1. HEINEKEN International Making HIV programmes work The Heineken HIV programme- First ten years

2. 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

3. Price of the drugs ♦ Accelerated Access Initiative ♦ Generic Producers

4. 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

5. 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

6. 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

7. Compliance and continuity ♦ Workplace allows for excellent compliance: active tracing ♦ Choose the best drugs, not the cheapest ♦ No interruption in drug supply

8. Laboratory Capacity and Quality Control ♦ Invest in technology ♦ Invest in training ♦ Building quality cycles ♦ External quality surveillance

9. 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

10. Causes of stigma 2 + + + + + + + - - -

11. Low level of stigmatisation ♦ Priority for Heineken to target stigma in these countries? studycountry S1 Mean Genberg, 2009 Tanzania1.66 Thailand1.35 Zimbabwe1.23 Vulinlela (SA)0.93 Soweto (SA)0.79 De Jong, 2010 DRC0.57 Burundi0.32

12. Immediate result

14. After 10 years still new infections

15. 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.

16. Fighting HIV in the supply chain

17. 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;

18. 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

19. ♦ Thank you ♦ (NB no conflicts of interest)