HIV & AIDS

Management systems and accountability

The management of HIV & AIDS is undertaken on a regional and operational basis, with the appropriate level of resources dedicated to the threat posed by the disease. This varies from operation to operation, with the exact nature of the facilities and services provided depending on specific circumstances and requirements. Further details are provided in the operation - and country-specific reports.

The pandemic is at its worst in southern Africa, with the highest levels of prevalence estimated at the South African operations. Other countries where HIV & AIDS is of concern are Namibia, Tanzania , Guinea and, to a lesser extent,  Ghana and Mali.

AngloGold Ashanti’s response to HIV & AIDS is underpinned by the Board-approved HIV & AIDS policy and, in South Africa, is supported by an HIV & AIDS agreement between the company and various unions. Arrangements at an operational level frequently provide for joint management and union HIV & AIDS committees that oversee the development and implementation of mine-based programmes.

In many countries, HIV & AIDS-related regulations and policies are in place at a national level and the company acts in accordance with these. Where possible, the company works within government framework and structures to try and make its own programmes as relevant, accessible and sustainable as possible. In Ghana, for instance, the government has issued national guidelines for HIV & AIDS programmes. The company hospital at Obuasi is a key location in the government’s regional campaign because, since 2006, it has been a registered site of the treatment acceleration scale-up programme (TAP). TAP is a joint World Bank, African Union and Economic Commission of Africa progamme that has been implemented in Ghana.

In South Africa, oversight and implementation of the HIV & AIDS programmes are undertaken by AngloGold Ashanti Health, a wholly owned subsidiary of AngloGold Ashanti, in association with the business units and their HIV & AIDS committees.

HIV & AIDS performance statistics are reported to the Southern Africa Division executive on a monthly basis and to the Safety, Health and Sustainable Development Committee of the Board every quarter. The issues are also considered during the company’s risk management process.

In South Africa, high HIV levels in conjunction with exposure to silica dust, exacerbates the turberculosis (TB) challenge, and management systems are in place to address the diseases in a holistic way. See the discussion on TB and silicosis in the Safety and health section.

While AngloGold Ashanti recognises that HIV & AIDS continues to have a major impact on employees and the company, it also believes that this impact can be managed. The provision of anti-retroviral therapy (ART), along with the comprehensive prevention and treatment campaigns, has meant that mortality rates have declined, while absenteeism remained stable.

At the other African operations, the management of HIV & AIDS, particularly, the drive for everyone to know their status, is also led by the HIV & AIDS committees. Unions are strongly represented on these committees and the programmes have proved to be highly successful when senior management has been seen to be involved. The programmes in place are aimed at both permanent employees and contractors, and frequently extend to dependants and community members.

Where appropriate, the company works closely with non-governmental organisations (NGOs), which are well placed to offer a comprehensive, integrated and sustainable service to both employees and local communities. One such NGO is the American Medical Research Foundation (Amref) operating near the Geita mine in Tanzania. AngloGold Ashanti provides financial and other support to Amref, and meets regularly with the NGO, which in turn provides a wide range of HIV & AIDS counselling, testing and support services as part of a broader health programme to Geita employees and contractors, their dependants, and community members. Women at high risk are a particular area of focus.

Prevalence estimates

In general, the estimated prevalence levels at AngloGold Ashanti’s operations are in line with those segments the general population that are demographically similar (that is, those portions consisting largely of males of working age).

It is estimated that the HIV & AIDS prevalence level among employees at the South African operations has continued to remain stable at around 30% of the workforce. Early actuarial modelling had indicated a gradual rise in prevalence levels to a peak of 30% in 2004, declining marginally to 29% in 2008. It is anticipated, however, that the provision of ART is likely to have the effect of increasing prevalence levels by extending the productive lives within HIV-positive employees.

Prevalence levels are estimated at around 8% at Navachab in Namibia; at around 6% for men and 10% for women (based on Amref estimates) in Geita town in Tanzania. Prevalence levels measured 1% at Sadiola and Yatela, and Morila in Mali; at Iduapriem, prevalence at the mine was 1.4%, and 3.3% in the Wasa Werst district (now incorporated in the municipal area). Prevalence measured 5% at Obuasi; and 6% in the region around Siguiri in Guinea.

AngloGold Ashanti’s HIV & AIDS programme

The group’s HIV & AIDS programme aims to:

• minimise the risk of HIV & AIDS to the company and its employees by reducing, and ultimately, eliminating new infections;
• efficiently manage and treat those infected; and
• support those who are AIDS-ill.

Consequently, AngloGold Ashanti’s programmes typically comprise three components:

• first, the prevention of HIV, through various workplace initiatives, including education and training, and voluntary counselling and testing (VCT);
• treatment programmes, which comprise the clinical care of those infected, preferably through early referrals from the VCT programme into the wellness programmes, which includes the use of ART where this is indicated; and
• support for the AIDS-ill, who may leave the employ of the company and require palliative care, includes support for various community initiatives. See the case study: Investing in home-based care for Carletonville’s HIV and AIDS patients.

Prevention

Education, combined with VCT, forms the cornerstone of all HIV & AIDS programmes. Both are available at all affected operations at no cost to employees.

Extensive education and awareness programmes are aimed at developing and promoting an awareness of HIV & AIDS and its consequences, as well as an understanding of its symptoms and treatment. This understanding will enable safer sexual practices, earlier access to care if needed, and will reduce and ultimately eliminate the stigma associated with the disease. Specific training programmes cover topics that include:

• the group HIV & AIDS policy;
• methods of transmission, including links to other sexually transmitted infections; and
• safer sex and condom usage.

These programmes involve working alongside HIV-positive employees and include sharing information about the medication used.

Peer educators are employees who have received special training to educate and counsel fellow employees, in addition to their normal work responsibilities. They play an important role in education and training programmes. It is the company’s intention to have a ratio of one peer educator for every 50 employees. During 2008, 125 new peer educators were trained at the South African operations, bringing the total trained over the three-year period from 2005 to 2008 to 749, giving a ratio of 1:46. It is the company’s intention to recruit and train additional peer educators in 2009. The ratio at Geita, which has an active peer educator programme, is 1:60.

Training material linked to HIV & AIDS is provided in a variety of languages and media to ensure that all employees are reached. At the Siguiri mine in Guinea, for example, extensive outreach campaigns are undertaken in local villages and make use of the local radio station, Siguiri fm. Condoms are freely available to employees.

VCT is undertaken in a strictly controlled, confidential environment that provides pre- and post-test counselling, and advice on further treatment options. Confidentiality and commitment to the fair treatment of individuals are enshrined within group policy and, in South Africa, in operation-level agreements with unions.

AngloGold Ashanti HIV & AIDS programmes – African operations*

	Employees	Employees' families	Community members
Education and training	Yes	Yes	Yes
Counselling	Yes	Yes	Yes
Prevention (risk control)	Yes	Yes	Yes
Treatment	Yes	No	No

^*Note that there are variations in the programmes from mine to mine, depending on the risk of the disease, the n been tested, (2.5%) were eeds of the communities and the facilities available in the communities.

Given that knowing one’s status is the key to treatment, a great deal of emphasis is placed on VCT, and some successes were recorded during the year as underlined below.

• In South Africa, 33,589 VCT encounters were recorded during the year (2007: 33,435) and, assuming single testing, this indicates that around 99% of the South African workforce was tested during the year (2007: 102%). Some employees tested more than once – it is known that 32% had two or more tests. Of the 68% who had single tests, 14% were HIV-positive and 86% HIV-negative.
  
  VCT targets have become an important part of performance management at senior levels and the various mine-based campaigns offer incentives to employees to participate. It is envisaged that in the future, with increasing levels of HIV education and awareness, the need for mass campaigns and incentivisation for testing will decrease.
• At Iduapriem in Ghana, 254 employees, out of 356 who have participated in the VCT programme, were counselled and tested at least once. This represented 71% coverage in 2008. Contract employees –numbering 630 – also participated in the VCT in 2008.
• At Obuasi in Ghana, 30% of those who participated in the VCT programme tested positive. This programme is small at present and this high prevalence level is not a true reflection of the level prevailing in the community, but more an indication that the AIDS-ill are presenting for VCT very late in the course of the disease. A number of initiatives were undertaken to increase VCT uptake, including the provision of VCT for community members at churches.
• At Geita in Tanzania, 2,265 employees and 5,132 community members participated in VCT during the year. (See box on VCT needs survey at Geita directs programme).
• At Siguiri in Guinea, almost a third of all employees on site underwent VCT during the year (1,019), with 4.2% being positive.
• At Navachab in Namibia, 96 employees participated in VCT, with all (100%) testing negative.
• At Sadiola and Yatela in Mali, data collection of VCT encounters only began in the latter part of the year. Of those known to have been tested, (2.5%) were HIV-positive.

Wellness programme

As VCT programme attendances recorded some success, so a corresponding rise in participation in wellness programmes was achieved at some operations, as those who tested positive were persuaded to understand and manage their health.

Wellness programmes vary from operation to operation but typically involve regular counselling by professional health care providers, monitoring and evaluation of an individual’s health, and advice, treatment and support regarding nutrition and the treatment of opportunistic infections.

• At the end of December 2008, there were cumulatively 5,432 participants registered on the wellness programme in South Africa (2007: 4,610 ), with 822 people having joined the programme for the first time during the year (2007: 1,182).
• At Sadiola and Yatela in Mali, medical care for those infected is provided by the mine’s medical services.
• At Geita in Tanzania, 26 employees participated in the wellness programme, with all 26 being provided with ART through the Geita government hospital. Geita, along with other mining companies, was instrumental in helping to bring government-funded ART to the local hospital.

• At Obuasi in Ghana, 150 people are now registered on the company’s wellness programme, with 55 people on ART.
• At Siguiri in Guinea, the wellness programme is run in conjunction with the local government hospital.
• At Navachab in Namibia, no employees were found to have newly-diagnosed HIV during the year, so the total number of people on the wellness programme remained at three, all of whom are on ART.

Anti-retroviral therapy

ART is available to all employees at the African operations either directly from company facilities (South African operations, Navachab in Namibia, Obuasi in Ghana, Siguiri in Guinea), through company sponsored or funded facilities (Iduapriem in Ghana, Geita in Tanzania, and Morila in Mali) or through state facilities (Sadiola and Yatela in Mali).

In South Africa, at the end of December 2008, a cumulative net total of 1,933 employees (2007: 2,061) at West Wits and Vaal River were being provided with ART through AngloGold Ashanti Health. A number of patients previously receiving ART withdrew from the programme for a variety of reasons, including poor adherence to the regimen, retirement, resignation and death. While ART is provided by the state, efforts are made to support the transition by former employees on ART to state-run facilities. See the case study: Increased ART uptake at TauTona.

Leaving the company

In 2008, a total of 1,167 employees left the employment of the company in South Africa as a result of ill health (2007: 942 in South Africa). Although not all of these separations were as a result of AIDS, it is likely that this was the reason behind most of the ill-health formal medical separations in South Africa.

A Medically Affected Employees Policy (MAEP) is in place to deal with employees who are found to be medically unfit for their current occupations. As a preference, alternative vacancies are sought, failing which the services of employees may be terminated. Employees have a right to representation in this process. To deal specifically with this sensitive issue, business units in South Africa have formed Business Unit Medically Affected Committees, which function jointly with the unions and deal with the assessment of medical incapacity.

It is estimated that 291 people died because of illness (and injury) while in the service of the company in South Africa in 2008 (2007: 285 people due to illness), with AIDS being one of the main causes of these deaths. The death rate due to illness, together with other indications of health care outcomes, has declined consistently following the company’s administration of ART. (Statistics related to deaths in service for operations outside of South Africa are not disclosed for reasons of confidentiality as the numbers are low.)

Cost of the HIV & AIDS programme

The cost to the company of HIV & AIDS is multi-faceted and complex, and involves an analysis and assessment of the costs related to absenteeism, lost productivity, skills loss, recruitment and training, insurance, sick leave, disability and ill health in the workplace, early retirement and in-service death benefits, medical aid contributions, and post-retirement liabilities.

Total expenditure on the company’s HIV & AIDS treatment programme in South Africa (excluding mine-based costs) amounted to approximately R21.36 million by December 2008. This relates primarily to VCT and wellness programmes and includes the provision of ART. The estimated total cost of providing ART in South Africa is around R1,200 per employee per month, and includes a drug cost of some R400 per employee per month.

A unique model of the impact of HIV on AngloGold Ashanti was developed by the Aurum Institute for Health Research in conjunction with the London School of Hygiene and Tropical Medicine. In addition, a study was commissioned on the cost-benefits of the ART programme to AngloGold Ashanti. (See box below).

^*This table excludes cost related to AngloGold Ashanti Health Services (outlined in the preceding paragraph) and includes the period up to December 2008.

^*HIV & AIDS expenditure is not recorded separately at Obuasi and therefore cannot be reported.

Community-based programmes

AngloGold Ashanti supports community-based HIV & AIDS programmes, directly and indirectly, both financially and in kind. In southern Africa, this support is provided directly by the operations, through AngloGold Ashanti’s corporate social investment initiatives and through Teba Development, an NGO that works directly in the communities from which mineworkers are drawn, particularly in rural areas and in countries neighbouring South Africa.

At Geita mine in Tanzania, the Post Test Club (PTC) has been formed to support those who are HIV-positive, and includes both employees and community members. Members of the PTC have been trained by Amref and this group regularly visits AIDS-ill patients to provide simple medication (paracetamol and oral rehydrants), family and individual education on care, and to discuss referrals. The group itself meets once a month. Income-generating activities have also begun.

Home-based care projects and community HIV projects supported in South Africa in 2008

A number of community-based projects were supported during the year.

• Mothusimpilo conducts prevention campaigns, particularly for high-risk individuals, in the Carletonville area.
• The Rudo Home-based Care Programme operates in Fochville.
• The Carletonville Home & Community Based Care Programme is also located in Carletonville. See the case study: Investing in home-based care for Carletonville’s HIV & AIDS patients.