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RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSA #1506/01 1930827
ZNR UUUUU ZZH
R 110827Z JUL 08
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 5034
INFO RUEHTN/AMCONSUL CAPE TOWN 5802
RUEHJO/AMCONSUL JOHANNESBURG 8204
RUEHDU/AMCONSUL DURBAN 9979
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA 2350
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE

UNCLAS SECTION 01 OF 03 PRETORIA 001506 
 
SIPDIS 
 
DEPT. FOR AF/S; OES/IHB 
STATE PLEASE PASS OGAC: BPATEL; WCOGGINS 
STATE PLEASE PASS TO USAID/W FOR GH AND AFR/SA 
HHS/PHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS WSTEIGER 
CDC FOR GLOBAL HEALTH OFFICE SBLOUNT 
 
E.O. 12958: N/A 
TAGS: SOCI TBIO ECON EMIN EAID KHIV KSCA ZU SF
SUBJECT:  Anglo-American Targets Workers' Families to Tackle HIV in 
Mines 
 
PRETORIA 00001506  001.2 OF 003 
 
 
¶1. Summary: Anglo American Plc (Anglo) has approved a country-wide 
expansion of its employee HIV and anti-retroviral treatment program 
(ART) for AIDS to encompass the families of its 75,000 workers. 
South Africa's Business Times reported that this is the first time a 
major South African company has moved on such a large scale to save 
dependents of its workforce from HIV/AIDS.  Anglo Senior Vice 
President for Health Dr. Brian Brink confirmed to Embassy Health 
Officer that Anglo has committed to extending HIV/AIDS testing and 
treatment to the dependants of all employees in southern Africa who 
are not covered by health insurance, but acknowledged that rollout 
of the program will be slow and face many hurdles.  Delivering on 
this commitment is not without major logistical challenges, 
especially since many employees have families living in remote rural 
parts of South Africa and neighboring countries.  End Summary. 
 
---------------- 
A Necessary Step 
---------------- 
 
¶2.  Anglo estimates HIV infection rates of between 20 percent and 30 
percent in the communities where its businesses are located, as well 
as in the communities where its employees originate or live.  This 
compares with an infection rate for its workforce of 21 percent in 
2006 and 19 percent in 2007, as reported in Anglo's Annual Report to 
Society.  Comment: Anglo noted that its 2007 numbers differ 
significantly from prior years due to certain divestments in 2006 
and 2007 and because AngloGold Ashanti's HIV and AIDS numbers were 
not included in its 2007 report.  Brink and South Africa Chamber of 
Mines Medical Advisor Dr. Mohamed Randera had indicated a much 
higher prevalence rate of 30 percent or more amongst mine workers in 
a previous conversation with Embassy Minerals/Energy Specialist. 
The 30 percent rate is in line with a survey funded by USAID and 
conducted by the Center for Scientific and Industrial Research and 
the Medical Research Council from 1998-2001 which found a 30 percent 
prevalence rate among miners in the Carletonville mining area of 
Northwest Province, South Africa.  End Comment. 
 
¶3.  Brink commented to Embassy Health Officer that the problem at 
Anglo was not that the rate of new HIV infection is getting worse, 
but rather that it is not getting better.  "The only way to really 
tackle the epidemic is to include the employees' families in 
prevention, counseling and treatment efforts.  This is because a 
high number of HIV negative employees return home where they may 
become infected with HIV.  Additionally, many HIV-positive employees 
discontinue ART after starting treatment and may return home to 
infect their spouses," he explained.  Anglo reports that one-third 
of those who start ART drop out for various reasons:  7.6 percent 
due to death, 10.5 percent do not adhere to treatment and 8.4 
percent leave employment.  Comment:  This is in accord with Brink's 
prior comments to Embassy Minerals/Energy Specialist that behavior 
patterns among miners had not changed despite all of Anglo's HIV 
awareness programs and interventions.  End Comment. 
 
¶4.  There are problems of identifying and locating family members, 
in addition to logistical difficulties in reaching families living 
Qin addition to logistical difficulties in reaching families living 
in remote areas.  Brink related that the initial start-up phase of 
the program will concentrate on encouraging employees to identify 
eligible family members.  One issue is the definition of "eligible 
family members," since many South Africans support large extended 
families and may not be legally married to their partner.  Brink 
noted that Anglo will be liberal in defining who a family member is 
and will accept an affidavit that the employee is obligated to 
support the individual.  He estimated that the program will cost 
approximately $50 million rand ($6.5 million) during its initial 
phase, with an estimated cost of $150 million rand ($19.5 million) 
over the longer term.  Brink was not certain how long it would take 
to fully roll-out the program. 
 
-------------------------------------- 
Anglo: A Long History of Tackling AIDS 
-------------------------------------- 
 
¶5.  Anglo has been tackling HIV/AIDS among its employees with a 
comprehensive HIV/AIDS management program that it first announced in 
¶2002.  Many industry and public health experts consider the program 
to be one of the best in the world.  Anglo's program starts 150 of 
the company's 28,000 HIV-positive employees on antiretroviral 
treatment (ART) every month.  Sixty nine percent of its estimated 
13,886 HIV-positive employees were enrolled in HIV disease 
management programs at the end of 2007.  Of these, twenty six 
 
PRETORIA 00001506  002.2 OF 003 
 
 
percent of HIV-positive employees (3,617) were receiving ART and 
sixty nine percent (9,529) were enrolled in wellness programs. 
During 2007, the company launched another major campaign to 
encourage all employees to be voluntarily tested for HIV.  Just over 
70 percent of Anglo's 75,000 employees throughout southern Africa 
underwent counseling and voluntary HIV testing (VCT).  Anglo's 
exploration division, which has a mobile workforce, provided VCT to 
90 percent of its African-based staff.  Knowledge is the major 
foundation for the program and high VCT coverage enhances Anglo's 
ability to gauge whether its commitment to preventing new infections 
is succeeding. 
 
 
------------------------------- 
The Benefits Outweigh the Costs 
------------------------------- 
 
¶6.  A study by Anglo Gold released in 2002 suggested that treatment 
would add $4-$6, or up to 2 percent, to the cost of producing an 
ounce of gold; but that the cost could rise to $9 per ounce if the 
company failed to act.  In 2002, Anglo Gold decided to provide ART 
to employees where medically indicated, in advance of the South 
African Government-provided ART program that followed in 2004.  The 
company was faced with either introducing what was deemed to be a 
high-cost intervention in the form of ART, or face the reality of 
rising death rates (peaking at 14 people per 1,000 employees in 
2004) and the consequent impact on the company, employees and their 
communities.  The loss of a breadwinner in the South African context 
could have an impact on more than 10 people, very often in rural and 
poverty-stricken areas of Southern Africa. 
 
¶7.  "The benefits outweigh the cost, and Anglo has data to prove 
it," according to Brink.  "If you compare the year before and the 
year after the company began offering the treatment, sick leave at 
Anglo dropped by 69 percent and absenteeism fell by 53 percent." 
Drug access and affordability have improved over the past five years 
and the cost implications have not been as significant as had 
originally been envisaged.  Interventions with ART have increased 
both the physical and economic lifespan of those affected, and have 
limited the social consequences associated with the loss of a 
breadwinner.  In addition, outcomes to date indicate lower costs of 
medical care and lower-than-expected recruitment costs.  The Aurum 
Institute for Health Research (another PEPFAR-funded organization) 
estimated the potential economic impact of untreated HIV/AIDS on 
AngloGold as part of an independent Anglo American group-wide 
assessment funded by GlaxoSmithKline and undertaken by Aurum.  This 
study indicated that if the company did not undertake treatment the 
economic impact of HIV to AngloGold Ashanti would continue to rise 
from 2003 and would reach 6percent of payroll in 2006.  The greatest 
impacts would occur in medical care (47percent) and absenteeism (36 
percent). 
 
---------------------------- 
Anglo Coal Confirms Benefits 
---------------------------- 
 
¶8.  Anglo Coal South Africa (ACSA), a wholly owned Anglo company, 
introduced its ART program in South Africa in August 2002 and became 
the first mining company in South Africa to administer ART to its 
Qthe first mining company in South Africa to administer ART to its 
workers at the company's expense.  An estimated 80 percent of 
HIV-infected employees have been registered on its HIV Disease 
Management Program.  By the end of February 2007, 1,099 employees 
were registered on the program with 350 receiving ART treatment. 
Anglo Coal achieved an impressive 84 percent coverage with its VCT 
program. 
 
 
¶9.  Anglo Coal relates that the overall benefits of its HIV program 
are a significant reduction in incidence of new HIV infections. 
ACSA recorded 80 new infections in employees previously known to be 
HIV negative (i.e. 1.8 percent), but this is significantly lower 
than the predicted 3-4 percent.  Anglo Coal believes that the lower 
rate of infection means that more than fifty new infections were 
prevented due to changed risk behavior.  Benefits include a 
reduction in morbidity and mortality, improved health/functionality 
of employees, and reductions in absenteeism, loss of skills, 
knowledge and experience.  ACSA concludes that it has retained the 
skills, knowledge and experience of a significant number of 
employees as a result of the HIV Disease Management Program, who 
would, in its absence, have died or retired.  Efforts to mitigate 
 
PRETORIA 00001506  003.2 OF 003 
 
 
the economic impact of HIV are constrained by employees' reluctance 
to be tested (although this has improved significantly), late 
presentation for treatment, and the still relatively low uptake of 
ART on the part of employees. 
 
------------------------------- 
Anglo's Program - Not the First 
------------------------------- 
 
¶10.  Anglo is not the first business to expand its treatment program 
to families of employees.  Anglo owns a 45 percent shareholding in 
De Beers, which was the first mining company in South Africa to 
provide free anti-retroviral treatment for spouses and retired and 
retrenched employees in July 2003.  PEPFAR is funding an innovative 
private-public partnership in South Africa between X-Strata Coal, 
South Africa (X-Strata) and Re-Action (a professional services 
agency for health and sustainability) to help stabilize the health 
and welfare of X-Strata's employees, their families and communities. 
 Sharon White of Re-Action related to Embassy Health officer that 
X-Strata has been rolling out its HIV program to family members of 
its employees for the past two years.  X-Strata employs 
approximately 8,000 people at its thermal coal operations in 
Mpumalanga Province, the 'Coal Powerbelt' of South Africa, where it 
is estimated that one-in-four people is living with HIV.  X-Strata 
has committed to multi-year funding of the program with its $2.1 
million annual contribution matched with PEPFAR funding beginning in 
¶2007.  Through a community clinic built and funded by X-Strata and a 
number of existing public sector clinics and hospitals, the program 
has expanded community outreach services; engaged traditional 
healers; delivered community-based health education and training; 
conducted HIV and TB testing campaigns; supported HIV care and 
antiretroviral (ARV) treatment delivery; staffed and upgraded health 
facilities; and strengthened community TB/HIV services.  X-Strata 
won a 2008 Global Business Coalition Award for Business Excellence 
for the program. 
¶11.  Comment:  It is important for the mining industry to have 
effective HIV programs since miners have one of the highest HIV 
incidence rates in the world due to high mobility of the workers, 
isolation, stress, and access to and ready availability of sex 
workers, alcohol and drugs.  The problem is part of a legacy that 
dates back a century when South Africa's mining companies began 
using migrant blacks as cheap laborers.  The South African mining 
sector also has one of the highest incidence rates of TB in the 
world, due to the twin risk factors for TB of high HIV-prevalence in 
mines and occupational exposure to silica dust. 
¶12.  Anglo's ability to make a dent in the HIV incidence rate in its 
employees and their families will depend on its ability to overcome 
the difficult logistical hurdles of locating and serving a largely 
remote, rural population.  It will be useful to see whether the 
program has an impact on HIV incidence among Anglo employees, who 
have not shown improvement even with Anglo's industry-leading, 
comprehensive employee HIV program.  Anglo is not the first South 
African business to extend HIV services to the families of its 
employees, but it is setting a positive example for other companies, 
Qemployees, but it is setting a positive example for other companies, 
many of which are just beginning to establish their own HIV 
programs.  End Comment. 
Bost