"What, me worry?" Businesses and AIDS at Davos.

At the Davos Summit in February, 2005, the World Economic Forum released its current survey on businesses and HIV/AIDS. In 1996, we outlined the case for business in Asia to play a pivotal role in preventing the epidemic. At that time, an estimated 3 million people in Asia had been infected with HIV. Today that number is estimated at 8·2 million. AIDS is a preventable disease. The survey finds an absence of alarm in the business sector which, if true, bodes poorly for success in controlling this epidemic.

Beyond the tragic human costs, the economic and financial tolls of this epidemic are well known. Costs to employers include: increased insurance premiums, larger expenditure on welfare benefits, decline in productivity, and increases in hiring and training costs. Loss of skill base, institutional knowledge, and potential conflict in the workplace because of stigmatisation are more difficult to measure. At the macro level, the business environment, including markets and disposable income of consumers, savings rates, interest rates, and general education of the labour force, are put at risk.

The findings in the survey from 8000 firms worldwide are a subset of global business surveyed annually by the World Economic Forum. Firms appear less concerned this year than last year. This lack of concern is accompanied by conjecture rather than science as a basis for decision-making. Informal policies prevail except in high-prevalence areas such as sub-Saharan Africa. Why such complacency? The global epidemic has shown its inexorable nature in community after community, country after country; will it now be business after business?

In Asia, the prospective new epicentre of the epidemic, the efforts of the Thailand Business Coalition on AIDS and the Tata Group in India highlight roles business can play: prevention and education for workers; workplace programmes to prevent discrimination; and public-private collaboration and funding for effective programmes. The Thailand Business Coalition on AIDS offers a range of tools for businesses to assure good-quality programming at all organisational levels. The Tata group has focused on a full range of workplace programmes to ensure the sexual health of their employees, including an emphasis on non-discrimination. Leadership at the top of firms, coupled with government commitment, is key.

The most populous countries in the global community, China and India, are now in the cross-hairs. Projections for India are alarming: 20–25 million people living with HIV by 2010, and a potential of 50 million cases by 2015. The epidemic is driven by commercial sex-work, and clients include businessmen who could benefit from education programmes in the workplace. There are peer-to-peer strategies that are effective in condom promotion. Thai experience suggests that also addressing the clients ensures success. Workplace programmes to secure the safety of the workforce would be a valuable contribution at this critical time.

Many economies are rural in Asia; the effects of HIV on the household level are profound. The health infrastructure in China is crumbling, especially in rural areas, even as market reforms have created unprecedented economic growth. The business sector in China should lead the reinvigoration of preventive and health services. The March 18 Summit of the Business Coalition on AIDS, in Beijing, was a perfect launch.

The expansion of access to antiretroviral treatment in Asia will not be a panacea. US experience shows that the reprieve from HIV is not forever, efficacy is not 100%, and people living with HIV face many obstacles in returning to work. From a business perspective, proactive prevention coupled with compassionate policies in the workplace and coverage of treatment through insurance is the wisest choice.

There is a gulf between the public and private sectors that must be bridged in the fight against AIDS and other emerging infections. The urgency of robust public-private partnering is clear in the Asia-Pacific region, where the threat of new human infections, such as severe acute respiratory syndrome and avian influenza, challenge systems that have not received adequate investment to scale-up to successfully meet these new threats. The economics of intervention by the private sector are not always self-evident. Much depends on the ability of the public sector to induce private firms to act for the common good. Market incentives, such as tax breaks and subsidies, can lower the cost of training and help businesses provide information and education for workers. The reduction in duties and taxes on imports of equipment and reagents could reduce drug costs. The cornerstone of partnership is for each sector to understand the needs and motivations of the other.

The World Economic Forum's survey is a pioneering work in progress. The kind of information it is positioning itself to capture is very important in the fight against the HIV epidemic. Business has brought innovation, energy, and investment in creating value in economies across the globe. The ongoing struggle against HIV and other emergent infections requires no less.