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HIV & AIDS

South Africa

Management of HIV & AIDS

The HIV & AIDS pandemic continues to have a significant impact on the company (through absenteeism, reduced performance, loss of skills) and employees and their families. Both local and labour-sending communities also continue to be affected as those who are the natural heads of households and at their peak of their earning capacities are ill or die, and as the economic burden on individual households and state health care facilities mounts.

At Harmony, HIV & AIDS is managed at three levels:

• At a clinical level, the symptoms of the illness are managed by the group’s health care services.
• Company-wide and mine-specific initiatives are conducted. Shaft-based HIV & AIDS committees form an integral part of the Health and Safety Committees, which meet on a monthly basis.
• Group policy and practice is overseen by a specialist health care professional.

A revised, integrated clinical strategy, developed as part of the new strategy to address TB and HIV & AIDS was developed during the year. This strategy was developed through a workshopping process led by academics and experts drawn from the Universities of Cape Town, Pretoria and Witwatersrand, and with the participation of the 19 Harmony health care staff members, ranging from medical doctors, to occupational health practitioners, nursing sisters and others.

A number of key issues have been highlighted in this new strategy that integrate and consolidate the traditional HIV & AIDS and TB approaches. These include:

• Concerted efforts will be made to enhance and sustain the group’s VCT programmes, and to implement a post-employment and pre-engagement testing programme. This is as reassurance to stakeholders of the company’s commitment to non-discrimination regarding employment based on an individual’s HIV status.
• Enhanced education and counselling will be provided to employees who are HIV-negative.
• Anti-retroviral therapy (ART) will be introduced at an earlier stage (a CD4 count of 500, rather than the current level of 350). This is advocated by experts as a vital measure in curbing the impact of HIV and its progression to AIDS-illness, and specifically to positively influence TB prevalence in the group by reducing the number of TB susceptible individuals within our employee population. While there are additional costs expected as a result of bringing patients on to ART at an earlier stage, these are not expected to be significant. This CD4 category is small and the impact is likely to be staggered as patients are identified through ongoing CD4 testing at hospitals and VCT clinics. The benefits, in this case, are expected to outweigh the costs in terms of extended life expectancy and reduced medical burden by far. This will be implemented first at a pilot site, with a monitoring methodology of the patients needs to be developed simultaneously.
• In addition, efforts will be made to intensify case findings, introduce isoniazid preventive treatment and improve infection control. This is in line with the WHO strategy to contain TB.
• Further introduce infection control measures such as the use of masks, UV lights, among others.

HIV & AIDS performance

The 2009 HIV/AIDS impact analysis conducted by The Health Monitor Company, using the Actuarial Society of South Africa model 2003 (ASSA2003) estimates that around 27% of Harmony’s employees are HIV positive. This is slightly higher than the 25% HIV prevalence levels projected in a similar analysis done in 2005. However, this is expected as anti-retroviral drugs would have a retention effect on the HIV positive pool of people thus increasing the prevalence levels. A follow-up financial impact analysis will be undertaken in FY12. New electronic data collation systems were implemented in FY09 and will improve the monitoring and evaluation of the programme outcomes.

The group’s programme is focussed on the following four areas:

• Prevention: Prevention campaigns are aimed at limiting new infections through education, promoting condom usage and behaviour change. Condoms are widely distributed free-of-charge at all operations. However, it is apparent that employees continue to engage in high-risk behaviour, evidenced by the treatment of sexually transmitted infections (STIs) by mine medical stations. A total of 936 000 condoms were distributed by the company in FY09.
• VCT: Our VCT programme is undertaken by an external provider (Careways) using qualified registered professional nurses and protocols aligned with the South African Department of Health, the WHO and the HIV Clinicians Society of Southern Africa. A total of 22 806 individuals were tested during the year (FY08: 16 800 tests).

• Treatment, care and support: In late FY09, further decentralisation of the HIV & AIDS treatment centres was effected so as to integrate them into formalised disease management units as part of the comprehensive primary health care centres. Here HIV & AIDS patients will be managed, together with all other chronic manageable illnesses, to specified standards and protocols. This now brings support and care closer to the place of work and stay for those who are still hostel-based.

  Ongoing counselling on lifestyle choices and nutrition, the treatment of opportunistic infections and HAART are an important part of Harmony’s strategic wellness programme. Access to HAART is available to all company employees, either through the company’s health care facilities or through private medical aid schemes where appropriate. As a result of the stigma associated with the disease, some employees may seek treatment at state-funded facilities in South Africa.

  At the end of June 2009, a total of 4 255 employees were enrolled in this programme, compared with 1 206 enrolled at the end of June 2008. A further 1 647 employees were enrolled on the pre-HAART programme for monitoring at the end of June 2009. This is a significant increase in uptake and is in line with the raising of the CD4 count at which the company initiates HAART from 250 to 350. An initiation CD4 count of 200 is used in state-funded facilities.

• Community-based interventions: Harmony continues to fund the mining industry’s home-based care project, established in 2002 and run by Teba Development. The project provides care in the major labour-sending areas, largely to former mineworkers who have retired as a result of ill health. Teba trains family members and volunteers in the provision of home-based care, and provides monthly home-based care kits. Harmony co-funds, with other mining houses and the Department of Health, five community-based organisations (CBOs) that render mobile clinic services to communities with the main aim of reducing new infections and provision of treatment of STIs for hosting communities. The five CBOs are Lesedi-Lechabile in the Free State, Tswaragano in Westonaria/Randfontein, Mothusimpilo in Carletonville, Powerbelt in Evander and Bambisanani in the Eastern Cape.

HIV & AIDS expenditure increased to R16 million in FY09 mainly due to a proactive VCT drive and increased resources associated with the clinical management of HIV & AIDS (staff at the clinics, HAART medication and associated laboratory tests). Approximately R4 million of this spend goes to community HIV & AIDS projects.

It is understood that 633 employees with AIDS were separated from the company during the year, and 185 employees died in service as a result of AIDS (FY08: 523 and 396 respectively).

PNG

HIV is not as critical an issue in PNG as it is in South Africa. Community prevalence levels are estimated to be in the region of 1.5%, much lower than those in sub-Saharan Africa. Partnerships with all other stakeholders in the region are being strengthened to ensure effectiveness of prevention programs.

The VCT/ART programme is conducted and managed by the Bulolo District HIV & AIDS Coordinating Team, and the company actively supports the programme by way of condom distribution and HIV & AIDS awareness material distribution and training. The community affairs team based at Wau has been conducting a similar programme in the township of Wau and surrounding communities.