Center for International Health and Development
Treatment of HIV/AIDS at South Africa's
Largest Employers: Myth and Reality
Patrick Connelly and Sydney Rosen
Health and Development
Discussion Paper No. 5
Center for International Health and Development
Boston University School of Public Health
85 East Concord St., 5th fl.
Boston, MA 02118 USA
Treatment of HIV/AIDS at South Africa's largest employers HDDP 5
Background: In the past three years, many large employers in South Africa have announced
publicly their intention of making antiretroviral treatment (ART) available to employees.
Reports of the scope and success of these programs have been mostly anecdotal. This study
surveyed the largest private sector employers in South Africa to determine the proportion of
employees with access to ART through employer-sponsored HIV/AIDS treatment programs.
Methods: All 64 private sector and parastatal employers in South Africa with more than 6,000
employees were identified and contacted. Those that agreed to participate were interviewed by
telephone using a structured questionnaire.
Results: 52 companies agreed to participate. Among these companies, 63% of employees had
access to employer-sponsored care and treatment for HIV/AIDS. Access varied widely by
sector, however. Approximately 27% of suspected HIV-positive employees were enrolled in
HIV/AIDS disease management programs, or 4.4% of the workforce overall. Fewer than 4,000
employees in the entire sample were receiving antiretroviral therapy. In-house (employer)
disease management programs and independent disease management programs achieved higher
uptake of services than did medical aid schemes.
Conclusions: Publicity by large employers about their treatment programs should be interpreted
cautiously. While there is a high level of access to treatment, uptake of services is low and only
a small fraction of employees medically eligible for antiretroviral therapy are receiving it.
Keywords: HIV/AIDS, South Africa, Private Sector,Antiretroviral Therapy, Disease
Patrick Connelly and Sydney Rosen are at the Center for International Health and Development
at Boston University in the U.S. and the Health Economics Research Unit at the Wits Health
Consortium, University of the Witwatersrand in South Africa.
Correspondence to: Patrick Connelly, firstname.lastname@example.org.
Treatment of HIV/AIDS at South Africa's largest employersHDDP 5
Funding for this study was provided by the South Africa Mission of the U.S. Agency for
International Development through its Cooperative Agreement No. 674-A-00-02-00018 with
Right to Care. We thank our research assistants, Kay Muller and Jeremy Ogusky, who
conducted many of the interviews reported here.
Bolin L. “SA firms lead the way on HIV-AIDS.” Sunday Times, 2 June 2005. Available at
Accessed 3 June 2005.
Brink B. An interim appraisal of the Anglo American AIDS treatment program. Plenary
presentation at the 2nd South African AIDS Conference, Durban, South Africa, June 10, 2005.
Connelly P, Rosen S. Can small and medium enterprises in South Africa provide HIV/AIDS
services to their employees? A market analysis. CIHD Project Report, March 2004. Available
at: http://www.bu.edu/dbin/sph/research_centers/cih_impact_hiv.php. Accessed 25 May 2005.
Dorrington RE, Bradshaw D, Johnson L, Budlender D. The demographic impact of HIV/AIDS
in South Africa. National indicators for 2004. Cape Town: Centre for Actuarial Research, South
African Medical Research Council and Actuarial Society of South Africa. 2004.
Ellis L, Terwin J. The impact of HIV/AIDS on selected business sectors in South Africa 2004.
Stellenbosch: Bureau for Economic Research, University of Stellenbosch, 2004.
Irin. South Africa: capacity shortfalls undermine roll-out.” Irin PlusNews, 3 March, 2005.
Available from http://www.irinnews.org/pnprint.asp?reportid=4546. Accessed on 4 March 2005.
Kahn T. Anglo workers slow to accept offer of free AIDS drugs. Business Day, 17 Feb 2005.
Available at http://www.businessday.co.za/Articles/TarkArticle.aspx?ID=1377835. Accessed 25
Planting S. Champions of the AIDS cause. Financial Mail, 5 September 2003. Available at
http://free.financialmail.co.za/innovations/0905/iinn.htm Accessed 6 June 2005.
Rosen S, Sanne I, Collier A, Simon J. Rationing antiretroviral therapy for HIV/AIDS in Africa:
choices and consequences. PLoS Medicine; in press.
TAC and ALP. ‘Let them eat cake’—a short assessment of provision of treatment and care 18
months after the adoption of the operational plan. Second joint report on the implementation of
the Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for
South Africa. Treatment Action Campaign and AIDS Law Project, 8 June 2005. Available at
http://www.tac.org.za. Accessed June 13, 2005.
Venter L. Firms fill antiretroviral gap in South Africa. Lancet 2005; 365: 1215–16.