If business directed the war on AIDS - the effects of using business management methods in the war on AIDS

Business Horizons, Nov-Dec, 1990 by Betsy D. Gelb

Conventional wisdom provides a fairly narrow definition of the responsibilities of an enlightened company in the age of AIDS. Such a company would not fire a worker diagnosed as testing positive for the human immunodeficiency virus (HIV), the cause of AIDS, but would provide medical leave when necessary. Furthermore, an enlightened company would educate other employees, so they would not be afraid to work alongside an individual with an HIV-positive diagnosis. What else, after all, could be expected?

In reality, little more may be expected, but businesses nevertheless have an opportunity to contribute significantly to the overall national, state, and local efforts against AIDS. Why should they do so? The justification lies in the realization by managers that business sophistication will vastly improve the way decisions are made. The discussion to be presented here will illustrate how public policy could be improved by a business perspective. Three areas of expertise found in the private sector seem particularly pertinent: marketing, economic analysis, and knowledge of the limits of economic analysis in an emotionally charged environment.

BACKGROUND

The human immunodeficiency virus, one of a family of retroviruses discovered in the 1980s, is the cause of Acquired Immunodeficiency Syndrome (AIDS). HIV is capable of infecting humans and slowly destroying a person's immune system, which normally protects against microorganisms that cause disease. As HIV attacks essential components of the immune system, the ability of that system to fight disease and certain kinds of cancer is diminished.

The report of the Presidential Commission on the Human immunodeficiency Virus (1988) cites estimates that almost 500,000 Americans will have died or progressed to later stages of AIDS by 1992. Further, it reports an estimate that one million to 1.5 million Americans are infected with the virus but not yet ill enough to recognize it.

Given the magnitude of the problem, public policy plays a major role at federal, state, and local levels. The role of such policy concerning AIDS has been outlined as actions to support three objectives:

1. To halt or slow the spread of HIV;

2. To provide appropriate and cost-effective care for those infected with HIV;

3. To protect the rights of infected and noninfected people.

A BUSINESS ORIENTATION

How might "thinking like a business manager" contribute to the likelihood of achieving the objectives outlined above? At the outset, it should be noted that HIV is not a problem that businesses can in any sense "solve." if such problems exist in the public health realm, they involve conditions in which a drug or treatment has been devised, its demand is price-elastic, and the obstacles to its widespread adoption are either ignorance of its existence, high cost, or both. In such a situation skillful marketing, using publicity, advertising, demonstrations, and appropriate distribution, can indeed increase volume and, in doing so, very likely make decreases in price possible.

For AIDS, however, there is no "magic bullet." Consequently, the influence of the business sector, even if it is brought to bear to a far greater extent than has been the case to date, will be less important. However, there is no reason that those who shape public policy should not benefit from business sophistication in doing so.

Such sophistication can be applied to the following:

* Education/health promotion aimed at preventing HIV transmission, including the distribution of free condoms;

* Regulation, which would benefit from greater understanding of its consequences and trade-offs; and

* The allocation of public funds, which would benefit from a greater understanding of the advantages of private-sector opportunities wherever possible.

Education/Health Promotion

The issue of education concerning AIDS transmission has at least three dimensions:

* Without an effective vaccine or effective treatment, the most attractive opportunity for coping with the AIDS epidemic is prevention, according to one School of Public Health dean (Osborn 1988). Thus, she argues, campaigns of public education and information must play a major role in public policy toward the epidemic.

* A second role for public education, in addition to prevention, is the reduction of misconceptions that have led to a reluctance to donate blood, calls for quarantines, and boycotts of schools where children infected with the AIDS virus are enrolled. Although there is no evidence to suggest that the AIDS virus has been transmitted through saliva, tears, urine, eating utensils, vaccines, casual contact, or insects, about one-fourth of the public believes otherwise.

* Barriers to the effective use of such communications media as national television are economic and, in effect, political-a reluctance, despite societal acceptance of the subject matter of daytime television programming, to talk "frankly about multiple sexual partners and unsafe sexual practices, about experimentation with drugs, about bisexuality, and about the ways to minimize risk" (Osborn 1988).