HIV/AIDS and Malaria

Note that the information relating to HIV/AIDS is for the group's South African operations only, which accounts for 69% of the workforce and is the region in which HIV/AIDS is the most significant regional health threat. Where this report has been extended to cover the other regions in which AngloGold Ashanti operates, this is specifically indicated.

HIV/AIDS policy and agreement

AngloGold Ashanti's HIV/AIDS policy is contained in an agreement signed with all recognised trade unions in July 2002. Embodied within this agreement are the principles of:

• non-discrimination;
• confidentiality and non-disclosure
• benefits applicable, and
• rules governing ill-health retirement.

While the provision of anti-retroviral therapy (ART) was not part of the original agreement, trade unions participated in the ART programme from inception through the project's steering committee and ethics forum.

Efforts have been made to engage with the primary union, the National Union of Mineworkers (NUM) to undertake an HIV-prevalence survey amongst employees, linked to a behavioural study. This information would be used to plan for and implement appropriate changes to the current programme. No progress has been made in this regard as the company has been unable to convice the NUM that this will be to the benefit of the company and employees alike.

Governance and structure

AngloGold Ashanti's HIV/AIDS programme is managed at both a clinical and operational level, and overseen by a joint management/union committee (See diagram below.)

The clinical expertise, resources and oversight is provided by AHS. AHS provides a comprehensive medical service at on-mine clinics, occupational health centres, and two world-class hospitals. These services are complemented by the research undertaken by Aurum Health, a subsidiary of AHS. Included as part of the AHS service is the company's voluntary counselling and testing (VCT) and wellness programme which includes the provision of ART. Since the health care service is managed independently of the mining operations, this promotes the confidentiality of the medical programme.

In addition to centralised education, training and management initatives undertaken under the auspices of AHS, each operation has a joint management/union HIV/AIDS committee that oversees the implementation of mine-based programmes, and raises any issues of concern.

Management of HIV/AIDS in South Africa

Prevalence levels

An anonymous unlinked survey undertaken in 1999 indicated an HIV prevalence level amongst AngloGold Ashanti employees of 24%. (See Report to Society 2003). This was followed up by a second survey in 2000/2001 undertaken in collaboration with the London School of Hygiene and Tropical Medicine which indicated a prevalence level of 29%. Based on these surveys, provincial ante-natal data and extrapolation from comparable reference groups, AngloGold Ashanti's current best estimate of prevalence levels amongst employees is 30.24%. Through actuarial modelling, the company is able to project prevalence levels going forward. In terms of this model (see graph), prevalence levels are thought to have peaked in 2004. However, without a scientifically-based survey, these numbers cannot be confirmed. Based on the current stance of the NUM on anonymous testing, such a survey is not likely to be conducted within the forseeable future.
 

The AngloGold Ashanti HIV/AIDS programme

The AngloGold Ashanti HIV/AIDS programme comprises five parts: education and training; voluntary counselling and testing (VCT); a wellness programme (including ART); ill-health retirement for employees who become AIDS-ill; and home-based and community-based programmes.

Education and training

Education and training is conducted at mine-level and is aimed at informing and changing behaviour. Issues dealt with include prevention of infection, the benefits of the VCT and wellness programmes (including ART) and ill health retirement. Education and training is aimed at those who are HIV positive, those who are not, and those in supervisory and management positions who deal with the ill-health consequences of the epidemic in the workplace.

A wide variety of communication media are used, including peer education and industrial theatre. Education and training is supported by condom distribution and STI management in the workplace and in the community, particularly amongst women at high risk.

Voluntary counselling and testing (VCT)

Free and confidential VCT has been offered to all employees since March 2001 at 19 VCT centres across the group. VCT usage has steadily increased over the years and is now also offered to dependents. In total, 4,071 tests were undertaken in 2004 at the AHS centres, bringing the cumulative total number of tests undertaken by AHS to 10,317 at year-end.

Wellness programme

A comprehensive Wellness programme was introduced in 1999, and since November 2002, this has included ART for those employees who are HIV positive and whose clinical condition meets the World Health Organization's medical guidelines for starting ART. (See case study: Success reported with ART implementation, although uptake still slow.)

The aim of the programme is to extend the productive life of the employee as long as possible. (See case study: Wellness Clinic at West Vaal hospital.) Treatment is undertaken on an out-patient basis as is customary for other chronic diseases. Opportunistic infections are managed through early detection as well as the prescription of prophylaxis (against TB for example). All employees have unlimited hospitalisation benefits. Nutritional and lifestyle counselling and psycho-social support is also provided to the employee and his or her family as part of the Wellness programme. 935 employees enrolled in the wellness programme in 2004; 849 employees were treated with ART as at the end of December 2004.

It must be stated that the extent of take-up of ART by prospective patients is lower than anticipated at the start of the programme. Estimations are that, more than two years after the launch of ART at AngloGold Ashanti in South Africa, no more than a quarter of employees for whom ART would be medically indicated have taken up the treatment. In most cases, these employees have not come forward for VCT and participation in the Wellness programme.

This is a trend apparent in other large scale ART programmes, such as, for example, those in the broader Anglo American group and the South African government's programme which is also failing to meet planned levels.

There are likely a multiplicity of causes, some of these inter-related, including the phenomena of stigma and denial, shortcomings in community and political leadership, and less than optimal communication and education efforts on the part of AngloGold Ashanti. Whatever the reasons may be, it remains a major challenge for this company and for society as a whole.

Ill-health retirements

A medical incapacitation process may be initiated by the employee, fellow workers or supervisors, medical or human resources practitioners. This process is exactly the same for any chronic illness that has permanently impaired an employee from carrying out his/her normal work duties. It seeks to find an alternative job placement within the employee's limitations, failing which the employee is ill health retired. The number of ill-health retirements* continued to rise during the year to 22.7 per 1,000 employees (15.2 in 2003). The untested assumption is that increasingly, employees with HIV infection are progressing to AIDS-illness and debilitation, but remain reluctant to acknowledge their status and seek treatment. Of those employees who were ill-health retired in 2004 due to a terminal illness, 71.6% were known to be terminally ill as a consequence of AIDS**.

The number of deaths*** per 1,000 employees has decreased marginally at 12.5 per 1,000 in 2004 (12.9 per 1,000 employees in 2003).****

Community-based programmes and home-based care

Community-based prevention interventions target high-risk populations in the two regions surrounding AngloGold Ashanti mines. AngloGold Ashanti provides home-based care for employees with AIDS through a wide range of partnerships, both in the communities surrounding its operations and the traditional labour sending areas. The latter is done particularly through TEBA, which provides both palliative care to the terminally ill and support for the bereaved families, assisting them in accessing financial and welfare support.

Community and home-based care organisations supported by AngloGold Ashanti in 2004

Number of ill health retirements per 1,000 employees - SA region

Deaths per 1,000 employees  SA region

HIV/AIDS programmes at the Africa operations (outside of South Africa)

While the prevalence of HIV/AIDS is not as high in countries such as Ghana, Mali, Tanzania and Namibia, the disease has had - and continues to have - an impact on both AngloGold Ashanti employees and their families in these areas. While AHS is becoming increasingly involved in directing these HIV/AIDS programmes, strategic direction and service delivery is managed on-mine, frequently involving other partners.

At Geita, in Tanzania, HIV and STI management has long been provided in collaboration between Geita and the African Medical and Research Foundation (AMREF) (See case study: Geita gold mine and AMREF: Working together to address HIV/AIDS.) A significant development during the year was the roll-out of ART at Geita, thanks to the intervention of the partners with Government. (See box.) In preparation for this Aurum conducted a four-day course on HIV management for all clinic doctors, nurses, AMREF staff and Geita hospital staff.

Geita's awareness and training programme is extensive: Its 27 on-mine peer health educators meet on a monthly basis to discuss issues faced during the previous month. A new topic for the month ahead is discussed, fact sheets are developed and demonstrations are held. All employees are exposed to the AIDS education at induction and as part of the monthly hazard identification training.

About 50 active peer health educators provide education and training to three local villages and plans are in place to extend this to two further villages in 2005.

At the VCT centre operated in Geita Town by AMREF both employees and members of the local community are equally entitled to make use of these services. The centre offers free STI testing and treatment and free family planning services. HIV tests are charged for a rate of $0.95. (See case study: Geita gold mine and AMREF: Working together to address HIV/AIDS.)

At Morila in Mali, an HIV prevention programme is in place, and focuses on prevention rather then treatment, owing to relatively low prevalance rates. The mine enjoys good collaboration with local NGOs in respect of HIV education and infection prevention: the mine distributed some 45,000 condoms during the year.

At the Sadiola and Yatela operations in Mali, peer educator training was implemented during the year. In addition, extensive community health education was provided by the mine to more than 13,000 community members during the year.

The Navachab mine in Namibia commenced the roll-out of its ART programme for employees in April 2004. The mine's comprehensive HIV prevention campaign is supported by VCT and a wellness programme.

At Obuasi in Ghana, VCT is offered free of charge at the Edwin Cade hospital. Medical care for HIV-positive employees is also provided by the hospital. The company has developed links with both NGOs (such as Care International) and government authorities (such as the Municipal Assembly, the Ministry of Health) in education communities in respect of reproductive health (including HIV/AIDS).
  

Malaria programmes

Malaria remains the most significant public health threat for AngloGold Ashanti's operations in Ghana, Mali, Tanzania and Guinea. Not only does the disease have a significant impact on the productivity of employees, but also on the functioning of entire communities in these regions.

The group aims to implement integrated malaria control programmes in each of these regions. While good progress has been made at some operations, for example Morila, further work remains necessary at others.

Such an integrated malaria control programme comprises four elements, namely:

• Vector control. Two elements of vector control need to be undertaken:
  • First, there needs to be some degree of understanding of the problem that is being dealt with, thus mosquito identification and insecticide susceptibility tests need to be undertaken.
  • Second, indoor residual house spraying, house screening and the provision of insecticide impregnated bed nets (ITNs) is an important component of the programme.
• Disease management. Effective diagnosis and treatment underpin a successful intervention campaign, leading to a limitation of the pool of infected people at any one time.
• Surveillance and monitoring. Ongoing monitoring of both the vectors and parasites (for drug resistance) and the compilation of accurate records and reports are an integral part of the programme.
• Information, education, communication (IEC) and health promotion. Ultimately, some of the burden of the programme falls on the community and the better informed and educated they are about malaria prevention, the more likely it is that such a programme will succeed.

At the Obuasi mine in Ghana the mine hospital was reporting an average 6,000 malaria cases per month at the time of the business combination. An average of about 20% of the workforce is believed to be afflicted with malaria at any one time and the average time off work for this condition is between two and three days. If these trends are extrapolated to the broader Obuasi community of 180,000 people, the problem can be seen to be immense.

AngloGold Ashanti is embarking on a major malaria control programme at Obuasi and, following on from this, the lessons learnt and experience gained will be used to manage the disease at other operations in Ghana (Iduapriem and Bibiani) and Guinea (Siguiri).

Intergrated malaria control programme

AngloGold Ashanti has committed itself to the implementation of an integrated malaria campaign at Obuasi and, in anticipation of this, Professor Richard Hunt of the National Institute of Communicable Diseases in South Africa, a world authority on insecticide resistance, was contracted to perform a study that would inform the way in which the malaria control programme is structured.

The $1.6 million proposed programme is set to begin in mid-2005. (See case study: A scientific approach to malaria control proposed at Obuasi.)

At Geita in Tanzania, resident mosquito species were identified and insecticide resistance profiling was completed in 2004, in preparation for the development of an integrated malaria programme. (See case study: Malaria vector survey and insecticide susceptibility assay on mosquito populations at Geita mine in Tanzania.) It is estimated that presently 10% of the workforce is afflicted by malaria every month. More comprehensive, standardised reporting on the incidence of malaria (including contractor incidence) us being implemented.

An integrated malaria control programme, introduced at Morila in Mali in 2003, has significantly reduced the incidence of malaria. The current incidence of malaria within the workforce per month is 4.7%, down from 9% three years ago. Ongoing mosquito specie identification and research relating to insecticide resistance patterns are planned for 2005.

Malaria remains a significant health cost and cause of absenteeism at the Sadiola and Yatela operations in Mali. The current incidence level within the workforce per month is estimated at 10%.