A Matter of Survival

On the front wall, there are posters promoting adventure and fair trade in tourism. At the back of the small briefing room, there are posters explaining the fatal impact of drug use. "Stormsriver Adventures" is active on different fronts. The South African company in Stormsriver has gained a reputation with canopy tours in the TsitsikammaNational Park. At the same time, it is one of the pioneers in fair trade in South African tourism.

Another poster in the restaurant next door explains what fair trade in tourism means. It gives details on what happens to the money spent by the guests on their tours with "Stormsriver Adventures". One percent is spent on combating HIV/Aids – one of the biggest challenges the tourism enterprise is facing.

"You cannot talk about sustainable tourism without talking about HIV/Aids", says Paul Miedema of "Calabash Tours" – "at least not in South Africa". The country is facing one of the largest HIV epidemics worldwide. In 2009, about 30 percent of all pregnant women tested as part of their antenatal care tested HIV positive. A broader survey of 2008 covering the South African population above two years of age found a prevalence of 10.9 percent. At 16.9 percent, the estimated HIV prevalence was significantly higher among those aged 15-49.

"In the 13 years we have been working in the townships of Port Elizabeth, the effects of Aids are becoming more visible," says Paul Miedema. "We see teachers dying, we see artists we worked with dying. We live with HIV, it is part of our life. For example, we don't call meetings on Saturdays, because people are at funerals."

Non-discrimination and open doors

Businesses in South Africahave no option but to address HIV/Aids. It is a threat to the well-being of their staff and reduces business productivity and profitability – in addition to the human suffering it causes. It therefore goes without saying that in South Africaproactive measures to address HIV/Aids are included in the criteria for fair trade certification in tourism.

The minimum requirements include non-discrimination in the workplace and an open doors policy. Furthermore, the problems associated with HIV/Aids need to be addressed openly. At "Stormsriver Adventures", HIV/Aids counsellor Abel works with DVDs provided by organisations such as the "Treatment Action Campaign". Drugs are one of the starting points for him to discuss HIV/Aids with the company's more than 40 employees. Or it may be "healthy and unhealthy relationships", violence, alcohol, or tuberculosis. The entry points at the regular staff meetings are as complex as the problems.

"I know" – or don't want to know

HIV/Aids still has a stigma attached to it. Lee Harris of the Backpacker hostel "The Backpack" in Cape Towndescribes the problem the other companies are also facing: "Nobody loses his job when revealing his HIV status, but hardly anyone does so". Many employees don't know whether they are infected or not, and they don't want to know. The companies encourage their staff to have themselves tested. For some time, "Stormsriver Adventures" used "I know"-badges for employees to encourage voluntary testing. For only those who know if they are infected can take antiretroviral medication at an early stage – medication thanks to which an HIV infection is no longer a death sentence.

A lot has changed in South Africaover the past few years: From denial to a proactive approach taken by health minister Aaron Motsoaledi. Antiretroviral therapy is provided by the government, theoretically for everybody who needs it. According to the South African HIV treatment guidelines, every patient with a CD4 count of less than 200/µl (measured according to CD4 lymphocytes*) should receive antiretroviral treatment. But that is too late, says Paul Miedema. That's why "Calabash" will help their staff, if they are HIV positive, to begin treatment at an earlier stage. According to the World Health Organisation (WHO), this should happen at a CD4 count of 350/µl.

Obstacles preventing effective treatment

Now that the South African government has launched a major HIV counselling and testing campaign (HCT) in 2010, the number of people who are having their blood tested is increasing. After all, the government also provides financial support for people with a low CD4 count. It is a necessary financial safety net for those affected, but there are also problems associated with it, says Ashley Wentworth, one of the owners of "Stormsriver Adventures". In order to get this financial support, some people do not take their medication until their CD4 count has deteriorated enough for them to avail the support. HIV/Aids counsellor Abel has observed another dangerous trend: Part of the antiretroviral medication can be sold as a drug. Another obstacle preventing effective treatment is the common belief in witchcraft. A person who has been bewitched will rather be taken home to his/her village and hidden in the house than provided with antiretroviral treatment.

Even more can be done

For the tourism businesses, there is no way round addressing these problems as actively as possible. With more than 40 employees, "Stormsriver Adventures" is a very important employer in the small village. Most of the employees are from Stormsriver and surroundings, and many of them are very young. The educational and counselling work done by the company is not restricted to the staff only, but extends to the community as a whole. For example, "Stormsriver Adventures" supports the local primary school in the educational work on HIV/Aids.

"Calabash" in Port Elizabethalso does more than just help their own employees. As part of a volunteer programme, the tour operator sends "volunteers", often retired pensioners, for at least one month to an aid project for Aids patients that looks after them in the home environment.

In view of the enormous challenges, and despite their great commitment, the companies still have their casualties and lose employees due to Aids and related diseases. Tuberculosis has also become a huge problem. According to official statistics, it is the main cause of death in South Africa. TB has tripled in the past two decades – a trend that is closely (but not exclusively) linked to the high HIV/Aids prevalence.

*The CD4 count shows the strength of a person's immune system at a certain point of time. The so called CD4 lymphocytes or helper T cells play a central role in the immune system. They show how advanced an HIV infection is and how urgent it is to begin antiretroviral therapy. A normal CD4 count would be between 500 and 1,000 CD4 cells per microlitre (µl), while a CD4 count of less than 200/µl describes a seriously weakened immune system.

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