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The premier health and medical news on the Internet
Indian firms waking up to HIV threat
Last Updated: 2006-07-14 11:22:09 -0400                         By Jonathan Allen

NEW DELHI - Jitendra Shekhawat has never been to a condom party before, but he has a great idea for an ice-breaker -- he blows up a condom until it explodes. The party, in a wooden shack festooned with condom balloons in the middle of a sprawling truck parking lot, is one of many approaches increasingly used by Indian businesses as they try to work out their role in a country that recently became the world's HIV capital. Shekhawat and the party's 30 or so other guests are all long-haul truckers, decked in oily clothes and with hair still untidy from a night's sleep in their vehicle's cabin.
The hosts are workers from an HIV-prevention charity, hoping to impart as much information about the deadly virus as possible before the truckers set off on their next job, where they will end up thousands of miles from their wives but only 100 rupees (1.17 pounds) away from sex with a prostitute.
"It has to be fun or the message doesn't get across," says Sumant Kumar, a coordinator for the charity, Modicare Foundation, as the truckers send freshly inflated condom zeppelins wafting behind his head. But attitudes can be hard to change, especially among many of India's countless millions of migrant workers who spend months away from home, and for many of whom hiring a prostitute is not unusual once a game of cards turns dull.
"I am quite faithful to my wife," one 23-year-old trucker says. "But sometimes if I find a good girl when I am out on long tours in south India, I'll sleep with her. It passes the time."

OSTRICH MENTALITY

India recently overtook South Africa as the country with to the most people living with HIV -- an estimated 5.7 million, according to the United Nations. And according to the National AIDS Control Organization, most of these people are between 15 and 35, in what should be the most productive years of their lives.

Employers know all this.

"Everyone's been to these conferences where they reel off relevant costs to the industry," points out economist Indrani Gupta. But only a minority of companies is choosing to act.
Unlike many African countries, the prevalence of HIV is still relatively low in India -- less than 1 percent of the billion-plus people, if estimates are correct. Some say this has lulled the many businesses into a false sense of security.
"There's a lot of ostrich mentality. People are thinking, 'There's no problem here so why do we need to do something?'" said Shefali Chaturvedi, director of the Indian Business Trust for HIV and AIDS. The trust was launched in 2001 by the Confederation of Indian Industry, an association of about 5,000 public and private sector businesses, to encourage industry to do more.
"Business has to play a leadership role," said Chaturvedi. "They must look at it as an issue which, given the way the situation is going, it is likely to affect their own productivity." The trust is asking companies to adopt its HIV policy, an undertaking to educate employees and not to discriminate against those with the virus. So far, about 500 have signed up, including Hero Honda Motors and Tata Steel Ltd.

NICE OR NECESSARY?

No one is sure to what extent a company should spend money on HIV-prevention programs out of some sense of corporate decency, and to what extent a smaller outlay now might stave off larger costs from HIV-related illnesses in employees.
R.N. Mukhija, a director at Larsen & Toubro Ltd., one of India's largest engineering firms, says it is a mixture of the two. The company, which employs about 20,000 people, has run an ever-expanding HIV-prevention strategy since the mid-1980s. The company is aware of about a dozen staff infected.
"If we had not spread awareness it would have been much more," he says. He describes the cost of the program as insignificant.
The cost of the Modicare Foundation's program would not make a big dent in a typical large company's training budget. In a recent program, Modicare's trainers visited Prakash Industries Ltd. five days a month over seven months, teaching 1,300 of its employees about HIV and AIDS.

For this, Prakash paid about 80,000 rupees.

The International Labour Organization estimates paying for treatment for just one HIV-infected employee, including antiretroviral drugs, would cost 20,000 rupees a year, plus costs from absenteeism and treatment for the opportunistic infections those with HIV are prone to catch.
It says the cost of late intervention is 3.5 to 7.5 times the cost of early prevention. But when many companies rely heavily on subcontracted migrant workers, it can be difficult to run an effective program.
"A company can have a superb policy for its 300 or 400 core staff, but if it doesn't trickle down to their informal workforce then it's not reaching the people who really need it," says Denis Broun, the India coordinator for the UN's HIV-prevention agency.
Worse still, there is little to prevent a business putting bottom lines ahead of an individual worker's welfare.
"There is no dearth of manpower in India," says Broun. "So, if one was to look at things cynically, if you lose an employee and advertise the position you're going to have a hundred applicants."
($1 = 46.40 rupee)

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