activists and scientists in the AIDS field (including the government’s own AIDS Advisory Committee).

Starting in March 1998, calls for the use of Azathioprine (AZT) in the public sector to prevent mother-to-child-transmission (MTCT) of HIV were heard from activists and scientists. This was based on a study from Thailand, which suggested that a short and therefore affordable treatment with AZT could significantly reduce the chance of HIV infection from HIV positive mothers to their children. The government first replied that AZT was not affordable, and then raised concerns about its toxicity and issues around

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drug resistance. The issue of the toxicity of AZT is closely linked to the so-called dissident view on AIDS which suggests that AIDS is not caused by HIV, but rather in this case by the very toxicity of AZT.

In mid-1999, the new Minister of Health followed the recommendations of the South African Law Commission, and gazetted regulations protecting the right to confidentiality for People Living With HIV/AIDS. At the same time, contact between the new ministry and activists renewed expectations that an MTCT programme would be initiated. This was boosted by successful Ugandan trials showing that a single dose of Nevirapine issued during delivery could reduce MTCT by 47%. Despite this, the Minis- ter of Health decided that a Nevirapine rollout in South Africa would only be consid- ered after South African clinical trials had been carried out. Again issues of toxicity and drug resistance were raised.

The most controversial of all government moves was the suggestion in government statements in 2000 that the link between HIV and AIDS needed to be re-examined. A Presidential AIDS Advisory Panel was convened, which included so-called dissident researchers. The declaration by 5000 scientists at the Durban AIDS Conference 2000 in favour of so-called orthodox views on AIDS (HIV causes AIDS), was dismissed by a presidential spokesperson as "suitable for the dustbin" (Schneider 2002).

During the same period, both researchers and key NGO groupings, notably the Treatment Action Campaign (TAC-an activist body of PLWA) and the AIDS Consor- tium (an umbrella body of various NGO's and CBO's) were excluded from the new South African National AIDS Council (SANAC), which was convened under the leadership of the Deputy President. This was divisive as other organisations (such as the National Association of People With AIDS (NAPWA) were included.

In 2000 the TAC supported the South African government in its court challenge brought by the drug industry to prevent regulatory measures to reduce the cost of AIDS. The Government and TAC forced the multinational drug companies to with- draw their legal challenge in a humiliating and very public defeat for the companies which was heralded across the globe as a victory for an ethical approach to the pharma- ceutical industry.

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The implementation of MTCT also continues to be turbulent, with the TAC taking the government to court in 2001 for failing to adequately implement it properly. The TAC won the case after being challenged at the highest level by the government, and is currently monitoring how the government is responding to the Constitutional Court ruling that government must provide Nevirapine for this purpose (contempt of court cases are in preparation against Mpumalanga and the Eastern Cape provinces).

Very recently, the cabinet took the decision to provide comprehensive anti-retroviral treatment for HIV, and a task team was established to draw up a costing and implementation plan for this. At the time of writing, this plan is still in preparation, although it is expected soon. Even now, the controversy over inclusiveness of civil society continues, with the TAC criticising government for excluding it from the task team, at the same time as commending it for taking the decision and the seriousness with which the task team is pursuing its mandate.

South African national policy on HIV/AIDS and em- ployment - a mixture of law, codes of practice, and official guidelines

In contrast to Botswana, the South African legislature has comprehensively regulated the relationship between employers and employees with regard to the latter's rights in respect of HIV/AIDS. This is therefore an important part of the context within which the findings from this survey must be interpreted. Businesses operate to make a profit, and some of them do that by minimising their costs, including their human resource costs, while some of them (especially those which have financial resources) do so by investing in human resources to maximise their productivity. The determinants of which of these main groups a business falls are complex. However, in the South African case, the lack of decisiveness which the national HIV/AIDS policy process has displayed (see above) is countered by a strong input in the field of labour and other law since 1995, which acts as one factor pushing companies in the direction of human resource investment over the question of HIV/AIDS, as a purely business decision.

The various laws that protect the rights of employees living with HIV or AIDS are summarised in table 2.

Crossing borders to fight HIV/AIDS

Pete Lewis

with Anne-Grete Larsen and Arne Groenningsaeter (Fafo), and Moses Galeboe and Spambaniso Taneka (BNPC)

Crossing borders to fight HIV/AIDS

The Role Of South African Multinationals In The Private Sector Response In Botswana

Fafo-report 431

Pete Lewis

with Anne-Grete Larsen and Arne Groenningsaeter (Fafo),and Moses Galeboe and Spambaniso Taneka (BNPC)

Crossing borders to fight HIV/AIDS

The Role Of South African Multinationals In

The Private Sector Response In Botswana

Contents

Index of tables and charts

Acknowledgements

List of acronyms

Executive summary

Chapter by chapter

1. Introduction

2. The regional context

The SADC Code on HIV/AIDS and employment

Regional economic relations: the context for HIV/AIDS and employment initiatives

The regional labour and employment context

3. South of the border: South Africa's national strategy and policy on HIV/AIDS

Controversy during the development of the na- tional South African HIV/AIDS policy

South African national policy on HIV/AIDS and em- ployment - a mixture of law, codes of practice, and official guidelines