Will HIV/Aids cripple SA construction?
Published in March 2006

The biggest threat to the growth of this country appears to be disease – the South African construction sector has the third highest incidence of HIV/Aids after mining and transport, according to statistics released on World Aids Day last 1 December. What will this cost in terms of delivery, profits, absenteeism, insurance payouts, education and healthcare? Edith Webster went in search of answers to these pertinent questions.

HIV/Aids runs rampant among South African construction workers largely because the labour force is migratory; construction camps are a breeding ground for the spread of the pandemic and sexually-transmitted diseases; and workers on contract generally disregard the consequences of casual sexual relationships, according to the Construction Industry Development Board (CIDB).
This being the case, the sector could be heading for a fall. How hard could it hit the ground?

 How bad is it?
“The impact is likely to be severe,” says Theo Haupt, research co-ordinator in the Southern African Built Environment Research Centre at the Cape Peninsula University of Technology. “The HIV/Aids pandemic in South Africa threatens to reduce the overall construction labour force, shift the age structure of the work force due to increased eventual mortality of HIV-infected workers and change the skill composition of the construction labour supply.

This is already under pressure due to skills shortages in the artisan and management categories of employment, and results in increased labour turnover,” he adds, quoting his research conducted with Professor John Smallwood, head of the construction management department at Nelson Mandela Metropolitan University in Port Elizabeth.

How much worse could it get?
If HIV/Aids is left to wreak havoc, Haupt predicts the costs facing construction employers will grow exponentially and definitely affect the bottom line as well as survival in a highly competitive environment.

He believes this could be aggravated by the threat to overall national productivity and the consequent displacement of regular spending on health – HIV/Aids threatens to absorb resources at all levels and cost a fortune in terms of medical aid claims, lower productivity and the replacement and training of new recruits. “Given the present poor image of the construction industry and the consequent decline in the numbers of new, younger persons choosing careers in construction, there is already a steady increase in the size of the older cohort relative to the size of the younger cohort,” he points out. “The situation is exacerbated by claims that the highest rate of infection is in young people in the 15- to 25-year age cohort.”

Standing his ground where angels fear to tread, Haupt believes construction employers are notorious for not providing sustainable employment for their older workers, opting instead to retrench them and thereby suffer greater loss in terms of skills and knowledge capital. “Additionally, a lack of adequate training and retraining of existing workers, and those brave enough to enter the industry, in critically needed construction skills virtually guarantee the inability of the industry to deliver and grow its capacity to deliver at a time when it is experiencing an unprecedented boom phase.”

Is this the death knell?
To put it quite simply, if a large portion of the skilled construction labour force is dying off, either due to old age or HIV/Aids in their youth, who’s going to build the country? If the only option is to tap into an unskilled pool of resources, of course HIV/Aids will thwart government’s infrastructure development and delivery efforts, Haupt warns. “The tardiness of government to recognise the threat of HIV and Aids for what it is and commit to and implement programmes that will improve the productive quality of workers through increased access to life-extending treatment such as antiretrovirals (ARVs) will negatively affect the government’s growth and employment expectations using the sector as the vehicle of delivery,” he says.

South Africa must double its construction over the next 10 years, according to Spencer Hodgson, CEO of the CIDB. “Going forward, the construction industry will need to rely on a much higher level of skills than it has done in the past,” he says. “In the context of growing construction demand and the existing skills shortage, it is critical that the drive to recruit and train young people is supported by aggressive workplace HIV/Aids programmes to reduce the risks of infection to the workforce, skilled artisans, the professions and local communities.”

What can be done?
“The solution is to find infected people and keep them alive,” says Harry Lake of Care Works, an organisation that undertakes HIV/Aids education, testing and intervention mainly for construction companies since 2002.
One of the major differences between HIV and other infectious diseases is the very long period between first infection and major symptoms, understands Lake. “This, together with the many cultural issues that frequently surround sexually-transmitted infections (STIs), lead to many people avoiding real discussion about HIV,” he says.

But this can be overcome by providing ‘personal knowledge’ as part of the solution. “By personal knowledge we mean that all staff should know their own HIV status and have adequate knowledge about HIV to be able to manage their own lives and be able to positively influence the lives of those that surround them,” explains Lake.

Knowledge is power
When people have adequate knowledge, they will most likely want to know their HIV status, continues Lake, but they are often held back by fear – fear of themselves, their partners and families, their employers and their colleagues. “We remove the last three of these fears by guaranteeing total confidentiality,” he says of the Care Works sessions. “Skillful counselling can go a long way to limiting the first.” Lake’s team find there is so much fear that people they test “literally jump with joy” when they are told they are HIV-negative. “This, of course, creates fertile grounds for preventative measures.”

However, on the flip side, Care Works finds people who test HIV-positive go into denial and the challenge then is to counsel individuals so that they open up to further assistance. “Our minimum requirement before embarking on an HIV programme that includes testing is to ensure that all those who test HIV-positive have access to free follow-up counselling for a year thereafter,” explains Lake. “This counselling often extends to the family and we offer assistance with registration on whatever treatment programmes are available.”
Unfortunately, funding remains a problem for the Care Works and other HIV/Aids programmes out there – particularly as the Construction Education and Training Authority (CETA) has withdrawn its support now. “We believe that effective progress will remain slow until meaningful funding is secured via a transparent delivery mechanism, payable against clearly defined deliverables,” proposes Lake.

“All of this can easily be put in place once HIV is recognised as a threat that can and must be contained.” While it costs about R150 000 to train an operator on a construction site (to drive a front-end loader, for example), the cost of treating a 35-year-old, HIV-positive person on antiretroviral therapy over their lifetime is around R110 000, according to Lake.

The bottom line
Ultimately, what is the likely effect HIV/Aids could have on construction sector profits? “Unless clients are willing to foot the bill for increased construction costs as a result of all the factors mentioned as well as the costs of recruitment and the increased wage and salary rates that will have to be paid, construction employers will not be able to realise returns that will sustain their financial survival and existence,” Haupt predicts. “However, the majority of construction employers have as yet not recognised the threat of the pandemic on their own business operations and eventual survival,” he points out.

“They have chosen not to become involved relegating the responsibility to other agencies despite the demands of the Occupational Health & Safety Act (OHSA) of 1993 that requires them to provide their workers with a work environment that is safe and does not threaten their health.”
A survey conducted by the Bureau for Economic Research (BER) and funded by the South African Business Coalition on HIV and Aids (SABCOHA) – The Impact Of HIV/Aids On Selected Business Sectors In South Africa, 2005 – reports some building and construction companies foresee appointing extra employees (‘work shadowing’) to compensate for the impact of HIV/Aids on productivity, absenteeism and mortality.

The situation may look bleak but, although he concedes HIV/Aids will have widespread effect on the construction sector, Muller Uys, speaking on behalf of SAFCEC, says “to what extent we are not sure as no proper scientific study of the impact on the industry has yet been conducted”. SAFCEC is currently considering a proposal to conduct this study.

How easy (or not) is it to get treatment?
Nathan Geffen, Treatment Action Campaign (TAC) policy co-ordinator, tells Civil Engineering Contractor there was a significant increase in rolling out ARV treatment in 2005.

The most recent model, ASSA2003, compiled by the Actuarial Society of South Africa (ASSA) Aids committee – established in 1987 to assist actuaries and society in general to estimate the impact of Aids in South Africa – estimates that 124 000 South Africans were receiving ARV treatment on 1 July 2005. Geffen says the TAC played a critical role here by advocating for an ARV treatment plan since 2000 – engaging with government, business and the public through demonstrations, the mass media, litigation, literacy workshops…and the work goes on.

The organisation has most successfully made drug companies reduce the price of the ‘first-line ARV regimen’ from over R2 500 per month in 2000 to R100 per month in 2005! Drugs like fluconazole (for treating two common opportunistic infections), cotrimoxazole and acyclovir are now available in many public clinics. 
But the ASSA2003 model also estimates there are many more people – 521 000 – with Aids who needed ARV treatment but were not receiving it on 1 July 2005. Geffen says there are also reports of long waiting lists at many facilities – the TAC continues to lobby government to correct this state of affairs.

What do construction employers say?
urges its clients to include an HIV/Aids awareness and action specification in all tenders and contracts for engineering and construction work. Contractors are required to raise awareness through on-site workshops; provide workers with access to condoms; facilitate HIV counselling, testing and referral services; and support STI diagnosis and treatment. This helps the CIDB price and monitor HIV/Aids awareness. So what’s happening on the ground?

Wayne Reddie, group human resources director, WBHO Construction:
“HIV/Aids will negatively affect all aspects of the industry – the magnitude of which will depend on our willingness to act, and quickly. WBHO has recently completed a group-wide HIV/Aids awareness, counselling and voluntary testing programme. Our objectives were to identify the prevalence rate within the group and to provide each employee with the opportunity of being tested and therefore knowing their HIV status: 98,9% of our employees participated in the awareness and counselling sessions, of which 83,2% volunteered for testing.

Employees were given the option of not requesting their test results if they did not want to know their status. This gave employees the opportunity to contribute to the survey without having to know their status if they so wished. This programme has enabled us to understand areas we need to concentrate on to ensure WBHO is not detrimentally affected by the pandemic. Furthermore, 95% of our employees who were tested now know their HIV status. This knowledge together with the ongoing provision of counselling services will help keep the negatives negative and provide support for the positives. The nature of the construction industry allows for the spread of HIV. This will continue until the employees take responsibility for maintaining their health and practice safe sex, and until the employers have provided the opportunities for the employees to understand and become aware of the fundamentals of the virus and what must be done to prevent it.

This will take time and money but has to be taken on. The industry will certainly feel the effects of the virus, not only in terms of the inability to deliver and financial consequences but also in terms of loss of market share with the possibility of foreign companies taking advantage of the economic upswing that is taking place. Adding the chronic skills shortage to the mix certainly makes the challenge more daunting but not insurmountable. To be successful, we need to analyse and understand the magnitude of the problems. The skills shortage issue has been analysed and a way forward proposed by Allyson Lawless in her book Numbers And Needs – Addressing Imbalances In The Civil Engineering Profession,and the HIV/Aids issue must be analysed similarly to the way WBHO has gone about it.”

Marlene Cronje, HR Director, Power Group of Companies:
“In our own company we forecast an HIV-positive infection rate of 9% but for the rest of the industry my gut feel is that it is about 18%. One of the reasons why our infection rate is lower is that we, five years ago, embarked on an intensive prevention and treatment programme. We are most concerned about the HIV status of our operators as they are a vital part of construction operations. There is a shortage of skilled operators in the market and the average age of operators in the industry is high.

If we cannot prevent the problem from increasing, it could have a seriously negative effect on all of the above. I believe that with adequate HIV prevention and treatment programmes we will be able to prevent such a disaster. If the rate is too high, it would obviously make it impossible for the sector to perform. Those contractors that are able to perform will probably be able to increase their profits because of the scarcity of skills but the contractors that are not able to perform would obviously suffer. It could make infrastructure development significantly more expensive.”

Peter Rantla, human resources director, Grinaker-LTA:
“HIV/Aids will add to the skills shortage – companies make profits because they have skilled people so there will obviously be an impact on profit. But we can do something: if someone is HIV-positive, it isn’t the end of the world. We are of the opinion that we can provide education, refer people to relevant institutions and still prolong their productive lives. We want to keep them working for us as long as we can.

We are better than our competitors because of our people. We have a wellness programme throughout the company which aims to support and encourage all measures and intentions aimed at minimising the spread and impact of HIV/Aids; we educate and keep employees and management informed of the basic HIV/Aids issues; we encourage employees and managers to know their status and assist them to access appropriate health service providers; we create an environment in the workplace for dealing with the pandemic constructively; we eliminate the stigma and discrimination on the basis of real or perceived HIV/Aids status.

The programme covers awareness, non-discrimination legislation, voluntary counselling and testing and care and support of affected employees, and condom distribution. We have also embarked on peer educator training, regarded as vital in the management of voluntary counselling and testing, the creation and maintenance of awareness and the promotion of behaviour change.”