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OVERVIEW
1
Notwithstanding these gains, significant challenges remain to achieve the UNAIDS vision of “zero
new infections, zero HIV-related deaths and zero discrimination.” While the number of people ac-
quiring HIV infection in 2011 was 20 per cent lower than in 2001,2 in some parts of the world, HIV
trends (for children and adults) are still cause for concern.3 In addition, while it is estimated that
in 2011, the majority (54 per cent) of people eligible for antiretroviral therapy in low- and middle-
income countries were receiving it, still treatment coverage remains low among children (28 per
cent) and men (47 per cent).4 To preserve the fragile gains made to date and achieve the vision
of “Getting to Zero”, HIV responses must scale up investment “in health care and social support
systems, working to eliminate violence against women and girls and promote gender equality and
working to end stigma and discrimination against people living with HIV (…) helping to provide so-
cial environments that are effective against the spread of HIV”.5
There are an estimated 34 million people living with HIV globally. Given that the vast majority of
those living with or affected by HIV are in the adult labour force, the epidemic impacts profoundly
on labour supply, productivity, investment and employment, particularly in those countries most af-
fected by the epidemic. The world of work is therefore a key entry point for scaling up HIV response,
promoting access to HIV prevention, treatment, care and support for women and men, in formal
and informal employment and in vocational training.6
All human beings, without any discrimination, have the right to life and livelihood, which includes
the right to work and the right to equal pay for equal work.7 HIV-related stigma and discrimination
in the world of work poses a clear obstacle to the attainment of decent work. People living with or
affected by HIV may be unable to access or remain in employment as a result of stigma and dis-
crimination. For many of them, denial of employment or loss of livelihood lead to denial of access
to needed treatment. This highlights the crucial link between employment security and access to
effective HIV treatment.8
Commit to mitigate the impact of the epidemic on workers, their families, their dependants, workplaces and
economies, including by taking into account all relevant conventions of the International Labour Organiza-
tion, as well as the guidance provided by the relevant International Labour Organization recommendations,
including the Recommendation on HIV and AIDS and the World of Work, 2010 (No. 200), and call upon
employers, trade and labour unions, employees and volunteers to eliminate stigma and discrimination, pro-
tect human rights and facilitate access to HIV prevention, treatment, care and support.
UN General Assembly, Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS, Resolution 65/277 adopted
10 June 2011 (A/RES/65/277), paragraph 85.
2
The ILO Recommendation concerning HIV and AIDS and the World of Work, 2010 (No. 200) is the
sole international labour standard aimed at preventing HIV and protecting rights at work. The United
Nations Political Declaration on HIV and AIDS: Intensifying our Efforts to Eliminate HIV and AIDS,
adopted in June 2011, highlights the importance of Recommendation No. 200 and the essential
role of the world of work in putting an end to HIV and AIDS.
In agricultural cooperatives, HIV and AIDS may lead, among other things, to labour shortages, in-
creased food insecurity, and loss of productive land. This is especially the case with AIDS widows
in countries where legal frameworks may impede their ability to inherit and cultural constraints may
block their access to justice. The impact of the epidemic on savings and credit cooperatives is also
severe, including: increased borrowing for medical expenses or funerals, declining participation in
savings and credit schemes, and higher risks of default. Insurance cooperatives are experiencing
difficulties with insufficient capitalisation while pay-outs and administrative costs are increasing.
In all cooperatives, HIV and AIDS come with a high human and economic cost, including the costs
associated with replacing skilled and experienced workers.10
3
THE COOPERATIVE POTENTIAL
Given the values and principles they embody and as a resilient business model which has been
shown to operate successfully in all sectors, cooperative enterprises can play a vital role in overcom-
ing HIV and AIDS.
•
Housing cooperatives, by providing low-cost but decent housing for poorer members, can help reduce
the number of people living in makeshift housing and can also help meet the housing needs of those
who are HIV-positive or who are ill with AIDS-related illnesses.
•
Cooperative banks, insurers and credit unions can provide members with savings facilities to help meet
health-related expenditures and provide members with the means to launch and develop their own
microenterprises. They can offer life insurance to members ensuring that a credit union debt dies with
the member and is not transferred to other family members.
• Health cooperatives can facilitate affordable access to antiretroviral treatment for PLHIV.
Cooperatives can:
• Use their large membership and network to reach out to communities, especially those in remote
areas and sensitize them on HIV-related issues such as HIV prevention, education and behavioural
change to reduce risk)
• Provide access to health services for people living with or affected by HIV
• Help people living with HIV access or stay in employment, including by providing reasonable
accommodation if necessary, for as long as they are fit to work.
Raising awareness
Conscious of the need for urgent measures to address HIV and AIDS in the cooperative workplace,
the cooperative movement and its partners have taken a series of initiatives to raise awareness
about the epidemic. In 2004, the ICA, adopted a strategy to accelerate the HIV response through
strengthening HIV prevention and impact mitigation efforts. Implementation is carried out at global,
regional and sectoral levels. The strategy is based on increasing awareness of HIV and AIDS, build-
ing training capacity , dissemination of good practices, networking at all levels and demonstrating
ICA’s political commitment to the HIV response. At the request of its members, ICA’s offices in
all regions have been actively engaged in implementing this strategy. The ICA Office for Asia and
Pacific developed a project to prevent HIV transmission among members of cooperatives in the
4
region through education and training. As part of this project and in collaboration with UNAIDS, co-
operative and government leaders in India were provided with training to raise their awareness and
enhance their political commitment to the national HIV response. In Africa, cooperatives became
engaged in 2001, when the ILO, in collaboration with the ICA and other cooperative stakeholders,
organized a regional consultative meeting in Swaziland on the role of cooperatives in overcoming
HIV11. This meeting was followed by specific activities carried out by ICA regional Office for East,
Central and Southern Africa in partnership with ILO, the Swedish Co-operative Centre and the Ca-
nadian Co-operative Association.
Considering the current and future repercussions of the epidemic on their operations, sectoral co-
operative organizations are also playing an active role in conveying meaningful messages to promote
HIV prevention and impact mitigation. For example, the World Council of Credit Unions (WOCCU)12
has significantly contributed to the assessment of the financial impact of HIV and AIDS on financial
cooperatives in Africa (e.g. Kenya and Rwanda). WOCCU has urged savings and credit cooperatives
to take adequate measures such as establishing alliance with insurance firms to offer credit life and
savings life policies to protect both the cooperatives and members’ beneficiaries, especially in HIV-
affected households in particular.
Given the strong correlation between inadequate shelter and increased HIV vulnerability in Kenya,
the National Cooperative Housing Union (NACHU) undertook efforts to respond to the epidemic
in 2002, recognizing its profound impact within NACHU as well as on its membership. Members
were dying and cooperatives undertook to take care of orphaned children in a context of stigma
and discrimination.13 In response, NACHU developed a policy to address HIV-related issues in and
through the workplace and materials on HIV and AIDS awareness were produced and disseminated.
Non-sectoral cooperative organizations have also been very active in this area.
The Vietnam Co-operative Alliance regularly conducts awareness and information workshops for
cooperative members on HIV prevention, in close collaboration with relevant government organiza-
tions. With support from the ILO, the Tanzania Federation of Cooperatives developed an HIV and
AIDS policy to mainstream HIV and AIDS issues in the cooperative sector and provides a framework
to increase the engagement of cooperatives in responding to the epidemic. In Asia and Africa, health
care cooperatives and hospital cooperatives run health awareness programmes on HIV and AIDS.
Meeting the needs of those living with and affected by HIV and AIDS
Cooperatives have a significant role to play in facilitating care and support to reach those living
with HIV and supporting their families, even if this requires the development and delivery of new
or additional services. For example, in Kenya, some SACCOs have introduced mandatory welfare
or benevolent funds in an effort to develop a SACCO-wide mechanism to cover loan losses due to
death and to assist members with burial expenses.14
In Singapore, the National Trade Union Congress Income, a cooperative insurance provider estab-
lished by trade unionists from the industrial, service and public sectors, became one of the first
insurers to offer coverage for AIDS to medical personnel such as doctors, nurses, ambulance work-
ers and other health sector workers.
5
Coop-Seguros in the Dominican Republic is another successful example of an insurance coopera-
tive that is responding to HIV and AIDS. Owned by 40 cooperatives, Coop-Seguros has been imple-
menting a cooperative financial preparedness programme to develop financial management and
financial risk-evaluation skills within cooperatives to help them develop risk mitigation strategies
to mitigate the financial consequences of HIV and AIDS and other risks. The organization has also
eliminated HIV and AIDS insurance exclusionary clauses in life insurance policies. It has also devel-
oped new policies that offer partial pay-outs in the event of illness, including HIV-related illness.15
To address the plight of increasing numbers of orphaned and vulnerable children (OVC) as a result
of the HIV epidemic, the Kilimanjaro Native Co-operative Union (KNCU), in the northern Kilimanjaro
Region of Tanzania, has designed a seven-year scholarship programme (2006 – 2012) that meets
the secondary educational expenses of these orphaned and vulnerable children. The programme is
financed through premium revenues that KNCU generates from sales of members’ coffee through
Fair Trade.16
Certain cooperatives are facilitating the provision of home-based care as a response to HIV and
AIDS. The Soweto Home-Based Care Givers Co-operative set up in 2001 provides nursing care,
counseling, hospital transport and food parcel distribution to people living with HIV.17
Employment creation
Cooperatives are an important source of employment for people living with HIV, particularly women
and vulnerable groups, such as workers in the informal economy, and workers with disabilities.
Many cooperatives have decided to put in place new income generating activities in order to support
members living with or affected by the virus. For example, there are a growing number of agricul-
tural cooperatives in Rwanda formed by farmers living with HIV who have embraced the cultivation
of orange fleshed sweet potatoes, a type of root crop that curbs malnutrition, disease and hunger
and generates income. Members of these cooperatives composed, primarily of young persons and
older workers, have become economically empowered and improved their physical health18. This
6
trend is part of a general effort being made across the country to strengthen associations of people
living with and affected by HIV and AIDS and is supported by development partners such as the
Cooperative Housing Foundation (CHF). With financial support from USAID, CHF is helping HIV-
affected individuals develop new productive enterprises and services through cooperative activities
so that they can become more financially independent.
The cooperative business model also represents one way in which groups at higher risk of HIV infec-
tion, such as sex workers, can generate alternative or additional sources of income. For example,
In India, the Usha multipurpose cooperative was founded in 1995 with 200 members. It provides
loans to members, supplies condoms, helps members to develop self-employment opportunities. Its
overall aim is to improve lives of sex workers and their family. The cooperative now has over 12,000
members. Similar initiatives exist in Africa and Americas.
ILO has recognized the enormous potential of cooperatives to prevent HIV and mitigate the impact
of AIDS. Cooperatives can be particularly helpful in reaching informal workers who are not easily
reached by HIV interventions. From 2008 to 2010, the ILO implemented a Swedish International
Development Cooperation Agency-funded programme on ‘HIV and AIDS prevention and impact
mitigation in the World of Work in Sub-Saharan Africa’. The programme coupled HIV awareness-
raising with economic empowerment activities aimed at reducing HIV vulnerability. It made use of
the ability of cooperatives to reach the most vulnerable and high risk segments of the population
in five countries: Benin, Cameroon, Ethiopia, Mozambique and Tanzania. The programme strength-
ened the capacity of cooperatives to serve as channels for HIV prevention initiatives and as vehicles
for impact mitigation. An “HIV and AIDS Education and Counseling Manual in Cooperatives and
the Informal Economy” was produced by the programme to educate and sensitize cooperatives and
informal workers about HIV.
Gender inequality and women’s lack of economic empowerment in particular plays a critical role
in the spread of HIV, primarily due to unequal power relations between women and men. The pro-
gramme also promotes prevention of mother-to-child transmission. The programme attached great
importance to empowering women in countries such as Cameroon, where over 190 women in the
informal economy living with or affected by HIV were assisted to start income generating activities
a broad range of areas, including commerce, tailoring, rearing pigs and poultry, providing secretarial
support and communication services. A second phase is being implemented in Southern Africa
along the transport corridors which are “hotspots” for HIV transmission, with a high concentration
of at-risk populations, including mobile and migrant populations. Sex workers, informal traders and
young people operating along these corridors are being supported through a dual approach: 1) pre-
vention and 2) economic empowerment through cooperatives or business formation, to enable them
to make more informed choices to prevent HIV transmission.
7
Voices from the field
The following stories illustrate the important role that cooperatives can play in responding to HIV
and AIDS by helping to meet the basic needs of PLHIV.
With support from an ILO programme funded by the Swedish International Development Cooperation
Agency (SIDA), the cooperative organizes entrepreneurial skills-building and HIV awareness-raising activi-
ties. This is seen as an essential source of empowerment for rural women like Faith, who live far from the
towns where most HIV-related services are located. Faith keeps three healthy dairy cows with good yields.
She makes up to US$ 250 a month from the milk she sells through the women’s dairy cooperative. “It is
a lot of money for me,” she says. “The cooperative trained me and provided a market for my cow’s milk.”
She is one of the 1,600 women and men who participated in a Start and Improve Your Own Business
training programme in Tanzania. The programme has a specific focus on cooperatives as businesses that
can help reach workers in the informal economy with the aim of preventing HIV, mitigating its impact
and improving conditions for workers living with or affected by the virus. When she tested HIV-positive
in 2005, Faith decided to accept her status and be open about it, despite the high levels of stigma and
discrimination in her community. After initial difficulties, Faith says that she has found acceptance and
has become a peer educator, supporting other HIV-positive people who want to start their own businesses.
She has now been able to diversify her sources of income and grows maize and other vegetables. “I get all
the nutritious food recommended by doctors from my own farm. I use part of the money to pay for school
fees for my two nieces.” According to Faith, her acceptance of her HIV status has given her a better life.
Her self-confidence, sense of dignity and economic independence have grown immeasurably along with
the opportunities created by the cooperative.
HIV and AIDS are not just an issue for co-operatives in developing countries. Cooperatives also have a vital
role to play in the industrialized world.
In Toronto, for example, the Margaret Laurence Housing Cooperative has been meeting the housing needs
of people living with HIV since its creation in 1987. The cooperative is a 17-story apartment block in cen-
tral Toronto, built in what had previously been a run-down neighbourhood. As well as the 149 apartments
8
(the majority available at levels of rent affordable by those on low and moderate incomes), there is also
space for offices, meeting rooms and even a rooftop garden. Thirteen units are wheelchair-accessible.
Subsidies are available for some apartments.
From the start, the Margaret Laurence cooperative has been providing accommodation for the needs of
residents living with HIV. Currently, approximately one- third of the cooperative’s residents are HIV-posi-
tive. The cooperative is committed to protecting the privacy and dignity of its members. It has traditionally
had close links with the gay and lesbian community in the city, as well as with the Persons with AIDS
Foundation, who are entitled to refer people to the cooperative for housing. The cooperative aims, however,
to be an inclusive community with a diverse membership. Some people join the cooperative after waiting
on the City of Toronto housing waiting list for somewhere to live.
The units that are specifically designed for those living with HIV are deliberately scattered throughout the
building. Neighbours, and even the cooperative manager, may not be aware that a household, aside from
those households occupying accessible apartments, includes someone living with HIV. A lot of informal
volunteer work takes place among neighbours. The cooperative’s board, which meets monthly, has seven
directors elected by the members, who are often drawn from the special-needs group.
Members of the cooperative have had to cope with the death of other cooperative members, particularly
in the early years of the epidemic. Nevertheless, the cooperative has successfully developed a strong,
supportive culture. As one resident stated, “Everybody is so kind and friendly – there is a very home-like
feeling”.
Source: A. Bibby, 2006, Cooperative Housing Federation of Canada (Undated) and CHF (2011).
The cooperative movement has the potential to play a greater role in overcoming HIV and reducing
the impact of AIDS. Its large membership and networks based on its presence in all countries and
all sectors make cooperatives one of the most promising ways to mainstream HIV-related issues
across a large section of society. Although cooperative enterprises are already helping to stop the
spread of HIV as well as providing care and support to those living with or affected by HIV and AIDS,
the potential of cooperatives in overcoming HIV has not been fully tapped. Governments, social
partners and development partners often fail to take advantage of the mass mobilization networks
that cooperatives have at their fingertips. Cooperatives can provide concrete solutions to challenges
faced by people living or affected by the epidemic and their families. Cooperatives could be better
and more actively involved in development and delivery of national and regional HIV and AIDS strat-
egies. At the same time, they could enhance their effectiveness by better understanding the impact
of HIV on their operations and addressing important crosscutting issues such as gender equality
and poverty and increase the engagement of young women and men in the cooperative movement,
promoting both strengthened cooperatives and an AIDS-free world for future generations.
9
For further reading
International Labour Organization: Recommendation 200 concerning HIV and AIDS and the world
of work. International Labour Conference, 99th session, Geneva, 2010.
http://www.ilo.org/wcmsp5/groups/public/---ed_norm/---relconf/documents/meetingdocument/
wcms_142613.pdf
[15 August 2012]
— Fair Trade - Fair Futures: The Kilimanjaro Native Cooperative Union scholarship programme
for Orphan and Vulnerable Children made vulnerable by AIDS. Working Paper 6, Dar es Salaam,
2009.
http://www.ilo.org/public/english/employment/ent/coop/africa/download/wp6_kncutanzania.pdf
[15 August 2012]
— Positive living with HIV in the Swazi social economy. Working Paper 11. Dar es Salaam, 2011
http://www.ilo.org/public/english/employment/ent/coop/africa/download/wp11_livinghivswazi.pdf
[15 August 2012]
USAID: Assessing the impact of Financial Impact of HIV/AIDS, A survey of Rwandan Credit Union
Members. 2005.
www.woccu.org/documents/Monograph_22
10
Notes
1
UNAIDS: Report on the Global AIDS Epidemic, Geneva, 2010, p.7.
2
UNAIDS: Report on the Global AIDS Epidemic, Geneva, 2012, p. 8.
3
Ibid., p. 10.
4
Ibid., p. 51.
5
UNAIDS: Report on the Global AIDS Epidemic, Geneva, 2010, p.7.
6
ILO: HIV/AIDS and the world of work, Report V(1) International Labour Conference, 99th Session,
Geneva, 2009.
7
Universal Declaration of Human Rights, Articles 2, 23.
8
Global Network of People Living with HIV: Stigma and Discrimination at Work (Amsterdam, 2012)
http://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@ilo_aids/documents/publication/
wcms_185808.pdf [15 August 2012]
9
Statement on the Co-operative Identity by the International Co-operative Alliance (1995).
www.ica.coop
10
A. Bibby: HIV/AIDS and co-operatives (Oldham, 2006)
11
ILO/COOPAfrica: HIV/AIDS Prevention and impact mitigation in the world of work in Tanzania (Dar es Salaam,
2009)
http://www.ilo.org/public/english/employment/ent/coop/africa/download/hiv_aids_pro.pdf [15 August 2012]
12
World Council of Credit Unions is the global trade association and development agency for credit unions also
knows as savings and credit cooperatives. www.woccu.org
13
Settlement Information Network Africa : HIV, AIDS and Housing; Newsletter (2009)
http://www.habitat.org/housing_finance/pdf/SINA_HMF_newsletter.pdf [15 August 2012]
14
WOCCU: The unpaved road ahead: HIV/AIDS & Microfinance, an Exploration of Kenyan Credit Unions (Wiscon-
sin, 2002)
15
US Overseas Cooperative Development Council : Cooperatives: Pathways to Economic, Democratic and Social
Development in the Global Economy (2010)
http://www.acdivoca.org/site/Lookup/OCDC_Pathways_Paper/$file/OCDC_Pathways_Paper.pdf
[15 August 2012]
16
ILO/COOPAfrica Working Paper 6: Fair Trade - Fair Futures: The Kilimanjaro Native Cooperative Union scholar-
ship programme for Orphan and Vulnerable Children made vulnerable by AIDS (Dar es Salaam, 2009)
http://www.ilo.org/public/english/employment/ent/coop/africa/download/wp6_kncutanzania.pdf
[15 August 2012]
17
ILO: Promising Practices: How cooperatives work for working women in Africa (Dar es Salaam, 2010)
http://www.ilo.org/public/english/employment/ent/coop/africa/download/women_day_coop.pdf
[15 August 2012]
18
The New Times: Farmers living with HIV/AIDS embrace farming to improve their lives, Undated.
http://www.newtimes.co.rw/news/views/article_print.php?15020&a=54643&icon=Print [15 August 2012]
11
This is a joint publication of the HIV/AIDS and the World of Work Branch and the Cooperatives Unit
[email protected] [email protected]
www.ilo.org/aids Website: www.ilo.org/coop