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Say South African health experts:

Global Fund SAB tie is extremely problematic

Published 21. 03 2011 by Øystein Bakke

South African Breweries and the Global Fund has formalised a partnership to fight against HIV and AIDS. "This arrangement is extremely problematic and is in our view, completely unacceptable" say health experts pointing to conflict of interest, lack of evidence base and questionable quality of programme.

In February The South African Breweries Limited (SAB) announced that the company, the South African Business Coalition on HIV and Aids (SABCOHA) and the Global Fund, had formalised a partnership to fight against HIV and AIDS.

According to SAB media release the The Global Fund will finance five initiatives relating to HIV/Aids under the Global Fund Workplace Programme through a contribution of over 36 million South African Rand (five million US Dollars) . These initiatives are:

  • Project Promote, a public private partnership to assist in reaching government condom distribution targets, 
  • BizAIDS, helping micro and small sized companies protect their businesses from threats such as HIV and AIDS, 
  • Peer Educator Training and Support, HIV and AIDS Counselling and Testing
  • SAB's Tavern Intervention Programme for Men (TIP).
SAB's TIP is aimed at encouraging behavioural change amongst men. Says SAB: "The initiative covers four trends most prevalent in South Africa: Responsible Alcohol Consumption, HIV/Aids, gender violence and child abuse. These are dealt with during interactive workshops held in taverns, a unique element of programme."

SAB is also a strategic partner in Project Promote, using its existing infrastructure, namely depots and truck drivers delivering stock to outlets, to deliver condoms to taverns.

Controversy

In a open letter to the Global Fund South African health experts request that the recent allocation of funds to support the South African Breweries’ (SAB) Tavern Intervention Programme be seriously reconsidered as a matter of urgency. Terming the arrangement  "extremely problematic" and "in our view, completely unacceptable" the experts point to the following reasons:

1. Conflict of interest
The core business of SAB is to increase profit from the sale of alcohol, which typically will occur through increasing consumption of alcohol products. To this end, large budgets are currently committed to the promotion of drinking SAB products and expanding operations both in South Africa and other developing countries. At the same time, legislation in South Africa demands that the liquor industry (including SAB Ltd) invest in measures intended to decrease how much people drink. A clear conflict of interest exists here. To put this issue into a broader context, funding the liquor industry to do interventions aimed at reducing alcohol-related harm is equivalent to the Global Fund funding the tobacco industry to run programmes on lung health. In addition, given that SAB is a multi-billion dollar global company, it is surprising that Global Fund would view SAB as being in need of funding, particularly given that the amount spent by SAB on alcohol abuse programmes is miniscule compared to that spent on promoting sale of their products. 

2. SAB programmes are typically not evidence based and are not properly targeted or evaluated
Reviewing the full range of SAB LTD’s alcohol-abuse programmes it  is clear the majority are not based on globally accepted evidence, few target the most at-risk population and few of the interventions are evaluated for effectiveness. The mass media campaigns on responsible drinking which they support (at far higher cost than the Taverner Intervention Programme (TIP)) indicate to consumers that the only people who should not abuse alcohol are teenagers, drivers and pregnant women, which completely ignores the main alcohol-related harms in South Africa (HIV/AIDS, TB, Violence, Pedestrian injuries, mental illness). Furthermore, following the example of Big Tobacco (who are in fact the majority shareholders of SAB Miller) SAB Ltd has actively lobbied government in opposition to proposals to reduce access to alcohol, despite the wealth of global evidence that these measures are the most cost-effective way in which to decrease alcohol abuse. Their lack of support for these measures, which would decrease sales of SAB products, is not particularly surprising given the inherent conflict of interest. It is likely that SAB would ideally like to increase sales without increasing alcohol-related harm, unfortunately this scenario is not possible, as demonstrated by the global evidence which shows unequivocally that per capita consumption levels are closely linked with rates of alcohol-related harms, particularly in contexts like our own, where we have high rates of risky drinking (approximately 30% of drinkers). 

3. The quality of the Tavern Intervention Programme (TIP) is questionable 
In terms of violence, male injury makes up the bulk of alcohol-related injury in South Africa with violence mortality amongst men is five times that of women (113.4 homicide deaths per 100000 men compared to 21 deaths per 100000 women) so focusing exclusively on gender violence is not in keeping with the burden of disease from alcohol.  Regarding HIV, women are at significantly higher risk for HIV and alcohol-related HIV deaths and DALYS so it is not clear why they have been excluded from this project. As to the appropriateness of the interventions themselves, it is unclear as to whether or not evidence-based methods are being employed and what measures are in place for its evaluation. 
 
The experts point out in their letter that  there are far more appropriate organizations and institutions that could benefit from this funding and they request that the Global Fund urgently review its commitment of funding to this project, which SAB has more than sufficient resources to fund on its own .
 
Signatories to the letter are: 
Dr Joanne Corrigall, Western Cape Department of Health 
Prof Charles Parry, Director: Alcohol & Drug Abuse Research Unit, Medical Research South Africa
Richard Matzopoulos,Specialist Scientist, Medical Research South Africa and Safety and Violence Initiative, University of Cape Town,
Prof Leslie London, Head of Department, School of Public Health and Family Medicine, University of Cape Town
Prof J Myers, Director: Centre for Occupational and Environmental Health Research, School of Public Health, University of Cape Town
Dr Sue Goldstein, Programme Director Soul City Institute for Health and Development Communication

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