Health GAP Position Paper
www.globaltreatmentaccess.org | www.healthgap.org

In June 2001, during the UN General Assembly Special Session on HIV/AIDS, Coca-Cola announced efforts in to combat AIDS in Africa in partnership with UNAIDS. Among the marketing and prevention initiatives was a plan to provide or pay for treatmentÑincluding antiretroviralsÑof employees living with HIV/AIDS. Pressed by activists and the media to differentiate between the 1,200 direct employees versus 100,000 workers of the Coca-Cola System, Coke representatives agreed to negotiate with its business and bottling partners to provide access to AIDS treatment to the entire Coca-Cola Africa workforce.

Beginning in April 2002, Health GAP and other treatment activists launched a worldwide campaign against Coca-Cola for its failure to provide a comprehensive workplace HIV/AIDS care and treatment program for its workers in Africa and elsewhere employed directly or indirectly by Coke's affiliated bottlers and distributors. After demonstrations in New York, Washington, Atlanta, Boston, and Barcelona in the summer of 2002, an October 17 Global Day of Action on four continents increased pressure on Coca-Cola to commit to a comprehensive and sustainable workplace treatment program.

Fifteen months after its promise to ensure treatment to all of its workers in the Coca-Cola System in Africa, the company for the first time committed in writing to enrolling all of its African system workforce in an HIV/AIDS healthcare program that includes antiretroviral therapy, launching The Coca-Cola Africa Foundation and Bottlers in Africa HIV/AIDS Healthcare Program.

As groups continuing to engage corporations to adopt workplace policies of non-discrimination and provision of prevention, care, and treatment programs for workers and their dependents living with HIV, we regret that Coca-Cola has failed to show proof of commitment.

UNIVERSAL ROLLOUT

Coke needs to revise its processes and address the problems to ensure a rapid, efficient rollout:

* While Coke has missed its March 2003 deadline of enrolling all bottlers in the cost-sharing scheme (currently 83% of bottlers are enrolled), the real problem is the lack of progress on rolling out actual treatment programs. Coke must commit to a rapid, firm timetable for implementation.

* Coke must report on the number of programs implemented thus far and the enrollment of people living with HIV/AIDS, which are true indicators of Coke's commitment. Memoranda of understanding between Coke and its bottlers are no substitute for comprehensive, clear reporting on the progress of Coke's program. Continual monitoring and evaluation of the overall program should be transparent and reports based on standard metrics available regularly.

* Implementation will continue to be hampered as long as Coke refuses to streamline the implementation process. Currently PharmAccess, a non-profit foundation based in the Netherlands contracted to roll out Coke's treatment programs, must negotiate separate agreements with all of Coke's bottlers individually in each country on all issues from planning to procurement.

* The current slowdown further delays the availability of AIDS treatment to Coke workers in developing countries outside of Africa. Coca-Cola is compromising its own stated intention to extend the coverage of AIDS treatment to Coke system workers in other developing countries.

QUALITY OF CARE

Coke's insistence on a decentralized process and the resultant lack off accountability has put the success of the program in jeopardy:.

* Coke must cease giving mixed messages to bottlers about working with PharmAccess or launching a treatment program on their own.

* Coke must centralize the program and put standard operating procedures in place not only to ensure quality, but also to allow the efficient procurement of drugs and diagnostics, consistent program-wide monitoring and evaluation, and reliable system-wide reporting methods. Unless Coke is willing to prescribe universal standards and treatment protocols, the quality of care is threatened and the integrity of Coke's Program is compromised.

* Coke must ensure bottlers are upholding the promise of confidentiality of all medical records without which uptake of services is likely to suffer. Voluntary and confidential HIV testing must be provided with clear statements of universal policies of non-discrimination.

10% CO-PAY FOR WORKERS

Activists predict that the announced 10% co-pay provisions will deter uptake of treatment, especially in light of the relative low wages of workers, the relative high cost of ARV treatment, and the possibility of multiple cases of HIV infection in a particular family. Although Coke has promised in writing that it "will not let inability to pay be a barrier to treatment," it has failed to address activist concerns that co-pays will negatively impact uptake, and has failed to show how it will prevent the co-pay from deterring program uptake. Accordingly, we demand that Coca-Cola:

* publicize the costs of annual treatment against average bottler salaries in each country;

* monitor uptake to be certain that 10% co-pay requirements are not negatively affecting uptake;

* revise its 10% co-pay provision if independent reporting shows that treatment uptake has suffered; and

* support workplace treatment literacy campaigns which will help educate system workers about the feasibility and pragmatics of treatment.

COST-SHARING WITH BOTTLERS

Coca-Cola has announced that its bottling "partners" will need to cover 40% of program costs, but that "cost-sharing will not serve as a barrier to participation by all bottlers in Africa." Coke must confirm its willingness to negotiate with smaller cost-sharing percentages with smaller and mid-sized bottlers. Coke must also be prepared to revise such percentages in the future as more workers take advantage of costly ARV treatment programs.

CHEAPEST MEDICINES

Coca-Cola has committed to expanding its potential sources of pharmaceutical products beyond those provided by GlaxoSmithKline, depending on national intellectual property and drug registration status. Coke should commit further to the principle of utilizing lowest cost generic producers wherever possible in order to decrease costs to bottlers and workers.

SUSTAINED CORPORATE COMMITMENT

At present, Coca-Cola's commitment to the Africa HIV/AIDS Healthcare Program is through its charitable arm, the Africa Foundation. In order to strengthen the program and increase its likelihood of success:

* Coke must publicly issue a formal corporate-level commitment to sustaining the Program indefinitely. Activists rightfully question Coke's long-term commitment to the Program in light of the statement by Robert Lindsay, VP of Public Affairs & Communication for the Africa Group, that the "Foundation will likely withdraw because the financial burden on the bottlers will become less."

* Coca-Cola must integrate HIV/AIDS workplace policies and protocols into its system-wide operations as a minimum standard for its bottling partners in Africa;

* Coca-Cola must formally state its commitment and generate a clear plan and timeline for extending coverage for AIDS treatment, as part of a comprehensive HIV/AIDS workplace policy, for its operations in developing countries outside of Africa.