Private-sector employers who face up to the HIV epidemic in Africa must be encouraged, not harangued.
Efforts to combat the AIDS pandemic in Africa and elsewhere are essentially public activities, led by national governments. Unfortunately, in many areas of Africa where the pandemic is most serious, the governments are barely functional. In some regions, there is no real authority in existence to help implement the monitoring, prevention and treatment of AIDS. In others, the body best placed to tackle the problem of AIDS may be the oil company, brewer or mining company whose presence dominates the local economy.
In this issue, Nature examines efforts being initiated by the oil and gas industry in one of Africa's most politically febrile and strategically important regions — the Niger River delta — to build a community-based programme that will limit the spread of AIDS (see page 140). This project is difficult to implement and fraught with risk. Yet it is an important experiment and, if successful, it could provide one way of tackling an immensely exacting challenge.
The Ibani-se initiative on Bonny Island, at the mouth of the Niger River, is being supported primarily by Nigeria Liquefied Natural Gas (NLNG), a joint venture between the Nigerian government and the energy companies Shell, ENI and Total. NLNG's main plant employs some 17,000 people and, at a cost of US$15 billion so far, is thought to be the largest single fixed investment in Africa.
The scheme is intended to engage every element of the island's community, from sex workers to truck drivers and shopkeepers, in building a programme that will study the pandemic in detail while undertaking educational and self-help programmes to limit its spread. As the programme develops, it will make antiretroviral drug treatment available, free of charge, to those who need it.
One of the many tragedies of AIDS in Africa is its propensity to strike at the most economically active members of the population. Major hubs of activity such as the NLNG plant are particularly vulnerable to the ravages of the epidemic. Yet given the size of the population just outside the plant — tens of thousands of migrants have been drawn to Bonny Island alone — it is unrealistic to expect the plant's operators to support AIDS prevention and treatment programmes for the general population.
The best outcome, instead, is for companies such as NLNG to use their extensive logistical abilities to help forge a community-based initiative that will eventually attract sustainable funding from outside sources, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, or the US President's Emergency Plan for AIDS Relief. That will require a project that is strongly identified with the private sector to forge an effective partnership with the public sector. This sounds simple but, as in many parts of Africa, it is in fact immensely difficult. Government officials at the local and national level have their own priorities and tend to assume that projects backed by corporations can look after themselves. The corporations, meanwhile, have learned to expect little in the way of competence or probity from public officials.
The multinational corporations have plenty to lose by squaring up publicly to the problem. Talk of the need for transparency and openness is cheap, but what employer really wants the painful facts about the extent of an AIDS epidemic among its employees to enter the scientific literature, or anywhere else in the public domain? At long last, major employers, such as multinational mining conglomerate Anglo American and NLNG, are biting the bullet in this regard and should be commended for doing so.
Private–public collaboration in tackling AIDS remains at an early stage of development, however. Some major companies still decline to participate, and the national committees that coordinate Global Fund programmes often remain unresponsive. The Global Fund won't tell these committees what to do — but it should prod them firmly in the direction of partnership with the private sector. Corporations, which are often the most viable institutions in their vicinities, have to accept some level of responsibility for what goes on there. But the penny has to drop that these companies, profitable as they may be, are not going fund health provision beyond that for their employees and immediate families.
In the West there is a widespread tendency to assume that the activities of multinationals in Africa are entirely malign. Some observers of political disquiet in Nigeria seem to think it would be better if Shell, for example, just packed its bags and went home. That is simply ridiculous. With AIDS, as in other spheres of social policy, the multinationals are not the problem. They should instead be seen as part of the solution.