Thesis (MBA (Business Management))--University of Stellenbosch, 2008. / AFRIKAANSE OPSOMMING: Menslike immuungebrekvirus (MIV) en Verworwe immuniteitsgebrek sindroom (VIGS) is een van die grootste uitdagings waarvoor werkgewers vandag te staan kom, en behoort die stukrag te wees vir ’n deeglike ondersoek om die voorkoms van hierdie toestand in die werkplek so akkuraat as moontlik te bepaal. So ’n ondersoek kan lig werp op toekomstige demografiese arbeidsmagtendense en verwante koste, byvoorbeeld verlies aan produktiwiteit en dienslewering weens afwesigheid, ’n toename in aftredes, en stygende sieke- en pensioenfondseise wat waarskynlik ingedien sal word. Daarbenewens kan so ’n ondersoek die werkgewer in staat stel om noukeuriger vir die toekoms te beplan, vanuit die oogpunt van finansies sowel as menslike hulpbronne. Daar is egter ’n neiging by werkgewers om MIV/VIGS steeds as ’n maatskaplike of samelewingsprobleem eerder as ’n besigheidspesifieke risiko te beskou. Onkunde is meestal die rede hiervoor. Werkgewers neig om weg te skram van direkte risikobestuur, dikwels met die argument dat dit die regering se plig is om MIV/VIGS-opleiding en gesondheidsorg te voorsien. Sodoende word die bestaande verhouding van ‘ekwilibriumkonvergensie’ tussen die staat, sakesektor en arbeid verydel. MIV/VIGS moet soos ander groot geïdentifiseerde sakerisiko’s beskou, gemeet en proaktief bestuur word, net soos met wisselkoers wisselvalligheid, politieke en infrastrukturele risiko’s, en persoonlike en batesekuriteit. Hoewel hierdie risikofaktore dwarsoor die wêreld bestaan, en sommiges in ander wêrelddele groter is, het hul gekombineerde uitwerking veral in Suider-Afrika ernstige implikasies vir investering en die koste om hier sake te doen. Soos alle ander sakerisiko’s moet die hantering daarvan multidimensioneel wees: • Identifiseer, meet en bestuur die risiko; plaas MIV/VIGS eerste op die direksie se agenda. • Stel senior beamptes aan om die risiko te bestuur. • Evalueer bestuurstrukture en intervensie stappe gereeld. • MIV/VIGS opleiding is die sleutel, vir bestuurslede sowel as werknemers. Risikobestuur moet holisties wees. So byvoorbeeld is dit nutteloos om gesondheidsorg sonder proaktiewe pasiëntebestuur te voorsien. En net soos wat behandelingsplanne sonder befondsing sinloos is, is dit futiel om goed befondsde voordeelplanne te skep as behandeling nie toeganklik is nie. Die doel van hierdie studie is om die proses wat Old Mutual (SA) gevolg het om die voorkoms van MIV onder sy 13 000 permanente werknemers landwyd te eksploreer. Die statistiese uitkoms sal dan gebruik word om te bepaal of Old Mutual (SA) wel sy doelwitte in terme van werknemersgelykheid sal bereik en behou, gegewe die MIV/VIGS pandemie. Vooruitskouings oor die implikasies van MIV/VIGS vir Old Mutual (SA) moet met die nodige omsigtigheid benader word, alhoewel hierdie studie aandui dat dit moontlik implikasies kan inhou vir werkverskaffing in die toekoms, gegewe die wetlike vereistes vir die verskeie aangewese groepe. MIV/VIGS lei nie net tot siekte, ongeskiktheid en dood onder Old Mutual (SA) se werknemers nie. Tesame met ernstige ekonomiese en emosionele ontwrigting vir hul gesinne, verhoog dit ook die koste om in Suid-Afrika sake te doen. Hierdie koste sluit die volgende in: • verhoogde gesondheidsorgkoste; • meer eise vir aftree-, pensioen- en doodsvoordele; • laer produktiwiteit namate afwesigheid van die werk styg weens siekte, hetsy eie of siek familielede na wie omgesien moet word; en • verhoogde koste vir personeelwerwing, arbeidsomset en opleiding weens die verlies van ervare personeel. / ENGLISH ABSTRACT: Human Immunodeficiency Virus infection and the Acquired Immune Deficiency Syndrome (HIV/AIDS) is one of the greatest challenges facing employers today, and should provide the impetus for a thorough investigation among employees in order to arrive at an estimate of HIV prevalence within the workplace. Such an investigation could shed light on future demographic workforce trends as well as related costs, e.g. loss in productivity and service delivery due to absenteeism, increased retirement and a rise in medical aid and pension fund claims that the employer is likely to encounter. Furthermore, this investigation could enable the employer to plan better for the future – both from a financial and human resources viewpoint. In the ‘real’ world though, employers still perceive HIV/AIDS as a social or community problem rather than a business specific risk. Employers, largely through ignorance, tend to shy away from direct risk management – often using the argument that it is the government’s responsibility to provide HIV/AIDS education and healthcare. In this way they nullify the existing ‘equilibrium convergence’ relationship between the state, business and labour. HIV/AIDS must be measured and proactively managed and should be regarded in the same light as other major identified business risks, e.g. personal and asset security, exchange rate volatility, and political and infrastructure risks. While it is true that all of these particular risk factors exist across the globe, and may be greater in other parts of the world, nowhere else do they seem to combine with such severe implications to deter investment and raise the cost of doing business than in Southern Africa. As for any other business risk, the response should be multi-dimensional: • Identify, measure and manage; place HIV/AIDS at the top of board agendas. • Appoint senior executives to manage the risk. • Regularly evaluate management structures and interventions. • HIV/AIDS education is key to both management and employees. Risk management should be holistic. For example, providing healthcare without proactive patient management is pointless. Similarly, treatment plans without funding are futile, and well-funded benefit plans without practical access to treatment are a waste of time. The aim of this study is to explore the process Old Mutual (SA) followed in estimating the HIV prevalence among its 13 000 permanent employees nationally. The resultant statistics would then be used to project whether or not Old Mutual (SA) will be able to achieve and sustain its employment equity targets, given the HIV/AIDS pandemic. Predictions on the implications of HIV/AIDS for Old Mutual (SA) should be approached with due caution, although this study suggests that it could probably seriously impact on shortages in the supply of labour in future, given the legislative requirements for the various designated groupings. HIV/AIDS not only causes illness, disability and death among Old Mutual (SA) employees, coupled with severe economic and emotional disruption for their families, it also increases the cost of doing business in South Africa. These costs include: • increased healthcare expenses; • increased retirement, pension and death benefit claims; • decreased productivity as worker absenteeism rises owing to personal illness, or absence from work to care for sick relatives; and • increased recruitment, labour turnover and training costs due to loss of experienced workers.

Thesis (MBA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: HIV infection has increased sharply in SA over the past decade, from almost zero to a level where between 4-6 million citizens are estimated to be HIV positive (i.e. around Il percent of the total population). Given the considerable lag and link between the HIV and AIDS epidemic, the mortality consequences of this exponential increase in HIV infection over the 1990s are more or less matter-of-fact over the coming decade; even drastic interventions can do little to avoid this reality, albeit possibly impactingfurther beyond. The health care industry, and more specifically the pharmaceutical industry, is the only industry that can have a direct impact on the outcome of the epidemic in terms of provision of antiretroviral drugs. More importantly, the decision by multinational companies to provide voluntary licensing to local SA pharmaceutical manufacturers for the manufacturing of generic ARVs has gone a long way into achieving the World Health Organisations' objective of providing an ARV cocktail for less than $1,00 per day. The mam aim of the study is to establish and study the micro-economic effect of HIV/AIDS on a South African pharmaceutical manufacturer and to evaluate their HIV/AIDS Policy with the framework of the mV/AIDS & SID Strategie Plan for South Africa 2000-2005. Both qualitative and quantitative methods were used to obtain data from various key informants, manufacturers and market survey companies. The analysis of quantitative data was done using Excel software and a descriptive analysis method was used to interpret the data. The key findings from the study are that Aspen Pharmacare will experience a 20,8 % HIV prevalence rate in 2005, which will progressively increase to a 25,6 % level in 2015. This prevalence level will be severely experienced in the skilled, semi-skilled and unskilled employment of the company during the 2010 period and will start to stabilise in the latter part of 2015. The AIDS prevalence in the company will increase from a 2,0 % level in 2005 to a 4,4 % level in 2015. This increase is largely due to the increase in the prevalence rates in the semi-skilled and unskilled employees. At a senior management level the forecasted number of employees that will have clinical AIDS after 2010 is between 6 and 8. This clearly indicates that mv/AIDS prevalence at this level is independent of race and is lifestyle dependent. If the company were to have the full responsibility for the provision of benefits, based on the current expected employee benefit structures, the direct cost to company would add 10 % to salary and wages by 2005 and around 20 % by 2010. Indirect costs to company, such as recruitment and training, increased labour turnover, lost skills and intellectual property, etc. are estimated to be 2,5 % by 2005 and 5 % by 2010. With the high HIV/AIDS prevalence rates, especially amongst the unemployed, companies will have to carry the costs of their mv/AIDS patients for longer and register then with Aid for AIDS when it becomes too costly. More importantly employers will have to investigate the cost implication of assisting employee dependents, as this will have a direct impact on the morale of the employees. Aspen Pharmacares' mv/AIDS Policy goes beyond the requirements of the mv/AIDS Strategic Plan for SA in terms of the legal and social requirements. The company also has a Corporate Social Investment division that assists many NGOs, clinics, hospitals and communities. Based on the intellectual property, the pharmaceutical competencies and the continuous dialogue that exists between the pharmaceutical industry and the department of health, the researcher concludes, that pharmaceutical companies have an advantage over nonpharmaceutical companies in dealing with the mv/AIDS issues. The paper concludes by suggesting recommendations that companies can adopt to ensure that their mv/AIDS policy can form a significant component of their skills retention strategy. / AFRIKAANSE OPSOMMING: MIV infeksie het skerp gestyg in SA oor die laaste dekade, vanaf amper geen tot 'n vlak waar tussen 4-6 miljoen inwoners beraam word om MIV positiefte wees (minstens 11% van die totale bevolking). Gegee die aansienlike vertraging en skakel tussen die MIV en VIGS epidemie, word die eksponensiële toename in die sterfte syfer as gevolg van MIV infeksies gedurende die jare negentig as vanselfsprekend aanvaar in die komende dekade. Selfs ingrypende veranderinge kan min doen om hierdie katastrofe te keer. Die gesondheidsorg industrie, en meer spesifiek die farmaseutiese industrie is die enigste industrie wat 'n direkte slag kan slaan om die uitkoms van die epidemie te beinvloed, in terme van voorsiening van antiretrovirale medisyne. Die besluit van die multinasionale maatskappye om vrywillige lisensiëring aan plaaslike farmaseutiese maatskappye te bied, vir die vervaardiging van generiese antiretrovirale medisyne, is een stap vorentoe om by die doelwit van die Wereld Gesondheidsorg Organisasie se doelwit van die voorsiening van 'n daaglikse toediening van antiretrovirale medisyne van minder as $1.00 per dag. Die primêre doelwit van hierdie projek is om te bepaal wat die mikro-ekonomiese effek van MIV/VIGS op 'n Suid Afriakaanse farmaseutiese vervaardiger is en hul MIV/VIGS beleid te evalueer binne die raamwerk van die MIV/VIGS en SOS Strategiese Plan vir SA 2000-2005. Beide kwalitatiewe en kwantitatiewe metodes is gebruik om data te verkry vanaf verskeie bronne, vervaardigers en marknavorsings maatskappye. Die kwantitatiewe inligting was geanaliseer deur gebruik te maak van "Excel" sagteware en 'n beskrywende analitiese metode was gebruik om die data te interpreteer. Die hoof bevindinge van die studie is dat Aspen Pharmacare 'n MIV infeksie vlak van 20.8 % in 2005 sal ondervind, wat progressief sal toeneem tot 25,6 % in 2015. Hierdie infeksie vlak sal in die geskoolde, semi-geskoolde en ongeskoolde arbeid die ergste voorkom gedurende die 2010 periode en sal dan stabiliseer in die latere gedeelte van 2015. Die VIGS infeksie vlak in die maatskappy sal toeneem vanaf 2,0 % in 2005 tot 'n 4,4 % in 2015. Hierdie toename kan toegeskryf word aan die toename in die infeksie vlakke van die semi-geskoolde and ongeskoolde arbeid. Op die senior bestuurs vlak word beraam dat tussen 6 en 8 werknemers VIGS onder lede sal hê na 2010. Hierdie beraming toon duidelik aan dat MIV/VIGS op hierdie vlak onafhankilik van kleurgroup is en direk leefstyl verwant is. Gebaseer op die huidige verwagte werknemer voordele struktuur, en die feit dat die maatskappy volle verantwoordelikheid sou aanvaar vir die voorsiening van voordele, word beraam dat die direkte koste as gevolg van MIV/VIGS 'n toename van 10 % in 2005 en 20 % in 2010 by salarisse en lone sal voeg. 'n Toename van 2,5 % in 2005 en 5 % in 2010 word beraam vir indirekte koste (werwing van personeel, opleiding, ens.)as gevolg van MIV/VIGS. Met die hoë MIV/VIGS infeksievlakke, veral onder werkloses, sal maatskappye die kostes vebonde aan hul MIV/VIGS werknemers vir langer moet verduur en dan later sulke werknemers registreer by "Aid for AIDS" indien dit onbekostigbaar word. Belangriker is die feit dat werknemers die koste implikasie bepaal in die verband, omdat dit 'n direkte invloed sal hê op werknemer selfvertroue. Aspen Pharmacare se MIV/VIGS beleid bied meer as die wettige en sosiale vereistes soos uiteengesit in die MIV/VIGS en SOS Strategiese Plan vir SA 2000-2005. Die maatskappy het ook 'n Korporatiewe Maatskaplike Beleggings afdeling wat 'n bydra lewer by NGOs, klinieke,hospitale en gemeenskappe. Gebaseer op die intelligensie eiendom, die farmaseutiese bekwaamheid en die aanhoudende gesprekvoering wat bestaan tussen die farmaseutiese bedryf en die department van gesondheid, oortuig die navorser dat farmaseutiese maatskappye 'n voordeel het bo nie-farmaseutiese maatskappye in die hantering van die MIV/VIGS strydvraag. Hierdie studie sluit af met aanbevelings wat maatskappye kan toepas om te verseker dat hul MIV/VIGS beleid 'n betekenisvolle komponent van hul bekwaanheids retensie strategie is.

The US Bureau of the Census (1999) projected that by 2004, 14 million people in sub-Saharan Africa will develop full blown AIDS, making this region by far the largest disease burden in the world (World Health Organization, 2002). The United Nations AIDS Programme judged South Africa to have the leading number of people living with HIV/AIDS worldwide (World Health Organisation, 2002). To date there has been extensive research conducted on the socio-economic impacts of HIV/AIDS on families in Africa. However an area of investigation that has remained largely underreported is the inquiry into the psychological impacts of HIV/AIDS on elderly caregivers. In African families older women increasingly have to provide care to their adult children with AIDS and their orphaned grandchildren. However few research studies have assessed the experience of parental caregiving and its psychological impacts on these women. This qualitative research study hypothesised that the role of primary parental caregiver in fact causes a range of psychologically distressing states, which serve to compromise the psychological well-being of these caregivers. To investigate this hypothesis three Xhosa speaking women living in informal settlements in Grahamstown, in the Eastern Cape Province of South Africa were selected for the study. The women were interviewed by means of semi-structured interviews, which consisted of questions related to their caregiving experiences, their experiences of loss, their choice of coping strategies, the role of support networks and their experiences of foster care responsibilities. The interviews were transcribed and analysed using a grounded hermeneutic approach. The research results confirmed the working hypothesis. The research revealed that although it was considered culturally appropriate for older women to care for their children and grandchildren, their caregiver roles caused significant psychological distress. Their distress was related to: emotional and physical exhaustion, complicated grief reactions and ongoing emotional and physical upheaval related to foster care responsibilities. Based on the results, the research recommendations emphasised the need for continual awareness of the psychological implications of caregiving for older African women with the aim to preserve their capacity to function as the primary caring resource to families struck by HIV/AIDS.

Background and purpose. The purpose of the study was to determine the costs incurred on the average length of stay (ALOS) on patients with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) related illnesses admitted in hospital and whether there are any other significant costs involved. Method. A quantitative approach was used to collect data; analysed; interpretation and report writing. Purposive sampling and data collection was done using data collection sheet. This was a retrospective cost analysis data from in-patients records (record review) of ages from 15 years to 49 years both gender. Data analysis and presentation of information was presented by the use of tables; different types of graphs and the interpretation thereof. Results. The study found that males (63%) with HIV Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) related illnesses had longer average length of stay in a hospital compared to females. However, females illustrated higher in-patient costs but majority of patients had costs of between R0–R17 500. Patients with longer hospital stay (>3 days of hospitalisation) had higher in-patient costs. Conclusion. The findings also showed that in-patient care costs were directly proportional to length of stay with higher costs for HIV and AIDS patient management care. Our findings are consistent with other studies regarding higher economic implications of care for HIV infected persons being almost as twice as people who are HIV negative due to longer periods of hospitalisation. / Health Studies / M.A. (Public Health)

Livelihood stressors in southern Africa, such as HIV/Aids and climate change, do not act in isolation but rather interact concurrently in complex socio-ecological systems with diverse, interrelated and compounded affects. Households experience differential vulnerability to such stressors based on contextual factors such as geographical location, income level and the gender and age of its members. Households’ differential experiences of vulnerability are further defined by the households’ use of their capital stocks: the human, social, natural, financial and physical capital available to the household to form livelihoods and resist the detrimental effects of a stressor. The capital stocks of 340 households were measured in two sites in the Eastern Cape, South Africa, using a household survey. These data were analysed to determine differences between the sites, households with heads of different gender and households of different income levels. Further data relating to the drivers and interactions of stressors over temporal and spatial scales, as well as the perceived value of various forms of capital by different social groups in the two sites, were collected via Participatory Learning and Action (PLA) methods including timelines, mental modelling and pair-wise ranking. Although the two sites have similar levels of income and fall within the same province, many significant differences emerged. The two sites showed different distributions of household head genders and different stressors and perceptions of vulnerability, perhaps owing to differences in their capital stocks, acting alongside the influence of culture and access on a shifting rural-urban continuum. These discrepancies further transpired to reflect crucial differential experiences along gender lines and income levels in each site. Vulnerability was often context specific, not only because of unique drivers of stress in different areas, but also because socio-economic groups and localities often had characteristics that could potentially exacerbate vulnerability, as well as characteristics that can potentially facilitate adaptive capacity. Stressors were found to have depleted multiple forms of capital over time, while new stressors were emerging, raising concerns over the most appropriate means of social protection within these contexts.

Climate change and the HIV/AIDS epidemic are two of the most critical long-term global challenges, especially for Africa and even more so Southern Africa. There is great concern that the poor will be unable to adapt to the impacts of climate variability and change while HIV/AIDS will exacerbate the impacts of such stressors and deepen the insecurities of many communities already affected by this disease. Studies that consider the interlinked effects of climate change and HIV/AIDS along with other multiple stressors are increasingly needed. This study, located in two rural communities in the Eastern Cape Province of South Africa, namely Lesseyton and Willowvale, assessed the responses of vulnerable households to the linked shocks and stressors of climate change and HIV/AIDS. This involved assessing, through household surveys, life history interviews and Participatory Learning and Action (PLA), the way in which multiple stressors interacted and affected vulnerable households, the way in which these households responded to and coped with such shocks and stressors, and the barriers which prevented them from coping and adapting effectively. Unemployment emerged as the dominant stress amongst households. The lack of development and having too few opportunities for employment has limited vulnerable households from being able to invest in assets, such as education or farming equipment. This, in combination with the impacts of increased food and water insecurity from recent drought, has created an extremely vulnerable environment for these households. They rely largely on two important safety-nets, namely social capital and the use of natural and cultivated resources; however the latter has been limited due to the impacts of water scarcity and an inability to farm. It was evident that there was little planned long-term adaptation amongst households and from government. Maladaptive short-term coping strategies, such numerous household members depending on one social grant and transactional sex, were too often relied upon, and although they may have helped relieve the stress of shocks momentarily, they did not provide for the long-term well-being of individuals and households. Poor communication and capacity between the different levels of government and between the government (especially at the local level) and the two rural communities has created an environment full of uncertainty and lacking in advocacy. Local government needs increased human, informational, and financial capacity and a clear delegation of responsibilities amongst the different departments in order for the two communities to benefit from the implementation of support strategies. There is also a great need for educational programmes and capacity development within the two rural communities, particularly based on improved coping and longer-term adaptation strategies in response to climate change in order for households to better prepare themselves for the future.

The study into the socio-economic challenges of HIV and AIDS on widowed women in rural communities of Zimbabwe was carried out in the village of Mukadziwashe. The main aim of the study was to find out the socio-economic challenges that are faced by HIV and AIDS widows. Of particular concern has been role played change agent since the dawn of the HIV and AIDS pandemic and its devastating socio-economic impact on families, especially widows. The findings of this study are based on a sample of limited number (12) widows based in the village of Mukadziwashe in Gutu Central District, as well interviews of key informants who happen to be representatives of change agents in the main. In-depth interviews were the tool used to collect information from the research participants identified above. The findings of the study revealed that widows still suffer from the serious social and economic challenges posed by HIV and AIDS such as cultural oppressions and prevention of women from inheriting their late husbands’ wealth The continued denial of women of their constitutionally enshrined rights is difficult to understand, because many studies have been conducted on this subject. It is reasonable to expect noticeable progress in promoting the rights of women, especially widows. What is apparent in this sad story is the mute role of change agents, be they government, non-governmental or community based, in affirming widows’ rights. Based on these observations, the study strongly recommends the design, implementation and constant monitoring of intervention programmes aimed at women empowerment in general. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)

The study into the socio-economic challenges of HIV and AIDS on widowed women in rural communities of Zimbabwe was carried out in the village of Mukadziwashe. The main aim of the study was to find out the socio-economic challenges that are faced by HIV and AIDS widows. Of particular concern has been role played change agent since the dawn of the HIV and AIDS pandemic and its devastating socio-economic impact on families, especially widows. The findings of this study are based on a sample of limited number (12) widows based in the village of Mukadziwashe in Gutu Central District, as well interviews of key informants who happen to be representatives of change agents in the main. In-depth interviews were the tool used to collect information from the research participants identified above. The findings of the study revealed that widows still suffer from the serious social and economic challenges posed by HIV and AIDS such as cultural oppressions and prevention of women from inheriting their late husbands’ wealth The continued denial of women of their constitutionally enshrined rights is difficult to understand, because many studies have been conducted on this subject. It is reasonable to expect noticeable progress in promoting the rights of women, especially widows. What is apparent in this sad story is the mute role of change agents, be they government, non-governmental or community based, in affirming widows’ rights. Based on these observations, the study strongly recommends the design, implementation and constant monitoring of intervention programmes aimed at women empowerment in general. / Sociology / M.A. (Social Behaviour Studies in HIV and AIDS)