1.  INTRODUCTION

  1.1  The following information is the TUC's written submission to the House of Commons International Development Committee inquiry into the impact of HIV/AIDS on developing countries' social and economic development.

  1.2  The TUC is an active member of the international trade union Movement, affiliated to the International Confederation of Free Trade Unions (ICFTU) which has 125 million members in 215 affiliated organisations in 145 countries and territories. We and our colleagues recognise that HIV/AIDS is the probably the most serious social challenge of our time and are alarmed at the devastating effects of the disease on workers, their families and the community at large. At the ICFTU's 17th World Congress in Durban, South Africa on 1-7 April 2000, the international trade union Movement made a commitment to raise general awareness of the epidemic and to seek immediate, strong and effective action to control and eradicate this terrible disease. Three priorities for action were identified: to adopt preventive measures; to mobilise against any form of discrimination against people with HIV/AIDS; and to press pharmaceutical companies to lower their prices to a level that developing countries can afford.

  1.3  The spread of HIV/AIDS in developing countries has been exacerbated by poverty, structural adjustment programmes which starve key sectors such as health and education of vital resources, and limited access to treatment. Ninety five per cent of people living with HIV/AIDS are to be found in this part of the world. However, it would be wrong to see HIV/AIDS as a problem primarily for developing countries. It is a global problem, undermining economic progress and development and requiring an integrated, co-ordinated and sustained international response.

  1.4  The workplace, in both formal and informal sectors, is one of the most important points of focus for initiatives to tackle the disastrous effects of the HIV/AIDS pandemic as it provides access to a large, yet captive audience. Many workplaces possess the infrastructure for training and education activities which can be utilised for HIV/AIDS awareness and prevention campaigns. For millions of people, the workplace may be the only place where they can access the necessary information and education which could help them, their families and communities meet the challenges posed by the disease. Trade unions also form networks both nationally and internationally which have been effective in promoting campaigns for social rights such as the banning of child and bonded labour. These network could be an effective tool in the struggle against HIV/AIDS.

  1.5  The values upheld by trade unionists around the world—non-discrimination; protection of children and vulnerable groups; gender equality; promotion of efficient social security systems and public services; and challenging the power of multinationals where they behave in a manner which is in conflict with the public interest—are the values required to combat HIV/AIDS.

2.  THE IMPACT OF HIV/AIDS ON DEVELOPING COUNTRIES

2.1  The impact of HIV/AIDS on workforces

  2.1.1  The HIV/AIDS pandemic has a profound and negative impact on the workforce, and by extension, the economy of affected countries. The ILO has analysed the probable impact of HIV/AIDS on the labour force in 15 countries, 13 in Africa, one in Asia (Thailand) and one in the Americas (Haiti). Eight of those countries have a high HIV prevalence (10 per cent or more of the adult population were HIV+ in 1997) and the other seven have lower prevalence (less than 10 per cent of the adult population). It is expected that the age and sex distribution of the labour force will change as a result of the rising number of widows and orphans seeking a livelihood. A large proportion of people suffering from AIDS in the age group 20-49 years will lead to their early withdrawal from the workforce. This in turn will result in the early entry of children into the active labour force and the retention of older persons due to economic need.

  2.1.2  The ILO estimates that the labour force in high prevalence countries in the year 2020 will be about 10-22 per cent smaller than it would have been if there had been no HIV/AIDS. In the case of the lower prevalence countries, the impact is significant but smaller. The labour force is expected to be between 3-9 per cent smaller (except for Thailand, where the difference is just over 1 per cent) than it would have been without HIV/AIDS.

  2.1.3  There is some evidence to suggest that with high unemployment and underemployment in many countries, the shortfall in the labour supply has been met by people seeking employment. In some cases, importing labour from neighbouring countries has also helped address the problem. However, even where there is high unemployment, it is not always possible to match the human resource requirements with the available labour supply in terms of qualifications and training. Labour mobility for economic reasons can increase the risk of HIV/AIDS transmission if adequate education and prevention campaigns are not implemented.

  2.1.4  Little is documented about the impact of HIV/AIDS on the quality of the labour force in terms of education, training and experience. However, it is probable that the disease will also have a major impact in this area as it claims the lives of skilled and experienced workers at the most productive period of their lives. Replacing such skilled workers is difficult and while it might be possible in some cases to substitute capital or technology for a dwindling workforce, this is not always an option. The situation is exacerbated by the toll that HIV/AIDS is taking on the education sector. In some countries, it is reducing the number of qualified teachers as they are dying from the disease. It is also leading to a rise in early school drop-out rates as students leave school when their parents become infected and/or die. This is a serious obstacle to the growth of human capital which is crucial to developing countries. With the revolution in information processing, communications and transport leading the way to a "new" knowledge-based economy, HIV/AIDS adds to the threat of the creation of a "digital divide" that reinforces and deepens social inequality between developing countries and industrialised ones.

2.2  The impact of HIV/AIDS on different economic sectors

  2.2.1  Certain sectors of the workforce are more vulnerable to infection than others. In general, these are characterised by the need for workers to work away from home for long periods at a time—circumstances that are conducive to multiple and casual sexual partnerships therefore increasing the risk of HIV infection. These sectors include transport, mining and fishing. Sectors relying on seasonal and short-term workers such as agriculture, tourism and construction are also vulnerable to the spread of HIV/AIDS.

  2.2.2  In the rural agricultural sector, losses of workers due to HIV/AIDS have led to reduced food production and declining food security. Labour and time from agricultural work is reallocated to non-agricultural care activities because of the disease. For example, according to a study by the Zimbabwe Farmers' Union, the HIV/AIDS-related reduction in the production of maize has reached 61 per cent; cotton 47 per cent; vegetables 49 per cent; and groundnuts 37 per cent.

  2.2.3  The impact of HIV/AIDS on some sectors may also be significant due to the pressure it exerts on resources and the negative implications it has for the sector. Most evident is the effect that it has on the health sector. The number of people seeking medical attention increases dramatically as a consequence of the disease, stretching poorly resourced health systems to breaking point. Most developing countries cannot afford the prohibitively expensive drugs required to treat the disease. Workers in the health sector are also at risk of HIV infection if proper health and safety measures are not taken.

  2.2.4  As stated previously, the education sector is badly affected by the pandemic. HIV/AIDS reduces the supply of teachers and forces children out of school for a number of reasons—they are needed to care for sick family members; to work; or because their families cannot afford to keep them in school due to inability to pay school fees as a result of reduced household income, coupled with increased expenditure for medical treatment. Apart from affecting the quality of the workforce, HIV/AIDS also leads to the increased incidence of child labour.

  2.2.5  Workers in the informal sector account for a large section of the workforce in developing countries. This sector covers small-scale income-generating activities which take place outside the official regulatory framework and typically utilise a low level of capital, technology and skills, while providing low incomes and unstable employment. Due to the lack of regulation and monitoring of the informal sector, workers have few rights, little training and often work in unhealthy and unsafe conditions. In the vast majority of cases, they do not have access to information vital to prevent infection and are unable to exercise their right to protection against discrimination if infected.

2.3  The effect of workforce illness on national economies and development

  2.3.1  HIV/AIDS has a far-reaching effect on the labour force in affected countries which covers its size, composition and quality. Once the disease spreads through the workforce and affects enterprises, its impact will sooner or later be felt at the national level.

  2.3.2  HIV/AIDS and related illnesses reduce the revenues of employers in a variety of ways. This includes increased expenditure on healthcare (where this is provided), and on recruitment and training of new employees. The loss of experienced workers who have to be replaced by less experienced ones combined with absenteeism arising from illness or attendance at funerals leads to loss of productivity and by extension, to higher production costs and loss of competitiveness both nationally and internationally. For the small enterprises which are prevalent in developing countries, loss of employees have even greater implications as there is less capacity to replace them. In the case of family businesses and micro-enterprises for example, the loss of the key entrepreneur can be devastating.

  2.3.3  The decrease in private savings due to higher individual expenditure on medical care and loss of earnings, combined with lower government revenues can lead to slower employment creation in the formal sector which is capital intensive. Consequently, more and more workers will be pushed into lower paid jobs with poor working conditions in the informal sector.

  2.3.4  Another significant impact may be the loss, or reduction, of markets for a variety of enterprises due to a decline in the purchasing power of the population.

  2.3.5  The pandemic also puts a huge strain on public services and the social security system (where this exists) and drains away precious resources required to fuel development.

2.4  The effect of HIV/AIDS on workers and dependent households

  2.4.1  HIV/AIDS has a huge impact on infected workers and their families, as well as on their extended families. Discrimination, stigmatisation and hostility against people living with HIV/AIDS is commonplace both in the community and at the workplace. They have difficulty obtaining decent jobs. If in employment, they are often forced to leave their jobs once their HIV status is revealed and are isolated in their communities. The economic situation of workers with HIV/AIDS forces them to take on any work that they can find in order to survive, making them particularly vulnerable to exploitation.

  2.4.2  HIV/AIDS is a debilitating disease, leading to disability that can put workers' livelihoods, and therefore their ability to continue supporting themselves and their families at risk. Disability leaves workers suffering from HIV/AIDS open to further discrimination.

  2.4.3  Family members, including children, are forced to work to supplement the family income when the main breadwinner succumbs to the disease. The number of children engaged in income-earning activities in countries with a high prevalence of HIV/AIDS increases significantly.

  2.4.4  Women are particularly badly affected by HIV/AIDS. They are at a high risk of being infected themselves. The burden of caring for HIV/AIDS orphans is also borne primarily by women. Circumstances compel many women and children, who on the whole possess limited education and training, to seek income, putting them at risk of sexual, and other forms of exploitation.

  2.4.5  Social security systems are practically non-existent in most developing countries. The extended family is, in effect, the only safety net available. Infected workers and their families are therefore left to deal with the full impact of the disease which drives them deeper into poverty.

3.  RESPONDING TO THE EFFECTS OF HIV/AIDS ON DEVELOPING COUNTRIES

3.1  The human and legal rights of those living with HIV/AIDS in developing countries

  3.1.1  HIV/AIDS generates fear and discrimination, robbing people of the right to equal protection and equality before the law, to privacy, liberty of movement, work, equal access to education, healthcare and other social services on the sole basis of their known or presumed HIV status. People living with HIV/AIDS will not seek testing, counselling, treatment or support in an environment where there is a lack of confidentiality and where they face the loss of employment and other negative consequences. This situation is further exacerbated by a culture of denial. Public education and the protection of human and workers' rights is therefore vital to the success of any campaign to tackle HIV/AIDS.

  3.1.2  Workers regularly face many abuses by employers, from tests at the time of hiring to dismissal of those who are HIV positive. Workers' rights have to be protected to enable them to carry on providing for their families for as long as possible and to have a decent quality of life. These rights include non-discrimination at work; no dismissal based on HIV status; no recruitment and employment testing; medical confidentiality; working time flexibility; early retirement options; and the right for trade unions to negotiate on issues over and above the statutory framework.

  3.1.3  While there is no international labour Convention that specifically addresses the issue of HIV/AIDS in the workplace, there are many instruments that can cover both protection against discrimination and prevention against infection. The ILO's 1998 Declaration on Fundamental Principles and Rights at Work declares four groups of principles as requiring respect, promotion and realisation whether or not the Conventions on the subjects have been ratified by member States. These principles are: non-discrimination, freedom of association and the right to collective bargaining, the elimination of forced labour and abolition of child labour.

  3.1.4  The Discrimination (Employment and Occupation) Convention, 1958 (No 111) bans any distinction, exclusion or preference which has the effect of nullifying or impairing equality of opportunity or treatment in access to training; access to jobs; promotion processes; security of tenure; remuneration; conditions of work including leave, rest periods; occupational safety and health measures; and social security benefits. The Convention not only prohibits discrimination but also promotes pro-active measures designed to meet the particular requirements of persons needing social protection. Article 5(2) lists persons with disability among the groups that might benefit from affirmative action or measures of accommodation at the workplace. Moreover, Recommendation no. 111, which accompanies the Convention, suggests the creation of appropriate agencies and advisory committees, composed of representatives of employers' and workers' organisations and of other interested bodies to promote acceptance of the principle on non-discrimination in employment, and to carry out specific activities such as information and education campaigns.

  3.1.5  The Termination of Employment Convention, 1982 (No 158) sets out the international position concerning possible dismissals. Article 4 specifies that the termination can only take place when there is a valid reason connected with the capacity or conduct of the worker, or based on the operational requirements of the undertaking, establishment or service. Article 6 makes it clear that temporary absence from work because of sickness or injury—whether occupationally related or not—is not a valid reason for dismissal. The Vocational Rehabilitation and Employment (Disabled Persons) Convention 1983 (No 159) bans discrimination based on disability. Article 4 promotes special protective measures, such as workplace accommodation and transfers in order to enable persons with disabilities to continue to gain a living until such time as their disability affects their capacity to do a particular job or until they are too ill to work.

  3.1.6  The Occupational Health and Safety Convention, 1981 (No 155) sets out basic requirements to protect workers such as the provision of protective clothing and equipment at no cost to the worker, and the right to be transferred to less onerous jobs and the right to leave a situation of imminent danger to the worker. The Occupational Health Services Convention 1985 (No 161) requires ratifying states to adopt comprehensive, co-ordinated national policies. Its accompanying Recommendation No 171 lists a number of measures including an assurance that health surveillance is not used for discriminatory purposes, confidentiality of medical examination data, collaboration in finding alternative employment where transfer is required for health reasons, worker counselling on the results of health examinations and the principle of no cost to the worker for the health-related facilities provided by such services.

  3.1.7  International labour standards dealing with negotiations and collective bargaining are also particularly effective tools in combating HIV/AIDS. Measures for addressing HIV/AIDS in the workplace can be included in the free negotiation of terms and conditions of employment between employers and trade unions which lead to binding collective agreements. A practical example of this at the sectoral level is the 1991 AIDS Agreement between the National Union of Mineworkers and the Chamber of Mines in South Africa. The Agreement covers protection against discrimination or harassment, non-consensual testing, counselling, benefits, awareness and education programmes and a ban on adverse employment consequences, including dismissal for the mere fact of HIV infection. The collective bargaining mechanism has the important advantage of providing an in-built monitoring system which enables workers to ensure the implementation of agreements with employers, as opposed to unilaterally adopted company guidelines for example, which require independent monitoring systems to be meaningful.

  3.1.8  The ratification and effective national implementation of these, and other relevant ILO Conventions such as those addressing specific groups of workers who by the nature of their work are groups at risk of infection eg health workers and migrant workers, will go a long way to address the devastating effects of the disease on the lives of working people. Such legal protection would enable them to live in dignity, maintain their families and be productive for longer than they otherwise would be. Crucially, it would also create a framework for prevention, which must be a priority.

3.2  Responsibility and opportunities for HIV/AIDS education and prevention

  3.2.1  HIV/AIDS is a universal threat and is the responsibility of all the social partners. Governments, trade unions and employers, need to work together to eradicate the disease, and to support the needs of those living with HIV/AIDS. The ILO resolved at its 88th International Labour Conference in Geneva this year to call upon member states, and where applicable, employers and workers' organisations to: raise national awareness with a view to eliminating the stigma and discrimination attached to HIV/AIDS, as well as to fight the culture of denial, thereby preventing the spread of HIV/AIDS; to strengthen the capacity of the social partners to address the pandemic; strengthen occupational safety and health systems to protect groups at risk; formulate and implement social and labour policies and programmes to mitigate the effects of HIV/AIDS; and to mobilise resources effectively.

  3.2.2  Workplace HIV/AIDS programmes are key to any strategy to address the pandemic and serve to strengthen legislation at national level. These should be developed in partnership with trade unions at enterprise level and include the following elements:

—  prohibition on direct and indirect discrimination on the basis of HIV status.

—  protection of occupational benefits.

—  working time and conditions of employment should be adapted to facilitate necessary medical treatment.

—  education and information campaigns to prevent the spread of HIV/AIDS, addressing issues such as stigmatisation and encouraging a culture of openness.

—  strengthening occupational health and safety programmes to protect groups of workers who are particularly at risk.

—  free distribution and availability of condoms through the workplace.

—  protection of the right of privacy and confidentiality about the health status of workers.

—  free testing and counselling services.

  Programmes need to be adapted to the needs and circumstances of specific enterprises and sectors. Where possible, national trade union centres and international trade secretariats (which cover sectors) should also be involved to provide a broad, co-ordinated approach.

  3.2.3  Trade unions have developed their own HIV/AIDS action programmes. The Trades Union Congress of the Philippines (TUCP), also affiliated to the ICFTU, joined the struggle against HIV/AIDS in the early 1990s, eventually becoming instrumental in creating the main NGO active in the struggle against HIV/AIDS. The TUCP conducts preventive awareness and training campaigns, producing a variety of materials and facilitates agreements with employers and the Government. It has a network of 14 health centres which provide its 600,000 members with counselling, diagnoses and treatment in the areas of reproductive health, STD and HIV/AIDS. Another ICFTU affiliate, the Congress of South African Trade Unions (COSATU) has launched an HIV/AIDS awareness campaign and developed a programme for its members on the issue. Activities have included regional workshops, dissemination of information, training shop stewards on HIV/AIDS issues and producing a manual for them. Many of COSATU's affiliates (individual unions) have comprehensive HIV/AIDS policies and programmes in place which include focus weeks in provinces, information blitzing among their membership and communities, training of peer educators, condom distribution in the workplace and at union offices, and the negotiation of workplace policies to protect the rights of workers. COSATU is also actively engaged in lobbying to improve public healthcare and for access to HIV/AIDS treatment, an issue of grave concern to the international trade union Movement as a whole, which will be discussed at a later stage in this memorandum. These are only two examples of what trade unions are doing to combat the disease.

  3.2.4  Clearly, trade unions can make an enormous contribution to the fight against HIV/AIDS by mobilising their members and by negotiating and monitoring agreements with employers through collective bargaining to create an effective HIV/AIDS prevention and management framework within the workplace. By not recognising and guaranteeing trade union rights, governments are effectively depriving themselves of essential partners in the struggle against HIV/AIDS. A commitment by governments of both industrialised and developing countries to core labour standards and to strengthening the capacity of trade unions, particularly those in developing countries, is a necessary component of any effective strategy to combat the HIV/AIDS pandemic.

3.3  The response of the international community

  3.3.1  The TUC supports the campaign by the Jubilee 2000 coalition for the cancellation of the external debt of developing countries. The crippling debt burden of developing countries has hampered their ability to prevent and manage HIV/AIDS effectively. In addition, there needs to be strong efforts to incorporate a social dimension into structural adjustment policies and programmes. Despite some effort by the World Bank and IMF to integrate social development goals into structural adjustment programmes (SAPs), the social costs of implementing SAPs remain high. It is crucial to protect public expenditure for essential social services such as health and education and to enable the development of public policies to halt the onslaught of the disease. Participatory approaches to the formulation and implementation of SAPs should also be adopted. The ILO tripartite model would serve as an effective consultative framework, and SAPs should be underpinned by respect for core labour standards, including freedom of association and the right to collective bargaining, which are powerful tools for HIV/AIDS protection and prevention.

  3.3.2  Prevention programmes can slow down the spread of HIV/AIDS. However, for the many millions already infected by the disease, treatment is the only hope. Few people living with HIV/AIDS in developing countries can afford the medication that can help them cope with the disease and extend their life expectancy. This is true of both anti-retroviral drugs which target the virus directly, and those which treat and prevent opportunistic infections brought on by the weakening of the immune system. The international trade union Movement is pressing the international community to take a strong stand on this issue and to force the major pharmaceutical companies to provide these drugs at a cost that developing countries can afford. Governments in developing countries must be allowed to make use of compulsory licences and parallel imports to make HIV/AIDS treatment available at affordable cost. There must also be greater commitment from governments to intensify the search for a vaccine that can cure the disease and is accessible to developing countries.

  3.3.3  The low social and economic status of women makes them less able to protect themselves and their children from infection, which in turn contributes to the spread of the disease. Development programmes need to aim at empowering women economically, socially and politically to reduce their vulnerability to HIV/AIDS. They should include measures to improve the enrolment of girls in basic education, and to ensure that adult education enhances the opportunities of women within their society. The education of women is in itself insufficient. Measures to promote and transform gender roles, traditional norms and social structures are also needed.

  3.3.4  The increase of child labour due to HIV/AIDS threatens not only the future of individual children but also that of countries in the developing world. The future of a country relies heavily on its human capital and skills base, particularly in the age of an emerging new economy. ILO Convention 182 requires the removal from work and into education of all children in the worst forms of child labour. The UK Government has ratified the Convention (and Convention 138 on minimum age for entry into employment) and should therefore build its aims into its international development policies. There is no evidence to support the view that children can work themselves and their families out of poverty. A more productive approach would be to educate them out of poverty and to replace child workers with adults, where possible from their extended families, who should be paid adult wages and ensured basic rights at work. Greater commitment to these goals are required from all governments. Governments of industrialised countries have a particularly important role to play in building the capacity of developing countries to address the problem of AIDS orphans and children exposed to infection or forced into child labour.

4.  CONCLUSION

  4.1  The full potential of the world of work as a key venue for addressing the HIV/AIDS pandemic needs to be tapped. The trade union Movement, inter-governmental organisations, national governments and employers need to work together to this end, drawing in other civil society organisations wherever possible.

Trades Union Congress

July 2000