HEINEKEN International

Making HIV programmes workThe Heineken HIV programme- First ten years

Heineken’s HIV programme

♦ Last century sickness and death for African workers:■Malaria under control■Diarrheal diseases under control■Upper respiratory infection : under control■Cause of death : AIDS

Price of the drugs

♦ Accelerated Access Initiative♦ Generic Producers

Obstacles in 2000

♦ Life long commitment of care

♦ Price and continuous supply of the drugs

♦ Quality assurance of the care provided

♦ Laboratory expertise

♦ Compliance by the patients

♦ Possible low uptake out of fear of discrimination by employer

HEINEKEN

♦ 90 000 employees globally

♦ 11700 employees in Africa and

Middle East

♦ 30 000 employees and

dependants covered in health care

program

♦ 15 doctors,

♦ 45 nurses,

♦ 4 lab techs,

♦ 1 pharmacist

Expertise of care providers

♦Define treatment protocols and training needs

♦Training courses for doctors and nurses♦Mentoring by teleconferences and database♦Organisation of refresher courses

Compliance and continuity

♦Workplace allows for excellent compliance: active tracing

♦Choose the best drugs, not the cheapest

♦No interruption in drug supply

Laboratory Capacity and Quality Control

♦Invest in technology

♦Invest in training

♦Building quality cycles

♦External quality surveillance

Stigma and discrimination : determinants of uptake of testing

♦Engage the top managers : General Manager and HR manager

■Do as you have promised -- Show the example

♦Confidentiality of medical information. ♦Uptake of VCT:

■Hesitating start, first the sick people■After 3 years approaching 80-95%

(c) Getty- A GBC member company

Causes of stigma

Figure 1 Cognitive-emotional model of HIV-related stigma. Adapted from Dijker & Koomen in 2003 (Bos, Schaalma & Pryor, 2008)

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Low level of stigmatisation

♦Priority for Heineken to target stigma in these countries?

study countryS1

Mean

Genberg, 2009

Tanzania 1.66

Thailand 1.35

Zimbabwe 1.23

Vulinlela (SA) 0.93

Soweto (SA) 0.79

De Jong, 2010

DRC 0.57

Burundi 0.32

Employee Mortality 1999-2007Great Lakes Countries.

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5

10

15

20

25

30

35

40

45

50

1999 2000 2001 2002 2003 2004 2005 2006 2007

Abs

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dea

ths

Total number ofemployee deaths

HIV related deaths

Immediate result

After 10 years still new infections

0

10

20

30

40

50

60

70

80

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

New cases detected in Heineken Opcos

Summary of the research

♦ HIV treatment programmes in the private sector can effectively

keep workers and family members alive.

♦ Uptake of voluntary counselling and testing showed that

employees will trust employers if action reinforces words.

♦ Cooperation with non-governmental actors can help a company

acquire necessary expertise that is not part of the core knowledge

♦ Short training courses and continuous mentorship of health care

providers can address quality concerns and accelerate start-up of

a treatment programme.

♦ Price of medicines was an important trigger to be able to start a

treatment programme.

Fighting HIV in the supply chain

Key accomplishments

♦ 19 SCC adopted a HIV/AIDS workplace policy;

♦ 19 SCC have active HIV/AIDS committees;

♦ The top managers of the SCC are becoming

increasingly supportive and engaged;

♦ 167 peer educators have been trained;

♦ IEC materials distributed;

♦ Employees have improved access to condoms;

♦ 819 employees received HCT and HIV-positive

clients were referred to care and treatment;

The future of HIV prevention and treatment programmes.

♦ Competition for diminishing funds for global health

♦ Employers should not offload their problem on the public sector but

seek genuine cooperation and contribute towards a solution

♦ Opportunities to try different approaches to be more effective and

efficient.

♦ Involving supply chain

♦ HIV prevention and treatment need sustained efforts for the

foreseeable future.

♦ Needs will increase during the next years

■More demand of HIV infected

■Resistance

● Better and more expensive drugs

■Treatment as prevention

♦Thank you

♦ (NB no conflicts of interest)