With operations in more than 170 countries, HEINEKEN is the world's most international brewing group. Production is based at more than 110 breweries in over 50 countries. Other parts of the world are served via HEINEKEN's export operations. The main brands are HEINEKEN, Amstel, and Murphy's, and in Africa, Primus, Gulder and Star.
The company has had an HIV prevention program in operation for over ten years in central Africa, with regular reviews and updates by the General Manager group for the region. The company has adopted a comprehensive approach that consists of:
In 2001, HEINEKEN's board decided to expand its HIV employee program to include access to care, support and treatment, most notably access to ARVs. Access is available to employees, a partner and children. HEINEKEN is currently considering how to ensure continuing access to treatment for chronic conditions once employees' children cease to qualify for company benefits (at age 18). The ARV program is being piloted in selected sites before being phased in throughout the Company's operations.
The Company has contracted Pharmaccess, a foundation that organizes ARV treatment in Africa, to acquire drugs and advise on the establishment of regimes. The program has been able to take advantage of the price reductions made by manufacturers. HEINEKEN has brought its own doctors to the Netherlands for training and arranged for the training of nurses and lab personnel in country. Treatment is then managed by the company's own clinics which are based in the workplace.
The Company supports employees in adhering to treatment: Periods of directly observed treatment are interspersed with times when employees and family members take medication outside of the clinic (including weekends, holidays and more prolonged breaks). To begin with treatment will be based on two regimes of ARV combinations, allowing one to be substituted for the other in the event of treatment failure.
Motivation for Action
HEINEKEN's Board defined HIV/AIDS is defined as a key issue for the Company. It undertook a risk assessment, considering the impact of HIV/AIDS and costs of interventions in three countries (Ghana, Burundi and Thailand). Data already collected by the company was handed to an external agency for analysis and recommendations. HEINEKEN's senior management identified HIV/AIDS not just as a medical issue, but as one with enormous social implications that could not be ignored. The results of the risk assessment gave confidence that its response made sense in financial as well as humanitarian terms.
Evaluation and Monitoring
The Company will carefully monitor the pilot programs, addressing for example, adherence success and side effects. Recognizing the relatively small scale of their own program, the Company is keen to use the wider experience of Pharmaccess and other AIDS organizations to help inform the expansion of its program.
Lessons Learned and Next Steps
HEINEKEN is a large company with many sites that could potentially join its ARV program. The central African region has already benefited from an established HIV prevention program, and thus makes it the obvious choice to begin piloting the program. This approach allows the Company to monitor and adapt its program to help guarantee the effectiveness and sustainability of a larger program.