Speech by U.S. Ambassador Marie T. Huhtala Address to the Harvard Business School Alumni Club of Malaysia The Threat Of Hiv/Aids: What Businesses Can Do

July 19, 2003 – Mandarin Oriental Hotel

Thank you so much for the kind invitation to address you this evening. The organizers told me I could speak about any topic I chose. I decided to take them at their word, and I have chosen a subject of great importance to us all. I want to spend a few moments discussing the great threat to Malaysia, and the entire Asia-Pacific region, posed by HIV/AIDS.

We know that HIV/AIDS has had a devastating effect on the nations of sub-Saharan Africa, where nearly 30 million persons are living with HIV/AIDS, 58 percent of them women. We have seen the collapse of African national economies, the health systems completely overwhelmed, the heartbreaking number of children orphaned by AIDS. And many of us have come to the conclusion that the AIDS epidemic primarily affects underdeveloped regions like Africa, that it is unlikely to hit our own region with similar force.

Well, earlier this month I attended a conference in Bangkok on HIV/AIDS for US Ambassadors posted to this region. What I learned there, frankly, shocked me. I realized how important it is for all of us to think about this issue and especially to focus on what we can do to avoid repeating the dreadful experience of African countries.

It turns out that the Asia-Pacific region is home to more people living with HIV/AIDS than any other region besides sub-Saharan Africa. An estimated 7.2 million people in this region were infected as of the end of 2002, out of a world-wide total of 42 million. That means 1 in 6 sufferers are in Asia. Moreover, that number is rising rapidly. Nearly a million adults and children in Asia were infected in the year 2001, and 490,000 people died. About 2.1 million young people (aged 15-24) are living with HIV/AIDS in this region.

It is estimated that an additional 45 million people worldwide will become infected with HIV between now and 2010. More than 40% of these infections are expected to occur in Asia and the Pacific, double the current rate. Combined, China and India are expected to have, by 2010, more people living with HIVAIDS than currently live in all of sub-Saharan Africa, and India will surpass South Africa as the country having the most people living with HIV/AIDS.

China, which has one-fifth of the world's population, saw a 64% rise in HIV infections in 2001. By the middle of 2002 official estimates put the number of people living with AIDS in China at 1 million, and the epidemic there shows no sign of abating. Unless effective responses rapidly take hold, a total of 10 million Chinese will have acquired HIV by the end of this decade - a number equivalent to the entire population of Belgium.

Last year India had nearly 4 million people living with HIV/AIDS, the second-highest figure in the world, after South Africa. In some regions of India more than 1% of women attending prenatal clinics were found to be infected. One percent may not sound like much, until you realize the population of India is over 1 billion 45 million. Moreover, the epidemic was spreading rapidly into the general population.

Indonesia, the world's fourth-most populous country, is an example of how quickly an AIDS epidemic can spread. After more than 10 years of negligible HIV prevalence, infection rates began shooting up in 2001. At one drug treatment center in Jakarta, HIV prevalence rose from 15.4% in mid-1999 to more than 40% by mid-2001.

Thailand is one of the few countries that have been able to arrest the spread of the disease through well-funded, comprehensive prevention programs that receive both political and public support. The Thais have been able to reduce the number of annual new HIV infections from 143,000 in 1991 to 29,000 in 2001. But they still have a million people living with AIDS, along with all the hardship and heartbreak that entails, and AIDS is still Thailand's leading cause of death.

Cambodia, too, has had some success, bringing down its prevalence rate from 4% at the end of 1999 to 2.7% at the end of 2001 as a result of a multi-faceted response that included a consistent, nearly 100% condom use program for sex workers.

What are the figures for Malaysia? Official government statistics say that there have been 53,158 HIV infections since the epidemic began in 1986, resulting in 7,554 cases of AIDS and 5,613 AIDS-related deaths. However, as in many countries, many Malaysians do not seek testing for fear of being stigmatized as HIV-positive, and the Ministry of Health believes its statistics capture only 60 percent of actual cases. The Malaysian AIDS Council suggests the official statistics should be doubled or even tripled. Thus, the actual number of infections since 1986 is probably between 85,000 and 160,000 cases. Up to now the epidemic in Malaysia has been pretty much restricted to injecting drug users, of whom 18% are infected, but many of those people then infect others, such as their wives, girl friends, husbands or boy friends. As a result, the number of infections due to heterosexual contact here increased dramatically, from 834 cases in 2001 to 1,218 cases in 2002 - an increase of nearly 50 percent.

For the moment, all these numbers pale by comparison with the figures for Africa, where nearly 30 million people have the disease and in some countries more than 30% of the population are infected. But, there are several reasons why we dare not be complacent.

First, it can take as long as ten years from the time of infection for a person to develop AIDS symptoms. Because not everyone is tested for HIV, many persons may be unaware they are infected. That means they can and often do pass HIV on to their spouses or romantic partners, or to people with whom they share needles, long before they realize they are doing so. Unlike SARS and other epidemics, where the contagious period is measured in days, the HIV/AIDS epidemic is measured in decades.

Second, the epidemic hit Asia about ten years after it hit Africa. That means Asia today is at the same stage of the epidemic that Africa was in the early 1990s, when it began to explode in major African cities. HIV/AIDS is beginning to explode in Asia, particularly in densely populated countries like China and India. There is no reason to expect Malaysia or any other country will be immune to the threat.

Finally, we know that AIDS is a fatal disease for which there is as yet no cure. Anti-retroviral drugs have been developed that can delay symptoms for years and greatly improve the quality of life for AIDS sufferers, but they cannot destroy the virus. The U.S. Government and the pharmaceutical industry are taking measures to reduce the cost of these drugs and increase their availability. Though researchers have been trying for years to develop a vaccine against the HIV virus, they have not yet been successful.

The best weapon against this dreadful disease is prevention, but that is not always easy to accomplish. There can be a great reluctance to discuss the risk behaviors that lead to HIV - injecting drugs, visiting prostitutes, or men having sex with men - and there is similar reluctance to promote the use of condoms to restrict an individual's exposure.

As business professionals, you should all be seriously concerned about the economic impact of this mushrooming epidemic. Just think for a moment about the devastating effects of the recent SARS epidemic. Even though it lasted just a few months and only 813 people died worldwide, all the countries in this region suffered a serious hit. It's been estimated that regional GDPs will be at least a full percent lower this year because of SARS. Local airlines, hotels, restaurants, tour operators and retail outlets all experienced serious losses. Hotel occupancy in Kuala Lumpur fell below 40% in April, and in Penang it went down to 26%. The Malaysian Retail Association estimated broad declines of at least 10%. Probably quite a few of you in this room tonight were affected by that short-lived epidemic.

Imagine how Malaysia would fare if 30% of its current population developed HIV/AIDS, as is now the case in some parts of Africa. The economic consequences would be incalculable. But the social effects would be just as bad. Africa has a growing problem of children orphaned by AIDS and children born with the disease because their mothers were infected. Not only are many African countries losing adults at the peak of their productive years, they are also losing their future.

Individuals infected with HIV/AIDS are likely to face loss of employment and increased health care costs. Their families suffer as well. Their children may be forced to work, leaving them vulnerable to human trafficking and the sex trade. HIV/AIDS also contributes to the disintegration of family units. Entire societies must face the prospect of a shrinking labor supply and reduced labor productivity. At high rates of infection, national GDPs drop sharply.

So what can any of us do to avert this doomsday scenario here in Asia? The first and most important task is prevention, prevention, prevention. The Malaysian AIDS Council, led by Datin Paduka Marina Mahathir, is doing excellent work educating the public and promoting prevention, and I salute them. Nothing is more effective in fighting AIDS than preventing the infection in the first place.

Governments have a very important role to play. In my country, President Bush has made stemming the AIDS pandemic a priority of his Administration. In addition to the billions the U.S. spends on research, the President pledged $1.65 billion to the Global Fund that fights HIV/AIDS, tuberculosis and malaria, making the U.S. the Fund's largest donor. The U.S. Secretary of Health and Human Services, Tommy Thompson, became Chairman of the Board of the global Fund this year, which shows our strong commitment to the fund. The Global Fund is a charitable foundation, based in Geneva, and it was unanimously endorsed at the UN General Assembly Special Session on HIV/AIDS in June 2001. So far it has raised pledges totaling over $4.7 billion, which it is using in projects in 56 countries around the world now, with plans to reach a total of 92 countries soon.

The U.S. has also announced an Emergency Plan for HIV/AIDS Relief, a five-year, $15-billion commitment which almost triples our current spending on HIV/AIDS. The money will be used to prevent 7 million new HIV infections - including HIV transmission between mothers and newborns - treat 2 million people living with HIV/AIDS with effective medicines, including anti-retrovirals and antibiotics, and care for 10 million HIV-infected individuals and AIDS orphans.

Businesses can also take action to address this terrible epidemic. There are three crucial reasons why HIV/AIDS is an issue for business leaders:

       # Most HIV infections occur in people aged 15-49, at their peak of productivity.

       # Transmission of HIV is increasing in Asia, and as more and more workers and consumers become infected, businesses will also suffer.

       # The lack of awareness and understanding of the disease, resulting in fear and negative attitudes among employees and managers, can cause workplace conflict and hurt your bottom line.

      The greatest challenge facing companies today is how to protect their own work forces against the spread of HIV/AIDS and to help their HIV-positive staff to remain healthy and productive. Companies wishing to protect their work place from the negative effects of HIV/AIDS can immediately implement three measures:

       # First, you can establish policies in your work place to manage sensitive issues related to HIV-positive employees. These policies should include a commitment to continuation of employment for HIV-positive employees, a guarantee of confidentiality of medical information, and provision of testing and counseling services on a voluntary, not mandatory, basis. Many prominent companies in Asia, such as Shell, General Motors, Sony and NIKE, have already put policies like these in place.

       # Second, companies can institute education and prevention programs to make sure their employees understand about how HIV is transmitted, how to prevent getting it, and why they should not discriminate against any HIV-positive colleagues. This kind of training is particularly important in the hospitality industry, where human resources are the backbone of their activity. Thus major hotels in Bangkok, for example, such as the Grand Hyatt Erawan, the Regent Hotel, the Pan Pacific and the JW Marriott provide HIV/AIDS education for their staff during working hours. It's an excellent example to follow.

       # Third, many companies in Asia provide health care and support facilities for HIV-positive employees. These can include counseling services, financial assistance or loans, time off for medical appointments, and provision of medical treatment including access to anti-retroviral drugs.

Companies that wish to go beyond these three basic steps can engage in broader efforts such as advocacy, support for community projects and awareness-raising among customers. It's really essential for businesses to take a long-term view and do their part in stopping the spread of HIV/AIDS and limiting its social and economic impact.

There are more than purely humanitarian motives at stake here. Given the realities of this world-wide epidemic, it is strongly in your corporate interests to do everything you can to fight HIV/AIDS. For those of you interested in more specifics, I will leave with you a document prepared by the Asian Business Coalition on AIDS, with support from the Ford Foundation. I am sure the Coalition will be more than happy to work with you on designing a plan of action that fits your company best within the Malaysian environment.

Let us all take to heart the tragedy of the HIV/AIDS epidemic that is sweeping the African continent, and let us all work diligently to keep the same thing from happening here in Asia. An ounce of prevention now will save many pounds of cure in the future.
 

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