In Cameroon they call it "le poison lent" "the slow poison" because of the long period between HIV infection, the loss of productivity and ultimately death. Here in this central African nation of 15 million inhabitants, the prevalence of HIV/AIDS has increased from an estimated 0.5% in 1987 to 12% today. Like the rest of sub-Saharan Africa, young adults" typically the most productive members of society" are hardest hit.

While the epidemic is devastating families and communities and overwhelming government resources, it is also profoundly impacting the private sector through increased absenteeism, escalating health care costs, and the loss of trained workers. According to recent UNAIDS estimates, by 2006, 11 countries in sub-Saharan Africa will have lost more than one-tenth of their labor force to AIDS. Per capita income and life expectancy have plummeted to 1960s levels throughout much of this fragile region. While the epidemic poses a grave and growing threat to African development, some businesses are taking a leadership role in the fight by launching effective HIV/AIDS workplace programs.

With the help of OPALS (Organisation Panafricaine de Lutte contre le Sida), they launched a two-week training program in 1997 conducted by Dr. Jean Baptiste Guiard-Schmid of the Department of Infectious and Tropical Diseases, Tenon Hospital, Paris, and anthropologist Damien Rwegera of Rwanda. "We trained 25 peer educators, and a doctor and nurse to perform a full-time awareness campaign," said Dr. Montagut. "Then, at the end of the training, Dr. Guiard-Schmid said, "Why not start antiretroviral [ARV] treatment at Alucam" And he offered to help us put the project together. That's how it all started."

That kind of thinking was, at the time, revolutionary. Although ARV drugs have been successfully extending the lives of those infected with HIV in wealthy, developed countries since 1995, many experts had warned that ARV therapy simply would not work in the developing world, including much of Africa. Cost was one obstacle, they argued; the strict daily, lifelong regimen required for successful therapy was another.

Bernard Montagut, Bruno Buclez, and their medical colleagues in Paris were about to prove otherwise. They managed to convince senior executives of Alucam and the parent firm that their plan to launch a pilot drug program was indeed viable and that it would prove to be cost-effective for the company to provide ARVs to its workers and their families desperately in need of therapy.

With the green light from management, they prepared to launch TRICAM (Trérapies Cameroun). There were, however, serious challenges to overcome before they could begin implementing their groundbreaking plan. "It was impossible for us to start a pilot project like that on our own, " Dr. Montagut explained. "First of all, the medicines were very expensive at that time." In addition, he said, they needed approval from the Ministry of Health in Cameroon before they could begin. But the government, which had no national ARV plan of its own at that time, refused to give them permission to begin the pilot program at the factory.

Then in 1999, sales manager Africa & Indian Ocean Lionel Laplace and health sciences associate Albert Djieumo of  Merck Sharp & Dohme (MSD) in Cameroon and a representative of GlaxoSmithKline (GSK) met with Dr. Montagut and his colleagues and learned about their difficulties in launching their project. They offered to provide Alucam with free ARV medicines for 40 people for one year (a value of approximately 300 million FCFA or about 460,000 euros).

But one major hurdle remained. "At the very beginning of the TRICAM project," Albert Djieumo recently explained in an interview shortly before his untimely death, "Dr. Montagut told us that the ARV project could not go on without the support of the Ministry of Health. That's when MSD sprang into action." Lionel and Albert immediately contacted the Ministry and pleaded Alucam's case successfully. "I believe," explains Dr. Montagut, "that if MSD had not come into the picture, we would have never gone forward. They had the right contacts at the ministry of health and a strong presence here in Cameroon. They also had the necessary energy, drive, and will power to make it happen." Following the training of the CMES staff at the Tenon Hospital in Paris, the project was successfully launched, lifting the spirit of workers and triggering an increase in the number of those seeking testing to know their status.

Mr. Titi Manyaka

Through the CMES-based program, Alucam conducts information, education and prevention campaigns; voluntary testing and counseling; and provides medical care including antiretroviral treatment all within a non-discriminatory, confidential and supportive environment. The company also provides free ARV medications for life to former employees (and their families), even after they leave the company or retire.

The success of TRICAM also helped trigger the development of the national ARV program in Cameroon, proving that a private company can play a critical role in strengthening the national response to AIDS. "Several times," explains the program's prevention coordinator, Dr. Sylvestre Makong, "Ministry of Health representatives came here and could not believe that somewhere in Cameroon there was an initiative of people making ARVs work and not bragging about it! TRICAM's success has helped convince medical officials of the importance of ARV treatment for the entire country."

TRICAM also helped trigger the birth of DARVIR (Douala Antiretroviral Project), a public-private association of health care professionals in Cameroon that provide ARV therapy. MSD has also provided support to this group for training in the management of their patients taking these medications.

Other companies have drawn inspiration from Alucam's success in developing their own HIV/AIDS workplace programs, including like Heineken/Bralima in the Democratic Republic of Congo. Alucam is also sharing its experience and knowledge gained with some of the largest companies in Cameroon through GICAM (Groupement Inter-patronal du Cameroun), the largest business association in the country. And according to Dr. Bruno Buclez, "Our program has impacted the development of HIV/AIDS programs at other Alcan sites around the world, such as Ghana, and we are now pushing to do the same thing in Guinea and at a new site in South Africa."

This program was one of the first to demonstrate that ARV therapy is both feasible and cost effective in a sub-Saharan African country. Currently, 33 patients from Alucam including workers, wifes and children, and 68 people from the local community are on ARV therapy. A 2003 survey of Alucam workers showed a low HIV prevalence (3.2%) compared with the national prevalence rate (estimated at 12%).

"It's much easier to help people live than to help people die," says Dr. Montagut. "I take great pride in what we have all done here at Alucam, because at one point, we were just helping people die. Now, people are living, and employees can come to work, and we don't have a problem with absenteeism. More babies are being born. We used to see kids suffering from the disease. Now they are healthy and can go to school again. This is something I am very proud of." The program is also a source of pride to the wide range of partners, both public and private, who played an important role in making it succeed on the front line in the war on HIV/AIDS in Cameroon.