Regional health threats |
 Regional health threats (PDF
- 1.26MB)Regional health threatsReview 2005
In South Africa, HIV/AIDS is recognised as a serious threat to the health of not only employees but also their families. Globally, between 34 and 46 million people are believed to be infected with HIV, with between 25 and 28 million people infected in sub-Saharan Africa. The national HIV prevalence level in South Africa is estimated at about 11% (Source: Human Sciences Research Council (HSRC)) while UNAIDS estimate an adult (15 to 49 years) prevalence of 21.5%. The age-specific rate for men aged 30 to 34 years in South Africa is estimated to be 24% (Source: HSRC) and for women also aged 30 to 34 years, attending antenatal clinics in South Africa, 34% (Source: National Antenatal Sero-Prevalence Survey 2004). The HIV prevalence level at AngloGold Ashanti's South African operations is estimated to be in the region of 30% (about 10,000 employees), based on research undertaken in 1999 and 2000 (See graph above). Based on these estimates, the HIV prevalence level is expected to have peaked in 2005, decreasing to about 26% in 2010. However, these projections are based on the assumption that the HIV/AIDS epidemic is maturing and that the number of HIV/AIDS deaths will exceed the number of new infections. With the advent of ART, it is expected that HIV-infected employees will live longer and that the prevalence level will thus rise. However, no more accurate data is available in the absence of a company-wide testing programme, to which the unions have historically been opposed. AngloGold Ashanti has played an active role in developing programmes to combat the spread of HIV/AIDS and to deal humanely with its consequences. While the company's programme is primarily aimed at employees, in many instances, VCT and home-based care have been extended to communities surrounding operations or from which employees have been drawn. Engaging with unionsIn line with the tripartite approach to safety and health in the South African mining industry, the company has actively engaged with unions to participate in the programme. AngloGold Ashanti has in place an HIV/AIDS policy which is supported by an agreement signed with the National Union of Mineworkers (NUM), Mineworkers’ Solidarity (MWU), National Employees' Trade Union (NETU), South African Equity Workers’ Association (SAEWA) and the United Associations of South Africa (UASA) in July 2002. Both the policy and agreement provide for:
The AngloGold Ashanti HIV/AIDS ProgrammeAngloGold Ashanti's HIV/AIDS programme is managed primarily at an operational level, overseen by joint management/union committees with clinical expertise, resources and oversight provided by AngloGold Health Service (AHS). AHS provides a comprehensive medical service to AngloGold Ashanti's employees at on-mine clinics, occupational health centres and two world-class hospitals. The company's HIV/AIDS programme has as its aim the reduction of new infections, and the efficient management of those already infected. To achieve these objectives, the programme is based on three fundamental pillars: prevention, treatment and support. PreventionThe primary aim of this segment of the programme is the reduction of the rate of new infections amongst the workforce by effecting behavioural change. A key element of the programme is to encourage employees to know their HIV status and some success was achieved in this regard during 2005 as 10,219 visits were recorded at AngloGold Ashanti's VCT centres, an increase of 150% on those recorded in 2004. By the end of December 2005, 32.4% of the workforce had undergone VCT, 22% of whom tested positive for HIV while 78% were HIV-negative. Importantly 77% of those who underwent VCT in 2005 had the test taken for the first time. This follows the introduction of a comprehensive strategy to increase VCT uptake in 2005. At the beginning of 2005, Guidelines for the Business Unit Prevention programmes were distributed and implemented at all of the South African business units. These guidelines address:
The business unit line managers are accountable for these programmes, although they receive technical support from AHS. AIDS co-cordinators and AIDS awareness committees have been established at all business units with awareness campaigns run on a quarterly basis, supported by annual induction and supervisory training in respect of HIV/AIDS. These committees comprise both management and union representatives and generally meet on a monthly basis to discuss issues of concern, evaluate the current programme and plan for special events. Greater emphasis was placed on the training of peer educators during the year, with 265 new peer educators being trained. (See case study: New impetus for peer education to combat HIV/AIDS.) In 2005, 2,844 cases of STIs were treated by AHS during the year, a decrease of approximately 18% on the number recorded in 2004. This may be as a result of the prevention campaigns, but may be an indication that employees are receiving treatment elsewhere. TreatmentCentral to the campaign is the effective management of those already infected with the HI virus. The programme includes early identification of the disease, prophylactic treatment for opportunistic infections and ART where appropriate. The company has provided wellness clinics for HIV-infected individuals since 1999, with the provision of anti-retroviral therapy having been introduced in November 2002. During 2005, 1,267 employees were registered for the first time on AngloGold Ashanti's Wellness Programme, an increase of 35.5%. The cumulative number of employees remaining registered with the Wellness Programme by the end of 2005 was 3,254. A major challenge facing the company is that, although these facilities and services are provided free of charge to employees, there are still large numbers of employees who are not undergoing VCT at an early stage of the infection (that is before they become ill) and who then present themselves too late for the effective provision of ART. While the number of HIV-infected patients attending the treatment programmes remain slower than desired, the programme has shown significant success with steady improvements in the immune status of HIV-infected individuals. (See case study: Delivering ART at AngloGold Ashanti.) In 2005, 653 employees were enrolled in the ART programme for the first time, bringing the cumulative total of employees currently on ART to 934. Importantly, 63% of those who started ART remain on the treatment. The majority (87% at West Wits and 80% at Vaal River) of those employees currently receiving ART are healthy and have returned to work. SupportThe third pillar of the HIV/AIDS programme is that of support. This starts with the appropriate placement of personnel through objective assessment (physical and functional work assessment – see Report to Society 2004) and early retirement on the grounds of ill-health for individuals unable to continue working. This is followed by palliative care where possible. In 2005, 274 employees in West Wits applied for and received ill-health retirement benefits from the company although not all of these applications can be ascribed to AIDS. Also during 2005, 225 employees were known to have died in hospital from AIDS. AngloGold Ashanti is involved in numerous home-based care programmes for employees who are AIDS-ill, including the TEBA Home-based Care, Carletonville Home- and Community-based Care, North West Hospice, Bambisanani Home-based Care and Rudo Home-based Care. See (case study: Into the community – home- and community-based care) and (case study: New lease on life for Lusikisiki Village Clinic.) HIV/AIDS research projectsAngloGold Ashanti together with Aurum, has been involved in a wide range of research projects aimed at improving understanding of the disease and, in particular, the use of ART specifically in the mining environment. In 2005, six research projects related to ART were undertaken by Aurum (see box on Aurum in the Occupational Safety and Health section). These include:
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Management of HIV/AIDSThe management of HIV/AIDS differs from country to country. While HIV/AIDS prevalence levels in Namibia are at similar levels to those found in South Africa, the prevalence level amongst employees at Navachab mine is estimated at about 8%. The mine's on-site clinic provides VCT and ART as part of an integrated HIV/AIDS management campaign. In 2005, 42 employees underwent VCT and a cumulative total of three employees were on ART. In Guinea, for example, a national HIV/AIDS Committee oversees the work done by individual companies, national organisations and NGOs. At the Siguiri mine, the Comity SIDA Enterprise SAG, a committee comprising members of management, the union and local authorities has developed an action plan in respect of the management of HIV/AIDS. In Ghana, a policy was developed under the auspices of the Ghana Employers' Association and the Ghana AIDS Commission. Although there is no formal VCT centre, the Iduapriem mine clinic is equipped to undertake VCT and undertook four tests in 2005. There are no confirmed cases of employees infected with HIV at Iduapriem. In 2005, the main thrust of the mine's HIV/AIDS programme was the distribution of condoms and the training of 35 peer educators. At Bibiani a company specific policy has been in place since 2000. The on-mine medical officer is charged with oversight of the HIV/AIDS programme, the main thrust of which is aimed at the prevention of infection. A monthly message is communicated to employees by the on-mine peer educators, HIV/AIDS messages are printed on all pay slips, and the monthly company newsletter has a dedicated HIV/AIDS column. An HIV/AIDS talk is given at the clinic each day and condoms are freely available to employees. The clinic also treats all STIs and encourages the treatment of partners of those present with STIs. The on-mine clinic also provides VCT free of charge to employees and their dependants and at a highly subsidised rate to community members. Since December 2004, when the VCT programme began, 24 tests have been done. Although there is no formal wellness programme, two employees are on ART. At Geita in Tanzania, HIV and STI prevention and management programmes are provided in a combined effort between the company and the African Medical and Research Foundation (AMREF). (See box below.) Based on a cross-sectional survey conducted by AMREF in 2004, the prevalence level is in the region of 9.4% for male mine workers and 16.2% for female mine workers. At Morila in Mali, an HIV/AIDS policy is in place that addresses the needs of employees and their dependants. In 2005, the programme at the mine included the recruitment of a community health educator, the provision of HIV testing kits, community peer educator training and specific awareness events (such as World AIDS day), condom distribution and training. The mine employs 19 peer educators, which is a ratio of 1:78. A list of the identified HIV/AIDS stakeholders, as well as the nature and frequency of interactions with them may be found on the website. HIV/AIDS programmes at GeitaThe Geita mine works closely with the African Medical and Research Foundation (AMREF)*. The mine's strategy is based on a policy that was drawn up in consultation with a wide range of stakeholders. While the mine's own clinic provides medical services, the bulk of the programme is administered by AMREF through funding from the mine. AMREF's brief is to provide services to both mine employees and their dependants and community members. On-mine activities include:
Community-based activities include:
The AMREF-operated HIV centre is located in the centre of the town of Geita in an old bus station building. Its services are promoted within the company through the peer health educator network, and awareness workshops. The provision of ART at Geita District Hospital started in June 2005, with about 80 people currently on treatment. The cost of the ART programme is borne by the Tanzanian government as part of its national roll-out of ART. However, the initial costs related to the roll-out, capacity building and equipment for the hospital in the town of Geita to be certified as an ART centre, was provided by Geita mine as part of the annual Kilimanjaro Challenge (See Report to Society 2004.) *AMREF is an NGO whose mission is to improve the health of disadvantaged people in Africa as a means for them to escape poverty and improve the quality of their lives. This mission determines that AMREF works in six areas of focus: STIs, safe water and basic sanitation, family health, training and health learning materials. For more information see www.amref.org. MalariaThe following table records the objectives set for 2005 and performance achieved against these objectives.
Malaria remains a significant risk for the AngloGold Ashanti operations in Central, West and East Africa, namely at Morila, Sadiola and Yatela in Mali; Siguiri in Guinea; Obuasi, Iduapriem and Bibiani in Ghana; and Geita in Tanzania. The disease has assumed epidemic proportions in many of these countries because of ineffective national control measures and despite the active intervention of international NGOs. The disease is a major cause of death in young children and pregnant women but also gives rise to morbidity and absenteeism in adult men. AngloGold Ashanti aims to implement integrated malaria control programmes at each of these operations. Such a programme comprises:
Integrated Malaria Management Programme
The malaria lost-time injury frequency rate (MLTIFR) is expressed as the number of cases due to malaria for every million man-hours worked. This allows the rate to be compared with the conventional LTIFR and clearly demonstrates the negative impact malaria has on productivity and health in the workforce. Malaria incidence rates are expressed as a percentage of employees affected by malaria in a given period. Because of seasonal changes in malaria incidence, this is usually reported as a quarterly rate. Integrated malaria control programmes have been successfully implemented at Sadiola, Yatela and Morila and malaria incidence rates have declined over time. The integrated malaria programme planned for Obuasi (See Report to Society 2004) was delayed until the first quarter of 2006. (See case study: Integrated malaria campaign at Obuasi under way.) A campaign is being implemented at Bibiani in Ghana. (See case study: Malaria study at Bibiani.) A malaria audit was recently undertaken at Siguiri in Guinea, and an appropriate programme is being developed. In the interim an entomology study has been commissioned.
Other regional health risksAt Siguiri in Guinea, the company has implemented a campaign to overcome cholera. (See case study: Anti-cholera campaign at Siguiri benefits communities.)
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