HIV/AIDS and Malaria

In April 2003, following a six-month pilot study, AngloGold Ashanti introduced its anti-retroviral therapy (ART) programme for those South African based employees infected with the HI virus and for whom ART was clinically indicated. (See Report to Society 2003.) This also followed extensive consultation and an eight-month implementation project to develop an understanding of and to find solutions to the challenges inherent in the provision of ART in the mining industry, particularly around supporting patient adherence to the drug regimen.

The delivery of ART is overseen by AngloGold Health Service, a subsidiary of AngloGold Ashanti. To date, uptake among employees has been slow. On the positive side the company has seen good progress among those employees who have taken up the treatment, says Dr Petra Kruger, formerly HIV/AIDS manager at AngloGold Ashanti and now a consultant to the company.

ART becomes medically indicated when a patient's CD4 count falls below 250 or if he or she has suffered an AIDS-defining illness. It is estimated that 20%, or about 2,400 of AngloGold Ashanti's South African-based HIV-infected employees (about 12,000 people), meet these medical eligibility criteria. Yet only 606 individuals are currently part of this programme.

In total 930 employees have been offered ART. Of these, 86% started the treatment; 10% declined to participate; in the case of 4%, a decision was taken along with their doctors not to embark on the treatment. In cases where the doctor was responsible for delaying the start of treatment it was because the patient was acutely ill and needed to recover before ART could be reconsidered. In a few cases it would have been because the patient was not, in the doctor's opinion, psychologically ready and would need more intensive counselling or even rehabilitation for substance abuse.

Of the 781 patients who started the treatment, 175 had dropped out for reasons ranging from non-adherence (43%), death (19%), adverse events (12%), leaving employment (7%) and other reasons (20%).

Of concern is the fact that the majority of employees (more than 70%) do not know their own HIV status because they choose not to be tested. The number of employees who chose to participate in the Voluntary Counselling and Testing (VCT) programme has been maintained year on year, at 3,264 people in 2003, and 4,071 in 2004. The reasons for this are varied, but are largely believed to be associated with the stigma of the disease and the resulting fear of discrimination. Other reasons cited are:

• concerns that clinic visits would mean lost shifts, affecting production bonuses;
• a lack of knowledge of ART and concern about its side-effects;
• the fact that some individuals are still feeling well and do not have any AIDS-related symptoms;
• insufficient evidence of individuals on ART who are visibly well or recovering, and who are willing to disclose their status and treatment; and
• concerns about their families and their well-being.

On the whole, patients who are on treatment return to work and show clinical improvement as evidenced by recovering CD4 counts and diminishing viral loads.

Says Dr Kruger, "We have fared well, particularly when looking at adherence rates, improvements in biological markers and return to work when on treatment. We can attribute this to very good counselling and education, a lesson that we can learn from and apply across the entire spectrum of chronic disease."

Reasons for not entering treatment