Plan for HIV coverage at UN stalls

Despite promise, subcontractors are lacking health care

By John Donnelly, Globe Staff, 9/29/2003

NAIROBI -- The United Nations, which has forcefully said that poor people around the world infected with AIDS should receive treatment, has become embroiled in a case inside its walls. At its sprawling regional headquarters in Kenya, people who perform such tasks as cleaning toilets and trimming bushes have asked for medical benefits, including AIDS coverage.

In July, after 10 months of negotiations, UN officials in Kenya declared the matter solved and said that starting next year all new contracts with outside services must include HIV and AIDS care, among other benefits.

But interviews with managers of the outside companies and the workers themselves last week found the problem unresolved. The companies said they cannot find an insurance firm willing to give HIV inpatient care and have asked the UN for help. The UN responded last week that it was the companies' responsibility to get the insurance.

Told of the standoff on AIDS insurance, Peter Piot, UNAIDS executive director, said the UN officials were wrong.

"We should help the companies find the insurance for the workers. This will be a test case for the whole UN system," said Piot, who was in Nairobi for the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa. Piot made a special trip to the UN Gigiri complex to inquire about the medical coverage for subcontractors, an issue first reported by the Globe this summer.

When he visited the compound, Piot said, UN officials "told me they had fixed the problem." But after learning later from a reporter that the problems had continued, Piot became visibly irritated.

"You know, if no one in the developing countries is willing to give HIV insurance coverage, then that's an indication of a huge, huge problem," he said. "We have to investigate this because it has implications for the entire system."

Two managers of the outside companies said last week that they had contacted more than a half-dozen insurance companies in Kenya and that none was willing to write AIDS policies.

J.D. Rehall, local manager of Kinetic Electric, which has 31 workers at the compound, said in an interview in his office that the company has asked the UN for help in finding insurance.

"We've tried hard to find insurance, but nobody will give it," Rehall said. "Somebody has to pay the cost of this. That's a moral issue. We provide free outpatient care for our workers, but we cannot now give pay for hospitalization."

Nick Nuttall, a spokesman for the UN compound in Nairobi, said UN negotiators were aware that "local insurance companies do not give HIV coverage. But the deal we have now is that the contractors must find a way to give HIV and AIDS coverage, or they won't get contracts. It's up to them to do it."

Stephen H. Lewis special envoy on AIDS in Africa for UN Secretary General Kofi Annan, disagreed with Nuttall and said the UN should get directly involved.

"It should be possible, given the power and scope of the UN, to be able to find an insurance company willing to write policies," Lewis said. "I thought this was resolved, but this is a serious complication."

Inside the heavily guarded compound, about 3 miles from the AIDS conference in downtown Nairobi, the subcontracted workers said in whispered conversations that they feared losing their jobs if they spoke out publicly on medical coverage. But in six interviews, all the workers, speaking on the condition of anonymity, said they were upset the issue had not been resolved.

"We don't know why they can't resolve it now, instead of waiting for next year," said a father of two children who is paid 4,000 shillings, or $50 a month, to clean UN offices. "If we have a problem and we have to go to the hospital, we pay the cost."

As part of the UN negotiations, the minimum salary will rise next year to 6,000 shillings, about $77 monthly.

A woman, who is paid the equivalent of $48 monthly to clean offices, hid behind a concrete wall while talking with a reporter.

"What I feel is that I will just have to wait until next year and hope for the best because I don't have anything else beside this job," she said.

The subcontractors said they were bothered by another issue as well.

Even though they work full time at the complex and are given security badges to enter the facility, they said the on-site UN medical clinic is off-limits to them. "It is very wrong," an electrician said. "It is one system for them at the UN and one for us."

Nuttall, the UN spokesman, said that the workers can use the clinic in an emergency and that he would reissue and widely post a statement to that effect around the compound to clear up any misimpressions. For nonemergency health care, the subcontractors have to seek help elsewhere, he said.

Ironically, several of the doors in the medical clinic had posters promoting HIV testing and counseling, services that are not yet available to the subcontracted workers.

John Donnelly can be reached at donnelly@globe.com