Anglo-American Targets Workers' Families to Tackle HIV in

UNCLAS SECTION 01 OF 03 PRETORIA 001506

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TAGS: SOCI TBIO ECON EMIN EAID KHIV KSCA ZU SF
SUBJECT: Anglo-American Targets Workers' Families to Tackle HIV in
Mines

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1. Summary: Anglo American Plc (Anglo) has approved a country-wide
expansion of its employee HIV and anti-retroviral treatment program
(ART) for AIDS to encompass the families of its 75,000 workers.
South Africa's Business Times reported that this is the first time a
major South African company has moved on such a large scale to save
dependents of its workforce from HIV/AIDS. Anglo Senior Vice
President for Health Dr. Brian Brink confirmed to Embassy Health
Officer that Anglo has committed to extending HIV/AIDS testing and
treatment to the dependants of all employees in southern Africa who
are not covered by health insurance, but acknowledged that rollout
of the program will be slow and face many hurdles. Delivering on
this commitment is not without major logistical challenges,
especially since many employees have families living in remote rural
parts of South Africa and neighboring countries. End Summary.

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A Necessary Step
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2. Anglo estimates HIV infection rates of between 20 percent and 30
percent in the communities where its businesses are located, as well
as in the communities where its employees originate or live. This
compares with an infection rate for its workforce of 21 percent in
2006 and 19 percent in 2007, as reported in Anglo's Annual Report to
Society. Comment: Anglo noted that its 2007 numbers differ
significantly from prior years due to certain divestments in 2006
and 2007 and because AngloGold Ashanti's HIV and AIDS numbers were
not included in its 2007 report. Brink and South Africa Chamber of
Mines Medical Advisor Dr. Mohamed Randera had indicated a much
higher prevalence rate of 30 percent or more amongst mine workers in
a previous conversation with Embassy Minerals/Energy Specialist.
The 30 percent rate is in line with a survey funded by USAID and
conducted by the Center for Scientific and Industrial Research and
the Medical Research Council from 1998-2001 which found a 30 percent
prevalence rate among miners in the Carletonville mining area of
Northwest Province, South Africa. End Comment.


3. Brink commented to Embassy Health Officer that the problem at
Anglo was not that the rate of new HIV infection is getting worse,
but rather that it is not getting better. "The only way to really
tackle the epidemic is to include the employees' families in
prevention, counseling and treatment efforts. This is because a
high number of HIV negative employees return home where they may
become infected with HIV. Additionally, many HIV-positive employees
discontinue ART after starting treatment and may return home to
infect their spouses," he explained. Anglo reports that one-third
of those who start ART drop out for various reasons: 7.6 percent
due to death, 10.5 percent do not adhere to treatment and 8.4
percent leave employment. Comment: This is in accord with Brink's
prior comments to Embassy Minerals/Energy Specialist that behavior
patterns among miners had not changed despite all of Anglo's HIV
awareness programs and interventions. End Comment.


4. There are problems of identifying and locating family members,
in addition to logistical difficulties in reaching families living
Qin addition to logistical difficulties in reaching families living
in remote areas. Brink related that the initial start-up phase of
the program will concentrate on encouraging employees to identify
eligible family members. One issue is the definition of "eligible
family members," since many South Africans support large extended
families and may not be legally married to their partner. Brink
noted that Anglo will be liberal in defining who a family member is
and will accept an affidavit that the employee is obligated to
support the individual. He estimated that the program will cost
approximately $50 million rand ($6.5 million) during its initial
phase, with an estimated cost of $150 million rand ($19.5 million)
over the longer term. Brink was not certain how long it would take
to fully roll-out the program.

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Anglo: A Long History of Tackling AIDS
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5. Anglo has been tackling HIV/AIDS among its employees with a
comprehensive HIV/AIDS management program that it first announced in

2002. Many industry and public health experts consider the program
to be one of the best in the world. Anglo's program starts 150 of
the company's 28,000 HIV-positive employees on antiretroviral
treatment (ART) every month. Sixty nine percent of its estimated
13,886 HIV-positive employees were enrolled in HIV disease
management programs at the end of 2007. Of these, twenty six

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percent of HIV-positive employees (3,617) were receiving ART and
sixty nine percent (9,529) were enrolled in wellness programs.
During 2007, the company launched another major campaign to
encourage all employees to be voluntarily tested for HIV. Just over
70 percent of Anglo's 75,000 employees throughout southern Africa
underwent counseling and voluntary HIV testing (VCT). Anglo's
exploration division, which has a mobile workforce, provided VCT to
90 percent of its African-based staff. Knowledge is the major
foundation for the program and high VCT coverage enhances Anglo's
ability to gauge whether its commitment to preventing new infections
is succeeding.


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The Benefits Outweigh the Costs
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6. A study by Anglo Gold released in 2002 suggested that treatment
would add $4-$6, or up to 2 percent, to the cost of producing an
ounce of gold; but that the cost could rise to $9 per ounce if the
company failed to act. In 2002, Anglo Gold decided to provide ART
to employees where medically indicated, in advance of the South
African Government-provided ART program that followed in 2004. The
company was faced with either introducing what was deemed to be a
high-cost intervention in the form of ART, or face the reality of
rising death rates (peaking at 14 people per 1,000 employees in
2004) and the consequent impact on the company, employees and their
communities. The loss of a breadwinner in the South African context
could have an impact on more than 10 people, very often in rural and
poverty-stricken areas of Southern Africa.


7. "The benefits outweigh the cost, and Anglo has data to prove
it," according to Brink. "If you compare the year before and the
year after the company began offering the treatment, sick leave at
Anglo dropped by 69 percent and absenteeism fell by 53 percent."
Drug access and affordability have improved over the past five years
and the cost implications have not been as significant as had
originally been envisaged. Interventions with ART have increased
both the physical and economic lifespan of those affected, and have
limited the social consequences associated with the loss of a
breadwinner. In addition, outcomes to date indicate lower costs of
medical care and lower-than-expected recruitment costs. The Aurum
Institute for Health Research (another PEPFAR-funded organization)
estimated the potential economic impact of untreated HIV/AIDS on
AngloGold as part of an independent Anglo American group-wide
assessment funded by GlaxoSmithKline and undertaken by Aurum. This
study indicated that if the company did not undertake treatment the
economic impact of HIV to AngloGold Ashanti would continue to rise
from 2003 and would reach 6percent of payroll in 2006. The greatest
impacts would occur in medical care (47percent) and absenteeism (36
percent).

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Anglo Coal Confirms Benefits
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8. Anglo Coal South Africa (ACSA),a wholly owned Anglo company,
introduced its ART program in South Africa in August 2002 and became
the first mining company in South Africa to administer ART to its
Qthe first mining company in South Africa to administer ART to its
workers at the company's expense. An estimated 80 percent of
HIV-infected employees have been registered on its HIV Disease
Management Program. By the end of February 2007, 1,099 employees
were registered on the program with 350 receiving ART treatment.
Anglo Coal achieved an impressive 84 percent coverage with its VCT
program.



9. Anglo Coal relates that the overall benefits of its HIV program
are a significant reduction in incidence of new HIV infections.
ACSA recorded 80 new infections in employees previously known to be
HIV negative (i.e. 1.8 percent),but this is significantly lower
than the predicted 3-4 percent. Anglo Coal believes that the lower
rate of infection means that more than fifty new infections were
prevented due to changed risk behavior. Benefits include a
reduction in morbidity and mortality, improved health/functionality
of employees, and reductions in absenteeism, loss of skills,
knowledge and experience. ACSA concludes that it has retained the
skills, knowledge and experience of a significant number of
employees as a result of the HIV Disease Management Program, who
would, in its absence, have died or retired. Efforts to mitigate

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the economic impact of HIV are constrained by employees' reluctance
to be tested (although this has improved significantly),late
presentation for treatment, and the still relatively low uptake of
ART on the part of employees.

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Anglo's Program - Not the First
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10. Anglo is not the first business to expand its treatment program
to families of employees. Anglo owns a 45 percent shareholding in
De Beers, which was the first mining company in South Africa to
provide free anti-retroviral treatment for spouses and retired and
retrenched employees in July 2003. PEPFAR is funding an innovative
private-public partnership in South Africa between X-Strata Coal,
South Africa (X-Strata) and Re-Action (a professional services
agency for health and sustainability) to help stabilize the health
and welfare of X-Strata's employees, their families and communities.
Sharon White of Re-Action related to Embassy Health officer that
X-Strata has been rolling out its HIV program to family members of
its employees for the past two years. X-Strata employs
approximately 8,000 people at its thermal coal operations in
Mpumalanga Province, the 'Coal Powerbelt' of South Africa, where it
is estimated that one-in-four people is living with HIV. X-Strata
has committed to multi-year funding of the program with its $2.1
million annual contribution matched with PEPFAR funding beginning in

2007. Through a community clinic built and funded by X-Strata and a
number of existing public sector clinics and hospitals, the program
has expanded community outreach services; engaged traditional
healers; delivered community-based health education and training;
conducted HIV and TB testing campaigns; supported HIV care and
antiretroviral (ARV) treatment delivery; staffed and upgraded health
facilities; and strengthened community TB/HIV services. X-Strata
won a 2008 Global Business Coalition Award for Business Excellence
for the program.

11. Comment: It is important for the mining industry to have
effective HIV programs since miners have one of the highest HIV
incidence rates in the world due to high mobility of the workers,
isolation, stress, and access to and ready availability of sex
workers, alcohol and drugs. The problem is part of a legacy that
dates back a century when South Africa's mining companies began
using migrant blacks as cheap laborers. The South African mining
sector also has one of the highest incidence rates of TB in the
world, due to the twin risk factors for TB of high HIV-prevalence in
mines and occupational exposure to silica dust.

12. Anglo's ability to make a dent in the HIV incidence rate in its
employees and their families will depend on its ability to overcome
the difficult logistical hurdles of locating and serving a largely
remote, rural population. It will be useful to see whether the
program has an impact on HIV incidence among Anglo employees, who
have not shown improvement even with Anglo's industry-leading,
comprehensive employee HIV program. Anglo is not the first South
African business to extend HIV services to the families of its
employees, but it is setting a positive example for other companies,
Qemployees, but it is setting a positive example for other companies,
many of which are just beginning to establish their own HIV
programs. End Comment.
Bost