Dece mbe r'201 9'
'
UTILIZING'PUBLIC-PR IVATE' PARTNERSHIPS'
TO'FURTHER'THE'PREVENTION'&'
TREATMENT'OF'HIV/AIDS'
'
The$Harv ard$Univ ers ity $Institute$of$Politics $Health$
Policy$Program$!!!!!'
Policy'Program'Co-Chairs'
Ryan!Zhang!
Swathi!Srinivasan'
'
Health'Policy'Group'Co-Chairs'
Alex!Grayson!
Cathy!Sun!
!
Associate'Editor'
Otto!Barenberg!
!
Authors'
Sadia!Demby!
Matt!Dickey!
Nicole!Fintel!
Jay!Garg!
Yvette!Han!
Michael!Hla!
Mariam!Kish!
Marin!Lang!
Michelle!Lara!
Varshini!Odayar!
Reem!Omer!
Simran!Shah!
Aristotle!Vainikos!
1
ABOUT THE INSTITUTE OF POLITICS POLICY PROGRAM
The Institute of Politics is a nonprofit organization located in the John F. Kennedy School of
Government at Harvard University. It is a living memorial to President John F. Kennedy, and its
mission is to unite and engage students, particularly undergraduates, with academics, politicians,
activists, and policymakers on a nonpartisan basis and to stimulate and nurture their interest in
public service and leadership. The Institute strives to promote greater understanding and
cooperation between the academic world and the world of politics and public affairs. Led by a
Director, Senior Advisory Board, Student Advisory Committee, and staff, the Institute provides
wide-ranging opportunities for both Harvard students and the general public. This report is the
result of a semester-long intensive effort by a team of undergraduates. The Institute of Politics
does not endorse specific policy positions; accordingly, all views expressed in this publication
should be understood to be solely those of the authors.
2019 by the Institute of Politics. All rights reserved.
Institute of Politics
Harvard University
79 John F. Kennedy Street
Cambridge, MA 02138
Tel: (617) 495-1360
Fax: (617) 496-4344
Web: www.iop.harvard.edu
Email: [email protected]
2
Executive Outline
1. Executive Summary……………………………………………………………………….3
2. Policy Recommendations.………………………………………………………………....3
2.1. Recommendation #1………………………………………………………………3
2.2. Recommendation #2……………………………………………………………....4
2.3. Recommendation #3……………………………………………………………....5
2.4. Recommendation #4……………………………………………………………....5
3. Economic Incentives for Private Companies…………………………………………..….6
3.1. Short Term Incentives……………………………………………………………..6
3.2. Long Term Incentives……………………………………………………………..7
3.3. Cost-Benefit Analysis……………………………………………………………10
3.3.1. Direct Costs…………………………………………………………….11
3.3.2. Indirect Costs…………………………………………….......................12
3.3.3. Benefits and Combating Costs of HIV/AIDS………….…………….....14
3.3.4. Conclusion……………………………………………….......................15
4. Humanitarian Incentives for Private Companies………………………………………..16
5. Ethical Concerns When Working with Private Companies……………………………..18
5.1. Heineken-Global Fund Case Study……………………………………………...22
6. Urban-Rural Divide……………………………………………………………………..24
7. Types of Public-Private Partnerships…………………………………………………....29
7.1. Awareness Building……………………………………………………………...29
7.1.1. Viacom: Staying Alive Case Study…………………………………......29
7.1.1.1. Educating Rural Residents…………………………………….....30
7.1.1.2. Prison Outreach Program………………………………………...32
7.1.1.3. LGBTQ+ Facing Projects………………………………………..33
7.1.1.4. Effective Awareness Programming………....................................34
7.1.2. Rede Globo Case Study………………………………………………...36
7.1.3. Durex Case Study……………………………………………………....37
7.2. Direct Services…………………………………………………………………...39
7.2.1. Volkswagen Case Study………………………………………………....39
7.2.2. Coca-Cola Case Study………………………………………………......41
7.2.2.1. Coca-Cola Africa Foundation……………………………….…..42
7.2.2.2. Project Last Mile………………………………………………...45
7.2.3. De Beers Case Study…………………………………………………....49
7.2.3.1. De Beers’s Incentives for Fighting HIV/AIDS………………......50
7.2.3.2. De Beers’s Activity as Debswana Company …………………....52
7.2.3.3. Company Controversy…………………………………………...53
7.2.4. Mastercard Case Study………………………………………………….54
7.2.5. Access Bank Case Study………………………………………………..55
7.2.6. Shell Case Study………………………………………………………...57
7.3. Fundraising……………………………………………………………………....59
7.3.1. Marc Jacobs Case Study………………………………………………...60
7.3.2. MAC Case Study………………………………………………………..62
7.4. Research Generating……………………………………………………………..65
7.4.1. Pfizer Case Study……………………………………………………….65
7.5. Conclusion……………………………………………………………………….72
3
1. Executive Summary
Public-private partnerships (PPPs) are a collaboration between public and private entities
in order to reach a common goal.
1
Through such a partnership, both entities can utilize each
others’ resources, thereby accomplishing tasks that would not have been possible before. By
analyzing the incentives that exist for private entities to invest in this public health crisis, new
PPPs can be created to fill in the current gaps. Four types of PPPs currently exist: a) awareness
building, b) direct services, c) fundraising, and d) research. Each type of PPP sees a new strategy
for addressing HIV/AIDS within the relevant communities.
This brief will examine explicit recommendations for companies to effectively create
new PPPs and eliminate HIV/AIDS among their workforce. Then, the various incentives for
companies to form PPPs will be introduced, including a cost-benefit analysis of the impact of
HIV/AIDS on companies. Finally, case studies on companies with successful or unsuccessful
PPPs will be presented alongside their campaigns and interventions as evidence for the
recommendations. Through these analyses, we will construct an argument for why PPPs should
be created to address HIV/AIDS globally.
2. Policy Recommendations
2.1. Recommendation #1
When companies create campaigns to raise awareness about HIV/AIDS, they must be
individualized to the specific community and region. Even within countries, the rural-urban
1
“HIV-related Public-Private Partnerships and Health Systems Strengthening,” UNAIDS, July 2009,
http://data.unaids.org/pub/report/2009/jc1721_publicprivatepartnerships_en.pdf.
4
divide creates differences in perception and access to healthcare.
2
As such, campaigns that would
be effective in one region of a country will not be effective in other regions of the country. By
identifying the target region and its characteristics, companies can determine the most effective
way to reach them. The case studies within the Awareness Building PPPs section from pages 29
- 39 detail different types of campaigns, which can provide an indication of what type of
campaign works best for a certain community. Additionally, companies should be aware of their
product reputation within a country, otherwise they risk failure. The Heineken-Global Fund case
study demonstrates the way a product reputation can cause PPP failure, and the Coca-Cola case
study indicates a successful way at avoiding PPP failure.
2.2. Recommendation #2
By establishing connections with local governments, labor unions, and local businesses,
companies can effectively implement their HIV/AIDS PPPs. By engaging government leadership
and local business partners, relevant business knowledge transfer occurs that is both compatible
with the company’s expertise and the goals and needs of the community.
3
It also strengthens a
company’s business network via engagement with implementing partners from multiple
industries.
4
In addition, programming becomes more sustainable, as there is a constant transfer of
supply-chain knowledge to local partners who can consistently execute operations.
5
The case
2
Marinka Van Der Hoeven, Annamarie Kruger, and Minrie Greeff, "Differences in Health Care Seeking Behaviour
between Rural and Urban Communities in South Africa," International Journal for Equity in Health 11, no. 1
(2012): 31, doi:10.1186/1475-9276-11-31.
3
Erika Linnander et al., “Process Evaluation of Knowledge Transfer across Industries: Leveraging Coca-Cola’s
Supply Chain Expertise for Medicine Availability in Tanzania,” PLOS ONE12, no. 11 (November 9, 2017),
https://doi.org/10.1371/journal.pone.0186832.
4
Ibid.
5
Ibid.
5
studies within the Direct Services PPPs section, pages 39 - 58, detail successful examples of
companies connecting with their communities, and they can serve as a guide for future PPPs.
2.3. Recommendation #3
Companies should conduct an internal audit to determine the exact financial loss that
occurs from the presence of HIV/AIDS amongst their employees, as well as to determine the
most effective interventions to address this issue. Audits allow for the issues plaguing the
company to be determined, and they allow for employees to voice their concerns about the
current situation around HIV/AIDS.
6
De Beers’s Botswanan group Debswana conducted their
own internal audit, and they have been able to effectively change the culture of HIV/AIDS in
their workplace and community.
7
More details about the campaigns and policy changes created
from this audit are detailed in the De Beers Case Study section, pages 49 - 54.
2.4. Recommendation #4
Companies should provide employee benefits, such as subsidizing HIV/AIDS
medications, in order to minimize financial loss from HIV/AIDS. By providing employees with
improved services and medications, companies see economic benefits from a healthy and
productive working population.
8
Therefore, in order to stay economically competitive,
companies should work to determine the best benefits to provide to their employees and
6
Tony Barnett, Tsetsele Fantan, Bekezela Mbakile, and Alan Whiteside, “The private sector responds to the
epidemic: Debswana - a global benchmark,” UNAIDS, September 2002, http://data.unaids.org/publications/irc-
pub02/jc769-debswana_en.pdf.
7
Ibid.
8
Harsha Thirumurthy, Omar Galarraga, Bruce Larson, and Sydney Rosen, “HIV Treatment Produces Economic
Returns Through Increased Work And Education, And Warrants Continued US Support,” Health Affairs 31, no. 7
(July 2012): 1470-7, doi: 10.1377/hlthaff.2012.0217.
6
communities. These benefits are further detailed in the Economic Incentives for Private
Companies section, pages 6 - 16.
3. Economic Incentives for Private Companies
3.1. Short Term Incentives
Higher levels of donor funding are undercutting the current fee-for-service model utilized
by many private corporations attempting to combat the HIV/AIDS epidemic. Given that little
public funding currently goes to private companies, the current method utilized by NGOs and
governments to give aid directly to those in need reduces the number of households willing to
pay out of pocket for private services and medications, pushing private companies out of the
effort against HIV/AIDS.
9
This crowding out effect reduces the innovation and efficiency-
enhancing effect of private sector contributions, and it reduces the impact of each dollar spent.
10
To combat this crowding out effect, organizations ought to spend in a way that leverages
the resources the private sector has to offer instead of in a way that opposes for-profit businesses.
For example, the Down Referral System in South Africa helps to stabilize patients at public
health clinics or hospitals, and then they are down-referred to a privately owned clinic for further
treatment.
11
The services and medications offered at the private clinics are paid for by the
government, as is training for workers, salaries, and patient education.
12
Overall, studies have
9
Sara Sulzbach, Susna De, and Wenjuan Wang, “The private sector role in HIV/AIDS in the context of an expanded
global response: expenditure trends in five sub-Saharan African countries,” Health Policy Plan 26, no. 1
supplement, (July 1, 2011): i72-i84, https://www.ncbi.nlm.nih.gov/pubmed/21729920.
10
Ibid.
11
John Sargent et al., “Private sector involvement in HIV service provision,” USAID, last modified December 2009,
https://www.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=11211&lid=3.
12
Ibid.
7
shown the program to have a patient retention rate of 97.3% and a viral load suppression rate of
96%.
13
Another potential mechanism for preventing private services and clinics from being
pushed out is to increase patient ability to pay for healthcare by expanding insurance coverage to
cover HIV/AIDS related expenses. In response to a declining international focus from
governmental organizations on the HIV/AIDS epidemic, it is more politically feasible to focus
on increasing healthcare coverage instead of more targeted approaches to fighting the disease.
14
This increase also serves as a viable mechanism to encourage private corporations to remain in
the fight against HIV/AIDS. As healthcare coverage directs payment to the treatment provider,
low-income individuals are still able to purchase from private healthcare companies, avoiding
the loss of revenue that comes when private clinics lose clients.
15
3.2. Long Term Incentives
When considering the incentive for the private sector to participate in PPPs, it is
important to consider the long term benefits for the nation as well. Citizen health plays a crucial
role in the development of a country, as healthier populations with longer lifespans tend to be
more productive and dedicate more of their wealth to savings.
16
Although ART for HIV/AIDS
has restored life expectancy for individuals living with HIV/AIDS to near normal levels, the
disease is still tremendously costly.
17
From 2000-2015, the global aggregate sum spent on
13
Sargent et al., “Private sector involvement in HIV service provision.”
14
Gorik Oooms and Krista Kruja, “The Integration of the Global HIV/AIDS Response into Universal Health
Coverage: Desirable, Perhaps Possible, but Far from Easy,” Globalization and Health 15, no. 1 (2019),
https://doi.org/10.1186/s12992-019-0487-5.
15
Ibid.
16
“Health and Development,” World Health Organization, last modified December 9, 2010,
https://www.who.int/hdp/en/.
17
Annamarya Scaccia and Robin Madell, “Facts About HIV: Life Expectancy and Long-Term Outlook,”
Healthline, April 27, 2018, https://www.healthline.com/health/hiv-aids/life-expectancy.
8
HIV/AIDS was approximately $562 billion USD.
18
Without the presence of a fatal, infectious
disease, the World Health Organization projects an increase in GDP and consumption, as a result
of increased ability to enjoy goods and services as well as increased income to purchase these
goods.
19
In 2002, HIV/AIDS limited economic growth by 2-4% per year across 41 African
countries.
20
Models from the University of Oxford project a continuous decrease in the growth
rate of GDP through 2040 if no intervention is taken.
21
These models also suggest that an
entirely government-driven approach funded by increased tax revenues could cause crowding
out, evidenced by lesser growth in employment of private capital.
22
As illustrated by the stagnation of many African economies in the early 2000s, the
prevalence of such a crippling disease can be detrimental to a nation's economy, and by proxy, to
companies’ success.
23
The economic status of the public sector and the private sector are
intertwined. National development correlates to better infrastructure for industry, which leads to
a more sustainable business environment for companies.
24
Infectious disease hampers the
government's ability to provide access to quality education, which then leads to a decrease in
human capital, a necessary component for the private sector’s longevity.
25
If the public sector
lessens its healthcare expenditures, it then has the possibility to alleviate private sector taxes and
18
Global Burden of Disease Health Financing Collaborator Network, “Spending on Health and HIV/AIDS:
Domestic Health Spending and Development Assistance in 188 Countries, 1995–2015,” The Lancet 391, no. 10132
(May 5, 2018), https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30698-6/fulltext#seccestitle10.
19
“Economic Burden of Disease,” World Health Organization, accessed on October 16, 2019,
https://www.who.int/choice/economicburden/en/.
20
Simon Dixon, Scott McDonald, and Jennifer Roberts, “The Impact of HIV and AIDS on Africa’s Economic
Development,” BMJ 324, no. 7331 (2002): 232–34, https://doi.org/10.1136/bmj.324.7331.232.
21
Judith Kabajulizi and Mthuli Ncube, “The Economy-Wide Impact of HIV/AIDS and the Funding Dilemma in
Africa,” EcoMod2015 8563 (September 2015), https://ideas.repec.org/p/ekd/008007/8563.html.
22
Ibid.
23
Dixon, McDonald, and Roberts, “The Impact of HIV and AIDS on Africa’s Economic Development.”
24
Abdesslam Boutayeb, “The Impact of Infectious Diseases on the Development of Africa,” Handbook of Disease
Burdens and Quality of Life Measures (2010): 1171–88, https://doi.org/10.1007/978-0-387-78665-0_66.
25
Boutayeb, “The Impact of Infectious Diseases on the Development of Africa.”
9
increase wages, thus cycling back to an increase in consumption and long term benefits for
private and public sectors.
26
Unfortunately, investment in PPPs has been low among low-income countries in the
International Development Association (IDA), peaking at roughly $15 billion USD in 2012,
whereas non-IDA countries invested $120 billion USD that same year.
27
While some ventures
were profitable for ten years afterwards, many companies partaking in PPPs reported a negative
return on investment after the decade.
28
Many attribute the failure of the PPPs to severe cost
underestimation, which consequently spurred renegotiations and legal hindrances.
29
These
renegotiations amplify already high legal preparation costs of the partnership.
30
It is also
important to note that there were significant issues with the private sector’s wealth distribution
following the conclusion of these PPPs due to lowered employees within the private companies,
which would create problems in countries where inequality runs rampant.
31
Many services
introduced by partnerships are inaccessible to the impoverished due to the lack of effective
regulation surrounding these services, raising questions of the true development impact of these
ventures.
32
Regardless, research conducted on telecommunications- and infrastructure-based PPPs in
the energy and transportation sector demonstrates that these types of PPPs play an important role
in the development of a country.
33
More research should be conducted on health-focused PPPs
26
Alan J. Auerbach, “Measuring the Effects of Corporate Tax Cuts,” Journal of Economic Perspectives 32, no. 4
(2018): 97–120, https://doi.org/10.1257/jep.32.4.97.
27
James Leigland, “Public-Private Partnerships in Developing Countries: The Emerging Evidence-Based Critique,”
The World Bank Research Observer 33, no. 1 (January 2018): 103–34, https://doi.org/10.1093/wbro/lkx008.
28
Ibid.
29
Ibid.
30
Ibid.
31
Ibid.
32
Ibid.
33
Leigland, “Public-Private Partnerships in Developing Countries: The Emerging Evidence-Based Critique,” 103-
34.
10
before drawing conclusions, though, since these PPPs are distinct from other varieties. As
competitive markets have dominated the global economic landscape, healthcare has increasingly
been viewed as a means to profit rather than purely as aid.
34
While this may be less favorable to
the consumer, the healthcare industry has witnessed increases in year over year earnings, and
hospital operating margins are at their highest in decades.
35
It is likely that the increased
commodification of emerging medical technologies will continue to produce more profitable
outcomes for the private sector. ART is projected to have profits up to $6.1 billion USD
worldwide from 2017-2021, so companies can see a benefit from providing these services when
subsidized through PPPs.
36
3.3. Cost-Benefit Analysis
Although HIV/AIDS has enormous economic consequences for private sector
corporations, managers consistently rank the disease as a low priority for the company, and only
38% of companies report discussing the potential impacts of the disease.
37
38
It is important to
highlight the economic costs of such a devastating disease to inform executives about the
financial benefits of addressing HIV/AIDS in their workforce and to stimulate conversation
34
Ellery Chih-Han Huang et al., “Public Trust in Physicians—Health Care Commodification as a Possible
Deteriorating Factor: Cross-Sectional Analysis of 23 Countries,” INQUIRY: The Journal of Health Care
Organization, Provision, and Financing 55 (2018), https://doi.org/10.1177/0046958018759174.
35
Emily Gee and Ethan Gurwitz, “Provider Consolidation Drives Up Health Care Costs,” Center for American
Progress, December 5, 2018,
https://www.americanprogress.org/issues/healthcare/reports/2018/12/05/461780/provider-consolidation-drives-
health-care-costs/.
36
Jake Schneider and Darrell M. West, “How Profitable Are HIV Drugs?” Brookings, April 16, 2018,
https://www.brookings.edu/blog/techtank/2018/04/16/how-profitable-are-hiv-drugs/.
37
Sydney Rosen, Frank Feeley, Patrick Connelly, and Jonathon Simon, “The Private Sector and HIV/AIDS in
Africa: taking stock of 6 years of applied research,” AIDS Journal 21 (June 2007),
https://journals.lww.com/aidsonline/fulltext/2007/06003/The_private_sector_and_HIV_AIDS_in_Africa__taking.7.
aspx.
38
Ibid.
11
about how to best combat HIV/AIDS. The cost of HIV/AIDS is typically divided into two
categories: direct and indirect costs. Direct costs are the expenses derived directly from a
company’s resources directed towards treatment of HIV/AIDS or compensation for workers,
whereas indirect costs are estimated costs in loss of productivity, sick leave, and other less easily
quantified expenses.
3.3.1. Direct Costs
In terms of direct costs, HIV/AIDS treatment depends on the severity of the ailment, but
can cost up to $300,000-500,000 USD per worker for a life expectancy of 16-24 if the disease is
treated in its later stages.
39
ART tends to comprise the bulk of this cost at roughly 73%, with
newer ARTs, such as fuzeon, costing $3,000 USD per month of treatment without insurance.
40
41
Recruitment and training of new employees is also considered a direct cost, and it should be
factored into the cost benefit analysis. A complete discussion of recruitment costs is included
alongside the cost of the learning curve on pages 12 - 13. Death compensation and disability
compensation can also cost companies $1,800 - $2,800 USD per worker, depending on the
company’s specific stipulations.
42
HIV/AIDS also places a financial burden on the public sector.
39
Yazdan Yazdenpanah et al., “Lifetime Costs of HIV Treatment in France during the Era of Highly Active
Antiretroviral Treatment,” Antiviral Therapy 7, no. 4 (Dec 2002): 257-66,
https://www.ncbi.nlm.nih.gov/pubmed/12553480.
40
B. H. Thiers, “The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States,”
Yearbook of Dermatology and Dermatologic Surgery (2007): 152–53, https://doi.org/10.1016/s0093-
3619(08)70445-3.
41
“How Much Does HIV/AIDS Treatment Cost?” CostHelper, September 4, 2019,
https://health.costhelper.com/hiv-aids.html.
42
Elliot Marseille, Joseph Saba, Sowedi Muyingo, and James G. Kahn, “The costs and benefits of private sector
provision of treatment to HIV-infected employees in Kampala, Uganda,” AIDS Journal 20, no. 6 (April 4th, 2006):
907-14, https://www.ncbi.nlm.nih.gov/pubmed/16549976.
12
For example, the U.S. federal government spent $11.6 billion USD on combating the disease in
2005.
43
3.3.2. Indirect Costs
Indirect costs are segmented into three major causal factors: absenteeism, productivity
loss, and learning curve of new employment. Absenteeism is the result of ill employees taking
sick leave, removing them from the day-to-day process of production and decreasing their
average output.
44
In the last year of employment, ill employees working for large, Sub-Saharan
African private corporations take anywhere between 11 and 68 more days of sick leave than an
HIV-negative employee prior to leaving the company due to the impact of HIV/AIDS.
45
In the
penultimate year of employment, absenteeism ranges from 5 to 36 days.
46
These data reflect a
66% to 87% increase in absenteeism over the standard, non-ill worker.
47
Sick leave has a direct
effect on productivity and may be the result of absenteeism or the individual’s weakened
capacity to work.
48
,
49
In the final year of employment, percent decrease in output per ill
individual, or productivity loss, ranges between 17% - 23%; in the penultimate year, output takes
a hit between 8% and 17%.
50
Even outside of Sub-Saharan Africa, these productivity costs are
43
Thiers, “The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States.”
44
Marseille, Saba, Muyingo, and Kahn, “The costs and benefits of private sector provision of treatment to HIV-
infected employees in Kampala, Uganda.”
45
Sydney Rosen, Jeffrey R. Vincent, William MacLeod, Matthew Fox, Donald M. Thea, and Jonathon L. Simon,
“The cost of HIV/AIDS to businesses in southern Africa,” AIDS Journal 18, no. 2 (January 23, 2004): 317-324,
https://journals.lww.com/aidsonline/Fulltext/2004/01230/The_cost_of_HIV_AIDS_to_businesses_in_southern.23.as
px.
46
Rosen, Feeley, Connelly, and Simon, “The Private Sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.”
47
Marseille, Saba, Muyingo, and Kahn, “The costs and benefits of private sector provision of treatment to HIV-
infected employees in Kampala, Uganda.”
48
Marseille, Saba, Muyingo, and Kahn, “The costs and benefits of private sector provision of treatment to HIV-
infected employees in Kampala, Uganda.”
49
Rosen, Feeley, Connelly, and Simon, “The Private Sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.”
50
Ibid.
13
high. A Canadian study found that HIV/AIDS mortality resulted in annual costs of $500,000
USD to the nation, as well as any future production yield.
51
The learning curve of new
employment is the final segment of the indirect cost calculation. When ill employees can no
longer work, either due to weakness or death, recruits must be obtained and trained to replace
those workers.
52
This learning curve results in a loss that can be represented in terms of months
of output lost, with between 1.5 and 3 months of productivity lost, equivalent to a reduction in
individual output of around 45%.
53
The above types of costs, direct and indirect, are usually summed up in two calculations:
the AIDS tax and cost as a multiple.
54
The AIDS tax reflects what percent of total company
compensation to employees is lost to AIDS. In reality, the AIDS tax for Sub-Saharan African
private sector companies usually falls between 2% and 4%, and can be as high as an 11%
increase in labor costs.
55
,
56
Cost can also be manifested as a multiple of an individual’s
compensation. For example, a multiple of 1 would indicate that companies are losing as much
money on an ill employee as they are paying that employee. The multiple for the Sub-Saharan
African private sector falls between .7 and 4.7, with an average of just about 2 times an
individual’s salary.
57
3.3.3. Benefits and Combating Costs of HIV/AIDS
51
C. Daniel Mullins, George Whitelaw, Jesse L. Cooke, and Eduard J. Beck, “Indirect Cost of HIV Infection in
England,” Clinical Therapeutics 22, no. 11 (2000): 1333–45, https://doi.org/10.1016/s0149-2918(00)83030-1.
52
Rosen, Feeley, Connelly, and Simon, “The Private Sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.”
53
Ibid.
54
Ibid.
55
Rosen, Vincent, MacLeod, Fox, Thea, and Simon, “The cost of HIV/AIDS to businesses in southern Africa.”
56
Rosen, Feeley, Connelly, and Simon, “The Private Sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.”
57
Rosen, Feeley, Connelly, and Simon, “The Private Sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.”
14
To counter these costs, corporations can choose to partake in PPPs, in which the company
and the public sector benefit from addressing these expenses. In the Dominican Republic and
Gabon, mass media efforts to combat HIV/AIDS and promote safer sexual practices ranged from
$0.06 to $0.32 USD per capita, while person to person contact to promote safer sex and condom
use ranged from $0.47 to $3.73 USD per capita.
58
There is also a significant time cost to
participating in these PPPs, as the average length of a PPP is three years, which means that a
corporation will have to sacrifice valuable time and resources to partake in these partnerships.
59
In terms of HIV/AIDS treatments, it is estimated that, on average, a sub-Saharan African
company must spend around $2,600 USD per person per year for treatment.
60
ART accounts for
about $1,600 USD of this sum, while other “incremental medical care costs” account for the
other $1,020 USD.
61
While there are costs to these efforts, these methods have directly measurable benefits.
In terms of productivity loss, treatments like ART add about 5 years of quality employment to a
worker’s lifetime, staving off replacement and recruiting costs.
62
In terms of quantified monetary
benefit, private sector companies experience an estimated return on investment of between
$2,000 and $10,000 USD per treated person per year, with the variation resulting from skill
levels.
63
Even investing as little as one third of the recommended amount can create positive
58
N. Soderlund, J. Lavis, J. Broomberg, and A. Mills, “The Costs of HIV Prevention Strategies in Developing
Countries,” Bull World Health Organization 71, no. 5 (1993): 595-604,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2393468/.
59
George Ingram and Julie Biau, “A Data Picture of USAID Public - Private Partnerships: 2001 - 2014,” Brookings
Institution, October 10, 2014, https://www.brookings.edu/research/a-data-picture-of-usaid-public-private-
partnerships-2001-2014/.
60
Marseille, Saba, Muyingo, and Kahn, “The costs and benefits of private sector provision of treatment to HIV-
infected employees in Kampala, Uganda.”
61
Ibid.
62
Rosen, Feeley, Connelly, and Simon, “The Private Sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.”
63
Ibid.
15
change. A June 2007 study found that spending $360 USD on medical care costs per patient per
year yields positive financial returns.
64
Treating employees can also cut company costs due to
HIV/AIDS by up to 30%.
65
It is important to note that the treatments for HIV/AIDS are highly
effective, too. Decreasing HIV/AIDS mortality by 85%, ART’s success rate proves that investing
in the treatment is not a mis-allocation of funds; rather, it is an investment in a proven, effective
method of combating HIV/AIDS.
66
3.3.4. Conclusion
Although there are costs to participating in a PPP, a thorough cost benefit analysis shows
how ignoring HIV/AIDS in the employee population is more costly than addressing the issue
directly. Indirect and direct costs accumulate to cripple a corporation’s gains, and the benefits
from decreasing HIV/AIDS prevalence are measurable on a private and public scale. Companies
and nations save millions, if not billions of dollars when HIV/AIDS prevention and awareness is
of high priority. It is important to note that the findings discussed tend to be amplified for larger
companies, and thus, the size of a company should also be considered when applying the
aforementioned conclusions.
67
4. Humanitarian Incentives for Private Companies
64
Ibid.
65
Ibid.
66
Marseille, Saba, Muyingo, and Kahn, “The costs and benefits of private sector provision of treatment to HIV-
infected employees in Kampala, Uganda.”
67
Rosen, Feeley, Connelly, and Simon, “The Private Sector and HIV/AIDS in Africa: taking stock of 6 years of
applied research.”
16
The historic and modern precedent for private sector philanthropic investments can be
seen in Andrew Carnegie, who was committed to the ideals of philanthropy.
68
Carnegie wrote
about these ideals in his essay The Gospel of Wealth, where he praises capitalism for its ability to
drive progress while recognizing the great social and economic inequalities introduced by such a
system.
69
He recognizes the system is unfair, but that it is the responsibility of the wealthy to
invest excess wealth to address these natural inequalities.
70
However, the role of businesses in philanthropic endeavors has changed in recent
decades. While fundraising and donating has often been the main way for companies to become
involved in such efforts, recently there has been an uptick in the number of companies becoming
directly involved in humanitarian efforts.
71
When most companies are faced with the decision of
whether or not to invest in a humanitarian project, the driving factors behind their decision are
brand image, reduction of future crisis risk, employee motivation, an increase in knowledge, and
a desire to act ethically.
72
Today, most companies choose to invest in such efforts as a way to
build up the company’s reputation and establish themselves as a corporate citizen.
73
These efforts
become more important as consumer consciousness to brands and their global footprint continues
to expand, encouraging businesses to establish a positive public rapport.
74
In fact, a report by
Weber Shandwick found that 60% of a company’s market value can be derived from its
68
“Philanthropy of Andrew Carnegie,” Columbia University Libraries, accessed October 7, 2019,
https://library.columbia.edu/libraries/rbml/units/carnegie/andrew.html.
69
Andrew Carnegie, “The Gospel of Wealth,” Carnegie Corporation of New York, accessed October 7, 2019,
https://www.carnegie.org/about/our-history/gospelofwealth/.
70
Ibid.
71
Andrea Binder and Jan Martin Witte, “Business Engagement in Humanitarian Relief: Key Trends and Policy
Implications,” Humanitarian Policy Group, June 2007, https://www.odi.org/sites/odi.org.uk/files/odi-
assets/publications-opinion-files/375.pdf.
72
Binder and Witte, “Business Engagement in Humanitarian Relief: Key Trends and Policy Implications.”
73
Ibid.
74
Ibid.
17
reputation.
75
By focusing on creating a positive reputation through these humanitarian projects,
new customers feel inclined to support a company that contributes to salient causes, the existing
customer base can be strengthened, different businesses and organizations are keen to build a
relationship, and access to new markets can materialize.
76
As this modern phenomenon of humanitarian engagement evolves, so too do the end
results. Recently, the International Committee of the Red Cross (ICRC) has begun recruiting
humanitarian help from businesses in Nigeria to introduce help to areas that do not typically see
private sector investments.
77
The goal of the ICRC is to connect businesses to projects that will
be profitable investments, so that these projects can be completed efficiently and effectively by
these profit-driven companies.
78
Tony Elumelu, an Nigerian entrepreneur already funding ICRC
projects, urges companies to also participate and to think of it as an investment, not aid.
79
This
emphasizes the fact that profit-driven companies can still find profitable humanitarian
investments that helps the targeted group while providing a financial boost to the company. A
study found that consumers viewed a company more favorably if they were associated with a
positive cause, and consumers also value spending more on the cause itself than company
advertisements about their actions.
80
Additionally, these investments help to develop commercial
75
“The Company behind the Brand: in Reputation We Trust,” Weber Shandwick, accessed October 7, 2019,
https://www.webershandwick.com/uploads/news/files/InRepWeTrust_ExecutiveSummary.pdf.
76
“The Business Case: A Study of Private Sector Engagement in Humanitarian Action,” The United Nations Office
for the Coordination of Humanitarian Affairs, last modified November 2017,
https://www.unocha.org/sites/unocha/files/PSS-BusinessCase-FINAL.PDF.
77
Libby George, “Red Cross to Create Private Investment Platforms for Humanitarian Work,” Reuters, September
12, 2019, https://www.reuters.com/article/nigeria-aid-idUSL5N263569.
78
Ibid.
79
Ibid.
80
Yeosun Yoon, Zeynep Gurhan-Canli, and Norbert Schwarz, “The Effect of Corporate Social Responsibility
(CSR) Activities on Companies with Bad Reputations,” Journal of Consumer Psychology 16, no. 4 (January 25,
2008): 377-90, https://doi.org/10.1207/s15327663jcp1604_9.
18
opportunities by accessing and testing new markets and build new relationships with other
businesses, international organizations and governments, which further build on future profits.
81
5. Ethical Concerns When Working with Private Companies
In considering the potential benefits of a private-public sector collaboration in responding
to the HIV/AIDS crisis, it is essential to acknowledge a history of exploitation within the private
sector. Historically, multinational companies have illegally exploited natural resources across
Africa, arming warlords, harming laborers, and even perpetuating conflict and instability.
82
A
notable example is detailed in the Report of the Panel of Experts on the Illegal Exploitation of
Natural Resources and Other Forms of Wealth of Democratic Republic of Congo. This UN
Security Council report, published in April 2001, notes that various resources in the Democratic
Republic of Congo (DRC) were illegally exploited by the Rwandan Patriotic Front in exchange
for arms or financial resources from the private sector.
83
Another more recent example of the exploitation seen in the private sector is seen in
Apple’s involvement in the cobalt mines in the DRC. In 2018, Apple was in talks to source
cobalt, a crucial material in its batteries, directly from the miners.
84
While Apple did not specify
which mines they were in talks with, the bulk of their cobalt comes from areas of the DRC where
human rights abuses commonly occur, such as child labor.
85
Apple should be aware of these
81
“The Business Case: A Study of Private Sector Engagement in Humanitarian Action.”
82
“Multinational Enterprises in Situations of Violent Conflict and Widespread Human Rights Abuses,” OECD,
2002, https://www.oecd.org/countries/myanmar/WP-2002_1.pdf.
83
Kassem, “Final report of the Panel of Experts on the Illegal Exploitation of Natural Resources and Other Forms of
Wealth of the Democratic Republic of the Congo.”
84
Jack Farchy and Mark Gurman, “Apple in Talks to Buy Cobalt Directly From Miners,” Bloomberg, February 21,
2018, https://www.bloomberg.com/news/articles/2018-02-21/apple-is-said-to-negotiate-buying-cobalt-direct-from-
miners.
85
Kotie Geldenhuys, “Eating a chocolate/using your cellphone? You might unknowingly be guilty of supporting
child labour” Servamus Community-Based Safety and Security Magazine 112, no. 5 (May 2019): 14-8,
https://journals.co.za/content/journal/10520/EJC-156f12634a.
19
issues and understand the negative reputation associated with human rights abuses, as well as
understand their large demand for cobalt creates an ideal environment for these abuses.
Another notable such example was recently uncovered in South Africa, where the
Department of Labor revealed exploitation of workers by security companies, which were not
complying with labor laws, such as providing payslips and annual bonuses.
86
The Department of
Labor has promised to implement programs to increase compliance.
87
This suggests that
oversight programs were not in place to begin with. In fostering public-private sector
partnerships, it is important that systems of oversight be put into place to avoid instances, like
this, of blatant exploitation.
Some specific challenges relating to private sector exploitation in the realm of HIV/AIDS
involve the steep costs of HIV/AIDS prevention and treatment, which renders these drugs
inaccessible to low income populations. For instance, the cost of daraprim, an important drug for
treating infections in HIV patients, is a major obstacle to access.
88
Currently, these costs reach
$800 USD for a single pill, forcing patients to resort to less-tested alternative medications.
89
The
perpetuation of this injustice highlights a dire lack of interventions by overseers in the private
sector. In September 2015, after the steep price increase from $13.50 USD per pill to $750 USD
per pill, representatives of Turing Pharmaceuticals communicated to the public that they were
looking to innovate and discover new medications.
90
However, this statement contradicted the
fact that the scientific community was content with the current drug’s efficacy and management
86
“Mpumalanga Security Companies Exploit Guards, Labour Dept Finds,” The Citizen, August 29, 2019,
citizen.co.za/news/south-africa/general/2172991/mpumalanga-security-companies-exploit-guards-labour-dept-
finds/.
87
Ibid.
88
“Daraprim Prices Still an Obstacle for Patients,” Healio, March 26, 2018, www.healio.com/infectious-
disease/hiv-aids/news/online/%7B90a0d411-0033-4269-ba41-89986411071d%7D/daraprim-prices-still-an-obstacle-
for-patients.
89
Ibid.
90
Ibid.
20
of side effects.
91
Furthermore, while Turing Pharmaceuticals announced plans in 2015 to lower
the price of daraprim, they did not specify by how much, or when.
92
This situation mirrors how
Gilead Sciences has made countless billions from its high HIV/AIDS drug prices, such as the
$2,000 USD needed for a month’s supply of PrEP, which leads to inaccessibility for those who
need them most.
93
In addition, in October 2019, the AIDS Healthcare Foundation called upon
Gilead Sciences to lower the price of Descovy, a new HIV medication that is used alongside
other HIV medications, to $1 USD per pill and stop their policy of limiting medicine availability
to increase profits.
94
These exorbitant prices and allegations call into question the efficacy of the systems of
oversight in place for the private sector and for private and public partnerships at large.
According to a report by the World Bank Group, regulation-by-contract is a commonly-used
system of oversight in which there is no separate agency for regulation; rather, the public sector
entity that seeks to benefit from the partnership provides the regulation.
95
While this ensures that
the contract is met, little information is released regarding the private entity’s work.
96
Currently,
in order to help countries mitigate the fiscal risks of PPPs, the International Monetary Fund has
created the PPP Fiscal Risk Assessment Model to assist countries in determining the impact of a
PPP on economic aspects of their government
97
91
Ibid.
92
Ibid.
93
Shefali Luthra and Anna Gorman, “Rising Cost Of PrEP To Prevent HIV Infection Pushes It Out Of Reach For
Many,” NPR, June 30, 2018, www.npr.org/sections/health-shots/2018/06/30/624045995/rising-cost-of-prep-a-pill-
that-prevents-hiv-pushes-it-out-of-reach-for-many.
94
Kyle Blankenship, “Gilead Called on to 'Significantly Cut' HIV Med Descovy's Price in PrEP,” FiercePharma,
October 7 2019, www.fiercepharma.com/pharma/a-1-pill-gilead-called-to-significantly-cut-price-hiv-aids-med-
descovy.
95
“Regulation by Contract,” World Bank Group, last modified February 16, 2016, ppp.worldbank.org/public-
private-partnership/regulation-contract.
96
Ibid.
97
“Helping Countries Manage Fiscal Risks from Public Private Partnerships.”
21
Despite the existent systems of oversight, progress remains to be made. A recent
Brookings report notes that governments should create PPP departments to efficiently set up
PPPs and protect the public from exploitation.
98
These departments would be particularly useful
in fostering a shared sense of purpose and objectives for PPPs, and would encourage consistency
in decision-making, as there is one overall place to look towards for guidance. In order to
improve oversight, the report also recommends that governments pass legislation to increase
transparency and select PPPs that will result in positive outcomes, serving as either the public
entity in the PPP or as a mediator in the partnership.
99
Further concerns arise when analyzing the frequency of tax evasion within countries
across Africa. Africa generates 28.2% of its revenue through international corporate taxes, so
when these taxes are evaded, the continent as a whole suffers.
100
Due to improper tax structures,
there is a tax gap of over 40% between what companies should pay and what they actually pay
across the continent.
101
It has been estimated that this translates into $14 billion USD of lost tax
revenues, which could be used for needed healthcare interventions.
102
Countries need to be
cognizant that many of the companies they want to form PPPs with are likely participating in this
tax evasion, so they should be careful when setting up these PPPs.
Outside countries have begun to recognize this issue, though. Countries that frequently
supply donations for development, such as the United Kingdom, are seeking ways to correct this
rampant corporate tax evasion. The United Kingdom has pledged £47 million to create stronger
98
Emilia Istrate and Robert Puentes, “Moving forward on public private partnerships: US and international
experience with PPP units,” Brookings-Rockefeller, December 2011, https://www.brookings.edu/wp-
content/uploads/2016/06/1208_transportation_istrate_puentes.pdf.
99
Ibid.
100
“Fiscal Implications of Trade Liberalization on African Countries,” African Trade Policy Centre, September
2004, http://repository.uneca.org/bitstream/handle/10855/5551/Bib-39542.pdf?sequence=1.
101
Ibid.
102
“Inequality and poverty: the hidden costs of tax dodging,” Oxfam International, accessed Dec 10, 2019,
https://www.oxfam.org/en/inequality-and-poverty-hidden-costs-tax-dodging.
22
tax systems within Africa that have built in oversight.
103
Their hope is to remove Africa’s
reliance on aid through this return of tax revenue, and to also provide companies with desired
stability.
104
This creates a benefit for donor countries, host countries, and companies alike, and
other donor countries should continue to build upon the United Kingdom’s work to remove this
issue.
5.1. Heineken-Global Fund Case Study
In January of 2018, Heineken Beer Company and The Global Fund initiated a public-
private partnership to fight the three leading infectious disease epidemics in Africa: tuberculosis
(TB), HIV/AIDS, and malaria.
105
With the goal of providing services to the hardest-to-reach
populations, the partnership intended to connect Heineken’s supply chain experts with logistics
teams at the Global Fund.
106
This would allow transfer of knowledge about identifying
populations in need of services and establishment of quality control during shipment to remote
areas.
107
The Global Fund also expressed excitement to leverage Heineken’s communications
and marketing expertise to craft HIV prevention and behavior change campaigns.
108
Despite the excitement expressed by the two entities upon announcing the partnership,
the Global Fund quickly suspended its partnership with Heineken in March of 2018 due to health
risks and sexual harassment for Heineken’s female promoters.
109
Additionally, public criticism
103
Harry Mance, “UK to step up help to fight tax evasion in Africa,” Financial Times, Feb 18, 2019,
https://www.ft.com/content/5aced2fc-33a2-11e9-bb0c-42459962a812.
104
Ibid.
105
“Global Fund and Heineken Enter Into Partnership to Fight Against Infectious Diseases in Africa,” Heineken,
January 26, 2018, https://www.theheinekencompany.com/media/media-releases/press-releases/2018/01/2164014.
106
Ibid.
107
Ibid.
108
Ibid.
109
“Global Fund Suspends Partnership with Heineken,” The Global Fund, March 29, 2018,
https://www.theglobalfund.org/en/news/2018-03-29-global-fund-suspends-partnership-with-heineken/.
23
and pressure called for the partnership to end for conflict-of-interest reasons. In an open letter to
the Global Fund, the International Organisation of Good Templars and ninety-three cosponsors
voiced deep concerns regarding the partnership and called for its end.
110
Highlighting that
alcohol is a major risk factor for TB and HIV/AIDS, the letter stated that Heinken’s partnership
obstructs progress towards Sustainable Development Goal (SDG) 3.3, which seeks an end to
communicable disease epidemics by 2030.
111
112
The Lancet Gastroenterology and Hepatology
group also cited that alcohol is a driver of certain non-communicable diseases, like esophageal
and bowel cancer, pancreatitis, and cardiovascular disease, so Heineken increasing product sales
would hinder efforts towards SDG 3.4, which seeks an end to premature deaths due to
noncommunicable disease by 2030.
113
114
The Lancet also cited that the Heineken partnership
would oppose SDG 3.5, which seeks to reduce substance abuse, due to the promotion of alcohol
abuse.
115
116
The overarching concern voiced in these oppositions to the Heineken-Global Fund
Partnership was that a public health organization partnering with a brewing company allows for
the increased consumption of a hazardous product that can reverse the intended goal of resolving
these infectious disease epidemics. The partnership not only introduces an unhealthy product in
110
IOGT et.al., “Joint Open Letter: Concern Regarding Global Fund Partnering With Heineken,” IOGT
International, February 1, 2018, https://iogt.org/open-letters/joint-open-letter-concern-regarding-global-fund-
partnering-heineken/.
111
IOGT et.al., “Joint Open Letter: Concern Regarding Global Fund Partnering With Heineken.”
112
“Sustainable Development Goal 3,” United Nations, accessed Dec 10, 2019,
https://sustainabledevelopment.un.org/sdg3.
113
“The Global Fund and Heineken,” The Lancet Gastroenterology & Hepatology 3, no. 4 (April 1, 2018): 213,
https://doi.org/10.1016/S2468-1253(18)30049-9.
114
“Sustainable Development Goal 3.”
115
“The Global Fund and Heineken.”
116
“Sustainable Development Goal 3.”
24
more abundance, but it also allows the company to create a false image of responsibility in order
to promote their brand.
117
6. Urban-Rural Divide
Residents of rural communities face a number of challenges that result in worse
healthcare outcomes than their urban and suburban counterparts.
118
On an individual level, these
challenges include increased mortality rates, higher incidences of disease and disability, shorter
life expectancies, increased prevalence of opioid addiction, and higher rates of cancers related to
modifiable risks.
119
120
In terms of healthcare, adults in rural communities are less likely to be tested for chronic
conditions than their urban/suburban counterparts.
121
Rural residents in the U.S., for example, are
less likely to get tested for HIV/AIDS than urban residents, despite the number of cases growing
rapidly in rural areas.
122
Among adults in rural areas who are aware they have HIV/AIDS, 75%
have to travel to urban areas to receive healthcare.
123
Healthcare is highly inaccessible to
individuals residing in rural communities, as residents of rural communities are less likely to be
insured and stay insured than urban residents.
124
This is at least partially due to the high
percentage of self-employed individuals, small businesses, and farm enterprises existing in rural
117
“The Global Fund and Heineken.”
118
“Rural health inequities: data and decisions,” The Lancet 385, no. 9980 (May 9, 2015): 1803,
https://doi.org/10.1016/S0140-6736(15)60910-2.
119
Robin Warshaw, “Health Disparities Affect Millions in Rural U.S. Communities,” AAMC, October 31, 2017,
https://www.aamc.org/news-insights/health-disparities-affect-millions-rural-us-communities.
120
“Rural Health Disparities Introduction,” Rural Health Information Hub, accessed October 7, 2019,
https://www.ruralhealthinfo.org/topics/rural-health-disparities.
121
“Rural and Urban Health,” Georgetown University Health Policy Institute, accessed October 7, 2019,
https://hpi.georgetown.edu/rural/.
122
Ibid.
123
Ibid.
124
Ibid.
25
areas.
125
Additionally, residents who live on farms, ranches, reservations, or frontiers must travel
further distances to access healthcare facilities, resulting in skipped appointments or delayed
care.
126
Rural patients travel an average of 12.5 miles to access healthcare, and many travel up to
25 miles.
127
This creates an especially precarious situation for those who are poor, elderly,
disabled, or do not have access to reliable transportation.
These issues are replicated across the global healthcare industry, as well. Asia and the
Pacific see some of the highest rural health inequities, and these are caused by low access to
legal healthcare coverage.
128
Even in countries with high rural populations, such as Zambia, there
exists a discrepancy between what services rural residents have access to.
129
Due to the lack of
healthcare facilities in rural settings, these countries tend to have low out-of-pocket costs for
healthcare, creating deceptive images of successful healthcare systems.
130
This unequal
distribution results from how private healthcare facilities are funded. In single payer systems,
frequent in countries with reliable healthcare systems, these facilities receive most of their
funding from the government, with few procedures covered by private insurance companies.
131
This allows many people to be able to afford treatments and procedures, such as treatments for
HIV/AIDS. However, in countries that rely upon private insurance companies or no direct source
of funding at all, it can be difficult for rural residents to be able to afford healthcare costs and
125
Ibid.
126
Warshaw, “Health Disparities Affect Millions in Rural U.S. Communities.”
127
George H. Pink, “Before the Committee on Finance U.S. Senate Washington, D.C.,” United States Senate
Committee for Finance, May 24, 2018,
https://www.finance.senate.gov/imo/media/doc/24MAY2018PinkSTMNT.pdf.
128
“Rural health inequities: data and decisions.”
129
Ibid.
130
Ibid.
131
Chris Slaybaugh, “International Healthcare Systems: The US Versus the World,” Axene Health Partners,
accessed Dec 10, 2019, https://axenehp.com/international-healthcare-systems-us-versus-world/.
26
access.
132
Non-profit funding does exist for countries in this situation, but this is an unreliable
source of funding for such a pressing need.
133
Another glaring issue is the closure of rural healthcare facilities, as this reduces access to
needed HIV/AIDS treatments. Over the past seven years, 82 of the 2244 rural hospitals in the
U.S. have closed, and one analysis shows that, without intervention, another 673 may close
within the next five years.
134
Over 57 million Americans rely on the services of rural healthcare
facilities, but a number of factors have contributed to these facilities’ financial instabilities and
closures, including a lack of human and financial resources to provide specialized inpatient
care.
135
Globally, this same trend is reflected, and it is caused by changing economic policies that
are shifting towards a focus on cost-effective investments.
136
A root cause of many of these issues is the socioeconomic disparities between rural and
urban/suburban communities. Rural communities in the U.S. that are most affected by the
closures of healthcare facilities are predominantly black, unemployed, lacking a high school
education, and report having fair to poor health.
137
Globally, the issues with low income and poor
health are also factors into the closure of healthcare facilities.
138
Thus, the closure of rural
healthcare facilities perpetuates the challenges already faced by disadvantaged communities.
132
“Health Care Systems - Four Basic Models,” Physicians for a National Health Program, accessed December 10,
2019, https://pnhp.org/resource/health-care-systems-four-basic-models/.
133
Patti L. Tracey, “Non-Governmental Organization’s (NGOs) Impact on Health Care Services in Rural Honduras:
Evaluating a Short–Term Medical Mission (STMM) Utilizing a Case Study Approach,” University of Toronto, 2015,
https://tspace.library.utoronto.ca/bitstream/1807/71357/1/Tracey_Patti_L_201511_PhD_thesis.pdf.
134
Karen M. Murphy, “Oral Testimony of Karen M. Murphy, PhD RN,” United States Senate Committee on
Finance, May, 24, 2018, https://www.finance.senate.gov/imo/media/doc/24MAY2018MurphySTMNT1.pdf.
135
Ibid.
136
Roger Strasser, “Rural health around the world: challenges and solutions,” Family Practice 20, no. 4 (August
2003): 457-63, https://doi.org/10.1093/fampra/cmg422.
137
Pink, “Before the Committee on Finance U.S. Senate Washington, D.C..”
138
Strasser, “Rural health around the world: challenges and solutions.”
27
In a study conducted in two urban and two rural areas within South Africa, residents of
urban communities preferred a private medical facility while participants from rural communities
preferred a health clinic.
139
Additionally, rural participants indicated that they would see a
private doctor only if they were very ill.
140
As health clinics in South Africa provide free services
and private medical doctors do not, the difference in the preferred facility was a result of income
disparity, which is dependent on employment and income.
141
The demographic questions of the
survey indicated that 24% of urban residents were employed compared to 9.9% from rural
residents.
142
The difference in the employment rate also brings up the income disparities that
arise between urban and rural areas, indicating that urban residents are more likely to have
money to spend on healthcare than rural residents.
143
Additionally, most of the residents of urban
communities sourced their income from labor, whereas rural participants depended on grants
sourced from different institutions, highlighting the inconsistency of income on a weekly
basis.
144
Reasons for the difference in preferred health care also included the distance to health
care facilities, availability of transportation, and the cost of transportation since transportation to
these facilities is not free.
145
With all of these differences, a problem arises regarding rural access
to quality HIV/AIDS treatments and service. As they cannot access healthcare regularly in
general, rural residents with HIV/AIDS will not be able to seek the treatment that they need.
139
Van Der Hoeven, Kruger, and Greeff, "Differences in Health Care Seeking Behaviour between Rural and Urban
Communities in South Africa.”
140
Ibid.
141
Ibid.
142
Van Der Hoeven, Kruger, and Greeff, "Differences in Health Care Seeking Behaviour between Rural and Urban
Communities in South Africa.”
143
Ibid.
144
Ibid.
145
Ibid.
28
The study also found that the quality of service at these facilities furthered the gap
between urban and rural participants. Although health clinic services are free, they are often not
funded sufficiently, thus resulting in the under-staffing and lack of resources to accommodate a
large number of patients waiting to be seen.
146
Consultation times are too short and, therefore,
ineffective. While urban communities have local pharmacies where medication can be purchased
without a prescription, rural areas lack these facilities and have to wait in long lines to get any
health care.
147
These factors result in participants from urban communities rating their health
status at a much higher rate than rural participants due to their ability to treat themselves
successfully.
148
While looking at the rural/urban divide, it is important to notice that the difference in the
participants’ health status and access to facilities do not solely depend on their geographical
boundaries. Instead, socioeconomic differences stemming from factors such as employment rates
and sources of income in played a more significant role in creating the urban/rural division.
7. Types of Public-Private Partnerships
7.1. Awareness Building
Awareness Building PPPs help to spread information about HIV/AIDS within their
communities. The following sections will outline several PPPs that have created successful
campaigns, and they can serve as models for future PPPs. These campaigns are Viacom’s global
partnership with UNAIDS called Staying Alive, Rede Globo’s television programs in Brazil, and
Durex’s campaigns in the U.S. and South Africa.
146
Ibid.
147
Ibid.
148
Van Der Hoeven, Kruger, and Greeff, "Differences in Health Care Seeking Behaviour between Rural and Urban
Communities in South Africa.”
29
7.1.1. Viacom: Staying Alive Case Study
MTV is a cable television network under Viacom Media Networks that reaches over half
a billion households globally each year.
149
Their partnership with UNAIDS called Staying Alive
was created to address the HIV/AIDS crisis, specifically facing young people who happen to be a
main aspect of MTV’s audience.
150
Staying Alive works to empower young people by creating
awareness-raising content, awarding grants to prevention projects, and supporting young people
around the world.
151
This partnership has been largely successful at making progress towards its
mission since it was founded over 20 years ago, as it has reached over 3 million young people,
distributed 9.7 million condoms, and helped test 270 thousand young people for HIV/AIDS.
152
As of 2017, Staying Alive is involved with 37 projects across the world and has had to
consider the unique conditions of each location when choosing what projects will be most worth
investment, as they must work with the individual cultural, financial, and legal barriers that arise
when addressing HIV/AIDS .
153
Staying Alive has established three de facto themes for their
new projects: educating rural residents, prison outreach, and LGBTQ+ targeted.
154
Almost every
program falls into one of these three categories, and each category is adjusted to the country the
program exists within.
7.1.1.1. Educating Rural Residents
The first Staying Alive theme is focused on outreach to people that are traditionally
harder to contact due to lack of infrastructure or rural lifestyles, such as residents in Zambia,
149
“#99 MTV” Forbes, last modified May 2019, https://www.forbes.com/companies/mtv/#74c87f277fb9.
150
Rob Graham et al., “Global Creative Summit on HIV/AIDS at the United Nations,” Horizon International
Solutions Site, accessed October 18, 2019, https://www.solutions-site.org/node/135.
151
“MTV Staying Alive,” MTV, accessed October 18, 2019, http://www.mtvstayingalive.org/.
152
Ibid.
153
“Introducing Our New 2017 MTV Staying Alive Projects,” Viacom Talent, February 24, 2017,
https://careers.vimn.com/blog/2017/02/24/introducing-our-new-2017-mtv-staying-alive-projects.
154
Ibid.
30
Uganda, and Suriname.
155
In Zambia, Staying Alive has partnered with a start up organization
called Clowns for Condoms, which utilizes a travelling circus called Circus Zambia to engage
with younger people in rural townships to help eliminate the stigma around HIV/AIDS, as well
as educate some of the most at-risk populations in the country.
156
In Uganda, Staying Alive’s
partner Ask Without Shame produces a mobile application through which people can ask
anonymous questions to be answered by licensed and registered physicians or counsellors, and
they are working to expand to peer-to-peer education and in-person outreach events.
157
Staying
Alive’s partner in Suriname is The Big Five Foundation that uses a buddy system to educate high
schoolers in rural communities about safe sex and HIV prevention.
158
By focusing on outreach to rural communities, Staying Alive is a proven example of how
to effectively spread awareness in communities with little infrastructure for digital
communication or internet access. In Uganda and Zambia, for example, only 24% and 14% of
their populations have internet access, respectively.
159
Suriname is slightly higher with 49% of
its residents on the internet, but the U.S., for comparison, is at 87%.
160
As such, programs in
Suriname cannot rely heavily on internet access, while programs in the U.S. can. By adjusting
their programs for this discrepancy, rural areas can be reached effectively.
Staying Alive and its partners demonstrated this adjustment through their implementation
of in-person communications aimed at younger rural populations.
161
As a result of their efforts,
155
Ibid.
156
Ibid.
157
“Introducing Our New 2017 MTV Staying Alive Projects.”
158
Ibid.
159
“Individuals using the Internet (% of population),” The World Bank, accessed October 20, 2019,
https://data.worldbank.org/indicator/it.net.user.zs.
160
Ibid.
161
Emma Batha, “Zambian acrobats use circus to flip HIV ‘juju’ myths,” Reuters, July 25, 2018,
https://www.reuters.com/article/us-zambia-circus-aids/zambian-acrobats-use-circus-to-flip-hiv-juju-myths-
idUSKBN1KF19R.
31
Circus Zambia is currently building new facilities for HIV/AIDS awareness spreading and
education, including a library, classroom, training room, and theater.
162
They are using their
model to inspire similar systems in Nepal and Colombia focused on other issues, with numerous
personal testimonies attesting to the effectiveness of the program.
163
Ask Without Shame has
answered over 80,000 questions from over 50,000 distinct users since its founding in December
of 2015 and continues to be active.
164
The Big Five Foundation has expanded to six districts in
just three years and continues to partner with other foundations in new districts, and, as a result
of their progress, their Staying Alive grant was renewed for three years in 2017.
165
Staying
Alive’s partnering strategy for these communities has been highly efficient and successful, and
by focusing efforts on rural communities, future partnerships should be able to achieve similar
levels of success as Staying Alive.
7.1.1.2. Prison Outreach Programs
Another area in which Staying Alive focuses efforts is outreach to prison populations.
Staying Alive has invested recently in two programs: Youth for New Beginnings in Tanzania and
the Nikolaev Regional Public Youth Movement Penitentiary Initiative in Ukraine.
166
These two
162
Ibid.
163
Ibid.
164
Jasmine Andersson, “This sexual health app created by a 22-year-old is saving lives in Uganda,” Stylist, 2017,
https://www.stylist.co.uk/life/ask-without-shame-app-uganda/766.
165
“The Big 5 Foundation for the second time an MTV SAF Grant winner,” Suriname Herald, December 29, 2017,
https://www.srherald.com/suriname/2017/12/29/the-big-5-foundation-voor-tweede-keer-mtv-saf-grant-winnaar/.
166
“Introducing Our New 2017 MTV Staying Alive Projects.”
32
programs both target educating prison populations, but are not localized to a certain type of
country.
167
168
Prisons have been found to be a center of HIV/AIDS spread, as studies have found that
the prevalence of HIV/AIDS is five times higher in prisons compared to the general
population.
169
Staying Alive’s efforts to support these two projects have been very successful and
have shown marked improvements in current HIV/AIDS prevalence among prison populations.
Along with hosting puppet shows in prisons to help break the taboo associated with the disease,
Youth for New Beginnings also hosts mass condom demonstrations, provides HIV testing for
prisoners, and trains prisoners to become peer educators who can spread the message further
themselves.
170
The Nikolaev Regional Public Youth Movement Penitentiary Initiative has also
found profound success in their mission: providing educational materials and psychological
support to men in prison who have sex with other men, as well as providing prisoners with
prevention kits, mental health counseling, and access to support groups.
171
They have recently
earned a thirty-thousand dollar grant for their efforts from amfAR, the Foundation for AIDS
Research.
172
By mirroring the past successes of prison-facing outreach programs, future
organizations can hope for similarly effective messaging and education among some of the most
at-risk individuals in the HIV/AIDS crisis.
167
“Current and future challenges and opportunities in Tanzania,” Ministry of Foreign Affairs of Denmark,
accessed October 22, 2019, https://um.dk/en/danida-en/strategies%20and%20priorities/country-
policies/tanzania/current-and-future-challenges-and-opportunities-in-tanzania/.
168
“Economic Development of the Ukraine: A Guide to Selected Information Sources,” The Library of Congress,
accessed October 22, 2019, https://www.loc.gov/rr/business/ukraine/investment.html.
169
“Prisoners, HIV and AIDS,” Avert, last modified October 10, 2019, https://www.avert.org/professionals/hiv-
social-issues/key-affected-populations/prisoners.
170
Corey Sutch, “Grantee Focus: Using Puppets to Break Taboo,” MTV, March 23, 2017,
http://www.mtvstayingalive.org/blog/2017/03/grantee-focus-using-puppets-to-break-taboo/.
171
Cub Barrett, “amfAR Announces Landmark Funding for HIV/AIDS Programs in Eastern Europe and Central
Asia,” amfAR, June 16, 2009, https://www.amfar.org/content.aspx?id=7532.
172
Ibid.
33
7.1.1.3. LGBTQ+ Facing Projects
Another important area that MTV Staying Alive is working within is engaging with
LGBTQ+ communities, especially in countries in which rights for these groups are severely
limited. This is demonstrated by Staying Alive’s two partners focused on such communities:
REVERS in Russia, where LGBTQ+ rights have been steadily declining, and Yaariyan in India,
where anti-sodomy laws persst. These populations are at extreme risk for HIV/AIDS due to
stigma and discrimination limiting access to testing and treatment and a high HIV/AIDS incident
rate.
173
Yaariyan is a successful, voluntary youth initiative that offers a safe space for LGBTQ+
young people to discuss the issues they face as a result of their identities both online, in a 8500
member Facebook group, and offline, through sponsored events and discussions.
174
Many of the
discussions and events focus on education and awareness of health issues, particularly HIV and
sexually transmitted diseases.
175
REVERS is also based around the concept of a LGBTQ+ safe
space and participates in outreach to popular gay bars and clubs to spread awareness, hosts
anonymous and free HIV testing, hosts counseling and psychological health services, and
monitors cases of gender and sexual identity discrimination.
176
These two projects are once again an example of MTV choosing target populations to
aim resources towards to maximize effectiveness in dissimilar countries and environments.
Staying Alive has found specific subsets of communities in each of the countries it is involved
173
“Gay men and other men who have sex with men,” UNAIDS, October 16, 2014,
https://www.unaids.org/en/resources/documents/2014/Gaymenandothermenwhohavesexwithmen.
174
“Yaariyan,” Humsafar Trust, accessed October 29, 2019, https://humsafar.org/yaariyan/.
175
Ibid.
176
“What We Do,” Karsnodar LGBT Social Movement “Revers”, accessed October 29, 2019,
https://reverslgbt.org/en/what-we-do/.
34
with to reach the most vulnerable and affected populations. This strategy helps them address the
most critical areas while maintaining efficiency with their limited resources. Future UNAIDS
partnerships should follow similar models of identifying the most at risk populations and
focusing programming, education, and awareness spreading to them.
7.1.1.4. Effective Awareness Programming
MTV seeks to spread awareness about a variety of topics through storytelling efforts that
advertisements would fail to achieve, in part by making their materials rights-free to non-MTV
broadcasters to reach a wider, diverse audience.
177
One example of this storytelling occurs in
Kenya and Nigeria, where MTV launched a TV series known as MTV Shuga, a drama series
addressing the stigma surrounding HIV testing.
178
MTV Shuga has proven to be so impactful that
it has aired on more than 150 broadcast television shows, reaching more than 500 million
viewers.
179
This show has also garnered support from several organizations including UNICEF,
The Bill and Melinda Gates Foundation, and several African governments.
180
The third season
especially focuses on reducing the stigma associated with HIV and further emphasizes the
importance of abstaining and also obtaining HIV treatment. MTV has proven to have a
significant impact on its viewers, as shown by the fact that mindsets surrounding testing, stigma,
177
C.W. Geary et al., “Exposure to MTV’s global HIV program in Kathmandu, Nepal; Sao Paulo, Brazil; and
Dakar, Senegal,” AIDS Education and Prevention 19, no. 1 (Feb 2007): 36-50,
https://www.ncbi.nlm.nih.gov/pubmed/17411388.
178
Abhijit Banerjee, Eliana La Ferrara, and Victor Orozco, “MTV Shuga: Changing social norms and behaviors
with entertainment education in Nigeria,” Abdul Latif Jameel Poverty Action Lab, 2018,
https://www.povertyactionlab.org/evaluation/mtv-shuga-changing-social-norms-and-behaviors-entertainment-
education-nigeria.
179
Ibid.
180
MTV, “New Research Reveals MTV, UNICEF and PEPFAR’s Ignite Campaign has Altered Young People’s
Thinking About HIV/AIDS Attitudes and Behaviors,” Cision, July 20, 2010, https://www.prnewswire.com/news-
releases/new-research-reveals-mtv-unicef-and-pepfars-ignite-campaign-has-altered-young-peoples-thinking-about-
hivaids-attitudes-and-behaviours-98809589.html.
35
and multiple partners positively changed in 80% of viewers.
181
Following the show, the World
Bank conducted a study in Nigeria to test the impact of MTV’s show and test whether it
achieved its true impact. This study showed that twice as many viewers went to get tested after
six months and eliminated misconceptions about transmission, such as the myth that HIV can be
transmitted through handshakes.
182
In addition, the survey data showed that 35% of Kenyans
were more likely to take a test after viewing the show.
183
This demonstrates MTV’s success in
conveying its intent and message. MTV also used their storytelling abilities to focus in on
another vulnerable population: youth. Through a partnership with Vlogit, they created a global
video project encouraging young people to share their stories and perspectives on their
experiences surrounding HIV/AIDS.
184
Through their storytelling skills, numerous populations
are reached and are positively impacted.
7.1.2. Rede Globo Case Study
Rede Globo, also referred to as Globo, is the single largest television network across
Latin America, and is headquartered in Rio de Janeiro, Brazil.
185
Globo has also begun to expand
to the Internet to host their own original web series and soap opera spin-offs.
186
Due to their
powerful media presence, Globo is a UNAIDS partner in order to help prevent HIV/AIDS,
181
Banerjee, La Ferrara, and Orozco, “MTV Shuga: Changing social norms and behaviors with entertainment
education in Nigeria.”
182
“Experimental Evaluation of MTV Shuga: Changing Social Norms and Behaviors with Entertainment
Education,” World Bank, June 3, 2016, http://pubdocs.worldbank.org/en/438421467236362785/Entertainment-Edu-
workshop-Flyer-6-3-16.pdf.
183
Ibid.
184
Cathy Phiri, Gerrit Beger, and Elizabeth Losleben, “Young voices crucial to fighting AIDS, says MTV Networks
International and UNICEF,” UNICEF, July 25, 2007, https://www.unicef.org/media/media_40398.html.
185
“TV Globo and You,” Rede Globo, accessed November 25, 2019,
http://redeglobo.globo.com/Portal/institucional/foldereletronico/ingles/g_tv_globo.html.
186
“UNAIDS and Globo launch new Internet web series on serodiscordant couples,” UNAIDS, April 12, 2016,
https://www.unaids.org/en/resources/presscentre/featurestories/2016/april/20160412_brazil.
36
especially among the youth in Brazil.
187
In 2015, Globo television played a major role in the Live
Better Campaign, which was aimed at addressing healthcare challenges and promoting a system
where treatments are tailored to the individual.
188
As a part of this campaign, Globo Television
broadcasted 30-second public service announcements three times a day throughout the duration
of September to further promote the importance and dire significance of HIV prevention, and the
campaign began during one of their popular youth shows, Altas Horas.
189
Additionally, Globo and UNAIDS have collaborated to produce the web series known as
“Young Hearts - I Just Want to Love.” This Emmy Kids Award-nominated production focuses
on a teenage girl and her boyfriend who has HIV and their struggle to maintain their relationship,
and its goal is to educate youth on serodiscordant couples, healthy relationships, and the
complicated relationships that arise with HIV diagnosis.
190
The production garnered 1 million
views, resulting in it being the 3rd highest viewed series on the Globo platform.
191
Therefore,
Globo is able to reach a larger audience to provide HIV/AIDS education, receiving positive
attention and business in the process.
7.1.3. Durex Case Study
Durex, a condom company, recognizes the unique role it serves in preventing HIV/AIDS
transmission, and, as such, they have worked on numerous campaigns with UNAIDS and other
groups over the years to increase condom usage. They first began their work with UNAIDS in
187
Ibid.
188
“UNAIDS Works with Globo Television to reduce new HIV infections among young people in Brazil,”
UNAIDS, September 22, 2015,
https://www.unaids.org/en/resources/presscentre/featurestories/2015/september/20150922_oglobo.
189
“UNAIDS Works with Globo Television to reduce new HIV infections among young people in Brazil.”
190
“Globo Television visits UNAIDS following Emmy Kids nomination,” UNAIDS, April 11, 2018,
https://www.unaids.org/en/resources/presscentre/featurestories/2018/april/unaids-globo-impact-on-the-media.
191
“UNAIDS and Globo launch new Internet web series on serodiscordant couples.”
37
2004 when they stopped production of condoms with nonoxynol-9 after concerns arose that the
chemical resulted in increased, not lowered, HIV transmission.
192
Since then, Durex has focused
on campaigns to increase condom use and donations of condoms to organizations. In 2012,
Durex worked with UNAIDS to create the CONDOMIZE! campaign that demonstrates the
benefits of using condoms and urges policymakers to increase access to condoms.
193
Later that
same year, Durex pledged to donate one condom for every tweet with #1share1condom, hoping
to reach 2.5 million condoms donated to HIV/AIDS charities by World AIDS Day on December
1st.
194
Durex donated 5 million condoms by the end of the campaign, and they reached over 65
million people through this campaign.
195
Durex also recognizes the importance of reaching youth, an at-risk population. Durex
South Africa created an education program known as CONNECT-ED that goes into secondary
schools and teaches about safe sex practices.
196
Durex has also created a #CondomEmoji
campaign to encourage safe sex and push for an official condom emoji on phones.
197
The emoji
campaign was the result of a survey that indicated over 75% of respondents aged 16-35 years old
preferred discussing sex using emojis.
198
By reaching out to youth where they are commonly
found, Durex was able to spread their message effectively, reaching over 7.9 billion interactions
192
“Durex Stops Making Condoms With Nonoxynol-9 Due to Possible Increased Risk of HIV Transmission,”
Kaiser Health News, January 21, 2004, https://khn.org/morning-breakout/dr00021776/.
193
“CONDOMIZE! Campaign hits AIDS 2012,” UNAIDS, July 24, 2012,
https://www.unaids.org/en/resources/presscentre/featurestories/2012/july/20120725condomize.
194
Reckitt Benckiser, “Durex Joins in the Fight Against HIV and AIDS,” Cision, November 26, 2012,
https://www.prnewswire.com/news-releases/durex-joins-in-the-fight-against-hiv-and-aids-180874661.html.
195
“Sustainability Report 2012,” Reckitt Benckiser, accessed November 25, 2019,
http://www.rb.com/media/1505/rb_sustainability_report_2012.pdf.
196
Ibid.
197
“IPPF joins Durex on World AIDS Day to detail the risks of unprotected sex,” International Planned
Parenthood Federation, November 28, 2016, https://www.ippf.org/news/ippf-joins-durex-world-aids-day-detail-
risks-unprotected-sex.
198
Ibid.
38
with their #CondomEmoji hashtag.
199
Additionally, a Nielson study found that Durex has been
able to positively increase their brand perception through various campaigns.
200
As such, Durex
has seen positive impacts from their numerous campaigns, such as a positive reputation and
increased product awareness.
7.2. Direct Services
Direct Services PPPs provide help accessing medications, testing, and education
surrounding HIV/AIDS for the communities they work in, as well as for their own employees.
The following case studies detail examples of such services, and they can serve as models for
future PPPs. They include Volkswagen’s work in Brazil and South Africa, Coca-Cola’s work
across Africa, De Beers’s modifications in Botswana, Mastercard’s promising new technology
within Africa, and both Access Bank and Shell’s work within Nigeria.
7.2.1. Volkswagen Case Study
In 1996, Volkswagen do Brasil, a subsidiary company of the Volkswagen Group, created
the AIDS Care Program.
201
The group’s focus was preventing, caring for, and treating employees
living with HIV.
202
Volkswagen do Brasil employees reported high incidences of HIV and HIV-
related illness, which resulted in high healthcare costs and high rates of withdrawal from work.
203
199
Gabrielle Lane, “The Joy of Emoji - Behind the Scenes of Durex’s Safe Sex Campaign,” Influence, May 11,
2017, https://influenceonline.co.uk/2017/05/11/joy-emoji-behind-scenes-durexs-safe-sex-campaign/.
200
“Durex creates global buzz and stimulates cultural conversation with its global #Connect campaign on
YouTube,” Google, accessed November 25, 2019,
https://www.thinkwithgoogle.com/_qs/documents/1238/Durex.pdf.
201
Peter Aggleton et al., “HIV-Related Stigma, Discrimination and Human Rights Violations: Case Studies of
Successful Programmes,” UNAIDS, April 2005, http://data.unaids.org/publications/irc-pub06/jc999-
humrightsviol_en.pdf.
202
Ibid.
203
Ibid.
39
By instituting the Volkswagen do Brasil’s AIDS Care Program, which provided coordinated and
specialized treatment and care to its employees, the company was able to save money from
reduced absenteeism and a greater retention of employees.
204
The program had three main
objectives: to create effective, efficient, and more afforable treatment services for employees, to
promote anti-discrimination policies, and to run an HIV-prevention program.
205
The AIDS Care Program for people living with HIV/AIDS aims to provide standardized
care, while still allowing for flexibility to fit an individual’s specific needs.
206
The care program
provides counseling and access to a variety of health specialists, and there is an option available
for home-based care.
207
The non-discrimination part of the program aims to reintigrate indiviuals
with HIV back into the workplace. It also includes policy measures such as the prohibition of
mandatory HIV testing, the prohibition of firing employees over HIV status, and the right to
confidentiality.
208
Lastly, the program aims to prevent the spread of HIV/AIDS through means
such as education and counseling.
209
By the end of 2002, Volkwagen do Brasil reported a 90% reduction in hospitalizations
and 40% reduction of costs of treatment/care among employees living with HIV.
210
Additionally,
employees noted a perceived increase in satisfaction with the company and quality of life.
Absenteeism due to the prevention/control of HIV/AIDS also decreased.
211
The Volkswagen do
Brasil’s AIDS Care Program was awarded an international distinction by the UN General
204
Ibid.
205
Aggleton et al., “HIV-Related Stigma, Discrimination and Human Rights Violations: Case Studies of Successful
Programmes.”
206
Ibid.
207
Ibid.
208
Ibid.
209
Ibid.
210
Ibid.
211
Ibid.
40
Secretary Kofi Annan, and it was awarded another honor by the Global Business Council in
1999.
212
Volkswagen Group South Africa is another subsidiary of Volkswagen Group, and has
been fighting the HIV/AIDS epidemic in the Uitenhage region since 2001.
213
The group is
supported by the National Union of Metalworkers in South Africa, and it collaborates with the
German Association for Technical Co-Operation.
214
The group’s goals are to treat those living
with HIV/AIDS and prevent further spread of the disease. For a number of years, Volkswagen
provided the cost of treatment for employees and their families, and they spent more than
545,000 EUR on education, counseling, medication, and treatment.
215
7.2.2. Coca-Cola Case Study
Coca-Cola has been a longtime partner with UNAIDS, going as far back as 2001 to
address the HIV/AIDS crisis within Africa.
216
Through its foundational work within the Coca-
Cola Africa Foundation, Coca-Cola has been able to lend its knowledge of logistics to reach
isolated areas that need HIV/AIDS medications through Project Last Mile, as well as provide
services to its employees and bottling partners.
217
218
The following sections will go into detail
212
“Volkswagen,” GBC Health, accessed October 21, 2019, http://archive.gbchealth.org/member_profiles/1403/.
213
GBCHealth, “Volkswagen.”
214
Ibid.
215
Ibid.
216
The Coca-Cola Company, "UNAIDS Signs Up Coca-Cola in Battle Against AIDS," The Corporate Social
Responsibility Newswire, June 20, 2001, https://www.csrwire.com/press_releases/22439-UNAIDS-Signs-Up-Coca-
Cola-in-Battle-Against-AIDS.
217
April Jordin, "Project Last Mile Expands to 8 More African Countries," The Coca-Cola Company, January 19,
2016, https://www.coca-colacompany.com/stories/projectlastmile.
218
Jem Bendell, “Waking Up to Risk: Corporate Responses to HIV/AIDS in the Workplace,” UNRISD Programme
on Technology, Business and Society 12 (October 2003), http://data.unaids.org/publications/irc-pub06/jc968-
wakinguptorisk_en.pdf.
41
about Coca-Cola’s work, and they can provide details for how other companies could do similar
work within their own communities.
7.2.2.1. Coca-Cola Africa Foundation
Coca-Cola, an international soft drinks company, has collaborated with UNAIDS since
2001 to address the elimination of HIV/AIDS. It utilized its non-profit arm, The Coca-Cola
Africa Foundation, to oversee the joint effort in the African region, where HIV/AIDS remains a
prevalent issue and relates to the foundation’s mission of philanthropic interventions.
219
Coca-
Cola’s expertise in logistics and distribution in Africa, stemming from its extensive network of
approximately 1,200 employees in Africa and 40 bottling partners that employ around 60,000
people, has supplied UNAIDS with the human resources to distribute pamphlets, medication,
vaccines, and contraceptives around the continent.
220
Coca-Cola’s partnership with UNAIDS has three main components: a) leveraging its
marketing, logistical, and infrastructural expertise to support HIV/AIDS prevention, education,
and treatment in local communities; b) promoting awareness campaigns; and c) implementing
human resources policies for its employees in Africa.
221
Coca-Cola has partnered with local anti-HIV institutions in Africa to prevent, treat, and
educate about HIV/AIDS in local communities. In Zambia, Coca-Cola and its bottling partners
partnered with Family Health Trust, an organization that works with 2,500 anti-AIDS clubs
throughout Zambia to educate young people.
222
Coca-Cola has opened up its facilities in Lusaka
to store education material, such as pamphlets, and assisted in the distribution of these materials
219
The Coca-Cola Company, "UNAIDS Signs Up Coca-Cola in Battle Against AIDS.”
220
Bendell, “Waking Up to Risk: Corporate Responses to HIV/AIDS in the Workplace.”
221
The Coca-Cola Company, "UNAIDS Signs Up Coca-Cola in Battle Against AIDS.”
222
Ibid.
42
to the anti-AIDS clubs.
223
Similarly, the Coca-Cola network in Nigeria supported the National
HIV Sero-Prevalence Sentinel Surveillance Survey to create educational material and distribute
over 10,000 pamphlets to pregnant women in the country.
224
Using its marketing strategy, Coca-Cola Africa has supported UNAIDS in creating
information campaigns that will increase public awareness of HIV/AIDS to be used by
UNAIDS’s partners across the globe.
225
More research needs to be conducted to evaluate
whether or not these campaigns spearheaded by Coca-Cola reflect the company’s goal to create
an open communication around sexuality and inclusion of people already affected by HIV/AIDS.
Coca-Cola is the biggest investor in the African continent. In 2016, the company invested
approximately 17 billion dollars to its business in Africa, an exponential growth from the 5.5
billion dollars it invested in the previous decade.
226
Coca-Cola also has partner contracts with 59
bottling groups in the Sub-Saharan region, and these bottling companies employ more than
70,000 workers, thus creating a making the Coca-Cola system one of the largest private sector
empires in the continent.
227
Given Coca-Cola’s enormous presence in Africa, its domestic
approach to combating HIV/AIDS in its own workforce has lasting impact in educating workers
and providing HIV/AIDS treatment to across the continent.
In 2002, Coca-Cola received international criticism from HIV/AIDS activists for only
providing antiretroviral drugs (ARV) to its core staff of approximately 1600, while neglecting
the rest of the 60,000 employees in their partner bottlers.
228
Lack of free access to ARV for the
223
Ibid.
224
The Coca-Cola Company, "UNAIDS Signs Up Coca-Cola in Battle Against AIDS.”
225
Ibid.
226
Journey Staff, "Increasing The Coca-Cola Company's Investment in Africa," The Coca-Cola Company, accessed
October 20, 2019, https://www.coca-cola.co.uk/stories/increasing-our-investment-in-Africa.
227
"Our Bottlers," The Coca-Cola Company, accessed October 20, 2019, https://www.coca-colaafrica.com/coca-
cola-in-africa/our-bottlers#.
228
Bendell, “Waking Up to Risk: Corporate Responses to HIV/AIDS in the Workplace.”
43
60,000 employees caused the dependents of employees to suffer from the lack of access to the
medication.
229
In response, Coca-Cola introduced various education programs, medical testing,
and counseling to serve all of its employees.
230
In 2003, Coca-Cola introduced the Coca-Cola
Company in Africa Bottling Partners’ HIV/AIDS Programme, a benefits program that committed
Coca-Cola’s bottling partners to institute benefits programs and to expand ARV access to
employees and their dependents who work for the participating bottling companies.
231
Under this
program, the foundation reimbursed up to 50% of the bottlers’ cost of HIV/AIDS programs from
2004-2006 for the 26 partners who participated.
232
These 26 bottling companies reported that
between 2004 and 2006, the number of employees who took HIV/AIDS tests increased by
approximately 53%.
233
In addition, the number of employees receiving ARV increased by about
295%.
234
The success of this program resulted in it becoming formally established in the Coca-
Cola Company’s policies and practices, and the control over the programme was moved to the
Human Resources departments of the company and its bottling partners.
235
In 2008, Coca-Cola established its formal HIV/AIDS Policy that outlines the guiding
principles of confidentiality, treatment, education, and work accommodations.
236
This policy
includes guidelines from the International Labour Organization and the Joint United Nations.
237
229
Bendell, “Waking Up to Risk: Corporate Responses to HIV/AIDS in the Workplace.”
230
"HIV Aids Policy," Coca-Cola Hellenic Bottling Company, accessed October 20, 2019, https://coca-
colahellenic.com/en/about-us/policies/hiv-aids-policy/.
231
“The Coca Cola Africa Foundation HIV/AIDS Report 2006,” The Coca-Cola Africa Foundation, accessed
October 20, 2019, https://www.coca-
colacompany.com/content/dam/journey/us/en/private/fileassets/pdf/unknown/unknown/tccaf_2006_hivaids_report.p
df.
232
Ibid.
233
Ibid.
234
Ibid.
235
Ibid.
236
"HIV/AIDS," The Coca-Cola Company, accessed October 28, 2019, https://www.coca-colacompany.com/our-
company/hiv-aids.
237
Ibid.
44
The policy promises every employee a right to privacy, meaning that the employee’s HIV/AIDS
test results, counseling, and records of treatment are strictly confidential. In addition, the
company no longer required new or existing employees to test for HIV/AIDS, and the employee
is not obliged to inform the company if they are infected with the virus.
238
For workers suffering
from HIV/AIDS, the company promised to provide reasonable accommodations such as re-
arrangement of working time, providing special equipment, and flexible schedule for medical
appointments.
239
Lastly, the company will continue to provide education programs to its
employees and their families to inform about safe sex practices and prevention methods.
240
7.2.2.2. Project Last Mile
The Project Last Mile Initiative was introduced in 2010 as a collaboration between the
Coca-Cola Company, Coca-Cola Africa Foundation, United States Agency for International
Development, Bill & Melinda Gates Foundation, and the Global Fund to support the distribution
of vital medicines and supplies to hard-to-reach communities.
241
Project Last Mile has been
instituted in multiple countries, such as Tanzania, Mozambique, and Ghana, and is in different
stages of development in such countries.
242
The goal of this initiative is to reach a total of 10
countries in Africa by 2020.
243
While Coca-Cola has a global presence, it has an extensive local
network, marketing knowledge, and technical expertise in the African region.
244
Additionally,
the region offers economic benefits to Coca-Cola. Coca-Cola has announced publicly its desire
238
The Coca-Cola Company, "HIV/AIDS."
239
Ibid.
240
Ibid.
241
Jordin, "Project Last Mile Expands to 8 More African Countries.”
242
Ibid.
243
Ibid.
244
“Why the Last Mile,” Project Last Mile, accessed November 3, 2019, https://www.projectlastmile.com/why-the-
last-mile/.
45
to increase investment in Africa to a total of $17 billion USD by the year 2020.
245
Coca-Cola
CEO Muhtar Kent indicated that their revenue has the best chance at an increase in Africa due to
its high market growth rate, so this investment will allow the revenue to reach its full potential.
246
In order to achieve Project Last Mile’s mission to provide access to direct services in
hard-to-reach African communities, Coca-Cola and partners customized the supply-chain
management techniques and distribution mechanisms used by Coca-Cola such that they could be
applied to a public health context.
247
The innovations of this partnership were geared towards
rural communities, as they are often the most difficult to reach.
248
In Tanzania, Coca-Cola, alongside Tanzanian bottling company Coca-Cola Kwanza and
Tanzanian Medical Stores Department, initiated a program in 2010 to improve availability of
essential medicines.
249
The program, which is ongoing, has resulted in the use of network
optimization to expand direct delivery of medication from 130 to 5,000 drop points.
250
Distribution routes to 2,021 facilities have been optimized such that medications can be delivered
more promptly and to those hardest to reach.
251
In Mozambique, starting in 2016, Coca-Cola assisted in using GPS data to determine the
best locations for intermediary warehouses to store medicines, discover ideal travel routes for
vehicles, and adjust delivery such that proper vehicles are deployed depending on the region,
terrain, and season. Their work also allowed for economic efficiencies, as the country observed a
245
Earl Nurse, “The Secret behind Coca-Cola’s Success in Africa,” CNN, January 21, 2016,
https://www.cnn.com/2016/01/21/africa/coca-cola-africa-mpa-feat/index.html.
246
Ibid.
247
Linnander et al., “Process Evaluation of Knowledge Transfer across Industries: Leveraging Coca-Cola’s Supply
Chain Expertise for Medicine Availability in Tanzania.”
248
Ibid.
249
Ibid.
250
“2019 Impact Report,” Project Last Mile, accessed October 28, 2019,
https://www.usaid.gov/sites/default/files/documents/1864/project-last-mile-2019-impact-report.pdf.
251
Ibid.
46
shift from 148 district depots and 11 provincial warehouses to 30 intermediary warehouses in
ideal locations.
252
Beginning in 2017 in Liberia, Coca-Cola used data collection, evidence-based
forecasting, and an organized ordering process to redesign the country’s medicine supply-chain
model.
253
The redesigned system was inspired by Coca-Cola’s PreSell model, whereby a service
technician follows a pre-planned route using a motorbike and services all 51 health facilities in
the county on a four-week rotation.
254
In Nigeria and Ghana, Project Last Mile conducted research to compare the efficiency of
cold chain capacity for storing and transporting vaccines to those used by Coca-Cola bottlers to
store soft-drinks.
255
Upon discovering the refrigerators for storing vaccines were more prone to
breakdown and were less efficient, Project Last Mile crafted a more proactive national
maintenance model for the countries and provided access to their processes, tools, and staff to
ensure equipment maintenance and more reliable vaccine availability.
256
Some of the challenges Coca-Cola encountered and attempted to resolve upon
introducing innovative business strategies included identifying the relevant business knowledge,
expertise, and practices to transfer over to a health-centered initiative, modifying operational
practices to fit a country’s cultural and regulatory environment, and maintaining the continuity of
the project in between phases.
257
To resolve the first challenge, Coca-Cola capitalized on the
receptivity of high-level leadership to the partnership to encourage participation in the project. It
also engaged a boundary spanner to pinpoint specific knowledge to share with partner countries
252
Project Last Mile, “2019 Impact Report.”
253
Ibid.
254
Ibid.
255
Ibid.
256
Ibid.
257
Linnander et al., “Process Evaluation of Knowledge Transfer across Industries.”
47
that matched Coca-Cola’s expertise with the ministry’s needs.
258
Coca-Cola promoted
recognition of industry overlap to engage multiple local partners in the initiative’s work.
259
To
resolve the challenge of region-appropriate operations, Coca-Cola engaged experts to manage
translation activities and developed tools with visible benefits for the national Ministry of
Health.
260
In doing so, company goals aligned with those of the country.
261
To address the third
observed challenge of periods of dormant activity, Coca-Cola invested in local relationships and
roles, and allocated adequate time for the partnership to evolve.
262
Despite the success of Project Last Mile, its prominent position in Africa does raise some
ethical concerns. The increase in investment in Africa may bring innovative strategies for
delivery of essential medicines, though it comes with the increased marketing and consumption
of soft drinks in communities, leading to adverse effects on health through increased rates of
obesity and diabetes.
263
In order to begin resolving this ethical concern for the advertisement of
sugary drinks in the U.S., Coca-Cola has taken steps to shift product production from primarily
soft drinks to Coke Zero, sparkling water, juices, and teas.
264
This shift has resulted in increased
economic gains for the company in the U.S. while reducing sugar intake for consumers.
265
7.2.3. De Beers Case Study
258
Linnander et al., “Process Evaluation of Knowledge Transfer across Industries.”
259
Ibid.
260
Ibid.
261
Ibid.
262
Ibid.
263
Vasanti S. Malik, Walter C. Willett, and Frank B. Hu, “Global Obesity: Trends, Risk Factors and Policy
Implications,” Nature Reviews Endocrinology 9, no. 1 (January 2013): 13–27,
https://doi.org/10.1038/nrendo.2012.199.
264
Jennifer Kaplan, “Coca-Cola’s Focus on Healthier Drinks Pays Off,” Bloomberg, April 24, 2018,
https://www.bloomberg.com/news/articles/2018-04-24/coca-cola-s-focus-on-healthier-drinks-pays-off-with-profit-
beat.
265
Ibid.
48
Historically stationed in Sub-Saharan Africa, the De Beers Group is a multinational
diamond corporation with over $5 billion USD in yearly sales at the turn of the century and over
20,000 employees at its disposal worldwide.
266267
The company is also at the geographical
epicenter of the African HIV/AIDS explosion due to its presence in Botswana and South Africa.
De Beers’ status and wealth of resources in southern Africa make it an ideal candidate for
integration with UNAIDS objectives in the region.
Since the start of the 21st century, De Beers Group has consistently reiterated efforts to
combat HIV/AIDS, particularly within the corporation. In 2003, De Beers signed the HIV/AIDS
Workplace Policy with the South African National Union of Mineworkers, a comprehensive
agreement that asserted De Beers’s commitment to providing ART, not only to employees, but
also to spouses of employees.
268
269
Around the same time, a peer educator program was
implemented, connecting employees with other trained employees to encourage awareness and
knowledge acquisition.
270
In 2005, De Beers was presented with the GlobalBusiness Coalition’s
Award for Excellence in addressing HIV/AIDS.
271
The following year, the company rolled out
its Community HIV/AIDS Partnership Programme, a partnership with stakeholders aimed at
investing in solutions to HIV/AIDS in southern Africa.
272
Voluntary counseling and testing
266
William Yu, “De Beers-Rulers of the Diamond Industry,” University of California, Berkeley Department of
Agricultural and Resource Economics, accessed October 21, 2019,
https://are.berkeley.edu/~sberto/DeBeersDiamondIndustry.pdf.
267
“HIV/AIDS Case Study 2006,” De Beers Group, accessed October 21, 2019,
http://archive.gbchealth.org/files/transfers/HIV-AIDS%20brochure.pdf.
268
“De Beers, mineworkers union agree on joint HIV/AIDS policy,” JCK Magazine, June 10, 2003,
https://www.jckonline.com/editorial-article/de-beers-mineworkers-union-agree-on-joint-hivaids-policy/.
269
“HIV/AIDS: De Beers will provide antiretroviral treatment worldwide for employees and partners,” Business
and Human Rights Resource Center, accessed October 21, 2019, https://www.business-humanrights.org/en/hivaids-
de-beers-will-provide-anti-retroviral-treatment-worldwide-for-employees-partners.
270
Liezel Hill, “De Beers wins award for corporate AIDS policy,” Mining Weekly, September 29, 2005,
https://www.miningweekly.com/article/de-beers-wins-award-for-corporate-aids-policy-2005-09-29/rep_id:3650.
271
“De Beers honored for its HIV/AIDS testing program,” JCK Online, September 29, 2005,
https://www.jckonline.com/editorial-article/de-beers-honored-for-its-hivaids-testing-program/.
272
De Beers Group, “HIV/AIDS Case Study 2006.”
49
services have also been made universally available to employees, in the hopes of catching the
disease early and mitigating metastasis.
273
Likewise, in 2017, De Beers established its Know
Your Status campaign, with the goal of ensuring that employees are tested for HIV/AIDS and
educated about their status.
274
The program highlights the corporation’s recent focus on disease
prevention through active communication with employees.
7.2.3.1. De Beers’s Incentives for Fighting HIV/AIDS
The reasons for De Beers to invest in combating HIV/AIDS are, while multifaceted,
heavily rooted in economic motivations. A 2006 Global Business Coalition analysis of De Beers’
HIV/AIDS programming found that the company would take a 1% - 2% revenue hit over the
next 10 - 14 years due to employee ailment and inability to work resulting from HIV/AIDS.
275
Indirect costs are less quantifiable: low employee morale, impact on safety, and impact of
dealing with business partners who are struggling with HIV/AIDS outbreaks also factor into De
Beers profit loss.
276
De Beers Group has also been able to institutionalize and systematize its fight against
HIV/AIDS by declaring the campaign a safety initiative. De Beers has a zero harm policy in
order to elevate occupational safety and eliminate workplace factors that may contribute to
employee danger.
277
The safety initiative is rooted in the company’s awareness of a greater
273
Geoffrey K.G. Setswe, “Best practice workplace HIV/AIDS programmes in South Africa: A review of case
studies and lessons learned,” NIH National Center For Biotechnology Information, July 21, 2009,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565933/.
274
Dr. Tshepo Sedibe, “We’re doing well but the battle goes on,” De Beers Group, December 1, 2018,
https://www.debeersgroup.com/media/views/2018/doing-well-but-battle-goes-on.
275
De Beers Group, “HIV/AIDS Case Study 2006.”
276
Ibid.
277
“Total Commitment on the Journey to Zero Harm,” De Beers Group, October 7, 2015,
https://www.debeersgroup.com/creating-stories/2015/total-commitment-on-the-journey-to-zero-harm.
50
emphasis on well-being and health in the 21st century.
278
The zero harm campaign encompasses
issues pertinent to De Beers’s workers, such as hearing loss, musculoskeletal degradation, and
HIV/AIDS.
279
The company adheres to the Anglo American Safety, Health, Environment Way,
as well as to the Group Occupational Health Policy, a manifesto of 21 bullet points outlining
company safety objectives and procedures.
280
281
Moreover, targeted campaigns have vitalized
the policy objectives, with the 2017 Project Vitae audit of company safety policy and the 2018
100 Day Safety Activation campaign to put the results of Project Vitae’s analysis into practice.
282
De Beers has held four consecutive CEO Safety Summits as well, bringing conversations
surrounding safety to the forefront of the company mindset.
283
While the overarching goal of
these efforts are economic sustainability and success, the fight is contextualized in a more
humanitarian light.
However, while launching these corporate initiatives, De Beers has been less involved in
collaboration with UNAIDS. No substantial evidence for cooperation between the organizations
could be found via internet search. That said, De Beers is not isolated from the United Nations.
In 2018, the De Beers Group united with the UN Entity for Women for Gender Equality to
launch a three-year program with the goal of providing 500 women entrepreneurs in Southern
Africa the education and resources needed to begin small businesses.
284
Additionally, in a
278
Deirdre Lingenfelder, “Our Pathway to Zero Harm,” De Beers Group, October 7, 2015,
https://www.debeersgroup.com/media/views/2015/our-pathway-to-zero-harm.
279
“Health and Well-Being - Our Approach,” De Beers Group, accessed November 3, 2019,
https://www.debeersgroup.com/building-forever/our-impact/people/health-and-wellbeing.
280
“Safety - Our Approach,” De Beers Group, accessed November 3, 2019,
https://www.debeersgroup.com/building-forever/our-impact/people/safety.
281
“Occupational Health Policy,” De Beers Group, accessed November 3, 2019,
https://www.debeersgroup.com/~/media/Files/D/De-Beers-Group/documents/our-approach/health/occupational-
health-policy-de-beers-group.pdf.
282
De Beers Group, “Safety - Our Approach.”
283
Ibid.
284
“De Beers partners with UN to empower women in its diamond producing countries,” Mining.com, September
20, 2017, https://www.mining.com/web/de-beers-partners-un-empower-women-diamond-producing-countries/.
51
December 2018 article posted on De Beers Group’s website, the company affirms its desire to
achieve the UNAIDS 90-90-90 aims, proudly declaring that the Group hopes to be the first
organization in Sub-Saharan Africa to adhere to the UNAIDS targets.
285
7.2.3.2. De Beers’s Activity as Debswana Company
A large portion of De Beers’s anti-HIV/AIDS activity is carried out by the Botswana-
based Debswana Diamond company. 15% of the De Beers Group is co-owned by the Debswana,
a Botswanan government entity.
286
The company implemented a variety of anti-HIV/AIDS
initiatives and measures at the turn of the century following a comprehensive internal evaluation
of HIV/AIDS prevalence.
287
Through the implementation of employee screening protocol,
therapy initiatives, and ART drug distribution, HIV/AIDS prevalence within the company
dropped 6.2% in 2 years.
288
The Debswana example demonstrates the role that De Beers can play
as an African private-sector corporation. Within the company, HIV/AIDS can be addressed,
diagnosed, and targeted, providing assistance to large swaths of the HIV/AIDS community on a
compartmentalized, microcosmic level.
289
Debswana also presents an example of a positive
public-private-partnership. De Beers operations account for about one-third of Botswana’s
GDP.
290
In fact, in March 2008, De Beers shifted its main diamond sorting facility from London
285
Sedibe, “We’re doing well but the battle goes on.”
286
Julian Meldrum, “De Beers follows Anglo with ARV commitment for South African workers,” NAM Aidsmap,
August 12, 2002, http://www.aidsmap.com/news/aug-2002/de-beers-follows-anglo-arv-commitment-south-african-
workers.
287
“The Private Sector Responds to the Epidemic: Debswana--A Global Benchmark,” UNAIDS Case Study,
September 2002,
http://data.unaids.org/publications/irc-pub02/jc769-debswana_en.pdf.
288
De Beers Group, “Health and Well-Being - Our Approach.”
289
“Case Studies,” SA Business Coalition on Health and AIDS (SABCOHA), accessed October 21, 2019,
https://www.sabcoha.org/case-study/.
290
Joe Nocera, “Diamonds are Forever in Botswana,” New York Times, August 8, 2008,
https://www.nytimes.com/2008/08/09/business/worldbusiness/09nocera.html?ref=business.
52
to Gaborone, Botswana’s capital.
291
Additional work for the government has included the
creation of infrastructure, such as schools, roads, hospitals.
292
In return, Botswana’s growth has
improved the nation’s standing among international firms, creditors, and banks, combining with
improved roads and a healthier workforce to benefit De Beers’ logistical operations in
Botswana.
293
7.2.3.3. Company Controversy
Throughout its history, De Beers has been implicated in a wide swath of controversies.
Principally, the company’s monopoly over power in the diamond industry has drawn
international backlash.
294
At one point controlling as much as 85% of the global diamond supply,
De Beers has instituted hardball economic policies meant to control the supply, demand, and
price of the diamond exchange, precluding industry competition.
295
Additionally, in 1994, De
Beers was charged by the U.S. Department of Justice with antitrust violations, and they plead
guilty in 2004.
296
More infamously, De Beers has been accused of conspiring with African rebel and cartel
groups to acquire illicit diamonds, so called blood diamonds.
297
Around 2000, however, the
company adopted a series of codes guaranteeing to consumers that blood diamonds would not be
acquired, traded, or sold by De Beers.
298
These commitments to clean diamonds have expanded
291
Ibid.
292
Ibid.
293
Ibid.
294
Yu, “De Beers-Rulers of the Diamond Industry.”
295
Ibid.
296
Ibid.
297
Dick Durham, “De Beers see threat of blood diamonds,” CNN, January 18, 2001,
http://edition.cnn.com/2001/WORLD/africa/01/18/diamonds.debeers/.
298
Alan Cowell, “Controversy Over Diamonds Made Into Virtue by De Beers,” New York Times, August 22, 2000,
https://www.nytimes.com/2000/08/22/business/controversy-over-diamonds-made-into-virtue-by-de-beers.html.
53
through the Kimberley Process, a trade regime created in 2003 to stop the flow of blood
diamonds.
299
In the past few years alone, De Beers has reiterated its desire for obtaining non-
conflict diamonds. It has utilized blockchain technology to monitor the lifetimes of diamonds
from the mine to the consumer, ensuring best practices along the way.
300
While in the past, De
Beers may have represented a monopolistic corporate lifestyle, it has markedly improved its
image and reputation.
7.2.4. Mastercard Case Study
In 2017, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and Mastercard
engaged in a public-private partnership to make progress toward controlling the HIV/AIDS
epidemic.
301
They announced that they will explore the use of digital technologies and data
analytics to improve the conditions of HIV/AIDS in Africa and help PEPFAR reach more
people.
302
Mastercard already has experience with helping rural areas expand their access to
different technologies, so this allows PEPFAR to gain access to this valuable expertise.
303
Mastercard began work to transform their Community Pass, which encompasses
platforms that help the most marginalized individuals and communities get access to critical
services, such as education and agriculture, intro the new Wellness Pass.
304
This platform enables
299
“How the Kimberley Process Works,” Kimberley Process, accessed November 3, 2019,
https://www.kimberleyprocess.com/en/what-kp.
300
Thomas Biesheuvel, “De Beers Tracks First Gems From Mine to Shop Using Blockchain,” Bloomberg, May 10,
2018, https://www.bloomberg.com/news/articles/2018-05-10/de-beers-tracks-first-gems-from-mine-to-shop-using-
blockchain.
301
“PEPFAR and Mastercard Team to Fight AIDS in Africa,” PYMNTS, September 19, 2017,
https://www.pymnts.com/news/international/2017/pepfar-mastercard-fight-aids-africa/.
302
Ibid.
303
David Haroz and Marisa Grimes, “PEPFAR and Mastercard Launch Partnership to Address HIV/AIDS
Epidemic Control,” Mastercard, September 18, 2017, https://newsroom.mastercard.com/press-releases/pepfar-and-
mastercard-launch-partnership-to-address-hivaids-epidemic-control/
304
“Private Sector Innovation Partners for the Global Fund’s Sixth Replenishment,” The Global Fund, October 9,
2019,
54
the digitization and safe storage of patient records, allowing for increased accessibility for
patients and healthcare professionals alike.
305
In this way, a better standard of care can be
established, and increased communication between patients and staff can occur.
306
This digital
technology will also allow for the increased ability to train rural healthcare providers, which is
often a barrier in successfully preventing the spread of diseases.
307
However, since the PPP’s initial announcement, no further announcements have been
made on its progress. This is likely due to numerous threats of massive funding cuts for PEPFAR
made by U.S. President Donald Trump.
308
While the U.S. Congress has prevented any such cuts
from becoming reality, the mere threat of funding reduction can have severe impacts on
PEPFAR’s confidence in pursuing or continuing new projects.
309
As such, this could explain the
lack of information on this PPP’s progress.
7.2.5. Access Bank Case Study
Access Bank, based in Nigeria, is one of Africa’s fastest growing banks.
310
They created
the first in-depth workplace policy in Nigeria, which promises a non-discrimination policy for
those with HIV/AIDS and educational efforts for employees and their families.
311
Over time,
they have expanded their work to include donations to the Global Fund and other groups, thereby
https://www.theglobalfund.org/media/8898/replenishment_2019sixthreplenishmentconferenceinnovationpartners_lis
t_en.pdf.
305
Ibid.
306
Ibid.
307
Micaela Fischer, “Digital AIDS Prevention in Africa,” The Borgen Project, October 4, 2017,
https://borgenproject.org/aids-prevention-in-africa/.
308
“The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR),” KFF Global Health Policy, November 25,
2019, https://www.kff.org/global-health-policy/fact-sheet/the-u-s-presidents-emergency-plan-for/.
309
Ibid.
310
“Access Bank plc,” GBCHealth, accessed November 25, 2019,
http://archive.gbchealth.org/member_profiles/1361/.
311
Ibid.
55
securing their reputation as a socially responsible financial company.
312
They are also a member
of the Nigerian Business Coalition Against AIDS (NiBUCAA), which unites various Nigerian
businesses to spread awareness and provide education about HIV/AIDS to their country.
313
NiBUCAA has also begun to advocate for increased investments in healthcare systems across the
country, so that people can have access to the medical services they need, like ART.
314
These
investments correspond to Access Bank’s work to increase knowledge about HIV/AIDS, as now
community members will be able to gain access to the services they have learned about.
Access Bank has also helped to fund specific events to help expand these efforts to their
community, such as an educational film to provide information about how HIV/AIDS is spread
and progresses and a call center for topics related to HIV/AIDS.
315
316
They have also
implemented screening programs, with one such program occurring during their City Marathon
and screening over 3,000 athletes for HIV/AIDS.
317
People have recognized the positive
influence Access Bank has created on fighting HIV/AIDS, and they were rewarded the BIG
TICK award to demonstrate the company’s commitment to using their power for good.
318
312
“Access Bank donates $1 million to Global Fund’s Gift from Africa Project,” Business & Human Rights
Resource Centre, September 28, 2010, https://www.business-humanrights.org/en/access-bank-donates-1-million-to-
global-fund%E2%80%99s-gift-from-africa-project.
313
“Access Bank joins private sector coalition for health care delivery in Africa,” Financial Nigeria, March 11,
2019, http://www.financialnigeria.com/access-bank-joins-private-sector-coalition-for-health-care-delivery-in-africa-
sustainable-1102.html.
314
Ibid.
315
James Ayodele and Adebisi Aderonke Arije, “Inside Story, Award-Winning Film on HIV & AIDS, Debuts in
Lagos, Nigeria,” Mangement Sciences for Health, December 10, 2012, https://www.msh.org/news-
events/stories/inside-story-award-winning-film-on-hiv-aids-debuts-in-lagos-nigeria.
316
“Global AIDS Response Country Progress Report,” National Agency for the Control of AIDS, 2015,
https://www.unaids.org/sites/default/files/country/documents/NGA_narrative_report_2015.pdf.
317
Gabriel Olawale, “Access Bank: 3,000 athletes screened for HIV at Access Bank City Marathon,” Market
Screener, February 3, 2019, https://www.marketscreener.com/ACCESS-BANK-PLC-6500790/news/Access-Bank-
3-000-athletes-screened-for-HIV-at-Access-Bank-City-Marathon-27957512/.
318
“Access Bank Retains Business in the Community ‘BIG TICK’ Award,” Access Bank Rwanda, accessed
November 25, 2019, https://rwanda.accessbankplc.com/pages/Media/Access-News/Access-Bank-Retains-Business-
in-the-Community-BIG.aspx.
56
7.2.6. Shell Case Study
Royal Dutch Shell PLC, also known as Shell, is one of the three major oil and gas
companies in the world.
319
Shell’s partnership with UNAIDS takes many forms, including
developing case scenarios to predict Africa’s future trajectory in dealing with HIV/AIDS,
creating an interactive game to educate teens about HIV/AIDS, and funding local hospitals in
Nigeria to offer treatment to HIV/AIDS patients.
320
Shell’s collaborative effort with UNAIDS,
NGOs, and governments demonstrates that public-private partnerships can expand beyond
fundraising efforts.
321
Shell’s major collaboration with UNAIDS started in 2003 with the AIDS in Africa: Three
Scenarios to 2025 collaboration with the African Union, the World Bank, and the United Nations
Development Programme.
322
The purpose of the Scenarios project was to research and represent
three possible scenarios for how Africa would respond to the HIV/AIDS epidemic over the next
20 years.
323
Shell served as the Process Advisor of the project through its Global Business
Environment division, and it leveraged expertise in scenario planning and offered UNAIDS
critical insight on the potential challenges that face Africa in the next twenty years.
324
Shell also
invested approximately $500,000 USD into providing the project office with necessary supplies,
such as purchasing office space and computers.
325
Shell’s intellectual and monetary contribution
to the Scenarios project helped to outline future partnerships with various stakeholders to
319
"Shell," GBCHealth, accessed November 20, 2019, http://archive.gbchealth.org/member_profiles/1309/.
320
Ibid.
321
Ibid.
322
Ibid.
323
GBCHealth, "Shell.”
324
Ibid.
325
Ibid.
57
develop policy responses to the HIV/AIDS epidemic and plan out the allocation of funding for
future projects.
326
Shell initiated the Niger Delta AIDS Response (NiDAR) project in partnership with local,
state, and federal ministries of Health and Family Health International to support more than 27
health facilities in the Niger Delta and to train more than 240 health care providers.
327
Local
communities were in charge of overseeing the project, working with the community-led
hospitals.
328
By utilizing the knowledge power of local communities to manage hospitals, Shell
has been successful in helping the Nigerian government to take control of its healthcare
system.
329
From 2008 to 2009, the NiDAR project helped 14,000 individuals receive testing for
HIV/AIDS, provided prenatal care to 7,300 pregnant women to prevent HIV/AIDS transmission,
and enrolled over 2,400 people in HIV/AIDS treatment programs.
330
Due to the NiDAR project’s
success, the NiDAR Plus extension program was introduced in 2010.
331
There are limited
findings on the success of the NiDAR Plus, which sought to strengthen the healthcare system in
Niger Delta and to raise awareness about HIV/AIDS.
332
However, the NiDAR project
demonstrates the importance of combining both the expertise of the private sector and local
knowledge in addressing HIV/AIDS.
Shell also partnered with Aiducators4life, the Gabonese government, and UNICEF to
launch an interactive board game called Vie2Jeune in 2009.
333
The game has 60 pairs of question
326
Ibid.
327
"Health Care," Shell Nigeria, accessed November 20, 2019,
https://www.shell.com.ng/sustainability/communities/health-in-nigeria.html.
328
Ibid.
329
Ibid.
330
Ibid.
331
Ibid.
332
Shell Nigeria, "Health Care.”
333
"Gaming for HIV Prevention: A Public-private Partnership in Gabon," UNAIDS, November 29, 2012,
https://www.unaids.org/en/resources/presscentre/featurestories/2012/december/20121203gabon.
58
and answer cards that provide information about HIV/AIDS facts, safe sex, teenage pregnancies,
and stigmatization of HIV/AIDS patients, offering a creative and fun alternative to learning
about HIV/AIDS.
334
The game was first implemented in schools in Libreville and Gamba, and
then later expanded to all of Gabon, showing that Shell’s innovative approach to education
serves as a useful example to other public-private partnerships.
335
Shell decided to invest in fighting HIV/AIDS within Africa due to economical reasons.
The Niger Delta is one of the most important oil-producing regions in Africa, and Shell relies on
its workers being able to complete their work to the best of their ability in order to make the most
money.
336
Thus, by working to improve their employees’ and communities’ health, they can
continue to operate at a high profit levels within this region and maintain a positive reputation
amongst community members.
337
7.3. Fundraising
Fundraising PPPs help to raise money for a specific cause, like HIV/AIDS. Using their
current customer base, they can help to effectively spread the word about an important cause.
The two case studies for this section are Marc Jacobs and MAC, and they both created special
lines through which they conduct their fundraising.
7.3.1. Marc Jacobs Case Study
Marc Jacobs International, a fashion brand, began their HIV/AIDS activism when they
launched two t-shirt collections in 2011 to benefit Aid for AIDS International (AFAI) programs
334
Ibid.
335
Ibid.
336
GBCHealth, "Shell.”
337
Ibid.
59
and activities.
338
The brand’s namesake, Marc Jacobs, was deeply impacted by the deaths of his
mentor, Chester Weinberg, and his hero, Perry Ellis, due to AIDS, inspiring the 2011
collections.
339
340
The designers of the shirts’ patterns were members of AFAI’s Children
Programs in Latin America and the Caribbean, furthering connecting the collection’s ties to those
affected by HIV/AIDS.
341
These shirts were retail-priced at $35 USD each, and all proceeds went
to AFAI.
342
In the AFAI 2011 annual report, Marc Jacobs International is listed as one of only
four donors to have donated between $100,000 and $200,000 USD to AFAI during that year.
343
Thus, the two t-shirt collections were very influential for AFAI.
In 2017, Marc Jacobs designed a new t-shirt to raise money for UNAIDS.
344
This t-shirt
was priced at $55 USD and was intended to raise awareness on World AIDS Day.
345
This helps
to expand Marc Jacobs International’s work with numerous HIV/AIDS groups, such as the
Elizabeth Glaser Pediatric AIDS Foundation, AFAI, Designers Against AIDS, and amfAR.
346
More recently, on June 25, 2019, Marc Jacobs was a host for Love Ball III, a high-fashion
benefit show presented by The Council of Fashion Designers of America (CFDA).
347
The first of
the two Love Balls donated over $2.5 million USD to HIV/AIDS programs, and Love Ball III
338
“For a World Without a Trace of HIV,” Aid for AIDS, last modified 2011,
aidforaids.org/download/annual_report_2011.pdf.
339
Jodie Layne, “Chester Weinberg Reminds Us To Fight For An End To HIV Stigma In And Outside The Fashion
Industry.” Bustle, April 26, 2015, https://www.bustle.com/articles/79015-chester-weinberg-reminds-us-to-fight-for-
an-end-to-hiv-stigma-in-and-outside-the-fashion-industry.
340
Maureen Callahan, “How Marc Jacobs Nearly Destroyed His Career,” New York Post, September 10, 2014,
https://nypost.com/2014/09/10/how-marc-jacobs-nearly-destroyed-his-career/.
341
“For a World Without a Trace of HIV.”
342
Ibid.
343
Ibid.
344
Michael Hollingdale, “Naomi Campbell, Marc Jacobs and UNAIDS Announce Collaboration on Limited Edition
T-Shirt for World AIDS Day,” UNAIDS, December 1 2017,
www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/december/20171201_t-shirt.
345
Ibid.
346
“Robert Duffy and Marc Jacobs International,” AmfAR, accessed October 18, 2019, www.amfar.org/in-the-
spotlight/amfar-awards/bios/robert-duffy-and-marc-jacobs-international/.
347
“CFDA & Susanne Bartsch Present Love Ball III,” The Council of Fashion Designers of America, accessed
October 19, 2019, https://cfda.com/programs/designers/love-ball-iii.
60
will donate all proceeds to the CFDA-Vogue Initiative and New York City AIDS Fund of the
New York Community Trust.
348
Marc Jacobs International helped amfAR to raise over $4 million USD at its inaugural
fundraising gala through its Presenting Sponsor role.
349
The designer also showed support for
amfAR at its 7th annual Inspiration Gala in New York by designing looks for the event and
serving as an Honorary Chair.
350
Marc Jacobs has also raised funds for Designers Against AIDS
through his partnership with Playboy, where three exclusive t-shirts were designed at a price of
$35 USD and all proceeds were donated.
351
Marc Jacobs International was also one of 16 advisory expert governance bodies for
Project Vogue.
352
This project aimed to create a new educational plan for educating about
effective HIV/STI prevention methods, decrease HIV/AIDS stigma in the research realm, and
promote the HIV vaccine.
353
Another notable effort by Marc Jacobs Intervention was the
December 2017 release of a limited-edition, fashionable safe-sex package. This kit was part of
the New York City Department of Health’s #PlaySure campaign to encourage safe sex habits.
354
Over 150,000 of these kits were distributed for free, accessible to anyone at events or New York
City Sexual Health Clinics.
355
Through this work, Marc Jacobs has been able to fundraise
348
Ibid.
349
Bennah Serfaty, “amfAR Raises More Than $4 Million for AIDS Research at Inaugural Event in Hong Kong,”
amfAR, March 15, 2015, https://www.amfar.org/pr-hong-kong-2015final/.
350
Ibid.
351
Ninette Murk, “Marc Jacobs X Playboy Tees To Benefit DAA And Our New Book Now Also For Sale in
London, Milan, and Paris,” Designers Against AIDS, accessed October 20, 2019,
https://designersagainstaids.com/blogs/collaborations/marc-jacobs-x-playboy-tees-to-benefit-daa-and-our-new-
book-now-also-for-sale-in-london-milan-and-paris.
352
Sheldon D. Fields, “Engaging Young MSM of Color in HIV Prevention in the Primary Care Setting,” University
of Rochester, June 1, 2011, http://www.lgbthealtheducation.org/wp-
content/uploads/2012/06/Fields.HIV_Prevention_in_young_MSM_of_color.pdf.
353
Ibid.
354
Jeff Simmons, “Safe Sex Kits Get a Hot Makeover from the Designers at Marc Jacobs,” Metrosource, April 16,
2018, https://metrosource.com/marc-jacobs-making-sure-play-safe/.
355
Ibid.
61
millions of dollars for HIV/AIDS research, demonstrating the influence large companies can
have on the cause. These campaigns also raise the brand’s recognition, resulting in higher
recognition and better reputation.
356
7.3.2. MAC Case Study
Make-Up Art Cosmetics, widely known as MAC, is a worldwide leader in makeup and
cosmetic products that prides itself on its expertise, diversity, integrity, and social impact.
357
The
company was created with the hopes of driving social change and creating a true impact in the
world.
358
The founders, as members of the LGBTQ+ community, chose to dedicate their
community engagement efforts to the fight against HIV/AIDS around the world through the Viva
Glam campaign, formerly known as the MAC AIDS Fund.
359
The campaign donates all proceeds
to the MAC Viva Glam Fund to provide healthcare access to everyone, regardless of age, race, or
gender.
360
Beginning in 1994, the Viva Glam lipstick and lipglass lines have donated 100% of their
proceeds to efforts to stop the HIV/AIDS epidemic.
361
Since its start, Viva Glam has partnered
with some of the biggest names in the fashion and entertainment industries, such as RuPaul,
Marc Jacobs, Chloë Sevigny, Dita Von Teese, Rihanna, Fergie, Sia, and Winnie Harlow to
promote its lipsticks and raise awareness about the HIV/AIDS efforts.
362
These celebrities helped
356
Ibid.
357
“Our Story,” MAC Cosmetics, accessed October 19, 2019, https://www.maccosmetics.com/our-story.
358
“Viva Glam Archives: 25 Years of Giving a Glam!” MAC Cosmetics, accessed October 19, 2019,
https://www.maccosmetics.com/vivaglam-timeline.
359
“Change Your Lipstick, Change a Life,” MAC Cosmetics, accessed October 19, 2019,
https://www.maccosmetics.com/vivaglam.
360
Ibid.
361
“Viva Glam Archives: 25 Years of Giving a Glam!”
362
Ibid.
62
Viva Glam foster incredible marketing campaigns to the lipsticks and brought international
attention to the HIV/AIDS epidemic.
363
Throughout its 25 years of existence, Viva Glam has
raised a total of over $500 USD million to fight against HIV/AIDS.
364
Each Viva Glam lipstick
sells for $18.50 USD, with 100% of the proceeds going toward HIV/AIDS.
365
Viva Glam has
raised roughly between $20 million and $30 million USD every year through this line, donating
to around 1,800 programs worldwide through 10,000 grants.
366
MAC’s efforts to help eradicate HIV/AIDS have been instrumental and numerous. By
2002, they were able to donate $250,000 USD to the United Nations to help fight HIV/AIDS in
Africa, Asia, and the Pacific.
367
Even further, they granted $2 million USD to the UNAIDS
Treatment 2015 initiative through a partnership between UNAIDS and Rihanna in 2014.
368
This
grant allowed UNAIDS to expand its programs for youth treatment and policies worldwide.
369
In
June 2016, MAC AIDS Fund put together a meeting between the mayors of New York and Paris
to discuss the opportunities to diminish HIV/AIDS within the cities through education, treatment,
and prevention.
370
While Viva Glam has been able to donate large amounts of money towards efforts
working to reduce HIV/AIDS from 1994 to 2019, there has been a standstill in the decline of
363
Ibid.
364
Devin Thorpe, “Rebranding at MAC Viva Glam Fund Explicitly Focuses on LGBTQ Equality to Boost HIV
Fight,” Forbes, June 28, 2019, https://www.forbes.com/sites/devinthorpe/2019/06/28/rebranding-at-
m%C2%B7a%C2%B7c-viva-glam-fund-explicitly-focuses-on-lgbtq-equality-to-boost-hiv-fight/#156f4b091f8e.
365
“Feel-good history: This lipstick has raised $500 million to fight AIDS,” The Economic Times, June 22, 2019,
https://economictimes.indiatimes.com/magazines/panache/feel-good-history-this-lipstick-has-raised-500-million-to-
fight-aids/articleshow/69901953.cms.
366
Ibid.
367
“Viva Glam Archives: 25 Years of Giving a Glam!”
368
“The MAC AIDS Fund, Rihanna and UNAIDS team up to reach nearly 2 million young people in need of
lifesaving HIV treatment,” UNAIDS, January 20, 2014,
https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2014/january/20140130mac.
369
Ibid.
370
“Mayors of New York and Paris convene a global meeting of mayors on ending AIDS in cities,” UNAIDS,
accessed on October 19, 2019, https://www.unaids.org/sites/default/files/20160606_PR_Cities_en.pdf.
63
HIV/AIDS since 2013.
371
In order to rebrand and revitalize their mission, the MAC AIDS Fund
took on the name MAC Viva Glam Fund during 2019 celebrations of their 25
th
anniversary,
focused on the LGBTQ+ community.
372
Given the high prevalence of HIV/AIDS in the
LGBTQ+ communities, this campaign works to destigmatize the disease and fund needed
services for women.
373
Through this new campaign, one Viva Glam lipstick will have the
capacity to buy a meal for two young homeless LGBTQ+ people, test 14 pregnant women for
HIV, or buy 254 condoms to protect against HIV.
374
MAC’s partnerships with UNAIDS and other HIV/AIDS organizations have had
incredible impacts on the efforts to end the HIV/AIDS epidemic through their awareness
building and significant monetary contribution.
375
While the motives that MAC has cited for
their immense involvement in HIV/AIDS have all been related to having a social impact, it can
be assumed that their campaigns have also drawn attention and customers to the rest of MAC’s
company, and thus drawn in more success for the business. There is no explicit data for MAC
regarding this, but these results have occurred for similar fundraising PPPs.
376
This increased
business can serve as an incentive for other companies to join the PPP’s to fight HIV/AIDS.
7.4. Research Generating
The final type of PPP is a research generating PPP, where they help to fund and conduct
valuable research for the desired cause. This allows a spread of private knowledge to the public,
371
Thorpe, “Rebranding at MAC Viva Glam Fund Explicitly Focuses on LGBTQ Equality to Boost HIV Fight.”
372
Ibid.
373
Ibid.
374
“Change Your Lipstick, Change a Life.”
375
Thorpe, “Rebranding at MAC Viva Glam Fund Explicitly Focuses on LGBTQ Equality to Boost HIV Fight.”
376
Matthew Berglind & Cheryl Nakata, “Cause-related marketing: More buck than bang?” Business Horizons 48,
no. 5 (September - October 2005): 443-53, https://doi.org/10.1016/j.bushor.2005.04.008.
64
allowing for shared resources and a potential for higher innovation. Pfizer was selected as the
case study for this type of PPP due to its work to increase the different types of HIV/AIDS
medications, as well as their improving their access and decreasing their cost.
377
7.4.1. Pfizer Case Study
Pfizer is one of the largest pharmaceutical companies in the world, developing major
brand name drugs such as Lyrica, Lipitor, and Zithromax.
378
It continues to grow through
research and development along with a series of acquisitions including, but not limited to,
Warner Lambert, Pharmacia Corporation, and Wyeth.
379
Recently, Pfizer has been responsible
for the development of a number of drugs to treat HIV/AIDS, including Selzentry, Dolutegravir,
and Diflucan.
380
In 2009, Pfizer launched a joint venture with GlaxoSmithKline called ViiV, an
HIV specialized pharmaceutical company that has been productive in its HIV/AIDS therapeutic
research.
381
Most recently, ViiV announced positive trials for an innovative 96 week treatment
targeted to already heavily treated HIV patients.
382
However, the company has also suffered from a slew of reputation-damaging stories and
decisions. Over the past few decades, Pfizer has been implicated in controversies such as the
illegal marketing of drugs, tax avoidance, testing of drugs on children without parental consent,
377
“One of the World's Premier Biopharmaceutical Companies,” Pfizer, accessed October 20, 2019,
https://www.pfizer.com/.
378
Ibid.
379
Nolen, “Pfizer, Inc.”
380
“One of the World's Premier Biopharmaceutical Companies.”
381
“Who We Are,” ViiV Healthcare, accessed October 20, 2019, https://viivhealthcare.com/en-gb/about-us/who-
we-are/.
382
Isabelle Scali, “ViiV Healthcare Presents Positive 96-Week Data from Phase III Study of Investigational
Fostemsavir in Heavily Treatment-Experienced Patients with HIV at IAS 2019,” ViiV Healthcare, July 22, 2019,
https://viivhealthcare.com/en-gb/media/press-releases/2019/july/viiv-healthcare-presents-positive-96-week-data-
from-phase-iii-st.
65
and bribery.
383
Consequently, a report through the research consulting firm Reputation Institute
found that, in a survey of 16,800 individuals, Pfizer had the lowest reputation score of 17
different large pharmaceutical companies.
384
Companies have an incentive to keep their reputations among consumers high. Studies
suggest that the value of tangible assets has fallen from 90% to 25% of corporate value, while
intangible assets, like reputation, now represent between 40% to 60% of value.
385
Moreover,
two-thirds of a company’s reputation has been shown to originate from perceptions of the
company, with only one-half of the value of a company’s reputation originating from the quality
of the products themselves.
386
This implies that a company which wishes to improve its
reputation among consumers will attempt to engage with initiatives or programs that make the
company itself look better.
Indeed, this need to rehabilitate corporate reputations seems to be a strong driver of Big
Pharma’s participation in fighting the HIV/AIDS epidemic. A Pfizer initiative to assist health
organizations in 19 countries, the Pfizer Global Health Fellows program, was used to improve
Pfizer’s corporate reputation, rebuilding eroding trust and creating the public acceptance needed
to stabilize a marketplace.
387
Although difficult to leverage, this desire for positive image
rehabilitation provides an incentive for large pharmaceutical companies to partner with
UNAIDS.
383
Philip Mattera, “Pfizer: Corporate Rap Sheet,” Corporate Research Project, February 3, 2017, https://www.corp-
research.org/pfizer.
384
Lydia Ramsey, “RANKED: These are the most and least reputable drug companies in the world,” Business
Insider, June 6, 2017, https://www.businessinsider.com/pharmaceutical-companies-reputation-rankings-2017-6.
385
Mark Kessel, “Restoring the pharmaceutical industry's reputation,” Nature, October 9, 2014,
https://www.nature.com/articles/nbt.3036?draft=collection.
386
Kessel, “Restoring the pharmaceutical industry's reputation.”
387
Taryn Vian et al., “Public-private partnerships to build human capacity in low income countries: findings from
the Pfizer program,” Human Resources for Health 5, no. 8 (March 2, 2011),
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820602/.
66
The risks associated with launching pharmaceutical research could also be considered as
a method to incentivize pharmaceutical companies to participate in PPPs. Pharmaceutical
companies are likely to face heightened risks in many categories, such as market access, clinical
trial design and drug approval, and foreign regulatory practices.
388
This could have
complications, as the odds of a company moving a product from Phase I to launch have
decreased over the past decade, largely due to late stage failures and sustained high attrition
rates.
389
Therefore, pharmaceutical companies may be more hesitant to fund riskier projects in
the upcoming years.
However, if pharmaceutical companies partner with external sources of funding, such as
the government, the need for investment and risks of the venture decrease, as they are shared
with the external source.
390
Pfizer has generally understood the benefits of this partnership, as the
company has worked with many publicly funded academic principal investigators in their
Centers for Therapeutic Innovation (CTI), which has resulted in the sharing of knowledge and
resources between public and private sector workers.
391
In these partnerships, efficient contract
negotiation was key, as the reward- and risk-sharing for the CTIs worked best on a project-by-
project basis.
392
One of Pfizer’s most successful attempts at fighting the HIV/AIDS epidemic has been
through the Positive Partnership program. The Positive Partnership provides microloans to
HIV/AIDS-afflicted communities in Thailand, working with the Population and Community
388
Ajay Dhankar, “Expanding Horizons for Risk Management in Pharma,” McKinsey & Company, May 2018,
https://www.mckinsey.com/business-functions/risk/our-insights/expanding-horizons-for-risk-management-in-
pharma.
389
Dhankar, “Expanding Horizons for Risk Management in Pharma,.”
390
Constance E. Bagley and Christina Tvarnoe, “Pharmaceutical Public-Private Partnerships in the United States
and Europe: Moving from the Bench to the Bedside,” Harvard Business Law Review 4 (2014),
https://doi.org/10.2139/ssrn.2310422.
391
Ibid.
392
Ibid.
67
Development Association, a Thai NGO. Between January 2004 and December 2006, $477,000
USD were provided in loans, with $300,000 USD coming from Pfizer.
393
There is a large demand for microloans within HIV/AIDS affected populations.
Individuals with HIV/AIDS are often less able to get jobs or loans from traditional banks due to
prejudice and fears about the individuals’ ability to perform or pay back loans.
394
Moreover,
lenders that do allow HIV-positive individuals to borrow often charge exorbitant interest rates,
pushing those individuals further into poverty.
395
In contrast, microloans allow HIV-positive
persons to access the capital to start their own businesses at a significantly lower interest rate,
creating an opportunity for fiscal independence.
396
Available evidence suggests that these programs have been successful in creating that
financial independence. Loans have been used to create the various businesses, like buying and
selling goods, food preparation, livestock-raising, vehicle repair, and craft-making.
397
91% of
loans have been repaid on time, suggesting that people with HIV are just as likely to meet
financial obligations as those without HIV, and that afflicted individuals are making enough
money with the initial capital to pay back the interest.
398
Another beneficial effect of the Positive Partnership is the decline in stigma surrounding
HIV/AIDS. Due to the structure of the program, loans are not given out to individuals, regardless
of their HIV status.
399
Loans are only given out to partnerships of HIV-positive and HIV-
393
“The Positive Partnerships Program in Thailand: Empowering People Living with HIV,” UNAIDS, July 2007,
https://www.unaids.org/sites/default/files/media_asset/jc1260_thailand_ppp_full_en_0.pdf.
394
Ibid.
395
“The Positive Partnerships Program in Thailand: Empowering People Living with HIV.”
396
Ibid.
397
Ibid.
398
Ibid.
399
Ibid.
68
negative persons, forcing integration of the two communities in order to access the money.
400
This forced integration has been shown to decrease the stigma surrounding HIV-positive persons
due to their new identities as business owners, business partners, and community leaders that
deserve respect, as they are no longer seen as a threat to public health. In a community-wide
survey of communities in which loans were given, respondents’ anxiety toward people living
with HIV/AIDS fell dramatically.
401
In January 2004, 47.7% of respondents felt a high level of
anxiety toward people with HIV. In October 2004, that number was 14%, a 33.7% drop.
402
Another program that Pfizer has participated in is directly subsidizing medications in
areas of the world that struggle to access these needed medications. In 2009, Pfizer announced
that it would be working with the Clinton Foundation’s HIV/AIDS Initiative to lower the costs of
these medications.
403
As part of the agreement, Pfizer lowered prices of rifabutin, a drug that is
often used to treat TB in HIV-positive patients.
404
Generally, ARVs that can assist patients
against HIV/AIDS interact poorly with traditional TB medications, forcing physicians to lower
the dosage of ARVs that patients consume and compromise their health.
405
Rifabutin combats
TB without interacting with ARVs, allowing patients to use medication at their normal doses.
406
Through this deal, the price of Rifabutin was lowered by 60% in areas where the drug used to
have an extremely high cost.
407
400
Ibid.
401
“The Positive Partnerships Program in Thailand: Empowering People Living with HIV.”
402
Ibid.
403
“President Clinton, Pfizer, and Mylan Announce New Agreements to Lower Prices of Medicines for Patients
with Drug-Resistant HIV in Developing Countries,” Pfizer, August 6, 2009, https://www.pfizer.com/news/press-
release/press-release-
detail/president_clinton_pfizer_and_mylan_announce_new_agreements_to_lower_prices_of_medicines_for_patient
s_with_drug_resistant_hiv_in_developing_countries.
404
Ibid.
405
Ibid.
406
Ibid.
407
Ibid.
69
Pfizer also launched a global health fellows initiative with the International AIDS
Vaccine Initiative (IAVI) from 2005-2009, working with the NGO and local research centers to
strengthen capacity to conduct and monitor vaccine trials to meet international standards and
expand trial activities.
408
The initiative took place primarily in Sub-Saharan Africa, and proved
to be effective through the achievement of its goals.
409
As the corporation and NGO shared
similar missions, expertise, and experience, the partnership was able to develop sustainable
infrastructure for the NGO to more effectively search for an HIV/AIDS vaccine.
410
The study
also concluded that sustained PPPs over several years may increase interorganizational learning
and trust, leading to stronger capacity to advance and achieve certain goals, such as decreased
drug costs.
411
This partnership will provide numerous benefits in terms of drug costs. Research
conducted at Stanford University indicates that newer drugs decrease total health expenditures by
7.2 times as much as they increase drug expenditures.
412
This insinuates that the cost of treatment
regimens and of providing for those with HIV/AIDS will decrease if PPPs that fund research like
this continue.
In addition to improving economic access to medicine, Pfizer works to improve their
economic standing by helping their employees. The company provides their employees with
access to their company-developed ARTs and antiseptics, as well as training initiatives and
counseling services to build a non-discriminatory work environment.
413
Pfizer executives
408
Vian et al., “Public-private partnerships to build human capacity in low income countries: findings from the
Pfizer program.”
409
Vian et al., “Public-private partnerships to build human capacity in low income countries: findings from the
Pfizer program.”
410
Ibid.
411
Ibid.
412
Daniel P. Kessler, “The Effects of Pharmaceutical Price Controls on the Cost and Quality of Medical Care: A
Review of the Empirical Literature,” Pharmaceutical Licensing Group, accessed October 12, 2019, http://plg-
group.com/wp-content/uploads/2014/03/The-effect-of-pharmacetuical-price-controls-on-the-cost-and-.pdf.
413
“HIV/AIDS Workplace Policy,” Pfizer, accessed November 4, 2019,
https://www.pfizer.com/responsibility/workplace-responsibility/hiv-aids-workplace-policy.
70
understand that maximum efficiency in the workplace will only occur if their employees are
mentally and physically healthy, so that is why they have put effort into helping their employees
gain access towards the aforementioned healthcare innovations.
414
However, Pfizer only provides
access to these treatments if their employees’ government does not already do so.
415
This means
that in countries with universal healthcare, the subsidization of treatments for employees would
not be as effective of a negotiation tool. This helps further prove that companies serve a financial
benefit in investing in their employees health, as mentioned throughout this brief.
7.5. Conclusion
Overall, there are numerous benefits for companies to join PPPs, from increased profits
to improved brand reputation. By looking at the various case studies within this brief, companies
can understand how to best begin and carry out a PPP, and communities can better understand
the motivation of the companies they are engaging with. The Harvard Kennedy School Institute
of Politics Health Policy Committee appreciated the opportunity to gather this information, and
they hope that it will be of great use in the fight to end the HIV/AIDS epidemic. They would also
like to thank UNAIDS for creating this opportunity and for all of the important work they do
globally.
414
Ibid.
415
Pfizer, “HIV/AIDS Workplace Policy.”
