| 7.4 Adopting
best practice at Geita gold mine |
Located some 20km west of Lake Victoria,
adjacent to the town of Geita in Tanzania, is the Geita gold
mine, which was established in May 1999. The mine currently has
an expected life of about 14 years. Geita employs 2,200 people
(600 employees and 1,400 contractors), of which about 90% are
local Tanzanians. The population of the town of Geita has grown
from 30,000 in 1999 to nearly 57,000 in 2002.
Although Geita is a very young mine, its early HIV interventions
have already begun to pay off. The programme has as its
overriding vision to improve the health of mineworkers at Geita
and surrounding communities through a sustainable programme of
health promotion and disease control measures. The
sustainability of the programme is particularly important given
the fact that the mine will, at some stage in the future, cease
operations. |
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| Establishing a baseline |
In 2001, a prevalence survey was conducted
by the African Medical and Research Foundation (AMREF)*, in
collaboration with the National Institute of Medical Research (NIMR),
in Mwanza, Tanzania, and the London School of Hygiene and
Tropical Medicine.
The survey confirmed the pre-existence of a local HIV epidemic
in the community: 19% of men, 16% of women and 39% of high-risk
women were found to be HIV positive. Mineworkers surveyed had a
comparatively lower HIV prevalence of 4%. (This is probably an
unreliable result, however, since the prevalence is expected to
be similar to that in the surrounding area.)
Despite these
results, both the community members and mineworkers demonstrated
that they were at high risk of becoming HIV positive because:
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All groups reported
very high rates of STIs in the previous 12 months; |
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All groups had high
rates of positive syphilis serology; |
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35% of mineworkers
indicated that they had had multiple sexual partners in
the previous three months; |
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54% of mineworkers
had paid for sex in the previous 12 months; and |
| • |
30% did not always
use condoms during these paid encounters. |
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| * |
AMREF is an
independent non-profit, non-governmental organisation
(NGO) whose mission is to improve the health of
disadvantaged people in Africa as a means for them to
escape poverty and improve the quality of their lives. |
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| Rapid intervention needed |
It was clear that without rapid
intervention the HIV prevalence amongst mineworkers could
rapidly escalate (estimated to between 20 and 40%) within the
life-span of the mine. Although a detailed financial assessment
of the potential impact was not conducted, it was felt that this
increase would constitute a significant threat to the mine?s
continued profitability.
Geita?s proposed interventions focused on:
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Preventing the escalation
of the local epidemic, and |
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Providing care and
support for those who were already HIV positive. |
|
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| Employee
HIV/AIDS policy at Geita |
| The
Employee HIV/AIDS policy at Geita provides for: |
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| • |
Non-discrimination: |
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| – |
Employees will
not be dismissed on grounds of their HIV
status |
| – |
Employees will
undergo a medical examination prior to
employment, but the examination does not
include an HIV test |
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| • |
Confidentiality
and disclosure: |
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| – |
Employees are
not required to disclose their HIV
status. |
| – |
If an employee
discloses his or her HIV status, this
information remains confidential without
written consent |
|
| • |
Medical
benefits: |
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| – |
Medical
Benefits are provided for employees and
their spouse and children registered
upon entry into employment |
| – |
Employees and
contractors have access to the Geita
clinic |
| – |
Geita covers
the cost of dependents of employees when
they access services from the Geita
Government hospital (including
referrals) |
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Termination: |
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| – |
When an
employee is deemed medically
incapacitated the medically affected
employee policy is enacted. |
| – |
The employee
is entitled to sick leave (three months
on full pay and three months on
half-pay) |
| – |
If the
employee is still medically
incapacitated as determined by a
multi-disciplinary team including
representatives from Human Resources,
management and the medical department,
his/her employment is terminated |
| – |
Upon
termination of service the employee
receives six months full salary but
medical services become the
responsibility of the employee |
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| • |
Contractors: |
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| – |
Contractors
are not required to adhere to Geita?s
HIV policy |
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| Voluntary Counselling and Testing |
In July 2001, Geita signed a memorandum of
understanding establishing a three-year contract with AMREF to
provide workplace and community HIV/AIDS services as part of a
comprehensive community programme. The programme was divided
into two related parts:
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Workplace
prevention programmes including top management
advocacy, peer health educators, free condom
distribution, syndromic STI management and HIV Voluntary
Counselling and Testing (VCT) and awareness workshops.
In 2003, preparation for the provision of ART was begun. |
| • |
Community
prevention programmes focussed on developing
community health educators, targeted interventions for
high-risk women and their male clients, condom social
marketing and Sexual and Reproductive Health (SRH)
services. A community HIV information centre providing
VCT and SRH services was established in March 2002. |
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Geita?s budget for both workplace and
community-based programmes over a three-year period (2002 to
2004) is $325,000 funded by the main stakeholders, the owners of
the mine (AngloGold and Ashanti Goldfields), the main contractor
(DTP Terrassement), Stanley Mining Services and other
contractors. The programme also receives in-kind donations ? the
Community HIV Information Centre, for example, is located in
facilities provided by the District Council, and District Health
Workers frequently act as facilitators during training.
The mine also finalised its Employee HIV/AIDS policy in January
2002, superseding the informal policy that had been in place
since January 1999. The policy provides for non-discrimination,
confidentiality and non-disclosure, benefits, termination and
the role played by contractors. (See Community intervention programmes at Geita below). There is an ongoing formal process of meetings to
refine and develop the process to culminate in the provision of
ART. |
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| Community
intervention programmes at Geita |
| Geita?s
influence on the community surrounding the operation
is one which is viewed seriously and responsibly by
the company. The company started funding community
prevention programmes in July 2001, extending the
AMREF programmes launched in June 2000. Elements of
the programme include the following:
Prevention and awareness:
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| • |
Community educators:
60 community educators trained (1 to 500) in
three villages surrounding the mine. These
part-time volunteers are trained to carry
out clearly defined health education
activities with ongoing support and
supervision provided at monthly support
meetings facilitated by project staff.
Activities conducted by the community
educators include visiting homes,
distributing health learning materials,
demonstrating the use of condoms and
recruiting clients for the HIV Information
Centre. |
| • |
Focussed interventions
for high-risk women. This was launched in
August 2001. The programme trained 23 women
in respect of life skills. These women in
turn conduct social marketing of male and
female condoms and distribute tokens to
their peers and male clients entitling them
to a full range of free SRH services at the
AMREF HIV Information Centre. |
| • |
Sexual and
Reproductive Health services. This started
in March 2002. Services are available at the
community HIV Information Centre located in
the centre of Geita town. It was launched at
a public event with guest speakers including
Geita?s Chief Executive Officer and the
Executive Director of the Tanzanian
Commission for AIDS, Major General Lupogo
and with the Regional Commissioner for
Mwanza as Guest of Honour. Services are
available to anyone for free (with the
exception of VCT) and clients are encouraged
to take advantage of multiple services.
|
Voluntary
Counselling and Testing
VCT services were initiated in March 2003 at
the community HIV Information centre. The
service is available to everyone in the
community for US$1 per visit, Geita
subsidising US$2.50 of the total US$3.50
cost of the test. Six VCT counsellors are
drawn from the district health personnel and
local community members that have been
trained by AMREF. Post-test counselling
includes a personal risk reduction strategy
referrals where necessary and an offer to
join the Post-test Club to obtain ongoing
emotional support, as well as home-based
care.
HIV status is assessed through parallel
rapid tests of a finger prick sample. Since
the launch, through 11 December 2003, 2,730
people had accessed the service, 11.5% of
whom were employees. 10.7% of those who have
been tested are HIV positive.
In addition,
2,252 people have undergone STI treatment
(901 of those have come in for
repeat/follow-up visits) 2,252 syphilis
screenings have been conducted and 442
family planning sessions have been held as
part of the Sexual and Reproductive Health
Service. |
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| Monitoring programme effectiveness |
| Programme effectiveness is closely
monitored through monthly and quarterly reporting that tracks
both the processes and outcomes. A multi-stakeholder group, the
Steering Committee, evaluates performance biannually. Every
three years the programme will be evaluated by external experts
and the partnership will conduct a cross-sectional snapshot
health survey. |
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| The way forward |
Although still in its infancy the project
has delivered some success. Future goals include:
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| • |
To provide VCT to 30% of Geita
employees and 20% of the community by the end of
December 2004. (11.5% of employees and 4% of the
community achieved by the end of 2003). |
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To successfully reach all high-risk
individuals in the community with two-monthly check-ups,
STI treatment, VCT and syphilis screening. |
| • |
To increase employee and contractor
knowledge of HIV. |
| • |
To change employee and community
members? behaviour to lower risk activities. This will
be demonstrated through increased condom usage,
decreased number of partners and increased
health-seeking behaviour. |
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| 7.5 HIV/AIDS programme being
implemented at Navachab |
Navachab is an open pit gold mine located
in the south-west African country of Namibia. Navachab has 145
full-time employees who live with their families in the local
town of Karabib.
In early 2003 Navachab undertook an HIV prevalence survey in
which all of the full-time employees participated. Seven
employees (5%) were found to test HIV positive. This is a far
lower rate than in the country as a whole or the region in which
the mine is located. A survey (Sentinel Sero Survey) undertaken
in 2000 amongst antenatal clinic attendees showed a national
prevalence of 20% in that grouping of pregnant women. The
regional prevalence rate amongst this same grouping in Karabib
was estimated to be 25 to 29% in 1998.
Whilst Navachab is still in the process of implementing all
elements of a comprehensive HIV/AIDS programme, it has
accomplished a range of achievements: |
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| Prevention and awareness: |
Ten peer educators (a ratio of 1 per 14
employees) receive ongoing training from the Namibia Chamber of
Mines. These peer educators have been made responsible for the
dissemination of information about HIV/AIDS and for the
distribution of condoms supplied free of charge by the Namibian
Government.
Treatment of Sexually Transmitted Infections (STIs) is available
at the local medical practitioner and primary health clinic. |
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| Voluntary Counselling and Testing
(VCT): |
| VCT is offered by appointment at Navachab?s
on-site clinic. A rapid fingerprick test method is available.
However, clients can choose to have their blood sample sent to
Windhoek for analysis at a laboratory. |
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| Care, support and treatment: |
A counselling help-line is available to all
employees. All employees and their dependents are covered by a
medical aid scheme. As part of this:
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| • |
Short-course
antiretroviral therapy (ART) is available for the
prevention of mother-to-child transmission. |
| • |
Post-exposure
prophylaxis (ART) is available at Navachab?s on-site
clinic for people subjected to a high-risk, usually
traumatic, exposure to potentially HIV-contaminated body
fluids, for example, needlestick injury in health care
workers, blood splashes in rescue workers and for rape
survivors. |
| • |
Other medical needs
are catered for through the on-site clinic or through
the Medical Aid scheme. |
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| Because there is no specific ART benefit at
this stage, those requiring ART are eroding their general
medication benefit. This is being addressed as part of
AngloGold?s comprehensive strategy. Wellness doctors and nurses
have been identified and trained by Aurum Health Research to
implement a fully comprehensive VCT/Wellness/ART Programme at
Navachab, which is positioned to start as soon as the need
arises. In addition, a range of other initiatives are being
introduced, such as the development of an HIV/AIDS policy, peer
education at induction, VCT drives, the implementation of a
Medically Affected Employees Process, and more rigorous
monitoring and auditing of HIV/AIDS programmes. In addition,
greater efforts will be made to assist in community outreach
programmes, such as involvement in home-based care and support
for a local information centre. |
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