By JIM FREEMAN
If one had to liken the prevalence of HIV / Aids in South Africa to the seasons of the year, the country seems to be headed to a bleak winter of discontent.
The signs were there for all to see, maintained Metropolitan chief executive Peter Boyle when he unpacked the group?s HIV and Aids scenarios at the University of Cape Town?s Graduate School of Business recently.
"We have all the ingredients as well as an extremely large epidemic and social factors that are not very positive.'
In terms of this scenario, said Boyle, the country could expect responses ranging from weak, self-serving leadership and contradictory beliefs about HIV and Aids to further degeneration of the country?s values in terms of drug abuse, sexual violence and gender inequality.
Reaction to the epidemic would continue to focus on blame, stigma and conspiracy. Fake cures would abound.
"In a "winter? scenario, labour becomes dispensable: one negative consequence of HIV / Aids is that it increases the cost of labour.
"We have the situation where we simultaneously have high rates of infection and unemployment. In the "winter? scenario, there is a low set of corporate values and business will increasingly see labour as a cost to be avoided, which could lead to mechanisation or offshore outsourcing.
"The costs of employment will increase markedly, both through the cost of benefits and the cost of retraining people to take the place of the sick and dying. This is already the case in Botswana and Zimbabwe, and we can expect the same to start happening in South Africa in five to ten years,' he said
Conversely, added Boyle, "corporates that get involved in fighting HIV / Aids in their workplaces have repeatedly demonstrated that proactive spending and programmes significantly reduces the impact on their workforces.'
Boyle said the scenario plan was not a prediction of the future: "it is creating the future by extrapolating the present into a number of alternative futures. Scenario planning is about how you want the future to look . in other words, how you can influence it.
"Our scenario-planning group in 2005 comprised about 80 people ranging from health-care professionals and people who were infected to actuaries and representatives from government, civil society and business.
While it was sometimes easy to agree to the future, he said, "it was very difficult to agree to the present.'
The closest the group could get to consensus of the status quo was that:
- ? There was an HIV epidemic.
? There were a growing number of Aids-related deaths, resulting in a growing number of orphans and increased poverty.
? There were myriad efforts at combating the epidemic but these were largely uncoordinated. "In terms of collaborative effort, part of the problem is that people are trying to deal with it on a segmented basis: they?re either trying to deal with HIV infection or they?re trying to deal with Aids. These are not separate issues,' maintained Boyle.
? There were mixed messages about the epidemic. "Even though young people in this county are among the most highly informed groups in the world on a theoretical level with respect to HIV and Aids, almost none of them think they are seriously at risk of infection. Education is not going to help much more.'
? There was a sense of hopelessness.
"We came up with a multi-dimensional set of scenarios that we reduced to two dimensions and arranged them in four quadrants. We chose to name the four scenarios after the four seasons of the year.
"It?s interesting to note the relationship between economic growth and HIV infection. The level of infection actually increases with the level of management, so there is a correlation between economic activity, wealth and the spread of HIV.'
This, he said, showed that high economic growth was, in fact, a risk factor. "In the past 10 - 15 years, Botswana has been the star economic performer in Africa. It is also the country with the highest level of HIV infection in the world.
"The same factors that drive the HIV epidemic drive the quality of life in South Africa. In fact, HIV is a marker of the level of social collaboration in South Africa.'
In terms of the Metropolitan model, "winter' became a low collaboration, low economic growth scenario.
"It?s a rather negative scenario: the country is not doing well economically, people are not collaborating, our values are poor and there is a very definite worsening of the HIV epidemic.
Boyle said the scenario-planners "generally thought South Africa was headed for an "autumn? scenario. There?s relatively high economic growth but we?re not sure about social cohesion and collaboration. There are still too many messages and conflicts, still too much crime and no agreement on a common set of values.
"The problem with an "autumn? scenario is that it is not sustainable. You can grow GDP for a period but, unless you have social cohesion, growth cannot be maintained.
At the time the scenarios were devised, there was a 19 percent HIV prevalence in the South African population. Under the "winter' scenario, the prevalence in 2025 was predicted to be reduced to 18 percent.
"Why is it not worse?' asked Boyle.
"We think we are more or less at the peak of the epidemic but I want to caution you against believing statements in the next few years that the epidemic has stabilised and is under control because there are not that many new infections.
"The truth of the matter is that, for the next few years, new infections will just replace people dying from Aids-related sicknesses.'