CORPORATE SOCIAL RESPONSIBILITY IN THE UGANDAN ALCOHOL INDUSTRY: ITS CONTRIBUTION TOWARDS THE PREVENTION AND MITIGATION OF HIV AND AIDS. NABULYA NINAH DIANA BAKOJJA A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy QUEEN MARGARET UNIVERSITY 2017 Abstract This thesis sets out to determine the contribution made by the Alcohol Industry in Uganda towards HIV and AIDS treatment, care and prevention through Corporate Social Responsibility (CSR) activities. Adopting a qualitative case study approach from two multinational breweries; Diageo and AB InBev, data was collected during fieldwork in Uganda using individual interviews, participant observation, two group interviews and secondary data from breweries and partners’ annual and media reports. The main study participants were brewery managers, health workers from partner health centres and beneficiaries including farmers and people living with HIV at the health centres. It is argued that the CSR activities of companies are established as a response to the perception that the high alcohol consumption in Uganda leads to greater risk behaviours for HIV. The study adopts Corporate Social Performance Framework (Ten Pierick et al. 2004) to identify the motivation of breweries to engage in HIV related CSR and the key activities that the breweries engage in. CSR activities include awareness raising, testing and counselling for HIV and AIDS. In addition, the breweries have improved the livelihoods of farmers through the provision of regular contracts to buy grain for brewing. This is perceived by stakeholders to have both a beneficial and detrimental effect: the regular income lifts poor populations out of extreme poverty. However, improved livelihoods can also enable access to social activities which have the potential to increase the risk of HIV infection. Findings from this research highlight the stakeholders’ views that the CSR activities are perceived as strategic due to the fact they have greater benefit for the breweries themselves rather than being largely altruistic. Furthermore, the most significant contribution of the CSR activities is the improved livelihood for farmers, which results from regular and consistent contracts for purchasing grain. This study makes a significant contribution to the field by carrying out a stakeholder perspective of CSR activities in a resource poor setting in the global South. Two distinct disciplines, business studies and global health, have been brought together in order to deepen understandings and provide a rich insight into the ways in which CSR activities can contribute to global health issues with both intended and unintended consequences. Key words: Corporate Social responsibility, HIV and AIDS, Alcohol, Uganda, Livelihoods, Breweries, Resource Poor Settings, Farmers, Stakeholders. i Declaration I hereby declare that this submission is my own work and that, to the best of my knowledge, it contains no material previously published or written by another person nor material which to a substantial extent has been accepted for the award of any degree of the university or other institute of higher learning, except where due acknowledgement has been made in the text. ii Acknowledgements First, I thank Almighty God for giving me the ability to work diligently and accomplish my goals. I would like to extend deep appreciation to my research supervisors, Oonagh O’Brien, Fiona O’May and Mike Pretious, for the assistance and support they have accorded me. Their input during all the process of research, research design, data collection, data analysis until writing up of the thesis were helpful and had a real impact on this success. I also thank all the staff and colleagues at the Institute for Global Health and Development for their help and advice at every stage. I wish to acknowledge the generous funding from Santander to carry out fieldwork for this research in Uganda, which greatly eased the burden of the cost of transport and accommodation in the study areas. I am also grateful for the second Santander grant, to make an oral presentation at the 6th Annual Global Health Conference in Singapore. As a consequence, the constructive criticism and feedback received from the conference contributed greatly to building on my initial thoughts for this research. My gratitude goes to all my family and friends – especially those whose names I have used in the place of participants in this study. To my parents for their great effort and continuous help. Thank you for believing in me and gently pushing me to complete this seemingly endless project. Special thanks to Sylvia and Geoff Mason for making me feel at home in Scotland. To the study participants, I am very thankful for your time and cooperation; particularly those in Kapchorwa, with whom we shared chapattis and chaffed barley. Thank you Moses Kamabare and Onapito Ekomoloit for your input and support. Finally, I am indebted to my father and special friend Richard Bakojja for the financial support to take on this project. You always encourage a commitment to continuous learning. Thank you for giving me the thirst for knowledge and hard work and for teaching me to strive regardless. I dedicate this to you and Elijah Scott Ruvuna, who will one day read this book and be proud of mummy; and hopefully forget all the times he asked me over the phone, “When are you coming back home, mum?” iii Acronyms and abbreviations AIDS Acquired Immuno-deficiency syndrome ABC Abstinence, Be faithful, Use condoms, ART Antiretroviral Treatment/ Antiretroviral Therapy. ARV Antiretroviral CSR Corporate Social Responsibility CSPF Corporate Social Performance Framework EABL East African Breweries Limited. EC European Commission HIV Human Immunodeficiency Virus HIPS Health Initiatives for the Private Sector Project. LIC Low Income Countries LMIC Low and Medium Income Countries MDG Millennium Development Goals MNCs Multi-national corporations NBL Nile Breweries Limited. NGOs Non-Governmental Organisations PEPFAR Presidents’ Emergency Plan for AIDS Relief. PLHIV People Living with HIV/AIDS PMTCT Prevention- Mother- To- Child -Treatment PO Participant Observation QD Qualitative Design iv QM Qualitative Methodology QMU Queen Margaret University SABMiller South African Breweries Limited SME Small and medium enterprises SDG Sustainable Development Goals SSA Sub Saharan Africa SSI Semi Structured Interviews TASO The AIDS Support Organisation TBL Triple bottom line TNCs Transnational corporations UAC Uganda AIDS Commission. UN United Nations UNAID United Nations Aid UNFPA United Nations Population Fund UAIS Uganda Aids Indicator Survey UAIA Uganda Alcohol Industry Association UNAIDS Joint United Nations Programme on UNDP United Nations Development Programme UNICEF United Nations Children’s Emergency Fund USAID United States Aid for International Development WHO World Health Organisation WBCSD World Council for Sustainable Development v vi Glossary of terms and phrases Acquired A disease of the immune system due to infection with HIV. HIV destroys the Immunodeficiency CD4 T lymphocytes (CD4 cells) of the immune system, leaving the body Syndrome (AIDS) vulnerable to life-threatening infections and cancers. Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV infection. To be diagnosed with AIDS, a person with HIV must have a CD4 count less than 200 cells/mm. Antiretroviral therapy Combination Therapy Combined Antiretroviral Therapy, and Highly Active Antiretroviral Therapy. The daily use of a combination of HIV medicines (called an HIV regimen) to treat HIV infection. A person’s initial HIV regimen generally includes three antiretroviral (ARV) drugs from at least two different HIV drug classes. CD4 count A laboratory test that measures the number of CD4 T lymphocytes (CD4 cells) in a sample of blood. In people with HIV, the CD4 count is the most important laboratory indicator of immune function and the strongest predictor of HIV progression. The CD4 count is one of the factors used to determine when to start antiretroviral therapy (ART). The CD4 count is also used to monitor response to ART. Centres for Disease Control A federal agency that protects the health and safety of people at home and and Prevention (CDC) abroad through health promotion; prevention and control of disease, injury, and disability; public health workforce development and training; and preparedness for new health threats. Condoms A product used during sex (including vaginal, anal, or oral sex) to prevent the transmission of sexually transmitted infections, such as HIV, and/or the likelihood of pregnancy. The male condom is a thin rubber cover that fits over a man’s erect penis. The female condom is a polyurethane pouch that fits inside the vagina. Corporate Social The commitment of businesses to contribute to sustainable economic Responsibility (CSR) development, working with employees, their families, the local community, and society at large, to improve overall quality of life (WBCSD 2013). Economy Simply refers to the material wellbeing of the country, or more simply how rich we are. The key measure of the performance of the economy is national income, output, or GDP (Gross Domestic Product). These all refer to the same thing: the total value of goods and services produced in a country. vii Epidemic A widespread outbreak of a disease in a large number of individuals over a particular period of time, either in a given area or among a specific group of people. Human Immunodeficiency The virus that causes AIDS, which is the most advanced stage of HIV Virus (HIV) infection. HIV is a retrovirus that occurs as two types: HIV-1 and HIV-2. Both types are transmitted through direct contact with HIV-infected body fluids, such as blood, semen, and genital secretions, or from an HIV-infected mother to her child during pregnancy, birth, or breastfeeding (through breast milk). Intervention A measure taken to prevent or treat disease or to improve health in other ways. The term is used to describe the process or action that is the focus of a clinical trial. Examples of interventions include vaccines, drugs, medical devices, and palliative care. Prophylaxis Prevention of, or protection against, disease.