| Governance and
structure |
AngloGold's HIV/AIDS programme is managed
internally by a workplace programme review committee, a clinical
working group and a joint management-labour committee. This is
complemented by external research conducted by Aurum Health
Research (Aurum) and both internal and external audit processes.
AngloGold Health Service provides a comprehensive health care
service to meet the medical needs of employees, including the
implementation of the VCT and Wellness programmes and the roll-out of ART. Since the health care service is managed
independently of the mining operations, this promotes the
confidentiality of the medical programme.
In addition to centralised education, training and management
initiatives, each operation has an AIDS committee that oversees
implementation of the programme and raises issues of concern.
The following measures are in place: |
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Workplace prevention
programme coordinators meet on a quarterly basis to
discuss the progress of the HIV/AIDS prevention
programme at each business unit and to communicate
strategic programme changes. |
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The HIV Working
Group, which includes peer education trainers, wellness
nursing managers, wellness doctors, counselling
trainers, research doctors, a wellness data manager and
core HIV management staff, meets monthly to implement
programme modifications, address operational issues and
to learn from experiences between the two regional
wellness programmes. |
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A joint management
and union AIDS committee meets quarterly and includes
representatives from each of the trade unions, human
resources
representatives from operations, industrial relations
officers and HIV/AIDS programme managers. They meet to
review programme implementation and debate areas of
contention such as prevalence studies, the use of
full-time peer educators, and the addition of immune
boosting therapy. |
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Aurum develops, adapts and assesses health care
interventions within the context of the mining
environment. For example, having developed the ART
programme, Aurum will be responsible for both its
clinical outcome and economic impact evaluations. |
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The AngloGold Group Internal Audit
department has been devising and implementing audit processes
for both workplace and wellness programmes. This is being
extended to the East and West African operations and more
extensive centralised information will be available on these in
the future.
An external auditor has been appointed to verify the company?s
Report to Society including this section on HIV/AIDS
interventions. |
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| Statistics based on best available
information |
In 1999, Aurum used an anonymous unlinked survey to
estimate an HIV prevalence of 24% among employees in the lower
pay scales in the Free State region. (Operations in this region
have subsequently been sold but it is likely that the
information can be applied to other operations in the South
Africa region). The employees in these pay scales represented
85% of the workforce in that region.
In 2001, a follow-up anonymous unlinked survey of employees in
the same lower pay scales estimated an HIV prevalence of 29%.
The second survey was done in collaboration with the London
School of Hygiene and Tropical Medicine (LSHTM). Between June
2000 and April 2001, the research team, using a stratified
random sampling method, selected employees visiting the
occupational health centre for their mandatory annual medical
examination. They invited 6,100 employees from both the Free
State region and the Vaal River region and had an 87% response
rate. Participants were informed using a video available in two
languages, which was followed by a question and answer session
with a nurse. HIV testing was done by means of a urine test. The
protocol was approved by two independent ethics committees, one
of which has local labour representation. Based on the surveys,
provincial antenatal data and extrapolation from comparable
reference groups in Carletonville, AngloGold estimated a HIV
prevalence rate of 29.19% in its South African workforce in 2002
and 29.95% in 2003.
The number of deaths* per 1,000 workers has remained steady at
12.9 per 1,000 in 2003 (13 per 1,000 in 2001 and 12.3 per 1,000
in 2002). The number of ill-health retirements** has gone up
fairly significantly in 2003, at 15.2 per 1,000 workers (11.7
per 1,000 in 2002 and 11.9 per 1,000 in 2001). The most obvious
explanation for this would be AIDS-related ill health, but it
must be emphasised that there are many factors affecting such
trends, and this has not been verified or researched.***
| * |
Includes all deaths in service except those due to
occupational injuries. |
| ** |
Includes all employees separated from the company due to
medical incapacitation, except those due to occupational injury. |
| *** |
Both sets of data are based on South African region
employees, excluding contractors. |
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| The AngloGold programme |
| The AngloGold HIV/AIDS programme comprises: |
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Information, education
and communication; |
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Voluntary counselling
and testing; |
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Wellness/ART programme; |
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Community programmes; |
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Ill-health retirement
for employees who become AIDS-sick; and |
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Home-based care programmes.
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| Information, education and communication:
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The management of HIV/AIDS begins with an
education programme on the prevention of infection and treatment
of AIDS-related illnesses. The benefits of VCT and of obtaining
treatment if infected are made clear to employees. In addition,
these education programmes focus on health promotion and, using
peer education, endeavour to bring about behaviour change,
particularly with regard to high-risk sexual practices.
To meet these needs, AngloGold?s prevention programmes focus on
awareness, education, peer education, condom distribution, STI
management, and community interventions that similarly address
the prevention and treatment of STIs coupled with peer education
in women at high risk. |
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Each business unit plans a campaign of mass
awareness events to be conducted each year. Some of the events
used in 2003 included: mass meetings to demonstrate VCT,
drumming sessions with AIDS themes, industrial theatre
performances, candle-lighting ceremonies, workshops, seminars,
mass e-mails, newsletters, pamphlets, etc.
Induction training: All new employees and
employees returning from annual leave undergo induction training
which includes an HIV/AIDS component. The HIV/AIDS component is
taught by qualified training officers and covers basic facts
about HIV/AIDS as well as related illnesses such as TB and STIs;
national and company policies and programmes; as well as
referral resources.
Supervisor and management training: Supervisors
and management receive the same training, as well as specialised
training on performance management processes, the legal
framework supporting confidentiality (and grievance procedures
if this is breached), reporting and compensation procedures for
occupational exposure to HIV-infected body fluids, and medical
incapacitation processes.
Peer educators: 242 peer educators had been
trained and registered by end December 2002. Of these, 122
presented for refresher training in 2003 to improve their
presentation skills and knowledge of ART. A further 109 new peer
educators were trained in 2003 to replace those that had become
inactive or had left the company, and to bring in line those
operations that had to date had a low quota of peer educators.
This brings the total number of peer educators to 351 by the end
of December 2003 across the company, maintaining the target of
having approximately one active peer educator per 100 employees.
Peer educators focus on the provision of informal education and
facilitating structured debate among employees with a view to
promoting an understanding of the value of and embracing
behaviour change. They are a valuable resource for AIDS training
and referrals, as well as replenishing condom dispensers.
AngloGold is currently evaluating methods to monitor their
activities more effectively.
STI treatment: An important intervention in
preventing the spread of HIV is the treatment of STIs as HIV is more readily transmitted
in the presence of another STI such as syphilis, gonorrhoea and
chlamydia. All employees have access to an STI treatment
service. In addition, AngloGold collaborates with other regional
industry players to provide local community interventions that
similarly address the prevention and treatment of STIs in women
at high risk. |
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| Treatment
of TB |
| Without
intervention, more than 50% of HIV-infected people in
the South African mining industry will develop TB and a
third of HIV-infected people will die from it. The
consequent increase in the pool of TB also puts HIV
negative people at greater risk of acquiring TB.
But, this can be contained if it is caught and treated
early. HIV positive individuals are as easily treated
for TB as those who are HIV negative. A comprehensive TB
control programme is in place in AngloGold, which
follows international best practice in identifying and
treating patients with TB. In addition, prevention
treatment is also given to HIV-infected employees to
prevent opportunistic infections such as TB.
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| Ill-health
retirement for employees sick with AIDS-related illnesses |
The medical
incapacitation process can be initiated by referrals
from the employee, fellow workers and supervisors,
medical practitioners or human resources practitioners.
The process: The incapacitation review
committee includes the employee and his/her
representative, representatives from occupational
health, line management and human resources. The
employee?s medical diagnosis is not disclosed to this
grouping ? instead a report on his/her functional
capacity limitations is submitted. Once this has been
reviewed, the committee will offer the employee an
alternative job, if the employee is capable and a
suitable job is available (27% of all cases in both 2002
and 2003). Should the employee not avail him/herself of
the job offer or should no alternative job be available,
the employee leaves the company. On leaving, he/she will
receive either a lump sum or pension depending on
whether they belonged to the company provident or
pension fund. If the employee is deemed terminally ill,
he/she will be kept on the company?s books for an
additional year even if they retire so that their family
can receive the death benefit which is usually only paid
out to employees who die while being actively employed
by the company. Of those employees who were separated
from the company, being terminally ill, 67% were
known to be HIV-infected in 2002 and 63% in
2003.
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| Voluntary Counselling and Testing
(VCT): |
AngloGold has offered free Voluntary
Counselling and Testing (VCT) services to all employees since
March 2001 and to their partners since June 2002. Services are
available at 18 VCT centres across the group. These centres are
staffed by 16 full-time trained lay counsellors, which ensures
that limited professional nurse capacity is not overly burdened
by time-consuming counselling. From March 2001 to December 2001,
1,285 visits were recorded at this service. In 2002, a further
1,697 tests were done and, in 2003, a further 3,264 tests were
conducted.
Pre-test counselling ensures that the client has an
understanding of the procedure he or she will undergo, and
prepares him or her for the implications of a positive or
negative test result. Both HIV positive and negative people
undergo post-test counselling. |
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| Wellness programme: |
| A Wellness Programme was introduced in 1999
to extend the productive life of HIV-infected employees as far
as possible. Long-term follow up of HIV-infected employees is
undertaken on an out-patient basis as is customary for other
chronic diseases. There the patients? disease status is
monitored, and their physical and psycho-social well-being is
addressed through counselling and lifestyle education, and
prevention treatment is instituted. The process is as follows: |
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Employees who receive
an HIV positive result and who elect to join the
Wellness Programme receive further counselling and an
initial baseline health assessment is conducted. |
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After two weeks,
there is a follow-up visit during which the results of
the tests taken are reviewed to decide whether to start
preventive treatment against opportunistic infections
and/or to start ART (as of November 2002). |
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Thereafter the
patient is reviewed every six months or sooner if he/she
is ill, or is suffering any side-effects. |
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Patients who take
advantage of ART will also be seen more frequently. |
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Opportunistic infections are managed by
prescribing prophylaxis against tuberculosis (TB) and other
diseases. Opportunistic diseases are identified early and
suitable treatments prescribed during regular check-ups at the
Wellness Clinics. In addition, annual medical surveillance at
the Occupational Health Centre, regular chest X-rays at the
medical stations and 24-hour access to health care services are
available.
Employees have unlimited hospitalisation benefits for
AIDS-related illnesses, as required by the prescribed minimum
benefits under the Medical Schemes Act. AngloGold also provides
HIV positive employees with nutritional and lifestyle
counselling as well as psychosocial support. By the end of 2003,
2,903 employees (2,074 in 2002) had enrolled in the Wellness
Programme. |
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St Bernard’s
Hospice – Duncan Village East London |
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| Community
programmes |
| Community-based
prevention interventions target high-risk populations in
the two regions surrounding AngloGold mines. An example
of this is the Mothusimpilo programme, a jointly funded
partnership with Gold Fields Limited, Harmony Mines and
the Gauteng Department of Health. The project provides
male and female condoms, peer education and curative and
preventative treatment for STIs to an estimated 4,000
commercial sex workers in Carletonville. In 2002,
AngloGold initiated a similar project in Orkney. A
situational analysis has confirmed the urgent need for
such an intervention. Funding for implementation as well
as evaluation has been committed by local AngloGold and
Harmony mines. |
| Home-based
care |
AngloGold
provides home-based care through a wide range of
partnerships, particularly in rural areas.
TEBA home-based care: Home-based care
is provided through a service level agreement with The
Employment Bureau of Africa (TEBA) that covers
approximately 45% of AngloGold's labour-sending areas.
The service provides palliative care for the dying with
links to primary care and assistance for bereaved
families to access welfare support for both the
incapacitated, terminally ill person and the orphans who
are left behind. From April 2002 to December 2003, 1,106
ex-AngloGold employees availed themselves of this
service. (See case study)
Carletonville Home and Community Based Care:
This is a multi-stakeholder programme involving
public, private, civic, NGO and faith-based sector
participation in partnership with the local community.
AngloGold has provided more than just financial support.
It has seconded a programme manager and a part-time
accountant, provides IT support and supports
income-generating activities. Carletonville Home and
Community Based Care successfully cares for a monthly
average of 35 bed-bound patients, 190 ambulant people
with AIDS and terminal illnesses, and 501 orphans, 154
of whom are living in child-headed households.
Bambisanani: Similarly, AngloGold has
seconded a nurse and donated the use of a vehicle to the
Bambisanani Home-Based Care Project in the Eastern Cape.
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