Treatment of HIV/AIDS at South Africa's Largest Employers: Myth and Reality

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.

The Private Sector and HIV/AIDS in Africa: Taking Stock of Six Years of Applied Research

Background: Until recently, little was known about the costs of the HIV/AIDS epidemic to businesses in Africa and business responses to the epidemic. This paper synthesizes the results of a set of studies conducted between 1999 and 2006 and draws conclusions about the role of the private sector in Africa’s response to AIDS. Methods: Detailed human resource, financial, and medical data were collected from 14 large private and parastatal companies in South Africa, Uganda, Kenya, Zambia, and Ethiopia. Surveys of small and medium-sized enterprises (SMEs) were conducted in South Africa, Kenya, and Zambia. Large companies’ responses or potential responses to the epidemic were investigated in South Africa, Uganda, Kenya, Zambia, and Rwanda. Results: Among the large companies, estimated workforce HIV prevalence ranged from 5%¬37%. The average cost per employee lost to AIDS varied from 0.5-5.6 times the average annual compensation of the employee affected. Labor cost increases as a result of AIDS were estimated at anywhere from 0.6%-10.8% but exceeded 3% at only 2 of 14 companies. Treatment of eligible employees with ART at a cost of $360/patient/year was shown to have positive financial returns for most but not all companies. Uptake of employer-provided testing and treatment services varied widely. Among SMEs, HIV prevalence in the workforce was estimated at 10%-26%. SME managers consistently reported low AIDS-related employee attrition, little concern about the impacts of AIDS on their companies, and relatively little interest in taking action, and fewer than half had ever discussed AIDS with their senior staff. AIDS was estimated to increase the average operating costs of small tourism companies in Zambia by less than 1%; labor cost increases in other sectors were probably smaller. Conclusions: Although there was wide variation among the firms studied, clear patterns emerged that will permit some prediction of impacts and responses in the future.

The Construction of Arbitrary Stable Dynamics in Non-Linear Neural Networks

In this paper, two methods for constructing systems of ordinary differential equations realizing any fixed finite set of equilibria in any fixed finite dimension are introduced; no spurious equilibria are possible for either method. By using the first method, one can construct a system with the fewest number of equilibria, given a fixed set of attractors. Using a strict Lyapunov function for each of these differential equations, a large class of systems with the same set of equilibria is constructed. A method of fitting these nonlinear systems to trajectories is proposed. In addition, a general method which will produce an arbitrary number of periodic orbits of shapes of arbitrary complexity is also discussed. A more general second method is given to construct a differential equation which converges to a fixed given finite set of equilibria. This technique is much more general in that it allows this set of equilibria to have any of a large class of indices which are consistent with the Morse Inequalities. It is clear that this class is not universal, because there is a large class of additional vector fields with convergent dynamics which cannot be constructed by the above method. The easiest way to see this is to enumerate the set of Morse indices which can be obtained by the above method and compare this class with the class of Morse indices of arbitrary differential equations with convergent dynamics. The former set of indices are a proper subclass of the latter, therefore, the above construction cannot be universal. In general, it is a difficult open problem to construct a specific example of a differential equation with a given fixed set of equilibria, permissible Morse indices, and permissible connections between stable and unstable manifolds. A strict Lyapunov function is given for this second case as well. This strict Lyapunov function as above enables construction of a large class of examples consistent with these more complicated dynamics and indices. The determination of all the basins of attraction in the general case for these systems is also difficult and open.