We report on our performance in 2006 against the relevant business principle.
The major public health threats facing AngloGold Ashanti operations – HIV/AIDS and malaria – are found principally at our African operations. HIV/AIDS poses the biggest challenge at our operations in South Africa, but is also a concern in Namibia and Tanzania, where prevalence levels are higher than at our west and central African operations in Ghana, Guinea and Mali.
Malaria represents a significant risk at the west and central Africa operations in Ghana, Guinea, Mali and Tanzania.
In Guinea, where cholera is endemic, a campaign is being implemented to overcome the disease at AngloGold Ashanti’s operation there.
Although an accurate survey of prevalence levels cannot be conducted, it is estimated that prevalence levels of HIV/AIDS have remained stable at around 30% of the workforce in recent years at the South African operations (2005: 30.0%; 2004: 30.24%). These estimates are based on best available information that includes regional antenatal data and extrapolations from comparable reference groups. The provision of anti-retroviral therapy (ART) – which was introduced in November 2002 – will, over time, logically lead to a higher prevalence rate than would otherwise be the case as infected individuals live longer than they would without ART.
The overall aims of the HIV/AIDS programme are to prevent the spread of infection, to care for those infected or affected by the disease and to provide support to both employees and communities. The programme, which is an integral part of the ‘wellness in the workplace’ initiative under way at the South African operations, aims to reduce the number of new infections and efficiently manage those already infected. (See Occupational health and safety section).
In 2006, the focus remained on the continued implementation of the programme. There was some measure of success and there is an indication that most employees have a clearer understanding of the structure and purpose of the HIV and AIDS programme. The programme model used in the South African operations has been effective in its simplicity in empowering individuals to make the decision to find out about their HIV status.
Each business unit participates in the prevention programme and various VCT initiatives, and now has its own workplace HIV/AIDS programme which it runs and manages. Technical support is provided by AngloGold Ashanti Health and the treatment programmes, including ART, are managed by the health service.
Prevention: Although a key aspect of this is VCT, it also includes induction training, peer education, awareness campaigns, information feedback sessions to the business units, condom distribution and the treatment of sexually transmitted infections (STIs).
The most notable achievement of 2006 was the increase in the uptake of VCT. In 2006, 23,389 encounters were recorded at VCT centres which, assuming single annual testing, is equivalent to 75% of the South African employee base. This was an increase of 129% on the 10,219 encounters recorded in 2005, and exceeded the target of 40% set for the year. Given the total anonymity of the administrative system, there is no way of monitoring repeat visits. However, indications of repeat visits are low.
While employees are encouraged to attend VCT once a year, those who attend VCT and whose sexual behaviour is considered to be high risk are encouraged to attend more frequently. The 2006 data compares with VCT rates of 32.4% and 10% in 2005 and 2004 respectively. Of those who underwent VCT, 79% were HIV-negative and 21% HIV-positive. The reluctance to be tested by those at higher risk of being HIV-positive is problematic and may explain why the rate of those testing positive is less than the estimated overall prevalence rate. (See case study: VCT, key to success of HIV/AIDS programme, and an example of this programme in practice in the case study: Prevention and VCT at TauTona – Progress made in 2006.)
In all, 265 peer educators were trained in 2006, bringing the total trained over the past two years to 530. This gives a ratio of one peer educator for every 59 employees (compared with 1:115 last year), and compares favourably with the target set for the year of 1:60. The peer education programme is aimed primarily at promoting awareness of HIV, including knowledge of HIV status, and lifestyle and behaviour change.
Condom distribution continued and close on 1.22 million male condoms were distributed during the year (2005: 520,000). Female condoms are now available for distribution at all AngloGold Ashanti operations in South Africa.
A new VCT centre was opened at the West Wits satellite training centre in Carletonville on 1 October 2006. Initially operated on a part-time basis, its services will be available on a full-time basis as from the first quarter of 2007.
Treatment: Corresponding with the increased uptake of VCT, there was an increase in attendance at the wellness clinics and in enrolment for anti-retroviral therapy (ART). A total of 4,513 patients were registered on the wellness programme as at the end of December 2006, with 1,467 (33%) of these on ART. Altogether 1,252 employees enrolled for the first time at the wellness clinic during 2006, and 617 new patients began ART during the year. This compares with new enrolment at wellness clinics of 1,267 and 630 on ART in 2005.
The number of new patients who started ART in 2006 (expressed as a rate per 1,000 employees at the South African operations) has remained stable year-on-year. The cumulative number of employees registered at wellness clinics as at the end of 2006 was 4,513, or 15% of all employees, and the cumulative number of employees maintained on ART was 1,467 or 5%.
Records show that 66% of patients who begin ART remain on treatment. The most frequently-cited reasons given by those who do not remain on treatment are non-adherence to treatment regimes (about a third) and employees leaving the company (another third); the remaining third cease treatment for a variety of reasons including death. AngloGold Ashanti Health provides three months of ART to employees who leave the company, and who could benefit from ART, and endeavours to facilitate the referral of individual patients to a government clinic in their community for ongoing treatment, care and support. The number of employees leaving the company may seem disproportionately high but this has been significantly influenced by the down-sizing at the operations during the year. Reasons for leaving include retirements, retrenchments, resignations, dismissals, and ill-health retirements.
The prognosis for those on ART remains good and monitoring of their progress indicates that viral suppression rates are being controlled by ART. 80% of those on ART have viral loads of less than 400 after six months of treatment and these viral suppression rates are maintained after two years on treatment. In addition, once ART has begun, the CD4 count rises steadily from a mean of 167 to a mean of 373 after two years of treatment. Some 80% of patients attending wellness clinics have been declared fit for work by their attending clinician.
The total cost of providing ART is R1,290 per patient per month. This includes monthly drug costs of R470 per patient. (See box on the Economic impact of HIV/AIDS on the South African operations)
Provisional results from research being conducted into the economic costs of the HIV/AIDS epidemic indicate that absenteeism has declined significantly with the provision of ART from a mean sick leave rate of seven days per month for employees starting ART, to two days per month after one year on ART. There has also been a similar decline in the use of health care facilities for the majority of those on ART.
With the increase in the participation of VCT and attendance at wellness clinics, there has been an increased workload at clinics. AngloGold Ashanti Health has budgeted to employ five additional members of staff in 2007 – three in the Vaal River region and two in the West Wits region.
Assuming an ideal annual VCT testing rate of 100% of employees, and an HIV/AIDS prevalence rate of 30%, and assuming that 25% of HIV-positive employees require ART, then the actual proportion of employees reached versus expected is 75% for VCT, 50% for the wellness clinic and 63% for ART.
Support: In terms of support, the focus is on providing palliative and home-based care for the AIDS-ill who retire from AngloGold Ashanti’s employment. This support extends to families and includes counselling and support groups, assistance with home-based palliative care and, where appropriate, the care of orphans in households headed by children or grandparents.
AngloGold Ashanti has formed partnerships with several home-based care programmes in the areas around its operations in South Africa. For example, the Carletonville Home-based Care Programme has 530 people enrolled in support groups, 90 patients receive palliative care and 513 orphans in households headed by children or grandparents are being cared for. Furthermore, a total of 126 former employees receive care from Teba Home-Based Care which is supported by AngloGold Ashanti and other mining companies operating in southern Africa.
The death rate of employees in service at the four largest business units at the South African operations has been declining over the past three years. There has also been a decline in medical absenteeism amongst those on ART. A key contribution to these declines has been the increased uptake of ART.
Expenditure related to the chronic disease management of HIV-infected employees (including the provision of ART), VCT, home-based care for terminally ill ex-employees, and certain programme-related research, monitoring and evaluation, amounted to R21.5 million in 2006 (2005: R16.45 million). This included R2.6 million which the AngloGold Ashanti Fund contributed to HIV/AIDS-related community projects.
Although the prevalence levels of HIV/AIDS are not as high at our other African operations as in South Africa, the disease does have an impact on employees and their communities. HIV/AIDS-related programmes are in place at operations in Ghana, Guinea, Mali, Namibia and Tanzania, to contain and lessen the impact of the disease. The management of HIV/AIDS differs from country to country and depends on the respective prevalence levels.
Ghana: An HIV/AIDS policy was developed under the auspices of the Ghana Employers’ Association and the National AIDS Commission in Ghana. According to the commission, the national prevalence rate was 3.1% in 2004 and 2.6% in 2005 (Sentinel Survey 2005) which is similar to those levels prevailing in the region of Iduapriem (2.7%) and of Obuasi (2.8%).
While there is no formal VCT centre at Iduapriem, the mine clinic is equipped to undertake VCT. Iduapriem, Ghana Goldfields Limited and the Ministry of Health collectively launched a VCT centre at a local government hospital on 18 January 2007. As part of the mine’s HIV/AIDS programme, condoms are distributed with pay slips.
Guinea: A national HIV/AIDS Committee oversees work done by individual companies, national organisations and NGOs. At the Siguiri mine, the Comité SIDA Entreprise SAG, a committee comprising members of management, the union and local authorities, has developed an action plan for the management of HIV/AIDS. The national prevalence level is estimated at 3%.
Mali: The national incidence of HIV/AIDS is relatively low at 3.5%. The state manages HIV/AIDS and patients are attended to at state hospitals which also provide ART if necessary. Known cases of HIV/AIDS at Sadiola make up 1.2% of employees. Four peer educators are provided by a local NGO.
An HIV/AIDS policy is in place at Morila to address the needs of employees and their dependants. Although VCT is not offered, condoms are available with 53,020 male condoms and 2,520 female condoms having been distributed during 2006. 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 18 peer educators, to give a ratio of 1:188.
Namibia: Although HIV/AIDS prevalence levels in Namibia are similar to those in South Africa, the prevalence level among employees at Navachab mine is estimated to be far lower – at about 8%. However, most of the workforce is young and at risk of contracting HIV/AIDS. An on-site clinic conducts an integrated HIV/AIDS management campaign and provides both voluntary counselling and testing, and anti-retroviral therapy. In 2006, 36 employees underwent VCT (2005: 17) and a cumulative total of five employees were on ART. A wellness committee with representatives from management, peer educators and the union is to be established in 2007.
Tanzania: According to the Tanzanian Commission for AIDS (TACAIDS), the national HIV prevalence in Tanzania is estimated to be 6.5%; in the Mwanza region where Geita is located, prevalence rates are estimated to be higher, at 15% to 20%. Geita and the African Medical and Research Foundation (AMREF) have joined forces to provide HIV and STI prevention and management programmes to both mine employees and the community. Data gathered at the AMREF VCT centre in Geita indicate that the overall HIV prevalence of attendees is 12.4%, with that of women being 19.6%, the community at large, 12.8%, and mineworkers, 6.5%. A total of 2,283 HIV tests were conducted (2005: 2,186) and 123 of those who attended VCT were mineworkers.
AMREF’s budget for 2006 was $100,000, which covered education campaigns, the provision of sexual health services, HIV test kits and care and support of those infected with HIV. The total cost of providing VCT and other sexual and reproductive health services was around $40,000. The planned budget for 2007 is $144,207.
Peer educators at the mine conducted 120 formal sessions during the year and reached 2,777 people; an additional 1,211 were reached informally. Plans are under way to increase the number of peer educators so that the ratio to employees increases to 1:100, in line with AngloGold Ashanti’s group recommendation.
At Geita, 10 people are currently receiving ART and a local non-government organisation, GDH, was awarded a grant of Tsh250 million from USAID in December 2005 for the expansion of HIV/AIDS care and treatment provided, to improve the infrastructure and to improve the provision of care given to those living with AIDS.
The annual Geita Kilimanjaro climb attracted 51 people and $260,000 was raised for HIV/AIDS projects in Tanzania. (See case studies Report to Society 2003, Climbing Kilimanjaro – an AIDS initiative, and Report to Society 2005, Caring for orphans and orphanages.)
Malaria remains a significant risk for the operations in Ghana, Guinea, Mali and Tanzania. Despite the active intervention of international NGOs, the disease has assumed epidemic proportions in these countries, largely a result of ineffective national control measures. The disease is a major cause of death in young children and pregnant women, and also gives rise to morbidity and absenteeism in adult men.
AngloGold Ashanti is in the process of implementing integrated malaria control programmes at each of the operations in these countries. Such a programme comprises:
The malaria lost-time injury frequency rate (MLTIFR), expressed as the number of cases (incidents) due to malaria for every million man-hours worked, 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.
Ghana: The incidence of malaria and the MLTIFR in 2006 have declined significantly to below 50% of 2005 rates. Implementation of the integrated malaria programme at Obuasi. (See case study: Successful implementation of campaign at Obuasi halves malaria incidence rates) began during the course of 2006 and includes the main features of the vector control programme as discussed above.
A malaria control centre has been established at Sansu, a suburb in the town of Obuasi, to serve as the headquarters for the Obuasi programme and as a training centre for group malarial projects being run at other AngloGold Ashanti mines and for other companies operating in Ghana. The control centre will also function as a satellite research centre and will be equipped with the necessary supporting infrastructure. The insectary is operational and satellite mosquito stations have been established. AngloGold Ashanti is sponsoring the resident entomologist’s doctoral studies at the University of the Witwatersrand in South Africa.
As the success of this campaign, which is a partnership with the community, depends on its acceptance by the community, presentations have been made to a range of stakeholders and interested parties. Around 150 community malaria advocates have been appointed to educate people on how the environment can be changed to prevent the breeding and harbouring of mosquitoes. These advocates will also assist in communicating with communities during periods of indoor residual spraying.
Use was also made of media, local radio stations, banners and leaflets to communicate with the community. Support for the programme was also received from local agencies and the local director of health. In addition, the official launch of the programme was attended by the President of Ghana and the King of the Ashanti. A presentation on Obuasi’s malaria programme was made to the Ghana Chamber of Mines.
The programme began with the training of spray teams and led to the creation of 125 additional jobs – including spray team supervisors – who, after stringent selection, have undergone extensive training. All positions created were filled by people from the local communities and villages.
Residual indoor house spraying began in April 2006 (spraying is to take place twice a year) and 134,000 structures were sprayed in the first round, of which 27,000 were dwellings; another 34,000 houses were sprayed in the second round which was completed in December 2006. The insecticide being used for spraying is approved by the World Health Organization (WHO).
The choice of an organophosphate insecticide for residual house spraying at Obuasi was based on entomological baseline studies performed by the National Institute for Communicable Diseases, based in Johannesburg, which showed significant resistance by resident mosquitoes to the standard insecticides recommended by WHO for malaria control, with the exception of the organophosphate group. These insecticides are expensive, difficult to apply and are potentially toxic to spraymen in high concentrations. For this reason a code of practice was developed to ensure that adequate medical surveillance was carried out on this group of employees. During 2006, two rounds of house spraying were completed using organophosphates and during 2007 house spraying will continue use standard pyrethroid insecticides. As part of this programme, around 6,000 nets were also purchased and distributed to high-risk areas such as orphanages, maternity clinics, and children and maternity wards at hospitals.
The Noguchi Institute at the University of Ghana completed a baseline study on parasite prevalence study at Obuasi, the results of which will be used to measure the success of the spray campaign.
At Iduapriem, there has been a decrease in the incidence of malaria from 11.1% to 8.6%.
| Obuasi | Iduapriem | |
|---|---|---|
| 2006 | 435 | 388 |
| 2005 | 1,477 | 416 |
Guinea: A malaria entomological audit was recently undertaken at Siguiri in Guinea, and an appropriate programme is being developed to combat the disease. The MLTIFR at this operation was 379 in the third quarter of 2006. Continued health education and the provision of clean water at the mine are being used in the fight against cholera.
Mali: Management of malaria at Morila is based on information obtained from WHO and the use of external consultants. There has been a sharp decline in the incidence of cases of malaria in 2006 to 103 from 314 in 2005, largely attributable to the twice-yearly spraying of houses and the annual re-impregnation of mosquito nets with insecticide. This is an incidence of 1.2%. The actual cost for the year of the vector programme at Sadiola was $90,365 (excluding treatment costs). The programme includes the following:
| Sadiola/Yatela | Morila | |
|---|---|---|
| 2006 | 46 | 66 |
| 2005 | 51 | 138 |
At Morila, there has been a marked improvement following the introduction of a new insecticide. The number of malaria cases declined from 425 in 2005 to 329 in 2006. The overall strategy here emphasises the use of prophylaxis by expatriates, information leaflets and an effective drug regimen. A two-year insecticide resistance study is currently under way on the use of pyrethroids and indications are that this is proving very effective. Integrated malaria control programmes have been successfully implemented at Sadiola, Yatela and Morila, and malaria incidence rates at these operations have declined over time.
Tanzania: The reported incidence of malaria at Geita during 2006 was 10.5%, which compares with 7.3% in 2005. Insecticide treated nets were distributed to employees and the community during the year, and a campaign for early and effective treatment using reliable anti-malarial medication was begun. This is in line with the national malaria policy in Tanzania. An integrated programme of malaria control, similar in content to that being conducted at Obuasi, and involving the mine concession area as well as Geita Town, has been developed and approved for implementation during 2007.
| Geita | |
|---|---|
| 2006 | 308 |
| 2005 | 194 |
Other regional health risks include cholera in Guinea (See case study in Report to Society 2005, Anti cholera campaign at Siguiri benefits communities), and a potential outbreak of avian flu, on AngloGold Ashanti establishes avian flu task force).
AngloGold Ashanti Annual Report 2006 - Report to Society