Market oriented approach – AIDS, aid and Business

Key UNAIDS documents related to private sector engagement in the HIV/AIDS response include The Business Response to HIV/AIDS: Impact and Lessons Learned (Daly with Parr 2000); AIDS is Everybody’s Business. UNAIDS & Business: Working Together (UNAIDS 2007a); and AIDS is Everybody’s Business. Partnerships with the Private Sector: A Collection of Case Studies from UNAIDS (UNAIDS 2007b). These documents promote private sector engagement, drawing on the following different, at times overlapping, at times conflicting discourses: a) Aid for AIDS¹⁴ is a partnership; b) AIDS is everybody’s business; c) AIDS is a threat for business; d) AIDS is a moral issue; and e) AIDS is about leadership. As follows, I examine these discourses, providing examples mostly from the above mentioned documents.

a.) Aid for AIDS is a partnership

The ideological perspectives of UNAIDS’ sponsorship are often quite far from each other, and the approach to private sector engagement has been quite ambiguous at times. For example, whilst the World Bank has focused on delivering the promises of market liberalization, ILO, by contrast, has advocated for the strong role of trade unions and national government in regulating and delimiting the negative effects of globalization and marketization. On the one hand, UNAIDS’ policies maintain the importance accredited by ILO to responsibility and duty. On the other hand, UNAIDS policies and guidelines emphasise private sector role as a “goodwill ambassador” emphasizing its

14 The preference for ‘AIDS’ is intentional, for whilst HIV refers to the virus, AIDS refers to the presence of opportunistic infections that develop in PLHIV in the last stages of their illness and which cause eventual death. Fear of HIV and calls made to respond to HIV draw from meanings connected to AIDS, not so much HIV (cf. Altman 2006;

Law 2000).

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potential role through a corporate social responsibility approach. This is reflected by discrepancies that exist in some of the key messages promoted by UNAIDS policies and guidelines related to the Private Sector response to HIV/AIDS, as it is to a (purposeful?) fuzziness in the definition of the tasks and functions of the different stakeholders involved, such as in the excerpt below, where a parallel is drawn between labour unions and businesses – or, more precisely, labour unions are presented as being businesses:

Businesses, from the largest global corporations to micro enterprises, private sector associations and coalitions, corporate and private philanthropies, labour unions and employers’ associations are recognizing the need to lend their resources and expertise An attempt to the AIDS response (UNAIDS 2007b, 3).

is made to position UNAIDS as supportive of the private sector’s will to do good (rather than vice versa): “We stand prepared to act as a partner in your efforts” as is writ in the Foreword of the Executive Director of UNAIDS, Peter Piot (ibid., 5). No difference is made between businesses’

vested interests and the raison d’être of bilateral and multilateral donors, celebrating the partnership of the private sector on par with other partnerships, as reflected by the excerpt from the report The Business Response to HIV/AIDS: Impact and lessons learned (Daly with Parr 2000) below:

The Alliance’s experience has shown that there is a legitimate role for NGOs to work in partnership with businesses with benefits for both parties. For NGOs, partnership with business allows access to decision-makers, exchange of information covering a range of issues, including HIV workplace policies, and sound programmatic philanthropy. From the Alliance’s experience, issues around the potential for business agendas to impact on that of an NGO are no more real than with any other donor, and can be effectively counteracted by sustaining a broad and diverse funding base. (71.) The innovative ideas put forth by businesses are celebrated, and the partnership between UN agencies and businesses are construed as building on the strengths of businesses, as reflected by the text below from UNAIDS’ ‘best practice’ collection detailing UNESCO’s collaboration with L’Oréal:

Beauty transcends national borders, and a trip to the hairdresser is a ritual in almost every country in the world. When the United Nations Educational, Scientific and 49

Cultural Organization (UNESCO) was looking for a private sector partner to help educate a mostly female global audience about HIV and AIDS, it turned to L’Oréal Professional Products. In 2005, through the initiative of Lady Owen-Jones, UNESCO Goodwill Ambassador for HIV/AIDS Prevention Education, the two organizations created Hairdressers Against AIDS, aimed at raising awareness of HIV by sensitizing hairdressers about HIV and encouraging them to talk about personal risk with their customers. (UNAIDS 2007b, 20.)

Differences in the private sector – in the scale, nature and spheres of operation of a business – are recognized as influencing the kind of partnerships that businesses will be willing to forge, as the competitive challenges different companies face influence the contributions they will be willing and able to make to the HIV/AIDS response. As Bloom et al. (2001, p. 5) write, “Exhortations for the private sector to participate in efforts against the global HIV/AIDS epidemic would be effective only if the resultant strategies mesh well with the private sector’s own objectives and values”.

b.) AIDS is everybody’s business

All three documents, in line with the official rhetoric of UNAIDS documents, construe HIV and AIDS as issues that effect everyone, everywhere. To successfully respond to HIV/AIDS, emphasis is placed on the need for everyone to respond, and whilst different bodies are presented as playing different, complimentary roles, AIDS, the AIDS is Everybody’s Business. UNAIDS & Business:

Working Together (2007a) emphasizes, has dissolved “Artificial distinctions between the health of a society and the strength of its business sector - - as private sector leaders recognize that the well-being and security of the communities they serve are essential to their shared futures” 85). The need to respond to AIDS, it is suggested, is an imperative – not from a moral, but from a common sense perspective: ““AIDS is not a moral issue; it is a sound business decision we all have to make in our workplaces” (UNAIDS 2007a, 16).

AIDS is presented as an issue that has the potential to either ‘make’ or ‘break’ the shared future of humanity. As an issue of survival, a parallel is drawn between the impact and potential threat of AIDS worldwide and the potential of a breakdown in international finance: “it is difficult to think of many other global problems that are in the same league as AIDS—arguably, only extreme poverty and deprivation as a whole; climate change; and the potential risks posed by nuclear war, chronic armed conflicts, or a sustained breakdown of international finance and trade”, as Peter Piot, the 50

Executive Director of UNAIDS, writes in the Lancet (2006, 526). The argument is a simple one:

anyone with interest in their own or of a collective future, (vis-à-vis a desperate and bleak future scenario), need inevitably to be concerned about AIDS, and also, every business, in their own way, can make a contribution: “Every business can contribute to the AIDS response depending on its size, type of workforce, geographical range, financial strength and core capabilities” (UNAIDS 2007a, 15). Similarly, business orientated language is adopted to describe the work of UNAIDS:

“We are seeing some early returns on investments in the AIDS response” as Peter Piot describes the effects of the response to HIV/AIDS (2007a, 5).

c.) AIDS is a threat for business

Closely coinciding with the discourse of Aids as ‘everyone’s business’, is that of AIDS as posing a serious threat for businesses. This discourse focuses on the threats of HIV to working-age people, who are described as “in the prime of life” (UNAIDS 2007a, 9), as representing “some of the most creative and economically active people” (Daly with Parr 2000, 8). Businesses are reminded that

“Nine out of 10 people living with HIV are adults in their most productive years. The global labour force has already lost 28 million people to AIDS” (2007a, 9), and no distinction is made between different epidemic scenarios: low-level scenarios, concentrated scenarios, generalized scenarios and hyperendemic scenarios in the documents related to the business response to HIV/AIDS (UNAIDS 2007b). The underlying rationale is, however, an economic one: one in which individual costs, benefits and losses to businesses are suggested as reasons for companies to respond to HIV/AIDS:

“The epidemic reduces the supply of labour, especially skilled labour. In the process, AIDS increases operational costs, reduces productivity, slows economic growth, threatens the livelihoods of workers and employers and undermines human rights” (UNAIDS 2007a, 11).

“Early investments in the AIDS response”, it is underlined, “have long-term benefits” (UNAIDS 2007a, 12). At least four different kinds of threats that HIV/AIDS may pose to businesses, are identified: it may impact core activities, business partners, the wider community, and business profits through the consumer choices of individuals (Daly with Parr 2000; UNAIDS 2007a; 2007b). Companies are approached in recognition of HIV as an epidemic with severe economic and social impacts, in their capacity to mobilize additional financial resources and, unlike the public sector, to take meaningful steps rapidly. The motivation of businesses for economic gain is a self-evident starting point for partnership, however, as evident in the following quotation from Rajat Gupta, the Chairman of the

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Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria: “The case for business is grounded in completely enlightened self-interest. We need a healthy workforce” (2007a, 10).

National governments are also reminded of the threats HIV/AIDS poses to their economies: “there is

a significant threat to national economies from declining investment, both internally and from foreign direct investment, as a result of high prevalence rates reducing available resources and the appeal to investors” (Daly with Parr 2000, 28).

An economic rationale also underpins UNAIDS’ own approach to HIV prevention, which is based on the identification of ‘high risk-groups’ (see UNAIDS 2007c). The practice of identifying priorities, target populations and ‘hot spots’, and the techniques that this implies, namely those of surveillance (of behaviour and prevalence) and monitoring progress are not unsimilar to calculation devices commonly used in businesses to measure and ensure efficiency and profitability. A key difference, however, is that whilst businesses apply these to enterprise, in the context of UNAIDS, this rationale is applied to governing the epidemic – to knowing and rendering knowledgeable populations and individual citizens and identifying which interventions carry the most weight.

d.) AIDS is a moral issue

A global moral imperative, in UNAIDS documents, is placed on responding to HIV/AIDS.

Reference is made to the ways in which HIV/AIDS disproportionately affects developing countries, as also to the magnitude of the epidemic – “The exceptional characteristics of AIDS mean that only an exceptional response—going far beyond the usual public-health parameters of epidemic control and technological interventions—can succeed in checking the epidemic”, Peter Piot (2006, 526) writes. Whilst reference is made to epidemiological factors, the imperative is a moral one. AIDS is defined as the “defining moral issue of our time”, and business, it is emphasized, “must play a critical role in the fight against the global spread of the epidemic” (UNAIDS 2007a, 6).

Interestingly, whilst the UNAIDS Terminology Guidelines (2007d. 5, 8) discourage the use of the word “fight”, stating that “Fight an other combatant language” should be avoided, exception is made of “direct quotation[s] or the context of the text (possibly a poster or very short publication designed to have high impact)” (8, cursive added). Documents on the private sector response to HIV/AIDS oscillate between using ‘combatant’ language and its focus on hard results, and softer language that suggests the good sense of companies responding to HIV/AIDS, such as in the 52

following quote: “Being part of an effective AIDS response generates goodwill and demonstrates a company’s commitment to strong, corporate citizenship and to well-being of its employees, customers and communities” (2007a, 11). Both kinds of language construe responding to HIV/AIDS as a moral issue, and the choice is thus of demonstrating good morals and high virtues, which is seen variously as either a ‘fight’ or as simply taking small, practical steps to address HIV/AIDS.

Rose, as Walter (in Tietäväinen et al. 2008) notes, introduces the concept of ‘ethopolitics’ to refer to what is sometimes called a ‘third way’ in politics, that is to a

kind of governmentalization of a new kind of territory, which partly explains the prominence that things like values or community came to have, all of these kinds of warm words. These warm words like community and individual have become central to political dialogue today. So it is a sort of ethopolitics, a domain that has become governmentalized: the promotion of community, the promotion of trust. (65.)

Ethopolitics thus draws from the recognition that values play to individuals, promoting community and trust in ways that extend the ability of politics to govern individual lives through the definition of virtues and values worth struggling for. An ‘ethopolitics’ of an international kind is also promoted by UNAIDS. HIV/AIDS programmes have sometimes been criticized for being hugely expensive for countries to implement, focusing attention on one specific problem in place of more general problems in, for example, health care. The excellent aid effectiveness of HIV programming within one sector may stand in contrast with the general, dilapidated state of the sector overall. However, as a special disease, HIV/AIDS is construed as calling for special measures, with the reminder that effects, not costs, should determine the response:

When considering costs, planners should remember that a costly measure that provides acceptable effectiveness and substantial benefits should take precedence over measures that are less expensive but have less impact on the epidemic. The responsibility of HIV programme planners is to provide realistic estimates of what it will cost to achieve the prevention targets. (UNAIDS 2006, 19.)

A inherent problem in such an approach, referred to by Simensen (2007) in his description of Norwegian aid efforts in Tanzania through the concept of “closed perception”, is that this, he writes,

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functions to focus attention on only the positive outcomes of development aid which were in line with donor values: “social-democratic values motivated Norwegian aid, and the social-democratic features of Nyerere’s policy attracted special attention, to the exclusion of other aspects (171). Calls made to respond to HIV/AIDS, similarly, place emphasis on ‘lessons learned’ rather than on the identification of failure, or mistakes. Thus a helpful exercise for monitoring and evaluation, for example, is suggested as being the writing up of “a short summary report that highlights achievements, failures, problems faced and how they were overcome, and proposed future steps”

(Ashbourne 2004, 56).

e.) AIDS is about leadership

Yet another discourse put forth by UNAIDS and ILO is that of AIDS being about leadership, that is, that the means to govern the epidemic is through demonstrating leadership, through providing guidance and ensuring workers are informed of the facts and consequences of HIV/AIDS. Private sector leaders, it is suggested, lead the business response themselves, drawing from the recognition that “the talent, resources, experience and commitment of business must play a central role in designing, implementing and promoting effective responses to AIDS” (UNAIDS 2007, 8).

The wise leader, it is suggested, is concerned about not only the physical working conditions of employees, but her/his management of employees suggests concern for also their feelings, emotions, communicating common purpose and high morale to employees – and customers: “Being part of an effective AIDS response generates goodwill and demonstrates a company’s commitment to strong corporate citizenship and to the wellbeing of its employees, customers and communities”

(UNAIDS 2007a, 11). The happy employee is the employee who is treated fairly and justly, who is cognizant of all the dangers of HIV/AIDS, and who works to ensure that no fellow employees are discriminated against on the basis of their HIV status.

As emphasized by various documents, business leaders can offer ‘unique lessons’ on leadership to others involved in the HIV/AIDS response, as good leadership skills, it is claimed, have already been demonstrated by business leaders in their ability to ensure good business (ILO 2002; UNAIDS 2007a, 2007b). The skills of business leaders, including “Corporate communication and marketing skills”, can be a key resource in “help[ing] raise AIDS awareness and promote behavioural change”

(UNAIDS 2007a, 14). Private businesses, in this discourse, are construed, to quote Rose (1999), as the “microcosm of democratic society, with the need for respect for the feelings and values of the 54

individual, with the focus upon interdependency of leader and led, with the emphasis on communication up and down the power hierarchy” (88).