As South Africa celebrates a generation of freedom, Anglo American acknowledges its deep roots in the country and looks ahead to its contribution in the next 25 years and beyond.
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In our lifetime, we could see the first HIV-free generation. So says UNAids, which hopes to end the worldwide epidemic by 2030.
Anglo American’s diamond business, De Beers Group, has announced its support of this global HIV-free vision.
In South Africa, and particularly in the country’s mining industry, the Aids epidemic has killed millions of young men.
In 1996, respected Aids activist Mark Heywood wrote that “mine workers in South Africa are now more at risk of contracting HIV than of being in a mining accident”.
At the time, Heywood noted how personnel at one Johannesburg mine – the now defunct Gencor – estimated that 20% of its employees were HIV-positive, and that 30 workers were dying of Aids each month.
In his award-winning book Three-Letter Plague, journalist Jonny Steinberg wrote that 2.1 million people died of Aids-related illnesses in sub-Saharan Africa in 2006. He added that nearly 6 million of South Africa’s population of 46 million – that’s more than one in eight people – were HIV positive at the time.
Since then, the fight against HIV and Aids has gained momentum in South Africa and around the world – and Anglo American’s diamond business, De Beers Group, has pledged to play its part.
The company has mines in Botswana, Canada, Namibia and South Africa, and employs more than 20 000 people – 11 000 of whom work in southern Africa.
It has set targets to achieve zero employee HIV deaths, zero new HIV infections and zero associated stigma by 2030, in line with the goals put forward by UNAids.
And while the group has had remarkable successes – for example, 89% of employees at the De Beers Group voluntarily tested for HIV last year – the battle is still far from won.
Last year, the De Beers Group reported 58 new incidents of HIV infections. In the same year, five employees in southern Africa died due to HIV-related illnesses.
In September 2018, the company consulted employees about the creation of an HIV-free organisation. The employees said their concerns included stigma, confidentiality, discrimination and a fear of losing their jobs.
These are not new issues. Dr Tshepo Sedibe, the senior occupational health manager at the De Beers Group, says the company is working hard to address them.
Sedibe notes the extent of the problem: “The South African mining industry exists in one of the most highly burdened regions in the world with regard to HIV. The death rate related to HIV and Aids has come down significantly, but even one death is one too many.”
26% - in 2016, only 26% of the workforce knew their HIV status
81% - in 2017, this improved to 81%
89% - In 2018, 89% of staff were tested and know their HIV status
98% - of those living with HIV, 98% are linked to treatment, care and support
92% - of those on antiretroviral drugs, 92% are suppressing the virus and living a healthy and productive life
Sedibe says that, while De Beers Group has achieved noteworthy milestones in combating the scourge and associated stigma, several challenges remain: “The rate of new cases – those who move from being HIV negative to HIV positive – remains a huge challenge, not just for the South African mining industry, but for the rest of the country. Our collective efforts are transitioning from providing treatment, care and support to prevention.
“At De Beers Group, employees are linked to treatment and support early. This has improved the health and productivity of our colleagues living with the disease, and has allowed them to continue participating in the economy.”
Sedibe, who is based in Johannesburg, is responsible for employee health at the De Beers Group globally.
He says the company first took steps to combat HIV and Aids in the workplace at its Debswana mine in Botswana. These initiatives were a world first, he says, and were later replicated at their business units in South Africa.
“In 1996, Debswana realised the devastating impact of HIV on its employees and the business, which was experienced through loss of skills and productivity, early retirements due to ill health, and deaths in service as a result of HIV. The workforce morale was justifiably low due to employees being either infected or affected.
“Debswana initiated discussions in exploring provision of an HIV workplace programme to provide treatment, care and support to those infected and affected. A voluntary saliva-based anonymous HIV survey was conducted in the same year to quantify the magnitude of the problem. It found that HIV prevalence averaged 29% across the company’s operations.
“So, in 2001, an HIV and Aids workplace policy was established to respond to the epidemic. This was followed by pioneering the first workplace HIV disease management programme in the world. The programme’s objective was to provide lifesaving antiretroviral drugs. This was not only seen as a business imperative, but as the right thing to do – in keeping with the De Beers Group values of showing care and building trust.”
He says the programme also set about addressing shame associated with HIV infection.
“At first, due to the stigma associated with HIV, our colleagues living with HIV found it difficult to access treatment, care and support because they feared being stigmatised. The greatest challenge was getting them tested to know their HIV status. At the time, we saw that the way confidentiality was dealt with became the key determinant to their participation. Back then, side-effects associated with antiretroviral drugs posed another challenge. It also contributed to poor compliance and, in certain instances, resistance to these lifesaving drugs.”
In 2002, De Beers Group introduced a similar HIV-related disease management programme at its mines in South Africa. One major milestone since then has been that HIV-positive women across the organisation have been giving birth to HIV-negative babies for the past 10 years. This translated into nearly 500 pregnancies with HIV-negative results, Sedibe says. In addition, he notes that mining employees appear happier and more productive, while the absenteeism rate has dropped.
However, like most programmes, the disease management plan suffered from what Sedibe calls “programme fatigue”. This required the company to go back to the drawing board to refresh its strategy. The result was a “know your status” campaign launched in 2017, which was actively supported by top executives. The aim was to remove the stigma attached to being tested for HIV.
“A senior leadership team at De Beers led from the front and took ownership. The objective was to reinforce the premise that knowing your HIV status is empowering,” says Sedibe.
“So, in 2017, the entire De Beers executive leadership went out and got tested for HIV, and they continue to do so every year to establish a culture of knowing your HIV status. Collectively, the senior leadership team was able to boldly state: ‘We know our status, and we are empowered. We urge you to do the same.’
“As a result, we have seen a significant improvement in the participation of our wellness programmes. In 2016, only 26% of our workforce knew their HIV status. In 2017, this improved to 81%. Last year, 89% of our colleagues tested and know their HIV status. Of those living with HIV, 98% were linked to treatment, care and support. And, of those on antiretroviral drugs, 92% are suppressing the virus and living a healthy and productive life.”
Sedibe says they learnt important lessons, including that continued leader-driven efforts are key to ensuring that complacency does not set in.
He adds that dialogue around HIV issues with management had been “open and honest, and truly ground-breaking for the organisation”. The conversation was shared with the rest of the group’s employees in a two-part video series, which kick-started the HIV testing campaign last year.
“Getting to zero has been an interesting and challenging journey,” says Sedibe. “With campaigns under way in each of our businesses to encourage employees to get tested and know their status, we believe that zero HIV deaths, zero new infections and zero stigma is ultimately achievable. We may have a long way to go on our journey, but we’re determined and committed, and won’t stop fighting this battle. We will arrive at a future free of HIV and Aids.”
In addition, Sedibe notes that he is proud of the company’s strides in reducing TB at its mines. He says the De Beers Group has reported no TB deaths since 2012, and that the company’s TB incidence is less than 100 per 100 000 employees. This is in a region that generally reports up to 800 cases per 100 000 people.
“This is probably one of the lowest levels in South Africa’s mining sector,” he says. “I see this as a commendable achievement that demonstrates that our efforts count.”