Regional health threats

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The provision of anti-retroviral therapy (ART) is an integral aspect of AngloGold Ashanti’s HIV/AIDS programme in the South Africa region. This follows on from voluntary counselling and testing (VCT) and attendance at the wellness clinics. The objectives of the HIV/AIDS programme, which is based on three pillars – prevention, treatment and support – are to prevent new infections and to actively care for and support those infected with HIV/AIDS.

The provision of company-funded ART was introduced in November 2002. And although studies have shown that ART is effective in extending the lives of those who are HIV-positive, this effectiveness is inhibited by the relatively poor uptake of ART on the part of employees who are clinically indicated and by employees presenting themselves too late for treatment. This is because employees are mostly unaware of their HIV-status, and this in turn is a consequence of the poor attendance at VCT. As a result, too many employees die of AIDS-related illnesses or return home on ill-health retirement.

Once a person’s HIV status is known, suitable action can be taken. Should test results be negative, appropriate behaviours can be reinforced to ensure that this status is maintained; if the results are positive, steps can be taken to delay the onset of end-stage AIDS for as long as possible by assisting with lifestyle planning, nutrition and appropriate behaviour to ensure that the person is able to lead as full a life as possible. People living with AIDS have an integral part to play in counselling, advising and demonstrating how to live a full life with AIDS. Thus, VCT is key in preventing HIV/AIDS by encouraging employees to know their HIV-status.

It is therefore a serious concern that the proportion of employees undergoing VCT is far less (32% of employees at the end of December 2005) than ideal. The company had set a target of 20% but ideally 100% of people should test. AngloGold Ashanti estimates its workforce to be 30% HIV-positive with ART being clinically indicated in approximately 20% of those infected. Again, the numbers of those attending wellness clinics and on ART are well below what they should be.

To address this issue, a concerted campaign to encourage attendance at VCT was begun at the start of 2005. This was over and above quarterly awareness campaigns and annual supervisory and induction training. In addition, AIDS co-cordinators and AIDS committees have been established at all business units in the South Africa region. A consequence of the campaign to encourage VCT has been that the monthly number of new patients embarking on ART increased steadily during the year, averaging 53 new ART patients per month in 2005, compared with a monthly average of 26 in 2004.

Although the take-up of ART is still lower than would be ideal, the outcomes for those on treatment is impressive. As at 31 December 2005, a total of 3,254 patients were enrolled in the HIV-wellness programme, 934 (29%) of whom are currently on ART. Over the past three years, of those who have begun ART, 63% remain on the treatment. Not adhering to the treatment regimes is the most frequently cited reason for not continuing with ART. Those patients who do not comply with the treatment are removed from ART as their non-compliance could lead to the development of a drug-resistant form of the HI virus which would place the entire community at risk.

The use of ART has led to significant improvements in the immune status of HIV-infected individuals. According to statistics, after two years of treatment, there is an average increase in the CD4 count from a baseline of 153 to 324. (Individuals are clinically eligible for ART if their CD4 count is less than 250, or if they have end-stage disease. The average CD4 count in an immuno-competent healthy person is in excess of 800.) Similarly, 78% of patients who begin ART have a viral load of less than 400 after two years on treatment, signifying a sustained positive response (viral suppression) to therapy for those who remain on ART. Most people currently on ART are healthy and have returned to work. In the West Wits region, 87% of patients on ART have been declared fit for work by their attending doctor and in the Vaal River region, the total is 80%. Of the patients on ART, 63% experienced only minor side-effects and just 2% of patients on ART have developed serious adverse reactions to the treatment.

Benefits of ART for the company include a significant reduction in absenteeism and in the use of health care facilities by those on ART.

Research by AngloGold Ashanti to improve its understanding of the use of ART on South African gold mines, its effectiveness, complications and the factors affecting adherence to ART, continues. Knowledge gained from this research will be applied to improve the implementation of the programme and to ensure that more of those clinically eligible take up ART. Investigations into the economic aspects, specifically absenteeism, health care costs and productivity, are also underway.

The costs of the HIV/AIDS programme for the year totalled R16.45 million: approximately R2 million for the prevention programme, R13.89 million for the treatment programme and the provision of ART, and another R2.5 million for the support programmes.