April 2002

AIDS Standard Organization (ASO) of Thailand encourages the private sector to create HIV/AIDS-friendly workplaces by providing life insurance premium bonuses of 5 to 10 percent to companies with workplace prevention activities. Effective HIV/AIDS workplace programs can benefit insurance companies through reductions in life insurance claims and medical costs related to HIV/AIDS.

The program is based on one begun by American International Assurance (AIA), the largest insurance company in Thailand, to promote the integration of HIV/AIDS prevention activities into business operations. In Thailand many companies buy group packages of life and health insurance from private insurance companies such as AIA.

Horizons, in collaboration with the NGO Thailand Business Coalition on AIDS (TBCA) and the business sector, are evaluating the outcomes of the ASO Thailand initiative to expand and improve workplace HIV/AIDS programs.

Benefits of Joining the ASO Program

For AIA companies, a bonus of 5 to 10 percent is available on the life component of their group insurance, depending on how well they meet the standards established by the project. The companies qualify for the minimum-level bonus if they:

• Do not test job applicants for HIV/AIDS.
• Do not test employees for HIV/AIDS.
• Continue to employ HIV-positive workers.

Further increases of up to 10 percent are provided, depending on the extent to which the HIV/AIDS workplace programs meet measurable standards, such as whether the company is offering staff training and information to workers on HIV/AIDS, or promoting and providing condoms.

A second incentive to join the program, particularly for companies that are not customers of AIA and thus not entitled to the insurance bonus premium, is an ASO certificate endorsed by the Ministry of Public Health. Senior ministry officials present certificates to companies in public ceremonies to honor them for their interest in the health and welfare of their workers.

How the Idea Was Sold

The project was launched in August 1999 at a press conference attended by senior government officials, business representatives, and the general public. TBCA then contacted 772 companies (624 in Bangkok and 148 in Chiang Mai) to encourage them to implement workplace HIV/AIDS programs under the auspices of the ASO. If they did so, the companies would receive guidance on program implementation, a group insurance bonus if they bought insurance from AIA, and an ASO certificate acknowledging their commitment to HIV prevention. The list of companies was compiled from AIA and TBCA contacts, as well as from commercial associations and personal networks of the TBCA board. Written communication was followed by telephone calls and visits. In addition, TBCA board members were involved in recruitment through their personal contacts in various industries.

Methods

Researchers first gathered data from the 772 companies using a structured survey that elicited information about the company, type of company, number of workers, and the main reasons why they joined or did not join the initiative. A second survey, based on a sample of the contacted companies, explored management decisions in relation to the project.

Getting companies to participate requires repeated contacts. Numerous follow-up contacts were necessary before companies joined the project. Only 15 percent of companies joined after the original contact, with up to seven contacts necessary before some companies decided to participate, thus making the project more labor intensive than expected.

Personal networks are crucial for enlisting companies in the project. The most successful recruitment strategy was contacting the personal networks of TBCA staff and board members; 61 percent of these contact decided to join. Only 18 percent of companies already in the AIA network joined the project. A greater proportion of companies in Chiang Mai joined than in Bangkok. In Bangkok and Chiang Mai, 14 and 22 percent of the companies, respectively, joined the project. The greater success in Chiang Mai, where HIV prevalence is the highest in the country, is likely due to long-standing personal relationships between TBCA staff and provincial businesses.

Thai service and hotel companies are most likely to join. Based on a sample of 67 companies that joined and 115 companies that did not, 42 percent of Thai companies joined compared to 30 percent of foreign companies, possibly because it was easier for TBCA to communicate in Thai with Thai managers rather than foreign ones. Service and hotel companies were the most likely to join the program; 43 percent of all such companies contacted joined, compared to 13 and 12 percent for factories and commercial/professional groups. Furthermore, the larger the company the more likely it was to join. A quarter of companies with 544 or more workers joined, compared to only 9 percent for companies with fewer than 120 workers.

Managers’ attitudes about HIV/AIDS greatly influence company decisions. Decision makers’ attitudes about HIV/AIDS and their motivation for becoming involved had an important role in whether companies joined the program. Managers who wanted to be personally involved in issues related to the disease, those who believed that it is likely that workers at their companies had contacted the disease, and those who felt that HIV/AIDS protection is more than a personal responsibility were more likely to join the program. Further, those managers who believed that HIV/AIDS is an issue for companies to be involved in and those who felt that HIV/AIDS workplace activities are worth the cost were more likely to participate than were other companies.

More insurance companies other than AIA need to offer the insurance bonus. One of the limitations of the project was that companies had to be clients of AIA to receive the insurance discount. Some companies therefore viewed the project as part of AIA’s recruiting strategy and regarded project staff as AIA staff. Any expansion of the program will require the participation of a large number of insurance companies, preferably the entire membership of the Thai Insurance Association. A second possible future strategy would be to have the government’s social insurance scheme adopt the concept behind this project. Two-thirds of managers contacted stated that they would be interested in the project if the government is involved. This could be a very successful future strategy, since such a scheme would cover a larger number of workers.

Study investigators are Anthony Pramualratana, Suparat Suksakulwat, and Surachai Panakitsuwan of TBCA; Srisuman Sartsara, Patchara Rumakom, and Philip Guest of Horizons/Population Council; and Simon Baker, Horizons/PATH. The study is ongoing and a final report will be available in late 2002. For more information on the study, contact Philip Guest (pguest@popcouncil.th.com).

About Horizons

Horizons conducts global operations research to improve prevention, care, and support program. Horizons is implemented by the Population Council under a cooperative agreement with the U.S. Agency for International Development. Horizons is implemented by the Population Council in partnership with the International Center for Research on Women (ICRW), the Program for Appropriate Technology in Health (PATH), the International HIV/AIDS Alliance, Tulane University, Family Health International (FHI), and Johns Hopkins University.

Copyright © 2002 The Population Council

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19 Oct 2007