In 2001, UNAIDS estimated the HIV/AIDS prevalence in South Africa to be just over 20% of the population. The Actuarial Society’s ASSA2002 model estimates that by 2010, there are likely to be roughly 380 000 AIDS-related deaths per annum. However, the number could be anywhere between 290 000 and 450 000, depending on the extent and impact of the national anti-retroviral treatment programme. Life expectancy at birth is expected to fall to a little below 50 years of age and then plateau around this level. Previous estimates suggested that life expectancy would fall to around 43 years of age before climbing back up to level off at around 50 years.

In 2002, Old Mutual (SA) conducted a voluntary saliva-based HIV-prevalence assessment of its workforce. The assessment had a 67% response rate. As a result of the assessment, 5% of the Old Mutual (SA) workforce was estimated to be HIV-positive. This corresponds roughly to 650 HIV-positive employees. This is consistent with expectations based on modelling conducted by the University of Cape Town’s Centre for Actuarial Research.

The prevalence assessment was also used to model the current and future number and profile of staff living with HIV/AIDS, and to provide estimates for the impact of the disease on: the costs of death and disability; medical aid costs; staff productivity; sick and compassionate leave; staff turnover; recruitment; and training and development.

During the company’s Care and Share Week in December 2005 (this aims to focus staff on human rights issues, including World AIDS and Disability Days), rapid-result testing was carried out over three days, with 7.8% of the Old Mutual (SA) workforce voluntarily undergoing testing.

The following table gives a breakdown by age and test result of the rapid-result testing. Sixteen people tested positive, 13 of whom were women.

Breakdown of rapid-result testing over three days of the Care and Share Week (2005)

Financing the fight

The Old Mutual (SA) HIV/AIDS workplace budget during 2005 amounted to just under R73 per employee.

Old Mutual Healthcare provides annual cover for treatment of R15 000 per registered family member.

During 2005, the Old Mutual Foundation contributed R4 613 460 towards community-based HIV/AIDS initiatives, mostly through the Rural Economic Development Initiative (REDI) and the AIDS Orphans Programme.

These budgets finance a four-dimensional strategy to combat the disease:

• in the workplace (employees);
   
• in the broader community;
   
• by offering financial services and advice (customers); and
   
• by managing the business impact.

Networking and communication with all stakeholders in the HIV/AIDS arena are regarded as a priority, and is led by Old Mutual (SA) Corporate Affairs and the Group External Relations office. Also important is the regular measurement of all HIV/AIDS initiatives to ensure that they yield meaningful results.

Networking, measurement and communication enable the company to keep in touch with current developments and to develop useful responses. They also help Old Mutual (SA) share vital information with appropriate groups and individuals in both the public and private sectors.

Fundamental to combating AIDS is the work of the Old Mutual Foundation team led by Kate Miszewski (left) and the Peer Educators (pictured right), led by Sebasti Lawson (second from left).

The Old Mutual (SA) HIV/AIDS policy

Old Mutual (SA) first developed a HIV/AIDS policy for its local operations in 1987/8. The HIV/AIDS Workplace Strategic Policy Committee, drawn from all business units and employee representative bodies, revised the policy in November 2001 as part of an ongoing review of the company’s stance. It is expected that the policy will again be reviewed during 2006. The major principles of the policy are:

• Non-discrimination: Employees will not be dismissed on the grounds of their HIV status; the company will not undertake pre-employment testing for HIV, neither will the company require existing employees to undergo testing as a condition of their employment; in rare cases, should prospective employees be required to undergo HIV testing as an “inherent job requirement”, the company will first obtain prior approval from the South African Labour Court.
   
• Confidentiality and disclosure: Employees are not required to disclose their HIV status. This status can only be disclosed to a third party with the prior written consent of the employee in question.
   
• Benefits: No discrimination is allowed in the allocation of employee benefits based on the employee’s HIV status, while all HIV-positive employees with or without medical insurance can register on the company’s medical aid HIV/AIDS management programme and qualify for the annual limit of R15 000 per family member. This benefit includes any chronic medication and blood tests required for the treatment of the disease. Dependants registered with the medical aid programme also have access to these benefits. All employees are entitled to a core life assurance cover amounting to 2.4 times their annual pensionable earnings without any need of evidence of health. A medical examination demonstrating that the applicant is HIV-negative is required for employees applying for more than the core life assurance cover.
   
• Ill-health retirement and disability: HIV-positive employees should continue to work in their current position for as long as they are medically fit to do so. If employees are unable to continue with their current tasks, efforts will be made to offer alternative employment. Employees, management, or the Human Resources division can initiate an ill-health retirement or disability application. No employee can be compelled to have an HIV test or disclose his/her status as part of the proceedings to apply for a disability benefit. Employees with HIV/AIDS are rather treated the same as employees with other life-threatening diseases. The disability plan will start paying the disability benefit of 76.5% of the member’s pensionable salary after completion of the six-month waiting period. The disabled employee will receive a full salary during the six-month waiting period.
   
• There is no explicit HIV/AIDS policy for contractors.

Prevention and awareness

The Old Mutual (SA) workplace prevention and awareness programme encompasses staff and management training, peer education, condom distribution, sexually transmitted infections (STI) treatment, and a youth-focused workshop.

• Staff and management training: In 2002 and 2003, the company trained over 5 000 employees using the Centre for Human Development. The training covered general facts about the disease, including statistics and impacts, modes of HIV transmission and the course of the disease, the company’s intervention strategy and employee rights, HIV/AIDS testing, risk reduction, and resources available for those living with HIV. For management, in addition to the list above, training included a component on managing HIV-positive employees. During 2004 and 2005, this training continued, although on a smaller scale. It is expected that in 2006 a concerted push will be made to update staff and management on the latest trends and impacts. In this regard, the Old Mutual (SA) - UCT partnership, managed by Professor Judith Head, should prove invaluable.
   
• In November 2002, the company held its first training session for its peer education programme with the aim to equip volunteer employees so that they can: provide information to colleagues on issues including medical facts, transmission, and safer sex; help colleagues think through issues including condom use and medication; act as a first line of support for employees dealing with HIV/AIDS issues and refer colleagues to relevant services. As at the end of 2005, there were 70 trained peer educators company-wide. The aim is a ratio of 1:100 employees, and so an additional 60 or so peer educators are still needed from within the business to make the desired ratio a reality. Line managers allow peer educators two hours per week to conduct their activities. During the past year, five “refresher” workshops took place. These will become an annual event in the workplace programme.
   
• Since 1998, Old Mutual (SA) has distributed free male condoms and instructional leaflets in workplace dispensers at its head office. The head office employs approximately 7 000 of a total 13 500 Old Mutual (SA) employees nationally, and distributes approximately 1.4 condoms per month per head-office employee. In the last few years condoms have been distributed at the larger branches. Wherever possible, distribution is supported by the work of peer educators.
   
• In October 2002, Old Mutual (SA) held a workshop for 50 children of employees that addressed the issues of transmission and prevention, discrimination, and stigmas attached to being HIV-positive. These workshops have not been held as regularly as first intended, and 2006 provides another opportunity for the company to play a role in educating the children of employees.

Voluntary counselling and testing service

All employees are offered ongoing free, voluntary and confidential HIV testing which includes pre- and post-test counselling through the Careways Group, an independent service provider.

The voluntary testing and counselling service was launched in 2002 as part of a three-month “Know Your Status” campaign. Since then, about 6.5% of Old Mutual (SA) staff has been tested. Although the uptake is much slower than when the campaign was launched, it remains active on a monthly basis. From time to time, free, confidential, and counsellor-supported rapid-result testing is also performed throughout the business, such as the testing conducted during the Care and Share Week in December 2005.

Affected and interested employees can use the following multi-step process to access the voluntary counselling and testing service:

• call the Employee Wellbeing Programme (EWP) toll-free number to schedule a pre-test counselling session with the Careways G oup;
  
• while at the pre-test counselling session, schedule an appointment at a nearby laboratory;
   
• go to the laboratory for testing;
   
• Careways will contact the individual to arrange for a post-test counselling session, irrespective of the results of the test;
   
• the results are shared with the person at the post-test counselling session; and
   
• if the employee is HIV-positive, the counsellor refers the person to the available support resources, both internally and externally.

Once a year, in December, Old Mutual (SA) staff have the opportunity to demonstrate their community involvement through the Greenland Magic initiative. On the far left, Astrid Meilich typifies this involvement through the giving of a gift.

Care, support and treatment

Old Mutual (SA) offers HIV-positive employees and dependants access to a HIV/AIDS management programme that includes medically appropriate access to Highly Active Anti-Retroviral Therapy (HAART).

The aims of the HIV management programme are to:

• support and educate members;
   
• assist members in optimally managing their medical aid benefits; and
   
• contain the increased medical costs resulting from treatment of HIV/AIDS.

By the end of May 2003, there were 94 people enrolled on the programme, including 73 employees. The programme enrolled 16 spouses and five children under the age of 13 years. As at the end of 2005, there were 189 active members. During the year, 77 people left the programme and 10 previous members passed away.

Employees and dependants may also access free professional counselling services offered by the EWP to discuss issues relating to HIV/AIDS. As these discussions and people’s names are kept confidential, the company does not track the number of HIV/AIDS-related sessions.

Old Mutual (SA) fighting HIV/AIDS in the community

Aggregating several sources, including statistics provided by the World Health Organisation, it is estimated that AIDS orphans will comprise between 9% and 12% of the population in South Africa by 2010. To assist widespread efforts to address this challenge, Old Mutual supports five independently-run HIV/AIDS programmes across the country. One of these, Soul City, is a multimedia initiative that addresses the educational challenge of adapting human behaviour towards responsible sexual practices. Some direct community work is done through the subsidiary Soul Buddyz initiative, which echoes the work done by the Old Mutual (SA) Community Builder programme that facilitates staff volunteerism.

Some 22 million South Africans have been reached by Soul City (statistics provided by Soul City) since 1992 through its multimedia strategy that includes over 14 million print publications in nine languages on different health and development issues, including HIV/AIDS.

As AIDS is not an isolated phenomenon, Old Mutual (SA) recognises the importance of helping people deal with related issues that can contribute to the spread of the disease. The Rural Economic Development Initiative (REDI) helps address the needs of people living in impoverished rural areas in six of the nine provinces around South Africa, providing education and training, and actively dealing with health and welfare issues, including HIV/AIDS.

The company has also partnered with several other organisations to address HIV/AIDS in the community:

• Heartbeat: Honouring the rights of the child, Heartbeat operates in Katlehong, Gauteng and Botshabelo, Free State.
   
• Bambisanani, with its community-based approach, targets the Eastern Cape areas of Lusikisiki, Bizana and Umzimkulu.
   
• The Topsy Foundation, with a sanctuary that can accommodate up to 2 000 orphans, is based in Mpumalanga and reaches the communities of Grootvlei, Balfour, Greylingstad and Villiers.
   
• Shepherd’s Keep in Durban, KwaZulu-Natal cares for newborn to six-month-old orphans until adoption.
   
• Nurturing Orphans of AIDS for Humanity (NOAH) operates primarily in Gauteng and KwaZulu-Natal.

Through links with various trade unions and other organisations, Old Mutual (SA) has been able to form partnerships with these groups to provide train-the-trainer programmes to help educate and mobilise their members and communities to better combat HIV/AIDS.

In addition, employees are encouraged to participate in the staff “Adopt” an Orphan programme. Through this, employees have voluntarily donated R1.8 million since 2002, and have had their donations matched on a rand-for-rand basis by the Old Mutual Foundation, making a total contribution of R3.7 million to the AIDS orphans cause.

Financial advice and products/managing the business impact

Old Mutual (SA) was party to the decision taken at the Life Offices’ Association (LOA) to scrap HIV/AIDS exclusions on new business underwritten from 2005. This development resulted from intense research which has assisted in risk assessment.

The effect of the decision is that standard underwriting principles will continue to be applied but where customers subsequently become HIV-positive and die of AIDS, their claims will not be declined.

In the course of regular reviews for corporate clients and employers offering employee benefit and medical aid schemes, Old Mutual (SA) evaluates the impact of the disease on the benefits offered. These reviews also present an opportunity for the client company to discuss emerging trends with Old Mutual (SA)’s experts, and to raise the option for proactive management of HIV/AIDS in its own workplace.

Business advocacy

Old Mutual (SA) is an active supporter of the South African Business Coalition on HIV/AIDS (SABCOHA) and the LOA’s strategic committee on HIV/AIDS. The company has also shared its programme with the Global Business Coalition on HIV/AIDS, winning recognition from the organisation for its outstanding workplace programme. The company constantly seeks to partner with other organisations that can help it achieve its objectives and vision – hence the sponsorship, in its third year, of UCT’s Master of Philosophy in HIV/AIDS in the Community.

• Programme success depends on various metrics being maintained and used to inform successive implementation initiatives. One of the most significant metrics is the KAPB (Knowledge, Attitude, Practices and Behaviour) study, which is carried out pre- and post-implementation.
   
• Old Mutual Group Schemes is active in training union members on HIV/AIDS prevention and treatment. To date, 480 members from the COSATU, NACTU and FEDUSA affiliations have undergone training.

Involvement in pressing issues faced by society extends through all ranks at Old Mutual (SA), over many years. On the left, pictured in 2000, executives demonstrate against abuse of women, and on the right, staff are about to experience “Breakfast in the Dark”, to attempt to understand the world of the blind.

Our case for action