Hitting back at HIV in the workplace

HIV programme are a company responsibility

A research article published in PLoS Medicine in September 2015* on the impact of company-level antiretroviral therapy (ART) provision to a mining workforce in South Africa, found “HIV impacts heavily on the operating costs of companies in sub-Saharan Africa.” Many South African mining companies, the research claims, are providing ART programmes in the workplace as a way to mitigate this.

The research further points out that HIV hits adults in the prime of their working lives, affecting 18.8% of the working-age population (15– 49 years old) in South Africa: “HIV disease increases rates of absenteeism, labour force turnover and, ultimately, the costs of company operations in sub-Saharan Africa,” the article states. To address this, some in the private sector, it says, now provide “a number of HIV services, ranging from prevention activities to HIV testing and ART.”

Some have even been ahead of the trend. “HIV care, including ART, has been provided by mining companies in South Africa since 2002, predating ART provision in the public sector,” says the study.

Anglo American has been running programmes aimed at HIV prevention, treatment and care for the past 30 years. “In 1986, the company launched two initiatives: an education and awareness programme aimed at the entire workforce; and the provision of more than $5-million in funding over the next few years to prominent researchers in Europe and the US to investigate treatment possibilities using decoy CD4 proteins inserted into red blood cells,” says Stefaan van der Borght, the group head of health for Anglo American.

“By 1990, we were the first South African company to develop a human-rights-based HIV policy,” he adds. “Because little was known about the disease, many employers required a ‘negative’ screening as a prerequisite to guarantee employment. During a time of uncertainty and closed-mindedness, our policy ensured that there was no discrimination against any person living with HIV.”

By 2002 Anglo American was lauded as a company with the largest free HIV workplace voluntary counselling, testing and treatment programme.

In 2011, the company partnered with department of health in Kathu (in the Northern Cape) to launch mobile clinics, which provide primary healthcare services and HIV treatment care to members of the public — from rural villages in the Northern Cape — who cannot travel along the 130km of dirt road to the nearest hospital.

According to Van der Borght, testing is the entry point to the company’s HIV programme. “In 2015, we tested and counselled 78 993 employees and contractors in Southern Africa, and in 2014, 95 244. Our mines continue to offer primary care services to communities around the mines, including the treatment of acute and chronic illnesses and health education. During 2015, nearly 8 000 primary care consultations were offered.”

Although the programmes are not mandatory, employees are encouraged to volunteer to get tested. Van der Borght points out that the annual number of new HIV infections shows a very encouraging decrease. “A record of 92% of HIV-positive employees were enrolled in our HIV wellness programmes in 2015,” he adds. “At 696 per 100 000 of the population, our tuberculosis (TB) incidence rate has decreased further and on average remains below the South African national rate of 860 per 100 000.”

Palabora Mining Company (PMC) runs a holistic HIV programme, which includes TB and broader wellness issues, says the company’s spokesperson, Lydia Jemima Radebe. “The programme includes HIV counselling, testing, education and awareness, a peer educator programme, follow-up care and counselling, condom supply and medical aid (for antiretroviral medicine supply, care and pathology tests),” she says.

Within this policy, PMC has implemented a peer educator programme where volunteers from different sections of the mine and of any rank act as “foot soldiers”, creating awareness in their sections, “especially on the current health topic with preeminence given to HIV”, explains Radebe.

Peer educators support colleagues who disclose their HIV status or other health issues and refer them to clinics. “This is a confidential process guided by respect for privacy as enshrined in the Constitution and PMC policies and procedures,” Radebe emphasises. “It is critical to highlight that we do not encourage employees to disclose to peer educators but where it happens, both the affected or infected employee and the peer educator involved are counselled and reminded of the confidentiality that should be involved in handling issues of people’s health and status.”

PMC has a full-time HIV co-ordinator who works at its wellness centre, reporting to the mine’s medical doctor.

Radebe points out that the company’s holistic approach seems to be effective — more employees now want to be tested. “For example, there are a few employees who once reported that they were not feeling well, felt fatigued at work and were noticing gradual loss of weight. These employees then approached our wellness center for HIV testing. Those who tested positive were put on treatment and then a few weeks after starting treatment [reported] a turnaround of their health status — feeling well, energetic and picking up weight.”

Like Anglo American, PMC’s programmes don’t just benefit employees — it has also extended its support to the broader community, constructing the biggest wellness centre in Namakgale township. “The clinic is operational and benefits the communities with the promotion of educational awareness and prevention, [and] delivers treatment, care and support of HIV, TB, sexually transmitted infections and access to social services,” says Radebe.

The PloS study found that running an HIV programme is attractive for companies. “Beyond making good business sense, a company-level HIV care programme, including ART could go a long way towards improving the strained labour relations in the South African mining sector, especially when improved access to healthcare extends to the entire community.”

* The authors are Gesine Meyer-Rath, Jan Pienaar, Brian Brink, Andrew van Zyl, Debbie Muirhead, Alison Grant, Gavin Churchyard, Charlotte Watts and Peter Vickerman